Case 2:18-cv-02081-TLN-KJN Document 1 Filed 07/31/18 Page 1 of 63

1 AARON J. FISCHER (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 ANNE HADREAS (SBN 253377) Anne.Hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201

6 TIFANEI RESSL-MOYER (SBN 319721) Tifanei.Ressl-Moyer@disabilityrightsca.org
7 DISABILITY RIGHTS CALIFORNIA 1831 K Street
8 Sacramento, CA 95811 Telephone: (916) 504-5800
9 Fax: (916) 504-5801

10 DON SPECTER (SBN 83925) DSpecter@prisonlaw.com
11 MARGOT MENDELSON (SBN 268583) MMendelson@prisonlaw.com
12 PRISON LAW OFFICE 1917 Fifth Street
13 Berkeley, California 94710 Telephone: (510) 280-2621
14 Fax: (510) 280-2704

15 Attorneys for Plaintiffs

16

17

UNITED STATES DISTRICT COURT

18

FOR THE EASTERN DISTRICT OF CALIFORNIA

19

20 LORENZO MAYS, RICKY RICHARDSON, JENNIFER BOTHUN, Case No.:
21 ARMANI LEE, LEERTESE BEIRGE,

22 and CODY GARLAND, on behalf of themselves and all others similarly
23 situated,

24
v.
25

Plaintiffs,

CLASS ACTION CLASS ACTION COMPLAINT FOR INJUNCTIVE AND DECLARATORY RELIEF

COUNTY OF SACRAMENTO,

26

Defendant.

27

28

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1

NATURE OF THE ACTION

2

1. This action arises out of Defendant’s unconstitutional and illegal

3 treatment of people incarcerated in Sacramento County’s two jails, Sacramento

4 County Main Jail (“Main Jail”) and Rio Cosumnes Correctional Center (“RCCC”).

5 Defendant knowingly has created and perpetuated overcrowded and understaffed

6 jails, subjecting the approximately 3,800 men and women held in the County’s

7 jails to dangerous, inhumane, and degrading conditions.

8

2. Defendant regularly subjects people in its custody—the majority of

9 whom have not been convicted of any crime—to harsh, prolonged, and undue

10 isolation. Every day, Defendant locks up hundreds of people in solitary

11 confinement in dark, cramped, filthy cells for 23 ½ hours or more per day. While

12 these individuals are held in isolation, Defendant deprives them of human contact,

13 programming, fresh air, and sunlight. Many people do not get outside to see the

14 sun for weeks or months at a time. The extreme isolation and deprivation place

15 people at serious risk of profound physical and psychological harm.

16

3. Defendant incarcerates people with serious mental illness at

17 dangerous and disproportionately high rates. Defendant subjects people with

18 serious mental illness to extreme isolation, with little or no mental health

19 treatment. More than one-third of Sacramento County’s jail population has a

20 mental illness, including dozens of people waiting for psychiatric inpatient

21 placements in state hospitals. Yet Defendant fails to provide adequate mental

22 health care, including basic measures to prevent suicide and self-harm.

23 Defendant’s failure to provide minimally adequate mental health treatment—

24 combined with the deplorable conditions of confinement in the jails—exacerbates

25 individuals’ existing mental illnesses and increases the likelihood that people will

26 suffer serious decompensation or death.

27

28

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1

4. Since November 2016, at least five individuals have died by suicide

2 while held in Sacramento County jails. Many more individuals have attempted

3 suicides, resulting in grave injuries as serious as permanent paralysis.

4

5. Defendant fails to provide minimally adequate medical care to the

5 people in its custody. Defendant fails to adequately screen people entering the jails

6 for medical conditions, does not timely or adequately respond to requests for

7 medical care, and denies or delays for excessive periods the provision of necessary

8 chronic and specialty care. Defendant examines and treats patients in common

9 spaces of the jail, without basic confidentiality, rather than in proper exam rooms

10 with necessary medical equipment. Defendant fails to sufficiently monitor or treat

11 people experiencing alcohol or drug withdrawal, leaving them instead to languish

12 in sobering cells in the decrepit booking loop in the basement of the Main Jail.

13 Defendant’s failure to provide adequate medical care subjects people in the jails to

14 serious risk of injury or death. Individuals held in the county’s jails have been

15 denied essential cancer treatment, lost their eyesight where treatment could have

16 prevented it, and faced needless pain and irreparable harms due to delayed or

17 denied care.

18

6. Defendant deprives people with disabilities access to jail programs,

19 activities and services. Defendant fails to adequately screen people with

20 disabilities or provide them necessary accommodations, including wheelchairs,

21 canes, eyeglasses, hearing aids, and other items they need to perform everyday

22 activities. Defendant’s jails are full of physical obstacles that prevent people with

23 mobility disabilities from bathing, moving around their housing units, or visiting

24 with family, friends, and attorneys.

25

7. Defendant has been aware of the constitutionally and legally

26 inadequate care and conditions in its jails for years. Reports from multiple outside

27 agencies and consultants have repeatedly documented chronic overcrowding and

28
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1 understaffing in the jails, major deficiencies in health care, excessive use of

2 isolation, and the denial of rights to people with disabilities.

3

8. In the last decade, no fewer than a dozen reports have detailed

4 significant deficiencies in the treatment of individuals in the Sacramento County

5 jails and, in particular, the treatment of individuals with disabilities. Inspector

6 General reports, Grand Jury reports, and reports completed by subject matter

7 experts retained by the County have repeatedly made clear that the health and well-

8 being of people incarcerated in the jails are at serious risk. They have found that

9 conditions are “unlikely to meet constitutional standards” and identified “serious

10 violations” of the rights of people with disabilities.

11

9. In 2015, after a detailed investigation, Disability Rights California

12 issued a report (see Exhibit A) on conditions in Sacramento County’s jails. The

13 report documented harmful policies, practices, and conditions that adversely

14 impact prisoners, in particular prisoners with serious mental illness, medical

15 conditions, and physical, sensory, or mental health disabilities. The report detailed

16 the Jail’s inadequate health care system, excessive use of solitary confinement, and

17 violations of federal disability law. Nearly all of the deficiencies identified in the

18 report persist, and recommendations to address those deficiencies remain largely

19 unimplemented.

20

10.

In January 2016, the parties entered into a Structured Negotiations

21 Agreement as an alternative to imminent litigation. The parties agreed to work

22 toward a settlement to address the conditions of confinement in Defendant’s jails.

23 The parties further agreed that Defendant would retain neutral experts to advise it

24 about health care and custodial practices in the jails, and that their reports would be

25 admissible in evidence and available to the public. After two and a half years of

26 negotiations, the settlement process broke down.

27

11.

Since early 2016, Defendant has contracted with five nationally

28 recognized subject matter experts to assess conditions in the jails and make
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1 recommendations. The experts issued written findings consistent with those of

2 Disability Rights California, condemning the conditions of confinement in the

3 jails, identifying serious risks of psychological and physical harm to people in the

4 jails, and calling for significant and immediate changes to address the deficiencies.

5

12.

Correctional expert Eldon Vail documented dangerous understaffing

6 and inhumane, excessively punitive conditions of confinement, such as the

7 widespread use of prolonged solitary confinement and the practice of withholding

8 food from individuals for disciplinary purposes. See Exhibit B: Eldon Vail,

9 Sacramento County Jail, Mentally Ill Prisoners and the Use of Segregation:

10 Recommendations for Policy, Practice and Resources. The Vail report concluded

11 that “custody staffing for both jails is startlingly and dangerously low,” and found

12 that Defendant’s jails “operate in a state of near perpetual emergency” on account

13 of chronic understaffing.

14

13.

Psychiatric expert Bruce Gage found that Defendant fails to provide

15 minimally adequate mental health care, in part due to significant understaffing of

16 mental health professionals. See Exhibit C: Bruce C. Gage, Evaluation of Mental

17 Health Services: Sacramento County Jails. Dr. Gage found that the conditions for

18 people with mental illness in the jails are dangerous, noting that “those with

19 psychotic disorders can be expected to become more psychotic” and “those who

20 are depressed, suicidal, or self-destructive are similarly placed at greater risk of

21 harming themselves” given the jail’s conditions and lack of treatment.

22

14.

Jail suicide prevention expert Lindsay Hayes identified numerous

23 problems with Defendant’s suicide prevention policies and practices. He reported

24 that Defendant subjects individuals on suicide watch to punitive and “anti-

25 therapeutic” conditions. See Exhibit D: Lindsay M. Hayes, Report on Suicide

26 Prevention Practices Within the Sacramento County Jail System. Mr. Hayes

27 identified structural hazards in the jails’ physical plant that increase the risk that

28 individuals will die by suicide. He provided twenty-six recommendations to
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1 address deficiencies in Defendant’s system. Defendant has failed to implement

2 many, if not all, of those recommendations. Meanwhile, the suicide rate in the

3 Defendant’s jails has increased since Mr. Hayes issued his report, with at least five

4 suicides occurring between November 2016 and April 2018 alone.

5

15.

Correctional disability access experts Sabot Consulting, LLC found

6 scores of “serious violations” of the Americans with Disabilities Act in

7 Defendant’s jails, including inadequate screening for disabilities, denials of

8 disability-related accommodations, improper housing of individuals with

9 disabilities, facilities that are inaccessible and dangerous to individuals with

10 disabilities, denials of equal access to jail programming and recreation, inadequate

11 disability-related policies and procedures, and lack of training for staff. See

12 Exhibit E: Sabot Consulting, Sacramento County Sheriff’s Department

13 Correctional Services Americans with Disabilities Act (ADA) Assessment. Few, if

14 any, of Sabot’s recommendations to address these serious violations have been

15 implemented.

16

16.

Correctional experts Jim Austin, Emmitt Sparkman, and Robin Allen

17 (“Austin et al.”) assessed Defendant’s highly isolated and punitive “Total

18 Separation” (or “T-Sep”) classification. See Exhibit F: James Austin et al.,

19 Evaluation of the Sacramento County Jail Inmate Classification and T-SEP

20 Systems. Austin et al. documented scores of people classified as T-Sep being

21 “placed in harsh conditions of solitary confinement and isolated from direct contact

22 with other inmates for excessive periods of time.” They found that the T-Sep

23 classification and its harsh solitary confinement conditions are “unique to

24 Sacramento County.” They also found that over 75% of the more than 162

25 individuals in the jails’ T-Sep units had mental health needs, and many were

26 housed in T-Sep in part because Defendant lacks appropriate and safe places to

27 house people with mental illness.

28
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1

17.

Even as Defendant’s own consultants have documented serious and

2 widespread violations of the rights of people in its custody, Defendant has failed to

3 take reasonable steps to mitigate the harms inflicted on people every day.

4 Widespread understaffing of mental health, medical, and custody personnel

5 persists. People in the jail remain unable to access timely and appropriate health

6 care. Hundreds of people live in conditions of profound sensory deprivation due to

7 their T-Sep status and related custodial practices at the jail. Defendant has failed to

8 make physical plant renovations to expand disability access or address known

9 suicide hazards. Nearly all of the serious and dangerous deficiencies identified by

10 the County’s experts remain to this day.

11

18.

Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and

12 GARLAND seek declaratory and injunctive relief for Defendant’s constitutional

13 and statutory violations.

14

JURISDICTION

15

19.

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

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

17 Americans with Disabilities Act (ADA), 42 U.S.C. §12101 et seq., and Section 504

18 of the Rehabilitation Act, 29 U.S.C. § 794.6, and related state law.

19

20.

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

20 1331, 1343, and 1367. Plaintiffs seek declaratory and injunctive relief under 28

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

22 California Government Code § 11135.

23

VENUE

24

21.

Venue is properly in this Court, pursuant to 28 U.S.C. § 1391(b)(1),

25 because Plaintiffs’ claims for relief arose in this District and one or more of the

26 Defendants reside in this District.

27

28
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1

PARTIES

2 PLAINTIFFS

3

22.

Plaintiff LORENZO MAYS is a pre-trial detainee with serious mental

4 illness and cognitive disabilities who has suffered significant physical and

5 psychological harm for nearly a decade while awaiting trial at the jail. Since 2010,

6 his criminal proceedings have been stalled based on repeated findings that Mr.

7 MAYS is not competent to stand trial due to an intellectual disability and mental

8 illness, including a possible traumatic brain injury. Defendant has placed Mr.

9 MAYS in solitary confinement housing for nearly his entire period of

10 incarceration. In solitary confinement, he has suffered auditory hallucinations,

11 worsening depression, suicidal thoughts, and a diagnosed Vitamin D deficiency

12 related to the lack of exposure to sunlight. Defendant has failed to provide Mr.

13 Mays adequate medical and mental health care and has subjected him to

14 discrimination based on his disability by denying him reasonable accommodations

15 and access to services and programs at the jail. Plaintiff MAYS is a person with a

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

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

18

23.

Plaintiff RICKY RICHARDSON is a pretrial detainee who sustained

19 a spinal cord injury in 2000 and is paraplegic. He relies on a wheelchair for

20 mobility. Defendant has denied Plaintiff RICHARDSON reasonable

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

22 his disability status. Defendant has further denied Plaintiff RICHARDSON

23 adequate medical treatment for his condition. Plaintiff RICHARDSON is a person

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

25 California Government Code § 12926(j) and (m).

26

24.

Plaintiff JENNIFER BOTHUN is a pretrial detainee who has limited

27 vision and a severe cataracts condition that has continued to get worse due to lack

28 of adequate treatment during her time incarcerated at the jail. She also has
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1 significant mental health needs. After receiving threats from other incarcerated

2 people, Plaintiff BOTHUN was placed in solitary confinement housing, where she

3 has suffered from depression and overwhelming anxiety. Defendant has failed to

4 provide her adequate medical and mental health treatment and with necessary

5 reasonable accommodations for her disability-related needs. Plaintiff BOTHUN is

6 a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B),

7 and California Government Code § 12926(j) and (m).

8

25.

Plaintiff ARMANI LEE is a pretrial detainee who has been diagnosed

9 with serious mental illness, including bipolar disorder, and has a history of

10 multiple suicide attempts. Defendant has placed Plaintiff LEE in solitary

11 confinement for extended periods of time, during which his mental health has

12 deteriorated. Plaintiff LEE was booked into the jail with recent gunshot-related

13 injuries, including a fractured pelvis and neurological injuries that impair his

14 ability to ambulate. Defendant has failed to provide Plaintiff LEE with adequate

15 medical and mental health care and with necessary reasonable accommodations for

16 his disability-related needs. Plaintiff LEE is a person with a disability as defined in

17 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code §

18 12926(j) and (m).

19

26.

Plaintiff LEERTESE BEIRGE is a pretrial detainee diagnosed with

20 serious mental illness with a history of suicidal ideations and attempts. He was

21 found incompetent to stand trial and referred to receive treatment in the

22 Department of State Hospitals. During the more than seven months he spent at the

23 Jail prior to the hospital placement, Defendant designated Plaintiff BEIRGE as

24 “Total Separation,” meaning he was placed in solitary confinement with essentially

25 no human contact and almost complete isolation. This setting worsened his

26 psychiatric condition, and Defendant failed to provide adequate mental health

27 treatment. Plaintiff BEIRGE attempted suicide while in Total Separation solitary

28 confinement and expressed suicidal ideation on multiple occasions, resulting in
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1 placements in cold safety cells and empty classrooms. He was referred for

2 placement in the acute mental health unit on multiple occasions, but repeatedly was

3 denied such placement due to lack of bed space. Instead, he was returned to the

4 same solitary confinement unit, resulting in a cycle of decompensation that

5 repeated itself at least four times in the months he was awaiting transfer to a state

6 psychiatric hospital. Plaintiff BEIRGE is a person with a disability as defined in

7 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code §

8 12926(j) and (m).

9

27.

Plaintiff CODY GARLAND is a sentenced prisoner at Sacramento

10 County Jail with extensive medical needs, including related to glaucoma and

11 chronic allergy and respiratory conditions. Plaintiff GARLAND is also diagnosed

12 with mental illness. Defendant has failed to provide Plaintiff GARLAND with

13 adequate medical and mental health care, which has led to irreversible loss of

14 vision, multiple emergency room visits and hospital stays, and at least one serious

15 suicide attempt that required outside medical attention. Plaintiff GARLAND is a

16 person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B),

17 and California Government Code § 12926(j) and (m).

18 DEFENDANT

19

28.

Defendant COUNTY OF SACRAMENTO (“County” or “Sacramento

20 County”) is a public entity, duly organized and existing under the laws of the State

21 of California. Under this authority, Defendant County operates and manages two

22 jails: the Main Jail, located in downtown Sacramento, and Rio Cosumnes

23 Correctional Center, located in a rural area of Elk Grove. The County has at all

24 relevant times been responsible for the actions and/or inactions and the policies,

25 procedures, practices, and customs of the Sacramento County Sheriff’s

26 Department.

27

29.

Defendant is responsible for ensuring that the basic human needs of

28 individuals in its custody are met, and for ensuring that individuals are not at risk
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1 of serious harm, including by providing appropriate funding, oversight, and

2 corrective action to ensure adequate conditions. Defendant is also responsible for

3 ensuring that jail policies and practices do not violate individuals’ substantive and

4 procedural rights or discriminate against individuals with disabilities.

5

FACTUAL ALLEGATIONS

6

I. DEFENDANT KNOWINGLY OPERATES DANGEROUSLY

7 UNDERSTAFFED JAILS

8

30.

Defendant incarcerates far more people than it is able to house safely

9 and humanely in its jails. Together, the two jails incarcerate approximately 3,800

10 people each day, including both pretrial and sentenced individuals.

11

31.

The large jail population stems from the County’s high incarceration

12 rates, particularly of people with mental illness and/or disabilities. In November

13 2016, an outside consultant hired by Defendant, CGL Management Group, LLC

14 (“CGL”), tied the overcrowding in Defendant’s jails to the County’s incarceration

15 rate, which was reported to be 41% higher than the California average, and higher

16 than most California counties. Defendant has a higher-than-average incarceration

17 rate because of long lengths of stay in the jails, lack of community diversion

18 programs, lack of transitional and supportive housing for people experiencing

19 homelessness, an unnecessarily harsh bail system and underutilized pretrial release

20 system, and longer-than-average probation terms. Defendant disproportionately

21 incarcerates people with serious mental illness. Because Defendant fails to provide

22 sufficient community resources to meet the needs of people with mental illness,

23 such as community mental health services, crisis intervention, and supportive

24 housing, people with mental illness regularly cycle in and out of the jails,

25 contributing to their unnecessary and harmful incarceration.

26

32.

In 2015, the Sacramento County Grand Jury reported that the number

27 of people who received a mental health diagnosis at the time of intake at

28 Defendant’s jails had nearly doubled since 2009, from 18% to 34%. Defendant has
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1 understaffed its mental health program for over a decade, and the program falls

2 further and further behind as the share of individuals with serious mental health

3 needs in Defendant’s custody remains exceedingly high.

4

A. Defendant Subjects People in its Custody to Serious Risk of Harm

5

by Failing to Provide Adequate Custody and Health Care Staff

6

33.

Defendant’s jails are alarmingly understaffed. Due to Defendant’s

7 failure to provide adequate resources, the jails maintain dangerously low levels of

8 custody staff.

9

34.

As a result, Defendant is unable to comply with its own policies and

10 procedures, as well as correctional practice standards, with respect to supervision,

11 out-of-cell time and programming, mental health and medical care, and cleanliness.

12 Defendant also maintains insufficient staff to ensure timely emergency or outside

13 hospital transportation. Inadequate staffing at the jails puts the safety, security, and

14 health of incarcerated people at serious risk.

15

35.

Because of custody staffing shortages, Defendant routinely staffs only

16 two deputies to areas that house as many as 200 people of differing security factors

17 and needs. Without sufficient custody staffing to supervise its population,

18 Defendant simply locks up hundreds of people inside their cells for 22 to 24 hours

19 every day.

20

36.

Dramatic shortages in medical and mental health care staffing also put

21 people in the jails at serious risk of harm. Chronic shortages in the number of

22 health care professionals contribute to inadequate intake procedures and follow-up,

23 extreme delays or lapses in care, an overreliance on nurses acting beyond their

24 scope of practice, and dangerous medication administration practices.

25

B. Defendant Has Ignored Report after Report Calling for

26

Significant Increases in Staffing in the Jails

27

37.

Defendant is aware of the dangerously low staffing levels because

28 multiple reports over the last decade – including Defendant’s own internal reports,
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1 reports commissioned by Defendant, and investigations conducted by the

2 Sacramento County Grand Jury – have repeatedly found that staffing is inadequate

3 and poses a danger to inmates and staff.

4

38.

In 2009, the Office of the Inspector General (“OIG”) conducted a Jail

5 Operations Audit for the Sacramento County Jails. The audit noted that

6 “significant staffing deficiencies” at Defendant’s jails had been reported as far

7 back as 2006, but nonetheless persisted. The OIG found that understaffing among

8 health care professionals was jeopardizing the effectiveness of intake health

9 screening at the jails, with implications for public health.

10

39.

A year later, the OIG again reported that Defendant’s jails were

11 “understaffed by any measure.” The staffing study concluded that “sufficient

12 staffing to safely and effectively do the job is rarely, if ever, reached,” and that the

13 low staffing levels compromised safety.

14

40.

In 2011, the Sacramento County Grand Jury reached the same

15 conclusion. The Grand Jury found that Defendant’s insufficient deputy staffing

16 prevented the provision of sufficient out-of-cell time to people in the jail and

17 contributed to low staff morale.

18

41.

In January 2015, Health Management Associates (HMA), a consulting

19 group hired by Defendant, found that “[m]ental health staffing compared to other

20 jails and increasing service demands and wait times may be placing the county at

21 risk for poor behavioral health outcomes.” HMA found that Defendant did not

22 have sufficient nursing or physician staff to address chronic care needs of patients,

23 and lacked a “regular process to collect and evaluate access to nursing, address

24 bottlenecks or situations that cause lags, and the subsequent risks.”

25

42.

In June 2016, the Sacramento Grand Jury issued a report describing

26 RCCC as “overcrowded” and observing that custody staffing levels were lower

27 than similar-sized facilities. The following year, the Grand Jury again found that

28 staff shortages were of primary concern.
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1

43.

In November 2016, yet another consultant, CGL reported that

2 Defendant operated the Main Jail with a staff-to-prisoner ratio that “far exceeds

3 advisable levels.” The CGL report found that “Main Jail staffing does not meet

4 contemporary standards for adequate supervision of the inmate population.” CGL

5 concluded that housing unit staffing alone would have to almost double in order to

6 meet recommended supervision levels.

7

44.

Mr. Vail, Defendant’s expert consultant in correctional practices,

8 recently reported that Defendant’s jail system was “dangerously understaffed and

9 struggling to meet even the minimal requirements of their current policies.” He

10 called for a “sizable increase in both mental health and custody staffing.”

11

45.

Other experts retained by Defendant made similar findings. Dr.

12 Austin, Dr. Gage, and Sabot Consulting reported that staffing shortages in

13 Defendant’s jails undermine the provision of minimally adequate health care,

14 prevent compliance with federal and state disability law, and contribute to

15 inhumane conditions of confinement.

16

46.

Despite these repeated warnings, Defendant has failed to increase

17 staffing levels in a meaningful way. Current staffing levels are nowhere close to

18 sufficient to address the risk of substantial harm to people incarcerated in

19 Defendant’s jails.

20

II. DEFENDANT IMPROPERLY SUBJECTS PEOPLE IN THE

21 JAILS TO PROFOUND, PROLONGED, AND HARMFUL ISOLATION

22

A. Conditions of Confinement in Defendant’s Restrictive Housing

23

Units Are Extremely Harsh and Harmful

24

47.

Defendant, by its policy and practice, locks hundreds of people each

25 day in tiny, dirty, concrete cells for at least 23 ½ hours per day, with little to no

26 opportunity for human interaction, exercise, or recreation, in many cases for

27 months or years at a time.

28
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1

48.

According to Defendant’s policies and practices, individuals in the jail

2 are entitled to only three hours of out-of-cell time per seven-day period. In

3 practice, Defendant often fails to ensure that even that small amount of out-of-cell

4 time is provided due to staffing shortages, lockdowns, and insufficient space.

5

49.

Defendant has created and maintains an extremely harsh form of

6 solitary confinement called “Total Separation,” otherwise known as “T-Sep.”

7 Defendant deprives individuals classified as T-Sep of virtually all human contact.

8 People on T-Sep live in single cells, by policy are permitted no more than 30

9 minutes outside of their cells per day, have essentially no access to sunlight or

10 fresh air, and have limited access to showers, phones, books, and canteen

11 privileges. Defendant often offers out-of-cell time only in the middle of the night,

12 preventing individuals from getting to a phone at a time when they can reach their

13 loved ones or attorneys. Even when individuals in T-Sep units are permitted to be

14 out of their cells, they are forbidden from recreating or socializing with others.

15

50.

Defendant holds hundreds of people in the extreme conditions of T-

16 Sep for months or years at a time. On average, people have been held on T-Sep

17 status for six months and, in some cases, for many years. Plaintiff MAYS has

18 spent nearly all of his approximately eight years at Sacramento County Jail in

19 solitary confinement as a “T-Sep” prisoner.

20

51.

Similarly, under its policies and practices, Defendant denies almost all

21 out-of-cell time to individuals subjected in disciplinary detention units. People in

22 disciplinary detention spend their days in total isolation, prohibited from social

23 contact and nearly all their property, phone calls, or other forms of normal human

24 contact. For example, Defendant has placed Plaintiff LEE in solitary confinement

25 for long periods, despite knowing that he has significant mental health needs, a

26 history of multiple suicide attempts, and a painful skin condition. During one

27 month-long stretch in disciplinary isolation, Defendant did not allow Mr. LEE any

28 time outside of his cell, even to shower. The denial of showers greatly exacerbated
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1 his already painful rashes and itchiness. He also experienced worsening

2 depression and suicidal ideation while in isolation.

3

52.

Defendant’s restrictive housing cells are tiny, concrete blocks. There

4 is no fresh air or natural light, no clocks, and no method to track time. Lack of

5 ventilation and inadequate temperature control lead to sweltering temperatures in

6 the summer and freezing conditions in the winter. Defendant sometimes fails to

7 provide mattresses, leaving people to sleep on hard, cold, dirty floors for days.

8 Defendant fails to maintain basic cleanliness and sanitation, housing individuals in

9 cells that are covered in feces and urine, old food, garbage, and bugs. Many lack

10 outside windows or visibility from one cell to another, and only small windows to

11 the dayroom that have been covered by flaps, increasing the isolation and sensory

12 deprivation. For example, Defendant has covered Plaintiff LEE’s solitary

13 confinement cell window for weeks at a time, leaving him unable to see outside of

14 his small, filthy cell.

15

16

17

18

19

20

21

22

23

24

25

26

27

Photo: Total Separation (“T-Sep”) Solitary Confinement Cell

28

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1

53.

Defendant’s failure to provide adequate mental health care

2 exacerbates these serious health and sanitation problems. One expert found that

3 Defendant lacks the resources to adequately treat people with serious mental illness

4 housed in isolation, in some cases leaving them to languish in their own urine,

5 feces, and garbage. Bodily fluids and garbage leak out of individual cells into the

6 hallways, making conditions unbearable to everyone around them.

7

B. Defendant Subjects People to Severe Isolation for Illegitimate

8

Reasons and Deny Them Any Meaningful Opportunity to

9

Challenge Their Placements.

10

54.

According to Defendant’s policy and practice, people are locked in

11 restrictive housing units even when there is no legitimate penological purpose for

12 doing so. Correctional experts Austin et al. found that Defendant automatically

13 places into T-Sep people with a history of serving time in T-Sep during a previous

14 jail detention or who have been in a Security Housing Unit (SHU) while in state

15 prison, even if such placement was years in the past and even if the individual

16 poses no current threat to safety or security. Once a person has been classified as

17 “T-Sep,” they may be placed on such status automatically in perpetuity. For

18 example, one individual got into an argument with a jail deputy over a decade ago.

19 She has been told that she would be “T-Sep for life” and has been placed in T-Sep

20 during her subsequent incarcerations, despite no recent disciplinary infractions.

21

55.

Defendant regularly places people with intellectual disabilities or

22 mental illness in T-Sep and other restrictive housing units, including people who

23 are actively psychotic and showing severe mental health symptoms such as

24 delusions, hallucinations, paranoia, and incoherent speech. People on T-Sep have

25 experienced severe physical and psychological harms, and frequently threaten or

26 engage in self-harm and suicide attempts. Many individuals spend months in T-

27 Sep isolation while awaiting placement in a state psychiatric hospital.

28
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1

56.

Defendant warehouses these vulnerable individuals in punitive and

2 isolated conditions, without adequate mental health treatment. Plaintiff BEIRGE

3 spent more than 200 days as a T-Sep prisoner while awaiting transfer to a

4 psychiatric hospital. He repeatedly communicated to jail staff that he was having

5 great difficulty coping and was “mentally exhausted” in the isolated T-Sep setting,

6 writing that he thought about “coming out in a box.” During that time, Plaintiff

7 BEIRGE decompensated and became suicidal at least four times. Each time, he

8 was placed on suicide precautions and then returned to the same T-Sep housing

9 where he had decompensated. Defendant also places individuals in long-term

10 solitary confinement for their own “protection.” Plaintiff BOTHUN has been held

11 in isolation for several months based on threats made against her by other people in

12 the jail. Rather than “protecting” her, such placement has been severely harmful.

13 In isolation, she has experienced depression and “overwhelming anxiety.”

14

15

16

17

18

19

20

21

22

23

24

25

26

27

Photo: Women’s Solitary Confinement Cell

28

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1

57.

Plaintiff MAYS offers another deeply troubling example. Defendant

2 placed Plaintiff MAYS in solitary confinement soon after his arrival at the jail in

3 2010, based on an incident in which he was assaulted by other prisoners. He has

4 been in restrictive housing for non-disciplinary reasons for almost his entire

5 incarceration – stretching out nearly a decade. His years in extreme isolation have

6 had detrimental effects on his psychological and physical health. He has

7 developed severe skin conditions and difficulty sleeping. He was diagnosed with a

8 Vitamin D deficiency, a health problem attributed to inadequate exposure to

9 sunlight. Plaintiff MAYS also experienced auditory hallucinations, suicidal

10 ideations, and depression while in isolation, for which Defendant provided limited

11 and inadequate mental health treatment.

12

58.

According to its experts, Defendant has failed to implement

13 appropriate criteria or meaningful review for placement in restrictive housing. The

14 Sheriff’s Department lacks the staffing and other resources to address this serious

15 deficiency. As a result, Defendant continues to lock hundreds of people in

16 restrictive housing based on an irrational and highly punitive system. By design,

17 Defendant regularly fails to notify individuals of the reason for their solitary

18 confinement placement, when they will be released, or what they can do to get

19 back to general population housing.

20

C. Defendant Is Aware of the Harm Caused by its Use of Excessive,

21

Harsh, and Prolonged Isolation

22

59.

Defendant has knowingly created and perpetuated a jail system that

23 relies heavily on excessive isolation, putting people at a serious risk of harm or

24 death. The United States Department of Justice defines “solitary confinement” as

25 the “state of being confined to one’s cell for approximately 22 hours per day or

26 more, alone or with other prisoners, that limits contact with others.” Prolonged

27 solitary confinement is defined as any period of time over three to four weeks.

28 Defendant is aware that individuals are confined to their locked cells for well over
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1 22 hours per day and remain in that setting for periods lasting as long as months

2 and years.

3

60.

Mental health and correctional experts have documented the harmful

4 effects of solitary confinement. Common side effects of prolonged solitary

5 confinement include anxiety, panic, withdrawal, hallucinations, self-mutilation,

6 and suicidal thoughts and behaviors. Davis v. Ayala, 135 S.Ct. 2187, 2210 (2015)

7 (Kennedy, J., concurring) (citing Grassian, Psychiatric Effects of Solitary

8 Confinement, 22 Wash. U.J.L. & Pol’y 325 (2006)). Prisoners punished with

9 solitary confinement may be up to seven times as likely to commit acts of self-

10 harm. Upon information and belief, a disproportionate number of the suicides and

11 suicide attempts inside Defendant’s jails occur in solitary confinement units.

12

61.

Defendant’s policies and practices of subjecting people in its custody

13 to severe isolation and idleness also cause serious physiological harm, including

14 cardiovascular and gastrointenstinal problems, migraines, profound fatigue,

15 deteriorating eyesight, back and joint pain, and aggravation of other preexisting

16 conditions. The physiological consequences are both physical manifestations of

17 the psychological effects of isolation and the result of periods of extreme

18 inactivity, lack of natural light, and lack of fresh air.

19

62.

Defendant’s overuse of restrictive housing is particularly harmful to

20 those with intellectual disabilities or mental illness, who are particularly sensitive

21 to psychological stressors and emotional distress associated with isolation

22 conditions. Defendant’s jails currently have almost 30 people with mental illness

23 waiting for transfer to a state psychiatric hospital. Despite full knowledge of their

24 severe mental health conditions, Defendant places many of these individuals in

25 solitary confinement units for extended periods.

26

63.

Despite the documented deleterious effects of restrictive housing,

27 Defendant continues to fail to conduct an adequate assessment before placing a

28 person in a restrictive housing unit to determine whether such placement is
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1 contraindicated for a person’s physical or mental health. Defendant also does not

2 conduct regular rounds in restrictive housing units to monitor individuals’ mental

3 health. These omissions place Plaintiffs at an unreasonable and unnecessary risk

4 of harm.

5

64.

Defendant is aware of the severe harm that prolonged and harsh

6 isolation causes because individuals in the jails regularly complain to staff

7 members, orally and in writing, about the conditions in restrictive housing units

8 and the damaging impact on their physical and mental health.

9

65.

Defendant also has been placed on notice of the impact of its

10 restrictive housing practices by multiple written reports. Disability Rights

11 California’s report documented the dangers of the overuse of restrictive housing in

12 harsh conditions, including extreme isolation, minimal out-of-cell time, few

13 opportunities for exercise or recreation, and inadequate monitoring of and care for

14 people with mental health needs in restrictive housing.

15

66.

In June 2016, Mr. Vail found that Defendant “overuses segregation

16 both for the mentally ill and the non-mentally ill,” and that the conditions in

17 Defendant’s restrictive housing units are “very stark and unlikely to meet

18 constitutional standards.”

19

67.

In November 2016, CGL found that “the amount of out of cell time

20 and recreation time provided to inmates in the Main Jail is insufficient . . . due at

21 least in part to the lack of correctional staff available to adequately supervise

22 inmates out of their cells.”

23

68.

In May 2017, Austin et al. reported that Defendant places individuals,

24 including those with mental illness, in “harsh conditions of solitary confinement . .

25 . for excessive periods of time,” and that there is no “credible or transparent

26 process” by which individuals are assigned to or removed from restrictive housing.

27

69.

Despite Defendant’s knowledge of its overuse of solitary confinement

28 and the harmful effects thereof, it continues to rely on profound and prolonged
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1 restrictive housing. Defendant has failed to meaningfully reduce the T-Sep

2 population in the jails or to commit the resources necessary to address this serious

3 problem. To this day, hundreds of individuals are still subjected to dangerous and

4 inhumane conditions in restrictive housing units. Similarly, Defendant has failed

5 to address systemic deficiencies in its disciplinary process or the degrading

6 conditions of confinement for individuals in disciplinary detention.

7 III. DEFENDANT FAILS TO PROVIDE MINIMALLY

8 ADEQUATE MENTAL HEALTH CARE IN ITS JAILS

9

70.

Defendant has a policy and practice of failing to provide sufficient

10 mental health care to the more than 1,500 individuals with mental health needs in

11 the jails. Many of those individuals suffer from severe mental illness and

12 experience symptoms such as paranoia, auditory and visual hallucinations, and

13 persistent thoughts of self-harm.

14

71.

Defendant’s mental health system is defined by severe staffing

15 shortages, an inadequate screening and assessment process, significant delays in

16 access to clinicians and medications, a dearth of treatment and services, inadequate

17 treatment space, and an overreliance on harsh, restrictive housing units.

18 Defendant’s system of care is wholly inadequate to meet the significant and

19 growing mental health needs of its population.

20

A. Defendant Fails to Identify or Respond Timely to the Mental

21

Health Needs of Individuals in the Jails

22

72.

Defendant’s mental health screening process at intake is inadequate to

23 identify the serious needs and risk factors of individuals in the jails. Nurses

24 conduct intake assessments in a noisy and crowded booking and intake area, within

25 earshot of custody staff and other people being interviewed and booked into the

26 jail. Privacy and confidentiality are compromised, reducing the likelihood that

27 people will disclose mental health needs and risk factors for suicide. The intake

28 assessment lacks critical questions regarding individuals’ mental health history and
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Case 2:18-cv-02081-TLN-KJN Document 1 Filed 07/31/18 Page 23 of 63

1 cognitive limitations, current mental health complaints, risk of self-harm and

2 suicidality, history of suicidality during past incarcerations, and medication needs.

3

73.

Defendant lacks a system for triaging and following up timely on

4 mental health referrals after intake, creating a significant risk that even someone

5 who discloses mental health needs during the screening process, such as recent or

6 current suicidal ideation, will not be timely seen by mental health staff, leaving

7 them to suffer or further decompensate without treatment. In several recent

8 suicides at the jails, Defendant had documented mental health referrals that had not

9 led to a clinical mental health contact by the time of the individual’s suicide death.

10

74.

Defendant’s severe understaffing leads to dangerously long wait times

11 for psychiatric assessments for those identified as requiring psychiatric care, with

12 some individuals waiting over a month. Mental health staff take days or weeks to

13 review and respond to kites seeking mental health treatment.

14

75.

Defendant’s dangerous understaffing and broken system of care

15 means that manageable mental health conditions deteriorate into emergent ones

16 that require crisis responses and, in far too many cases, lead to an individual’s

17 death or permanent injury.

18

B. Defendant Fails to Provide Minimally Adequate Mental Health

19

Treatment

20

76.

For the vast majority of individuals identified as having mental health

21 needs, Defendant provides no more than the most rudimentary mental health care:

22 basic assessment, psychotropic medication management, and crisis response.

23 Defendant does not provide adequate treatment planning, and it does not offer

24 adequate individual or group therapy, structured activities, or rehabilitative

25 services. Defendant’s experts have found that when mental health care staff

26 respond to requests for care, such visits can be as short as 15-30 seconds.

27

77.

Defendant fails to provide confidentiality for mental health contacts.

28 Instead, clinicians routinely meet with patients at cell front or in other heavily
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1 trafficked areas. This practice severely limits patients’ privacy and interferes with

2 the provision of mental health services. Many people refuse treatment in public or

3 are unwilling to share important information when other staff or prisoners can hear

4 them.

5

78.

The experience of Plaintiff LEE, who has a history of suicide attempts

6 and significant mental health needs, illustrates this systemic problem. Defendant’s

7 mental health staff has communicated with Mr. LEE almost exclusively at cell

8 front through a closed metal door. Mr. LEE does not feel safe disclosing his

9 mental health within earshot of custody staff and others in the area. The lack of

10 privacy has undermined any clinical treatment provided by mental health staff,

11 leading to Mr. Lee experiencing worsening depression and suicidal thoughts.

12

79.

Defendant maintains a haphazard and dangerous medication

13 distribution system. Due to insufficient staffing, psychiatric prescribers frequently

14 start or change individuals’ medications without even seeing the patients or

15 providing any follow-up to monitor side effects and medication efficacy.

16 Psychotropic medications are distributed to patients at inconsistent and odd hours

17 of the day, sometimes in the middle of the night.

18

80.

Defendant’s dangerous practices leave many people with mental

19 illness either over- or under-medicated. One woman received such an

20 inappropriately high dosage of her medication that she lost consciousness.

21

81.

Even in the Main Jail’s acute psychiatric unit, Defendant fails to

22 provide necessary mental health care. Mental health staff provide little to no

23 individualized treatment beyond medication management. The conditions in the

24 acute care unit are grim. Defendant confines patients to their cells, which are

25 small, dirty concrete boxes that often smell like urine and feces, for up to 23 hours

26 per day. Out-of-cell time for acute patients is limited to no more than one hour per

27 day, in a bare dayroom with no space to exercise and no opportunity to engage in

28
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1 therapeutic activity. The unit is extremely noisy, with people shrieking and

2 banging on their cell doors because of poorly treated mental illness.

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

Photo: Main Jail Acute Mental Health Unit Cell

23

82.

The acute inpatient unit also lacks sufficient capacity to meet the

24 demand for inpatient care. Many people requiring inpatient care are left waiting

25 for extended periods of time because the unit is understaffed, has an insufficient

26 number of beds, and frequently has a waitlist for admission. Individuals with acute

27 treatment needs are routinely left to languish in isolation cells and in rooms

28 designed to be used for jail programming because Defendant has no treatment bed
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Case 2:18-cv-02081-TLN-KJN Document 1 Filed 07/31/18 Page 26 of 63

1 available for them. Plaintiff BEIRGE has been referred several times for

2 placement in the inpatient mental health unit due to suicidal ideation and other

3 symptoms of mental illness. Each time, he was placed on the inpatient wait list

4 due to lack of bed space, resulting in a delay – and often outright denial – of

5 clinically indicated inpatient care.

6

83.

Defendant’s treatment of people who require outpatient care is no

7 better. Defendant provides no dedicated outpatient mental health unit or program

8 for women with mental health needs. Even the men’s Outpatient Psychiatric

9 Program (“OPP”) provides no additional outpatient care or programming beyond

10 basic medication management. Far from a therapeutic environment, OPP often

11 amounts to solitary confinement for people with mental health needs.

12

84.

Defendant’s Intensive Outpatient Program (“IOP”), created to provide

13 sheltered living to male prisoners with sub-acute mental health needs, has

14 markedly inadequate capacity to meet the treatment needs of the jail population.

15 No such program exists for women with urgent mental health needs. As a result,

16 people cycle in and out of acute care settings and suicide watch, or simply end up

17 warehoused in solitary confinement.

18

85.

Defendant punishes people with mental illness for behaviors

19 associated with their mental health or other disabilities. Defendant has no

20 mechanism for identifying individuals with disabilities during the disciplinary

21 process or for providing accommodations to ensure they understand the charges

22 against them and can participate in the process.

23

86.

Defendant even imposes disciplinary sanctions for individuals on

24 suicide watch. In one case, an individual on suicide watch allegedly removed a

25 piece of the ceiling and used it to cut his wrists. Defendant handcuffed the

26 individual, put him in a barren cell, and charged him with vandalism/theft and

27 insubordination for talking back to an officer. Defendant failed to provide the

28
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1 individual with adequate treatment for his self-harming behavior and did not

2 consider how mental illness contributed to his behavior before imposing sanctions.

3

87.

Plaintiff MAYS, who has developed irregular sleep patterns and other

4 ill effects from his years in isolation in Sacramento County’s jails, has been

5 disciplined more than twenty-five times for “Failure to Rise” when jail staff count

6 prisoners in the unit during the few hours he is able to sleep. Each time, Defendant

7 imposed further “lock-downs” as punishment, thus denying Mr. MAYS the already

8 miniscule out-of-cell time permitted to individuals in Total Separation units.

9 These practices are extremely harmful and discriminate against people based on

10 their disabilities.

11

88.

Defendant’s failure to provide adequate mental health care placements

12 and treatment creates an unreasonable risk of victimization and violence. In one

13 case, a woman diagnosed with schizophrenia and bipolar disorder was celled with

14 a person without mental illness. She was attacked by her cellmate. After the

15 incident, the woman was placed in solitary confinement on Total Separation status,

16 a placement that served only to worsen her psychological condition.

17

C. Defendant Fails to Provide Basic Pre-Release Discharge Planning

18

to Individuals with Serious Mental Illness

19

89.

Defendant fails to adequately prepare people with mental illness for

20 transition back to the community after their incarceration. Barely three percent of

21 the nearly 4,000 people released each month receive reentry services. Due to

22 insufficient staffing and resources, Defendant fails to supply medications to people

23 receiving psychiatric medications in the jail when they are released to the

24 community, leaving people with dangerous gaps in treatment. Some do not even

25 know what their diagnosis is, what medications they take, or how to renew their

26 prescriptions.

27

28
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1

90.

Defendant’s failure to provide sufficient discharge planning services

2 means that individuals cycle in and out of the jail again and again, in some cases

3 returning to the jail within 24 hours of release.

4

91.

Defendant also routinely discharges individuals directly from solitary

5 confinement to the streets, with no preparation for the transition and little regard

6 for the well-established lingering psychological effects of isolation.

7

D. Defendant Is Deliberately Indifferent to the Harm Caused by Its

8

Deficient Mental Health Care Practices

9

92.

Defendant’s policy and practices cause severe harm to people with

10 serious mental illness. Defendant’s practice of subjecting people with mental

11 illness to severe isolation, deprivation, and lack of treatment exacerbates existing

12 mental illness, leading to increased anxiety, depression, psychosis and other mental

13 health symptoms.

14

93.

Defendant is well aware of the inadequacy of its mental health care

15 system. The November 2016 report by CGL found that “[t]reatment programs and

16 housing for mentally ill offenders . . . do not meet contemporary professional

17 standards.” CGL documented that many people with mental illness in the jails are

18 “confined to their cells for most of the day.” This, in turn, “affects the safety of

19 staff, who face more challenging and volatile inmates in a physical plant that was

20 not designed for that population, and the mentally ill offenders themselves, who

21 may become a danger to themselves and those around them because of inadequate

22 facilities and treatment.”

23

94.

Defendant’s expert Dr. Gage made similar findings of a failing mental

24 health system, documenting numerous critical failures in the provision of care to

25 individuals with severe psychiatric disabilities.

26

95.

Mr. Vail and Sabot Consulting reported on deficient mental health

27 services and the unjustifiable reliance on solitary confinement to deal with the

28 individuals with mental health needs in Defendant’s jails.
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1

96.

Despite knowledge of its woefully inadequate mental health care

2 system and systematic overuse of restrictive housing for individuals with serious

3 mental illness, Defendant has failed to take reasonable steps to address the grave

4 and ongoing harm to Plaintiffs and others. Defendant has failed to expand mental

5 health staffing, substantially increase the number of treatment beds to meet the

6 needs of the inmate population, ensure adequate treatment planning, or improve its

7 deficient discharge planning practices.

8

IV.

DEFENDANT FAILS TO TAKE BASIC MEASURES TO

9 PREVENT SUICIDE

10

97.

Defendant fails to take basic measures to prevent suicide in the jails.

11 Defendant’s policies and procedures fail to identify individuals at risk of suicide

12 during intake, provide insufficient support to those who demonstrate self-harm or

13 express suicidal ideation, and treat individuals in a punitive manner that

14 discourages reporting of suicidality and increases the risk that suicide attempts and

15 suicides will occur. As a result, individuals are dying by suicide at an alarmingly

16 high rate in Defendant’s jails.

17

98.

Defendant fails to provide sufficient supervision of people at risk of

18 suicide. Because of insufficient custody staffing, there are few deputies to interact

19 with and identify people who may be experiencing suicidal ideation or engaging in

20 self-harming behaviors. The absence of adequate staff is particularly troubling in

21 isolation units, where individuals may not be seen by or interact with another

22 person for hours or days at a time.

23

99.

Defendant fails to properly train staff about suicide risks and

24 prevention. Defendant’s training for custody staff fails to adequately address how

25 to handle suicidal individuals and does not mention basic crisis intervention

26 strategies.

27

28
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1

A. Defendant Subjects Individuals on Suicide Watch to Punitive and

2

Degrading Conditions

3 100. Defendant grossly mistreats people who are identified as suicidal.

4 Defendant’s policies and practices are unnecessarily and inappropriately punitive,

5 relying on excessive isolation and deprivation, which can be even harsher than the

6 conditions experienced by people facing disciplinary sanctions.

7 101. When a person is identified as suicidal, Defendant strips him or her of

8 clothes, removes the person from his or her cell, and places him or her in

9 temporary housing without any personal belongings and no access to phones or

10 visitation with family. If a person is unwilling or unable to take off his or her

11 clothing, deputies forcibly remove it by ripping or cutting it off with scissors. On

12 information and belief, this practice has included male deputies forcibly removing

13 women’s clothes.

14 102. Defendant routinely places people who are actively suicidal in barren

15 “safety cells” or empty classrooms while they await psychiatric attention.

16 Classrooms, also known as multi-purpose rooms, are located in the center of

17 housing pods and enclosed in windows, leaving the person exposed to the gazes of

18 others during a mental health crisis. Defendant confines people who are suicidal in

19 these harsh conditions around the clock for extended periods of time while they

20 await psychiatric assessment. These placements have no beds, mattresses, toilets,

21 or sinks, and are ill-equipped to house anyone on an extended basis, let alone a

22 person who is actively suicidal. One woman on suicide watch in a classroom was

23

24

25

26

27

28
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1 prohibited from leaving the room to use the bathroom, and was told by custody

2 staff to “piss in the drain” in the floor.

3

4

5

6

7

8

9

10

11

12

13

14

15 Photo: “Safety Cell” for Suicidal Prisoners, with Floor Grate Serving as a Toilet

16 103.

Defendant’s experts have condemned Defendant’s reliance on

17 classrooms for suicide watch. Dr. Gage described the setting as “punitive” and

18 stated that “[t]he use of the so-called ‘classrooms’ holding inmates pending

19 evaluation or on [suicide watch] monitoring needs to be halted. These are not

20 living spaces, have no toileting provisions, are publicly visible spaces, and are not

21 suicide-proof.” Similarly, Mr. Hayes reported that “[t]he classrooms . . . should

22 never be utilized for the housing of suicidal inmates (for any duration).” Mr. Vail

23 called the setting “humiliati[ng]” and recommended that Defendant immediately

24 cease using classrooms for suicide watch. Nonetheless, Defendant continues to put

25 people in dire psychiatric crisis in these degrading and unsafe settings.

26

27

28
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1

2

3

4

5

6

7

8

9

10

11 Photo: “Classroom” Used to Hold Overflow Prisoners with Acute Mental Illness 12 104. Plaintiff BEIRGE has been placed in these cells several times. On at

13 least one occasion, he begged mental health staff to remove him from suicide

14 precautions because sleeping on the hard floor without clothing was so cold.

15 105. Defendant has a practice of placing individuals on suicide watch in

16 places with known suicide hazards. For example, the classrooms that Defendant

17 uses for suicide watch contain light fixtures, vents, and other protrusions that can

18 be used by individuals attempting to hang themselves. Defendant’s experts have

19 found that even the designated “mental health units” in the jails have unsafe

20 features for people at risk of suicide or self-harm. Yet Defendant has failed to

21 commit the resources to address these known hazards in its jail facilities.

22 106.

Defendant’s own experts have found that Defendant relies

23 excessively and inappropriately on “safety suits,” which are garments designed to

24 prevent a person from using the fabric as a noose or to otherwise commit suicide.

25 Safety suits are heavy, bulky, uncomfortable, and stigmatizing. Defendant uses

26 safety suits indiscriminately and for excessively long periods of time, in some

27 cases several months. In addition, Defendant forces some people to wear safety

28
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1 suits – with no other clothing, including underwear – even after they are no longer

2 suicidal, a degrading and punitive practice.

3 107. One man with a mobility disability who requires use of a walker or

4 cane has been placed on suicide watch in a barren “safety cell” or classroom more

5 than six times at Sacramento County Jail. During one such incident, he was placed

6 in a safety cell without an assistive device and no alternative accommodation for

7 his disability. Defendant left the individual lying on the floor in a safety suit,

8 where he urinated on himself and remained in a urine-soaked suit for more than

9 four hours.

10 108. Defendant’s practice of subjecting people who are suicidal to punitive

11 isolation and deprivations is extremely harmful, exacerbating existing mental

12 health crises. Research indicates that these types of punitive responses to

13 suicidality makes incarcerated people reluctant to discuss their suicidal thoughts

14 because of the harsh conditions they will face on suicide precautions. Defendant’s

15 policies and practices place an already vulnerable population at further risk of

16 decompensation and death.

17

B. Defendant’s Knowing Failure to Take Adequate Suicide

18

Prevention Measures Has Tragic Consequences.

19 109. Defendant’s knowing failure to reform its suicide prevention practices

20 consistent with the detailed report of its expert, Lindsay Hayes, has had tragic

21 consequences. Since November 2016, there has been a rash of suicides in

22 Defendant’s jails, with inmates dying by suicide at a rate nearly twice the national

23 jail population average. At least three suicide deaths have occurred in solitary

24 confinement housing units.

25 110. In 2017, two men died by suicide in the Defendant’s jails. One man

26 hanged himself hours after he was booked into the jail. He indicated at the time of

27 intake that he previously had been hospitalized for mental health treatment. At the

28 time of his death, he had a pending referral for psychiatric services.
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1 111. Another man hanged himself in his cell after spending almost four

2 months in solitary confinement as a “Total Separation” inmate. He had previously

3 sought mental health treatment at the jail, stating that he was nearing a mental

4 breakdown and needed help coping with suicidal thoughts.

5 112. So far in 2018, there have been two suicides in Defendant’s jails. One

6 man hanged himself with a ripped towel in his T-Sep cell. At the time of his arrest,

7 the individual had been taken by police for psychiatric evaluation because of

8 erratic behavior. Despite indications that the man had serious mental health needs,

9 he was housed for nearly two months in solitary confinement in “Total Separation”

10 status. He remained a T-Sep prisoner until the time of his death by suicide.

11 113. Another man hanged himself in his cell the day after his attorney had

12 requested a mental health evaluation on his behalf. The evaluation never took

13 place. The man had been openly sobbing in his housing unit on the day he died.

14 114. In a recent period of less than 15 weeks, Defendant’s recorded more

15 than 500 placements of individuals on suicide precautions. On information and

16 belief, nearly 300 of these placements were in the makeshift “classrooms” that

17 were never designed to house people with acute mental health needs. Dozens more

18 were placed in barren safety cells.

19 115. Despite knowledge of the serious shortcomings in its suicide

20 prevention practices and ongoing physical hazards in the jails, Defendant has failed

21 to take reasonable steps to address the harm to Plaintiffs.

22

V.

DEFENDANT FAILS TO PROVIDE MINIMALLY

23 ADEQUATE MEDICAL CARE

24 116. Defendant provides grossly deficient medical care to individuals in

25 custody in the jails. Defendant’s medical care system is plagued with inadequate

26 staffing, an inefficient and incomplete intake process, excessive delays in

27 responding to requests for care and providing treatment, an incoherent system for

28 tracking and treating chronic care conditions or providing specialty care, and
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1 decrepit infirmary conditions that lack even basic privacy protections. Defendant

2 has failed to commit the resources necessary to remedy these widespread and

3 obvious problems.

4

A. Defendant Fails to Identify and Track the Medical Needs of

5

People in its Custody or to Ensure the Timely Provision of

6

Necessary Medical Care

7 117. Defendant’s intake system is inadequate to identify individuals’

8 serious medical needs and to ensure the provision of adequate care. Defendant’s

9 experts have found that the intake screening process is confusing, unwieldy, and

10 fails to cover critically important topics. Nurses fail to ask all questions on the

11 intake form or to consult available medical records that contain critical health

12 information. Nurses conduct intake assessments in the noisy and crowded booking

13 and intake area, within earshot of custody staff and other people being interviewed

14 and booked into the jail. Privacy and confidentiality are severely compromised.

15 118. Defendant’s practices for verifying patient medications and requesting

16 medical records from community health providers are disorganized, haphazard,

17 and ineffective, resulting in dangerous disruptions in care.

18 119. Defendant’s system for handling health services requests (“HSRs” or

19 “kites”) is inefficient and ineffective, forcing patients with serious medical needs

20 to languish without care in their cells for excessive periods of time. Although

21 Defendant’s own policy requires that nurses make contact with an individual

22 within 24 hours of receiving a kite, patients routinely wait days or weeks before

23 they receive a response to their request. People in the jail, particularly those in

24 solitary confinement units, lack reliable access to kites, and generally must submit

25 medical care requests to custody staff, a practice that compromises patient

26 confidentiality, discourages reporting of medical needs, and creates an opportunity

27 for abuse or harassment by staff.

28
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1 120. Defendant has a “one problem per visit” policy, whereby nurses and 2 providers refuse to see patients for more than one medical issue at a time. In other 3 words, if a patient requires care for multiple (and even related) medical issues, he 4 or she must submit multiple requests and wait for multiple appointments to address 5 their needs. This system is ineffective for addressing co-morbidities that require 6 coordinated care. 7 121. Plaintiff RICHARDSON’s experience is but one example of the 8 consequences of Defendant’s inadequate system of care. Mr. RICHARDSON 9 arrived at the jail in early 2016 with signs of a deep bone infection and a “stage 10 four pressure sore” for which a scheduled surgery with an outside provider was 11 precluded by his incarceration. Several medical staff recommended that Mr. 12 RICHARDSON receive an evaluation for surgery to address the “open,” “deep,” 13 and often foul-smelling wound. Nearly two years later, in March 2018, a physician 14 again recommended referral for surgical intervention to treat the wound. As of 15 July 2018, Mr. RICHARDSON was still waiting for surgical care, suffering 16 significant pain, discomfort, and stress every day due to the lack of treatment. 17 122. In another example, Plaintiff BOTHUN entered the jail with bilateral 18 cataracts and limited vision. For months as far back as August 2017, Ms. 19 BOTHUN repeatedly notified Defendant of constant and severe pain in her eyes. 20 Defendant’s failure to provide adequate care led to Ms. BOTHUN’s complete loss 21 of vision in her right eye, increased ocular pressure in both eyes, dizziness, and 22 constant pain. Defendant has failed to provide clinically indicated surgery for Ms. 23 BOTHUN to address her condition. Each day of delay in care has brought her 24 closer to permanent and complete blindness. 25 123. Because Defendant has failed to adequately staff medical care 26 positions, it is almost impossible for patients to timely see a doctor when they need 27 care. Instead, Defendant relies excessively on nurses, who are often acting outside 28 of their scope of practice and without nursing protocols to inform their practices.
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1 Such a system leads to delays or mistakes in diagnosis and treatment, putting

2 patients at a serious risk of harm.

3

B. Defendant Has an Ineffective, Ad Hoc System for Chronic and

4

Specialty Care and Fails to Provide Adequate Dental Care

5 124. Defendant lacks an adequate system for providing regular care to

6 patients with chronic conditions, such as diabetes and hepatitis. Defendant has a

7 haphazard and inconsistent approach to providing chronic care. Defendant lacks

8 appropriate protocols and guidelines to ensure that people with chronic conditions

9 do not suffer needlessly in the absence of treatment.

10 125. For example, Defendant has denied Plaintiff GARLAND appropriate

11 care for a chronic medical condition that puts him at constant risk of severe and

12 life-threatening allergic reactions. Plaintiff GARLAND has experienced

13 approximately fifteen emergent anaphylactic reactions during his time in

14 Defendant’s custody, but Defendant has repeatedly failed to provide timely care

15 for his condition. On one occasion, Plaintiff GARLAND suffered severe shortness

16 of breath and excruciating itching that did not improve with the basic breathing

17 treatment and Benadryl that was provided at the jail. Defendant failed to provide

18 timely emergent care. Instead, medical staff documented that they thought his

19 symptoms were a “stunt.” It was not until the next day, after Plaintiff GARLAND

20 had gone hours in a panic, feeling like his throat was closing, that Defendant

21 transferred him to a hospital, where he required inpatient treatment for more than a

22 month.

23 126. Defendant also fails to provide timely and appropriate specialty care,

24 such as neurology, oncology, and ophthalmology. Defendant’s system for

25 providing specialty care is disorganized, with no effective mechanism for tracking

26 and following up on specialty care requests from physicians. Defendant fails to

27 provide sufficient guidance to physicians and nurses about when specialty care is

28 appropriate.
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1 127. In many cases, Defendant denies patients access to urgently needed 2 specialty care. For example, health care staff determined in September 2015 that 3 Richard Galindo, who was incarcerated at the Main Jail, had cancer. Health care 4 staff referred Mr. Galindo for surgery, but arrangements for the surgery were not 5 made for seven months. By the time steps were taken to schedule the surgery, in 6 or about April 2016, it was determined that Mr. Galindo’s cancer had advanced to 7 the point that surgery was no longer an option. Defendant did not provide Mr. 8 Galindo with alternative therapy for his condition until November 30, 2016 – 9 fifteen months after the original referral for surgery. 10 128. In the case of Plaintiff MAYS, Defendant failed to provide a 11 necessary surgery to remove temporary pins from his fractured hand. Mr. MAYS 12 submitted repeated requests for medical care over a period of twelve months. 13 These requests document that he was experiencing excessive pain and even that the 14 pins were coming through his skin, causing his hand to bleed and putting him at 15 risk of infection. Such alarming symptoms continued for nearly a year due to 16 Defendant’s delay in providing treatment. 17 129. Jail medical staff referred Plaintiff GARLAND to a glaucoma 18 specialist for his serious ophthalmological needs more than three years ago. To 19 date, Defendant has not provided Plaintiff GARLAND with the specialty care 20 recommended by its own medical professionals. During his lengthy incarceration, 21 Plaintiff GARLAND has suffered irreversible vision loss, having lost nearly all 22 vision in his left eye and deteriorated vision in his right eye since the initial referral 23 by jail medical staff in or about 2015. 24 130. Defendant provides inadequate dental care and generally limits dental 25 treatment to emergency situations. Defendant has failed to commit the resources 26 necessary to provide routine or basic dental care. Defendant restricts access to 27 toothbrushes and toothpaste to people in restrictive housing units, creating or 28 exacerbating dental problems.
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1 131. Patients wait weeks or months to receive dental care, in many cases

2 having to deal with severe pain or decay on their own. Due to lack of space and

3 insufficient staffing, dental care providers at times conduct examinations at cell-

4 front, through closed doors and glass. Patients report that the dentists reach

5 flashlights through the cell doors to examine their mouths.

6

C. Defendant Uses Deficient Medical Treatment Spaces and

7

Medically Inappropriate Housing Units

8 132. Defendant examines and treats patients in highly public areas that lack

9 visual and auditory privacy, and do not contain basic equipment such as exam

10 tables and sinks. At the Main Jail, medical staff conduct physical exams and

11 provide treatment right in the middle of the 2 East unit. In the Medical Housing

12 Unit (MHU) at RCCC, physicians regularly perform examinations in the open

13 dormitory space as well. The exams are conducted in plain sight of deputies and

14 other prisoners in the housing units.

15 133. The acute medical housing units at both jails are dingy and grim. At

16 both Main Jail and RCCC, the conditions in the acute medical units are excessively

17 harsh and restrictive, limiting out-of-cell time, personal property, and recreational

18 activities. Defendant provides extremely limited out-of-cell time each day in the

19 medical units at the Mail Jail or the high security medical unit cells at RCCC,

20 regardless of a patient’s security classification. In the medical units, Defendant

21 does not offer educational, vocational, job, recreation, religious, or other

22 programming.

23 134. Plaintiff GARLAND experienced extreme stress while housed in a

24 restrictive medical unit cell at RCCC (similar to the one pictured below) over a

25 period of five months. He reached a point where he “just could not take it

26 anymore,” and attempted suicide by swallowing staples and other metal objects,

27 and then trying to hanging himself with noose fashioned out of bed sheets.

28
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1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

Photo: High Security “Medical” Unit Cell

17 135. Without adequate medical housing for women, women requiring a

18 medical placement must be housed in the extremely restrictive inpatient medical

19 unit at the Main Jail, regardless of the acuity of their needs or their security

20 classification.

21

D. Defendant Fails to Ensure Continuity of Care

22 136. Defendant lacks a functioning system for prescription and distribution

23 of medication. Individuals receiving medication in the community prior to arrest

24 often experience delays in getting necessary medication after they arrive in

25 custody. Medical staff terminate or change medications or dosages without proper

26 examination of patients, leading to disruptions in treatment and dangerous side

27 effects.

28
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1 137. Due in part to insufficient resources, Defendant also lacks an adequate

2 system for ensuring continuity of care for people being released from the jails back

3 to the community. Defendant does not reliably supply medications to people

4 receiving medications in the jail when they are released to the community or

5 ensure that they are connected to community resources to continue their medical

6 treatment. These practices are extremely harmful, leaving individuals with

7 medical needs without critical health care information and medications.

8

E. Defendant Fails to Provide Necessary Care to People with

9

Disabilities, People Who Are Experiencing Detoxification, and

10

Transgender People in the Jails

11 138. Defendant’s inadequate medical care system is especially harmful to

12 people with disabilities housed in the jail. The kite system prevents some

13 individuals with disabilities from accessing care, as staff generally do not assist

14 individuals with filling out medical kites. Defendant’s inadequate medical system

15 leaves people with disabilities without access to needed medical care and

16 accommodations.

17 139. In one illustrative case, Defendant’s consultant found that a person

18 with several disabilities required diapers for incontinence. Medical staff failed to

19 provide them, causing her to soil herself. Staff then failed to provide her clean

20 clothes.

21 140. Defendant’s protocols and practices for detoxification are also

22 alarmingly deficient, putting patients at serious risk of injury or death. Defendant

23 leaves individuals experiencing withdrawal in small, grim “detox cells” for hours

24 at a time without adequate supervision. Notably, in July 2017, a man died in the

25 booking loop at the Main Jail due to alcohol withdrawal.

26 141. Defendant also fails to provide medication-assisted interventions for

27 substance abuse disorders. Defendant’s failure to conform to community standards

28 by providing medications to people with substance abuse disorders needlessly
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1 exposes those individuals to risk of suffering and death, both while housed in the

2 jails and upon release.

3 142. Defendant fails to provide necessary medical services to transgender

4 people in its custody. Defendant lacks a system or adequate policy for evaluating,

5 diagnosing, or providing transgender people with necessary care, including

6 hormone therapy. Defendant also has no system for identifying those who have

7 received treatment, including hormone therapy, in the community and for

8 continuing such treatment consistent with medical need.

9

F. Defendant Is Deliberately Indifferent to the Harm Caused by Its

10

Deficient Medical Care Practices

11 143. Defendant has been placed on notice for years about inadequate

12 medical care. In 2009, the OIG reported on significant cuts to the Correctional

13 Health Services budget, resulting in a major reduction of health care staff.

14 According to the OIG, the cuts resulted in significant treatment delays and

15 compromised access to care.

16 144. In 2010, the OIG again reported on “unprecedented reductions” in the

17 Correctional Health Services operating budget. The OIG found that budget cuts

18 had “a profound effect on medical care services in the jail facilities,” and that

19 “service levels have been severely compromised.” In particular, the OIG found

20 that the lack of nurses in the housing units “severely threaten[ed] [the jails’] ability

21 to respond to emergencies or issues with patients on the acute units.”

22 145. In January 2015, Defendant’s consultant, HMA, reported that

23 Defendant’s approach to managing chronic care was “insufficient to adequately

24 mitigate the risk associated” with its population. HMA found that “[n]either

25 facility has a process to treat chronic conditions in an organized and proactive

26 manner. Each provider schedules follow-ups in the absence of clinical guidelines

27 and there is no standardization of determining disease classification or level of

28 control.”
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1 146. HMA reported that current staffing levels prevented Defendant from 2 providing necessary services to individuals with disabilities. HMA characterized 3 jail health care staff as “maxed out.” 4 147. HMA faulted Defendant for staffing an inadequate number of nurses 5 to serve the jail population, noting that Sacramento is an outlier in its inmate-to6 nurse ratio. HMA found that Defendant was “exposing [itself] to significant 7 clinical risk” by understaffing nurses and relying on temporary and agency staff 8 nurses. The HMA report stated: “Merely providing a nurse—rather than a 9 competency-tested, well-prepared correctional nurse—is not enough to mitigate 10 [the County’s] risk for adverse clinical outcomes, incorrect processes and 11 procedures, and threats to staff and inmate safety.” 12 148. HMA also raised concerns about the conditions of confinement in 13 Defendant’s medical units, noting that the unit at Main Jail is “dark and crowded 14 with equipment and boxes in the hallways.” HMA documented that individuals in 15 these units have “no access to exercise or daylight and there is no day room.” 16 149. Disability Rights California reported that “the medical staff at RCCC 17 conceded that they ‘struggle’ to provide care for chronic conditions and plan to 18 develop policies for long-term management of conditions such as asthma, diabetes, 19 hypertension, and hyperlipidemia.” 20 150. Even more recently, Defendant’s expert, Sabot Consulting, reached 21 many of the same conclusions about deficiencies in the medical care provided to 22 people in the jail. Sabot reported on problems with medication continuity, 23 including delays in the provision of medications after booking and changes to 24 medications that caused serious side effects. 25 151. Sabot also reported on delays in responding to requests for medical 26 care. According to Sabot, “medical staff cited a backlog . . . in large part due to 27 staffing vacancies across all disciplines. They acknowledged that this ultimately 28 adversely affects the health care process.”
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1 152. Sabot further reported on Defendant’s pervasive failure to ensure

2 confidentiality in medical encounters, noting that “health care staff talk with

3 inmates at cell doors, inside pods, [and] inside rec/dayroom areas with inmates in

4 the areas.”

5 153. Despite these alarming findings, Defendant has made virtually no

6 changes to meaningfully enhance health care staffing, ensure confidentiality of

7 medical encounters, or provide adequate chronic and specialty medical care.

8 154. Defendant’s inadequate medical care system places all people in the

9 jails, and especially people with disabilities, at serious risk of harm or death.

10

VI.

DEFENDANT DISCRIMINATES AGAINST AND FAILS TO

11 ACCOMMODATE PEOPLE WITH DISABILITIES

12 155. Defendant incarcerates a significant number of people with disabilities

13 in its jails. Defendant fails to ensure that those individuals have equal access to

14 programs, services and activities, and fails to provide people with disabilities

15 reasonable accommodations. Defendant’s written policies often ignore completely

16 the needs of individuals with disabilities.

17 156. As a result of these failures, Defendant places people with disabilities

18 at a substantial risk that they will be improperly housed in unduly restrictive

19 placements, subjected to discipline based on their disabilities, injured or left behind

20 in an emergency, victimized by others, and unable to access necessary health care.

21

A. Defendant Fails to Adequately Identify or Track People with

22

Disabilities

23 157. Defendant fails to appropriately identify individuals’ disabilities and

24 whether they need assistive devices or other accommodations. Defendant’s

25 disability screening is conducted in an inconsistent and incomplete manner.

26 Defendant’s expert found that medical staff sometimes skip entirely the questions

27 related to disability. Rather than relying on a standard assessment, staff report that

28 they know who has a disability “by the way [they] walk and talk.” Such a
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1 haphazard screening system virtually guarantees that individuals with disabilities

2 are not appropriately identified and provided accommodations they need.

3 158. Defendant fails to screen, evaluate, and provide accommodations to

4 individuals with intellectual disabilities. Defendant often houses individuals with

5 intellectual disabilities in the acute psychiatric unit or in solitary confinement units

6 simply because there are no appropriate housing options to meet their specific

7 disability needs. Plaintiff MAYS’ many years in Total Separation isolation is but

8 one example.

9 159. Even if Defendant does identify individuals’ disabilities at intake,

10 Defendant fails to maintain an adequate system for tracking people with disabilities

11 once identified. Defendant’s inmate tracking system does not track individuals

12 identified as having intellectual disabilities, mental health concerns, or physical

13 disabilities, nor whether they have been issued health care appliances, assistive

14 devices, durable medical equipment, or other accommodations.

15

B. Defendant Fails to Provide Reasonable Accommodations to

16

People with Disabilities in the Jails Who Need Them

17 160. Defendant does not have a process for providing timely and

18 appropriate reasonable accommodations to people once they are housed in the jail,

19 or for maintaining that disability-related equipment. For example, individuals

20 whose personal wheelchairs are confiscated must use jail-issued chairs or walkers

21 that are often old and in disrepair. Individuals requiring canes frequently wait

22 weeks or months, or never receive them at all. Individuals requiring eyeglasses

23 and hearing aids have difficulty obtaining them in a timely fashion.

24 161. For example, after medical staff recommended a cushion as a support

25 surface for Plaintiff RICHARDSON’s wheelchair, the accommodation was not

26 provided for more than four months. As a result, Mr. RICHARDSON suffered the

27 pain of intense pressure on his wounds and infections caused by the lack of an

28 adequate support surface, along with reduced ability to get around on his own.
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1 162. Similarly, Defendant has refused to provide Plaintiff LEE with a 2 wheelchair to assist him with his condition based on his severe pelvic and 3 neurological injuries. Medical providers confirmed that it was difficult and painful 4 for him to walk, but Defendant provided him only a heavy, cumbersome walker 5 that he was unable to use safely. Staff noted that they could not provide him a 6 more suitable assistive device because they did not have one available. He has 7 fallen on multiple occasions while trying to use the walker, including in front of 8 jail staff. 9 163. Defendant fails to provide even basic maintenance for assistive 10 devices, such as replacement batteries for hearing aids. Instead, Defendant 11 requires individuals’ family members to bring those items to the jail. 12 164. Defendant routinely confiscates assistive devices, such as 13 wheelchairs, walkers, crutches, cranes, braces, hearing aids, and eyeglasses, during 14 the booking and intake process and does not allow individuals to retain them once 15 they are classified and housed in the jail. Defendant thereby denies individuals 16 with disabilities the ability to complete everyday activities, such as getting around 17 safely, seeing, reading, or hearing. 18 165. Defendant fails to provide individuals with disabilities with 19 reasonable accommodations during transportation to court. Defendant denies 20 individuals canes and other assistive devices during the transit process. 21 Defendant’s consultant noted that Defendant has subjected some people with 22 disabilities to the dehumanizing practice of having to crawl into vans and buses on 23 their way to court. 24 166. Defendant does not provide effective communication or basic 25 reasonable accommodations to people with hearing, speech, or other 26 communication impairments during critical interactions with jail staff, including 27 intake and screening, classification, education and other programming, disciplinary 28 proceedings, and medical and mental health care appointments. For example,
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1 Defendant fails to provide sign language interpreters during intake screening for

2 people with hearing disabilities. Similarly, Defendant does not provide sign

3 language interpreters for educational or vocational programs, leaving individuals

4 with hearing disabilities excluded and isolated.

5 167. Defendant has no policy or practice for accommodating people with

6 disabilities in emergency situations. For example, there are no visual alarms for

7 people with hearing impairments. There is no method for staff to identify those

8 with disabilities, or their needed accommodations, during an emergency. This

9 failure leaves people with disabilities extremely vulnerable during emergencies and

10 creates an unreasonable risk of harm.

11

C. Defendant Houses Individuals with Disabilities in Unsafe and

12

Unduly Restrictive Settings and Denies Them Equal Access to Jail

13

Programs, Services, and Activities

14 168. Defendant fails to house people with disabilities in locations where

15 they can safely access programs and services. The Main Jail has no ADA-

16 accessible general population housing for full-time wheelchair-users or those

17 needing other medical equipment. As a result, many individuals requiring use of a

18 wheelchair, regardless of security classification level, are housed in medical

19 housing units solely due to their disabilities. These units themselves lack sufficient

20 ADA-accessible showers and other features. People with wheelchairs in the

21 medical housing units struggle to move around, do not have access to safe showers,

22 and cannot engage in healthy physical activity. For example, Defendant has

23 denied Plaintiff RICHARDSON, a wheelchair-user, physical therapy or any other

24 meaningful opportunity for physical activity in the medical unit’s restrictive

25 setting. Given the forced level of inactivity during his two years at the jail,

26 Plaintiff RICHARDSON has developed symptoms of diabetes and other health

27 problems.

28
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1 169. Defendant’s consultant found extensive evidence of ADA violations 2 in Defendant’s jails and significant resulting harms. There is not a single ADA3 compliant cell shower, bathroom, or living unit in Defendant’s jail facilities, and 4 paths of travel have potholes, cracks, steep slopes, and other non-compliant 5 features. The consultant found that one individual who requires a wheelchair 6 reported that because the two shower chairs in his unit were unstable (and also 7 filthy), he was forced to sit on his knees to clean himself, and that he had fallen in 8 the process. Another person requiring a cane to ambulate was housed up a flight of 9 stairs for three days, and staff provided him with no assistance navigating the stairs 10 or accessing meals. Others have fallen trying to move up and down stairs to the 11 visiting room and yards, or have slept on the floor because they do not have access 12 to a lower bunk. 13 170. Defendant denied Plaintiff RICHARDSON, who has a mobility 14 disability, the opportunity to shower for six days after he was booked at the jail. 15 This denial exacerbated his wheelchair-related pressure sores and wound 16 infections. When Defendant finally provided Mr. RICHARDSON the opportunity 17 to shower, the shower was inaccessible and unsafe. The shower chair was old, 18 flimsy, and unstable. Mr. RICHARDSON fell out of the shower chair when it 19 became stuck in the drain. With no assistance, Mr. RICHARDSON had to drag his 20 body across the filthy shower floor back to his wheelchair. Since that incident, Mr. 21 RICHARDSON has had to bring his wheelchair into the shower to mitigate the risk 22 of falling, leaving him with a wet seat after he showers. 23 171. Plaintiff BOTHUN has been housed in inappropriate and dangerous 24 locations for her disability. She has limited vision and suffers from bouts of 25 dizziness. She reported to jail medical staff that she did not feel safe navigating 26 stairs. She was nevertheless housed on an upper tier in her housing unit, exposing 27 her to significant danger each time she had to navigate the stairs to get to 28 appointments, her meals, or other activities.
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1 172. Defendant denies individuals with disabilities equal access to

2 vocational and recreational programming, religious services, visitation, and phone

3 calls. Plaintiff GARLAND has long been housed in restrictive medical units due

4 to his severe allergies, sleep apnea condition, and need for a Continuous Positive

5 Airway Pressure (CPAP) machine. By policy, because of his medical housing

6 placement, Mr. GARLAND has been denied the opportunity to participate in

7 programs and activities available to people in the general population who do not

8 have a medical condition or disability.

9 173. Visiting areas for both legal and social visits require climbing stairs

10 and/or navigating inaccessible paths of travel, making them inaccessible and

11 unsafe to individuals with mobility-related disabilities. Plaintiff RICHARDSON,

12 for example, who has no use of his legs, must hoist himself out of his wheelchair to

13 enter the attorney visiting booth and stumble into a plastic chair inside the booth

14 through a dangerous set of maneuvers.

15 174. Defendant’s system for work assignments also discriminates against

16 individuals with disabilities due to lack of accommodations. For example,

17 individuals with intellectual disabilities are not provided with assistance necessary

18 to enable them to participate in work programs successfully.

19

D. Defendant Lacks Basic Mechanisms to Inform Individuals with

20

Disabilities about Their Rights, Respond to Disability-Related

21

Requests, or Monitor Compliance with Disability Law.

22 175. Defendant does not provide individuals with disabilities notice of their

23 rights or how to request reasonable accommodations.

24 176. Defendant does not have an effective complaint mechanism for people

25 with disabilities to report discrimination or to request accommodations, forcing

26 them to rely on the poorly tracked general grievance system. In addition,

27 individuals with visual, speech, or intellectual disabilities who may have difficulty

28
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Case 2:18-cv-02081-TLN-KJN Document 1 Filed 07/31/18 Page 50 of 63

1 reading, writing, or comprehending the grievance process are denied the assistance

2 necessary for them to be able to report disability discrimination.

3 177. Even when individuals are able to submit grievances, Defendant’s

4 responses are delayed, do not address the underlying needs, and are not effectively

5 communicated. For example, one person submitted a grievance requesting help

6 with showering; he was told by a nurse that “There [are] more important things to

7 do besides helping you with your shower.” Understaffing and insufficient

8 resources make an adequate disability accommodation system nearly impossible.

9

E. Defendant Is Deliberately Indifferent to the Harm Caused by its

10

Inadequate Disability-Related Policies and Practices

11 178. Defendant has failed to take reasonable steps to address the well-

12 documented, serious, and harmful deficiencies in its disability-related policies and

13 practices.

14 179. For example, Disability Rights California’s report documented the

15 vast denial of rights to people with disabilities in Defendant’s jails. Disability

16 Rights California reported that Defendant denies individuals access to jail

17 programs and services on account of their disabilities, including by housing them

18 in units without dayrooms and denying them opportunities for outdoor recreation.

19 The report also reported a range of serious physical plant problems that prevent

20 people with disabilities from safely accessing the showers and other jail facilities.

21 180. Sabot Consulting produced a nearly 500-page report detailing

22 pervasive discrimination against people with disabilities in Defendant’s jails. The

23 report documented major deficiencies in screening practices, major physical plant

24 problems, serious denials of disability-related accommodations, improper housing

25 of individuals with disabilities, and widespread denial of equal access to jail

26 programming and recreation.

27 181. Despite these highly detailed and extensive reports about serious and

28 harmful shortcomings in the treatment of people with disabilities in Defendant’s
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1 jails, Defendant has failed to make necessary changes to its policies, practices, nad

2 physical plant.

3 VII. CLASS ACTION ALLEGATIONS

4 182. Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and

5 GARLAND bring this action on behalf of themselves and on behalf of all people

6 who are, or will be in the future, incarcerated in the Sacramento County jails,

7 pursuant to Federal Rule of Civil Procedure 23(a), (b)(1), and (b)(2).

8 183. All class members are at risk of harm due to the following policies

9 and practices:

10

a. Failure to provide minimally adequate medical, mental health, and

11

dental care, including identification and monitoring of serious medical

12

and mental health conditions, sufficient staffing levels, timely access

13

to appropriate clinicians, medications, and treatment plans, effective

14

suicide prevention practices, and the complete range of medical and

15

mental health care services necessary to maintain health;

16

b. Failure to provide basic human needs, including basic hygiene,

17

physical exercise, fresh air, normal human contact, meaningful

18

activity, and environmental stimulation to people in restrictive

19

housing placements; and

20

c. Failure to provide equal access of individuals with disabilities to

21

programs, services and activities in the jails, the denial of health care

22

appliances, assistive devices, durable medical equipment, and other

23

reasonable accommodations, and the improper housing of individuals

24

with disabilities in unnecessarily restrictive placements because of

25

their disability.

26 184. There are questions of law and fact common to the Class, including

27 whether Defendant, by its policy and practice of (a) denying individuals’ basic

28 human needs by locking them in their cells for 22 to 24 hours a day for indefinite
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Case 2:18-cv-02081-TLN-KJN Document 1 Filed 07/31/18 Page 52 of 63
1 periods of time violates the Due Process Clause of the Fourteenth Amendment and 2 the Cruel and Unusual Punishment Clause of the Eighth Amendment; (b) locking 3 people in restrictive housing cells due to untreated mental illness, past 4 incarceration in restrictive housing, or victimization concerns, in the absence of 5 immediate safety or security concerns, violates the Due Process Clause of the 6 Fourteenth Amendment and the Cruel and Unusual Punishment Clause of the 7 Eighth Amendment; (c) locking people in restrictive housing without a hearing, 8 written notice, an opportunity to defend themselves through witness or 9 documentary evidence, or meaningful review of their placements, violates the Due 10 Process Clause of the Fourteenth Amendment; (d) denying minimally adequate 11 mental health, medical, and dental care violates the Due Process Clause of the 12 Fourteenth Amendment and the Cruel and Unusual Punishment Clause of the 13 Eighth Amendment; (e) locking people with psychiatric disabilities and/or 14 intellectual disabilities in restrictive housing or medical housing units based on 15 their disabilities, violates the ADA, Section 504 of the Rehabilitation Act, and 16 California Government Code § 11135; (f) denying people with disabilities 17 reasonable accommodations, assistive devices, effective communication, and 18 accessible housing violates the ADA, Section 504 of the Rehabilitation Act, and 19 California Government Code § 11135; (g) failing to provide notice to people with 20 disabilities about their rights under the ADA and a meaningful way to request 21 accommodations or to challenge disability discrimination violates the ADA. 22 185. Since there are thousands of Class members, separate actions by 23 individuals would in all likelihood result in inconsistent and varying decisions, 24 which in turn would result in conflicting and incompatible standards of conduct for 25 Defendant. 26 186. Plaintiffs’ claims are typical of the Class, since their claims arise from 27 the same policies, practices, and courses of conduct and their claims are based on 28 the same theories of law as the Class’s claims.
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1 187. The Named Plaintiffs, through counsel, will fairly and adequately 2 protect the interests of the class. Plaintiffs do not have any interests antagonistic to 3 the Plaintiff Class. Plaintiffs, as well as the Plaintiff Class members, seek to enjoin 4 the unlawful acts and omissions of Defendant. Further, Plaintiffs are represented 5 by counsel experienced in civil rights litigation, prisoners’ rights litigation, and 6 complex class action litigation. 7 Disabilities Subclass 8 188. The named Plaintiffs further bring this action on their own behalf and, 9 pursuant to Rule 23(a), b(1), and (b)(2) of the Federal Rules of Civil Procedure, on 10 behalf of all qualified individuals with disabilities, as that term is defined in 42 11 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12 12926(j) and (m), who are, or will be in the future, incarcerated in the Jail 13 (“Disabilities Subclass”). All prisoners with disabilities who are incarcerated in 14 the Jail are at risk of being discriminated against or denied access to programs, 15 services, and activities offered at the Jail as a result of the policies and practices of 16 Defendant. 17 189. The Disabilities Subclass is so numerous that joinder of all members 18 is impracticable. The exact number of members of the Disabilities Subclass is 19 unknown. According to data gathered by the United States Department of Justice’s 20 Bureau of Justice Statistics regarding the incidence of disabilities among 21 individuals in jails, approximately 40% of Jail prisoners have one or more 22 disabilities, suggesting an estimated 1,500 or more members of the Disabilities 23 Subclass. There are likely many hundreds of Sacramento County Jail prisoners 24 who would be members of the Disabilities Subclass based on a mental health 25 disability alone. Defendant’s mental health care consultant, found that 26 approximately 19% of the jail population receive psychotropic medications, and 27 that nearly 40% of the jail population are on the mental health caseload.
28 - 52 -
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1 190. There are questions of law and fact common to the Disabilities

2 Subclass, including whether Defendant violated the Americans with Disabilities

3 Act, Section 504 of the Rehabilitation Act, and California Government Code §

4 11135.

5 191. Defendant has acted and failed to act on grounds that apply generally

6 to the Disabilities Subclass, so that final injunctive or corresponding declaratory

7 relief is appropriate respecting the Disabilities Subclass as a whole.

8 192. The claims of the named Plaintiffs are typical of the claims of the

9 Disabilities Subclass, since their claims arise from the same policies, practices, and

10 courses of conduct and his claims are based on the same theory of law as the

11 Disabilities Subclass’s claims.

12 193. Plaintiffs, through counsel, will fairly and adequately protect the

13 interests of the Disabilities Subclass. Plaintiffs do not have any interests

14 antagonistic to the Disabilities Subclass. Plaintiffs, as well as the Disabilities

15 Subclass members, seek to enjoin the unlawful acts and omissions of Defendant.

16 Further, Plaintiffs are represented by counsel experienced in civil rights litigation,

17 prisoners’ rights litigation, and complex class action litigation.

18

CLAIMS FOR RELIEF

19

FIRST CAUSE OF ACTION

20 (Eighth Amendment – Cruel and Unusual Punishment, 42 U.S.C. § 1983)

21 194. Plaintiffs incorporate by reference each and every allegation contained

22 in the above paragraphs as if set forth fully herein.

23 195. By the policies and practices described herein, Defendant subjects

24 Plaintiffs and the Class to a substantial risk of serious harm and injury from

25 inadequate medical and mental health care, and deprive Plaintiffs and the Class of

26 the minimal civilized measure of life’s necessities and human dignity through the

27 excessive and inappropriate use of solitary confinement and other restrictive

28
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1 placements, thus violating Plaintiffs’ rights to be free from cruel and unusual

2 punishment under the Eighth Amendment to the United States Constitution.

3 196. These policies have been and continue to be implemented by

4 Defendant and its agents, officials, employees, and all persons acting in concert

5 under color of state law, in their official capacity, and are the proximate cause of

6 the Plaintiffs’ and the Class’s ongoing deprivation of rights secured under the

7 Eighth Amendment.

8 197. Defendant has been and is aware of all of the deprivations complained

9 of herein, and have condoned or been deliberately indifferent to such conduct. It

10 should be obvious to Defendant and to any reasonable person that the conditions

11 imposed on class members for many months or years cause tremendous mental

12 anguish, suffering, and pain to such individuals. Moreover, Defendant has

13 repeatedly been made aware, through administrative grievances and written

14 complaints, that class members are currently experiencing, or are at risk of,

15 significant and lasting injury.

16

SECOND CAUSE OF ACTION

17 (Fourteenth Amendment – Cruel and Unusual Conditions, 42 U.S.C. § 1983)

18 198. Plaintiffs incorporate by reference each and every allegation contained

19 in the above paragraphs as if set forth fully herein.

20 199. By the policies and practices described herein, Defendant subjects

21 Plaintiffs and the Class to a substantial risk of serious harm and injury from

22 inadequate medical and mental health care, and deprive Plaintiffs and the Class of

23 the minimal civilized measure of life’s necessities and human dignity through the

24 excessive and inappropriate use of solitary confinement and other restrictive

25 placements, thus violating Plaintiffs’ rights to due process under the Fourteenth

26 Amendment to the United States Constitution.

27 200. These policies have been and continue to be implemented by

28 Defendant and its agents, officials, employees, and all persons acting in concert
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1 under color of state law, in their official capacity, and are the proximate cause of

2 the Plaintiffs’ and the Class’s ongoing deprivation of rights secured under the

3 Fourteenth Amendment.

4 201. Defendant has been and is aware of all of the deprivations complained

5 of herein, and have condoned or been deliberately indifferent to such conduct. It

6 should be obvious to Defendant and to any reasonable person that the conditions

7 imposed on class members for many months or years cause tremendous mental

8 anguish, suffering, and pain to such individuals.

9 202. In addition, Defendant violates the Fourteenth Amendment due

10 process rights of prisoners who are awaiting trial or are civil detainees, and thus are

11 not convicted of a crime, on the basis that the conditions of confinement amount to

12 punishment, or alternatively, that Defendant made an intentional decision with

13 respect to: (1) Plaintiffs and members of the Class’s health care and (2) the

14 conditions under which Plaintiffs and members of the Class are confined put them

15 at substantial risk of suffering serious harm. Defendant failed to take reasonable

16 available measures to abate that risk, even though a reasonable actor in the

17 circumstances would have appreciated the high degree of risk involved.

18

THIRD CAUSE OF ACTION

19

(Fourteenth Amendment – Procedural Due Process, 42 U.S.C. § 1983)

20 203. Plaintiffs incorporate by reference each and every allegation contained

21 in the above paragraphs as if set forth fully herein.

22 204. Defendant’s policy and practice of using indefinite and prolonged

23 restrictive housing and other restrictive placements, such as T-Sep, subject

24 Plaintiffs and the Class to a significant deprivation of liberty without any

25 procedural safeguards. Plaintiffs have a liberty interest in not being confined in a

26 restrictive housing unit unless it is necessary to ensure the safety and security of

27 staff and other individuals.

28
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1 205. The conditions and the duration of Defendant’s placement of 2 Plaintiffs and Class members in restrictive housing and other restrictive placements 3 constitute an atypical and significant hardship as compared with the ordinary 4 incidents of jail life because of the harsh and isolated conditions and the lengthy 5 duration of confinement in those conditions. People in restrictive housing and other 6 restrictive placements, such as T-Sep, as compared to other individuals in the jail, 7 have significantly less or no access to social interaction, environmental 8 stimulation, programs and activities, physical exercise, personal property, hygiene 9 products, sunlight, and fresh air. 10 206. Because prolonged placement in restrictive housing and other 11 restrictive placements constitutes a significant and atypical hardship, by the 12 policies and practices described herein, Defendant has deprived Plaintiffs and class 13 members of a liberty interest without due process of law by denying them: (1) a 14 hearing with advance written notice before initial placement in restrictive housing 15 or other restrictive placements, (2) the opportunity to present witnesses and 16 documentary evidence, (3) written reasons for the decision, (4) counsel-substitute 17 for illiterate or disabled individuals or in a case with complex issues, and (5) 18 meaningful and timely periodic review of their continued long-term and indefinite 19 detention in restrictive housing and other restrictive placements, and meaningful 20 notice of what they must do to earn release, in violation of the Fourteenth 21 Amendment to the United States Constitution. 22 207. The costs to Defendant of providing such procedural safeguards 23 would be minimal, and any such costs are outweighed by the great risk of 24 erroneous deprivation of liberty that exists under Defendant’s current policies and 25 practices. 26 208. The policies and practices complained of herein have been and 27 continue to be implemented by Defendant and its agents, officials, employees, and 28 all persons acting in concert under color of state law, in their official capacity.
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1

FOURTH CAUSE OF ACTION

2

(Americans with Disabilities Act, 42 U.S.C. § 12132 and 28 C.F.R. §

3

35.152(b)(1))

4 209. Plaintiffs incorporate by reference each and every allegation contained

5 in the above paragraphs as if set forth fully herein.

6 210. By its policies and practices of discriminating against prisoners with

7 disabilities, Defendant violates the Americans with Disabilities Act, 42 U.S.C. §

8 12132 and 28 C.F.R. § 35.152(b)(1) (“ADA”).

9 211. Defendant is a public entity as defined under 42 U.S.C. §

10 12131(1)(A).

11 212. Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and

12 GARLAND and members of the Disabilities Subclass have physical, psychiatric,

13 or intellectual disabilities, and are qualified individuals with disabilities. They

14 have an impairment that substantially limits one or more major life activities, they

15 have a record of such impairment, or they are regarded as having such an

16 impairment. All people with disabilities in the jails meet the eligibility

17 requirements for the receipt of services or the participation in programs or

18 activities provided by Defendant. 42 U.S.C. § 12102(2); 42 U.S.C. § 12131(2).

19 213. Defendant violates the ADA by failing to ensure that people with

20 disabilities have access to, are permitted to participate in, and are not denied the

21 benefits of programs, services, and activities provided by the Defendant, 42 U.S.C.

22 § 12132; 28 C.F.R. § 35.152(b)(1).

23 214. Defendant violates the ADA by failing to make “reasonable

24 modifications in policies, practices or procedures when the modifications are

25 necessary to avoid discrimination on the basis of disability. . . .” 28 C.F.R. §

26 35.130(b)(7)(i).

27

28
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1 215. Defendant violates the ADA by failing to “ensure that inmates or

2 detainees with disabilities are housed in the most integrated setting appropriate to

3 the needs of the individuals. 28 C.F.R. § 35.152(b)(2).

4 216. Defendant violates the ADA by failing to “furnish appropriate

5 auxiliary aids and services where necessary to afford individuals with disabilities

6 … an equal opportunity to participate in … a service, program, or activity of a

7 public entity.” 28 C.F.R. § 35.160(b)(1).

8 217. Defendant violates the ADA by failing to notify people about their

9 rights under the ADA while detained in its jails. 28 C.F.R. § 35.106.

10 218. Defendant violates the ADA by failing to “adopt and publish

11 grievance procedures providing for prompt and equitable resolution of complaints

12 alleging any action that would be prohibited by … [the ADA].” 28 C.F.R. §

13 35.107(b).

14 219. As a result of Defendant’s policies and procedures regarding

15 individuals with disabilities in the jails, members of the Plaintiff class and

16 Disabilities Subclass are unnecessarily placed in solitary confinement and other

17 types of restrictive housing due to their disabilities; and are denied equal access to

18 jail activities, programs and services for which they are otherwise qualified.

19

FIFTH CAUSE OF ACTION

20

(Section 504 of the Rehabilitation Act, 29 U.S.C. § 794)

21 220. Plaintiffs incorporate by reference each and every allegation contained

22 in the above paragraphs as if set forth fully herein.

23 221. Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and

24 GARLAND and members of the Disabilities Subclass are qualified individuals

25 with disabilities as defined in Section 504 of the Rehabilitation Act, 29 U.S.C. §

26 794.

27 222. Defendant received federal funding within the meaning of the

28 Rehabilitation Act.
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1 223. By its policy and practice of discriminating against and failing to

2 reasonably accommodate prisoners with disabilities, Defendant violates Section

3 504 of the Rehabilitation Act, 29 U.S.C. § 794.

4 224. As a result of Defendant’s discriminating against and failing to

5 provide a grievance procedure and reasonable accommodations, Plaintiffs MAYS,

6 RICHARDSON, BOTHUN, LEE, BEIRGE, and GARLAND and members of the

7 Disabilities Subclass do not have equal access to Jail activities, programs, and

8 services for which they are otherwise qualified.

9

SIXTH CAUSE OF ACTION

10

(California Government Code § 11135)

11 225. Plaintiffs incorporate by reference each and every allegation contained

12 in the above paragraphs as if set forth fully herein.

13 226. Defendant receives financial assistance from the State of California as

14 part of Realignment Legislation, California Government Code §§ 30025, 30026,

15 and 30029, and through other statutes and funding mechanisms.

16 227. Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and

17 GARLAND and members of the Disabilities Subclass are persons with disabilities

18 as defined by California Government Code § 11135.

19 228. Defendant denies Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE,

20 BEIRGE, and GARLAND and members of the Disabilities Subclass full access to

21 the benefits of the Jail’s programs and activities which receive financial assistance

22 from the State of California and unlawfully subject Plaintiffs and members of the

23 Disabilities Subclass to discrimination within the meaning of California

24 Government Code § 11135(a) on the basis of their disabilities.

25 229. Through their counsel and through grievances and other

26 documentation submitted to the Jail, Plaintiffs MAYS, RICHARDSON,

27 BOTHUN, LEE, BEIRGE, and GARLAND demanded that Defendant stop its

28
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1 unlawful discriminatory conduct described above, but Defendant refused and still

2 refuses to refrain from that conduct.

3

PRAYER FOR RELIEF

4 230. Plaintiffs and the Class and the Disabilities Subclass have no adequate

5 remedy at law to redress the wrongs suffered as set forth in this Complaint.

6 Plaintiffs have suffered and will continue to suffer irreparable injury as a result of

7 the unlawful acts, omissions, policies and practices of the Defendant as alleged

8 herein, unless Plaintiffs are granted the relief they request. The need for relief is

9 critical because the rights at issue are paramount under the Constitution of the

10 United States, the ADA, and Section 504 of the Rehabilitation Act.

11 231. WHEREFORE, Plaintiffs on behalf of themselves, the Class and the

12 Disabilities Subclass they represent, request that the Court grant the following

13 relief:

14

a. Declare the suit is maintainable as a class action pursuant to Federal

15

Rule of Civil Procedure 23(a), (b)(1) and (b)(2);

16

b. Adjudge and declare that the conditions, acts, omissions, policies and

17

practices of Defendant and its agents, officials, and employees are in

18

violation of the rights of Plaintiffs, the Class, and the Disabilities

19

Subclass they represent under the Eighth and Fourteenth Amendments

20

to the U.S. Constitution, the ADA, and Section 504 of the

21

Rehabilitation Act;

22

c. Enjoin Defendant, its agents, officials, and employees and all persons

23

acting in concert under the color of state law or otherwise, from

24

continuing the unlawful acts, conditions, and practices described in

25

this Complaint;

26

d. Order Defendant, its agents, officials, employees, and all persons

27

acting in concert under color of state law or otherwise, to provide

28

adequate mental health, medical, and dental care, including but not

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1

limited to sufficient, timely, and confidential intake screening,

2

triaging and responses to health care requests, access to appropriate

3

clinicians, prescription and distribution of appropriate medications

4

and supplies, access to chronic care and specialty care, access to

5

adequate treatment, inpatient and outpatient mental health treatment,

6

suicide prevention, and sufficient medical and mental health staffing;

7

e. Order Defendant, its agents, officials, employees, and all persons

8

acting in concert with them under color of state law or otherwise, to

9

develop and implement, as soon as practical, a plan to eliminate the

10

substantial risk of serious harm that Plaintiffs and members of the

11

class suffer due to Defendant’s policy and practice of locking people

12

in their cells for 22 hours or more a day for prolonged or indefinite

13

periods of time, to end the harmful practice of housing people with

14

serious mental illness in solitary confinement conditions, to ensure

15

that people are not housed in restrictive housing without a legitimate

16

penological purpose, and to provide a meaningful opportunity to be

17

heard and to challenge classification decisions resulting in restrictive

18

housing or other restrictive placements;

19

f. Order Defendant, its agents, officials, employees, and all persons

20

acting in concert under color of state law or otherwise, to provide

21

equal access to programs, services, and activities for people with

22

disabilities, including but not limited to housing people with physical

23

disabilities in accessible housing appropriate to their needs, timely

24

delivery of and appropriate access to assistive devices and medical

25

supplies, housing people with disabilities in the least restrictive and

26

most integrated settings appropriate to their needs, providing an

27

effective grievance system to contest disability discrimination, and

28
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1

notifying people with disabilities their rights under the ADA and

2

Section 504 of the Rehabilitation Act;

3

g. Award Plaintiffs, pursuant to 29 U.S.C. § 794, 42 U.S.C. § 1988, and

4

42 U.S.C. §§ 12205, 12133, and other applicable law, the costs of this

5

suit and reasonable attorneys’ fees and litigation expenses;

6

h. Retain jurisdiction of this case until Defendant has fully complied

7

with the orders of this Court, and there is reasonable assurance that

8

Defendant will continue to comply in the future absent continuing

9

jurisdiction;

10

i. Appoint the undersigned counsel as class counsel pursuant to Federal

11

Rule of Civil Procedure 23(g); and

12

j. Award such other and further relief as the Court deems just and

13

proper.

14
15 Dated: July 31, 2018

Respectfully submitted,

16

/s/ Aaron J. Fischer

17

AARON J. FISCHER (SBN 247391)

Aaron.Fischer@disabilityrightsca.org

18

DISABILITY RIGHTS CALIFORNIA

19

1330 Broadway, Suite 500

Oakland, CA 94612

20

Telephone: (510) 267-1200

21

Fax: (510) 267-1201

22

/s/ Margot Mendelson

23

(as authorized on 7/31/18)

MARGOT MENDELSON (SBN 268583)

24

MMendelson@prisonlaw.com

25

PRISON LAW OFFICE

1917 Fifth Street

26

Berkeley, California 94710

27

Telephone: (510) 280-2621

Fax: (510) 280-2704

28

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 U.S. District Court Eastern District of California - Live System (Sacramento) CIVIL DOCKET FOR CASE #: 2:18-cv-02081-TLN-KJN

(PC) Mays v. County of Sacramento Assigned to: District Judge Troy L. Nunley Referred to: Magistrate Judge Kendall J. Newman Cause: 42:1983 Prisoner Civil Rights

Date Filed: 07/31/2018 Date Terminated: 01/13/2020 Jury Demand: None Nature of Suit: 550 Prisoner: Civil Rights Jurisdiction: Federal Question

Movant
Sammy Davis Morgan also known as Sammy Davis Dewitt Morgan

represented by Sammy Davis Morgan 77266-097 VICTORVILLE MEDIUM I FEDERAL CORRECTIONAL INSTITUTION Inmate Mail/Parcels P.O. Box 3725 Adelanto, CA 92301 PRO SE

Plaintiff Lorenzo Mays

represented by Anne Catherine Hadreas Disability Rights California 2111 J Street #406 Sacramento, CA 95816 510-267-1250 Fax: 510-267-1201 Email: anne.hadreas@disabilityrightsca.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Donald Specter Prison Law Office 1917 Fifth St Berkeley, CA 94710 510-280-2621 Email: dspecter@prisonlaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Margot Knight Mendelson Prison Law Office 1917 Fifth Street Berkeley, CA 94710 510-280-2621 Email: mmendelson@prisonlaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart Prison Law Office 1917 5th Street Berkeley, CA 94710 510-280-2621 Email: sophieh@prisonlaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Addison Mills Litton Cooley LLP 3175 Hanover Street Palo Alto, CA 94304 650-843-5112 Fax: 650-849-7400 Email: alitton@cooley.com TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria Cooley LLP 3175 Hanover Street Palo Alto, CA 94304 650-843-5672 Fax: 650-849-7400 Email: jsantamaria@cooley.com TERMINATED: 12/07/2020
Kathlyn Anne Querubin Cooley LLP 101 California Street 5th Floor San Francisco, CA 94111-5800 415-693-2000 Fax: 415-693-2222 Email: kquerubin@cooley.com TERMINATED: 06/11/2019

Plaintiff Ricky Lee Richardson, Jr.

Mark Anthony Zambarda Cooley LLP 3175 Hanover Street Palo Alto, CA 94304-1130 650-843-5360 Fax: 650-849-7400 Email: mzambarda@cooley.com TERMINATED: 12/07/2020
Tifanei Ressl-Moyer Disability Rights California 1831 K Street Sacramento, CA 95811 916-504-5954 Email: tifanei.resslmoyer@disabilityrightsca.org TERMINATED: 10/17/2019
Aaron Joseph Fischer Law Office of Aaron J. Fischer 2001 Addison Street, Suite 300 Berkeley, CA 94704 510-806-7366 Fax: 510-694-6314 Email: ajf@aaronfischerlaw.com ATTORNEY TO BE NOTICED
represented by Anne Catherine Hadreas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Specter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Margot Knight Mendelson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart (See above for address)

Plaintiff Jennifer Bothun

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Addison Mills Litton (See above for address) TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria (See above for address) TERMINATED: 12/07/2020
Kathlyn Anne Querubin (See above for address) TERMINATED: 06/11/2019
Mark Anthony Zambarda (See above for address) TERMINATED: 12/07/2020
Tifanei Ressl-Moyer (See above for address) TERMINATED: 10/17/2019
Aaron Joseph Fischer (See above for address) ATTORNEY TO BE NOTICED
represented by Anne Catherine Hadreas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Specter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Margot Knight Mendelson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart (See above for address) LEAD ATTORNEY

Plaintiff Armani Lee

ATTORNEY TO BE NOTICED
Addison Mills Litton (See above for address) TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria (See above for address) TERMINATED: 12/07/2020
Kathlyn Anne Querubin (See above for address) TERMINATED: 06/11/2019
Mark Anthony Zambarda (See above for address) TERMINATED: 12/07/2020
Tifanei Ressl-Moyer (See above for address) TERMINATED: 10/17/2019
Aaron Joseph Fischer (See above for address) ATTORNEY TO BE NOTICED
represented by Anne Catherine Hadreas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Specter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Margot Knight Mendelson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Leertese Beirge

Addison Mills Litton (See above for address) TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria (See above for address) TERMINATED: 12/07/2020
Kathlyn Anne Querubin (See above for address) TERMINATED: 06/11/2019
Mark Anthony Zambarda (See above for address) TERMINATED: 12/07/2020
Tifanei Ressl-Moyer (See above for address) TERMINATED: 10/17/2019
Aaron Joseph Fischer (See above for address) ATTORNEY TO BE NOTICED
represented by Anne Catherine Hadreas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Specter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Margot Knight Mendelson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff
Cody Garland TERMINATED: 12/19/2019

Addison Mills Litton (See above for address) TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria (See above for address) TERMINATED: 12/07/2020
Kathlyn Anne Querubin (See above for address) TERMINATED: 06/11/2019
Mark Anthony Zambarda (See above for address) TERMINATED: 12/07/2020
Tifanei Ressl-Moyer (See above for address) TERMINATED: 10/17/2019
Aaron Joseph Fischer (See above for address) ATTORNEY TO BE NOTICED
represented by Anne Catherine Hadreas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Specter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Margot Knight Mendelson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Sophie Jedeikin Hart (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Addison Mills Litton

V. Defendant County of Sacramento

(See above for address) TERMINATED: 12/07/2020
Jessica Valenzuela Santamaria (See above for address) TERMINATED: 12/07/2020
Kathlyn Anne Querubin (See above for address) TERMINATED: 06/11/2019
Mark Anthony Zambarda (See above for address) TERMINATED: 12/07/2020
Tifanei Ressl-Moyer (See above for address) TERMINATED: 10/17/2019
Aaron Joseph Fischer (See above for address) ATTORNEY TO BE NOTICED
represented by Lisa Ann Travis Sacramento County Counsel 700 H Street Suite 2650 Sacramento, CA 95818 (916) 874-5557 Fax: (916) 874-8207 Email: travisl@saccounty.net LEAD ATTORNEY ATTORNEY TO BE NOTICED
Rick J. Heyer Sacramento County Counsel 700 H Street Ste. 2650 Sacramento, CA 95814 916-874-7538 Fax: 916-874-8207 Email: heyerr@saccounty.net

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Todd Holton Master Howard Rome Martin & Ridley LLP 1900 O'Farrell Street Suite 280 San Mateo, CA 94403 650-980-1012 Fax: 650-364-58297 Email: tmaster@hrmrlaw.com TERMINATED: 02/19/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shawn M. Ridley Howard Rome Martin & Ridley 1900 O'Farrell St. Suite 280 San Mateo, CA 94403 650-365-7715-201 Fax: 650-364-5297 Email: sridley@hrmrlaw.com TERMINATED: 02/19/2020 ATTORNEY TO BE NOTICED

Date Filed

#

Docket Text

07/31/2018 1

COMPLAINT against All Defendants by Lorenzo Mays, Ricky Lee Richardson, Jr, Leertese Beirge, Jennifer Bothun, Armani Lee, Cody Garland. Attorney Fischer, Aaron Joseph added. (Filing fee $ 400, receipt number 0972-7787776) (Attachments: # 1

Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4

Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7

Civil Cover Sheet)(Fischer, Aaron) (Entered: 07/31/2018)

07/31/2018 2

PRISONER NEW CASE DOCUMENTS and ORDER RE CONSENT ISSUED; Consent or Decline due by 9/4/2018

(Attachments: # 1 07/31/2018)

Order re Consent) (Becknal, R) (Entered:

08/10/2018
08/10/2018 08/10/2018 08/10/2018
08/24/2018 09/04/2018 09/10/2018

ORDER signed by Magistrate Judge Kendall J. Newman on

3

8/9/2018 DIRECTING Clerk of Court to issue and send plaintiff

one summons for defendant County of Sacramento and copies of

the form "Consent to Proceed Before United States Magistrate

Judge" with this order; ORDERING Plaintiffs to complete service

of process on defendant within 60 days from the date of this order;

ORDERING parties to file status reports, as detailed in this Order,

on or before close of business on 11/29/2018; and SETTING

Status Conference for 12/13/2018 at 10:00 AM in Courtroom 25

(KJN) before Magistrate Judge Kendall J. Newman. Clerk of

Court to change the short title of this case to Mays v. County of

Sacramento. (Henshaw, R) (Entered: 08/10/2018)

4 SUMMONS ISSUED as to *County of Sacramento* with answer to complaint due within *21* days. Attorney *Aaron Joseph Fischer* *Disability Rights California* *1330 Broadway, Suite 500* *Oakland, CA 94612*. (Henshaw, R) (Entered: 08/10/2018)

5 ORDER RE CONSENT OR REQUEST FOR REASSIGNMENT signed by Magistrate Judge Kendall J. Newman on 8/10/2018. Consent or Decline due by 9/13/2018. (Henshaw, R) (Entered: 08/10/2018)

6 MINUTE ORDER issued by Courtroom Deputy J. Fabillaran for Magistrate Judge Kendall J. Newman on 8/10/2018: On the Court's own motion, the filing deadline and Status Conference set

forth in the previous 3 Order are hereby VACATED. The Status Conference is RESET for 12/06/2018 at 10:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman and the parties are ORDERED to file status reports, as detailed in

the previous 3 Order, on or before close of business on 11/27/2018. (TEXT ONLY ENTRY) (Fabillaran, J) (Entered: 08/10/2018)

7 SUMMONS RETURNED EXECUTED: All Defendants. (Fischer, Aaron) (Entered: 08/24/2018)

8 STIPULATION to EXTEND TIME for defendant County of Sacramento to file response to complaint by County of Sacramento. Attorney Master, Todd Holton added. (Master, Todd) (Entered: 09/04/2018)

ORDER signed by Magistrate Judge Kendall J. Newman on

9

9/10/2018 GRANTING Defendant until 10/2/2018 to file its

response to the complaint. (Henshaw, R) (Entered: 09/10/2018)

09/13/2018 09/13/2018 09/14/2018 09/14/2018 09/14/2018 09/17/2018 09/17/2018
09/19/2018

10 NOTICE of APPEARANCE by Margot Knight Mendelson on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Mendelson, Margot Knight added. (Mendelson, Margot) (Entered: 09/13/2018)
11 DECLINE to PROCEED BEFORE US MAGISTRATE JUDGE by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Fischer, Aaron) (Entered: 09/13/2018)
12 CLERK'S NOTICE REASSIGNING CASE (TEXT ONLY) pursuant to 11 Decline of Jurisdiction of US Magistrate Judge, this case has been assigned to District Judge Troy L. Nunley and Magistrate Judge Kendall J. Newman. The new case number is: 2:18-cv-2081 TLN KJN (PC). (Henshaw, R) (Entered: 09/14/2018)
13 NOTICE of APPEARANCE by Jessica Valenzuela Santamaria on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Santamaria, Jessica Valenzuela added. (Santamaria, Jessica) (Entered: 09/14/2018)
14 NOTICE of APPEARANCE by Kathlyn Anne Querubin on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Querubin, Kathlyn Anne added. (Querubin, Kathlyn) (Entered: 09/14/2018)
15 NOTICE of RELATED CASE 2:18-cv-00044, 2:13-vs-02499 by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Mendelson, Margot) (Entered: 09/17/2018)
16 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 9/17/2018: The Court is in receipt of Plaintiffs' Notice of Related Cases (ECF No. 15 ). Pursuant to Local Rule 123(b), Counsel shall promptly file the Notice of Related Cases in cases 2:18-cv-00044-JAM-KJN and 2:13-cv-2499-JAM-AC, and serve a copy on all parties. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 09/17/2018)
17 NOTICE of APPEARANCE by Addison Mills Litton on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Litton, Addison Mills added. (Litton, Addison) (Entered: 09/19/2018)

09/19/2018
09/21/2018 09/21/2018 09/25/2018 09/27/2018 09/27/2018 10/02/2018 10/03/2018 10/10/2018 10/16/2018

18 NOTICE of APPEARANCE by Mark Anthony Zambarda on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Zambarda, Mark Anthony added. (Zambarda, Mark) (Entered: 09/19/2018)

19 OPPOSITION by Defendant County of Sacramento to 15 Notice of Related Case. Attorney Ridley, Shawn M. added. (Attachments: # 1 Declaration of Ridley, # 2 Request for Judicial Notice)(Ridley, Shawn) (Entered: 09/21/2018)

20 NOTICE of APPEARANCE by Anne Hadreas on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Hadreas, Anne added. (Hadreas, Anne) (Entered: 09/21/2018)

21 NOTICE of APPEARANCE by Sophie Jedeikin Hart on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Hart, Sophie Jedeikin added. (Hart, Sophie) (Entered: 09/25/2018)

ORDER OF NON-RELATED CASES signed by District Judge

22

John A. Mendez on 9/27/2018 ACCORDINGLY Case 2:18-CV-

2081 TLN KJN, shall not be reassigned to the undersigned

judge. 15 (Reader, L)(Reader, L) (Entered: 09/27/2018)

23 NOTICE of APPEARANCE by Tifanei Ressl-Moyer on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Ressl-Moyer, Tifanei added. (Ressl-Moyer, Tifanei) (Entered: 09/27/2018)

24 ANSWER to the Complaint by County of Sacramento.(Master, Todd) (Entered: 10/02/2018)

25 NOTICE of APPEARANCE by Donald Specter on behalf of Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Attorney Specter, Donald added. (Specter, Donald) (Entered: 10/03/2018)

26 STIPULATION and PROPOSED ORDER for Protective Order by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Fischer, Aaron) (Entered: 10/10/2018)

PROTECTIVE ORDER signed by Magistrate Judge Kendall J.

27

Newman on 10/16/2018 ORDERING the parties Stipulated

10/18/2018
10/18/2018 10/18/2018 10/18/2018 10/18/2018 10/18/2018 10/18/2018 10/18/2018 10/18/2018

Protective order is APPROVED. (Reader, L) (Entered: 10/16/2018)
28 JOINT MOTION to CERTIFY CLASS by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Motion Hearing set for 11/15/2018 at 02:00 PM in Courtroom 2 (TLN) before District Judge Troy L.
Nunley. (Attachments: # 1 Joint Stipulation of Facts, # 2 Proposed Order)(Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
29 DECLARATION of Lorenzo Mays in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
30 DECLARATION of Ricky Richardson in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
31 DECLARATION of Armani Lee in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
32 DECLARATION of Jennifer Bothun in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
33 DECLARATION of Leertese Beirge in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
34 DECLARATION of Cody Garland in support of 28 Joint Motion to Certify Class. (Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
35 DECLARATION of Aaron J. Fischer in support of 28 Joint Motion to Certify Class. (Attachments: # 1 Exhibit A)(Fischer, Aaron) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)
36 DECLARATION of Jessica Valenzuela Santamaria in support of 28 Joint Motion to Certify Class. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7 Exhibit G, # 8 Exhibit H, # 9 Exhibit I)(Santamaria, Jessica) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)

10/18/2018
10/18/2018
10/18/2018 10/22/2018 10/26/2018 11/27/2018 11/27/2018

37 DECLARATION of Tifanei Ressl-Moyer in support of 28 Joint Motion to Certify Class. Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7

Exhibit G-Expert Report of Eldon Vail, # 8 Exhibit H-

Expert Report of Bruce Gage, MD, # 9 Exhibit I-Expert

Report of Lindsay Hayes, # 10 Exhibit J-Expert Report of

Sabot Consulting, # 11 Exhibit K-Expert Report of James Austin)(Ressl-Moyer, Tifanei) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)

38 MINUTE ORDER issued by Relief Courtroom Deputy G. Michel for District Judge Troy L. Nunley on 10/18/2018: Pursuant to Local Rule 302(c)(17), the parties' Joint Motion to Certify Class (ECF No. 28 ) shall be noticed before the assigned Magistrate Judge. Plaintiff shall contact the Clerk for Magistrate Judge Kendall J. Newman for available law and motion dates, and renotice the motion before the Magistrate Judge with the proper time and date. Accordingly, the 11/15/2018 hearing before District Judge Troy L. Nunley is VACATED. [TEXT ONLY ENTRY](Michel, G.) (Entered: 10/18/2018)

39 DECLARATION of Donald Specter in support of 28 Joint Motion to Certify Class. (Specter, Donald) Modified on 10/19/2018 (Plummer, M). (Entered: 10/18/2018)

40 NOTICE to RESCHEDULE HEARING on 28 Joint Motion to Certify Class : Motion Hearing set for 11/29/2018 at 10:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman. (Fischer, Aaron) (Entered: 10/22/2018)

ORDER signed by Chief Judge Lawrence J. O'Neill on 10/26/18

41

ORDERING that U.S. Magistrate Judge Nathanael M. Cousins is

DESIGNATED to hold court and perform any and all judicial

duties designated under 28 U.S.C. § 636, subsections (a), (b), and

(c), in the Eastern District of California, to act as a settlement

judge in this action. (Kastilahn, A) (Entered: 10/26/2018)

42 STATUS REPORT by County of Sacramento. (Master, Todd) (Entered: 11/27/2018)

43 STATUS REPORT by Plaintiffs. (Attachments: # 1 Declaration of Aaron J. Fischer)(Fischer, Aaron) (Entered: 11/27/2018)

11/29/2018
11/30/2018 11/30/2018

44 MINUTES (Text Only) for proceedings before Magistrate Judge Kendall J. Newman: MOTION HEARING held on 11/29/2018. Counsel for parties present. The Court and counsel discussed the Joint Motion to Certify Class (ECF No. 28 ) and scheduling of the case. After hearing from parties and for reasons stated on the record, the Joint Motion was submitted. Order to issue. Plaintiffs' Counsel Aaron Fishcher, Jessica Santamaria, Margot Mendelson, Tifanei Ressl-Moyer, Mark Zambarda, Addison Litton, and Sophie Hart present. Defendant's Counsel Shawn Ridley present. Court Reporter: Jonathan Anderson (ECRO). (Waldrop, A) (Entered: 11/29/2018)

ORDER signed by Magistrate Judge Kendall J. Newman on

45

11/30/18 ORDERING the 12/06/18 status conference is

VACATED. Plaintiff's request to set a discovery conference

deadline at this time is DENIED without prejudice. On 12/17/18,

the parties shall file a joint status report as provided above.

(Plummer, M) (Entered: 11/30/2018)

FINDINGS and RECOMMENDATIONS signed by Magistrate

46

Judge Kendall J. Newman on 11/30/18 RECOMMENDING that

the parties Joint Motion for Class Certification 28 be granted. The

numerosity, commonality, typicality, and adequacy requirements

of Rule 23(a) are satisfied. The requirements under both Rule

23(b)(1) and Rule 23(b)(2) are satisfied. The action should be

certified as a class action as to all claims and defenses at issue in

the Complaint pursuant to Rules 23(a), 23(b)(1), and 23(b)(2) of

the Federal Rules of Civil Procedure. The undersigned

recommends certification of the following classes: Plaintiff Class:

All people who are now, or in the future will be, incarcerated in

the Sacramento County jails. Plaintiff Subclass (the Disability

Class): All qualified individuals with disabilities, as that term is

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

California Government Code § 12926(j) and (m), who are, or will

be in the future, incarcerated in the Sacramento County jails.

Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE,

and GARLAND be certified to serve as representatives of the

Plaintiff Class and Disability Subclass. Plaintiffs MAYS,

RICHARDSON, BOTHUN, LEE, BEIRGE, and GARLAND be

certified to serve as representatives of the Plaintiff Class and

Disability Subclass. Disability Rights California, the Prison Law

Office, and Cooley LLP be appointed as class counsel to represent

the interests of the Plaintiff Class and Disability Subclass. Fed. R.

Civ. P. 23(c)(1)(B). Pursuant to Rule 23(c)(2)(A), the parties shall

confer and, in their joint status report to be filed on December 17,

2018, shall address the status of their proposed notice to the

12/17/2018 12/19/2018 12/28/2018
01/07/2019

Plaintiff Class and Disabilities Subclass, and the proposed method of distribution of such notice. Joint Motion to Certify Class 28 referred to Judge Troy L. Nunley. Objections to F&R due within 10 days. (Plummer, M) Modified on 12/3/2018 (Plummer, M). (Entered: 11/30/2018)

47 JOINT STATUS REPORT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order re Class Notice, # 2 Notice to Class (Proposed))(Fischer, Aaron) (Entered: 12/17/2018)

ORDER signed by Magistrate Judge Kendall J. Newman on

48

12/19/18 SETTING Scheduling Conference for 1/17/2018 at 10:00

AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J.

Newman. (Coll, A) (Entered: 12/19/2018)

49

ORDER ADOPTING 46 FINDINGS AND

RECOMMENDATIONS in full signed by District Judge Troy L.

Nunley on 12/27/18 GRANTING 28 Motion to Certify Class. The

following classes are certified: Plaintiff Class: All people who are

now, or in the future will be, incarcerated in the Sacramento

County jails. disabilities, as that term is defined in 42 U.S.C. §

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

§ 12926(j) and (m), who are, or will be in the future, incarcerated

in the Sacramento County jails. Plaintiffs Mays, Richardson,

Bothun, Lee, Beirge and Garland are certified to serve as

representatives of the Plaintiff Class and Disability Subclass.

Disability Rights California, the Prison Law Office, and Cooley

LLP are APPOINTED as class counsel to represent the interests of

the Plaintiff Class and Disability Subclass. A proposed notice to

the Plaintiff Class and Disabilities Subclass, and the proposed

method of distribution of such notice, was appended to the parties'

joint status report and is under review by the assigned magistrate

judge. (Benson, A.) (Entered: 12/28/2018)

ORDER signed by Magistrate Judge Kendall J. Newman on

50

1/7/2019 APPROVING the substance, form, and manner

of 47 Class Notice, and finds that the proposed method of

disseminating the Class Notice meets all due process and other

legal requirements and is the best notice practicable under the

circumstances; DIRECTING the County, within 30 days, to post

the Class Notice in English and Spanish in all housing pods and

units, and at all intake locations, insuch a manner as to make the

Class Notice clearly visible to class members, and provide

01/07/2019 01/14/2019 01/15/2019 01/17/2019
01/18/2019

translation of the Class Notice into other languages upon request, and hand deliver an English and Spanish copy of the Class Notice to each person housed in the Jail facilities; ORDERING the County to provide all arriving prisoners an English and Spanish copy of the Class Notice as part of the Jails intake and orientation procedures during the pendency of this action or until further direction by the Court; ORDERING the County to provide assistance reviewing the Class Notice to individuals who are illiterate or have a disability that may affect their ability to read or understand the Class Notice; ORDERING the County to file and serve on Plaintiffs' counsel a declaration affirming that the Class Notice is distributed and will be distributed to arriving class members, consistent with this order; ORDERING the County to

make a copy of 1 Complaint available upon request to individuals detained in all housing units at the Jail; and ORDERING Clerk of Court to separately file and docket as "Class Notice" the "Important Notice" filed as ECF No. 47-2. (Henshaw, R) (Entered: 01/07/2019)

51 CLASS NOTICE (Henshaw, R) (Entered: 01/07/2019)

52 MINUTE ORDER issued by Courtroom Deputy for Magistrate Judge Kendall J. Newman on 1/14/2019: The parties shall file their joint discovery plan on or before close of business Tuesday, January 15, 2019. Fed. R. Civ. P. 26(f)(2). (TEXT ONLY ENTRY) (Waldrop, A) (Entered: 01/14/2019)

53 JOINT SCHEDULING REPORT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Fischer, Aaron) (Entered: 01/15/2019)

54 MINUTES (Text Only) for proceedings before Magistrate Judge Kendall J. Newman: STATUS (INITIAL SCHEDULING) CONFERENCE held on 1/17/2019. Counsel for parties present. The Court and counsel discussed scheduling of the case. The Court ORDERED a joint statement regarding status of case to be filed after parties further confer. Plaintiffs Counsel Aaron Fischer and Margot Mendelson present. Defendants Counsel Shawn Ridley and Todd Master present. Court Reporter: ECRO. (Waldrop, A) (Entered: 01/17/2019)

ORDER signed by Magistrate Judge Kendall J. Newman on

55

1/18/2019 DECLINING to schedule the case at this time. Shortly

after confirming a date for a further settlement conference, the

parties shall file a brief joint statement with this court advising the

01/18/2019 01/25/2019 01/29/2019
02/06/2019 02/11/2019 02/11/2019

case status, including the date for follow-up with Judge Cousins, and a proposed date thereafter for the parties to file a further joint statement regarding scheduling, and to set a further scheduling hearing. (Yin, K) (Entered: 01/18/2019)

56 TRANSCRIPT REQUEST by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr for proceedings held on 01/17/2019 before Judge Kendall J. Newman. Court Reporter ECRO Jonathan Anderson. (Litton, Addison) (Entered: 01/18/2019)

57 REQUEST Permission to Exceed Page Limits by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Mendelson, Margot) (Entered: 01/25/2019)

ORDER signed by Magistrate Judge Kendall J. Newman on

58

1/29/2019 GRANTING plaintiff's 57 request. Plaintiff's opening

memorandum in support of their Motion for Partial Summary

Judgment or in the Alternative Preliminary Injunction may be up

to 35 pages in length; defendants' memorandum in opposition to

the motion may be up to 35 pages in length; and plaintiffs' reply in

support of the motion may be up to 15 pages in length. (Yin, K)

(Entered: 01/29/2019)

59 DECLARATION of Chief Deputy Jennifer Freeworth re 50

Order. (Master, Todd) (Entered: 02/06/2019)

60 JOINT STATUS REPORT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Fischer, Aaron) (Entered: 02/11/2019)

61 TRANSCRIPT of Proceedings Initial status conference held on 1/17/19, before Magistrate Judge Kendall J. Newman, filed by Jennifer Coulthard, Phone number 312-617-9858 E-mail jenrmrcrr2@gmail.com. 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 3/4/2019. Redacted Transcript Deadline set for 3/14/2019. Release of Transcript Restriction set for 5/13/2019. (Dunn-Coulthard, J) (Entered: 02/11/2019)

02/12/2019
02/12/2019 02/12/2019 02/12/2019 02/12/2019 02/12/2019 02/12/2019 02/12/2019 02/12/2019
02/12/2019

62 [WITHDRAWN PER 82 ORDER] MOTION FOR SUMMARY JUDGMENT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Motion Hearing set for 5/16/2019 at 10:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman.

(Attachments: # 1 Memo of Points and Authorities, # 2 Undisputed Facts, # 3 Proposed Order Granting Partial Summary Judgment, # 4 Proposed Order Granting Preliminary Injunction)(Mendelson, Margot) Modified on 6/12/2019 (Henshaw, R). (Entered: 02/12/2019)

DECLARATION of Goldyn Cooper in re 62 Motion for Summary

63

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of Jackie Burke in re 62 Motion for Summary

64

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of James Holston in re 62 Motion for Summary

65

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of James Nelson in re 62 Motion for Summary

66

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of Joseph Brooks in re 62 Motion for Summary

67

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of Frank Moppins in re 62 Motion for Summary

68

Judgment. (Mendelson, Margot) (Entered: 02/12/2019)

DECLARATION of Jonathan Rykert in re 62 Motion for

69

Summary Judgment (Mendelson, Margot) (Entered: 02/12/2019)

NOTICE of Request to Seal Document pursuant to L.R. 141 by

70

Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee,

Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments:

# 1 Plaintiff's Request to File Under Seal)(Mendelson, Margot)

Modified on 2/13/2019 (Henshaw, R). (Entered: 02/12/2019)

71 DECLARATION of Aaron J. Fischer in support of 62 Motion for Summary Judgment. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7 Exhibit G, # 8 Exhibit H, # 9 Exhibit I, # 10 Exhibit J, # 11 Exhibit K, # 12 Exhibit L, # 13 Exhibit M, # 14 Exhibit N, # 15 Exhibit O, # 16 Exhibit P, # 17 Exhibit Q, # 18 Exhibit R)(Fischer, Aaron) (Entered: 02/12/2019)

02/12/2019 02/12/2019 02/14/2019
02/14/2019 03/07/2019 03/07/2019 03/11/2019

72 STIPULATION and PROPOSED ORDER for Briefing Schedule re 62 Motion for Summary Judgment by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Mendelson, Margot) (Entered: 02/12/2019)

73 REQUEST for 62 Motion for Summary Judgment to be Heard by District Judge by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Mendelson, Margot) (Entered: 02/12/2019)

STIPULATION and ORDER signed by Magistrate Judge Kendall

74

J. Newman on 02/14/19 ORDERING defendants Opposition to

Plaintiffs Motion for Partial Summary Judgment or in the

Alternative Preliminary Injunction re Mental Health Care and

Solitary Confinement shall be filed no later than March 29, 2019.

Plaintiffs reply to Defendants Opposition shall be filed no later

than April 19, 2019. Plaintiffs motion shall be heard on May 16,

2019, at 10:00 a.m., or as soon thereafter as the matter may be

heard. (Plummer, M) Modified on 2/14/2019 (Plummer, M).

(Entered: 02/14/2019)

ORDER signed by Magistrate Judge Kendall J. Newman on

75

2/14/19 ORDERING plaintiffs request to seal is GRANTED. The

Clerk of Court shall file the documents listed above under

seal.(Plummer, M) (Entered: 02/14/2019)

JOINT STATUS REPORT by Leertese Beirge, Jennifer Bothun,

76

Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee

Richardson, Jr. (Fischer, Aaron) (Entered: 03/07/2019)

77 STIPULATION and PROPOSED ORDER for Briefing Schedule re 62 Motion for Summary Judgment by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Fischer, Aaron) (Entered: 03/07/2019)

ORDER signed by Magistrate Judge Kendall J. Newman on 78
3/11/2019 MODIFYING 74 Briefing Schedule Order and ADOPTING 77 Stipulated Modification to Briefing Schedule Order. Defendant's Opposition to Motion for Partial Summary Judgment or in the Alternative Preliminary Injunction re Mental Health Care and Solitary Confinement shall be filed no later than 5/13/2019, Plaintiff's Reply to be filed no later than 6/3/2019, and Motion Hearing scheduled for 7/11/2019 at 10:00a.m., or as soon thereafter as the matter may be heard. (Henshaw, R) (Entered: 03/11/2019)

05/07/2019 05/08/2019 06/10/2019 06/11/2019
06/11/2019 06/20/2019 06/20/2019 08/08/2019

79 STIPULATION and PROPOSED ORDER for stipulated briefing schedule for plaintiff's motion for partial summary judgment or in the alternative preliminary injunction regarding mental health care and solitary confinement by County of Sacramento. (Master, Todd) Modified on 5/8/2019 (Plummer, M). (Entered: 05/07/2019)

STIPULATION and ORDER signed by Magistrate Judge Kendall

80

J. Newman on 5/8/2019 ORDERING that defendant's opposition

to plaintiffs' 62 Motion for Summary Judgment shall be filed by

6/13/2019; Plaintiffs' reply shall be filed by 7/3/2019; Plaintiffs'

motion shall be heard 8/1/2019 at 10:00 AM. (Zignago, K.)

(Entered: 05/08/2019)

NOTICE of SETTLEMENT and Joint Request to Vacate Briefing

81

Schedule; Proposed Order by Leertese Beirge, Jennifer Bothun,

Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee

Richardson, Jr. Dispositional Docs due by 7/5/2019. (Mendelson,

Margot) (Entered: 06/10/2019)

ORDER signed by Magistrate Judge Kendall J. Newman on

82

6/11/2019 WITHDRAWING 62 Partial Motion for Summary

Judgment; VACATING 80 Briefing Schedule on 62 Partial Motion for Summary Judgment; and ORDERING parties to file the Motion for Preliminary Approval of the Settlement on or before 7/5/2019. (Henshaw, R) (Entered: 06/11/2019)

83 DESIGNATION of COUNSEL FOR SERVICE by Plaintiffs. Attorney Kathlyn Anne Querubin terminated.(Santamaria, Jessica) Modified on 6/12/2019 (Yin, K). (Entered: 06/11/2019)

84 STIPULATION and PROPOSED ORDER for Preliminary Approval of Consent Decree and Notice to Class by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Mendelson, Margot) (Entered: 06/20/2019)

85 DECLARATION of Margot Mendelson re 84 Stipulation and

Proposed Order,. (Attachments: # 1 Exhibit 1, # 2 Exhibit 2)(Mendelson, Margot) (Entered: 06/20/2019)

FINDINGS and RECOMMENDATIONS signed by Magistrate

86

Judge Kendall J. Newman on 8/8/2019 RECOMMENDING

granting approval for preliminary approval of consent decree and

class notice. Referred to Judge Troy L. Nunley. Objections due

08/12/2019 08/13/2019 09/03/2019 09/04/2019
09/06/2019 09/10/2019

within 14 days after being served with these findings and recommendations. (Henshaw, R) (Entered: 08/08/2019)

87 JOINT STATEMENT of NON-OPPOSITION to 86 Findings and Recommendations. (Zambarda, Mark) Modified on 8/13/2019 (Yin, K). (Entered: 08/12/2019)

ORDER signed by District Judge Troy L. Nunley on 8/13/2019 88
ADOPTING 86 Findings and Recommendations in full and GRANTING approval for preliminary approval of consent decree and class notice. (Huang, H) (Entered: 08/13/2019)

89 STIPULATION and PROPOSED ORDER for Approval of Revised Class Notice by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr.

(Attachments: # 1 Exhibit A, # 2 Margot) (Entered: 09/03/2019)

Exhibit B)(Mendelson,

STIPULATION AND REVISED CLASS NOTICE AND ORDER

90

signed by Magistrate Judge Kendall J. Newman on 9/4/19

ORDERING that the revised Notice, attached hereto as Exhibit A

(ECF No. 89 -1), is approved in lieu of the Notice approved by the

Court on 8/13/19 (Doc. No. 88), which was attached as Exhibit 2

to the Declaration of Margot Mendelson in Support of the

Stipulated Motion for Preliminary Approval of Consent Decree

and Notice to the Class (Doc. No. 85 ). Attached as Exhibit B

(ECF No. 89 -2) is a redlined version of the previous Notice,

which identifies the proposed edits for the Court's

convenience. Comments by incarcerated people must be

postmarked by October 11, 2019 and sent to the US District

Court, Office of the Clerk. Clerk to file Comments in

Case. (Attachments: # 1 Exhibit A, # 2 Exhibit B)(Becknal, R)

Modified on 9/27/2019 (Donati, J). (Entered: 09/04/2019)

91

DECLARATION of Lieutenant Alex McCamy re 88 Order

Adopting Findings and Recommendations and 90 (Master, Todd) (Entered: 09/06/2019)

Order.

92 UNOPPOSED MOTION for ATTORNEY FEES by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Motion Hearing set for 12/5/2019 at 11:00 AM in Courtroom 25 (KJN) before Magistrate

Judge Kendall J. Newman. (Attachments: # 1 Proposed Order)(Fischer, Aaron) (Entered: 09/10/2019)

09/10/2019

93 DECLARATION of Aaron J. Fischer in support of 92 Unopposed Motion for Attorney Fees. (Fischer, Aaron) (Entered: 09/10/2019)

09/10/2019

94 DECLARATION of Donald Specter in support of 92 Unopposed Motion for Attorney Fees. (Specter, Donald) (Entered: 09/10/2019)

09/10/2019 95

DECLARATION of Jessica Valenzuela Santamaria in support of 92 Unopposed Motion for Attorney Fees. (Santamaria, Jessica) (Entered: 09/10/2019)

09/16/2019 96

NOTICE by Sammy Davis Morgan re: upcoming decision in this case. (Mena-Sanchez, L) (Entered: 09/19/2019)

09/26/2019

97 COMMENTS re fairness of settlement by Demetrius Davis. (Zignago, K.) (Entered: 10/02/2019)

10/15/2019

98 COMMENTS re fairness of settlement by Steve Brown. (MenaSanchez, L) (Entered: 10/16/2019)

10/17/2019

99 DESIGNATION of COUNSEL FOR SERVICE. Plaintiffs' Attorney Tifanei Ressl-Moyer terminated. (Fischer, Aaron) (Entered: 10/17/2019)

10/21/2019 100

COMMENTS re fairness of settlement by Matthew Muller re 90 Order. (Kaminski, H) (Entered: 10/22/2019)

11/05/2019

101 MINUTE ORDER issued by Courtroom Deputy for Magistrate Judge Kendall J. Newman on 11/5/2019: On the Court's own motion, the hearing on the Plaintiffs' Motion for Attorney Fees (ECF No. 92 ) and Fairness Hearing are RESET for 12/6/2019 at 11:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman. (TEXT ONLY ENTRY) (Waldrop, A) (Entered: 11/05/2019)

11/05/2019

SERVICE BY MAIL: 101 Minute Order served on Sammy Davis Morgan. (Waldrop, A) (Entered: 11/05/2019)

11/12/2019

102 JOINT MOTION to APPROVE CONSENT JUDGMENT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. Motion Hearing set for 12/6/2019 at 11:00 AM in Courtroom 25 (KJN) before Magistrate

Judge Kendall J. Newman. (Attachments: # 1 Proposed Order)(Mendelson, Margot) (Entered: 11/12/2019)

12/03/2019

ADDRESS UPDATED to c/o Cerese Masters 126 Esa Drive Vallejo, CA 94590 pursuant to Notice of Change of Address filed in 2:19-cv-01600-CKD by Sammy Davis Morgan. (MenaSanchez, L) (Entered: 12/12/2019)

12/06/2019

103 MINUTES (Text Only) for proceedings before Magistrate Judge Kendall J. Newman: MOTION HEARING held on 12/6/2019. Counsel for the parties present. The Court and counsel discussed the plaintiffs' Motion for Attorney Fees (ECF No. 92 ), the Joint Motion to Approve Consent Judgment (ECF No. 102 ), and other issues in the case. Order to issue. Plaintiffs' Counsel Aaron Fischer, Margot Mendelson, Anne Hadreas, and Mark Zambarda present. Defendants' Counsel Todd Master and Tracy Lee present. Court Reporter: ECRO. (Waldrop, A) (Entered: 12/06/2019)

12/06/2019

SERVICE BY MAIL: 103 Motion Hearing minutes served on Sammy Davis Morgan. (Waldrop, A) (Entered: 12/06/2019)

12/09/2019 104

FINDINGS and RECOMMENDATIONS signed by Magistrate Judge Kendall J. Newman on 12/9/2019 RECOMMENDING 102 Joint Motion for Final Approval of the Class Action Settlement be granted; Consent Decree should be approved and adopted as the Order of the Court; the parties should be ordered to comply with all its terms; and Defendant should be ordered to implement the Remedial Plan and accompanying policies pursuant to the schedule set forth therein. Referred to Judge Troy L. Nunley. Objections due within 10 days after being served with these findings and recommendations. (Henshaw, R) (Entered: 12/09/2019)

12/09/2019 105

FINDINGS and RECOMMENDATIONS signed by Magistrate Judge Kendall J. Newman on 12/9/2019 RECOMMENDING 92 Unopposed Motion for Attorney Fees be granted, as detailed in this Findings and Recommendations. Referred to Judge Troy L. Nunley. Objections due within 10 days after being served with these findings and recommendations. (Henshaw, R) (Entered: 12/09/2019)

12/09/2019

SERVICE BY MAIL: 104 Findings and Recommendations

and 105 Findings and Recommendations served on Sammy Davis Morgan. (Henshaw, R) (Entered: 12/09/2019)

12/13/2019

RE-SERVICE BY MAIL: 104 Findings and

Recommendations (Motion),, 105 Findings and Recommendations (Motion), served on Sammy Davis Morgan to updated address. (Plummer, M) (Entered: 12/13/2019)

12/18/2019

106 STIPULATION and PROPOSED ORDER for to Remove Class Representative Cody Garland by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Zambarda, Mark) (Entered: 12/18/2019)

12/19/2019 107

ORDER signed by Magistrate Judge Kendall J. Newman on 12/18/19 ORDERING Cody Garland is removed as a class representative of the plaintiff class and the Disability Subclass and pursuant to FRCP 41(a)(1)(A)(ii), Cody Garland claims are dismissed without prejudice. (Plummer, M) (Entered: 12/19/2019)

12/19/2019

SERVICE BY MAIL: 107 Order,, Add and Terminate Parties, served on Sammy Davis Morgan. (Plummer, M) (Entered: 12/19/2019)

12/19/2019

108 JOINT STATEMENT of NON-OPPOSITION to 105

Findings and Recommendations. (Zambarda, Mark) (Entered: 12/19/2019)

12/19/2019

109 JOINT STATEMENT of NON-OPPOSITION to 104

Findings and Recommendations. (Zambarda, Mark) (Entered: 12/19/2019)

12/26/2019

MAIL RETURNED as Undeliverable, Refused-No Longer in Custody: 103 Minutes sent to Sammy Davis Morgan. Notice of Change of Address due by 3/5/2020. (Tupolo, A) (Entered: 12/27/2019)

12/30/2019

RE-SERVICE BY MAIL: 103 Minutes re-served on Sammy Davis Morgan at Elsa Drive address. (Yin, K) (Entered: 12/30/2019)

01/07/2020

Movant's ADDRESS UPDATED to FCI-Victorville, P.O. Box 3725 Adelanto, CA 92301 pursuant to Notice of Change of Address filed in 2:19-cv-01179-KJM-DMC on 1/6/2020. (MenaSanchez, L) (Entered: 01/07/2020)

01/08/2020

RE-SERVICE BY MAIL: (ECF No. 103) Minutes, 104

and 105 Findings and Recommendations re-served on Sammy Davis Morgan at FCI Victorville. (Yin, K) (Entered: 01/08/2020)

01/13/2020 110

ORDER signed by District Judge Troy L. Nunley on 1/8/2020
ADOPTING 104 findings and recommendations in full. The 102 Joint Motion for Final Approval of the Class Action Settlement is GRANTED. The 85 Consent Decree is APPROVED and adopted as the Order of the Court. The Clerk of the Court shall enter judgment and terminate this action. CASE CLOSED. (Zignago, K.) (Entered: 01/13/2020)

01/13/2020 111

ORDER signed by District Judge Troy L. Nunley on 1/8/2020
ADOPTING 105 Findings and Recommendations in full and GRANTING 92 Motion for Attorney Fees. Defendant shall pay Plaintiffs' counsel $2,100,000.00 for reasonable attorney's fees, expenses, and costs. Payment shall be made in two installments: (1) the first installment in the amount of $1,050,000.00 by no later than 1/31/2020, and (2) the second installment in the amount of $1,050,000.00 by no later than 7/31/2020. Defendant shall pay Plaintiffs' counsel reasonable attorneys' fees and expenses up to $250,000.00 per year for monitoring of implementation of the Consent Decree and Remedial Plan. (Zignago, K.) (Entered: 01/13/2020)

01/13/2020

SERVICE BY MAIL: 110 Order, 111 Order served on Sammy Davis Morgan. (Zignago, K.) (Entered: 01/13/2020)

01/13/2020

MAIL RETURNED as Undeliverable, Not Deliverable as

Addressed: 104 Findings and Recommendations and 105

Findings and Recommendations sent to Sammy Davis Morgan. Notice of Change of Address due by 3/23/2020. (Coll, A) (Entered: 01/14/2020)

02/13/2020

112 SUBSTITUTION of ATTORNEY - PROPOSED, submitted by County of Sacramento. (Master, Todd) (Entered: 02/13/2020)

02/13/2020

113 SUBSTITUTION of ATTORNEY - PROPOSED, submitted by County of Sacramento. (Master, Todd) (Entered: 02/13/2020)

02/19/2020

114 ORDER SUBSTITUTING ATTORNEY signed by Magistrate Judge Kendall J. Newman on 2/18/2020. Rick J. Heyer for County of Sacramento in place of attorney Todd Holton Master and Shawn M. Ridley. (Coll, A) (Entered: 02/20/2020)

02/19/2020

115 ORDER SUBSTITUTING ATTORNEY signed by Magistrate Judge Kendall J. Newman on 2/18/2020. Lisa Ann Travis for County of Sacramento in place of attorney Todd Holton Master and Shawn M. Ridley. (Coll, A) (Entered: 02/20/2020)

02/20/2020

SERVICE BY MAIL: 114 Substitution of Attorney Order and 115 Substitution of Attorney Order served on Sammy Davis Morgan. (Coll, A) (Entered: 02/20/2020)

03/04/2020

116 JOINT REQUEST for Appointment of Court Experts by Leertese Beirge, Jennifer Bothun, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Fischer, Aaron) Modified on 3/5/2020 (Plummer, M). (Entered: 03/04/2020)

03/10/2020 117

ORDER signed by Magistrate Judge Kendall J. Newman on 3/9/2020 ORDERING the named individuals are appointed as Court Experts, to be compensated by Defendant, and ORDERING the Court Experts to have the responsibilities, powers, and protections set forth in the Consent Decree and this Order. See Order for details. (Henshaw, R) (Entered: 03/10/2020)

03/10/2020

SERVICE BY MAIL: 117 Order served on Sammy Davis Morgan. (Henshaw, R) (Entered: 03/10/2020)

04/27/2020

118 STIPULATION and PROPOSED ORDER for Extension of Deadlines for Expert Reports by Leertese Beirge, Jennifer Bothun, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Mendelson, Margot) (Entered: 04/27/2020)

04/30/2020 119

ORDER signed by Magistrate Judge Kendall J. Newman on 4/30/20 ORDERING the deadline for the Court Experts first compliance reports, set forth in the Consent Decree in this

matter 110 , is extended in light of the COVID-19 pandemic. The parties shall file a status report on or before June 24, 2020, providing further information to the Court about the status of monitoring compliance with the Consent Decree and proposing a modification to the reporting deadlines. (Plummer, M) (Entered: 04/30/2020)

04/30/2020

SERVICE BY MAIL: 119 Order, served on Sammy Davis Morgan. (Plummer, M) (Entered: 04/30/2020)

06/24/2020

120 JOINT STATUS REPORT by Leertese Beirge, Jennifer Bothun, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Exhibit, # 2 Proposed Order)(Fischer, Aaron) Modified on 6/25/2020 (Plummer, M). (Entered: 06/24/2020)

06/26/2020 121

ORDER signed by Magistrate Judge Kendall J. Newman on 06/25/20 regarding visitation and on-site monitoring by court experts and plaintiffs counsel. The Court Experts will prepare a draft written report on Defendants efforts to meet the terms of the Consent Decree, as set forth in the Courts Order re: Joint Request

for Appointment of Court Experts 117 , 4) no later than October 7, 2020. The parties will provide written comments or objections to the Court Experts draft reports no later than October 21, 2020. The Court Experts will issue their final reports no later than October 28, 2020. The parties will promptly file a Joint Status Report with the final reports. (See order for further details.)(Plummer, M) Modified on 6/26/2020 (Plummer, M). (Entered: 06/26/2020)

06/26/2020

SERVICE BY MAIL: 121 Order,, served on Sammy Davis Morgan. (Plummer, M) (Entered: 06/26/2020)

09/03/2020

123 CLASS MEMBER LETTERS regarding solitary confinement at Sacramento County Main Jail. (First letter from George Westbrook.) (Attachments: # 1 Rudy Martinez Letter, # 2 Juan Vasquez Letter, # 3 Dereck GI Letter, # 4 Aaron Hudson Letter, # 5 Thien Quach Letter, # 6 Juan C. Torres Letter) (Plummer, M) Modified on 9/4/2020 (Plummer, M). (Entered: 09/04/2020)

09/04/2020 122

ORDER signed by Magistrate Judge Kendall J. Newman on 09/04/20 ORDERING the clerk of the court shall file the inmate letters on the docket. The clerk of the court shall serve copies of the letters on plaintiff's class counsel. Plaintiffs class counsel shall ensure that the concerns of these jail inmates are addressed in the draft written report due October 7, 2020. The Clerk of the Court shall serve a copy of this order on the following inmates housed at the Sacramento County Jail, 651 I Street, Sacramento, CA 95814: George Westbrook, X-Ref No. 4102334, Rudy Martinez, X-Ref No. 5238059, Juan Vasquez, aka Juan VasquezOrozco, X-Ref No. 5287140, Dereck GI, X-Ref No. 4391053, Aaron Hudson, X-Ref No. 3668238, Thien Quach, X-Ref No. 4842965, Juan Torres, aka

Juan Carlos Torresbobadilla, X-Ref No. 4649439.(Plummer, M) Modified on 9/4/2020 (Plummer, M). (Entered: 09/04/2020)

09/04/2020

SERVICE BY MAIL: 122 Order,,, served on Sammy Davis Morgan. A copy of this order served on inmates George Westbrook, Rudy Martinez, Juan Vasquez aka Juan VasquezOrozco, Dereck GI, Aaron Hudson, Thien Quach and Joan Torres aka Juan Carlos Torresbobaddilla listed on page 2 of this order at Sacramento County Jail. (Plummer, M) Modified on 9/4/2020 (Plummer, M). Modified on 9/4/2020 (Plummer, M). (Entered: 09/04/2020)

09/04/2020

124 DOCUMENT(S) SERVED ELECTRONICALLY: 123 Class member letters regarding solitary confinement as Sacramento County Main Jail served on Plaintiff's class counsel, Donald Specter, Jessica Valenzuela Santamaria, Addison Mills Litton, Anne Catherine Hadreas, Margot Knight Mendelson, Mark Anthony Zambarda, Sophie Jedeikin Hart and Aaron Joseph Fischer. (First Letter for George Westbrook) (Attachments: # 1 Rudy Martinez Letter, # 2 Juan Vasquez Letter, # 3 Dereck GI Letter, # 4 Aaron Hudson Letter, # 5 Thien Quach Letter, # 6 Juan Torres Letter) (Plummer, M) Modified on 9/4/2020 (Plummer, M). Modified on 9/4/2020 (Plummer, M). Modified on 9/4/2020 (Plummer, M). (Entered: 09/04/2020)

10/01/2020

125 STATUS REPORT by Leertese Beirge, Jennifer Bothun, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Proposed Order)(Fischer, Aaron) (Entered: 10/01/2020)

10/01/2020

126 STATUS REPORT by County of Sacramento. (Heyer, Rick) (Entered: 10/01/2020)

10/05/2020

127 APPENDIX A to 125 Status Report by Plaintiffs . (Attachments: # 1 Appendix)(Fischer, Aaron) (Entered: 10/05/2020)

10/07/2020 128

ORDER signed by Magistrate Judge Kendall J. Newman on 10/6/2020 ORDERING, after considering the parties' Status Report and Stipulation, the Court Experts' monitoring reports shall be completed in accordance with this order. (See Order for Details) (Yin, K) (Entered: 10/07/2020)

10/07/2020

SERVICE BY MAIL: 128 Order served on Sammy Davis Morgan. (Yin, K) (Entered: 10/07/2020)

10/27/2020

129 JOINT STATUS REPORT by Leertese Beirge, Jennifer Bothun, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Exhibit Ex. A - Court Expert Reports on COVID-19)(Fischer, Aaron) (Entered: 10/27/2020)

11/16/2020

131 LETTER from Sacramento County Jail inmates [Filed in pursuant to 11/23/20 order.] (Plummer, M) (Entered: 11/23/2020)

11/23/2020 130

ORDER signed by Magistrate Judge Kendall J. Newman on 11/23/20 ORDERING the Clerk of the Court shall file the inmate letter on the docket. The Clerk of the Court shall serve a copy of the letter on plaintiffs class counsel. Plaintiffs class counsel shall ensure that the concerns of these jail inmates are also addressed in

their first report due January 20, 2021 ( 128 at 4); and The Clerk of the Court shall serve a copy of this order on the following inmates housed at the Sacramento County Jail, 651 I Street, Sacramento, CA 95814: George Westbrook, X-Ref No. 4102334, Dereck Gl, X-Ref No. 4391053, Thien Quach, X-Ref No. 4842965, Juan Torres, aka Juan Carlos Torresbobadilla, X-Ref No. 4649439 and Joel Avila, X-Ref No. 5238061(Plummer, M) (Entered: 11/23/2020)

11/23/2020

SERVICE BY MAIL: 130 Order,, served on Sammy Davis Morgan. A copy of this order served on inmates George Westbroo, Derek GI, Thien Quach, Juan Torres aka Juan Carlos Torresbobadilla and Joel Avila. (Plummer, M) (Entered: 11/23/2020)

11/23/2020

132 DOCUMENT(S) SERVED ELECTRONICALLY: Inmate letter 131 served on plaintiff's class counsel Donald Specter, Jessica Santamaria, Addison Litton, Anne Hadrea, Margot Mendelson, Mark Zambarda, Sophie Hart, Tifanei Ressl-Moyer, Aaron Fischer. (Plummer, M) (Entered: 11/23/2020)

12/03/2020

133 NOTICE of WITHDRAW as attorney by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Santamaria, Jessica) Modified on 12/7/2020 (Zignago, K.). (Entered: 12/03/2020)

12/08/2020

134 RESPONSE by County of Sacramento to 129 Status Report. (Heyer, Rick) (Entered: 12/08/2020)

12/08/2020

135 CERTIFICATE of SERVICE by County of Sacramento re 134 Response. Attorney Heyer, Rick J. added.. Attorney Heyer,

Rick J. added as counsel of record. (Heyer, Rick) (Entered: 12/08/2020)

01/20/2021

136 STIPULATION and PROPOSED ORDER for First Monitoring Reports of Court-Appointed Experts by Plaintiffs and Defendant. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Proposed Order)(Mendelson, Margot) (Entered: 01/20/2021)

01/22/2021

137 STATUS REPORT by County of Sacramento. (Heyer, Rick) (Entered: 01/22/2021)

01/25/2021 138

ORDER signed by Magistrate Judge Kendall J. Newman on 1/24/2021 ORDERING Plaintiff's counsel to file restrictive housing report by 2/26/2021 and ADA/disability report by 3/26/2021. (Henshaw, R) (Entered: 01/25/2021)

01/25/2021

SERVICE BY MAIL: 138 Order served on Sammy Davis Morgan. (Henshaw, R) (Entered: 01/25/2021)

02/19/2021

139 NOTICE of CHANGE of ADDRESS by Aaron Joseph Fischer. (Fischer, Aaron) (Entered: 02/19/2021)

02/25/2021

140 STATUS REPORT by Leertese Beirge, Jennifer Bothun, Cody Garland, Armani Lee, Lorenzo Mays, Ricky Lee Richardson, Jr. (Attachments: # 1 Exhibit A)(Mendelson, Margot) Modified on 2/26/2021 (Plummer, M). (Entered: 02/25/2021)

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 Case 2:18-cv-02081-TLN-KJN Document 49 Filed 12/28/18 Page 1 of 2

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UNITED STATES DISTRICT COURT

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FOR THE EASTERN DISTRICT OF CALIFORNIA

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11 LORENZO MAYS, et al.,

No. 2:18-cv-02081-TLN-KJN

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Plaintiffs,

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v.

ORDER

14 COUNTY OF SACRAMENTO,

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Defendant.

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Plaintiffs, state prisoners proceeding with retained counsel, filed this civil rights action

18 seeking relief under 42 U.S.C. § 1983. Plaintiffs and Defendants brought a joint motion for class

19 certification. (ECF No. 28.) The matter was referred to a United States Magistrate Judge

20 pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 302.

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On November 30, 2018, the magistrate judge filed findings and recommendations herein

22 which were served on all parties and which contained notice to all parties that any objections to

23 the findings and recommendations were to be filed within ten days. (ECF No. 46.) Neither party

24 has filed objections to the findings and recommendations.

25

The Court has reviewed the file and finds the findings and recommendations to be

26 supported by the record and by the magistrate judge’s analysis. Accordingly, IT IS HEREBY

27 ORDERED that:

28

1. The findings and recommendations filed November 30, 2018, are adopted in full;

1

Case 2:18-cv-02081-TLN-KJN Document 49 Filed 12/28/18 Page 2 of 2

1

2. The numerosity, commonality, typicality, and adequacy requirements of Rule 23(a) are

2 satisfied.

3

3. The requirements under both Rule 23(b)(1) and Rule 23(b)(2) are satisfied.

4

4. This action is certified as a class action as to all claims and defenses at issue in the

5 Complaint pursuant to Rules 23(a), 23(b)(1), and 23(b)(2) of the Federal Rules of Civil

6 Procedure.

7

5. The following classes are certified:

8

Plaintiff Class: All people who are now, or in the future will be,

9

incarcerated in the Sacramento County jails.

10

Plaintiff Subclass (the “Disability Class”): All qualified individuals with disabilities, as that term is defined in 42 U.S.C. §

11

12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m), who are, or will be in the future, incarcerated in

12

the Sacramento County jails.

13

6. Plaintiffs MAYS, RICHARDSON, BOTHUN, LEE, BEIRGE, and GARLAND are

14 certified to serve as representatives of the Plaintiff Class and Disability Subclass.

15

7. Disability Rights California, the Prison Law Office, and Cooley LLP are appointed as

16 class counsel to represent the interests of the Plaintiff Class and Disability Subclass. Fed. R. Civ.

17 P. 23(c)(1)(B).

18

8. A proposed notice to the Plaintiff Class and Disabilities Subclass, and the proposed

19 method of distribution of such notice, was appended to the parties’ joint status report and is under

20 review by the assigned magistrate judge.

21 Dated: December 27, 2018

22

23

24

25

Troy L. Nunley

United States District Judge

26

27

28 2

 
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 16 of 119
EXHIBIT A
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 17 of 119
MAYS V. COUNTY OF SACRAMENTO
REMEDIAL PLAN
Definitions “Chief Disciplinary Officer” is the individual who is responsible for overseeing the disciplinary system and ensuring consistency in disciplinary practices and procedures.
“County” refers to Sacramento County.
“Designated Mental Health Units” refers to any specialized units specifically operated to house and serve prisoners requiring mental health treatment, including the inpatient unit (2P), the Intensive Outpatient Program (IOP), the Outpatient Psychiatric Pods.
“Disciplinary Hearing Officer” includes any sergeant, officer, or other individual who has responsibility for adjudicating a disciplinary report and/or imposing disciplinary measures.
“Discipline” is the imposition of penalties for prisoner misconduct that violates Jail facility rules.
“Disability” means any physical or mental impairment that substantially limits one or more major life activities. These include, but are not limited to, any disability that would substantially limit the mobility of an individual or an impairment of vision and/or hearing, speaking or performing manual tasks that require some level of dexterity. Additionally, disability includes a physical or mental impairment that would inhibit a person's ability to meet the rules and regulations of the facility.
“Effective Communication” means that any written or spoken communication must be as clear and understandable to people with disabilities as it is for people who do not have disabilities.
“Intellectual Disability” is a disability characterized by significant limitations in intellectual functioning (such as learning, reasoning, and problem-solving) and in adaptive behavior (conceptual skills such as language, literacy, money, time, and selfdirection; social and interpersonal skills; and practical skills such as personal care and schedules/routines). This includes people for whom the onset of the disability occurred before age 18 (developmental disabilities) and people for whom events later in life resulted in similar limitations (for example, head injury, stroke, or dementia).
“Medical Staff” means medical personnel including physicians, dentist, pharmacist, nurse practitioners, supervising registered nurses, registered nurses, registered dental hygienists, licensed vocational nurses, pharmacy technicians, medical assistants, registered dental assistants, certified nursing aids and other medical personnel.

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 18 of 119
“Medical services,” “medical treatment” and “medical staff” includes dental services, dental treatment and dental staff, as well as medical pharmacy services and pharmacy staff.
“Mental health caseload” means all prisoners in the jail with a current need for any mental health services.
“Out-of-cell activities” are activities which occur out of the inmates’ cell. Examples of such activities include but are not limited to games, the use of tablets and other socialization among inmates.
“Provider” means physician, dentist, pharmacist, physician’s assistant, or nurse practitioner.
“Qualified Mental Health Professional” means psychiatrists, psychologists, master’s level social workers, licensed professional counselors, licensed nurses, or others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide mental health care to patients.
“Qualified Health Care Professional” means physicians, physician assistants, nurses, nurse practitioners, dentists, qualified mental health professionals, and others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide health care to patients.
“Qualified Sign Language Interpreter” (“SLI”) is an individual, available on-site or through a VRI service, who is adept at American Sign Language and has passed a test and qualified in one of the categories established by the National Association for the Deaf (NAD) or one of the categories established by the Registry of Interpreters for the Deaf (RID).
“Segregation” means the confinement in a locked room or cell, with or without a cellmate, with limited social contact as compared with the general population, in conditions characterized by substantial isolation, whether pursuant to disciplinary, administrative, or classification action. If a housing unit or location does not meet the above definition, the unit will not be considered a segregation unit, regardless of name.
“Serious Mental Illness” (“SMI”) means a mental, behavioral, or emotional disorder of mood, thought, or anxiety that significantly impairs judgment, behavior, capacity to recognize reality, or substantially interferes with primary activities of daily living.
“Temporary Suicide Precautions Housing” refers to any non-inpatient unit where the Jail houses prisoners requiring suicide precautions and/or inpatient level of psychiatric care, including but not limited to safety cells, holding cells, North Holding Cell No. 2 at RCCC, Main Jail booking segregation cells, and the classrooms/multipurpose rooms adjacent to the Main Jail housing units.
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 19 of 119
“TTYs” or “TDDs” means devices that are used with a telephone to communicate with persons who are Deaf by typing and reading communications.
“Videophone” means a device with a video camera that can perform bi-directional video and audio transmissions between people in real-time.
“Video-Relay Services” or “VRS” is a video telecommunications relay service that enables persons with hearing-related disabilities who use Sign Language to communicate with voice telephone users through video equipment, such as a Videophone, rather than through typed text.
“Video Remote Interpreting service” or “VRI service” means an interpreting service that uses video conference technology over dedicated lines or wireless technology offering clear, delay-free, full-motion video and audio over high-speed connection that delivers high-quality video images as provided in 28 § 35.160(d).
GENERAL PROVISIONS
The County shall maintain sufficient medical, mental health, and custody staff to meet the requirements of this Remedial Plan.
The parties agree that the custodial and health care staff must be increased to meet minimal constitutional and statutory standards. Presently, there are insufficient deputies to supervise out-of-cell activities for people in the general population and administrative segregation, and to provide security for health-related tasks. The parties agree that reduction in jail population is a cost-effective means to achieve constitutional and statutory standards.
1. The County intends to hire additional custodial and health care staff. The parties agree that population reduction of the jails will facilitate compliance with this Remedial Plan. All population reduction measures should be designed to promote public safety through evidence-based programs.
2. If through the monitoring process it is determined that the County is not fulfilling the provisions of this Remedial Plan due to staffing deficiencies, the parties will meet and confer regarding what steps to take to reduce the population of the jail, including available resources to facilitate population reduction.
The parties agree to meet and confer regarding the gathering and posting of data related to the Jail population. The parties agree that the categories of information to be gathered and publicly posted on a quarterly basis are the following:
a) the number of people with mental illness booked into jail;
b) their average length of stay;
c) the percentage of people connected to treatment;
d) their recidivism rates;
Page 3 of 62

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 20 of 119
e) the total number of people in jail with a mental health need;
f) the number of people who were receiving mental health services at the time of booking; and
g) the number of sentenced and unsentenced inmates in custody.
h) For sentenced people in the jail, the nature of the commitment convictions, length of sentence(s), and level of mental health care (e.g., Acute, IOP, OPP).
i) For unsentenced people in the jail, the nature of the charges, length of pre-trial detention, and level of mental health care (e.g., Acute, IOP, OPP).
AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE
Policies and Procedures
1. It is the County’s policy to provide access to its programs and services to prisoners with disabilities, with or without reasonable accommodation, consistent with legitimate penological interests. No prisoner with a disability, as defined in 42 U.S.C. § 12102 shall, because of that disability, be excluded from participation in or denied the benefits of services, programs, or activities or be subjected to discrimination. The County’s policy is to provide reasonable accommodations or modifications where necessary, consistent with 28 C.F.R. §§ 35.150 & 35.152, and other applicable federal and state disability law.
2. The County shall, in consultation with Plaintiffs’ counsel, revise its Operations Order to establish standard and consistent procedures for the Jail to ensure compliance with the ADA and the remedial provisions outlined herein.
3. The County shall, within 12 months from court approval of the Settlement and in consultation with Plaintiffs’ counsel, revise policies, procedures, and inmate orientation materials (e.g. Inmate Handbook), in accordance with the revised Operations Order and the remedial provisions outlined herein. A list of policies which the County will revise consistent with the provisions outlined herein, as appropriate and in consultation with Plaintiffs’ counsel, is attached as Exhibit A-1.
4. All staff will receive training appropriate to their position on policies and procedures related to compliance with the Americans with Disabilities Act (ADA) and related disability laws.
ADA Tracking System
1. The County shall develop and implement a comprehensive system (an “ADA Tracking System”) to identify and track screened prisoners with disabilities as well as accommodation and Effective Communication needs.
2. The ADA Tracking System shall identify:
Page 4 of 62

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 21 of 119
a) All types of disabilities, including but not limited to psychiatric, intellectual, developmental, learning, sensory, mobility, or other physical disabilities, and special health care needs;
b) Prisoners with disabilities that may pose a barrier to communication, including but not limited to learning, intellectual, or developmental disabilities, and hearing, speech, or vision impairments;
c) Accommodation needs, including as to housing, classification, Effective Communication, adaptive supports, and assistive devices;
d) Prisoners who require specific health care appliances, assistive devices, and/or durable medical equipment (HCA/AD/DME);
e) Prisoners who are class members in Armstrong v. Newsom (N.D. Cal. No. 94-cv-02307), with their applicable disability classification(s) and accommodation need(s).
3. The ADA Tracking System’s prisoner disability information will be readily accessible to custody, medical, mental health, and other staff at the Jail who need such information to ensure appropriate accommodations and adequate program access for prisoners with disabilities.
ADA Coordinator
1. The County shall have a dedicated ADA Coordinator at each facility.
2. The ADA Coordinator position shall be dedicated to coordinating efforts to comply with and carry out ADA-related requirements and policies, shall have sufficient command authority to carry out such duties, and shall work with the executive management team regarding ADA-related compliance, training, and program needs.
3. The County shall clearly enumerate, in consultation with Plaintiffs’ counsel, the job duties and training requirements for the ADA Coordinator position and for ADA Deputies assigned to support the ADA Coordinator position.
4. The County shall ensure that ADA Coordinators and ADA Deputies possess requisite training to implement and ensure compliance with the Jail’s disability program and services, including operation of the ADA Tracking System.
Screening for Disability and Disability-Related Needs.
1. The County shall conduct adequate screening of prisoners to be housed in the Jail in order to identify disabilities and disability-related accommodation, housing, classification, and other needs. All individuals detained at the Jail for any period of time will be assessed for Effective Communication needs, consistent with the provisions herein.
2. The County shall take steps to identify and verify each prisoner’s disability and disability-related needs during medical intake screening, including based on:
Page 5 of 62

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 22 of 119
a) The individual’s self-identification or claim to have a disability;
b) Documentation of a disability in the individual’s health record;
c) Staff observation that the individual may have a disability that affects placement, program access, or Effective Communication; or
d) The request of a third party (such as a family member) for an evaluation of the individual for an alleged disability.
Orientation
1. The County shall ensure that, for the population to be housed in the Jails, prisoners with disabilities are adequately informed of their rights under the ADA, including but not limited to:
a) Accommodations available to prisoners;
b) The process for requesting a reasonable accommodation;
c) The role of the ADA coordinator(s) and method to contact them;
d) The grievance process, location of the forms, and process for getting assistance in completing grievance process;
e) Instructions on how prisoners with disabilities can access health care services, including the provision of Effective Communication and other accommodations available in accessing those services.
2. Upon processing and classification, prisoners with disabilities shall receive, in an accessible format, the jail rulebook; orientation handbook; and a verbal orientation or orientation video regarding rules or expectations.
3. The County shall accommodate individuals with disabilities in the orientation process through the use of alternative formats (e.g. verbal communication, large print, audio/video presentation), when necessary for Effective Communication of the information.
4. The County shall develop an Americans with Disabilities Act Inmate Notice. The Notice shall be prominently posted in all prisoner housing units, in the booking/intake areas, in medical/mental health/dental treatment areas, and at the public entrances of all Jail facilities.
Health Care Appliances, Assistive Devices, Durable Medical Equipment
1. The County shall establish a written policy to ensure provision of safe and operational HCA/AD/DME, with a process for repair and replacement.
2. The County shall timely provide HCA/AD/DME to prisoners with disabilities who require such assistance. The County shall ensure an individualized assessment by medical staff to determine whether HCA/AD/DME is warranted to ensure equal and meaningful access to programs, services, and activities in the Jail.
Page 6 of 62

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 23 of 119
3. The County shall allow prisoners to retain personal HCAs/ADs/DME (which will include reading glasses), unless there is an individualized determination that doing so would create an articulated safety or security risk.
a) Where Jail staff determine it is necessary to remove a prisoner’s personal HCA/AD/DME for security reasons, the County shall provide an equivalent Jail-issued device unless custody staff, with supervisory review, determine and document, based on an individualized assessment, that the device constitutes a risk of bodily harm or threatens the security of the facility.
b) If such a determination is made, the ADA coordinator or supervisorylevel designee shall document the decision and reasons for it, in writing, and shall consult with medical staff to determine an appropriate alternative accommodation.
4. The County shall, in consultation with Plaintiffs’ counsel, implement a written policy governing the release of prisoners who need assistive devices upon release.
a) The County will ensure that any personal mobility device belonging to a prisoner is returned to the prisoner prior to release from custody.
b) If a prisoner does not have a personal mobility device, but is ambulatory with the assistance of a cane, crutch, or walker, the prisoner will be permitted to retain such device that was used while in custody upon release, or will be provided a comparable device, upon release.
c) If a prisoner who is due for release requires a wheelchair, but does not have a personal wheelchair, Jail staff shall coordinate with the prisoner, the prisoner’s family or friends, and other County agencies as needed to secure a wheelchair or take other steps to address the individual’s needs upon release. The County shall document this process in the ADA Tracking System for purposes of individual tracking and quality assurance.
Housing Placements
1. The County shall house prisoners with disabilities in facilities that accommodate their disabilities.
2. The County shall implement a housing assignment system that includes an individualized assessment of each individual’s functioning limitations and restrictions, including but not limited to:
a) The need for ground floor housing;
b) The need for a lower bunk;
c) The need for grab bars in the cell and/or shower;
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d) The need for accessible toilets; e) The need for no stairs in the path of travel; and f) The need for level terrain. 3. Prisoners with disabilities shall be housed in the Jail consistent with their individual security classification. Prisoners prescribed or possessing HCAs/ADs/DME will not automatically be housed in a medical housing unit. Placement in a medical housing unit will be based on individualized clinical determination of need for treatment. 4. Classification staff shall not place prisoners with disabilities in: a) Inappropriate security classifications simply because no ADA-
accessible cells or beds are available; b) Designated medical areas unless the prisoner is currently receiving
medical care or treatment that necessitates placement in a medical setting; or c) Any location that does not offer the same or equivalent programs, services, or activities as the facilities where they would be housed absent a disability. Access to Programs, Services, and Activities 1. The County shall ensure prisoners with disabilities, including those housed in specialized medical units or mental health units (e.g., OPP, IOP, Acute) have equal access to programs, services, and activities available to similarly situated prisoners without disabilities, consistent with their health and security needs. Such programs, services, and activities include, but are not limited to: a) Educational, vocational, reentry and substance abuse programs b) Work Assignments c) Dayroom and other out-of-cell time d) Outdoor recreation and fitted exercise equipment e) Showers f) Telephones g) Reading materials h) Social visiting i) Attorney visiting j) Religious services k) Medical, mental health, and dental services and treatment
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2. The County shall provide reasonable accommodations and modifications as necessary to ensure that prisoners with disabilities have equal access to programs, services, and activities available to similarly situated prisoners without disabilities.
3. The County shall develop and implement a written policy for staff to provide appropriate assistance to prisoners with psychiatric, developmental, or cognitive disabilities so that they can fully participate in programs, services, and activities provided at the Jail.
4. The County shall implement a written policy for staff to provide assistance to prisoners with disabilities in reading or scribing documents.
5. The County shall provide equal access to library, recreational, and educational reading materials for prisoners with disabilities, including easy reading and large print books for individuals who require such accommodations.
6. The County shall ensure equitable inmate worker opportunities for prisoners with disabilities, including by:
a) Ensuring clear job duty statements, with essential functions and specific criteria, for each Worker position;
b) Ensuring that medical staff conduct an individualized assessment to identify work duty restrictions and/or physical limitations to facilitate appropriate work/industry assignments and to prevent improper exclusions from work opportunities;
c) Providing reasonable accommodations to enable prisoners with disabilities to participate in inmate worker opportunities.
Effective Communication
1. The County shall assess all individuals detained at the Jail for any period of time for Effective Communication needs, and shall take steps to provide Effective Communication based on individual need.
2. The County’s ADA policies shall include comprehensive guidance to ensure Effective Communication for prisoners with vision, speech, hearing, intellectual, learning, or other disabilities. The County shall, in consultation with Plaintiffs’ counsel, ensure that sufficient guidance on the provision of Effective Communication is included in Jail custody and health care policies and procedures.
3. Standard for Provision of Effective Communication in Due Process Events and Clinical Encounters
a) A higher standard for the provision of Effective Communication shall apply in the following situations:
i. Due Process Events, including the following:
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 Classification processes  Prisoner disciplinary hearing and related processes  Service of notice (to appear and/or for new charges)  Release processes  Probation encounters/meetings in custody
ii. Clinical Encounters, including the following:  Determination of medical history or description of ailment or injury  Diagnosis or prognosis  Medical care and medical evaluations  Provision of mental health evaluations, rounds, group and individual therapy, counseling and other therapeutic activities  Provision of the patient’s rights, informed consent, or permission for treatment  Explanation of medications, procedures, treatment, treatment options, or surgery  Discharge instructions
b) In the situations described in subsection (a), above, Jail staff shall:
i. Identify each prisoner’s disability where there may be a barrier to comprehension or communication requiring reasonable accommodation(s);
ii. Provide effective reasonable accommodation(s) to overcome the communication barrier; and
iii. Document the method used to achieve Effective Communication and how the staff person determined that the prisoner understood the encounter, process, and/or proceeding.
4. Effective auxiliary aids and services that are appropriate to the needs of a prisoner with Effective Communication needs shall be provided when simple written or oral communication is not effective. Such aids may include bilingual aides, SLIs, readers, sound amplification devices, captioned television/video text displays, Videophones and other telecommunication devices for deaf persons (TDDs), audiotaped texts, Braille materials, large print materials, writing materials, and signage.
5. In determining what auxiliary aid service to provide, the County shall give primary consideration to the request of prisoner with Effective Communication needs.
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6. Education providers (e.g., Elk Grove Unified School District) at the Jail will ensure Effective Communication for prisoners participating in education programs, including by providing necessary assistive equipment and take steps to accommodate learning strategies of those prisoner-students who have special needs, such as those with developmental, learning, vision, hearing, and speech disabilities.
7. The County shall assist prisoners who are unable to complete necessary paperwork (e.g., related to health care, due process, Jail processes) on their own with reading and/or writing as needed.
8. The County shall permit prisoners, including those who are illiterate, nonEnglish speaking, or otherwise unable to submit written or electronic sick call requests, to verbally request care. Such verbal requests shall immediately be documented by the staff member who receives the request on an appropriate form and transmitted to a qualified mental health or medical professional for response in the same priority as those sick call requests received in writing.
9. The County shall post and disseminate notices, policies, job announcements, and other written material in alternative formats to promote Effective Communication.
Effective Communication and Access for Individuals with Hearing Impairments
1. The County shall develop and implement a policy for newly arrived and newly identified prisoners with hearing disabilities to determine each prisoner’s preferred method of communication.
2. Qualified Sign Language Interpreters (SLIs) will be provided during intake and for due process functions, health care encounters, and Jail programming, when sign language is the prisoner’s primary or only means of Effective Communication, unless the prisoner waives the assistance of an interpreter and/or delay would pose a safety or security risk.
a) The County shall maintain a contract or service agreement with interpreter services in order to provide such services for deaf or hearing impaired prisoners. Jail staff will be informed of the availability of contract interpreter services.
b) Lip reading will not be the sole method of Effective Communication used by staff, unless the prisoner has no other means of communication.
c) In cases where the use of an SLI is not practicable, or is waived by the prisoner, Jail staff shall employ the most effective form of communication available.
d) The County will maintain a log of (a) when, for whom, and for what purpose an SLI was used; and (b) when, for whom, and why a SLI was
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not used for a prisoner with an identified need for SLI services (e.g., prisoner waived SLI or delay would have posed safety or security risk).
e) When a prisoner waives an SLI, the log must document (a) the method of communication of the waiver, and (b) the method staff used to determine that the waiver was knowing and freely given.
3. Jail Staff shall effectively communicate the contents of the Inmate Handbook and other materials providing information on Jail rules and procedures to all prisoners to be housed in the Jail who are deaf or hard of hearing. For those prisoners for whom written language is not an effective means of communication, Jail Staff may meet this obligation by providing a video of an SLI signing the contents of the Inmate Handbook, along with appropriate technology for viewing, or by providing an SLI to interpret the contents of the Inmate Handbook to the prisoner who is deaf or hard of hearing.
4. The County shall, within 12 months from court approval of the Settlement, make Videophones available for deaf and hard of hearing prisoners. The Videophones shall provide for calls through the use of Video-Relay Services (VRS) at no cost to deaf and hard of hearing prisoners or for calls directly to another Videophone.
5. Deaf/hard of hearing prisoners who use telecommunication relay services, such as Videophone or TDD/TTY machine, in lieu of the telephone shall receive equal access to the Videophone or TDD/TTY services as non-disabled prisoners are afforded for regular telephone usage.
6. The County shall provide deaf/hard of hearing prisoners with additional time for calls using telecommunication relay services, such as a Videophone or TDD/TTY, to account for the fact that signed and typed conversations take longer than spoken conversations. The County shall document the time that each prisoner uses and has access to such equipment.
7. Prisoners who require an SLI as their primary method of communication shall be provided an SLI for education, vocational, or religious programs and services.
8. Public verbal announcements in housing units where individuals who are deaf or hard of hearing reside shall be delivered on the public address system (if applicable) and by flicking the unit lights on and off several times to alert prisoners that an announcement is imminent. This includes announcements regarding visiting, meals, recreation release and recall, count, lock-up, and unlock. Verbal announcements may be effectively communicated via written messages on a chalkboard or by personal notification, as consistent with individual need. These procedures shall be communicated to prisoners during the orientation process and also shall be incorporated into relevant policies and post orders.
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Disability-Related Grievance Process
1. The County shall implement a grievance system for prisoners with disabilities to report any disability-based discrimination or violation of the ADA, this Remedial Plan, or Jail ADA-related policy, and shall provide a prompt response and equitable resolution in each case.
2. The County shall ensure that the grievance procedures are readily available and accessible to all prisoners.
a) The County shall make reasonable efforts to ensure all prisoners are aware of the disability grievance procedures, including the availability of accommodations and staff assistance to submit a grievance and/or appeal.
b) The County shall ensure the prisoners with disabilities have meaningful access to grievance forms, including through provision of staff assistance and large print materials.
3. Response to Grievances
a) The County shall develop and implement an ADA grievance process that includes (1) a reasonable timeline for response to ADA-related grievances and appeals, including an expedited process for urgent ADA grievance (e.g., involving prisoner safety or physical well-being); and (2) provision for interim accommodations pending review of the individual’s grievances/appeals.
b) The County shall ensure that prisoners with communication needs are interviewed and provided assistance as part of the grievance/appeal process where necessary to ensure meaningful access and Effective Communication.
c) The County shall document each denial of a reasonable accommodation request and shall record the basis for such determination.
d) The County shall provide in writing a copy of the grievance (or appeal) response to the prisoner, including the resolution, the basis for a denial (if applicable), and the process for appeal.
e) The County shall ensure that completed grievance responses are effectively communicated to prisoners with disabilities.
4. The submission, processing, and responses for disability-related grievances and complaints shall be tracked.
Alarms/Emergencies
1. The County shall ensure that all written policies regarding alarms and emergencies contain mandatory provisions to accommodate prisoners with disabilities.
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2. The County shall implement written policies regarding the expectations of staff as to prisoners with identified disabilities during emergencies and alarms, including as to disabilities that may affect prisoners’ ability to comply with orders or otherwise respond to emergencies and alarms. For example, the policies shall ensure appropriate handling of prisoners with mobility-related disabilities who are unable to prone or take a seated position on the ground during an alarm or emergency. Such policies shall be communicated to staff, incorporated into the relevant Operations Orders, and communicated to prisoners with disabilities using Effective Communication.
3. The County shall implement written policies for staff regarding communicating effectively and appropriately with prisoners who have disabilities that may present barriers to communication during emergencies or alarms.
4. In order to facilitate appropriate accommodations during alarms or emergencies, the County shall offer, but shall not require, individuals who have disabilities visible markers to identify their disability needs (e.g., identification vests). The County shall maintain a list, posted in such a way to be readily available to Jail staff in each unit, of prisoners with disabilities that may require accommodations during an alarm or emergency.
5. The County shall install visual alarms appropriate for individuals who are deaf or hard of hearing, which shall comply with relevant fire code regulations.
6. All housing units shall post notices for emergency and fire exit routes.
Searches, Restraints, and Extractions
1. The County shall modify its written policies to ensure that prisoners with mobility impairments, including those with prosthetic devices, receive reasonable accommodations with the respect to the following: (1) Pat searches and unclothed body searches; (2) Application of restraints devices, including Pro-Straint Chair; and (3) Cell extractions.
Transportation
1. The County shall provide reasonable accommodations for prisoners with disabilities when they are in transit, including during transport to court or outside health care services.
2. Prescribed HCAs/ADs/DME, including canes, for prisoners with disabilities shall be available to the prisoner at all times during the transport process, including in temporary holding cells, consistent with procedures outlined in Part VII.
3. The County shall use accessible vehicles to transport prisoners in wheelchairs and other prisoners whose disabilities necessitate special transportation, including by maintaining a sufficient number of accessible vehicles. (295)
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4. Prisoners with mobility impairments shall be provided assistance onto transport vehicles.
Prisoners with Intellectual Disabilities
1. The County shall, in consultation with Plaintiffs’ counsel, develop and implement a comprehensive written policy and procedure regarding prisoners with an Intellectual Disability, including:
a) Screening for Intellectual Disabilities;
b) Identification of prisoners’ adaptive support needs and adaptive functioning deficits; and
c) Monitoring, management, and accommodations for prisoners with Intellectual Disabilities.
2. A multidisciplinary team that includes appropriate health care staff will monitor and ensure appropriate care for prisoners with an Intellectual Disability. The multidisciplinary team will develop an individualized plan for each prisoner with an Intellectual Disability, which addresses: (1) safety, vulnerability, and victimization concerns, (2) adaptive support needs, (3) programming, housing, and accommodation needs. The multidisciplinary team’s plan will be regularly reviewed and updated as needed.
3. Prisoners with an Intellectual Disability assigned to a work/industry position will be provided additional supervision and training as necessary to help them meet the requirements of the assignment.
ADA Training, Accountability, and Quality Assurance
1. The County shall ensure all custody, health care, facility maintenance, and other Jail staff receive ADA training appropriate to their position.
a) The County shall provide to all staff appropriate training on disability awareness, including the use and purpose of accommodations and modifications in accordance with the ADA.
b) The ADA training shall include: formalized lesson plans and inclassroom or virtual training for staff (including managers, supervisors, and rank-and-file staff) provided by certified or otherwise qualified ADA trainers.
2. ADA instructors shall have appropriate ADA training and subject matter expertise necessary to effectively provide ADA training to staff.
3. The County shall, in consultation with Plaintiffs’ counsel, develop and implement written policies and procedures regarding monitoring, investigating, and tracking staff violations (or allegations of violations) of ADA requirements and Jail ADA policies.
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4. The County shall develop an ADA accountability plan that will ensure quality assurance and establish staff accountability for egregious, serious, or repeated violations of the ADA and Jail ADA-related policies and procedures.
Accessibility Remedial Plan to Address Physical Plant Deficiencies
1. The County shall, within 24 months from court approval of the Settlement and in consultation with Plaintiffs’ counsel, develop and fully implement an Accessibility Remedial Plan to address Jail physical plant deficiencies that result in access barriers for prisoners with disabilities. In the interim, the Sheriff’s Office shall house prisoners with disabilities in the most integrated and appropriate housing possible, providing reasonable accommodations and assistance where necessary to ensure appropriate accessibility to Jail programs, services, and activities.
2. The Accessibility Remedial Plan shall ensure the following:
a) Adequate provision of accessible cells and housing areas with required maneuvering clearances and accessible toilet fixtures, sanitary facilities, showers, dining/dayroom seating, and recreation/yard areas.
b) Accessible paths of travel that are compliant with the ADA.
c) Equal and adequate access for all prisoners with disabilities to Family and Attorney Visiting areas in reasonable proximity to their housing location.
MENTAL HEALTH CARE
Policies and Procedures
1. The County shall establish policies and procedures that are consistent with the provisions of this Remedial Plan and include the following:
a) A written document reflecting the complete spectrum of mental healthcare programming and services provided to prisoners;
b) Minimum and maximum timeframes for when each type of mental healthcare service will be completed, including but not limited to laboratory tracking and psychiatry follow-up services, in accordance with prevailing community and professional standards;
c) An intake and referral triage system to ensure timely and effective resolution of inmate requests and staff referrals for mental healthcare;
d) Specific credentialing requirements for the delivery of mental healthcare services, including but not limited to only qualified mental health professionals may make critical treatment decisions.
e) Clinical monitoring of inmates, including but not limited to those who are involuntarily medicated, clinically restrained or secluded, segregated, or on suicide watch;
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f) Descriptions of specialized mental health programming that specifically identify admitting and discharge criteria and the staff members who have the authority to place inmates in specialized mental health housing;
g) Procedures for involuntary medications and other appropriate measures for the management of inmates with serious mental illness who lack the capacity to give informed consent, in accordance with relevant state law;
h) Training for all staff members who are working with inmates with mental illness in all aspects of their respective duty assignments.
2. The County’s policies and procedures shall be revised, as necessary, to reflect all of the remedial measures described in this Remedial Plan.
3. The County shall continue to operate its acute inpatient program and its Outpatient Psychiatric Pod (OPP) program. The County shall establish a new Intensive Outpatient Program (IOP) for inmates who require a higher level of outpatient psychiatric care than what is provided in the OPP program.
4. The County shall operate its non-acute mental health programs – IOP, OPP, and General Population-Mental Health – consistent with the JPS Psychiatric Services overview, attached as Exhibit A-2.
Organizational Structure
1. The County shall develop and implement a comprehensive organizational chart that includes the Sheriff’s Department (“Department”), Correctional Health Services (“CHS”), Jail Psychiatric Services (“JPS”), Chief Administrative Officer, Medical Director of the JPS Program, and any other mental health staff, and clearly defines the scope of services, chains of authority, performance expectations, and consequences for deficiencies in the delivery of mental health care services.
2. A Medical Director of Jail Psychiatric Services shall be designated and shall oversee all mental health care functions in the jails, including psychiatric prescribers and psychiatric nurses. The Director shall possess clinical experience and a doctoral degree.
3. The Medical Director of Jail Psychiatric Services shall participate in jail executive leadership and shall be responsible for overseeing program development, clinical practice, and policy, as well as interfacing with jail and medical leadership and community mental health.
Patient Privacy
1. All clinical interactions shall be private and confidential absent a specific, current risk that necessitates the presence of custody staff. In making such determination, custody and clinical staff shall confer and review individual case factors, including the patient’s current behavior and functioning and any
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other security concerns necessary to ensure the safety of medical staff. Such determinations shall not be based on housing placement or custodial classification.
a) For any determination that a clinical interaction with a patient requires the presence of custody staff, staff shall document the specific reasons for the determination. Such decisions shall be reviewed through the Quality Assurance process.
b) If the presence of custody staff is determined to be necessary to ensure the safety of medical staff for any clinical counter, steps shall be taken to ensure auditory privacy of the encounter.
c) The County’s patient privacy policies, as described in this section, shall apply to contacts between inmates and Triage Navigator Program staff and/or other staff that provide mental health-related services on site at the Jail.
2. Jail policies that mandate custody staff to be present for any mental health treatment in such a way that disrupts confidentiality shall be revised to reflect the individualized process set forth above. Custody and mental health staff shall be trained accordingly.
3. It shall be the policy of the County that mental health clinicians shall not conduct their patient contacts at cell front except pursuant to documented refusals or specific, documented security concerns that warrant cell front contacts.
4. For each clinical contact, mental health staff shall document whether the encounter was confidential, including whether it took place at cell front. If the contact occurred at cell front or otherwise was non-confidential, the reasons shall be clearly documented in the individual patient record and for purposes of Quality Assurance review procedures.
5. A process shall exist for sick call slips or other mental health treatment-related requests to be collected without the involvement of custody staff.
Clinical Practices
1. Mental health staff shall develop and maintain at each jail facility an accurate case list of all prisoners requiring mental health treatment services at the jail (“caseload”) which, at a minimum, lists the patient’s name, medical chart number, current psychiatric diagnoses, date of booking, date of last appointment, date of next appointment, and the name of the treating prescriber.
2. Qualified mental health professionals shall have access to the patient’s medical record for all scheduled clinical encounters.
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3. Qualified mental health professionals shall provide individual counseling, group counseling, and psychosocial/psychoeducational programs based on individual patients’ clinical needs.
4. A qualified mental health professional shall conduct and document a thorough assessment of each individual in need of mental health care following identification.
5. The County shall ensure prompt access to psychiatric prescribers following intake and in response to referrals and individual patient requests in accordance with the referral and triage timelines defined in the Access to Care provisions, below.
6. The County shall, in consultation with Plaintiffs’ counsel, implement an electronic system for tracking mental health evaluation, treatment, and other clinical contacts, as well as sick call slips and other mental health treatmentrelated requests or referrals.
7. The County shall develop and implement an electronic tracking system with alert and scheduling functions to ensure timely delivery of mental health services to individual patients.
8. Treatment planning:
a) The County shall ensure that each prisoner on the mental health caseload receives a comprehensive, individualized treatment plan based on the input of the Multi-Disciplinary Treatment Team (MDT). The MDT shall include multiple clinical disciplines with appropriate custody and counseling staff involvement.
b) The treatment plan shall reflect individual clinical need, and the County shall ensure that all clinically indicated services are available and provided.
c) The treatment plan shall include, at a minimum, the frequency of follow-up for clinical evaluation and adjustment of treatment modality, the type and frequency of diagnostic testing and therapeutic regimens (which may include clinical contacts more frequent than the minimum intervals described herein), and instructions about adaptation to the correctional environment.
d) This treatment plan shall include referral to treatment after release from the facility when recommended by treatment staff.
e) Custody staff shall be informed of a patient’s treatment plan where appropriate to ensure coordination and cooperation in the ongoing care of the patient.
f) The County shall, in consultation with Plaintiffs’ counsel, develop and implement a Treatment Plan Form that will be used to select and
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document individualized services for prisoners who require mental health treatment.
g) The County shall implement guidelines and timelines for the initiation and review of individual treatment plans, consistent with the JPS Psychiatric Services overview, attached as Exhibit A-2.
Medication Administration and Monitoring
1. The County shall develop and implement policies and procedures to ensure that all medications are appropriately prescribed, stored, controlled, dispensed, and administered in accordance with all applicable laws and through the following:
a) The County shall ensure that initial doses of prescribed medications are delivered to inmates within 48 hours of the prescription, unless it is clinically required to deliver the medication sooner;
b) The County shall make best efforts to verify a patient’s prescribed medications and current treatment needs at intake, including outreach to pharmacies and community providers to request prescriptions and other health care records relating to ongoing care needs. The policy shall ensure that any ongoing medication, or a clinically appropriate alternative, shall be provided within 48 hours of verification of the prescription or from a determination by a physician that the medication is medically necessary. Any orders that cannot be reconciled or verified, such as those with conflicting prescriptions from multiple prescribers, shall be referred to a health care provider for reconciliation or verification the next clinic day after booking.
c) The County shall ensure that medical staff who administer medications to inmates document in the inmate’s Medical Administration Record (1) name and dosage of each dispensed medication, (2) each date and time medication is administered, and (3) the date and time for any refusal of medication.
2. Qualified mental health professionals shall, for each individual patient, establish targets for treatment with respect to the use of psychotropic medication and shall assess and document progress toward those targets at each clinical visit.
3. Qualified mental health professionals shall, for each individual patient, monitor and document the following with respect to psychotropic mediations: (1) levels of medications, (2) adverse impacts (including through renal and liver function tests where indicated), (3) side effects, and (4) efficacy.
4. Qualified mental health professionals shall, for each individual patient, conduct and document baseline studies, including ECG, blood, urine, and other studies, as clinically appropriate, prior to the initiation of treatment.
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5. The County shall provide sufficient nursing and custody staffing to ensure timely delivery and administration of medication.
6. Medication adherence checks that serve a clinical function shall be conducted by nursing staff, not custody staff. Custody staff shall conduct mouth checks when necessary to ensure institutional safety and security.
7. Psychiatric prescribers shall consider clinically indicated considerations and conduct an in-person consultation, with the patient prior to changing or initiating medications. In the event there is no in-person consultation before prescribing or changing medications the psychiatric prescriber shall note and document the reasons for why there was not an in-person consultation with the patient.
Placement, Conditions, Privileges, and Programming
1. Placement:
a) It shall be the policy of the County to place and treat all prisoners on the mental health caseload in the least restrictive setting appropriate to their needs.
b) Placement in and discharge from Designated Mental Health Units shall be determined by qualified mental health professionals, with consultation with custody staff as appropriate.
c) Absent emergency circumstances, the County shall obtain the assent of qualified mental health professionals before transferring prisoners with SMI into or out of Designated Mental Health Units.
d) It shall be the policy of the County to place prisoners with SMI in appropriate settings that ensure provision of mental health services, patient safety, and the facilitation of appropriate programs, activities, and out-of-cell time. Co-housing with other populations shall be avoided to the extent that such a practice prevents or hinders any of the above.
e) All patients requiring placement in a Designated Mental Health Unit shall be provided access to such placement and care based on current clinical need and without any requirement for director-level approval.
2. Programming and Privileges
a) All Designated Mental Health Units shall offer a minimum of 7 hours of unstructured out-of-cell time per week and 10 hours of structured outof-cell time per week for each prisoner. While out-of-cell hours per prisoner may vary from day to day, each prisoner will be offered some amount of out-of-cell time every day of the week. All treatment and outof-cell time shall be documented for each prisoner, and reviewed as part of Quality Assurance procedures.
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b) The County shall ensure that prisoners on the mental health caseload have access and opportunity to participate in jail programming, work opportunities, and education programs, consistent with individual clinical input.
c) The County shall develop and implement, in the 2P inpatient unit and the IOP unit, a program for progressive privileges (including time out of cell, property allowances, etc.) for patients as they demonstrate behavioral progress. A patient’s level of privileges and restrictions shall be based on both clinical and custody input regarding current individual needs. The County shall ensure a process to review custody classification factors when necessary, so that placement, privileges, and restrictions match current individual circumstances and needs.
d) Individuals on a mental health caseload shall receive, at minimum, privileges consistent with their classification levels, absent specific, documented factors which necessitate the withholding of such privileges. Clinical staff shall be informed of the withholding of privileges and the reasons for the withdrawal shall be documented and regularly reviewed by clinical and custody staff. The restoration of privileges shall occur at the earliest time appropriate based on individual factors.
e) Where a prisoner in a Designated Mental Health Unit is subject to any restrictions of property, privileges, or out-of-cell time, the mental health treatment provider and Multi-Disciplinary Treatment Team will, on a weekly basis, assess and discuss with the prisoner progress and compliance with the prisoner’s individual case plan. This process will include clinical contact in a private, face-to-face, out-of-cell setting. The Multi-Disciplinary Treatment Team will provide input to classification staff regarding the prisoner’s mental health and appropriateness for removal of imposed restrictions. Classification staff will follow the recommendation of the Multi-Disciplinary Treatment Team to remove restrictions unless there is a clear, documented security reason to maintain the restriction.
3. Conditions:
a) Staff shall provide prisoners in Designated Mental Health Units with the opportunity to maintain cell cleanliness and the opportunity to meet their hygiene needs. Custody and clinical staff shall provide assistance to prisoners on these matters, as appropriate to individual patient needs
b) The County shall ensure uniformity of practice with respect to cell searches, such that searches are not done for punitive or harassment reasons. The County shall monitor whether cell search practices may be serving as a disincentive for prisoners in Designated Mental Health
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Units to leave their cells for treatment or other out-of-cell activities, and shall take steps to address the issue as appropriate.
4. Bed planning:
a) The County shall provide a sufficient number of beds in Designated Mental Health Unit, at all necessary levels of clinical care and levels of security, to meet the needs of the population of prisoners with SMI.
b) The County shall conduct a bed needs assessment, to be updated as appropriate, in order to determine demand for each category of Designated Mental Health Unit beds and shall ensure timely access to all levels of mental health care, consistent with individual treatment needs.
c) The County shall establish mental health programming for women that ensures timely access to all levels of care and is equivalent to the range of services offered to men.
5. General Exclusion of Prisoners with Serious Mental Illness from Segregation
a) Prisoners with Serious Mental Illness will not be housed in Segregation units, except in rare cases where the prisoner presents an immediate danger or significant disruption to the therapeutic setting, and there is no reasonable alternative, in which cases the provisions of Section VIII.D of the Segregation/Restrictive Housing Remedial Plan shall apply.
b) Where prisoners with a mental health condition meeting criteria for placement in a Designated Mental Health Unit are assessed a Disciplinary Segregation term, they will serve the term in a Designated Mental Health Unit, except in rare cases where the prisoner presents an immediate danger or significant disruption to the therapeutic setting, and shall receive structured out-of-cell time and programming as determined by the Multi-Disciplinary Treatment Team.
6. Access to Care
a) The County shall designate and make available custody escorts for mental health staff in order to facilitate timely completion of appointments and any other clinical contacts or treatment-related events.
b) The County shall ensure sufficient and suitable treatment and office space for mental health care services, including the Triage Navigator Program and other mental health-related services provided on site at the Jail.
c) Locations shall be arranged in advance for all scheduled clinical encounters.
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d) The County shall track and document all completed, delayed, and canceled mental health appointments, including reasons for delays and cancelations. Such documentation shall be reviewed as part of the Quality Assurance process.
e) Referrals and triage:
i. The County shall maintain a staff referral process (custody and medical) and a kite system for prisoners to request mental health services. Referrals by staff or prisoners must be triaged within 24 hours.
ii. Referrals and requests for mental health services shall be handled in accordance with the following timeframes, and based on the definitions and guidance in Exhibit A-2:
 Prisoners with “Must See” (Emergent) mental health needs shall be seen for assessment or treatment by a qualified mental health professional as soon as possible, and within six (6) hours. Prisoners with emergent mental health needs shall be monitored through continuous observation until evaluated by a mental health professional.
 Prisoners with Priority (Urgent) mental health needs shall be seen for assessment or treatment by a qualified mental health professional within 36 hours.
 Prisoners with Routine mental health needs shall be seen for assessment or treatment by a qualified mental health professional within two (2) weeks;
 Prisoners whose requests do not require formal clinical assessment or intervention shall be issued a written response, with steps taken to ensure effective communication.
Medico-Legal Practices
1. The County shall provide access to appropriate inpatient psychiatric beds to all patients who meet WIC § 5150 commitment criteria. At the time a patient’s need for inpatient care is identified, commitment paperwork shall be initiated immediately. Placement in an inpatient unit shall occur at the earliest possible time, and in all cases within 24 hours. For individual prisoners placed on a pre-admit or wait list for inpatient placement, affirmative steps to process and place them shall begin immediately.
2. The County shall not discharge patients from the LPS unit and immediately readmit them for the purpose of circumventing LPS Act requirements. For patients with continuing need for LPS commitment, the County shall follow all required procedures under the LPS Act.
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3. The County shall review all County and JPS policies and procedures for PREA compliance, and revise them as necessary to address all mental health-related requirements.
Clinical Restraints and Seclusion
1. Generally:
a) It is the policy of the County to employ restraints and seclusion only when necessary and to remove restraints and seclusion as soon as possible.
b) It is the policy of the County to employ clinical restraints and seclusion only when less restrictive alternative methods are not sufficient to protect the inmate-patient or others from injury. Clinical restraint and seclusion shall not be used as punishment, in place of treatment, or for the convenience of staff.
c) The placement of a prisoner in clinical restraint or seclusion shall trigger an “emergent” mental health referral, and a qualified mental health professional shall evaluate the prisoner to assess immediate and/or longterm mental health treatment needs.
d) When clinical restraints or seclusion are used, Jail staff will document justification for their application and the times of application and removal of restraints.
e) There shall be no “as needed” or “standing” orders for clinical restraint or seclusion.
f) Individuals in clinical restraints or on seclusion shall be on constant watch, or on constant video monitoring with direct visualization every 15 minutes. All checks will be documented.
g) Fluids shall be offered at least every four hours and at meal times.
2. Clinical Restraints
a) The opinion of a qualified health care professional or qualified mental health professional on placement and retention in restraints will be obtained within one hour from the time of placement.
b) A thorough clinical assessment shall be conducted by qualified health care professional or qualified mental health professional every four hours to determine the need for continued restraint.
c) Individuals in restraints shall be checked every two hours by a nurse for vital signs, neurovascular assessment, and limb range, and offered an opportunity for toileting.
3. Reentry Services
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a) The County shall provide a 30-day supply of current psychotropic medications to inmates on the mental health caseload, who have been sentenced and have a scheduled released date, immediately upon release.
b) Within 24 hours of release of any inmate who is on the mental health caseload and classified as pre-sentence, the County shall transmit to a designated County facility a prescription for a 30-day supply of the inmate’s current psychotropic medications.
c) The County, in consultation with Plaintiffs’ counsel, develop and implement a reentry services policy governing the provision of assistance to prisoners on the mental health caseload, including outpatient referrals and appointments, public benefits, medical insurance, housing, substance abuse treatment, parenting and family services, inpatient treatment, and other reentry services.
d) The County agrees that, during the course of the implementation of the remedial plans contained in this agreement, it will consider Plaintiffs’ input on measures to prevent unnecessary or avoidable incarceration of individuals with serious mental illness.
Training
1. The County shall develop and implement, in collaboration with Plaintiffs’ counsel, training curricula and schedules in accordance with the following:
a) All jail custody staff shall receive formal training in mental health, which shall encompass mental health policies, critical incident response, crisis intervention techniques, recognizing different types of mental illness, interacting with prisoners with mental illness, appropriate referral practices, suicide and self-harm detection and preventions, relevant bias and cultural competency issues, and confidentiality standards. Training shall be received every two years, at minimum.
b) Custody staff working in Designated Mental Health Units shall receive additional training, including additional information on mental illness, special medico-legal considerations, de-escalation techniques, working with individuals with mental health needs, relevant bias and cultural competency issues, and the jail’s mental health treatment programs.
c) Mental health staff shall receive training on the correctional mental health system, correctional mental health policies, suicide assessment and intervention, relevant bias and cultural competency issues, and treatment modalities to be offered in the jails.
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DISCIPLINARY MEASURES AND USE OF FORCE FOR PRISONERS WITH MENTAL HEALTH OR INTELLECTUAL DISABILITIES
Role of Mental Health Staff in Disciplinary Process 1. The County’s policies and procedures shall require meaningful consideration
of the relationship of a prisoner’s behavior to any mental health or intellectual disability, the efficacy of disciplinary measures versus alternative interventions, and the impact of disciplinary measures on the health and wellbeing of prisoners with disabilities. 2. Prisoners who are alleged to have committed a rules violation shall be reviewed by a qualified mental health professional if any of the following apply:
a) Prisoner is housed in any Designated Mental Health Unit; b) Jail staff have reason to believe the prisoner’s behavior was unusual,
uncharacteristic, or a possible manifestation of mental illness; c) Prisoner is on the mental health caseload and may lose good time credit
as a consequence of the disciplinary infraction with which he or she is charged. 3. If any of the above criteria is met, the qualified mental health professional shall complete the form attached as Exhibit A-3 (JPS-Rules Violation Mental Health Review) and indicate: a) Whether or not the reported behavior was related to mental illness, adaptive functioning deficits, or other disability; b) Whether the prisoner’s behavior is, or may be, connected to any of the following circumstances:
i. An act of self-harm or attempted suicide ii. A cell extraction related to transfer to a medical/mental health
unit or provision of involuntary treatment iii. Placement in clinical restraints or seclusion. c) Any other mitigating factors regarding the prisoner’s behavior, disability, and/or circumstances that should be considered and whether certain sanctions should be avoided in light of the prisoner’s mental health disability or intellectual disability, treatment plan, or adaptive support needs.
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Consideration of Mental Health Input and Other Disability Information in Disciplinary Process 1. The County shall designate one Chief Disciplinary Hearing Officer for each
jail facility, who shall be responsible for ensuring consistency in disciplinary practices and procedures.
2. The Disciplinary Hearing Officer shall ensure that prisoners are not disciplined for conduct that is related to their mental health or intellectual disability.
3. The Disciplinary Hearing Officer shall consider the qualified mental health professional’s findings and any other available disability information when deciding what, if any, disciplinary action should be imposed.
4. The Disciplinary Hearing Officer shall consider the qualified mental health professional’s input on minimizing the deleterious effect of disciplinary measures on the prisoner in view of his or her mental health or adaptive support needs.
5. If the Disciplinary Hearing Officer does not follow the mental health staff’s input regarding whether the behavior was related to symptoms of mental illness or intellectual disability, whether any mitigating factors should be considered, and whether certain sanctions should be avoided, the Disciplinary Hearing Officer shall explain in writing why it was not followed.
6. Prisoners will not be subjected to discipline which prevents the delivery of mental health treatment or adaptive support needs, unless necessary for institutional safety.
7. Prisoners shall not be subject to discipline for refusing treatment or medications, or for engaging in self-injurious behavior or threats of selfinjurious behavior.
Accommodations for Prisoners with Mental Health or Intellectual Disabilities During the Disciplinary Process 1. The County shall provide reasonable accommodations during the hearing
process for prisoners with mental health or intellectual disabilities.
2. The County shall take reasonable steps to ensure the provision of effective communication and necessary assistance to prisoners with disabilities at all stages of the disciplinary process.
Use of Force for Prisoners with Mental Health or Intellectual Disabilities 1. The County’s Correctional Services Operations Orders shall include language
that ensures meaningful consideration of whether a prisoner’s behavior is a manifestation of mental health or intellectual disability.
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2. For prisoners with a known mental health or intellectual disability, and absent an imminent threat to safety, staff shall employ de-escalation methods that take into account the individual’s mental health or adaptive support needs.
3. The County’s Correctional Services Use of Force policies shall include a definition and a protocol for a planned Use of Force that provides appropriate guidance for a planned Use of Force that involves a prisoner with mental health or intellectual disability.
4. Prior to any planned Use of Force, such as a cell extraction, against a prisoner with mental health or intellectual disabilities, there will be a “cooling down period,” consistent with safety and security needs. This period includes a structured attempt by mental health staff (and other staff if appropriate), to deescalate the situation and to reach a resolution without Use of Force. Such efforts, including the use of adaptive supports, will be documented in writing. Medical and/or mental health staff should be consulted if the purpose of the cell extraction is related to the delivery of treatment.
5. The County shall require video documentation for any planned Use of Force, absent exigent circumstances. Jail staff shall endeavor to record the specific actions, behavior, or threats leading to the need for Use of Force, as well as efforts to resolve the situation without Use of Force.
6. The County shall ensure the completion of supervisory review of Use of Force incidents, including video (for any planned Use of Force), interviews, and written incident documentation, in order to ensure appropriateness of Use of Force practices including de-escalation efforts. The County shall take corrective action when necessary.
7. The County shall review and amend as appropriate its policies on Use of Force, including its policies on Custody Emergency Response Team (CERT) and Cell Extraction Procedures.
Training and Quality Assurance
1. All custody staff, and mental health staff, shall be trained on the policies and procedures outlined herein that are relevant to their job and classification requirements. Custody staff will receive periodic training on identifying behaviors that may be manifestations of mental illness and other situations warranting a referral to mental health staff, including for a Rules Violation Mental Health Review or other mental health assessment.
2. All custody staff shall be trained on the identification of symptoms of mental illness, the provision of adaptive supports, and the use of de-escalation methods appropriate for prisoners with mental health or intellectual disabilities.
3. The County shall track the outcomes of all disciplinary hearings for prisoners who are on the mental health caseload or who have intellectual disabilities,
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including whether the recommendation of the mental health professional was followed.
4. The County shall track all Uses of Force (planned and reactive) involving prisoners who are on the mental health caseload or who have intellectual disabilities, including the number of Uses of Force and the number of cell extractions by facility.
5. The County shall implement a continuous quality assurance/quality improvement plan to periodically audit disciplinary and Use of Force practices as they apply to prisoners who are on the mental health caseload or who have intellectual disabilities.
MEDICAL CARE
Staffing
1. The County shall provide and maintain sufficient staffing to meet professional standards of care and to execute the requirements of this Remedial Plan, including clinical staff, office and technological support, QA/QI units, and custody staff for escorts and transportation.
2. Provider quality shall be evaluated regularly to ensure that relevant quality of care standards are maintained. This review shall be in addition to the peer review and quality improvement processes described in this plan. The parties shall meet and confer regarding any deficiencies identified in the evaluation. Should the parties disagree regarding matters of provider quality, the Court Expert shall evaluate the quality of provider care and to complete a written report.
Intake
1. All prisoners who are to be housed shall be screened on arrival in custody by Registered Nurses (RNs). RN screening shall take place prior to placement in jail housing.
2. Health care intake screening shall take place in a setting that ensures confidentiality of communications between nurses and individual patients. Custody staff may maintain visual supervision but may not be close enough to overhear communication, unless security concerns based on an individualized determination of risk that includes a consideration of requests by the health care staff require that custody staff be closer at hand. There shall be visual and auditory privacy from other prisoners.
3. The County shall, in consultation with Plaintiffs, revise the contents of its intake screening, medical intake screening, and special needs documentation to reflect community standards and ensure proper identification of medical and disability related needs.
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4. Nurses who perform intake screening shall consult any available electronic health care records from prior incarcerations or other County agencies. The form shall include a check box to confirm that such a review was done.
5. The County shall make best efforts to verify a patient’s prescribed medications and current treatment needs at intake, including outreach to pharmacies and community providers to request prescriptions and other health care records relating to ongoing care needs. The policy shall ensure that any ongoing medication, or a clinically appropriate alternative, shall be provided within 48 hours of verification of the prescription or from a determination by a physician that the medication is medically necessary. Any orders that cannot be reconciled or verified, such as those with conflicting prescriptions from multiple prescribers, shall be referred to a health care provider for reconciliation or verification the next clinic day after booking.
6. The County shall follow a triage process in which intake nurses schedule patients for follow-up appointments based on their medical needs and acuity at intake, and shall not rely solely on patients to submit Health Services Requests once housed. The policy shall, in consultation with Plaintiffs’ counsel, establish clear protocols that include appropriate intervals of care based on clinical guidelines, and that intake nurses shall schedule follow-up appointments at the time of intake based on those protocols.
7. All nurses who perform intake screenings will be trained annually on how to perform that function.
Access to Care
1. The County shall ensure that Health Services Requests (HSRs) are readily available to all prisoners, including those in segregation housing, from nurses and custody officers.
2. The County shall provide patients with a mechanism for submitting HSRs that does not require them to share confidential health information with custody staff. The County shall install lockboxes or other secure physical or electronic mechanism for the submission of HSRs (as well as health care grievances) in every housing unit. Designated health care staff shall collect (if submitted physically) or review (if submitted electronically) HSRs at least two times per day in order to ensure that CHS receives critical health information in a timely manner. Designated health care staff shall also collect HSRs during pill call and shall go door to door in all restricted housing units at least once a day to collect HSRs. HSRs and health care grievances will be promptly date- and time-stamped. The County may implement an accessible electronic solution for secure and confidential submission of HSRs and health care grievances.
3. The County shall establish clear timeframes to respond to HSRs:
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a) All patients whose HSRs raise emergent concerns shall be seen by the RN immediately on receipt of the HSR. For all other HSRs, a triage RN shall, within 24 hours of receipt of the form (for urgent concerns) or within 72 hours of receipt of the form (for routine concerns):
i. conduct a brief face-to-face visit with the patient in a confidential, clinical setting;
ii. take a full set of vital signs, if appropriate;
iii. conduct a physical exam, if appropriate;
iv. assign a triage level for a provider appointment of emergent, urgent, routine, or written response only;
v. inform the patient of his or her triage level and response time frames;
vi. provide over-the-counter medications pursuant to protocols; and
vii. consult with providers regarding patient care pursuant to protocols, as appropriate.
b) If the triage nurse determines that the patient should be seen by a provider:
i. patients with emergent conditions shall be treated or sent out for emergency treatment immediately;
ii. patients with urgent conditions shall be seen within 24 hours of the RN face-to-face; and
iii. patients with only routine concerns shall be seen within two weeks of the RN face-to-face.
c) Patients whose requests do not require formal clinical assessment or intervention shall be issued a written response, with steps taken to ensure effective communication, within two weeks of receipt of the form.
d) The County shall permit patients, including those who are illiterate, non-English speaking, or otherwise unable to submit written or electronic HSRs, to verbally request care. Such verbal requests shall immediately be documented by the staff member who receives the request on an appropriate form and transmitted to a qualified medical professional for response in the same priority as those HSRs received in writing.
4. The County shall designate and make available custody escorts for medical staff in order to facilitate timely and confidential clinical contacts or treatmentrelated events.
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5. The County shall track and regularly review response times to ensure that the above timelines are met.
6. The County shall discontinue its policy of prohibiting patients from reporting or inquiring about multiple medical needs in the same appointment.
7. When a patient refuses a medical evaluation or appointment, such refusal will not indicate a waiver of subsequent health care.
a) When a patient refuses a service that was ordered by medical staff based on an identified clinical need, medical staff will follow up to ensure that the patient understands any adverse health consequences and to address individual issues that caused the patient to refuse the service.
b) Any such refusal will be documented by medical staff and must include (1) a description of the nature of the service being refused, (2) confirmation that the patient was made aware of and understands any adverse health consequences by medical staff, (3) the signature of the patient, and (4) the signature of medical staff witness. In the event that obtaining the signature of a patient is not possible, medical staff shall document the circumstances.
Chronic care
1. Within three months of the date the Consent Decree is issued by the Court, the County shall, in consultation with Plaintiffs’ counsel, develop and implement a chronic disease management program that is consistent with national clinical practice guidelines. The chronic disease program will include procedures for the identification and monitoring of such patients and the establishment and implementation of individualized treatment plans consistent with national clinical practice guidelines.
a) The chronic disease management program shall ensure that patients with chronic illness shall be identified and seen after intake based on acuity (on the day of arrival for patients with high acuity and not to exceed 30 days for all others). The County will timely provide clinically indicated diagnostic testing and treatment, including prior to this post-intake appointment. Follow-up appointments will be provided in intervals that do not exceed 90 days unless such patients are clinically stable on at least two consecutive encounters, in which case follow-up appointment intervals will not exceed 365 days (and sooner if clinically indicated), subject to a chart review by a clinician at least every six (6) months.
b) The chronic disease management program shall ensure that patients are screened for Hepatitis C at intake. If medical staff recommend Hepatitis testing based on screening results, such testing shall be offered on an “opt-out” basis for those individuals who remain in custody long enough to receive a housing unit assignment. If the individual declines
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the testing, the refusal shall be documented in the health record. Patients found to have Hepatitis C shall be offered immunizations against Hepatitis A and Hepatitis B.
c) The chronic disease management program shall include a comprehensive diabetic management protocol that conforms to the guidance of the ADA’s Diabetes Management in Correctional Institutions. The protocol shall be developed in coordination with custody administration to address normal circadian rhythms, food consumption times, and insulin dosing times.
d) The chronic disease management program shall ensure that patients who take medications for their chronic conditions shall have the medications automatically renewed unless the provider determines that it is necessary to see the patient before renewing the medication. In that case, the patient shall be scheduled to be seen in a reasonable time period to ensure medication continuity.
2. The County shall track compliance with the chronic disease management program requirements for timely provision of appointments, procedures, and medications. The County shall ensure that its electronic medical record system is adequate to support these critical functions.
3. The County shall review its infection control policies and procedures for dialysis treatment to ensure that appropriate precautions are taken to minimize the risk of transmission of blood-borne pathogens, given the proximity of HCV+ and HCV- patients receiving dialysis in the same room.
Specialty care
1. The County shall develop and implement policies regarding specialty referrals using an algorithm with evidence-based referral criteria and guidelines.
2. Within three months of the date the Consent Decree is issued by the Court, the County shall develop and implement policies and procedures to ensure that emergency consultations and diagnostic and treatment procedures, as determined by the medical provider, are provided immediately; high priority consultations and procedures, as determined by the medical provider, are seen within 21 calendar days of the date of the referral; and routine consultations and procedures, as determined by the medical provider, are seen within 90 calendar days of the date of the referral.
3. Patients whose routine specialty consultation or procedure do not take place within 90 calendar days from the date of the referral shall be examined by a clinician monthly and evaluated to determine if urgent specialty care is indicated.
4. Within 5 calendar days of the completion of a high priority specialty consultation or procedure or within 14 calendar days of a routine specialty
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consultation or procedure, patients returning to the Sacramento jails shall have their specialty reports and follow up recommendations reviewed by a jail nurse practitioner, physician’s assistant or physician. A nurse practitioner, physician’s assistant or physician will review this information with the patient within 14 calendar days of the receipt of the specialist’s report.
5. Specialty care consultations and outside diagnostic and treatment procedures shall be tracked in a log that identifies the referral request date, the date the referral was sent to the specialty care provider, the appointment date for the consultation or procedure is scheduled, the date the appointment takes place, and, if the appointment is rescheduled or cancelled, the reason it was rescheduled or canceled.
6. Requests for specialty consultations and outside diagnostic and treatment procedures shall also be tracked to determine the length of time it takes to grant or deny the requests and the circumstances and reasons for denials.
7. At least twice a year, the County shall conduct an audit of specialty care referral logs described in subsections (5) and (6), above, and complete a report as to whether each category of specialty care is provided in a reasonable timeframe, consistent with established timeframes. If any specialty care area has a record of untimely appointments as determined by the Correctional Health Service Continuous Quality Improvement Committee, the County shall report to Plaintiffs and the parties shall meet and confer to take prompt steps to address the issue. The County will provide Plaintiffs access to the specialty care referral logs and audit reports periodically and upon written request. The parties will work to resolve issues with untimely specialty care in individual patient cases and with respect to systemic trends, including through the dispute resolution process.
8. The County shall consider implementing an e-referral system to reduce delays and facilitate communication between specialists and primary care providers, as well as reducing unnecessary transportation costs and unnecessary specialist appointments by ensuring that the specialist has all the information he or she needs before an appointment takes place.
9. The County shall ensure that utilization management and/or scheduling staff provides notification of whether a patient’s specialty care appointment is scheduled to occur within the timeline pursuant to the referral and/or clinical recommendation, including as follows:
a) Medical staff may request and obtain information as to whether any patient’s specialty care appointment is scheduled, and as to the general timing of the appointment (e.g. within a one-week’s date range).
b) If a specialty care appointment is denied or is not scheduled to occur within the timeline pursuant to the referral and/or clinical
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recommendation, such information will be affirmatively provided to the treatment team and to the patient.
c) If a previously scheduled specialty care appointment is postponed to a date that is outside the timeline pursuant to the referral and/or clinical recommendation, such information will be affirmatively provided to the treatment team and to the patient.
10. The County shall consider creating a physical therapy clinic at the jail to more efficiently meet the significant demand for this service.
Medication administration and monitoring
1. The County shall develop and implement policies and procedures to ensure that all medications are appropriately prescribed, stored, controlled, dispensed, and administered in accordance with all applicable laws and through the following:
a) ensuring that initial doses of prescribed medications are delivered to patients within 48 hours of the prescription, unless it is clinically required to deliver the medication sooner;
b) ensuring that medical staff who administer medications to patients document in the patient’s Medical Administration Record (1) name and dosage of each dispensed medication, (2) each date and time medication is administered, (3) the date and time for any refusal of medication, and (4) in the event of patient refusal, documentation that the prisoner was made aware of and understands any adverse health consequences by medical staff.
2. The County shall provide sufficient nursing and custody staffing to ensure timely delivery and administration of medication.
3. The County shall provide pill call twice a day in each housing unit, at regular times that are consistent from day to day, except as may be required by nonroutine facility security concerns. The County shall develop and implement policies and procedures to ensure that prescribed medications are provided at therapeutically appropriate times as determined by the ordering physician. Any patient who requires administration of medications at times outside the regular pill call shall be provided that medication at the times determined by the ordering physician.
4. The County shall develop and implement policies and procedures to ensure that patients are provided medications at therapeutically appropriate times when out to court, in transit to or from any outside appointment, or being transferred between facilities. If administration time occurs when a patient is in court, in transit or at an outside appointment, medication will be administered as close as possible to the regular administration time.
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5. The County shall develop and implement policies and procedures to ensure that medication efficacy and side effects are monitored by staff and reviewed by appropriate clinicians at appropriate intervals.
6. The County shall explore the expansion of its Keep-on-Person medication program, (especially for inhalers and medications that are available over-thecounter in the community) and to facilitate provision of medications for people who are out to court, in transit, or at an outside appointment.
Clinical space and medical placements
1. The County shall provide adequate clinical space in every facility to support clinical operations while also securing appropriate privacy for patients. Adequate clinical space includes visual and auditory privacy from prisoners and auditory privacy from staff, the space needed reasonably to perform clinical functions as well as an examination table, sink, proper lighting, proper equipment, and access to health care records.
2. The County shall ensure that any negative pressure isolation rooms meet community standards, including an antechamber to ensure that the room remains airtight, appropriate pressure gauges, and regular documented checks of the pressure gauges.
3. The County shall ensure that absent individualized, documented safety and security concerns, patients in acute medical or quarantine placements shall be allowed property and privileges equivalent to what they would receive in general population based on their classification levels.
4. The County shall ensure that patients in medical placements are not forced to sleep on the floor, including by providing beds with rails or other features appropriate for patients’ clinical needs and any risk of falling.
5. The County shall not discriminate against patients in medical placements solely because of their need for C-Pap machines, but instead shall provide access to programs and services in accordance with their classification level, as set forth in the ADA Remedial Plan.
Patient privacy
1. The County shall develop and implement policies and procedures to ensure that appropriate confidentiality is maintained for health care services. The policies shall ensure confidentiality for clinical encounters, including health care intake screening, pill call, nursing and provider sick call, specialty appointments, and mental health treatment. The policies shall also ensure confidentiality for written health care documents, such as health care needs requests and grievances raising medical care or mental health care concerns, which shall not be collected by custody staff.
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2. The County shall provide adequate clinical space in each jail to support clinical operations while also securing appropriate privacy for patients, including visual and auditory privacy from prisoners and auditory privacy from staff.
3. All clinical interactions shall be private and confidential absent a specific, current risk that necessitates the presence of custody staff. In making such determination, custody and clinical staff shall confer and review individual case factors, including the patient’s current behavior and functioning and any other security concerns necessary to ensure the safety of medical staff. Such determinations shall not be based on housing placement or custodial classification. The issuance of pills does not constitute a clinical interaction.
a) For any determination that a clinical interaction with a patient requires the presence of custody staff, staff shall document the specific reasons for the determination. Such decisions shall be reviewed through the Quality Assurance process.
b) If the presence of a correctional officer is determined to be necessary to ensure the safety of staff for any clinical counter, steps shall be taken to ensure auditory privacy of the encounter.
c) The County’s patient privacy policies, as described in this section, shall apply to contacts between patients and all staff who provide healthrelated services on site at the Jail.
4. Jail policies that mandate custody staff to be present for any medical treatment in such a way that disrupts confidentiality shall be revised to reflect the individualized process set forth above. Custody and medical staff shall be trained accordingly.
Health care records
1. The County shall develop and implement a fully integrated electronic health record system that includes medical, psychiatric, and dental records and allows mental health and medical staff to view the medical and mental health information about each patient in a single record. This shall be accomplished within 12 months of the date the Consent Decree is issued by the Court.
2. Until such a system is implemented, the County shall develop and implement policies and procedures to ensure that medical staff have access to mental health information and mental health staff have access to medical information, as needed to perform their clinical duties. This information shall include all intake records. Medical and mental health staff shall be trained in these policies and procedures within one month of the date the Consent Decree is issued by the Court.
3. The County shall develop and implement policies and procedures to monitor the deployment of the CHS Electronic Health Records to ensure the records system is modified, maintained, and improved as needed on an ongoing basis,
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including ongoing information technology support for the network infrastructure and end users.
Utilization management
1. The County shall revise its utilization management (UM) system to ensure that critical health decisions about patients’ access to care are made with sufficient input from providers and a thorough review of the health care records.
2. The County shall ensure that decisions about a patient’s access to, timing of or need for health care are made by a physician, with documented reference to the patient’s medical record. Nurses may gather information and coordinate the UM process, so long as it does not interfere with that requirement. All decisions by the UM committee shall be documented, including the clinical justification for the decision.
3. The UM system shall ensure that providers and patients are promptly informed about decisions made by the UM committee, including denial of a specialist referral request.
4. The UM system shall include an appeal process to enable patients and providers to appeal a decision denying a referral request.
Sanitation
1. The County shall consult with an Environment of Care expert to evaluate facilities where patients are housed and/or receive clinical treatment, and to make written recommendations to address issues of cleanliness and sanitation that may adversely impact health.
Reproductive and Pregnancy-Related Care
1. The County shall ensure that pregnant patients receive timely and appropriate prenatal care, specialized obstetrical services when indicated, and postpartum care (including mental health services).
2. The County will provide pregnant patients comprehensive counseling and timely assistance in accordance with their expressed desires regarding their pregnancies, whether they elect to keep the child, use adoptive services, or have an abortion.
3. The County shall provide non-directive counseling about contraception to female prisoners, shall allow female prisoners to continue an appropriate method of birth control while incarcerated (with consideration given to the patient’s preference and/or current method of birth control), and shall provide access to emergency or other contraception when appropriate.
Transgender and gender nonconforming health care
1. The County shall implement policies and procedures to provide transgender and intersex prisoners with care based upon an individualized assessment of
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the patient’s medical needs in accordance with accepted standards of care and prevailing legal and constitutional requirements, including, as appropriate:
a) Hormone therapy
b) Surgical care
c) Access to gender-affirming clothing
d) Access to gender-affirming commissary items, make-up, and other property items
2. The County shall ensure that medical and mental health staff have specific knowledge of and training on the WPATH Standards of Care.
Detoxification protocols 1. Within three months of the date the Consent Decree is issued by the Court, the
County shall develop and implement protocols for assessment, treatment, and medication interventions for alcohol, opiate, and benzodiazepine withdrawal that are consistent with community standards.
2. The protocols shall include the requirements that (i) nursing assessments of people experiencing detoxification shall be done at least twice times a day for five days and reviewed by a physician; (ii) nursing assessments shall include both physical findings, including a full set of vital signs, as well as psychiatric findings; (iii) medication interventions to treat withdrawal syndromes shall be updated to provide evidence-based medication in sufficient doses to be efficacious; (iv) the County shall provide specific guidelines to the nurses for intervention and escalation of care when patients do not respond to initial therapy; and (v) patients experiencing severe, life-threatening intoxication (an overdose) or withdrawal shall be immediately transferred under appropriate security conditions to a facility where specialized care is available.
Nursing protocols 1. Nurses shall not act outside their scope of practice.
2. To that end, the County shall revise its nursing standardized protocols to include assessment protocols that are sorted, based on symptoms, into low, medium, and high risk categories.
a) Low-risk protocols would allow RNs to manage straightforward symptoms with over-the-counter medications;
b) Medium-risk protocols would require a consultation with a provider prior to treatment; and
c) High-risk protocols would facilitate emergency stabilization while awaiting transfer to higher level of care.
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Reviews of in-custody deaths
1. Preliminary reviews of in-custody deaths shall take place within 30 days of the death and shall include a written report of the circumstances and events leading to the death, with the goal to identify and remedy preventable causes of death and any other potentially systematic problems.
2. Mortality reviews shall include an investigation of the events occurring prior to the death, an analysis of any acts or omissions by any staff or prisoners which might have contributed to the death, and the identification of problems for which corrective action should be undertaken.
Reentry Services
1. The County shall provide a 30-day supply of current medications to patients who have been sentenced and have a scheduled released date, immediately upon release.
2. Within 24 hours of release of any patient who receives prescription medications while in custody and is classified as pre-sentence, the County shall transmit to a designated County facility a prescription for a 30-day supply of the patient’s current prescription medications.
3. The County, in consultation with Plaintiffs, shall develop and implement a reentry services policy governing the provision of assistance to chronic care patients, including outpatient referrals and appointments, public benefits, inpatient treatment, and other appropriate reentry services.
Training
1. The County shall develop and implement, in collaboration with Plaintiffs’ counsel, training curricula and schedules in accordance with the following:
a) All jail custody staff shall receive formal training in medical needs, which shall encompass medical treatment, critical incident response, crisis intervention techniques, recognizing different types of medical emergencies, and acute medical needs, appropriate referral practices, relevant bias and cultural competency issues, and confidentiality standards. Training shall be received every two years, at minimum.
SUICIDE PREVENTION
Substantive Provisions
1. The County recognizes that comprehensive review and restructuring of its suicide assessment, monitoring, and prevention practices are necessary to address the risk of suicide and self-harm attendant to detention in a jail setting.
2. The County shall establish, in consultation with Plaintiffs’ counsel, a new Suicide Prevention Policy that shall be in accordance with the following:
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Training 1. The County shall develop, in consultation with Plaintiffs’ counsel, a four- to
eight-hour pre-service suicide prevention curriculum for new Jail employees (including custody, medical, and mental health staff), to be conducted in person in a classroom or virtual classroom setting, that includes the following topics:
a) avoiding obstacles (negative attitudes) to suicide prevention;
b) prisoner suicide research;
c) why facility environments are conducive to suicidal behavior;
d) identifying suicide risk despite the denial of risk;
e) potential predisposing factors to suicide;
f) high-risk suicide periods;
g) warning signs and symptoms;
h) components of the jail suicide prevention program
i) liability issues associated with prisoner suicide;
j) crisis intervention.
2. The County shall develop, in consultation with Plaintiffs’ counsel, a two-hour annual suicide prevention curriculum for all custody, medical, and mental health staff, to be conducted in person in a classroom or virtual classroom setting, that includes:
a) review of topics (a)-(j) above
b) review of any changes to the jail suicide prevention program
c) discussion of recent jail suicides or attempts
3. Custody officers assigned to Designated Mental Health Units shall receive additional specialized training on suicide prevention and working with prisoners with serious mental illness.
4. All mental health staff, including nurses, clinicians, and psychiatrists, shall receive additional training on how to complete a comprehensive suicide risk assessment and how to develop a reasonable treatment plan that contains specific strategies for reducing future suicidal ideation.
5. All mental health staff and custody officers shall be trained on the appropriate use of safety suits—i.e., not to be utilized as a default, not to be used as a tool in behavior management, not to be utilized for patients being observed at 30minute observations.
6. The County shall ensure that all staff are trained in the new Suicide Prevention Policy.
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Nursing Intake Screening
1. Intake screening for suicide risk will take place at the booking screening and prior to a housing assignment. If clinically indicated, JPS will then perform an additional clinical assessment after the inmate is placed in a housing assignment.
2. All nursing intake screening shall be conducted in an area that provides reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk.
3. The County shall revise its nursing intake assessment procedures and screening forms to ensure timely identification of acute and high-risk mental health conditions, consistent with the recommendations made by Lindsey Hayes. Intake screening, as documented on screening forms, shall include:
a) Review of suicide risk notifications in relevant medical, mental health, and custody records, including as to prior suicide attempts, self-harm, and/or mental health needs;
b) Any prior suicidal ideation or attempts, self-harm, mental health treatment, or hospitalization;
c) Current suicidal ideation, threat, or plan, or feelings of helplessness and/or hopelessness;
d) Other relevant suicide risk factors, such as:
i. Recent significant loss (job, relationship, death of family member/close friend);
ii. History of suicidal behavior by family member/close friend;
iii. Upcoming court appearances;
e) Transporting officer’s impressions about risk.
4. Regardless of the prisoner’s behavior or answers given during intake screening, a mental health referral shall always be initiated if there is a documented history related to suicide or self-harm, including during a prior incarceration.
5. The County shall develop and implement a written policy and procedure for referrals to mental health by intake staff. The policy shall correspond with the triage system and timeframes set forth in the Mental Health Remedial Plan.
6. Any prisoner expressing current suicidal ideation and/or current suicidal/selfinjurious behavior shall be designated as an emergent referral and immediately referred to mental health staff.
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Post-Intake Mental Health Assessment Procedures
1. All mental health assessments shall be conducted in an area that provides reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk.
2. Mental health staff shall conduct assessments within the timeframes defined in the mental health referral triage system.
3. The County shall revise its mental health assessment procedures and related forms to ensure identification of historical and current patient mental health and suicide risk information, consistent with the recommendations of the subject matter expert.
Response to Identification of Suicide Risk or Need for Higher Level of Care
1. When a prisoner is identified as at risk for suicide and placed by custody staff in a safety cell, on suicide precautions, and/or in a safety suit, mental health staff shall be contacted immediately. A qualified mental health professional, or other appropriately trained medical staff in consultation with mental health staff, shall complete a confidential in-person suicide risk assessment as soon as possible, consistent with the “must-see” referral timeline.
2. Consistent with current RCCC policy, if there is no mental health staff on site at RCCC at the time that an emergent mental health need is identified, the prisoner shall be transported to the Main Jail for emergency evaluation within two hours of the initial report.
3. The County shall revise its JPS suicide risk assessment procedures and forms in consultation with Plaintiffs. The County shall ensure that its JPS suicide risk assessment process, policies, and procedures consider and document the following:
a) Review of suicide risk notifications and records from any previous incarcerations at the Jail, including records pertaining to suicide attempts, self-harm, and/or mental health needs;
b) Other prior suicide ideation or attempts, self-harm, mental health treatment or hospitalization;
c) Current suicidal ideation, threat, or plan, or feelings of helplessness and/or hopelessness;
d) Suicide risk factors and protective factors, such as:
i. Recent significant loss (job, relationship, death of family member/close friend);
ii. History of suicidal behavior by family member/close friend;
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iii. Upcoming court appearances;
e) Transporting officer’s impressions about risk;
f) Suicide precautions, including level of observation.
4. The County shall ensure that the meal service schedule or other custody-related activities cause no delay in the completion of suicide risk assessments for prisoners.
Housing of Inmates on Suicide Precautions
1. The County’s policy and procedures shall direct that prisoners, including those identified as being at risk for suicide, be treated in the least restrictive setting appropriate to their individual clinical and safety needs.
Inpatient Placements
1. The County shall ensure that prisoners who require psychiatric inpatient care as clinically indicated are placed in the 2P unit within 24 hours of identification, absent exceptional circumstances. In all cases, the provision of clinically indicated treatment to any prisoner requiring inpatient level of care shall be initiated within 24 hours.
Temporary Suicide Precautions
1. No prisoner shall be housed in a safety cell, segregation holding cell, or other Temporary Suicide Precautions Housing for more than six (6) hours. If mental health or medical staff determine it to be clinically appropriate based on detoxification-related needs, this time limit may be extended to no more than eight (8) hours. If exceptional circumstances prevent transfer within these timelines, those circumstances shall be documented, and transfer shall occur as soon as possible. This does not preclude the housing of a prisoner in the IOP unit if clinically indicated.
2. The County shall ensure, including by revising written policies and procedures where necessary, the timely and adequate completion of medical assessments for prisoners in need of suicide precautions, as required under Operations Order 4/05 (i.e., within 12 hours of placement of the next daily sick call, whichever is earliest, and then every 24 hours thereafter).
3. The County shall ensure that any cell used for holding prisoners on suicide precautions is clean prior to the placement of a new prisoner, as well as cleaned on a normal cleaning schedule.
4. The County shall create and implement a written policy ensuring adequate frequency for meals, fluids, hygiene, showers, prescribed medications, and toileting when a prisoner is in cell used for holding prisoners on suicide precautions.
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5. Inmates on suicide precautions shall not automatically be on lockdown and should be allowed dayroom or out-of-cell access consistent with security and clinical judgments.
6. The classrooms or multipurpose rooms adjacent to the housing units in the Main Jail are designed for, and should be made available for, prisoner programs and treatment. Absent an emergency, the County shall not use the classrooms and multipurpose rooms to hold prisoners pending a mental health evaluation or on suicide precautions. Where such emergency occurs, the County shall document the reasons for retention and move the prisoner, within six (6) hours, to the inpatient unit or other appropriate housing location for continued observation, evaluation, and treatment.
Suicide Hazards in High-Risk Housing Locations
1. The County shall not place prisoners identified as being at risk for suicide or self-harm, or for prisoners requiring IOP level of care, in settings that are not suicide-resistant as consistent with Lindsay Hayes’s “Checklist for the ‘Suicide-Resistant’ Design of Correctional Facilities.”
2. Cells with structural blind spots shall not be used for suicide precaution.
Supervision/Monitoring of Suicidal Inmates
1. The County shall ensure adequate visibility and supervision of prisoners on suicide precautions.
2. The County shall not cover cell windows with magnetic flaps or any other visual barrier preventing visibility into any cell that is housing a prisoner on suicide precautions or awaiting an inpatient bed, unless there is a specific security need and then for only a period of time necessary to address such security need.
3. The County shall revise its policies regarding the monitoring of prisoners on suicide precautions to provide for at least the following two defined levels of observation:
a) Close observation shall be used for prisoners who are not actively suicidal but express suicidal ideation (e.g., expressing a wish to die without a specific threat or plan) or have a recent prior history of selfdestructive behavior. Close observation shall also be used for prisoners who deny suicidal ideation or do not threaten suicide but are engaging in other concerning behaviors indicating the potential for self-injury. Staff shall observe the prisoner at staggered intervals not to exceed every 15 minutes and shall document the observation as it occurs.
b) Constant observation shall be used for prisoners who are actively suicidal, either threatening or engaging in self-injury, and considered a high risk for suicide. An assigned staff member shall observe the
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prisoner on a continuous, uninterrupted basis. The observation should be documented at 15-minute intervals. Staff should be physically stationed outside of the prisoner’s cell to permit continuous, uninterrupted observation.
4. For any prisoner requiring suicide precautions, a qualified mental health professional shall assess, determine, and document the clinically appropriate level of monitoring based on the prisoner’s individual circumstances. Placement in a safety cell shall not serve as a substitute for the clinicallydetermined level of monitoring.
5. Video monitoring of prisoners on suicide precaution shall not serve as a substitute for Close or Constant observation.
Treatment of Inmates Identified as at Risk Of Suicide
1. Qualified mental health professionals shall develop an individualized treatment plan and/or behavior management plan for every prisoner that mental health staff assesses as being a suicide risk.
2. Treatment plans shall be designed to reduce suicide risk and shall contain individualized goals and interventions. Treatment plans shall be reviewed following discharge from suicide precautions and updated as clinically indicated.
3. All assessments, treatment, and other clinical encounters shall occur in an area that provides reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk.
Conditions for Individual Inmates on Suicide Precautions
1. The County’s Suicide Prevention Policy shall set forth clear and internally consistent procedures regarding decisional authority for determining the conditions for individual inmates on suicide precautions. Mental health staff shall have primary authority, consistent with individualized classification and security needs, with respect to the following:
Property and Privileges
1. Qualified mental health professionals shall have the primary responsibility to determine, based on clinical judgment and on a case-by-case basis in consultation with custody staff, depending on suicide risk, the removal and/or return of routine privileges (e.g., visits, telephone calls, recreation) that are otherwise within the limitations of a prisoner’s classification security level. Any removal of privileges shall be documented with clinical justification in the prisoner’s medical/mental health record and reviewed on a regular basis.
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2. Qualified mental health professionals shall have the primary responsibility to determine, based on clinical judgment and on a case-by-case basis in consultation with custody staff depending on suicide risk, the removal and/or return of a prisoner’s clothing and possessions (e.g., books, slippers/sandals, eyeglasses) that are otherwise within the limitations of a prisoner’s classification security level. The removal of property shall be documented with clinical justification in the prisoner’s medical/mental health record and reviewed on a regular basis.
3. Cancellation of privileges should be avoided whenever possible and utilized only as a last resort.
Use of Safety Suits
1. Decisions about the use of a safety suit (smock) or removal of normal clothing will be under mental health staff’s authority, based on individualized clinical judgment along with input from custody staff.
2. Custody staff may only temporarily place an inmate in a safety suit based on an identified risk of suicide by hanging until the qualified mental health professional’s evaluation, to be completed within the “must see” referral timeline. Upon completion of the mental health evaluation, the mental health professional will determine whether to continue or discontinue use of the safety suit.
3. If an inmate’s clothing is removed, the inmate shall be issued a safety suit and safety blanket.
4. As soon as clinically appropriate, the provision of regular clothing shall be restored. The goal shall be to return full clothing to the inmate prior to discharge from suicide precautions.
5. A qualified mental health professional shall conduct daily assessments of any prisoner in a safety suit and document reasons for continued use when clinically indicated.
6. If a qualified mental health professional determines that 30-minute (or less frequent) observations are warranted for a prisoner, safety suits shall not be used on that prisoner.
7. Safety suits shall not be used as a tool for behavior management or punishment.
Beds and Bedding
1. All prisoners housed for more than four hours on suicide precautions and/or in an inpatient placement shall be provided with an appropriate bed, mattress, and bedding unless the prisoner uses these items in ways for which they were not intended (e.g., tampering or obstructing visibility into the cell). Such a determination shall be documented and shall be reviewed on a regular basis.
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Discharge from Suicide Precautions
1. A qualified mental health professional shall complete and document a suicide risk assessment prior to discharging a prisoner from suicide precautions in order to ensure that the discharge is appropriate and that appropriate treatment and safety planning is completed.
2. Treatment plans shall be written for all prisoners discharged from suicide precautions. The treatment plan shall describe signs, symptoms, and circumstances in which the risk for suicide is likely to recur, how recurrence of suicidal thoughts can be avoided, and actions the patient or staff can take if suicidal thoughts do occur.
3. Qualified mental health professionals shall provide clinical input regarding clinically appropriate housing placement (e.g., whether isolation is contraindicated for the prisoner) upon discharge. Custody and classification shall consider such clinical input in determining post-discharge placement and conditions of confinement. Once clinically discharged from suicide precautions, the prisoner shall be promptly transferred to appropriate housing.
4. Prisoners discharged from suicide precautions shall remain on the mental health caseload and receive regularly scheduled clinical assessments and contacts. Unless a prisoner’s individual circumstances direct otherwise, a qualified mental health professional shall provide follow-up assessment and clinical contacts within 24 hours of discharge, again within 72 hours of discharge, again within one week of discharge.
Emergency Response
1. The County shall keep an emergency response bag that includes appropriate equipment, including a first aid kit, CPR mask or Ambu bag, and emergency rescue tool in close proximity to all housing units. All custodial and medical staff be trained on the location of this emergency response bag and shall receive regular training on emergency response procedures, including how to use appropriate equipment.
2. All custody and medical staff shall be trained in first aid and CPR.
3. It shall be the policy of the County that any staff who discovers an inmate attempting suicide shall immediately respond, survey the scene to ensure the emergency is genuine, and alert other staff to call for medical personnel. Trained staff shall begin to administer standard first aid and/or CPR, as appropriate.
Quality Assurance and Quality Improvement
1. The County shall establish regularly scheduled multidisciplinary meetings related to treatment, and plan of care issues, on a monthly basis, between medical, and mental health personnel.
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2. The County shall, in consultation with Plaintiffs’ counsel, revise its in-custody death review policy and procedures. Reviews shall be conducted with the active participation of custody, medical, and mental health staff. Reviews shall include analysis of policy or systemic issues and the development of corrective action plans when warranted.
3. For each suicide and serious suicide attempt (e.g., requiring hospitalization), the County’s Suicide Prevention Task Force shall review: 1) the circumstances surrounding the incident; 2) the procedures relevant to the incident; 3) all relevant training received by involved staff; 4) pertinent medical and mental health services/reports involving the victim; and 5) any possible precipitating factors that may have caused the victim to commit suicide or suffer a serious suicide attempt. Where applicable, the Review Team shall generate recommendations for changes in policy, training, physical plant, medical or mental health services, and operational procedures.
4. The County will track all critical incidents which include prisoner suicides, attempted suicides, and incidents involving serious self-harm. The County shall review critical incidents and related data through its quality assurance and improvement processes.
5. The County shall implement a continuous quality assurance/quality improvement plan to periodically audit suicide prevention procedures that include, but are not limited to: intake screening (to include audits to ensure that staff ask and record all suicide screening questions), mental health assessments, suicide risk assessments, crisis response, and treatment plans/behavior management plans for prisoners identified as being at risk of suicide or self-harm.
SEGREGATION/RESTRICTIVE HOUSING
General Principles
1. Prisoners will be housed in the least restrictive setting necessary to ensure their own safety, as well as the safety of staff, other prisoners, and the public.
a) The County shall not place prisoners in more restrictive settings, including Segregation, based solely on a mental illness or any other disability. Prisoners will be housed in the most integrated setting appropriate to their individual needs.
b) The County shall not place prisoners into Segregation units based solely on classification score.
c) The County shall review the housing and restrictions of female prisoners classified as high security to ensure that this population is not subject to Segregation conditions of confinement.
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d) Specialized medical units (e.g., Main Jail 2 West Med/Psych, Main Jail 2 East) and mental health units (e.g., OPP, IOP, MHU, 2P) are not Segregation housing units. The County shall ensure that prisoners housed in these units receive daily access to out-of-cell time, telephones, showers, and other programs, services, and activities consistent with their classification and treatment plan.
2. The County shall not place a prisoner in Segregation units without first determining that such confinement is necessary for the safety of the staff, other prisoners, or the public. The County shall clearly document in writing the specific reason(s) for a prisoner’s placement and retention in Segregation housing. The reason(s) shall be supported by clear, objective evidence. Prisoners will remain in Segregation housing for no longer than necessary to address the reason(s) for placement.
3. The County shall not place the following prisoners in a Segregation setting unless necessary to address a serious risk of physical harm, and in such cases only for the minimum time necessary to identify an alternative appropriate placement:
a) Prisoners with acute medical needs that require an inpatient level of care and/or daily nursing care;
b) Prisoners who are pregnant, post-partum, who recently had a miscarriage, or who recently had a terminated pregnancy.
Conditions of Confinement
1. The County will provide at least 17 hours of out-of-cell time per week for all prisoners, with the exception of prisoners subject to Administrative Segregation Phase I and Disciplinary Segregation in accordance with this remedial plan. The County will monitor out-of-cell time, and if minimum outof-cell time requirements are routinely not being met at a particular facility or in a particular housing unit, the Sheriff’s Department division commander or designee will review the situation and take appropriate steps to resolve the issue.
a) The County shall implement a policy to document out-of-cell time provided to each prisoner. The County shall conduct monthly audits to ensure that prisoners have been provided the required treatment and recreation time out of cell. This data will be regularly reviewed as part of the County’s Quality Assurance procedures.
2. Out-of-cell time with the opportunity to exercise shall be provided to each prisoner seven (7) days per week, including outdoors/recreation time when feasible. The County shall offer out-of-cell time at appropriate times of day.
3. The County shall modify its non-disciplinary Segregation policies and procedures to allow reasonable access to the following: (1) Personal phone
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calls for all prisoners, including at least five hours or three weekdays per week of phone access during normal business hours; (2) Education, rehabilitation, and other materials (e.g. writing implements, art supplies, tablets), for in-cell activities; (3) Personal and legal visiting; (4) Religious services; and (5) Commissary.
a) The conditions and privileges described above shall be provided unless there is a specific safety or security issue preventing provision of such materials or the prisoner is subjected to disciplinary action.
4. Cell windows shall not be covered with magnetic flaps, towels, sheets, or any other visual barrier preventing visibility into and out of the cell, unless there is a specific security or privacy need that is documented, and then for only a period of time necessary to address such security or privacy need. This provision shall apply to all cells housing prisoners.
5. The County shall establish procedures so that all housing unit cells are searched and cleaned prior to a prisoner’s placement in the cell.
6. The County shall establish procedures to ensure that no prisoner is placed in a Segregation housing cell without a mattress and appropriate bedding.
Mental Health Functions in Segregation Units
1. Segregation Placement Mental Health Review
a) All prisoners placed in a non-disciplinary Segregation housing unit and all prisoners housed in a Disciplinary Detention unit shall be assessed by a qualified mental health professional within 24 hours of placement to determine whether such placement is contraindicated. All prisoners subjected to Disciplinary Segregation conditions for 72 hours in their general population housing unit (i.e., confined to cell 23 hours per day) shall also be assessed by a qualified mental health professional no later than the fourth day of such placement.
b) Any decision to place prisoners with Serious Mental Illness in Segregation shall include the input of a qualified mental health professional who has conducted a clinical evaluation of the prisoner in a private and confidential setting (absent a specific current risk that necessitates the presence of custody staff), is familiar with the details of the available clinical history, and has considered the prisoner’s mental health needs and history.
c) Mental Health Staff shall consider each prisoner’s age and cognitive functioning as part of the Segregation Placement review. Staff shall receive training regarding the features of youth and brain development of young adults (i.e., 24 years old and younger) and the needs of individuals with intellectual disabilities.
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d) If mental health or medical staff find that a prisoner has a Serious Mental Illness or has other contraindications to Segregation, that prisoner shall be removed from Segregation absent exceptional and exigent circumstances.
e) The County shall document and retain records of all Segregation Placement mental health evaluations, as described above. The County shall consult with Plaintiffs regarding such documentation, including the development of new forms where necessary.
2. Segregation Rounds and Clinical Contacts
a) Cell checks (to ensure that prisoners are safe and breathing) shall be conducted for all prisoners in Segregation at least every 30 minutes, at staggered intervals. Completion of cell checks will be timely documented.
b) A qualified mental health or medical professional shall conduct checkins at least once a week, to assess and document the health status of all prisoners in Segregation, and shall make referrals as necessary. The check-in shall include a brief conversation with each prisoner, a visual observation of the cell, and an inquiry into whether the prisoner would like to request a confidential meeting with a mental health or medical provider. Steps shall be taken to ensure effective communication, as well as auditory privacy consistent with security needs. When a prisoner in Segregation requests a confidential meeting with a mental health or medical provider, or the medical or mental health professional identifies a mental health or medical need, staff shall make appropriate arrangements to include triage, examination and treatment in an appropriate clinical setting. In such cases, staff shall give the prisoner the opportunity to complete a health care request but will otherwise initiate a referral without requiring the prisoner to complete a request form.
3. Response to Decompensation in Segregation
a) If a prisoner in Segregation develops signs or symptoms of mental illness where such signs or symptoms had not previously been identified, suffers deterioration in his or her mental health, engages in self-harm, or develops a heightened risk of suicide, the prisoner shall immediately be referred for appropriate assessment and treatment from a qualified mental health professional who will recommend appropriate housing and/or programming.
b) Jail staff shall follow a mental health recommendation to remove a prisoner from Segregation unless such removal poses a current safety risk that is documented. In such a case, the Commander or management-
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level designee shall be notified and staff shall work to remove the prisoner from Segregation and secure a placement in an appropriate treatment setting at the earliest possible time.
Placement of Prisoners with Serious Mental Illness in Segregation
1. Prisoners with a mental health condition meeting criteria for placement in a Designated Mental Health Unit (2P, IOP, OPP) will not be placed in Segregation, but rather will be placed in an appropriate treatment setting – specifically, the inpatient unit or other Designated Mental Health Unit providing programming as described in Exhibit A-2.
2. In rare cases where a prisoner with a mental health condition meeting criteria for placement in a Designated Mental Health Unit presents an immediate danger or significant disruption to the therapeutic milieu, and there is no reasonable alternative, such a prisoner may be housed separately for the briefest period of time necessary to address the issue, subject to the following:
a) The prisoner shall receive commensurate out-of-cell time and programming as described in Exhibit A-2 (including for IOP and OPP, 10 hours/week of group treatment/structured activities, 7 hours/week unstructured out-of-cell time, weekly individual clinical contact) with graduated programming subject to an individualized Alternative Treatment Program.
b) The prisoner shall receive the following:
i. As part of the weekly confidential clinical contact, the clinician shall assess and document the prisoner’s mental health status and the effect of the current placement on his or her mental health, and determine whether the prisoner has decompensated or is at risk of decompensation.
ii. The weekly check-ins described in Section VIII.C.2.b shall supplement, and not be a substitute for, the weekly treatment session described herein.
iii. Treatment provided in the least restrictive setting that is appropriate based on the prisoner’s circumstances.
iv. Privileges commensurate with the Designated Mental Health Unit program, unless modified in an Alternative Treatment Program based on individual case factors that are regularly reviewed.
v. Daily opportunity to shower.
3. A prisoner with Serious Mental Illness requiring restraints (e.g., handcuffs, belly chains, etc.) shall not be denied clinically indicated group or individual treatment due to security factors, absent exceptional circumstances that are
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documented. Prisoners with Serious Mental Illness housed in Segregation who require restraints when out of cell shall have the opportunity to work their way out of restraints through graduated programming subject to an individualized Alternative Treatment Program.
Administrative Segregation
1. Use of Administrative Segregation
a) Only the Classification Unit can assign a prisoner to Administrative Segregation.
b) The County may use Administrative Segregation in the following circumstances:
i. Objective evidence indicates that a prisoner participated in a recent assault and the assaultive behavior involved an assault on staff or visitors, serious injury, use of a weapon, gang removals, or multiple prisoner assaults. Mutual combat situations that do not otherwise qualify for Administrative Segregation are excluded.
ii. During a brief investigative period not to exceed ten days while Classification staff attempts to verify the need for Protective Custody or while the prisoner is awaiting transfer to another facility.
c) The Compliance Commander shall have the authority to place prisoners in Administrative Segregation under the following circumstances:
i. The prisoner poses an extraordinary safety risk and no other housing unit is sufficient to protect the prisoner from harm;
ii. The prisoner has failed to integrate into a lesser restrictive housing setting because of repeated and recent history of assaultive behavior or current threats of violence associated with being in a lesser restrictive setting; or
iii. Objective evidence indicates that the prisoner attempted to escape or presents an escape risk.
2. Notice, Documentation, and Review of Administrative Segregation Designations
a) The Classification Unit shall document the rationale for designating a prisoner for Administrative Segregation in the classification file using objective evidence. For prisoners younger than 24, the Classification Unit shall consider the prisoner’s age as a mitigating factor when assigning the prisoner to Administrative Segregation.
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b) Classification shall attempt to down-class prisoners to a lesser restrictive housing setting at the earliest possible opportunity, consistent with safety and security.
c) County shall provide prisoners in Administrative Segregation with a written notice within 72 hours of the prisoner’s initial placement in Administrative Segregation, explaining the reasons for the prisoner’s Administrative Segregation designation and how the prisoner may progress to a lesser restrictive housing setting.
d) Prisoners housed in Segregation units will, at least every thirty (30) days, receive face-to-face interviews in a private out-of-cell setting, consistent with individual security needs, to discuss progress and compliance with their individual case plan as part of a classification review. Consideration will be given to their mental health and to their appropriateness for transfer to a less restrictive setting.
e) The Compliance Commander or higher-ranked officer will review and approve the decision to designate a prisoner for Administrative Segregation for longer than 15 days.
f) The County shall document the reason the prisoner is retained in the same Administrative Segregation Phase. The prisoner will be given written notice of the reasons the prisoner is being retained in the same Phase of Administrative Segregation and what conduct the prisoner is required to exhibit to progress to a lesser restrictive housing setting.
g) The Compliance Commander or higher-ranked officer must approve the continued retention of a prisoner in Administrative Segregation for longer than 90 days, and the Compliance Commander or higher-ranked officers must reauthorize such placement at least every 90 days thereafter.
3. Administrative Segregation Phases
a) The County shall develop and implement a phased system for prisoners designated as Administrative Segregation to achieve a lesser restrictive housing setting.
b) Administrative Segregation Phase I:
i. This is the most restrictive designation for prisoners in Administrative Segregation.
ii. Prisoners shall be offered a minimum of one hour per day out of cell time for a total of seven hours per week.
iii. Prisoners shall be offered an opportunity for Out-of-Cell Activities for at least five of the seven hours per week.
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iv. Prisoners shall not remain in Phase I for longer than 15 days unless the prisoner engages in new conduct warranting retention in Administrative Segregation as specified in Section VIII.E.1.b.
c) Administrative Segregation Phase II:
a) Prisoners shall be offered a minimum of 17 hours of out of cell time per week.
b) Prisoners shall be offered an opportunity for Out-of-Cell Activities for at least 10 of the 17 hours per week.
c) Prisoners shall be offered the opportunity to program in groups of two to four prisoners, unless pairing with another prisoner is not possible for safety or security reasons, and those reasons are documented by the County.
d) The County shall develop a program of incentives for good behavior.
e) Prisoners shall not remain in Phase II for longer than 30 days unless the prisoner commits a serious behavioral violation while in Administrative Segregation: fighting; threatening staff or other prisoners; resisting or delaying an order from staff that impedes Jail operations (e.g., failure to lock down); refusing to submit to a search of person or property; destroying or damaging Jail property (excluding property issued to a prisoner and/or minor defacing of property or destruction of low-value property) or facilities; possessing contraband that implicates safety or security (e.g., weapons, razors, unauthorized medication, but not extra clothing, commissary items, or food); cell flooding; tampering with cell locking mechanisms or other security features (e.g., cameras); and/or sexual activity/harassment. In the event a prisoner engages in a serious behavioral violation, the conduct will be referred to the Classification Sergeant or higher-ranking officer, who shall have the discretion to extend the prisoner’s Phase II time by 15 days, and shall develop an individual behavioral management plan, if one does not yet exist, for the prisoner.
Protective Custody
1. When a prisoner faces a legitimate threat from other prisoners, the County will seek alternative housing, by transferring the threatened prisoner to the general population of another facility or unit, or to a special-purpose housing (Protective Custody) unit for prisoners who face similar threats.
2. The County will not operate Protective Custody units with Segregation-type conditions of confinement. Prisoners placed in Protective Custody shall have
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the same programs and privileges as general population prisoners, absent exceptional circumstances that are documented.
3. The County shall create a policy that describes the process and criteria for placement of prisoners into Protective Custody. The County shall consult with Plaintiffs to develop such a policy.
4. Prisoners who are lesbian, gay, bisexual, transgender, or intersex (LGBTI) or whose appearance or manner does not conform to traditional gender expectations should not be placed in Segregation or Protective Custody solely on the basis of such identification or status, or because they are receiving gender dysphoria treatment.
a) When a prisoner who is LGBTI or gender nonconforming faces a legitimate threat, the County shall identify alternative housing, with conditions comparable to those of general population. Privileges and out-of-cell time for this population will be documented and regularly reviewed by supervisory level staff to ensure appropriate housing, outof-cell-time, and related conditions for this group of prisoners.
b) In deciding whether to assign a transgender or intersex prisoner to a facility or program for male or female prisoners, the County shall consider on a case-by-case basis whether a placement would ensure the prisoner’s health and safety, and the health and safety of other prisoners, giving serious consideration to the prisoner’s own views.
c) Jail staff will receive training on the unique issues of managing transgender prisoners, with refresher training at least bi-annually.
5. For prisoners who are LGBTI or whose appearance or manner does not conform to traditional gender expectations, the County shall identify the prisoner’s preferred gender of jail staff who will perform searches of the prisoner. The County shall honor the request except in exigent circumstances when doing so is not possible.
Disciplinary Segregation
1. The County will not place a prisoner in disciplinary housing pending investigation of, and due process procedures for, an alleged disciplinary offense unless the prisoner’s presence in general population would pose a danger to the prisoner, staff, other prisoners or the public.
2. The County will adhere to a discipline matrix, developed in consultation with Plaintiffs, that clearly defines when disciplinary housing may be imposed.
3. Prisoners who are found to have violated disciplinary rules following due process procedures will be placed in Segregation only after the County has determined that other available disciplinary options are insufficient, with reasons documented in writing.
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4. The denial of out-of-cell time for more than four (4) hours will not be imposed as a sanction absent a formal disciplinary write-up and due process hearing.
5. Prisoners serving a Disciplinary Segregation term shall receive at least seven (7) hours per week of out-of-cell time. Out-of-cell time with the opportunity to exercise shall be provided to each prisoner one (1) hour a day, seven (7) days per week.
6. Prisoners in Disciplinary Segregation shall, absent an individualized assessment of security risk that is documented be provided at least one book (which prisoners may regularly exchange), legal documents, hygiene materials, legal phone calls, and legal visits.
7. No Disciplinary Segregation term for non-violent rules violations will exceed 15 days.
8. The County will, in consultation with Plaintiffs’ counsel, modify its inmate discipline policy and practice to limit placements in Disciplinary Segregation conditions to no more than 15 days, absent cases of serious violations stemming from distinct incidents and with Watch Commander-level approval.
9. No prisoner shall be placed in Disciplinary Segregation for more than 30 consecutive days.
10. If after a Disciplinary Segregation term, Jail staff, with the input of a mental health clinician, determine that the prisoner cannot safely be removed from Segregation, placement on Administrative Segregation status may occur only subject to the process set forth in Section VIII.E.
11. Once a prisoner has been moved out of Disciplinary Segregation, that prisoner shall not be placed back into Disciplinary Segregation absent (a) a new incident warranting discipline, and (b) completion of all mental health review procedures required for new Segregation placements.
Avoiding Release from Jail Directly from Segregation
1. The County will avoid the release of prisoners from custody directly from Segregation-type housing, to the maximum extent possible.
2. If a sentenced prisoner housed in Segregation has an upcoming expected release date (i.e. less than 120 days), the County will take and document steps to move the prisoner to a less restrictive setting, consistent with safety and security needs. If Segregation becomes necessary during this time, the County will provide individualized discharge planning to prepare the sentenced prisoner for release to the community.
No Food-Related Punishment
1. The County shall modify its policy and take steps to ensure that the denial or modification of food is never used as punishment. The County shall eliminate
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use of “the loaf” as a disciplinary diet. Nothing in this paragraph shall be read to preclude the County from denying a prisoner use of the commissary. Restraint Chairs 1. Restraint chairs shall be utilized for no more than six hours. 2. The placement of a prisoner in a restraint chair shall trigger an “emergent” mental health referral, and a qualified mental health professional shall evaluate the prisoner to assess immediate and/or long-term mental health treatment needs. 3. The opinion of a qualified medical professional on placement and retention in a restraint chair will be obtained within one hour from the time of placement. QUALITY ASSURANCE SYSTEMS FOR HEALTH CARE TREATMENT Generally 1. The County shall develop and implement, in collaboration with Plaintiffs’ counsel, a quality assurance (“QA”) plan to regularly assess and take all necessary measures to ensure compliance with the terms of this Remedial Plan. 2. The QA/QI Unit shall meet regularly and include representatives from all levels of the organization and from all facilities. The meeting shall include custody representatives for topics that are relevant to custody operations. 3. The County shall provide sufficient resources to the QA/QI program. Quality Assurance, Mental Health Care 1. The JPS Medical Director, the JPS Program Manager, jail administrators, and the medical psychiatric, dental, and nursing directors, or appropriate designees, will attend and participate in this process at a minimum of every quarter. Formal minutes will be taken and maintained whenever the committee convenes. 2. The mental health care quality assurance plan shall include, but is not limited to, the following:
a) Intake processing; b) Medication services; c) Screening and assessments; d) Use of psychotropic medications; e) Crisis response; f) Case management; g) Out-of-cell time; h) Timeliness of clinical contacts;
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i) Provision of mental health evaluation and treatment in confidential settings;
j) Housing of inmates with SMI, including timeliness of placements in higher levels of care and length of stay in various units;
k) Number of commitments pursuant to Welf. & Inst. Code § 5150, et seq.; l) Use of restraint and seclusion; m) Tracking and trending of agreed upon data on a quarterly basis; n) Clinical and custody staffing; o) Morbidity and mortality reviews with critical analyses of causes or
contributing factors, recommendations, and corrective action plans with timelines for completion; and p) Corrective action plans with timelines for completion to address problems that arise during the implementation of this Remedial Plan and prevent those problems from reoccurring. 3. The County will conduct peer and supervisory reviews of all mental health staff and professionals at least annually to assess compliance with policies and procedures and professional standards of care. Quality Assurance, Medical Care 1. The County shall establish a Quality Assurance/Quality Improvement (QA/QI) Unit to develop accurate tracking mechanisms and monitor the timeliness and effectiveness of the following processes of health care, ensuring that all are reviewed at least annually, and shall recommend corrective action for all deficiencies: a) intake screenings; b) emergent, urgent, and routine requests from patients and staff referrals for health care, including Health Service Request availability; c) clinical monitoring of patients, including the delivery of chronic care services to those patients who qualify as chronic care patients; d) prescriptive practices by the prescribing staff; e) medication administration, including the initiation of verified medications, the first doses of medications, medication errors, patient refusals, and patterns of medication administration; f) grievances regarding healthcare; g) specialty care (including outside diagnostic tests and procedures); h) clinical caseloads;
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 78 of 119 i) coordination between custody staff and medical staff, including escorts to medical appointments and delivery of care.
2. The studies shall be done with sufficient sample numbers to arrive at statistically valid conclusions. The studies shall include (a) a clearly articulated goals, objective, and methodology to determine if standards have been met, including a sampling strategy; (b) data collection; (c) analysis of data to identify trends and patterns; (d) analysis to identify the underlying causes of problems; (e) development of remedies to solve problems; (f) a written plan that identifies responsible staff and establishes a specific timeline for implementing remedies; (g) follow-up data collection; and (h) analysis to determine if the remedies are effective.
3. The QA/QI Unit study recommendations shall be published to all staff. 4. The County will conduct peer and supervisory reviews of all medical staff and
professionals at least annually to assess compliance with policies and procedures and professional standards of care.
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EXHIBIT A-1
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 80 of 119
EXHIBIT A-1 ADA COMPLIANCE REMEDIAL PLAN Sacramento County Jail – Policies Warranting ADA-Related Revisions
SHERIFF’S DEPARTMENT OPERATIONS ORDERS 02/01 Use of Force
Effective Communication Procedures for Prisoners Manifesting Serious Mental Illness 02/02 Use of Restraint Devices Effective Communication Mobility-Related Disability Accommodations 02/03 Use of Pro-Straint Chair Effective Communication Mobility-Related Disability Accommodations 02/05 CERT and Cell Extraction Procedures Effective Communication Identification and Tracking of ADA Needs and Accommodations Procedures for Prisoners Manifesting Serious Mental Illness 02/06 Prisoner Searches Effective Communication Identification and Tracking of ADA Needs and Accommodations 02/12 Transportation of Prisoners Mobility-Related Disability Accommodations, HCA/AD/DME 03/12 Evacuation Plan - Main Jail Provision of ADA Reasonable Accommodations 03/13 Evacuation Plan – RCCC Provision of ADA Reasonable Accommodations

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 81 of 119
Sacramento County Jail – Policies to Revise re ADA Page | 2
04/01 Intake, Search, Reception and Holding Identification and Tracking of ADA Needs and Accommodations Effective Communication
04/08 Prisoner Orientation Effective Communication ADA Coordinator and Disability-Related Grievance and Accommodation Process
04/09 Release Procedures HCA/AD/DME, Provision of ADA Reasonable Accommodations Effective Communication
06/02 Housing Plan Identification and Tracking of ADA Needs and Accommodations Equal Access
06/10 Recreation, Exercise and Showering Equal Access Mobility-Related Disability Accommodations Staff Assistance of Inmates with Disabilities
06/13 Telephone/TDD/TTY Equipment Access Equal Access Effective Communication Video Relay Services/Videophones
06/14 Interpreter Services Identification and Tracking of ADA Needs and Accommodations Updates as to Provision of Sign Language Interpreter Procedures
07/01 Inmate Message Requests (KITE’s)

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Sacramento County Jail – Policies to Revise re ADA Page | 3
ADA Coordinator and Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 07/02 Grievances ADA Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 07/03 Discipline Plan Effective Communication Coordination with JPS, Consideration of Mental Health/Intellectual Disability Factors Identification and Tracking of ADA Needs and Accommodations 08/04 Educational Services Equal Access. Reasonable Accommodations Effective Communication 08/06 Prisoner Services Equal Access 10/01 Health Care Services Identification and Tracking of ADA Needs and Accommodations Effective Communication 10/04 Medical Intake Screening Identification and Tracking of ADA Needs and Accommodations Effective Communication

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Sacramento County Jail – Policies to Revise re ADA Page | 4
CORRECTIONAL HEALTH SERVICES POLICIES AND PROCEDURES 1107 Decision Making-Special Needs
Identification and Tracking of ADA Needs and Accommodations Prisoners with ID/DD 1302 Staff Development and Training General ADA Requirements Identification and Tracking of ADA Needs and Accommodations Effective Communication ADA Coordinator and Disability-Related Grievance and Accommodation Process 1400 Medical Transportation Mobility-Related Disability Accommodations, HCA/AD/DME 1404 Receiving Screening Identification and Tracking of ADA Needs and Accommodations Effective Communication Prisoners with ID/DD 1407 Access to Treatment ADA Coordinator and Disability-Related Grievance and Accommodation Process Effective Communication 1409 Clinic Care Equal Access Staff Assistance of Inmates with Disabilities 1413 Use of Restraints and the Pro-Straint Chair Identification and Tracking of ADA Needs and Accommodations Effective Communication

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Sacramento County Jail – Policies to Revise re ADA Page | 5
Mobility-Related Disability Accommodations 1417 Adult Developmental Disability
Updates to Policy Consistent with Remedial Plan 1423 Post Release Medical Care Planning
HCA/AD/DME 1435 Inmate Health Care Grievances
Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 1436 Two East Inmate Transfers Equal Access Disability-Related Grievance and Accommodation Process 1439 Reports of Disabilities or Impairments Identification and Tracking of ADA Needs and Accommodations

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 85 of 119
Sacramento County Jail – Policies to Revise re ADA Page | 6
JAIL PSYCHIATRIC SERVICES POLICIES 800 Discharge Planning
Effective Communication 1022 Overview of Staff Responsibilities
Updates Pursuant to Mental Health Remedial Plan, ADA Remedial Plan, Mental Health/Disciplinary Measures Remedial Plan Effective Communication 1025 Interpreters for the Hearing Impaired Identification and Tracking of ADA Needs and Accommodations Updates as to Provision of Sign Language Interpreter Procedures 1037 Outpatient Intake Identification and Tracking of ADA Needs and Accommodations Effective Communication 1049 Suicide Prevention Program Effective Communication

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EXHIBIT A-2
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 87 of 119
MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
INTENSIVE OUTPATIENT PROGRAM (Projected - 85 to 120 beds)
Caseload of 10 per LCSW/MSW
I. Admission Criteria x The presence of suicidal ideations without a plan or intent and requiring enhanced observation and safety measures; x 2P Pre-Admissions who require 1:1 observation for acute suicidal ideations and/or attempts (with placement in inpatient unit within 24 hours of identified inpatient need); x Discharge from the Acute Inpatient Unit upon recommendation of discharging Psychiatrist; x Acute onset or significant decompensation of a serious mental illness characterized by increased delusional thinking, hallucinatory experiences, marked changes in affect, and vegetative signs with definitive impairment of reality testing and/or judgment; and/or x Inability to function in General Population (GP) or Outpatient Psychiatric Pod (OPP) and, i. The presence of dysfunctional or disruptive social interaction including withdrawal, bizarre or disruptive behavior, inability to respond to staff directions, provocative behavior toward others, inappropriate sexual behavior, etc., as a consequence of serious mental illness; and/or ii. A significant impairment in the activities of daily living including eating, grooming and personal hygiene, maintenance of housing area, and ambulation, as a consequence of serious mental illness.
II. Service Components x Case Management provided by LCSW or MSW. x Two (2), one (1)-hour Group Therapy Sessions per day, 5 days a week, will be offered to each inmate-patient, unless clinical indicators or Alternative Treatment Plan (see below) precludes participation. x At least seven (7) hours of unstructured out-of-cell time per week x 1:1 confidential contact with a mental health professional every 7 days or more often if clinically indicated. x Psychological testing as clinically indicated. x Graduated Programming for inmate-patients requiring restrictive housing and/or restriction of privileges due to severity of symptoms and/or behaviors and/or classification. Alternative Treatment Program (ATP) will be initiated and documented in Treatment Plan. ATP will address barriers to treatment, ATP goals and progress toward least restrictive housing and/or privileges. ATP will provide clear system of opportunities for inmate-patients to gain additional
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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
privileges based on progress in program. x Multi-Disciplinary Treatment Team (MDT) Meetings (Initial 14 day and then
every 60 days or sooner if clinically indicated). x Treatment Plan initiated within 14 days of IOP placement and then every 60 days
or sooner if clinically indicated. x Initial MD or NP assessment within 5 days of admit and then every 30 days
thereafter (or more often if clinically indicated). x Staggered 30-minute cell checks performed by Custody for all inmate-patients
participating in the program. x Designated Custody Staff who participate as part of the MDT. x Treatment planning when moving to less intensive level of mental health care. x Discharge planning and continuity of care with community providers
III. Treatment Goals Treatment goals will address mental health conditions which are limiting an inmate's ability to adjust to incarceration and focus on symptom reduction and management, coping skills and stress reduction. Treatment goals may include: x Medication compliance (if applicable) x Substance Abuse Recovery/Prevention x Activities of Daily Living (ADL) Skill Development x Crisis intervention/Adjusting to incarceration x Symptom reduction x Socialization and recreation x Behavior management (if applicable) x Coping skills x Stress reduction x Return to GP-MHC or OPP-MHC
IV. IOP Officers (24/7 Coverage)
Designated IOP Officers will be active members of the treatment team. In order for the Officers to take active roles in treatment, dayshift Officers must participate in weekly (or more often if needed) treatment team meetings with JPS staff and contribute information on inmate-patient behavior (both directly observed, and communicated by night shift deputies).

Duties and Responsibilities of the IOP Officers include:

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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
x Staggered 30-minute safety checks of all inmate-patients housed in the IOP. x Daily security checks. Inmate movements to, from, and within the facility. x Oversight of food delivery. x Oversight of medical, dental, and psychiatric requests/services. x Oversight of daily indoor and outdoor recreation. x Housing moves and inmate conflict mediation. x Incident investigation/documentation for both jail and criminal level offenses.
The IOP Officer also has additional program specific duties which include: x Ensuring the safety and security of the JPS/IOP civilian staff. x Inmate-patient movement to/from groups and individual contacts with JPS/IOP staff. If needed, Officers will stand by while the civilian staff conducts daily group therapy (two to three hours each day) and separate one-to-one therapy/education sessions. x Daily cell inspections. x Provide IOP inmate-patients with the opportunity or assistance needed to meet their basic hygiene needs and the opportunity to maintain clean cells and activity/housing areas.
V. Discharge Criteria x Able to function in a GP-MHC or OPP-MHC setting. x Stabilization of the crisis behavior and the ability to function in a less clinically structured environment. x Has clinically decompensated to the extent that placement into the Acute Inpatient Unit is required. x Has reached release date, and clinical services will be transferred to community service provider.
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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

OUTPATIENT PSYCHIATRIC POD (PROJECTED - 200 BEDS)

Caseload of 25 per LCSW/MSW

I.

Admission Criteria

x Qualifying diagnosis (see below) and are unable to house in general population

due to severity of symptoms, potential for victimization and/or significant

difficulty maintaining ADLs.

x Diagnosed with a serious mental illness (SMI): 1. Schizophrenia (all subtypes) 2. Delusional Disorder 3. Schizophreniform Disorder 4. Schizoaffective Disorder 5. Brief Psychotic Disorder 6. Intellectual Disability with prior Regional Center Services and/or with a cooccurring serious mental illness 7. Other Specified and Unspecified Schizophrenia Spectrum and other Psychotic Disorder 8. Major Depressive Disorder 9. Bipolar Disorders I and II

10. Other Specified and Unspecified Bipolar and Related Disorders

11. Borderline Personality Disorder

II.

Service Components

x Case Management provided by LCSW or MSW.

x One (1) 1-hour Group Therapy Sessions per day, 7 days a week, will be offered to

each OPP-MHC inmate-patient. Three (3) additional hours of structured out-of-

cell time will be offered to each OPP-MHC inmate-patient by recreational

technicians or other service providers.

x At least seven (7) hours of unstructured out-of-cell time per week

x Psychological testing as clinically indicated.

x 1:1 confidential contact with mental health professional at least every 14 days or

more often if clinically indicated.

x Treatment Plan initiated within 30 days of placement in OPP-MHC and updated

every 6 months or sooner if clinically indicated.

x Evaluation by psychiatrist or psychiatric nurse practitioner every 30-90 days (or

more often if clinically indicated).

x Treatment planning when moving to less intensive level of mental health care.

x Discharge planning and continuity of care with community providers

III. Treatment Goals

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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

x Stabilization of mental health symptoms and overall improvement in functioning x Medication compliance (if applicable) x Substance Abuse Recovery/Prevention x Activities of Daily Living (ADL) Skill Development x Crisis intervention/Adjusting to incarceration x Symptom reduction x Socialization and recreation x Behavior management (if applicable) x Hygiene skills x Coping skills x Stress reduction x Discharge planning and continuity of care with community providers

IV.

Discharge Criteria

x Able to function in a GP-MHC.

x Stabilization/resolution of mental health symptoms and ability to function in a

less clinically structured environment.

x Clinically decompensates and requires higher level of care and placement in IOP.

x Clinically decompensates to the extent that placement into the Acute Inpatient Unit is required.

x Has reached release date, and clinical services will be transferred to community service provider.

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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

GENERAL POPULATION – MENTAL HEALTH CASELOAD

Caseload of 28-30 per LCSW/MSW

I.

Admission Criteria

x Diagnosed mental health disorder

x Exhibits symptom control or partial remission as result of treatment

II.

Service Components

x Case Management provided by LCSW or MSW.

x Individual or group treatment provided as clinically indicated.

x Psychological testing as clinically indicated.

x 1:1 confidential contact by mental health professional at least every 90 days or

more often if clinically indicated.

x Treatment Plan initiated within 30 days of placement in GP-MHC and updated

every 12 months or sooner if clinically indicated.

x Evaluation by psychiatrist or psychiatric nurse practitioner every 90 days (if

prescribed psychotropics), or more often if clinically indicated.

x Treatment planning when moving off mental health caseload.

x Discharge planning and continuity of care with community providers

III. Treatment Goals x Symptom management x Medication monitoring x Crisis intervention/Adjusting to incarceration x Preventing decompensation

IV.

Discharge Criteria

x Remission of symptoms, no longer requires medication monitoring or mental health services.
x Clinically decompensates and requires higher level of care and placement in IOP or OPP.
x Clinically decompensates to the extent that placement into the Acute Inpatient Unit is required.
x Has reached release date, and clinical services will be transferred to community

service provider.

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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

INTAKE & CRISIS RESPONSE TEAM

Current JPS staff will continue to manage all new intakes, priority referrals and must-sees. These staff will not carry a caseload and will be available to respond to new intakes and crisis referrals on a 24/7 basis.

Must-See Referrals

DEFINITIONS

Referrals for currently suicidal (i.e., attempt, ideation, or self-injurious behavior), homicidal or gravely disabled inmate-patients (5150 evaluations), acute crisis related to nature of charges or other arrest factors, alleged Prison Rape Elimination Act victim assessments, and/or custody or administration requests urgent evaluation.

Priority Referrals

Referrals for inmate-patients reporting recent psychiatric hospitalization, intellectual disability with observed poor adaptive functioning, suicidal ideation within past two weeks, demonstrating worsening of mental health symptoms, identified as a possible suspect per Prison Rape Elimination Act, or other significant mental health symptoms that staff may have reason to be concerned about inmate’s mental stability.

Routine Referrals

Referrals for inmate-patients reporting current or prior mental health treatment, currently prescribed psychiatric medication or reporting to receive medication in community. May have complaints of adjustment or other mental health issues, and/or significant AVATAR history, but are stable.

Mental Health Caseload (MHC)

Inmate-patients open to JPS and receiving mental health services in General Population-Mental Health Caseload (GP-MHC), Outpatient Psychiatric Pod (OPP-MHC), Intensive Outpatient Program (IOP-MHC), or on the Acute Inpatient Unit (2P).

General Population (GP-MHC)

Inmate-patients classified as GP-MHC meet the following criteria:

x Stable, on psychotropics, or x Stable, not receiving psychotropics but may require time-limited services to address
mental health symptoms.

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MENTAL HEALTH TREATMENT OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES) DEFINITIONS
Intensive Outpatient Unit (IOP-MHC) Inmate-patients classified as IOP-MHC meet any of the following criteria:
x The presence of suicidal ideations without a plan or intent and requiring enhanced observation and safety measures;
x 2P Pre-Admissions who require 1:1 observation for acute suicidal ideations and/or attempts;
x Discharge from the Acute Inpatient Unit upon recommendation of discharging Psychiatrist;
x Acute onset or significant decompensation of a serious mental illness. Outpatient Psychiatric Pod (OPP) Inmate-patients classified as OPP-MHC meet the following criteria:
x Diagnosed with serious mental illness and are unable to be housed in general population due to severity of symptoms, potential for victimization and/or significant difficulty maintaining ADLs.
Acute Inpatient Unit (2P) 18-bed LPS designated facility.
x Inmate-patients meet criteria for either voluntary or involuntary acute inpatient psychiatric treatment
8|Page

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 95 of 119
EXHIBIT A-3
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 96 of 119
Sacramento County Sheriff’s Department
Correctional Health Services JPS – Rules Violation Mental Health Review

Name: X-Ref:

DOB:

Date of Incident: __________ Rules Violation Charge(s): __________________________________________________

Type of Review:

 Record Review and Clinical Evaluation

 Record Review Only

(The clinician will complete an in-person interview with the inmate unless there are specific reasons why an interview

is not necessary or appropriate.) For Clinical Evaluations: Inform the inmate of purpose of evaluation and that information is not confidential and will be used for purposes discipline review/hearing.

Is the inmate currently receiving mental health services?

 Yes  No

      Level of MH services:

2P Pre-Admit

2P

IOP

OPP

GP

JBCT

1a) Is there a possibility of a nexus between the inmate’s mental illness/symptoms and/or

developmental disability/functioning deficits and the behavior(s)?

 Yes  No

1b) Was the inmate’s behavior connected to any of the following? (If any are checked, Rule Violation should be cancelled.)
 An act of self-harm or attempted suicide  A cell extraction related to transfer to a medical/mental health unit or provision of involuntary treatment  Placement in mental health restraints or seclusion

2) If the inmate is found guilty of the offense(s), what mental health factors and/or developmental disability/cognitive or adaptive functioning deficits should the hearing officer consider when assessing the penalty? (Check all that apply):

 N/A

 Dementia

 Difficulty maintaining/performing ADLs

 Poor social skills and/or peer interactions

 Psychotic symptoms

 Difficulty processing information/verbal commands

 Intellectual disability

 Traumatic Brain Injury

 Poor impulse control (must be related to mental health diagnosis)

 Other Mitigating Factors: ___________________________________________________________

3) If the inmate is found guilty of the offense(s), what penalties may have an adverse impact on inmate’s mental health condition or functioning (Check all that apply):

 N/A

 Loss of commissary privileges

 Loss of social visits

 Loss of dayroom/outdoor recreation

 Loss of tablet privileges

 Loss of telephones

 Housing Relocation

 Loss of good time

 Loss of work time

 Disciplinary housing unit

 Isolation Housing (Full restriction)

 Lockdown for less than 24 hours

 Assigned Extra Work Duty

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 97 of 119
6) Provide narrative of findings that should be considered by the hearing officer, regarding: (1) whether there is a nexus between the inmate’s behavior and mental illness and/or developmental disability, (2) any relevant mitigating circumstances, and (3) penalties that should be avoided. (If no in-person interview/clinical evaluation was completed, please explain.)

Reviewer’s Name

Signature
__________________________________________________ Date of Review

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 98 of 119
EXHIBIT B
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 99 of 119
MAYS v. COUNTY OF SACRAMENTO DUTIES OF RULE 706 EXPERTS
Pursuant to Rule 706(b) of the Federal Rules of Evidence, the parties set forth the duties of the Court Experts.
1. The Court Experts shall advise the parties and the Court on Defendant’s compliance or non-compliance with the medical care, mental health care, and suicide prevention provisions of the Remedial Plan, to assist with dispute resolution matters, and to provide testimony, if required, in any proceedings before the Court.
2. Within 180 days after entry of this Consent Decree, and then every 180 days thereafter during the term of this Consent Decree, the Court Experts shall each complete comprehensive reviews and reports (“180-Day Reports”) to advise the parties and the Court on Defendant’s compliance or non-compliance with the Remedial Plan.
3. In each 180-Day Report, the Court Experts shall state their opinion as to whether Defendant is or is not in substantial compliance with each material component of the Remedial Plan within the expert’s area of expertise. These opinions are referred to in the Consent Decree as “Substantial Compliance Determinations.” The 180-Day Reports shall be considered separate and apart from any evaluations and reports prepared as part of the dispute resolution process set forth in the Consent Decree and shall be admissible in evidence in any proceedings before the Court.
4. The Court Experts shall be entitled to reasonable expenses incurred plus reasonable hourly and/or daily rates, which shall be paid by Defendant.
5. With appropriate notice, the Court Experts shall have reasonable access to all parts of any Sacramento County jail facility. Access to the facilities will not be unreasonably restricted. The Court Experts shall have access to correctional and health care staff and people incarcerated in the jails, including confidential and voluntary interviews as they deem appropriate. The Court Experts shall also have access to documents, including budgetary, custody, and health care documents, and institutional meetings, proceedings, and programs to the extent the Court Experts determine such access is needed to fulfill their obligations. The Court Experts’ tours shall be undertaken in a manner that does not unreasonably interfere with jail operations as reasonably determined by jail administrators.
6. The Court Experts may engage in ex parte communications with the parties, as requested. However, all of the Court Experts’ findings and recommendations shall be set forth in writing in their reports.
7. Pursuant to the dispute resolution procedures set forth in the Consent Decree, either party may request that the relevant Court Expert evaluate the issue in dispute and prepare a
1 of 2

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 100 of 119 report. The expert must provide the report regarding the area of disagreement to the parties and the Mediator within 45 days of the request. Defendant will pay the Court Experts’ reasonable fees for any reports prepared by a Court expert at the request of a party about a disputed issue, as contemplated by this paragraph.
2 of 2

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 101 of 119
EXHIBIT C
Consent Decree
Mays v. County of Sacramento

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 Case 2:18-cv-02081-TLN-KJN Document 88 Filed 08/13/19 Page 1 of 4

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UNITED STATES DISTRICT COURT

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FOR THE EASTERN DISTRICT OF CALIFORNIA

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11 LORENZO MAYS, RICKY

No. 2:18-cv-02081-TLN-KJN

RICHARDSON, JENNIFER BOTHUN,

12 ARMANI LEE, LEERTESE BEIRGE, and

CODY GARLAND, on behalf of

13 themselves and all others similarly situated, CLASS ACTION

14

Plaintiffs,

15

v.

16 COUNTY OF SACRAMENTO,

ORDER GRANTING APPROVAL FOR PRELIMINARY APPROVAL OF CONSENT DECREE AND CLASS NOTICE

17

Defendant.

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19

Plaintiffs are state prisoners, proceeding through counsel. The matter was referred to a

20 United States Magistrate Judge pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 302.

21

On August 8, 2019, the magistrate judge filed findings and recommendations herein

22 which were served on all parties and which contained notice to all parties that any objections to

23 the findings and recommendations were to be filed within fourteen days. (ECF No. 86.) On

24 August 12, 2019, the parties filed a joint statement of non-opposition to the findings and

25 recommendations. (ECF No. 87.)

26

The Court has reviewed the file and finds the findings and recommendations to be

27 supported by the record and by the magistrate judge’s analysis. Accordingly, IT IS HEREBY

28 ORDERED that: 1

Case 2:18-cv-02081-TLN-KJN Document 88 Filed 08/13/19 Page 2 of 4

1

1. The findings and recommendations filed August 8, 2019, are adopted in full;

2

2. A court should preliminarily approve a class action settlement if it “appears to be the

3 product of serious, informed, non-collusive negotiations, has no obvious deficiencies, does not

4 improperly grant preferential treatment to class representatives or segments of the class, and falls

5 within the range of possible approval.” In re Tableware Antitrust Litig., 484 F. Supp. 2d 1078,

6 1079 (N.D. Cal. 2007) (quotation marks and citations omitted). The Court finds that this standard

7 is met in this case, as the proposed settlement is the product of arms-length, serious, informed,

8 and non-collusive negotiations between experienced and knowledgeable counsel who have

9 actively prosecuted and defended this litigation.

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3. The Court finds that the requirements of Rule 23(b)(1) and (b)(2) are met because this

11 action seeks declaratory and injunctive relief against policies and practices that risk harm and

12 discriminatory treatment to the class.

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4. The Court finds that the Consent Decree meets the requirements of 18 U.S.C.

14 § 3626(a)(1). The Consent Decree, (see ECF No. 85-1), granted preliminary approval and

15 incorporated by reference herein, subject to the right of class members to challenge the fairness,

16 reasonableness, or adequacy of the Consent Decree.

17

5. Under Federal Rule of Civil Procedure 23(e)(1), the Court approves the substance,

18 form and manner of the Notice of Proposed Class Action Settlement (the “Notice”) filed by the

19 parties and finds that the proposed method of disseminating the Notice meets all due process and

20 other legal requirements and is the best notice practicable under the circumstances. Within three

21 days of this Order, the parties shall prepare a final version of the Notice, incorporating the dates

22 set forth herein.

23

6. No later than September 9, 2019, the County is directed to post the Notice in English

24 and Spanish in all housing units in such a manner as to make the notice visible to all people

25 incarcerated in the Jails. The County shall hand deliver a copy of the Notice to each inmate in

26 administrative segregation. The Notice shall be posted and delivered for thirty days.

27

7. The County is also directed to provide a copy of this Order and the full Consent Decree

28 and the Remedial Plan to people who complete an inmate request form and request the 2

Case 2:18-cv-02081-TLN-KJN Document 88 Filed 08/13/19 Page 3 of 4

1 documents. Defendant must file and serve on Plaintiffs’ counsel a declaration affirming that

2 notice was published as required in this order.

3

8. A fairness hearing shall take place at 11:00 a.m. on Thursday, December 5, 2019,

4 Courtroom #25, at the United States District Court for the Eastern District of California,

5 Sacramento Division, 501 I Street, Sacramento, CA 95814, to determine whether the proposed

6 settlement of this action on the terms and conditions provided for in the Consent Decree is fair,

7 reasonable, and adequate and should be finally approved by the Court. The hearing may be

8 continued from time to time without further notice to the class. Any further briefing from the

9 parties in advance of the hearing shall be filed no later than November 12, 2019.

10

9. Any member of the class may enter an appearance on his or her own behalf in this

11 action through that class member’s own attorney (at their own expense) but need not do so. Class

12 members who do not enter an appearance through their own attorneys will be represented by class

13 counsel. Alternatively, any member of the class may write to the Court about whether the

14 settlement is fair. The County will provide all people incarcerated in the Jails with a cost-free

15 way to write to the Court.

16

10. The Court will consider written communications when deciding whether to approve

17 the settlement. Comments regarding the fairness of the settlement must include at the top of the

18 first page the case name (Mays v. County of Sacramento) and the case number (E.D. Cal. No.

19 2:18-cv-02081 TLN KJN). A written comment must contain the author’s full name and must

20 include all objections and the reasons for them, must include any and all supporting papers

21 (including, without limitation, all briefs, written evidence, and declarations), and must be signed

22 by the class member. A class member who desires to comment but who fails to comply with the

23 above objection procedure and timeline shall be deemed to have not objected and the objection

24 shall not be heard or considered at the hearing. Comments must be postmarked by October 11,

25 2019, and must be sent to the following address:

26

Clerk of the Court

27

United States District Court

501 I Street

28

Sacramento, CA 95814

3

Case 2:18-cv-02081-TLN-KJN Document 88 Filed 08/13/19 Page 4 of 4

1 The Notice to Class members shall highlight the deadline, October 11, 2019, by which comments

2 must be postmarked.

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IT IS SO ORDERED.

4 Dated: August 13, 2019

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Troy L. Nunley

United States District Judge 9

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 Case 2:18-cv-02081-TLN-KJN Document 89-2 Filed 09/03/19 Page 1 of 3
NOTICE: CLASS ACTION SETTLEMENT Sacramento County Jail
Mays v. County of Sacramento, E.D. Cal. No. 2:18-at-02081-TLN-KJN
A proposed settlement has been reached in a federal civil rights class action lawsuit regarding certain conditions in the Sacramento County Jails (“the Jails”). The Mays v. Sacramento class action lawsuit claims that people in the Jails are subject to conditions that violate the Eighth and Fourteenth Amendments to the United States Constitution and that the Jails do not comply with the Americans with Disabilities Act (ADA).
The lawyers for people incarcerated in the Jails are the Prison Law Office and Disability Rights California.
The Court has preliminarily approved the settlement of this matter. This notice explains the proposed settlement, how you can see it, and how you can tell the court whether you think it is fair.
The terms of the settlement agreement are described in a document called the Consent Decree. The Consent Decree includes a document called the “Remedial Plan.” The Remedial Plan explains what the County has agreed to do to fix the issues described in the lawsuit. The Consent Decree and Remedial Plan will be available to read in your housing unit. You can also ask for a copy of the Consent Decree and Remedial Plan by using an Inmate Request Form.
Key terms of the settlement agreement include the following:
1. The County will be required to: a) Make sure that people in the Jails get adequate medical and mental health care; b) Provide reasonable accommodations to people with disabilities and ensure that they have access to programs and services in the Jails; c) Take measures to prevent suicide in the Jails; d) Consider mental health and other disability issues in the Jails’ disciplinary and use of force practices; and e) Limit the use and duration of solitary confinement.

Case 2:18-cv-02081-TLN-KJN Document 89-2 Filed 09/03/19 Page 2 of 3

2. The Prison Law Office, Disability Rights California, and court-approved experts will monitor the County’s compliance with the settlement agreement.

3. The parties can bring any disputes about whether the County is complying with the settlement agreement back to the Court.

This case seeks changes to the way that County operates the Jails. This case does not seek money damages for the class and none will be awarded. This means that no individual will receive any financial benefit.

The settlement does not affect your ability to sue for money damages or to petition for a writ of habeas corpus.

The attorneys who brought the class action will ask the Court to have the County pay for their attorneys’ fees and expenses. The parties have agreed that Plaintiffs’ attorneys will seek $2.1 million for their work to this point and up to $250,000 per year to monitor compliance with the Consent Decree. You can read Plaintiffs’ counsel’s motion for fees by filling out an Inmate Request Form and asking to see it. will not seek more than $3 million in fees and expenses. The Court will decide the amount of these fees and expenses.

If you have any questions about the settlement, you can write to:

Prison Law Office

Disability Rights California

General Delivery

Attn: Sacramento Jail Class Action Team

San Quentin, CA 94964

1831 K Street

Sacramento, CA 95811

The Court will hold a hearing on the fairness of the settlement at 11:00 a.m. on December 5, 2019 at Courtroom #25, at the United States District Court for the Eastern District of California, Sacramento Division, 501 I Street, Sacramento, CA 95814. on _______at __________.

People incarcerated in the Jails can write to the federal court about whether the settlement is fair. The County will provide all people incarcerated in the Jails with a cost-free way to write to the Court. The federal court will consider those written comments when deciding whether to approve the settlement. Comments regarding the fairness of the settlement must include at the top of the first page the case name (Mays v. Sacramento County) and the case number (E.D. Cal No. 2:18-at-02081-

Case 2:18-cv-02081-TLN-KJN Document 89-2 Filed 09/03/19 Page 3 of 3
TLN-KJN). Comments must be received postmarked by October 11, 2019______________ and must be sent to the following address:
Clerk of the Court United States District Court 501 I Street Sacramento, CA 95814

 
 Case 2:18-cv-02081-TLN-KJN Document 90 Filed 09/04/19 Page 1 of 3

1 Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201
6 Tifanei Ressl-Moyer (SBN 319721) tifanei.ressl-moyer@disabilityrightsca.org
7 DISABILITY RIGHTS CALIFORNIA 1831 K Street
8 Sacramento, CA 95811 Telephone: (916) 504-5800
9 Fax: (916) 504-5801

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

10 Donald Specter (SBN 83925) dspecter@prisonlaw.com
11 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
12 Sophie Hart (SBN 321663) sophieh@prisonlaw.coom
13 PRISON LAW OFFICE 1917 Fifth Street
14 Berkeley, California 94710 Telephone: (510) 280-2621
15 Fax: (510) 280-2704 Attorneys for Plaintiffs
16 UNITED STATES DISTRICT COURT
17 EASTERN DISTRICT OF CALIFORNIA
18 SACRAMENTO DIVISION
19

20

LORENZO MAYS, RICKY

) Case No. 2:18-cv-02081 TLN KJN

21 RICHARDSON, JENNIFER BOTHUN, )

ARMANI LEE, LEERTESE BEIRGE, and ) STIPULATION FOR REVISED CLASS

22 CODY GARLAND, on behalf of themselves ) NOTICE AND [PROPOSED] ORDER

and all others similarly situated,

)

23

)

Plaintiffs,

) JUDGE: Hon. Kendall J. Newman

24

)

v. 25

) Complaint Filed: July 31, 2018 )

COUNTY OF SACRAMENTO,

)

26

)

Defendant.

)

27

)

)

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Case 2:18-cv-02081-TLN-KJN Document 90 Filed 09/04/19 Page 2 of 3

1

Plaintiffs Mays, Richardson, Bothun, Lee, Beirge, and Garland, on behalf of the Plaintiff

2 Class, and Defendant County of Sacramento, through their respective counsels of record, enter into
3 this stipulation based on the following facts:
4 1) The parties have reached agreement as to the amount of attorney’s fees to be sought in
5 connection with this case. Plaintiffs’ counsel is preparing a motion for attorney’s fees in which
6
7 Plaintiffs will ask the Court to grant attorney’s fees in the amount of $2.1 million. Plaintiffs also

8 will seek an annual cap of $250,000 for monitoring compliance with the Consent Decree in this

9 matter. Defendants have indicated that they will not oppose the motion.

10

2) In light of this agreement and the forthcoming motion, the parties seek approval of a

11 revised notice to the class which identifies the precise amount of attorney’s fees to be sought and
12 advises class members about how to access a copy of the fees motion, in accordance with Federal
13

14 Rule of Civil Procedure 23(h).

15

ACCORDINGLY, the Parties hereby stipulate as follows:

16

1) The revised Notice, attached hereto as Exhibit A (ECF No. 89-1), should be approved in

17 lieu of the Notice approved by the Court on August 13, 2019 (Doc. No. 88), which was attached as
18 Exhibit 2 to the Declaration of Margot Mendelson in Support of the Stipulated Motion for 19
Preliminary Approval of Consent Decree and Notice to the Class (Doc. No. 85). Attached as 20
Exhibit B (ECF No. 89-2) is a redlined version of the previous Notice, which identifies the proposed 21
22 edits for the Court’s convenience.

23

IT IS SO STIPULATED.

24

25 Dated: 9/3/19
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Margot Mendelson Margot Mendelson PRISON LAW OFFICE Attorney for Plaintiffs

Case 2:18-cv-02081-TLN-KJN Document 90 Filed 09/04/19 Page 3 of 3

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3 Dated: 9/3/19

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6 Dated: 9/3/19

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9 Dated: 9/3/19
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IT IS SO ORDERED.

14 Dated: September 4, 2019

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17 /mays2081.ntc2

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Aaron J. Fischer (as authorized 9/3/19) Aaron J. Fischer DISABILITY RIGHTS CALIFORNIA Attorney for Plaintiffs
Jessica Valenzuela Santamaria (as authorized 9/3/19) Jessica Valenzuela Santamaria COOLEY LLP Attorney for Plaintiffs
Todd Master (as authorized 9/3/19) Todd Master HOWARD ROME MARTIN & RIDLEY Attorney for Defendants

 
 California’s protection & advocacy system Toll-Free (800) 776-5746
Report on Inspection of the Sacramento County Jail (Conducted April 13-14, 2015)
- Dated August 4, 2015 - Revised October 15, 2015
EXECUTIVE SUMMARY
Disability Rights California (DRC) is the state and federally designated protection and advocacy agency charged with protecting the rights of people with disabilities in California. DRC has the authority to inspect and monitor conditions in any facility that holds people with disabilities. Pursuant to this authority, DRC is conducting inspections of conditions in six county correctional facilities in 2015. One of these facilities is the Sacramento County Jail (“Jail”), which we inspected on April 13 and 14, 2015. We appreciate that Sheriff Department staff were helpful and cooperative during our inspection.
We observed many positive practices and programs. Booking was efficient, with a private screening area and procedures to expedite intake for prisoners with acute medical or mental health needs. Health and mental health staff were engaged and followed up immediately on our concerns about individual prisoners. The Main Jail has mental health staff available 24 hours per day, 7 days per week due to the inpatient unit. The Main Jail and the non-dorm areas in Rio Cosumnes Correctional Center are of a podular design, with two tiers of cells opening on to a central dayroom. Custody staff was aware of an accessible route that avoided the stairs between the booking area in which buses unload in the Main Jail, and had also monitored compliance with lower bunk orders in Rio Cosumnes. The Sheriff’s Department has a strong emphasis on education and re-entry that is apparent from its website.

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However, we also found evidence of the following violations of the rights of prisoners with disabilities:
(a) Undue and excessive isolation and solitary confinement; (b) Inadequate mental health care; and (c) Denial of rights under the Americans with Disabilities Act (ADA).
Pursuant to our authority under 42 U.S.C. §10805(a)(1) and 29 U.S.C. § 794(f)(3) and as a result of this initial inspection, we find there is probable cause to conclude that prisoners with disabilities are subjected to abuse and/or neglect in the Sacramento County Jail. We are opening an investigation into the treatment of prisoners with disabilities and will be requesting additional documents and information. We are also interested in meeting with you to discuss these findings and the next steps in our investigation.
Background
The Sacramento County Jail currently houses approximately 4300 prisoners in two facilities – the Main Jail and Rio Cosumnes Correctional Center. When the Main Jail was completed in 1989, its 1250 cells were intended to hold single prisoners with a rated capacity of 1625. Later, these single cells were converted to double cells and the rated capacity increased to 2400 prisoners.1 In 1989, a federal court set a population cap of 2432 for the Main Jail.
Rio Cosumnes Correctional Center (“RCCC”) consists of some newer podular buildings and older dormitories dating to the 1960s. RCCC has a rated capacity of 1,625 prisoners but its actual census has
1 Sacramento County Office of Inspector General, Jail Operations Audit, September 2009, p. 2627, available at http://www.inspectorgeneral.saccounty.net/Documents/sac_020670.pdf. “Return to Main Document”

Page 3 of 33
ranged from the current level of 1900 to as high as 2400 prisoners. Sentenced prisoners are primarily housed at RCCC but can also be housed in the Main Jail. Pre-trial detainees may also be housed in RCCC to comply with the population cap in the Main Jail.
Following the implementation of AB 109 in 2011, prisoners may be sentenced to California jails for years at a time. A recent report found that by late 2014, the number of prisoners housed in county jails serving sentences of more than five years has skyrocketed due to AB 109.2 Sacramento County is no exception. In late 2014, between 1700 and 1900 (about 40% of the total) prisoners in the Sacramento Jail were there because they had been sentenced, with jail terms ranging from several months to as long as eight years.3
FINDINGS RE: ABUSE AND/OR NEGLECT OF
PRISONERS WITH DISABILITIES
Based on our monitoring visits on April 13 and 14, 2015, review of records and documents accessed, as well as review of other public documents, we found the following evidence of abuse and neglect in Sacramento County Jail.
1. Excessive use of Isolation and Solitary Confinement
2Public Policy Institute of California, “California’s County Jails,” available from http://www.ppic.org/main/publication_show.asp?i=1061. “Return to Main Document”
3 California Board of State and Community Corrections, Jail Profile Study, http://www.bscc.ca.gov/downloads/2014_3rd_Qtr_JPS_Full_Report.pdf; Sacramento County Grand Jury 2012-2013 Report, p. 44 (under AB 109, prisoners at RCCC began serving sentences of 18 months to 8 years), available from http://www.sacgrandjury.org/reports/1213/2012-2013-Report.pdf. “Return to Main Document”

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Isolation and solitary confinement in correctional facilities are generally considered to be situations in which prisoners are held in their cells, alone or with a cellmate, for 22 to 24 hours per day.4 Prisoners may be held in isolation because they are classified as maximum security, are in administrative segregation or Protective Custody, or subject to short-term discipline. In contrast, prisoners in general population typically are locked in their cells only during sleeping hours, and are in dayrooms, activities or recreation areas during waking hours.
Even a short stay in conditions of extreme isolation is likely to worsen prisoners’ mental health symptoms, causing them “to lapse in and out of a mindless state” or “semi-fatuous condition” at a heightened risk for suicide. See Davis v. Ayala, 576 U.S. ___, No. 13-1428, 2015 WL 2473373, at *20 (U.S. June 18, 2015) (Kennedy, J., concurring). Consequently, correctional facilities should place prisoners in isolation only when security conditions permit no alternative.5 Prisoners with mental health problems are especially harmed by prolonged isolation (defined as a duration of more than three to four weeks).6 Many state
4 For support for this accepted definition of isolation, see, e.g., U.S. Department of Justice, Investigation of State Correctional Institution at Cresson, May 13, 2013, Attachment #7, p. 5, available at http://www.justice.gov/crt/about/spl/documents/cresson_findings_5-31-13.pdf (“terms ‘isolation’ or ‘solitary confinement’ mean the state of being confined to one’s cell for approximately 22 hours per day or more, alone or with other prisoners, that limits contact with others. … An isolation unit means a unit where either all or most of those housed in the unit are subjected to isolation.”); Wilkinson v. Austin, 545 U.S. 209, 214, 224 (2005) (describing solitary confinement as limiting human contact for 23 hours per day); Tillery v. Owens, 907 F.2d 418, 422 (3d Cir. 1990) (21 to 22 hours per day). “Return to Main Document”
5 Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics,” J Am Acad Psychiatry Law 38:104–8, 2010, Attachment #2. “Return to Main
Document”
6 American Psychiatric Association, Position statement on segregation of prisoners with mental illness (2012), Attachment #4, available from

Page 5 of 33
correctional systems, including those in California, Illinois, Massachusetts, Ohio and Pennsylvania, have adopted policies to ensure that prisoners with mental illness are excluded from isolation and solitary confinement.7
We observed widespread overuse of isolation throughout the Sacramento Jail. Conditions in isolation units in the Jail were characterized by inadequate exercise, extreme social isolation and inadequate mental health monitoring. Many prisoners and many categories of prisoners were locked in small cells alone or with a cellmate for 22 to 24 hours per day. We observed this in the Main Jail in pods on the 4th and 8th floor and in pods throughout RCCC. This isolation occurs in areas that were designed to permit indirect supervision and easy access to dayrooms for most of every day,8 but are instead operated to restrict prisoners to small cells for extended periods.
http://www.psychiatry.org/File%20Library/Learn/Archives/Position-2012-PrisonersSegregation.pdf. Accord, Society for Correctional Physicians, “Restricted Housing of Mentally Ill Inmates, Position Statement,” July 9, 2013, Attachment #5, avaiable from http://societyofcorrectionalphysicians.org/resources/position-statements/restrictedhousing-of-mentally-ill-inmates (“prolonged segregation of inmates with serious mental illness, with rare exceptions, violates basic tenets of mental health treatment.”) “Return to Main Document”
7 Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Psychiatr Clin North Am 29:761–72 (2006), Attachment #1. See also, U.S. Department of Justice, “Investigation of the Pennsylvania Department of Corrections’ Use of Solitary Confinement on Prisoners with Serious Mental Illness and/or Intellectual Disabilities,” February 24, 2014, Attachment #8, http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-24-14.pdf. “Return to Main Document”
8 See Attachment #10, photographs of the Sacramento Main Jail Pods, 1989, available from http://www.inspectorgeneral.saccounty.net/Documents/sac_023929.pdf; http://www.inspectorgeneral.saccounty.net/Documents/sac_026412.pdf. “Return to Main Document”

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The widespread use of isolation in the Sacramento Jail affects prisoners with mental illness in at least two ways. First, the Jail makes no attempt to screen and exclude prisoners with mental illness from isolation conditions in administrative segregation, protective custody and maximum security. Second, the housing areas specifically set aside for prisoners with mental illness are operated as isolation units, in which conditions are more solitary than in many maximum security and supermax facilities.
ISOLATION IN MAXIMUM SECURITY AND ADMINISTRATIVE SEGREGATION.
Prisoners are held in isolation if they are given a classification status of maximum security using the Northpointe classification system common to many jails, or if they are determined to be at risk of assault by or upon other prisoners and classified as Administrative Segregation, Protective Custody or Total Separation. Once assigned to isolation units for these reasons, prisoners have no clear means to work their way into less restrictive housing,9 and thus may remain in isolation for the duration of their jail stay.
Prisoners with mental illness are not excluded from these isolation conditions, although this is the recommended practice.10 In fact, during
9 See Report from MGT of America, “ICE Detention Standards Compliance Review,” Dec. 12, 2009, pps 6, 9, 56, Attachment # 11 (no notice of classification status or how to appeal this). “Return to Main Document”
10 See Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Attachment #1. A recent agreement between the Department of Justice and a county jail in Georgia provides that segregation “shall be presumed contraindicated” for inmates with serious mental illness. If an inmate has a “serious mental illness” or other acute mental health contraindications to segregation, that inmate “shall not remain in segregation absent extraordinary and exceptional circumstances.” MOA Between the U.S. Department of Justice and Columbus, Georgia Regarding the Muscogee County Jail, January 16, 2015, Attachment #9, available from

Page 7 of 33
our inspection, custody staff volunteered that 30% of the prisoners in Maximum Security, Total Separation and Protective Custody pods in the Main Jail also had mental illness and were taking psychotropic medication.11 In interviews, several prisoners in a Total Separation pod confirmed that they have a serious mental illness.
Custody staff reported the following schedules for out-of-cell time in segregation housing areas:
- In Maximum Security and Protective Custody areas, the most generous out-of-cell program described by custody was an hour in the dayroom in the morning, 90 minutes in the afternoon. Other than a scheduled three hours of outdoor recreation once per week, prisoners spend the remaining 21.5 hours per day locked down in their cells, sometimes with a cellmate;
- In Total Separation areas, custody stated that prisoners were allowed out of their cells for 30 minutes daily. The remaining 23.5 hours per day were spent locked down in their cells, other than outdoor recreation for an hour per day, three times per week.
Significantly, every prisoner in isolation units whom we interviewed reported that he received far less than the out-of-cell time reported by custody and only inconsistently received access to outdoor exercise each week, if at all. Earlier reports on conditions in the Sacramento Jail
http://www.justice.gov/crt/about/spl/documents/muscogee_moa_1-16-15.pdf. “Return to Main Document”
11 The Sacramento County Grand Jury recently described these classification categories and reported that one third of the prisoners in the jail have mental illness. Grand Jury Report, 20132014, pps 48-49, available from http://www.sacgrandjury.org/reports/13-14/2013-2014Report-CF.pdf. “Return to Main Document”

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contained similar observations about the lack of out-of-cell time and outdoor recreation.12
Conditions in all of the isolation units are very austere, with extended, enforced idleness. Prisoners report that lights are left on constantly for days at a time. Prisoners receive their meals through a slot in their solid cell doors and eat alone in their cells. They are not permitted to have televisions or radios in their cells. Generally, the central day-rooms have a large television, but most prisoners cannot see or hear these when locked in their cells. Sentenced prisoners in isolation units may not leave their cells to participate in the vocational and educational programs available to other sentenced inmates.
Some prisoners in the maximum security and administrative segregation pods are housed alone, but others are held with a cell-mate. Conditions for these prisoners are especially difficult because they are confined in close quarters with a stranger (who may also have mental illness), while simultaneously deprived of access to programming, meaningful forms of social interaction and distractions such a television or radio. Since all the cells in the Main Jail were originally designed to hold only a single prisoner, they are small for two people by any measure.13
12 See MGT of America report, Attachment # 11, p. 29 (jail population in Ad Seg and other special management housing “does not routinely receive outdoor recreation”); Sacramento County Grand Jury Report, 2010-2011, p. 5 (warning that prisoners are allowed out of their cells for only three hours per week “due to limited staff. This presents a potential ‘boil-over’ situation. Assaults among inmates are increasing.”), available from http://www.sacgrandjury.org/reports/10-11/2010-2011%20Report.pdf. “Return to Main Document”
13 See note 1, supra, and 2010-2011 Grand Jury Report, p. 17. http://www.sacgrandjury.org/reports/10-11/2010-2011%20Report.pdf. “Return to Main Document”

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The Sacramento Jail’s practice of double-celling prisoners in isolation may have contributed to the death of a prisoner in protective custody in December 2014.14 The victim’s cell-mate had bipolar disorder and has been charged with the murder, according to news reports. The cell-mate had earlier complained to custody staff that the victim – a registered sex offender who also had mental illness – was harassing him and soiling his clothes and their cell and that if they did not move his cellmate, “he’s going to get beat up.”15 Custody staff took no action, and the second prisoner was found dead the next day.
ISOLATION AND MENTAL HEALTH UNITS
The Jail has designated areas in the Main Jail and RCCC as special housing for prisoners with mental illness who are stepping down from suicide watch or the inpatient unit, or are deemed unable to function in general population. Custody has elected to operate these housing units as isolation housing, in which prisoners have even less out-of-cell time than in maximum security units. According to custody, this occurs because the mentally ill prisoners on the unit have different security classifications, so deputies will not let an entire tier into the dayroom together for showers and telephone. Because only a few prisoners of the same classification level are let out at the same time, out-of-cell time for prisoners with mental illness is reduced to 60 to 90 minutes per day. In interviews, prisoners stated that they customarily had far less than this, with reports of no out-of-cell time (and thus, no showers or telephone) for three days at a time, and of getting one hour
14 Sacramento Bee, “Two Inmates Killed in Separate Incidents at Sacramento County Jail,” March 8, 2015, http://www/sacbee.com/news/local/crime/article13048712.html, accessed April 17, 2015. “Return to Main Document”
15 Id. “Return to Main Document”

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of dayroom time every other day at 8 pm or 9 pm, which is too late to call legal representation.
In the Outpatient Psych Pod in the Main Jail and in the mental health pods in RCCC, prisoners reported that they rarely get outdoor recreation, and are provided recreation as seldom as once per month, or even once every few months. The claims are credible in light of reported custody practices. Custody staff in the mental health pod that we observed in RCCC confirmed that they do not schedule regular recreation times for prisoners on the unit. Custody stated that prisoners could request outdoor recreation, but in interviews, prisoners denied any knowledge of this procedure. Other custody staff stated that prisoners declined outdoor recreation when it was offered. In interviews, prisoners stated that when they were offered recreation in early morning or very late at night, they would decline because it was too cold and dark.
In addition to the Outpatient Psych Pod, the Main Jail has an 18 bed inpatient mental health unit, in which the conditions of isolation were especially disturbing. The unit is devoid of stimulation and without essential mental health treatment. Cells are bare, with only a combination sink/toilet and a steel bed with a thin mattress. The steel bed has tie-off points that create an unreasonable risk of suicide. A steel door facing the dayroom or hallway has a small window and a food-port. These otherwise featureless rooms have no chairs or desks, and many lack any natural light. There is no programming or television, and staff report letting the prisoners out of their cells for dayroom only once or twice per week.16 The dayroom, which was dirty and stunk of feces
16 Compare, Position Statement from Society for Correctional Physicians, Attachment #5 (“Inmates who are seriously mentally ill should be either excluded from prolonged segregation status (i.e. beyond 4 weeks) or the conditions of their confinement should be modified in a manner that allows for adequate out-of-cell structured therapeutic activities and adequate time in an appropriately designed outdoor exercise area.”) “Return to Main Document”

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during the tour, is itself largely featureless with only a round bench in the middle, and there are no recreational activities provided. Prisoners are not released from their cells for clinical contacts. Instead, clinicians speak through the food-port, preventing face-to-face contact and confidentiality. This is not mental health treatment and does not provide a therapeutic environment. Indeed, during the DRC tour, a prisoner— celled in what staff said was a medical bed portion of the unit, where conditions were indistinguishable from those of the mental health beds— tried to commit suicide by submerging his head in a toilet. Prisoners remained in bed in their cells throughout the tour, other than a shirtless youth who was pressed against the cell window, crying and ignored by staff; a sense of despair hung over the unit.
2. Inadequate Mental Health Care
Under the U.S. Constitution, there are “six basic, essentially common sense, components of a minimally adequate prison mental health care delivery system.” Coleman v. Brown, 938 F. Supp.2d 955, 970 (E.D. Cal. 2013). The components are: screening, staffing, recordkeeping, medication, suicide prevention, and “a treatment program that involves more than segregation and close supervision of mentally ill inmates.” Id. at 970 n. 24; Balla v. Idaho State Board of Corrections, 595 F. Supp. 1558, 1577 (D. Idaho 1984); Ruiz v. Estelle, 503 F. Supp. 1265, 1339 (S.D.Tex.1980). The jail must address the negative effects of housing in harsh segregated environments (Coleman, 938 F. Supp.2d at 979–80), and provide “treat[ment] in an individualized manner” for mental disorders. Id. at 984. Treatment must have the goal of “stabilization and symptom management.” Madrid v. Gomez, 889 F. Supp. 1146, 1222 (N.D. Cal. 1995).
The mental health treatment provided in the Sacramento Jail does not meet these constitutional minimums, nor does it ameliorate the harsh isolation conditions in which prisoners are confined. The prisoners we interviewed described multiple suicide attempts, long delays in receiving medication and that repeated requests to see a psychiatrist were often ignored.

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Mental health staff report that they do not offer group or individual counseling and therapy, even in the Outpatient Psych Pod and areas set aside in the RCCC for mental health housing. Outpatient mental health care appears consists solely of medication management and what staff described as “brief supportive contact” at cell-front or in dayrooms. The absence of any structured out-of-cell therapeutic activities violates minimum standards of care for prisoners with mental illness. For example, the National Commission on Correctional Health Care provides that “[r]egardless of facility size or type, basic on-site outpatient [mental health] services include, at a minimum, … individual counseling, group counseling and psychosocial/psychoeducational programs.” Standards for Health Services in Jails (2014), Standard J-G-04, Attachment #3.17
Some of the other disturbing conditions we observed were: - Suicide gowns are used as “long-term” clothing for prisoners in
the Outpatient psych pod; and - Custody staff appear to rely heavily on restraint chairs to
manage prisoner behavior.18
17 See also APA Position Statement on Segregation of Prisoners with Mental Illness,” Attachment #4 (“If an inmate with serious mental illness is placed in segregation, out of cell structured therapeutic activities (i.e., mental health/psychiatric treatment) in appropriate programming space and adequate unstructured out of cell time should be permitted.”); Muscogee County Jail Agreement, Attachment #9, p. 12 – 13 (Prisoners with mental illness “shall be offered a minimum of (i) at least 10 hours of out-of-cell structured time each week” including a schedule of individual or group therapeutic treatment). “Return to Main Document”
18 This finding is based on staff report and is consistent with an earlier report that restraint chairs were used several times per week during some time periods. MGT of America Review, Attachment #11, p. 5 (restraint chair used 26 times in a three month period). “Return to Main Document”

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At both jail facilities, mental health staff were clear that they did not make regular rounds of any segregation areas, including the outpatient psych pods or other isolation units. In monitoring prisoners’ mental health status, staff stated that they rely primarily on “kites” that prisoners give to custody staff, who then forward the requests to medical or mental health. Mental health staff also stated that they are on the mental health units in both jails every day.
As we discuss below, relying primarily on requests transmitted via custody officers violates confidentiality and may lead to drastic underreporting of prisoner need. Instead, prisoners must be able to give their health and mental health care requests directly to health care staff, or place their requests in a locked box; custody should not be responsible for/involved in collecting requests. In addition, the Jail has no real-time means to tell whether kites that make it through to mental health staff have been addressed in a timely manner. Mental health staff stated that a report on overdue responses to kites could be run, but that they do not do so on a regular basis.19
The absence of regular mental health rounds for the Outpatient Psych Pod and other isolation units violates accepted standards of care.20 Even assuming that the Jail had a confidential and timely procedure for requesting mental health assistance, an adequate mental health care system cannot rely on requests alone and must include
19 This is consistent with findings by the Grand Jury about the absence of reliable data regarding timely response to medical requests generally. Grand Jury 2005-2006 Report, http://www.sacgrandjury.org/reports/05-06/GJReport2005-2006.pdf. The Grand Jury also raised concerns, which we share, about the ability of medical and mental health staff to adequately triage requests for care. “Return to Main Document”
20 For example, the 2009 MGT Report found the Jail out of compliance with a federal requirement that prisoners in Administrative Segregation have rounds from a medical professional three times per week. Attachment #11 at page 65. “Return to Main Document”

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regular rounds, especially of isolation and segregation units. The National Commission on Correctional Health Care addresses the need for regular rounds in segregation. For “inmates who are segregated and have limited contact with staff or other inmates,” the Commission recommends documented monitoring rounds three times per week. Standard J-E-09 (2), Attachment #3. Accord, Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Attachment #1.
3. Denial of Rights under the Americans with Disabilities Act
Title II of the Americans with Disabilities Act (“ADA”) provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.” 42 U.S.C. § 12132. Jails and prisons are subject to the prohibitions and protections in Title II. Pierce v. County of Orange, 526 F.3d 1190, 1214 (9th Cir. 2008) (citing Pa. Dep’t of Corr. v. Yeskey, 524 U.S. 206, 209-10 (1998). In correctional settings, the ADA protects participation in jail programs, services and activities including the ability to safely use personal hygiene services such as toilets and showers, to engage in activities such as ambulation and exercise, and participate in programs such as visitation, educational classes, religious services, and inmate worker programs on the same basis as non-disabled prisoners.
In 2010, the Department of Justice issued a new regulation specifically addressing the “nondiscrimination and program access obligations” of a correctional facility. 28 C.F.R. § 35.152, effective March 15, 2011.21 This regulation provides in part that “[p]ublic entities shall
21 U.S. Department of Justice, Notice re: Final Regulations implementing Title II of the ADA, 75 Fed. Reg. 56164, 56218-56223 (2010), Attachment #6, also available at http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.htm#a2010guidance. “Return to Main Document”

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implement reasonable policies, including physical modifications to additional cells in accordance with the 2010 Standards, so as to ensure that each inmate with a disability is housed in a cell with the accessible elements necessary to afford the inmate access to safe, appropriate housing.” 42 C.F.R. § 35.152(b)(3). Justice Department commentary on this regulation makes clear that it concerns the program access obligations of a correctional facility, which do not depend on the date of construction, as opposed to requirements for architectural accessibility, which are tied to the date of construction or modification.22
Segregation of Inmates with Disabilities
In the Sacramento Jail, it is policy to place prisoners with physical disabilities and mobility impairments in single cells in the medical area in 2 East 100, an area in which prisoners have no regular access to a day room or outdoor recreation. Housing prisoners in the infirmary solely because they use assistive devices, as the jail appears to do, is not an effective use of medical resources.
Housing prisoners with disabilities in the infirmary also violates 28 C.F.R. §135.152 (b)(2), which requires correctional facilities to “ensure that inmates or detainees with disabilities are housed in the most integrated setting appropriate to the needs of the individuals.” The regulation expressly prohibits a jail from “plac[ing] inmates or detainees with disabilities in designated medical areas unless they are actually receiving medical care or treatment,” unless certain limited exceptions are present. To resolve this problem, DOJ emphasized the importance
22 Id., 75 Fed. Reg. at 56218-56223, Attachment #6. “Return to Main Document”

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of dispersing accessible cells throughout a facility and correctional system. 75 Fed. Reg. 56219 (2010).23
As noted above, the Jail also segregates prisoners with mental illness in isolation units in which they have less access to outdoor recreation, out-of-cell time and programming than non-disabled prisoners. According to the Department of Justice, such a practice of isolating prisoners on the basis of their mental illness constitutes impermissible discrimination under the Americans with Disabilities Act “where it unjustifiably denies those prisoners access to services and programs provided to most other prisoners.”24
Toilet and Shower Areas
The toilet and shower areas in the medical area of the Main Jail do not meet architectural standards for wheelchair use, and lack properly placed grab bars, shower heads, etc.25 In interviews, prisoners said they
23 For example, veterans who use wheelchairs cannot participate in the special “Honor Dorm” in RCCC, even if they meet other criteria for acceptance into this much lauded program, because it has no ADA accessible cells. “Return to Main Document”
24 U.S. Department of Justice, “Investigation of the State Correctional Institution at Cresson and Notice of Expanded Investigation,” May 31, 2013, Attachment #7, available from http://www.justice.gov/crt/about/spl/documents/cresson_findings_5-31-13.pdf. “Return to
Main Document”
25 We are happy to provide you with copies of DOJ publications on accessibility standards for correctional facilities, which can also be obtained online: ADA/Section 504 Design Guide: Accessible Cells in Correctional Facilities, available from http://www.ada.gov/accessiblecells.htm and the ADA standards for Accessible Design that specify the requirements for an accessible shower, §§ 603.1 to 610.4; acceptable reach ranges for fixtures, § 308, and accessible faucet and handle types, § 309.4. http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#sec805. “Return to Main Document”

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were afraid of falling in the bathroom and shower, had requested assistance from jail staff and been refused this help, and that some prisoners had already fallen because of unsafe conditions in the shower area. Segregating prisoners with disabilities in the medical area without ensuring safe access to sanitary facilities violates 28 C.F.R § 35.152(b)(2).
ADA Coordinator
The ADA regulations require the Jail to have an ADA coordinator. 42 C.F.R. § 35.106. The coordinator’s role is “to ensure that individuals dealing with large agencies [such as the Sheriff’s Department] are able to easily find a responsible person who is familiar with the requirements of the [ADA and the DOJ regulations] and can communicate those requirements to other individuals in the agency who may be unaware of their responsibilities.” Appendix A to Part 35, 28 C.F.R. at page 568. We saw no evidence of an ADA coordinator in the Jail. When questioned, staff were unaware of such a position and could not identify any particular individual responsible for arranging accommodations. We conclude that the Jail does not have an ADA coordinator and is not in compliance with this requirement.
Notice of Rights and Complaint Procedure
The Jail also has an obligation to provide notice to prisoners of their rights under the ADA (28 C.F.R. § 35.106), and must have an ADA complaint procedure by which prisoners with disabilities may contest any disability-based discrimination or violation of the ADA. 28 C.F.R. § 35.107(b). The complaint procedure must provide for “prompt and equitable resolution of complaints alleging any action that would be prohibited by [the ADA regulations.].” § 35.107(b) (emphasis added). The Jail’s designated ADA coordinator is responsible for investigating complaints submitted through this process. § 35.107(a).
Custody staff provided us with a copy of the Sacramento County Main Jail Inmate Handbook, which is 66 pages and supposedly “contains

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information about some of the services available to you, and what you have to do to obtain or benefit from these services.” However, this handbook did not mention rights under the ADA or how to submit an ADA complaint. This omission violates the notice requirement in 28 C.F.R. § 35.106, as well as making the ADA complaint system effectively unavailable. Not surprisingly, in interviews, prisoners were unfamiliar with any procedure for requesting accommodations for their disabilities.
By report, the Jail does not have an ADA complaint system, and its existing grievance system cannot substitute because it does not meet the ADA requirements. In the Main Jail we saw no boxes in which to place completed requests or grievances. There were request boxes in RCCC but no grievance boxes. Custody stated that prisoners would give them a “kite,” and they would “try to resolve the issue at the lowest possible level” rather than communicating the request or complaint to a supervisor.26 This means that neither prisoners nor jail administration have a record of how custody responds to their requests and grievances.
We did not have an opportunity to review the Jail’s substantive policies regarding prisoners with disabilities. However, we have concerns about what these will reveal because staff appeared to be untrained in how to respond to disability issues in general. Asked about accommodations for prisoners who are deaf or hard of hearing, staff said that they had never seen a deaf person in the jail, and did not know how to locate an American Sign Language (ASL) interpreter if needed, but thought that a custody officer might know ASL. In addition, the Inmate
26 The Inmate Handbook for the Main Jail confirms this practice. Prisoners are to “file the completed [grievance] form with the housing unit officer.” P. 12-13. The Sheriff’s Department order regarding grievances states that “grievances shall not be discarded” even if resolved. However, in light of prisoners’ reports that they frequently receive no response to their requests and complaints, jail management has no effective means to assess compliance with this policy. “Return to Main Document”

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Handbook (pg. 21) states that hearing aids or hearing aid batteries are not provided, and medical staff reported there is no contract with an audiologist for these services.
Medical staff were unable to describe any procedure to obtain disability accommodations for a prisoner, other than requests for a lower bunk. In interviews, prisoners described how they were given jail-issued wheelchairs without brakes and were refused staff assistance in bathing, and with writing requests and kites.27 The Inmate Handbook (at pg. 21) confirms the Jail’s policy of categorically denying items such as special shoes and extra clothing and linen, without permitting any exception for disability-related needs. We will continue to investigate this issue in the future.
More generally, the ADA regulations require the Sheriff’s Department to conduct a self-evaluation of its services, policies and practices to determine whether they meet the requirements of the ADA. 28 C.F.R. § 35.105(a). Since the Jail has more than 50 employees, it was also required to complete a Transition Plan by July 1993, detailing the steps and timeline it will take to achieve compliance with the ADA. Although the deadline to complete a self-evaluation and transition plan is long past, this is a continuing obligation and public entities that missed this deadline are not exempt from compliance. Reviewing policies and procedures is one part of the self-evaluation required by §35.105(a).
4. Other Areas of Concern, Including Medical and Dental Care a. Floor sleeping and Overcrowding
27 MGT of America Report, Attachment #11, p. 16 (no information about “how detainees may obtain … special assistance if illiterate, disabled or non-English speaking during the grievance process”) (emphasis added). “Return to Main Document”

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In the Main Jail in the medical unit and inpatient psych unit, we saw prisoners who did not have a bunk or a boat and had only mattresses on the floor. A county audit in 2009 also noted that although the census in the Main Jail is 2400 prisoners, “the design and infrastructure for this facility call for housing just over 1,200 inmates. The problem is that staffing levels and facility infrastructure (kitchen, medical facilities, day rooms, holding tanks, plumbing, etc.), for the most part, still reflect the original design intent of around 1,200 inmates. This greatly compounds the challenges associated with operating the Main Jail.”28 Also, the Sacramento Grand Jury has reported on overcrowded conditions and low staffing levels in RCCC, which it described as “jam-packed.”29 Unlike the Main Jail, which is subject to a population cap of 2432 set by the federal court, RCCC has no population cap.
b. Request and Complaint Process
The Jail does not have a confidential, reliable request and complaint process. In addition to the ADA concerns described above, we have questions about timely responses to medical and mental health kites, and about confidential reporting of deputy misconduct.
c. Inmate Handbook
The Main Jail has an inmate handbook that explains inmate rights, how to request medical and dental care, PREA, confidentiality, discipline, visiting, canteen, etc. An earlier review also noted the inadequacies in the handbook as regards appeals and prisoner rights.30
28 Office of Inspector General, 2009 Jail Operations Audit, note 1, supra, page 26. “Return to Main Document”
29 2013-14 Grand Jury Report, p. 41, available from http://www.sacgrandjury.org/reports/1314/2013-2014-Report-CF.pdf. “Return to Main Document”
30 MGT of America Review, Attachment #11, pps 18, 24. “Return to Main Document”

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According to Custody staff, the handbook is provided to prisoners with their clothing and bedroll at booking. However, no prisoners with whom we spoke recalled having received this handbook, and RCCC did not have a comparable handbook available for our review.
d. Dental Care
The Jail has a dental service in both facilities that provides extractions and treats dental infection. The Jail does not offer dental cleanings, periodontal care or dental floss; for sentenced prisoners with months or years to serve, this practice violates standards of care. Jail staff stated that the dentists will provide restorative dental care on a “case by case” basis to prisoners sentenced to the Jail for a long period under AB 109. Such a policy is not transparent and fails to offer prisoners information about their options and their right to appeal if dental care is denied.
e. Medical Care for Chronic Conditions and Disabilities
In interviews, prisoners complained about poor care for diabetes and other chronic conditions. The medical staff at RCCC conceded that they “struggle” to provide care for chronic conditions and plan to develop policies for long-term management of conditions such as asthma, diabetes, hypertension, and hyperlipidemia. Prisoners also stated that they were denied access to physical therapy, even when medically necessary and/or prescribed by an outside physician. Since physical therapy is part of a normal continuum of care, the Jail must either hire or contract with a physical therapist to treat prisoners in the jail or take prisoners to providers in the community when medically necessary.

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SUMMARY OF INITIAL RECOMMENDATIONS31
1. Isolation a. Increase out-of-cell time and ameliorate isolation conditions in Administrative Segregation, Protective Custody, Total Separation, Maximum Security and mental health housing. b. Exclude prisoners with mental illness from any isolation settings. c. Develop a system to continuously monitor compliance with standards for out-of-cell time and outdoor recreation.
2. Mental health Treatment a. Provide regular mental health rounds and offer structured therapeutic activities and unstructured out of cell time in mental health housing areas. b. Reduce reliance on restraint chair, suicide gowns and isolation as means to address disability-related behavior. c. Schedule regular rounds to check on all prisoners in isolation housing. d. Develop a more effective therapeutic environment in the inpatient psych unit. e. Develop a confidential system for prisoners to submit requests for mental health treatment directly to health care staff, and implement a monitoring and tracking system to ensure those requests received timely and appropriate
31 The Sacramento County Sheriff’s Office provided DRC responses to these initial recommendations prior to the public release of this report. Those response are included in the Appendix, infra. “Return to Main Document”

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responses.
3. ADA a. Add wheelchair accessible cells in different classification and housing areas, including the honor dorms at RCCC. b. Ensure that prisoners with physical, sensory and mental health disabilities have access to the full range of jail programs and activities, including all vocational and education programs RCCC. c. Appoint an ADA coordinator, establish an effective ADA complaint system, conduct a self-evaluation and develop a Transition plan to achieve ADA compliance. d. Develop informational materials for prisoners with disabilities about how to request accommodations.

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APPENDIX
Sacramento County Sheriff’s Department
Correctional Services
Response to Disability Rights California initial recommendations
1. Isolation
a. Increase out-of-cell time and ameliorate isolation conditions in Administrative Segregation, Protective Custody, Total Separation, Maximum Security and mental health housing.
The Sacramento County Sheriff’s Department responds as follows:
The maximum amount of recreation time a housing unit can offer without negatively impacting the security, floor and daily operations will be explored for all classification of inmates. The current Operations Order will be amended to include any operational changes. We are still awaiting a list of consultant experts to be provided by DRC as discussed and open to implementing reasonable suggestions.
b. Exclude prisoners with mental illness from any isolation settings.
The Sacramento County Sheriff’s Department responds as follows:
The above changes will include Out-Patient Psych inmates.
c. Develop a system to continuously monitor compliance with standards for out-of-cell time and outdoor recreation.
The Sacramento County Sheriff’s Department responds as follows:

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Outdoor recreation and dayroom activities are noted in the control room log book by control room officers. The log books are checked twice a shift by a sergeant and once by a lieutenant. The Operations Order pertaining to the monitoring of out of cell time and outdoor recreation will be amended to add that a watch commander or acting watch commander will be required to check the log books to ensure compliance with inmate out of cell time or outdoor recreation. We are currently looking at the feasibility of electronically departing inmates on dayroom/outdoor recreation in our current JIMS system. This would allow additional reports to be generated to account for recreational time. The reports will further assist in the monitoring of recreational activities. We are also releasing an RFP this month for a new JIMS system that will include reports for monitoring dayroom and outdoor recreation activities along with the routine scheduling of these functions.
2. Mental health Treatment
a. Provide regular mental health rounds and offer structure therapeutic activities and unstructured out of cell time in mental health housing areas.
The Sacramento County Sheriff’s Department responds as follows:
Jail Psychiatric staff is required to meet with all inmates to diagnose any mental health issues. Based upon the inmate’s diagnosis, medications administered for treatment and the medical assessment of the inmate, will dictate the level of care each inmate receives. We are currently working on increasing the amount of out of cell time for those inmates in the outpatient mental health housing areas. We are exploring the costs and requirements for providing structured and unstructured therapeutic activities in addition to the regular assessments and interventions provided in our outpatient psychiatric areas.

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b. Reduce reliance on restraint chair, suicide gowns, and isolation as means to address disability-related behavior.
The Sacramento County Sheriff’s Department responds as follows:
The restraint chair, suicide gowns, and isolation are not used to address disability-related behavior. The restraint chair is used to restrain an individual that is uncontrollably violent and demonstrating a desire to harm staff members, other inmates, and/or themselves. A medical evaluation is immediately performed upon placement in the restraint chair, and followed up in the first 15 minutes. A psychiatric evaluation is ordered, and completed within eight hours of placement. Unless extended by the Watch commander, no person will be placed in the restraint chair in excess of one hour. Between January 1, 2015 and September 4, 2015, the restraint chair was only used 38 times.
The safety suit “suicide gown” program is currently being evaluated and will most likely be modified and ONLY used for inmates that state or report suicidal ideation and/or engages in deliberate selfharm. Every inmate placed in a safety suit is assessed by psychiatric staff and regularly evaluated depending upon their diagnosis and the assessment of their overall mental health. Ongoing dialogue is occurring with Jail Psychiatric services on the safety suit program.
The Operations Order pertaining to the use of safety suits will be amended to include the changes as described.
Isolation is not used to address disability related behavior. Placement into Administrative Segregation and Total Separation

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“isolation” is used to separate inmates from general population when specific facts demonstrate they cannot be housed for the safety of themselves or others. The inmate can also request Administrative Segregation and or total separation at which time a classification review will be initiated to determine the validity of their request.
Schedule regular rounds to check on all prisoners in isolation housing.
The Sacramento County Sheriff’s Department responds as follows:
Medical staff is required to perform daily checks on all inmates who have been placed in isolation. These checks are required to be done twice daily by medical staff. During these checks an inmate can request medical, mental health or dental services via a hand delivered KITE to medical staff. All requests received are triaged by priority of services needed. Any noted change, medical or psychiatric, in an inmate while in isolation housing will be reported to the correct medical discipline and triaged appropriately. The inmate handbook will be updated to specify the necessary procedures required by an inmate to ensure that their request for medical, mental, or dental services is received and reviewed by medical staff.
c. Develop a more effective therapeutic environment in the inpatient psych unit.
The Sacramento County Sheriff’s Department responds as follows:

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The inpatient psychiatric unit is an 18-bed unit used to treat acute psychiatric issues. The average length of stay in the inpatient psychiatric unit is six days. While in this unit, 24-hour care is provided and inmate rounds are completed every thirty minutes in addition to any extra checks order by the psychiatrist. A multidisciplinary treatment team makes daily rounds and assesses inmates daily in the inpatient psychiatric unit. Treatment plans are evaluated during all phases of treatment and conferences are held within 72 hours of admission. The goal of the inpatient psychiatric unit is to stabilize the patient’s mental health issues so they can be discharged to the outpatient psychiatric area and eventually released to general population.
d. Develop a confidential system for prisoners to submit requests for mental health treatment to health care staff and implement a monitoring and tracking system to ensure those request received timely and appropriate response.
The Sacramento County Sheriff’s Department responds as follows:
Inmates can request medical, mental health, and dental services by completing a paper KITE. Instructions for requesting these services and completing the KITE are provided during the medical intake and in the inmate handbook. Additionally, complete instructions for completing and submitting a KITE are spelled out on the back of each KITE in Spanish and English. Inmates are instructed to give completed KITEs to the nurse that delivers medication to inmate housing locations, or other medical staff members. Once the KITE is received, it is reviewed and urgent mental health needs are immediately referred to our psychiatric unit. All other KITES are entered into our electronic medical records system and are triaged by an RN. All KITES are triaged within 24 hours, but most are triaged within 12. Depending upon

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the medical request and the inmate's medical history an appointment will be scheduled appropriately. Emergent requests will be seen and assessed immediately in the medical housing area. Urgent requests will be seen and assessed by an RN within 12 hours in the housing units. The timing for all other appointments is based on medical need. All requests for medical, mental health, and dental services, are logged and tracked within our electronic medical records system.
The Department is currently evaluating new systems (kiosks) which will allow inmates to request medical, mental health, and dental services electronically. These systems will be able to electronically transmit and track all requests for services. The electronic system will also interface and upload directly to our electronic medical records system confidentially.
The inmate handbook will be updated to specify and describe how an inmate is to submit a confidential medical request to medical staff.
3. ADA
a. Add wheelchair accessible cells in different classification and housing areas, including the honor dorms at RCCC.
The Sacramento County Sheriff’s Department responds as follows:
The Sheriff’s Department is planning on consulting with an ADA expert to devise solutions to address the issues associated with the use of wheel chairs at the Main Jail.
b. Ensure that prisoners with physical, sensory and mental health disabilities have access to the full range of jail programs and activities, including all vocational and education programs RCCC.

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The Sacramento County Sheriff’s Department responds as follows:
We are currently developing a comprehensive transition plan to ensure our facilities are ADA compliant. This will include an ADA manager, ADA coordinator, and ADA policy. Once implemented, the ADA Manager and Coordinator will facilitate the placement of inmates with physical, sensory, and mental health disabilities and ensure access to the full range of jail programs and activities, including all appropriate vocational and education programs at RCCC.
c. Appoint an ADA coordinator, establish an effective ADA complaint system, conduct a self-evaluation and develop a Transition plan to achieve ADA compliance.
The Sacramento County Sheriff’s Department responds as follows:
We are currently developing a comprehensive transition plan to ensure our facilities are ADA compliant. This will consist of an ADA manager, ADA coordinator, and ADA policy. The transition plan will include an effective ADA complaint system. The final goal overall is full ADA compliance in our correctional facilities.
d. Develop informational materials for prisoners with disabilities about how to request accommodations.
The Sacramento County Sheriff’s Department responds as follows:
This will be part of the transition plan to full ADA compliance. The inmate handbook will be updated to include information advising all inmates of their ADA rights and how to submit a request for accommodation. Future technology in the form of inmate kiosks will

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make it easier to inform inmates of the ability to request accommodations and for facility personnel to process those requests.

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ATTACHMENTS
1. Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Psychiatr Clin North Am 29:761–72 (2006).
2. Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics,” J Am Acad Psychiatry Law 38:104–8, 2010.
3. National Commission on Correctional Health Care, Standards for Health Services in Jails (2014), Standards J-E-09 and J-G-04.
4. American Psychiatric Association, Position statement on segregation of prisoners with mental illness (2012), http://www.psychiatry.org/File%20Library/Learn/Archives/Position2012-Prisoners-Segregation.pdf
5. Society for Correctional Physicians, “Restricted Housing of Mentally Ill Inmates, Position Statement,” July 9, 2013, available from http://societyofcorrectionalphysicians.org/resources/positionstatements/restricted-housing-of-mentally-ill-inmates.
6. U.S. Department of Justice, Notice re: Final Regulations implementing Title II of the ADA, 75 Fed. Reg. 56164, 5621856223 (2010), also available from http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.h tm#a2010guidance.
7. U.S. Department of Justice, Investigation of State Correctional Institution at Cresson, May 13, 2013 at 5, available at http://www.justice.gov/crt/about/spl/documents/cresson_findings_531-13.pdf
8. U.S. Department of Justice, “Investigation of the Pennsylvania Department of Corrections’ Use of Solitary Confinement on Prisoners with Serious Mental Illness and/or Intellectual Disabilities,” February 24, 2014, http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-2414.pdf

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9. Memorandum of Agreement Between the United States Department of Justice and the Consolidated Government of Columbus, Georgia Regarding the Muscogee County Jail, January 16, 2015, available from http://www.justice.gov/crt/about/spl/documents/muscogee_moa_116-15.pdf
10. View of Pods in Sacramento Main Jail, from http://www.inspectorgeneral.saccounty.net/Documents/sac_02392 9.pdf; http://www.inspectorgeneral.saccounty.net/Documents/sac_02641 2.pdf
11. MGT of America, ICE Detention Standards Compliance Review, Dec. 12, 2009.
12. Sacramento Bee, “Two Inmates Killed in Separate Incidents at Sacramento County Jail,” March 8, 2015, http://www/sacbee.com/news/local/crime/article13048712.html.
Disability Rights California is funded by a variety of sources, for a complete list of funders, go to http://www.disabilityrightsca.org/ Documents/ListofGrantsAndContracts.html.

 
 Case 2:18-cv-02081-TLN-KJN Document 1-5 Filed 07/31/18 Page 1 of 488
Sacramento County Sheriff’s Department Correctional Services Americans with Disabilities Act Assessment (ADA)
Submitted to: County of Sacramento
Rick Heyer, Supervising Deputy County Counsel James Wood, Deputy County Counsel
Produced by: Sabot Consulting ADA Experts
Mike Brady, Director Julian Martinez, Consultant Rick Wells, Consultant Paul Bishop, Architect and ADA Access Specialist
Submitted: December 22, 2016

Case 2:18-cv-0208S1H-ETRLIFNF’-SKDJENPARTDMoEcNuTmCOeUnNtT1Y-O5F SFACilReAdM0E7N/T3O1C/O1R8RECPTaIOgNeAL2SEoRfV4IC8E8S
AMERICANS WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Table of Contents
Executive Summary ........................................................................................................ 1 Intake/Booking (Disability Identification)................................................................ 1111 Delivery, Repair, Removal, and Use of Health Care Appliances/Assistive Devices/Durable Medical Equipment/ Medical Supplies ....................................... 2727 Tracking ..................................................................................................................... 4242 Housing Placements ..................................................................................................... 52 Medical/Mental Health/Dental....................................................................................... 73 Access to Out-of-cell Time (Outside Recreation/Dayroom) .................................... 100 Access to Programs ................................................................................................... 125 Access to Education, Vocation, Reentry and Substance Abuse Programs .......... 147 Access to Industries and Work Assignments .......................................................... 166 Effective Communication ........................................................................................... 177 Administrative Segregation Unit, Total Separation, Disciplinary Detention Unit . 216 Inmate Grievances ...................................................................................................... 223 Inmate Disciplinary Process ...................................................................................... 236 Inmate Orientation ...................................................................................................... 254 Alarms/Emergencies................................................................................................... 264 Mechanical Restraints/Searches/Count .................................................................... 271 Release/Discharge/Transfer ....................................................................................... 287 Transportation............................................................................................................. 290 Intellectual Disabilities (Housing Units Adaptive Supports)................................... 298 Training ........................................................................................................................ 309 ADA Coordinator......................................................................................................... 313 Notices ......................................................................................................................... 328 Custody Staff............................................................................................................... 330 Accountability ............................................................................................................. 334 Policies and Procedures ............................................................................................ 338 Americans with Disabilities Act Assets/Features .................................................... 345 Introduction Accessibility Survey ............................................................................. 353 Accessibility Survey’s ................................................................................................ 359 Technical Requirements / Standards ........................................................................ 454 Conclusions and Recommendations ........................................................................ 464
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016 Assumptions and Considerations ............................................................................. 468 List of Polices Reviewed ............................................................................................ 472 List of Forms, Notices and Documents Reviewed ................................................... 479 Abbreviations and Acronyms Used .......................................................................... 481
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Executive Summary
Sabot Consulting was retained by the Sacramento County Sheriff’s Office to conduct a comprehensive evaluation of their Americans with Disabilities Act (ADA) programs, policies, procedures, practices, forms, and architectural access for disabled inmates in their two Sacramento County detention facilities.
At the outset, we would like to commend the Sacramento County Sheriff, Undersheriff, the Chief Deputy, Correctional Services, the executive management staff, rank and file officers, support staff and contractors for their welcoming, transparent, candid, and cooperative interactions with our experts. We recognize that we added significantly more work to and took valuable time away from these consummate professionals during our time on this project, but because of the unfettered access, cooperation, and transparency of the Chief of Correctional Services and his staff, we were able to complete a far more detailed review in less time than that which could have been accomplished otherwise.
As a result, Sabot Consulting is pleased to provide this independent comprehensive evaluation of the Sacramento County Sheriff’s Department (SCSD) detention facilities ADA program and the architectural accessibility of the two detention facilities for inmates with disabilities. The facilities include, the Sacramento Main Jail (MJ) located at 651 I Street in downtown Sacramento and the Rio Cosumnes Correctional Center (RCCC) located at 12500 Bruceville Road, about 10 minutes south of Elk Grove. The MJ houses nearly all the County’s pretrial population, and a number of federal pretrial prisoners. RCCC primarily houses overflow pretrial detainees, those inmates who are “post-trial” and have been sentenced to serve jail time in a County facility, and Immigrations and Customs Enforcement (ICE) detainees.
This comprehensive assessment included a field review performed from August 10, 2016 through September 16, 2016, as well as a review and analysis of all relevant existing policies, procedures, forms, logs, training records, processes and practices implemented by both the Sacramento County Sheriff and the Sacramento County Correctional Health Services (CHS). An architectural accessibility survey was also conducted from October 17, 2016 through October 18, 2016, to identify accessibility barriers for mobility impaired inmates as defined by the 1991 Americans with Disabilities Act Standards for Accessible Design (Revised July 1, 1994), and the Americans with Disabilities Act Accessibility Guidelines (ADAAG) including the 2010 amendments to the Americans with Disabilities Act Standards (ADAS). As part of the field review, team members from Sabot Consulting (Assessment Team) conducted interviews of a large number of staff members assigned to the SCSD detention facilities, CHS, Jail Psychiatric Services (JPS), and Elk Grove Unified School District (EGUSD), as
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
well as a large number of selected and randomly chosen inmates incarcerated at the two SCSD detention facilities.
The specific scope of the review was to conduct a comprehensive assessment of the SCSD detention facilities and programs with respect to access by inmates with disabilities. The assessment consisted of a full review of policies, procedures and practices, which include but was not limited to:
 All policies, procedures and practices regarding inmates with disabilities;  All policies, procedures and practices regarding the classification and/or
housing of inmates with disabilities;  All policies, procedures and practices regarding inmates requiring Health
Care Appliances (HCAs)/Assistive Devices (ADs)/Durable Medical Equipment (DME);  All policies, procedures and practices regarding out-of-cell time as they relate to disabled inmates as well as all other inmates incarcerated within the SCSD detention facilities;  All policies, procedures and practices regarding the provision or access to programs, services and activities offered at the SCSD detention facilities, i.e., the MJ and RCCC, to inmates (including those with physical, intellectual, and mental health disabilities), including but not limited to; those currently assigned to work assignments, formally organized programs, services or activities;  All policies, procedures and practices regarding staff training;  With respect to addressing the needs of inmates with disabilities;    All policies, procedures and practices regarding the identification and tracking of inmates with disabilities; and  All policies, procedures and practices regarding the grievance process as it relates to inmates with disabilities, including but not limited to requests for accommodations (e.g., disability-related accommodation requests and allegations of discrimination).
The Assessment Team’s approach was to observe all processes and practices at the SCSD detention facilities that impact (or may impact) disabled inmates. This included:
 Intake and Booking Process;  Classification Process;  Health Care Services (including Disability Identification);  HCA/AD/DME;  Housing Units;  Orientation;  Library Services;  Religious Services/Activities;  Telecommunications;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Academic Education;  Work Assignments;  Vocational Assignments;  Transportation;  Inmate Release Process;  Application of Reasonable Accommodations;  Work Order Requests;  Training;  Out-of-Cell Time;  Infraction Process (and other due process events);  Grievances;  Tracking System;  All buildings to which inmates had access including the ingress and
egress of those buildings and the facility paths of travel utilized by inmates.
In addition, the Assessment Team interviewed staff throughout the SCSD detention facilities directly involved in the processes and practices listed above including a minimum of one staff member assigned to each respective housing unit or pod area. The Assessment Team also interviewed approximately 179 inmates with representatives selected from each respective housing unit area. Inmates selected and interviewed included those with identified or possible/potential disabilities as well as individuals who were randomly chosen. In most cases, between two to four inmates were selected from every housing unit or separate dorm or pod area.
The Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act as well as the United States Constitution protect the rights of individuals with disabilities including those housed in correctional facilities.
The command of Title II of the ADA states: “[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”
In accordance with Title 42 of the United States Code - Section 12101-12213, no qualified inmate or parolee with a disability shall, because of that disability, be excluded from participation in or be denied the benefits of programs, services and activities of the department or its jails/facilities or be subjected to discrimination.
California Code - Section 11135 provides that no person in the State of California shall, on the basis of race, national origin, ethnic group identification, religion, age, sex, sexual orientation, color, or disability, be unlawfully denied full and equal access to the benefits of, or be unlawfully subjected to discrimination under, any program or activity that is conducted, operated, or administered by the state
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
or by any state agency, which is funded directly by the state, or receives any financial assistance from the state.
Title II of the ADA covers all activities of state and local governments regardless of the government entity’s size or receipt of federal funding. Title II requires that state and local governments provide individuals with disabilities an equal opportunity to benefit from all programs, services and activities (e.g. education, employment, transportation, recreation, health care and social services). State and local governments are required to follow the 2010 ADA Standards for Accessible Design in the new construction and alteration of their buildings. They also must relocate programs or otherwise provide access in inaccessible older buildings; to ensure disabled inmates have equal access to programs, services and activities.
Although public entities are not required to take actions that would result in undue financial and administrative burdens, they are required to make reasonable modifications to policies, practices and procedures where necessary to avoid discrimination, unless they can demonstrate that doing so would fundamentally alter the nature of the service, program, or activity being provided. They are also required to provide auxiliary aids necessary to ensure effective communication, provide legally-required architectural and programmatic access, and provide programs and services in the most integrated setting available.
Facilities covered by Title II of the ADA, including detention and correction facilities, are required to make services, programs and activities accessible to individuals with disabilities. Many inmates housed in local correctional facilities have mobility disabilities and need to be housed in accessible cells. It must be emphasized that detention and correctional institutions/jails are unique facilities under Title II. Inmates cannot leave the facilities and must have their needs met by the corrections system, including needs relating to a disability. If the detention and correctional facilities fail to accommodate inmates with disabilities, these individuals have little recourse, particularly when the need is great (e.g., an accessible toilet; adequate catheters; or a shower chair). It is essential that corrections systems fulfill their nondiscrimination and program/facilities access obligations by adequately addressing the needs of inmates with disabilities, which include, but are not limited to, proper medication and medical treatment, accessible toilet and shower facilities, devices or accommodations such as a bed transfer or a shower chair, and assistance with hygiene methods for inmates with physical disabilities.1
Systemic violations of the ADA have resulted in numerous litigation cases throughout the United States at the federal, state and local levels. Systemic violations have also resulted in consent decrees, enforcement orders and formal
1 Title II Regulations 2010 Guidance and Section-by-Section Analysis
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
settlement agreements by the United States Department of Justice (USDOJ), Disability Rights Section, the American Civil Liberties Union, the Disabilities Rights Office, Rosen, Bien, Galvan, and Grunfeld, Attorneys at law, and The Prison Law Office.
Two of the longest major federal cases (which are still ongoing) in California are Clark v. California and Armstrong v. Wilson (now Armstrong v. Brown). Clark v. California is an ADA case filed in 1996 against the California Department of Corrections and Rehabilitation (CDCR). This class action lawsuit contended that the CDCR violated the Americans with Disabilities Act by discriminating against prison inmates with developmental disabilities and denying them adequate accommodations, protection, and services because of their developmental disabilities. The state agreed in 2001 to take a series of actions to settle the case including complying with a set of revised policies and procedures as set forth in a court-approved remedial plan. In January 2010, the court found that CDCR was failing to identify, conservatively, at least half of those prisoners who would qualify for protection and accommodation under the Remedial Plan. The court noted, disturbingly, that CDCR systematically failed to provide those developmentally disabled prisoners they did identify with assistance in reading and writing, access to medical care, access to canteen, access to the grievance system, assistance with self-care, and effective communication (e.g. at disciplinary hearings). It found, moreover, that CDCR failed to protect developmentally disabled prisoners from abuse initiated by other prisoners and, more egregiously, by staff.
Armstrong v. Brown is another ADA case filed in 1994 against the CDCR. Subsequent to the January 3, 2001 approved settlement agreement (which outlined CDCR’s set of plans, policies, and procedures to assure nondiscrimination against inmates with disabilities) and relevant here, the same federal court ruled on, August 28, 2012 that:
Given the ineffectiveness of Defendants' County Jail Plan, Defendants' consequent reliance on the county jails to accommodate Armstrong class members, and the deficiencies identified in the disability-related county jail policies and procedures, and in certain facilities' housing, the Court finds that the types of ADA violations experienced by the class member-declarants have been, and will continue to be, experienced by many other class members who have been and will be housed in county jails throughout California. The serious violations of the rights of class members while housed in county jails are systemic, persistent, and continuing throughout the State and are directly attributable to Defendants' failure to implement appropriate policies and procedures to identify, track, and accommodate these class members to communicate appropriate information to the county jails, and to monitor compliance by the county jails. The Court finds that the harm experienced by class members is caused not only by Defendants'
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
statewide policies (or lack thereof) regarding the housing of Armstrong class members in county jails, but also by Defendants' ongoing failure to train, supervise, and monitor CDCR employees and agents concerning their responsibilities, ongoing failure to communicate with county jails regarding the known needs of class members, and ongoing failure to take responsibility for and to assert influence over county jails through contracts, regulations, letters, meetings, or other communications. The Court therefore finds that only system-wide injunctive relief could prevent Armstrong class members from experiencing future ADA violations when housed in county jails.
Although the Armstrong case class members only include the CDCR inmates who are housed in a county jail while on out-to-court status or those serving a parole violation in a county jail, the requirement of providing equal access to programs, services and activities for all inmates housed in county jails (as required by Title II) rests with the county jail and is a non-delegable duty. The County Jail Plan is inclusive of Clark class members as well as inmates with mental health disabilities, just as the Armstrong v. Board of Parole Hearings (BPH) litigation includes individuals with all disabilities covered under ADA.
In addition, with the passage of Assembly Bill (AB) 109, known as the California Realignment Act of 2011, the mission and the fiscal/programmatic demands on county jails in California have become significantly more complex. County jails are no longer a transitory facility only housing pre-sentenced inmates, or inmates sentenced to a year or less.
County jails now have exponentially greater operational, fiscal, regulatory, statutory, and constitutional challenges to provide services for inmates, many of whom, are serving sentences that are significantly longer than one year. We are aware of at least one county in which an inmate has been sentenced to over 18 years to be served in the county jail.
AB 109 inmates are on average older, sicker, and have more complex medical, mental health, and dental care needs that simply cannot be ignored. The constitutional operation of county jails since realignment has become far more complex and far more expensive, because county jails now serve as a hybrid, providing both the services of a jail and a prison.
Because of this recent, unanticipated phenomenon, county jails must act quickly to adapt their current operations to accommodate the needs of this population and to ensure compliance with Title II and the ADA.
This report details the Assessment Team’s review of the policies, procedures and practices of programs, services and activities provided to the SCSD detention facilities’ inmate population.
Listed below is a summary of findings of the most serious violations of the ADA as noted by the Assessment Team:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The current SCSD detention facilities intake medical screening process is wholly inadequate to identify disabled inmates, to determine if the inmate is a qualified individual, or to determine if the disabled inmate has an impairment that requires a reasonable accommodation;
 Inmates are not being provided with the HCA/AD/DME needed to access programs, services and activities and the subtler upper body disabilities are missed altogether;
 There are cases where the SCSD detention facilities are not allowing inmates to retain their HCAs/ADs/DME during the booking process and therefore these inmates are being systematically housed without the necessary devices to assist them in accessing programs, services and activities which violates the ADA;
 There is no process in place to identify intellectually disabled inmates’ adaptive support needs and adaptive functioning deficits such as, communication skills, academic skills, self-care skills, socialization skills, self-advocacy/use of resources, work, health and safety, self-direction, leisure, and assistance staff must provide such as coaching, assisting, monitoring and prompting;
 Disabled inmates (such as those with vision, hearing, speech, learning, and developmental disabilities, as well as those with mental illness and other disabilities) are not informed of available reasonable accommodations, they are not appropriately informed of available programs, services and activities, and they are not receiving the jail rulebook, or observing an inmate orientation video, or having specific rules or expectations explained to them by staff;
 Disabled inmates in the MJ are housed in a medical setting solely based on their disability;
 Inmates housed in the medical housing unit at the MJ are not offered or provided access to equivalent programs, services and activities consistent with their custody level as inmates who are housed in the general population housing units;
 Disabled inmates housed in a medical setting at the MJ and are eligible for housing at RCCC based on classification factors, do not have equal access to education, vocation, self-help programs or jobs;
 Disabled inmates housed in MJ 2 West M/P are not being provided equal access to the outside recreation yard as all other inmates housed in the MJ;
 Disabled inmates housed in 2 East Pod 100 (wheelchair users) are not being provided equal access to the outside recreation yard as all other inmates housed in the MJ;
 The SCSD detention facilities Mental Health staff do not make routine rounds or monitor mentally disabled inmates housed in Disciplinary Detention, Total Separation, and Administrative Segregation units;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 There is no group therapy provided for mentally disabled inmates (except those assigned to the Restoration of Competency (ROC) program/evaluation);
 The responses to requests for mental health services in some cases are not expeditious or within a reasonable timeframe;
 Mentally disabled inmates placed on suicide precaution (“green suits”) at the MJ are often temporarily housed on the housing unit floors (from days to weeks at a time), in the recreation/classroom areas;
 In some cases, there is a lack of confidentiality for JPS and medical encounters/interviews;
 There are delays and in some cases no follow-up regarding requests for psychiatric services;
 There is a common concern amongst numerous custody and JPS staff as to a lack of JPS clinicians;
 The staffing levels at the MJ are impacting the ability for staff to provide the required out-of-cell time (dayroom and outdoor recreation) for disabled inmates;
 The disabled mentally ill inmates housed in the mental health residential units referred to as Outpatient Psychiatry (OPP) at the MJ are not being provided equal access to the outside recreation yard and in some cases the dayroom as other non-disabled inmates housed in the SCSD detention facilities;
 The SCSD detention facilities do not provide equal access to the recreational reading material for disabled inmates;
 The SCSD detention facilities do not provide equal access to religious programming for disabled inmates;
 Some of the SCSD detention facility visiting areas do not provide equal access to visiting or attorney visiting for disabled inmates;
 The SCSD detention facilities do not provide equal access to showers for disabled inmates;
 The Inmate Grievance process does not include an expedited process for ADA related appeals or the provision of interim accommodations pending a decision on their grievances/appeals;
 There is no ADA training provided to SCSD detention facility custody staff (custody, medical and support);
 The SCSD detention facilities do not always provide reasonable accommodations for disabled inmates during transport to court;
 There is only one accessible vehicle available for Long Hauls, court transports from RCCC to the MJ, transports from the MJ to RCCC and medical transports;
 Inmate worker and industry positions do not have essential functions identified and listed;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Medical staff does not identify work duty restrictions, physical limitations, or place inmates on limited/full duty status to assist staff when placing disabled inmates in the appropriate work/industry assignments;
 Inmates with intellectual disabilities assigned to the work/industry position are not provided additional supervision and training to help them meet the requirements of the assignment such as lower production expectations, expanded time frames for completion of projects, etc.;
 There is no comprehensive networked ADA tracking system to identify disabled inmates, to ensure that their EC needs and reasonable accommodations allowing them access to SCSD detention facilities programs, services, and activities are being provided for, and to monitor/identify/correct episodic and systemic non-compliant ADA issues in a timely fashion;
 There is not an effective tracking system in place to identify HCA/DME/AD that have been issued to inmates or were in an inmate’s possession upon arrival into custody;
 The ADA coordinators are inexperienced/ineffective, and they have not had the requisite comprehensive ADA training to perform their jobs effectively;
 The ADA coordinators spend a mere 20-25 percent of their time on ADA compliance issues;
 There is not a comprehensive EC policy or practice in place, particularly with events involving due process, clinical encounters, education, or selfhelp type groups or meetings, e.g., Alcoholics Anonymous and Narcotics Anonymous;
 There currently is not an ADA accountability plan in place to hold staff accountable for egregious, serious or repeated violations of ADA, e.g., discrimination, willful disobedience;
 The SCSD detention facilities do not provide (or adequately provide) inmate orientation information or materials, and do not accommodate disabled inmates (such as those with vision, hearing, speech, learning and developmental disabilities, or those with mental illness or other disabilities) during orientation;
 Operations Orders, Policies and Procedures need to be revised/modified to incorporate applicable ADA language related to inmates with disabilities;
 There are no ADA notices posted in the housing units;  The inmate disciplinary process is flawed, as there are inconsistencies
regarding effective communication being provided, the issuance of the initial and final copies of the write-up report and hearing summaries, and the hearings themselves;  There is no real mechanism to query for or identify inmates who may have a learning disability, and inmates do not receive a basic education or
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
reading level test for identification of reading and comprehension ability (except those who have tested for EGUSD);  A lack of office space (as well as staffing levels for custody and health care staff) has provided for an atmosphere that is not conducive to protecting confidentiality for health care encounters (medical and mental health), classification interviews, and inmate disciplinary hearings;  Many inmates are not aware of legal law library services or how to request access;  There isn’t a single ADA compliant inmate cell shower, bathroom, or living unit in the SCSD detention facilities;  Many paths of travel are non-compliant with the wrong slope or huge potholes and cracks directly in the paths of inmate travel;  The ADA grab bar placements are haphazard. Some are too short, some are in the wrong location, and some are outright missing;  There is insufficient turn around space in the cells, toilet and sink areas;  There are no ADA compliant shower chairs;  There are no high low shower controls or shower hoses; and  The Facility and Fleet (FAF) staff (County employees responsible for facilities maintenance) lack even a basic understanding of the requirements of the ADA/ADAG/ADAS. This detailed report outlines the aforementioned and other violations under ADA, as well as best practices needed for an ADA compliant/comprehensive inmate disability program. To be clear, while the ADA does not require a comprehensive, networked ADA tracking system, a comprehensive training program for all staff who have any inmate contact, or a revision of specific policies and procedures, duty statements and forms, it is our expert opinion that without those three best practice components being implemented alongside a comprehensive disability identification process, the SCSD detention facilities will not be successful in coming into compliance with or have any hope of remaining in compliance with the mandates of the ADA in their two detention facilities.
The report of findings for each area reviewed is contained within the various sections of this document.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Intake/Booking (Disability Identification)
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to screening and identification of disabled inmates and the retention of HCAs/ADs/DME, are outlined in the following policies; 04/01 Intake Search, Receptions and Holding, 04/06 Identification Process, 04/07 Dress In / Dress out Procedure, 05/09 Weekenders, 06/03 Classification Process, 10/04 Medical Intake Screening, Draft Operations Order Inmates with Disabilities - ADA, 1129 ICE Detainee Procedural Considerations, 1404 Receiving Screening, 1417 Adult Developmental Disability, 1422 Special Needs Patients, and 1439 Reports of Disabilities or Impairments.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1207 Medical Receiving Screening, requires that:
With the exception of inmates transferred directly within a custody system that has documented receiving screenings, a screening shall be completed on all inmates at the time of intake. This screening shall be completed in accordance with written procedures and shall include but not be limited to medical and mental health problems, developmental disabilities, and communicable diseases, including, but not limited to, tuberculosis and other airborne diseases. The screening shall be performed by licensed health personnel or trained facility staff.
The facility administrator and responsible physician shall develop a written plan for complying with Penal Code Section 2656 (orthopedic or prosthetic appliance used by inmates).
There shall be a written plan to provide care for any inmate who appears at this screening to be in need of or who requests medical, mental health, or developmental disability treatment.
Written procedures and screening protocol shall be established by the responsible physician in cooperation with the facility administrator.
Per Operations Order 04/01, Intake Search, Receptions and Holdings, arresting/transporting officers are responsible for completing booking paperwork prior to bringing the inmate to the booking area. The booking paperwork includes, but is not limited to:
 Arrest Report  Probable Cause form (signed by the arresting/transporting officer)  Intake medical screening forms  Property and Clothing Record Form (to be completed in accordance with
Operations Order 04/03, Prisoner Clothing, Property, and Funds)
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Intake Classification Form (to be completed in accordance with Operations Order 06/03, Classification Process)
 Custody staff is responsible for maintaining an available supply of the necessary booking forms
 And interpreter services are to be provided as needed in accordance with Operations Order 06/14, Interpreter Services
Custody staff is responsible for performing an initial evaluation of the inmate and assigning an appropriate temporary holding location using the Intake Classification Form and the procedures in Operations Orders 06/03, 04/05, Use of Safety, Segregation, North Holding #2 and Multipurpose Rooms, and 04/04, Use of Sobering Cells. Telephone access to the inmates will be provided in accordance with Operations Order 06/13, Telephone and TDD/TTY Equipment Access.
After the inmate has been identified and the booking process has been completed, the inmate is processed according to booking status. Inmates who are eligible to be released or who have posted bail will be processed in accordance with Operations Order 04/09, Releases. Inmates who are not eligible for release will be moved to the appropriate holding area while waiting to be dressed into facility clothing. Inmates will be issued facility clothing and housed in accordance with Operations Order 04/07, Dress In / Dress Out Procedures.
Per Operations Order 04/06, Identification process, inmates who are going to be housed at the MJ or RCCC will be provided a copy of the “Inmate Booking Information Receipt” before they are placed in a housing unit. The information on the receipt should include, but is not limited to:
 Charges/Holds.  Bail amount.
Custody staff working at the Identification (ID) station should be able to obtain answers to inmates’ questions about the booking and/or release process. Information pertaining to the booking process should be made available by custody staff to those who have difficulty understanding English or who are hard of hearing or deaf, or who are visually impaired.
Per Operations Order 04/07, Dress In/Dress out Procedure, during the inmate dress-in process, sworn custody staff shall perform strip searches of inmates who fall under the criteria for strip searches in accordance with current policy and procedures. Sworn custody staff shall dress in inmates who are eligible for a strip search separately from those who will not be strip-searched. Sworn custody staff will move inmates to individual stalls divided by solid opaque dividers or opaque curtains blocking view of each inmate from each other and from outside the dress in area. Sworn custody staff will issue the prescribed inmate clothing for the facility, including but not limited to, the following items:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 One (1) shirt  One (1) undershirt  One (1) pair of pants  One (1) pair of socks  One (1) pair of shoes  One (1) towel  One (1) complete set of undergarments. Female inmates receive two (2)
pairs of panties and one (1) bra.
Custody staff shall issue the inmate a personal hygiene kit, which minimally includes a toothbrush, toothpaste, and comb. Custody staff shall provide the inmate with orientation materials in accordance with Operations Order 04/08Prisoner Orientation. Once inmates have been dressed in prisoner clothing, custody staff will deliver or make arrangements to deliver the inmates to the housing units in accordance with Operations Orders 06/02, Housing Plan and 6/03, Classification. The inmates may also be issued additional clothing and bedding appropriate to his/her housing facility. The clothing assigned to the inmate will be in accordance with Operations Order 06/11, Laundry, Clothing, and Linens.
Per Operations Order 05/09, Weekenders, at initial booking, males and females are required to report to the Front Counter at the MJ and to the Gatehouse at RCCC to confirm that the commitment order has been received from the court. For purposes of the booking process, weekenders are booked according to the standard booking procedures in accordance with existing booking, property, orientation, and classification orders; however an arrest report and probable clause declaration are typically not needed. If a weekender is on medication which should be continued during incarceration, he/she should bring the currently dated, properly packaged and labeled prescription to the facility so medical staff may evaluate the medication. Medical staff shall determine the course of action with regard to the inmate’s medical needs.
Per Operations Order 06/03 Classification Process, at intake, custody staff will perform an initial classification of inmates using the Intake Classification Form. Custody staff will be responsible for separating inmates as appropriate per this order.
Per Operations Order 10/04 Medical Intake Screening, Correctional Health Services staff shall complete a health screening procedure on each arrestee at the time of booking in accordance with Article 11, Section 1207 of the California Code of Regulations, Title 15. Any person not deemed medically fit for incarceration will not be accepted.
At the time of intake a medical receiving screening shall be performed by health personnel for all new inmates, including transfers, and documented on the appropriate forms. The intake medical screening shall minimally include
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
observations of the subject’s behavior and physical condition and inquiries into past and present illness and health problems, use of medications, drugs and/or alcohol, and for females, gynecological issues and pregnancies. Medical staff shall, in coordination with Jail Psychiatric Services (JPS), complete a cursory evaluation of the inmate’s mental health. If during the intake medical receiving screening process an inmate is found to be in need of immediate medical attention, the inmate shall be promptly referred for emergency care. If referred to an outside medical facility, a written medical clearance shall be obtained prior to acceptance into a facility as described in section III of this order. Inmates accepted for custody and deemed to be a “Medical Expedite” shall be processed through the booking process within two hours. A “Medical Expedite” form shall be initiated by medical staff and completed by custody staff when the inmate is escorted to the medical housing area.
If the arresting/transporting officer finds medication in the inmate’s possession, he/she should present the medication to the intake nurse. Medical staff will note the dosage and return the medication to the arresting/transporting officer. If medically required, medical staff will retrieve medication which is a medical equivalent to that taken by the arrested person, and package it for dispensing to the inmate at scheduled pill call in accordance with Operations Order 10/08, Medication Distribution. If an inmate is on medication, he/she should report the details to the nurse conducting the medical screening.
An ambulatory subject who requires but has refused medical attention may be booked at the discretion of medical staff. Medical staff shall verify with the subject that he/she refuses medical treatment, and shall note the refusal. In situations where the arrestee is unable or refuses to respond to the receiving screening questions, health personnel shall visually examine the subject for obvious or noticeable medical problems. If the subject is accepted for incarceration, the form shall be completed at a later time when the subject becomes cooperative or communicative.
Paraplegic arrestees and those who must use crutches or orthopedic appliances but who are otherwise fit shall be accepted for incarceration. Correctional Health Services staff shall not accept for booking any arrestee who is unconscious, unable to walk without the aid of another person or in need of obvious medical attention. If an inmate is deemed unfit for incarceration at the time of intake, the arresting/transporting officer/agency is responsible for transport or providing appropriate staff in the event an ambulance is summoned. Upon return, the inmate shall not be accepted for incarceration unless the arresting/transporting officer provides documentation from an examining physician certifying the subject is fit for incarceration and the previously unfit condition must be rendered appropriate for the level of care provided at the jail as determined by health care staff.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Per Draft Operations Order Inmates with Disabilities - ADA, the medical screening process during intake serves to identify most disabilities and the need for accommodations prior to the housing of an inmate. It is the responsibility of booking and medical staff to assess inmates upon admission for evidence of a disability or special medical need. This assessment information will be recorded on the Inmate Disability Evaluation Form (IDEF) as applicable. Information may be garnered from the inmate’s prior custody or medical records.
Custody or medical staff may observe and report a disability or medical condition that would:
 Impact the inmate’s housing;  Impact the intimate’s / arrestee’s Activities of Daily Living;  Affect the inmate’s program access; or  Present a safety or security concern for the inmate or others.
It is the responsibility of the intake medical staff to:
 Initiate and sign an IDEF, and forward the form to the Booking Unit and the ADA Coordinator upon determination that an inmate may have a disability.
 Create an “ADA” ALERT in the inmate’s medical chart making appropriate notations on the inmate’s particular disability or limitation.
A designated deputy will be assigned to assist any obviously disabled inmate in the booking area, as needed. The identified inmate will be escorted either through the dress-in process to an intake floor, to the release holding tank or another holding area as necessary.
For those inmates with disabilities who were not identified at intake booking or processing, there shall be Americans with Disabilities Act Notices posted in the housing units that inform inmates how to obtain information regarding an ADA issue or how to request accommodation. The same information will be duplicated in the Inmate Orientation Handbook. Staff may notify the ADA Coordinator at any time, for any inmate that they feel has a disability, based upon personal observation of the inmate, an oral statement by the inmate, or a written request by the inmate.
Inmates may keep items in their possession, which do not pose a security risk to the facility or a safety risk to staff or other inmates. Such items include, but are not limited to, prescription eyewear, dentures, hearing devices, prostheses, crutches, and medical braces. Intake medical staff shall determine if the requested item is medically necessary. If there is any question on whether an appliance/device is medically necessary, the inmate shall be allowed to keep the item. The inmate shall then be scheduled to be examined by a physician within 24 hours to determine the medical necessity of the requested item. If there is no identifiable medical need, then the item will be placed in the inmate’s property.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
If an inmate does not have an appliance/device and is in need of one, medical staff shall:
 Evaluate the severity of the need and either approve or deny the request.  Provide the inmate with crutches, walker, wheelchair or other device as
deemed necessary, or  Make arrangements to obtain the appliance/device.
Per policy 1129 ICE Detainee Procedural Considerations, during intake all ICE Detainees will receive a Tuberculin Skin Test (TST) using Purified Protein Derivative (PPD) solution unless they have a documented positive TST. Documented TST must have the date of the TST, the mm of induration, and a medical provider’s signature.
ICE Detainees will receive a complete Personal Health History (PHH) within 14 days of arrival at the facility or within 14 days of being identified as an ICE Detainee. Registered nurses (RNs) completing a PHH will receive training from a physician on how to complete a PHH.
Per policy 1404 Receiving Screening, a receiving health screening is performed by medical staff on all arrestee(s) (including transfers) immediately upon arrival at the facility. Arrestee(s), who are unconscious, semi-conscious, bleeding, or otherwise obviously in need of immediate medical attention, are referred to outside medical care prior to acceptance. The purpose of this health screening is to obtain prompt medical care for those needing it, to identify ongoing or chronic medical needs, and to detect those arrestee(s) who pose a potential threat to the health or safety of others within the general population. Baseline data is established for use in subsequent care and treatment. When referred to an outside emergency department, their return to the jail is predicated upon written medical clearance. Receiving screening findings are recorded on a printed form approved by the Health Authority. At a minimum, the screening includes:
Inquiry into:
 Current illnesses and health problems, including medical, dental, and communicable diseases (including sexually transmitted diseases).
 Medications taken and special health requirements.  Use of alcohol and other drugs, including types, methods, amounts,
frequency, date or time of last use, and a history of problems, which may have occurred after ceasing use (i.e., seizures).  History or appearance of suspected mental illness, including suicidal ideation or behavior.  Appearance or history of developmental disability.  For female arrestee(s), a history of gynecological problems, possibility of current pregnancy, and present use of birth control.  A complete set of vital signs and a stated height and weight.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Observation of:
 Behavior, which includes state of consciousness, mental status, appearance, conduct, tremors, and sweating.
 Body deformities and ease of movement.  Condition of skin, including trauma markings, bruises, lesions, jaundice,
rashes and infestations, needle marks or other indication of drug abuse.  Slowness in speech or lack of comprehension of questions suggestive of
developmental disabilities.
Disposition, such as:
 Referral to an appropriate Health Care Service or Mental Health Service on an emergency basis; or
 Placement in the general inmate population and later referral to an appropriate Health Care Service; or
 Clearance for housing; or  Isolation or special observation in the facility.
Procedures will include provisions for segregation and/or special housing for patients with suspected communicable diseases, mental illness, or developmental or physical disabilities, pending medical clearance. Disposition should also provide for referral and follow-up care.
Nursing Staff will provide a medical evaluation on all new arrestees. Arrestees in need of immediate medical treatment are referred to the facility physician. NO arrestee is to be accepted into the jail until he/she has completed the Receiving Screening process. Arrestees may be placed on next scheduled Sick Call.
Jail Psychiatric Services (JPS) may be requested to evaluate an arrestee's mental status. Arrestees may be housed in the Outpatient Housing Unit. They may also be referred for follow-up psychiatric care.
The Receiving Screening shall be conducted by the Nursing Staff at MJ and RCCC. This will become a part of the medical record.
Per policy 1417 Adult Developmental Disability, the identification of a person with developmental disability begins at booking and continues throughout incarceration. The Intake medical personnel should be alert to the possibility of developmental disability by looking for:
 Difficulty in performing basic tasks associated with the process.  Slowness or apparent difficulty in understanding.  A history of treatment for developmental disability through a Regional
Center or special education class.
If there is suspicion of a developmental disability, a notation will be made on the Receiving Screening medical form and a referral made to the JPS Outpatient Department. In cases where there is uncertainty as to whether the inmate has a
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
psychiatric condition as opposed (or in addition to) development disability, referral for mental health evaluation is appropriate. It is the responsibility of Jail Psychiatric Services' clinical staff to initiate an Alta Regional Center referral for a person suspected to have developmental disability or to contact Alta Regional for those persons who are already clients of Alta Regional.
Per policy 1439, Reports of Disabilities or Impairments, the ADA provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”
Any report of physical disability or impairment by an inmate or outside organization will be referred to a clinician for review and assessment. This can include reports of mobility impairments such as amputations or paraplegia, or other disabilities that limit daily functioning such as visual, hearing, or speech. The clinician will review the report, assess the inmate’s needs and make a determination if special housing or assistive devices are needed. If indicated, these needs will be recorded in the patient-inmate’s chart, and communicated to medical and custody staff. Upon report of a disability or impairment (verbal or written):
 A Medical Doctor (MD)/Nurse Practitioner (NP) Sick Call appointment will be scheduled and the nature of the report will be documented.
 The patient-inmates will be seen and their disability or impairment will be assessed and if indicated a plan of care will be developed.
 Any specific patient-inmate’s needs or accommodations will be documented in the chart and communicated to medical and custody staff.
Observations
The Assessment Team observed the entire intake booking process at the MJ and RCCC facilities on multiple days and various times of the day (morning/afternoon/evening/) for male and female inmates. This included the initial arrival of the arrestee, completion of the Special Needs Form, medical intake screening process, the custody booking process and the classification process. The Sacramento County Sheriff’s Department Correctional Health Services Medical Intake screening form addresses the following; Vitals, Fever Evaluation, Chest Pain, Shortness Of Breath, or Dyspnea Evaluation, Injury, Trauma, and Life/Limb Medical Issues Evaluation, Asthma Chronic Obstructive Pulmonary Disease (COPD) Evaluation, Diabetes Evaluation, Alcohol or Benzodiazepine Withdrawal Evaluation, Opiate Withdrawal Evaluation, Medical History Conditions, Medical Evaluation, Allergies, Essential Medications, JPS Evaluation and Female Health Evaluation. The following disability-related question is part of the medical intake screening form, “Does the arrestee have physical/developmental disabilities that prevent them from caring for themselves? If yes, arrestee needs segregation or observation in booking and Medical Expedite.” The Sacramento County Sheriff’s Department Correctional Health
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Services Special Needs form addresses the following; Disposition, Special Medical Needs and Arrestee/Detainee possession of specific devices while in medical intake. This form allows medical staff to identify HCA/AD/DME the inmate had in their possession while in medical intake. This form also has a section for custody staff to note if the HCA/AD/DME was sent to property. There are very general disability-related questions that are asked during the medical intake screening process regarding hearing aids, glasses, and other medical conditions.
The medical intake process is conducted in a private setting at both the MJ and RCCC. However, on one occasion, the Assessment Team observed the medical intake process being conducted on the bench in the arresting officers report room. Two nurses were conducting the medical assessment while 7 inmates sat on a bench as the other inmates could overhear the screening questions and inmate responses. Medical staff all used the Sacramento County Sheriff’s Department Correctional Health Services Medical Intake screening form, however, the method in which the questions were asked and how information was collected was inconsistent. At RCCC the medical screening nurse was very thorough and ensured that the inmate understood each question being asked. At the MJ, one nurse was observed completing the medical screening process in less than 60 seconds. This nurse was heard stating, “took me more than a minute, I am getting slower.” In some cases, medical staff did not ask all and in some cases none of the questions related to screening for disabilities. One nurse was observed referring an inmate to a chart posted on the wall that reflects the medical history and conditions listed in the medical intake screening form, instead of asking the inmate the questions, not inquiring of the inmate whether he could read, see or understand the information on the chart. The medical staff had the inmates sign the medical intake form, however, they did not query or ensure that the inmate understood the information noted on the form.
The Assessment Team observed the JPS intake screening process at the MJ. The Assessment Team noted that the JPS intake screening process is conducted in a non-confidential setting. The screening is conducted cell front with the cell door open and custody staff providing security coverage for the JPS staff member.
The Assessment Team observed the inmate identification process. In booking, inmates were being provided a copy of the “Inmate Booking Information Receipt;” however, staff working at the ID station were only handing the document to the inmates and were not providing EC to ensure disabled inmates understood the information contained in the document.
Neither the custody booking or classification processes included a system to identify disabled inmates as custody staff primarily rely on medical intake screening staff to identify the disabled inmates.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The Assessment Team also conducted a tour of the MJ and RCCC property rooms. During this tour the team observed a significant number of HCAs/ADs/DME that were being stored. The HCAs/ADs/DME observed included; wheelchairs, walkers, canes and crutches.
Although the Assessment Team did not observe any disabled inmates with HCAs/ADs/DME being processed for booking, medical and custody staff informed the Assessment Team that disabled inmates who have such devices are allowed to retain these devices.
Staff Interviews
The Assessment Team interviewed medical, custody, and mental health staff assigned to the booking and intake process. Medical staff in booking stated that during the medical intake process inmates are asked the questions from the medical intake form line by line. If the inmate is identified as having psych or medical issues they are expedited through the intake process and housed on the 2nd floor. Medical staff stated that they could identify disabled inmates by the way they were walking. If they limped, had a cane, crutches or a wheelchair they were identified as disabled. Inmates with wheelchairs would be housed on 2 East and inmates with other assistive devices would be housed according to classification. Medical staff stated they would also identify disabled inmates by how they answered questions. Additionally, there could be information from a previous stay that would alert medical staff to a potential disability. If an inmate requested a cane or other assistive device, he/she would be scheduled for a medical evaluation. If the inmate arrived with an HCA/AD/DME medical staff would complete a Special Needs form and forward the information to custody. This form would also alert custody staff if an inmate required a lower bunk/lower tier (LB/LT). Medical staff stated there is no centralized tracking system to alert staff of a disabled inmate’s accommodation needs. Medical staff stated that if the inmate’s glasses (prescription/reading) had metal frames they were not allowed to them and the custody officers would place them in their property. They stated that if a hearing-impaired or deaf inmate were being processed they would write the questions and have the inmate respond in writing because there is no sign language interpreter (SLI) available.
If the medical assessment provides evidence of mental illness, a nurse will refer the inmate to JPS by completing the Special Needs form. The inmate is then moved to a safety holding cell pending evaluation by JPS staff. JPS staff stated that a clinical assessment is completed on inmates referred to JPS by medical staff during the intake/booking process. They also stated that an inmate will either be cleared for housing or referred to the psychiatrist to determine if inpatient housing is warranted. The psychiatrist will either clear the inmate for housing or determine that the inmate requires acute inpatient housing on 2 WestP. Staff stated that based on lack of bed availability inmates at times must remain in the safety cells for up to 2 weeks.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Medical staff stated that ICE detainees receive a PHH exam within 14 days of arrival. The PHH is more thorough and includes a more thorough review/assessment/evaluation for disabilities (physical/intellectual). The PHH asks the detainees questions for self-reporting of mental health and developmental history. The PHH also includes a general physical exam and a mental status exam where the examiner/clinician notes the detainees orientation, perceptions/thought content, appearance, posture, gait/walk, movement, mood, attitude, speech, intelligence and insight.
Custody staff stated that the arresting officers complete the Intake Screening form. Medical staff then complete the intake medical screening. The inmates are searched, photographed, placed in holding cells, ID’d and fingerprinted, placed in a holding cell depending on type of arrest (Quick/Felony), for felony arrests dressed out, shown the Prison Rape Elimination Act (PREA) video, and then housed.
Medical staff acknowledged that inmates expected to be at the jail for a short period of time (e.g., 12 hours or less), and who are undergoing intake booking medical screening are given a Quick Medical Assessment, which consists of less questioning, with little to no disability related questions, other than mental health (MH). One of the RNs who was interviewed indicated that medical staff know who has a disability by the way inmates walk and talk. When asked, another RN admitted that a 60-second medical intake or health screening (as observed by the assessment team) would not constitute a thorough screening.
When asked how cumbersome the workload would be (if any) to increase the medical screening to match that of the ICE medical screening, a nurse replied that more medical staff would have to be hired. She stated that health services is already understaffed, and that medical clearances are a major problem. She cited there are about 7 vacancies now, and they use registry staff to fill the void. She also stated that on some days, positions get filled, and on other days they do not get staffed. When asked what (if anything) suffers when medical positions are not filled, the nurse indicated that some sick calls won’t get handled, the less severe Health Services (HS) KITE’s are not responded to, and blood pressure checks may go undone. She mentioned that pill call nurses sometimes fill the void, or management attempts to hire overtime if they can.
Inmate interviews
During the interviews, numerous inmates alleged that staff did not provide and/or confiscated their HCA/AD/DME during the booking process. Inmates also stated that they were not allowed to retain prescription glasses when processed through intake/booking. Numerous inmates who could not read and claimed to have a learning disability and/or attended special education classes in public school stated that they did not understand the booking/classification process. Inmates
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
with intellectual, learning, vision, and hearing disabilities were not identified as having a disability by SCSD detention facility staff.
Conclusions
The current SCSD detention facilities intake medical screening process is wholly inadequate to identify disabled inmates to determine if the inmate is a qualified individual or to determine if the disabled inmate has an impairment that requires a reasonable accommodation.
Although SCSD detention facilities have a process in place to allegedly identify the accommodation needs of disabled inmates covered under Title II of the ADA, inmates are not being provided with the HCA/AD/DME needed to access programs, services and activities. The subtler upper body disabilities are missed altogether.
Based on the observations in the property rooms and statements by medical staff and inmates, the SCSD detention facilities are not allowing some inmates to retain their HCAs/ADs/DME during the booking process and therefore are systematically being housed without the necessary devices to assist them in accessing programs, services and activities in violation of the ADA.
There are cases in which inmates have not been provided an HCA/AD/DME to assist them in accessing programs, services and activities. This includes inmates with vision impairments not being allowed to retain prescription glasses when processed through intake/booking. Medical staff does not always approve assistive devices that would assist inmates in accessing programs, services and activities at the SCSD detention facilities.
Inmates with intellectual disabilities are not being screened or reliably and effectively identified when they enter the SCSD detention facilities. The SCSD detention facility staff is not using reliable and valid screening tools for intellectual disabilities. Moreover, screening is done primarily by medical staff who have not received training in identifying and working with individuals with these disabilities.
Inmates with intellectual disabilities are not always easy to distinguish from nondisabled inmates. According to experts only a small percentage of people with developmental disabilities have identifying physical characteristics or impairments in physical or motor skills. In addition, many intellectually disabled individuals work hard to mask their disabilities. Individuals with intellectual disabilities also have inconsistent and uneven skill development, which can mask areas of impairment. A person with adequate self-care skills, for example, may have significant functional impairments in other areas. People with intellectual disabilities might have deficits in information durability. In other words, they might need repeated reminders, even if a task is one they have undertaken before. Many individuals with developmental disabilities have trouble transferring information: taking a skill they have learned in one area and applying it to a
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
similar task in another area. An intellectually disabled inmate might learn to stay inside the yellow boundary lines painted in his housing unit, but may not apply that skill to another prison if transferred. People with intellectual disabilities can usually function well in highly structured environments such as prisons, where personal choices regarding food, clothing and activities are eliminated. However, jails also have numerous and complex rules. The stress of learning, understanding, remembering, and complying with the multitude of rules that govern jail life can offset the potential benefits of the highly-structured environment for intellectually disabled inmates.
There is no process in place to identify intellectually disabled inmates’ adaptive support needs and adaptive functioning deficits such as, communication skills, academic skills, self-care skills, socialization skills, self-advocacy/use of resources, work, health and safety, self-direction, leisure, and assistance staff must provide such as coaching, assisting, monitoring and prompting.
The mental health screening process is being conducted in a non-confidential setting cell front or in the safety cells.
The screening process for inmates with potential intellectual disabilities needs to be refined to include a more detailed screening assessment tool.
A screening process needs to be developed and put in place to screen inmates for learning disabilities and/or literacy concerns.
Inmates who were interviewed by the Assessment Team were identified as having a history of intellectual disabilities, however, SCSD detention facilities staff did not identify these disabilities during the screening and booking process.
During the entire intake process, medical, mental health and custody staff did not ensure EC was established with inmates who may have had disabilities impacting their ability to understand terminology used by staff and documents that they are required to sign acknowledging understanding. Staff must ensure they effectively communicate with all inmates who may have difficulty understanding due to intellectual, mental health, learning and other disabilities. The goal of EC is to understand and to be understood. Staff must adapt their communication techniques when communicating with disabled inmates to ensure EC is established.
References
28 C.F.R § 35.104 defines a Disability as a physical or mental impairment that substantially limits one or more of the major life activities. The phrase “major life activities” means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. Mobility disability means and refers to any impairment or condition that limits a person's ability to move any part of his or her body or position of his or her body including,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
but not limited to, a person's ability to walk, ambulate, maneuver around objects, and ascend or descend steps or slopes. A person with a mobility disability may or may not use a wheelchair, scooter, Electric Personal Assisted Mobility Device, crutches, walker, cane, brace, orthopedic device, Functional Electrical Stimulation, or similar equipment or device, or may be semi-ambulatory.
28 C.F.R. § 35.130 (b)(1)(iii) and (vii) state “A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others; Otherwise limit a qualified individual with a disability in the enjoyment of any right, privilege, advantage, or opportunity enjoyed by others receiving the aid, benefit, or service.”
42 U.S.C. § 12132: no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.
28 CFR § 35.130(a) No qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service; (ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others;
28 CFR § 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities;
28 CFR § 35.130(b)(7) A public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
that making the modifications would fundamentally alter the nature of the service, program, or activity.
The following reference from Armstrong v Brown pertains to inmates with disabilities or possible or suspected disabilities:
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Verification Process:
It is the mutual responsibility of the inmate/parolee and CDC to verify disabilities that might affect their placement and verifying credible claims of disability in response to requests for accommodations of complaints about disability-based discrimination.
Verification may be triggered by:  The inmate self-identifies or claims to have a disability;  Staff observes what appears to be a disability severe enough to impact placement, affect program access, or present a safety or security concern;  The inmate’s health care or file contains documentation of a disability; and  A Third party (such as a family member) requests an evaluation of the inmate for an alleged disability.
Health care appliances shall be documented as property of the inmate and identified as such. No inmate shall be deprived of a health care appliance that was in the inmate’s possession upon entry into the CDC system or was properly obtained while in CDC custody, unless for documented safety or security reasons or a physician determines that the appliance is no longer medically necessary or appropriate.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Clark v. California amended March 1, 2002, mandates the following:
SCREENING PROCESS
All inmates will be screened for developmental disabilities using standard instruments, as described below, to ensure uniform application of departmental policies and procedures for screening, identifying, and verifying developmental
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
disabilities and placing identified inmates in appropriate settings. A four-phase process and clinical judgment will be used to identify those inmates who fit the criteria for developmental disabilities. Phase I should take place within seven days after an inmate arrives at an RC or clinical staff receives a referral. Phase II should take place within seven days after an inmate fails the test administered in Phase 1. Phase III should take place within seven days after an inmate fails the test administered in Phase II. Phase I and Phase II cognitive tests may be refused and, with justification, skipped. The later phase is due seven days after the decision to refuse or skip a phase is documented. The Clark Adaptive Support Evaluation (CASE), which is used for Phase III and Phase IV, is not dependent on inmate cooperation; however, if an inmate refuses to be interviewed for the CASE, the clinician must make use of collateral information such as observation of inmate and his living conditions, staff interviews, central file (C-File), unit health record, and other records.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Delivery, Repair, Removal, and Use of Health Care Appliances/Assistive Devices/Durable Medical Equipment/ Medical Supplies
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to the delivery, repair, removal, and use of Health Care Appliances, Assistive Devices and Durable Medical Equipment (HCAs/ADs/DME) are outlined in the following policies; 04/03 Prisoner Clothing, Property and Funds, 04/07 Dress In/Dress Out Procedure, 10/04 Medical Intake Screening, Draft Operations Order Inmates with Disabilities - ADA, 1125 Prosthesis, 1128 Reading Glasses for Inmates, 1404 Receiving Screening, 1431 Footwear In The Jails, and 1439 Reports of Disabilities or Impairments.
Per Operations Orders, 04/03 Prisoner Clothing, Property and Funds and 04/07 Dress In/Dress Out Procedure, inmates may keep items in their possession, which do not pose a security risk to the facility or a safety risk to staff or other inmates. Such items include, but are not limited to:
 Prescription eyewear, dentures, hearing devices  Prostheses, crutches, and medical braces  Legal materials  Lists of telephone numbers and addresses
Per Operations Order 10/04, Medical Intake Screening, at the time of intake a medical receiving screening shall be performed by health personnel for all new inmates, including transfers, and documented on the appropriate forms. The intake medical screening shall minimally include observations of the subject’s behavior and physical condition and inquiries into past and present illness and health problems, use of medications, drugs and/or alcohol, and for females, gynecological issues and pregnancies. Paraplegic arrestees and those who must use crutches or orthopedic appliances but who are otherwise fit shall be accepted for incarceration.
Draft Operations Order Inmates with Disabilities - ADA, defines an assistive device as, any device that is designed, made, or adapted to assist a person to perform a particular task (e.g., canes, crutches, walkers, wheelchairs, shower chairs). The draft order defines an orthopedic appliance as a device used to support, align, prevent, or correct deformities or to improve the function of the movable parts of the body (e.g., support braces, orthopedic shoes). The appliance must be prescribed or recommended and fitted by a physician and be subject to the rules delineated in Penal Code Section 2656 and addressed in Section XII of this policy. Prosthesis is defined as a device used to replace a defective or missing part of the body (e.g., artificial limbs).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Per Draft Operations Order Inmates with Disabilities - ADA, inmates may keep items in their possession, which do not pose a security risk to the facility or a safety risk to staff or other inmates. Such items include, but are not limited to, prescription eyewear, dentures, hearing devices, prostheses, crutches, and medical braces. Intake medical staff shall determine if the requested item is medically necessary. If there is any question on whether an appliance/device is medically necessary, the inmate shall be allowed to keep the item. The inmate shall be scheduled to be examined by a physician within 24 hours to determine the medical necessity of the requested item. If there is no identifiable medical need, then the item will be placed in the inmate’s property.
If an inmate does not have an appliance/device and is in need of one, medical staff shall:
 Evaluate the severity of the need and either approve or deny the request.  Provide the inmate with crutches, a walker, a wheelchair or other device
as deemed necessary, or  Make arrangements to obtain the appliance/device.
If there is probable cause to believe an inmate’s possession of an appliance or device constitutes an immediate risk of bodily harm to any person in the facility or threatens the safety and security of the facility, the Watch Commander shall direct the removal of the appliance/device. The removal shall be documented at minimum in an Inmate Incident Report (PF10). The item shall be maintained in the facility property room or storage area until final disposition has been received by the Watch Commander.
Whenever an appliance/device is removed, the inmate shall be examined by a physician within 24 hours of the removal. If an alternative appliance/device can be utilized to provide the medical need then it should be considered. If there is no suitable alternative and the examining physician determines that removal is or will be injurious to the health or safety of the inmate, the physician shall inform the inmate and the Watch Commander. Upon receipt of the physician’s opinion, the Watch Commander shall either return the appliance/device to the inmate or refuse to return such appliance/device. If the appliance/device is returned, such shall be documented in an Inmate Incident Report (PF10).
If an appliance/device is not returned, the Watch Commander shall:
 Notify the Facility Compliance Supervisor and the reviewing physician.  Place the appliance/device in the inmate’s booking property. If the item is
too large to fit in the inmate’s property, it shall be booked for safekeeping and sent to the property warehouse.  Provide the inmate with a completed Petition for Return of an Orthopedic or Prosthetic Appliance form. A copy shall also be placed in the inmate’s file.  Provide final disposition in an Inmate Incident Report (PF10).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Per policy 1128, Reading Glasses For Inmates, if a patient needs assessment for reading glasses this assessment should be done at nurse sick call. A referral to the MD is not required. To determine the appropriate strength for reading glasses, nurses should use the following guidelines:
Age less than 40 =>1.25 40 – 44 =>1.75 45 – 49 =>2.00 50 and older =>2.25
A nurse would provide the inmate with the appropriate strength based on their age, and the inmate could purchase the glasses through commissary.
If the inmate is medically indigent, a note to that effect and the strength of the glasses needed is to be recorded in the medical file. At that time, a Miscellaneous Medical Needs form will also be completed with the following notation: Medically indigent, needs reading glasses at [the required strength.] A copy of the Miscellaneous Medical Needs form is to be given to the inmate. A second copy is to be placed in the medical file, and the third copy is forwarded to the social worker who will facilitate provision of the glasses. The reading glasses will be paid for through Inmate Welfare Fund (IWF) funds and will be delivered to the inmate by the social worker.
CHS will be purchasing repair kits for each facility, which will be kept in the senior registered nurse (SRN) offices. Please instruct staff (licensed vocational nurses [LVN’s] during pill call or RN’s during sick call) to take glasses and bring them to the SRN office for repair. Staff will try to repair and return or else replace them.
Per policy 1404, Receiving Screening, a receiving health screening is performed by medical staff on all arrestees (including transfers) immediately upon arrival at the facility. Arrestees who are unconscious, semi-conscious, bleeding, or otherwise obviously in need of immediate medical attention, are referred to outside medical care prior to acceptance. The purpose of this health screening is to obtain prompt medical care for those needing it, to identify ongoing or chronic medical needs, and to detect those arrestees who pose a potential threat to the health or safety of others within the general population. Baseline data is established for use in subsequent care and treatment. When referred to an outside emergency department, their return to the jail is predicated upon written medical clearance. Receiving screening findings are recorded on a printed form approved by the Health Authority. At a minimum, the screening includes:
Inquiry into:
 Current illnesses and health problems, including medical, dental, and communicable diseases (including sexually transmitted diseases).
 Medications taken and special health requirements.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Use of alcohol and other drugs, including types, methods, amounts, frequency, date or time of last use, and a history of problems, which may have occurred after ceasing use (i.e., seizures).
 History or appearance of suspected mental illness, including suicidal ideation or behavior.
 Appearance or history of developmental disability.  For female arrestees, a history of gynecological problems, possibility of
current pregnancy, and present use of birth control.  A complete set of vital signs and a stated height and weight.
And observation of:
 Behavior, which includes state of consciousness, mental status, appearance, conduct, tremors, and sweating.
 Body deformities and ease of movement.  Condition of skin, including trauma markings, bruises, lesions, jaundice,
rashes and infestations, needle marks or other indication of drug abuse.  Slowness in speech or lack of comprehension of questions suggestive of
developmental disabilities.
Per policy 1431, Footwear In The Jails, detainees seeing physicians or mid-level practitioners with complaints of foot discomfort, especially from jumping activities related to playing basketball, frequently request the use of their street shoes. Most of these have shoelaces. The jail has a strict suicide prevention philosophy. One of the ways this philosophy is implemented is to provide footwear that does not contain shoelaces.
The SCSD detention facilities provide its jail inmates with a soft-soled, all purpose shoe. It is sufficient for most activities, including sports. If, after examination of the patient, a physician believes there is a foot problem such as a deformity, or a disease condition such as neuropathy that requires an orthotic shoe during the stay in the jail to prevent significant pain or deterioration of the condition, the patient should be referred to a specialist for a prescription for the correct orthotic device. The prescriber should be made aware of the ban on shoelaces and metal bracing.
If the patient already has a legitimate orthotic prescription, the orthotic device/shoe needs to be examined by the custody staff for clear and present safety issues. Medically necessary care to alleviate pain and prevent deterioration should not be denied even if some alteration in the means of providing it is required in this environment. Medical staff may need to assist in determining that alternative. This is an appropriate use of the miscellaneous medical needs form (Chrono) to indicate the need for non-jail-issued footwear. Today’s average sports shoes now come equipped with additional supports for active lifestyles built into them, and patients may prefer these to putting inserts into the jail shoes. Some podiatrists are advising patients to use these in lieu of
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
an actual orthotic prescription; however, we cannot substitute this recommendation for an actual orthotic prescription.
If, after an examination of the feet, no orthotic prescription appears needed, the patient should be counseled to make use of the over-the-counter availability of appropriate inserts recommended by our current orthopedist to provide arch support or heel cushioning. If the patient has a complaint of flat feet, heel spurs, or plantar fasciitis, the shoe insert may be helpful. These should be available in canteen, or can be ordered through pharmacy or medical supply if not.
In order to accommodate certain foot or ankle conditions or to better allow the use of the recommended shoe insert, the physician may determine that a closed depth type shoe may be useful. This is a shoe that has an upper that comes up over the top of the foot and closes low around the ankle. It is not a high-top shoe. The Jail has approved such a shoe with a Velcro closure that is available through the commissary. It will be necessary to advise custody staff via the Special Needs form (Chrono) that the patient should be allowed to purchase and use the shoe. It is also necessary to notify Fiscal about the shoe.
This shoe is not a prescription device or an orthopedic or medical shoe, but it is an alternative clothing item. It is not intended or designed to provide therapy for any medical condition and should not be referred to as such for liability reasons. However, it does provide a more secure closure and foot support and may accommodate a shoe insert better than the deck type standard jail issue shoe.
Per policy 1439, Reports of Disabilities or Impairments, the ADA provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”
Any report of physical disability or impairment by an inmate or outside organization will be referred to a clinician for review and assessment. This can include reports of mobility impairments such as amputations or paraplegia, or other disabilities that limit daily functioning such as visual, hearing, or speech. The clinician will review the report, assess the inmate’s needs and make a determination if special housing or assistive devices are needed. If indicated, these needs will be recorded in the patient-inmate’s chart, and communicated to medical and custody staff. Upon report of a disability or impairment (verbal or written):
 An MD/NP Sick Call appointment will be scheduled and the nature of the report will be documented.
 The patient-inmates will be seen and their disability or impairment will be assessed and if indicated a plan of care will be developed.
 Any specific patient-inmate’s needs or accommodations will be documented in the chart and communicated to medical and custody staff.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Observations
The Assessment Team observed the intake booking process on 4 separate occasions. During the observation, there were no disabled inmates with HCA/AD/DME in their possession during the medical intake screening process. However, the Assessment Team observed on 2 separate occasions a cane that was positioned outside a holding cell/room in the MJ booking area. When questioned, custody staff stated that inmates are not allowed to retain the assistive device in the holding cell/room because it is a security concern. The Assessment Team also toured the inmate property rooms located in the MJ and RCCC. Both inmate property rooms had HCAs/ADs/DME that were being stored with other inmate personal property. This included, wheelchairs, canes, walkers, and crutches. The Assessment Team observed assistive devices that were issued to inmates in the medical housing units ([MHU’s] 2-East and RCCC MHU). The wheelchairs available for inmate uses at the RCCC MHU were missing leg rests and were not in working order. The wheelchairs issued to inmates housed in 2-East were not in good working condition. Some had missing leg rests and inmates that were interviewed by the Assessment Team had to hold their legs up while being pushed or have their feet drag on the floor while being pushed.
Staff Interviews
The Assessment Team interviewed nurses who conduct medical screenings during intake/booking, nurses who provide patient care, medical staff who coordinate delivery of HCAs/ADs/DME to the inmates, physicians assigned to provide patient care, and custody staff. One of the MJ physicians indicated that referrals for disabilities and HCAs/ADs/DMEs are frequent. There are numerous medical staff who schedule the appointments. The doctor admitted not having access to any type of tracking system or roster to identify disabilities or accommodations, but thought that the custody administration was tracking that information. The doctor indicated that nurses are authorized to provide a mobility disabled inmates with interim accommodations such as HCAs/ADs/DME (e.g., cane, walker), and lower bunk chronos, etc., until the inmate could be seen by one of the physicians. HCAs/ADs/DME are ordered via a physician’s order. Once the order is written, an RN or LVN writes an electronic supply request. Medical staff is supposed to enter the issuance of any device or accommodation into the electronic E-Chart Main Screen, specifically in the “Problem List.” The physician was not sure whether the MJ has a master list of approved/disapproved types of HCAs/ADs/DMEs, but thought that would be a custody management function. The physician said there may be delays with receiving ordered devices, but there are usually some canes, walkers, wheelchairs and crutches in stock at the medical supply area.
One of the MJ nurses indicated that doctors evaluate inmate HCA/AD/DME needs on a case-by-case basis, and will write the orders if needed. The inmates can maintain devices so long as they are not a danger to themselves. If there is
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
a danger concerned, a written order can provide certain restrictions. The nurse added that in cases where a device is denied by the doctor, nursing staff can collaborate with custody staff and have the inmate rehoused to a lower bunk or another bed area closer to a toilet, and that nursing staff could provide assistance if needed.
The nurses who conduct booking/intake medical screening described the process for delivery of HCAs/ADs/DME during the booking process; If the intake medical assessment indicates the inmate needs a HCA/AD/DME, medical staff will complete the Special Needs form to advise custody. The Special Needs form allows medical staff to identify the HCA/AD/DME that the inmate had in his/her possession while in medical intake. This includes glasses, canes, crutches, walkers, wheelchairs, prosthetic eyes, prosthetic legs, prosthetic arms and other medical equipment. Medical staff stated that the completed form is given to custody. In some instances custody staff will not authorize the inmate to retain the HCA/AD/DME. This is in cases where there is a security concern like metal/aluminum canes or braces with metal. Medical staff also stated that inmates are not allowed to keep glasses that have metal frames. The Special Needs form has an area for custody to indicate if the HCA/AD/DME is sent to property. Medical staff interviewed also stated that the initiation of an inmate’s request for a HCA/AD/DME at any point of incarceration is as follows; inmates can submit a HS KITE to medical staff to request health care services. Medical staff will assess the inmate for the need to issue a HCA/AD/DME. A physician schedules the inmate for an assessment; however, typically the device is not issued on an interim/temporary basis. Once prescribed, by a physician, a chrono is generated and issued to the inmate, which documents the approval for the inmate to retain the HCA/AD/DME. A copy of the chrono is also forwarded to custody staff. An email is sent to supply request (office assistant) that provides the HCA/AD/DME to the RN/LVN for issuance to the inmate. The staff assigned to the medical supply area stated that the delivery time of the HCA/AD/DME to an inmate once prescribed by a physician ranges from the next day to up to 4 weeks. The Assessment Team did observe canes, wheelchairs and crutches in stock in the MJ medical supply area. The Assessment Team also observed canes, walkers and crutches in the RCCC medical supply area; however, there were no wheelchairs identified. Medical staff stated that distributed HCAs/ADs/DME remain property of the county which custody staff later collect from the inmates. Inmates may, however, retain their personal HCA/AD/DME if there is not a security safety concern.
Medical staff that was interviewed also stated that the SCSD detention facilities do not have a policy on maintenance or repair of HCAs/ADs/DME; however, a wheelchair repair contract (for county owned wheelchairs) is in the process of being approved. Medical staff added that inmates and family members are responsible for any personally owned wheelchairs. Medical staff stated that there is not an approved (or unapproved) list of HCA/AD/DME that can be prescribed
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
to inmates to which custody has approved. Medical staff stated that at times case management staff has to approve HCA/AD/DME before they are authorized to order the devices. Several medical staff members who were interviewed acknowledged that there is not a wheelchair repair or inspection log being maintained by medical staff.
The Assessment Team also interviewed custody staff assigned to the housing units. Staff interviewed stated that it is the policy of the SCSD detention facilities to allow inmates with prescribed HCAs/ADs/DME to be housed in any housing unit at the MJ. However, this is a new policy that has recently been implemented, which means that some inmates with assistive devices are not able to access visiting, yard and showers based on path of travel issues and lack of ADA assets and features in the showers and cells.
Recreation staff at the MJ stated that they are responsible for coordinating the provision of reading glasses for inmates at the MJ. Recreation staff provided the following documents to the Assessment Team:
 Process For Delivered Reading Glasses,  Reading Glasses Fee, and  Reading Glasses Waiting List.
The inmates receive the following notice when requesting reading glasses:
You have been placed on our reading glasses waiting list. Please allow 2-3 weeks for delivery. The MJ does not offer free reading glasses. They are $12.00 (the same price as commissary glasses). Once you receive the glasses, you will be charged $12.00 from your account. If you do not have $12.00 at the time of receipt, then you will be charged when/if you get money on your account. If you do not want to receive these glasses due to the $12.00 charge, please send us a KITE canceling your request as soon as possible. It is cheaper and quicker to have a friend/family member drop off glasses for you at the MJ front counter if possible. If you still want to receive glasses from us, then you do not need to send us another KITE; we have kept a record of this request. Thank you, The Recreation Staff.
The social worker at RCCC indicated that social workers are responsible for coordinating the delivery of reading glasses when inmates at RCCC request them.
Inmate Interviews
During the Assessment Team’s inmate interviews, the following information was received regarding the issuance and retention of HCAs/ADs/DME:
 MJ - Inmate claims difficulty transferring from his wheelchair to a somewhat flimsy or unstable and “filthy” shower chair. There are 2 shower chairs in the unit, and 1 appears to be more stable than the other,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
but neither appears to be very stable. He claims that he must sit in the shower chair on his knees and take a shower in that manner, as it is the easiest and the safest of his options. He claimed that when he tries to lock the wheels, he sometime falls off the chair. Inmate demonstrated that he has very minimal use of his legs. He was able to slightly lean out in front of his wheelchair, put his feet on the ground, and delicately move his feet and lower legs in a walking-type motion while holding on to the wheelchair. His legs, however, were awkwardly positioned with very limited movement due to his cerebral palsy. The inmate tries to ambulate in this fashion occasionally if just for a few feet for exercise, but he pointed out that his jail-issued orange hard plastic slip on shoes are different sizes. One is a size 9 (his normal size), and the other is a size 10. He claims that this poses a big problem for him when he does try to use his feet. He indicated that he has been asking for the correct size shoe since his arrival 1 month earlier (7/16/16).  MJ - Inmate claims rear sores/ulcers. He states he would benefit from the use of a trapeze device and has asked to use one. He claims the medical unit has one, but he does not have access to it. He complained about the showerheads and water flow from the shower, as it had been broken for a long period of time, but was recently fixed.  MJ – Inmate claims he also has an ulcer/sores in his buttocks area. He claims to have to have previously requested and subsequently received a blow-up/cushion, but they busted (2 of them). He claims that he has made requests, but has not received anything since. It is noteworthy to add that the inmate is a somewhat large framed person. Also, the right wheelchair footrest is missing from the wheelchair. According to the inmate, it has been missing since the wheelchair was issued to him (the wheelchair he arrived with was removed as it was an electric version). He claims to have requested (in writing) a new right footrest, but has not received any response. The inmate also expressed an issue with the shower chairs, a difficulty locking the shower chair wheels and trouble transferring from the wheelchair to the shower chair. When he attempts to lock the shower chair wheels, he sometimes “overshoots” his body and falls, but if he does not lock the wheels, then the shower chair is “wobbly” and unstable. The shower does not have a shower hose and he claims that he asked for one. He said he would benefit greatly from a fixed wooden foldout shower bench as opposed to a “wobbly” chair.  MJ - Inmate states he has requested an allen wrench and an open-ended wrench to adjust the back of his wheelchair and foot rests. His feet are dangling and do not comfortably reach the wheelchair footrest. His right leg/foot is in essence dead, and he can’t place his right foot on the footrest. The footrest needs to be adjusted to protrude slightly outward so both feet can rest (the foot rest is one piece [not 2 pieces like normal]). He needs the footrest to also be very slightly tilted in a backward direction. The
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
inmate said that staff would not take care of this. He has the wheelchair manual and does not have a problem fixing it himself if necessary. Sitting up straight in the wheelchair causes him discomfort/pain.  RCCC – Barracks – Mobility impaired – Inmate claims he uses a cane on the streets because leg was broken in 3 places and has pins and rods. Medical staff did not provide a cane or a LB/LT chrono.  RCCC – Barracks – Mobility impaired – Inmate claims staff took his cane in the MJ and have not replaced it.  RCCC – Barracks – Mobility impaired/Parkinson’s – Inmate claims he fell when he arrived because he needed a cane and one was not provided. It took 1 month for a cane to be issued.  RCCC – Barracks – Mobility impaired – Inmate needed a cane but was not provided one at the MJ. He was not issued one until he arrived at RCCC. It took 1 month to be issued the cane.  RCCC – SLF – MH – Inmate needs glasses. Glasses were removed in booking because of metal frames.  RCCC – SLF – Vision impairment. Inmate needs glasses. He has written KITE’s to social worker.  RCCC – Barracks – Mobility impairment – Inmate claims he needs a cane for long distances. Has not been issued one.  RCCC – KBF – Mobility impairment – Inmate has a cane. Claims he had to hop around for 1 week before the cane was issued.  RCCC- KBF – Hearing impaired – Inmate has put in KITE’s 3 times for hearing aid batteries. No response for 2 weeks.  RCCC – KPF – Hearing impaired/Mobility impaired – Inmate claims staff took his cane in booking. He has put 2 KITE's in for his cane and received no response. Needs hearing aids and can’t afford them.  MJ – Vision impairment – Inmate claims staff did not allow him to keep glasses. Took him 1 month to get reading glasses.  MJ- Mobility impairment – Inmate states he has had a cane and needs a cane; however, does not want a cane because they will move him to the 2nd floor.  MJ – Mobility/Vision impairment – Inmate states he needs a cane. Staff took his cane and leg brace because they contained metal.  MJ – Mobility impairment – Inmate states he needs a cane and had one in CDCR. Advised medical staff in booking and they did not issue him a cane. Needs orthopedic shoes, as one leg is longer than the other. Medical staff have not issued him or evaluated him for orthopedic shoes.  MJ – Mobility impairment – Inmate uses prosthetics and requires special shoes. When he first arrived staff took his special shoes that he needs for his prosthetics.  MJ – Mobility/Vision impairment – Inmate claims he had a wheelchair and medical staff issued him a walker. States he needs a wheelchair.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ – Mobility impairment – Inmate states he needs a cane. Staff did not allow him to keep his in booking and he had to hold on to the wall for 2 weeks.
 MJ – Mobility impairment – Inmate states he had a cane issued by Kaiser (metal) and staff took it away. It took 1 day for staff to issue him a replacement. States that if someone is with him staff takes it away.
 MJ – Mobility impairment – Inmate needs tennis shoes to protect the bottom of his prosthetics. The prosthetic is wearing down and without the tennis shoes the bottom of his prosthetics slip. Claims a sergeant threatened to take his leg and staff do not want to issue him tennis shoes.
 MJ – Mobility impairment – Inmate had a cane but the cane was taken in booking.
 MJ – Mobility/Vision/Hearing impairment – Inmate states he had a cane in CDCR. Had a cane in booking and because it was metal staff took it from him and did not issue him a replacement.
 MJ – Mobility/Paralyzed left side – Inmate has a metal cane. Was housed upstairs for 3 days and found it very difficult to ambulate up the stairs. Staff did not provide assistance or accommodations with meals. Claims if it wasn’t for his cellmate he would not be able to eat.
 MJ – Mobility/Vision impairment – Court staff do not allow inmate to keep a cane in his holding cell. Inmate also claims he has to ambulate to court with his cane (including going up stairs), even though he has a walker and wheelchair prescribed.
 MJ – Mobility impairment – Inmate had a cane. He claims though that staff advised him that if he gave up his cane he could be transferred upstairs.
 MJ – Mobility impairment – Inmate had a cane in CDCR and was not issued one in jail. Needs one because of difficulty walking.
 RCCC – CBF – Mobility impairment – Inmate states that arresting officers did not allow him to bring his wheelchair. They prescribed him a wheelchair and a walker; however, they took them away and told him they needed room in 2-East.
 RCCC – SBF – Mobility impairment – Inmate claims he had a cane in the streets; however, staff has not issued him one.
 RCCC KBF – Hearing-impaired inmate stated he needs a hearing aid but he cannot afford one.
 MJ - A hearing-impaired inmate who is prescribed hearing aids advised the Assessment Team that he had been requesting hearing aid batteries from medical staff. The Assessment Team members asked the medical staff if hearing aid batteries were provided to inmates. Medical staff stated that they were and that the inmate had to submit a HS KITE requesting the batteries, and they would be provided. The Assessment Team asked medical staff if there were batteries in stock to provide to inmates requesting them. The medical staff stated that the batteries were available
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
in a supply cabinet. The Assessment Team verified that hearing aid batteries were available in the cabinet. This information was shared with the inmate. On a subsequent visit the Assessment Team asked the inmate if medical staff had provided the batteries and the inmate stated that medical staff had not. The inmate stated that after medical staff denied his request he submitted a grievance that was responded to by a custody sergeant. The response states “I apologize for the miscommunication or confusion. Your family is allowed to bring your reading glasses and hearing aid batteries to the Main Jail front counter. The Deputy at the front counter will accept your items. The Recreation Technician (Rec Tech) would be responsible for logging the items received and the items would be given to medical staff. Once the medical staff receives your items they will be inspected and given to you. If you have extra batteries, medical staff will store the batteries. They will be granted to you upon your request. It was a pleasure to assist you with your complaint. This matter is considered resolved.”  MJ – An inmate who is a permanent wheelchair user, who at the time of the interview, had been at the jail for several months. He showed the assessment team that his right side foot peg/rest to his wheelchair is missing, and he claims it has been missing since the SCSD detention facilities issued him the wheelchair. He indicated he has requested (in writing) for a new right foot peg/rest. He claimed that he initially arrived at the jail with an electric wheelchair, but he was issued the county wheelchair instead, and his wheelchair was confiscated.  MJ – An inmate who is paraplegic, a permanent wheelchair user, and claims to have a vision impairment, alleges that he has made numerous attempts to utilize a trapeze device that he claims in available in the second floor medical area. He also stated that staff broke his wheelchair, when they “jammed” his wheelchair in to the lift of a wheelchair accessible van. The wheelchair has not been replaced or repaired.
Conclusions
The SCSD detention facilities do not have a detailed operations order or policy for the delivery of HCAs/ADs/DME to disabled inmates.
There is no written operations order or policy for maintenance, repair or replacement of HCAs/ADs/DME.
Of great concern are the numerous complaints by inmates alleging that SCSD detention facilities staff did not provide or took away disabled inmates HCAs/ADs/DME. The lack of provision of these assistive devices amounts to unequal treatment and may cause severe harm to the disabled inmates.
The SCSD detention facilities do not have a policy for wheelchair inspections and as a result wheelchairs issued to inmates are not being monitored to ensure they
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
are operational. Wheelchairs that are currently issued to inmates are in need of repair and maintenance.
Although medical staff stated that the SCSD detention facilities’ medical staff coordinates the provision of HCAs/ADs/DME for inmates, the SCSD detention facilities do not have a policy for the purchase of the devices for disabled inmates that are indigent.
The SCSD detention facilities do not have a policy to review disabled inmates who are in Mental Health Crisis for possible removal of HCAs/ADs/DME.
There are some inconsistencies in cases where inmates with glasses are being processed through booking, as some inmates are not being allowed to retain their prescription/reading glasses.
There is no standardized process in which inmates can request and obtain reading glasses. The SCSD CHS Policies and Procedure 1128 Reading Glasses for Inmates states that medical staff conducts an assessment of the inmate to determine the need for reading glasses. If the inmate requires reading glasses the social worker coordinates delivery. This is not consistent with the information staff provided at the MJ. At the MJ, staff indicated that the Recreation staff are responsible for the coordination of the delivery of reading glasses. At RCCC staff indicated that the social workers were responsible.
The SCSD detention facilities Draft Operations Order Inmates with Disabilities ADA when adopted will govern the circumstances in which disabled inmates’ HCAs/ADs/DME can be removed. However, the Draft Operations Order does not address the removal of HCA/AD/DME in specialized housing, monitoring the health condition of disabled inmates whose HCA/AD/DME has been taken away in specialized housing units, nor a process in place to issue alternate in-cell accommodations when an HCA/AD/DME is removed from in cell use.
The SCSD detention facilities Draft Operations Order Inmates with Disabilities ADA when adopted will direct staff to provide HCAs/ADs/DME upon a finding of “medical necessity.” This operations order will violate federal law. Under Title II of the ADA, specifically, 28 CFR 35.130(b)(7), a public entity has an affirmative obligation to make a reasonable modification to its policies, practices and procedures to avoid discrimination against persons with disabilities. Here, as a reasonable modification to policies, practices and procedures, SCSD detention facilities must adopt a policy of case-by-case analysis as to whether HCAs/ADs/DME are needed to ensure a given individual is provided meaningful access to programs, services and activities offered by SCSD detention facilities. In sum, the standard for the provision of HCAs/ADs/DME is access, not medical necessity.
References
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Appendix B to Part 35 of the Code of Federal Regulations, which provides Section-by-Section Analysis of the ADA regulations states, “The determination that a person poses a direct threat to the health or safety of others may not be based on generalizations or stereotypes about the effects of a particular disability. It must be based on an individualized assessment, based on reasonable judgment that relies on current medical evidence or on the best available objective evidence, to determine: the nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures will mitigate the risk. This is the test established by the Supreme Court in Arline. Such an inquiry is essential if the law is to achieve its goal of protecting disabled individuals from discrimination based on prejudice, stereotypes, or unfounded fear, while giving appropriate weight to legitimate concerns, such as the need to avoid exposing others to significant health and safety risks.”
Additionally, 28 C.F.R. § 35.130(h) prohibits a public entity from imposing safety requirements unless they “are based on actual risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities.”
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Health Care Appliances:
An inmate’s health care appliances, including those belonging to the inmate prior to entering into CDC’s system, must be approved by custody staff for conformance with safety and security standards. If custody staff, upon inspecting the appliance determines there is a safety or security concern, a physician shall be consulted immediately to determine appropriate action to accommodate the inmate’s needs. Accommodations may include modifying the appliance or substitution a different appliance.
Health care appliances shall be documented as property of the inmate and identified as such. No inmate shall be deprived of a health care appliance that was in the inmate’s possession upon entry into the CDC system or was properly obtained while in CDC custody, unless for documented safety or security reasons or a physician determines that the appliance is no longer medically necessary or appropriate.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Health care appliances shall be retained and maintained by inmates upon release to parole. Custody staff shall conduct and log periodic safety and security inspections on all wheelchairs on at least a monthly basis. If a wheelchair is in need of repair medical staff shall be notified to secure necessary repairs.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Tracking
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures related to the tracking of disabled inmates and their accommodation needs are outlined in the following policies; 04/01 Intake, Search, Reception and Holding, 06/03 Classification Process, 10/04 Medical Intake Screening, 1404, Receiving Screening, 1417, Adult Developmental Disability, 1422 Special Needs Patients, 1439 Reports of Disabilities or Impairments, 1900 Health Record Format and Contents and Draft Operations Order Inmates with Disabilities - ADA.
The Jail Inmate Management System (JIMS) and WebJPF (Web based Jail Person File) used by custody and the Electronic Medical Record (E-Chart) used by medical staff are the electronic systems used to track custody, classification and medical information for inmates housed at the Sacramento County Jail. The WebJPF is a quick and simple way to access information from multiple systems. Within these systems, there is limited ability to track disabled inmates or their accommodation needs. The electronic systems do not have the ability to track developmentally disabled inmates, inmates with learning disabilities and inmates with other disabilities that impact a major life activity. There is no process in place to identify the accommodations that may be required for learning disabled inmates, or to identify a developmentally disabled inmate’s adaptive support needs, adaptive functioning deficits, or the assistance (accommodations) staff must provide such as coaching, assisting, monitoring and prompting. These systems are also not able to identify the disabled inmates who have been issued HCAs/DME/ADs (e.g., hearing aids, canes, crutches, wheelchairs, etc.) or their accommodation needs. They also cannot identify inmates with physical limitations who require accommodations to access programs, services or activities. In addition, although inmates with mental health concerns are identified during the intake/booking process and at times subsequent to housing, the electronic system used by SCSD detention facilities is limited in its capability to track inmates with mental health concerns.
Per policy 1404, Receiving Screening, a receiving health screening is performed by medical staff on all arrestee(s) (including transfers) immediately upon arrival at the facility. Arrestee(s), who are unconscious, semi-conscious, bleeding, or otherwise obviously in need of immediate medical attention, are referred to outside medical care prior to acceptance. The purpose of this health screening is to obtain prompt medical care for those needing it, to identify ongoing or chronic medical needs, and to detect those arrestee(s) who pose a potential threat to the health or safety of others within the general population. Baseline data is established for use in subsequent care and treatment. When referred to an outside emergency department, their return to the jail is predicated upon written medical clearance. Receiving screening findings are recorded on a printed form approved by the Health Authority. At a minimum, the screening includes:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inquiry into:
 Current illnesses and health problems, including medical, dental, and communicable diseases (including sexually transmitted diseases),
 Medications taken and special health requirements,  Use of alcohol and other drugs, including types, methods, amounts,
frequency, date or time of last use, and a history of problems that may have occurred after ceasing use (i.e., seizures),  History or appearance of suspected mental illness, including suicidal ideation or behavior,  Appearance or history of developmental disability,  For female arrestees, a history of gynecological problems, possibility of current pregnancy, and present use of birth control,  A complete set of vital signs and a stated height and weight.
Observation of:
 Behavior, which includes state of consciousness, mental status, appearance, conduct, tremors, and sweating,
 Body deformities and ease of movement,  Condition of skin, including trauma markings, bruises, lesions, jaundice,
rashes and infestations, needle marks or other indications of drug abuse,  Slowness in speech or lack of comprehension of questions suggestive of
developmental disabilities,
Disposition, such as:
 Referral to an appropriate Health Care Service or Mental Health Service on an emergency basis,
 Placement in the general inmate population and later referral to an appropriate Health Care Service,
 Clearance for housing, or  Isolation or special observation in the facility.
Procedures will include provisions for segregation and/or special housing for patients with suspected communicable diseases, mental illness, or developmental or physical disabilities, pending medical clearance.
All findings shall be recorded on a form approved by the Health Authority. The Receiving Screening shall be conducted by the Nursing Staff at the MJ and RCCC. This will become a part of the medical record.
Per policy 10/04, Medical Intake Screening, Correctional Health Services staff shall complete a health screening procedure on each arrestee at the time of booking in accordance with Article 11, Section 1207 of the California Code of Regulations, Title 15. Any person not deemed medically fit for incarceration will not be accepted.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
At the time of intake a medical receiving screening shall be performed by health personnel for all new inmates, including transfers, and documented on the appropriate forms. The intake medical screening shall minimally include observations of the subject’s behavior and physical condition and inquiries into past and present illness and health problems, use of medications, drugs and/or alcohol, and for females, gynecological issues and pregnancies. Medical staff shall, in coordination with JPS, complete a cursory evaluation of the inmate’s mental health. If during the intake medical receiving screening process an inmate is found to be in need of immediate medical attention, the inmate shall be promptly referred for emergency care.
An ambulatory subject who requires but has refused medical attention may be booked at the discretion of medical staff. Medical staff shall verify with the subject that he/she refuses medical treatment, and shall note the refusal. In situations where the arrestee is unable or refuses to respond to the receiving screening questions, health personnel shall visually examine the subject for obvious or noticeable medical problems. If the subject is accepted for incarceration, the form shall be completed at a later time when the subject becomes cooperative or communicative. Paraplegic arrestees and those who must use crutches or orthopedic appliances but who are otherwise fit shall be accepted for incarceration.
Per policy 1900, Health Record Format and Contents, the Health Record shall contain written documentation of all health care services rendered to inmates. It shall provide a means of communication to assure continuity of care; serve as a basis for planning and administering individual patient care; provide data for quality improvement activities; and assist in protecting the medico-legal interests of the inmate, institution, and health care providers.
It shall also serve as a source for required statistical reports, and program planning data and staff education.
Within the jail system, the Problem Oriented Health Record (POHR) is used. In this system, the physician defines and follows each clinical problem and organizes them for solution. The POHR contains a problem list, initial plans, progress notes, and a specific database. This database, or content, includes the inmate’s chief complaint, present illness, past history, physical examination, and diagnostic data. The problem list is contained on a sheet, which is placed in the front of the chart. Initial treatment plans describe the patient’s condition, treatment for the condition, and a continuing evaluation of the patient on his/her condition. Progress notes follow a S.O.A.P. format, that is, the progress note is arranged generally in this order: Subjective (symptomatic); Objective (measurable); Assessment (interpretation or impression of current condition); and Plan statements.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
A health record file is not necessarily established on every patient. However, any health intervention after the initial screening requires the initiation of a record. The "Receiving Screening" form becomes a part of the record at the time of the first health encounter. If a patient is incarcerated more than once, any existing health records will be drawn from storage.
Health records are stored in a secure area readily accessible to health-care providers and inaccessible to custody staff and inmates.
All inmates will have a Health Record established after any health care intervention. The initial health screening completed during booking does not require initiation of a health record. Any health or nursing evaluation provided as a follow-up to the receiving screening does require initiation of a Health Record. Then the Receiving Screening Form becomes a part of the Health Record.
Health record files shall include, but not be limited to:
 The completed Receiving Screening form,  Health Appraisal Data forms,  All findings, diagnoses, treatments and dispositions,  Prescribed medications and documentation of their administration,  Laboratory, x-ray, and diagnostic studies,  Signature and title of each documenter,  Consent and refusal forms,  Release of information forms,  Date and time of health encounters,  Discharge summary of admissions or hospitalizations,  Health Services Reports (i.e., emergency department, dental, psychiatric
and other consultations),  Individualized Treatment Plans.
Per policy 1417, Adult Developmental Disability, the identification of a person with developmental disability begins at booking and continues throughout incarceration. Intake medical personnel should be alert to the possibility of developmental disability by looking for:
 Difficulty in performing basic tasks associated with the process,  Slowness or apparent difficulty in understanding,  A history of treatment for developmental disability through a Regional
Center or special education class.
If there is suspicion of a developmental disability, a notation will be made on the Receiving Screening medical form and a referral made to the JPS Outpatient Department.
In cases where there is uncertainty as to whether the inmate has a psychiatric condition as opposed (or in addition) to a developmental disability, referral for mental health evaluation is appropriate.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
If the patient doesn’t have medical problems he or she will be managed by jail psychiatric services. If the patient has a medical condition he/she will be managed in conjunction with the medical staff.
Documentation
JPS staff will make an entry in the medical record when Alta Regional Center is contacted. The Master Problem List in the medical record should be updated to note the presence of known or suspected developmental disability. JPS staff should also make an entry into the Jail Inmate Management System (JIMS) system and if necessary, notify Classification of any special housing recommendations.
Coordination with Classification Plan/Multidisciplinary Treatment Planning:
Where a developmental disability was not identified during the booking or initial classification process, notification of the jail classification officer should be made by JPS Staff as soon as the condition is identified.
Persons with developmental disability are potentially vulnerable in the custody setting and may require special consideration in the classification process.
Likewise, multidisciplinary treatment and discharge planning should take this information into account. The inmate’s developmental disability status should be shared as necessary with treating health professionals, discharge planners, probation officers, and others who are actively involved in the care and custody of the individual.
The Medical Transfer Summary should include information about the inmate’s developmental disability, as well as any recommendations that have been generated as the result of treatment planning for this condition.
Per policy 1422, Special Needs Patients, medical staff in coordination with custody personnel, ensure that inmates with special needs receive health care that is both appropriate and beneficial.
Treatment plans will be developed for patients with special health care needs. These patients include but are not necessarily limited to those in the following categories:
 Patients who have sustained an acute injury requiring major medical or surgical intervention
 Patients with medical conditions requiring assistive devices or assistance with the activities of daily living
 Developmentally disabled patients  Patients with a terminal illness  Frail or elderly patients  Patients who are physically handicapped
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Patients with organ transplants or those requiring chronic renal dialysis  Patients with special nutritional needs  Pregnant Females.
An inmate’s health condition(s) will be listed on the Problem List. Medical and nursing staff will communicate necessary custody interventions promptly with custody staff. When the inmate’s condition warrants, the inmate will be admitted to the Outpatient Housing Unit. The nursing service, as part of the inmate’s plan of care, will make an effort to address pending discharge needs.
Per policy 1439, Reports of Disabilities or Impairments, the ADA provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”
Any report of physical disability or impairment by an inmate or outside organization will be referred to a clinician for review and assessment. This can include reports of mobility impairments such as amputations or paraplegia, or other disabilities that limit daily functioning such as visual, hearing, or speech. The clinician will review the report, assess the inmate’s needs and make a determination if special housing or assistive devices are needed. If indicated, these needs will be recorded in the patient-inmate’s chart, and communicated to medical and custody staff. Upon report of a disability or impairment (verbal or written):
 An MD/NP Sick Call appointment will be scheduled and the nature of the report will be documented.
 The patient-inmates will be seen and their disability or impairment will be assessed and if indicated a plan of care will be developed.
 Any specific patient-inmate’s needs or accommodations will be documented in the chart and communicated to medical and custody staff.
Per Draft Operations Order Inmates with Disabilities - ADA, Identification of Disabled Inmates - At Intake, the medical screening process during intake serves to identify most disabilities and the need for accommodations prior to the housing of the inmate. It is the responsibility of booking and medical staff to assess inmates upon admission for evidence of a disability or special medical need. This assessment information will be recorded on the Inmate IDEF as applicable. Information may be garnered from the inmate’s prior custody or medical records.
Custody or medical staff may observe and report a disability or medical condition that would:
 Impact the inmate’s housing;  Impact the intimate’s / arrestee’s Activities of Daily Living  Affect the inmate’s program access; or  Present a safety or security concern for the inmate or others.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
It is the responsibility of the intake medical staff to:
 Initiate and sign an IDEF, and forward the form to the Booking Unit and the ADA Coordinator upon determination that an inmate may have a disability.
 Create an “ADA” ALERT in the inmate’s medical chart making appropriate notations on the inmate’s particular disability or limitations.
Classification staff shall review all Inmate Disability Evaluation Forms and:
 Make appropriate notations on the inmate’s “Class Comment” log based upon the inmate’s individual housing needs;
 Ensure that an “ADA” ALERT is in the JIMS system with the appropriate notations made in the remarks section;
 Notify the ADA Coordinator to arrange for orientation of inmates who are visually impaired or unable to read;
 Make appropriate notations on the Inmate Disability Evaluation Form, and forward the form to the ADA Coordinator for ADA compliance review.
Identifying and Handling of Armstrong Class Inmates
An “Armstrong class inmate” is an inmate identified by the CDCR as having ADA concerns due to current or ongoing medical and/or mental health issues. CDCR will notify the Sheriff’s Department of inmates in our custody who they have identified as “Armstrong class inmates.” They will contact the ADA Coordinator of inmates in our custody who have previously been identified. The ADA Coordinator will act as the central contact point for CDCR. The ADA Coordinator at each facility will act as a liaison between identified Armstrong inmates and the Classification Unit. After CDCR notifies the ADA Coordinator of inmates in our custody who have previously been identified as Armstrong class inmates, the ADA Coordinator will notify the ADA Division Representative. The ADA Coordinator will ensure the inmate is entered in JIMS under the Special Tracking Needs and will follow the same process outlined in section 11.0 of this policy. Once contact is made with the inmate, the ADA Coordinator will notify Health Management Unit via e-mail. This e-mail should include any steps taken to address issues/concerns as well as the resolution. Any medical or mental health grievance concerning Armstrong Class inmates should be addressed as outlined in section 15.0 of this policy.
Staff Interviews
The Assessment Team interviewed custody deputies from each housing unit, staff from the medical, dental, mental health and education departments, and work supervisors. All custody staff members interviewed indicated that the only system to alert them of disabled inmates was the medical “Special Needs Chrono” issued to inmates by medical staff. Custody staff indicated that this chrono would
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
list if the inmate had been prescribed an assistive device by medical staff such as a cane, crutches, walker, wheelchair etc. In addition, the chrono would list if inmates required a low tier or bottom bunk. The chrono would be attached to the inmate locater card that moves with the inmate from housing unit to housing unit while he/she is in custody. Custody staff stated that in some cases information regarding an inmate’s disability may be located in the JIM System’s PF4, PF10 and PF11 screens for some of the disabilities; however, this information would only be available if medical had identified the disability. Most staff stated that they would not be aware of the inmate’s disability unless the inmate advised them of the disability. This would be the case for physical disabilities that were not obvious, intellectual disabilities, and learning disabilities. Custody staff stated that other than the accommodation needs listed on the chrono, they would not be aware of a disabled inmate’s accommodation needs.
Although the CDCR provides notification to Sacramento County Jail in compliance with the August 28, 2012 Federal court order (County Jail Plan for addressing Armstrong Class Members housed in county jails), staff stated that a tracking list is not maintained of the Armstrong class members. Medical staff stated that they receive the information from CDCR, and medical staff schedules the inmate for an evaluation to determine if the accommodation needs listed by CDCR are needed by the inmate while housed in SCSD detention facilities custody. Medical staff stated that this information is forwarded to custody staff. Custody staff stated that this information is not tracked and neither medical or custody staff maintain a list of Armstrong class members currently housed at the SCSD detention facilities other than information maintained in the inmates’ medical records. This includes the inmates’ accommodation needs.
Medical, dental and mental health staff stated that some disability-related information is contained in the electronic medical record in the e-chart. The staff member would have to query each individual inmate, as there is no comprehensive tracking system to track inmates with disabilities and their accommodation needs.
Education, vocation and reentry staff stated that the only method for them to identify disabled inmates assigned to their classes or area would be based on their observations and or the inmate self reporting. Education, vocation and reentry staff stated they would not be aware of disabled inmates’ accommodation needs other than when an inmate self reports those needs to them.
Conclusion
The SCSD detention facilities must ensure that disabled inmates are properly identified in order to provide reasonable accommodations as required by the ADA. Because regulations implementing the ADA require a public entity to accommodate persons identified as disabled, a tracking system is a necessary part of compliance.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The SCSD detention facilities are lacking even a basic ADA tracking system to track all disabled inmates once they have been identified and verified as having a disability. In addition, there is no system in place other than the chrono for staff to be aware of a disabled inmate’s accommodation needs and physical limitations. Therefore, staff assigned to the housing units, work supervisors, education staff and medical staff cannot identify disabled inmates assigned to their work areas, and inmates with disabilities are systematically excluded from privileges, programs, and jobs that non-disabled inmates enjoy. Currently staff must query an individual in the JIMS, WebJPF, individual inmate’s locater card or electronic medical record (e-chart) to identify an inmate’s disability and accommodation needs.
Although the Special Needs Form and chrono alerts the housing unit staff as to some of the disabled inmates’ accommodation needs, it does not identify all of the disabled inmates’ accommodation needs.
Although the chrono when approved is maintained by the inmate and by the housing unit deputy, there is no centralized electronic repository for the chronos that are approved by medical staff.
The current medical screening process does not identify all qualified disabled inmates meeting the criteria under Title II of the ADA (i.e. those with developmental, learning, vision, and mental health disabilities as well as all other qualified physical disabilities covered under the ADA.
References
28 CFR § 35.130 (a) requires that no qualified individual with a disability shall, on the basis of that disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity. To ensure that the SCSD detention facilities comply with this requirement, there must be a comprehensive networked tracking system to alert staff of qualified individuals and their accommodation needs.
Armstrong v. Davis, 275 F.3d 849, 876 (9th Cir. 2001) (“Because the regulations implementing the ADA require a public entity to accommodate individuals it has identified as disabled, 28 C.F.R. § 35.104, some form of tracking system is necessary in order to enable the Board to comply with the Act.”).
The information below is for reference only. Due to Federal Court Ordered Injunction (January 18, 2007), the CDCR was ordered to do the following (with regard to developing and implementing computerized, real-time tracking system to track prisoners with disabilities (as well as other disabilities):
Inadequate Disability Tracking
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Underlying all of these violations is defendants’ failure to adequately track prisoners’ disabilities and the accommodations they need. As this court held on May 30, 2006, “[t]he current system for tracking prisoner . . . disabilities is unreliable, non comprehensive, and insufficient,” This court further stated that “[u]se of a tracking system to prevent such violations is required . . . by the underlying law.” Defendants’ Armstrong and Clark Automated Tracking System has failed to identify and track CDCR prisoners’ disabilities and the accommodations needed for those disabilities. The lack of an adequate tracking system has resulted in significant harm to plaintiff class, including but not limited to denial of safe, accessible housing, prompt transfers to designated institutions, and sign language interpretation.
B. Tracking System
Defendants shall develop, implement, and begin to use a statewide, computerized, networked real-time tracking system to track prisoners with disabilities by May 30, 2007. This system shall be integrated with BPH tracking system previously ordered by the Court. The tracking system shall include prisoners’ disability designations and the disability accommodations they require including but not limited to lower bunks, ground floor housing, assistive devices, and effective communication needs such as sign language interpreters, large print, and scribes.
For prisoners whose disabilities impact placement (DPW, DPO, DPM, DPV, and DPH), as well as for prisoners who are DPM with housing restrictions, the tracking system shall include placement and classification factors, including but limited to mental health placement needs protective custody, administrative segregation, Security Housing Unit, security level, and developmental disability designation.
The tracking system shall be updated continuously as new information is received about prisoners with disabilities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Housing Placements
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to the classification and housing of inmates are outlined in the following policies; 06/02 Housing Plan, 06/03 Classification Process, Draft Operations Order Inmates with Disabilities - ADA, 1410 Outpatient Housing Unit, 1436 Two East Inmate Transfers, 1417 Adult Developmental Disability, and 1107 Decision Making-Special Needs.
Per Operations Order 06/02, Housing Plan, inmates shall be housed according to specific housing locations for various types of inmate classifications. The housing plan may be adjusted as necessary to accommodate the ever-changing nature of the inmate population.
Inmates will be housed according to their classification in accordance with Operations Order 6/03-Classification Process. The housing plan for MJ and for RCCC will be determined by physical plant capabilities of the facility and by the classification unit of each facility. Special housing descriptions, locations, and use will be in accordance with Operations Order 4/05, Use of Safety Cells/Segregation Cells/North Holding #2 and Multipurpose Rooms.
The MJ Classification Unit will assign inmates to a housing unit based on the current housing needs of the facility and/or in accordance with Operations Order 6/03, Classification Process. The MJ has two (2) basic housing areas: West Tower and East Tower. General population housing is established as follows:
 The West Tower houses Crips, Mexican Mafia (EME), southern Mexican gangs, Aryan Brotherhood, and compatible gang members.
 The East Tower houses Bloods, northern Mexican gangs, Black Guerilla Family (BGF), Nuestra Familia (NF), Masters of Destruction (MOD), and compatible gang members.
The MJ has two (2) floors, which have designated housing areas that may be used for inmates who have received disciplinary isolation.
 The 8 West 400 Pod is available for male disciplinary isolation.  The 7 West 400 Pod is available for female disciplinary isolation.
The MJ has a medical and psychiatric services floor located on 2 West. The MJ has a sub acute medical floor located on 2 East.
The RCCC Classification Unit will assign inmates to a housing unit based on the current housing needs of the facility and/or in accordance with Operations Order 6/03, Classification Process. At RCCC, the housing is assigned according to security level. The Classification Unit will determine an appropriate housing plan based on the following guidelines:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Minimum Security will include: C, D, G, H, and M Barracks at the Honor Facility (HF), the Medical Housing Unit (MHU) Main Floor, and Kinya Dormitory at the Sandra Larson Facility (SLF). In addition, SLF classifies Golden Poppy Dormitory as Minimum Security for housing inmate workers.
 Medium Security will include: Roger Bauman Facility (RBF), 448 North and 448 South, A, B, J, and K Barracks of the Medium Security (MS) Housing Unit, Camellia Dormitory of SLF, and the MHU single cells as available.
 High Security will include: Christopher Boone Facility (CBF), Stewart Baird Facility (SBF), and Ramona Wing of SLF.
RCCC has one facility for inmates with medical needs located in the MHU.
Per Operations Order 06/03, Classification Process, at intake, custody staff will perform an initial classification of inmates using the Intake Classification Form. Custody staff will be responsible for separating inmates as appropriate per this order.
Designated Classification Officers will perform the duties of classification including, but not limited to:
 Evaluate each inmate to be housed and assign an appropriate housing location in accordance with Operations Order 6/2-Housing Plan.
 Conduct classification interviews of inmates as necessary, and make all necessary entries in the Jail Information Management System (JIMS).
 Research and investigate information supplied by the inmate for verification purposes.
 Respond to inmate grievances related to classification and process inmate requests related to housing locations and/or classification.
 Conduct classification reviews and reclassifications as requested by authorized personnel.
 Forward copies of Incident Report Details (PF-10’s) to the appropriate CDC Parole Agent or Probation Officer to allow parole and probation violations to be filed.
 Respond to requests from within the department and other law enforcement agencies and direct new information developed within the facility to the appropriate detective/agency.
 Maintain and update as necessary a classification file system.
For inter-facility transfers, classification officers will review inmate information to ensure each inmate has been properly classified prior to transfer to the facility. A cancelled transfer, or “scratch”, will be generated by the receiving facility classification officer or the transport officer when the receiving facility does not have the appropriate housing for a particular inmate’s classification and housing needs. The transfer cancellation will be documented on the inter-facility transfer list. It is the duty of the classification officers at the MJ and RCCC to coordinate the transfer of inmates between facilities to ensure appropriate facility housing
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

requirements are met and to maximize the efficiency of the inter-facility transfer process. For the logistics of inter-facility transfers and court appearances, refer to Operations Order 02/13, Inter-Facility Transportation and Court Appearances.

Inmate classification should be based on factors, which affect the security of the facility, staff, and the inmate. Some of these factors include, but are not limited to:

 Physical characteristics, including gender, age, mental and medical conditions.
 Criminal history both in and out of custody, known gang affiliation, prior classification history, current charges or nature of charges against the inmate.
 Legal status, including propria persona (pro per) status, civil commitments, extradition status, or detention as a witness.
 Administrative segregation considerations including prior peace officer or corrections officer employment, gravely disabled status, and/or case notoriety.
 Criminal sophistication, former victims or enemies currently housed within the facility, status as a known law enforcement informant, sexual orientation/transgender status, or status as an inmate worker.
ICE detainees will be additionally assigned a numeric level based on their current charges. This numeric level will assist classification officers with identification of the potential housing unit and also enhance the safety and security of the detainee.

 Level 3  Level 2  Level 1

Violent Felonies Non-violent felonies Non violent crimes or ICE holds

The inmates should be housed in the appropriate type of housing with regards to the inmate’s classification; and the facility’s available housing locations, as per Operations Order 6/2- Housing. For the purposes of this order, the levels of housing and housing unit availability will be described based on the following guidelines:

 High Security Housing refers to single occupancy or double occupancy cells as defined in Title 24 Section 470A. High Security Housing is available at both facilities.
 Medium Security Housing refers to dormitory style housing as defined in Title 24 Section 470A. Medium Security Housing is available only at RCCC.
 Minimum Security Housing refers to dormitory style housing as defined in Title 24 Section 470A. Minimum Security Housing is available only at RCCC.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Special Housing refers to housing designated for inmates with specific segregation needs, status as inmate workers, medical or mental health requirements, and disciplinary isolation. Special Housing needs will be determined by the classification unit and by physical plant design and limitations of each facility.
 General Population Housing refers to housing within each facility, which does not have any specific isolation, protection, or special services needs. Each facility’s classification unit will determine the location and use of General Population Housing.
High Security Housing may be used to house inmates at the MJ and RCCC based on guidelines including, but not limited to:
 Inmates with a documented history of in-custody assaults in the last two (2) years. Assault history includes, but is not limited to, past cases of assault and pending cases. Assault history includes predatory behavior involving or victimizing other inmates.
 Inmates with escape or attempted escape histories from secured facilities within the last ten (10) years.
 Inmates who have a current or past criminal history involving victimization of children or the elderly.
 Inmates with two (2) or more major write-ups during the current custody period for rule violations.
 Inmates who are validated gang members and/or have a history of gang related crimes.
 Inmates who have charges filed against them as a result of a write-up during the current custody period.
 Inmates involved in cases that have considerable press coverage or notoriety.
Medium Security Housing may be used to house unsentenced inmates at RCCC who do not meet the criteria for Special or High Security Housing, including but not limited to the following guidelines:
 Inmates who have a felony foreign agency hold for which they could be sentenced to five (5) or more years.
 Inmates with a history of assaults and/or a history of predatory behavior involving/victimizing other inmates which is at least five (5) years old.
 Inmates who have an escape or attempted escape charge from a secured facility, which is at least ten (10) years old.
Minimum Security Housing may be used to house sentenced inmates at RCCC who do not meet the criteria for High or Medium Security Housing or for Special Housing. Minimum Security Housing may also be used to house:
 Inmates who are sentenced with misdemeanor foreign agency holds and/or US Border Patrol Holds, per US Title 8, Sections 1325 and 1326.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmates who are in custody only for a parole hold, per California Penal Code 3056.
Special Housing may be used to house inmates at Main Jail and RCCC who have special separation or housing needs, including but not limited to:
 Medical or mental health problems or disabilities which prevent the inmates from caring for themselves in a jail setting, or who are required to be isolated for medical reasons.
 Inmates who are classified as Administrative Segregation, Protective Custody, Total Separation, or Civil Commitment status, per Operations Order 6/02.
 Inmates who are placed in disciplinary isolation. A Hearing Sergeant will assign inmates to disciplinary isolation based on the findings of the disciplinary hearing.
General Population refers to inmates who do not meet the criteria for any type of special housing or separation. The divisions’ classification staff will designate the housing for General Population inmates at the respective facility.
Classification officers will be responsible for conducting classification reviews in accordance with but not limited to the following guidelines:
 For inmates in High Security Housing, every thirty (30) days.  For inmates in General Population Housing, after the first sixty (60) days
of custody.  Upon request from custody staff, Medical Staff, Jail Psychiatric Services,
and/or court officials, or when the legal status of the inmate changes.  When an inmate is relocated and/or reclassified due to the outcome of a
disciplinary hearing.
All classification reviews will be documented on a Classification Review/Reclassification Form and placed in the classification file system. Classification officers will update JIMS as appropriate. Inmates may appeal the classification or housing assignment and request a classification review using the normal inmate message request or inmate grievance process.
Once an inmate has been assigned to a housing unit, he/she will typically remain in place until the resolution of his/her case or classification review dictates otherwise. If an inmate needs to be moved for security, disciplinary, pod harmony, medical, or other reasons, the housing unit officer should consult with a classification officer. The housing unit officer requesting the move shall minimally complete the facility’s Classification Review / Reclassification form and/or the Incident Report Detail (PF-10) Classification Review template and forward it to the classification office. Any other Incident Report Detail (PF-10) generated in connection with the request for reclassification shall also be forwarded to the classification officer. If there is no classification officer available,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
a supervisor shall make the determination of whether or not to relocate the inmate. Inmates wising to appeal a reclassification may appeal through the grievance appeals process.
Per Draft Operations Order Inmates with Disabilities - ADA, staff assigned to the Classification Unit are responsible to ensure that inmates with disabilities are housed in the most integrated setting appropriate to the needs of the individuals. Unless it is appropriate to make an exception, Classification staff shall not place inmates with disabilities:
 In inappropriate security classifications because no ADA accessible cells or beds are available.
 In designated medical areas unless they are actually receiving medical care or treatment.
 In facilities that do not offer the same programs as the facilities where they would otherwise be housed.
Classification staff shall review all Inmate Disability Evaluation Forms and:
 Make appropriate notations on the inmate’s “Class Comment” log based upon the inmate’s individual housing needs.
 Ensure that an “ADA” ALERT is in the JIMS system with the appropriate notations made in the remarks section.
 Ensure the inmate is assigned to appropriate housing, or make necessary moves to ensure the inmate’s housing is appropriate based upon his/her needs.
 Notify the ADA Coordinator to arrange for orientation of inmates who are visually impaired or unable to read.
 Make appropriate notations on the Inmate Disability Evaluation Form; forward the form to the ADA Coordinator for ADA compliance review.
Per policy 1410, Outpatient Housing Unit, admission to the medical housing units is authorized by the physician. Physician Assistants or a Nurse Practitioner may authorize admissions subject to the review and approval of the physician. The patient’s health problems or illness must not be severe enough to require care in an acute care hospital setting. The medical housing unit at Rio Cosumnes Correctional Center includes 6 locked cells, and another 20 beds in an open ward. The Main Jail medical housing unit has 10 single-cell medical beds: and the Psychiatric In-Patient Unit has 16 single cells and 1 double cell. There are an additional 5 beds set aside for handicapped inmates on the second floor.
Inmates who require mental health services may be housed in medical beds when mental health wing beds are not available. These inmates are not admitted for medical purposes and will receive the same care they would have received elsewhere in the general population as outpatients. Jail Psychiatric Services staff will document the patient’s mental health status every 15 minutes and log their observations.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Per policy 1436, Two East Inmate Transfers, the Sacramento County Jail is experiencing a trend where the age of the inmates that are being arrested and housed at both the New Main Jail and Rio Cosumnes Correctional Center is increasing. As the age of the inmate population increases, the inmates tend to need more care and also need more assistance with ambulation including the use of canes, crutches, and walkers. At the New Main Jail, 2 East is where inmates that require assistive devices are housed. 2 East has become chronically overcrowded, where the demand for beds exceeds the number of beds available.
To help alleviate the chronic overcrowding medical staff work with Custody Staff to determine which of the inmates who have already been sentenced or are solely on a parole hold are appropriate to be housed at RCCC. When room is available these inmates will be transferring from 2 East to RCCC. If the inmate is a security patient and a room is available, they will be moved to 448 100 Pod where sentenced inmates may have assistive devices and casts. If an inmate is an Honors inmate, they will be sent to the MHU or the Medical “M” Dorm where inmates may have assistive devices. This will require the help and coordination of both Custody Staff and Correctional Health Services Staff at both facilities.
Every Tuesday Classification at the New Main Jail will generate a list of inmates housed on 2 East that are either sentenced or simply in custody for a parole hold. This list will be given to the 2 East Nurse who will pull each of the patients’ charts and determine who would be a possible candidate for transfer to RCCC. Candidates for movement to RCCC should meet the following criteria:
 They are not a total separation or “TSEP” patient  They are not a paraplegic or quadriplegic  They are not a security patient on a CPAP or BiPAP machine (Honors
patients are acceptable)  They are not a dialysis patient  They have not had any known fights or other behavioral issues on 2 East  They are not being housed because of a previous suicide attempt by
jumping (e.g. from an upper tier.)  They do not have a wired jaw.  Ideally the inmate would have no or minor medical issues and is being
housed on 2 East simply due to crutches, cast, cane, walker or prosthesis.
The 2 East Nurse will write down the reason(s) why the inmate is housed on 2 East next to the patient’s identifying data. This list will be faxed to the SRN office at RCCC. The SRN at RCCC will review the list and recheck that the inmates on the list are appropriate for RCCC housing. The SRN at RCCC will contact the Administration Sergeant and send the list to either the Administration Sergeant or the Classification Officer. The Classification Officer will pick 2 or 3 inmates from this list that are appropriate to be housed at RCCC and make the arrangements to have patients transferred from the New Main Jail to RCCC.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Per policy 1417, Adult Developmental Disability, persons with developmental disability are potentially vulnerable in the custody setting and may require special consideration in the classification process. JPS staff should also make an entry into the JIMS system and if necessary, notify classification of any special housing recommendations.

Per policy 1107, Decision Making-Special Needs, consultation between the Facility Commander and the Medical Director is required for actions regarding patients who are diagnosed as having significant medical or mental health disorders, as follows:

 Housing assignments.  Program assignments.  Disciplinary measures.  Admissions to and transfers from institutions.
Maximum cooperation between custody personnel and health care providers is essential so that both groups are made aware of movements and decisions regarding patients with special medical or psychiatric needs. For example, health care staff must inform custody personnel when an inmate is suicidal, homicidal, or inappropriately housed in the jail for health care reasons. An inmate’s special needs may complicate housing or work assignments or disciplinary management. Medications may need to be adjusted for safety at the work assignment or before transfer.

Observations
The SCSD detention facilities use the Northpointe classification system. This system uses the COMPAS Decision Tree Classification System, which is designed to interface with SCSD detention facilities JIMS. The system classifies inmates into one of three security levels. In addition, it also assigns the inmate a custody level within the security level to better describe the inmate populations within the three security levels and for housing purposes into four levels maximum, medium, minimum and special housing.

The MJ COMPAS Classification Housing Plan (04/03/15)

COMPAS Classification Levels Key:

Level 1, 2

High (House In Same Cell)

Level 3, 4, 5

Medium (House In Same Cell)

Level 6, 7, 8, 9 Low (House In SAME Cell)

2 West 2 East

M P 100 200/300

Acute Medical Acute Psychiatric Wheelchair Male Sub-Acute Medical Detox

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

3 West 3 East
4 West 4 East 5 West 5 East 6 West 6 East 7 West
7 East 8 West 8 East

100/200 Inmate Workers

300

Out Patient Psych (Levels 2-9) H/M/L

100

P.C. (Levels 2-9) H/M/L

200

P.C. (Levels 2-9) H/M/L

300

L/T Out Patient Psych (Levels 2-9) H/M/L

U/T P. C. (Levels 2-9) H/M/L

100

DVHU/IMAP/REHAB (Levels 3-9) M/L

200

P.C. (Levels 2-9) H/M/L

300

G.P (Levels 2-5) H/M

100

P.C./PSEG (Levels 2-9) H/M/L

200

P.C. (Levels 2-9) H/M/L

300

P.C. (Levels 2-9) H/M/L

100

G.P. (Levels 3-9) M/L

200

G.P. (Levels 3-5) M

300

G.P. (Levels 2-5) H/M

100

G.P. (Levels 3-9) M/L

200

G.P. (Levels 3-5) M

300

G.P. (Levels 2-5) H/M

100

G.P. (Levels 3-9) M/L

200

G.P. (Levels 3-5) M

300

G.P. (Levels 2-9) H/M/L

100

G.P. (Levels 3-9) M/L

200

G.P. (Levels 3-5) M

300

G.P. (Levels 2-5) H/M

100

Female G.P. (Levels 3-9) M/L

200

Female G.P. (Levels 3-5) M

300

Female P.C. /OPP/TSEP/ADSEG/G.P.

400

Female Discipline/ADSEG/TSEP/PC/OPP

100

Female Intake/P.C./SEP/OPP

200/300 Male Intake Housing

100/200/300 Male ADSEG/TSEP

400

Male Disciplinary Housing

100/200/300 Male ADSG/TSEP Housing

RCCC Classification Housing Plan

A Barracks B Barracks C Barracks D Barracks G Barracks H Barracks J Barracks K Barracks

Medium (un-sentenced) Minimum Honor Facility Reentry Minimum Honor Facility Minimum Honor Facility Minimum Honor Facility Minimum Honor Facility Medium (un-sentenced) Medium (un-sentenced)

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

M Barracks MHU

Minimum Honor Facility/Medical Medical Housing Unit

SLF Kinya

Female Minimum

SLF Golden Poppy Female Minimum

SLF Camellia

Female Medium

SLF Ramona

Female Maximum

JKF 100 200 300 400 500 600

Medium Medium Medium Medium Medium Medium

KBF 100 200 300 400 500 600

ICE P.C. Medium ICE ICE ICE P.C. Medium

CBF 100 200 300 400 500 600

Restriction Intake/Overflow P.C Maximum County Out Patient Psychiatric Maximum ROC/CBJT

SBF 100 200 300 400 500 600

TSEP & ICE SMU Maximum Maximum Maximum Maximum P.C Maximum

The Assessment Team conducted site assessments/tours of all housing units including medical and special housing units where disabled inmates are housed. The team also conducted staff interviews of medical, custody and classification staff, and reviewed applicable operations orders, policies and procedures.

Information obtained from staff, site assessments, and through the review of operations orders, policies and procedures revealed that inmates that have prescribed HCAs/ADs/DME (canes, wheelchairs, walkers etc.) are housed based on classification case factors and they can be housed on any floor/housing unit.

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Case 2:18-cv-02081S-HTELRINFF-’KS DJENPARDTMocENuTmCeOnUtN1TY-5OF SFAiCleRdAM0E7N/3TO1/C1O8RREPCTaIOgNeA6L5SEoRVf I4C8ES8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
However, the housing of inmates with prescribed HCAs/ADs/DME in housing units based on classification case factors is a change in housing protocols that was made within the past year. At the MJ, it is very difficult to house disabled inmates who have been prescribed a HCA/AD/DME in housing units based on their classification factors. This is based on the fact that the housing units on floors 3 through 8 do not have ADA-compliant in-cell accessible features, accessible showers, accessible visiting areas and accessible access to outdoor recreation. Based on this, disabled inmates that require these types of accommodations must be housed in 2 East (Pods 100/200/300), the male sub acute housing unit. In the 100 Pod, there are 5 cells designed for disabled inmates that have been prescribed a wheelchair. The cells and shower in this pod have ADA accessible features, however, they are not ADA-compliant. Staff reported that there is no accessible housing for fulltime wheelchair users other than in the medical housing units (RCCC MHU, MJ 2 East and MJ 2 West). There is no wheelchair accessible housing for female inmates at RCCC.
Disabled inmates are being housed in a medical/sub acute housing unit solely based on their disability or need for ADA accessible housing. Medical staff stated that half of the inmates housed in 2 East are housed solely based on their need for accommodations and/or based on the prescription of a HCA/AD/DME as these inmates cannot be housed on the upper floors. The housing of this mixed population with varying classification case factors makes it very difficult to provide inmates with out-of-cell time and outdoor recreation. This is because of the numerous factors that restrict the ability for the inmates to program together, requiring multiple groups in order to program the inmates safely (Protective Custody [PC], Total Separation (TSEP), OPP, Classification Level, etc.) Based on the limited number of beds/cells available on 2 East, at times, disabled inmates with prescribed HCAs (cane or crutches), or those who have physical limitations are being housed on the upper floors and struggle to access the programs, services and activities on the upper floors.
There is no ADA accessible housing for disabled female inmates in the female housing units at the MJ who require in-cell ADA accessible features, accessible showers, accessible visiting areas and accessible access to outdoor recreation. If a female requires ADA accessible housing she has to be housed in the medical housing unit on 2 West, transferred to RCCC or housed on the upper floors without the required accommodations.
At RCCC the only housing unit with some ADA accessible features for inmates who are mobility impaired and do not require wheelchair accessible housing is Kinya, which is a minimum-security housing unit. If a female medium security inmate at SLF requires ADA accessible housing, staff would have to allow the inmate to be housed in Kinya on a classification override. If a female maximumsecurity inmate at SLF requires ADA accessible housing, she would have to be
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
housed in the non-ADA-accessible housing (Ramona) or be transferred to the medical housing unit at the MJ.
There are specific housing units for inmates with mental health disabilities. The housing unit for inpatient (acute) mental health inmate-patients is 2 West P. Designated housing for OPP disabled inmates at the MJ are 3 West 300, 3 East 300 U/T, 7 West 300/400 and 7 East 100. Inmates at the MJ with mental health disabilities and other classification case factors (ADSEG and TSEP) are housed in the designated housing units based on classification case factors. Designated housing for OPP disabled inmates at the RCCC is CBF 400. There is also a special housing unit Jail Based Competency Treatment (JBCT) Program designed to restore mentally ill inmates who’ve been found incompetent to stand trial to competency without transferring them to a state hospital. Inmates at RCCC with mental health disabilities and other classification case factors (ADSEG and TSEP) are housed in the designated housing units based on classification case factors. If an inmate, male or female, at RCCC requires acute mental health treatment they are transferred to the MJ 2 West P. There is no OPP housing at RCCC SLF for female inmates. Female inmates at RCCC who require OPP housing are transferred to the MJ.
There is no designated housing for male or female inmates with developmental disabilities at the MJ or RCCC.
During the initial classification and subsequent classification processes, classification officers did not provide EC during the inmate interviews to ensure the inmates understood the classification process, and the decisions made regarding classification and housing placement. Although Northpointe classification system has the capability to produce an Inmate Classification Notice that details the inmates case factors such as; Name X-Ref, CII Number, SSN, Race, FBI Number, Ethnicity, Original Bail Set, Date of Birth, Agency, Gender, Inmate Number, Booking Number, Booking date, Current Classification, and Next Review Date, Classification staff reported that this Notice is not issued to inmates. The Inmate Classification Notice also contains a narrative that advises the inmate. A sample provided to the Assessment Team reads as follows:
“You have been placed in the following classification: 3-High Medium (Medium) by the Classification Department. This classification is determined by: current/past convictions; current/past institutional behavior; pending charges or holds in other jurisdictions (if any); unsentenced/sentenced status; and/or any other information that may be deemed appropriate with regard to your personal security or the security of the facility.
Note: Your classification may change when charges are altered or reduced; you are sentenced; due to administrative hearings; due to regular periodic review; program participation; and/or other reasons recommended by the jail staff.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Appeal Process: Any inmate who so desires may appeal his/her classification (in writing) in any of the three basic areas (security level, housing assignment or programs) within 10 days of the primary classification or reclassification by addressing the appeal to: Classification Department.”
As reported by the classification staff, inmates do not receive written notice when placed into TSEP, ADSEG or initial housing. Inmates are also not provided written notice of initial classification or reclassification results. More than 95 percent of the inmates interviewed were not aware of their classification status or classification level. Because inmates are not advised of their classification level/score or their appeal rights, they are not informed on how to reduce their classification level/score which in turn impacts their program opportunities (dayroom/yard etc.)
Staff Interviews
The Assessment Team conducted interviews of custody deputies/officers assigned to housing units and intake booking, as well as medical and classification staff. Intake booking, classification and housing unit staff stated that disabled inmates are housed based on their classification case factors. Staff stated that this is a change in housing policy that has recently been implemented. Staff stated that inmates prescribed wheelchairs or other HCA/AD/DME who have a difficult time ambulating are housed in the medical floor on 2 East and that this is a medical decision. Custody staff also stated that medical staff designate and approve an inmate to be housed in a L/B L/T. This is reflected in a chrono and is also noted in JIMS. Staff stated that once the JPS designates an inmate as OPP they are moved to the OPP housing unit if case factors allow. There are case factors such as Protective Custody (PC), ADSEG and TSEP that “trump” the inmate’s housing in an OPP unit. Staff at RCCC SLF stated that inmates with canes, walkers and crutches are housed based on their classification and that they have never seen a female inmate with a wheelchair housed at RCCC SLF.
Medical staff stated that more than half of the inmates housed in 2 East are being housed in 2 East solely based on their disability and that they do not actually have medical issues that require housing in 2 East. The Assessment Team asked an RN how many inmates housed in 2E have disabilities without any other overriding (or underlying) medical issues, to which the nurse responded that she believes this applies to more than half the inmates housed within the unit. Another RN stated that inmates who are determined at intake medical screening to have an intellectual disability or a learning disability, may be housed in MJ 2 East (medical housing), and if they are housed “upstairs” (another floor), they may be referred to medical.
An RCCC RN explained stated mobility impaired inmates with prescribed canes are housed in the GP, and inmates with walkers are assigned to M Dorm;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Classifications staff stated that a classification worksheet is completed for all arrivals. The MJ Classification Worksheet does not contain questions regarding disabilities other than a mental health disability. Classification staff stated that disability-related information is obtained from the medical intake screening and the Special Needs Form. The RCCC Classification Worksheet has a question regarding the need for special housing considerations due to a disability. The ICE Classification Worksheet in the Special Management Vulnerabilities and Management Concerns has check boxes for staff to check if a special vulnerability exists such as, serious mental illness and/or disability. Classification staff indicated that a classification interview is conducted on all inmates that arrive at the MJ and RCCC with the exception of inmates initially housed on the 2nd floor of the MJ (Medical Floor). The Assessment Team observed the classification interviews for 15 inmates at the MJ. During the interviews the classification deputies did not ask any disability-related questions with the exception of an inquiry about mental health concerns. The interviews were conducted in the open dayroom with a proximity of 15 feet from other inmates waiting to be interviewed. Classification staff stated that following the interview, the information obtained from the interview and information available in JIMS is entered into the Northpointe system and a recommended classification level is obtained to determine housing.
Although the Operations Order 06/03 Classification requires classification staff to conduct a reclassification for inmates in High Security Housing, every thirty (30) days, for inmates in General Population Housing, after the first sixty (60) days of custody, upon request from custody staff, Medical Staff, Jail Psychiatric Services, and/or court officials, or when the legal status of the inmate changes, and when an inmate is relocated and/or reclassified due to the outcome of a disciplinary hearing, classification staff stated that based on the shortage of classification staff, these reviews are typically done via a paper review as there is insufficient classification officers to conduct face-to-face classification reviews.
Inmate Interviews
The Assessment Team conducted inmate interviews. Listed below are claims made by inmates during the Assessment Team interviews:
 RCCC CBF inmate: Mobility - Had a wheelchair and walker at MJ 2 East. Staff told him they needed the room, took HCAs, and transferred him to RCCC. Needs grab bars or shower chair. Very difficult for him to walk around in dayroom and yard without a HCA;
 MJ 4 East inmate: Mobility - Claims staff told him if he gave up his cane he would be able to go upstairs. Needs rails in shower or shower chair. Fell 2 times in shower. Very difficult to walk upstairs;
 MJ 2 East inmate: Mobility - Claims when he arrived he was housed in a regular cell on upper bunk and he fell from top bunk. Needs in cell and shower accommodations. Difficult to step over shower lip;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ 2 East inmate: Wears prosthetics - Needs in-cell ADA features. Has to hold on to table to balance when using toilet. Goes to Pod 100 to shower;
 MJ 2 East inmate: Mobility - Needs in-cell ADA features. Has to hold on to table to balance when using toilet. Goes to Pod 100 to shower;
 MJ 2 East inmate: Mobility – Needs shower chair;  MJ 2 East inmate: Wears prosthetics – Needs ADA features in shower.
Difficult to step over shower lip;  MJ 2 East inmate: Claims that he requires LB/LT and he was celled with
another inmate that has LB/LT chrono. He had to sleep on floor.  MJ 6 West inmate: Mobility – Needs grab bars in cell and shower
accommodations. Difficult to walk upstairs;  MJ 6 West inmate: Mobility – Has fallen in shower without ADA accessible
features. It is difficult to walk up and down stairs to visiting and yard;  MJ 6 West inmate: Parkinson’s – Needs a cane but does not want one
because he doesn’t want to be moved to the 2nd floor. Needs shower chair or grab bars;  RCCC KBF inmate: Hearing/Vision/Stroke – Uses wall to support himself in shower. Needs cane;  RCCC KBF inmate: Mobility – Has to use plastic chair to shower;  RCCC H Barrack inmate: Mobility – Needs to stabilize himself on wall to shower. Needs cane to be able to go to yard does not have one;  RCCC G Barrack inmate: Mobility – It is difficult to shower. Has to hold on to wall. Needs cane for long distances, but does not have one.  RCCC B Barrack inmate: Mobility/Gout – Needs grab bars when gout flares up. Difficult to step over lip in shower;  RCCC K Barracks inmate: Mobility – Has to lean against wall. Needs shower chair or grab bars;  RCCC KBF inmate: Mobility/Amputee – Housed in MHU for 1 night. Needs shower chair;  RCCC SBF inmate: Mobility – Needs shower chair or grab bars in shower;  MJ 2 East inmate: Mobility – Has a walker. Needs grab bars in shower;  MJ 3 West inmate: Mobility – Has crutches. Needs to hold on to wall to shower. Difficult to walk up and down stairs;  MJ 2 East inmate: Mobility – Fulltime wheelchair user not in ADA cell. Needs grab bars in cell and shower. Has to hold on to walls to shower, no shower chair;  MJ 5 West inmate: Mobility – Difficult to walk up and down stairs;  MJ 7 East inmate: Temporary Crutches – Needs grab bars. Struggles to climb up and down stairs to visiting;  RCCC SBF inmate: Mobility – Needs grab bars in cell;  MJ 8 East inmate: Mobility – Hard to take a shower;  MJ 2 East: Mobility – 3 inmates claimed that although they had a chrono for a low bunk, staff housed them in a cell with another inmate with a low bunk chrono. The inmates claimed that when they advised staff about the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
low bunk chrono, staff told them they would either have to climb to the top bunk or sleep on the floor. One of the inmates claimed that he had to sleep with his mattress on the floor for 2 weeks until staff relocated him to a low bunk;  RCCC JKF inmate: Claims mobility disability (organ failure/breathing) and mental disability. Was denied shower bench and then moved to current location;  MJ 5E inmate: Claims mobility impairment (lungs/breathing), mental illness, and vision impairment. Claims his cellmate asked for a cell move but staff told his cellmate that they would not move him unless they got in to a fight. The inmate claimed his cellmate assaulted him (1/16) and a small melee ensued;  MJ 7W inmate: Claims mobility impairment (uses walker), and vision and mental health disability. Has difficulties without a walker and falls down. Had an issue about 7 months after arrival and was moved to 2M once he was issued a walker. Has routinely fallen when entering or exiting the shower because of the raised lip;  MJ 4E inmate: Mobility impaired (uses a cane). Has a chrono to use a cane for court movement, but custody and medical staff have never honored it or provided a cane. Was initially housed in 2M, but 2 weeks after the chrono was written, he was housed in 4E;  MJ 4E inmate: Claims a mobility disability (needs hip replacement). Says UCD recommended surgery, but he has been unsuccessful getting it scheduled. He requested a cane 6 months ago, but has not received one;  MJ 2M inmate: Mobility disabled (permanent wheelchair). Suffers from sores/ulcers in buttocks area. He is a very large individual, and has had 2 separate air blow-up cushions, but they busted. Has not received anything since. His right foot peg/rest to his wheelchair has been broken since it was issued several months ago. The wheelchair is a county-owned wheelchair, as his electric wheelchair was confiscated upon arrival;  MJ 2M inmate: Mobility disabled (permanent wheelchair user, paraplegic), mentally disabled, and vision impaired. Has sores/ulcers in buttocks area. Hs requested a trapeze but has been denied. Claims that staff broke his chair en route to a transport, as staff “jammed” the wheelchair into the wheelchair van lift;  MJ 2M inmate: Mobility disabled (permanent wheelchair user). Claims to have difficulty transferring from the wheelchair to the “flimsy” shower chair, which is “filthy.” He claims to normally sits on the “flimsy” shower chair on his knees because it is old and dirty;  MJ 2M inmate – Mobility impaired (prosthetic right leg, and right arm is non-functional). Claims to not be receiving assistance with daily living for showers, and has fallen down in the pod shower repeatedly, as there is not a handrail in the shower;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ 2M inmate: Mobility disabled (quadriplegic and permanent wheelchair user) and mentally disabled. Claims his wheelchair back needs adjustment to relieve pressure. Also, his foot peg/rest has been missing, and his feet “dangle” when he is in his wheelchair. His right foot is not functional, but he can’t get his foot on to the foot peg as it needs adjustment;
 MJ 2M inmate: Mobility disabled (permanent wheelchair, Cerebral Palsy since birth). Demonstrated a very awkward angle where he has very minimal use of his lower extremities so long as he is holding his wheelchair. He occasionally performs this movement for therapy and exercise. Has 2 different sized county-issued shoes (size 9 for one foot, and a size 10 for the other). He has made numerous attempts to get the correct shoe size for one shoe, but has not received any accommodation. This is paramount for him to maneuver and obtain minimal movement of his feet and lower legs. He also indicated that he has fallen in the “wobbly” shower chairs on several occasions;
 RCCC JKF inmate: Mobility disabled (crutches, broken pelvis and was in wheelchair for 2 years). Claims his request for orthopedic shoes or shoes with a lift was denied;
 RCCC D Dorm inmate: Mobility disabled (Cerebral Palsy, DPM in CDCR). Claims his cane was taken by Elk Grove Police Department at the time of arrest, but the medical department has refused to issue him a cane. He claims he had a cane in CDCR;
 MJ 6E inmate: Mobility disabled (cane, partially paralyzed in left leg). Claims staff do not honor lower bunk chromos. Instead, they tell cellmates that one of them will have to sleep on the floor. Claims he has been on transports where staff do not let him use his cane to board the transport vehicle. On one such occasion, a court judge ordered that he be taken to court via wheelchair; and
 RCCC CBF Inmate - This inmate is on OPP status, and claims he has been moved as inmates historically tease him.
Conclusions
There is no ADA accessible housing for disabled inmates who have been prescribed a HCA/AD/DME in the MJ except in 2 East medical housing units. However, as noted in the physical accessibility section, these housing areas are not ADA compliant.
There is no accessible housing for fulltime wheelchair users at RCCC (male or female) except in the MHU, which houses male inmates. Therefore male and female inmates whose case factors allow for lower custody/level housing are being housed in a medical setting solely based on their disability. This is in violation of 28 C.F.R. § 35.152 (b)(1) and (b)(2)(i), (ii), and (iii) of the Title II regulations.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Full-time female/male wheelchair users eligible for RCCC housing are not given the same opportunity to participate in programs, services, and activities as other inmates as they are being housed in the MJ medical housing that does not provide most of the programs, services and activities available at RCCC.
There is no ADA accessible housing for disabled inmates who have been prescribed a HCA/AD/DME in the RCCC except in the MHU, M-Dorm and JKF 100. However, as noted in the physical accessibility section, these housing areas are not ADA-compliant.
All disabled inmates with a wheelchair at the MJ are housed in the medical housing unit for the duration of their incarceration. This is in violation of 28 C.F.R. § 35.152 (b)(1) and (b)(2)(i), (ii), and (iii) of the Title II regulations.
Although it is the policy of SCSD detention facilities to house disabled inmates based on their classification case factors, some disabled inmates with assistive devices who require ADA accessible housing at the MJ are housed in the medical housing unit for the duration of their incarceration. This is in violation of 28 C.F.R. § 35.152 (b)(1) and (b)(2)(i), (ii), and (iii) of the Title II regulations.
Inmates housed in the medical housing unit at the MJ are not offered or provided access to equivalent programs, services and activities consistent with their custody level as inmates who are housed in the general population housing units. This is in violation of 28 C.F.R. § 35.152 (b)(1) and (b)(2)(i), (ii), and (iii) of the Title II regulations.
Although the Draft Operations Order Inmates with Disabilities - ADA, states that unless it is appropriate to make an exception, Classification staff shall not place inmates with disabilities: in inappropriate security classifications simply because no ADA-accessible cells or beds are available, in designated medical areas unless they are actually receiving medical care or treatment, or in facilities that do not offer the same programs as the facilities where they would otherwise be housed. The SCSD detention facilities will not be able to comply with this order unless physical plant modifications are made to the upper floor housing areas of the MJ and RCCC facilities.
Policy 1436 2 East inmate transfers, reflects that sentenced inmates at RCCC may have assistive devices in the 448 100 Pod and the MHU or the Medical “M” Dorm. Restricting disabled inmates with assistive devices to medical housing units violates 28 C.F.R. § 35.152 (b)(1) and (b)(2)(i), (ii), and (iii) of the Title II regulations.
Classification staff does not provide EC for inmates with cognitive deficits that have a difficult time understanding the classification process.
The SCSD detention facilities Classification process does not provide specific housing and placement criteria for developmentally disabled inmates. Staff
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
members have a duty to protect all inmates, including disabled inmates, from violence at the hands of other inmates. Intellectual disabilities put those inmates at greater risk for abuse and exploitation than non-intellectually disabled inmates. Intellectually disabled inmates may give up possessions to other inmates or become vulnerable to sexual predators or manipulation by other inmates. Therefore staff must monitor these inmates to promote their personal safety. The SCSD detention facilities must also establish specific housing criteria for disabled inmates.
References
28 C.F.R. § 35.137 (a) requires that a public entity permit individuals with mobility disabilities to use wheelchairs and manually-powered mobility aids, such as walkers, crutches, canes, braces or other similar devices designed for use by individuals with mobility disabilities in any areas open to pedestrian use. Additionally 28 § 35.152 (b)(2)(i),(ii), and (iii) state that public entities shall ensure that inmates or detainees with disabilities are housed in the most integrated setting appropriate to the needs of the individuals. Unless it is appropriate to make an exception, a public entity, shall not place inmates or detainees with disabilities in inappropriate security classifications because no ADA accessible cells or beds are available. A public entity shall not place inmates or detainees with disabilities in designated medical areas unless they are actually receiving medical care or treatment. A public entity shall not place inmates or detainees with disabilities in facilities that do not offer the same programs as the facilities where they would otherwise be housed.
28 CFR 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service…
28 CFR § 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability.
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections—
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
(i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities.
28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
28 C.F.R. § 35.152 (b)(2) (i), (ii), (iii): Public entities shall ensure that inmates or detainees with disabilities are housed in the most integrated setting appropriate to the needs of the individuals. Unless it is appropriate to make an exception, a public entity, shall not place inmates or detainees with disabilities in inappropriate security classifications because no ADA accessible cells or beds are available. A public entity shall not place inmates or detainees with disabilities in designated medical areas unless they are actually receiving medical care or treatment. A public entity shall not place inmates or detainees with disabilities in facilities that do not offer the same programs as the facilities where they would otherwise be housed.
28 C.F.R. § 35.152 (b)(3) states that a public entities shall implement reasonable policies, including physical modifications to additional cells in accordance with the 2010 Standards, so as to ensure that each inmate with a disability is housed in a cell with the accessible elements necessary to afford the inmate access to safe, appropriate housing.
Pierce v. Cty. of Orange, 526 F.3d 1190 (9th Cir. 2008)
A group of pretrial detainees housed in the county jail facilities brought a claim that the county failed to provide accessible bathrooms,  sinks, and showers, and other fixtures or curative measures.  
Jaros v. Illinois Department of Correction., 684 F.3d 667 (7th Cir. 2012)  
Illinois prison lacked grab bars and thus prevented plaintiff from   using his shower and transporting himself to meals.  Illinois Department of Correction refused to add accessibility features because the facility was not designated  as ADA accessible, but also refused to transfer the inmate to an ADA accessible facility because he would not be incarcerated long enough to meet the Department’s criteria for transfer.  
Clemons v. Dart 2016 WL 890697 (N.D. Ill. Mar. 9, 2016)
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Inmate who used wheelchair was not assigned to an accessible room.  Nurses were on call to help him access the sink, shower, and toilet.   Sheriff’s Position: No ADA violation because nursing staff allowed plaintiff to access  all the same facilities. Court: On-demand nursing support was not equivalent to providing   an accessible cell because it reduced plaintiff’s ability to engage in  independent living to the fullest extent possible.   Note: Clarifies that Title II “requires affirmative, proactive   accommodations necessary to ensure meaningful access to public services and programs, not accommodation upon request.”   Wright v. New York State Department of Corrections 2016 WL 4056036 (2nd Cir. July 29, 2016) Inmate with cerebral palsy and scoliosis who could operate a motorized wheelchair, but not a manual wheelchair, successfully challenged ban on motorized chairs in prison due to safety concerns. Court: Policy prevented plaintiff from accessing prison services. Rejected option of “inmate mobility aids” as “in tension” with ADA’s emphasis on independent living. Also said inmate mobility assistant program was ineffective in practice because it required advanced scheduling. Reaves v. Department of Corrections, 2016 WL 4124301 (D. Mass July 15, 2016) Successfully challenging procedure that prevented plaintiff from going outdoors in 16 years finding the procedures could be modified.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Medical/Mental Health/Dental
Under the Eighth Amendment, the SCSD detention facilities are required to "provide medical care for those whom it is punishing by incarceration. An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met." Estelle v. Gamble, 429 U.S. 97, 103, 97 S. Ct. 285, 290, 50 L. Ed. 2d 251 (1976). Inmates are entitled to medical care and attention as needed to treat both short-term conditions and long-term illnesses. Inmates who need mental health care are entitled to receive that treatment in a manner that is appropriate under the circumstances. Under the ADA, the SCSD detention facilities are required to ensure disabled inmates have equal access to the programs, services, and activities including access to medical, dental and mental health care.
The Minimum Standards for Local Detention Facilities, Title 15-Crime Prevention and Corrections, Division 1, Chapter 1, Subchapter 4, Article 11, Medical/Mental Health Services, contains several sections applicable to medical, mental health, and dental services:
§ 1200. Responsibility for Health Care Services.
(a) In Type I, II, III and IV facilities, the facility administrator shall have the responsibility to ensure provision of emergency and basic health care services to all inmates. Medical, dental, and mental health matters involving clinical judgments are the sole province of the responsible physician, dentist, and psychiatrist or psychologist respectively; however, security regulations applicable to facility personnel also apply to health personnel.
Each facility shall have at least one physician available to treat physical disorders. In Type IV facilities, compliance may be attained by providing access into the community; however, in such cases, there shall be a written plan for the treatment, transfer, or referral in the event of an emergency.
(b) In court holding and temporary holding facilities, the facility administrator shall have the responsibility to develop written policies and procedures which ensure provision of emergency health care services to all inmates.
§ 1208. Access to Treatment.
The health authority, in cooperation with the facility administrator, shall develop a written plan for identifying and/or referring any inmate who appears to be in need of medical, mental health or developmental disability treatment at any time during his/her incarceration subsequent to the receiving screening. The written plan shall also include the assessment and treatment of such inmates as described in Section 1207, Medical Receiving Screening. Assessment and treatment shall be performed by either licensed health personnel or by persons operating under the authority and/or direction of licensed health personnel.
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§ 1209. Mental Health Services and Transfer to Treatment Facility.
(a) The health authority, in cooperation with the mental health director and facility administrator, shall establish policies and procedures to provide mental health services. These services shall include but not be limited to:
1. screening for mental health problems;
2. crisis intervention and management of acute psychiatric episodes;
3. stabilization and treatment of mental disorders; and
4. medication support services.
(b) Unless the county has elected to implement the provisions of Penal Code Section 1369.1, a mentally disordered inmate who appears to be a danger to himself or others, or to be gravely disabled, shall be transferred for further evaluation to a designated Lanterman Petris Short treatment facility designated by the county and approved by the State Department of Mental Health for diagnosis and treatment of such apparent mental disorder pursuant to Penal Code section 4011.6 or 4011.8 unless the jail contains a designated treatment facility. Prior to the transfer, the inmate may be evaluated by licensed health personnel to determine if treatment can be initiated at the correctional facility. Licensed health personnel may perform an onsite assessment to determine if the inmate meets the criteria for admission to an inpatient facility, or if treatment can be initiated in the correctional facility.
(c) If the county elects to implement the provisions of Penal Code Section 1369.1, the health authority, in cooperation with the facility administrator, shall establish policies and procedures for involuntary administration of medications.
The procedures shall include, but not be limited to:
1. Designation of licensed personnel, including psychiatrist and nursing staff, authorized to order and administer involuntary medication;
2. Designation of an appropriate setting where the involuntary administration of medication will occur;
3. Designation of restraint procedures and/or devices that may be used to maintain the safety of the inmate and facility staff;
4. Development of a written plan to monitor the inmate’s medical condition following the initial involuntary administration of a medication, until the inmate is cleared as a result of an evaluation by, or consultation with, a psychiatrist;
5. Development of a written plan to provide a minimum level of ongoing monitoring of the inmate following return to facility housing. This monitoring may be performed by custody staff trained to recognize signs of possible medical problems and alert medical staff when indicated; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
6. Documentation of the administration of involuntary medication in the inmate’s medical record.
§ 1210. Individualized Treatment Plans.
(a) For each inmate treated by a mental health service in a jail, the treatment staff shall develop a written treatment plan. The custody staff shall be informed of the treatment plan when necessary, to ensure coordination and cooperation in the ongoing care of the inmate. This treatment plan shall include referral to treatment after release from the facility when recommended by treatment staff.
(b) For each inmate treated for a major medical problem in a jail, the treatment staff shall develop a written treatment plan. The custody staff shall be informed of the treatment plan when necessary, to ensure coordination and cooperation in the ongoing care of the inmate. This treatment plan shall include referral to treatment after release from the facility when recommended by treatment staff.
§ 1211. Sick Call.
There shall be written policies and procedures developed by the facility administrator, in cooperation with the health authority, which provides for a daily sick call conducted for all inmates or provision made that any inmate requesting medical/mental health attention be given such attention.
§ 1215. Dental Care.
The facility administrator shall develop written policies and procedures to ensure emergency and medically required dental care is provided to each inmate, upon request, under the direction and supervision of a dentist, licensed in the state.
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to the provision of medical, dental and mental health services for inmates are outlined in the following Operations Orders and policies:
Operations Orders
 3/07 Medical Emergencies;  10/01 Health Care Services;  10/02 Psychiatric Services;  10/03 Health Care Treatment Access;  10/04 Medical Intake Screening;  10/05 Suicide Peer Program;  10/08 Medicine Distribution “Pill Call”;  10/09 Dental Services;  10/10 Health Equipment and Control; and  10/11 Health Records.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Policies
 1107 Decision Making – Special Needs;  1110 Access to Diagnostic Services;  1119 Individualized Treatment Plans;  1120 Continuity of Care;  1122 Hospital Care;  1125 Prosthesis;  1126 Health Care Maintenance;  1128 Reading Glasses;  1130 Transfer Medications;  1404 Receiving Screening;  1407 Access to Treatment;  1409 Clinic Care;  1410 Medical Services Provided in the Medical Housing Unit;  1411 Mental Health Services;  1412 Suicide Prevention – 2M – Joint Policy with JPS;  1415 Patients in Safety Cells;  1416 Patients in Segregation;  1417 Adult Developmental Disability;  1422 Special Needs Patients;  1425 Admission to Jail Acute Psychiatric Inpatient Unit;  1435 Inmate Health Care Grievances;  1439 Reports of Disabilities or Impairments;  1440 Emergency Mode; and  2000 Dental Care.
Per Operations Order 10/1, Health Care Services, “The Main Jail and RCCC shall ensure provisions of emergency and basic health care services and psychiatric services are available to all inmates pursuant to Article 10 of the California Code of Regulations.”
Per Operations Order 10/02, Psychiatric Services, “Jail Psychiatric Services (JPS) staff shall respond to requests from custody and medical staff to screen, evaluate and treat inmates in order to provide necessary mental health evaluation and treatment during incarceration.”
Per Operations Order 10/9, Dental Services, “The Main Jail and RCCC shall provide emergency and medically required dental care to inmates under the direction and supervision of a state licensed dentist. Whenever possible, dental care shall be delivered on site rather than at an outside facility.”
Per Policy 1409, Clinic Care, states the following, ”Sick Call is conducted by a physician, mid-level practitioner or nurse, a minimum of five days a week. If a patient’s custody status precludes attendance at a clinic, arrangements are made to provide clinic services at the place of the patient’s detention. Clinic care is
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
available for ambulatory patient(s) with health concerns and is held at a scheduled time and place. When conducted by a nurse practitioner it is expected that a physician will be on site or available for consultation.”
The written procedures contained within policy 1409, state, “Medical Health Services (HS) KITE’s (request for medical attention) are available in the Housing Units, from the pill call nurses and from custody officers. HS KITE’s are triaged by an RN within 24 hours of being received and appropriate appointments are scheduled. A physician, nurse practitioner or registered nurse is responsible for conducting sick call. Sick call is conducted on a regular weekly basis. Patients with relatively new health problems or those needing immediate attention are seen at that time. The Physician is available on site or by telephone for a consultation regarding patient’s treatment. Patients are referred to the Physician on the next scheduled Sick Call for evaluation if necessary. In case of emergency, the patient is transferred to an appropriate facility upon physician’s orders.”
With regard to documentation of health care, the policy states the following, “Progress notes describing the inmate’s complaint, assessment, and plan of care taken are entered in the patient’s Medical record. HS KITE’s are scanned and added to the inmate’s medical record. If ‘Standardized Procedures’ are utilized, all actions performed are recorded in the Medical Record. Height, weight and vital signs will be obtained and recorded in the medical record as required by the patient’s condition.”
Per Policy 1125, Prosthesis, states the following, “Medical and dental prostheses, including eye glasses, will be provided when the health of the patients would otherwise be adversely affected as determined by the responsible physician or dentist. Inmates will not be deprived of the possession or use of any orthopedic prosthetic or assistive device if the appliance has been approved by the responsible physician.
 Prostheses are artificial devices to replace missing body parts or compensate for defective bodily functions; and
 Assistive devices include wheelchairs, crutches, and other devices intended to improve functioning due to injured or defective body parts.
In accordance with local Operations Orders and policies, the jail handbook (rulebook) provides specific information to disabled (and all) inmates regarding access to HS (medical, mental health and dental care). The rulebook informs the reader that the SCSD detention facilities have 24-hour per day emergency services for medical, mental health, and dental, and the inmates can contact their respective floor officer for assistance.
The rulebook also explains the process for non-emergency access to health care services. Each inmate must complete a pink Health Services KITE request (pink KITE), which are available from the housing officers, through nurses during the pill call process, and from any medical staff member. The rulebook explains that
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
inmates can follow the instructions on the back of the KITE request form, must sign it, and give it to any medical services provider, or a pill call nurse.
The rulebook also informs inmates that if they need an assistive device, or if they have a disability, they can complete a pink KITE request, and medical staff will subsequently review the requesting inmate’s specific needs, and determine what accommodations may be required. It also states that any ADA accommodations for disabilities are provided free of charge.
For specific medical requests, the rulebook adds that the request for services will be reviewed, and appropriate actions will be taken to address the needs. “Sick Call” is conducted every day. The inmates may be seen by a nurse or a doctor depending on the request and medical condition. If the inmate refuses sick call, he/she will need to sign a refusal form when the service is offered. The inmate must complete additional KITE requests for future appointments.
For specific dental care requests, the rulebook states that after the pink KITE request is submitted, the dentist may come to see the inmate in the day room or dorms to assess the inmate’s dental condition and schedule a dental appointment.
For specific JPS mental health requests, the rulebook emphasizes that they don’t want inmates to harm themselves. It explains that if an inmate feels severely depressed, or feels like harming him/herself, or feels suicidal, the inmate must tell any custody or health care staff member immediately. The rulebook lays out the same process if an inmate knows of any other inmate that has similar thoughts. For psychiatric KITE requests, the process is also the same, in that upon completion of the KITE (and checking the box for psychiatric services), the inmate must give the KITE to any medical services provider or the pill call nurse. The rulebook articulates that psychiatric services are focused on providing mental health care to inmates during incarceration, and some of the JPS provided are:
 Determine the appropriate level of care needed, including Inpatient Services;
 Continue the care the inmate may have received in the community;  Intervene in a crisis or emergency; and  Assist in developing plans to continue treatment after release.
Per Policy 1416, Patients in Segregation, inmates who have been removed from the general population and placed in segregation are evaluated daily by medical personnel, and these encounters are documented. Notations are made of any signs of physical illness or trauma. Observations regarding the patient’s attitude or outlook such as depression, suicidal ideations shall be reported to Nursing Supervisor and documented.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Behavior permitting, inmates in administrative segregation are not to be deprived of privileges afforded other inmates. All health care services are available. PillCall will be delivered to the cell when necessary. A physician shall visit a cell if it is not practical to move the inmate. Sick Call will be available as usual at other housing units.
Inmates shall be checked on each shift by the pill call nurse. Notation shall be made in the Officers Log Book at Main Jail and at Rio Cosumnes Correctional Center that the pill call nurse made rounds. Pill Call nurses on the p.m. shift at the MJ and RCCC will personally observe every inmate who is in a segregation cell and inquire into their well-being. The nurse will make this inquiry during pill call. Patients will be offered a health service KITE if they need medical services. If an emergency condition is identified, the nurse supervisor or physician will be notified.
There is a draft Operations Order pending revisions ad approval, titled, “Inmates with Disabilities ADA.” The draft order contains some language relative to compliance with ADA, assistive devices, assistance with daily living, orthopedic appliances, prosthetic devices, reasonable accommodations, identification of disabilities at intake, identifying disabilities subsequent to intake booking, auxiliary aids for hearing impaired inmates, identifying and handling of Armstrong class members, and other related procedures.
Observations
The Assessment Team observed numerous health care related activities between the two jails. There were numerous areas of concerns observed. Several activities of primary concern included the following:
 Lack of MH clinicians;  MH staff do not make routine rounds or monitor mentally disabled inmates
housed in Disciplinary Detention (DD), TSEP, and ADSEG units;  MH staff do not make routine rounds or monitor mentally disabled inmates
classified as OPP;  No group therapy for mentally disabled inmates (except those assigned to
the ROC program/evaluation);  Inmates claimed that 1-on-1 sessions are often very brief and inmates do
not feel as if they are getting any meaningful treatment or therapy from it;  The KITE response process for mental health requests is not expeditious
or within a reasonable timeframe;  Mentally disabled inmates on suicide precaution (“green suits”) are often
temporarily housed on deck floors, in recreation/classroom areas;  Social isolation and lack of out-of-cell time for mentally disabled inmates
(ADSEG, TSEP, DD, Inpatient, and OPP);  Lack of a MH step-down program/housing from ADSEG and TSEP to a
program with adequate out-of-cell program activities;
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 Lack of in-cell activities for mentally disabled inmates housed in ADSEG, TSEP, and DD, and Inpatient program;
 Lack of a classification/screening practice to divert mentally disabled inmates to other viable housing options which would be less restrictive or isolated;
 A lack of programming for mentally disabled inmates classified as OPP;  A lack of confidentiality for numerous JPS and medical
encounters/interviews;  Lack of confidentiality regarding custody staff handling inmate requests for
health care services (HS KITE system);  Inmates claimed delays and in some cases no follow-up regarding
requests for psychiatric services;  Inmates claimed delays in receiving medication from the time they were
booked;  Inmates claimed that medication they were prescribed and taking in the
community was often changed, which caused major side effects for them;  The KITE response process for medical requests is not expeditious or
within a reasonable timeframe;  Inmates claimed that they had to rely on other inmates in completing
requests for HS KITE’s as staff would not provide assistance;  Medical doctors are not issuing physical limitations chronos for inmates as
applicable.
The Assessment Team observed numerous CHS and JPS inmate interviews of mentally disabled and other disabled inmates. Areas observed included intake booking at the MJ, and interviews in many of the housing units at both jails, which included male and female inmates, all custody/classification levels, general population, Inpatient, OPP, TSEP, ADSEG, DD, medical housing, and the ROC program, etc.
A common theme was the lack of available office space to conduct the interviews in confidence. The Assessment Team observed JPS interviews taking place at cell doors, in common areas within housing units, e.g., recreation/classroom areas, dayroom areas, outside near the mail boxes and fish bowl (RCCC), and other areas. In most observed cases, there were other inmates sitting in the immediate area or within close proximity and waiting for pill-call or other activities, or inmates were within a reasonable hearing distance from the encounters.
The Assessment Team observed the intake booking JPS referral process. During the intake medical screening, nurses who believe (based on their medical assessment and other factors) that an inmate may be suicidal or possibly have other mental health concerns, refer the inmate to be evaluated by an on-staff Marriage and Family Therapist (MFT) or Licensed Clinical Social Worker (LCSW). Inmates who are deemed to be possibly suicidal or who may be a danger to self or others are placed in a temporary safety cell within the intake booking area pending the MH assessment. Pending the clinical assessment by the clinician
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
the inmate is placed on suicide precaution 15-minute checks. A LCSW or MFT conducts an assessment; this is typically done at the safety cell’s door or cell. Based on the clinician’s assessment, the inmate is either cleared for housing, or referred for a more in-depth clinical assessment by a psychiatrist. Based on the psychiatrist’s clinical assessment, the inmate is either cleared for housing (GP or OPP), or referred for inpatient housing. If the inmate is referred for inpatient housing in the MJ 2 West-P, the psychiatrist orders the continuation of the 15 minute rotating visual observation checks, until the inmate is transferred to the psychiatric unit (2/P) or cleared for GP/OPP housing. During the intake booking process, if an inmate is placed on suicide precaution status, the primary housing location is a MJ safety cell, located on the first floor. Other locations that are used are the recreation/classrooms in the housing unit decks for inmates who are already housed. The inmate-patients are provided with safety suits, “green suits.” Due to a lack of available beds in the inpatient psychiatric unit on 2/P, there are almost always inmates being housed in either a safety cell or the temporary holding areas (recreation/classrooms). Staff reported that there is normally a wait time of up to two or three weeks for bed availability in the inpatient psychiatric unit at the MJ 2/P. This concern will be addressed in more detail below. For inmates housed at RCCC who require placement on suicide precaution status due to MH concerns, these inmates are transported to the MJ, as there is no MH staff (psychiatrist) on duty during afterhours and no designated locations for these inmates to be temporarily housed at RCCC pending clinical evaluation. Once the inmates arrive at the MJ, they are placed in either a safety cell if available, or placed in the alternate locations (recreation/classrooms).
Aside from the obvious concern with the interviews conducted at cell-front, there is a lengthy wait list for available inpatient housing at the MJ 2P-housing unit due to the lack of insufficient number of beds in the psychiatric unit on 2/P.
Especially disturbing was the JPS interview process for psychiatric referrals. As will be discussed below, many inmates who were interviewed complained about this process. The Assessment Team observed several interviews at the cell doors inside the processing area of intake booking. The LCSWs and MFTs have access to and generally utilize a standard “Jail Psychiatric Services Clinical Assessment” worksheet during the interviews. However, during at least one interview, a JPS clinician admitted that the LCSWs and MFTs sometimes utilize their own forms/worksheets. Most surprising was that in at least 2 of the inmatepatient interviews observed, there was an assigned inmate worker (“trustee”) seated in a chair at his work site (just a few yards from the interviews) and could hear the dialogue between the clinician and inmate-patient. One of the inmatepatients arrived at the jail at approximately 0156 hours, and was seen by an LCSW at about 0830 hours, and claimed to be hearing voices. A second inmatepatient arrived at about 0300 hours, and was seen at about 0835 hours, was suicidal, and was unable to answer any questions from the LCSW, and was referred to a psychiatrist.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Although the Assessment Team did not specifically observe disabled inmates complete a medical request KITE and hand deliver to housing unit staff (to process through the health care services department), inmates claimed that they had to rely on other inmates to complete the medical request as staff would not provide them assistance. However, a few of the inmates also had voiced concerns with staff reading their HS KITE’s.
The Assessment Team observed that OPP inmates at the MJ and RCCC are not afforded any therapeutic programs. In contrast, inmates assigned to the RCCC ROC program receive access to the following programs; therapeutic movement, therapeutic recreation and legal knowledge, therapeutic recreation and communication, therapeutic recreation and coping, Jail Based Competency Treatment Program (JBCT) cinema, individual contacts, social skills, symptom management, substance abuse education, wellness, anger management, incentive store, and leisure activity. There is no individual or group therapy provided for OPP inmates or other mentally disabled inmates at the MJ and RCCC (with the exception of the ROC program). Several inmates also indicated to the assessment team that 1-on-1 sessions with JPS staff are often very brief and some of the inmates feel that there is no meaningful treatment/therapy provided during some of these encounters. Also, as cited in detail in the “Programs” section of this report, there is a major disparity with regard to yard and dayroom time allotted, versus that provided to ROC inmates, and also general population inmates. The OPP inmates widely do not receive outside yard time at all, and have limited dayroom (as outlined in detail in the “Programs” section).
The Assessment Team spoke to several staff assigned to MJ 2P (inpatient psychiatric housing), and observed the living conditions for mentally disabled inmates housed within the unit. The staff indicated that they are employed through the UCD system, and the 18 beds contained within the unit are LPS licensed beds. They confirmed that they do not conduct 1-on-1 suicide prevention contacts in that unit, and only provide the 15-minute checks. When asked about the suicide precaution inmates (“green suits”) housed in the MJ floor classrooms, they admitted that housing those inmates in classrooms without access to a toilet and other sanitary concerns is not within best operational practices. They acknowledged that housing them in cells with 15 minute checks would certainly be an improvement for their mental stability and overall living conditions. With regard to 2P, all of the inmates were locked in their assigned cells. The Assessment Team did not observe any interaction between staff and the inmates. At the time the Assessment Team was in the unit, there was not any dayroom, exercise yard, or other program activities taking place. Health care staff indicated that the deputy regularly assigned to the unit was on vacation and the position was left vacant and not filled during the duration of the vacation period (2 weeks). The JPS staff did state that if needed the deputies assigned to the medical area of the floor would provide custody/security coverage for the
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psychiatric unit. The dayroom area is very small with no equipment or built in apparatus or other features that would seem to suffice as real exercise or program activities. There is a small lounging area (e.g., couch) located in the dayroom. The lighting and mood of the unit seemed somewhat somber. When walking through the unit, it was noticeably quiet. During the 30 or so minutes spent in the unit, very few inmates appeared to be looking through their windows or appeared interested in any interactions taking place in the adjacent nurse’s office. Staff indicated that inmates receive access to the dayroom a couple of times each week, but no outside yard. Interestingly, one of the female inmates permanently housed across the hall in 2M (medical inpatient housing) indicated that she rarely gets dayroom, but when she does, she is forced to program in the 2P unit. She said that despite her need to get out of her cell, it is very depressing in 2P. She complained that the unit is always dirty, the inmates seem very distant and depressed, and there are no meaningful activities available there. She claimed that she rarely participates in dayroom anymore. She indicated that it is more depressing to go to 2P then to remain in her cell.
In general, MH clinicians and social workers do not make regular rounds to check on and interact with OPP and other mentally ill inmates housed in the OPP, TSEP, ADSEG and DD units. One of the major complaints the Assessment Team received from the inmates was the isolation and infrequent contact with social workers or other MH staff. Clinicians and social workers for JPS operate under the UCD Health systems Frequency of Services Scale (FOSS). The purpose of the scale is to provide a framework for follow-up care of patients that have been triaged by the JPS clinical staff. The service breakdown is as follows:
 Level I Follow-up / Daily by clinical staff;  Patients are those who meet criteria for Welfare and institutions (W&I) 5150 and are either on 2P, on the wait list for 2P, or are 2M suicidal;
 Level II Follow-up / At least once per month;  Patients that are discharged from 2P, cleared from 2M suicidal status, cleared from 2P wait list prior to admission, or in need of follow-up related to significant psychiatric history at this jail. Follow-up visit after discharge from 2P, or last clinical contact must be within one-month or sooner if clinically indicated;
 Level III Follow-up / Per MD, at least every 90-days;  Patients are open to JPS and receiving medication management services. Follow-up will be determined by JPS physician or clinician if not on medications. This follow-up will be no more than 90-days from MD contact;
 Level IV Initial Assessment with No Planned Follow-up;  Patients are assessed by a clinician and are not in need of additional JPS services at this time. These patients are advised to KITE for services as needed.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Patients may be assigned a different status or more frequent follow-up by the psychiatrist or clinician based on clinical evaluation.
Only inmates housed in the MJ 2 West P psychiatric unit have daily contact with MH staff. Inmates in OPP units are only required to be seen once per month and inmates on medication management are only required to be seen once every 90 days. Inmates interviewed stated that there are delays in receiving psychiatric services at both RCCC and the MJ.
Observing the high number of inmates on suicide precaution (green suits) throughout many of the decks at the MJ was both surprising and alarming. The inmates were housed in recreation/classrooms (just adjacent to the main lobby areas within the decks). More alarming was the manner with which they were housed, and the extended periods of time they remained in the same environment. The inmates are required to sleep on the floor, as there is no bed and only a mattress on the floor. There were serious concerns as inmates had the appearance of being on display for both inmates and staff from the wide-open view as the recreation/classrooms have large windows that run along the entire wall for staff observation. The inmates were isolated with no way to interact with staff or inmates. Some could view the circumstances as the inmates being on “display” for others observation. Due to the Assessment Team’s schedules, and the rotating to different areas of the two jails on various days, the team only saw individual inmates housed in these conditions for no more than a couple of days at a time. But many of the staff and inmates interviewed acknowledged that it is a major concern, and some inmates have been housed in those conditions for a week and even two weeks or more, although a few days at most seemed to be the average. The Assessment Team was informed by staff and inmates that inmates have had to defecate on the floors as there is no water or toilet in these rooms, and often the rooms are not clean or sanitary. The inmates have to rely on custody staff to give them access to the restrooms and water. Based on the staffing levels at times there is only one deputy assigned to the unit. The lone deputy must remain in the control room, therefore, if the inmate needs access to the restroom, the deputy must contact another deputy that will provide the inmate access to the restroom. The temporary housing areas do not have a bed, the inmates sleep on a mattress on the floor, there is no table, and therefore they are in essence forced to eat while seated on the floor. On each and every day the Assessment Team was at the MJ, the team observed inmates in these conditions. On numerous occasions there were multiple inmates (3 to 4) in “green suits” in a single recreation/classroom. Staff indicated that the inmates housed in the recreation/classrooms were awaiting placement into the inpatient psychiatric unit located on MJ 2 East 2/P due to a lack of available inpatient psychiatric beds.
It appeared that there was a lack of custody staff as a well as clinicians throughout both jails. Custody and mental health staff, as well as medical personnel corroborated this.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The Assessment Team also observed the medical clinic and pill call process at both the MJ and RCCC. Based on the medication being delivered to the units at the MJ, and the majority of mobility disabled inmates at RCCC housed in MHU and M-Dorm, the Assessment Team did not observe any issues relative to physical access to pill call or medical care.
Staff Interviews
The Assessment Team interviewed JPS staff assigned to both the MJ and RCCC.
The team initially observed an LCSW, conducting outpatient initial psychiatric interviews on 5W. He conducted the interview in the open dayroom area, near the staff control booth window. There were 2 inmates within several yards from the interview location. The 2 inmates were walking back and forth in the area. Upon the termination of the JPS interview, the Assessment Team interviewed the LCSW. He explained that after an inmate’s initial assessment, they see a psychiatrist every 4-10 weeks. The LCSW takes care of the initial assessment, and then the inmate can submit a HS KITE to be seen again by the LCSW. He admitted that he is not aware of any disabilities, unless he is alerted through the intake screening process via a JPS referral. He indicated that he would contact the Alta Regional Center and write a referral, if the inmate-patient is a past regional center client. In speaking with inmate-patients, he does his best to communicate, and looks for possible signs of suicide. He indicated that he would use written notes when trying to communicate with a deaf/hearing-impaired inmate.
With regard to suicide assessments, the LCSW indicated that the old safety-suit program (whereas inmates wore the “green suits” and were housed in the pods with non-mentally disabled inmates) was abolished 10-12 months earlier. When asked, he stated that nothing should preclude JPS staff from housing overflow psychiatric suicide precaution inmate-patients in a cell with regular observation. He cited a possible problem with that, in that there would be less visibility inside the cell. He acknowledged that the cameras assist with constant observation in the multi-purpose room area (where the “green suits” are often placed). When asked what concerns he has with the usage of the multi-purpose room for “green suits”, he cited there is a waitlist; it takes too long to get to the patients; and there is a need for more inpatient beds. He admitted that the practice of having “green suits” sleep on the floor is not feasible, and he has heard of cases where these inmates have defecated on the multi-purpose room floor. He admitted that JPS staffing levels are insufficient, and their workload is as busy at is has been since about 2009/2010. He said a by-product of the lack of staffing is that JPS staff do not get to talk with the patients as soon as they should, and they typically don’t get to the inmates until at least several days after the “KITE” is received. When asked, he acknowledged that JPS staff is not consulted to provide clinical input for the inmate disciplinary (write-up) process. The only time JPS is contacted by
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
custody staff is for psychiatric referrals, not discipline-related. He ended the interview by adding that isolation is not helpful to psychiatric patients.
JPS staff at RCCC stated that there are 2 clinicians and one supervising clinician assigned to RCCC. The frequency of MH contacts varies by individual inmatepatients MH needs after the initial MH assessment. The follow-up MH contacts are based on the FOSS. There is no group therapy provided for OPP inmates. One-on-one contact for OPP inmates is typically every 30 days. There are no MH programs available to inmates housed in the OPP unit at RCCC. If an inmate requests MH services by submitting a HS KITE, the timeframe for MH contact is about 2 weeks. Some of the MH (about 30 percent) contacts are conducted adjacent to the “fishbowl” on the Honor Facility.
The Assessment Team interviewed medical staff assigned to the MJ and RCCC jail facilities. In general, medical staff confirmed the practice regarding the HS KITE process. As the aforementioned policy states, inmates can obtain a HS KITE from either their housing deputy or a medical staff member. Again, there is a concern with the confidentiality aspect. The inmate must submit the signed HS KITE’s for medical, mental health, and dental requests, and this can be done during pill call, where the nurses can retrieve them either from the unit custody staff or directly from the inmates. Medical staff indicated that the HS KITE’s are triaged by a nurse (within 24 hours of receiving the KITE) and appointments are scheduled. A physician, nurse practitioner or registered nurse is responsible for conducting sick calls. Sick call is conducted on a regular weekly basis. Emergencies are handled on a case-by-case basis as appropriate.
The large majority of custody, mental health and medical staff cited a backlog in work or concerns with timely custody and health care responsiveness in large part due to staffing vacancies across all disciplines. They acknowledged that this ultimately adversely affects the health care process.
As mentioned above, the “green suits” being housed in the aforementioned recreation/classrooms on the various decks, create custody and health care concerns for staff.
Most of the staff interviewed were all well aware of the apparent disparity with regard to programming for the different classifications of inmates. Of most concern was the fact that the inmates in administrative segregation do not receive ample out-of-cell time or access to clinical staff, and that inmates assigned to the DD housing unit do not get outside exercise yard time for up to 30 days and do not receive dayroom or out-of-cell time. Even more concerning is that there have been reported cases of inmates being housed on DD status for a 30-day period, then released to general population (or non-specialized housing) for one day before being returned for a second stint in DD housing. Staff members were well aware that OPP inmates receive limited outdoor activities, limited dayroom, and no out-of-cell individual or group therapy at all.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Health care staff acknowledged that there is not a database or disability tracking system available to identify specific disabilities or accommodation needs for health care encounters. Health care staff use the E-Chart and Health Record systems, but with few exceptions, there is no electronic documentation as to some of the specific disabilities and accommodation needs, and health care staff are not commonly logging accommodations provided. Health care staff explained that they generally draw related disability and accommodation information from the initial medical intake screening, from the E-Chart and from progress notes. As stated throughout this report, the current medical intake screening process is not comprehensive. It lacks pertinent testing/evaluations and/or disability-related questions/screening, and the process that is used is not consistent amongst the health care staff.
Some of the housing unit staff interviewed stated that they would be willing to assist inmates in completing the HS KITE request for health care appointments; however, other staff stated that they would refer the inmate to a “houseman” or “trustee”, or to another inmate or trustee to assist the inmate in filling out the HS KITE. Many of the staff conveyed much of the same with regard to assisting inmates with a grievance (in the event an inmate wanted to grieve/appeal a health care or other issue), although staff were on average, a little more reluctant to assist with the grievance process.
Other staff interviews provided the following information:
 A JPS referral could be triggered by any of the following; gravely disabled (MH issues), suicidal, and an inmate who has recently been treated for a “5150.”;
 JPS staff admitted conducting psychiatric 1-on-1 sessions in main recreation/lobby areas within the MJ;
 A JPS clinician acknowledged that the recreation/classrooms where “green suits” are routinely housed on suicide precaution status are often not clean and contain trash and food on the floors, etc.;
 A JPS clinician assigned to RCCC, stated that OPP inmates must “KITE” for psychiatric services (or be referred by custody or other staff);
 A JPS clinician indicated that HS KITE’s are prioritized, with suicidal cases with the highest priority;
 A JPS clinician mentioned that there is no case management, just KITE services;
 JPS clinicians admitted that there are no group services for OPP inmates;  A JPS clinician stated that 1-on-1 interviews must either be via an inmate
HS KITE request or staff referral;  A JPS clinician (when asked) admitted that there is no evaluation for
intellectual disabilities;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 JPS clinicians who were interviewed acknowledged getting calls from Alta Regional Center, but are not aware of any lists or rosters of previous clients;
 JPS clinicians acknowledged conducting welfare checks and chart reviews for inmates identified as past Alta Regional Center consumers;
 A JPS clinician indicated that custody staff determine where prior regional center consumers are housed;
 One of the RCCC JPS clinicians indicated a shortage of staffing at RCCC, and that there are only 2 LCSWs and 1 (or sometimes 2) psychiatrists assigned to RCCC;
 Although doctors appropriately determine which inmates remain in 2E medical housing, and who is removed, medical staff admitted that custody staff sometimes provide input to medical staff;
 When a nurse was asked about encountering an inmate who does not appear to understand, the nurse explained that they would rehouse the inmate to the MJ second floor so that the inmate can be more closely monitored, e.g., MH, Alzheimer’s, dementia, and previous regional center consumer;
 An RCCC nurse indicated that ICE inmates have an extra form and more detailed process for medical assessments that are required, and that the medical screening process for non-ICE inmates should be as thorough and comprehensive as that of the ICE medical screening process;  ICE inmates are only housed at RCCC (male only);
 An RCCC nurse indicated that only ICE inmates can obtain an outside Optometrist appointment; and
 A deputy assigned to RCCC CBF indicated that the unit houses ROC, OPP, GP, TSEP, DD, and ICE inmates. With regard to staffing, he claimed that JPS staff are sometimes overwhelmed when custody staff have to call on them, and deputies need quicker response time from the JPS staff during MH crisis situations. He believes there needs to be more JPS clinicians hired, and also cited a shortage of custody staff.
Inmate Interviews
The Assessment Team also interviewed disabled inmates with various disabilities. Based on these interviews, the inmates claimed they have difficulty accessing health care. Listed below are the specific examples provided during the inmate interviews:
 MJ inmate: The inmate is a permanent wheelchair user, and claims that he has ulcers/sores in his buttocks area. The inmate claims he requires, and has had two separate blow-up cushions to lay on, but they both busted, and he has not received anything since that time. This inmate is a very large-framed individual;
 MJ inmate: The inmate is a permanent wheelchair user, and at the time of the interview, he had been at the jail for several months. He showed the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Assessment Team that his right side foot peg/rest to his wheelchair is missing, and he claims it has been missing since the SCSD detention facilities issued him the wheelchair. He indicated he has requested (in writing) a new right foot peg/rest. He claimed that he initially arrived at the jail with an electric wheelchair, but he was issued the county wheelchair instead, and his wheelchair was confiscated;  MJ inmate: This inmate is paraplegic and a permanent wheelchair user, and claims to have a vision impairment. He claims he has made numerous attempts to utilize a trapeze device that he claims is available in the second floor medical area. He also stated that staff broke his wheelchair, when they “jammed” his wheelchair into the lift of a wheelchair accessible van. The wheelchair has not been replaced or repaired;  MJ inmate: This inmate is a permanent wheelchair user, and has had cerebral palsy his entire life. He claims that the medical department is inconsistent with issuance of his “Carnation” milk;  MJ Inmate: This inmate is a permanent wheelchair user, and has a prosthetic right leg, and his right arm is not functional. He claims that he showers in the unit (second floor) only once per week. He claims a nurse had told him that she would assist him in showering twice per week, but after he filed a grievance, he no longer received any help. He further claimed that he filed a second grievance that he was not receiving assistance with his daily living activities (specifically with showering), and then he began getting assistance with showering once per week. He claimed that a health care manager recently indicated in a grievance response that he would not be receiving any assistance. He also indicated that he has been using the shower in 2M, and still needs assistance, but he is no longer falling from shower chairs, as he was doing before he began showering in 2M;  MJ inmate: This inmate is a permanent wheelchair user, and suffers from mental illness and depression. He claims that most medical staff are very good, but pointed out that on one occasion he had to lie in his own waste for about 2 hours, and he has had 3 or 4 similar encounters. He said the problems usually occur during the nurse shift change at 7 PM, and the problems or lack of treatment are usually between 7 PM – 10 PM. He claims that despite having been housed at the MJ for nearly a year (at the time of the interview), and despite being prescribed and taking antidepression medications nightly, he has only seen a psychiatrist on two occasions (and 1 of those times was on his initial arrival date, and the other time was after they had discontinued his medications, which have been restored). He also claimed there are no regular MH interviews with MH staff. He complained that his wheelchair needs to be adjusted. Specifically, the back of the wheelchair and foot peg/rest need to be adjusted, and his feet are “dangling.” His right foot is 100 percent nonfunctional, so he can’t put his right foot on the peg/rest. The foot peg/rest
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
needs to be adjusted to protrude slightly outward so that both feet can rest on it (the wheelchair is designed to have only one long foot peg/rest for both feet). The current adjustment of the wheelchair back and foot peg/rest causes him pain and discomfort. Finally, the inmate reported that many inmates housed in the second floor medical area feel uncomfortable going to staff for any assistance;  MJ Inmate: This inmate is a dialysis patient and diabetic. The inmate claims that PM nurses sometimes sleep, and at times the emergency call button is turned off or ignored. She claims to have missed a couple of dialysis appointments in the past, and due to complications between the dialysis and diabetes, she was taken to the UCD Medical Center, and spent about 10 days in the hospital;  RCCC SLF Inmate: This inmate is incontinent and requires and is prescribed diapers. The inmate claims that medical staff only provide her 3 diapers per week. She stated that she needs 5-6 diapers per day. She stated that because she is not provided the diapers she has to resort to using sanitary napkins to absorb her bodily fluids (urine). She further stated that inmates in her dorm complain about the smell when she soils herself because she was not provided the diapers. When the Assessment Team member inquired of medical staff assigned to the facility about the inmate’s diapers, the medical staff assigned to the unit was unaware of the inmate being prescribed diapers. When the medical staff queried the inmate’s medical record, it was noted that the inmate is prescribed 6 diapers daily;  MJ 8W Inmate: This inmate is on DD status (for past 20 days), and is a mentally disabled inmate. He claimed that JPS staff interviewed him about his psychiatric medications, but the interview was conducted at the cell door, and was not confidential. He also claimed that he does not receive any group therapy;  MJ 8W Inmate: This inmate is on TSEP status, and is a mentally disabled inmate. He complained that mental health and medical staff conduct interviews at cell doors (all units). He also indicated that inmates with mental health issues have more difficulty and are not treated fairly by staff. He cited an incident regarding an mentally disabled inmate receiving instructions to “lock-up” was having trouble understanding, and spoke about how staff became angry and did not try to establish any communications or patience. He also stated that “green suits” will also be in the TSEP/ADSEG unit about 30-40 percent of the time, with 4-5 days being the longest duration, but 1-3 days each as more typical;  MJ 2/P Inmate: This inmate is a psychiatric inpatient inmate. He said that he asked staff about dental, but staff told him dental is only for emergencies, so he never filled out a HS KITE for dental. He said he has never seen a psychiatrist, and there is no group therapy. He also stated that he was on suicide precaution status “green suit” for about 4 days on
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
the 7th floor. He had to urinate on the classroom floor in the corner of the classroom. He said that staff were not checking on him. A psychiatric staff member came walked by the classroom on a couple of occasions briefly, only to tell him that they were trying to get him rehoused;  RCCC CBF Inmate: This inmate is mentally disabled, and is in the ROC program. He acknowledged that there are numerous programs available, but he complained that social workers talk to him by using “big words”, and he often does not understand them;  RCCC JKF Inmate: This inmate is mentally disabled and has a speech disability. He complained that there is no interaction with social workers at all, and a named staff member teases him regarding his speech impediment. He also complained that there is not any group therapy offered;  MJ 3E Inmate: This inmate is mentally disabled (currently OPP). He claimed that while on suicide watch status, and housed in a “rubber room”, there was feces, urine, and bloodstains on the floor in the cell, which ultimately caused an infection in his left foot. He claims that his medical records corroborate this. He also stated that psychiatric staff interview him in the main recreation area in front of other inmates;  MJ 4E Inmate: This inmate is mentally disabled. He indicated that “green suits” are often housed in the multi-purpose/classroom area within the floor/unit, and he has observed these inmates defecate on the floor. He also cited the lack of confidentiality concerning psychiatric interviews;  MJ 3E Inmate: This inmate is mentally disabled. He claims that despite being on psychotropic medications, a psychiatrist had not been in to see him in the approximate 90 days of his incarceration at the detention facility, and added that medical staff often do not respond to HS KITE’s;  MJ 4E Inmate: This inmate is mentally disabled and currently takes psychotropic medications. He claims that although a psychiatrist used to see him monthly, he has not seen a psychiatrist in about 2 months;  MJ 3E Inmate: This inmate is mentally disabled (currently on OPP status), and claims he was on a suicide precaution (“green suit”) status recently. He complained that he felt as if he had been on display while housed on one of the floor classrooms. He said that staff do not help them, they (OPP inmates) do not feel safe, and inmates on such status must sometimes kick their windows out to get any response from staff. He stated that psychiatrists only check on them for their medications “from a distance”, but not in person;  MJ 3E Inmate: This inmate is mentally disabled (currently on OPP status), and claims he has submitted about 8 HS KITE’s for psychiatric services, but was only seen about 3 times.
Other than the inmates housed at RCCC who are in the ROC program almost every inmate interviewed at the MJ and RCCC indicated that there is no group therapy, and several inmates had concerns with what they deemed as
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
sometimes brief 1-on-1 JPS interviews. When the Assessment Team asked (inmates with known or admitted mental illness) whether they would want to participate in group therapy, most all of the inmates affirmed that they would.
Inmates were well aware of and complained about the lack of confidentiality for medical and mental health encounters, and most had some concerns with their interviews taking place in common areas or at cell doors.
The assessment team also interviewed at least one inmate with mental illness who claimed that a few months earlier he was housed on suicide precaution status (“green suit”), and was housed on one of the deck floors. He claimed that the conditions were dirty and unhealthy, and he felt isolated.
Overall general inmate comments included:
Mental Health:
 Was not aware of the HS KITE process for health care requests;  JPS HS KITE requests go unanswered;  They won’t see us” unless we fill out a HS KITE, but we get charged a co-
pay;  “LCSW only sees me if I submit a HS KITE”;  Social workers answer HS KITE’s, but they will not see us in person;  Sometimes unable to see a social worker;  MH visits/appointments are too infrequent.  No confidentiality with JPS interviews (health care staff talk with inmates
at cell doors, inside pods, inside rec/dayroom areas with inmates in the areas, outside by the mailbox in the RCCC fishbowl area);  No group therapy offered;  Individual 1-on-1 interviews were sometimes to brief;  “Was having psychiatric problems and dreams about my deceased son, but it took about 3-4 HS KITE’s to be submitted before psych staff saw me”;  Psych visits are sometimes as brief as only 15-30 seconds at the fishbowl;  Have not seen a psychiatrist about prescribed psychiatric medications;  OPP inmates not receiving out-of-cell programs;  Regularly see “green suits” on floor classrooms;  Don’t understand the social workers or other staff;
Medical:
 No confidentiality (health care staff talk with inmates at cell doors, inside pods, inside rec/dayroom areas with inmates in the areas, outside by the mailbox in the RCCC fishbowl area); and
 Was not aware of the HS KITE process for health care requests;
Dental:
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 Dental not responding to HS KITE’s;  Was not aware of the HS KITE process for health care requests;
Conclusion
There are significant flaws in the processes as well as apparent discrimination with regard to equitable programming for MH inpatient and OPP inmates, as well as inmates with disabilities that are housed in medical housing or who are assigned to other units. To ensure nondiscrimination under the ADA, the SCSD detention facilities must ensure that disabled inmates are not subjected to discrimination and they receive equal access to health care services.
Although health care and custody staff should be commended for the hard work they perform, there were alarming observations by the assessment team, and obvious space, access, and accommodation concerns noted, as well as numerous complaints relative to a real or perceived lack of adequate staffing resources, to which (according to numerous staff members) can and has effected access to health care.
The SCSD must ensure nondiscrimination and equal access, and must ensure the following:
Staff must ensure disabled inmates are equally afforded the ability to access medical, dental and mental health services. Reasonable accommodations must also be provided as necessary;
 Operational Orders and CHS policies must be modified as appropriate;  Confidentiality during medical and JPS inmate encounters;  Confidentiality regarding staff handling of inmate health care requests (HS
KITE's);  Unless the policy and practice is modified, and staff are expected to
assist to write/scribe/explain documents and processes to inmates, including HS KITE’s, staff must ensure the inmates receives assistance from an appropriate staff member;  Group therapy for all mentally disabled inmates (not just inmates assigned to the ROC program/evaluation);  Adequate individual therapy (1-on-1 sessions) for mentally ill inmates (not just inmates assigned to the ROC program/evaluation);  JPS staff must make routine rounds/check for mentally disabled inmates classified as OPP;  The current UCD FOSS scale of services frequencies that JPS staff must be evaluated;  Cease temporarily housing “green suit” inmates who are on suicide precaution in the classroom areas on the MJ decks/floors;  Adequate JPS staffing resources;  JPS staff must make routine rounds and monitor mentally disabled inmates housed in DD, TSEP, and ADSEG units;
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 JPS staff must make routine rounds and monitor mentally disabled inmates classified as OPP;
 The HS KITE response process for mental health and medical requests must be expeditious or within a reasonable timeframe;
 There should be a classification/screening practice to divert mentally disabled inmates to other viable housing options which would be less restrictive or isolated;
 There must not be unnecessary delays or follow-up regarding requests for psychiatric services;
 The intake medical screening and subsequent diagnostic or medical follow-up process (as applicable) must properly identify disabled inmates or determine whether a qualified inmate has an impairment that requires a reasonable accommodation;
 Staff must provide appropriate medical care accommodations for disabled inmates;
 For example, mobility impaired permanent wheelchair users, particularly those housed at the MJ, on the second floor medical unit. As stated above, some of the issues included; assistance with daily living (showers, bodily fluids), wheelchairs with missing foot peg/rest, wheelchairs in need of adjustment, and use of trapeze device, etc.;
 Inmate orientation must be provided and include detailed instructions on how disabled inmates can access medical, dental, and mental health care;
 As outlined in the training section of this report, staff must receive training regarding ADA Title II, and inmates with disabilities.
References
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service; (ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
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28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; 28 CFR 35.130(b)(7) A public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Clark v. California amended March 1, 2002, mandates the following:
Medical Care
Inmate with developmental disabilities must have access to necessary medical, psychiatric, and dental care in accordance with CCR Title 15, starting at Section 3350.
The assigned correctional officer, CC-I, and medical staff at designated DDP institutions will be responsible for assisting DDP inmates in obtaining emergency and routine health care. Assistance may include;
 Assistance with completion of sick call requests, including assistance with requesting and obtaining new prescription refills;
 Prompt/escorts to medical appointments;
 Referral to medical staff if the inmate appears to have symptoms that may require medical care; and
 Medical staff must be trained to communicate with developmentally disabled individuals and to gather information necessary to provide medical/psychiatric/dental services.
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Case 2:18-cv-02081S-HTELRINFF-’KS DJENPARDTMocENuTmCeOnUtN1TY-5OF SFAiCleRdAM0E7N/3TO1/C1O8RREPCTaIOgNeA9L9SEoRVf I4C8ES8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Rasho v. Walker, 07-CV-1298 (C.D. Ill.)   Class action litigation has been successful at reducing number of hours inmates with mental illness spend in isolation.
Allegations raised in class complaint (filed in 2007)
 Lack of adequate treatment;  Space for individual or group therapy;    Lack of private areas for treatment;    Trained and licensed personnel;    Hospital level of care;  
 Unmonitored use of psychotropic medication;    Punitive approach to mental illness;  Physical restraints;  Crisis cells;  Use of fines and segregation; and    Physical and verbal abuse by guards;  
Case settled in 2015
 Hospital for prisoners who need inpatient services;    Significantly increased staff, including more than 300 new clinical  staff
and 400 new security staff;  Construction of four new residential treatment units;    Drastic improvement of treatment systems; and    Significant reduction of solitary confinement.    www.clearinghouse.net/detail.php?id=12369  
The information below is provided for reference only. This information is provided by recognized expert Bruce C. Gage, M.D. Mr. Gage is an expert in general and forensic psychiatry, and has treated thousands of patients with behavioral disorders. He recently completed a gap analysis of mental health services for a large county’s detention facilities which is comparable to the Sacramento County detention facilities, with regard to size, structure, and detention facility sites, as well as the populations of the inmates and staff work force.
Treatment
The most important populations to treat are those with severe illness and those who represent a danger to self or others by virtue of their mental illness. While crisis response is an important first step, it is only a first step, just as is the case in the treatment of any medical condition. Continued care is necessary.
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
In order to provide appropriate care, good assessment in all cases is an indispensable first step. There must be sufficient resource and access to allow for a thorough assessment prior to initiation of treatment, absent an emergency (and then assessment must ensue).
For those with psychotic disorders, highly structured activities and treatment and avoidance of isolation while also limiting stimulation are the key elements in addition to medication. These patients cannot organize themselves and readily fall more deeply into their psychotic thinking when isolated and become more agitated or disorganized when over stimulated. Psychosis itself is a destructive condition that must be alleviated. Such treatment does not seek deep psychological insight but to reduce symptoms, develop self-management skills (e.g. symptom and emotion management), develop capacities to interact sufficiently to get needs met and limit conflict, provide education about mental illness and medications, and expand living skills (activities of daily living, self-care, accessing jail and community services, etc.). It is reasonable for the jail to focus these services on those aspects most relevant to correctional interests: reducing recidivism and jail misbehavior, successful reentry (in that it contributes to reduced recidivism and inmate mortality), treatment adherence (in that it improves all outcomes), and coping with the jail environment. These are not highly technical interventions and do not take extensive resources; most can be done by master’s clinicians (social workers, psychologists) or others with special training (recreational therapists, occupational therapists, and bachelor’s level staff with appropriate training, experience, and supervision). They are most efficiently delivered in group settings. This necessitates having adequate staff to provide the treatment and to move the inmates as well as policies and procedures to support such activities.
Those with serious mood disorders often need much of the preceding. Those with depression may also require some individual or group treatment focused specifically on depression. There are many “off the shelf” short-term group and individual treatment modules that are readily run in correctional settings. Many of these employ cognitive behavioral therapy but other methods are also effective.
Those with recurrent and severe self-injurious behavior require different approaches. It is essential to be able to develop and implement behavior management plans to decrease the inadvertent reinforcement of such behavior that occurs in the correctional setting. One of the most common dynamics is that when the system is crisis-driven, crises are reinforced, as they are the only sure way to get both correctional and clinical staff to respond. Developing plans to limit this dynamic is important and can be expanded to other populations exhibiting acting out behavior as well. This population also needs interventions focused on self-management rather than the development of insight or addressing psychological traumas, which is beyond the reasonable scope of
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
what a correctional setting can be expected to offer. There are simple and low cost “off the shelf” treatments for this population suited to the correctional setting.
In order to provide such treatment, which will almost exclusively occur in residential mental health settings, requires about 10 hours of structured activities per week. This can consist of both treatment and other structured activities such as educational services or other correctional programs. It is also necessary for this population to have 10 hours of unstructured out-of-cell time, with others as much as possible, to limit the deleterious effects of isolation and inactivity. Such activities also provide the data for determination of readiness to step down to a lower acuity/security setting.
Restrictive Housing
Those admitted to restrictive housing need to be promptly screened. It is reasonable for nursing staff to conduct the initial screening of those admitted to restrictive housing in order to identify a possible emergency but mental health staff should screen new arrivals by the next working day. Mental health should also do at least weekly rounds in restrictive settings. At a minimum, those identified as suicidal must be appropriately treated and managed and those needing commitment identified and admitted to 8A. Others may be treated in place but consideration for diversion to mental health SMU is something the County should consider in cases involving the SMI. It is especially important to consider this when those with mental illness are deteriorating in this isolated setting prior to becoming so ill that they must be committed. Once the jail staff become aware of their deteriorating condition, a meaningful response of some sort is obligatory.
Medication Monitoring
Psychiatrists must be expected to adhere to the standard of care for medication monitoring. While I saw evidence of some monitoring, there was a clear pattern of failure to adequately monitor those prescribed antipsychotics. Drug levels and labs for mood stabilizers, baseline studies prior to initiating treatment, EKGs for certain medications, etc. need to be done routinely.
Medication administration
Medication administration by nursing staff needs to be standardized and done per community standards. This must include appropriate identification checks. Further, mouth checks for the purpose of establishing adherence should be done by clinical staff, as this is a clinical function. The custody function is subserved by the cell searches detailed above; custody can also perform mouth checks for safety and security reasons.
Confidentiality
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Provide for confidentiality in all settings to the maximum degree possible. All

written documents including personal health information should be processed by

health care staff, including administrative staff (sealed or otherwise protected

materials can be handled by any staff, e.g., for the purposes of transport) or

custody staff who are bound by the same confidentiality strictures. Patient-

clinician encounters should be confidential to the maximum extent possible,

absent an identified (not potential) risk. It is reasonable and desirable for officers

to be able to observe intake screenings but the content of the conversation

should remain confidential. In the case of grievances, they should be marked as

medical or mental health and should be so directed and not reviewed by any

custody

staff.

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Access to Out-of-cell Time (Outside Recreation/Dayroom)
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to inmate access to out-of-cell time (outside recreation/dayroom), are in: Operations Order 06/10 Recreation, Exercise, and Showering; Draft Operations Order Inmates with Disabilities - ADA, and 1123 Exercising.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1065 Exercise and Recreation, requires that,
(a) The facility administrator of a Type II or III facility shall develop written policies and procedures for an exercise and recreation program, in an area designed for recreation, which will allow a minimum of three hours of exercise distributed over a period of seven days. Such regulations as are reasonable and necessary to protect the facility’s security and the inmates’ welfare shall be included in such a program. In Type IV facilities, such a program can be either in-house or provided through access to the community.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, defines exercise as follows:
“Exercise” means physical exertion of large muscle groups.
Per Operations Order 06/10, Recreation, Exercise, and Showering, all inmates shall receive an exercise program in an area designed for recreation (indoor/outdoor) which will allow a minimum of three (3) hours of exercise distributed over a period of seven (7) days to benefit social, physical and emotional health. All inmates will be allowed to shower upon assignment to a housing unit and at least every other day or more often if possible.
All inmates, regardless of classification or intake housing unit status, shall be given the opportunity for a minimum of three (3) hours of exercise and recreation in a seven (7) day period in an area designed for recreation. The exercise and recreation may be allotted through combined indoor and outdoor recreation periods. Title 15 mandates a minimum of three hours of recreation in seven days; however, the maximum amount of recreation time a housing unit can offer without negatively impacting floor operations should be implemented.
Civil detainees, including Sexually Violent Predator Act (SVPA) detainees, will be allowed more access to recreation, dayroom, showers and telephones than offered to general population inmates, without negatively impacting the safe and efficient operations of the facility. All additional access for civil detainees shall be documented in the unit logbook.
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Recreation activities typically will not take place during scheduled or unscheduled lockdowns without supervisor approval. All or part of any recreation and its privileges may be restricted as part of a prescribed punishment determined by a disciplinary proceeding.
Recreation staff develops and distributes recreation schedules to each housing unit. These schedules are ever changing and therefore specific recreation times are not included in the order. Housing unit staff shall make every attempt to follow the schedule.
Recreation staff is responsible for developing, implementing, and supervising a comprehensive recreation program at both facilities. Recreation staff shall monitor any activity, which involves competing for prizes.
Housing unit staff shall log in the logbook the start and end times, any refusals, the type of recreation (indoor/outdoor), and inmate classification if multiple classifications of inmates are housed in a housing unit. Inmates classified, as TSEP shall be given indoor/outdoor recreation alone without any other class of inmate. Inmates classified as ADSEG, PC, GP, or Civil shall be given indoor/outdoor recreation only with inmates within the same classification. Exceptions may exist when inmates or groups of inmates within a classification are unable to recreate together. Inmates on discipline status shall not be scheduled for minimum recreation requirements unless stated in the disciplinary hearing or specified by medical staff.
Indoor and/or outdoor recreation at the MJ and in security housing areas at RCCC may be run between the hours of 0800-2300 hours. Lockdown occurs at 2300 hours each night and no out-of-cell recreation will occur without supervisor approval.
At RCCC, the honor facility and SLF have outdoor recreation “yards” that have minimum lighting. Due to the security and safety issues that may arise, outdoor recreation at these facilities is limited to daylight hours only.
Inmates are to remain inside the prescribed boundaries of the recreation areas, whether indoors or outdoors. Inmates are not allowed to communicate with inmates in other pods/housing units/barracks or with persons outside the facility. Exceptions exist for inmates to communicate by telephone or mail to persons outside the facility.
Housing units that share a recreation area shall coordinate with each other for use of the recreation area. Priority for the use of the recreation area during open periods will be given to inmates who have not yet had the minimum required recreation time. In cell-style housing units, it may be reasonable for housing unit staff to periodically allow inmates access to their cells; however inmates are not allowed into one another’s cell.
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
In cell style housing units, only one (1) pod tier at a time will be allowed to recreate together within their pod. Pods are not allowed to intermingle. All tiers are allowed equal amounts of dayroom time separately.
At the MJ, inmates housed on the inmate worker floor may be allowed to recreate together within their assigned pod.
Only minimum-security inmates at RCCC may be allowed to participate in sporting activities on the athletic fields.
Per Draft Operations Order Inmates with Disabilities - ADA, all inmates shall receive exercise in an area designed for recreation (indoor/outdoor) which will allow for a minimum amount of required exercise distributed over a period of seven (7) days to benefit social, physical and emotional health following Operations Order 6/10, Recreation, Exercise, and Showering.
Per Policy 1123, Exercising, it is policy that each inmate be allowed a minimum of seven (7) hours per week of exercise involving large muscle activity, away from the cell, on a planned, supervised basis.
Examples of large muscle activity include walking, jogging in place, basketball, Ping-Pong, and isometrics. The dayroom adjacent to the cell may be used for this purpose. The dayroom satisfies compliance. Program activities are directly supervised by staff and/or trained volunteers. Television and table games do not satisfy compliance. The use of outside yards, gymnasiums, and multi-purpose rooms for exercising opportunities (i.e. basketball, handball, jogging, running and calisthenics) satisfies compliance, even though the inmate may not take advantage of them.
The Assessment Team reviewed an Inter-Departmental Correspondence dated December 29, 2015, which states,
“As many of you have heard, changes to our current recreation design are underway. We are implementing a “30/60/90” schedule for both dayroom and outdoor recreation. This entails 30 minutes of recreation for High classified inmates, 60 for Medium, and 90 for Low, once per shift, as minimums. Outdoor recreation will be offered according to the outdoor recreation schedule posted on each floor and will count towards overall outof-cell time for that shift.
Increasing out-of-cell time for inmates at the MJ is a primary goal and the above times should be considered minimums. In general, the maximum amount of recreation a housing unit can offer without negatively impacting floor operations should be implemented (Operations Order 6/10).
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
If your floor completes all minimum recreation programming for the day and you are able to offer more, time should be given to Low and Medium classifications. High-classified inmates will be held to 30 minutes per shift for dayroom and 30 minutes per outdoor rec session to create an incentive to move to a lower classification.
 Floor 2: Dayroom: Offered once per shift with minimum goal of 30/60/90 based on classification.
Outdoor Recreation: Offered 3 times a week per outdoor rec schedule with minimum goal of 30/60/90 based on classification.
2P/2M dayroom and outdoor rec will be offered to those inmates who are deemed fit by Psych/Medical staff. If dayroom/outdoor rec is not afforded to inmates in this area a log book entry will be made indicating the reason. 2E dayroom and outdoor rec will be run by our Rec Tech staff in conjunction with the 2E Officer based on the outdoor recreation schedule.
 Floors 3-6: Dayroom: Offered once per shift with minimum goal of 30/60/90 based on classification.
Outdoor Recreation: Offered 3 times a week per outdoor rec schedule with minimum goal of 30/60/90 based on classification.
Late Night: Low and Medium classified inmates are eligible for “Late Night” dayroom or outdoor recreation as a reward for good behavior.
 Floors 7-8: Dayroom: Offered once per shift with minimum goal of 30/60/90 based on classification.
Outdoor Recreation: Offered 3 times a week per outdoor rec schedule with minimum goal of 30/60/90 based on classification.
All inmates who have not been classed will be treated as a High classified inmate for the purposes of recreation.
Due to the high number of TSEP, ADSEG, and other classifications, Indoor/Outdoor recreation times will be afforded 24 hours a day. It will be the floor officers’ responsibility to ensure that inmates are allowed out during daytime and nighttime hours. When possible, attempts should be
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
made to have small groups or individuals out for outdoor rec during late hours due to noise issues and the surrounding buildings.”
The Operation Orders do not contain language or references regarding reasonable accommodations or modifications such as specifically fitted equipment on the exercise yards or sundecks. Many of the yards throughout the facilities contain exercise equipment such as dip bars and pull-up bars.
Observations
The Assessment Team toured the MJ and RCCC and noted that there are 3 outdoor recreation yards at the MJ. Floors 2, 3 and 4, share a yard, floors 5 and 6 share a yard and floors 7 and 8 share a yard. The inmates housed on floors 3, 5 and 7 must ambulate a flight of stairs to access the yard and the inmates housed on floors 4, 6 and 7 must ambulate up a flight of stairs to access the yard. There is elevator access to each of the yards through the mezzanine level. At RCCC the pods in JKF (Joseph Kievernagel Facility), KBF (Kevin Blount Facility), SBF and CBF each share their own recreation yard that is shared by all 6 pods in each building. At the RCCC SLF all 4 housing units (Ramona, Kinya and Golden Poppy, Camilla) have their own individual yard. For the barracks at RCCC, barracks J, K, A, and B all have an individual yard, barracks C, D, G and H have mini yards adjacent to the barracks, barrack M does not have a yard, however, this barrack has a patio and grass area adjacent to the barrack that is used as a yard, the MHU has an individual yard. At the RCCC honor facility, there is a large recreation yard that provides recreation services for inmates housed there (barracks B, C, D, G, H, and M).
At the MJ, inmates have access to the dayrooms in the unit pods. There is no dayroom in the medical unit at MJ 2 West. There is a dayroom in the MJ 2 West Psych unit. At RCCC’s higher security units with celled housing (SBF and CBF), inmates have access to the dayrooms. The pods in units JKF and KBF are dorm housing and inmates have open access to the dayroom most of the day with the exception of lights out and count. The housing units at the SLF at RCCC with the exception of Ramona are dorm housing and inmates have open access to the dayrooms most of the day with the exception of lights out and count. There is no dayroom for the RCCC inmates housed in Ramona. All barracks at RCCC are dorm housing and inmates have open access to the dayroom most of the day with the exception of lights out and count. The MHU at RCCC is an open dormhousing unit with the exception of 6 cells. The inmates in the open dorm have access to the dayroom most of the day with the exception of lights out and count. The inmates housed in the celled housing in MHU do not have access to the dayroom.
At the MJ the goal for dayroom is to offer dayroom once per shift with a minimum goal of 30/60/90 based on classification. There is no schedule for dayroom use at the MJ. At RCCC for all barracks, JKF, KBF and SLF housing units with the
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L0S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

exception of Ramona, inmates have access to dayroom most of the day and evening as these housing units are dorm type units with an open dayroom. The RCCC staff provided the dayroom schedules for the CBF (Christopher Boone Facility) and SBF units. The schedules are detailed below:

SBF Indoor Recreation Schedule

All GP/PC tiers will be offered indoor recreation 3 times daily. Indoor recreation will be a minimum of 1 hour in length. All ICE detainees and TSEP will be offered indoor recreation daily. Indoor recreation shall be a minimum of 1 hour in length. TSEP indoor recreation should be alternated to vary start times across the population. Reasonable efforts should be made to allow inmates who have participated in outdoor recreation to shower before lockdown. GP/PC Indoor Recreation Hours are 0800-2300. TSEP Indoor Recreation Hours are 0700-2400.

Sunday-Saturday

200-600 Pod 200-600 Pod 200-600 Pod 200-600 Pod 200-600 Pod 200-600 Pod
Sunday-Saturday

Lower Tiers Upper Tiers Lower Tiers Upper Tiers Lower Tiers Upper Tiers

Days AM Days AM Days PM Days PM Nights PM Nights PM

100 Pod 100 Pod

County TSEP ICE TSEP

CBF Indoor Recreation Schedule

All Day All Day

All GP/PC/Psych tiers will be offered indoor recreation 3 times daily. Indoor recreation will be a minimum of 1 hour in length. All ROC tiers shall be offered indoor recreation nightly and over the weekend by custody staff. ROC inmates will receive additional indoor recreation during weekday program hours. Indoor recreation shall be a minimum of 1 hour in length. Reasonable efforts should be made to allow inmates who have participated in outdoor recreation to shower before lockdown. Indoor Recreation Hours are 0800-2300.

Sunday-Saturday

200-500 Pod 200-500 Pod 200-500 Pod 200-500 Pod 200-600 Pod 200-600 Pod

Lower Tiers Upper Tiers Lower Tiers Upper Tiers Lower Tiers Upper Tiers

Day Shift - AM Day Shift - AM Day Shift - PM Day Shift - PM Night Shift - PM Night Shift - PM

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

The SCSD detention facilities provided the outdoor recreation schedules for the MJ and RCCC (Security Housing) recreation yards. The schedules are listed below:
MJ Floors 2, 3, and 4 (1st Week of Pay Period)

2 East P

Monday 1400-1700

Wednesday 1400-1700

Friday

1400- 1700

3 East

Monday 0700-1400 Wednesday 1700-2400 Thursday 1100-1500 Saturday 0700-1500

Make-up

3 West

Sunday Tuesday Thursday Friday

0700-1500 1500-2300 0700-1100 0700-1400

Make-up

4 East

Monday 1700-2400 Wednesday 0700-1400 Thursday 1900-2300 Saturday 1500-0200

Make-up

MJ Floors 2, 3, and 4 (2nd Week of Pay Period)

2 East P

Monday 1400-1700

Wednesday 1400-1700

Friday

1400- 1700

3 East

Monday 0700-1400 Wednesday 1700-2400 Thursday 1100-1500 Saturday 1500-0200

Make-up

3 West

Sunday Tuesday Thursday Friday

0700-1500 1500-2300 0700-1100 1700-0200

Make-up

4 East

Monday 1700-2400 Wednesday 0700-1400 Thursday 1900-2300 Saturday 0700-1500

Make-up

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

MJ Floors 5 and 6 (1st Week of Pay Period)

5 East

Monday Wednesday Thursday Saturday

0700-1500 1500-2300 1100-1500 0700- 1500

Make-up

5 West

Sunday Tuesday Thursday Friday

0700-1500 1500-2300 0700-1100 0700-1500

Make-up

6 East

Monday 1500-2400 Wednesday 0700-1500 Thursday 1900-2300 Saturday 1500-0200

Make-up

6 West

Sunday Tuesday Thursday Friday

1500-2300 0700-1500 1500-1900 1500-0200

MJ Floors 5 and 6 (2nd Week of Pay Period)

Make-up

5 East

Monday Wednesday Thursday Saturday

0700-1500 1500-2300 1100-1500 1500- 0200

Make-up

5 West

Sunday Tuesday Thursday Friday

0700-1500 1500-2300 0700-1100 1500-0200

Make-up

6 East

Monday 1500-2400 Wednesday 0700-1500 Thursday 1900-2300 Saturday 0700-1500

Make-up

6 West

Sunday Tuesday Thursday Friday

1500-2300 0700-1500 1500-1900 0700-1500

Make-up

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

MJ Floors 7 and 8 (1st Week of Pay Period)

7 East

Monday Wednesday Thursday Saturday

0700-1900 1900-0600 1100-1500 0700- 1900

Make-up

7 West

Sunday Tuesday Thursday Friday

0700-1900 1900-0600 1700-2200 0700-1900

Make-up

8 East

Monday 1900-0600 Wednesday 0700-1900 Thursday 1200-1700 Saturday 1900-0600

Make-up

8 West

Sunday Tuesday Thursday Friday

1900-0600 0700-1900 0700-1200 1900-0600

MJ Floors 7 and 8 (2nd Week of Pay Period)

Make-up

7 East

Monday Wednesday Thursday Saturday

0700-1900 1900-0600 0700-1200 1900- 0600

Make-up

7 West

Sunday Tuesday Thursday Friday

0700-1900 1900-0600 1200-1700 1900-0600

Make-up

8 East

Monday 1900-0600 Wednesday 0700-1900 Thursday 1700-2200 Saturday 0800-1900

Make-up

8 West

Sunday Tuesday Thursday Friday

1900-0600 0700-1900 2200-0300 0700-1900

Make-up

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

RCCC JKF - Outdoor Recreation Hours 0800-2300

Minimum Hours of Outdoor Recreation for County Inmates – 7 hours per week. All county inmates will be offered a minimum of 1 hour of outdoor recreation per scheduled day.

100 Pod

Sunday

A Days

PM

Monday A Days

AM

Tuesday A Nights PM

Wednesday A/B Days AM

Thursday B Days

PM

Friday

B Days

AM

Saturday A/B Nights PM

200 Pod Sunday

A Days

AM

Monday A Nights PM

Tuesday A Days

PM

Wednesday A Nights PM

Thursday B Days

AM

Friday

B Nights PM

Saturday B Days

PM

300 Pod

Sunday

A Nights PM

Monday A Days

PM

Tuesday A Days

AM

Wednesday A/B Days PM

Thursday B Nights PM

Friday

B Days

PM

Saturday B Days

AM

400 Pod

Sunday

A Nights PM

Monday A Days

PM

Tuesday A Days

AM

Wednesday A/B Days PM

Thursday B Nights PM

Friday

B Days

PM

Saturday B Days

AM

500 Pod

Sunday

A Days

PM

Monday A Days

AM

Tuesday A Nights PM

Wednesday A/B Days AM

Thursday B Days

PM

Friday

B Days

AM

Saturday A/B Nights PM

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

600 Pod Sunday

A Days

AM

Monday A Nights PM

Tuesday A Days

PM

Wednesday A Days

PM

Thursday B Days

AM

Friday

B Nights PM

Saturday B Days

PM

RCCC KBF - Outdoor Recreation Hours 0800-2300

Minimum Hours of Outdoor Recreation for County and ICE Inmates/Detainees – 7 hours per week. All county inmates and ICE detainees will be offered a minimum of 1 hour of outdoor recreation per scheduled day.

100 Pod

Sunday

ICE/PC

Monday ICE/PC

Tuesday ICE/PC

Wednesday ICE/PC

Thursday ICE/PC

Friday

ICE/PC

Saturday ICE/PC

A Days

PM

A Days

AM

A Nights PM

A/B Days AM

B Days

PM

B Days

AM

A/B Nights PM

200 Pod Sunday

County PC A Days

AM

Monday County PC A Nights PM

Tuesday County PC A Days

PM

Wednesday County PC A Nights PM

Thursday County PC B Days

AM

Friday

County PC B Nights PM

Saturday County PC B Days

PM

300 Pod

Sunday

ICE GP

Monday ICE GP

Tuesday ICE GP

Wednesday ICE GP

Thursday ICE GP

Friday

ICE GP

Saturday ICE GP

A Nights PM

A Days

PM

A Days

AM

A/B Days PM

B Nights PM

B Days

PM

B Days

AM

400 Pod

Sunday

ICE GP

Monday ICE GP

Tuesday ICE GP

Wednesday ICE GP

Thursday ICE GP

Friday

ICE GP

Saturday ICE GP

A Nights PM

A Days

PM

A Days

AM

A/B Days PM

B Nights PM

B Days

PM

B Days

AM

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

500 Pod

Sunday

ICE/Sureno GP

Monday ICE/Sureno GP

Tuesday ICE/Sureno GP

Wednesday ICE/Sureno GP

Thursday ICE/Sureno GP

Friday

ICE/Sureno GP

Saturday ICE/Sureno GP

A Days

PM

A Days

AM

A Nights PM

A/B Days AM

B Days

PM

B Days

AM

A/B Nights PM

600 Pod Sunday

County PC A Days

AM

Monday County PC A Nights PM

Tuesday County PC A Days

PM

Wednesday County PC A Days

PM

Thursday County PC B Days

AM

Friday

County PC B Nights PM

Saturday County PC B Days

PM

RCCC SBF - GP/PC Outdoor Recreation Hours 0800-2300. TSEP Outdoor Recreation Hours 0700-2400. TSEP County Inmates 2 hours per week. Other county inmates 3 hours per week. ICE detainees 5 hours per week. All ICE detainees and TSEP county inmates will be offered a minimum of 1 hour of outdoor recreation per scheduled day. All GP/PC county inmates will be offered a minimum of 1.5 hours of outdoor recreation per scheduled day.

100 Pod

Sunday

ICE/SMU

Monday ICE/SMU

Tuesday ICE/SMU

Wednesday County TSEP

Thursday ICE/SMU

Friday

ICE/SMU

Saturday County TSEP

A Days

AM

A Nights PM

A Days

PM

All Day

B Nights PM

B Days

AM

All Day

200 Pod Lower Monday GP A Days

AM

Upper Monday GP A Days

AM

Lower Thursday GP B Days

PM

Upper Thursday GP B Days

PM

300 Pod Lower Sunday

GP A Days

PM

Upper Sunday

GP A Days

PM

Lower Tuesday GP A Nights PM

Upper Tuesday GP A Nights PM

400 Pod Lower Monday GP A Days

AM

Upper Monday GP A Days

AM

Lower Friday

GP B Days

PM

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Upper Friday

GP B Days

PM

500 Pod Lower Sunday

GP A Nights PM

Upper Sunday

GP A Nights PM

Lower Thursday GP B Days

AM

Upper Thursday GP B Days

AM

600 Pod Lower Tuesday PC A Days

AM

Upper Tuesday PC A Days

AM

Lower Friday

PC B Nights PM

Upper Friday

PC B Nights PM

RCCC CBF - Outdoor Recreation Hours 0800-2300. County Inmates 3 hours per week. ICE detainees 5 hours per week. ROC inmates will receive additional outdoor recreation during weekday program slots. All other inmates will be offered a minimum of 1 hour of outdoor recreation per scheduled day. ICE detainees on restriction are required to be offered outdoor recreation 5 days a week unless outdoor recreation is specifically taken as part of the disciplinary process. ICE/overflow outdoor recreation time slots are to be used for detainees on restriction or for those housed in 200-pod overflow as required.

100 Pod Disciplinary Isolation No Yard

200 Pod

Monday ICE/Overflow

Monday ICE/Overflow

Tuesday ICE/Overflow

Tuesday ICE/Overflow

Wednesday ICE/Overflow

Wednesday ICE/Overflow

Thursday ICE/Overflow

Thursday ICE/Overflow

Friday

ICE/Overflow

Friday

ICE/Overflow

A Nights PM

B Nights PM

A Days

AM

A Days

AM

A/B Days PM

A/B Days PM

B Nights PM

B Nights PM

B Nights PM

B Nights PM

300 Pod Lower Sunday

PC A Days

PM

Upper Sunday

PC A Days

PM

Lower Tuesday PC A Nights PM

Upper Tuesday PC A Nights PM

Lower Friday

PC B Days

AM

Upper Friday

PC B Days

AM

400 Pod

Lower Sunday Upper Sunday Lower Thursday Upper Thursday

Psych Psych Psych Psych

A Nights PM

A Nights PM

B Days

AM

B Days

AM

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Lower Saturday Upper Saturday

Psych Psych

B Days

AM

B Days

AM

500 Pod Lower Monday GP A Days

PM

Upper Monday GP A Days

PM

Lower Wednesday GP B Nights PM

Upper Wednesday GP B Nights PM

Lower Saturday GP B Days

PM

Upper Saturday GP B Days

PM

600 Pod

Lower Sunday Upper Sunday Monday Tuesday Wednesday Thursday Friday

ROC ROC ROC ROC ROC ROC ROC

A Days

AM

A Days

AM

A Days

AM

A Days

PM

A/B Days AM

B Days

PM

B Days

PM

The Assessment Team observed the following recreation equipment on each individual yard and the MJ and RCCC:

 MJ Floors 2, 3, and 4 – Basketball Hoop  MJ Floors 5 and 6 –Basketball Hoop  MJ Floors 7 and 8 Basketball Hoop

All housing units on the MJ floors 3-8 have an indoor recreation area equipped with a pull-up bar and dip bar, however, the indoor recreation area is not used.
 RCCC MHU yard is a small concrete and grass yard with no exercise equipment. The MHU yard is mostly grass with a small concrete section near the doorway. The only accessible area of the yard is the small concrete area near the doorway.
 RCCC M-Dorm Grassy area and patio are used as a yard with no exercise equipment.
 RCCC A, B, J and K Barracks yards have basketball and volleyball and tables.
 RCCC Kinya, Golden Poppy, Camellia yards have basketball and volleyball and tables.
 RCC SLF has an indoor recreation area with a treadmill and 12 exercise machines. Inmates housed in Camellia, Golden Poppy and Kinya use this indoor recreation area.
 RCCC Ramona yard has no exercise equipment.  RCCC CBF and SBF yards have a ping pong table, basketball and 3 dip
and pull-up bar combos.  RCCC JKF and KBF have 3 dip and pull-up bar combos.

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 RCCC Main Yard is a large exercise yard with handball courts, basketball courts, baseball/softball field, soccer field, pull-up bars, dip bars, push-up bars, horseshoe pits, and a running track. The main yard is not accessible to disabled inmates who are fulltime/part-time wheelchair users.
The goal for outside recreation at the MJ is, 30 minutes for high custody inmates, 60 minutes for medium custody inmates and 90 minutes for low custody inmates per session. At RCCC (JKF, KBF, SBF and CBF) all county inmates are offered a minimum of 1 hour of outdoor recreation per scheduled day. The goal for dayroom at the MJ is 30 minutes for high custody inmates, 60 minutes for medium custody inmates and 90 minutes for low custody inmates per session. Some housing units can offer dayroom daily based on the number of separate groups. Specialized units (TSEP, ADSEG, units that house multiple custody classifications) cannot offer dayroom daily, as these inmates require separate dayroom time. The inmates housed in the RCCC honor facility, barracks and SLF are offered recreation yard as time allows. For barracks A, B J, and K recreation yard is usually provided on alternate a.m. and p.m. shifts. For the Ramona unit in SLF inmates are allowed 1 hour of yard per session.
At the MJ staff enter out-of-cell activity into a tracking system designed to track compliance with out-of-cell time. The deputies check inmates out as dayroom or outside recreation in the WEPJPF recreation tracking system. When the inmates return to their cell the deputy checks them in, and the system tracks the out-ofcell time (dayroom and outside recreation). If an inmate is returned to his/her cell and/or leaves the dayroom or recreation yard the deputy reflects this and the system does not count the time in cell as part of the out-of-cell activity. The recreation tracking system was fully placed on line February 2016.
The Assessment Team requested and was provided the following information/data from the recreation tracking system. A detailed report reflecting the inmates’ names, housing, time dayroom program was provided (beginning time and ending time), time outside recreation was provided (beginning time and ending time) or if the inmate refused for the following pods and time periods (weeks of March 20th, April 17th, May 8th, and June 26th) for the following housing areas 2 West Medical and Psych, 2 East 100/200/300, 3 West 300, 3 East 200, 4 East 300, 5 East 300, 6 West 300, 7 West 100/300, and 8 West 300/400.
The SCSD detention facilities provided the following, a detailed excel spreadsheet listing the inmates XREF, ShiftStart, ShiftName, DayRoomGoal, DayRoomOffered, DayRoomActual, RecRoomGoal, RecRoomOffered, RecRoomActual, Facility, Area, and pod for the weeks requested.
Listed below is a summary of the data:
2 West M/P – There are 1,471 entries (1,009 for P and 462 for M). Of the 1,471 entries 1,383 reflect a dayroom goal, with 26 entries reflecting that the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
goal for dayroom was met. Of the 1,471 entries, zero reflect a RecRoomGoal and that recreation was offered or provided.
2 East 100 (designated wheelchair housing) – There are 273 entries. Of the 273 entries 215 reflect a dayroom goal, with 159 entries reflecting that the goal for dayroom was met. Of the 58 entries where no dayroom goal is noted, 47 reflect that dayroom was provided. Of the 273 entries, zero reflect a RecRoomGoal and that recreation was offered or provided.
2 East 200 (designated medical) – There are 1,244 entries. Of the 1,244 entries 962 reflect a dayroom goal, with 582 entries reflecting that the goal for dayroom was met. Of the 281 entries where no dayroom goal is noted, 184 reflect that dayroom was provided. Of the 1,244 entries, 19 reflect that recreation was provided. Of the 1,244 entries, 269 reflect a RecRoomGoal with zero reflecting that recreation room was offered or provided.
2 East 300 (designated medical) – There are 1,084 entries. Of the 1,084 entries, 850 reflect a dayroom goal, with 457 entries reflecting that the goal for dayroom was met. Of the 234 entries where no dayroom goal is noted, 105 reflect that dayroom was provided. Of the 1,084 entries, 16 reflect that recreation was provided. Of the 1,084 entries, 219 reflect a RecRoomGoal with zero reflecting that recreation room was offered or provided.
2 East 300 (designated medical) – There are 1,084 entries. Of the 1,084 entries, 850 reflect a dayroom goal, with 457 entries reflecting that the goal for dayroom was met. Of the 234 entries where no dayroom goal is noted, 105 reflect that dayroom was provided. Of the 1,084 entries, 16 reflect that recreation was provided. Of the 1,084 entries, 219 reflect a RecRoomGoal with zero reflecting that recreation room was offered or provided.
3 East 200 (designated housing P.C.) – There are 3,543 entries. Of the 3,543 entries, 2,773 reflect a dayroom goal with 2,141 reflecting that the goal for dayroom was met. Of the 771 entries where no dayroom goal is noted, 429 reflect that dayroom was provided. Of the 3,543 entries, 460 reflect that recreation was provided. Of the 3,543 entries, 758 reflect a RecRoomGoal with 326 reflecting that recreation room goal was met. Of the 2,785 entries where no recreation goal is noted, 122 entries reflect recreation room was provided.
3 West 300 (designated housing OPP) – There are 4,094 entries. Of the 4,094 entries, 3,192 reflect a dayroom goal with 939 reflecting that the goal for dayroom was met. Of the 902 entries where no dayroom goal is noted,
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L1S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
489 reflect that dayroom was provided. Of the 4,094 entries, 22 reflect that recreation was provided.
4 East 300 (designated housing P.C.) – There are 3,489 entries. Of the 3,489 entries, 2,705 reflect a dayroom goal with 2,010 reflecting that the goal for dayroom was met. Of the 784 entries where no dayroom goal is noted, 410 reflect that dayroom was provided. Of the 3,489 entries, 282 reflect that recreation was provided. Of the 3,489 entries, 736 reflect a RecRoomGoal with 109 reflecting that recreation room goal was met. Of the 2,753 entries where no recreation goal is noted, 170 entries reflect recreation room was provided.
5 East 300 (designated housing G.P.) – There are 3,363 entries. Of the 3,363 entries, 2,573 reflect a dayroom goal with 1,877 reflecting that the goal for dayroom was met. Of the 791 entries where no dayroom goal is noted, 645 reflect that dayroom was provided. Of the 3,363 entries, 345 reflect that recreation was provided. Of the 3,363 entries, 697 reflect a RecRoomGoal with 306 reflecting that recreation room goal was met. Of the 2,666 entries where no recreation goal is noted, zero entries reflect recreation room was provided.
6 West 300 (designated housing G.P.) - There are 4,300 entries. Of the 4,300 entries, 3,169 reflect a dayroom goal with 1,868 reflecting that the goal for dayroom was met. Of the 1,141 entries where no dayroom goal is noted, 663 reflect that dayroom was provided. Of the 4,300 entries, 281 reflect that recreation was provided. Of the 4,300 entries, 869 reflect a RecRoomGoal with 159 reflecting that recreation room goal was met. Of the 3,431 entries where no recreation goal is noted, 61 entries reflect recreation room was provided.
7 West 100 (designated housing female G.P.) - There are 3,484 entries. Of the 3,484 entries, 2,698 reflect a dayroom goal with 1,853 reflecting that the goal for dayroom was met. Of the 786 entries where no dayroom goal is noted, 436 reflect that dayroom was provided. Of the 3,484 entries, 449 reflect that recreation was provided. Of the 3,484 entries, 738 reflect a RecRoomGoal with 220 reflecting that recreation room goal was met. Of the 2,746 entries where no recreation goal is noted, 139 entries reflect recreation room was provided.
7 West 300 (designated housing female P.C., OPP, TSEP, ADSEG, G.P.) There are 2,007 entries. Of the 2,007 entries, 1,524 reflect a dayroom goal with 395 reflecting that the goal for dayroom was met. Of the 484 entries
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L2S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
where no dayroom goal is noted, 200 reflect that dayroom was provided. Of the 2,007 entries, 80 reflect that recreation was provided. Of the 2,007 entries, 417 reflect a RecRoomGoal with 22 reflecting that recreation room goal was met. Of the 1,524 entries where no recreation goal is noted, 22 entries reflect recreation room was provided.
8 West 300 (designated housing ADSEG, TSEP.) - There are 1,335 entries. Of the 1,335 entries, 1,018 reflect a dayroom goal with 224 reflecting that the goal for dayroom was met. Of the 317 entries where no dayroom goal is noted, 90 reflect that dayroom was provided. Of the 1,335 entries, 7 reflect that recreation was provided. Of the 1,335 entries, 279 reflect a RecRoomGoal with 2 reflecting that recreation room goal was met. Of the 1,056 entries where no recreation goal is noted, 5 entries reflect recreation room was provided.
8 West 400 (designated disciplinary housing) - There are 691 entries. Of the 691 entries, 616 reflect inmate isDiscipline, 224 reflect a dayroom goal with zero reflecting that the goal for dayroom was met. Of the 466 entries where no dayroom goal is noted, 2 reflect that dayroom was provided. Of the 691 entries, zero reflect that recreation was provided. Of the 691 entries, 63 reflect a RecRoomGoal with zero reflecting that recreation room goal was met. Of the 628 entries where no recreation goal is noted, zero entries reflect recreation room was provided.
Staff Interviews
During the Assessment Team interviews, the MJ recreation staff stated that recreation staff conducts yard activities for the inmates. These yard activities include; organized basketball, handball, football and soccer games, corn toss, and wellness activities (bodyworks). In addition, they coordinate in-house exercise activities. The yard activities are provided to inmates housed on the 3rd, 4th, 5th and 6th floor. They are not provided to inmates housed on the 2nd or 8th floor. The in-house exercise activities are provided to inmates housed on all floors.
The RCCC recreation staff stated that the recreation staff coordinates indoor and outdoor ball activities for male and female inmates for all RCCC outdoor recreation yards. For the females, recreations staff also provide an exercise program. For inmates housed in the honor facility, there is a walking program that is facilitated by recreation staff in addition to the yard activities.
During the Assessment Team interviews housing unit deputies reported that inmates do not always get yard. They may get it once a week. And 2 West does not run outdoor recreation, as inmates can’t climb the stairs. The housing unit deputies stated that the impediment in providing the required outdoor recreation
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L2S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
time to inmates is the shortage of staff. The MJ staff stated that staffing for the units is typically 2 deputies in each unit (one in control and one on the floor). However, it is common for there to be only 1 housing unit deputy. This is a result of staffing vacancies due to sick calls, vacation, vacant positions, medical transports etc. When there is only 1 deputy per housing unit, the deputy must remain in the control room. This impacts the ability to provide programing for inmates due to a lack of required custody supervision. The MJ staff reported that at times there have been multiple housing units with only 1 deputy in the control room. The staffing in the MJ 2 East is only 1 deputy; therefore, in order to provide security coverage for escorts to the recreation yard a deputy from the medical unit 2 West is required. When asked how inmates who could not ambulate the stairs to access the yard would be accommodated, more than half of the deputies interviewed were not aware that disabled inmates could be accommodated by allowing them to use the elevator via the mezzanine level to access the yard.
Custody staff stated that inmates on disciplinary isolation do not receive access to dayroom or outside recreation and are only allowed out of their cell for a 15minute shower every other day. Staff stated that inmates could remain in disciplinary isolation for the time imposed by the disciplinary hearing officer. If an inmate remains in disciplinary isolation for more than 30 days, staff is required to notify the facility commander. Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1080 Rules and Disciplinary Penalties requires that: if an inmate is on disciplinary isolation status for 30 consecutive days there shall be a review by the facility manager before the disciplinary isolation status is continued. This review shall include a consultation with health care staff. Such reviews shall continue at least every fifteen (15) days thereafter until the disciplinary status has ended.  Staff stated that a practice exists that if an inmate is approaching the 30th day in disciplinary isolation, the inmate is removed from disciplinary isolation for one day and then placed back on disciplinary isolation again. This eliminates the requirements of title 15 stated above. The Assessment Team asked a custody staff member how many cycles they recall this practice being followed with an inmate. They stated 2 cycles (60 days).
Custody staff specifically assigned to MJ 2/M stated that inmates housed in the unit do not receive outside exercise/recreation opportunities.
A deputy assigned to MJ 3W acknowledged that OPP inmates are housed in pod 300. He stated that inmates housed in pods 100 and 200 are out of the cell “pretty much all of the time”, but the OPP inmates classified as high security may get 30 minutes of dayroom on some days, medium security OPP inmates may get an hour on some days, and civil commitments may get 1-1.5 hours on some days. With regard to outside exercise yard, he indicated that non-OPP inmates
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L2S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
(pods 100 and 200) receive exercise yard once per week, but OPP inmates only receive yard once every 2 weeks.
Inmate Interviews
During the inmate interviews the inmates reported the following information regarding access to the yard and dayroom:
 MJ 2 West M – A female inmate housed in the medical unit claims she has to use the psych dayroom (she does not live in that area and is not a psych inmate). Stated that using the psych dayroom in front of all of the psych inmates poses a problem to her because she is emotionally stressed because of her severe dialysis condition as well as the seriousness of her diabetes. Claims that for months she was never offered dayroom at all and that she began getting dayroom (but only in the psych area) about 2 month before the Assessment Team interviews at the jail. Stated that a particular deputy on PM shift offers dayroom nightly, and the other deputy on the PM shift offers dayroom sometimes. Also stated that the AM/afternoon shift does not offer dayroom at all. Stated that she has never been offered yard.
 MJ 2 West P - Inmate stated that dayroom is offered 1 to 2 times per week for 15-30 minutes. Stated he has never been offered yard.
 MJ 2 West P - Inmate housed in 2 West Psych stated that dayroom is offered 30 minutes every other day. He stated he has never been offered yard.
 MJ 2 West P - Inmate stated that staff does not offer dayroom or yard.  MJ 2 West P Inmate - This inmate is a psychiatric inpatient, and
complained that he has never been offered outside exercise yard, and is only offered dayroom every other day (AM shift) for about 30 minutes. He stated that there is no dayroom offered for the PM shift, and there are no other programs of any type offered.  MJ 2 West M - This inmate is a permanent wheelchair user, and complained that he has never been offered outside exercise yard.  MJ 2 East Pod 100 (wheelchair) - Inmate claims he has been offered outside recreation once in 16 months. Claims the Coach/Recreation Technician tries to pacify the inmates with movies. Stated dayroom is provided for about 2 hours on dayshift and sometimes 1 to 2 hours at night.  MJ 2 East Pod 100 (wheelchair) - Inmate claims he has never been offered yard and wants to go. Claims he is provided dayroom for about 1 hour on the day shift and 1 hour on the night shift.  MJ 2 East Pod 100 (wheelchair) - Inmate claims he has never been to yard. Claims he is provided about 1 to 1.5 hours of dayroom each day.  MJ 2 East Pods 200/300 - Inmates stated that yard is not offered and dayroom depends on the shift working. At times dayroom is offered very late at night (midnight). There is a mixture of classifications (TSEP, PC, and GP) that have to be accommodated for dayroom.
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L2S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ 3 West – Inmates in the OPP overflow stated that outside recreation is offered once a month. GP inmates stated yard is offered 1 time a week for 30 minutes. Dayroom is offered 30/60 minutes 2 times a day. Inmates in the workers unit stated that dayroom is open all day and yard 2 times a week. Some of the OPP inmates were also frustrated with the lack of activities afforded to them during dayroom time, including a lack of the same equal access to reading materials and board games as the non OPP inmates housed in the same pod receive.
 MJ 3- Dayroom is on average 1-1.5 hours per day on the day shift, but occasionally offered on PM shift. Yard is offered on average once per week on day shift.
 MJ 4 West – Dayroom is offered 2 times a day for 30/60 minutes. Yard is random, sometimes 2 times a week for an hour and sometimes once a week for an hour.
 MJ 4 East - Dayroom is offered 2 times a day for 30/60 minutes. Yard is random, sometimes 2 times a week for an hour, and sometimes once a week for an hour. An inmate claimed that yard was only offered 2 times in 6 months.
 MJ 5 West - Dayroom is offered 2 times a day for 30/60 minutes; however at times dayroom is offered late night (0200). Yard is offered 1 time a week for an hour.
 MJ 5 East – Dayroom is offered on average 2 times daily, 1 hour on day shift and 1 hour on PM shift. Yard is offered on average twice per week for 1 hour each, and generally rotates between shifts. A couple of inmates complained that sometimes yard is offered very late at night or very early in the morning (0100 hours).
 MJ 6 West - Dayroom is offered 2 times a day for 30/60 minutes; however at times dayroom is offered late night (0100-0200). Yard is offered 1 time a week for an hour and sometimes not at all.
 MJ 6 East – Dayroom is offered on average 1 hour on day shift and 1 hour on PM shift on most days (sometimes not on weekends). Yard is offered on average once per week for 1 hour (various times), but recently they have occasionally received it twice per week.
 MJ 7 West – For Pod 100, inmates claim that dayroom is offered during morning/afternoon shift between one to 3 days per week, for about 45 minutes to 90 minutes each. Dayroom is rarely offered during the evening shift. Outside exercise yard is offered about once per week (usually on Sundays) for about one hour. For Pod 200, inmates claim dayroom is offered between one to 2 times per day (no set time schedule) for about 60-90 minutes each (sometimes morning/day shift, and sometimes in the evening). Outside exercise yard is provided either once or twice per week, for about 60 minutes each. For Pod 300, inmates claim that dayroom is offered for about 60 minutes each day (sometimes during
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA1L2S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
morning/afternoon shift, and sometimes during evening shift). Outside exercise yard has not been offered in the last 2 months.  MJ 7 East - Dayroom is offered 30/60 minutes, however at times dayroom is offered late night (midnight). Yard is not offered.  MJ 8 West – No dayroom or yard offered for DD inmates in Pod 400. TSEP Pod 300 was offered dayroom twice. Dayroom for the other pods is offered on average 30 minutes per day on day shift, and 2 nights per week for 30 minutes each. No yard information.  MJ 8 East - Dayroom is offered 1 time a day or every other day for 30/60 minutes, however at times dayroom is offered late night (0100). Yard is offered 1 time a week for an hour. One inmate stated that yard has only been offered 2-3 times in the past 2 months.  RCCC SLF – Inmates housed in Kinya, Camellia and Golden Poppy stated they have access to the dayroom and yard most of the day. Inmates housed in Ramona do not have access to a dayroom. The inmates stated that they are offered yard every day for 1 hour.  RCCC MHU – Inmates stated they have access to the small yard most of the day. They also stated they can go to the main yard; however, it is too far to walk.  RCCC M-Dorm – Inmates stated they have access to the small yard for several hours daily on day shift, and up to 2 hours daily on PM shift. They also stated they can go to the main yard for about 45-60 minutes daily on day shift;  RCCC A, B, J and K Barracks – Inmates have open access to dayroom all day. Inmates stated they have access to the yard 4 to 6 hours every day.  RCCC C, D, G and H Barracks – Inmates have access to dayroom all day. Access to the small yards is 2-4 hours a day. Access to the main yard is when recreation staff provides access.  RCCC KBF, SBF, JKF and CBF –Dayroom access is consistent with dayroom schedule. Yard access is consistent with yard schedule. CBF Pod 400 (OPP Inmates) are offered dayroom on average twice per day (1 hour each) on day shift (occasionally 1.5 hours), and on PM shift sometimes about 1 hour after the evening meal. Yard is offered on average 1-2 times weekly for about 1.5 hours each on day shift, and sometimes on Sunday evening for about 1.5 hours.
Conclusions:
There are significant flaws in the processes as well as discrimination with regard to equitable programming for disabled inmates. To ensure nondiscrimination under the ADA, the SCSD detention facilities must ensure that disabled inmates receive equivalent exercise/yard time and access to fitted exercise equipment.
Disabled inmates housed in MJ West M/P are not being provided equal access to the outside recreation yard relative to all other inmates housed in the MJ. This is
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
supported by the outside recreation tracking data provided by SCSD detention facilities.
Disabled inmates housed in 2 East Pod 100 (wheelchair users) are not being provided equal access to the outside recreation yard relative to all other inmates housed in the MJ. This is supported by the outside recreation tracking data provided by SCSD detention facilities.
Disabled inmates housed in 2 East who are not able to ambulate stairs to access the yard are not being provided equal access to the outside recreation yard relative to all other inmates housed in the MJ. This is supported by the outside recreation tracking data provided by SCSD detention facilities.
The staffing levels at the MJ are impacting the ability for staff to provide the required out-of-cell time (dayroom and outdoor recreation) for disabled inmates.
When disabled mentally ill inmates are found guilty of disciplinary write-ups and are placed in disciplinary isolation by the disciplinary hearing official, they are completely isolated from interactions with others and are not allowed access to dayroom or yard for up to 30 days. It is also a practice to release an inmate for 1 day and return them to disciplinary isolation for 60 days. These inmates are only allowed outside their cell for 45 minutes in a 7-day period. If the reason for the misconduct is due to mental illness, these inmates are being punished and disciplined for their disability, when instead they need to be provided with necessary mental health treatment. In the GAP Analysis of Mental Health Services Santa Clara County Jails, Bruce C. Gage, M.D., states, ”It is also vitally important to recognize that some mentally ill that may score at low classification security levels may nonetheless be quite dangerous, especially until treated, and this must be accommodated as well – but not through the vehicle of infraction and sanction as this amounts to punishing inmates for being mentally ill or by universally placing the mentally ill in restrictive settings. This requires mental health input into the infraction process and sometimes not infracting when the behavior is driven by mental illness but when tighter conditions of confinement are nonetheless necessary by virtue of their present risk. In short, they are not infracted but they are placed in what amounts to a higher security setting for risks related to their illness. Sometimes, there may be no infractable behavior but elevated risk is still present; this requires mental health staff to have some ability to drive custody overrides and/or be able to place the mentally ill under more restrictive conditions other than by the sole vehicle of LPS commitment. Similarly, those who are seriously mentally ill and are not a danger to others, usually those who are gravely disabled, often need to be engaged in activities rather than isolated, where they sink further into despair or psychosis.”
The disabled mentally ill inmates housed in the OPP are not being provided equal access to outside recreation yard and in some cases dayroom relative to other non-disabled inmates housed in the SCSD detention facilities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Disabled inmates do not have equal access to the dip and pull-up bars (and other equipment). If this equipment is to remain in the exercise areas for inmate usage, then disabled inmates must either be able to access such bars (for housing units designated to house inmates with disabilities) with reasonable accommodations, or specifically fitted bars or equipment must also be installed.
References
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
(iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State. 28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections— (i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities. 28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered. The information below is for reference only. As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following with regard to mobility-disabled inmates (and inmates with other disabilities):
 Reasonable accommodation for inmates with disabilities at designated facilities may include the provision of accessible recreation areas and specially fitted equipment. The successful completion of a test to show proper and safe use of fitness apparatus items shall be required and documented.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Access to Programs
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable pertaining to inmate orientation are outlined in Operations Orders 06/10 Recreation, Exercise and Showering, 06/13 Telephone and TDD / TTY Equipment Access, 06/17 Social, Social Service Consultation, and Media Visits, 08/06 Prisoner Services, 08/07 Law Library, 08/11 Religious Services, Draft Operations Order Inmates with Disabilities - ADA, and Policy 1124 Personal Hygiene.
The following sections of the Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations address inmate programs in a county jail:
§ 1062. Visiting
(a) The facility administrator shall develop written policies and procedures for inmate visiting, which shall provide for as many visits and visitors as facility schedules, space, and number of personnel will allow. For sentenced inmates in Type I facilities and all inmates in Type II facilities there shall be allowed no fewer than two visits totaling at least one hour per inmate each week. In Type III and Type IV facilities there shall be allowed one or more visits, totaling at least one hour, per week. (b) In Type I facilities, the facility administrator shall develop and implement written policies and procedures to allow visiting for non-sentenced detainees. The policies and procedures will include a schedule to assure that nonsentenced detainees will be afforded a visit no later than the calendar day following arrest. (c) The visiting policies developed pursuant to this section shall include provision for visitation by minor children of the inmate.
§ 1064. Library Service
The facility administrator shall develop written policies and procedures for library service in all Type II, III, and IV facilities. The scope of such service shall be determined by the facility administrator. The library service shall include access to legal reference materials, current information on community services and resources, and religious, educational, and recreational reading material. In Type IV facilities such a program can be either in-house or provided through access to the community.
§ 1067. Access to Telephone
The facility administrator shall develop written policies and procedures which allow reasonable access to a telephone beyond those telephone calls required by Section 851.5 of the Penal Code.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
§ 1070. Individual/Family Service Programs
The facility administrator of a Type II, III, or IV facility shall develop written policies and procedures, which facilitate cooperation with appropriate public or private agencies for individual and/or family social service programs for inmates. Such a program shall utilize the services and resources available in the community and may be in the form of a resource guide and/or actual service delivery. The range and source of such services shall be at the discretion of the facility administrator and may include:
a. individual, group and/or family counseling;   b. drug and alcohol abuse counseling;   c. community volunteers;   d. vocational testing and counseling;   e. employment counseling;   f. referral to community resources and programs;   g. prerelease and release assistance;   h. legal assistance; and,   i. regional center services for the developmentally disabled
§ 1072. Religious Observances
The facility administrator of a Type I, II, III or IV facility shall develop written policies and procedures to provide opportunities for inmates to participate in religious services, practices and counseling on a voluntary basis.
§ 1266. Showering
There shall be written policies and procedures developed by the facility administrator for inmate showering/bathing. Inmates shall be permitted to shower/bathe upon assignment to a housing unit and at least every other day or more often if possible.
Per Operations Order 06/10, Recreation, Exercise and Showering, televisions are provided as a leisure time activity to help alleviate boredom, reduce tension, and to facilitate inmates’ continued contact with the community. The use of the televisions located within each housing unit is a privilege and pod television privileges may be suspended with supervisor approval. Televisions are typically turned on during indoor recreation periods. Additional viewing times may be authorized by custody staff when all routine tasks and activities have been completed. Televisions damaged or inoperative shall be immediately removed from the housing unit, and housing unit staff will submit a Maintenance Request. Any removal of a television for intentional abuse or vandalism requires watch commander approval. Any removal will be logged and a replacement television will not be installed until the investigation or disciplinary action has been completed.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Title 15, Section 1067 provides that inmates be afforded reasonable access to a telephone beyond those arrest/booking telephone calls which are required by Penal Code 851.5. General telephone access is granted during normal indoor recreation periods, however, telephone access is still a privilege and any individual revocation will be in accordance with the discipline process. The use and access of telephones will be in accordance with Operations Order 6/13, Telephones/TDD/TTY Access.
Inmates are afforded enough time during indoor recreation periods to shower. Each inmate shall be allowed a maximum of fifteen (15) minutes of shower time so it is incumbent upon the inmate to manage his/her dayroom time accordingly. In the event recreation is held to minimum standards, inmates will be afforded the opportunity to shower every other day. Inmates on disciplinary status are allowed to shower once every other day. Acceptance or refusal shall be documented. Reasonable efforts should be made to allow inmates who have participated in outdoor recreation to shower before lockdown. The shower shall not be used as a means of punishment or used to isolate a disruptive or combative inmate. An exception may occur if custody staff needs to control a volatile situation and use of the shower stall is the only means to control that situation. As soon as the situation is stabilized the inmate shall be removed from the shower stall. Inmates whose jobs or work assignments cause them to require more frequent showers should be permitted to shower whenever necessary.
Operations Order 06/12 outlines shaving and cosmetology procedures; however, inmates are afforded the opportunity to shave each day. Inmates scheduled for court shall be provided shower access on the day of the scheduled court appearance. Upon request, males shall be allowed to shave and females shall be allowed to use cosmetology equipment.
Per Operations Order 06/13, Telephone and TDD / TTY Equipment Access, Custody staff shall provide telephone access so that arrestees are able to make the required number of telephone calls upon being booked as per Penal Code 851.5. Reasonable telephone access is also provided to inmates during recreation periods. Once an inmate is identified as hearing impaired, all efforts will be made so that such inmate receives all rights and privileges as would be given any other inmate.
Telephones are accessible to inmates who are participating in dayroom activities. Dayroom typically occurs everyday, unless a situation arises that would prevent or limit the recreation program. Inmates may make unlimited fifteen (15) minute telephone calls. Any individual restriction of telephone access shall be noted in an Inmate Disciplinary Report (PF-10). A logbook entry will be done in the event dayroom access is restricted to the housing unit for any reason. Inmates on disciplinary restriction shall not have access to telephones for the duration of their disciplinary status. Inmates housed in areas, such as the medical infirmary,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
that are not equipped with “pod” phones shall be allowed access to an inmate telephone that can be plugged into a telephone outlet.
Inmates who are speech and/or hearing impaired shall be given access to the TDD/TTY equipment and are subjected to the same rules as described for telephone access. Inmates may request use of the TDD/TTY equipment through an Inmate Message Request. Housing units that are equipped with free phones will use TDD/TTY equipment for the speech/hearing impaired. Speech/hearing impaired inmates will be escorted to booking or another appropriate area if the housing unit does not have access to TDD/TTY equipment. Housing unit staff shall make an entry in the logbook each time the TDD/TTY equipment is used with the inmate’s name, X-reference number, date and time of use and location of where it was used. If the inmate needs to talk to someone who has no TDD/TTY equipment he/she may call the Nor Cal Center for Deafness, a free service, at (916) 973-8448.
Per Operations Order 06/17, Social, Social Service Consultation, and Media Visits, all inmates shall be allowed to have social, social service consultation and media visits during the visit schedule times of the respective facility. All incarcerated inmates shall have reasonable access to social, social service consultation and media visits in an effort to reduce stress and maintain family ties. Reasonable access is based on the individual facility’s established visit schedule and physical plant design.
Social, social service consultation, and media visits shall take place in the general social visit booths. Attorney pass-through and non-pass-through booths shall not be used as overflow. Inmates may have social, social service consultation, or media visit privileges taken away for disciplinary reasons. Visit restrictions will only occur as a result of a disciplinary hearing in accordance with the discipline plan.
Social visits are visits with any person who does not meet the confidential visitor, media visitor, or social service visitor requirements. Social visits may include family, friends, minor relatives, associates, etc. Media visits are visits with any person who is a representative of any media source where the purpose of the visit is media-related. Media visits may include correspondents from television, newspaper, magazine, Internet sources etc. Social Service Consultations include visits with governmental service providers and nonprofit advocacy and charity organizations.
At the Main Jail and RCCC, pre-trial inmates may receive a maximum of two forty-five-minute NON-CONTACT social visits per week. At the Main Jail, sentenced inmates may receive three forty-five-minute NON-CONTACT social visits per week. At RCCC, sentenced inmates may receive one sixty-minute NON-CONTACT social visit per week.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Visits for inmates housed in the acute psychiatric unit at the MJ, including inmates wearing blue suits, will be on a case-by-case basis. If the visit is authorized, it shall take place in the 2 East visit area. The visit shall be visually monitored by a deputy. Supervisory approval is required for all visits, whether approved or denied.
Per Operations Order 08/06, Prisoner Services, social service programs will be provided which employ a wide range of in-house and community resources to assist inmates in solving personal and family problems and assist in their rehabilitation. Social services for inmates include, but are not limited to, the following:
 Alcoholics Anonymous.  Individual and group counseling.  Religious and community services.  Substance abuse counseling.  Notary Public services.
Per Operations Order 08/07, Law Library, Law Libraries in each facility are available to any inmate requesting access to legal materials, however Pro Per status inmates shall have priority to the Law Library. Custody staff will provide assistance to inmates in accessing up to date legal research material and/or accessing the courts. Inmates wanting access to the law library to conduct legal research must submit an “Inmate Message Request” form to the Law Librarian.
Inmates may request legal materials, copies, writ forms, and legal books from the Law Librarian by submitting an Inmate Message Request. Each request will be limited to no more than five books. Up to 25 copies of legal material may be allowed per inmate per week. This number may be limited due to staff availability and budgetary restraints. Inmates, other than Pro Per status inmates, may normally utilize the law library for one (1) hour per week per inmate. Inmates requiring more time may request additional time, subject to availability.
Per Operations Order 08/11, Religious Services, the MJ and RCCC shall make every effort to allow the sincere free practice of religion, limited only by legitimate security and operational considerations. Inmate participation in the religious programs is subject to the review and approval of the Correctional Ministries Director, the Division Commander, and his /her designee.
Inmates may ask to see the Correctional Ministries Director or a Volunteer Chaplain; request religious materials, individual counseling, or a special religious diet; or seek additional information on matters relating to religious practice by submitting a KITE. Custody staff receiving KITE’s which contain such requests shall route the request to the Chaplaincy in a timely manner. Inmates wishing to submit a grievance relating to religious issues shall follow the normal inmate grievance procedure.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inmates may receive religious publications and other materials that have been approved and do not jeopardize the safety and security of the facility, staff, or other inmates, and otherwise conform to the facilities rules and regulations. All publications and other materials will go through the Correctional Ministries Director. Any item in question will be referred to the Division Commander and/or his/her designee for review.
Religious services and programs in Corrections may include, but are not limited to, one-on-one religious counseling and prayer, religious practices and rituals, religious education and classes, and religious counseling.
Per Draft Operations Order Inmates with Disabilities - ADA, persons with a disability are entitled to an equal opportunity to participate in programs, services, or activities offered by the SCSD detention facilities unless doing so creates an undue hardship.
The Sheriff’s Department may impose legitimate safety requirements necessary for the safe operation of its services, programs, or activities. However, those requirements must be based on actual risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities.
The ADA coordinator, or their designee, is required to perform a follow-up review every thirty calendar days to ensure the inmate has equal opportunity to participate in programs, services and activities and to discuss any issue the inmate may have regarding his/her treatment.
The programs and services offered within the SCSD detention facilities shall be accessible to all inmates. Provisions shall be made by to ensure that all services, programs, and activities are readily accessible to and usable by, individuals with disabilities.
Exercise and Recreation: All inmates shall receive exercise in an area designed for recreation (indoor/outdoor) which will allow for a minimum amount of required exercise distributed over a period of seven (7) days to benefit social, physical and emotional health following Operations Order 6/10, Recreation, Exercise, and Showering.
Library Service: The California State Library lends books and magazines in braille and on cassette tapes. To obtain any of the available materials, the inmate must first be registered with the State of California Braille and Talking Book Library (BTBL). The inmate must complete and submit an application prior to use. To obtain an application, the inmate must submit an Inmate Request Form (KITE) to the Recreation Technician. A designated Recreation Technician will assist in completing the form, providing certification and returning the application to the Library. The Library will mail a cassette player, along with a catalog of available titles to the inmate, free of charge. A free-return label is included in the package. Once the package arrives at the custody facility, it shall be routed to
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
the Recreation Technicians who will ensure distribution of the materials. A designated Recreation Technician shall provide the inmate with the audio tape equipment, inform the inmate of the resources available and explain how the inmate can access the resources via KITE.
Eligibility requirements for services shall not be imposed if they eliminate or tend to eliminate participation by inmates with disabilities, unless it can be shown that such requirements are necessary for the provision of the service. Inmates who volunteer for, or are required to participate in the drug education course and who experience learning disabilities must be provided a reasonable accommodation toward completion of the course, including an alternate means of testing. All program offerings shall be located in areas that are accessible to all inmates regardless of ability. American Sign Language interpreters are available for all program services and can be arranged by contacting (916) 874-1448.
Substance Abuse Treatment programs include:
Housing for Accountable Living Transitions/Residential Substance Abuse Treatment (HALT/RSAT)
HALT/RSAT provides substance abuse treatment and reentry service to offenders and supports their transition back into the community. This program provides substance abuse treatment and education, assisting the offender in changing learned behaviors while offering him or her the tools to become a productive member of the community. Participants receive individual needs assessments and assistance with aftercare services for up to one year after they are released from custody. Participants receive a program certificate upon successful completion and time off their sentence for education hours when eligible. Program is 200 hours for low offenders and 300 for medium to high offenders.
Substance Misuse
The goal of this course is to educate participants in the biological, psychological, and social issues of addiction and chemical dependency and introduce them to appropriate options for recovery. Program is 12 sessions.
Denial Management
The goal of this course is to help participants recognized their denial patterns and to overcome them. Program completion is dependent on workbook completion.
Relapse Prevention
This course focuses on the thinking process that leads to relapse and understanding the belief system that can lead to prevention. Program completion is dependent on workbook completion.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Man Alive/Woman Alive
Rio Cosumnes Correctional Center partners with a Sacramento County Certified Batterers Treatment provider to offer participants the strategies needed to stop their pattern of violent behavior and be accountable to themselves, their families, and their community. Program is 52 hours.
Thinking for Change
This cognitive behavioral course teaches social skills, cognitive self-change and problem solving strategies. It is designed to help participants set personal and professional goals. Certificate is based on 27 sessions.
Moral Reconation Therapy
A cognitive behavioral course aiming to decrease recidivism rates through lessons focused on criminal thought and the treatment of substance abuse. Program ranges from 24-36 hours.
QUEST
The QUEST Program is the in-custody gang diversion program. QUEST (Question, Understand, Evaluate, Succeed, Transform) contains an evidence-based curriculum, which uses behavioral therapy principles, training and success principles. All participants must be documented gang members or gang associates. All participants are housed together in a joint QUEST / HALT barrack, separate from non-program inmates. This therapeutic housing environment allows participants to focus on their programming and development.
Reentry Services
Reentry services are provided to sentenced inmates. It provides evidence based vocational, educational, and treatment programs. The goal is to reduce the rate of incarceration and to offer inmates the tools necessary for successful reintegration into the community. Inmates with over 60 days to serve will be assessed to determine the track they will be placed on. These tracks include: vocational, treatment and education. If you are placed on the reentry services track a reentry specialist will meet with you to complete an individualized assessment and create a reentry plan. Your reentry plan may include cognitive behavioral groups, substance abuse classes, employment classes, education, vocational training programs, and family reintegration. Post-release services may be available to those inmates who participate in reentry services. The post-release services may include supportive services based on individual needs and eligibility will be determined during your participation in the reentry program.
Per Policy 1124, Personal Hygiene, any inmate detained over 48 hours will be furnished bathing facilities in the form of either a tub or shower with hot and cold
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

running water. All inmates shall be permitted regular bathing at least every other day. Inmates will be permitted daily bathing during hot weather in facilities without air temperature control. Inmates whose work assignments cause them to require more frequent showers should be permitted to shower whenever necessary.

Staff shall provide the following items:

 Individual or disposable shaving implements. (These must not be shared among inmates unless properly sterilized.)
 Soap.  Toothbrush and comb.  Toothpaste or powder.  Dental floss (subject to security regulations).  Toilet paper.  Sanitary napkins when required.  Laundry services at least weekly.  Hair care services are also available unless restricted due to reason of
identification.
Observations
The Assessment Team toured all housing units at each facility including the inmate visiting areas, telephone areas, recreational areas (e.g., television, recreational reading and game room areas). Team representatives also toured the areas where religious services are often conducted, e.g., classrooms and multi-purpose rooms.

The Assessment Team reviewed the current schedules for religious services and other non-religious program, services and activities for the MJ and RCCC Complexes. The following is a breakdown of the listed schedule:

MJ 2 East

Tuesday Saturday Saturday

1800-1930 Islamic Quran Class (100 Pod) 1000-1045 Bible Study (300 Pod) 1100-1200 Protestant

MJ 2 West No Programs Offered

MJ 3 East

Monday Tuesday Tuesday Thursday Thursday Saturday

1900-2030 1300-1430 1900-2100 0930-1130 1130-1300 Protestant

Protestant Bible Study (100-300 Pods) 7th Day Adventist (100-300 Pods) Protestant Bible Study (100-300 Pods) Jehovah Witness Jehovah Witness Bible Study (100-300 Pods)

MJ 3 West Sunday Monday

2000-2130 Cocaine Anonymous (on 4 West) 2000-2130 Narcotics Anonymous

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Tuesday 0900-1030 Wednesday 2030-2200 Thursday 1900-2030 Saturday 0800-0930

Substance Abuse (on 4 West) Alcoholics Anonymous Protestant Bible Study (100-200 Pods) Protestant Bible Study (100-200 Pods)

MJ 4 East

Monday 1900-2030 Protestant Bible Study (100-300 Pods) Wednesday 1300-1400 All Faith Studies (100-300 Pods) Saturday 0800-0930 Protestant Bible Study (100-300 Pods)

MJ 4 West

Sunday

1300-1400

Sunday

2000-2130

Monday 2000-2130

Tuesday 1830-2000

Wednesday 1900-2030

Wednesday 2030-2200

Thursday 2000-2130

Saturday 0900-1000

Religious Cocaine Anonymous Narcotics Anonymous Celebrate Recovery Protestant Bible Study (100-200 Pods) Alcoholics Anonymous Narcotics Anonymous Book Study Protestant Bible Study (open)

MJ 5 East

Tuesday Friday Saturday

1900-2030 Protestant Bible Study (200 Pod) 2000-2130 Protestant Bible Study (200 Pod) 2000-2130 Protestant Bible Study (200 Pod)

MJ 5 West Tuesday 2000-2130 Protestant Bible Study (100 Pod) Wednesday 1900-2030 Russian Bible Study(100 Pod) Saturday 0800-0930 Protestant Bible Study (100 Pod)

MJ 6 East

Sunday Thursday Saturday

0800-0930 Protestant Bible Study (200 Pod) 1300-1430 Jehovah Witness (200 Pod) 0800-0930 Protestant Bible Study (200 Pod)

MJ 7 East Monday Saturday

1900-2030 Protestant Bible Study (300 Pod) 0800-1000 Protestant Bible Study (300 Pod)

MJ 7 West Tuesday 2000-2130 Protestant Bible Study (100 Pod) Wednesday 2000-2130 Alcoholics Anonymous Saturday 0800-0930 Protestant Bible Study (100 Pod)

MJ 7 West

Sunday Sunday Monday Monday Tuesday Tuesday Tuesday

1300-1430 1930-2100 1900-2030 2030-2200 1130-1300 1230-1400 1830-2000

Protestant Bible Study (100/300 Pods)
Narcotics Anonymous
Protestant Bible Study (100/300 Pods)
Narcotics Anonymous Self Esteem (1st and 3rd Tuesday) Substance Abuse (2nd and 4th Tuesday)
Celebrate Recovery (100/300 Pods)

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Tuesday 2000-2130

Wednesday 2000-2130

Thursday 1230-1330

Thursday 1345-1445

Thursday 1900-2130

Friday

2000-2130

Saturday 0900-1030

Protestant Bible Study Alcoholics Anonymous Book Club (1st and 3rd Thursday) Catholic Bible Studies Protestant Bible Study (100/300 Pods) Alcoholics Anonymous Protestant Bible Study (100/300 Pods)

MJ 8 East No Programs Offered

MJ 8 West No Programs Offered

RCCC CBF Sunday Tuesday Thursday

1200-1500 1300-1400 1300-1400

Bible Study (Custody/Volunteer decides which Pod attends 100-600) Bible Study (Custody/Volunteer decides which Pod attends 100-600) Bible Study (Custody/Volunteer decides which Pod attends 100-600)

RCCC JKF KBF

Sunday

1200-1500 Bible Study (Custody/Volunteer decides

which Pod attends 100-600)

Monday 0900-1100 Man Alive (General Population)

Wednesday 1900-2000 Bible Study (JKF)

Wednesday 2000-21000 Bible Study (KBF)

Thursday 2000-2130 Narcotics Anonymous

Saturday

Substance Misuse (General Population)

RCCC KBF Thursday 1330-1430 ICE Bible Study (Pod 500 Classroom) Thursday 1930-2030 ICE Bible Study (Pod 500 Classroom)

RCCC SBF Sunday Thursday

1200-1500 1300-1400

Bible Study (Custody/Volunteer decides which Pod attends 100-600) Bible Study (Custody/Volunteer decides which Pod attends 100-600)

RCCC SLF

Sunday

0900-1100

Monday 2000-2130

Monday 0900-1100

Tuesday 0900-1100

Tuesday 0900-1100

Tuesday 1900-2030

Tuesday 1200-1500

Tuesday 1200-1500

Wednesday 0900-1100

Bible Study (Sutter Hall) Bible Study (Dining Hall) Thinking for Change HALT (Lecture Hall) Substance Misuse HALT (Sutter Hall 1) Job Readiness HALT (Sutter Hall 2) Alcoholics Anonymous (Dining Hall) CENAPS HALT (Sutter Hall 1) Relapse Prevention (Sutter Hall 2) Woman Alive AB 109 (Lecture Hall)

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Wednesday 2000-2130

Thursday 0900-1100

Thursday 0900-1100

Thursday 0900-1100

Thursday 1200-1500

Thursday 2030-2200

Thursday 1200-1500

Thursday 1200-1500

Friday

0900-1100

Friday

1200-1500

Saturday 0900-1100

Saturday 1200-1500

Alcoholics Anonymous (Dining Hall) Thinking for Change AB 109 (Lecture) Substance Misuse HALT (Sutter Hall 1) Job Readiness HALT (Sutter Hall 2) CENAPS AB109 (Lecture Hall) Bible Study Catholic (Dining Hall) CENAPS HALT (Sutter Hall 1) Relapse Prevention (Sutter Hall 2) Thinking for Change (Sutter Hall 1) Substance Misuse AB109 (Lecture Hall) Bible Study (Sutter Hall 1) Life Skills HALT (Lecture Hall)

RCCC HF

Monday 0900-1100 Monday 0900-1100 Monday 0900-1100 Monday 0900-1100 Monday 1200-1500 Monday 1200-1500 Monday 1200-1500 Monday 1200-1500 Monday 1900-2130 Tuesday 0900-1100 Tuesday 0900-1100 Tuesday 0900-1100 Tuesday 0900-1100 Tuesday 1200-1500 Tuesday 1200-1500 Tuesday 1200-1500 Tuesday 1200-1500 Tuesday 1900-2200 Tuesday 1900-2100 Tuesday 1900-2000 Tuesday 2000-2100 Tuesday 2000-2100 Wednesday 0900-1100 Wednesday 0900-1100 Wednesday 0900-1100 Wednesday 0900-1100 Wednesday 1200-1500 Wednesday 1200-1500 Wednesday 1200-1500 Wednesday 1200-1500 Wednesday 1900-2100

Gang Diversion Quest (B Barracks) Thinking for Change (AB109 HF Library) Life Skills (HF Rec 1) Parenting (HALT HF Rec 2) Job Readiness (AB 109 HF Library) Thinking for Change (HALT HF Rec 1) Man Alive (HF Rec 2) Thinking for Change (HALT Rec Hall) Alcoholics Anonymous (HF Rec Hall) Thinking for Change (QUEST HF) CENAPS (HALT HF Library) Relapse Prevention (HALT HF Rec 1) Parenting (HALT HF Rec 2) Relapse Prevention (HALT HF Library) CENAPS (HALT HF Rec 1) Parenting (HF Rec 2) Substance Misuse (AB109 HF Rec Hall) Bible Study (A Barracks) Bible Study (Rec Hall) Bible Study (J Barracks) Bible Study (K Barracks) Bible Study (B Barracks) Gang Diversion Quest (B Barracks) Man Alive (HF Library) Thinking for Change (HALT HF Rec 1) Parenting (HALT HF Rec 2) Man Alive (QUEST Rec 1) Thinking for Change (HALT HF Library) Thinking for Change (HALT HF Rec 2) Recreation (HF Rec Hall) Celebrate Recovery (HF Rec Hall)

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Thursday Thursday Thursday Thursday Thursday Thursday Thursday Thursday Thursday Thursday Friday Friday Friday Friday Friday Friday Friday Friday Friday Friday Saturday Saturday Saturday Saturday Saturday Saturday Saturday

0900-1100 0900-1100 0900-1100 0900-1100 1200-1500 1200-1500 1200-1500 1200-1500 1200-1500 2000-2200 0900-1100 0900-1100 0900-1100 0900-1100 0900-1100 1200-1500 1200-1500 1200-1500 1200-1500 2000-2130 0900-1100 0900-1100 0900-1100 0900-1100 1200-1500 1200-1500 1200-1500

CENAPS (HALT HF Lecture Room) Job Readiness (QUEST HF Library) Relapse Prevention (HALT (HF Rec 1) Parenting (HALT HF Rec 2) Substance Misuse (HALT HF Lecture) Substance Misuse (HF Rec 1) Job Readiness (HALT HF Library) Parenting (HF Rec 2) Substance Misuse (AB109 Rec Hall) Bible Study Catholic (HF Rec 2) Gang Diversion Quest (B Barracks) Relapse Prevention (HALT HF Library) Substance Misuse (HALT HF Rec 1) CENAPS (HALT HF Rec 2) Job Readiness (HALT HF Rec Hall) Thinking for Change (HALT HF Rec 1) Job Readiness (AB 109 HF Library) CENAPS (QUEST HF Rec 2) Life Skills (HF Rec Hall) Alcoholics Anonymous (HF Rec Hall) Life Skills (HALT HF Rec Room) Life Skills (HALT HF Library) Thinking for Change (QUEST HF Rec 1) Bible Study (HF Rec 2) Substance Misuse QUEST HF Rec1) Thinking for Change (HALT HF Library) CENAPS (AB 109 REC 2)

Showers
The Assessment Team examined the showers in every housing unit and pod. The team found that with the exception of MJ 2 West Medical and 2 East Pod 100, none of the housing units/pods at the MJ maintained shower chairs and grab bars for disabled inmates who may have difficulty standing while talking a shower. The team also found that with the exception of the MHU, M Barracks, JKF Pod 100, KBF Pod 100, and SLF Kinya no other housing unit at RCCC maintained grab bars and shower chairs for disabled inmates who may have difficulty standing while talking a shower. These housing units/pods did not maintain shower hoses or lowered nozzles for disabled inmates to use while seated. The KBF and JKF pods (200-600) did maintain grab bars in the shower, but no other ADA asset or feature was maintained. It was also noted that ADA assets and features maintained in the housing units/pods listed above were not ADA compliant as noted in the accessibility section of this report.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Library
The Assessment Team noted that there is no physical library access as each pod maintains a selection of recreational reading material that is managed by recreation staff. The selection of books varies from pod to pod. Some pods have a larger selection than others (book shelves vs. books scattered around the pod). The selection of books did not contain easy reading or large print books for disabled inmates.
Law Library
The law library is accessible to all disabled inmates. There is a law library in the MJ 8th floor in the multi-purpose room, RCCC RBF facility, and individual terminal access in the CBF, SBF, SLF, KBF and JKF facilities. All law library areas are accessible to disabled inmates.
Visiting
All social visiting at the SCSD detention facilities is non-contact. All visiting areas (social and attorney) on the upper floors (3-8) of the MJ are not accessible to mobility-disabled inmates who cannot ambulate a flight of stairs. The 2nd floor on the MJ (medical floor) does have 2 social visiting booths and 1 attorney-visiting booth; however, the attorney-visiting booth is not accessible for a wheelchair user. The visiting areas (social and attorney) in the CBF and SBF facilities at RCCC are not accessible to mobility-disabled inmates that cannot ambulate a flight of stairs. The visiting areas (social and attorney) are shared by the JKF/KBF facilities at RCCC and are accessible to disabled inmates via elevator access. The visiting areas (social and attorney) in the RCCC booking area and SLF facility are accessible to all inmates with the exception of disabled inmates in a wheelchair. The social visiting area in the RCCC recreation visiting is accessible to all disabled inmates. All visiting phones have volume control capability.
Religious Services
All religious services are accessible to disabled inmates with the exception of the services conducted in the CBF and SBF classroom as this classroom is upstairs with no elevator access for disabled inmates who cannot ambulate a flight of stairs.
Telephones
The Assessment Team observed the telephone process in many of the housing units. There are no phone sign-ups nor is there close monitoring by staff. Inmates in celled housing in a majority of the units alternate dayroom schedules by various groups or tiers. With a lack of close staff oversight or supervision as well as limited time for inmates to participate in dayroom, phone calls, showers, etc., it is likely that some disabled inmates, especially those who have a
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
developmental disability have difficulty utilizing the telephones with equal opportunity and access as non-disabled inmates do.
It is unclear as to whether deaf or hearing-impaired inmates who use the TTY machine are receiving equal access to the TTY services as non-hearing disabled inmates are afforded for regular telephone usage.
Staff Interviews
The Assessment Team interviewed deputies from every housing unit at the MJ and RCCC. The team representatives also interviewed many additional staff members, including chaplains, social workers, and recreation staff who provide program services to inmates housed at the SCSD detention facilities.
One of the deputies assigned to MJ 2/M stated that inmates housed in the unit do not receive access to any programs, e.g., self-help groups, etc. A deputy assigned to MJ 6E admitted that there are almost never any program activities, e.g., education groups in 6E due to “green suits” being temporarily housed in the 6E, and estimates that “green suits” are housed in the 6E classroom about 90 percent of the time, and are “taking over.” He said the average stay is about one week per inmate, and the “green suit” currently housed in the unit has been there for about 2 weeks. He said that education used to be the only program offered, but not any longer.
A deputy assigned to MJ 8W explained that Pod 100 includes TSEP and ADSEG inmates, pod 200 includes TSEP and ADSEG inmates including those that are affiliated “bloods and nortenos”, Pod 300 includes TSEP and ADSEG inmates including those that are affiliated “crips and surenos”, and Pod 400 which are inmates on DD status. The deputy acknowledged that there are inmates in the MH program housed within the different Pods, and stated that there are no programs, e.g., education, self-help, group or individual therapy for mentally disabled inmates, etc., and cited that only a couple of inmates in the past have received their “GED” in the past, but that was because the inmates had begun the program in other housing units prior to being moved to 8W special housing. He further explained that TSEP inmates come out of their assigned cell 1 at a time to dayroom, ADSEG inmates come out 1 cell at a time (with an average of 30 minutes per day), and outdoor exercise yard is usually for about 1 hour, whenever yard may be available, but it is not consistent. He indicated that a lack of MH staffing is a concern.
A deputy assigned to MJ 4E acknowledged that “green suits” are temporarily housed in the 4E classroom about 50 percent of the time, and it negatively effects the academic education classes normally scheduled on Mondays. He said that inmates housed on 4E as well as other floors are assigned, but the classes are usually cancelled. The deputy cited a lack of custody staff, and that deputy sick calls often go un-filled.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
A deputy assigned to MJ 2/M indicated that custody staffing is a problem and to some degree can contribute to a lack of program on occasion. He provided that one of the two assigned medical deputies must also cover 2E. He said there is not sufficient staffing, and he must often provide additional duties, such monitoring as pill call, conducting hourly cell checks, conducting AM and PM counts, respond to “man-down” calls, respond to mutual combats (fights), provide inmate escorts, deal with inmate visits, etc.;
A deputy assigned to RCCC CBF indicated that the unit houses ROC, OPP, GP, TSEP, DD, and ICE inmates. He indicated that there are no programs for OPP, TSEP, or DD on the PM shift (other than some of the pods having 1 hour of nightly dayroom, and dayroom on the morning shift), but there is plenty of program time and numerous programs for inmates assigned to the ROC program. The deputy was unsure as to any program (other than dayroom) on the morning shift. He did mention that each pod has outdoor yard about once per week.
Recreation Services
The following information was obtained from recreation staff. Recreation staff are responsible for managing the recreational reading materials for inmates. The books are donated to the county. About once a month the recreation staff distribute the books to the pods/housing units. Inmates can request specific books (easy read and large print) by submitting a KITE. If they have these books in stock, staff will deliver the books to the inmates. Recreation staff is also responsible for the management and delivery of recreation activities to the inmates. This includes puzzles, word search, board games and cards. These items are delivered about every other month. The books and other recreation material are delivered to the pod/unit “houseman” who in turn distributes to the unit/pod. Recreation staff stated that inmates are advised of programs and services available in the inmate handbook.
Religious Services
The following information was obtained via chaplain interviews regarding religious services for the MJ and RCCC. Religious services are either a bible study in a classroom setting or 1-on-1 with an inmate. Religious material is also delivered to the pods/housing units 3 times per week. Religious services available to the MJ 2nd floor are limited to 1-on-1’s or distribution of religious material. If an inmate requests a large print bible, the chaplain will try to provide it if it is available. The chaplain at RCCC stated that when bible studies are provided in the high security housing units (SBF and CBF) the housing deputy decides what pod attends from the unit pods, as certain pods cannot mix. KITE’s from inmates requesting a 1-on-1 or religious material are parceled out to the chaplaincy volunteers.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Social Services
There are a total of 4 social workers assigned to the SCSD detention facilities (2 at the MJ and 2 at RCCC). The social workers provide social services by providing inmates with information on social services available to inmates in and out of custody. Also provided are reentry services, notary services, grief counseling, and requests for reading glasses. The social workers stated that inmates are advised of the social workers services available to them in the inmate handbook or as they are seen walking around. The social workers also coordinate the Narcotics and Alcoholic Anonymous programs at the SCSD detention facilities. The social workers also coordinate the assessment of intellectually disabled inmates thorough the Alta Regional Center.
Inmate Interviews
As mentioned above, the Assessment Team interviewed numerous inmates from all housing units throughout the MJ and RCCC. Inmates interviewed included those with the following disabilities or conditions (or suspected disabilities or conditions): mental illness; developmental, learning, mobility, vision, speech, and deaf/hearing disabilities; and those with epilepsy, diabetes, hypertension, memory disorders, as well as other disabilities and conditions.
Although many of the inmates interviewed provided positive feedback regarding staff, programs, services and activities, a number of them also gave negative feedback regarding these and other subject areas. This section of the report primarily captures the concerns levied, many of which have been corroborated throughout this report based on policy and other document reviews, staff interviews, and the Assessment Team observations, while other allegations or claims could not be substantiated. The following outlines information received during interviews as related to religious services, recreational reading, showers etc.
Four inmates who were interviewed had a body odor (during the interviews) consistent with not having showered recently, and appeared to be dirty and unkempt in their jail attire. Two of these inmates have a mental illness, and the other two inmates are likely developmentally disabled. During the Assessment Team interview, these inmates showed signs of possible cognitive deficits and admitted issues with what the Assessment Team representative understood to be adaptive support deficits. Based on their appearance, their body odor, and their responses to some of the questions asked of them during the interviews, it appears that housing unit staff are sometimes helpful to them, but staff are unaware of their disability status and accommodation needs, and are not being proactive to monitor them and provide the hygiene and other prompts as necessary. Some of their responses included the following information and additional concerns: the inmates acknowledged needing help with cleaning their cell and reminders for hygiene, e.g., brushing teeth, and showering. Although some inmates stated that other inmates provide assistance, there are some
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
concerns with this. Utilizing the inmate “houseman” does not relieve staff of their responsibilities to provide monitoring, assistance and prompting to developmentally disabled inmates. Another key concern is that many developmentally disabled inmates are subject to victimization and vulnerability. Having other inmates have responsibility over issues (with regard to a developmentally disabled inmate) could be problematic. At a minimum, staff must monitor these inmates very closely, or staff must assume this responsibility with this inmate population. In general, many disabled inmates, including OPP and numerous others, complained about an overall lack of programming activities available to them.
A few specific interviews yielded the following information:
 RCCC KBF – Intellectually disabled inmate with prior use of Alta Regional Services stated he doesn’t remember to get his laundry.
 RCCC SLF – Inmate with possible intellectual disability claims she requires diapers for incontinence and medical staff will not provide them, when she soils her clothes she can’t get clean clothes.
 RCCC SLF – Inmate with intellectual disability claims that she forgets to shower.
 MJ 2 West M - This inmate is a permanent wheelchair user, and complained that there is no program activities offered to medical inpatients, e.g., self-help or education.
 MJ 3E Inmate - He also complained that there are no program opportunities (e.g., self-help groups or education or jobs) for OPP inmates (who constitute approximately half of one pod), and only the PC inmates (who make-up the other half of the pod) have these opportunities.
Showers
Numerous inmates with more severe mobility disabilities housed throughout the MJ and RCCC stated that they need a shower chair to stabilize themselves in the showers, however shower chairs are not available in the housing units. Inmates also claim that it is difficult to step over the shower threshold/barrier. Some inmates state they must use the wall to support themselves as they shower as there is no shower chair available. Four inmates stated that they have fallen in the shower as a result of not having a shower chair available to use.
A common issue in housing units that house multiple classification levels is that inmates are often times relegated to choosing between either taking a shower or, making a phone call during their dayroom time. This is due to alternate tier rotations or multiple designated dayroom groups within the units. Many inmates complained that there normally isn’t adequate time to do both. The dayroom schedule often varies and are not consistent, and the telephones are not closely monitored, e.g., sign-up process, and limited time usage.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Library Services Inmates stated that the books that are available in the pods/housing units are very scarce. The inmates also claim that there are no easy reading or large print books available in the pods/housing units.
Conclusion There are significant flaws in the processes as well as discrimination with regard to equitable programming for disabled inmates. To ensure nondiscrimination under the ADA, the SCSD detention facilities must ensure that disabled inmates receive equivalent programming, e.g., access to library materials, accessible visiting areas and equal access to religious services.
The SCSD detention facilities do not provide equal access to recreational reading material for disabled inmates. There is limited access to easy reading and large print books for disabled inmates who require these accommodations.
The SCSD detention facilities do not provide equal access to religious programing for disabled inmates. Disabled inmates housed in the medical unit at the MJ are not being afforded equal access to religious services as inmates housed in other areas of the MJ.
The SCSD detention facilities do not provide equal access to visiting or attorney visiting for disabled inmates. Disabled inmates not housed on the medical floor at the MJ must ambulate a flight of stairs to participate in social and attorney visits, which is difficult for them based on their disability.
The SCSD detention facilities do not provide equal access to showers for disabled inmates. There are no shower chairs and shower hoses available for disabled inmates that require these accommodations for their disability.
The SCSD detention facilities have a draft policy for staff to assist disabled inmates with reading or scribing documents; however, this policy has not been placed into practice.
The SCSD detention facilities do not have a policy or required practice for staff to provide coaching, assistance, monitoring, and prompting of disabled inmates so that they can complete work tasks or participate in other activities, services, and programs.
The SCSD detention facilities do not have a policy or practice for facility staff to interview speech and deaf/hearing-impaired inmates upon arrival to the jail or housing unit, or after being identified with a speech or hearing disability, to determine the inmate’s preferred method of communication.
Based on the lack of an effective tracking system for qualified disabled inmates SCSD detention facilities staff do not have the capability to know what
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
accommodations disabled inmates require to access program, services and activities.
There is no established inmate orientation provided to inmates advising them of services available to them (social services and recreation). The absence of an orientation process is problematic for many disabled inmates (whether they have been identified or not through disability evaluation/screening processes). For disabled inmates (e.g., those with vision, learning and developmental disabilities) where communication, understanding, or advocacy are of concern, it is important they receive necessary information that would enable them to know what services are available, to know how to seek assistance, and to learn what accommodations they may have access to.
Most of the housing deputies and non-custody staff who were interviewed appeared to work very diligently in their assigned positions and have an interest in obtaining as much knowledge as possible to perform their job duties effectively. However, some of the staff interviewed admitted that they don’t know who their disabled inmate population is. Some of the staff believe they do know who the disabled inmates are based on the information contained in the JIMS and on locator cards. Even the staff who believe they know who their disabled inmates are often admitted that they do not always know what type of reasonable accommodations are required or what should be provided. Although speech and deaf/hearing-impaired inmates may be screened and identified during the intake/booking process, health care, classification or other custody staff do not interview these inmates to determine their primary or preferred method of communication (for EC concerns). This is not done at the time of intake/booking, classification, housing, or at any other time either upon or after arrival.
In response to the Assessment Team’s questions, many staff members interviewed stated that they would help (and have assisted) inmates with reading documents or materials, if they (staff) were asked. Few staff acknowledged being proactive to approach inmates who may need assistance and providing or offering such help. The Assessment Team specifically asked about providing assistance with commissary (e.g., filling out commissary slips, explaining commissary processes, and helping to inventory received commissary items). Very few have done this, but many said they would if they were asked. Nearly all staff interviewed were unaware of adaptive support needs for intellectually disabled inmates. When asked, custody and non-custody work supervisors were also largely unaware of inmates who may need special assistance while performing their work duties. Staff were largely unaware of the need to provide coaching, assisting, monitoring and prompting (to intellectual disabled inmates) to effectively complete work assignments as necessary.
As stated throughout this report, the Assessment Team has strong concerns as the SCSD detention facilities do not have a comprehensive testing/evaluation/screening process to effectively identify inmates with
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
disabilities, such as those with intellectual and learning disabilities. As a result, custody and non-custody staff are not fully aware of disabled inmates assigned to their housing or work areas. There are obvious exceptions to this as disabilityrelated information is noted on some of the locator cards and the JIMS for disabled inmates, etc., as well as those who reside in OPP designated housing.
References
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
(iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State. 28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections— (i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities. 28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered. The information below is for reference only. As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following with regard to mobility-disabled inmates (and inmates with other disabilities):  Reasonable accommodations shall be afforded inmates with disabilities
(e.g., mobility disabilities) to facilitate their full participation in visiting as provided in these rules, whether contact, noncontact, or family visiting.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Access to Education, Vocation, Reentry and Substance Abuse Programs
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to inmate access to education programs, in custody reentry programs, are: Operations Order 08/04 Educational Services, Draft Operations Order Inmates with Disabilities - ADA, and 1107 Decision Making-Special Needs.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1061 Inmate Education Plan requires that:
The facility administrator of any Type II or III facility shall plan and shall request of appropriate public officials an inmate education program. When such services are not made available by the appropriate public officials, then the facility administrator shall develop and implement an education program with available resources. Such a plan shall provide for the voluntary academic and/or vocational education of both sentenced and non-sentenced inmates. Reasonable criteria for eligibility shall be established, and an inmate may be excluded or removed from any class based on sound security practices or failure to abide by facility rules and regulations.
Per Operations Order, 08/04 Educational Services, the MJ and RCCC, through the Elk Grove Unified School District (EGUSD), provide a variety of voluntary educational programs in an attempt to equip inmates for productive reentry into the community. The EGUSD has the responsibility of ensuring that programs conform to statutory mandates and professional standards.
Eligible inmates housed in general population or minimum-security housing units will be allowed to participate in educational programs, except those who fail to abide by facility rules or pose a security threat. For these inmates, instruction may be given on an individual basis. Inmates must have a minimum of sixty days remaining in their sentence to be considered for the Education Program. If classes are full, an inmate’s name will be added to the waiting list. The availability of classes offered is dependent upon the resources of Elk Grove Adult Education and the constraints of a particular housing location. Inmates shall request educational services by submitting a KITE to Adult Education. It is the responsibility of a teacher to contact the inmate either personally on a regularly scheduled visit of the housing location or via an “Inmate Message Request” informing the inmate of when the class meets. Participation in educational programs is voluntary with the exception of a student’s literacy level as determined by the Comprehensive Adult Student Assessment System (CASAS). Inmates who are assigned jobs that are part of the vocational education program, are eligible to have their work time certified by the education department. A certificate is issued attesting to the time and skills acquired in that field while the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
inmate was incarcerated. The Adult Education Department must be notified by the inmate at least two (2) weeks prior to his/her release date in order to obtain the certificate.
The EGUSD provides a variety of educational programs geared to the needs of the inmates. Programs may include, but are not limited to:
 Vocational programs  GED preparation program  Adult basic education  Literacy training  Substance abuse and self-awareness classes  Parenting  Employability courses
A pilot program “Read Out Program” is a joint venture between the EGUSD, the Sacramento Municipal and Superior Courts, and the Sacramento Sheriff’s Department. The “Read Out” program allows for time credits of up to twenty (20) days for sentenced inmates who successfully complete a course of education while at a Sacramento County Sheriff’s Department Correctional Facility. All interested inmates must meet the following minimum qualifications to be accepted into this program:
 Have thirty or more days remaining on their sentence.  Must be serving time on a mandatory minimum term of confinement
required by law.
The EGUSD Education Department will be responsible for the enrollment of students into the program. Student inmates may earn early release within the following rules:
 In order to encourage individuals to improve their academic abilities and to provide an educational incentive to those who cannot be adequately represented in paragraphs VIII (1) and (2), an inmate will be given one day off of a sentence for every fifteen (15) hours of active participation and progress in an approved education course, up to two (2) days a calendar month.
 A student inmate is able to earn up to ten (10) days off his/her sentence if he/she passes the five sections of the GED test.  A student inmate must positively participate in and successfully complete at least seventy-five (75) hours of classroom work in adult education to be eligible.  Inmates housed at the Sandra Larson Facility may satisfy the requirement with forty-five (45) hours of participation in classroom work subject to the approval of education staff.  Student inmates diagnosed as functionally illiterate (with a reading level below the fourth grade) will be eligible to earn two (2) days off
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
their sentence for each grade level of progress that they demonstrate in reading. This is limited to five (5) days of earned time credits.  Upon notification of successful completion of the program, booking personnel will again ensure that the inmate meets the minimum eligibility requirements.  For those inmates who qualify, booking records staff will adjust the inmate’s release date in the JIMS computer system and notify the inmate of the time credited and of the new release date. All completed forms will be signed by the booking officer and placed in the inmate’s file.  The Education Department will have the responsibility of maintaining careful and certified records of educational achievement, which will be contemporaneously logged and preserved for the length of each student inmate’s custody and probation period.  Time earned off any sentence must be used exclusively for the particular student inmate’s current Sacramento County sentence.  Once the inmate is released from custody remaining time will not be “banked” or “stored.”  An inmate’s new sentence based on a probation violation on the same case or any sentence on a new and different case will begin with zero in-custody literacy and education incentive program credits.
Per Draft Operations Order Inmates with Disabilities - ADA, the programs and services offered within the Sacramento County Sheriff’s Department detention facilities shall be accessible to all inmates. Provisions shall be made to ensure that all services, programs, and activities are readily accessible to and usable by individuals with disabilities. Inmates shall have equal access to educational services within the Sacramento County Detention Facilities. The ADA Coordinator will make arrangements to accommodate special educational needs unless access to these services prevents safe operation of the programs or activities. Eligibility requirements shall not be imposed that eliminate or tend to eliminate inmates with disabilities, unless it can be shown that such requirements are necessary for the provision of the service. Inmates who volunteer for, or are required to participate in, the drug education course and who experience learning disabilities must be provided a reasonable accommodation toward completion of the course, including an alternate means of testing. All program offerings shall be located in areas that are accessible to all inmates regardless of ability. For inmates with an inability to read or write, the ADA Coordinator will ensure reasonable accommodations are made for inmates who are illiterate or who are physically incapable of reading or writing, which may include, but is not limited to, enlarged print materials, identification of desired materials, and assistance in reading and scribing forms.
Per policy 1107, Decision Making-Special Needs, consultation between the Facility Commander and the Medical Director is required for actions regarding
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

patients who are diagnosed as having significant medical or mental health disorders, as follows:
 Housing assignments.  Program assignments.  Disciplinary measures.  Admissions to and transfers from institutions.
Maximum cooperation between custody personnel and health care providers is essential so that both groups are made aware of movements and decisions regarding patients with special medical or psychiatric needs. For example, health care staff must inform custody personnel when an inmate is suicidal, homicidal, or inappropriately housed in the jail for health care reasons. An inmate’s special needs may complicate housing or work assignments or disciplinary management. Medications may need to be adjusted for safety at the work assignment or before transfer.
Programs Overview

Main Jail Educational Programs:
High School Equivalency preparation covers math, English language arts (ELA), social science and science content assessed by the HiSET examination. Participants take practice tests and prepare to take the five-part exam. Participants take the official HiSET exams onsite once they have passed the practice tests.

2-East 2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Only Offered 1 on 1 with 3 slots available Not Offered PC Pods 100/200 Not offered on Pod 300 (OPP) Not Offered PC Pods 100/200/300 GP Pods 100/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 TSEP/ADSG/MED/7 East PC 1 on 1 with 3 slots only GP Pods 100/200 Only Offered 1 on 1 with 3 slots available Only Offered 1 on 1 with 3 slots available

Adult Basic Education (ABE)
Designed to develop skills to an eighth grade level, this course is offered to help participants improve in the areas of reading, writing, and mathematics. Length of program varies based on testing scores.

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2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered PC Pods 100/200 Not offered on Pod 300 (OPP) Not Offered PC Pods 100/200/300 GP Pods 100/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 TSEP/ADSG/MED/7 East PC 1 on 1 with 3 slots only GP Pods 100/200 Only Offered 1 on 1 with 3 slots available Only Offered 1 on 1 with 3 slots available

English as a Second Language (ESL)
This course teaches English to participants whose primary language is not English. Length of program varies based on testing scores.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered PC Pods 100/200 Not offered on Pod 300 (OPP) Not Offered PC Pods 100/200/300 GP Pods 100/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 GP Pods 100/200/300 TSEP/ADSG/MED/7 East PC 1 on 1 with 3 slots only GP Pods 100/200 Only Offered 1 on 1 with 3 slots available Only Offered 1 on 1 with 3 slots available

There are only a total of 3 slots available for inmates housed in 2-East, 7-East, 8East and 8-West.

Main Jail Substance Abuse Self Help Programs:

Substance Misuse/Abuse
The goal of this course is to educate participants in the biological, psychological, and social issues of addiction and chemical dependency and introduce them to appropriate options for recovery. Program is 12 sessions. Alcohol Anonymous, Cocaine Anonymous, Narcotic Anonymous, Substance Abuse

2-West 3-East

Not Offered Not Offered

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Pods 100/200 Not offered on Pod 300 (OPP) Not Offered GP Pods 100/300 Not Offered Not Offered Not Offered Not Offered Pod 100 GP Pods 100/200 Not Offered Not Offered

Life Skills
A weekly class teaching men a variety of topics including goals, relationship skills, self-image, healthy eating, etc.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered Not Offered Not Offered Not Offered GP Pods 100/300 Not Offered Not Offered Not Offered Not Offered Not Offered GP Pods 100/200 Not Offered Not Offered

Man Alive/Woman Alive
The MJ partners with a Sacramento County Certified Batterers Treatment provider to offer participants the strategies needed to stop their pattern of violent behavior and be accountable to themselves, their families, and their community. Program is 52 hours.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East

Not Offered Not Offered Not Offered Not Offered GP Pods 100/300 Not Offered Not Offered Not Offered

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

6-West 7-East 7-West 8-East 8-West

Not Offered Not Offered GP Pods 100/200 Not Offered Not Offered

Parent Education (CPS approved)
This program exposes participants to how negative and hurtful parenting affects the psychological and physical development of children. Participants learn ways to create a healthy family environment through nurturing behavior practices. Parent Education Certificate is 60 hours.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered GP Pods 100/200 Not Offered Not Offered

Book Club
A Biweekly group for women to read and discuss books of a variety of genres including Forgiveness, Gratitude, Resilience, and Family.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered GP Pods 100/200 Not Offered Not Offered

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Self Esteem Weekly 10 course class addressing awareness, choices, and change for Women.

2-West 3-East 3-West 4-East 4-West 5-East 5-West 6-East 6-West 7-East 7-West 8-East 8-West

Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered Not Offered GP Pods 100/200 Not Offered Not Offered

RCCC Educational Programs:
High School Equivalency preparation covers math, English language arts (ELA), social science and science content assessed by the HiSET examination. Participants take practice tests and prepare to take the five-part exam. Participants take the official HiSET exams onsite once they have passed the practice tests.
Adult Basic Education (ABE)
Designed to develop skills to an eighth grade level, this course is offered to help participants improve in the areas of reading, writing, and mathematics. Length of program varies based on testing scores.
English as a Second Language (ESL)
This course teaches English to participants whose primary language is not English. Length of program varies based on testing scores.
Parent Education (CPS approved)
This program exposes participants to how negative and hurtful parenting affects the psychological and physical development of children. Participants learn ways to create a healthy family environment through nurturing behavior practices. Parent Education Certificate is 60 hours.
Computers
Participants learn office computer skills relevant to the current job market including Microsoft applications such as Word, Excel, and PowerPoint. Filing procedures, telephone communications, and document duplication are also covered. Computer Application certificate is 150 hours.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Computer Aided Design/SolidWorks
Participants will apply their knowledge of fundamental engineering and design principles and practices to review SolidWorks concepts. Additionally, students will have prepared industry-related projects designated by the instructors. They will be prepared for entry-level jobs in the mechanical drafting field. The CAD/SolidWorks certificate is 240 hours.
Read Out
Read Out is an educational incentive for students. Students can earn time off of a non-mandated sentence for active participation in class(es). Read Out is tied to good attendance.
Transition Assistance
Elk Grove Adult and Community Education (“EGACE”) offers a transition program to students exiting the MJ and RCCC. Upon release, students can schedule to meet with a transition specialist at EGACE on Gerber Road. The transition specialist can help students develop an education and work plan, enroll in academic or training classes at EGACE, transfer to college, or transfer to work. GED Test Preparation students who have taken and passed one exam while at the MJ or RCCC may transfer to EGACE to complete the GED Test Preparation and Testing.
 Inmates housed in JKF/KBF can participate in the following education programs ESL/HiSET/ABE.
 Inmates housed in CBF are not offered education programs.  Inmates housed in SBF can participate in ESL/HiSET/ABE.  Inmates housed in SLF (Female) can participate in ESL/HiSET/ABE, and
Computers.  Inmates housed in Barracks A, J, and K are not offered education
programs based on pre-sentenced status.  Inmates housed in Barracks B, C, D, G, H, and M can participate in all
educational programs.
RCCC Reentry Services:
Reentry services are provided to sentenced offenders. These services provide evidence-based vocational, educational, and treatment programs. The goal is to reduce the rate of incarceration and to offer offenders the tools necessary for successful reintegration into the community. Inmates with over 60 days to serve will be assessed to determine the track they will be placed on. These tracks include: vocational, treatment and education. If an inmate is placed on the reentry services track a reentry specialist will meet with him/her to complete an individualized assessment and create a reentry plan. A reentry plan may include cognitive behavioral groups, substance abuse classes, employment classes,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
education, vocational training programs, and family reintegration. Post-release services may be available to those inmates who participate in reentry services. Post-release services may include supportive services based on individual needs, and eligibility is determined during an inmate’s participation in the reentry program.
 Inmates housed in JKF/KBF are not offered reentry programs.  Inmates housed in CBF are not offered reentry programs.  Inmates housed in SBF are not offered reentry programs.  Inmates housed in SLF (Female) can participate in reentry programs.  Inmates housed in Barracks A, J, and K are not offered reentry programs
based on pre-sentenced status.  Inmates housed in Barracks B, C, D, G, H, and M can participate in all
reentry programs.
RCCC Vocational Programs:
Culinary Arts
Participants learn core culinary skills and are provided with basic training that enables them to get employment in the food service industry. Participants also receive an industry-recognized certificate upon completion. Program length for Cook Assistant and Cook Training Certificate is 170 Hours and Cake Decorating is 8 weeks.
Employment Readiness and Life Skills
Participants are taught strategies for employment success including the development of a resumé, interview practice, and how to dress and present oneself in a professional setting. The Reentry Services Bureau has one Reentry Specialist specifically dedicated to the area of Employment Readiness and Life Skills. Employment partnerships in Sacramento, Elk Grove, and other surrounding areas have been, and are continuing to be, established and job placements are occurring. Life skills is 18 sessions.
Custodial Training
Participants learn basic procedures in custodial and housekeeping operations to include knowledge of janitorial equipment, basic repairs, cleaning materials, safety along with blood-borne pathogens and infectious waste training. The goal of the course is that upon completion participants are prepared for custodial employment. Custodial Certificate is 150 hours.
Horticulture and Landscaping
Participants are exposed to different techniques of propagation and irrigation with an emphasis on environmental horticulture and landscape maintenance. Upon completion, participants will have been given the knowledge, practical skills, and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
training necessary to successfully attain employment in the nursery and landscaping industry. Introduction to Ornamental Horticulture is 435 hours.
Welding
The welding program is a three-step program designed to provide participants with knowledge of welding and manufacturing. Participants complete this program in a shop environment to gain an understanding of shop safety, welding, and metal manufacturing. When participants complete the welding program, they will have all of the necessary skills to gain employment in the welding and manufacturing field. The program offers three levels: a Beginning Class, an Advanced Class, and an Apprenticeship. Participants are eligible to test to receive an American Welding Society Welding Certification. Those who complete the Advanced Class are eligible to receive two college credits from Cosumnes River College and are eligible to apply for the Apprenticeship Program. The program is accredited by the California’s Division of Apprenticeship Standards. Participants at this level receive apprenticeship hours for the time spent working on projects in the shop. Participants can continue their apprenticeship when they leave the facility. Beginning Certificate is 240 hours and Advanced Welding is an additional 240 hours.
Northern California Construction Training (NCCT)
NCCT offers a building trade pre-apprenticeship program at the Rio Cosumnes Correctional Center. Participants learn through classroom material and beginning hands-on trade skills. Upon release, the participants can continue the preapprenticeship program with NCCT’s community-based program.
Sacramento Wild Horse Program
In partnership with the Bureau of Land Management, Rio Cosumnes Correctional Center offers participants the opportunity to train and maintain the well-being of wild horses. The program has 6 levels of instruction to teach participants basic horsemanship, equipment, gentling techniques, feeding, care and horse anatomy. Certificates are awarded upon successful completion of each domain.
Engraving/Print Shop
Participants learn how to operate and properly service 3D printers, large format printers, laser engravers, and binding machines while learning various design software including Adobe Photoshop, Adobe Illustrator, Adobe InDesign, and Solid Works. Inmates who successfully complete the training are awarded a certificate of completion that outlines the level of competency they have achieved. Length of program varies.
 Inmates housed in JKF/KBF are not offered vocational programs.  Inmates housed in CBF are not offered vocational programs.  Inmates housed in SBF are not offered vocational programs.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmates housed in SLF (Female) can participate in vocational programs.  Inmates housed in Barracks A, J, and K are not offered vocational
programs based on pre-sentenced status.  Inmates housed in Barracks B, C, D, G, H, and M can participate in all
vocational programs offered at RCCC.
Substance Abuse Treatment RCCC:
Housing for Accountable Living Transitions/Residential Substance Abuse Treatment (HALT/RSAT)
HALT/RSAT provides substance abuse treatment and reentry service to inmates and supports their transition back into the community. This program provides substance abuse treatment and education, assisting the offender in changing learned behaviors while offering him or her the tools to become a productive member of the community. Participants receive individual needs assessments and assistance with aftercare services for up to one year after they are released from custody. Participants receive a program certificate upon successful completion and time off their sentence for education hours when eligible. Program is 200 hours for low offenders and 300 for medium to high offenders.
Substance Misuse
The goal of this course is to educate participants in the biological, psychological, and social issues of addiction and chemical dependency and introduce them to appropriate options for recovery. Program is 12 sessions.
Denial Management
The goal of this course is to help participants recognize their denial patterns and to overcome them. Program completion is dependent on workbook completion.
Relapse Prevention
This course focuses on the thinking process that leads to relapse and understanding the belief system that can lead to prevention. Program completion is dependent on workbook completion.
Man Alive/Woman Alive
Rio Cosumnes Correctional Center partners with a Sacramento County Certified Batterers Treatment provider to offer participants the strategies needed to stop their pattern of violent behavior and be accountable to themselves, their families, and their community. Program is 52 hours.
Thinking for Change
This cognitive behavioral course teaches social skills, cognitive self-change and problem solving strategies. It is designed to help participants set personal and professional goals. Certificate is based on 27 sessions.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Moral Reconation Therapy
A cognitive behavioral course aiming to decrease recidivism rates through lessons focused on criminal thought and the treatment of substance abuse. Program ranges from 24-36 hours.
 Inmates housed in JKF/KBF are offered Man Alive, Substance Misuse and Narcotic Anonymous.
 Inmates housed in CBF are not offered substance abuse programs.  Inmates housed in SBF are not offered substance abuse programs.  Inmates housed in SLF (Female) can participate in substance abuse
programs.  Inmates housed in Barracks A, J, and K are not offered substance abuse
programs based on pre-sentenced status.  Inmates housed in Barracks B, C, D, G, H, and M can participate in all
vocational programs offered at RCCC.
QUEST
The QUEST Program is the in-custody gang diversion program. QUEST (Question, Understand, Evaluate, Succeed, Transform) contains an evidencebased curriculum which uses behavioral therapy principles, training and success principles. All participants must be documented gang members or gang associates. All participants are housed together in a joint QUEST / HALT barrack, separate from non-program inmates. This therapeutic housing environment allows participants to focus on their programming and development.
Incarcerated Men’s Accountability Program (IMAP):
Incarcerated Men’s Accountability Program is a specialized housing unit for offenders seeking substance abuse, batterer’s intervention and accountability awareness. The IMAP is not a treatment program, nor does the unit expect to produce, by itself, a profound change in the offender. The program does seek to raise the offender’s awareness and provide direction and support for change during the time an inmate is incarcerated after his/her initial arrest.
 Inmates housed in J Barracks can participate in IMAP and Quest.
Observations
The Assessment Team noted during the on-site assessment that on a regular basis the multi-purpose room where programs are conducted was regularly occupied by an inmate on 15-minute checks. Based on this the program scheduled would have to be re-located to another area or in most cases canceled due. Staff indicated that the placing of inmates in the multi purpose rooms occurs frequently and as a result programs are cancelled.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Staff Interviews
The Assessment Team interviewed staff assigned to the reentry programs, EGUSD, and program providers. Staff stated that there is no system that would alert the programs unit of an inmate’s disability. Staff stated they could identify an inmate with a physical disability by sight and an inmate with either a learning disability or developmental disability by interacting with the inmate (writing assignments). In some cases the inmate may self-identify the disability. The only mechanism that may alert education staff to an inmates learning or intellectual disability would be when the inmate is given the CASAS exam. However, the EGUSD does not share this information with custody staff. The EGUSD staff and the program providers all indicated that inmates with disabilities would be accommodated in the classrooms once the instructor was advised of the disabled inmate’s specific needs i.e. allowed to stand, restroom breaks etc. The EGUSD, reentry unit, and program providers do not have a tracking system to identify disabled inmates; therefore, the Assessment Team could not determine how many disabled inmates have been assigned or are currently assigned to an education, reentry, vocation and substance abuse program. EGUSD staff stated that OPP inmates cannot attend education classes as they are screened out by classification. In addition, for inmates classified as TSEP or ADSEG and those housed on 2-East there are only 3 slots available. Accommodations for vision-impaired inmates are limited to provision of reading glasses following the reading glasses policy and in some cases enlarging the educational material to a larger font including on a computer screen. In cases where an inmate requires prescription glasses, the inmate’s family is contacted to see if they can provide the glasses. There are no other assistive devices (large print, magnifiers, Galileo machines etc.) provided for vision-impaired inmates. In some cases, the teachers stated that they would read the material to the inmate. For hearing-impaired inmates, the only accommodations that the programs can provide is headphones for the computer classes or allowing the inmates to move closer to the instructor during program time when there is no SLI available and/or provided. An EGUSD teacher stated that there is a deaf inmate assigned to his program, and communication is achieved with written notes.
There are no pull out sessions or teacher’s assistants for inmates who are learning or intellectually disabled. Individual Education Plans (IEPs) are not followed and individual teachers make accommodations on a case-by-case basis. Accommodations that are made include pairing an inmate with another student, and providing one-on-one instruction if time allows. The teachers stated that they would repeat and rephrase the material/lesson in cases where an inmate required accommodations to understand the lesson being presented.
Staff stated that at the MJ inmates are advised of the education and self-help programs via the Inmates Rulebook. Staff also stated that inmates become aware of the programs via other inmates. At RCCC, staff stated that inmates become aware of educational, reentry and substance abuse/self help programs
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via the inmate handbook and also by word of mouth. The EGUSD staff stated that a weekly orientation is provided based on inmate sign-up/request. Orientation sign-up sheets are delivered to every housing unit/barrack on a weekly basis. The EGUSD staff schedule the inmates for an orientation where staff explain to them the programs that are available. In addition, inmates take the CASAS placement exam and program eligibility is based on their score. If inmates do not receive a score making them eligible for a program, they are enrolled in ABE/ESL in an effort to improve their score.
Staff stated that EGUSD does not test all inmates to identify their reading level. However, for inmates requesting assignment to an EGUSD program, the CASAS test, which is a Life Skills Literacy Test, can be used to identify literacy concerns. In the event information becomes available that an inmate was in special education classes and had an IEP in the community, EGUSD is compelled to follow the IEP. The EGUSD staff stated that they do not receive formal ADA or EC training.
Inmate Interviews
During the inmate interviews, most inmates housed in locations where education, vocation, reentry and substance abuse programs are not offered stated they are not aware of programs are offered or what types of programs are offered. Most inmates stated that they become aware of the programs available from other inmates as staff does not provide orientation and in some cases inmates are not provided with the Inmate/Detainee Handbook. Most inmates stated they would participate in the programs if they were offered. Inmates housed in the OPP pods and in the medical housing unit at the MJ stated that there is no program availability for them and they would participate if they were offered.
Many inmates assigned to housing on nearly all floors (MJ) indicated that psychiatric inmate-patients on suicide precaution status (“green suits”) are often housed in the multi-purpose/classroom areas within the floors/units (for as much as three weeks at a time), and as a result, academic classes are often cancelled.
Conclusions
Housing the MJ disabled inmates with wheelchairs, walkers, crutches etc. who require accommodations (grab bars, showers chairs etc.) or those that cannot ambulate up stairs or over the shower lip in 2-East Male Sub-Acute housing units is a violation of the ADA. The only program available to disabled inmates housed in 2-East are ESL/ABE/GED. If the inmates were housed in units consistent with their security and classification level, they would have access to the programs available to all other inmates of the same level housed in the MJ. This violates 28 CFR § 35.152 (b)(1) of the Title II Regulations.
Inmates housed in OPP units are being screened out by classification staff and are not able to participate in education, reentry, and substance abuse programs
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in the MJ. At RCCC the inmates housed in the OPP are not being provided program opportunities available to non-disabled inmates with similar custody and classification factors. This is in violation of 28 CFR § 35.152 (b)(1) of the Title II regulations.
Disabled inmates are not uniformly advised of educational, reentry and substance abuse self help programs available to them. Although information is contained in the Inmate/Detainee Handbook, this information is not being effectively communicated to disabled inmates. Inmates who are vision, learning or developmentally disabled are not being advised of program availability by staff and must therefore rely on information being provided from other inmates. Although a SCSD detention facilities operations order states that inmates are provided notice via the inmate rulebook given to arriving inmates and verbal orientation of programs offered and available to inmates while in custody, orientation is not being provided, in addition, many vision impaired, learning disabled and developmentally disabled inmates cannot read. Therefore, these disabled inmates are unaware of the programs available and how to access the programs. Inmates must submit a Message Request Form requesting services; however, these disabled inmates cannot complete the Message Request Form since they cannot read or write.
The SCSD detention facilities must ensure disabled inmates are equally afforded the ability to be assigned to educational, vocational, reentry and substance abuse programs.
Based on the lack of an effective tracking system for qualified disabled inmates SCSD detention facilities staff do not have the capability to notify the EGUSD, reentry, vocation, and substance abuse providers/staff of inmates that require accommodations to access programs, services and activities.
Inmates who are hearing impaired and require an SLI as their primary method of communication are being denied this accommodation. The EGUSD does not have a contract in place to provide SLI services for deaf inmates who participate in education and vocational services provided by EGUSD, which is a requirement of ADA.
Inmates with vision disabilities are not being provided the necessary accommodations to participate in the programs. In some cases no accommodations are being provided, as not all inmates who require reading glasses are being provided this accommodation.
There is no testing process in place to identify inmates who cannot read and write or who have potential learning disabilities and may require accommodations during their assigned program.
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Reference
28 CFR§ 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State.
28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections—
(i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or
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(ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities.
28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis (now Armstrong v. Brown) amended January 3, 2001, mandates the following (for mobility-disabled inmates as well as those with other disabilities):
Inmate Programs and Work Assignments:
Eligibility to participate in any program depends upon the inmate’s ability to perform the essential functions of the program, with or without reasonable accommodation.
Reasonable accommodations for all disabled inmates to access program assignments may include, but are not limited to, a modified work or school schedule, early release to/from meals, or assignments for mobility impaired inmates.
Only when an inmate’s disability even with reasonable accommodations renders the inmate ineligible to participate in any available work program for which the inmates is otherwise qualified will the inmate be deemed “Medically Disabled”.
Essential functions are defined as the basic duties/requirements of services, assignments, or program an inmate performs, receives or desires. This does not include the marginal duties of the position, services, assignments, or programs. Duties/requirements should be examined to determine which tasks are essential and which are nonessential.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
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As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Clark v. California amended March 1, 2002, mandates the following: Inmate Education and Work Assignments: Modification of reading prerequisites, terminal objectives for a class program, and other accommodations are essential if inmates with developmental disabilities are to have equal access to academic, vocational, and work assignments. Inmates with developmental disabilities assigned to an education, vocational, work, or other program may receive additional supervision and training to help them meet the requirements of the assignment. Accommodations may include oral rather than written tests, lower production expectations, expanded time frames for completion of projects etc. Evaluation of an inmate’s removal from a program assignment must be done on a case-by-case basis, and will take into account a number of factors including the inmate’s ability to perform the essential functions of the program, the inmate’s misbehavior and refusal to work as directed.
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Access to Industries and Work Assignments
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to inmate access to Industries, and Work Assignments, for disabled inmates are outlined in: Operations Order 06/19 Inmate Workers, Operations Order 07/07 Jail Industries, Draft Operations Order Inmates with Disabilities ADA, and 1107 Decision Making-Special Needs.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1061 Inmate Education Plan requires that:
The facility administrator of any Type II or III facility shall plan and shall request of appropriate public officials an inmate education program. When such services are not made available by the appropriate public officials, then the facility administrator shall develop and implement an education program with available resources. Such a plan shall provide for the voluntary academic and/or vocational education of both sentenced and non-sentenced inmates. Reasonable criteria for eligibility shall be established and an inmate may be excluded or removed from any class based on sound security practices or failure to abide by facility rules and regulations.
Per Operations Order 06/19 Work Assignments, the Selection Process for Sentenced Inmate Workers is as follows:
Although subject to change, the housing units currently used for housing sentenced inmate workers are 3 West at the MJ, the honor facility barracks, and Kenya and Golden Poppy dorms at RCCC. Custody staff assigned to inmate worker housing units will have the same general responsibilities at both custody facilities. Classification staff is responsible for initially determining which sentenced inmates are eligible to be assigned as sentenced inmate workers. The following factors should be taken into consideration:
 An escape record.  An extensive criminal history of possession or transportation of narcotics.  History of assault on officers, staff or other inmates.  Pending 3056 PC or 2620 PC holds.  Medical problems or mental deficiencies which would interfere with job
performance.  History and/or current exhibition of anti-social behavior.  History of, or current, major disciplinary actions.  Gang membership or association may be a declining factor.
Once a sentenced inmate has been assigned to an inmate worker housing unit, the custody staff assigned to the housing unit will determine what assignment best suits the needs of the facility and inmate. Further evaluation of past history
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may aid in determining suitability for a certain position. Custody staff assigned to work crews (kitchen, laundry, etc.) will generally be permitted to make the final decision to accept or release a particular worker for the specified work crew.
Sentenced inmate workers are sometimes referred to as minimum-security inmates due to their supervised access to tools, off site facility work, contact with custody staff and access to places within a facility not normally accessed by other inmates.
Custody staff who are most closely associated with directly supervising the job task assigned to an inmate are responsible for presenting that inmate with the training needed to safely and properly perform that task. Inmates should not perform a job or task prior to receiving safety instruction.
Inmates who refuse to work or perform unsatisfactorily may be subject to disciplinary action. If the violations are sustained as a result of a disciplinary hearing, the inmate may lose good time and/or work time credits. As a result of disciplinary action, the inmate may lose worker status. If an inmate worker receives discipline, he/she may appeal the action through the normal grievance appeals process.
Inmates assigned as housing unit pod workers are generally not sentenced inmate workers, rather are pre-trial or post-trial, non-sentenced or pending sentence status inmates. Typical duties of a housing unit worker may include janitorial duties, meal delivery/service, empty cell cleanup, etc. Housing unit inmate workers shall be subjected to a selection process prior to hiring. Inmates meeting the following criteria will not be hired or used as housing unit workers:
 Inmates with murder charges.  Inmates with a history of escape or attempted escape.  Inmates with a history of assaultive behavior towards staff or other
inmates during this or any previous custody period.  Inmates with a medical condition that would prevent them from fulfilling the
assigned duties.  Inmates posing a security risk or who are being monitored.  Inmates assigned to a 100 Pod and affiliated with a gang.  Inmates who have numerous major violations of jail rules that have
resulted in disciplinary action should be evaluated prior to selection.
If a housing unit worker is fired, an Incident Report Detail (PF-10) and logbook entry shall be completed. If another shift wishes to re-hire the fired worker, the firing shift will be consulted and a supervisor will approve the reinstatement.
Per Operations Order 08/10 Jail Industries, program selection for the Jail Industry programs will be based on the value of the training to inmates in terms of providing usable vocational skills, as well as the demand for services and products, allowing private individuals and businesses to conduct programs which
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employ inmate labor. County staff, instructors from the Elk Grove School District Adult Education Program, qualified volunteers, and other persons as deemed appropriate may be assigned to supervise inmates participating in the Jail Industries program.
Selection of inmates for voluntary participation in the Jail Industry Program will be accomplished in accordance with Operations Order 06/19, Inmate Workers. The shop supervisor or assigned staff will evaluate the inmates before acceptance into the program. Inmates with unacceptable performance histories, custody problems or other disqualifying problems should not be accepted. After acceptance into the program, continued good performance is required for continued participation.
Shop supervisors will have authority to dismiss an inmate from the program at any time. The termination may be for reasons including, but not limited to lack of adequate performance, unruly behavior, and the need to maintain a harmonious environment.
Based on the specifications established by the shop supervisor who must be mastered for beginning competency in the specified trade, a certificate will be issued to the inmate upon discharge or reassignment if the inmate has met the qualifications and has completed the program in good standing.
Per Draft Operations Order Inmates with Disabilities - ADA, all qualified inmates are eligible for job assignments. This includes inmates with disabilities, who, with or without reasonable accommodation, can perform the essential function of the work assignment. Classification staff, in coordination with the ADA Coordinator, shall ensure necessary, reasonable accommodations are made to allow inmates with disabilities equal access to work assignments.
Eligibility requirements for service programs shall not be imposed that eliminate or tend to eliminate inmates with disabilities, unless it can be shown that such requirements are necessary for the provision of the service. Inmates who volunteer for, or are required to participate in, the drug education course and who experience learning disabilities must be provided a reasonable accommodation toward completion of the course, including an alternate means of testing. All program offerings shall be located in areas that are accessible to all inmates regardless of ability. American Sign Language (ASL) interpreters are available for all program services and can be arranged for by contacting (916) 874-1448. All expenses incurred from the utilization of interpreters shall be submitted for payment through the IWF or an alternative. The ADA Coordinator will maintain a list of qualified sign language interpreters who can be utilized in time of need. Temporary clearance can be granted by the Watch Commander on an asneeded basis.
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Per Policy 1107 Decision Making-Special Needs, consultation between the Facility Commander and the Medical Director is required for actions regarding patients who are diagnosed as having significant medical or mental health disorders, as follows:
 Housing assignments.  Program assignments.  Disciplinary measures.  Admissions to and transfers from institutions.
Maximum cooperation between custody personnel and health care providers is essential so that both groups are made aware of movements and decisions regarding patients with special medical or psychiatric needs. For example, health care staff must inform custody personnel when an inmate is suicidal, homicidal, or inappropriately housed in the jail for health care reasons. An inmate’s special needs may complicate housing or work assignments or disciplinary management. Medications may need to be adjusted for safety at the work assignment or before transfer.
Staff Interviews
The Assessment Team interviewed custody staff assigned to the housing units where sentenced inmate workers are housed, work supervisors assigned to the laundry and kitchen areas, EGUSD staff assigned to the industry programs, and deputies who are involved in the selection of housing unit pod workers also referred to as “Housemen”. All staff interviewed stated that there is no system in place to alert staff that an inmate being considered for a work or industries assignment may have a disability other than information contained in the PF4 and PF10 screen of JIMS. Staff stated that one of the ways staff would be alerted to a potential disability would be based on staff observation or the inmate’s self-identification. All staff also stated that there is no system in place to advise staff of an inmate’s physical limitations and the inmate’s accommodation needs.
Staff from the EGUSD cited the following specific information; there is one regularly assigned teacher (Monday through Friday), and an ESL teacher on Fridays. There are no special education teachers on staff, and none of the current teachers have special education credentials. Currently there are no teacher’s aides or assistants on staff. The teachers indicated that they do not facilitate IEPs per se, but they honor them and provide assistance if inmates provides their applicable outside (public) education information. They do not provide formal “pullouts” (1-on-1 sessions), but they try to provide assistance to inmates as much as possible. Staff also mentioned that sometimes they would assign these inmates into low levels in the ESL program.
The EGUSD teachers indicated that they actively recruit, and one of the methods is by sending interest forms to the housing units every month. Once staff
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receives them, they pass them out to the trustees (“Housemen”) to place under the cell doors. Inmates also submit a KITE if they are interested in education services. Staff added that a registration form is completed; if they qualify, they will be placed on a waitlist and ultimately take the CASAS examinations so long as there are no disqualifying concerns. The CASAS score (or any associated reading level/score) is not provided to custody or health care staff or other staff. The CASAS score is the mechanism they use that may alert the teachers as to any possible cognitive or disability-related concerns or special needs. Also, there is some basic information contained within the registration form regarding disabilities.
Inmates who are denied for program consideration are removed from the waitlist. Inmates who are housed on TSEP status usually have a lengthy wait time. Inmates who are rehoused to a different floor are placed at the top of any waitlist, except TSEP inmates are placed at the bottom of the list. Most classes have a cap of 15 students, i.e., ABE/ESL/HISET (GED), and parenting. However, for TSEP/ADSEG and 2M, there is a cap of 3 students. Most classes are offered 3 hours each weekly, but students housed in ADSEG, TSEP, and 2M receive 1 hour per week of 1-on-1 instruction weekly. Parenting class is only available for female inmates. For HISET and ABE, there is one class for 5E and 6E; and there are 2 classes for 4, 5, and 6W. Staff acknowledged that there are times when program classes are closed due to “green suits” (suicide precaution) in classrooms. Per classification practices, mentally disabled inmates who are classified as OPP are disqualified for consideration for assignment based on their disability. Other than OPP inmates, the teachers interviewed are not aware of other disabled inmates being refused admittance to education. One of the teachers admitted that only 1 student from 2M has been accepted into a class within the last 2 years. There is no available data as to how many 2M inmates have applied.
With regard to in-class accommodations, as stated above, teachers do not have a disability roster or tracking list, and will only know whether an inmate has a disability if the inmate self identifies verbally or on the registration form. Accommodations that are available include: a large screen magnifier; computer headphones for hearing-impaired inmates; and mobility-impaired inmates may stand periodically as needed. There is not a seating chart, and inmates who have vision or hearing impairments may sit in the front of class if they need to.
The Assessment Team interviewed staff assigned to 3W, regarding inmate job assignments outside the unit, as well as within the unit. The 3W deputies select the inmates to fill vacant work positions within the MJ detention facility. Staff indicated that the main kitchen is their primary area both in terms of importance and in the number of inmate workers. Inmates housed in pods 100 and 200 are all potential workers. Areas of possible assignment include; main kitchen, law library, shoe shine, staff dining room, and janitorial (throughout the jail including
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intake/booking). On a daily basis, the deputies screen inmates housed at RCCC, who have been cleared for work duties. Their own screening process includes some exclusionary criteria, e.g., no gang history, no protective custody classification, no excessive write-ups, and non-suicidal inmates. Staff admitted that they generally are not aware of whether any prospective inmates have a disability. When asked about learning disabled or intellectually disabled inmates, the 2 staff members interviewed indicated that those types of inmates would probably be classified as OPP, so they would not consider them for employment. When asked about mobility impaired inmates who happen to have an HCA/AD/DME, such as a cane, they indicated that there are slip hazards for most jobs, especially in areas such as the kitchen and other areas, and therefore they would not consider them for hire. They also mentioned that these types of inmate are then rehoused to a different floor or unit.
The 3W staff also acknowledged that there are no written inmate job descriptions/duty statements for any of the work positions (except possibly the law library position), and there are no identified essential functions (or marginal functions) listed. Most workers are either low or medium custody level, but there are a few high custody level workers. They described possible inmate work incentives as; daily clothing exchange, having a cellmate will be on a similar schedule, more dayroom and out-of-cell time (almost as much time as they choose), good-time credits, extra commissary privileges, and they can later be recruited for the Sheriff’s outside work projects. If selected for outside work projects, the inmates will then be out-of-custody. They also added that those assigned to home detention could be recruited for the program as well.
Custody work supervisors from RCCC stated that there is no Work Assignment Coordinator and staff selects inmates for assignments based on recommendation from other inmates or may know inmates from previous work assignment. The inmates that are available for placement into work assignments are housed in the honor barracks at RCCC. There is no clear criteria or guidelines for hiring inmate workers. Workers do not earn sentencing or good behavior credits for working, but risk losing good time credits if they do not report to work or receive an infraction and are subsequently found guilty. The incentive for working in the laundry would be the ability to select and pick their laundry and extra trays from the dining hall. The incentive for working in the kitchen is extra food. Some of the custody work supervisors stated that they would work with the inmate and accommodate him/her by prompting, reminding, assigning them to a simpler job assignment, etc. Other custody work supervisors stated that they would remove an inmate from the job assignment if they could not perform the job or if they had to repeat instructions and remind inmates of their duties.
The Assessment Team interviewed industry supervisors/instructors assigned to welding, horticultural, and cooking. The supervisors stated that there is no system to alert them of a disabled inmate being assigned to their area. However,
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in the event that a disabled inmate is assigned to their work area, they would accommodate him/her. Specifically, if the disabled inmate could not perform the duties assigned, staff would provide him/her with alternate job responsibilities. The supervisors stated that there have been disabled inmates assigned to their work area, and they have accommodated them in the past.
The Assessment Team interviewed housing unit staff that oversee and supervise the housing unit pod workers. Most staff stated that the selection of housing unit pod workers is based on each individual housing unit assigned custody staff with approval from Intel and classification. Two staff members indicated that the selection of the housing unit pod workers is based on other inmates’ selection/vote with final approval from the custody housing unit staff. Most custody housing unit staff indicated that with the exception of information in JIMS (PF4 and PF10 screens) there was no system to alert them of inmate disabilities, physical limitations and accommodation needs. Some staff indicated that they would consider a disabled inmate for assignment as a housing pod worker; however, there were staff that stated that they would not consider or place a disabled inmate as a housing unit pod worker. These staff stated that it is the housing unit pod workers responsibility to control the unit and be able to diffuse problems before bringing them to the custody housing unit staff, therefore, the housing unit pod workers must have the respect of the other inmates and disabled inmates (intellectual, learning disabled and inmates with MH concerns) would not be suitable for the position.
The Assessment Team observed (and was confirmed through subsequent staff and inmate interviews) that inmates who are mentally disabled (OPP) and assigned to MJ 3E (which constitutes approximately half the inmates residing in one of the pods), are excluded from consideration to work as inmate trustees.
The assessment team also received verbal inmate complaints regarding mentally disabled inmates not being afforded equal access to job opportunities.
Conclusions
Based on the inmate worker and industry positions not having essential functions identified and listed, it is difficult to determine what jobs disabled inmates could be assigned to based on their physical limitations and accommodation needs.
It does not appear that medical staff identifies work duty restrictions or places inmates on limited/full duty status to assist staff when placing disabled inmates in the appropriate work/industry assignments.
Inmates with intellectual disabilities assigned to work/industry positions are not provided additional supervision and training to help them meet the requirements of the assignment such as lower production expectations, expanded time frames for completion of projects, etc.
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The criteria for the selection of inmate housing unit pod worker positions may lead to screening out of disabled inmates solely based on their disability as the criteria states that inmates with a medical condition that would prevent them from fulfilling the assigned duties will not be used or hired as housing unit pod workers. The selection process does not allow or require staff to consider and/or provide reasonable accommodations for disabled inmates who request to be considered as housing unit pod workers.
The SCSD detention facilities’ operations orders do not outline whether disabled inmates will be or can be excluded from any specific assignments based on their disability or other criteria. As mentioned above, the current policy and practice does not require a listing of essential job functions for each respective inmate work/industry position.
Operations orders should be modified to provide language or references regarding equitable job opportunities and hiring practices as between disabled inmates and non-disabled inmates (not just between male and female inmates).
Operations Order 06/19 Inmate Workers and Operations Order 07/07 Jail Industries should be modified to contain language or references regarding:
 Disabled inmates, reasonable accommodations or modifications, evaluation by appropriate medical staff for physical limitations (if any), and accessibility for disabled inmates in the workplace;
 Equitable hiring practices, or ensuring that disabled inmates are hired or considered for hire in all work areas available to non-disabled inmates;  Hiring staff use clear hiring criteria; and  Staff avoids using hiring practices that screen out or tend to screen out inmates with disabilities.
 Essential job functions listed for each respective inmate work position.
The SCSD detention facilities must: ensure there are detailed job duties, or duty statements for inmate worker positions; list the essential functions associated with each position; and utilize specific approved hiring criteria.
Staff must ensure disabled inmates receive reasonable accommodations during their work hours (e.g., being allowed to stand periodically or folding laundry in a seated position).
The SCSD detention facilities must ensure that disability identification is conducted and identified in an electronic tracking system as appropriate. The JIMS (or other system) must provide disability code/information including accommodation needs and physical limitations (if any) for inmates with disabilities (whether lower extremity or due to upper extremity respiratory or other contributing factors).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The SCSD detention facilities must develop and implement a training program that brings about disability awareness and ensures staff is knowledgeable with respect to inmate accommodation needs. The training should help foster an understanding that providing accommodations or modifications does not deter staff from accomplishing their job duties and does not create a heavy workload, but rather it puts the disabled inmate on a level playing field and provides equal access to that of non-disabled inmates in accordance with the ADA.
References
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity. The SCSD detention facilities must ensure disabled inmates are equally afforded the ability to be assigned to facility and housing unit worker positions.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
(ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State. 28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Inmate Programs and Work Assignments:
Eligibility to participate in any program depends upon the inmate’s ability to perform the essential functions of the program, with or without reasonable accommodation.
Reasonable accommodations for all disabled inmates to access program assignments may include, but are not limited to, a modified work or school schedule, early release to/from meals, or assignments for mobility impaired inmates.
Only when an inmate’s disability even with reasonable accommodations renders the inmate ineligible to participate in any available work program for which the inmates is otherwise qualified will the inmate be deemed “Medically Disabled”.
Essential functions are defined as the basic duties/requirements of services, assignments, or program an inmate performs, receives or desires. This does not include the marginal duties of the position, services, assignments, or programs. Duties/requirements should be examined to determine which tasks are essential and which are nonessential.
The information below is for reference only. Due to the settlement
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement. As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Clark v. California amended March 1, 2002, mandates the following: Inmate Education and Work Assignments: Modification of reading prerequisites, terminal objectives for a class program, and other accommodations are essential if inmates with developmental disabilities are to have equal access to academic, vocational, and work assignments. Inmates with developmental disabilities assigned to an education, vocational, work, or other program may receive additional supervision and training to help them meet the requirements of the assignment. Accommodations may include oral rather than written tests, lower production expectations, expanded time frames for completion of projects etc. Evaluation of an inmate’s removal from a program assignment must be done on a case-by-case basis, and will take into account a number of factors including the inmate’s ability to perform the essential functions of the program, the inmate’s misbehavior and refusal to work as directed.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Effective Communication
The Title II Effective Communication (EC) regulation states two requirements: First, public entities must “take appropriate steps to ensure that communications with applicants, participants, and members of the public with disabilities are as effective as communications with others.” Second, public entities must “furnish appropriate auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity to participate in, and enjoy the benefits of, a service, program, or activity conducted by a public entity.”
Because a disabled inmate’s literacy level can impede his/her ability to use jail services, participate in jail activities or programs, and understand classification processes, the regulations implementing the ADA require public entities to take appropriate steps to ensure that the communication of information concerning jail services, activities, and programs is as effective for the disabled as for the nondisabled. In doing so, the jail must provide such services as are necessary to afford an individual with a disability an equal opportunity to participate in jail programs and activities and to determine what services are necessary. Jail staff must give primary consideration to the requests of the individual. Only through EC can staff guarantee that disabled inmates have meaningful access to these proceedings.
Additionally, developmentally disabled inmates may have poor ability to express themselves in writing and they will likely have difficulty with any task requiring reading or processing of written material. In particular, they may have difficulty with disciplinary, classification, and/or appeal processes that require reading and understanding. Accordingly, correctional staff is duty-bound to provide reading and writing assistance to disabled inmates who need assistance. Staff must ensure that notices, orientation, announcements, and similar printed materials are ADA accessible to inmates with developmental disabilities.
Throughout this section of the report, the Assessment Team has reported some concerns regarding EC and the requirement to establish such. Within this section, EC processes, requirements, and concerns are detailed for deaf/hearing-impaired, blind/vision-impaired, and speech-impaired inmates, as well as inmates with learning and intellectual (developmental) disabilities and those with mental illness. Some of the major processes correlated to EC will be outlined below, e.g., inmate disciplinary, grievance, classification, administrative segregation, TSEP, disciplinary detention, medical/mental health/dental encounters (including medical intake screening and JPS interviews, and all other clinical encounters), orientation, release, issuance of documents where due process is at stake, e.g., notice to appear, etc.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1080 Rules and Disciplinary Penalties requires that:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Wherever discipline is administered, each facility administrator shall establish written rules and disciplinary penalties to guide inmate conduct. Such rules and disciplinary penalties shall be stated simply and affirmatively, and posted conspicuously in housing units and in the booking area or issued to each inmate upon booking. For those inmates who are illiterate or unable to read English, and for persons with disabilities, provision shall be made for the jail staff to instruct them verbally or provide them with material in an understandable form regarding jail rules and disciplinary procedures and penalties.
The Assessment Team identified numerous existing Sheriff’s Department County of Sacramento Correctional Services Operations Orders and Correctional Health Services Policies and Procedures that should have language relative to EC, or could possibly contain such information. The team examined the operations orders and CHS policies for EC language that could be applicable to inmates with disabilities where a barrier to communication could reasonably exist. Specifically, the Assessment Team reviewed the below listed operations orders and policies:
Operations Orders
 02/01 Use-of-Force  No ADA or EC language contained;  No language regarding identification of the involved inmates for disability-related concerns and possible EC accommodation needs; and  No de-escalation language specific to mentally ill inmates, intellectually (developmentally) disabled or other disabled inmates, or directives to attempt or ensure EC (as feasible based on the situation) with disabled inmates for de-escalation or other purposes.
 02/02 Use of Restraint Devices  No ADA or EC language contained;  No language relative to identifying inmate disabilities or possible EC needs, or to provide EC as needed for inmates during the restraint process (to the extent possible based on the situation) and pending (and during) a MH evaluation, e.g., inmates with mental illness, intellectual (developmental) disabilities, or those with other disabilities to which the disability may pose a barrier to communication.
 02/03 Use of Pro-Straint Chair  No language relative to custody staff identifying inmate disabilities, possible EC needs, or providing EC as needed for inmates during the search or restraint processes (to the extent possible based on the situation), e.g., for inmates with mental illness, intellectual (developmental) disabilities, or those with other disabilities where the disability may pose a barrier to communication; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No information for MH or medical staff to provide accommodations and ensure EC during any health care encounters as described.
 02/05 Custody Emergency Response Team (CERT) and Cell Extraction Procedures  No ADA or EC language contained;  No language regarding identification of the involved inmates for disability-related concerns and possible EC needs; and  No de-escalation language contained with respect to mentally ill or intellectually (developmentally) disabled inmates, or other disabled inmates, or directives to attempt or ensure EC (as feasible based on the situation) with disabled offenders for de-escalation or other purposes.
 03/12 Evacuation Plan – Main Jail  No ADA or EC language contained;  No language regarding identification of inmates with disabilities for disability-related concerns and possible EC accommodation needs during the evacuation process; and  No language directing custody staff to provide EC as needed for inmates during the evacuation process, or search or restraint processes (to the extent possible based on the situation), e.g., for inmates with mental illness, intellectual (developmental) disabilities, or those with other disabilities to which the disability may pose a barrier to communication.
 03/13 Evacuation Plan – RCCC  No ADA or EC language contained;  No language regarding identification of inmates with disabilities for disability-related concerns and possible accommodation needs during the evacuation process; and  No language directing custody staff to provide EC as needed for inmates during the evacuation process, or search or restraint processes (to the extent possible based on the situation), e.g., for inmates with mental illness, intellectual (developmental) disabilities, or those with other disabilities to which the disability may pose a barrier to communication.
 04/01 Intake, Search, Reception and Holding  No ADA or EC language contained; and  No language regarding staff responsibilities to attempt or to ensure EC is provided in the completion and issuance of the “paperwork” during intake/reception and holding processes.
 04/06 Identification Process  Very limited ADA-related language contained;  No language regarding attempts to provide or ensure EC is provided or documented during the questioning (from staff or from inmates) and issuance of the “Inmate Booking Information Receipt” (which should
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
contain information regarding charges/holds as well as bail amount and other information); and  Despite general language in the order that information pertaining to the booking process should be made available by custody staff to those who have difficulty understanding English or who are hard of hearing or deaf, or who are visually-impaired, it does not extend far enough. o This must include inmates who have mental illness, and those with
intellectual (developmental), and learning disabilities as applicable.  04/08 Prisoner Orientation
 No ADA or EC language contained;  The “Prisoner Orientation Handbook” (rulebook) referenced in the
Order does not contain EC language (this will be identified in greater detail in the “Inmate Orientation” section of this report);  The “Verbal Orientation” referenced in the Order is not occurring (with rare exceptions, and will be captured in more detail in the “Inmate Orientation” section of this report);  Because inmate orientation is not being provided, there is no standard format that is reasonably understandable to some disabled inmates (for those whose disability may pose a barrier to communications), so there is no EC taking place; o The rulebook only identifies inmates who do not speak or write
English, and inmates with disabilities such as those with hearing or visual impairments, but does not reference inmates with other disabilities which may pose a barrier to communications, e.g., mental illness, intellectual (developmental) disability, as well as speech and learning disabilities; o There is no Inmate Orientation video (despite the policy speaking to it);  An inmate orientation video must include an ASL signer within
the video, or must be delivered via an outside certified sign language interpreter (this will be outlined in greater detail in the “Inmate Orientation” section of this report).  04/09 Release Procedures  No ADA or EC language contained;  No language pertaining to staff (working the “Release” area) identifying a disability for possible EC needs and medically-prescribed or inmateowned health care appliances/durable medical equipment/assistive devices (HCAs/DME/ADs); o Likewise, there is no language requiring staff to provide EC as necessary, e.g., when discussing, completing, having an inmate sign, and issuance of any paperwork (e.g., Release Screening Form, Citation (Cite and Release), ICE forms, etc.), or when an inmate is being advised about his/her right to make health care
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
complaints or when being evaluated by medical staff prior to release (if applicable); and o There is no language to ensure the inmate is permitted to be released with any prescribed or owned HCA/DME/AD. o 05/05 Pre-Trial Release Program  No ADA or EC language contained;  No language regarding jail staff ensuring that inmates understand when discussing the possibility that they may be eligible for Pre-Trial Release and that a representative from the Pre-Trial Release program will/may be interviewing them for a judge’s possible approval for an OR.  05/06 Bail and Surrender  No ADA or EC language contained;  No language pertaining to staff responsibilities to ensure EC for the Bond or Cash Bail Surrender processes; and  No specific TTY language relative to the Bail Reduction process which outlines TTY telephone usage for deaf/hearing-impaired, and speechimpaired inmates as applicable.  05/08 Work Project Assignment  No ADA or EC language contained;  No language relative to staff providing EC (if necessary) or to assist inmates in understanding or completion of the Sheriff’s Work Project (SWP) application prior to the inmate’s signature and submittal to custody staff; and o Likewise, EC may need to be provided to some inmates with disabilities upon an inmate’s receipt of either approval or program denial;  If approved, then EC may also need to be provided at the time
of an inmate’s receipt of an appointment date, time, and new release date;  If approved for SWP, and on the date of the appropriate adjusted release date, staff may need to provide EC to some disabled inmates with regard to explanation and reporting date and time to SWP, and to obtain the inmate’s signature, and issuance of a copy of the SWP Referral Advisement Form; and  If denied, then staff may need to provide EC to some disabled inmates to explain the inmate’s appeal rights to the watch commander.  05/09 Weekenders  No ADA or EC language contained; and  No language (for Weekender booking) directing MJ or RCCC Front Counter deputies to provide EC to disabled inmates (as applicable) with regard to a Commitment Order, or as related to other general forms or processes.  05/10 Service of Processes of Prisoners
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No ADA or EC language contained for staff to ensure EC during the service of processes.
 06/03 Classification Process  No ADA or EC language contained;  No directives for Classification deputies to provide EC to disabled inmates (as applicable) during the intake classification, or reclassification processes; o There must be language relative to EC being provided during classification-related interviews, e.g., while questioning an inmate and completing the Intake Classification Form; when evaluating and explaining housing assignment, custody/classification level; o There must be language specific to EC being provided as pertinent to any classification-related documentation issued to an inmate, e.g., Classification Review/Classification or Reclassification Form, inmate grievance responses (when needed, and as related to the Classification or housing processes), as well as other related types of documentation;  Note: Currently inmates housed at the MJ or RCCC do not receive copies of documentation (outcome of classification processes). This will be outlined in greater detail in the Classification section of this report.
 06/13 Telephone/TDD/TTY;  No language relevant to staff being trained in the usage and operations of the TTY machines, and providing assistance (EC) to deaf/hearingimpaired or speech-impaired inmates (or those who may have a dual diagnosis, e.g., also mental illness, intellectual [developmental] disability or learning disability), and as a result may have difficulty remembering their access code or how to effectively operate the TTY equipment.
 06/14 Interpreter Services  Outlines the process for obtaining a sign language interpreter for “deaf and hard of hearing prisoners”, but does not mention inmates with speech impairments who may need the services of a certified sign language interpreter to effect communications; o Note: The Operations Order (as well as other applicable Orders) does not identify specific events or occurrences when there is a higher standard to achieve EC and provide qualified interpreter services as applicable, e.g., intake medical screening, other health care encounters, inmate disciplinary (write-up) process, classification, inmate grievance processes, inmate release process, etc.  Contains details about an outside contract interpreter service (NorCal Center for Deafness), but most staff and inmates are not aware of this.
 07/02 Grievances
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No ADA or EC language contained;  No language in the Order relative to staff providing EC to disabled inmates
(whose disability poses or may pose a barrier to communication) as it pertains to the inmate grievance process;  No language included that instructs staff to provide EC during inmate
interviews (when applicable) during the grievance process;  No language that requires staff to provide EC to disabled inmates (as
applicable) when the inmate is writing a grievance as related to health care, the inmate disciplinary (write-up) process, classification, notice of charges, the release process, or other events that may be considered as due process related events;  No language relative to staff providing EC for a disabled inmate (when applicable) to deliver a staff response to a grievance, e.g., as related to a due process event or clinical encounter, as described above.  07/03 Discipline Plan  No ADA or EC information contained, other than the following general language: “For those inmates who are illiterate or unable to read English, and for persons with disabilities, verbal instructions or material in an understandable form regarding jail rules and disciplinary procedures and penalties will be provided”; o As addressed in more detail throughout this report, most inmates
(including disabled inmates) are not receiving rulebooks or materials in an “understandable form” regarding jail rules and disciplinary procedures and penalties;  No language requiring the approving sergeant or deputy to provide and document EC to disabled inmates (as applicable) at the time of issuance of the initial copy of the disciplinary report to the inmate, which the inmate signs;  No language describing that some disabled inmates (e.g., intellectually [developmentally] disabled) may not fully comprehend the waiving of the 24-hour limitation and thus have a disciplinary hearing immediately upon receipt of the write-up report. The same concept may apply for any waivers;  No language to address the issue or explain the significance of ensuring EC is established with disabled inmates (those whose disability may pose a barrier to communication) to ensure they understand the inmate disciplinary process, including but not limited to: their rights prior to the hearing, e.g., request witnesses; their rights during the disciplinary hearing; and their post hearing rights, e.g., grievance rights, understanding the disposition and imposed sanctions, understanding the contents of the final copy of the disciplinary report, etc.;  No language with regard to ensuring EC (as applicable) when a disabled inmate is moved from the general population and placed in
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
disciplinary isolation housing, pending outcome of the disciplinary process; o The Order must also address the EC requirement (as applicable)
when issuing written documentation explaining the removal from general population housing to disciplinary isolation housing (or other non-general population special housing as a result of disciplinary or discipline-related allegations), e.g., administrative segregation, etc.;  Currently the MJ and RCCC do not provide such documentation
as described above;  This also applies to any subsequent custody reviews for
duration or extended stays, and health care screenings/reviews for current or continued placement; and o No language requiring the watch commander (or other staff) to provide and document EC (as needed for disabled inmates) for any inmate appeal submitted, whether during an appeal interview of the inmate (if applicable), or to explain the watch commander’s appeal response.  08/04 Educational Services  No specific ADA or EC language contained; o There is a brief reference to “functionally illiterate” inmates;  No language requiring staff to assist disabled inmates (those whose disability may pose a barrier to communication) as could be needed in the completion of a KITE to Adult Education or for the “Read Out Program”;  No language requiring the teacher (or custody staff) to ensure EC for the teacher’s response to the inmate (either personally or via a KITE) regarding when the class is scheduled to meet; and  No language to address assistance or accommodations to “functionally illiterate” inmates (or those with disabilities who may have difficulties with reading, thinking, understanding or learning), e.g., intellectual (developmental) or learning disabilities.  08/11 Religious Services  No ADA or EC language contained;  No language regarding staff requirements to provide assistance in possibly serving as a scribe for an inmate in writing a KITE, or to ensure EC for disabled inmates (for those whose disability may pose a barrier to communications) as needed, when verbally interacting with chaplain staff;  No language specific to nondiscrimination toward disabled inmates; o SCSD detention facilities must not limit or exclude disabled inmates from religious services/activities based solely on their disability (or for those who may be housed in specific or specialized units solely because of their disability); and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No language specific to providing writing/scribing assistance to disabled inmates (as needed) during the grievance process as related to religious services, as well as no information regarding EC in the delivery of any written responses to grievances.
 10/01 Health Care Services  No ADA or EC language contained;  Only contains generalized high level information relative to medical and mental health operations; and  This particular order needs only a brief generic EC reference that medical and mental health staff will ensure EC during medical and mental health encounters.
 10/02 Psychiatric Services  States in part; “Prisoners identified as mentally disordered or developmentally disabled through the intake medical receiving screening process and requiring a more extensive evaluation shall be referred to Jail Psychiatric Services”;  Does not provide information regarding medical or mental health staff responsibilities to ensure EC during health care encounters, e.g., during the intake, booking and health care screening (or other processes);  No information about JPS requirements to ensure EC in responding to inmate HS KITE's; and  Does not address staff providing EC to disabled inmates (as applicable) regarding observation placement as well as restraints.
 10/03 Health Care Treatment Access  No ADA or EC language contained;  No language pertaining to staff responsibilities to assist disabled inmates who need help requesting dental or mental health care by completing a medical request KITE;  No EC language relative to “Nurse’s call” e.g., new instructions or medications, etc.;  No language to identify EC needs (as applicable) for disabled inmates, when scheduling them for Nurse’s call, doctor appointments, or other health care appointments; and  No language regarding the need for medical staff to provide EC to disabled inmates (as applicable) when an inmate refuses to attend a scheduled appointment, and the inmate is required to sign a "Medical Refusal" form.
 10/04 Medical Intake Screening  No ADA or EC language contained;  No language relative to medical staff providing EC to disabled inmates (as applicable) at the time of medical screening for new inmates, including transfers, or documenting EC on the appropriate forms; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No language relative to EC for medical or mental health (JPS) staff coordinating in a “cursory’ evaluation of the inmate’s mental health.
 10/05 Suicide Prevention Program  No ADA or EC language; and  No language relative to the intake nurse and JPS staff providing EC for occurrences where the intake nurse identifies an inmate as displaying suicidal behavior, completes the screening form, and refers the inmate to JPS, and JPS staff conduct an evaluation; and where the inmate is subsequently rehoused.
 10/08 Medicine Distribution “Pill Call”  No ADA or EC language contained;  No language relative to pill call nurses providing EC, when necessary, for disabled inmates during pill call e.g., when giving new medications or new instructions; and  No language regarding EC for circumstances when inmates refuse medication, and they are required to sign a “Refusal of Prescribed Medication 1x” form by health care services staff. o The EC requirement is also applicable for circumstances when an inmate refuses to sign the form. The circumstances must still be explained to the inmate.
 10/09 Dental Services  No ADA or EC language contained;  No EC language requiring staff to provide assistance or scribing for inmates requesting non-emergency dental care and having to complete a "Dental Request Form”;  No language relative to obtaining a disabled inmate’s EC concerns (if applicable) during the scheduling of dental appointments, and having the EC information available for the dentist or dental staff at the time of the scheduled appointment; and  No language with regard to dental staff providing EC to inmate-patients during appointments.
Correctional Health Care Services Administrative Policies
 1107 Decision making – Special Needs  No EC language contained; and  There is only brief general information pertaining to mental health inmate-patients, and consultation between health care and custody staff relative to housing, program, disciplinary, and admission to and transfer from institutions; o Does not include a formalized process for custody disciplinary hearing staff (lieutenants or sergeants) to consult with mental health staff regarding the inmate disciplinary (write-up) process in terms of obtaining a clinician’s input on whether the inmatepatient’s mental health status contributed to the alleged rule
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
violation, or regarding an imposed disposition at the disciplinary hearing;  Also does not include any EC-related language or requirements
for health care (medical/mental health) or custody staff.  1110 Access to Diagnostic Services
 No ADA or EC language is applicable, as this policy only identifies three approved outside medical providers to provide diagnostic services. o The policy does not identify how the services will be provided or how interactions/communications with inmate-patients will take place.
 1119 Individualized Treatment Plans  No ADA or EC language contained;  No instruction or information that within the written treatment plan, health care staff must provide EC to disabled inmates whose disability may pose a barrier to communication.
 1120 Continuity of Care  No ADA or EC language contained;  No information that health care staff must ensure EC when obtaining an inmate-patient’s written authorization to obtain medical records regarding previous medical care.
 1128 Reading Glasses for Inmates  No EC language contained;  No language instructing medical staff to provide EC (as applicable) to disabled inmates whose disability may pose a barrier to communication for related health care encounters, e.g., during a patient’s needs assessment for reading glasses (at nurse sick call), when discussing an inmate’s magnification strength and explaining options, e.g., commissary or process for indigent inmates, or when issuing a copy of a Miscellaneous Medical Needs form to an inmatepatient.
 1404 Receiving Screening  No EC language contained;  No language relative to intake nurses providing EC to disabled inmates (as applicable) during the intake/booking (Receiving) medical screening process. This includes: o When considering disabled inmates for isolation or special observation in the facility; o When determining an inmate-patient’s suicide (or past suicide behavior) or withdrawal potential; o When observing a patient’s behavior (communication difficulties, speech problems and posturing, impaired level of consciousness, disorganization, memory defects, depression, or evidence of selfmutilation);
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o When considering a disabled inmate for “segregation and/or special housing for patients with suspected communicable diseases, mental illness, or developmental or physical disabilities, pending medical clearance”;
 No language requiring EC: for the process when nurses are screening for “appearance or history of developmental disability”, or “slowness in speech or lack of comprehension of questions suggestive of developmental disabilities”; for any associated intellectual (developmental) disability evaluation/screening tests; or for any referrals for such tests.
 1407 Access to Treatment  No EC language contained (except as noted below);  Existing policy language requires “facility nursing staff [to] explain access procedures orally to all individuals, especially to those unable to read.” It also states that “videotapes and/or other materials may be used as an adjunct to orientation”; o The nurses are not consistent with delivering this information verbally or otherwise to the inmates; o This policy and process does not include EC requirements, or the assistance of a certified sign language interpreter for deaf/hearing or speech-impaired inmate-patients when the inmate-patient’s primary or sole method of communication is sign language (policy only addresses or infers foreign language); o There is no written requirement for the nurses to document EC provided, e.g., what methods were used to ensure the inmatepatient understood (spoke slowly, used simple terminology, rephrased sentences and words, repeated instructions/information), and determination as to how the inmate-patient understood, e.g., the inmate-patient repeated back in his/her own words their understanding of the process/information/instructions, to the nurse’s satisfaction that the inmate-patient understood the encounter. o The SCSD detention facilities custody staff and CHS staff do not currently use videotapes as a source of orientation or to explain health care access procedures.  With regard to “medical care services and how to obtain health care” being contained in the “Inmate Handbook” (rulebook), as mentioned in other sections throughout this report, the Assessment Team’s observations (coupled with inmate interview information received) revealed that there is no consistency with issuance of the rulebooks at both the MJ and RCCC. The majority of inmates interviewed by the Assessment Team claimed that they have never been issued a rulebook; and
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 With regard to the policy language relative to “HS KITE’s for sick call sign up”, there is no EC language to require staff to provide writing/scribing assistance to disabled inmates (as needed) for completion and understanding of the document;
 1409 Clinic Care – Sick Call  No ADA or EC language contained;  No language requiring a physician, mid-level practitioner or nurse, to ensure EC for disabled inmates (as needed), during scheduled appointments, pill call (as applicable), etc.;  Does not address medical staff citing EC-related language within the medical progress notes (for placement into the inmate-patient’s medical record); and  Does not address staff requirements to assist with writing/scribing “HS KITE’s (request for medical attention).” HS KITE’s are available in the housing units, from the pill call nurses and from custody officers.
 1410 Medical Services Provided in the Medical Housing Units  EC-related language does not appear necessary for this policy.
 1411 Mental Health Services  No EC language contained;  Does not address health care staff responsibilities to ensure EC to disabled inmates (as needed) for the following identified clinical encounters: o Screening for mental health problems in intake during the booking process; o Crisis intervention and management of acute psychiatric episodes; o Stabilization of the mentally ill and the prevention of psychiatric deterioration in the jail setting; o When administering an assessment interview for MH treatment, or admitting or informing an inmate-patient about involuntary short term or voluntary admission for MH services; o When informing inmate-patients they have been referred to alternative care such as for substance abuse, alcoholism, and social services;  Does not address staff requirements to assist disabled inmates (as applicable) with writing/scribing HS KITE’s; and  Addresses requirement that request forms “HS KITE’s” (for mental health services) are made available to inmates, and that inmates are informed of the availability of mental health services, both verbally and in writing, with "Mental Health Request" forms available on each floor at central dayroom locations; o However, as mentioned previously, health care staff are inconsistent with providing inmate-patients with information about access to health care (including information about HS KITE’s);
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custody staff do not provide a verbal or video orientation, and many inmates do not receive copies of the jail rulebook.  1412 Suicide Prevention – 2M – Joint Policy with JPS  No EC language contained;  No requirement for medical (CHS) and mental health (JPS) staff to provide (to the extent possible) and subsequently document EC provided to inmate-patients when providing both psychiatric and medical care for inmates who are verbalizing or exhibiting suicidal behavior. In accordance with this policy, this includes nursing intervention activities (as ordered by the treating physician) with inmate-patients, including: o Having the patient moved (when the patient is not already assigned a 2M bed), and providing a blue safety suit and suicide precautions; o Having custody staff modify the environment for the patient’s safety, and explaining this procedure to the patient; o Documenting the nursing assessment, observations, and intervention, with a timed and dated entry in the patient’s chart; o Having JPS staff conduct outpatient clinician evaluations within twenty-four (24) hours of receiving the psychiatric referrals from the 2M clinical staff; o Psychiatrist visits every 24 hours until an acute episode is resolved, and documentation of the consultative notes and treatment recommendations within the psychiatric chart; and o Having the psychiatrist or medical staff document within the inmatepatient’s chart, the conclusion, recommendations, and termination of the 2M suicidal status (when the inmate-patient’s suicide or psychiatric status is resolved and the patient no longer is at risk of suicide, and the inmate-patient continues to require medical care in the 2M unit).  1413 Use of Restraints and the Pro-Straint Chair;  No EC language contained;  No information requiring health care staff to provide EC (to the extent possible) or document EC for situations where mentally disordered inmates or other disabled inmates are being prepared to be placed in, or are being placed in restraints and/or the Pro-Straint chair. This includes: o During a medical evaluation (including circulatory status and vital sign checks) within the first 15 minutes and every two hours thereafter; o When medical offer and subsequently document the offering of fluids and nourishment, and when documenting exercising of the extremities, in the inmate’s Health Record;
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o During medical and MH examinations prior to continuance of such restraints, and when documenting as such in the progress notes; and  During JPS MH assessments to assess the need for MH treatment.
 1414 Restraint Check Method  No EC language contained; and  No language requiring medical staff to provide EC to disabled inmates as needed (for those inmates whose disability may pose a barrier to communication) for the following encounters: o Medical evaluations, including an inmate’s circulatory status and vital signs; and o When medical staff document in the inmate-patient’s medical record any significant change in the restrained individual’s condition, and whether the restrained inmate-patient remains in the restraints longer than 2 hours.
 1415 Patients in Safety Cells  No EC language contained;  No language requiring medical staff to provide or document EC for disabled inmates as needed for the following described encounters: o During medical checks of the inmate within the first 6 hours of placement in a safety cell, and every six hours thereafter (if an inmate asks questions or is asked questions by medical staff, or if there is an explanation or exchange of health care-related information) to assess the inmate’s condition; o During physician re-evaluations for inmates who have remained in the safety or segregation cell for 24 hours beyond the initial medical clearance; and
 1416 Patients in Segregation  No EC language contained;  No language requiring medical staff to provide and document EC for disabled inmates as needed for the following encounters: o Daily medical evaluations for inmates being removed from the general population and placed in segregation; o During pill-call while housed in segregation; and o During physician cell visits while in segregation (if applicable);  No EC language relative to the KITE process while an inmate is housed in segregation, e.g. requiring a nurse (or custody staff) to provide writing/scribing assistance or explain the KITE process with regard to medical services.
 1417 Adult Developmental Disability  No EC language contained;
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 No language requiring health staff to provide or document EC for intellectually (developmentally) disabled inmates for the following described medical encounters or related processes; o When identifying inmates for intellectual (developmental) disabilities at booking and other encounters throughout the incarceration; o When determining whether the inmate has difficulties performing basic tasks, slowness or apparent difficulty in understanding; o When making notations on the Receiving Screening medical form or medical progress notes.  Note: Despite the fact that the policy requires medical staff to make appropriate notations in the “Master Problem List” in the medical record and in the JIMS system relative to a known or suspected “developmental disability” and to notify Classification staff of any housing recommendations, as mentioned in greater detail in other areas of this report, the SCSD detention facilities do not have a comprehensive or effective intellectual (developmental) disability testing/screening process, or an inmate disability tracking system.
 1422 Special Needs Patients  No EC language contained;  No language requiring medical staff to provide or document EC to disabled inmates (as applicable) for the following health care encounters described in the policy: o When interacting with inmates and discussing medical conditions (and developing treatment plans) for inmates requiring assistive devices and for “developmentally disabled” inmates; o When admitting an inmate to the Outpatient Housing Unit; o For inmate plan of care and addressing pending discharge needs.
 1425 Patients in Segregation Cells in Intake  No EC language contained: and  No language requiring medical staff to provide or document EC to disabled inmates (as applicable) for the following health care encounters described in the policy; o Medical assessments of the inmate-patient within the first six (6) hours of placement and at least every six (6) hours thereafter to assess the inmate’s medical condition; and o Physician assessments for inmate-patients who remain in a segregated cell for at least 24 hours.
 1433 Admission to Jail Acute Psychiatric Inpatient Unit  No EC language contained; and  No language requiring health care staff to provide or document EC to disabled inmates (as applicable) for the following health care encounters described in the policy:
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o JPS clinical assessments, including vital signs and a mini-mental status exam, prior to a patient being admitted to 2P, or when a patient has a change in condition, to determine if the patient meets the delirium guidelines; and
o CHS medical assessments (based on JPS referral to 2M), and subsequent housing of the patient on 2M, 2P, or transfer to an outside medical facility for acute or emergency care.
 1435 Inmate Health Care Grievances  No EC language contained; and  No language requiring health care staff to provide or document EC to disabled inmates (as applicable) for Priority Administrative Review appointments where the inmate is medically assessed.
 1439 Reports of Disabilities or Impairments  No EC language contained; and  Although the policy cites general ADA-related language (as outlined in the bullet below) it contains no EC direction or requirements to provide and document EC for related health care encounters. Policy language cited includes: o Any report of physical disability or impairment by an inmate or outside organization will be referred to a clinician for review and assessment;  This can include reports of mobility impairments such as amputations or paraplegic, or other disabilities that limit daily functioning such as visual, hearing, or speech. The clinician will review the report, assess the inmate’s needs, and make a determination if special housing or assistive devices are needed; o Upon report of disability or impairment (verbal or written):  An MD/NP Sick Call appointment will be scheduled and the nature of the report will be documented;  The patient-inmates will be seen and their disability or impairment will be assessed and if indicated a plan of care will be developed; and  Any specific patient-inmate’s needs or accommodations will be documented in the chart and communicated to medical and custody staff. o Note: It does not appear that the intent of the policy language as outlined in the above bullet is meant to include EC-specific needs (at least in terms of requiring staff to provide EC and document accordingly).
 2000 Dental Care  No EC language contained; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No language requiring dental (or medical) staff to provide or document EC to disabled inmates (as applicable) for the following dental encounters described in the policy; o Intake nurse discussing dental history with inmate; o During dental examinations and treatment; o During dental/oral hygiene education; o When providing information (during routine sick-call and medication administration services) on how to access dental hygiene services; o During x-rays for diagnostic purposes; o When discussing dental treatment plan with an inmate-patient; and o When discussing with the inmate and/or accepting an inmate’s completed “Request for Medical Attention” (KITE) or specific dental referral form.
Although the Assessment Team cited EC-related concerns with all the custody operations orders and CHS policies detailed above, it will not be necessary to include detailed EC information in each policy. A comprehensive EC policy, or a comprehensive EC section within an operations order and CHS policy would suffice. Depending on the individual order or policy, either brief language or a simple reference to an approved EC policy would suffice.
With the exception of Operations Order 06/14, titled, “Interpreter Services”, none of the aforementioned SCSD detention facilities Custody or Health Care Orders contain any specific EC-related language or references.
Operations Order 06/14, “Interpreter Services”, Section I., Policy, states: “Correctional Services staff shall endeavor to communicate effectively with people who have difficulty speaking English or who are deaf or hard of hearing.”
Section IV., Interpreter Services for Deaf and Hard of Hearing Prisoners, states in part: “Under the Americans with Disabilities Act (ADA), people who are deaf or hard of hearing are entitled to the same services law enforcement provides to anyone else. They may not be excluded or segregated from services, be denied services, or otherwise be treated differently than other people.”
It also states, “Custody staff must provide the communication aids and services needed to communicate effectively with people who are deaf or hard of hearing, except when a particular aid or service would result in an undue burden or a fundamental change in the nature of the law enforcement services being provided.
Custody staff must give primary consideration to providing the aid or service requested by the person with the hearing disability.
The County has a contract for interpreter services for deaf and hard of hearing prisoners with the NorCal Center on Deafness. The address and phone numbers are:
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4708 Roseville Road, Ste. #112, North Highlands, CA 95660 / Voice/TTY (916) 349-7500 and FAX 349-7578.
Interpreter services are available during business hours (0830-1700) by contacting NorCal Interpreter Services at (916) 349-7525. Requests for interpreters can also be emailed to dispatcher@norcalcenter.org or faxed to (916) 349-7578.
If an interpreter is needed outside of business hours, the request can be made by calling (866) 658-8417.”
Section IV., also states in part, “A form is provided to assist deaf and hard of hearing prisoners in understanding the booking process. The form outlines the overall steps involved in booking and release at the Main Jail and at RCCC.
Additional information that may be helpful for law enforcement officers is available at the following website: http://www.usdoj.gov/crt/ada/policeinfo.htm
The U.S. Department of Justice pamphlet, Communicating with People Who Are Deaf or Hard of Hearing, is available at the above website or in Appendix 12-C.”
The SCSD detention facilities do not have a stand-alone comprehensive EC operations order, but the draft Operations Order Inmates with Disabilities - ADA, does contain some EC procedural language.
As stated above, each individual SCSD detention facilities custody policy and each CHS policy may not need to have specific EC language embedded if a comprehensive EC policy were to be implemented for custody and health care services. The aforementioned SCSD detention facilities draft Operations Order would suffice for custody staff if it were to include a complete EC section, and subsequently be approved.
Section I titled, “Policy Statement” states in part, “It is the policy of the Sacramento County Sheriff’s Department to ensure procedures are in place to provide equal treatment to all incarcerated adults. The Department will ensure inmates with qualified disabilities are afforded equal access to programs, services, and activities unless doing so would alter the nature or operations of the institution or program.” It also states in part, “The Department will ensure that procedures are in place for inmates with disabilities to request reasonable accommodations and to dispute the accommodations provided under Title II of the Americans with Disabilities Act.”
Section II., titled, “Definitions”, provides several ADA related definitions, but does not include a definition as to EC. Included are the following definitions:
 Activities of Daily Living (ADL): “includes, but is not limited to, functions such as caring for one's self, eating, bathing, performing manual tasks, walking, seeing, hearing, speaking, learning, and working”; and
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 Reasonable Accommodation: “any change or adjustment to an environment that permits a qualified person with a known disability to participate in a job, or to enjoy benefits and privileges of programs or services as an equal to everyone without a disability.”
Section III titled, “Compliance with ADA” states in part, “The Sacramento County Sheriff’s Department will not discriminate against inmates or members of the public on the basis of disability in providing access to its detention facilities, programs, services and activities.”
It also states in part, “Persons with a disability are entitled to an equal opportunity to participate in programs, services, or activities offered by the Sacramento County Sheriff’s Department unless doing so creates an undue hardship.”
The section further outlines that the duties of the ADA Division Representative (ADA Deputy) include reviewing requests, complaints and grievances related to ADA issues, and that the ADA Division Representative may respond to ADA requests or ADA grievances.
Section IV titled, “Identification of Disabled Inmates - At Intake”, describes in part that the medical screening process during intake serves to identify most disabilities and accommodation needs prior to the housing of the inmate. It also explains that it is the responsibility of booking and medical staff to assess inmates upon admission for evidence of a disability or special medical need. This assessment information will be recorded on the Inmate Disability Evaluation Form (IDEF) as applicable. Language also references medical intake staff responsibilities to initiate and sign an IDEF, and forward the form to the Booking Unit and the ADA Coordinator upon determination that an inmate may have a disability.
Section V titled, “Classification and Inmate Housing”, details that classification staff will be responsible for ensuring that inmates with disabilities are housed appropriately (based on their needs), reviewing all IDEF forms, notifying the ADA Coordinator to arrange for orientation of inmates who are visually impaired or unable to read, making appropriate notations on the IDEF form and forwarding the form to the ADA Coordinator for compliance review.
Section VI titled, “ADA Coordinator” explains that coordinator’s responsibilities regarding reviewing and monitoring of ADA or disability-related grievances.
Section VII titled “Identifying Disabilities – Subsequent to Booking”, contains general information about notifying the ADA Coordinator for any inmate staff feel has a disability.
Section VIII titled, “Program Access”, outlines equal access to inmates for education and library services, including responsibilities of the Recreation
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Technician to obtain an audio headset and assortment of audio tapes that are available from the Offender Programs Unit. A designated Offender Programs Unit staff member shall provide inmates with audiotape equipment, inform them of the resources available and explain the Inmate Request Form process by which the inmate can access those resources via the Inmate Request Form (KITE). This section also contains policy information pertaining to service programs, and availability of American SLIs.
Section IX titled “Auxiliary Aids for Individuals with Hearing Impairments”, states in part, “The type of auxiliary aid or service necessary to ensure effective communication will vary depending on the length and complexity of the communication involved. In routine matters, the exchange of written notes may be sufficient. However, when communication is more complex, extensive, or significant (e.g., during classes, counseling sessions, or disciplinary hearings in which the inmate may lose privileges), the use of a UbiDuo real-time split-screen communication device or a qualified sign language interpreter may be required.”
Section X titled, ““Telecommunications Devices (TDD/TTY Equipment)”, states, “Prisoners who are speech and/or hearing impaired shall be given access to the TDD/TTY equipment following Operations Order 06/13, Telephone and TDD/TTY Equipment Access.”
Section XI titled, “Interpreter Services”, states in part, “Interpreter services shall be provided to Non-English speaking prisoners or for prisoners who are speech and/or hearing impaired following Operations Order 06/14, Interpreter Services.”
Section XII titled, “Inability to Read and Write”, states in part, “[t]he ADA Coordinator will ensure reasonable accommodations are made for inmates who are illiterate or who are physically incapable of reading or writing, which may include, but is not limited to, enlarged print materials, identification of desired materials, and assistance in reading and scribing forms. All staff members shall assist inmates who have language, physical, or competency and capacity barriers, when requested to do so (e.g., assist in completing Inmate Request Forms, grievances, and medical requests).”
Section XVII titled, “Identifying and Handling of Armstrong Class Inmates”, states in part, “[a]n ‘Armstrong class inmate’ is an inmate identified by the California Department of Corrections Rehabilitation (CDCR) as having ADA concerns due to current or ongoing medical and/or mental health issues. CDCR will notify the Sheriff’s Department of inmates in our custody who they have identified as ‘Armstrong class inmates.’ They will contact the ADA Coordinator of inmates in our custody who have previously been identified. The ADA Coordinator will ensure the inmate is entered in JIMS under the Special Tracking Needs. Once contact is made with the inmate, the ADA Coordinator will notify HMU via e-mail. This e-mail should include any steps taken to address issues/concerns as well as the resolution.”
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Other sections contained within the draft Operations Order include, “Mail - Free Matter for The Blind”, “Prosthetic/Orthopedic Appliances and Assistive Devices”, “Restraints”, “Searches”, and “Facility Visitors.”
Section XIX titled, “Grievances”, states in part, “[a] prisoner with a disability who believes he/she is the subject of disability discrimination or who wants to appeal any denial of ADA housing and/or accommodation may submit a grievance. All grievances concerning conditions of ADA housing and/or accommodations will be made on a Grievance Form following the guidelines in Operation Order (7/02), Grievances. All ADA related grievances shall be routed through the facility Compliance unit. The Compliance unit will determine the best course of action for the grievance (e.g. Medical, Custody, Food Services) and then route it as deemed appropriate.”
Section XX titled, “Compliance with PREA, states in part, “The Sheriff’s Department will take the appropriate steps to ensure that inmates with disabilities (including, for example, inmates who are deaf, hard of hearing, sight impaired, have low vision, or those with intellectual, psychiatric, or speech disabilities), have an equal opportunity to participate in or benefit from all aspects of the Sheriff’s Department efforts to prevent, detect and respond to sexual abuse and sexual harassment. The Sheriff’s Department will ensure effective communication with inmates who are deaf or hard of hearing and when necessary will provide access to interpreters who can interpret effectively, accurately, and impartially, using any necessary specialized vocabulary. In addition, the Department will ensure written materials are provided in formats or through methods that ensure effective communication with inmates with disabilities, including inmates who have intellectual disabilities, limited reading skills, or who are sight impaired or have low vision. Inmate interpreters, inmate readers, or other types of inmate assistants will not be used except in limited circumstances where an extended delay in obtaining an effective interpreter could compromise the inmate’s safety, the performance of first-responders’ duties or the investigation of the inmate’s allegations.”
The SCSD detention facilities’ Inmate/Detainee Handbook (rulebook) does not contain specific information relative to EC. There is one page of general information pertaining to inmates with disabilities. Included in the content is general information regarding Title II of the ADA and a brief explanation that inmates who have difficulty with seeing, hearing, talking, walking, moving, breathing, and learning may have a disability. The rulebook also explains that the SCSD detention facilities will ensure inmates with qualified disabilities are afforded equal access to programs, services, and activities unless doing so would alter the nature of operations of the institution or program. It also has brief non-specific information with regard to reasonable accommodations and requests.
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The SCSD detention facilities do not have an EC policy for daily encounters or interactions, nor is there an EC policy when there is a higher standard for providing an ensuring EC, such as for clinical encounters (e.g., mental health, medical, or dental), due process events (e.g., classification process, inmate disciplinary [write-up] process, pre-release process, conditions of release process, Notice of Charges, or probation encounters/meetings), or other specific activities such as self-help groups e.g., Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or other events such as religious activities. Likewise, there is no comprehensive policy relative to providing reasonable accommodations for inmates with disabilities, e.g., deaf/hearing-impaired, vision, speech, learning, and developmentally disabled inmates to ensure equally effective communication during the aforementioned types of events or processes, including applicable interactions with staff, other inmates, and, where applicable, the public.
There are existing policies, as cited above, which contain general information regarding adult “developmental disability,” identification and report of disabilities/impairments, orientation, inmate discipline, classification, grievance processes, reading glasses, religious services, education services, interpreter services, and release processes. These policies also include some general language regarding teletypewriter (TTY) and interpreters, but they and other policies do not extend far enough, and do not provide comprehensive requirements or direction with regard to EC. Virtually all of the policies are silent with regard to providing and documenting EC, and there are no policies which define the topic or provide examples. There is no specific policy outlining a requirement to provide auxiliary aids, which are reasonable, effective, and appropriate to the needs of an inmate when simple written or oral communication is not effective. Such aids that could be included in such an EC policy could include, but not be limited to; qualified interpreters, readers, sound amplification devices, captioned television/video text displays, video remote interpreting, video visiting, Telecommunication Devices for the Deaf (TDD)/TTY, audiotaped texts, Braille materials, large print materials, and signage.
Observations
The Assessment Team observed a multitude of processes at various sites throughout the MJ and RCCC jails to examine the establishment of EC. Specific processes examined included but were not limited to the following: Intake/booking; medical and mental health screening; inmate classification; service of Notification of Charges; initial serving of inmate write-ups (disciplinary reports) and the inmate disciplinary hearing/process; and inmate orientation. There are additional processes where EC must also be established including education, library services, religious services, and various programs and selfhelp groups, e.g., Alcoholics Anonymous (AA)/Narcotics Anonymous (NA), etc. These areas were also examined as indicated below, via staff and inmate interviews.
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The Assessment Team looked to determine whether staff was making all reasonable attempts to communicate with disabled inmates (e.g., those with vision, hearing, speech, learning and developmental disabilities, as well as others) for all contacts, including normal daily interactions. The team also examined whether staff made all reasonable attempts to achieve EC while applying a higher threshold or standard for due process events (e.g., classification process, inmate disciplinary hearing and related processes, service of notice to appear), and clinical encounters (e.g., diagnosis or prognosis, intake/booking medical and other medical evaluations, discharge instructions, provision of mental health (JPS) evaluations, explanation of medications, procedures, treatment, treatment options, or surgery).
The higher standard of EC includes: identifying an inmate’s disability where there may be a barrier to comprehension or communication requiring reasonable accommodation(s); providing effective reasonable accommodation(s) to overcome the communication barrier; and documenting the EC, including the method used to achieve EC and how the staff person determined that the inmate understood the encounter, process, and/or proceeding.
Inmate Disciplinary (Write-up) Process
The Assessment Team observed the inmate disciplinary (write-up) process with regard to EC. Staff who interacted with inmates during the inmate disciplinary (write-up) process did not have an inmate disability tracking list; they did not establish or provide EC to the inmates during the process; nor was there any documentation of such. This includes sergeants or deputies issuing initial copies of the reports, and sergeants conducting the disciplinary hearings. It is the Assessment Team’s position that the inmate disciplinary processes not observed also lacked the provision of EC. This includes issuance of the final copy of the inmate disciplinary (write-up) hearing summary and findings (disposition). This is attributed to the lack of a tracking system that would otherwise identify inmates who require staff to provide EC during these types of due process encounters.
Classification Process
The Assessment Team observed the Classification process with regard to EC. Classification staff that interacted with inmates during the classification process did not establish or provide EC to the inmates during the initial classification interviews. This is attributed to the lack of a tracking system that would otherwise identify inmates who require staff to provide EC during these types of due process encounters.
Although the Assessment Team did not observe the Service of Notice of New Charges, it is the Assessment Team’s position that this process lacked the provision of EC. This is attributed to the lack of a tracking system that identifies inmates who require staff to provide EC during these due process encounters.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
There is no current SCSD detention facilities requirement for staff to ensure a higher threshold for EC by identifying the disability, potential communication barrier, providing the necessary accommodations to ensure EC, and to document the EC and accommodations provided as well as how the staff determined that the communication and accommodations were effective.
Medical/Mental Health/Dental Encounters:
The Assessment Team observed numerous health care-related processes for EC concerns. These observations began with the intake/booking medical screening process and branched out from there.
The Assessment Team observed several inmates being interviewed by a phlebotomist (for those inmates required to do so commensurate to their charged offense) prior to their intake/medical screening. The questions asked were generally consistent. Aside from drawing the inmate’s blood, the phlebotomist took blood pressure and temperature readings. Questions commonly asked were regarding the following: allergies, open wounds, asthma, diabetes, medical medications, psychiatric medications, intent to harm self or others, alcohol use, drug usage, seizures, previous housing if previously incarcerated under the jurisdiction of the SCSD detention facilities, as well as other questions. The phlebotomist appeared to be clear in her communications with the arrestees.
The phlebotomist did not ask the inmates whether they had any disabilities, whether the inmate had any issues in comprehending the process or questions being asked, or if they needed assistance in understanding the process. The phlebotomist was not aware of any mechanism for documenting any EC assistance or concerns if applicable. Because there is not an inmate disability tracking system, even for returning arrestees, the phlebotomist would be (and was) unaware of any disability concerns, unless the inmate going through the process claimed such.
The Assessment Team also observed dozens of inmates (male and female) being processed through the MJ and RCCC intake medical screening process, by several different nurses. The team observed dozens of inmates go through this process on various dates, and on both AM and PM shifts, as well as weekdays and weekends.
The intake medical screenings were not consistent, and did not contain any EC practices in terms of ensuring or documenting EC. Most of the nurses used the standard Receiving Screening Form (SCSD Correctional Health Services Medical Intake), but the form does not contain any disability-related questions. The intake screening staff also completes a form, titled, “SCSD Correctional Health Services Special Needs” with a list of contained items. The list includes a few check boxes for some physical disability-related concerns, but nothing for intellectual (developmental) disabilities, learning disabilities, or deafness/hearing
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

or speech impairments. There are check boxes relative to MH and glasses/contacts that would or could have EC-related concerns.

The specific questions asked are outlined in more detail in the Health Care section of this report, but depending on the nurse observed, minimal or no disability-related questions were asked, and the nurses were not aware of the need to provide and document EC for disabled inmates whose disability poses or may pose a barrier to communication, or even which inmates would need such assistance.

With regard to securing certified sign language interpreters, the Assessment Team asked numerous intake/screening nurses as well as other nurses throughout the MJ and RCCC about the process at the two jail facilities. The Assessment Team received many different responses. Most nurses were not aware that the SCSD detention facilities had a contract with an outside provider for sign language services, and did not know how to obtain a certified sign language interpreter, or if that was even an option. The Assessment Team received the following verbal responses;

 Have the inmate write everything out;  Some inmates lip read;  Use an officer who knows sign language;
 A couple of names of deputies were provided to the Assessment Team as those who have been used on occasion;
 The jail has a telephone language line;  Inmates “Surenos” have been used to sign with deaf/hearing-impaired
inmates because some of them know sign language; and  There is a TTY machine located in the sergeant’s office.
One of the nursing supervisors at RCCC was aware of a list of five providers in the greater Sacramento area, and was aware of the process.

The Assessment Team was unable to observe any ICE physical

examinations/health appraisals (for ICE detainees).

Although the

aforementioned ICE form includes some disability-related information as to

mental health, learning disabilities, and “developmental history,” or “appears to

be developmentally delayed or mildly retarded”, it is highly unlikely that an EC is

being documented. It appears that staff assigned to housing units or other areas

where they maintain supervision over ICE detainees, or have contact with those

detainees, have minimal knowledge of the listed possible concerns. But with a

lack of ADA training, no EC documentation requirements, and no policy,

procedures, or practice to appropriately deal with cognitive deficits and adaptive

support deficits (for intellectual [developmental] disabilities), it is highly unlikely

that the EC needs are being met for intellectually disabled or learning disabled

inmates, as well as other ICE detainees whose disability poses a barrier to

communication.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
JPS Encounters:
The Assessment Team was able to observe several JPS interviews in the intake/booking area, including expedited referrals. More detailed information will be outlined in the health care section of this report. Obviously JPS interviews are challenging at most times, and are centered on the inmate’s mental health state. But as mentioned throughout this report, clinicians and social workers largely do not have the information necessary to know about EC issues for disabled inmates. The clinicians and social workers appeared to be patient and professional in their communications with the inmate-patients.
Although the Assessment Team did not observe any other types of medical, mental health or dental encounters, it is the team’s position that those also lacked the provision of EC. This is attributed to the lack of a tracking system that identifies inmates who require staff to provide EC during these clinical encounters. There is no current SCSD detention facilities or CHS requirement for medical, mental health or dental staff to ensure a higher threshold for EC by identifying the disability, potential communication barrier, providing the necessary accommodation(s) to ensure EC, and documenting the EC and accommodations provided as well as how the medical, mental health or dental staff determined that the communication and accommodations were effective.
Intake/Booking Process (Custody Staff):
The Assessment Team observed intake/booking staff process numerous inmates at the MJ. The process included interviewing the new inmates with general intake questions, e.g., gang status, prior incarceration, and enemies. The intake deputies also had discussion with the inmates during the fingerprinting and photos “mugshot” process, had the inmates sign associated paperwork, and issued the inmates the Inmate Booking Information Receipt that includes charges and bail information. During this process, staff did not know whether the inmates had a disability that may pose a barrier to communication, and as such were not prepared to provide or document EC, if necessary.
Release Process:
The Assessment Team observed the MJ release and Bond release processes. Included in the process was the serving of various documents to different inmates, which required an explanation and subsequent inmate signatures/initials, e.g., PF11 form, Release Screening form, Work Project paperwork, receipt of returned property. Other information relayed included instructions to contact a specific bail bonds company, and information on property, money, dates to report to court or other county jurisdictions. The releasing deputy does not know who may have a disability where there may be a barrier to communication. There was no EC provided, and no EC documentation for this process.
Special housing/Administrative Segregation Process/TSEP Process:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
After observations and interviews of staff and inmates at the MJ, the Assessment Team found that inmates are not being provided written notification documentation when they are removed from the general population and placed in special housing, such as administrative segregation or TSEP. As such, there is no EC or documentation being provided to the inmates. The only documentation provided is any associated inmate disciplinary reports (write-up). Again, disabled inmates (those with barriers to communication) are being placed in these restricted environments often without fully understanding the nature of the move, or their rights within the process.
Staff Interviews
Through interviewing dozens of housing unit deputies and sergeants, programs staff, work supervisors, and educators, and health care staff, etc., the Assessment Team concluded the following:
 Custody staff, health care staff, teachers, librarians, and other staff have not received adequate ADA training regarding EC and reasonable accommodations;
 With very limited exceptions (primarily deaf/hearing-impaired inmates), custody and non-custody staff do not know which inmates have disabilities where communication barriers exist or may exist;
 A registered nurse indicated that she has never encountered a deaf/hearing impaired or speech impaired inmate who needed a sign language interpreter. She indicated that she would use written notes if confronted with that situation;
 An RCCC nurse indicated that an SLI could be obtained through Case Management staff if necessary, but she also said that they could contact the “language line.” She admitted that there are no protocols, but could write notes back and forth if that works for the inmate. She also admitted that it could be a challenge trying to secure an interpreter on the same date needed;
 An RN stated that deaf inmates can read lips and they (medical staff) would communicate with them via writing;
 A medical doctor was able to explain that the E-Chart main screen will often list a disability, and that accommodations will be provided as needed, and communications are made by using simple terminology, and written notes, if necessary;  An RN also indicated that only on some occasions there may alerts within the E-Chart as to inmate communication issues;
 An RN admitted that often the E-Chart does not indicate whether staff provided EC, or often does not articulate how staff communicated with a disabled inmate (those who may have communication concerns);
 An RN stated that if an intellectually disabled or learning disabled inmate is unable to read medical instructions, the inmate must first inform medical
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
staff, then medical staff will have the inmate repeat back the verbal instructions, and medical staff will input the information in to the medical progress notes;  When asked what to do when an inmate can’t read medical related documentation, another nurse mentioned she would explain it to the inmate, and provide a copy of the document to the inmate and also to a deputy;  One of the nurses (when asked) stated that hearing impaired inmates who need an SLI will receive one through court services (by going through the medical director), but also said that most inmates can and often write notes back and forth with medical staff;  Other than Locator Cards (sometimes attached with a chrono for a listed health care appliance or other general information) in the housing units, and rare written notations contained within the electronic JIMS system (PF2, PF4 and/or PF 10 screens), staff do not have accurate or complete lists/rosters of disabled inmates;  Most of the disabled inmates identified or known to staff at both jails (where a communication barrier exists or is likely to exist) are deaf/hearing-impaired;  This is attributed to not having a comprehensive screening process and subsequent inmate disability tracking system, e.g., testing for intellectual (developmental) disabilities or a process for identifying reading scores to assist in the query process to assess for possible learning disabilities;  Nearly all staff are not aware of specific EC needs for the large majority of inmates housed or assigned to their living or work areas;  The majority of staff do not understand how to provide EC and/or are not effectively providing it;  Most deputies who were interviewed indicated that they would explain documents, processes, and forms to inmates, and would read pertinent information, e.g., written response to grievances and KITE’s, if they were asked to do so;  A smaller number of deputies said that they write/scribe a document for an inmate if they asked, and if an inmate needed the help;  A few of the staff members interviewed acknowledged that they have provided that specific type of assistance in the past;  Staff do not currently document any EC (if provided);  Most custody staff do not fully understand the difference between inmates with mental illness, intellectual “developmental” disabilities, and learning disabilities, and generally do not understand the types of accommodations that are necessary to ensure EC for these types of inmates;  The staff that were most aware of inmate disabilities were those in the ROC program at RCCC where, by nature of the program, inmates are continuously examined for competency;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 There is also a disability alert process, in that MH records are reviewed, and Intelligence Quotient (IQ) test is administered, and inmates receive a “MOCA” quick exam (Montreal Cognitive Assessment), which takes about 15 minutes to administer;
 A ROC-assigned psychologist explained that large print handouts are provided, and instructions are explained, rephrased/broken-down in simple terminology, and often 1-on-1 sessions are conducted to maximize inmates’ understanding of instructions;
 However, ROC staff acknowledged that there is no inmate disability tracking system or disability designation process in place.
Most custody staff and other staff were open-minded and positive when asked how they would respond to an inmate who didn’t seem to understand rules, policies, or expectations. Some staff stated that they would be patient and continue explaining. But most of the staff that was interviewed was not aware of specific methods (e.g., speak slowly, use simple phrases/words, allow more time for the inmate to process information, etc.) to use in order to achieve EC.
When asked about providing assistance to disabled inmates to overcome communication barriers or encountering an inmate with communication needs, staff responses included but were not limited to the following:
 Check to see if the inmate has medical or psychiatric issues, and if needed refer the inmate via a psych or medical referral;
 Refer the inmate to a “houseman” or “trustee” for help;  Try to cell or bunk him with another inmate who is a friend of the inmate’s,
so the cellmate/bunkmate friend could help him/her;  Would assist the inmate with writing grievances or KITE’s, or explaining
information;  Have helped inmates with writing commissary slips and request slips
(KITE’s);  Provide 1-on-1 attention if necessary;  Would not write an inmate up without first having a 1-on-1 conversation
and explaining instructions;  Be patient and explain, and talk to the inmate individually;  I would not help an inmate write; the inmate can go to another inmate or
trustee; and I would give the inmate a grievance form if needed;  Be understanding because some inmates have learning disabilities or
developmental disabilities;  Give it more effort in explaining;  Use levels of communication;  Use non-verbal communication and gestures;  Review the locator card for possible information, and contact classification
staff for a bed move if needed; and  Talk to the inmate every day to get to know and understand the inmate
better.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
As related to Programs, staff admitted that they do not have a tracking list (electronic or hardcopy roster) for inmates with disabilities, or for any accommodation needs or physical limitation information on the inmates (other than what might be occasionally documented on the Locator card’s attached chrono [if available], or within the JIMS system PF2, PF4, or PF 10 screens). As such, staff acknowledged that they generally don’t know what type of disabled inmates they have or what the inmates’ specific accommodation needs are.
When asked, most staff indicated that there is a lack of assistive equipment available to assist inmates. Most staff also indicated that reading glasses can be purchased from the commissary or can be sent in by family members.
With regard to education, academic and vocational instructors from the EGUSD admitted that they do not have a list of disabled inmates, or those with EC concerns. But they indicated they would pull inmates aside and work with them individually to the extent possible to ensure each inmate understands. The teachers interviewed had no concerns with disabled inmates being assigned or possibly being assigned to their classes. One instructor indicated that there would be no problem with a deaf inmate working, and that he (instructor) believes the inmate would not need a sign language interpreter. Another teacher said she would not put a deaf inmate into any classes because they don’t have access to a sign language interpreter. One teacher stated that she would use an inmate signer if he were a friend of the deaf/hearing (or speech) impaired inmate. Another teacher stated that he has a deaf inmate in his computer class and the method of communication he uses is written notes.
Most of the teachers acknowledged there are not any large print materials, but that they can enlarge material on the computer screen and print it out if necessary. Some of the instructors cited that they have access to a case of reading glasses (for students) containing various reading prescription levels. Other available education accommodations that were noted include a full sheet magnifier (although at least one of the teachers claimed that some of the magnifiers turned up missing in the past), larger font on the computer screens, and lower level tests that can be administered if a student is struggling. When asked, some of the teachers said they would not have a problem moving a hearing-impaired inmate to the front of the classroom.
There are no IEPs at the SCSD detention facilities or under the EGUSD at the jail facilities, and previous IEP needs are not identified. Most teachers indicated that they would still try to accommodate disabled inmates with EC concerns, and accommodate their learning strategies to the extent possible. But some of the instructors admitted that inmates don’t usually ask for help or inform the teachers as to a disability or any EC needs. Due to claimed staffing shortages, and no IEPs in place, there are no formal or recognized “pullouts” being conducted for remedial or tutoring sessions, and there are no available teacher assistants to provide needed communication and assistance to learning disabled,
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
developmentally disabled, or other disabled inmates as applicable. As stated above, some of the teachers attempt to provide individual assistance to the extent possible, but this is not in policy, there is no set schedule for it, and it does not appear to be formally documented. Most of the vocational instructors would consider moving a disabled inmate to another position in the event the inmate was struggling with learning (but was still trying), and the workload appeared to be difficult for the inmate to maintain.
Inmate Interviews
The Assessment Team interviewed numerous disabled inmates, including those with mental illness, intellectual (developmental) disabilities (or some who may likely have intellectual disabilities), learning disabilities (or some likely to have learning disabilities), speech impairment, hearing impairment, vision impairment and other disabilities. Numerous inmates who were interviewed admitted attending special education classes in public school, and several others either claimed to have been diagnosed as learning disabled, or thought they were but were uncertain. A small number of inmates interviewed were not able to read at all, while there were additional inmates who struggled or had difficulties reading and/or comprehending short excerpts from the SCSD detention facilities Correctional Services Inmate/Detainee Handbook (rulebook), or in reading an ADA Notice as provided by the Assessment Team during the interviews.
With regard to the inmate disciplinary process, most inmates interviewed did not have a history of receiving write-ups. Some of the inmates interviewed complained that they had difficulties in understanding the disciplinary hearings. Some inmates indicated that staff does not explain to them the charges or their rights, and some disabled inmates interviewed acknowledged that they often do not understand the charges or the disciplinary process, or their rights when they receive their initial copy of the write-up, and they are often confused. Some of the inmates interviewed also explained that the hearing sergeants sometimes do not explain the charges or the outcome of the hearing to their understanding. Some complained that there have been occurrences where they did not receive an initial copy of the write-up, but had to attend the disciplinary hearing. A few of the inmates interviewed indicated that they never received their final copy of the report (with the disposition).
The Assessment Team also received several complaints from inmates categorized as OPP (as well as other disabled inmates) that staff will not assist them with writing/scribing/explaining grievances and other forms.
Classification Process:
The vast majority of inmates (including disabled inmates) interviewed had the same complaints. Most of the inmates mentioned that the classification deputies speak too fast, they don’t explain what they are talking about, and they quickly
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
complete the classification process. Many inmates do not understand their classification/custody level, or why they are being housed in a particular area. They claim that they often leave the classification meeting confused, and often don’t understand the decisions reached during the classification meeting. Although one of the classification forms at the SCSD detention facilities has a question pertaining to any special considerations due to a disability, the classification deputies were widely not asking this or any other disability-related questions (other than mental illness-related questions). The classification process does not include an EC component (either verbally ensuring EC or associated documentation), and classification deputies do not have a mechanism to identify who the disabled inmate population is. Numerous disabled inmates who were interviewed claimed that classification deputies didn’t ask them if they understood the encounter or their decision/outcome, and that they were not provided any accommodations or EC during the process.
The most egregious EC violations reported by inmates include:
MJ 2 East – An inmate who is legally blind with a TABE score of 2.0 stated that he has been requesting assistance in completing a grievance and staff are not being responsive. He stated that because there is only one custody staff member in 2 East, staff must stay in the control booth and are not available to help him with the grievance. He has requested assistance from medical staff specifically requesting that they read him medical information that is provided to him regarding his treatment and diagnosis, and medical staff do not provide him with any assistance.
RCCC KBF – A hearing-impaired inmate stated that it is difficult to hear the announcements on the public address (PA) system. He has to ask other inmates what the announcement was as staff do not communicate with him directly.
RCCC K Barracks – A deaf inmate stated that a SLI has only been provided for his initial JPS interview in booking. He claims that no SLI has been provided for his classification interview and medical appointments at the MJ. He claims that he had to pay an inmate $25.00 to make a phone call for him when the TTY was not working. The inmate said he arrived at the MJ on May 3, 2016 and that 2 days later he was moved to TSEP and kept there for 3 weeks. He stated that staff did not inform him of why he was in TSEP status. He also said that the chaplain does not provide SLI for religious services.
A deaf inmate arrived at the SCSD detention facility MJ on May 24, 2016. The arresting officers report notes a response of “No” to all questions on the Intake Screening Form. Question #9 “Is the arrestee non-responsive to the above questions” is also marked as “No”. The SCSD detention facilities CHS Special Needs form reflects “Non-English Speaking and Deaf” and notes that the inmate is “Cleared for 2 East Housing”. The Request for Reclassification Form dated 5/26/16 reflects 6 E housing is not appropriate and states, “Patient/Inmate is hard
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
of hearing/deaf. Requires assistance for ADL’s. House in 2E for LOS.” It was also noted that the inmate was placed on 15-minute checks from 7/7/16 at 1125 hours to 7/8/16 at 1310 hours. The Assessment Team asked medical staff to review the inmate’s medical chart to see how many occasions a physician or nurse had seen the inmate. Medical staff reported that a physician had seen the inmate on at least 6 occasions and nursing staff had seen the inmate on at least 10 occasions. There is no indication that staff attempted to determine the inmate’s primary method of communication. The Assessment Team attempted to interview and communicate with the inmate on 8/12/16. The inmate is totally deaf, so the team attempted to communicate with him using written notes. This was unsuccessful as the inmate was unable to read or write English. The inmate was distraught and crying during the interview as the Assessment Team attempted to communicate with him. The SCSD staff were not able to provide the team with documentation that a SLI had been used to determine the inmate’s primary method of communication, or if one was used during the Intake/Booking Process (medical and custody), classification process or medical/psychiatric encounters that occurred during the inmates 2 ½ months of being in custody. Medical staff reported that the inmate’s family has indicated that he communicates in Mien; however, SCSD detention facilities staff had not verified this with the inmate using a SLI. The SCSD detention facilities medical staff reported that on August 18, 2016 an inmate who communicates in ASL was used in an attempt to communicate with the deaf inmate, but the inmate being used as an interpreter reported that the deaf inmate does not communicate using ASL.
Conclusion
The SCSD detention facilities do not provide disabled inmates with accommodations for medical/mental health/dental encounters.
The SCSD detention facilities do not provide disabled inmates with accommodations for the Inmate Disciplinary (Write-up) process.
The SCSD detention facilities do not provide disabled inmates with accommodations for the classification process.
The SCSD detention facilities do not provide disabled inmates with accommodations for the release processes.
The SCSD detention facilities must have a comprehensive EC custody Operations Order (policy) and CHS policy in place to ensure that reasonable accommodations are provided and EC is achieved (or all reasonable attempts are made) for disabled inmates during clinical encounters (medical, mental health and dental), due process events (e.g., classification process, inmate disciplinary process, release processes, notification of charges, probation encounters/meetings), and other specific activities such as self-help groups e.g., AA/NA or religious activities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
A comprehensive EC custody Operations Order and CHS policy must also include inmate access to various auxiliary aids (e.g., qualified interpreters, readers, sound amplification devices, captioned television/video text displays, video remote interpreting, video visiting, TDD/TTY, audiotaped texts, Braille materials, large print materials, and signage), whether pertaining to a specific type of encounter, for work, or for recreation.
The SCSD detention facilities may decide to have a stand-alone comprehensive EC Operations Order and CHS policy, or, a comprehensive EC section within an ADA Order and policy (such as the draft ADA Operations Order, upon approval), or, incorporate necessary language within the numerous local Orders and policies as cited above. Also, as indicated above, nearly all of the local custody Operations Orders and CHS policies contain no EC language or references. A select few (as cited above) outline very brief and general EC related language, but do not extend far enough to ensure a higher standard and threshold to ensure EC and nondiscrimination.
Numerous operations orders and CHS policies contain some general EC-related language, but do not extend far enough and are not described in sufficient detail. Most are silent and do not address EC requirements.
The SCSD detention facilities must also ensure the following:
 Training: custody, health care (medical/dental/mental health), teachers, librarians, and other staff must receive adequate ADA training regarding EC, reasonable accommodations and auxiliary aids.
 Development of a comprehensive disability assessment process, with applicable screening instruments, and forms/documentation;
 Development and implementation of an electronic inmate disability tracking system, to provide custody, health care, classification, education, library and other staff with an updated identification and tracking roster/list or system for identifying disabled inmates as well as their accommodation and EC needs;
 Staff must understand and follow the higher standard and threshold for EC; identify the disability and EC needs of the inmate; provide the necessary accommodations/make all reasonable attempts to ensure EC (the inmate understands staff, and staff understand the inmate); and document the encounter (including the type of EC or accommodation(s) provided, and how the staff member concluded that the inmate understood the encounter);
 Staff must understand specific methods for providing EC (e.g., speak slowly, use simple phrases/words, allow more time for the inmate to process information);
 Staff must document EC provided for clinical contacts, and various due process events;
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 The EGUSD education staff should be provided with necessary assistive equipment to assist disabled inmates (those who have EC needs);
 The EGUSD education staff should have the resources to accommodate learning strategies of those inmate-students who have special needs, such as those with developmental, learning, vision, hearing, and speech disabilities;
 Sign language interpreters must be provided as necessary for due process events, clinical encounters, as well as educational and religious services when warranted;
 Classification and Inmate Disciplinary Hearing staff (as well as other staff during various due process events or clinical encounters) must make all reasonable attempts to carefully explain the process, charges, outcome, etc., and provide EC during the encounter.
An effective EC Operations Order/Policy must contain but not be limited to the following references:
 Assurance of EC with all inmates during all encounters or interactions;  A higher standard or threshold for due process events and clinical
encounters;  A general literacy trigger (e.g., reading level) for purposes of querying
inmates for inmate disciplinary events (for those who may not have been tested for learning disabilities or intellectual [developmental] disabilities, or otherwise may have literacy or cognitive concerns);  Relevant formal classroom EC training for all staff.  Requirement that disabled inmates with communication needs are interviewed (and provided EC as necessary) as part of the inmate grievance/appeal process as warranted.
References
28 CFR 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability:
(i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service.
28 CFR § 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability.
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
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28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections:
(i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities.
28 CFR 35.160 (a) (1) A public entity shall take appropriate steps to ensure that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with others.
28 CFR 35.160 (b) (1) A public entity shall furnish appropriate auxiliary aids and services where necessary to afford qualified individuals with disabilities, including applicants, participants, companions, and members of the public, an equal opportunity to participate in, and enjoy the benefits of, a service, program, or activity of a public entity.
28 CFR 35.160 (b) (2) The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the method   of communication used by the individual; the nature, length, and complexity of the communication involved; and the context in which the communication is taking place. In determining what types of auxiliary aids and services are necessary, a public entity shall give primary consideration to the requests of individuals with disabilities. In order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability.
U.S. Department of Justice Civil Rights Division Disability Rights Section Commonly Asked Questions About The Americans With Disabilities Act and Law Enforcement:
V. Modifications of Policies, Practices, and Procedures
23. Q: What types of modifications in law enforcement policies, practices, and procedures does the ADA require?
Example - A department modifies the procedures for giving Miranda warnings when arresting an individual who has mental retardation. Law enforcement personnel use simple words and ask the individual to repeat each phrase of the warnings in her or his own words. The personnel also check for understanding, by asking the individual such questions as what a lawyer is and how a lawyer might help the individual, or asking the individual for an example of what a right is. Using simple language or pictures and symbols, speaking slowly and clearly, and asking concrete questions, are all ways to communicate with individuals who
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have mental retardation.
ADA Best Practices Tool Kit for State and Local Governments
Chapter 3
General Effective Communication Requirements Under Title II of the ADA
A. Providing Equally Effective Communication
Under Title II of the ADA, all state and local governments are required to take steps to ensure that their communications with people with disabilities are as effective as communications with others. This requirement is referred to as “effective communication and it is required except where a state or local government can show that providing effective communication would fundamentally alter the nature of the service or program in question or would result in an undue financial and administrative burden.”
What does it mean for communication to be “effective”? Simply put, “effective communication” means that whatever is written or spoken must be as clear and understandable to people with disabilities as it is for people who do not have disabilities. This is important because some people have disabilities that affect how they communicate.
How is communication with individuals with disabilities different from communication with people without disabilities? For most individuals with disabilities, there is no difference. But people who have disabilities that affect hearing, seeing, speaking, reading, writing, or understanding may use different ways to communicate than people who do not.
Pierce v. D.C. 128 F. Supp. 3d 250 (D.D.C. 2015) Deaf individual was incarcerated for 51 days.   Prison staff never assessed Plaintiff’s communication needs.  Assumed lip-reading and written notes were sufficient. Plaintiff asserts he asked for an interpreter for medical intake, health services and various classes.  
Court: Granted summary judgment for Plaintiff on effective  communication and intentional discrimination. Denied prison’s motion for summary judgment.   Court: Prison violated ADA/504 as a matter of law by failing to evaluate Plaintiff’s need for accommodation when taken into custody. Violation: Failure to assess needs of deaf inmate. Prisons have an affirmative duty to assess the accommodation  needs of inmates with known
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disabilities taken into custody.  Even if the individual has not made a specific request. Prison officials cannot rely solely on their own assumptions.   Violation: Plaintiff was not provided with required interpreter. Requested interpreter – evidenced by notes, testimony.   Needed an interpreter evidenced by differences in ASL/English versus dealing with complex communications. Rejected argument that District employees said they believed   Pierce understood them.   No undue hardship/fundamental alteration. Holmes v. Godinez 311 F.R.D. 177 (N.D. Ill. 2015) Plaintiffs (deaf/hard of hearing inmates) argued that prisons fail to provide effective communication, including:  Visual alarms and notifications, access to TTYs, hearing aids and batteries, other auxiliary aids. Court: Found for plaintiffs (denied MSJ) and granted class certification.   Case demonstrates the wide range of programming requiring   access, including:   religious services, disciplinary hearings, medical, mental health   and rehabilitation programs, educational and vocational  programming.
See also Bearden v. Clark Cty., 2016 WL 1158693 (W.D. Wash. Mar. 24, 2016) Advocates argue that effective communication requires prisons to provide videophones, not just TTYs. Recent agreements out of Maryland and Kentucky Deaf and hard of hearing inmates will have access to videophones to communicate with people outside of prison.   Other select provisions: Visual notification of oral announcements regarding: emergencies; Access to interpreters and other auxiliary aids and services; Broad scheme of policy implementation, training, outreach, and monitoring to ensure equal treatment.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Administrative Segregation Unit, Total Separation, Disciplinary Detention Unit
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures pertaining to Administrative Segregation process are outlined in Operations Orders 06/03 Classification Process and 06/02 Housing Plan and Policy 1107 Decision Making-Special Needs.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1080 Rules and Disciplinary Penalties requires that:
Wherever discipline is administered, each facility administrator shall establish written rules and disciplinary penalties to guide inmate conduct. Such rules and disciplinary penalties shall be stated simply and affirmatively, and posted conspicuously in housing units and the booking area or issued to each inmate upon booking. For those inmates who are illiterate or unable to read English, and for persons with disabilities, provision shall be made for the jail staff to instruct them verbally or provide them with material in an understandable form regarding jail rules and disciplinary procedures and penalties.
“People with disabilities” are defined to include, but not be limited to, persons with a physical or mental impairment that substantially limits one or more of their major life activities or those persons with a record of such impairment or perceived impairment that does not include substance use disorders resulting from current illegal use of a controlled substance.
Operations Order 06/03 Classification Process states, “Prisoner classification should be based on factors, which affect the security of the facility, staff, and the prisoner. Some of these factors include, but are not limited to:
 Physical characteristics, including gender, age, mental and medical conditions.
 Criminal history both in and out of custody, known gang affiliation, prior classification history, current charges or nature of charges against prisoner.
 Legal status, including propria persona (pro per) status, civil commitments, extradition status, or detention as a witness.
 Administrative segregation considerations including prior peace officer or corrections officer employment, gravely disabled status, and/or case notoriety.
 Criminal sophistication, former victims or enemies currently housed within the facility, status as a known law enforcement informant, sexual orientation/transgender status, or status as an inmate worker.”
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“High Security Housing may be used to house prisoners at the MJ and RCCC based on guidelines including, but not limited to:
 Prisoners with a documented history of in-custody assaults in the last two (2) years. Assault history includes, but is not limited to, past cases of assault and pending cases. Assault history includes predatory behavior involving or victimizing other prisoners.
 Prisoners with escape or attempted escape histories from secured facilities within the last ten (10) years.
 Prisoners who have a current or past criminal history involving victimization of children or the elderly.
 Prisoners with two (2) or more major write-ups during the current custody period for rule violations.
 Prisoners who are validated gang members and/or have a history of gang related crimes.
 Prisoners who have charges filed against them as a result of a write-up during the current custody period.
 Prisoners involved in cases that have considerable press coverage or notoriety.”
“Medium and Minimum Security Housing may be used to house unsentenced prisoners at RCCC who do not meet the criteria for Special or High Security Housing.
Special Housing refers to housing designated for prisoners with specific segregation needs, status as inmate workers, medical or mental health requirements, and disciplinary isolation. Special Housing needs will be determined by the classification unit and by physical plant design and limitations of each facility.
Special Housing may be used to house prisoners at MJ and RCCC who have special separation or housing needs, including but not limited to:
 Medical or mental health problems or disabilities which prevent the prisoners from caring for themselves in a jail setting, or who are required to be isolated for medical reasons.
 Prisoners who are classified as Administrative Segregation, Protective Custody, Total Separation, or Civil Commitment status, per Operations Order 06/02.
 Prisoners who are placed in disciplinary isolation. A Hearing Sergeant will assign prisoners to disciplinary isolation based on the findings of the disciplinary hearing.”
“Classification officers will be responsible for conducting classification reviews in accordance with but not limited to the following guidelines:
 For prisoners in High Security Housing, every thirty (30) days.
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 For prisoners in General Population Housing, after the first sixty (60) days of custody.
 Upon request from custody staff, Medical Staff, Jail Psychiatric Services, and/or court officials, or when the legal status of the prisoner changes.
 When a prisoner is relocated and/or reclassified due to the outcome of a disciplinary hearing.”
Operations Order 06/02, Housing Plan states, “the MJ and RCCC Classification Unit will assign prisoners to a housing unit based on the current housing needs of the facility and/or in accordance with Operations Order 6/03, Classification Process.”
“The MJ has two (2) floors, which have designated housing areas that may be used for prisoners who have received disciplinary isolation.
 The 8 West 400 Pod is available for male disciplinary isolation.  The 7 West 400 Pod is available for female disciplinary isolation.”
Operations Order 07/03, Inmate Discipline Plan states, “no inmate may be deprived of the implements necessary to maintain an acceptable level of personal hygiene. Inmates will be allowed to keep or be provided with a toothbrush, toothpaste, soap, shaving implements, comb and tampons/sanitary napkins pads for female inmates. Inmates will be allowed to shower at least every other day. While on disciplinary isolation, prisoners are allowed to keep the above items, a bible, and all legal materials to include paper/envelopes/pencil for legal correspondence.”
“Major facility violations shall be punishable by any of the disciplines listed in the applicable regulations, as well as loss of commissary privileges, social visits, dayroom/outdoor recreation, telephones, housing unit programs, removal from inmate worker status, relocation, loss of good time, disciplinary isolation diet, and disciplinary isolation housing.
An inmate may be removed from general population housing when a rule violation is aggravated or if it could recur or incite other misconduct. To ensure the safety and security of the facility, an inmate may be moved to another housing unit, including a disciplinary housing unit, pending the outcome of either the disciplinary process or prosecution. A sergeant or watch commander may make this decision. The person making the decision will not be involved in the hearing.
Inmates found guilty of violating major rules may be moved to a disciplinary isolation-housing unit to serve his/her discipline. The maximum time any privilege can be suspended for a single facility Major violation shall not exceed 15 days. When multiple violations arise from a single incident, each violation may be punished concurrently or consecutively, but shall not exceed 30 days suspension. Any inmate on disciplinary isolation housing status for more than 30
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days because of multiple incidents shall have a review by the division commander before the disciplinary isolation status is continued. This review shall include a consultation with health care staff and continue every 15 days until the inmate is off discipline.”
The SCSD detention facilities TSEP and ADSEG Inmate Housing Plan outlines the following privileges provided to TSEP and ADSEG inmates while they are housed at the Main Jail. Inmates classified as TSEP and ADSEG present special consideration based upon their inability or unwillingness to be near other inmates. In order to comply with Title 15, the SCSD detention facilities will provide the base minimum Title 15 standards for inmates classified as TSEP and ADSEG.
“TELEPHONE – TSEP and ADSEG inmates shall be allowed no more than 5 contact numbers entered into the phone system at any one time. Removing or adding numbers will require a request identifying the number to be added, person’s name, area code and relation to inmate.
CORRESPONDENCE – TSEP and ADSEG inmates shall only be able to correspond with 5 verified mailing addresses at any one time. Removing or adding names will require a request identifying the address, receiver’s name, and the person’s relation to the inmate. This does not apply to legal mail.
COMMISSARY – TSEP and ADSEG inmates shall only purchase from the approved item menu and will only be allowed a maximum of $100.00 in their account at any given time. TSEP and ADSEG inmates will only be allowed a maximum weekly gift order of $30.00. If an inmate receives a gift order they will not be allowed to order commissary that week. Additionally, TSEP and ADSEG inmates will gain access to commissary only once per week.
READING MATERIAL – TSEP and ADSEG inmates shall not be allowed to loan any book, periodical or newspaper to any other inmate and will comply with the jail rules associated with the total number of publications allowed.
INMATE ORIENTATION – TSEP and ADSEG inmates shall not be allowed to have television playing when an inmate is not in the dayroom. During that time, a jail orientation video will discuss jail rules associated with general population and TSEP status.”
Per policy 1107, Decision Making-Special Needs, “consultation between the Facility Commander and the Medical Director is required for actions regarding patients who are diagnosed as having significant medical or mental health disorders, as follows:
 Housing assignments.  Program assignments.  Disciplinary measures.
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 Admissions to and transfers from institutions.
Maximum cooperation between custody personnel and health care providers is essential so that both groups are made aware of movements and decisions regarding patients with special medical or psychiatric needs. For example, health care staff must inform custody personnel when an inmate is suicidal, homicidal, or inappropriately housed in the jail for health care reasons. An inmate’s special needs may complicate housing or work assignments or disciplinary management. Medications may need to be adjusted for safety at the work assignment or before transfer.”
Observations
The Assessment Team toured the housing units that are designated to house ADEG, TSEP and Disciplinary Detention prisoners. The MJ housing is located in 8-West Pods 100, 200, 300 and 400, 8-East Pods 100, 200 and 300, 7-East Pod 100, and 7-West Pods 300 and 400. The RCCC housing is located in SBF Pod 100 and CPF Pod 100. The Assessment Team also noted that there were TSEP designated inmates housed in 2-East where inmates with medical conditions and inmates with assistive devices or disabilities that cannot ambulate stairs to access visiting, outside recreation or showers.
Staff Interviews
The Assessment Team interviewed staff to determine if disabled inmates housed in the ADSEG, TSEP and Disciplinary Detention units have equal access to programs and services as other inmates housed in the general population units. Classification staff stated that the designation of TSEP is based on classification factors that require an inmate to be totally separated from other inmates and includes type of charges, criminal history, behavior or high notoriety crime/person. The criteria for ADSEG are escape risks, current validated prison gang, assaultive towards staff or other inmates, or who by the nature of their behavior have demonstrated potential for violence. Criteria for being placed in Disciplinary Detention are based on the disposition of a major rule infraction. Inmates do not receive written notice and/or final notice of the decision made to place or retain them in TSEP other than a verbal notice at the time of placement or the 30-day re-reviews, which are conducted face-to-face. Inmates do not receive written notice and/or final notice of the decision made to place or retain them in ADSEG status/housing. Staff stated that inmates are allowed to retain their HCAs in ADSEG, TSEP and Disciplinary Housing. Staff stated that inmates on TSEP status are restricted to $30.00 of commissary in cell. All other programs, services and activities are the same as general population inmates with the exception of available education/self-help programs due to program space restrictions.
Inmate Interviews
The Assessment Team interviewed 9 inmates that were on TSEP and ADSEG status. Of the inmates interviewed 5 were not aware of their classification
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designation and stated that they did not understand the classification process. Three of the inmates stated that they couldn’t read without reading glasses. There were 3 inmates with mobility impairments who stated that they had a difficult time ambulating up the stairs to the visiting area and also to the yard. Most inmates interviewed indicated that they would participate in education and self-help programs if they were offered. The inmates housed in MJ stated that at times yard is offered; however, some of those times it is offered at 1 or 2 a.m. Inmates also stated that the chaplain does come around, however, very infrequently. A few of the ADSEG and TSEP inmates claimed to have little contact with JPS staff.
One of the inmates housed at the MJ (was formerly on TSEP status) indicated that when he was on TSEP status, he was never informed as to why he was on that status, and he subsequently submitted a KITE to ascertain why. He later came to his own conclusion that he was placed on TSEP because he was sexually assaulted. He then agreed to go to PC status, but had remained on TSEP for about another week.
Conclusion
Disabled inmates placed in TSEP, ADSEG and Disciplinary Detention housing have equal access to the programs, services, and activities as non-disabled inmates. However, there are some concerns with disabled inmates having a difficult time accessing visiting and the recreation yard. This is not based on their specific housing, as these barriers would exist if they were in general population housing. More than ninety percent of the inmates interviewed were not aware of their classification, which is mainly due to staff not providing effective communication during the classification interview. This is addressed in further detail in the effective communication section of this report. The Operations Orders must include the criteria for placement into and the criteria for removal from TSEP and ADSEG status. This needs to be effectively communicated to inmates to ensure they are aware of such criteria. Although classification staff advised the Assessment Team of the criteria for designation and placement into TSEP and ADSEG status/housing, the Operations Orders do not include the specific criteria for TSEP and ADSEG classification designation. The Classification training PowerPoint does detail the specific criteria for TSEP and ADSEG classifications.
The Operations Orders should also include the following specific privileges afforded to segregated inmates:
 Hygiene;  Exchange of clothing and bed linens and access to barbering and hair
care;  Correspondence privileges;  Opportunity for visitation;
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 Opportunity to use the telephone;  Access to courts and counsel;  Access to leisure;  Access to legal research assistance services via a unit-based or delivery
system;  Opportunity to exercise outside the cell a minimum of three hours per
week; and  Access to programs and services that will generally include:
 Education;  Commissary;  Social Services;  Counseling;  Religious services; and  Medical and Mental Health Services. References 28 CFR § 35.130 (a) states no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity. 28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inmate Grievances
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to the ADA Grievance process are outlined in: Operations Order 07/02 Grievances, 1435 Inmate Health Care Grievances, and Draft Operations Order Inmates with Disabilities - ADA.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1073 Inmate Grievance Procedure requires that;
(a) Each administrator of a Type II, III, or IV facility and Type I facilities which hold inmate workers shall develop written policies and procedures whereby any inmate may appeal and have resolved grievances relating to any conditions of confinement, included but not limited to: medical care; classification actions; disciplinary actions; program participation; telephone, mail, and visiting procedures; and food, clothing, and bedding. Such policies and procedures shall include:
(1) a grievance form or instructions for registering a grievance; (2) resolution of the grievance at the lowest appropriate staff level; (3) appeal to the next level of review; (4) written reasons for denial of grievance at each level of review which acts
on the grievance; (5) provision for response within a reasonable time limit; and, (6) provision for resolving questions of jurisdiction within the facility.
Per Operations Order 07/02, Grievances, Correctional Services shall provide a written process that allows inmates to grieve specific conditions. All written grievances shall receive a written response within a reasonable time limit and will be resolved at the lowest appropriate staff level.
A grievance is a complaint by an inmate regarding any condition of confinement, act, rule or policy, written or unwritten, in which an inmate contends that there is an infringement upon his or her personal, human or constitutional rights. A grievance may include complaints against the substance of policies or rules, as well as their application. A grievance may include complaints about disciplinary and classification actions or rulings, conditions of confinement, work project supervision or home detention as well as complaints about:
 Medical care  Program participation  Telephone and Mail  Visiting Procedures  Food, Clothing, Bedding
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An inmate should first direct his/her issue to custody or supervising staff as the issue should be resolved at the lowest appropriate staff level. If custody or supervising staff is unable to resolve the issue, the inmate may file a formal written grievance. The inmate has the right to file a grievance within five (5) calendar days following the occurrence of, or after the inmate became aware of a specific incident regarding any condition of confinement, work project supervision or home detention. A grievance regarding Department policy may be filed at any time. Only one issue may be included in the grievance. If an inmate wishes to challenge several issues, each issue must be set forth on a separate grievance.
When an inmate requests a grievance form, custody or supervising staff shall provide the form. Once an inmate completes a grievance, the grievance must be turned into any housing unit staff assigned to the inmate’s housing location or staff assigned to supervise the inmate’s work project or home detention activities. When an inmate submits a grievance, housing unit or supervising staff shall accept the grievance.
The receiving housing unit or supervising staff shall print and sign his/her name, badge number, date and time of the acceptance of the grievance and return a copy to the inmate. Housing unit or supervising staff shall review the grievance and resolve it if possible. Any action taken or resolution offered by housing unit or supervising staff shall be documented in the grievance reply section or on a separate grievance reply form. Housing unit or supervising staff shall place the grievance and any reply in the appropriate facility repository (grievance box located on the second floor of the RCCC administration office; black box in the MJ Administration area; Administrative Supervisor’s box of the Work Release Division), whether or not staff is able to resolve the problem.
ALL grievances and replies shall be forwarded to administration. Grievances shall NOT be discarded simply because the issue has been resolved. Administration will log the grievance, scan it into the Department Records Management System (RMS) and distribute unresolved grievances to the appropriate supervisor(s) for review.
Once received, the supervisor shall review each grievance submitted by custody or supervising staff and determine the initial course of action for the grievance. If the supervisor determines that the grievance has been resolved, the supervisor will approve the resolution by signing and dating the grievance and reply, then return both to administration as required above. If the supervisor determines that the grievance should be routed to a specific section for review and potential resolution, the supervisor will note this on the grievance. The supervisor will then:
 Distribute the original copy of the grievance to the appropriate shift or unit (i.e. medical, JPS, food services, home detention, work project.)
 Distribute the yellow or other copy of the grievance to the division secretary or designee so the grievance can be updated with the
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appropriate shift or unit handling the grievance into the grievance tracking system.
The supervisor assigned to handle the grievance shall review the grievance and all pertinent documents, reports, records and files related to the grievance. The supervisor may distribute the grievance to appropriate staff for resolution. If the appropriate staff person was not able to resolve the problem or the inmate wishes to appeal, the supervisor will take the appropriate action necessary to resolve the problem. This action or supervisor reply will be documented in the grievance reply section or on a separate grievance reply form. Once the grievance is answered, the supervisor will forward the entire grievance and any responses to the watch commander or unit manager within four (4) days for review.
The watch commander/unit manager has (4) four days to review and approve the response, add additional responses to the grievance or require further investigation. The completed grievance response will be forwarded to the assistant division commander for review. The assistant division commander may approve the reply by signing the completed form. In the event the grievance involves staff conduct, the assistant division commander shall notify the division commander who thereafter will decide if a copy should be forwarded to Professional Standards. The assistant division commander may return the package to a supervisor or the investigating staff for further investigation if needed.
When a grievance package is complete, the entire package shall be logged into the facility’s grievance tracking system. The original grievance and any replies will be maintained by the division for seven years. The yellow copy or other copy and any response shall be placed in the inmate’s file. A copy of any response will be sent back to the inmate after the investigation is completed.
If the inmate is dissatisfied with the reply, the inmate may send a written appeal on a grievance form to the division commander within five (5) days of the initial reply. The division commander will decide the manner in which the grievance is handled. Any time limit may be extended upon mutual agreement by the division commander. No reprisal shall be taken against any inmate for filing a grievance or an appeal of a grievance decision.
All inmates have the right to appeal and have resolved any grievances related to any condition of their confinement; however, grievances are to be filed on an individual basis. So-called “Group” or “Class-action” grievances are not permitted. When multiple grievances are received from more than one inmate on an identical issue, each such grievance will be processed individually. Each inmate shall be provided with a response. A statement shall be included in the response explaining that the grievance has been designated as one of multiple
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identical grievances for processing purposes and the same response is being distributed to each inmate.
The division commander, at his or her discretion, may refuse to accept grievances from an inmate if it is found the inmate is filing an excessive number of grievances of a frivolous nature or grieving issues that were previously grieved and resolved.
Per Draft Operations Order Inmates with Disabilities - ADA, the intent of the ADA Division Representative is to review requests, complaints and grievances related to ADA issues, maintain the Division’s ADA files, and provide training to facility staff on auxiliary aids and services. The ADA Division Representative may respond to ADA requests or ADA grievances and will ensure the Facility ADA Coordinators are updated and informed of all ADA issues as well as perform inspections.
The ADA Coordinator, or his/her designee, is responsible for keeping the ADA division representative informed of all requests, complaints, or grievances related to ADA issues, review claims, complaints and grievances regarding disabilities, and ensuring complaints and grievances are finalized.
An inmate with a disability who believes he/she is the subject of disability discrimination or who wants to appeal any denial of ADA housing and/or accommodation may submit a grievance. All grievances concerning conditions of ADA housing and/or accommodations will be made on a Grievance Form following the guidelines in Operation Order (7/02), Grievances. All ADA related grievances shall be routed through the facility Compliance unit. The Compliance unit will determine the best course of action for the grievance (e.g. Medical, Custody, Food Services) and then route it as deemed appropriate. The Compliance unit will track all ADA related grievances until finalized. A copy will be forwarded to the ADA Corrections Division Representative.
Any grievance in which an inmate claims the ADA housing and/or accommodations are causing an imminent threat to his/her health or safety shall be expedited. A copy will be forwarded to the facility Compliance unit. A copy of any grievance for ADA conditions and/or accommodations made by an inmate being held for the California Department of Corrections and Rehabilitation (e.g. parole hold, detainer) or for any Federal contract (e.g. U.S. Marshals, Immigration and Customs Enforcement) shall be made available upon that agency’s official request.
Per policy 1435, Inmate Healthcare Grievances, an inmate has the right to file a grievance within five (5) calendar days of the incident regarding the problem with his/her health care. Once an inmate completes the grievance, the grievance must be turned into any housing unit custody staff assigned to the inmate’s housing location.
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Custody staff will review each grievance submitted and forward the grievance to the nurse who is responsible for handling inmate health care grievances. All healthcare grievances will be logged into a CHS grievance log for tracking and resolution. The nurse will review the grievance and all pertinent medical records. The nurse may schedule a Priority Administrative Review appointment so the patient-inmate can be medically assessed. A written response indicating the action taken will be prepared and delivered to custody within ten (10) days.

The watch commander/other equivalent support unit supervisor will have four (4) days to review and approve, add additional responses to the grievance, or require further investigation. The completed grievance response will be forwarded to the assistant division commander for review. The assistant division commander may approve the reply by signing the completed form. In the event the grievance involves staff conduct, the assistant division commander, after notification of the division commander, will decide if a copy should be forwarded to Internal Affairs.

The assistant division commander may return the package to Correctional Health Services for further action. When a grievance package is complete, the entire package is forwarded to the respective division’s employee responsible for logging it into the facility’s grievance tracking system. The original grievance and any replies will be maintained by the division for seven (7) years. A copy of all responses will be sent back to the inmate after the investigation is completed.

If the inmate is dissatisfied with the reply, the inmate may send a written appeal on a grievance form to the division commander within five (5) days of the initial reply. The division commander will decide the manner in which the grievance is handled. Any time limit may be extended upon mutual agreement by the division commander or his/her designee.

All inmates have the right to appeal and have grievances resolved with respect to any aspect of their health care; however, grievances are to be filed on an individual basis. So-called “Group” or “Class-action” grievances will not be reviewed. The division commander, at his or her discretion, may refuse to accept grievances from an inmate if it is found the inmate is filing an excessive number of grievances of a frivolous nature or grieving issues that were previously grieved and resolved.

Observations
The grievance coordinators at the MJ and RCCC provided the Assessment Team with the categories used to track grievances. This listing identifies 8 Grievance categories with 32 sub-categories and 1 Appeal category with 7 sub-categories.

Grievance – Health

JPS Medical - Treatment Medicine

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Treatment - Conduct not Medical Attention

Grievance – Legal

Attorney Courts Law Library

Grievance – Other

Other - Commendations Maintenance Issues

Grievance – Policy or Procedure

Classification Discipline Facility Other - Time Comps Security

Grievance - Program

Education Reentry Religious SWP Program

Grievance – Property

Mail Money - Commissary/Me Co-Pays Personal Tank Property

Grievance – Services

Clothing Commissary Food Laundry Phones Recreation Showers Visitation

Grievance – Staff Conduct Sexual Misconduct – Staff Treatment Use-of-Force

Grievance – Appeal

Commissary - Items only Discipline Food Law Library Medical Money - Welfare Kit Charge Other

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There is no category for ADA grievances or appeals including requests for reasonable accommodations. The grievance coordinators provided the Assessment Team with the previous 90 days of grievances. Although there is no specific ADA category the Assessment Team identified the grievances that are ADA-related. A detailed summary of these grievances is as follows:
 MJ 2 East: Inmate states he fell in the shower in 2 East Pod 100, requested to use the 2 medical shower, requested medical needs form for 2 medical shower. Response states request for showering on 2 medical is a custody matter please discuss your request with custody;
 MJ 2 East: Inmate requested assistance with showering; claims nurse stated, “There is more important things to do besides helping you with your shower”. Response states this issue has already been addressed by the Medical Director and the Director of Nursing;
 MJ 8 East: Inmate states he is a developmentally disabled inmate with a TABE scorer of 0.7. He states he needs help all the time with everything and he cannot get it on TSEP. Deputy responded that he was not aware the inmate was developmentally disabled. Inmate received assistance in writing a letter and information about his charges;
 MJ 4 East: Inmate is requesting grab bars and shower chair. States he slipped and fell in the shower.
 MJ 8 East: Inmate states he had a “no stair” chrono in CDCR. Inmate states he is fully disabled due to multiple disabilities. Needs accommodations for health and safety;
 MJ 8 East: Inmate states he can’t walk that 1 step to shower. How will I get to visit? He is not allowed to shower with a chair. What was the doctor thinking when he said I was clear? Response states “Patients who use assistive devices such as canes, walkers and crutches no longer require housing on the medical floor; you are ordered a lower bunk, lower tier, an extra mattress and blanket;”
 MJ 4 East: Inmate requests access to showers with handicap railing, handicap cell with lower bunk. Claims he is forced to “bird bath” or use plastic slippery chair. Claims he fell outside the shower. Claims he has been sleeping on the floor;
 MJ 3 East: Inmate is requesting an extra mattress due to degenerative disk disease. Response states an extra mattress was ordered;
 MJ 8 West: Inmates states he is an Armstrong class member and requires ground floor, limited stairs, lower/bottom bunk, eyeglasses, hearing aids, assistive device for mobility and mental health care. Response states inmate is provided a lower bed on a lower floor, as well as reasonable accommodations for stairs. Will add that inmate will have personal and attorney visits on the 2nd floor where there are no stairs. If you are unable to navigate the stairs to the recreation area a Deputy will escort you through the mezzanine level. You are already in contact with Jail Psych
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Services; eyeglasses, hearing aids mobility devices were ordered at this time;  MJ 5 West: Inmate states he has a low bunk/low tier chrono that is not being honored. Response recommends that inmate submit a HS KITE requesting one;  MJ 7 East: Inmate states he is totally disabled and can’t do stairs for family and attorney visits. Response does not address inmates request only medical care provided;  MJ 4 East: Inmate is requesting glasses for trial, to see witnesses and read documents. Response states that the Jail policy on glasses has been revised to accept all glasses. Contact whoever can deliver your glasses;  MJ 6 West: Inmate states he has fallen a few times and is requesting a cane. Response states a cane was ordered. Medical contacted the floor deputy regarding the cane that was ordered by medical. The floor deputy reported that the cane was in control, and inmate was issued the cane;  RCCC JKF: Inmate is requesting his psych medications. Response states medication were discontinued due to inmate “cheeking” meds;  RCCC H Barrack: Inmate states he is not receiving psych meds. Response states he has orders for psych medications;  RCCC SLF: Inmate states she was being questioned in the hallway outside the bubble by correctional officers and psychiatric staff while inmate workers were around walking and talking by. “I don’t need anyone to know my business.”
Staff Interviews
The Assessment Team interviewed the grievance coordinators for the MJ and RCCC facilities. The grievance coordinator at the MJ stated that she receives the custody-related grievances after they have been responded to by custody. The completed grievances must have a sergeant’s signature. Deputies try to resolve the grievance issue at the lowest level. There are no timelines in which the grievance must be completed. Once the custody response is received, the grievance is forwarded to the lieutenant for review and final approval. Once the lieutenant approves the custody grievance, the grievance is issued a log number and entered into RMS.
The grievances that require a medical response or are outside the purview of custody, are forwarded to the grievance coordinator by custody staff. These grievances do not have a completed response. For medical grievances, the grievance coordinator emails a scanned copy of the grievance to medical staff for response. Once medical staff completes the response, medical staff forwards the typed completed response to the grievance coordinator. The grievance coordinator prints the response and attaches the response to the grievance and forwards the grievance and the typed response to the lieutenant for review and approval.
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Inmate copies of the completed grievances (custody and medical) are forwarded to the floor officers and distributed to the inmates. The completed grievance is scanned into the inmate record. There is no detailed policy of how custody staff must distribute the copy of the grievance to ensure EC when issuing a grievance response to a disabled inmate. Prior to May of 2016, all completed grievances were shredded after being scanned; however, administrative staff is now retaining the completed grievances.
The grievance coordinator at the RCCC stated grievances are placed in a designated grievance folder in the booking area. The grievances are collected every business day morning and afternoon. Once received, grievances are assigned a log number and entered into RMS. The grievances are assigned to the appropriate area for response. There are no timelines in which the grievance must be completed. The grievances that require a medical response are scanned and emailed to medical staff for response. Once medical staff completes the response, medical staff forwards the typed response to the grievance coordinator. The grievance coordinator prints the response and attaches the response to the grievance.
Once the grievance responses are received, the grievance is forwarded to the sergeant and lieutenant for review and approval. Once the grievance response is approved, the grievance and response are scanned into RMS. The inmate copies of the completed grievances (custody and medical) are distributed to the officers inbox and are distributed to the inmates. There is no detailed policy of how custody staff must distribute the copy of the grievance to ensure EC when issuing a grievance response to a disabled inmate. All completed grievances are shredded after being scanned.
To comply with the August 28, 2012, federal court order (County Jail Plan for addressing Armstrong Class Members housed in county jails), issued by Judge Claudia Wilkins, in the matter of Armstrong vs. Brown, Case Number 94-2307CW, the SCSD detention facilities received CDCR 2275-CJ Forms-Requests for Reasonable Modification or Accommodation for Access to Housing and/or Program(s) in a County Jail from CDCR. The Assessment Team reviewed 4 CDCR 2275-CJ forms.
 DNM – Notification - Requires level terrain no obstructions in the path of travel. Ground Floor- Limited stairs. Lower/Bottom Bunk Only.
 No (Disability Placement Program) DPP Code EOP – CDCR 2275-CJ Requires Ground Floor, Lower/Bunk, No Climbing, No prolonged standing. Requests mental health treatment.
 DD1 – CDCR 2275-CJ - Lower/Bottom Bunk. Requests help reading and comprehending docs.
 No DPP Code CCCMS – CDCR 2275-CJ – Basic nonreader. Needs reading glasses and help understanding documents.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 DD2 – CDCR 2275-CJ – Requests assistance with reading and understanding all documents.
The SCSD detention facilities medical staff stated that after receipt of a CDCR 2275-CJ, the patient’s Electronic Medical Record (EMR) is pulled and reviewed. The information from the CDCR letter attached to the CDCR 2275-CJ is placed into the EMR chart in the clinical notes. The inmate is scheduled for a face-toface clinical visit with a doctor. During this exam the doctor evaluates and determines if the accommodations listed on the CDCR letter and CDCR 2275-CJ are appropriate.
Medical staff stated that they also receive the email notification from CDCR notifying SCSD detention facilities and identifying each parolee with a disability, including those subject to California Penal Code section 3056, being held in SCSD detention facilities, each parolee with a disability booked in the SCSD detention facilities, each CDCR out-to-court prisoner with a disability housed in SCSD detention facilities and the last-known disabilities and the accommodations in housing or programming the prisoner received as of the date he or she was transferred from a prison. Medical staff stated that the same process for the CDCR 2275-CJ listed above is followed for CDCR’s County Jail Plan email notification. Medical staff stated that the information is forwarded to the facility lieutenant; however, the facility lieutenant stated that custody staff does not track the information provided by medical staff.
More than half of the housing unit officers interviewed stated that they would not assist inmates in completing grievances. The officers stated they would direct the inmate to other inmates or the “houseman” for assistance in completing the grievance.
Inmate Interviews
More than 35 percent of the inmates interviewed stated that they either did not know how to access the grievance process or needed assistance in completing and submitting grievances. These inmates also stated that staff had not explained the grievance process to them and that they had to rely on other inmates to explain the grievance process to them. About 10 percent of the inmates interviewed claimed that staff were reluctant to give them a grievance if the issue involved a custody staff member; however, custody staff was willing to provide the grievance if the issue being grieved was a medical issue.
Conclusions
One of the most important tools for any jail is the grievance process provided to inmates in order to file complaints regarding conditions as well as events in the jail where the inmate believes their rights are violated, including violations of the ADA. By providing inmates with a proper grievance process, the jail administration can resolve issues within the jail environment before the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
conditions or events lead to litigation. For the grievance process to be effective, inmates must be made aware of the process. Although the SCSD detention facilities have adopted and published a grievance process, inmates are not being made aware of the grievance process as required by the Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations which requires that information regarding the grievance process be made available during inmate orientation. As stated in this report, orientation is not being provided to inmates.
Although the Draft Operations Order Inmates with Disabilities - ADA speaks to the ADA Grievance Process, this Order has not been implemented. And based on inmates not being made aware of the method in which to request accommodations, disabled inmates essentially do not have a means to request accommodations for their disabilities or address discrimination based on violations of the ADA.
Although the Draft Operations Order Inmates with Disabilities - ADA addresses an expedited process for ADA grievances there are no specific timelines outlined in the order.
The Draft Operations Order Inmates with Disabilities - ADA does not provide for interim accommodations for inmates during the time frame the ADA grievance is being processed and responded to.
The SCSD detention facilities’ ADA grievance process does not comply with the requirements of the “Opinion in Support of Order Distributing and Enforcing the Amended County Jail Order and Plan dated 8/28/12” (Armstrong v. Brown, 857 F. Supp. 2d 919, 939 (N.D. Cal. 2012), order enforced (Aug. 28, 2012), order aff'd, appeal dismissed, 732 F.3d 955 (9th Cir. 2013)).
Disabled inmates may have poor ability to express themselves in writing and they will likely have difficulty with any task requiring reading or processing written material. In particular, they may have difficulty with the grievance process which requires reading and understanding. Accordingly, correctional staff is duty-bound to provide reading and writing assistance to disabled inmates who need assistance. More than half of the staff interviewed indicated they would not assist disabled inmates in accessing the grievance process. The Draft Operations Order Inmates with Disabilities - ADA requires that staff assist disabled inmates in accessing the grievance process, SCSD detention facilities must ensure staff is trained in this requirement.
SCSD detention facilities must ensure the grievance procedures are readily available to all inmates. Staff must make appropriate provisions to communicate those procedures to the disabled. Because access to the grievance process must be meaningful, staff must ensure that developmentally disabled inmates can submit grievances and staff must provide the necessary assistance to all
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
disabled inmates on a case-by-case basis to ensure that those who have difficulty communicating in writing will be provided reasonable access to the grievance process. The right of meaningful access to grievance procedures is particularly important because an inmate must exhaust the jails administrative remedies by complying with that procedure before he can access the courts.
Completed grievance responses are not effectively communicated to inmates that are developmentally disabled and learning disabled.
Consideration must be given to requests for reasonable modification or accommodations separate from the grievance process for inmates to request ADA accommodations and modifications.
The CDCR 2275-CJ should be tracked in the SCSD detention facilities grievance tracking system in RMS.
References
28 CFR §35.107 (b) Requires that a public entity that employs 50 or more persons adopt and publish grievance procedures providing for prompt and equitable resolution of complaints alleging any action that would be prohibited by Title II of the ADA.
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
The information below is for reference only. Due to the “Opinion in Support of Order Distributing and Enforcing the Amended County Jail Order and Plan dated 8/28/12” (Armstrong v. Brown, 857 F. Supp. 2d 919, 939 (N.D. Cal. 2012), order enforced (Aug. 28, 2012), order aff'd, appeal dismissed, 732 F.3d 955 (9th Cir. 2013)).
“Class members housed in county jails must have ready access to disability grievance forms, either the CDCR's Reasonable Modification or Accommodation Request form (CDC 1824) or a separate county jail grievance form.” If Defendants elect to utilize the CDC 1824 form in any of the counties, Defendants shall collect the grievance forms from class members no less than twice a week, and shall provide copies to a designated person at the county jail. Defendants shall respond to all grievances within fifteen calendar days of receipt and make their best efforts to ensure that necessary and reasonable accommodations are provided. If a class member identifies the grievance as urgent or an emergency (i.e., if it alleges a condition which is a threat to the parolee's health or safety, or is necessary for participation or effective
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communication in a parole revocation proceeding), Defendants shall respond to such a grievance within five calendar days of receipt and make their best efforts to ensure that necessary and reasonable accommodations are provided on an interim basis. For the first six months in which the plan is in effect, Defendants must produce to Plaintiffs' counsel on a monthly basis all grievances collected by Defendants pursuant to this subsection. Production may shift to two times a year after the first six months.
d. If Defendants contend that the process outlined in Paragraph (1)(c) is unnecessary because a jail has an adequate disability grievance process, Defendants must certify, within thirty days of the acceptance of their plan, that each such jail's disability grievance policy contains the following elements:
i. Is readily available to all class members housed in that county's jail facilities;
ii. Has an initial response deadline of no later than fifteen calendar days from receipt by the designated jail staff member; iii. Contains a provision for expediting a response if the appeal alleges a condition, which is a threat to the parolee's health or safety, or is necessary for participation or effective communication in a parole revocation proceeding;
iv. Includes a provision for review of the parolee's request by medical staff, if necessary;
v. Provides a right to appeal denials; and
vi. Requires that a copy of each and every grievance and response be provided to Defendants at the same time it is provided to the Armstrong class member.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inmate Disciplinary Process
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures pertaining to the inmate disciplinary process are outlined in Operations Order 07/03 Discipline Plan, and Policy 1107, Decision Making-Special Needs.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1080 Rules and Disciplinary Penalties requires that:
Rules and disciplinary penalties shall be stated simply and affirmatively, and posted conspicuously in housing units and the booking area or issued to each inmate upon booking. For those inmates who are illiterate or unable to read English, and for persons with disabilities, provision shall be made for the jail staff to instruct them verbally or provide them with material in an understandable form regarding jail rules and disciplinary procedures and penalties.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1081 Plan for Inmate Discipline requires that:
Each facility administrator shall develop written policies and procedures for inmate discipline, which shall include, but not be limited to, the following elements:
a) Designation of one or more subordinates who will act on all formal charges of violation of facility rules by inmates, and who shall have investigative and punitive powers. Staff so designated shall not participate in disciplinary review if they are involved in the charges.
b) Minor acts of non-conformance or minor violations of institution rules may be handled informally by any staff member by counseling or advising the inmate of expected conduct, assignment to an extra work detail, or removal from a work assignment without loss of work time credit. In addition, temporary loss of privileges such as, but not limited to, access to television, telephones, or commissary, or lockdown for less than 24 hours, may be considered minor discipline if such acts are accompanied by written documentation, and a policy of review and appeal to a supervisor.
c) Major violations or repetitive minor acts of non-conformance or repetitive minor violations of institutional rules shall be reported in writing by the staff member observing the act and submitted to the disciplinary officer. The inmate shall be informed of the charge(s) in writing. The consequences of a major violation may include, but are not limited to, loss of good time/work time, placement in disciplinary isolation, disciplinary isolation diet, or loss of privileges mandated by regulations. In addition: (1) Charges pending against an inmate shall be acted on no sooner than
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24 hours after the report has been submitted to the disciplinary officer and the inmate has been informed of the charges in writing. A violation(s) shall be acted on no later than 72 hours after an inmate has been informed of the charge(s) in writing. The inmate may waive the 24-hour limitation. The hearing may be postponed or continued for a reasonable time through a written waiver by the inmate or for good cause.   (2) The inmate shall be permitted to appear on his/her own behalf at the time of hearing.   (3) Subsequent to final disposition of disciplinary charges by the disciplinary officer, the   charges and the action taken shall be reviewed by the facility manager or designee.   (4) The inmate shall be advised of the action taken by the disciplinary officer by a copy   of the record required to be kept by Penal Code Section 4019.5.   d) Nothing in this section precludes a facility administrator from administratively segregating any inmate from the general population or program for reasons of personal, mental, or physical health, or under any circumstance in which the safety of the inmates, staff, program, or community is endangered, pending disciplinary action or a review as required by Section 1054 of these regulations.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, §1082 Forms of Discipline states that:
The degree of punitive actions taken by the disciplinary officer shall be directly related to the severity of the rule infraction. Acceptable forms of discipline shall consist of, but not be limited to, the following:
a) Loss of privileges.  b) Extra work detail.  c) Short term lockdown for less than 24 hours.  d) Removal from work details.  e) Forfeiture of “good time” credits earned under Penal Code Section 4019. f) Forfeiture of “work time” credits earned under Penal Code Section 4019. g) Disciplinary isolation.  h) Disciplinary isolation diet.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, §1083 Limitations on Disciplinary Actions, states in part:
The Penal Code and the State Constitution expressly prohibit all cruel and unusual punishment. Additionally, there shall be the following limitations:
a) If an inmate is on disciplinary isolation status for 30 consecutive days
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there shall be a review by the facility manager before the disciplinary isolation status is continued. This review shall include a consultation with health care staff. Such reviews shall continue at least every fifteen days thereafter until the disciplinary status has ended. This review shall be documented.   b) The disciplinary isolation cells or cell shall have the minimum furnishings and space specified in Title 24, Part 2, 1231.2.6 and 2.7. Occupants shall be issued clothing and bedding as specified in Articles 13 and 14 of these regulations and shall not be deprived of them through any portion of the day except that those inmates who engage in the destruction of bedding or clothing may be deprived of such articles. The decision to deprive inmates of such articles of clothing and bedding shall be reviewed by the facility manager or designee during each 24-hour period.   c) Penal Code Section 4019.5 expressly prohibits the delegation of authority to any inmate or group of inmates to exercise the right of punishment over any other inmate or group of inmates.   d) In no case shall a safety cell, as specified in Title 24, Part 2, 1231.2.5, or any restraint device be used for disciplinary purposes.   e) No inmate may be deprived of the implements necessary to maintain an acceptable level of personal hygiene as specified in Section 1265 of these regulations. f) Food shall not be withheld as a disciplinary measure.   h) Correspondence privileges shall not be withheld except in cases where the inmate has violated correspondence regulations, in which case correspondence may be suspended for no longer than 72 hours, without the review and approval of the facility manager.   i) In no case shall access to courts and legal counsel be suspended as a disciplinary measure.  
The SCSD detention facilities Operations Orders 07/03, Discipline Plan, specifically pertains to the Inmate Disciplinary (Write-up) process for inmates and detainees. The purpose of the Order is to standardize procedures for administering discipline and disciplinary diets, establishing rules and penalties for inmate conduct, and to ensure a fair and impartial inmate disciplinary process in accordance with Article 7 of Title 15 of the California Code of Regulations (“Title 15”).
Section I. Policy, states, “Prisoners accused of violating a facility rule shall be provided a fair and impartial disciplinary process. Discipline shall be directly related to the severity of the offense and shall be administered in a firm, fair and consistent manner.
Section II. Compliance with California Code of Regulations Title 15, states in part, “The discipline plan shall be administered in compliance with Title 15 of the California Code of Regulations;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All prisoners being housed will receive an orientation booklet that contains all facility rules guiding inmate conduct and the corresponding disciplinary penalties; and
 For those inmates who are illiterate or unable to read English, and for persons with disabilities, verbal instructions or material in an understandable form regarding jail rules and disciplinary procedures and penalties will be provided;”
Section VI. Major Incident Procedures, states in part, “Once the sergeant approves the report, the approving sergeant shall deliver a copy to the inmate. The sergeant delivering a written copy of the report to the inmate shall obtain the inmate’s signature on a copy, note the date and time of delivery on that copy and sign that notation.” Language within the Order also states,
 “Inmates must receive a written copy of the disciplinary report at least 24 hours in advance of the hearing;
 Consequently, no disciplinary hearing for violations pending against an inmate shall occur sooner than 24 hours after the inmate has been informed of the violations in writing;
 The inmate may waive the 24-hour limitation and have a disciplinary hearing conducted immediately upon delivery of the report in writing to the inmate;
 The inmate will sign the appropriate space on the write-up acknowledging the waiver;
 The waiver shall be documented in the report. Once the inmate has received a written notice that he/she has received a disciplinary write-up (PF-10), the violation must be acted on by the hearing sergeant within 72 hours;
 The hearing officer will render a decision regarding the violations and impose discipline pursuant to Section IV, which shall be included in the report;
 A written copy of the final hearing results (PF-10) will be given to the inmate;
 An inmate may be removed from general population housing when a rule violation is aggravated or if it could recur or incite other misconduct. To ensure the safety and security of the facility, an inmate may be moved to another housing unit, including a disciplinary housing unit, pending the outcome of either the disciplinary process or prosecution;
 Inmates found guilty of violating major rules may be moved to a disciplinary isolation housing unit to serve their discipline;
 Any inmate on disciplinary isolation housing status for more than 30 days because of multiple incidents shall have a review by the division commander before the disciplinary isolation status is continued; and
 This review shall include a consultation with health care staff and continue every 15 days until the inmate is off discipline.”
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Section VII. Minor incident report procedures, states in part, “Custody staff witnessing a violation of minor facility rules and wishing to impose any discipline listed above will be required to complete an Incident Report Detail (PF-10) by the end of shift.” It also states in part,
 Upon completion of the report, the staff member writing the report shall notify a sergeant so the sergeant can review the report and approve/disapprove of the discipline. No hearing is required;
 If the sergeant approves the discipline, the sergeant will note the discipline imposed in the PF-10 report;
 A written copy of the report will be delivered to the inmate by the housing unit officer. The staff member delivering a written copy of the report to the inmate shall obtain the inmate’s signature on a copy, note the date and time of delivery on that copy; and
 The inmate will be allowed to appeal the supervisor’s discipline via the grievance procedure.”
Section X. Inmate Appeals, states in part, “Inmates may appeal the disciplinary actions to a watch commander through the inmate grievance procedure within five days from the time the disciplinary decision was delivered to the inmate.” It also states in part, “Inmate appeals shall be answered and returned within five working days from the time they were received by the watch commander.”
The Inmate Handbook (rulebook) contains a section titled, “Conduct and Discipline”, and a section titled, “Rules of Conduct Codes.” The Conduct and Discipline section outlines specific rights that inmates and detainees will be afforded, their responsibilities within the process, categories of violations, contraband, and disciplinary process and penalties. The Rules of Conduct section lists the various rule codes with corresponding descriptions (specific acts).
Although there is a requirement in the Operation Orders that for those inmates who are illiterate or unable to read English, and for persons with disabilities, provisions are not routinely made by the jail staff to instruct the inmates verbally or provide them with reasonable accommodations and/or materials in an understandable form regarding jail rules and disciplinary procedures and penalties. As such, staff does not routinely provide reasonable accommodations for deaf/hearing-impaired or speech-impaired inmates (or other inmates) such as access to a qualified interpreter or accommodations for disabled inmates who have compromised communication skills, or who are otherwise unable to meaningfully participate in an infraction hearing.
Observations
The Assessment Team observed several Major Disciplinary (Write-up) Hearings at the MJ and RCCC jail facilities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
During observation of a hearing at the MJ, the Assessment Team observed the following SCSD detention facilities disciplinary hearing practices: inmates are permitted witnesses; inmates do not have a right to have the reporting employee present at the hearing; facilities do not utilize a staff assistant employee or an investigative employee system; hearing sergeants draw possible disposition penalties from the Sacramento County Sheriff’s Department Correctional Services Inmate Rule Code Violation Schedule. Of concern was the location and method of where and how the disciplinary hearings are conducted. The hearings at the MJ are conducted in the dayrooms or near the dayrooms. The hearings at RCCC were conducted just outside the pod doorways (rotunda area) with the inmate and the hearing sergeant standing just outside the pod.
During observation of a hearing at the MJ, the respective inmate was charged with a rule violation. The hearing sergeant asked the inmate if he was aware of the write-up. The sergeant read the report aloud, and then asked the inmate what happened, to which the inmate responded with an explanation, and there were several back and forth questions and answers between both parties. The sergeant ended the hearing by assessing a verbal warning to the inmate, and told the inmate he was going to be rehoused to another unit (as the inmate had complained of safety concerns). The sergeant advised the inmate of his appeal rights.
During observation of another hearing at the MJ (a different hearing sergeant), the Assessment Team observed the following: the sergeant read the report out loud, the inmate provided an explanation, and there were a few back and forth questions and answers. The sergeant then asked how the inmate wanted to plea, to which the inmate replied, “not guilty.” The inmate was found guilty and assessed 12 hours of full restriction (but could maintain attorney visits or any program such as education, self-help groups, etc.). The sergeant explained to the inmate his right to appeal the findings to the jail commander, and he provided an explanation of possible outcomes from the appeal process.
During observation of another hearing at the MJ, the Assessment Team observed the following: The charged inmate appeared to have mental health concerns, and admitted to the charge of fighting. The sergeant asked the inmate to explain the circumstances as to what happened. The Assessment Team noted that the hearing was conducted in the unit indoor recreation area lobby, approximately 30 feet from a 1-on-1 psychiatric interview with an inmate-patient, with no barrier to preserve confidentiality for the MH encounter or for the disciplinary hearing. The sergeant asked the inmate, “do you think it is alright to fight”, and asked him if he knew that fighting was against the rules. The inmate replied “yes.” The inmate was found guilty, and assessed 10 days of full restriction. The sergeant explained that the inmate would receive a disciplinary shower every other PM shift, to which the inmate replied, “I don’t need a shower.” The inmate made slight verbalizations about harming his parents. After the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
completion of the hearing and dismissal of the inmate, the Assessment Team asked the sergeant whether there was a process built-in to consult with a clinician prior to the hearing to obtain input for MH purposes, specifically, whether the clinician believes the MH status may have contributed to some degree as to the inmate’s actions. The sergeant indicted that there is no such policy or practice.
During observation of a major violation hearing at RCCC, the Assessment Team observed the following: the sergeant asked whether the inmate had received a copy of the write-up, and asked if the inmate had any questions. The sergeant asked the inmate whether he wanted to plead guilty, not guilty, or guilty with an explanation, to which the inmate pled not guilty. The sergeant asked what happened, and the inmate responded. The sergeant asked if the inmate could have pressed the emergency button and avoided the fight, and asked about the inmate’s injuries. The sergeant then instructed the inmate to go back inside to his assigned pod area. There was no explanation as to the disposition, whether the hearing would be resumed later, or any other detail or instructions.
During observation of another major violation hearing at RCCC, the Assessment Team observed the following; the sergeant read the report and asked whether the inmate had received a copy of the write-up, to which the inmate acknowledged that he had. The sergeant asked whether he had been written up before, and the inmate replied, “yes.” The sergeant asked the inmate to state his plea, which was “guilty.” Several questions and answers were delivered back and forth, and then this hearing was also halted with any further explanation or disposition.
There were at least 2 additional hearing at the RCCC with very similar observations.
The Assessment Team was able to observe the issuance of initial copies of write-ups to inmates at the MJ, however, our multiple requests to observe the issuance of initial copies of write-ups to inmates at RCCC was not facilitated. During the initial service of write-ups, the Assessment Team noted that the control room deputies issued the initial copy of the write-up to the inmate through the control room window slot. The deputies advised the inmate of the charge and had the inmate sign the document. The deputies issued the inmate a copy and advised the inmate that the sergeant would conduct the hearing. There was no EC provided to ensure the inmate understood the charges and/or the disciplinary process.
Staff Interviews
The Assessment Team interviewed sergeants who conduct disciplinary hearings and issue initial copies of write-ups for major (and minor offenses), and also spoke with deputies who issue initial copies of write-ups for minor violations. The team was informed that the deputies primarily deliver the initial copies of the
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write-ups to the charged inmates. The team was also informed that within the process, inmates/detainees receive an initial copy of the charges to which they sign acknowledgement of receipt, or they can refuse to sign. Most of the sergeants interviewed indicated that they read the write-up out loud in front of the inmate.
The sergeants review and approve a deputy or staff member’s report. A sergeant then schedules a disciplinary hearing. Information regarding the minimum amount of time that a hearing can be scheduled from the date and time of initial issuance of the write-up report, was identified as 24 hours, and also 48 hours, but no more than 72 hours later, unless the charged inmate waives that right to prepare for the hearing, and therefore opts for a quicker hearing to be conducted. The staff interviewed told the Assessment Team that the common practice is for the opposite shift (AM versus PM) to conduct the hearings for the write-up reports written for the opposite shift. The hearings are conducted on the floors/housing unit areas where the charged inmates/detainees reside.
The staff that was interviewed indicated that the sergeants could take away time credits (for guilty findings) for major violations, for inmates who have been sentenced by the court. The sergeants indicated that they follow an approved inmate disciplinary matrix for possible imposed penalties. Aside from time taken, other penalties include but are not limited to, DD/TSEP, loss of privileges, e.g., dayroom, visits, telephone calls, etc.
The sergeants and deputies acknowledged that there is not an alert system or tracking system to help them identify inmates with disabilities, or those whose disabilities may pose a barrier to communication, e.g., learning disabled, intellectually (developmentally) disabled, or those who may be deaf/hearingimpaired, or speech-impaired. They mentioned the JIMS system PF10 screen that provides them some information, and may contain some disability-related information. When asked about a hypothetical scenario in which an inmate did not understand the hearing or process, one of the sergeants mentioned that he would not do the hearing, would research the issue further, and might ask a psychologist as to the best approach to deal with the inmate. When asked their response if the charged inmate was unable to read the write-up, one sergeant indicated that that issue has never happened with him. He said he would have someone read it to the inmate, and that the hearing would be held at a later date. When asked about possible hearing-impaired inmates, one sergeant stated that he would conduct the hearing by reading and writing with the inmate, and he would maintain the written notes used back and forth until completion of the writing of the disposition, then he would shred all notes used. Most of the sergeants indicated that inmates receive final copies of the hearing findings, and the sergeants usually deliver them. Some of the staff said that the inmate appeal rights are written on the back of the initial and final report copies, but this was inconsistent. He said that inmates cannot call witnesses, and they can gather
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their own evidence for the hearings. The Assessment Team was also told that there is no standard assistance provided for inmates who are “illiterate.” When asked about the process when a charged inmate gets moved from a specific building or pod to another, the Assessment Team was told that it is up to the discretion of the respective hearing sergeant.
The staff explained that after completion of the disciplinary hearings, the sergeant verbally explains his/her findings. However, the supervising lieutenant can later modify the findings and disposition, and ultimately is the approving authority for findings. Most of the staff interviewed stated that there is not a final copy of the disposition that is provided to the inmate. There is an employee who tracks all inmate disciplinary actions. When asked, the staff interviewed indicated that although inmates have appeal rights regarding the write-up, disposition and penalty, inmates do not receive any written documentation advising them of their appeal rights.
Inmate Interviews
During the inmate interviews several inmates who could not read and understand (or had some difficulties with) a section of the inmate rulebook and other material used by the Assessment Team to assist in determining inmate literacy and inmates who may have a history of developmental and learning disabilities stated they did not fully understand the write-up process. A few of the inmates were unable to remember if they had received a write-up in the past.
A summary of the statements made by inmates who recall receiving an Infraction is detailed below.
 MJ inmate (Mental Illness, prior special education): 5 write-ups; no explanation about rights while signing for initial copy or at hearing; process is confusing; no EC provided, no assistance provided;
 MJ inmate (Mental Illness): not enough time to prepare for hearing, no access to witnesses, no complaints as to the hearing, but very confused at the time of issuance of first copy and not knowing his rights;
 MJ inmate (Mental illness): 2 separate write-ups, and didn’t receive initial copies; no assistance; no explanation of rights or process; was confused and had to research with no staff assistance; one sergeant explained everything, and the other sergeant did not;
 MJ inmate (Mental Illness): nobody explained the process or his rights throughout the process;
 MJ inmate (Mental Illness and likely Intellectual [developmental] Disability, and prior Special Education): does not remember everything about the process, was confused;
 MJ inmate: no EC, no explanation, was confused throughout entire process;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ inmate (Mental Illness): 19 write-ups; no EC; never received final copies; is afraid to appeal to risk getting a more serious penalty than was imposed by the sergeants;
 MJ inmate: served 3 weeks on disciplinary detention, and never received initial copy of write-up; when he received write-ups for a different offense, the staff member handed it to him without any explanation, and told him to sign it;
 MJ inmate (Mental Illness); served disciplinary detention; his only concern was not being told his rights throughout the process and an explanation as to how the process works;
 MJ inmate (Mental Illness): no EC; no assistance;  RCCC inmate (Mental Illness)” no explanation at the time of signing for
initial copy; afraid to appeal due to the possibility of getting a stronger penalty;  RCCC inmate: no explanation of charges, process or rights;  RCCC inmate; initial copy was slid under the cell door, and 2 days later had the hearing; sergeant did not explain anything at the hearing; no mention of appeal rights; never received a final copy summary;  RCCC inmate: while at MJ, never received an explanation as to charges, rights, process at the time of issuance of initial copy of write-up;  RCCC inmate (Mental Illness, prior Special Education): went to administrative segregation with no paperwork or explanation; never received an initial copy of the write-up, but did have a hearing.
Conclusions
Because a disabled inmate’s literacy level can impede his/her ability to participate in jail services, the regulations implementing the ADA require public entities to take appropriate steps to ensure that the communication of information concerning jail services, activities, and programs is as effective for the disabled as for the non-disabled. In doing so, the jail must provide such services as are necessary to afford an individual with a disability an equal opportunity to participate in jail programs and activities and in determining what services are necessary. Jail staff must give primary consideration to the requests of the individual.
Intellectually (developmentally) disabled inmates may have poor ability to express themselves in writing and will likely have difficulty with any task requiring reading or processing written material. In particular, they may have difficulty with disciplinary processes which require reading and understanding. Accordingly, jail staff is duty-bound to provide reading and writing assistance to disabled inmates who need assistance. Only through EC can staff guarantee that an intellectually disabled inmate has meaningful access to the disciplinary proceedings. The Due Process Clause requires that staff assistants provide EC to developmentally disabled prisoners during disciplinary proceedings where there is a protected liberty interest at stake.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Additionally, when addressing inmate misconduct, staff members must take into consideration the severity of the inmate's disability and the inmate's need for adaptive services when determining the appropriate method of discipline. When the inmate does not understand that he has broken a rule, staff should provide the reasonable accommodation of direct instructions, prompting, or verbal counseling. Only if the intellectually disabled inmate continues to engage in the misconduct should staff resort to the disciplinary process.
Since inmates under the jurisdiction of the SCSD detention facilities can in some cases lose good time credits if they are guilty of major violations, the procedure for determining whether such misconduct has occurred must observe certain minimal due process requirements based on constitutional case law.
In Wolff v. McDonnell, 418 U.S. 539 (1974), the Supreme Court found that, when prisoners lose good time credits because of a disciplinary offense, they are entitled to:
 Written notice of the disciplinary violation;  The right to call witnesses at their hearing;  Assistance in preparing for the hearing;  A written statement of the reasons for being found guilty; and  A fair and impartial decision-maker in the hearing.
A second important Supreme Court case, Sandin v. Conner, 515 U.S. 472 (1995), however, sharply limits the decision of Wolff and sets a higher standard that has to be met in order to show that you have a liberty interest.
The inmates have the right to assistance if illiterate and issues are complex. This certainly includes inmates who are intellectually disabled, mentally disabled, learning disabled, and those who are unable or have difficulty reading and comprehending.
The inmates must be provided advanced written notice of charges which must be given to the disciplinary charged inmate, no less than 24 hours before his/her appearance before the Hearing Official. Additionally, applies or must be adhered to:
 There must be a written statement by the fact finders as to the evidence relied on and reasons for the disciplinary action;
 The inmate should be allowed to call witnesses and present documentary evidence in his/her defense if permitting him/her to do so will not jeopardize institutional safety or correctional goals;
 The inmate has no constitutional right to confrontation and crossexamination in disciplinary proceedings, such procedures in the current environment, where disruption remains a serious concern, being discretionary with the officials; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmates have no right to retain or appoint counsel in such proceedings, although counsel substitutes should be provided in certain cases.
There is no system in place for sergeants conducting the disciplinary hearings to identify disabled inmates during the hearing process. Therefore, hearing sergeants are not providing the necessary accommodations for disabled inmates. Hearing sergeants do not provide EC for disabled inmates (learning, developmental and vision), assistive devices are not provided for vision-impaired inmates (magnifiers and large print documents). Effective communication is required throughout the entire disciplinary process from the issuance of the initial copy, during the hearing, during the final issuance of the disciplinary report and during the appeal process. By not providing EC, disabled inmates are not being afforded equal access to the disciplinary process and their due process rights.
Disabled inmates (learning, developmental and mental health) are not being provided staff assistance to ensure that they are aware of their rights and that their position is presented during the disciplinary process.
The SCSD detention facilities Operations Order and local practice must allow for provision of accommodations for disabled inmates, and should be mandatory.
In cases when an inmate indicates he/she does not understand the charges or otherwise objects to the clarity of the write-up or has any question about it, the Hearing Sergeant must not be allowed to proceed with the hearing. This applies even if the Hearing Sergeant determines that a reasonable person reading the charge would be able to understand the nature of what the inmate was charged with and there is no rational reason why the particular inmate might not have been able to understand the charge (e.g. inmate’s inability to read or limited intellectual capacity). Remember, there is no effective tracking system to alert the Hearing Sergeant of an inmate’s disability that would limit his/her ability to comprehend the nature of the charges, the Hearing process, and the inmate’s rights. Additionally, and as stated above, inmates are not being provided staff assistance to ensure their position is presented at the hearing.
Staff is not taking into account the inmate’s developmental and mental health disability and the adaptive support needs of the inmate (if applicable) when making a determination of the method used to address the misconduct.
Although a sergeant who was interviewed stated that he would request information from mental health if it appeared that the inmate’s mental health contributed to the violation, this is not policy, and it is not uniformly applied. Staff should consult with mental health staff in cases where an inmate in the mental health program has received a disciplinary write-up, so that mental health staff can provide information relative to the inmate’s mental health status at the time of the offense and information regarding the potential mental health implications of the penalty being imposed by the Hearing Sergeant (e.g., DD, TSEP, loss of
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
visits, phone etc.). Imposing these types of penalties may have a detrimental effect on the inmate’s mental health and well-being.
The policy states that an inmate can grieve/appeal a restriction to the watch commander, but it does not require a face-to-face review to ensure the inmate’s position is presented during the formal review process. In addition, violations of policy and jail rules for inmates with mental health concerns or inmates with developmental disabilities may be as a result of their disability and staff may not be aware of these factors when determining the method of intervention/discipline. Placing an inmate who is acting-out based on his mental health condition in isolation may be detrimental to his mental health and well-being.
References
28 CFR§ 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(a) requires that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability;
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(ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State.
28 CFR 35.130(b)(4): A public entity may not, in determining the site or location of a facility, make selections—
(i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities.
28 CFR 35.130(b)(8): A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Disciplinary Process
Reasonable accommodations shall be afforded inmates with disabilities in the disciplinary process.
To assure a fair and just proceeding, the assignment of a Staff Assistant (SA) and/or an Investigative Employee (IE), as provided in CCR Sections 3315 (d)(1) an (2), may be required for the inmate. The inmate and/or SA or IE may need to be assigned by a bilingual aide or qualified interpreter in order to ensure effective communication. Additional accommodations may be appropriate. All written notes utilized and exchanged for effective communication between the inmate and staff shall be attached and included with the disciplinary documents for placement in the inmate’s central file.
The information below is for reference only. Due to the settlement
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agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Clark v. California” amended March 1, 2002, mandates the following:
DISCIPLINARY PROCESS
To assist DDP inmates in conforming departmental rules and regulations, all staff who interact with this population must closely monitor the inmates' daily activities. An employee may attempt to address problematic behavior informally; e.g., direct instructions, prompting, verbal counseling. The employee must ensure the inmate understands (to the best of his/her ability) the consequences of continued misconduct. If this informal intervention successfully corrects the behavior, no further disciplinary action is required. If the inmate continues the misconduct and informal intervention was not successful or the behavior was of a serious nature the misconduct must be handled in accordance with CCR, Title 15,starting at Section 3310. The method of discipline may include:
 Issuing a CDC Form 128-A, Chrono-Custodial Counseling  Issuing a CDC Form 115 the staff member observing the misconduct must
take into consideration the severity of the inmate's disability and the inmate's need for adaptive support services when determining the method of discipline.
To assure a fair and just proceeding, if the misconduct is recorded on a CDC Form 115 (administrative or serious rules violations), all DDP inmates must be assigned an SA. The SA can be any staff who have received training referenced in Section X, D, and training in due process hearings. The assigned SA may be assisted by a bilingual aide, reader, mental health clinician, etc., as necessary. In accordance with CCR, Title 15, Sections 3318(b) and 3315 (d)(2), the SA must:
 Inform the inmate of his/her rights and ensure that he/she understands the disciplinary procedures to the best of the inmate's ability;
 Help the inmate to prepare for the disciplinary hearing;  Represent the inmate's position at the hearing;  Ensure the inmate's position is understood;  Ensure the inmate understands to the best of his/her ability the decisions
reached;  Provide the hearing official with information related to the inmate's
developmental disability and the adaptive support services required;  Be present at the disciplinary hearing and all interviews related to the
disciplinary process;
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 Refrain from giving legal counselor specifying the position the inmate should take in any disciplinary proceeding; and
 Additional assistance as appropriate.
The SAs and hearing officials must be trained to communicate with DDP inmates. The SA must complete courses in the Overview of Developmental Disabilities, Staff Assistance for Inmates with Developmental Disabilities, and the Overview of the Inmate Disciplinary Process.
If the inmate is found guilty of a rules violation, the Chief Disciplinary Officer (CDO) must review the completed CDC Form 115 in accordance with CCR, Title 15, Section 3312.
The CDO must consult with the clinician assigned to DDP inmates regarding the findings and disposition of the hearing before taking action. The clinician assigned to DDP inmates must provide input as to the effectiveness of the disposition in correcting the inmate's behavior. Both the CDO and clinician must sign the completed CDC Form 115. By signing the CDC Form 115, the clinician is not endorsing the disposition of the CDC Form 115, but only acknowledging the consultation. The need for the CDO to consult with clinicians concerning the disposition of CDC Forms 115 for inmates with developmental disabilities must be incorporated into applicable Lesson Plans, Post Orders, and Operational Procedures of all designated institutions. In accordance with CCR, Title 15, Section 3313(c), the classification of a CDC Form 115 may be changed before, during, or after a disciplinary hearing from serious to administrative. Other decisions for CDC Forms 115 can be to:
 Affirm, reverse, or modify the disciplinary action and/or credit forfeiture;  Order a different action or a different method of discipline;  Dismiss the charge;  Order a rehearing of the charge;  Refer the charge for criminal prosecution; and  Order a combination of any of these actions.
If a DDP inmate exhibits on going behavioral problems, institution clinical staff shall refer the case to HCSD Clark Coordinator for assistance in assessing the causes of the behavior and creating an intensive behavioral modification and treatment plan.
The ADA Coordinator will review CDC Form 115s at least monthly to identify any patterns of misbehavior that may be related to the DDP inmates' disabilities (see Section VI, L).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
U.S. Department of Justice Civil Rights Division Disability Rights Section Commonly Asked Questions About The Americans With Disabilities Act and Law Enforcement II. Interacting with People with Disabilities
8. Q: What steps should officers follow to communicate effectively with an individual who is blind or visually impaired?
A: It is important for officers to identify themselves and to state clearly and completely any directions or instructions -- including any information that is posted visually. Officers must read out loud in full any documents that a person who is blind or visually impaired needs to sign. Before taking photos or fingerprints, it is a good idea to describe the procedures in advance so that the individual will know what to expect. III. Effective Communication
11. Q: If the person uses sign language, what kinds of communication will require an interpreter?
A: The length, importance, or complexity of the communication will help determine whether an interpreter is necessary for effective communication.
 In a simple encounter, such as checking a driver's license or giving street directions, a notepad and pencil normally will be sufficient;
 During interrogations and arrests, a sign language interpreter will often be necessary to effectively communicate with an individual who uses sign language;
 If the legality of a conversation will be questioned in court, such as where Miranda warnings are issued, a sign language interpreter may be necessary. Police officers should be careful about miscommunication in the absence of a qualified interpreter -- a nod of the head may be an attempt to appear cooperative in the midst of misunderstanding, rather than consent or a confession of wrongdoing;
 In general, if an individual who does not have a hearing disability would be subject to police action without interrogation, then an interpreter will not be required, unless one is necessary to explain the action being taken.
18. Q: Procedures at my office require citizens to fill out forms when reporting crimes. What if the person has a vision disability, a learning disability, mental
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
retardation or some other disability that may prevent the person from filling out a form?
A: The simplest solution is to have an officer or clerk assist the person in reading and filling out the form. Police officers have probably been doing this for years. The form itself could also be provided in an alternative format. Providing a copy of the form in large print (which is usually as simple as using a copy machine or computer to increase type size) will make the form accessible to many individuals with moderate vision disabilities.
V. Modifications of Policies, Practices, and Procedures
23. Q: What types of modifications in law enforcement policies, practices, and procedures does the ADA require?
A: The ADA requires law enforcement agencies to make reasonable modifications in their policies, practices, and procedures that are necessary to ensure accessibility for individuals with disabilities, unless making such modifications would fundamentally alter the program or service involved. There are many ways in which a police or sheriff’s department might need to modify its normal practices to accommodate a person with a disability. Example: A department modifies the procedures for giving Miranda warnings when arresting an individual who has mental retardation. Law enforcement personnel use simple words and ask the individual to repeat each phrase of the warnings in her or his own words. The personnel also check for understanding, by asking the individual such questions as what a lawyer is and how a lawyer might help the individual, or asking the individual for an example of what a right is. Using simple language or pictures and symbols, speaking slowly and clearly, and asking concrete questions, are all ways to communicate with individuals who have mental retardation.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inmate Orientation
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders pertaining to inmate orientation are outlined in Operations Orders 04/07 Dress In/Dress Out Procedures, 04/08 Prisoner Orientation and 07/03 Inmate Discipline Plan.
Minimum Standards for Local Detention Facilities Title 15 - Crime Prevention and Corrections Division 1, Chapter 1, Subchapter 42010 Regulations, § 1069 Inmate Orientation requires that:
(a) In Type II, III, and IV facilities, the facility administrator shall develop written policies and procedures for the implementation of a program reasonably understandable to inmates designed to orient a newly received inmate at the time of placement in a living area. Such a program shall be published and include, but not be limited to, the following:
1) correspondence, visiting, and telephone usage rules;  2) rules and disciplinary procedures;  3) inmate grievance procedures;  4) programs and activities available and method of application; 5) medical services; 6) classification/housing assignments;  7) court appearance where scheduled, if known; and, 8) voting, including registration.
§ 1080. Rules and Disciplinary Penalties requires that;
Wherever discipline is administered, each facility administrator shall establish written rules and disciplinary penalties to guide inmate conduct. Such rules and disciplinary penalties shall be stated simply and affirmatively, and posted conspicuously in housing units and the booking area or issued to each inmate upon booking. For those inmates who are illiterate or unable to read English, and for persons with disabilities, provision shall be made for the jail staff to instruct them verbally or provide them with material in an understandable form regarding jail rules and disciplinary procedures and penalties.
§ 1080 defines people with disabilities as including but not limited to:
Persons with a physical or mental impairment that substantially limits one or more of their major life activities or those persons with a record of such impairment or perceived impairment that does not include substance use disorders resulting from current illegal use of a controlled substance.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Per Operations Order 04/07, Dress in/Dress Out Procedures, custody staff shall provide the prisoner with orientation materials in accordance with Operations Order 04/08 Prisoner Orientation.
Per Operations Order 07/03, Inmate Discipline Plan, all inmates being housed will receive an orientation booklet that contains all facility rules guiding inmate conduct and the corresponding disciplinary penalties. For those inmates who are illiterate or unable to read English, and for persons with disabilities, verbal instructions or material in an understandable form regarding jail rules and disciplinary procedures and penalties will be provided.
A copy of the inmate orientation book describing the inmate discipline plan, rules and penalties shall be kept at the Public Counter/Gatehouse and shall be made available to the public upon request.
Per Operations Order 04/08, Prisoner Orientation, custody staff shall be responsible for providing each inmate with an orientation handbook and giving each inmate a verbal orientation prior to being located in a housing unit.
Inmates shall be provided with an inmate orientation handbook, which includes but is not limited to the following information:
 Correspondence, visiting, and telephone usage rules.  Rules of conduct and disciplinary procedures.  Inmate grievance procedures.  Available programs, activities, and inmate services.  Medical, dental, and psychiatric services.
Custody staff are responsible for being able to provide inmate orientation information in a format reasonably understandable to inmates. Considerations for providing this information includes, but is not limited to, the following:
 Inmates who do not speak or write English.  Inmates with disabilities such as hearing or visual impairment.
Custody staff is responsible for providing a verbal orientation in summary to all inmates prior to the inmate(s) being housed in a housing unit. The verbal orientation includes, but is not limited to:
 Explaining the basic rules of conduct of the respective facility.  Referring inmates to the inmate handbook or other appropriate orientation
information.
Inmates are provided the opportunity to have questions answered about their housing facility or incarceration. The methods inmates may use to ask questions include, but are not limited to:
 Prisoner request forms.  Medical, dental, and psychiatric service request forms.
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 Direct questions to custody staff.
Orientation information may be provided in person and/or by using a video format presentation prepared by the respective facility. At the MJ, the orientation material will be presented by custody staff in property. At RCCC, the orientation material will be presented by custody staff during intake.
Orientation information may be given in the housing unit to supplement the information given at the above locations at each facility.
Observations
The Assessment Team observed the intake/booking/classification and housing process at the MJ, as well as intake and processing at RCCC for both male and female inmates.
At the MJ, on several occasions during the day shift (0600-1800 hours) and night shift (1800-0600 hours), the Assessment Team observed the entire intake, booking, medical and mental health screening, and housing (including “dress-in”) process. On different dates and shifts, the Assessment Team observed numerous inmates go through the entire process from beginning to end. Additionally, the Assessment Team observed several other inmates go through various parts of the process, whether intake, booking, medical screening, mental health screening, or housing. Note: in many of the latter cases, Assessment Team representatives would alternate observing particular inmates go through each phase of the process, meaning several more of these inmates were observed through the entire process.
There is no video orientation provided at the MJ, however, inmates that are being housed at the MJ are shown a PREA video. This video is shown after the inmate has been dressed out into jail-issued clothing in the felony holding tank. When observing the MJ dress out process the Assessment Team noted that there are inconsistencies on how the different teams process inmates through the dress out process. One of the teams was observed providing all inmates with an Inmate/Detainee Handbook at the time of the dress out. Another team advised the inmate that the Inmate/Detainee Handbook was being offered and they could obtain one from the counter as they were placing the identification band on the inmates. Another team didn’t offer or provide the inmates with an Inmate/Detainee Handbook during the dress out process. All of the teams required the inmates to sign the Inmate/Detainee PREA Attestation Form indicating that they had received the inmate handbook and had viewed the PREA education video, even though they had not received the inmate handbook.
At no time was there any verbal inmate orientation as to the jail rules, expectations, or information relative to programs, services or activities, nor was any information provided to inmates (including those with disabilities) with regard to emergencies, alarms, evacuations, disability programs or services. The
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Assessment Team also observed the classification process, and there was no verbal orientation provided during the classification interview either.
At the RCCC, the Assessment Team made numerous attempts to observe inmate processing; however, as most of the new arrivals are processed through the MJ, the team was unable to observe new arrivals being processed at RCCC.
The Assessment Team notes that at RCCC, ICE detainees are required to receive orientation. The RCCC detainee orientation is a typed 2-page document that notes “To Be Read To The Detainee” and reads as follows:
The RCCC Detainee Orientation
The following information must be read to all U.S. Immigrations and Customs Enforcement (ICE) detainees during intake/classification process after arrival to the Rio Cosumnes Correctional Center (RCCC). A signed copy of this document shall be placed in the detainee’s file.
You are currently being detained by the U/S Immigration and Customs Enforcement (ICE) pending the outcome of your immigration proceedings. This facility is the Rio Cosumnes Correctional Center (RCCC), which is operated by the Sacramento County Sheriff’s Department. The facility is located in Sacramento, California.
The following is a brief overview of the RCCC policies and services available to you at the facility. Detailed information of each of the below items can be found in the RCCC Inmate and Detainee Orientation Handbook.
 Detainees housed at RCCC must follow all facility rules. These rules must be followed or you will be subject to disciplinary action. Anyone accused of violating a facility rule shall be provided a fair and impartial disciplinary process.
 All detainees will be counted a minimum of six times in a 24-hour period. These counts will generally occur before meals and during shift exchange. There is no talking or activities allowed during any count. All detainees will remain on their assigned bunks until count is clear.
 Meals are served three times a day. Special allergen free food trays are available for those with a doctor’s order. Special religious food trays are available for those who are approved by the facility Chaplain.
 All detainees will be issued jail clothing, bedding, a towel, and personal hygiene kit. Laundry services for all clothing and bedding will be provided on a regular basis.
 All detainees will have access to telephones, mail services, incoming email services, visitation, televisions, outdoor recreation, religious
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
programs, and a variety of reading materials. A schedule of programs services and daily activities is posted in your housing unit.
 All detainees will be afforded access to the law library. To visit the law library, you will need to send an inmate message request (KITE) to the law librarian. The librarian will schedule your visits.
 All detainees will have access to medical and psychiatric services 24 hours each day / seven days each week. Detainees will not be charged a co-payment for healthcare services. You can request to see medical or psychiatric staff by submitting a pink medical request (KITE) that is available in your housing location. Any medical or psychiatric emergencies should be reported to facility staff immediately.
 The ICE Know Your Rights video is shown regularly on facility televisions in English, Spanish and French. Information on how to contact your consulate is contained in the RCCC Inmate and Detainee Handbook.
 Additional information can also be found in the information packet posted in each housing location. This packet contains a variety of information related to pro bono legal services and how to pursue those services. This packet also contains information on how to contact ICE.
 Any ICE related questions should be directed to the onsite ICE representative or by completing an ICE inmate message request form (KITE). These request forms can be placed in the mailbox labeled “ICE” located in your housing location or given directly to the ICE representative.
 Any other questions, not ICE related may be directed to housing officers or written on a RCCC inmate message request form (KITE). You will receive an answer in a timely manner.
 Do you have any questions?
You are being provided a copy of the RCCC Inmate and Detainee Handbook. You are encouraged to read through the handbook to familiarize yourself with the rules, regulations, policies and procedures to be followed while housed at RCCC.
Detainees are required to initial and certify that they were provided orientation. The staff member is required to also note if any translation service or interpreter was utilized to provide the information to the detainee.
Staff Interviews The Assessment Team interviewed deputies assigned to the intake, booking and property area (assigned to escort new arrivals to their respective housing units) upon completion of intake processing). The Assessment Team also interviewed approximately 52 custody staff, which included deputies from every housing unit
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
at the MJ and RCCC, where inmates are housed. Much of the interview information obtained relative to inmate orientation was inconsistent and wasn’t in accordance with the aforementioned policy.
Most deputies indicated that all inmates are provided an Inmate/Detainee Handbook during processing. A few of the staff interviewed indicated that inmates are required to view a orientation video; however, the video referred to is actually specific to PREA and does not pertain to inmate orientation.
Nearly all of the housing unit deputies interviewed admitted that they (themselves) do not issue rulebooks to inmates upon arrival to their respective units. However, a few of the staff mentioned that they would provide them if the inmate asked for one.
Most of the intake, booking or housing unit staff indicated that they provide verbal orientation to inmates, or that orientation is normally given in any of those areas. A couple of the deputies mentioned they provide verbal orientation to inmates. Some staff stated that they provide the rules of the unit or basic expectations like use of the emergency call button, inmate responsibility during alarms, KITE’s, and count process. However, this information is not specific to orientation-type material, such as available programs, services and activities, e.g., grievance process, library/law library, religious services, etc. including orientation material required to be covered by Title 15. Moreover, after being asked, these deputies acknowledged that they do not follow any script or written material, but rather provide these basic house rules from their memory. Although many of the deputies did acknowledge that they verbally provide the basic rules of the housing unit to the newly arrived inmates, the vast majority of them also admitted that that does not suffice as an official inmate orientation. The deputies further acknowledged that there is not a current process in place to log whether orientation was provided or to determine the specific orientation material that should be covered.
Inmate Interviews
During the inmate interviews, about two-thirds of the inmates interviewed indicated that they were not provided a rulebook. About ninety percent of the inmates stated that staff did not provide any form of orientation.
The inmates who acknowledged ever receiving a verbal orientation/information indicated that this orientation was of basic unit rules, but even most of those inmates believed that the information was more of the deputies’ own house rules rather than a detailed inmate orientation. Some inmates admitted they received information from other inmates, such as their cellmates and/or “houseman”. Some inmates stated that they felt lost and just learned about pertinent jail information such as programs and expectations from other inmates and not staff. Some inmates that received the Inmate/Detainee Handbook cannot read and therefore, they were not aware of the information contained in the handbook.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Of the 8 ICE detainees interviewed; only one indicated that staff had read the orientation information to him. All detainees with the exception of one stated that they had been issued the handbook in booking.
Conclusion The SCSD detention facilities do not accommodate disabled inmates during the inmate orientation process.
Disabled inmates (e.g., those with vision, hearing, speech, learning and developmental disabilities, as well as those with mental illness and other disabilities) are being held accountable for their actions, and are expected to understand the jail’s rules and expectations. Yet the disabled inmates as well as the rest of the inmate population are not being informed of jail rules. Disabled inmates (such as those with vision, hearing, speech, learning, and developmental disabilities, as well as those with mental illness and other disabilities) are not informed of available reasonable accommodations; they are not appropriately informed of available programs, services and activities; and they are not receiving the jail rulebook, or observing an inmate orientation video, or having specific rules or expectations explained to them by staff. As a result, the SCSD detention facilities are exposing disabled inmates to possible discrimination and exclusion from equal participation in the jail’s programs and other activities.
The SCSD detention facilities do not provide (or adequately provide) inmate orientation information or materials, and do not accommodate disabled inmates (such as those with vision, hearing, speech, learning and developmental disabilities, or those with mental illness or other disabilities) during orientation. Because orientation is not provided, there is no mechanism to allow for EC and alternate or accessible methods in presenting inmate orientation materials or information.
As a result of the assessment, which included reviews of applicable policies and other documents, as well as staff and inmate interviews, findings for this area include:
 SCSD detention facilities staff are not adhering to Operations Order 04/08 Prisoner Orientation, which requires staff to provide each inmate with an orientation handbook and to give each prisoner a verbal orientation prior to being located in a housing unit. As a result:  There is no verbal inmate orientation information being provided (other than isolated cases where unit deputies provide an unscripted or unwritten account of the deputies’ personal unit expectations); and  Inmates are rarely being issued jail rulebooks.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
In order for the SCSD detention facilities to come into compliance with Title II of the ADA, Operation Orders, and to ensure best practices, staff must ensure the following:
 The inmate orientation process must be comprehensive and provided in accessible formats;
 Vision-impaired and deaf/hearing-impaired inmates as well as those with learning disabilities shall be accommodated with alternate forms of communication, e.g., verbal communication, video/audio presentation, and written material (large print), in order to ensure EC in presentation of the information;
 Staff must effectively communicate the contents of the rulebook (handbook) and related materials to all inmates. This obviously includes inmates who are deaf or hearing-impaired, including those for whom written language is not an effective means of communication;  Staff may meet this obligation by providing a video of a qualified interpreter signing the contents of the jail rulebook, or by using on onsite interpreter or an interpreter through video interpreter services; and  Appropriate technology for viewing the video must be utilized.
The following information should be incorporated as part of the inmate orientation process:
 The purpose of the disability program;  Availability of Title 15 and any pertinent existing and future disability-
related forms or materials (in accessible formats to inmates with disabilities);  The inmate grievance process and location of the forms (this should also include any possible future related forms or materials if implemented, e.g., request for Reasonable Modifications or Accommodation forms and information);  Reasonable modifications or accommodations available to qualified inmates, e.g., SLIs for due process settings (i.e. inmate infraction hearings, notifications of charges, notices to appear) health care consultations, and classification interviews/processes;  If implemented in the future, information regarding access to inmate staff readers or scribes, and availability of specialized library equipment for qualified hearing/vision-impaired and learning disabled inmates such as text magnifiers, large print materials, audiocassette tapes;  The process of personal notification by staff and possible use of a dry erase/chalk board and/or lighted electrical banner for notification of announcements, visits, ducats (appointment slips) or messages in the housing unit;  Access to a TTY and volume control telephone;  Access to a closed captioning television in the housing unit;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Information regarding emergency alarms, evacuations, announcements and notices; and
 The SCSD detention facilities inmate assistance program (if further developed in the future to include assistance to hearing, vision, speech, learning and intellectually disabled inmates).
References
28 CFR § 35.130(a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 C.F.R. 35.106 states that a public entity shall make available to applicants, participants, beneficiaries, and other interested persons information regarding non-discrimination on the basis of disabilities in the services, programs, or activities of the public entity.
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
The information below is for reference only.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates delivery of inmate orientation at each of CDCR’s adult institutions. Examples of required information for mobility impaired inmates include the following: the purpose of the inmate disability program, availability of Title 15, rulebooks, availability of grievances and reasonable accommodation requests, reasonable accommodations/modifications available to qualified inmates, inmate assistance program or assistance that may be provided by inmates (if applicable), information regarding emergency alarms, evacuations, etc.
As a result of the initiation of an administrative investigation (by the United States Department of Justice [USDOJ]) due to a complaint filed pursuant to Title II of the ADA, and Section 504 of the Rehabilitation Act of 1973, in March 2013, a settlement agreement was reached between the United States of America (United States Department of Justice) and the County of Arapahoe, Colorado.
The settlement agreement specifically applied to inmates who were deaf or hearing impaired. As related to inmate orientation, terms and conditions of the settlement agreement included but were not limited to the following:
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Inmate handbook: At the earliest reasonable time, Personnel will effectively communicate the contents of the Inmate Handbook and similar publications to all inmates who are deaf or hard of hearing, including those for whom written language is not an effective means of communication. Personnel may choose to meet this obligation by providing a video of a qualified interpreter signing the contents of the Inmate Handbook, along with appropriate technology for viewing, or by providing a qualified interpreter to interpret the contents of the Inmate Handbook to the inmate who is deaf or hard of hearing.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Alarms/Emergencies
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders pertaining to the emergency response and evacuation processes include: 02/01 Use of Force; 02/04 Weapons, Tactical Weapons, and Specialized Equipment; 03/01 Critical Incident Response Plan; 03/09 Fights, Riots, Hostage and Minor Disturbances; 03/12 Evacuation Plan – Main Jail; and 03/13 Evacuation Plan – RCCC. The Assessment Team reviewed the above listed Operations Orders to identify whether they contained any language specific to ADA or inmates with disabilities.
Specifically, the Assessment Team reviewed the operations orders to determine if language included: information about staff access to a current roster/list from an electronic tracking system for disabled inmates; requirements for inmates during emergency alarms or evacuations, e.g., return to their assigned cell/bed areas, freeze movement, ‘take a knee’ on the ground, face the nearest wall, sit on the ground, lay on ground in a prone position, or await for specific verbal instructions from staff; inmate identification vests (or similar process), e.g., for mobility, deaf/hearing, and blind/vision impaired inmates; inmate notification; reasonable accommodations/assistance (during evacuations or emergencies); effectively communicating (as feasible) with inmates whose disability may make it difficult for them to either know or understand that an alarm or emergency may be taking place, or whose disability may pose a barrier to communications and therefore may encounter difficulties understanding how to appropriately react to emergencies, e.g., deaf/hearing impaired inmates as well as those with an intellectual (developmental) disability; de-escalation for inmates with mental illness (as applicable), and special considerations for mobility impaired inmates or others during movement or transport.
None of the operations orders reviewed contained any ADA or inmate disability language or references, and all were silent regarding an expectation to either return to their cell/bed area, freeze movement, ‘take a knee’ on the ground, face the nearest wall, sit on the ground, lay in a prone position on the ground, or await other verbal instructions.
Operations Order 03/12, Evacuation Plan - MJ, Section II.D. outlines the evacuation priorities of individual housing units:
1) Evacuation of prisoners exposed to immediate risk of injury;
2) Evacuation of the infirmary (2-West) and the sub-acute (2-East) prisoners;
3) Evacuation of female prisoners;
4) Evacuation of High Security, Disciplinary Housing, and acute psychiatric prisoners separate from the general population; and
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
5) Evacuation of Booking and Court Holding areas.
Section II.F., states in part, “Each housing unit shall follow the evacuation procedure contained in this Order unless directed otherwise by the Incident Commander:
1) Housing unit officers should account for prisoners in their housing area, by both locator card and Control Point Group List (PF-11) unless the resources are unavailable; and
2) If locator cards or the PF-11 lists are unavailable, handwritten lists or location boards may be substituted.”
The Assessment Team also reviewed the following list of Operations Orders to ascertain whether pertinent ADA language existed as well: 01/14 Division Safety Program; 01/15 Reporting of Incidents and Crimes; 02/02 Use of restraint Devices; 02/03 Use of Pro-Straint Chair; 02/05 Custody Emergency Response Team; 02/06 Prisoner Searches; 02/12 Transportation of Prisoners; 03/02 Fire Prevention – Main Jail; 03/03 Fire Suppression – Main Jail; 03/04 Fire Prevention – RCCC; 03/05 Fire Suppression – RCCC; 03/06 Emergency Systems and Equipment; 03/07 Medical Emergencies; 03/11 Natural Disasters, and 03/15 Escape Response. These Operations Orders also did not contain any relevant ADA or inmate disability information. However, most of these Orders will be outlined with noted concerns and recommendations for other ADA-related issues, and will be detailed in other sections of this report as applicable.
Observations
During the time periods the Assessment Team was on grounds at the MJ and RCCC facilities, the team members observed a few emergency alarms primarily from adjacent housing areas or just outside the respective units. The Assessment Team did not observe any visual alarms (e.g., flashing lights) to alert deaf/hearing-impaired inmates as to an emergency situation or incident. It appears that the alarms are audible only. A deaf inmate housed at RCCC complained to the Assessment Team that there is no mechanism for him to immediately or quickly learn of an alarm sounding.
There were no evacuations; therefore, the Assessment Team was unable to observe these processes.
In touring the housing units, most of the units/pods had notices for emergency and fire exits routes posted, but several units/pods throughout the MJ and RCCC did not. This will be outlined in more detail in another section of this report.
Staff Interviews
The Assessment Team interviewed one or more deputies from every housing unit at both the MJ and RCCC facilities to obtain information relative to staff
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
knowledge and practices, and their expectations of inmates during emergencies and inmate evacuations. The Assessment Team asked questions pertaining to: identification of disabled inmates or staff access to an updated tracking roster of disabled inmates; requirements or expectations for inmates during emergency alarms, e.g., freeze movement, ‘take a knee’ on the ground, sit on the ground, face the nearest wall, lay on ground in a prone position, or await for specific verbal instructions from staff; inmate identification vests (or similar process), inmate notification; reasonable accommodations/assistance (during evacuations or emergencies); effectively communicating (as feasible) with inmates whose disability may make it difficult for them to either know or understand that an alarm or emergency may be taking place, or whose disability may pose a barrier to communications and therefore may encounter difficulties understanding how to appropriately react to emergencies; and special considerations for mobility impaired inmates or others during movement or transport.
All staff interviewed acknowledged that there is no master-tracking roster of identified inmates with disabilities. Most staff were not aware of the Operations Orders requirement for staff to use the Locator Cards during emergency evacuations, and there was no consistency in a primary method with which staff would identify inmates during an emergency evacuation.
Staff provided the following responses or cited the following methods with which they would identify an inmate as having a disability or special need: they (staff) are regularly assigned to their specific unit and already know who their disabled inmates (and those with medical needs) are; observing and talking/interviewing with the inmates; the JIMS system PF2, PF4, and PF10 screens (although some staff admitted that this system usually does not tell them if an inmate has a specific disability); Locator Cards and attached medical chronos for health care appliances/assistive devices (inmates are required to maintain the chronos on their persons); face-to-face identification check (using Locator Cards); white boards in control booths (written in grease pencil) for RCCC housing units; and the white board in the Nurses Station (second floor medical at MJ) will indicate ‘MA Assist’ for inmates who require extra care or assistance; disabled inmates are usually housed on the second floor medical unit (for MJ).
The Assessment Team asked the housing unit deputies about the current practices and expectations of inmates during emergency alarms. Staff mentioned that they conduct periodic evacuation drills for readiness. The overwhelming majority of staff indicated that inmates are ultimately expected to ‘lockdown’ and return to their respective assigned cells/bed areas. The inmates must turn and face the nearest wall, place their hands inside the waistband of their pants, and stop all movement. About 20 percent of the housing unit staff stated that they use discretion as to whether to require the inmates to lay on the ground in a prone position. Some staff said they use further discretion whether
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to use physical force to ensure an inmate assumes a prone position (if an inmate does not voluntarily assume such position).
However, most of these staff acknowledged that if they are aware that a particular inmate has a mobility or other disability that precludes them from assuming a prone position, then an exception would be made, and those inmates would not be required to lay or sit on the ground if they were unable to do so.
Most staff acknowledged that when they respond to an emergency alarm in a unit where they are not regularly assigned, it is very difficult or impossible to know each inmate and whether any inmates have a disability that could prevent them from immediately being aware of an alarm, or from being able to immediately face the nearest wall or assume a prone position on the ground. Some of the staff admitted that the wristband and locator card identification systems are not effective for emergency alarm situations. Most of the staff also thought a more visible type of identification system could be more appropriate for quick identification as well as staff safety during emergency alarm situations, e.g., identification vests for specific types of disabilities, e.g., mobility, blind/vision, and deaf/hearing.
Nearly all staff interviewed stated they would provide any inmate accommodations as necessary during an evacuation or emergency situation. For emergency inmate notification, staff make a verbal announcement on their cell/housing unit intercom system. Staff indicated that they have the capability to do a major group release if necessary.
Staff seemed to be very accommodating with their responses. Most staff said they would use their assigned radio to call for staff assistance as warranted, and would provide any assistance to disabled inmates as needed, including physically helping them, obtaining a wheelchair if necessary, etc. During evacuations, staff cycle each inmate out one-by-one to make sure no inmates are left behind, and they check each cell/bed area, common area, and other areas.
Conclusion
Listed below are noted concerns regarding the Sheriff’s Department County of Sacramento Correctional Services Operations Orders and/or staff practices and expectations of disabled inmates during emergencies and alarms:
 The aforementioned applicable Operations Orders must contain ADA or disability-related language;
 There must be a comprehensive inmate disability screening and identification process as well as an electronic tracking system in place to ensure all staff are aware of all inmates with disabilities, physical limitations, and accommodations/assistance needs;
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o Operations Order 03/12, Evacuation Plan – MJ Section II.F. must reflect any future modifications for staff responsibilities toward identifying inmates during emergencies and alarms;
 There must be written information contained in the applicable Operations Orders regarding directives or expectations for inmates (including disabled inmates) during emergencies and alarms;
o There must be staff consistency with their expectations of inmates during emergency alarms;
o Without any directive from the applicable Operations Orders, most staff are directing inmates to face the nearest wall (with their hands placed inside the waist bands of their pants), while other staff instruct inmates to lay on the ground in a prone position. As stated above, a portion of these staff also indicate they may use physical force if an inmate refuses to lay in a prone position;
o Because of an inadequate health care screening process for disabilities, physical limitations, and accommodation needs, staff don’t generally know which inmates have a disability, or who has the ability to assume a prone position on the ground, or who may need assistance;
o Unless the Operations Order is modified to indicate that no inmates will be required to lay on the ground in a prone position during alarms or emergencies, then the applicable Order must contain language that mobility-disabled inmates will not be forced to a prone or in a seated position on the ground during an emergency alarm;
 There must be written information in the applicable Operations Orders regarding inmate notification (during alarms or emergencies);
 There must be written information in the applicable Operations Orders regarding identifying accommodation/assistance needs for disabled inmates, so staff can provide help as necessary during emergencies or alarms;
 There must be written information in the applicable Operations Orders regarding communicating appropriately (effectively) during emergencies or alarms, with inmates who may have a disability that provides a potential barrier to communications;
 Any prioritization for evacuating individual housing units and/or disabled inmates must be articulated in the appropriate Operations Orders;
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o Operations Order, 03/12 Evacuation Plan – MJ, Section II.D. as shown above, outlines the guidelines in determining how to prioritize the evacuation of individual housing units. However, in the past nearly all disabled inmates either were or were assumed to be housed on the MJ second floor (2/W and 2/E). There is no priority listed in the Order for the evacuation of disabled inmates. Although a large percentage of disabled inmates at the MJ are still housed on the second floor infirmary, many of them (various disabilities) are now being housed in other areas of the MJ as well as the RCCC.
 There are no visual alarms (audible only);
o Deaf inmates would not quickly be alerted to alarms or emergencies;
 All housing units/pods must have the notices for emergency and fire exits routes posted;
 The SCSD detention facilities should give consideration to other more visible and easily identifiable methods of inmate identification (during emergencies) other than wristbands, e.g., identification vests for mobility, deaf/hearing-impaired and blind/vision impaired inmates.
o Staff acknowledged that they are largely unfamiliar with inmates, their disabilities, or their special needs, when they (staff) respond to other housing units for alarms or emergencies. Most staff indicated that the wristband identification process is not effective for emergency situations.
References 28 CFR § 35.105 (a) requires that a public entity evaluate its current policies, and practices, and to the extent modification of any such policies, and practices is required, the public entity shall proceed to make the necessary modifications if they do not or may not meet the requirements Title II.
28 CFR § 35.130 (b)(7) requires a public entity to make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.
28 CFR 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
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(iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others. 28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity. The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Evacuation Procedures:
Each institution/facility (DPP designated institutions, nondesignated institutions, and reception centers) shall ensure the safe and effective evacuation of inmates with disabilities.
Local evacuation procedures shall be adopted at each facility.
Each institution/facility (DPP designated institutions, nondesignated institutions, and reception centers) shall ensure custody staff in housing units where inmates with disabilities that impact placement reside maintain a copy of the identification card/picture for that inmate with the inmate roster, to alert unit staff of the special needs required for emergency evacuation of the inmate. Special needs may include personal notification for hearing-impaired inmates, or assistance provided to vision or mobility impaired inmates in responding to emergency situations.
Evacuation procedures shall be effectively communicated to disabled inmates during orientation process. These procedures shall also be incorporated into unit staff’s post orders.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Mechanical Restraints/Searches/Count
The Minimum Standards for Local Detention Facilities, Title 15-Crime Prevention and Corrections, Division 1, Chapter 1, Subchapter 4, Article 5. Classification and Segregation, contains the following section applicable to Mechanical Restraints:
§ 1058. Use of Restraint Devices.
The facility administrator, in cooperation with the responsible physician, shall develop written policies and procedures for the use of restraint devices and may delegate authority to place an inmate in restraints to a physician. In addition to the areas specifically outlined in this regulation, at a minimum, the policy shall address the following areas: acceptable restraint devices; signs or symptoms which should result in immediate medical/mental health referral; availability of cardiopulmonary resuscitation equipment; protective housing of restrained persons; provision for hydration and sanitation needs; and exercising of extremities.
Restraint devices shall only be used on inmates who display behavior which results in the destruction of property or reveal an intent to cause physical harm to self or others. Restraint devices include any devices, which immobilize an inmate’s extremities and/or prevent the inmate from being ambulatory. Physical restraints should be utilized only when it appears less restrictive alternatives would be ineffective in controlling the disordered behavior.
Inmates shall be placed in restraints only with the approval of the facility manager, the facility watch commander, or the designated physician; continued retention shall be reviewed a minimum of every two hours. A medical opinion on placement and retention shall be secured as soon as possible, but no later than four hours from the time of placement. The inmate shall be medically cleared for continued retention at least every six hours thereafter. A mental health consultation shall be secured as soon as possible, but in no case longer than eight hours from the time of placement, to assess the need for mental health treatment.
Direct visual observation shall be conducted at least twice every thirty minutes to ensure that the restraints are properly employed, and to ensure the safety and well-being of the inmate. Such observation shall be documented. While in restraint devices all inmates shall be housed alone or in a specified housing area for restrained inmates which makes provisions to protect the inmate from abuse. In no case shall restraints be used for discipline, or as a substitute for treatment.
The provisions of this section do not apply to the use of handcuffs, shackles or other restraint devices when used to restrain inmates for security reasons.
The SCSD detention facilities Operations Orders applicable to inmate searches, mechanical restraints, and inmate counts, are outlined in the following Orders:
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02/01 Use of Force; 02/02 Use of Restraint Devices; 02/03 Use of Pro-Straint Chair; 02/05 Custody Emergency Response Team (CERT) and Cell Extraction Procedure; 02/06 Prisoner Searches; 02/12 Transportation of Prisoners; 04/01 Intake, Search, Reception and Holding; 04/04 Use of Sobering Cell; 04/05 Use of Safety, Segregation, North Holding #2, and Multipurpose Rooms; 06/04 Counts and Lockdowns; 06/06 Organized Searches in a Housing Unit (Shakedowns), and 06/08 Court Pull Procedures.
The CHS Administrative Policies applicable to inmate searches, mechanical restraints, and inmate counts, are outlined in the following policies: 1413 Use of Restraints and the Pro-Straint Chair; 1414 Restraint Check Method; 1415 Patients in Safety Cells; 1416 Patients in Segregation; and 1425 Patients in Segregated Cells at Intake.
Operations Order 02/01 Use of Force, states in part, “Officers shall use only that force which is reasonable, given the facts and circumstances perceived by the officer at the time of the event, to effectively bring an incident under control. The reasonableness of the force used must be judged from the perspective of a reasonable officer on the scene at the time of the incident.”
It also states in part, “The application of force shall cease when control of a prisoner or situation is achieved and shall not be used as a form of punishment. The objective in applying reasonable force is to control persons and incidents thereby minimizing injury to all persons involved.”
With regard to Alternative Resolutions in Lieu of Force/De-escalation, it states,
“Staff should be cognizant of the unique environment in a correctional setting. Each situation shall be evaluated to determine the urgency of enforcement action. In situations where an immediate response may escalate or aggravate the situation, officers should consider the containment of the event as a tactic. Further, staff shall appropriately de-escalate the level of force in response to the suspect’s level of compliance. Possible alternative resolutions in lieu of the application of force include:
 Containment of the situation;  Shutting off utilities (Water, Electricity);  Negotiation; and  Waiting situation out until suspect(s) voluntarily comply
Operations Order 02/02 Use of Restraint Devices, states in part, “Restraint devices shall only be used on prisoners who display behavior that results in the destruction of property or reveals the intent to cause physical harm to self or others. Physical restraints should be utilized only when it appears less restrictive alternatives would be ineffective in controlling the disorderly behavior. The use of restraints shall not be used as a form of discipline or as a substitution for treatment. Sworn staff utilizing restraints shall be trained in the proper use of the
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device(s). The provisions of this order do not apply to the use of handcuffs, shackles, or other restraint devices when used to restrain prisoners for security or transportation purposes. Sworn staff has the option of using an appropriate authorized restraint device to move or restrain a prisoner for security reasons.”

The Order also states in part, “Restraint devices include any devices which immobilize a prisoner’s extremities and/or prevent the prisoner from being ambulatory. The following restraint devices are authorized for use:

 Pro-Straint Chair;  Protective Helmet;  Handcuffs / Leg Shackles / Belly Chains;  Posey (5-point) soft ties;  Leather leg and/or wrist cuffs;  Plastic Handcuffs;
 Plastic cuffs should only be used when none of the more conventional methods can be used due to the size of the inmate or lack of available equipment. A cutting tool must be readily available in case the cuffs need to be removed;
 Multi-Prisoner Cuff Chains (used for transportation/security only); and  R.E.A.C.T. Belt (used only in court when authorized).
With regard to Procedures and Observation of Restrained Prisoner, the Order also states in part, “Custody staff shall follow these procedures when restraining prisoners, who threaten or display behavior that results in the destruction of property or reveal an intent to cause physical harm to self or others, in restraint devices: Prisoners shall be placed in restraints only with the approval of the watch commander or designated watch commander;

 Restraints shall not be used in a manner that would cause unnecessary

injury or discomfort. Only sworn staff shall apply and remove restraints.

Sworn staff applying the restraints shall always thoroughly search the

prisoner, double-lock the restraints, and check all restraints to reduce the

risk of injury to the inmate;

 A “Spit Net” will be used when appropriate to prevent spitting or biting;

 While in restraint devices all prisoners shall be housed alone or in an area

that will protect the person from abuse;

 A custody supervisor shall ensure the prisoner’s sanitary needs are met;

 A medical evaluation shall be requested and conducted, if possible, within

the first fifteen (15) minutes and every two hours thereafter. Prisoners

restrained for a period exceeding six (6) hours shall require a medical

evaluation prior to continuance of such restraints;

 Custody staff shall conduct direct visual observation of the restrained

prisoner at least twice every thirty (30) minutes to ensure the restraints are

properly employed and to ensure the safety and

well-being of the

prisoner;

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 A custody supervisor shall conduct a direct visual observation once every thirty (30) minutes;
 Continued retention in restraints beyond one hour shall be reviewed and approved by the watch commander or designated watch commander. Clear and articulable facts must exist to justify continued retention;
 A mental health evaluation shall be requested and conducted as soon as possible but within six (6) hours of placement in restraints. Prisoners restrained for a period exceeding six (6) hours shall require a mental health evaluation prior to continuance of such restraints.”
The Order further states in part, “Prisoners housed in the Acute Psychiatric Unit (JPS) at the Main Jail, shall require the consent of the psychiatrist or designee prior to being placed in restraints except when emergency circumstances exist;
 Upon the request by JPS personnel to restrain a prisoner, custody staff shall notify a watch commander and receive additional authorization;
 Prisoners shall be restrained in those cells designated for JPS use and JPS staff shall primarily be responsible for observation of the prisoner;
 Custody staff assigned to the medical floor will be responsible for following the procedures outlined in Section III.”
With regard to dialysis treatment, the Order states in part, “Restraints will not be routinely used on prisoners receiving dialysis treatment. Limitations of the use of restraints during dialysis:
 Restraints will only be applied on inmates who display behavior which results in the destruction of property or reveals an intent to cause physical harm to self or others; and
 An individualized assessment of any need for restraints will be made for each inmate who receives dialysis treatments.”
Operations Order 02/03 Use of the Pro-Straint Chair, states in part, “The ProStraint Chair is a restraint device which immobilizes a prisoners extremities and/or prevents the inmate from being ambulatory. Other restraint devices that may be utilized with the Pro-Straint Chair are:
 Handcuffs / Leg shackles;  Leather leg and/or wrist cuffs;  Protective helmet; and  Soft restraints attached to the side of the Pro-Straint Chair.”
The Order also states, “Custody staff shall follow these procedures when restraining prisoners, who threaten or display behavior that results in the destruction of property or reveal an intent to cause physical harm to self or others, in the Pro-Straint Chair;
 The Pro-Straint Chair shall not be used in a manner that would cause unnecessary injury or discomfort. Only sworn staff shall apply and remove
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
the restraints. Sworn staff placing a prisoner into the Pro-Straint Chair shall always thoroughly search the prisoner and double-lock and check all restraints/straps to reduce the risk of injury to the prisoner.;  Prisoners may be placed in the Pro-Straint Chair with their hands handcuffed behind their back or with the prisoners arms handcuffed to the sides of the Pro-Straint Chair with soft restraints or handcuffs;  If it becomes necessary to hold the prisoner handcuffed behind the back for more than one hour, the prisoner should be released from the metal handcuffs and re-handcuffed to each side of the Pro-Straint Chair with soft or “Posey” restraints or handcuffs;  While in the Pro-Straint Chair, a prisoner shall be housed alone or in an area that will protect him/her from abuse;  Custody staff shall notify a custody supervisor and request medical staff if the prisoner’s condition appears to deteriorate;  In addition to the cardiopulmonary resuscitation (CPR) equipment that is maintained at each medical station, rescue breathing “pocket” masks and Automated External Defibrillators are strategically placed throughout each facility, available for rapid emergency response in the event that CPR is necessary;  A medical evaluation shall be requested and conducted, if possible, within the first fifteen (15) minutes and every two hours thereafter. Prisoners restrained in the Pro-Straint Chair for a period exceeding six (6) hours shall require a medical evaluation prior to continuance of such restraints;  Custody staff shall conduct direct visual observation of a prisoner in the Pro-Straint Chair at least twice every thirty (30) minutes to ensure the restraints are properly employed and to ensure the safety and well-being of the prisoner;  A custody supervisor shall conduct a direct visual observation once every thirty (30) minutes; and  A mental health evaluation shall be requested and conducted as soon as possible but within six (6) hours of placement in the Pro-Straint Chair. Prisoners restrained for a period exceeding six (6) hours shall require a mental health evaluation prior to continuance of such restraints.”
Operations Order 02/05 Custody Emergency Response Team (CERT) and Cell Extraction Procedures, states in part, “The intent of this is to establish consistent and safe methods to handle critical incidents that may require the utilization of C.E.R.T. and the implementation of cell extraction procedures to reduce the risk of injury to staff and prisoners. Safe procedures to extract a violent, noncooperative or armed prisoner from his/her cell who fails to comply with direct orders will be addressed. Only the amount of force necessary to overcome resistance and maintain control shall be used during a cell extraction. The use of force shall cease when control of a prisoner or situation is achieved and shall not be used as a form of punishment. This policy is to be used in conjunction with,
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but does not supersede, either the General Order or Correctional Services Operations Order regarding the use of force.”
With regard to cell extraction procedures, the policy states in part, “The C.E.R.T. Sergeant or designee may take the following steps during the cell extraction:
 Direct the prisoner to voluntarily exit the cell;  Direct the prisoner to comply with the commands given to him/her so that
he/she can be escorted safely out of the cell;  Give the prisoner reasonable time to comply with the commands;  If the prisoner does not comply, the C.E.R.T. Sergeant or designee will
direct the extraction team to remove the prisoner  The C.E.R.T. Sergeant or designee will determine if the prisoner will be
placed in:  An authorized restraint device(s) as per Operations Order 02/02, Use
of Restraints; and  A safety or segregation cell, multipurpose room, or other area where
the prisoner can be regularly monitored and safe from other prisoners as per Operations Order 04/05, Use of Safety Cell, Segregation Cell, North Holding #2, and Multipurpose Rooms;  If the prisoner and/or staff are injured, necessary medical treatment will immediately be summoned. Treatment of the injured party will occur when the scene is rendered safe.”
Operations Order 02/06, Prisoner Searches, states in part, “Intake staff shall use the type of search, level of force and means of restraint necessary to conduct a thorough search of combative, uncooperative or high-risk arrestees.” It also states, “All strip searches shall be conducted individually and in an area of privacy so that the search can be observed only by officers participating in the search. Only necessary personnel shall be present during the search. At least two sworn personnel shall participate in a search.”
Operations Order 02/12, Transportation of Prisoners, states in part, “Prior to transporting a prisoner from another facility, transport staff should check with custody staff, medical staff, and/or psychiatric staff to determine if the prisoner has any special needs or to determine any anticipated behavior…. Transporting deputies shall minimally conduct a pat-down search and metal detector search consistent with departmental guidelines on all prisoners before placing the prisoner in the vehicle…. Transporting deputies shall ensure that all prisoners are restrained. All restraints that have a locking cuff will be double locked. All prisoners will be restrained by one of the following means:
 Handcuffs;  Security Belly/Waist Chains;  Leg Chains/Shackles; and  Multiple Prisoner Chains (four, six, ten, chains).
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The Order also states, “If a vehicle needs to be evacuated at any time during a transport, deputies may have prisoners stand, sit, kneel, or lie prone in a safe area. One deputy shall monitor the prisoners. Medical needs, not perceived as emergencies, shall be attended to by medical staff upon arrival at the destination or as soon as practical.”
Operations Order 04/01 Intake, Search, Reception and Holding states in part, “If a strip search is required, the search shall be performed in accordance with Operations Order 02/06”, and also states, “telephone access to the prisoners will be provided in accordance with Operations Order 06/13-Telephone and TDD/TTY Equipment Access.”
Operations Order 04/04 Use of Sobering Cell, states in part, “Prisoners placed in the sobering cell should be medically cleared for custody by medical staff, and should not have a medical condition which requires emergency medical treatment. It also states, “Custody staff shall perform direct visual observations of prisoners in a sobering cell no less than once every half hour. Each check shall include a visual check of the prisoner to ensure he or she is breathing regularly. An arousal attempt to ensure the prisoner will respond to verbal or pressure stimulation shall be done by custody staff.” It further states, “Prisoners will not remain in a sobering cell longer than six (6) hours without an evaluation by medical or custody staff to determine if the prisoner has an urgent medical problem”, and “[i]f the prisoner has a serious medical condition, he or she will be removed from the sobering cell. Urgent medical needs will be addressed by available medical staff or the prisoner will be referred to the appropriate medical facility. A report will be taken to document the incident.”
Order 04/05 Use of Safety, Segregation, North Holding #2, and Multipurpose Rooms, states in part, “The Safety Cell shall only be used to hold those prisoners who threaten or display behavior that endangers self, other people, or property. Examples include, but are not limited to:
 Combative or violent behavior;  Threats or attempts to harm self or others; and  Destruction of property.”
The Order also states, “Prisoners placed in physical restraints may be placed in a safety cell” and “ shall only be kept in a safety cell until they are no longer a danger to self or others and/or they no longer pose a threat to the safety or security of the facility.”
The Order further outlines the following:
“Custody staff shall make reasonable accommodations to provide prisoners access to the inmate telephone system in accordance with California Penal Code 851.5. Custody staff shall document the telephone access for prisoners placed
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
in segregation cells and/or will document the reasons why telephone access is restricted;
Prisoners in housing units who are in need of immediate mental health services referral and/or have been placed in restraints may be temporarily placed in a multipurpose room or North Holding #2 at RCCC for observation;
Custody staff shall notify medical staff within fifteen (15) minutes that a prisoner is temporarily housed in a safety or segregation cell and shall work with medical staff to address the nutritional, fluid, and hygiene needs of the prisoner; and
If a prisoner’s behavior indicates that entering the cell to provide food, fluids, medical evaluation, or sanitary needs would result in a use of force incident or be unsafe for the prisoner, medical staff, or deputies, then a supervisor shall be notified.”
Operations Order 06/04 Counts and Lockdowns, states in part, “Scheduled lockdowns and counts of all prisoners shall be conducted at least three times during each shift. Each shift shall be responsible for conducting one face-tolocator counts as described in Section III of this order conducted at the beginning of a shift.”
The Order also states, in part, “Prisoners housed in infirmary cells shall be locked down at all times unless undergoing medical treatment which makes it necessary for them to be out of their cells... The standard procedure for advising prisoners to return to their cells is via a verbal announcement or an announcement over the intercoms located in the housing units.”
Operations Order 06/06 Organized Searches in a Housing Unit (Shakedowns), states in part, “Routine searches shall be conducted by custody staff to maintain the security of the facility, provide for the safety of staff and inmates, and to provide for the division commander to manage operations. These described searches shall be conducted by sworn and non-sworn staff of all areas of the facility to which prisoners and/or the public have or could have access.”
Operations Order 06/08 Court Pull Procedures, states in part, “If a prisoner(s) is leaving a custody facility to attend court in a different building, custody staff shall apply the proper restraints for transport. Prisoners restrained solely for security reasons are not subject to Title 15, Section 1058 restraint device requirements. The restraints may include a multi prisoner handcuff chain or belly chain/shackle combination. Although not preferred, handcuffs or other restraint devices may be used with supervisor approval.” It also states, “Transport staff is responsible for segregating prisoners in the transport vehicle according to classifications.”
Correctional Health Services (CHS) Administrative Policy 1413 Use of Restraints and the Pro-Straint Chair, states in part, “Restraint devices may be used to overcome resistance and to gain and maintain control of persons in custody.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Restraint devices include any devices which immobilize an inmate's extremities and/or prevent the inmate from being ambulatory. The use of restraints shall not be used as a form of punishment. Except as defined separately under Jail Psychiatric Services Policy, the application of restraints is not initiated by medical staff.”
The Order also states in various parts, “Deputies shall visually monitor inmates restrained in Safety and/or Segregation Cells at least twice every thirty (30) minutes. Deputies shall document observations in the Safety and/or Segregation Log”, and “Deputies shall notify a Sergeant and request medical staff if the inmate’s condition appears to deteriorate.”
The order also indicates the following: the Sergeant shall review the continued need for restraint of the inmate at least once every two (2) hours; a medical evaluation shall be requested within the first fifteen (15) minutes and every two (2) hours thereafter which will include circulatory status and vital signs; and inmates restrained for a period exceeding eight (6) hours shall require a medical and mental health examination prior to continuance of such restraints.
The (CHS) Administrative Policy 1414 Restraints Check Method, states in part, “Restraint checks will be completed by medical staff on all individuals placed in physical restraints by custody. Patients in the Psychiatric Unit will be monitored by JPS staff. Restraint checks will be initiated within 15 minutes of the time medical staff is notified that an individual has been placed in restraints. Deputies will perform a visual restraint check twice every thirty minutes. Additional checks will be completed by medical staff when medically indicated to ensure restraints are properly employed. All necessary adjustments to the position of restraints will be completed by custody. Each restraint-check by nursing staff will be documented on the Restraint Check Flow Sheet by the Nurse. Medical evaluation, including the circulatory status and vital signs, will be completed on restrained individuals within the first fifteen minutes, and at least every two (2) hours, and as often as medically indicated.”
The Order also states in part, “JPS will be notified of the individual’s placement in restraints.” The Order contains language that recommendations shall be made to custody every two hours for range of motion to all extremities based upon nursing judgment, and that in cases of persons with altered sensorium or possible history of diabetes or overdose, the physician shall be contacted.
Correctional Health Services (CHS) Administrative Policy 1416 Patients in Segregation states in part, “Inmates that have been removed from the general population and placed in segregation are evaluated daily by medical personnel, and these encounters are documented. Notations are made of any signs of physical illness or trauma. Observations regarding the patient’s attitude or outlook such as depression, suicidal ideations shall be reported to Nursing Supervisor and documented.” It also states, “Behavior permitting, inmates in
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
administrative segregation are not to be deprived of privileges afforded other Inmates. All health care services are available.”
The (CHS) Administrative Policy 1425 Patients in Segregated Cells at Intake, states in part, “Recently arrived arrestees with behavior serious enough to require isolation in a segregation cell may have underlying medical or mental health problems. Medical staff must be alerted when an arrestee, who may be unknown to facility staff, is placed in a segregation cell.” It also states, “Evaluation shall emphasize detection of serious infectious disease, head trauma, acute states of delirium, and serious mental disorders which would require intervention to prevent life-threatening deterioration.” The Order states, “Once the initial assessment has been completed, nursing staff will continue to assess, evaluate and document every six (6) hours”, and “The Nursing Supervisor will be notified when a patient has remained in a segregation cell for eight hours. If an arrestee remains in the segregation cell for 24 hours, he/she must be evaluated by a physician. Should the nurse observe a significant change in the patient’s condition or an injury, the Nursing Supervisor and the physician shall be notified immediately.”
With the exception of mental illness, all of the aforementioned SCSD detention facilities Operations Orders and CHS Policies are silent regarding inmates with mobility impairments (or other disabilities). Likewise, there is no information regarding accommodations for mobility-disabled inmates (including those with prosthetic limbs), such as those inmates whose disabilities may prevent the application of restraint equipment in the ordinarily prescribed manner. Reasonable accommodations must be applied in these instances as warranted. There is no policy or procedure verbiage with respect to mechanical restraints being applied to ensure effective application while reasonably accommodating an inmate’s mobility disability.
None of the Orders contain procedures for custody staff to follow relative to mobility-disabled inmates during the pat-down or strip search process. There is no information pertaining to inmates who use wheelchairs and/or who have severe mobility impairments and are unable to perform standard strip search maneuvers to be afforded reasonable accommodation to ensure a thorough search.
None of the Orders contain information or direction to staff relative to prosthetic devices, dental plates, or other removable items. There is no language pertaining to modifications for pat-searches or strip-searches, for inmates who have a disability (mental or physical) that prevents the employment of standard search methods.
None of the Orders contain procedures as to what to do in the event an inmate does not voluntarily remove or relinquish his/her prosthetic device during the unclothed body search process.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Operations Order 06/04 Counts and Lockdowns does not require standing inmate counts, therefore there is no reasonable accommodation concerns for this area.
Operations Order 02/05 CERT and Cell Extraction Procedures is silent with respect to inmates with mobility disabilities (including those with prosthetic limbs). As a result, there are no specific procedures for staff to follow with regard to consideration for accommodations for mobility-disabled inmates or those with prosthetic limbs during these occurrences.
None of the aforementioned Operations Orders or CHS Policies pertaining to safety cells, sobering cells or Pro-Straint Chair, and Safety and Segregation Rooms contain any language pertaining to inmates with mobility disabilities, or prosthetic limbs, or directions for custody staff to follow regarding application of restraints on an inmate with a prosthetic limb prior to being placed in a Restraint Chair.
Operations Order 06/08 Court Pull Procedures, does not contain language requiring staff to ensure that inmates with prescribed HCAs/ADs/DME are allowed to maintain their devices at all times, including the time period while the inmate is waiting in the court processing/holding area while being processed to or from court.
The Order (as well as all of the aforementioned Orders and Policies are silent with regard to possible assistance (staff assistance or inmate assistance), which could be provided for inmates with severe mobility impairments, e.g., wheelchair users, or those who may have difficulty ambulating to or from court, with or without an assistive device.
Observations The Assessment Team did not observe the court processing, as those services are under the authority of the county and court system. The Assessment Team did observe the court processing (bus loading process) at both the MJ and RCCC jails. Detailed information is contained in the Transportation section of this report.
The Assessment Team did not observe any physical restraints being actively applied.
Staff Interviews The Assessment Team did not interview deputies assigned to the court processing area, as the process is under the authority of the county and court system. The Transportation section of this report captures interviews of Transportation staff.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Most of the custody staff (MJ and RCCC) that was interviewed was not aware of any specific procedures pertaining to special accommodations for mobility impaired inmates (or those with prosthetic devices) during the search restraint process, and they had not been trained in that area. Nearly all of the custody staff who were interviewed had not had to search a mobility impaired inmate wheelchair user or an inmate with a prosthetic limb. However, most indicated that they would conduct any searches in a separate setting (except during emergencies), and would preserve the inmate’s dignity. Most of the staff indicated that they would accommodate inmates with reasonable accommodations as necessary, e.g., using a chair next to the wheelchair to transfer back and forth during the search process, etc.
Inmate Interviews
The Assessment Team did not interview any inmates during the transportation or court bus loading process. The Assessment Team did not interview any inmates during the court movement process, as the oversight authority for that process falls under the county and court system.
Conclusion
The SCSD detention facilities do not currently have adequate SCSD detention facilities Operations Orders or CHS policies, procedures and training in place to ensure that staff provides mobility-disabled inmates (including those with prosthetic limbs) the necessary accommodations with respect to using mechanical restraints and conducting searches. It is essential that this be incorporated into the orders, policies and training and that staff be sufficiently trained within the local policies.
The SCSD detention facilities Operations Orders should contain procedures with regard to possible assistance (staff assistance or inmate assistance), which could be provided for inmates with severe mobility impairments, e.g., wheelchair users, or those who may have difficulty ambulating to or from court, and other areas with or without an assistive device.
The SCSD detention facilities do not have a modified restraint policy for mobilitydisabled inmates.
The SCSD detention facilities do not provide accommodations for mobilitydisabled inmates who are subjected to body searches.
Operations Order 02/02 Use of Restraint Devices should include language regarding inmates with mobility disabilities. Specifically, the Order should include information relative to accommodations for mobility-disabled inmates (including those with prosthetic limbs), such as for those inmates whose disabilities may prevent the application of restraint equipment in the ordinarily prescribed manner. Language should also be included to indicate that reasonable accommodations must be applied in these instances as warranted. Procedure language should
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
articulate that when applying mechanical restraints staff must ensure effective application while reasonably accommodating the inmate’s mobility disability.
Operations Order 02/06 Prisoner Searches (and possibly other related Orders) should include procedures for custody staff to follow in the event an inmate does not voluntarily remove or relinquish his/her prosthetic device during the stripsearch search process. The Order and procedures should contain information for staff to follow relative to mobility-disabled inmates (including wheelchair users, and those with prosthetic limbs, etc.) during the clothed body search process. The Order should contain information pertaining to inmates who use wheelchairs and/or who have severe mobility impairments and are unable to perform standard strip search maneuvers to be afforded reasonable accommodation to ensure a thorough search.
Operations Order 02/05 CERT and Cell Extraction Procedure, should contain procedures regarding staff considerations when preparing to cell extract or while extracting mobility-disabled inmates (including those with prosthetic limbs).
Operations Order 04/05 Use of Safety, Segregation, North Holding #2, and Multipurpose Rooms, should contain procedures regarding the handling and placement of inmates with mobility disabilities.
Operations Order 02/03 Use of Pro-Straint Chair and CHS Policy 1413 Use of Restraints and the Pro-Straint Chair, should contain procedures for staff to follow relative to the application of restraints for inmates with a prosthetic limb prior to being placed in a Restraint Chair.
Operations Orders 02/12 Transportation of Prisoners, and 06/08 Court Pull Procedures, should include procedures which would require staff to ensure that inmates with prescribed or authorized HCAs/ADs/DME are allowed to maintain their devices at all times, including the time period while the inmate is waiting or preparing to be processed to or from court. The SCSD detention facilities policies should also include procedures regarding providing assistance (staff assistance or inmate assistance) to inmates with severe mobility disabilities, e.g., wheelchair users, or those who may have difficulty ambulating to or from court (or in preparation for court) with or without an assistive device.
The SCSD detention facilities’ administration and staff should ensure the following; assistance is provided to inmates who struggle or may struggle to push themselves in their wheelchairs moving to or from court.
The SCSD detention facilities staff must not temporarily remove canes or other assistive devices, which have been prescribed to or otherwise authorized for the inmates, and staff must receive training to that end. Custody staff must be trained and understand the medical referral process for inmates who may have difficulties ambulating and may need a reasonable accommodation such as an HCA/AD/DME, i.e. a cane, walker, or crutches.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
References
28 CFR § 35.130(a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(i) Deny a qualified individual with a disability the opportunity to participate in or benefit from the aid, benefit, or service; (ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others; (iv) Provide different or separate aids, benefits, or services to individuals with disabilities or to any class of individuals with disabilities than is provided to others unless such action is necessary to provide qualified individuals with disabilities with aids, benefits, or services that are as effective as those provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State.
28 CFR 35.130(b)(4) A public entity may not, in determining the site or location of a facility, make selections—
(i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
28 CFR 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(8) A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
28 CFR 35.130(h) A public entity may impose legitimate safety requirements necessary for the safe operation of its services, programs, or activities. However, the public entity must ensure that its safety requirements are based on actual risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities.
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
The information below is for reference only.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following relative to mobility-disabled inmates (and inmates with other disabilities): Restraints
 Inmates who have a disability that prevents application of restraint equipment in the ordinarily prescribed manner shall be afforded reasonable accommodation, under the direction of the supervisor in charge. Mechanical restraints shall be applied to ensure effective application while reasonably accommodating the inmate’s disability.
Searches
 Inmates who have a disability that prevents the employment of standard search methods shall be afforded reasonable accommodation under the direction of the supervisor in charge. Such searches shall be thorough and professional, with the safety and security being the paramount concern.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
o Inmates who use wheelchairs and who may have severe mobility impairments and are unable to perform standard unclothed body search maneuvers shall be afforded reasonable accommodation to ensure a thorough search, including body cavities. If the search includes removal or disassembly of a health care appliance, it shall be conducted in a clean setting.
o If a search requires removal of the appliance, a compliant inmate shall be allowed to remove the appliance and tender it to staff. If forcible removal of an appliance from a noncompliant inmate is necessary, health care staff shall be available for consultation regarding the safe removal of the appliance.
o No inmate/parolee shall be required to lie or sit on extremely hot or cold surfaces to perform strip search maneuvers.
o Health appliances attached to the inmate's/parolee's body will be removed for inspection only during an unclothed body search.
o Complex devices (i.e., electronic medical devices, etc.) shall be· disassembled for inspection only when there is reasonable cause to believe the inmate has concealed contraband inside the device. Inspection of such devices shall require approval from a Captain or above after consultation with appropriate medical staff. Only a trained professional shall disassemble such devices.
 To ensure the safety of staff and inmates/parolees, all institutions/facilities (DPP designated institutions, nondesignated institutions, and reception centers) shall establish procedures for the routine inspection of health care appliances, i.e., inspection of a mobility impaired inmate's prosthetic device whose disability does not impact placement.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Release/Discharge/Transfer
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures applicable to the release and transfer of inmates, and the issuance and retention of HCAs/ADs/DME are outlined in: Operations Orders 02/12 Transportation of Prisoners, 04/03 Prisoner Clothing, Property and Funds, 04/07 Dress In/Dress Out Procedures, 04/09 Releases, 04/10 Property and Money Return and Release Procedure, Draft Operations Order Inmates With Disabilities - ADA, Policy 1423 Post Release Medical Care Planning, and Policy 1439 Reports of Disabilities and Impairments.
These policies are silent with respect to the disposition of prescribed HCAs/ADs/DME upon the release and transfer from the SCSD detention facilities. In an effort to identify the practice of whether inmates are allowed to retain their devices upon transfer or release, the Assessment Team interviewed custody, transportation and medical staff. The Assessment Team also observed the inmate release process at the MJ and RCCC.
Observations
The Assessment Team observed the release process at the MJ and RCCC. During the observations there were no disabled inmates with prescribed HCAs/ADs/DME being released or discharged. The Assessment Team also toured the property rooms in both the MJ and RCCC. During the tour/observations the team identified numerous HCAs/ADs/DME that were stored in the property rooms at both MJ and RCCC property rooms. The team identified the following HCAs/ADs/DME being stored; a wheelchair, and numerous walkers, canes, and crutches.
Staff Interviews
The Assessment Team interviewed transportation staff as well as deputies assigned to the inmate release process. Staff who were interviewed stated there is no tracking system to identify inmates who are disabled or who have an HCA/AD/DME prescribed to them. Some staff stated that if the inmates had an assistive device on their person, when released the inmates would be allowed to retain their respective device. Other staff stated that an inmate would not be released with the assistive device unless it was verified that it was his/her personal property.
The Assessment Team interviewed transportation staff relative to the transfer of disabled inmates with HCAs/ADs/DME. Staff stated that disabled inmates are transferred with their device. Staff also mentioned that inmates are allowed to use their HCA/AD/DME to access the transportation vehicle at which point the device is retained by staff until the transport has reached its final destination. The inmate is then re-issued their HCA/AD/DME to exit the transportation vehicle.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The Assessment Team interviewed medical staff assigned to the area responsible for the issuance of HCAs/ADs/DME and custody staff involved in the release process. Medical staff stated that the HCAs/ADs/DME issued by the SCSD detention facilities do not become the property of the disabled inmates, and inmates are not supposed to take them when released. One RN stated that arrangements could possibly be made for permanent full time wheelchair users to be released with a wheelchair. Custody staff stated that the inmates could retain their HCAs/ADs/DME when released; however, wheelchairs are not provided to the inmates upon release. Staff stated that they would try to see if someone could pick the inmate up as opposed to allowing the inmate to be released with a county-issued wheelchair. Staff stated that there have been occasions when an inmate’s personal HCA/AD/DME was put in stored property and they had to issue an HCA/AD/DME to the inmate upon his/her release.
Conclusion
There was conflicting information provided by staff whether inmates are allowed to retain their HCA/AD/DME when being released. In addition, the SCSD detention facilities do not have a policy regarding the retention of the devices for inmates that are being released. The Assessment Team observations of the property room storage that had HCAs/ADs/DME being stored was very concerning. There is not an effective tracking system in place for inmates that have been issued or arrived into custody with a HCA/AD/DME. There is a potential possibility that some disabled inmates are being released without their HCA/AD/DME, which are necessary for them to ambulate.
The SCSD detention facilities do not have a policy for the retention of HCAs/ADs/DME by disabled inmates that are being transferred. The Sacramento County Jail must incorporate provisions into their operations orders to ensure inmates are permitted to retain their prescribed or authorized HCAs/ADs/DME upon release, transfer or discharge.
References
28 CFR § 35.130 (a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others; 28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; 28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Health Care Appliances:
Health care appliances shall be retained and maintained by inmates upon release to parole.
Transportation:
The special needs of inmates with disabilities shall be considered in transporting them. An inmate’s special health care aids and appliances shall be transported with the inmate upon transfer.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Transportation
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders applicable to inmate transportation are outlined in Operations Orders 02/12 Transportation of Prisoners, 02/13 Inter-Facility Transfers/Court Appearances, and 03/07 Medical Emergencies.
Per Operations Order 02/12, custody staff assigned to the transportation of prisoners shall transport prisoners in a manner that will provide the highest levels of safety and security available to both the prisoners and transport staff. Custody staff shall operate Sheriff Department vehicles in accordance with the General Orders and state law.
Sworn staff assigned to the correctional facilities may be responsible for transporting prisoners. Prisoner transport may occur for a variety of reasons and may be scheduled or unscheduled. Most scheduled transports are conducted by the Long Haul Transportation Unit, the Medical Transportation Units, and the RCCC Facility Transportation Bus Details; however, it may become necessary for the individual shifts to assign staff for transportation duties.
Situations where individual shifts may be responsible for supplying transportation staff may include:
 Unscheduled emergency medical transports “Med Runs”.  Transportations to the Sacramento County Mental Health Center
(SCMHC).  Late notice scheduled medical appointments.  Warrant pickups from other agencies.  Inter-facility transfers (FATRNS).
Medical Transport Units (“Med Transport”) operate out of the MJ and RCCC. Each facility has designated personnel that are responsible for transporting inmates to and from scheduled appointments.
The Long Haul Transportation Unit operates out of the MJ Division and is supervised by the Intelligence Unit Supervisor. The Long Haul Transportation Unit is responsible for transporting inmates to various places within the State of California. The unit is minimally responsible for transporting the following inmates:
 All newly committed state prisoners to state facilities.  Prisoners returning from state and county facilities back to Sacramento
County per court order.  Prisoners committed to state and mental health facilities.  Persons held in other California jurisdictions on Sacramento County
Superior Court and Sacramento County Juvenile Court warrants.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Sacramento County Juvenile Probation Wards to their guardian’s county of residence.
 Local prisoners scheduled for satellite courts within the county.
The RCCC Facility Transportation Bus(es) (“branch bus”) operates out of RCCC and is supervised by on duty RCCC shift supervisors. The RCCC buses are generally used for transporting prisoners scheduled for court and inter-facility transfers to and from the MJ and RCCC.
Transportation staff assigned to transport prisoners shall, prior to transporting a prisoner from another facility, check with custody staff, medical staff, and/or psychiatric staff to determine if the prisoner has any special needs or to determine any anticipated behavior.
Transporting deputies shall ensure that all prisoners are restrained. All restraints that have a locking cuff will be double locked. All prisoners will be restrained by one of the following means:
 Handcuffs  Security Belly/Waist Chains  Leg Chains/Shackles  Multiple Prisoner Chains (four, six, ten, chains)
Unscheduled “med runs” are typically handled by the individual shifts. Staff assigned to a “med run” involving prisoners having an emergency medical issue that requires ambulance transport shall follow the procedures outlined in the previous sections.
Per Operations Order 02/13, Inter-Facility Transfers/Court Appearances, RCCC booking staff will verify releases and which prisoners will go on Bus #1. Releases from RCCC without their own transportation arrangements will be transported to the MJ. Releases from RCCC will be processed within the MJ Central Control lobby. Bus Crew #1 will coordinate with MJ Central Control in securing the Central Control Lobby and processing the group of released prisoners. Once the release process is completed the prisoners will be directed out through the Front Lobby.
RCCC prisoners with court appearances generally will not gather their cell/tank property as it is anticipated they will return to RCCC upon completion of the court appearance. RCCC Bus Crews will coordinate with Court Transportation for exchange of inmates in the MJ garage.
After transporting the first group of inmates to court, Bus Crew #1 will transport FATRNS to RCCC, focusing on taking the general population transfer inmates. Departure from the Main Jail is approximately 0700 hours. The inmate files and paperwork bound for RCCC should transfer on the same trip as the transferring inmates. RCCC laundry services will be notified of the arriving transfers.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Bus Crew #2 will transport FATRNS to RCCC, focusing on taking the remaining general population transfer inmates and inmates who need to be separated from the general population. Upon returning to RCCC, Bus Crew #1 will transport remaining inmates with court appearances and assist with processing FATRNS as needed.
The bus crews will coordinate with Court Transportation for court returns at approximately 1130 hours and will transport afternoon court appearances from RCCC. Arrival at the MJ is approximately 1230 hours. Bus crews will coordinate with Court Transportation for court returns at approximately 1500 hours and again at approximately 1700 hours. Any inmates remaining in court or at the MJ after 1700 hours will be transported to RCCC, prior to 2300 hours. Transportation duties will be a shared responsibility between MJ and RCCC. On odd numbered calendar days, RCCC will be responsible for transportation. On even numbered calendar days, MJ will be responsible for transportation.
Per Operations Order 03/07, Medical Emergencies, if medical staff determines the inmate must be transported to an outside medical facility, a sworn supervisor shall assign custody staff to accompany the inmate. If the inmate is transported by ambulance, at least one custody staff member shall accompany the inmate in the ambulance. Additional custody staff may respond to the hospital in a separate Sheriff’s Department vehicle. If the inmate is to be transported by custody staff, normal transportation procedures shall apply.
Observations
The Assessment Team observed two deputies coordinate and process a busload of inmates being transported from the RCCC to the MJ (releases and court). One of the inmates that was processed and boarded that particular transport bus was walking with assistive devices (crutches). During the processing, the transporting deputy processed the inmate last, allowed him to use his assistive devices until he was seated in the transport bus, at which point the deputy took the assistive devices and secured them for the transport. The deputy assisted the inmate in navigating up the bus steps stabilizing the inmates and ensuring he did not fall.
Although not assigned to the SCSD detention facilities transportation teams, the Assessment Team observed 2 court transportation deputies process 2 mobility disabled inmates onto a wheelchair accessible transport vehicle. One of the inmates was able to navigate into the vehicle, as he wasn’t a fulltime wheelchair user. The deputies assisted him into the transport vehicle. The other inmate was a fulltime wheelchair user and the deputies after lifting the inmate and the wheelchair into the vehicle, ensured the inmate in his wheelchair was secured with the wheelchair straps.
The Assessment Team inquired about the accessible vehicles used to transport wheelchair users. MJ staff advised the Assessment Team that the accessible
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
transport vehicle was maintained in a county vehicle garage next the MJ. The Assessment Team obtained the keys to the vehicle and with the assistance of a county garage employee examined the accessible transport vehicle. The vehicle can accommodate one wheelchair user, the lift is functional, has the safety straps/belts for securing the wheelchair and inmate, and they appear to meet safety and ADA regulations.
Staff Interviews
The Assessment Team asked questions of various deputies, including those assigned to Long Haul transportation, RCCC facility transport, and medical transports.
The deputy assigned to Long Haul transportation stated that the identification of disabled inmates that require wheelchair accessible transportation is based on the location of the inmates housing. Inmates in wheelchairs are housed on the 2nd floor and this would alert them of the need for the accessible vehicle. If a disabled inmate with an assistive device (cane, walker etc.) is being transported, they are allowed to retain their assistive device until they are seated at which time the transporting officer stores the assistive device until the inmate arrives at his/her destination. Once at the destination, the inmate can again use the assistive device to disembark the transportation vehicle. In the event the inmate requires assistance in navigating the steps to the bus, the deputies assist the inmate in boarding the bus. If an inmate cannot safely board the bus with staff’s assistance, the inmate would be transported in an accessible vehicle. The deputy stated that there is one wheelchair accessible vehicle to transport disabled inmates that require accessible transportation.
The deputy assigned to RCCC facility transport stated that they receive the court list of inmates to be transported. There may be information in JIMS (PF4/PF10) that would alert them of a disabled inmate and the need for an accessible vehicle. The inmate’s housing (M-Barracks/MHU) may also alert transportation staff of a disabled inmate’s need for accessible transportation. In the event they need a wheelchair accessible van, transportation staff must get the van from the MJ since the wheelchair accessible vehicle is kept there. The deputy stated that if a disabled inmate with an assistive device (cane, walker etc.) is being transported, they are allowed to retain their assistive device until they are seated at which time the transporting officer stores the assistive device until the inmate arrives at their destination. Once at the destination, the inmate can again use the assistive device to disembark the transportation vehicle. In the event the inmate requires assistance in navigating the steps to the bus, the deputies assist the inmate in boarding the bus. If an inmate cannot safely board the bus with staff assistance, the inmate would be transported in an accessible vehicle. The deputy stated that there is one wheelchair accessible vehicle to transport disabled inmates that require accessible transportation.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The SCSD detention facilities transportation staff stated that this is the only ADA accessible transport vehicle available for transporting inmates that require accessible transportation from the MJ to other jurisdictions (jails/prisons), medical transports, from the MJ to RCCC and from RCCC to the MJ.
The staff responsible for issuing the keys to the wheelchair accessible vehicle stated that there is no specific tracking of disabled inmates transported by the vehicle other than the record of staff who were issued the vehicle keys.
Inmate Interviews
During the inmate interviews some disabled inmates stated that deputies provide accommodations during the court transport process such as, assisting them up the vehicles and providing assistance in pushing wheelchairs; however, some reported the following issues and concerns regarding the transpiration process:
 Inmate housed in CBF stated that after arrival at the MJ he was transported to court in a “paddy wagon”. The vehicle has steel benches and no handrails for him to hold on to during the transport and it is very difficult for him to remain seated without falling to the vehicle floor. He stated he is transported in a wheelchair from his housing unit to the transportation area and from the vehicle to the courthouse;
 Inmate housed in 2 East stated that he has to crawl into the van when being transported to court;
 Inmate housed in 2 East stated he is usually transported in a wheelchair; however on one occasion a wheelchair was not provided;
 Inmate housed in 2 East stated that when he was housed at RCCC he had to crawl into a regular van. Claims that the deputies told him if he didn’t get in the vehicle, he was essentially refusing court. He further claims that on one occasion when he was scheduled for court staff did not transport him to court. Following this, his attorney asked him why he had refused court, and he advised his attorney that he had not refused;
 Inmate housed in 2 East stated he has been left on 3 separate occasions when he was scheduled for court and no accessible vehicle was available. Claims the deputies advised the court that he had refused court. Stated that he is transported in a big “paddy wagon” and staff tell him to try to get up on the vehicle, and he has to slide to get on;
 Inmate housed in 4 East stated that he is not provided accommodations for long distances and stairs;
 Inmate housed in 4 West stated that it is very painful to walk to court. When he doesn’t go to court across the street it is very difficult to walk up the stairs;
 Inmate housed in 5 West stated that cane was taken away in court holding cell. Claims he has to climb up stairs to court. States it is very difficult with a cane, and;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmate housed in 6 West stated that cane was taken away in court holding cell;
 Inmate housed in 2M stated that custody staff broke his wheelchair when they tried to force it into the wheelchair van, and thus jammed it against the lift;
 Inmate housed in 2M stated that he has broad shoulders, and it is very painful when the custody staff does not double handcuff him. He has to walk up 2 sets of stairs to court with the restraints on while in pain, and he claims it is dangerous walking up the stairs;
 Inmate housed in 6E stated that he has been transported where staff didn’t let him use his cane to get on to the transport vehicle. On one occasion he refused, and ultimately a judge ordered the administration to provide him a wheelchair in the future;
 Inmate housed in 7W claimed that he has to get out of his wheelchair and “crawl” into the van and seat. He acknowledged that staff does assist him. He stated that on about three occasions, custody staff hurt him while trying to help him, as they “grabbed” his arms and bruised him; and
 Inmate housed in 7W claimed that on one occasion, a custody officer tightened his handcuffs too tight, and he considered it “excessive.”
Conclusion
The SCSD detention facilities do not always provide reasonable accommodations for disabled inmates during transport to court. One of the most egregious ADA violations that the Assessment Team learned of pertained to staff requiring inmates to crawl into transport vehicles. It was also difficult to understand the process and temporary denial of canes while the inmates are placed in temporary holding cells with other inmates.
Alarming to hear were the claims that disabled inmates were not transported to court while the court was advised that the inmate had refused to attend court.
With the lack of a tracking system to identify disabled inmates and their accommodation needs, inmates are being required to access the courts without the necessary accommodations.
Operations Orders and practices should ensure that prescribed canes for disabled inmates are maintained in the possession of the respective inmate at all times.
With only one accessible vehicle, if the vehicle is in use for a Long Haul transport, court transport from RCCC to the MJ, transport from the MJ to RCCC or a medical transport that does not require emergency transport and another disabled inmate requires accessible transportation, the SCSD detention facilities would not be able to accommodate the disabled inmate.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
References
28 CFR § 35.130 (a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR 35.130(b)(7) states that a public entity shall make reasonable modifications in policies, practices or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity.
28 CFR 35.130(b)(1): A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(ii) Afford a qualified individual with a disability an opportunity to participate in or benefit from the aid, benefit, or service that is not equal to that afforded others; (iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others;
28 CFR 35.130(b)(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State.
28 CFR 35.130(b)(8) A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered.
28 CFR 35.130(h) A public entity may impose legitimate safety requirements necessary for the safe operation of its services, programs, or activities. However, the public entity must ensure that its safety requirements are based on actual
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities. 28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity. The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to mobility-disabled inmates under the Armstrong v. Brown settlement agreement. As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following: Transportation: The special needs of inmate’s with disabilities shall be considered in transporting them. An inmate’s/parolee’s special health care aids and appliances shall be transported with the inmate/parolee upon transfer. Accessible vehicles shall be used to transport inmates/parolees in wheelchairs and those whose disability, i.e., mobility, necessitates specialized transportation. All other inmates/parolees shall be transported in standard vehicles.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Intellectual Disabilities (Housing Units Adaptive Supports)
The Minimum Standards for Local Detention Facilities, Title 15 - Crime Prevention and Corrections, Division 1, Chapter 1, Subchapter 4, Article 5. Classification and Segregation, contains the following section applicable to intellectual disabilities:
§ 1057. Developmentally Disabled Inmates.
The facility administrator, in cooperation with the responsible physician, shall develop written policies and procedures for the identification and evaluation of all developmentally disabled inmates. The health authority or designee shall contact the regional center on any inmate suspected or confirmed to be developmentally disabled for the purposes of diagnosis and/or treatment within 24 hours of such determination, excluding holidays and weekends.
Correctional Health Services Administrative Policy 1417, Adult Developmental Disability, describes the purpose of the policy as, “To stress the identification of persons with developmental disability and to refer known or suspected cases for appropriate evaluation and treatment.” The policy requires that “medical shall contact Jail Psychiatric Services regarding any inmate who is suspected or confirmed to be developmentally disabled.”
Developmental disability is defined as “represent[ing] one or more conditions whose onset occurs before age 18 and results in a substantial handicap. Qualifying conditions include mental retardation with an I.Q. of 70 or less, autism, neurological disability, cerebral palsy, and epilepsy.”
The policy and procedures provide that “The identification of a person with developmental disability begins at booking and continues throughout incarceration. The intake medical personnel should be alert to the possibility of developmental disability by looking for:
 Difficulty in performing basic tasks associated with the process;  Slowness or apparent difficulty in understanding; and  A history of treatment for developmental disability through a Regional
Center or special education class.”
Policy 1417 further explains the following procedure:
If there is suspicion of a developmental disability, a notation will be made on the Receiving Screening medical form and a referral made to the JPS Outpatient Department.
In cases where there is uncertainty as to whether the inmate has a psychiatric condition as opposed (or in addition to) development disability, referral for mental health evaluation is appropriate.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
With regard to referrals, a referral will be made once JPS clinical staff contacts the inmate and identifies an inmate's developmental disability status. The regional center serving Sacramento County is:
 Alta California Regional Center 2241 Harvard St., Sacramento, CA 95815 (916) 978-6400 FAX (916) 489-1033
Counties served: Alpine, Colusa, El Dorado, Nevada, Placer, Sacramento, Sierra, Sutter, Yolo, Yuba.
It is the responsibility of Jail Psychiatric Services' clinical staff to initiate an Alta Regional Center referral for a person suspected to have developmental disability or to contact Alta Regional for those persons who are already clients of Alta Regional.
Policy 1417 provides information relative to the role of the Alta Regional Center, the referral process, establishing a diagnosis, recommendations for management and treatment, etc. The procedures address assistance to be rendered by CHS and JPS for the local regional center, and that regional center representatives may provide input to health care services staff.
The Master Problem List in the medical record should be updated to note the presence of known or suspected developmental disability. JPS staff should also make an entry into the JIMS system and if necessary, notify classification of any special housing recommendations.
Where developmental disability was not identified during the booking or initial classification process, notification of the jail classification officer should be made by JPS Staff as soon as the condition is identified.
Policy 1417 also states that, “Persons with developmental disability are potentially vulnerable in the custody setting and may require special consideration in the classification process. Likewise, multidisciplinary treatment and discharge planning should take this information into account. The inmate’s developmental disability status should be shared as necessary with treating health professionals, discharge planners, probation officers, and others who are actively involved in the care and custody of the individual.” Additionally, there is brief language relative to sharing information when a “developmental disabled” inmate is transferred.
Correctional Health Services Administrative Policy 1107, Decision Making – Special Needs, defines the treatment for patients with special medical or psychiatric needs. The policy states that consultation between the Facility Commander and the Medical Director is required for actions regarding patients
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who are diagnosed as having significant medical or mental health disorders, as follows:
 Housing assignments;  Program assignments;  Disciplinary measures; and  Admissions to and transfers from institutions.
The procedures within the policy describe that “maximum cooperation between custody personnel and health care providers is essential so that both groups are made aware of movements and decisions regarding patients with special medical or psychiatric needs. For example, health care staff must inform custody personnel when an inmate is suicidal, homicidal, or inappropriately housed in the jail for health care reasons. An inmate’s special needs may complicate housing or work assignments or disciplinary management. Medications may need to be adjusted for safety at the work assignment or before transfer. Other examples include:
 Suitability for travel based on medical evaluation;  Preparation of a summary or copy of pertinent Health Record information
to ensure continuity of care;  Medication or other therapy required en route;  Instructions for transporting patients in lay terminology regarding
medications or other special treatment; and  Specific precautions that should be taken (i.e. masks or gloves).”
The procedures also state, “For each inmate treated for a major medical problem in jail, the treatment staff will develop a written treatment plan. Custody staff must be informed of the treatment plan when necessary to ensure coordination and cooperation in the ongoing care of the inmate without violating the confidentiality of the clinical record.”
Observations
As the aforementioned CHS Policies do not reflect a comprehensive screening process or program, there is not a disability tracking system in place, custody post orders do not reflect specific responsibilities relative to intellectually disabled inmates/detainees, and there are numerous noticeable gaps as related to staff duties and ensuring equal access to services, programs, and activities for intellectually disabled inmates. Many intellectually disabled inmates are often vulnerable and manipulated, and historically victimized. Nondiscrimination and safety are of paramount concern with this population in the jail environment.
Without proper identification of an inmate’s cognitive deficits coupled with adaptive deficits (and adaptive support needs/accommodations) custody, health care services, EGUSD teachers, and other staff will not be able to know what reasonable accommodations to provide intellectually disabled inmates, and may
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
have difficulty ensuring safety. An acceptable screening instrument/testing process and screening results form would enable Mental Health clinician to outline the adaptive support needs of each developmentally (intellectually) disabled inmate. Such form could be maintained and secured in all housing units where intellectually disabled inmates are housed, and by all work supervisors and teachers who supervise these inmates.
There is not currently a testing instrument or process in place to examine for inclusion into an Intellectual Disability Program (regardless of the age or onset), where the following are both present:
 Low cognitive functioning (usually IQ of 75 or below); and  Concurrent deficits or impairments in adaptive functioning (the abilities
necessary to care for oneself and to access programming and services in the jail setting).
Staff is widely unaware of the safety/vulnerability/victimization concerns and special concerns and accommodations needs of this population, as they have not been identified. Even those with prior regional center services, or those who were tested in CDCR and placed in the Developmental Disability Program (DDP) are not placed on a jail-wide tracking list, and there are no documented adaptive support accommodations needs. Also, because there is no tracking system or testing process, there is not a clustering or semi-clustering approach for these inmates. Other inmates such as cellmates, and inmates housed in the same pods/units may not be thoroughly screened for predatory/victimization concerns.
There is a strong likelihood that non-diagnosed intellectually disabled inmates are receiving write-ups, being found guilty, and possibly being moved to ADSEG or TSEP without procedural due process rights or reasonable accommodations being provided. If this is happening, part of the explanation is because staff are not aware of the need to provide specific types of adaptive support services/accommodations to the intellectually disabled inmates (which are specific to each individual), and because there is not a consult process built into the disciplinary hearing process between the hearing sergeant and a clinician.
Staff are not aware of the primary adaptive deficits that intellectually disabled inmates may possess. Adaptive Deficits may be identified in various areas during the adaptive deficit evaluation conducted by a psychiatrist, psychologist or LCSW. Examples of areas in which adaptive deficits may be presented are:
 Health and Safety  The intellectually disabled inmates may appear naïve about maintaining health in terms of eating; identifying, treating, or preventing illness; basic safety considerations, such as following rules or seeking assistance. These inmates will likely use inappropriate behavior with others and have difficulty communicating choices/needs and participating in social interactions.
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 Socialization Skills  The intellectually disabled inmates may show difficulty establishing and maintaining positive relationships. They may give up possessions to other inmates. They may become vulnerable to sexual predators, manipulation by other inmates, and/or be recruited for gang activities. The intellectually disabled inmates may engage in a repetitive cycle of disciplinary infractions involving other inmates or correctional officers. This could be suggestive of a lack of judgment and failure to understand the consequences of their actions.
 Academic Skills  The intellectually disabled inmates may show evidence of poor cognitive abilities/skills related to learning, such as reading, writing, and using basic mathematical concepts.
 Communications Skills  The intellectually disabled inmates may have poor ability to express themselves verbally or in writing.
 Leisure  The intellectually disabled inmates may not have acquired many leisure and recreational interests that reflect personal preferences and choices.
 Self-Advocacy/Use of Inmate Resources  The intellectually disabled inmates may have difficulty advocating for themselves during classification interviews/processes, disciplinary proceedings, and the inmate grievance process, and may waive their rights without understanding what they are doing.
 Self-Care Skills  The intellectually disabled inmates may show evidence of poor selfcare; e.g., seldom bathing, soiled or unkempt clothing, poor eating habits, and/or the inmate’s cell may be disorganized/dirty.
 Self-Direction  The intellectually disabled inmates may have difficulty making choices; learning and following a schedule; initiating activities appropriate to particular settings, conditions, schedules, and personal interests; completing necessary or required tasks; seeking assistance when needed; resolving problems in familiar and unfamiliar situations; and demonstrating appropriate assertiveness and self-advocacy skills.
 Work  The intellectually disabled inmates may have difficulty maintaining a work assignment due to inappropriate social behavior and a lack of related work skills.
Staff are widely unaware of some of the common adaptive support services that intellectually disabled inmates may need, such as;
 Monitoring for Pressuring/Victimization
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Assistance with reading/writing/scribing/explaining  Reminders to brush their teeth  Reminders/instructions on cell cleaning  Monitoring clothing (dirty/clean)  Monitoring and assistance with Commissary/Packages/Property
 Intellectually disabled inmates are often taken advantage of  Health Care Appointments/Pill-line/Medications  Laundry Exchange  Showers  Yard/Dayroom/Social Interaction.
There is not a multi-disciplinary committee or support team specific to periodically monitor intellectually disabled inmates, monitor the on-going potential for victimization and whether they can function safely, monitor their programming, ensure their accommodation needs are being met, and ensure the inmates are functioning at an acceptable level in the jail environment.
Staff Interviews
Most custody staff that were interviewed admitted that they have received little to no ADA training, or training specific to intellectual disabilities. Many staff do not understand the difference between intellectual disabilities, mental illness, and learning disabilities, and they don’t know who the intellectually disabled population is. There were a couple of deputies who knew of inmates who had received services from Alta Regional Center in the past. But the staff members acknowledged that the only way to know what type of assistance to provide the inmates is just through knowing and observing them, and from any help that a respective inmate may ask for.
The large majority of staff indicated that they would help intellectually disabled inmates. When asked general questions about observing behavior traits that may be associated with an intellectual disability, staff responded with some of the following answers: refer the inmate to JPS, refer the inmate to CHS, be patient, provide simple instructions, repeat instructions, have trustee or houseman help the inmate, observe the inmate more closely, talk to him every day, house in MDorm or MHU, give them extra time, talk confidentially, give very specific directions, use levels of communication, use non-verbal gestures, etc.
When asked questions involving safety or possible victimization concerns for intellectually disabled (or possible intellectually disabled) inmates, staff provided the following responses; move him to a different pod, move him “off the floor”, talk to the inmate and find out what the issues are, “nip it in the bud if we see someone doing something”, confirm issue and “roll-up” the suspect (and issue a write-up), “we need more training on this, but I would try to handle internally”, nobody gets victimized in this unit, address the issue with the responsible inmate, address the issue with the entire dorm, investigate, look for possible video
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
evidence, put him (intellectual disabled inmate) in TSEP or PC, make sure he is not housed with an enemy, and take care of the inmate the best we can.
Inmate Interviews
As addressed throughout this report, because the SCSD detention facilities do not administer a comprehensive testing/screening process for intellectual (developmental) disabilities, and there is not a disability tracking system in place, it was difficult for the Assessment Team to accurately select intellectually disabled inmates for interview. However, through the process, several inmates (from the MJ and RCCC) were interviewed who were or were possibly intellectually disabled. A few of the inmates claimed that they received services from Alta Regional Center. Some of the inmates admitted to being in special education in public school, which was one possible indicator. Some of the inmates interviewed also admitted (when asked) that they needed reminders for activities in the jail, e.g., showering, cleaning their cell/bed area, programming, meeting time schedules, managing their time, and keeping clean clothing.
Some of the inmate comments and concerns are outlined below:
 RCCC KBF – Intellectually disabled inmate with prior Alta Regional Services stated that when he asks for assistance from staff, they do not help him. Claims that inmates call him a “crybaby and retard.” Says that he doesn’t remember to get his laundry.
 RCCC SLF – Possible intellectual disability. Has had to pay inmates to write her letters. Stated she paid $25.00 for another inmate to write 4 letters. All of her commissary was stolen from her. Doesn’t know how to use the telephone. Her Bunkie helps her out, and she shares her food with her. Claims she was forced to hold contraband for other inmates. She does not know about any programs (visiting, medical, and law library etc.). She claims she requires diapers for incontinence, and medical staff will not provide them. She soils her clothes and can’t get clean clothes. Another inmate that assists her also reported this.
 RCCC SLF – Intellectual disability. She is an Alta Regional Center client. Inmate claims that she was moved from her dorm to a cell because other inmates were teasing her and threatened her. Claims that she forgets to shower.
 MJ Inmate – Possible intellectual disability (unable to read, special education in public school and receives SSI benefits). Has had numerous write-ups. Claims his cell is “filthy,” and he has trouble cleaning it or getting help to do so.
 MJ Inmate - Intellectual disability (prior Alta Regional Center consumer, special education, unable to read). Has trouble understanding many jail processes. Was very confused with the inmate disciplinary process. Has difficulty remembering, and staff does not help him (he goes to trustees).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 MJ Inmate – Possible intellectual disability (poor reading). Claims he has been victimized for commissary items in the past.
Conclusion
The SCSD detention facilities must have a comprehensive custody Operations Order relative to intellectually disabled inmates. The CHS must either create a new policy relative to JPS services and services for intellectually disabled inmates, or provide necessary modifications for policies 1417, Adult Developmental Disability, and 1107, Decision Making – Special Needs.
Policies and procedures must include directions and information regarding the following:
 A comprehensive screening/testing process with recognized instruments, to allow psychiatrists, psychologists, or LCSW’s to determine whether inmates are intellectually (developmentally) disabled. The testing must include an examination for:  Low cognitive functioning (usually IQ of 75 or below); and  Concurrent deficits or impairments in adaptive functioning (the abilities necessary to care for oneself and to access programming and services in the jail setting).
 An electronic disability tracking system to identify inmates with disabilities (including intellectual disabilities), their required accommodation needs (including adaptive support services), any physical limitations, and other pertinent information
 Staff responsibilities regarding safety/vulnerability/victimization issues, special concerns, and accommodations needs of this population  This includes classification screening for predator/victimization concerns with other inmates within the housing unit, as well as other related responsibilities.
 Housing protocols for intellectually disabled inmates (possible clustering/semi-clustering approach)
 Inmate disciplinary process as related to intellectual disabilities  Including responsibilities for deputies, sergeants, work supervisors, mental JPS staff, etc.  Clinical consult process for inmate write-ups  Monitoring of patterns or numerous individual write-ups o Monitor possible placement in administrative segregation or TSEP housing for intellectually disabled inmates, possibly as a result of receiving write-ups and being found guilty, but not being afforded procedural due process rights, or their required adaptive support needs.
 Multi-disciplinary committee or support team specific to periodically monitor intellectually disabled inmates, their ongoing potential for victimization, and whether they can function safely; monitor programming;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
ensure inmates’ accommodation needs are being met, and ensure that inmates are functioning at an acceptable level in the jail environment  Monitoring may include but not be limited to:
safety/victimization/vulnerability, commissary, write-ups, personal hygiene (e.g., showering, brushing teeth, clean clothes), work, education, program activities, yard/dayroom, leisure activities and ensuring that housing unit deputies and work supervisors are providing adaptive support accommodations.
An ADA training component must be developed and implemented regarding disabilities (including intellectual disabilities) to provide custody and non-custody staff the tools and knowledge to ensure all disabled inmates are not discriminated against on the basis of their disabilities, and to ensure equal access to all programs, services and activities offered by the SCSD detention facilities and any associated contractor, e.g., EGUSD, CHS. Staff must be trained to:
 Be aware of safety and victimization concerns and uphold a policy of zero tolerance for inmates or staff belittling or name calling individuals with intellectual disabilities
 Be proactive to engage intellectually disabled inmates verbally (sometimes in confidential settings), provide accommodations, assistance, and adaptive support services, and not delegate this to inmate trustees or “housemen”
 Understand that this population may have difficulties advocating for themselves, and may be reluctant to ask for help  Understand that many intellectually disabled inmates may have a dual diagnosis, with either medical and/or mental health concerns, and those concerns must also be met, whether or not the inmate seeks assistance
 Understand that disabled inmates cannot arbitrarily be rehoused or moved without a thorough examination of associated events/circumstances, and they must be treated fairly and equally
 Understand that intellectually disabled inmates may be confused at times, and may need constant or periodic instructions, or simple reminders to complete a task or to understand.
Custody staff post orders should also reflect assigned duties as applicable to this population.
References
28 CFR § 35.105 (a) requires that a public entity evaluate its current policies, and practices, and to the extent modification of any such policies, and practices is required, the public entity shall proceed to make the necessary modifications if they do not or may not meet the requirements Title II.
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28 CFR § 35.130 (b)(7) requires a public entity to make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.
28 CFR 35.130(b)(1) A public entity, in providing any aid, benefit, or service, may not, directly or through contractual, licensing, or other arrangements, on the basis of disability—
(iii) Provide a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others.
28 CFR § 35.152(b)(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
Notices, Announcements, and Alarms:
Written Materials: Each designated DDP institution/facility must ensure that CCR notices, orientation packages, announcements, and similar printed materials are accessible to inmates with developmental disabilities. Institution staff must provide the necessary assistance to all DDP inmates on a case-by-case basis to ensure that those who have difficulty reading and/or communicating in writing will be provided reasonable access to forms, regulations, and procedures. Local operational procedures must reflect specific notices, announcements, and alarm procedures for DD2 and DD3 inmates. Post orders for staff assigned to provide such services to DD2 and DD3 inmates must reflect these specific procedures.
Verbal Announcements: Each designated DDP institution/facility must ensure effective communication is made with inmates with developmental disabilities regarding public address announcements and reporting instructions, including those regarding visiting, yard release and recall, count, lock-up, and unlock, etc. Local operational procedures must reflect specific requirements for verbal announcements impacting DD2 and DD3 inmates. Post orders for staff assigned to provide such services to DD2 and DD3 inmates must reflect these specific procedures, i.e., prompts for visits or hearings, if an inmate does not respond.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Count And Movement Each designated DDP institution and facility must review local policies and procedures to ensure DDP inmates are provided with necessary prompting so that they comply with count time expectations, respond to visits, keep work/school schedules, and respond to meals and other movement calls. Local operational procedures must reflect specific count and movement procedures for DD2 and DD3 inmates. Post orders for staff assigned to designated buildings/units/wings that house DD2 or DD3 inmates must reflect the specific count and movement procedures. Evacuation Procedures Local evacuation procedures must be adopted at each designated DDP facility to ensure the safe and effective evacuation of inmates with developmental disabilities. Local operational procedures must reflect specific evacuation procedures for DD2 or DD3 inmates. Post orders for staff providing services for DD2 or DD3 inmates must reflect these procedures. All DDP inmates will be provided instructions for evacuation/emergency procedures during orientation before initial classification at designated institutions.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Training
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures pertinent to training are outlined in Operations Order 01/02 Command and Responsibility, Draft Operations Order Inmates with Disabilities - ADA, and policy 1302, Staff Development and Training.
Per Operations Order, 01/02 Command and Responsibility, the Administrative/Training Sergeant works under the supervision of the Assistant Division Commander and/or the Operations Lieutenant for the division to coordinate all training, including the jail-training program for new officers. The Admin/Training Sergeant maintains division forms, Operations Orders, fire and armory equipment, and assists with personnel assignments and issues. He/she also directly supervises the Training Coordinator, Law Library Officer, Safety Officer, Facility Maintenance staff, and other authorized positions.
Per Draft Operations Order Inmates with Disabilities - ADA, the ADA Coordinator is responsible to provide training to staff in regards to ADA policies and procedures. Additionally, it is the ADA Corrections Division Representative’s responsibility to provide training to facility staff on auxiliary aids and services. Although, these policies require the ADA Division Representative and ADA Coordinator to provide ADA training, this Draft Operations Order is currently not approved and in place. As such, there is no order or policy requirement to provide annual formalized ADA training, one-time formalized ADA training, or formalized ADA training during new employee orientation.
Observations
The SCSD detention facilities require all officers assigned to the MJ and RCCC to attend and complete a 66-hour Standard Training for Corrections Program certified course titled Adult Corrections Officer Supplemental Core Course. This course is for officers who completed the Peace Officer Standards and Training (POST) Regular Basic Course (academy) and are newly assigned to corrections. The course is designed to complete competencies in the following topics, Title 15 regulations on inmate supervision; codes, statues, and legal documents, inmate classification, gangs and subcultures, evidence and contraband, communication, mechanical restraints and safety cells, cell extractions, booking and receiving, releasing, maintaining security, distribution of supplies and commissary, monitoring psychological and physical health, and PREA. Although some of these modules contain some ADA-related information, these training modules are specific to general training requirements for corrections, and are not ADAspecific.
The training modules do not cover a deeper sense of what disabilities or impairments are, and how these disabilities affect inmates and staff with respect
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to discrimination (nondiscrimination) and disabled inmates gaining equal access

to programming, services and activities in accordance with Title II of the ADA.

The training modules do not cover effective communication, reasonable

accommodations,

HCAs/ADs/DME,

disability

identification

(screening/testing/evaluating),

interim

accommodations,

inmate

grievances/requests for modifications or accommodations, staff assistance,

inmate disciplinary (infraction) process, accessibility/path of travel, learning

disabilities, adaptive deficits/adaptive supports (for developmentally disabled

inmates), housing, work/education, law library/recreational library, group

therapy/individual therapy, or inmate orientation.

Staff Interviews
Most housing unit, medical (including county and registry staff), and support staff who were interviewed could not recall specific ADA training they had received either at the academy or on site at the jail. Some staff members were able to recall having received training at the academy regarding mental health and other disabilities; however, this training was directed towards street law enforcement.

Conclusion
Because the SCSD detention facilities do not currently have a comprehensive ADA identification process, and because there is not an ADA tracking system in place, nor an adequate ADA training program, the Assessment Team representatives determined that staff in large part are not aware of many inmates who have disabilities covered under the ADA. Moreover, staff members do not have a thorough understanding of the rights afforded to inmates under the ADA, or how to ensure equal access and non-discrimination (whether they know who the particular disabled inmates are or not).

In accordance with the spirit of Title II of the ADA, and the 1991 Section-bySection Analysis, the SCSD detention facilities have failed to develop and incorporate a comprehensive ADA training component for custody and noncustody staff. The ADA or inmate disability program/plan cannot and will not function unless a comprehensive training regimen consists of: formalized lesson plans, certified or otherwise qualified ADA expert trainers, close monitoring of the training program, and curriculum consisting of all major aspects of ADA, including but not limited to: disability identification/verification, tracking system, housing, HCAS/ADs/DME (including removal/non-removal), reasonable accommodations, equal access, transportation, searches, mechanical restraints, inmate grievances, orientation, work/industries/job assignments, education, alarms, notices, emergencies, evacuations, library operations/equipment, religious services, and visiting. Quite simply, a quality ADA training program must be in place to ensure staff are appropriately trained to perform their job duties and to help ensure disabled inmates are provided equal access to programs, services and activities provided at the jail facilities, and thus not discriminated against.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The SCSD detention facility training requirements should include the requirement that formalized ADA training be provided to custody and non-custody staff (managers, supervisors, and rank-and-file employees) at the jail facilities.
A comprehensive formalized ADA training curriculum must be developed and incorporated. This should be a primary formal classroom-training course for custody and non-custody staff (managers, supervisors, and rank-and-file staff) at the jail.
The SCSD detention facilities must ensure that ADA instructors receive appropriate ADA training and provide the level of subject matter expertise needed to effectively provide formalized classroom ADA training to staff.
References 28 CFR § 35.130 (a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR Section-by-Section Analysis, Section 35.105 Self-Evaluation commenters suggested that the rule require that every self-evaluation include an examination of training efforts to assure that individuals with disabilities are not subjected to discrimination because of insensitivity, particularly in the law enforcement area. Although the Department of Justice did not add such a specific requirement to the rule, the Department felt it would be appropriate for public entities to evaluate training efforts because, in many cases, lack of training leads to discriminatory practices, even when the policies in place are nondiscriminatory.
The information below is for reference only. Due to the settlement agreement and subsequent Armstrong v. Schwarzenegger Federal Court Ordered Injunction (January 18, 2007), the CDCR was ordered to do the following (with regard to providing ADA related training, which pertains to disabled inmates as well as inmates with other disabilities):
Settlement Agreement (January 3, 2001)
The CDC (CDCR) will provide Disability Placement Program (DPP) training to institution/parole staff on ADA regulations and DPP requirements. This training shall include but not be limited to evacuation and emergency procedures, reasonable accommodations and effective communication.
Federal Court Injunction (January 18, 2007)
Within 60 days of the date of this Order, defendants, subject to the approval of
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
plaintiff’s counsel, shall select and retain outside experts to provide training of health care staff and correctional counselors in effective communication issues. Within 60 days of the date of this Order, the parties shall jointly agree on outside experts, and defendants shall retain them to provide training to all custody staff who work in administrative segregation units, the security housing units, or Receiving and Release on their obligations not to confiscate assistive devices and the reasons therefor. Defendants’ employees may jointly provide training with the outside experts. The training of all appropriate staff shall be completed by September 1, 2007, and a regular schedule of ongoing and refresher training shall be established.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
ADA Coordinator
The SCSD detention facilities do not have any operations orders, policies or procedures solely for the MJ and RCCC Compliance Sergeant (ADA Coordinator) or for the ADA Deputy (Assistant ADA Coordinator/ADA Corrections Division Representative) in place. However, there is a Draft Operations Order titled, ‘Inmates with Disabilities – ADA’, which is pending further revision and approval.
The MJ and RCCC facilities each have their own Compliance Sergeant and ADA Deputy assigned to ADA or disability-related compliance responsibilities.
In accordance with a County of Sacramento, Department of Personnel Services, Position Description Questionnaire (PDQ), for the RCCC Compliance Sergeant position, general work/oversight responsibilities include: 25 percent of the work time to create and implement an ADA transition plan and future compliance enforcement; 25 percent monitoring and enforcing compliance efforts related to the ICE Contract and the 2000 Federal Detention Standards; 15 percent coordinating and monitoring the custody/classification portion of the JBCT program; 15 percent conferring and cooperating with personnel associated with other county agencies, outside law enforcement, mental health, medical, and others as required to ensure compliance; 10 percent coordinating facility audits and inspections; 5 percent monitoring Title 15 compliance, dayroom and recreation goals, and policy updates; and 5 percent engaging in the protection of life and property, as well as participating in investigations of criminal offenses to identify, apprehend, and prosecute the responsible parties by collection, preservation, and analysis of facts and evidence, and other related responsibilities include locating, interviewing or interrogating victims, witnesses, and suspects.
In accordance with the specific PDQ for the RCCC ADA Deputy position, general work/oversight responsibilities include: 40 percent assisting in creating and implementing an ADA transition plan and future compliance enforcement; 20 percent conferring and cooperating with personnel associated with other county agencies, outside law enforcement, mental health, medical, and others as required ensuring compliance; 20 percent assisting in coordinating facility audits and inspections; 15 percent assisting in monitoring Title 15 compliance, dayroom and recreation goals, and policy updates, etc.; and 5 percent engaging in the protection of life and property, and participating in investigations of criminal offenses to identify, apprehend, and prosecute the responsible parties by collection, preservation, and analysis of facts and evidence, and additional duties such as locating, interviewing, or interrogating victims, witnesses, and suspects.
The Assessment Team also requested a copy of any existing documents relative to ADA or disability-related duties, e.g., PDQ, post orders, and duty statements, for the MJ Compliance Sergeant and ADA Deputy. However, upon interviewing
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
the staff in these two identified positions, they indicated that such documentation did not exist specific to their assignments.
Specific ADA/disability-related functions and responsibilities for the Compliance Sergeant and ADA Deputy at both the MJ and RCCC facilities are outlined in the aforementioned Draft Operations Order Inmates with Disabilities – ADA.
In accordance with the Draft Operations Order, the purpose of the policy is to establish standard and consistent procedures by which an inmate with a disability is identified, assessed, and provided appropriate reasonable accommodations in compliance with Title II of the ADA.
The policy statement (within the Order) provides that is it the policy of the SCSD detention facilities to ensure procedures are in place to provide equal treatment to all incarcerated adults. The policy statement states, “The Department will ensure inmates with qualified disabilities are afforded equal access to programs, services, and activities unless doing so would alter the nature or operations of the institution or program. Limitations may be imposed for legitimate safety requirements necessary for the safe operations of services, programs, and/or activities.” The policy statement further adds, “The Department will implement modifications to facilities and programs where possible to allow for reasonable accommodations for inmates with disabilities. This practice will be followed unless doing so would be an undue burden to the Department, cause a fundamental alteration to a program, or pose a direct threat of substantial harm to the health and safety of the individual or others. The Department will ensure that procedures are in place for inmates with disabilities to request reasonable accommodations and to dispute the accommodations provided under Title II of the ADA.”
The Operations Order provides numerous ADA/disability-related definitions, including: ADA, Assistive Device, Disability, Activities of Daily Living (ADL), Orthopedic Appliance, Prosthesis, Reasonable Accommodation, Service Animal, and Undue Hardship.
The definition provided for ‘Disability’ is:
1. “A physical or mental impairment that substantially limits one or more of the major life activities of such individual;
2. A record of such an impairment; or
3. Being regarded as having such impairment.”
Draft Operations Order Inmates with Disabilities - ADA, Section III. A., states, “The Sacramento County Sheriff’s Department will not discriminate against inmates or members of the public on the basis of disability in providing access to its detention facilities, programs, services and activities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
1. The Americans with Disabilities Act Inmate Notice will be prominently posted in all inmate housing units; and
2. The Americans with Disabilities Act Public Notice will be prominently posted at the public entrances of all jail facilities.”
Section B. states, “Persons with a disability are entitled to an equal opportunity to participate in programs, services, or activities offered by the Sacramento County Sheriff’s Department unless doing so creates an undue hardship.”
The Draft Operations Order contains ADA/disability information and responsibilities specific to the ADA Corrections Division Representative (ADA Deputy/Assistant ADA Coordinator), and the ADA Coordinator (Compliance Sergeant).
Section III. C. (Compliance with ADA), (ADA Corrections Division Representative), states,
1. “The intent of the ADA Division Representative is to review requests, complaints and grievances related to ADA issues, maintain the Division’s ADA files, and provide training to facility staff on auxiliary aids and services;
2. The ADA Division Representative may respond to ADA requests or ADA grievances and will ensure the Facility ADA Coordinators are updated and informed of all ADA issues as well as perform inspections; and
3. The ADA Division Representative will represent the Department on ADA related issues.”
Note: the other identified ADA Corrections Division Representative duties outlined in the Order, are captured below within the language relative to ADA Coordinator’s responsibilities (i.e., Section XVII. [Identifying and Handling of Armstrong Class members], and Section XIX. [Grievances]).
Section VI. of the Draft Order indicates that the ADA Coordinator (or designee) will:
1. “Keep the ADA Division Representative informed of all ADA related requests, complaints, and grievances related to ADA issues;
2. Maintain an ADA file on each disabled arrestee/inmate documenting each contact in regards to their ADA needs, accommodations, special education and requests;
3. Provide training to staff in regards to ADA policies and procedures;
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
4. Initiate contact with the disabled inmate within two working days of receiving the ADA paperwork and, if necessary, ensure that the court is notified of any accommodations needed;
a. The ADA Coordinator and inmate may agree at any time to suspend monthly follow-ups if there is no change in the inmate’s status; and
b. If the inmate needs to contact the ADA Coordinator after suspending follow-up visits, the inmate can do so via an Inmate Request form (KITE);
5. Notify classification deputies when a disabled inmate is housed and may require an accommodation to access programs, services, or special education;
6. Review claims, complaints and grievances regarding disabilities;
7. Ensure complaints and grievances are finalized;
8. Confer with medical staff each month to review whether accommodations continue to be appropriate and necessary and document the contact;
9. Audit the location and condition of the TDD machine once per month; and
10. Perform a follow-up review every thirty calendar days to ensure the inmate has equal opportunity to participate in programs, services and activities and to discuss any issue the inmate may have regarding their treatment.”
There are numerous ADA Coordinator duties outlined throughout the Operations Order in various sections or the Order. These responsibilities include:
Section IV. (Identification of Disabled Inmates – At Intake):
1. Receipt of all Inmate Disability Evaluation Forms (IDEF) from intake medical staff, for inmates who have (or may have) a disability.
Section V. (Classification and Inmate Housing);
1. Receive notifications from classification staff to arrange inmate orientation of inmates who are visually impaired or unable to read;
2. Receive IDEF forms with appropriate notations from classification staff for compliance review; and
3. In coordination with classification staff, ensure necessary, reasonable accommodations are made to allow inmates with disabilities equal access to work assignments.
Section VII. (Identifying Disabilities – Subsequent to Booking);
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May receive notifications from staff at any time for an inmates who staff believe has a disability, based upon personal observation of the inmate, oral statements by the inmate, or a written request from the inmate.
Section VIII. (Program Access);
1. Make arrangements to accommodate special educational needs unless access to these services prevents safe operation of the program or activities; and
2. Maintain a list of qualified sign language interpreters who can be utilized in time of need.
Section XII. (Inability to Read or Write);
1. Ensure reasonable accommodations are made for inmates who are physically incapable of reading or writing, which may include, but is not limited to; enlarged print materials, identification of desired materials, and assistance in reading and scribing forms.
Section XIV. (Prosthetic/Orthopedic Appliances and Assistive Devices):
1. Receive notification (from the Watch Commander) if an appliance/assistive device is not returned to or provided to an inmate (after a physician examined the inmate and determined that the previously removed device or an alternative accommodation is to be provided to the inmate).
Section XVII. (Identifying and Handling of Armstrong Class Members);
1. Receive contacts from staff regarding in-custody inmates who have been previously identified as a CDCR Armstrong class member;
2. Will act as the central contact point for CDCR. The ADA Coordinator at each facility (MJ and RCCC) will act as a liaison between identified Armstrong inmates and the classification unit;
3. After receiving notification from CDCR as to an Armstrong class member in custody at an SCSD detention facility, the ADA Coordinator will notify the ADA Division representative. The ADA Coordinator will ensure the inmate is entered into the JIMS, under the Special Tracking Needs, and will follow the same process outlined in Section 11.0 of this policy (Order); and
4. Once contact is made with the inmate, the ADA Coordinator will notify HMU via email. This email should include any steps taken to address issues/concerns as well as a resolution.
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Section XVIII. (Facility Visitors);
1. Visitors who will require reasonable accommodation will be asked to notify the ADA Coordinator or on-duty Watch Commander of their needs prior to visiting.
Section XIX. (Grievances);
1. All ADA related grievances shall be routed through the facility Compliance Unit. The Compliance unit will determine the best course of action for the grievance (e.g., medical, custody) and then route it as deemed appropriate. The Compliance Unit will track all ADA related grievances until finalized. A copy will be forwarded to the ADA Corrections Division Representative.
The following sections of the Operations Order do not contain information or responsibilities specific to the Compliance Sergeant: Section III. (Compliance with ADA); Section IX. (Auxiliary Aids for Individuals with Hearing Impairments); Section X. (Telecommunications devices [TDD/TTY Equipment]); Section XI. (Interpreter Services); Section XIII. (Mail – Free for the Blind); Section XV. (Restraints); Section XVI. (Searches); and Section XX. (Compliance with PREA).
The Draft Operations Order, PDQs (RCCC), and information received from the two Compliance Sergeants and both ADA Deputies are conflicting as to the working titles of the positions.
The Compliance Sergeant position must have the authority and the civil service rank to raise pertinent issues to executive level management and affect change or modifications to the ADA inmate disability program as warranted. The Compliance Sergeant positions (at the MJ and RCCC) must also have normal ‘hands on’ day-to-day oversight and involvement over the ADA or inmate disability program. The Compliance Sergeant or ADA Deputy positions must maintain all ADA related documents to assist in identifying ADA or disabilityrelated requirements for the operation of the SCSD detention facilities.
Observations
The Assessment Team did not have any specific observations to report with regard to the Compliance Sergeants, or ADA Deputies at either the MJ or RCCC facilities. However, through staff interviews of the MJ Compliance Sergeant and MJ ADA Deputy, as well as the same positions for the RCCC facility, and a multitude of staff (from numerous disciplines) assigned to the MJ and RCCC facilities, numerous inmate interviews, examinations of applicable documents and forms, and general observations of virtually all detention facility processes and activities, the Assessment Team determined there are numerous areas where a detailed Operations Order is necessary to provide procedures for applicable ADA or disability-related functions. For many applicable ADA or
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disability-related topics, the Draft Operations Order does not address the issues, there is key information not included within the content, or there are concerns with the written Order itself as well as with current practices. Some of the key concerns will be captured in the conclusion (below), and the major concerns will be cited throughout this entire report.
Staff Interviews
As mentioned above, the Assessment Team interviewed both Compliance Sergeants (MJ and RCCC), and both ADA Deputies (MJ and RCCC), and asked pertinent questions of other selected staff (e.g., housing officers, custody and non-custody staff who deal with grievances, infractions, and inmate referrals).
The team attempted to gain a better understanding of the separate roles and responsibilities between both Compliance Sergeants as well as both ADA Deputies.
From interviews of staff (custody and non-custody), a review of documents and logs, and general overall observation, the Assessment Team drew the following findings: The Compliance Sergeants for the MJ and RCCC facilities are designated at the Sheriff’s Sergeant classification, but the positions are not dedicated solely for ADA-related duties. Per the PDQ for the RCCC position, only 25 percent of the duties are associated to ADA or a disability program (charged with creating a transition plan and for future compliance enforcement). Within the other 75 percent of the duties (as outlined above) there is a very small percentage of responsibilities tied to inmates with disabilities, e.g., ICE inmates who happen to have a disability, and monitoring of the custody/classification portion of the JBCT program will have some involvement with inmates who happen to have a disability. The Compliance Sergeants acknowledged that they have various responsibilities outside of ADA, as stated above, e.g., MOUs, contracts, litigation or compliance with Federal laws. One of the ADA staff members interviewed confirmed that the RCCC PDQs are consistent with the duties and percentage of work time actually being completed.
As mentioned above, there is not a PDQ, post order or duty statement for the MJ Compliance Sergeant (ADA Coordinator) to outline any ADA or disability program responsibilities, or, the Assessment Team was not provided with such. Both Compliance Sergeants have been in their respective positions a very short time. They have received no ADA Coordinator-specific training, and relatively little training applicable to ADA or disabilities. However, PREA, MH, and Crisis Intervention Team (CIT) trainings were cited as having been received in the past.
The ADA Deputies for the MJ and RCCC facilities are designated at the Sheriff’s Deputy level, but the positions are not dedicated solely for ADA or disability program related duties. The MJ and RCCC ADA Deputies have been assigned to their new positions for approximately five months and two months respectively (at the time of interviews). They have not had any specific ADA training to
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prepare them for their new assignment, other than minimal general ADA information provided at the Sheriff’s Academy, and an 8-hour online course that reportedly did not focus in any depth on Title II of the ADA. One of the deputies explained that despite being new in the position, he would be transitioning out of the assignment very soon.
Per the PDQ for the RCCC position, only 40 percent of the duties are geared toward ADA or an inmate disability program (tasked with assisting in creating and implementing an ADA transition plan and future compliance enforcement). As explained earlier in this report section, there is not a PDQ, post order, or duty statement for the MJ ADA Deputy to outline the ADA or disability program responsibilities, or, the Assessment Team was not provided with such. The specific duties of the new positions have not been fully explained to them, and they are in the process of attempting to better understand their roles and responsibilities.
One of the ADA Deputies admitted that he has not really performed much ADA or disability-related work outside of a physical accessibility standpoint. The other ADA Deputy admitted that only a small amount of work time is allocated to ADA or disability-related duties, but he works primarily on PREA and jail operations. One of the ADA Deputies indicated some contact with non-mobility-impaired, inmates, e.g., assisting an intellectually disabled inmate with access to legal law materials and addressing issues brought to his attention, such as grievance and KITE issues. But he clarified that he does not automatically receive ADA-related grievances or KITE’s, and most are funneled to the medical department. The ADA deputies have admittedly not reviewed any grievances pertaining to effective communication issues or inmates with learning or intellectual/developmental disabilities.
The ADA staff is aware of the email notifications received from CDCR, for CDCR Armstrong class members housed at the SCSD detention facilities. But they do not receive these notices, unless the receiving medical staff informs them (which rarely occurs). A couple of the ADA staff members were not aware of previous inmate grievances submitted regarding either shower chair issues or accessibility concerns.
Although some staff and inmates are aware of the newly assigned ADA staff, and have reportedly asked the ADA staff for assistance or information, e.g., health care appliances and reasonable accommodations for inmates, many inmates and some staff are not aware of their existence or positions. The staff interviewed admitted that there is not a health care appliance/assistive device inspection log (for accountability or functionality).
Although one of the ADA staff believed that the jail rulebook addresses the Compliance Sergeant (ADA Coordinator) position, the rulebook has a very brief
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section about ADA and Title II, but there is no language regarding the ADA Coordinator or other ADA staff.
Additional information obtained through the ADA staff interviews included but is not limited to the following: the Compliance Sergeants for the MJ and RCCC as well as both ADA Deputies do not maintain daily monitoring of the ADA Program, and do not currently have on-going ADA or disability monitoring (whether daily, weekly or monthly) relative to the inmate grievance process/resolution, inmate request (KITE) process, inmate disciplinary process, inmate tracking process, touring ADA housing units and work sites, interviewing housing officers, clinicians, teachers, work supervisors, or other staff, or interviewing inmates regarding ADA concerns or issues.
The ADA staff at both detention facilities have numerous other required duties outside of ADA or inmate disabilities. There is no adequate inmate disability identification or tracking system in place for proper identification of inmates with disabilities. In speaking with the ADA staff, they did not have a clear or thorough understanding as to what their specific job duties entailed as related to inmates with disabilities. At the time of the interviews, it did not appear that the Draft Operations Order had been available to them to review. The Compliance Sergeants and ADA Deputies do discuss pertinent ADA-related issues as necessary.
The majority of all detention facility staff (both facilities) who were interviewed were not familiar with the process to secure a contract sign language interpreter in the event of a due process event or clinical encounter (if the inmate’s primary method of communication is signing). One of the ADA staff provided the Assessment Team with an SLI list of contractors, and both ADA Deputies were aware of this list. One of the ADA Deputies did not believe that health care staff has ever inquired about the list or did not know if some of them are aware of its existence. The ADA Deputies were not aware of any instances where jail staff have had to utilize a contract provider, but indicated that staff have done “workarounds” in the past by having deaf/hearing-impaired or speech-impaired inmates use written notes. When asked whether a certified SLI has ever been used for a deaf and mute inmate housed in MJ 2nd floor medical unit, the ADA Deputy who was asked did not know. The ADA Deputies explained where the TTY machines were located in the 2 detention facilities. Of the dozens of staff interviewed, only a couple of them were trained in or knew how to use the TTY equipment.
The ADA staff were not trained in or familiar with providing EC to inmates with disabilities, where there may be barriers to communication, e.g., intellectually disabled/developmentally disabled, learning disabled, mental health, deaf/hearing-impaired, and speech-impaired. The ADA Deputies were unsure as to how to obtain the names of inmates who have an intellectual/developmental disability or a learning disability, but would consult with staff from the psychiatric
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department for a list of inmates with mental health concerns. One of the ADA Deputies said he has provided alternatives to writing inmate disciplinary reports on some inmates with disabilities, but acknowledged that disciplinary reports for ADA inmates by other staff are generally not routed to the ADA staff for review.
Some of the ADA staff interviewed (as well as medical and other custody staff) indicated that there was no master list of health care appliances/assistive devices issued to inmates at the MJ and RCCC facilities.
The Compliance Sergeants (ADA Coordinators) do not track or log any activities or tours through the housing units or other areas, and do not track or log any interviews of disabled inmates or key staff.
Neither the Compliance Sergeants nor the ADA Deputies have received any formal ADA training that would qualify them to perform the relevant ADA functions and oversight over the program or to serve as ADA trainers to staff.
The Compliance Sergeants do not maintain or have access to an inmate disability tracking system or list to identify inmates with disabilities. Currently, they also do not receive the names or a list of CDCR Armstrong class members housed at the MJ or RCCC facilities.
Conclusion
In violation of Title II of the ADA (as specifically described below), the SCSD detention facilities do not have a dedicated ADA Coordinator in place at either the MJ or RCCC facility to coordinate efforts to comply with and carry out the multitude of necessary responsibilities of the position, which also includes oversight of employee accountability and allegations of noncompliance. In the absence of a comprehensive inmate disability program/plan, and clear duties delineated for the positions, the Compliance Sergeants (ADA Coordinators) for the MJ and RCCC facilities as well as the ADA Deputies (Assistant ADA Coordinator/ADA Corrections Division Representative) for both facilities are unable to effectively perform their duties.
As a result, they will ultimately be unable to help ensure that the SCSD detention facilities are abiding with Title II of the ADA, and will not be able to ensure the employment of best practices with respect to inmates with disabilities. Given the mandates under ADA, the various court orders, injunctions and settlement agreements ordered or approved by the courts (around the nation), the current lack of an acceptable ADA training component for both custody and non-custody staff is concerning.
The Compliance Sergeants (ADA Coordinators) and ADA Deputies (ADA Assistants/ADA Corrections Division Representatives) at the two facilities have not been adequately trained regarding ADA or in the development of a comprehensive inmate disability program. Likewise, they do not currently
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
possess the requisite expertise or training to provide effective oversight to ensure overall program and staff accountability or to ensure that all detention facility staff is trained with regard to ADA and an effective inmate disability program.
28 CFR § 35.107(a) states that a public entity that employs 50 or more persons shall designate at least one employee to coordinate its efforts to comply with and carry out its responsibilities under this part, including any investigation of any complaint communicated to it alleging its noncompliance with this part or alleging any actions that would be prohibited by this part.
As stated above, the SCSD detention facilities have not designated a dedicated employee to coordinate its efforts to comply with and carry out its responsibilities under Tittle II of the ADA, including investigation of any complaint alleging noncompliance or any actions that would be prohibited. The Compliance Sergeant at each facility (MJ and RCCC) only performs ADA/disability-related functions about 25 percent of the time (or slightly more as there are likely occasional ADA-related issues during the course of the other approximate 75 percent of their duties). The Compliance Sergeants are still working to determine what their job duties fully entail or what they should consist of in the future. Much of the ADA/disability-related workload is either shared or handled by the two respective ADA Deputies. However, the Deputies are also in the process of working to determine their own work responsibilities within the position while trying to also determine what additional specific job duties must be added.
Although the Compliance Sergeants have electronic access to the JIMS system PF-2, PF-4 and PF-10 screens for very limited ADA/disability-related information; they do not maintain ADA related documents to assist them in identifying ADA requirements for the operation of their respective detention facility.
The Operations Order Inmates with Disabilities - ADA, is currently in draft form and is likely going to be modified further prior to approval. Although a senior supervisory or manager level (e.g., Sheriff’s Lieutenant) is the strongly recommended employee classification for a dedicated ADA Coordinator position, the position of Sheriff’s Sergeant may be acceptable so long as the incumbent has sufficient command authority over the program to effect necessary change and program modifications as needed and has ongoing dialogue with the executive management team to keep them apprised of compliance, trends, training needs, and recommendations for overall program improvement.
The operations order should require the ADA Coordinators to be dedicated positions (or a single dedicated position for oversight of both facilities) for ADA responsibilities, and not have other duties (e.g., PREA, ICE, custody/classification monitoring of the JBCT Program).
The position must have command authority over the program, have the ability to effectively oversee daily operations, have the responsibility to affect change or
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
modifications as needed, and have the authority to engage with executive level management on a regular basis.
The operations order must include a more exhaustive list of responsibilities for the ADA Coordinators.
The operations order must also require the ADA Coordinators to tour units, interview staff and inmates on a regular basis, and monitor all disability-related tracking documents. The ADA Coordinators should maintain all ADA-related documents to assist them in identifying ADA requirements for the operation of the SCSD detention facilities.
The operations order should articulate that the ADA Coordinators will regularly monitor all facets of the ADA program to help ensure that inmates are being afforded equal access to all programs, services and activities offered by the SCSD detention facilities (and other entities, e.g., EGUSD and volunteer chaplains), and not being discriminated against in accordance with Title II of the ADA.
As a result of the assessment, which included reviews of applicable operations orders and policies as well as staff and inmate interviews, findings for this area include:
 Draft Operations Order Inmates with Disabilities – ADA, must include the following:  Articulate that the ADA Coordinators will regularly monitor all facets of the ADA program to help ensure that inmates with disabilities are being afforded equal access to all programs, services and activities offered by the SCSD detention facilities, and not being discriminated against in accordance with the ADA, Title II;  Provide greater information and a more exhaustive list of additional ADA/disability-related responsibilities for the ADA Coordinators and ADA Deputies which are not currently captured in the Order: o These duties are outlined in detail throughout most of the sections of this entire report. Examples include:  Oversee an inmate disability tracking system; tour housing, work, education, library and other units; interview inmates with disabilities and other inmates; periodically interview custody and non-custody staff (e.g., housing officers, academic/vocational instructors, classification staff, health care staff, self-help group sponsors/staff); review inmate request for accommodations and inmate grievances related to ADA/disabilities; monitor the inmate disciplinary process as related to inmates with disabilities; ensure EC for inmates with disabilities relative to due process events and clinical encounters; provide auxiliary aids, reasonable accommodations, and equal access to
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programs, services and activities; review removal/non-removal of health care appliances/assistive devices;  The operations order must contain a listing of all applicable disabilityrelated forms and documents, including forms/documents currently being used as well as those that will need to be developed and implemented in the future (e.g., related to custody, medical, mental health, and academic), based on future management decisions. Specific examples are cited throughout other sections of this report;  Examine whether the ADA Coordinator positions should be designated at a Sheriff’s Lieutenant level or above, or to remain at the Sheriff’s Sergeant classification;  There must be a requirement for both ADA Coordinators to be dedicated positions for ADA responsibilities (no PREA or other nonADA duties), or consider approval for a single dedicated ADA Coordinator position for oversight over both MJ and RCCC facilities;  The ADA Coordinator position(s) must have command authority over the ADA program; o The ability to effectively oversee daily operations; o The ability to affect change or modifications as needed; and o The authority to engage with executive level management on a regular basis;  The MJ ADA Coordinator and ADA Deputy positions must have a PDQ, duty statement or post order to identify specific duties and responsibilities for the positions;  Clarification must be made as to the specific working title of the positions (Compliance Supervisor/ADA Coordinator, and ADA Deputy/Assistant ADA Coordinator/ADA Corrections Division Representative);  The Compliance Sergeants, and ADA Deputies must be adequately trained to effectively perform their ADA and disability-related duties, and all custody and non-custody staff must be trained with regard to the ADA and an inmate disability program;  The Compliance Sergeants and ADA Deputies must have a greater understanding of their respective roles and responsibilities;  While the Draft Operations Order indicates that the purpose of the policy is to establish standards and consistent procedures by which an inmate with a disability is identified, the current inmate disability identification process is severely flawed. For example, there is no testing/screening for intellectual disabilities; there are concerns with the medical intake screening process for potential disabilities; there is no current method to identify possible learning disabilities, e.g., a reading or literacy test (other than for those testing for EGUSD classes);
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 Develop and implement an electronic comprehensive inmate disability tracking system;
 The Compliance Sergeants and ADA Deputies must be made aware of the CDCR Armstrong class members housed at the SCSD detention facilities;
 The operations order does not contain the newer revised full ADA definition (the revised definition is defined in another section of this report);
 The operations order must also contain other pertinent definitions not currently captured in the order, e.g., Compliance Supervisor (ADA Coordinator), ADA Deputy, TDD/TTY, Talking Book Program, Inmate Disability Tracking Program, disability codes (to be established), qualified interpreter, intellectual disability (developmental disability), Equally Effective Communication, due process, clinical encounter, auxiliary aids and services (e.g., qualified readers and qualified interpreters);
 Section III. of the order cites non-discrimination and ADA compliance, but numerous processes, forms, and training (as explained in detail throughout other sections of this report) must be put in place to ensure that discrimination does not take place relative to ADA and inmates with disabilities; and
 The jail rulebook does not refer to Compliance Sergeants (ADA Coordinators) or ADA Deputies (ADA Corrections Division representatives), and has very limited ADA/disability-related information. Numerous disability-related topics must be included, and are outlined in other sections throughout this report.
References
28 CFR § 35.130(a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.107(a) states that a public entity that employs 50 or more persons shall designate at least one employee to coordinate its efforts to comply with and carry out its responsibilities under this part, including any investigation of any complaint communicated to it alleging its noncompliance with this part or alleging any actions that would be prohibited by this part.
The information below is for reference only.
Due to the settlement agreement and subsequent Armstrong v. Schwarzenegger Federal Court Ordered Injunction (January 18, 2007), the CDCR was ordered to do the following with regard to their ADA program which includes inmates with disabilities, e.g., mobility, blind/vision, deaf/hearing, learning, and those with
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kidney disease (undergoing dialysis treatment): “Within 45 days of this Order, defendants shall appoint one full-time staff member at the Associate Warden level or higher as the ADA Coordinator at each institution designated to house prisoners with disabilities impacting placement (including designated reception centers and designated security housing units and condemned housing) to work only on ADA compliance matters…”
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Notices
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders pertaining to ADA Notices are outlined in the draft Operations Order Inmates with Disabilities - ADA. This Operations Order indicates that The Americans with Disabilities Act Inmate Notice will be prominently posted in all inmate-housing units and the Americans with Disabilities Act Public Notice will be prominently posted at the public entrances of all Jail facilities.
These Notices are required to advise disabled inmates and other interested persons of information regarding the provisions of Title II of the ADA and its applicability to services, programs, or activities and to make the information available in a manner necessary to apprise individuals of the protections against discrimination assured them by the ADA. The Notices are also required to make available to all individuals the name, office address, and telephone number (for the public) of the employee designated to coordinate compliance with the ADA.
Observations
The Assessment Team conducted a site assessment and review of all inmate housing units and public entrances at the MJ and the RCCC facilities. The site assessment revealed that the ADA Notices are not prominently displayed in any of the housing units in the MJ and RCCC facilities. The public entrances at the MJ and RCCC facilities do have ADA Public Notices posted. However, the ADA Notices refer individuals to the Department ADA Coordinator “Ivanna Chow” and to the Manager, EEO Disability Compliance Countywide ADA Coordinator.
Conclusions
The SCSD detention facilities do not provide the Notices to all inmates as required by 28 CFR §35.106. As a result, inmates are not provided information regarding the provisions of Tittle II of the ADA and its applicability to the services, programs, or activities. They are not apprised of the protections against discrimination assured them by the ADA, and they are not informed as to the name, office address, and telephone number of the employee or employees designated to coordinate compliance with the ADA.
References
28 C.F.R. § 35.106 requires a public entity to make available to applicants, participants, beneficiaries and other interested persons information regarding the provisions of Title II and its applicability to the services, programs, or activities of the public entity, and make such information available to them in such manner as the head of the entity finds necessary to apprise such persons of the protections against discrimination assured them by Title II of the ADA.
28 C.F.R § 35.107 requires a public entity that employs 50 or more persons to designate at least one employee to coordinate its efforts to comply with and
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carry out its responsibilities of title II of the ADA, including any investigation of any complaint communicated to it alleging its noncompliance or alleging any actions that would be prohibited. The public entity shall make available to all interested individuals the name, office address, and telephone number of the employee or employees designated pursuant to this paragraph.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Custody Staff
All staff must have a working knowledge of and comply with all existing operations orders, post orders, policies, procedures and directives. Unlike the operations orders, policies and procedures, post orders contain specific postrelated instructions and requirements and typically are required to remain at the specific post site. Post orders clearly outline duties, responsibilities, and expectations of staff. Without post orders, there is limited accountability for staff performing their day-to-day responsibilities/duties. In addition, staff should be required to sign the post orders acknowledgement log acknowledging that they read and understood the post orders.
Observations
The Assessment Team reviewed the following post orders:
 8 WEST 400 Pod Disciplinary Housing Unit  JKF Security Checks Post Order Protocol  Booking Security Check Post Order Protocol  CBF Cleaning Procedures Post Order Protocol  CBF Daily Event Schedule  CBF Security Checks Protocol  Detainee Correspondence Post Order Protocol  Detainee Orientation Post Order Protocol  Emergency Psychiatric Evaluation Post Order Protocol  Gatehouse Security Check Post Order Protocol  Hunger Strike Post Order Protocol  ICE Compliance Fire Drills Post Order Protocol  ICE Detainee Classification Process Post Order Protocol  ICE Detainee Strip Search Post Order Protocol  ICE Guidelines Post Order Protocol  ICE Notifications Post Order Protocol  JKF Cleaning Procedures Post Order Protocol  JKF Daily Event Schedule  KBF Cleaning Procedures Post Order Protocol  KBF Daily Event Schedule  KBF Security Checks Post Order Protocol  Kitchen Security Check Post Order Protocol  Laundry Security Check Post Order Protocol  MSDS/Hazardous Substance Inventory Log Post Order Protocol  RBF Cleaning Procedures Post Order Protocol  RBF Daily Event Schedule  RBF Security Checks Post Order Protocol  SBF Cleaning Procedures Post Order Protocol  SBF Daily Event Schedule  SBF Security Checks Post Order Protocol
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Security Housing Food Services Post Order Protocol  Special Management Unit Post Order Protocol  Tower Security Check Post Order Protocol  Booking Post Order  CBF Post Order  Gatehouse Post Order  JBCT (ROC) Program Post Order  JKF Post Order  KBF Post Order  Kitchen Post Order  Laundry Post Order  RBF Post Order  SBF Post Order  Tower Post Order
Based on this review it was found that the custody post orders do not contain any language relative to staff requirements and duties regarding disabled inmates, or reasonable accommodation requirements, etc. It was also found that there are no post orders for custody positions at the MJ and the RCCC minimum and medium security barracks housing units and custody support positions.
Conclusions
The existing SCSD detention facilities custody post orders must be developed and/or revised with specific requirements for staff to ensure disabled inmates have equal access to programs, services and activities, and staff are aware of the assistance and accommodations/modifications that they must provide for disabled inmates. Examples of specific information to be inserted include, but are not limited to: assistance to inmates with learning and developmental disabilities, reasonable accommodation requirements during verbal announcements, alarms, and evacuation procedures for disabled inmates. For custody positions that currently do not have post orders in place, post orders must be developed with specific requirements for staff to ensure disabled inmates have access to programs, services and activities. This means, in part that staff must be aware of the assistance and accommodations/modifications they need to provide for disabled inmates.
References
28 CFR § 35.105 (a) requires that a public entity evaluate its current policies and practices, and to the extent that modification of any such policies and practices is required, the public entity shall proceed to make the necessary modifications if they do not or may not meet the requirements of Title II.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
“Each institution/facility (DPP designated institution, nondesignated institution, and reception center), shall ensure custody staff in housing units where an inmate with impairments that impact placement resides, maintains a copy of the identification card/picture for that inmate with the inmate roster, to alert unit staff of the special needs of the inmate during count, emergency evacuation, verbal announcements, etc.”
Post Orders:
Specific ADA requirements are required to be incorporated into staff unit post orders. This includes the following areas:
 Verbal Announcements and Alarms;  Evacuation Procedures; and  Count.
Staff post orders must be revised to include the specific requirements for staff to ensure they are aware of assistance and modifications that must be provided to disabled inmates.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
Notices, Announcements, and Alarms:
Written Materials: Each designated DDP institution/facility must ensure that CCR notices, orientation packages, announcements, and similar printed materials are accessible to inmates with developmental disabilities. Institution staff must provide the necessary assistance to all DDP inmates on a case-by-case basis to ensure that those who have difficulty reading and/or communicating in writing will be provided reasonable access to forms, regulations, and procedures. Local operational procedures must reflect specific notices, announcements, and alarm procedures for DD2 and DD3 inmates. Post orders for staff assigned to provide such services to DD2 and DD3 inmates must reflect these specific procedures.
Verbal Announcements: Each designated DDP institution/facility must ensure effective communication is made with inmates with developmental disabilities regarding public address announcements and reporting instructions, including
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
those regarding visiting, yard release and recall, count, lock-up, and unlock, etc. Local operational procedures must reflect specific requirements for verbal announcements impacting DD2 and DD3 inmates. Post orders for staff assigned to provide such services to DD2 and DD3 inmates must reflect these specific procedures, i.e., prompts for visits or hearings, if an inmate does not respond. Count And Movement Each designated DDP institution and facility must review local policies and procedures to ensure DDP inmates are provided with necessary prompting so that they comply with count time expectations, respond to visits, keep work/school schedules, and respond to meals and other movement calls. Local operational procedures must reflect specific count and movement procedures for DD2 and DD3 inmates. Post orders for staff assigned to designated buildings/units/wings that house DD2 or DD3 inmates must reflect the specific count and movement procedures. Evacuation Procedures Local evacuation procedures must be adopted at each designated DDP facility to ensure the safe and effective evacuation of inmates with developmental disabilities. Local operational procedures must reflect specific evacuation procedures for DD2 or DD3 inmates. Post orders for staff providing services for DD2 or DD3 inmates must reflect these procedures. All DDP inmates will be provided instructions for evacuation/emergency procedures during orientation before initial classification at designated institutions.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Accountability
The SCSD detention facilities do not have any existing operations orders, policies or procedures for the MJ or RCCC pertinent to investigating, monitoring or tracking allegations or violations of Title II of the ADA. Since there is no local policy requirement, the Assessment Team did not observe or review the tracking of ADA or disability-related allegations or violations against inmates.
Observations
Sacramento County Sheriff’s Department, Operations Order 01/03, Employee Conduct, states in part; “The purpose of this Order is to outline the standards of employee conduct at the Main Jail and Rio Cosumnes Correctional Center (RCCC).”
Section II. Related General Orders, states in part, “Employees shall be aware of and adhere to the policies and regulations within the Sheriff’s Department’s Departmental General Orders and Divisional Operations Orders.”
Section III. General Behavior, states in part; “All persons employed at the correctional facilities, either in a paid or volunteer capacity must observe all rules, regulations, and laws pertaining to custodial facilities. Any failure to do so may result in disciplinary action, exclusion from the facilities, or legal consequences.”
However, Operations Order 01/03, Employee Conduct, does not contain specific language regarding staff accountability with regard to violations or allegations relative to the ADA or inmates with disabilities.
Sacramento County Sheriff’s Department, Operations Order 07/02 Grievances, states in part, “Correctional Services shall provide a written process that allows inmates to grieve specific conditions. All written grievances shall receive a written response within a reasonable time limit and will be resolved at the lowest appropriate staff level.”
Section II. Definitions, states in part, “A grievance is a complaint by an inmate regarding any condition of confinement, act, rule or policy, written or unwritten, in which an inmate contends that there is an infringement upon his or her personal, human or constitutional rights.” It also contains language indicating that a grievance may include complaints against the substance of policies or rules, conditions of confinement, medical care, classification actions, disciplinary actions, program participation, telephone, mail and visiting procedures.
Section III. Grievance Procedures, states in part; “An inmate should first direct his/her issue to custody or supervising staff as the issue should be resolved at the lowest appropriate staff level. If custody or supervising staff is unable to resolve the issue, the inmate may file a formal written grievance.”
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Section IV. Supervisor Responsibilities, states in part; “The watch commander/unit manager has four days to review and approve the response, add additional responses to the grievance or require further investigation. The completed grievance response will be forwarded to the assistant division commander for review. In the event the grievance involves staff conduct, the assistant division commander shall notify the division commander who thereafter will decide if a copy should be forwarded to Professional Standards.”
Operations Order 07/02 Grievances, encourages and expects internal problems to be solved at the lowest possible level of inmate contact, offers administrators a means for continuous review of administrative policy and procedure, and provides written documentation of inmate complaints. The Order allows inmates a grievance/appeal process for a multitude of issues, e.g., conditions of confinement, including but not limited to: health care, classification actions, disciplinary actions, program participation, telephone, mail, visiting, etc.
Although the Order does not contain a separate avenue for writing or tracking confidential letters directly to an executive or other administrators, and does not contain specific information relative to disabilities, health care appliances, or other ADA or disability concerns/issues, the grievance process is the mechanism for formal and informal resolution of disability-related concerns. Likewise, although not defined in written policy as such, KITE’s (including HS KITE’s) are the expected process for disability-related requests, e.g., access to programs, services and activities, including health care, reasonable accommodations, effective communication, staff assistance, health care appliances/assistive devices/durable medical equipment, and auxiliary aids.
Section IV. Supervisor Responsibilities, states in part, “The watch commander/unit manager has four days to review and approve the response, add additional responses to the grievance or require further investigation. The completed grievance response will be forwarded to the assistant division commander for review. In the event the grievance involves staff conduct, the assistant division commander shall notify the division commander who thereafter will decide if a copy should be forwarded to Professional Standards.
There is no specific policy or procedure, however, to formally track ADA-related grievances or issues (either by egregious, serious, or repeat allegations or violations, or by housing unit, nature of complaint, team/shift, date, or other criteria) in order to monitor disability-related problem areas for immediate or ongoing attention.
As stated above in Section IV. Supervisor Responsibilities, it is implied that the administration and Professional Standards staff would follow-up on complaints of staff misconduct. But this does not describe or include any timelines or any specific course of action (or staff disciplinary matrix for any substantiated ADA or disability-related allegations).
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Staff Interviews
Assessment Team members interviewed the Compliance Sergeants (ADA Coordinators) and the ADA Deputies (Assistant ADA Coordinators), as well as Inmate Grievance Office staff and numerous other custody and non-custody supervisors and staff throughout the MJ and RCCC.
Inmate Interviews
During the inmate interviews, some inmates who are permanent wheelchairusers and other mobility-disabled inmates, as well as inmates who are deaf, have kidney disease (undergoing kidney dialysis), mental illness, and those with other disabilities reported incidents that can be classified as egregious ADA or disability-related violations and which would meet the criteria for investigating, monitoring and tracking. Specific allegations and information are captured throughout this report.
Conclusion
The SCSD detention facilities are in violation of Title II of the ADA, with regard to implementation or oversight of a defined accountability or investigative mechanism to monitor and track staff ADA violations. It is paramount that the SCSD detention facilities develop and implement a policy and practice relative to accountability and investigations specific to ADA and disabled inmates.
The SCSD detention facilities do not have an existing policy (or procedures) pertinent to monitoring, investigating and tracking violations of Title II of the ADA. Nor do they have a mechanism to specifically capture staff ADA violations (e.g., egregious or serious violations or repeat occurrences).
The SCSD detention facilities currently handle inmate grievances and staff complaints in accordance with existing SCSD detention facilities Operations Order 07/02, Grievances. However, this process only captures alleged violations as a result of inmate grievances filed. This process does not capture events where supervisors, managers or other staff identify violations of Title II of the ADA (or any violations relative to future SCSD detention facilities policies).
The SCSD detention facilities must ensure a new policy (and related procedures) are written and implemented regarding monitoring, investigating and tracking staff violations or allegations of violations of Title II of the ADA (as well as violations or allegations of violations of future local ADA-related policies).
As a result of the assessment, the team found:
 There is no existing policy pertaining to monitoring, investigating and tracking staff violations (or allegations of such violations) of Title II of the ADA;
 The SCSD detention facilities need to incorporate a written policy and procedures regarding monitoring, investigating, and tracking staff
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
violations (or allegations of violations) of Title II of the ADA (and any new SCSD detention facilities operations orders pertaining to the ADA or an inmate disability program);  Staff must be trained on any new policy and expectations; and  Staff must be subject to discipline for violations of the ADA. References 28 CFR § 35.130 (a) states that no qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
28 CFR § 35.107 (a) states that a public entity that employs 50 or more persons shall designate at least one employee to coordinate its efforts to comply with and carry out its responsibilities under this part, including any investigation of any complaint communicated to it alleging its noncompliance with this part or alleging any actions that would be prohibited by this part.
The information below is for reference only. Due to Federal Court Ordered Injunction (January 18, 2007), the CDCR was ordered to do the following (with regard to instituting an Accountability Plan) to hold managers and staff accountable for violations of the ADA and related settlement agreements, court injunctions, etc., as pertained to inmates with disabilities:
Federal Court Injunction (January 18, 2007)
Accountability:
“Within 120 days of the date of this Order, defendants, in cooperation with the Office of the Inspector General and the Receiver in Plata v. Schwarzenegger, shall develop a system for holding wardens and prison medical administrators accountable for compliance with the Armstrong Remedial Plan and the orders of this court. This system shall track the record of each institution and the conduct of individual staff members who are not complying with these requirements. Defendants shall refer individuals with repeated instances of non-compliance to the Office of Internal Affairs for investigation and discipline if appropriate.”
“Within 60 days of the date of this Order, defendants shall amend post orders and duty statements of correctional staff as appropriate to include the Armstrong requirements for which they are responsible.”
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Policies and Procedures

The Assessment Team reviewed the Sheriff’s Department County of Sacramento Correctional Services Operations Orders, Correctional Health Services Policies and Procedures and the Correctional Health Services Standardized Nursing Procedures that specifically pertain to or should pertain to inmates with disabilities. The following list details the Operation Orders and Policies and Procedures that require revision with ADA-specific requirements.
Sheriff’s Department County of Sacramento Correctional Services Operations Orders

01/05 01/11 01/15 02/01 02/02 02/03 02/04 02/05 02/06 02/12 02/13 03/03 03/05 03/09 03/12 03/13 03/16 03/17
04/01 04/02 04/03 04/04 04/05
04/07 04/08 04/09 04/10 04/12 05/04 05/08 05/09

Training Program / Training Requests Line-Ups Reporting of Incidents and Crimes Use of Force Use of Restraint Devices Use of Pro-Straint Chair Weapons, Tactical Weapons, and Specialized Equipment CERT and Cell Extraction Procedures Prisoner Searches Transportation of Prisoners Inter-Facility Transportation and Court Appearances Fire Suppression - Main Jail Fire Suppression – RCCC Fights, Riots, Hostage and Minor Disturbances Evacuation Plan - Main Jail Evacuation Plan - RCCC Crimes Occurring Within Correctional Facilities Preventing, Detecting, Responding to Inmate Detainee Sexual Assault Intake, Search, Reception and Holding Evidentiary/ Exposure Blood Draws Prisoner Clothing, Property, and Funds Use of Sobering Cell Use of Safety, Segregation, North Holding #2, and Multipurpose Rooms Dress-In/Dress-Out Procedures Prisoner Orientation Release Procedures Property and Money Return and Release Procedures Missing Property and Property Claims DNA Samples Work Project Assignment Weekenders

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

05/10 06/02 06/03 06/04 06/08 06/09 06/10 06/11 06/13 06/14 06/17 06/19 06/20 07/01 07/02 07/03 08/04 08/05 08/06 08/07 08/10 08/11 09/01 09/10 10/01 10/02 10/03 10/04 10/05 10/08 10/09 Draft

Service of Processes on Prisoners Housing Plan Classification Process Count and Lockdowns Court Pull Procedures Prisoner Movement Within a Facility Recreation, Exercise and Showering Laundry, Clothing & Linen Telephone/TDD/TTY Equipment Access Interpreter Services Social and Media Visits Inmate Workers Court Holding Area and Courtroom Security Inmate Message Requests (KITE’s) Grievances Discipline Plan Educational Services Commissary Operations Prisoner Services Law Library Jail Industries Religious Services Housing Unit Inspections and Cost Recovery Maintenance Requests and Equipment Repair Health Care Services Psychiatric Services Health Care Treatment Access Medical Intake Screening Suicide Prevention Program Medicine Distribution "Pill Call" Dental Services Inmates With Disabilities - ADA

Correctional Health Services Policies and Procedures

1125 1128 1129 1302 1404 1407 1409 1410 1411

Prosthesis Reading Glasses for Inmates ICE Detainee Procedural Considerations Staff Development and Training Receiving Screening Access to Treatment Clinic Care – Sick Call Medical Services Provided in the Medical Housing Unit Mental Health Services

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

1412 1413 1414 1415 1417 1421 1422 1423 1424 1425 1431 1433 1435 1436 1439 1601 1801 1803 1900 2000

Suicide Prevention – 2M – Joint Policy with JPS Use of Restraints and the Pro-Straint Chair Restraint Check Method Patients in Safety Cells Adult Developmental Disability Hunger Strike Special Needs Patients Post Release Medical Care Planning Sexual Assault Patients in Segregation Cells in Intake Footwear in the Jails Admission to Jail Acute Psychiatric Inpatient Unit Inmate Health Care Grievances Two East Inmate Transfers Reports of Disabilities or Impairments Medication Administration Informed Consent DNA Procedure at MJ and RCCC Health Record Format and Contents Dental Care

Conclusion
The Sheriff’s Department County of Sacramento Correctional Services and Correctional Health Services must revise the operations orders and policies and procedures identified above adding specific ADA language and requirements, as they relate to disabled inmates. In addition, policies and procedures must be created to ensure: EC is provided to disabled inmates; inmates are screened and evaluated for disabilities and accommodations needs based on their disabilities; and out-of-cell time is made equitable to the extent possible for inmates with disabilities. The Sheriff’s Department County of Sacramento Correctional Services and Correctional Health Services must also ensure their operations orders and policies and procedures address accommodations that must be provided to disabled inmates (e.g., those with learning and developmental disabilities) to ensure disabled inmates have equal access to programs, services, and activities.
References
28 CFR § 35.130 (b)(7) requires a public entity to make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
28 CFR 35.105 requires a public entity to evaluate its current services, policies, and practices and the effects thereof, that do not or may not meet the requirements of Title II of the ADA and to the extent modification of any such services, policies and practices is required, the public entity shall proceed to make the necessary modifications.
28 CFR 35.130 (a) No qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
(3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
(i) That have the effect of subjecting qualified individuals with disabilities to discrimination on the basis of disability; (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity's program with respect to individuals with disabilities; or (iii) That perpetuate the discrimination of another public entity if both public entities are subject to common administrative control or are agencies of the same State. (4) A public entity may not, in determining the site or location of a facility, make selections— (i) That have the effect of excluding individuals with disabilities from, denying them the benefits of, or otherwise subjecting them to discrimination; or (ii) That have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the service, program, or activity with respect to individuals with disabilities. (7) A public entity shall make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity. (8) A public entity shall not impose or apply eligibility criteria that screen out or tend to screen out an individual with a disability or any class of individuals with disabilities from fully and equally enjoying any service, program, or activity, unless such criteria can be shown to be necessary for the provision of the service, program, or activity being offered. The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Armstrong v. Brown settlement agreement.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
As a result of the ADA, the court approved settlement agreement for CDCR, titled, “Armstrong v. Davis” (now Armstrong v. Brown) amended January 3, 2001, mandates the following:
Notice, Announcements, and Alarms
Written Materials
Each institution/facility (DPP designated institutions, nondesignated institutions and reception centers) shall ensure that CCRs, Notices, Orientation Packages, Job Announcements and similar printed materials that it distributes to inmates are accessible to inmates with disabilities.
Each institution/facility shall ensure that accommodations such as magnifiers, photocopying machines with capability to enlarge print for vision-impaired inmates, inmate or staff assistance, computer assisted devices audiotapes and Braille are provided when necessary. Institution staff shall provide the assistance and equipment necessary to all inmates with disabilities on a case-by-case basis to ensure that have difficulty reading and/or communication in writing e.g., learning disabled inmates, are provided reasonable access to forms CCRs, and procedures. The type of equipment available will vary based upon the institution’s mission designation. Information regarding access to written materials will be provided to disabled inmates during the orientation process.
Verbal Announcements and Alarms
Each institution/facility (DPP designated institutions, nondesignated institutions and reception centers) shall ensure that effective communication is made with inmates who have hearing impairments impacting placement regarding public address announcements and reporting instructions, including those regarding visiting, yard release and recall, count, lock-up, unlock etc.
All verbal announcements in housing units where inmates with hearing impairments impacting placement reside shall be done on the public address system (if applicable) and by flickering the unit lights on and off several times alerting impaired inmates that an announcement is imminent.
The verbal announcements may be effectively communicated via written messages on a chalkboard or by personal notification, etc. These procedures shall be communicated to disabled inmates during the orientation process. These requirements shall be incorporated into unit staff post orders.
Local policies and procedures shall be adopted to reflect this obligation.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Evacuation Procedures:
Each institution/facility (DPP designated institutions, nondesignated institutions and reception centers) shall ensure the safe and effective evacuation of inmates with disabilities.
Local evacuation procedures shall be adopted at each facility.
Each institution/facility (DPP designated institutions, nondesignated institutions, and reception centers) shall ensure custody staff in housing units where inmates with disabilities that impact placement reside maintain a copy of the identification card/picture for that inmate with the inmate roster, to alert unit staff of the special needs required for emergency evacuation of the inmate. Special needs may include personal notification for hearing impaired inmates, or assistance provided to vision or mobility impaired inmates in responding to emergency situations.
Evacuation procedures shall be effectively communicated to disabled inmates during orientation process. These procedures shall also be incorporated into unit staff’s post orders.
The information below is for reference only. Due to the settlement agreement and approval by the Federal Court, the information outlined is applicable to disabled inmates under the Clark v. California settlement agreement.
Notices, Announcements, and Alarms:
Written Materials: Each designated DDP institution/facility must ensure that CCR notices, orientation packages, announcements, and similar printed materials are accessible to inmates with developmental disabilities. Institution staff must provide the necessary assistance to all DDP inmates on a case-by-case basis to ensure that those who have difficulty reading and/or communicating in writing will be provided reasonable access to forms, regulations, and procedures. Local operational procedures must reflect specific notices, announcements, and alarm procedures for DD2 and DD3 inmates. Post orders for staff assigned to provide such services to DD2 and DD3 inmates must reflect these specific procedures.
Verbal Announcements: Each designated DDP institution/facility must ensure effective communication is made with inmates with developmental disabilities regarding public address announcements and reporting instructions, including those regarding visiting, yard release and recall, count, lock-up, and unlock, etc. Local operational procedures must reflect specific requirements for verbal announcements impacting DD2 and DD3 inmates. Post orders for staff assigned
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
to provide such services to DD2 and DD3 inmates must reflect these specific procedures, i.e., prompts for visits or hearings, if an inmate does not respond. Count And Movement Each designated DDP institution and facility must review local policies and procedures to ensure DDP inmates are provided with necessary prompting so that they comply with count time expectations, respond to visits, keep work/school schedules, and respond to meals and other movement calls. Local operational procedures must reflect specific count and movement procedures for DD2 and DD3 inmates. Post orders for staff assigned to designated buildings/units/wings that house DD2 or DD3 inmates must reflect the specific count and movement procedures. Evacuation Procedures Local evacuation procedures must be adopted at each designated DDP facility to ensure the safe and effective evacuation of inmates with developmental disabilities. Local operational procedures must reflect specific evacuation procedures for DD2 or DD3 inmates. Post orders for staff providing services for DD2 or DD3 inmates must reflect these procedures. All DDP inmates will be provided instructions for evacuation/emergency procedures during orientation before initial classification at designated institutions.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Americans with Disabilities Act Assets/Features
The Sheriff’s Department County of Sacramento Correctional Services Operations Orders applicable to requesting or facilitating repair and maintenance requests, are outlined in Operations Orders 09/10, Maintenance Requests and Equipment Repair.
The purpose of the Order is to standardize the procedures for maintenance requests and facility equipment repair at the MJ and RCCC.
Section I of the policy (Overall maintenance), states in part, “Custody and assigned staff at each facility are responsible for inspecting facility equipment in their respective work areas on a daily basis and will promptly report all needed repairs.”
Section II (Main Jail), state in part, “At the Main Jail facility equipment needing repair and general maintenance will be fielded through the project officer using a Maintenance Request form.”
Section III (RCCC), states in part, “At RCCC, facility equipment needing repair and general maintenance will be fielded through the project officer using the maintenance hotline phone listing, which is available from the projects officer and/or administration.
Section III also states in part, “If a maintenance issue is not urgent, the afterhours non-emergency line may be used to leave a message”, and “If the maintenance issue is an emergency, a supervisor shall be notified. Employees should not leave a message on the non-emergency line and should contact the projects officer or the trade directly.
However, there are no policies or procedures with regard to inventorying and tracking structural or fixed assets/features, e.g., grab bars, transfer bars, raised toilets, sinks, water fountains, and exercise apparatus. Likewise, there are no existing policies or procedures to identify specific categories or priorities specific to ADA-related maintenance requests/repairs.
For the MJ, the Assessment Team interviewed the Basement Project Manager (sworn sheriff’s deputy), as well as an SCSD Sheriff’s Lieutenant. The Basement Project Manager is responsible for receiving maintenance/work request issues, and submitting them to the SCGS. For RCCC, the Assessment Team interviewed SCSD detention facilities Records Officer (non-sworn) who is responsible for the RCCC maintenance and work order process. The team also interviewed two SCGS Facility Managers, who work collaboratively with the aforementioned staff, and are responsible for receiving and following up on maintenance requests. The process at both detention facilities is basically identical. There are minor differences, e.g., the specific buildings and areas for
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
written work requests/work orders are different, and some of the RCCC areas include industries.
For both jails, potential work orders/requests can be initially identified by staff, or inmates can report an issue or discrepancy and notify a deputy or appropriate jail staff. Staff may initiate a general order (work request) for maintenance and repair work requests electronically through the SCSD detention facilities WebPortal. Specifically, staff complete the order (work request) by identifying the location and specific issue warranting repair or replacement, and answering relevant questions via drop-down menus and a comments section. All electronic requests submitted by staff are received by either the MJ Basement Project Manager or the RCCC Records Officer who has oversight of the RCCC work request process.
The MJ Basement Project Manager and RCCC assigned Records Officer receive the electronic email notification of requests (from requesting staff member), and make all reasonable attempts to informally ensure all appropriate maintenance/repair/replacement requests are completed as soon as possible. If the issue(s) cannot be resolved informally, the MJ Basement Project Manager or RCCC Records Officer electronically navigates through the County Automated Facility Maintenance (CAFM) management system. Each respective party (as applicable) will input the requests and information (type of issue, location, etc.) into a work order, and forward the order to the SCGS.
Categories for work orders include: routine, urgent and emergent. The aforementioned staff at both the MJ and RCCC indicated that they make immediate phone calls to the SCGS for emergent issues, and ongoing communication takes place between them and the SCGS Facility Managers as to any remaining open work orders (including those in immediate need). The Assessment Team was informed that work orders never ‘fall off’ (are not deleted from) the CAFM system until 7 days after completion of the repair or replacement. Most work orders associated with ADA are considered routine maintenance issues (which are the lowest level of the priorities), but both the MJ Basement Project Manager and RCCC Records Officer indicated that they inform an SCGS Facility Manager if an issue involves ADA non-compliance.
Once the SCGS Facility Manager receives the electronic Work Order from either the MJ Basement Project Manager or RCCC Records Officer, he dispatches a maintenance staff member to provide maintenance repair or replacement as necessary. According to the staff members interviewed, routine maintenance requests generally take 2-3 working days to complete. The Assessment Team was informed, however, that routine ADA work requests as well as emergency requests are usually completed on the same day that the SCGS Facility Manager receives the electronic work order from the MJ or RCCC.
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Both aforementioned staff members from the MJ and RCCC admitted that there is not a master listing or inventory of ADA structural or fixed assets or features, nor is there a policy, procedure, or standard practice for identifying ‘ADA’ within the work order or request process. The only current method to identify a maintenance issue as ADA-related, would be to incorporate language into the comments section of the initial request email and subsequent work order outlining the discrepancy as ADA-related. However, as Operations Order 09/10 currently does not require this, and there is no other related written policy or procedure, there is no current directive for staff to do this. The MJ Basement Project Manager and RCCC Records Officer both acknowledged the SCGS maintenance staff for their diligence with regard to promptly fixing maintenance issues as they arise.
The SCGS Facility Managers interviewed confirmed there is no standard report generated or monitored to track the state of repairs for ADA or disability-related maintenance issues, unless SCGS staff individually sort [in the CAFM system] by a specific known item/issue/discrepancy, or, unless requesting staff or the MJ Basement Project Manager or RCCC Records Officer identify a particular issue as ‘ADA’ (in the request email or electronic work order comments section). They also confirmed the following: there is no master list of structural or fixed ADA assets/features; there are no ADA or disability categories for maintenance work orders; there are no expedited timelines or priority categories specifically for ADA or disability-related maintenance requests; and there is no regular preventive maintenance or serviceability checks for the few structural or fixed ADA assets/features that do exist at the MJ and RCCC.
One of the SCGS Facility Managers interviewed indicated that he could create or produce just about any type of report or spreadsheet as requested. But in interviewing all pertinent staff members, the primary report utilized is a general report listing open and completed work orders.
The Assessment Team received the following related documents (reports) produced from the CAFM system: spreadsheet of all open and closed work orders submitted during the previous 12 months (and beyond); a spreadsheet of all open and completed work orders for Facility 505 (MJ - Lorenzo Patino Hall of Justice) and Facility 507 (RCCC); and a listing of all open and completed work orders (since 6/1/16) specifically focusing on areas (not necessarily specific to actual structural or fixed ADA assets or features) where mobility-disabled inmates are most likely housed and where ADA fixed/structural assets or features exist or should exist (e.g., MJ 2nd floor, RCCC MHU, M-Dorm). However, SCGS staff was unable to produce any historic list of service call or maintenance requests (open or completed) specifically for ADA or disabilityrelated issues.
One of the CAFM reports (spreadsheet) received for open/completed work orders contained the following fields: preventive maintenance work record code,
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description, requestor, status, current date, and current time. A second CAFM report received contained the following fields: facility code (505 [MJ] or 507 [RCCC]); floor (e.g., 2nd floor); facility name; address; work order #; work order description; status (e.g., O, C, X, D, T); status description (e.g., in-progress, dispatched, completed, on-line); work order creation day; work order completion day; and requestor. The above listed ‘status’ letters/codes represent the following: O=Open (possibly dispatched, in-progress, on-hold, on-line, or vendor); C=Completed; D=Deferred; T=Terminated work order (possibly work was not needed or had already been completed); X=Duplicate (previous work order had already been completed.
A review of the CAFM generated Report for the MJ (for the previous 12 months) showed a listing of approximately 3,060 work orders submitted. Of those work orders, only 2 were identified in the CAFM Report as ADA or disability-related. As stated above, this is the exception, as there is no current policy or common practice to identify these as such. One of the two work orders was applicable to inmates (including mobility-impaired inmates). This particular work order was submitted as a facility-wide request to install handrails in every shower in the MJ due to “ADA Compliance rules”, and also “old style showers” need to have a slip grip tape installed on the floor. The work order was submitted on 1/19/16, and is still categorized as an ‘Open’ work order. The second ADA-related work order concerns visiting civilians/non-inmates (not applicable to an Inmate Disability Program), and is specific to the Women’s ADA (courtroom side) toilet not flushing. This work order was submitted on 8/11/16, and is currently categorized as an ‘Open’ work order.
Of the more than 3,000 MJ work orders submitted during the previous 12-month period, only about 13 of the work orders were either clearly, likely, or somewhat likely to be ADA (disability/accessibility) related. A number of these would depend on what type of inmate (whether disabled and depending on specific type of disability) lived in the cell, bed area, or was housed in the respective housing unit. There were at least a couple of dozen additional work orders (in addition to the aforementioned 13 referred to) that may have also been ADA (disability/accessibility) related, also depending upon whether a disabled inmate lived in the cell, bed area, or was assigned to the respective housing unit. However, for both scenarios, without an electronic or other tracking process to identify disabled inmates (e.g., mobility and vision-impaired), and in the absence of a policy and process to identify and track ADA-related work orders, it is extremely difficult to obtain this information.
A review of the second CAFM generated report (spreadsheet) depicted all existing ‘Open’ work orders (regardless of when submitted) as well as all work orders submitted since 6/1/16, regardless of status (e.g., open, completed, etc.). This spreadsheet captured the MJ building/area 505 (Lorenzo Patino), specifically the 2nd floor, and RCCC building/area 537, specifically MHU and M-
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barracks. This report is not normally generated or reviewed specifically for identifying or tracking ADA related work requests/work orders or otherwise. However, the Assessment Team specifically asked for this type of report as these are the primary areas (though not exclusive) where inmates with disabilities are currently or most likely to be housed, e.g., those with mobility and vision-impairments.
Information gleaned from approximately 129 MJ (2nd floor) work orders included: none of the work orders were flagged or identified as ADA (disability or accessibility) related; about 47 of the work orders are categorized as current ‘Open’ work orders (approximately 22 between 2011-2015 [primarily 2015]); About 82 are categorized as ‘Completed’; and about 7 are either clearly, likely, or somewhat likely to be ADA (disability/accessibility) related. Of the approximate 7 ADA (or likely ADA related) work orders; about 4 of them are currently categorized as ‘Open’ work orders. Note: some of the work orders from this spreadsheet are also captured in the previously identified spreadsheet (CAFM generated report for work orders for the previous 12 months).
Information obtained from the 41 RCCC (building/area 537 – MHU, and MBarracks) work orders included: none of the work orders are flagged or identified as ADA (disability or accessibility) related; 3 of the work orders are categorized as ‘Open’ work orders; 38 are identified as ‘Completed’; and about 7 from RCCC are either clearly, likely, or somewhat likely to be ADA (disability/accessibility) related. Of the 7 ADA (or likely ADA) related work orders, all of them are identified as ‘Completed.’
There is no identification or tracking category to specifically identify ADA or disability-related Work Requests/Work Orders, there is no log or list specific to ADA/disabled inmates or disability-related work requests/orders, and there are no existing records of ADA or disability-related maintenance or service calls.
The requests are categorized according to problem, but not relative to ADA, a disabled inmate, or a disability-related maintenance/repair issue.
Staff explained that ADA or disability-related maintenance/repair issues are normally categorized as ‘Routine’ (lowest level of priority category), but are often fixed or replaced immediately or within about 2-3 days.
Staff interviewed indicated the Compliance Sergeants (ADA Coordinators) and ADA Deputies (Assistant ADA Coordinators) for the MJ and RCCC do not receive copies of the work requests/work orders for monitoring, tracking or other purposes.
Conclusion
Although Operations Order 09/10, Maintenance Requests and Equipment Repair is applicable to requesting or facilitating repair and maintenance requests, neither
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the SCSD detention facilities nor SCGS have an operations order, policy, procedure, or process in place to track the state of repair for structural or fixed ADA assets and features. The current housing process is severely flawed in that it places mobility-disabled inmates in housing which is not accessible with regard to their cells, paths of travel, and inappropriate or non-fixed assets/features, such as grab bars, transfer bars, accessible toilets, showers, and sinks. It is vital that the SCSD detention facilities house mobility-disabled inmates in housing commensurate with their ADA needs as well as their custody level and programming needs (notwithstanding other overriding placement factors, e.g., mental health housing). The SCSD detention facilities must develop and put into place a comprehensive process to include an inventory and tracking system of housing placements available to inmates with mobility disabilities (i.e. full-time wheelchair users, intermittent wheelchair users, mobility-disabled inmates who do not use wheelchairs [but may require the use of an assistive device], etc.), and the status of repairs for ADA accessible assets/features and ADA-related maintenance (Work Requests/Work Orders).
ADA Title II Regulations, 28 CFR 35.133 Maintenance of Accessible Features, mandates that a public entity must maintain in operable working condition those features of facilities and equipment that are required to be readily accessible to and usable by qualified individuals with disabilities (e.g., inmates with mobility disabilities).
28 CFR 35.152 Jails, Detention and Correctional Facilities, and Community Correctional Facilities, subsection (b)(3) Discrimination Prohibited, requires public entities to implement reasonable policies, including physical modifications to additional cells in accordance with the 2010 Standards, so as to ensure that each inmate with a disability is housed in a cell with the accessible elements necessary to afford the inmate access to safe and appropriate housing.
As a result of the assessment, which included reviews of applicable policies and other documents, as well as staff interviews, findings for this area include:
 The SCSD detention facilities and SCGS have no policies or procedures that pertain to requesting or facilitating repair and maintenance requests.
 The SCSD detention facilities and SCGS have no policies or procedures with regard to inventorying and tracking structural or fixed assets/features, e.g., grab bars, transfer bars, raised toilets, sinks, water fountains, exercise apparatus.
 There are no existing SCSD detention facilities operations orders or SCGS policies or procedures to identify categories or priorities specific to ADA requests/repairs.
 There is no identification or tracking category to specifically identify ADArelated Work Requests.
 There is not a log or list specific to ADA-related work requests.
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 There is not currently a requirement for staff or supervisors to indicate on the electronic Work Request or Work Order that a request pertains to an ADA issue.  A couple of the employees interviewed (who have maintenance-related duties) indicated that the only way of knowing whether a work request/work order is ADA related is if the staff member who input the information into the work request email or work order request to SCGS indicates such in the comments section, but this is not currently required or routinely done.
 There is not an existing inventory list or tracking system for structural or fixed ADA assets/features (i.e.., grab bars, transfer bars, raised toilet seats, accessible sinks, water fountains, and exercise apparatus).
 There are no existing records to track ADA-related service calls for repairs or replacements completed, or to identify the length of time an ADA asset or feature may have been inoperable or missing.
 Fixed or structural ADA assets or features are not routinely checked for serviceability, and there is no known documentation of such.
 Work Requests/Work Orders are categorized according to the problem/discrepancy, but not relative to whether it’s an ADA asset or feature or ADA related issue.
 There is not an official automatic priority list for ADA-related Work Requests (priority is based on criteria levels [e.g., emergent, urgent, routine], that do not pertain to the ADA).
 ADA-related Work Request/Work Order information is not being forwarded to the Compliance Sergeants (ADA Coordinators) or ADA Deputies (Assistant ADA Coordinators) at the MJ or RCCC for possible monitoring or tracking.
 In the two CAFM generated reports (spreadsheets) which tracked the description of work requested and submitted for the MJ and RCCC, with the exception of 2 (out of over 3,000 work orders submitted) there was no indication as to whether the listed requested repairs were ADA (disability or accessibility) issues, fixed ADA structural assets or features, or from a mobility-disabled inmate’s cell or bed area.
References
28 C.F.R. §§ 35.133 and 35.152, detailed above.
The information below is for reference only. Due to Federal Court Ordered Injunction (January 18, 2007), the CDCR was ordered to do the following (with regard to the state of repair of accessible ADA features):
In January 2007, in the United States District Court, Northern District of California, the Honorable Judge Claudia Wilken issued a Federal Court Injunction against the California Department of Corrections and Rehabilitation (CDCR) as a result of violations of the Americans with Disabilities Act (ADA), Section 504 of the
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Rehabilitation Act, and a previous court settlement agreement. One of several key issues cited in the Federal Injunction pertained to an inventory of housing placements, the status of state of repairs of accessible ADA features, and maintenance (Work Requests/Work Orders). Specifically, the Order mandated CDCR to generate an inventory of housing placements available to inmates with mobility disabilities (i.e., full time wheelchair users, intermittent wheelchair users, mobility impaired inmates not requiring the use of wheelchairs, and inmates with a vision disability). The Order included the requirement to include information regarding the current state of repair of accessible features for each placement. The placement inventory was required to be updated continuously as new information is received regarding placement factors and maintenance. Upon completion of the inventory, CDCR was required to no longer house the aforementioned type of disabled inmates at any placements without adequate accessible housing, including working (operational) accessible toilets and showers, etc.
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Introduction Accessibility Survey
The survey section of this report is an effort to identify accessibility barriers as defined according to the 1991 Americans with Disabilities Act Standards for Accessible Design (Revised July 1, 1994) (ADAAG) and/or the 2010 Americans with Disabilities Act Standards (ADAS). Although “ADAAG” is the commonly used term for the 1991 ADA Standards, the term technically applies to the Guidelines published by the Unites States Access Board. When Guidelines are codified into law by the United States Department of Justice, they become Standards and are enforceable as law. Please refer to Part III Assumptions & Considerations / Technical Assumptions for a detailed explanation of ADAAG and ADAS. For purposes of this report, we will use the term “ADAAG” when referring to the 1991 ADA Standards and “ADAS” when referring to the 2010 ADA Standards.
The field survey for SCSD detention facilities was conducted using a digital level, tape measure and door pressure gauge. Photographs of typical compliant and noncompliant conditions were taken at each of the facilities. Collected data was reviewed and analyzed for appropriate recommendations to remove the barriers.
The field surveys were performed on October 17 and 18, 2016. Both areas that were currently being used as well as inactive areas such as Rodger Bauman Facility (RBF) were surveyed.
OVERVIEW OF ADA REQUIREMENTS AS APPLICABLE TO SACRAMENTO COUNTY JAIL FACILITIES
The Americans with Disabilities Act of 1990 (ADA) is civil rights legislation designed to extend civil rights protection to persons with disabilities.
There are four Titles to the ADA. Title II is the one that applies to Public Entities such as SCSD detention facilities.
Title II Public Services and Transportation - Prohibits state and local governments from discrimination by requiring "program accessibility". Program accessibility can be attained by rescheduling and/or relocating programs to accessible locations or by making physical facility changes, called "structural changes" in the ADA. Program accessibility must be achieved to the extent that it does not cause "an undue burden" to the Public Entity.
28 CFR, PART 35 --NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES is the document that describes the ADA requirements for Public Entities such as SCSD detention facilities. These requirements include:
§35.105 Self Evaluation – requires that all Public Entities were to have evaluated all of their services, policies and practices to determine if they are all accessible
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to persons with disabilities. The Self Evaluation was to have been completed by July 26, 1993. We have not been provided with a copy of an ADA Self Evaluation prepared by Sacramento County that included the County Jail facilities. Online research provided information that other County departments such as Transportation had prepared ADA Transition Plans (http://www.sacdot.com/Pages/AmericansWithDisabilitiesAct-ADA.aspx).
It should also be noted that corrective work to remove architectural barriers to program access did not begin with the ADA. Previous requirements to prepare a Self Evaluation and Transition Plan and to remove architectural barriers began with Section 504 of the Rehabilitation Act of 1973 for public entities receiving federal funding. We have likewise not been provided with a copy of a Section 504 Self Evaluation prepared by Sacramento County that included the County Jail.
§35.150 Existing Facilities – requires that “a Public Entity shall operate each service, program, or activity so that the service, program, or activity, when viewed in its entirety, is readily accessible to and usable by individuals with disabilities.” However, the law does not require a “public entity to take any action that it can demonstrate would result in a fundamental alteration in the nature of a service, program, or activity or in undue financial and administrative burdens. In those circumstances where personnel of the public entity believe that the proposed action would fundamentally alter the service, program, or activity or would result in undue financial and administrative burdens, a public entity has the burden of proving that compliance with § 35.150(a) of this part would result in such alteration or burdens.
The decision that compliance would result in such alteration or burdens must be made by the head of a public entity or his or her designee after considering all resources available for use in the funding and operation of the service, program, or activity, and must be accompanied by a written statement of the reasons for reaching that conclusion. If an action would result in such an alteration or such burdens, a public entity shall take any other action that would not result in such an alteration or such burdens but would nevertheless ensure that individuals with disabilities receive the benefits or services provided by the public entity.” We are not aware that the Sacramento County Sheriff’s Office determined that any action that would have improved access to any of the services, programs and activities represent a fundamental alteration of those services, programs or activities or would result in an undue financial burden.
35.150(b)(1) indicates that a public entity is not required to make structural changes in existing facilities where other methods are effective in achieving compliance. 35.150(d) also requires that In the event that structural changes are required to achieve program accessibility, the Public Entity shall develop by January 26, 1993 a Transition Plan setting forth the steps necessary to complete
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such changes. Structural changes were to have been completed by July 26, 1995.
We are not aware if the County of Sacramento prepared a Transition Plan or of any structural changes that were performed at any of the SCSD detention facilities between January 26, 1993 and July 26, 1995.
It should be noted that the requirements for a Self Evaluation and Transition Plan under the ADA are taken from Section 504 of the Rehabilitation Act of 1973, which applied to projects that received federal funding. The ADA extended those requirements to Public Entities receiving state or local funding.
§ 35.151 New construction and alterations – requires that newly constructed and altered facilities built by or on behalf of Public Entities shall be fully accessible if construction commenced after January 26, 1992. Public Entities had the option of using the Uniform Federal Accessibility Standards (UFAS) or ADAAG as the technical standards for new construction and alterations.
28 CFR Part 35 was amended on September 15, 2010 and included new sections that affect the SCSD detention facilities:
35.151(k) Detention and correctional facilities
(1) New construction of jails, prisons, and other detention and correctional facilities shall comply with the 2010 Standards except that public entities shall provide accessible mobility features complying with section 807.2 of the 2010 Standards for a minimum of 3%, but no fewer than one, of the total number of cells in a facility. Cells with mobility features shall be provided in each classification level.
(2) Alterations to detention and correctional facilities. Alterations to jails, prisons, and other detention and correctional facilities shall comply with the 2010 Standards except that public entities shall provide accessible mobility features complying with section 807.2 of the 2010 Standards for a minimum of 3%, but no fewer than one, of the total number of cells being altered until at least 3%, but no fewer than one, of the total number of cells in a facility shall provide mobility features complying with section 807.2. Altered cells with mobility features shall be provided in each classification level. However, when alterations are made to specific cells, detention and correctional facility operators may satisfy their obligation to provide the required number of cells with mobility features by providing the required mobility features in substitute cells (cells other than those where alterations are originally planned), provided that each substitute cell—
(i) Is located within the same prison site;
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(ii) Is integrated with other cells to the maximum extent feasible;
(ii) Has, at a minimum, equal physical access as the altered cells to areas used by inmates or detainees for visitation, dining, recreation, educational programs, medical services, work programs, religious services, and participation in other programs that the facility offers to inmates or detainees; and
(iv) If it is technically infeasible to locate a substitute cell within the same prison site, a substitute cell must be provided at another prison site within the corrections system.
(3) With respect to medical and long-term care facilities in jails, prisons, and other detention and correctional facilities, public entities shall apply the 2010 Standards technical and scoping requirements for those facilities irrespective of whether those facilities are licensed.
§ 35.152 Jails, detention and correctional facilities, and community correctional facilities.
(b) Discrimination prohibited.
(1) Public entities shall ensure that qualified inmates or detainees with disabilities shall not, because a facility is inaccessible to or unusable by individuals with disabilities, be excluded from participation in, or be denied the benefits of, the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
(2) Public entities shall ensure that inmates or detainees with disabilities are housed in the most integrated setting appropriate to the needs of the individuals. Unless it is appropriate to make an exception, a public entity–
(i) Shall not place inmates or detainees with disabilities in inappropriate security classifications because no accessible cells or beds are available;
(ii) Shall not place inmates or detainees with disabilities in designated medical areas unless they are actually receiving medical care or treatment;
(iii) Shall not place inmates or detainees with disabilities in facilities that do not offer the same programs as the facilities where they would otherwise be housed; and
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(iv) Shall not deprive inmates or detainees with disabilities of visitation with family members by placing them in distant facilities where they would not otherwise be housed.
(3) Public entities shall implement reasonable policies, including physical modifications to additional cells in accordance with the 2010 Standards, so as to ensure that each inmate with a disability is housed in a cell with the accessible elements necessary to afford the inmate access to safe, appropriate housing.
The United States Department of Justice (USDOJ) has issued a document titled “Guidance on the 2010 ADA Standards” and a copy can be found in Appendix A.
It should be noted that Title II does not define “barrier” as does Title III for Public Accommodations. Similarly, Title II entities are not required to remove physical barriers even if they are “Readily Achievable”, since this concept does not apply to Public Entities. As described in §35.150, a Public Entity is required to identify all programs, services and activities and to determine if people with disabilities are provided nondiscriminatory access to them. An example of a “service” at Sacramento County Jail would be a toilet within a prison cell; if there are no accessible cells/toilets with grab bars as required by the 1991 ADAAG or UFAS, that would be an example of lack of program access. Another example would be a path of travel leading to a building where a program (e.g., classroom) is provided that has a slope of 10%. While this latter condition could be addressed by providing an assistant that could push a wheelchair user up the steep slope, it is doubtful that the former condition could be made fully accessible by other means than installing grab bars.
Citing past case law is also illustrative of the nexus between correcting conditions that are non-compliant with the 1991 ADAAG or UFAS and the obligation to provide program access. “While the ADAAG regulations clearly are not dispositive in this case, they can still provide guidance as to whether an existing facility is readily accessible and usable by individuals with disabilities.” Brown v. County of Nassau, 736 F. Supp. 2d 602, 617 (E.D.N.Y. 2010). The United State Supreme Court has also noted that “older facilities” can avoid structural changes by “relocating services to alternative accessible sites” or using other methodology, but if these measures are “ineffective in achieving accessibility” the public entity is “required to make structural changes.” Tennessee v. Lane, 541 U.S. 509, 532 (2004). Title II “imposes on public entities the requirement that they provide qualified disabled individuals with meaningful access to public services, which in certain instances necessitates that public entities take affirmative steps to remove architectural barriers to such access in the process of altering existing facilities.” Ability Center of Greater Toledo v. City of Sandusky, 385 F.3d 901, 913 (6th Cir. 2004).
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Therefore, there are two different criteria that apply to the two SCSD detention facilities: FACILITIES CONSTRUCTED PRIOR TO JANUARY 26, 1992: For those facilities that were constructed prior to January 26, 1992, structural changes are required if any condition that does not comply with ADAAG limits or prevents the ability of an inmate with a disability to access any program at the Sacramento County Jail and other methods do not provide a similar level of compliance. FACILITIES CONSTRUCTED OR ALTERED AFTER JANUARY 26, 1992: For construction projects that have been performed after January 26, 1992 (including alteration projects), all work should be in compliance with ADAAG. For projects that commenced construction after March 15, 2012, all work should be in compliance with the 2010 ADAS, which for Title II entities includes 28 CFR Part 35.151 and the 2004 ADAAG. Refer to the detailed description of both standards in Section D below.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Accessibility Survey’s
The SCSD is responsible for the care and custody or all prisoners falling under the jurisdiction of the Sacramento County Court System. The SCSD also contracts with the U.S. Government to house federal inmates. The SCSD operates two detention facilities: the MJ and the RCCC. The MJ is located at 651 I Street in downtown Sacramento and RCCC is located approximately 25 miles South at 12500 Bruceville Road in Elk Grove. The MJ, opened in approximately 1989 and is a Type II facility that houses nearly all of the County’s pretrial population, a number of federal pretrial prisoners. The structure is comprised of two 9-story towers with a vertical spine in between that contain circulation and exercise space. Inmates are housed on seven floors (each floor includes two levels of stacked cells), with the Superior Court and Jail Administration support space located on the first two floors of the facility. The MJ has a rated capacity for 2,380 male and female inmates and contains 2,432 beds. Inmate areas include the basement level, which contains the Kitchen and Laundry; first floor, which includes Medical Intake Screening, Women’s Booking, Holding, Clothing Exchange & Release, Men’s Booking & Holding; second floor, which includes the Medical, Dental and Psychiatry Units; third floor and general inmate housing on floors 3-8. Each inmate has a cell with a toilet, lavatory, mirror, and bed. Inmates eat and participate in programs in a common day room area equipped with tables, chairs, and telephones. Some areas such as the Male Release Tank were occupied on the day of the site visit and were not inspected. The SCSD detention facilities accommodates inmates with disabilities by issuing different size wheelchairs to inmates who require this type of mobility device, and some inmates are allowed to keep their personal wheelchairs. Nursing staff assists inmates with disabilities with their bathing activities while housed in the Medical Unit. SCSD detention facility staff indicated that the MJ currently houses a small population of inmates with various types of disabilities.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Typical conditions observed in the MJ that are not compliant with ADAS: Basement Neither of the Kitchen inmate restrooms provide a 60” diameter clear turning space, grab bars or toilet accessories within accessible reach range and the doors only provide 30” clear width. The urinal rim in one of the restrooms is 25” AFF and there is no 60” wide space at the toilet
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All of the Laundry folding counter is 36” AFF, which is too high for a person in a wheelchair to work at
1st Floor  Transaction counters are typically 42” - 44” AFF and openings that are used to pass items back and forth between staff and inmates are 52” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Changing benches in Dress In rooms that are not a minimum of 24” deep x 48” long
 Use of typical combination lavatory/toilet unit that does not provide knee space for a front approach at the lavatory or drinking fountain bubbler
 Female segregation cell restroom is only 26” wide at rear of toilet and lacks 60” diameter clear maneuvering space, toilet lacks grab bars, flush control is not on wide side of fixture and centerline of fixture is 13-1/2” from adjacent wall
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Lack of 60” clear width at toilet and 60” diameter turning space in holding cells and inmate restrooms
 No grab bars at toilet in holding cells or inmate restrooms
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmate restrooms and holding cells with toilet seat height of 14-3/4” – 151/2” AFF and flush control is not on wide side of fixture
 Width of opening into toilet compartment in holding cells, Male Interview Waiting Room, Male Dress In rooms and Female Clothing Exchange is 24” - 28”
 No 30” wide x 29” high x 17” deep knee space at lavatory or drinking fountain in holding cells or inmate restrooms, drinking fountain bubbler is more than 5” from front of fixture and mirrors are too high for a wheelchair user to see their reflection
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Bottom of reflective surface of mirror 47” - 49” AFF in holding cells and inmate restrooms
 Highest operating part of paper towel dispenser in Medical Intake Screening inmate restroom is 52” AFF
 Toilet paper dispenser in Medical Intake Screening inmate restroom and Women’s Booking & Holding Side inmate restroom is located behind toilet and not on side wall 7” – 9” in front of toilet
 Slope of floor in holding cells is 4.0%
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L6S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Holding cell, Male Interview Waiting Room, Male Dress In rooms & Female Release pay telephones lack 29” long cords and/or are not adjacent to a 30” x 48” clear floor space due to benches located below and/or the volume control buttons are 57-1/2” – 62” AFF
 The clear accessible width to the Female Release counter is only 30”
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
2nd Floor  Drinking fountain in corridor is not accessible to a wheelchair user or person who cannot bend or stoop due to the spout height and lack of knee space
 Psychiatry Unit shower is not 60” wide minimum, lacks a compliant seat and spray attachment, the controls are not mounted on the wall adjacent to the seat and the mirror and coat hook are too high
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Psychiatry Unit & Medical Unit cells lack grab bars at the toilet, toilet seat height is 15-1/2” AFF and there is no knee space at the lavatory/drinking fountain
 Lack of wheelchair seating with a 30” wide x 27” high x 19” deep knee space in Psychiatry Unit, Medical Housing and Medical Unit Wheelchair Pod day rooms
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Psychiatry Unit showers lacks grab bars or a folding seat
 Medical Unit Housing and Wheelchair Pod day room drinking fountain lacks knee space for a front approach, spout height is 37” - 41” AFF and/or lacks a spout high enough for individuals who have difficulty bending or stooping
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Medical Unit Wheelchair Pod cells lack 36” long rear grab bar, the side grab bar only projects 43” – 44” from the rear wall and the lavatory lacks knee space and the rim height is 36-1/2” AFF
 Wheelchair Pod shower controls are not located on wall adjacent to seat, seat is not the required minimum size, there is no spray attachment, a grab bar extends above the seat so a wheelchair user cannot lean against that wall and the mirror and coat hook are too high
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Medical Unit Housing shower is not a standard 30” x 60” or alternate 36” x 60” roll-in shower design, the door is only 24” wide and has a 6” curb
 Lack of 60” diameter clear turning space in Dental Exam room and X-Ray room
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Fixed examination chairs and tables do not accommodate wheelchair side transfer
 Medical Holding Cell lacks 60” wide space at toilet, toilet seat height is 15” AFF and clear width of opening into toilet compartment is only 27” wide
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Medical Housing Day Room telephones are too high and lack a 29” long cord
 Medical Housing Cell 6 door is only 30” wide, lacks grab bars at toilet, toilet seat height is 15” AFF, lavatory lacks knee space and encroaches on required clear space at cell door
Page 373

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Medical Housing 200 Pod Day Room drinking fountain lacks knee space and spout is 40-1/2” AFF
 Door from Family Visiting to Attorney Visiting Room is only 24” wide
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Attorney Visiting Room rooms lack 30” x 48” clear floor space at counter due to fixed stool and lacks 60” diameter turning space since room is only 42-1/2” wide
 Release Cell door is only 32” wide, there is only 39” clear width at the toilet and 28” at the lavatory, the toilet lacks grab bars and the toilet seat height is 15-1/2” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L7S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Release Cell issue counter is 38” AFF
 Inmate restroom door requires 8 pounds of opening force and closes from fully open to within 12 degrees of the latch in only 2-1/2 seconds, rear grab bar is mounted with ½” clearance to the flush valve, not parallel to wall and 15” past centerline of toilet to one side and 21” to the other side, centerline of toilet is 23” from adjacent wall, lavatory rim is 35-1/2” AFF, pipes are not insulated and soap and paper towel dispensers are more than 40” AFF to the highest operating part
Page 376

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
3rd Floor  Medical Exam Room table cannot be lowered to 17” – 19” to allow a wheelchair user to transfer on and off and there is only 22” clear width on each side of the table
 Medical Exam Room toilet room is only 38” wide and rear grab bar is only 24” long
3rd, 4th, 5th,, 6th, 7th & 8th Floor  All visiting rooms are located up a flight of stairs from the housing unit levels and there is no accessible route
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All Attorney Visiting rooms lack a 60” diameter clear maneuvering space, and a 30” w. 27” h. x 19” d. knee space below the counter to allow a wheelchair user to make a front approach
 Stairs to mezzanine levels in dayrooms and Recreation Rooms lack a cane detectable railing below
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Lack of 30” w. x 27” h. x 19” knee space at all dayroom tables
 Housing Unit showers are not a standard 30” x 60” or alternate 36” x 60” roll-in shower design, the door is only 24” wide and has a 6” curb
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Housing Unit dayroom pay telephone volume control buttons are 58-1/2” AFF and have 18” long cords
 Housing Unit day room drinking fountains are not high/low and not located in an alcove or out of the circulation path and lack a 27” high knee space 8” in from the front of the fixture
 Common Recreation Room drinking fountain is not high/low, is not located in an alcove or out of the circulation path, lacks a 27” high knee space 8” in from the front of the fixture and the shaving mirrors are too high
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Cell doors only provide 28-1/2” clear opening  Cell toilets lack grab bars, toilet seat height is 15” AFF, combination
toilet/lavatory lacks knee space at lavatory and bottom of mirror is 53” AFF
 Recreation Room toilets only have a 35” wide clear floor space, the seat height is 15” AFF, there is no knee space at the lavatory and the door is only 30” wide
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Yard toilets lack grab bars and only provide 32” clear space in front of toilet and 27” clear width at cased opening to toilet compartment
 Yard urinal rims are 25” AFF and the flush controls are 47” AFF
RCCC in Elk Grove has a rated capacity for 1,625 male and female inmates. The campus is divided into 2 separate compounds for male and female inmates and serves as the County’s branch jail facility housing overflow pretrial detainees and sentenced male and female inmates. The County operated the original facility as a road camp until the first facilities and infrastructure were built in 1959. Currently, RCCC contains more than 18 temporary and permanent buildings of various vintages and uses. RCCC can house male and female inmates of all classifications and houses inmates en route to other jurisdictions, federal prisoners under contract with the U.S Bureau of Prisons, and reciprocal prisoners from other counties. A staff of more than 180 Sheriff’s Department employees supervises inmates and several support services activities augment the custody staff and provide services and programs for inmate housing. The female side of the compound is known as the Sandra Larsen Facility (SLF) and is entirely self-contained and has no interaction with the male side. SLF has
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
3 dormitory pods; Golden Poppy (60 beds - minimum security), Kinya (92 beds minimum security) and Camelia (70 beds - medium facility), each with its own day room and recreation yard. Ramona Hall houses maximum-security inmates in cell-type housing. A kitchen, dining hall, infirmary, visiting area and recreation room are also provided at SLF. The men’s minimum-security housing is all provided in the HF. Medium security inmates are housed in the A, J & K barracks as well as JKF and RBF. Maximum-security inmates are housed in CBF 500 mod and SBF 200-500 mods. The original construction dates of RCCC are unknown. The County of Sacramento took possession of RCCC and the existing buildings in 1947. The first structures and infrastructure constructed by Sacramento County as part of a detention facility starting in 1959, prior to the enactment of the ADA. RBF, CBF, JKF and SBF are all masonry construction and the barracks are a combination of masonry and wood frame construction. Several modular classroom buildings were placed on site in and provide educational and program space. Although the topography of the RCCC is generally level and much of the walkway system complies with ADAS and CBC, we observed a number of locations with noncompliant running slope, cross slope and level changes. Also observed were a number of wood and metal ramps with noncompliant slopes and handrails. Typical conditions observed at RCCC that are not compliant with ADAS: SLF Intake & Booking, Laundry, Medical & Visiting
 Transaction counters are typically 42-1/2” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Holding cell doors are only 30” wide and provide a 29” clear width when fully open
 Holding cell and dorm dayroom pay telephones are not adjacent to a 30” x 48” clear floor space due to benches or counters located below and/or the volume control buttons are 54” - 56” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Laundry unisex restroom lacks a 60” diameter clear turning space and a 60” clear space adjacent to the toilet, grab bars at the toilet, centerline of toilet is 15” from adjacent bathtub and toilet seat height is 15-1/2”, lavatory apron is 27-3/4” AFF and pipes are not insulated, bottom of reflective surface of mirror is 56” AF and paper towel dispenser is 54” AFF
 Less than 42” clear aisle width in the Laundry storage area where inmates work
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L8S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Fixed examination chairs and tables do not accommodate wheelchair side transfer
 All Attorney Visiting stations have a 28” wide door and have fixed stools and lack a 60” diameter clear maneuvering space, and a 30” w. 27” h. x 19” d. knee space below the counter to allow a wheelchair user to make a front approach
Page 386

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All Social Visiting stations have a fixed stool and lack a 60” diameter clear maneuvering space
Program & Dining Area (Sutter Hall)  Inmate restroom lacks a 60” wide toilet compartment with grab bars to accommodate a wheelchair user, the lavatory apron is all 25-1/2” AFF and the pipes are not insulated, the shower compartment has a 4-1/2” curb and is not a standard 30” x 60” or alternate 36” x 60” roll-in configuration and lacks grab bars and a seat, the bottom of the mirrors is 52” and the paper towel dispenser is 52-1/2” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Hall and Dining Hall drinking fountain only provides a 22” - 23” high knee space, is not in an alcove or outside the path of travel and the spout is 39” - 40” AFF
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 There is not a 30” wide x 48” long clear floor space adjacent to at least one of each type of exercise machine
 Law Library station in the Dining Hall has a fixed stool and lacks a 30” wide x 27” high x 19” deep knee space
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Dining Hall tray slide is 37-1/2” AFF
 Lack of 30” w. x 27” h. x 19” knee space at all Dining Hall tables
Page 390

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Housing Areas  Kinya dorm dayroom restroom has 28” high lavatory aprons, pipes are not insulated, shelves are all 64” AFF, 31” clear space provided in front of toilet, centerline of toilet is 19-1/2” from adjacent wall and toilet compartment door stile width is 16”
 Kinya dorm ambulant toilet compartment only provides a 31” wide door that is not self-closing, the seat height is 15” AFF and the grab bars are only 36” long
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Golden Poppy dorm bathrooms lack any lavatories with 30” wide x 27” high x 19” deep knee space, the lavatory pipes are not insulated, none of the toilet compartments have a 32” wide door, grab bars and are 60” wide and provide a 48” clear space in front of the toilet
Page 392

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Golden Poppy dorm showers lack a seat and grab bars and have a 3-1/2” high curb
 All dorm dayroom showers compartment are not a standard 30” x 60” or alternate 36” x 60” roll-in configuration with grab bars on 2 walls, seat and spray attachment and the floor slopes 4.9%
Page 393

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Dorm bathroom drinking fountains provide a 22” - 23” high knee space, is not in an alcove or outside the path of travel and the spout is 39” - 40” AFF
 Lack of 30” w. x 27” h. x 19” knee space at all dorm dayroom tables
 Door threshold at entrance to Kinya and Camelia dorms is 1-1/2” high
Page 394

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Door thresholds from dayrooms to yards are 1” – 2-1/2” high and the exterior landing at Kinya dorm slopes 12.7%
 Kinya dorm recreation yard cross slope is 3.1% - 4.6% and no picnic tables at any recreation yard with 30” wide x 27” high x 19” deep knee space
Page 395

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA3L9S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No picnic tables at any recreation yard with 30” wide x 27” high x 19” deep knee space
 Much of the recreation yard for Camelia dorm does not provide a stable, firm and slip-resistant surface
Page 396

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All Ramona Hall housing and safety cell doors are only 29” wide, centerline of toilet is 15-1/2” from adjacent wall, combination toilet/lavatory unit lacks knee space at lavatory and drinking fountain bubbler, no clear floor space at desk due to fixed stool and desk only provides 25-1/2” high knee space
 Ramona Hall bathroom door is only 30” wide, the bathtub lacks grab bars and a seat, the toilet lacks grab bars and the seat height is 15-1/2”, neither shower is a standard 30” x 60” or alternate 36” x 60” roll-in shower and both have a 12” high curb at the compartment entrance and the room lacks a 60” diameter clear maneuvering space
Page 397

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Exterior Circulation Route  1” high elevation change at several locations along path of travel to Program Area at relocatables
 There is no accessible route to the portable toilets adjacent to the classrooms and none of the portable toilets is accessible to a wheelchair user
Page 398

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The ramp to Classroom 1 & 2 slopes 19/1%, the handrails circumference exceeds 6-1/4” and lack extensions, the lower landing is only 48” deep and has a ¾” high elevation change
Classrooms 1, 2 & 3  Door threshold at Classroom 1 is 1” high
Page 399

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The threshold from the ramp access at Classroom 3 is 2” high
 Ramp to Classroom 3 slopes 9.5% and lacks handrail extensions at the top and the handrails are not continuous
Page 400

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 None of the tables in Classroom 3 provide a 30” wide x 27” high x 19” deep knee space
 Classroom 3 sink is 38” AFF and lacks knee space
Page 401

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Classroom 3 only has an 18” wide clear width to reach the baking area and all counters are 35-1/2” AFF
CBF  Cell doors are only 27-1/2” wide and provide a 27” clear opening when fully open, combination toilet/lavatory unit lacks knee space at lavatory and drinking fountain bubbler, no clear floor space at desk due to fixed stool and cell lacks 60” diameter clear maneuvering space
Page 402

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Lack of 30” w. x 27” h. x 19” knee space at all dayroom tables
 Lack of cane detectable barrier below dayroom stairs and stairs lack level handrail extensions and have open risers with no contrasting striping at nosing and upper approach
Page 403

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Dayroom sink is 36” AFF and lacks knee space below to allow a wheelchair user to make a front approach
 All dorm dayroom showers compartment are not a standard 30” x 60” or alternate 36” x 60” roll-in configuration with grab bars on 2 walls, seat and spray attachment and the floor slopes 4.9%
Page 404

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No pull up stations are accessible to a wheelchair user since the bars are 61” AFF, which is above accessible reach range
 Yard toilet centerline is 21” from adjacent angled wall and lacks grab bars and 60” clear width to side of lavatory, lavatory lacks knee space and rim height is 35-1/2”
Page 405

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L0S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Law Library lacks clear floor space at station due to fixed stool
 No accessible route to Visiting or Classrooms upstairs (stairs only), handrails lack level extensions, horizontal portion of handrail brackets is less than 1-1/2” below the handrails and upper approach and stair treads lack a contrasting nosing stripe
Page 406

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 None of the 19 Visiting stations provide a 30” x 48” clear floor space due to the fixed stool and the 2 private Visiting room doors also have fixed stools and only have a 27” clear opening when the door is fully open
 2nd floor classrooms lack any stations with a 30” wide x 27” high clear floor space due to the fixed stools and the sink rim height is 36” AFF
Page 407

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 floor classroom door is only 31” wide, toilet lacks grab bars and 60” clear width from adjacent wall to side of lavatory, lavatory centerline is only 14” from adjacent wall, rim height is 36” AFF and only 23” high knee space is provided below, mirror is 58” AFF and shelf is 49” AFF
SBF  Law Library lacks clear floor space at station due to fixed stool
Page 408

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No showers are a standard 30” x 60” or alternate 36” x 60” roll-in shower with spray attachment, folding seat and grab bars
 None of the 19 Visiting stations provide a 30” x 48” clear floor space due to the fixed stool and the top telephone button is 63” AFF
Page 409

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
KBF  Holding cells and Classroom restroom only provide 53” – 57-1/2” clear width between wall and side of lavatory at toilet, side grab bar only projects 48” from rear wall and lavatory only provides 27” high knee space at apron
 Holding tank #1 toilet only provides 36” clear width at toilet, toilet seat height is 15-1/2” AFF, lacks grab bars and bottom of reflective surface of mirror is 55-1/2” AFF
Page 410

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Yard toilet only has 55” clear width from wall to side of toilet, lacks grab bars, lavatory apron only provides 27-1/2” high knee space, bottom of reflective surface of mirror is 43” AFF and drinking fountain does not accommodate inmates who have difficulty bending or stooping
Page 411

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Although a wheelchair seating space is provided in the 100 Pod day room, there is not a 19” deep toe space due to the ½” high metal base plate
 100 Pod day room drinking fountain does not accommodate inmates who have difficulty bending or stooping
Page 412

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 100 Pod accessible toilet side grab bar only projects 48” from rear wall
 100 Pod shower is not a compliant alternate 36” x 60” roll-in shower with spray attachment, folding seat and grab bars are on the wrong walls
Page 413

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 200 Pod, 300 Pod, 400 Pod, 500 Pod and 600 Pod shower is similar to 100 Pod shower but lacks a folding seat
 Barbershop counter is 39” AFF and only 16” deep and is a protruding object, fixed stool encroaches into 60” diameter clear turning space, centerline of sink is only 13-1/2” from side wall and sink lacks insulated pipes and knee space below to allow for a front wheelchair approach
Page 414

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Kitchen inmate restroom toilet centerline is 20” from adjacent wall, only 53-1/2’ is provided from the adjacent wall to the side of the lavatory, the side grab bar only projects 48” from the rear wall, the lavatory apron is only 26-1/2” AFF and the highest operating part of the soap and paper towel dispensers is 51” – 52” AFF
 Kitchen inmate worker tables do not provide a 30” wide x 27” high x 19” deep wheelchair seating space
Page 415

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L1S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Booking  The 4 counters are all 41” AFF and there is no lowered counter for a wheelchair user
 Holding Cells 1 & 2 provide 42-1/2” clear space in front of toilet, toilet lacks grab bars, centerline of toilets is 19-1/2” from adjacent wall and combination unit does not provide knee space at lavatory and drinking fountain bubbler
Page 416

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Holding Cell 3 only provides 32” clear width at toilet, toilet lacks grab bars and seat height is 15-1/2” AFF and combination unit does not provide knee space at lavatory and drinking fountain bubbler
 The mat in front of the fingerprint machine is 1” thick
Page 417

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Medical Screening  Door is only 29-1/2” wide and room lacks 60” diameter clear maneuvering space
 Urinal only projects 13” from wall, rim is 24” AFF, only a 21-1/2” deep clear floor space is provided in front to the lavatory, lavatory is only 14-1/2” deep and pipes are not insulated
Page 418

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The 4 clothing window counters are all 40-1/2” AFF and there is no lowered counter for a wheelchair user
 Changing benches are only 12” deep
Page 419

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 None of the 28 Visiting stations provide a 30” x 48” clear floor space due to the fixed stool and there is only 26-1/2” high knee space provided below the counter
 All 3 attorney rooms lack a 60” diameter clear turning space and a 30” x 48” clear floor space due to the fixed stool
Page 420

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Medical Housing Unit  Hard and soft cells only provide 29” clear width at toilet, toilet lacks grab bars and centerline is 10” from adjacent wall, combination unit does not provide knee space at lavatory and drinking fountain bubbler and door is only 29-1/2” wide
 All of the lavatories only provide a 25” high knee space to the underside of the support beam and the bottom of the reflective surface of the mirror is 42” and the mirrors are tilted away from the user
Page 421

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The restroom has 6 toilets but no 36” wide ambulant toilet with parallel grab bars is provided, there is only 28” clear width between the toilets to reach the accessible toilet, only 40-1/2” clear width is provided at the accessible toilet to the adjacent toilet and the urinal rim is 18” AFF
 The ramp to the shower has a 10.0% slope, is only 37” wide, has a handrail on only one side and the horizontal portion of the handrail bracket is less than 1-1/2” below the handrail
Page 422

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 The open shower is not a standard 30” x 60” or alternate 36” x 60” roll-in configuration with grab bars on 2 walls, seat and spray attachment and the floor slopes 6.0% at the floor drain
 None of the 3 changing seats outside the shower is a minimum of 24” x 48”
Page 423

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Most of the yard is not a stable, firm and slip-resistant surface
 Door to yard has a 1” high vertical threshold, knob hardware, exterior landing with a 6.6% slope and closer projects 5” into door opening and bottom of closer is 76” AFF
Page 424

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
M Dorm  Entry door threshold is 1-3/4” high and vertical
 All of the lavatories only provide a 25-1/2” high knee space to the underside of the support beam, the pipes are not insulated, the floor slopes 7.7% at the floor drain and the mirrors are tilted away from the user
Page 425

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L2S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 There is only 27” clear width between the toilets to reach the accessible toilet, only 35” clear width is provided at the accessible toilet to the adjacent toilet and the urinal rim is 19” AFF
 The ramp to the shower has a 12.2% slope, is only 37” wide, has a handrail on only one side and the horizontal portion of the handrail bracket is less than 1-1/2” below the handrail
Page 426

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
B Barracks (re-entry Dorm)  The exterior landing at the entry slopes 14.2%, has s 40” long bottom landing and lacks handrails and lacks a 24” landing at the strike side of the door
 Counter is 49” AFF
Page 427

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All 12 lavatories have a 24-1/2” high knee space to the bottom of the support beam, the pipes are not insulated and the bottom of the reflective surface of the mirrors is more than 40” AFF and the mirrors tilt away from the user
 The rim at all 3 urinals is 19” AFF and none of the toilets are accessible or provide grab bars
Page 428

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Open shower has a 6” high curb at the entry and lacks a folding seat and grab bars
 Lowest leading edge of security mirror is 69” AFF and projects 16” from wall
Page 429

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
A Barracks  Exterior landing at the entry slopes more than 8.33% and lacks a 24” landing at the strike side of the door
 Running slope at transition from concrete to asphalt paving in yard is 13.7%
Page 430

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
K Barracks  None of the telephones are within reach range as the highest control is 59” AFF and all have 18” long cords
 Both doors to the yard have a 1-1/2” high vertical threshold and a 4-1/2” elevation change at the edge of the stoop
Page 431

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Fishbowl  Adjacent KITE’s box handle is 54-1/2” above walking surface
 Walk from KITE’s box to Fishbowl has 4.6% cross slope
Page 432

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Fishbowl counter is 38” AFF
D Barracks  Entry door threshold is 1” high and vertical
Page 433

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Rim at all 4 urinals is 25” AFF and no toilets are accessible and have grab bars, most likely accessible toilet centerline is 14-1/2” from adjacent wall and only provides 34-1/2” clear width to adjacent toilet
 Walk to yard has 4” vertical elevation change at stoop
Page 434

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 All exterior telephones top button is 56” AFF and have 18” long cord
 Walk to Yard at adjacent gate has 7.1% running slope and 1” vertical lip at the bottom
Page 435

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L3S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Laundry Exchange  Exterior issue counter is 43” AFF
 Threshold at inmate entry door is 1-1/2” high and vertical
Page 436

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmate restroom lacks 60” diameter clear turning radius and has only 42” clear width from wall adjacent to toilet to side of lavatory, toilet lacks grab bars and door is only 32” wide and has knob hardware, lavatory pipes are not insulated and soap and paper towel dispensers are more than 40” AFF
 Sewing machine station is not usable by a wheelchair user since the treadle encroaches on the required knee space
Page 437

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Barbershop and classroom doors have a 1-1/2” high threshold
 Barbershop sink is 36-1/2” AFF and lacks knee space below
 Exterior walks between Laundry and classrooms have cross slopes of 3.7% - 4.8%
Page 438

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Prefabricated ramp to Classrooms 3 & 4 has a 10.3% slope and handrails are 32” above ramp surface and lack horizontal extensions at the top landing and inside handrail is not continuous
 None of the stations in Classroom 3, 4 or 5 provide a 27” high knee space
Page 439

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Ramp to Classroom 5 slopes 18.8%, has handrails that exceed a 6-1/4” outside diameter and lack horizontal extensions, top landing is only 45” x 48” and is 1-1/2” below the floor level and bottom landing does not align with direction of ramp
Page 440

Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Big Yard  No accessible route that is stable, firm and slip-resistant is provided to handball, baseball, horseshoe, picnic and basketball areas or drinking fountain
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 No wheelchair accessible portable toilets are provided
 Inmate worker approach to Kitchen has 7.9% running slope but no handrails
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Exterior Kitchen inmate restroom door landing has 7.0% running slope at entrance, wash sink lacks knee space below and soap and paper towel dispensers are more than 40” AFF
 Exterior Kitchen inmate restroom toilet lacks grab bars, centerline is 151/2” from adjacent wall and toilet paper dispenser is above and behind toilet
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Dining Hall  Entry and exit ramps lack horizontal handrail extensions and edge protection and intermediate landing is only 62” long
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
RBF  Barbershop sink is 36-1/2” AFF and lacks knee space below
 Temporary Holding Cell has combination unit that lacks knee space at lavatory and grab bars at toilet, centerline of toilet is 15-1/2” from adjacent wall, doorway only provides 28” clear opening and only 27-1/2” clear width is provided between fixed bed and toilet
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L4S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Open shower has a 4-1/2” high curb at the entry and the folding seat is not mounted on the compliant wall with respect to the grab bars, and lacks a spray attachment
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S0ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Dorm 11  Toilet lacks grab bars and only provides 29” clear width at rear wall and 45” clear space from rear wall, entrance into toilet is only 20” wide to shelf, centerline of lavatory is only 11” from adjacent wall and provides 17” high knee space
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Dorm 20  Combination unit lacks grab bars at toilet and knee space at lavatory and entrance to toilet is less than 32” clear width
 “Accessible“ door to Yard has 5” vertical elevation change at stoop
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 West and East Yard toilets lack grab bars, enclosure is only 36” wide x 44” long and has a 2-1/2” vertical elevation change at entrance (West yard) and combination unit lacks knee space at lavatory
Main Law Library (Honor Side)  None of the stations provide knee space due to the fixed stool
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Inmate worker restroom has 7” step at entrance, no accessible toilets with grab bars, only 35” clear space in front of toilets to lavatories and lavatories have knob faucets, only provide 28” high knee space at apron and lack insulated pipes
Re-Entry Dorm  None of the stations in Classroom 1 & 2 provide a 27” high knee space
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Sink in Classroom 2 is used by inmates for art classes and lacks a 27” high knee space below and sink height is 36” AFF
 Inmate restroom lacks 60” diameter clear turning space, only provides 34” width at toilet, toilet lacks grab bars, door has knob hardware and only provides 9” strike side clearance on pull side and lavatory only has 22-1/2” high knee space
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Recreation Hall  Entrance door has 1-1/2” high threshold and only 10” strike side clearance at the exterior pull side
 No accessible route is provided to the stage
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
JKF
 North Holding Tank #2 (used as safety cell) restroom has typical combination toilet/lavatory unit that lacks knee space at lavatory and grab bars at toilet and lacks 60” wide clear space at toilet due to fixed restraint bed

The conditions cited above are not intended to be an all-inclusive list of noncompliant conditions; numerous other noncompliant conditions were observed and noted during our site visit.

Other factors that should be considered when reviewing this Report:

Although there are no ADA requirements for the clear vertical height above a bunk bed when a disabled inmate occupies the lower bunk, some cell arrangements provide limited headroom above the lower bunk, resulting in the inability for a wheelchair user to transfer onto and off the bunk from their wheelchair and remain erect. Studies have indicated that a minimum vertical clearance be provided above the top of the mattress to provide adequate space for an adult male to sit upright.

Although the ADA has not yet adopted requirements for examination tables in

medical facilities, the US Access Board has recently proposed guidelines that

address the need for adjustable examination tables that enable disabled patients

to transfer between the table and their wheelchair. More information can be

obtained at http://www.access-board.gov/medical-equipment.htm.

We

recommend that SCSD consider purchase of new medical diagnostic equipment

that complies with the Access Board recommendations.

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Technical Requirements / Standards
28 CFR Part 35 Nondiscrimination on the Basis of Disability in State and Local Government Services; Final Rule, which implements subtitle A of Title II of the ADA, Public Law 101-336, prohibits discrimination on the basis of disability by public entities. Per the preamble to Subpart D – Program Accessibility, Section 35.149 Discrimination Prohibited, this requirement applies to “facilities now in existence, because the cost of retrofitting existing facilities is often prohibitive.” The preamble goes on to note “the regulation makes clear, however, that a public entity is not required to make each of its existing facilities accessible.” The law requires that Public Entities must make all of its programs accessible “except where to do so would result in a fundamental alteration in the nature of the program or in undue financial and administrative burdens.” It does not require that a Public Entity make all of its existing facilities accessible via structural changes where other methods provide accessibility to services, programs and activities of the Public Entity.
Since the Sacramento County Jail is subject to Title II of the ADA, the primary obligation to inmates of the jail (as opposed to employees who are covered under Title I of the ADA) is to provide access to individuals with disabilities to all of its services, programs and activities. This concept was adopted directly from Section 504 of the Rehabilitation Act, which required access to programs and activities that received Federal assistance.
28 CFR 35.150 applies to alteration projects; all alteration projects commenced after July 26, 1992 were to comply with the scoping and technical requirements in force at the time. Modular buildings placed on the RCCC after that date would also have been required to comply with the same requirements. Please refer to the next section for an explanation of these requirements.
1991 ADAAG & 2010 ADAS
The 1991 Americans with Disabilities Act Accessibility Guidelines (ADAAG), published by the U.S. Access Board and adopted as the Americans with Disabilities Act Standards for Accessible Design (ADA Standards) by the USDOJ, was the Federal technical standard applicable when constructing new facilities or altering existing public accommodations to comply with the ADA up until March 15, 2012. The U.S. Department of Justice published new requirements in 2004 that have now been codified as the 2010 Americans with Disabilities Act Standards (ADAS), which replaced the 1991 ADAAG as of March 15, 2012 for Title II entities
However, even in the absence of a technical requirement under ADAAG or ADAS, a public entity must provide access to all of its programs subject to the exceptions described above.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
The 2010 ADAS introduced new scoping requirements that did not appear in the 1991 ADAAG. Specific to Sacramento County Jail, ADAS Section 232 Detention Facilities and Correctional Facilities includes requirements that had no precedent in the 1991 ADAAG, and therefore are not subject to the Safe Harbor provision of ADAS. Refer to Section III General Assumptions Item No. 1 for an explanation of the Safe Harbor provision. As of March 15, 2012, Sacramento County Jail is required to comply with these new scoping provisions for new construction and alteration work subject to the exceptions provided under Title II.
Among these new requirements are:
1. At least 3% of the total number of cells in a facility are required to provide mobility features that comply with ADAS Section 807.2. These features include a 60 inch diameter turning space, accessible bench, clear floor space at the bed for a wheelchair transfer, and accessible toilet and bathing facilities that serve these cells.
2. At least 2% of the total number of cells are required to be equipped with audible emergency alarm systems.
3. Patient bedrooms or cells in infirmaries are required to comply with the percentages listed above, as well as applying to medical isolation cells.
4. Special holding cells are required to provide a minimum of one (1) cell that complies with Section 807.2. Such cells include cells for the purpose of orientation, protective custody, administrative or disciplinary detention or segregation, detoxification or medical isolation.
5. Visiting areas serving accessible cells shall be accessible on both the visitor and inmate side.
California Building Code
The California Building Code (CBC), as opposed to the ADA, which is a civil rights law, is a building code modeled after the International Building Code, which is a “model code”. Building codes such as the CBC do not apply to existing buildings as does the ADA, but only apply when new construction, additions and alteration projects occur. The CBC contains accessibility requirements that were first developed in 1982 and are only applicable in California. Since the CBC requirements pre-date the ADA, the technical and scoping requirements are different than those found in ADAS. In recent years, the differences between the CBC and ADAS have been reduced, but some still remain. The State of California Division of the State Architect is currently attempting to have the CBC certified by the USDOJ as equivalent with the ADA. This has resulted in the current 2013 edition of the CBC being at least as stringent in all respects with ADAS, as well as having more stringent requirements for certain elements such as accessible toilet compartments. The 2016 edition of the CBC becomes
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L5S9ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
effective on January 1, 2017, but there are no code changes that affect the Sacramento County Jail facilities.
Although the CBC does not act as a “trigger” to require barrier removal, its requirements come into play when performing certain types of barrier removal work. As described above, if an element does not comply with ADAS (and does not qualify for the Safe Harbor exemption), then it must be corrected subject to the undue hardship limitation. However, if the CBC has a more stringent requirement than ADAS, then the corrective work must then comply with the CBC.
As described above, some buildings have been remodeled or placed into service since the passage of the ADA, particularly at the RCCC. While these should have fully complied with ADAAG/ADAS and the CBC accessibility requirements in force at the time of building permit submittal, we found that there were several locations where these buildings did not comply, such as at KBF. Additionally, the CBC has contained accessibility requirements since 1982, although its applicability to detention and correction facilities has been a subject of contention for some time. Lastly, as indicated above, Sacramento County is required to comply with Section 504 of the Rehabilitation Act of 1973. Section 504 scoping and technical requirements for accessibility were provided in the Uniform Federal Accessibility Standards (UFAS), first issued in 1984. Although UFAS did not include scoping requirements for detention and correction facilities, it did include most of the same type of requirements for building elements as now found in ADAS and the CBC.
Current ADAS and CBC requirements for Detention & Correction Facilities
If structural changes to existing facilities will be performed, the following is a partial list of scoping and technical requirements that apply to the SCSD detention facilities:
 There must be a minimum of 2 drinking fountains per floor and one must accommodate wheelchair users with a maximum spout height of 36” AFF and another spout at 38” – 43” AFF (ADAS 211.2 & CBC 11B-211.2)
 There must be a minimum of 5% of the total of each type of seating that provides a knee space that allows a wheelchair user to make a front approach (ADAS 226.1 & CBC 11B-226.1)
 Floor and ground surfaces must be stable, firm and slip-resistant (ADAS 302.1 & CBC 11B-302.1)
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Changes in level are not permitted to exceed 1/4” vertical or 1/2” at a
maximum 1:2 bevel (ADAS 303 & CBC 11B-303)  All accessible spaces shall provide a 60” diameter clear maneuvering
space or a T-shaped space per Figure 304.3.2 / 11B-304.3.2 (ADAS 304.3.1 & CBC 11B-304.3.1)
  The bottom of objects along a path of travel must be 80” AFF minimum if
they project more than 4” into the path of travel (ADAS 307.2 & CBC 11B307.2)  27” minimum height cane-detectable railings are required where the vertical clearance below an object is reduced to less than 80” AFF (ADAS 307.4 & CBC 11B-307.4)
  The maximum reach range to an accessible control is 48” AFF (ADAS 308
& CBC 11B-308)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S1ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Walking surfaces shall not exceed 2.08% cross slope and 5.0% running slope unless they provide handrails on both sides and level landings for each 30” of vertical rise (ADAS 403.3 & CBC 11B-403.3)
 The minimum clear width along an accessible route must be 36” (ADAS 403.5.1 & CBC 11B-403.5.1)
 The minimum clear width at a turn must be 42” (ADAS 403.5.2 and CBC 11B-403.5.2)
 Doors must be 36” minimum width and provide a minimum 32” clear width opening when open 90 degrees (ADAS 404.2.3 & CBC 11B-404.2.3)
 Accessible doors (including doors to accessible toilet compartments) must have 18” minimum strike side clearance and 60” deep clearance on the pull side (ADAS 404.2.4.1 & CBC 11B-404.2.4.1)
 Accessible door landings must not exceed 2.08% (1/4”:1’-0”) slope (ADAS 404.2.4.4 & CBC 11B-404.2.4.4)
 Accessible door thresholds must be ½” high maximum and be beveled at a 1:2 maximum slope (ADAS 404.2.5 & CBC 11B-404.2.5)
 Accessible door hardware shall not require tight grasping, pinching or twisting of the wrist and shall be operable with one hand (ADAS 404.2.7 & CBC 11B-404.2.7)
 Door opening force shall not exceed 5 pounds and closing speed shall not be less than 5 seconds from 90 degrees open to within 12 degrees of door latch (ADAS 404.2.8 and CBC 11B-404.2.8 and 11B-404.2.9)
 Ramp slope shall not exceed 8.33% (ADAS 405.2 & CBC 11B-405.2)  Top landings at ramps must be 60” x 60” minimum and bottom landings 72”
minimum in length (ADAS 405.7 & CBC 11B-405.7)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S2ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Ramps must have a curb or barrier with the bottom less than 4” above the ramp surface (ADAS 405.9.2 & CBC 11B-405.9.2)
 Stair nosing must have contrasting stripes (ADAS Advisory 504.4 & CBC 11B-504.4.1)
 Ramp handrails must be 34” minimum - 38” AFF maximum above ramp surface (ADAS 505.4 & CBC 11B-505.4)
 Horizontal portion of handrail brackets shall be 1-1/2” minimum below handrail (ADAS 505.6 & CBC 11B-505.6)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S3ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Ramp handrails must have 12” long level extensions at the top and bottom of ramp runs (ADAS 505.10 & CBC 11B-505.10)
 Accessible drinking fountain spouts must be 36” AFF maximum (ADAS 602.4 & CBC 11B-602.4)
 Accessible drinking fountain spouts must be 5” maximum from the front edge of the fixture (ADAS 602.5 & CBC 11B-602.5)
 All drinking fountains must be located in alcoves or otherwise out of pedestrian way (CBC 11B-602.9)
 Accessible mirrors must have the bottom of the reflective surface at 40” AFF maximum (ADAS 603.3 & CBC 11B-603.3)
 Shelves must be located between 40” - 48” AFF (ADAS 603.4 & CBC 11B-603.4)
 Accessible toilet accessories in sanitary facilities must have the highest operating part at 40” AFF maximum (CBC 11B-603.5)
 Accessible toilets must be located 17” – 18” from the adjacent wall (ADAS 604.2 & CBC 11B-604.2)
 Accessible toilets must have 60” clear width to adjoining obstructions and 48” clear in front of toilet (ADAS 604.3 & CBC 11B-604.3)
 Accessible toilet seats must be 17” – 19” AFF (ADAS 604.4 & CBC 11B604.4)
 Accessible toilets must have a minimum 36” long rear grab bar and a minimum 42” long side grab bar, both mounted 33” – 36” AFF (ADAS 604.5 & CBC 11B-604.5)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S4ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Accessible toilet flush controls must be located on the wide side of the fixture and not require more than 5 pounds of operating force (ADAS 604.6 & CBC 11B-604.6)
 Toilet rooms with 6 or more toilets or combination of toilets and urinals must have an ambulatory toilet with parallel grab bars 35” - 37” apart (ADAS 604.8.2 & CBC 11B-604.8.2)
 Accessible urinal rims must be 17” AFF maximum and the flush controls must be 44” AFF maximum (ADAS 605.2 & CBC 11B-605.2)
 Accessible urinals must be 13-1/2” deep minimum (ADAS 605.2 & CBC 11B-605.2)
 Accessible lavatories must provide a minimum 27” high knee space 8” in from the front of the lavatory and the apron must be 29” minimum AFF (ADAS 606.2 & CBC 11B-606.2)
 Accessible lavatories must be 34” AFF maximum to the rim (ADAS 606.3 & CBC 11B-606.3)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Accessible lavatory controls must not require grasping (ADAS 606.4 & CBC 11B-606.4)
 Accessible lavatory pipes must be insulated (ADAS 606.5 & CBC 11B606.5)
 Roll-in showers must have a minimum 60” wide opening, a 17” – 19” high folding seat with controls on the adjacent wall, grab bars and 60” long spray hose attachment (ADAS 608.2.2 & CBC 11B-608.2.2)
 Roll-in shower thresholds must not exceed ½” high (ADAS 608.7 & CBC 11B-608.7)
 Space between grab bar and objects below must be 1-1/2” minimum (ADAS 609.3 & CBC 11B-609.3)
 Accessible telephones must have an adjacent 30” x 48” clear floor space and minimum 29” long cords (ADAS 704.2.1 & 704.2.4 & CBC 11B704.2.1 & 11B-704.2.4)
 Accessible seating must provide a minimum 30” w. x 27” h. x 19” d. knee space (ADAS 902.4.1 & CBC 11B-902.4.1)
 Dressing and changing benches must be 24” d. x 48” l. minimum (CBC 11B-903.3)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Transaction counters and work surfaces must provide a minimum 36” long section at 28” – 34” AFF and provide a minimum 30” x 48” clear floor space that allows for a front or parallel approach (ADAS 904.4 & CBC 11B-904.4)
 Tray slides at food service lines shall be 28” - 34” AFF (ADAS 904.5.2 & CBC 11B-904.5.2)
 A minimum of one of each type of exercise equipment shall have a 30” wide by 48” long adjacent clear floor space
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

Conclusions and Recommendations

We believe that due to inadequacies with the physical plant at both SCSD

detention facilities, SCSD does not comply with the ADA in providing access to

all programs for inmates with disabilities. The area that presents the most

physical barriers is the MJ. Barriers in this area include lack of accessible cells

with required maneuvering clearances and accessible toilet fixtures, sanitary

facilities and showers and dining/day room seating that does not accommodate

wheelchair users.

It also appears that inmates with disabilities are

underrepresented in the worker population and that an inmate with a disability

would encounter difficulties in many of the RCCC work environments.

An additional problem that was noted was the reported lack of an accessible route to any of the yard areas, which are located midway between the main level and mezzanine level of each housing floor. Access from each level of housing is provided by stairs, which are used able-bodied inmates but do not provide an accessible route for inmates with disabilities. From discussions with staff, we learned that elevator access is provided from the main level at each housing floor, but not all staff was aware of the location of this elevator (Elevator ‘D’). Therefore, this barrier can be removed by informing all staff of the location of the elevator and installing policies to allow inmates with disabilities to use the elevator when they are provided with yard time.

Main Jail
Although the construction of MJ utilizes poured in place concrete for walls, it is possible to alter these structures to create wider openings and walls can be removed to combine multiple smaller rooms into one larger room. This type of alteration can be costly, so use of this alternative should be kept to a minimum and used when placing different classifications of inmates in other more accessible facilities is not feasible.

However, a number of accessibility improvements can be made without these expensive types of projects, including:

 Enlarging a minimum of one shower and/or installing partitions or walls
and installing folding seat, grab bars and shower spray attachment to
create compliant configuration roll-in showers in each area  Replacing combination toilet room fixtures with newer fixtures that provide
the required clearances  Installing or relocating grab bars at toilets  Installing toilet seats to raise the seat height to accessible range  Lowering a minimum of one (1) urinal in toilet rooms to accessible height
in each area  Insulating lavatory pipes  Lowering mirrors

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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L6S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Replacing benches in dressing and shower rooms with accessible size benches with backs or long side against walls
 Replacing a 36” long section of each type of counter with an accessible counter at 28” – 34” AFF
 Removing fixed stools at a minimum of one (1) of each type of visiting or interview room
 Lowering a minimum of one (1) 1 telephone in each area and call buttons so the highest operating part is 48” AFF and replacing cords with minimum 29” long cords
 Rearranging furnishings and equipment to provide a minimum 36” wide clear accessible route and 60” diameter turning space in all rooms and spaces where services, programs and activities occur, especially at medical examination tables
 Where inmates with visual impairments are present, relocate protruding objects out of the circulation path and install cane detectable railing below stairs
The most difficult barrier to correct at the MJ is the lack of any Family or Attorney Visiting Rooms on the main level of each housing floor. Providing elevator access from the main level to the mezzanine level at any of these pods would be problematic, if not impossible. We recommend that SCSD detention facilities explore the possibility of converting cell space into Visiting Rooms on the main level of at least some housing floors.
Rio Cosumnes Correctional Center
As noted elsewhere in this report, some of the barracks housing facilities do provide accessible beds but the sanitary facilities are not designed and constructed to enable ease of use for inmates with disabilities and several building entrances and doors to adjacent yards are not compliant. Part of this condition can be attributed to the age of the buildings, since most were designed prior to the passage of the ADA. The barracks housing units are constructed of concrete masonry and/or wood frame, which is a construction type that is relatively simple and inexpensive to alter compared to the MJ. Replacing plumbing fixtures with compliant accessible fixtures, adding partitions to create compliant roll-in showers, installing grab bars, replacing ramps and exterior door landings are all reasonably inexpensive alterations. Other recommended alterations to improved the level of accessibility in the barracks buildings include:
 Relocate toilets to 17” -18” from adjacent wall and install rear and side grab bars
 Lower a minimum of one (1) urinal so that the rim is 17” AFF maximum and the flush controls are 44” AFF maximum
 Relate / replace a minimum of one (1) lavatory so the rim is 34” AFF maximum, the minimum clear knee height at the apron is 29” AFF and insulate the pipes
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Lower the mirror above the proposed accessible lavatory so the bottom of the reflective surface is 40” AFF maximum
 Install walls/partitions, folding seat, grab bars & shower spray hose and reconfigure shower controls to create a compliant accessible roll-in shower
 Replace ramps and install handrails where running slope exceeds 5.0%  Replace exterior door landings so the threshold height does not exceed ½”
with a 1:2 maximum bevel.
Accessible routes must be provided to all activity areas such as athletic fields and classrooms. Compliant aluminum ramps can replace existing ramps and stairs at modular buildings and are available from a number of manufacturers such as TMP Services (http://www.tmpservices.com/aluminum.aspx).
Seating within dining facilities and housing unit dayrooms is another area where SCSD detention facilities has not provided equal access to inmates with disabilities. Most tables do not provide a knee space that allows a wheelchair user to roll completely under the table and have use of a dining surface equivalent to able-bodied inmates. Replacement tables should be provided or stools should be removed in these spaces so that wheelchair users can dine comfortably with other wheelchair users as well as able-bodied companions. We recommend that dining and dayroom seating should be reconfigured in each area so that wheelchair users are provided with the opportunity to sit with other wheelchair users or able-bodied companions. Removal of fixed stools at a minimum of one (1) Visiting Room in each area would also provide the minimum required quantity of visiting rooms.
RCCC is generally quite accessible due to its level topography. A system of concrete and asphalt pedestrian routes is provided through the facility that experiences a large amount of pedestrian traffic from inmates and staff. Concrete is a far longer-lasting paving material than asphalt or other surfaces and usually provides the greatest degree of accessibility due to its longevity and relative need for maintenance, but is more costly than asphalt. We encountered a number of areas where the running slope and cross slope exceed the maximum allowed by the ADA. Additionally, we observed several where the concrete has moved vertically and level changes along the Path of Travel exceed the maximums allowed by the ADA.
Although the SCSD detention facilities employs a program whereby deputies assist inmates with disabilities in circulating throughout the facility, the ADA encourages independent movement if it is feasible to do so. The alternative system currently employed would only be considered an equivalent alternative to structural barrier removal if a deputy was available at all times to all inmates needing such assistance. Additionally, deputies should receive proper training on how to provide safe assistance to wheelchair users. Therefore, the exterior pedestrian route should be made as compliant as possible. All required
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
emergency exits should also be provided with compliant walks that connect to the pedestrian circulation path to enable these inmates to reach a safe distance away from a building in the event of an emergency. Several features at the SCSD detention facilities can be easily corrected, such as replacement of knob-type door hardware with lever hardware, replacement of non-compliant door thresholds and provision of accessible changing benches. Mirrors can be added or lowered to accessible heights, lavatory pipe insulation can be added, and grab bars can be replaced or relocated; there are a number of newer penal-style toilet fixtures that are now available that were not available when these facilities were originally constructed. High/low drinking fountains can replace existing single-height fixtures and exterior door landings can be replaced. Toilet seats can be installed on existing toilets, depending upon security requirements. These seats are available in 1” – 4” thicknesses to correct existing toilet seat heights as low as 13” AFF. We recommend that these barrier removal efforts be undertaken as soon as possible, especially where it can be demonstrated that the changes will significantly increase the level of accessibility. Some barrier removal will required the services of a licensed architect and structural engineer and will involve additional design study.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Assumptions and Considerations
In performing this survey, there are a number of parameters which are defined to document the application of the requirements of the 1991 ADAAG, 2010 ADAS & CBC. We have divided these assumptions and considerations about the survey into three broad categories: Facility, General, and Technical Assumptions. While some of the General issues may sound very technical, the concepts are important and have general implications.
Facility Assumptions / Considerations
1. Inmate Areas versus Staff Areas –All areas that inmates currently use were surveyed for purposes of identifying and correcting barriers as part of this survey. However, we did not survey staff work stations since they would be included as part of a reasonable accommodation per Title I of the ADA. Areas where inmate workers perform their job duties are not considered staff work areas for the purpose of this study.
2. Shower Spray Attachment –Due to safety concerns, flexible spray attachments at accessible showers may be provided by staff on an asneeded basis when inmates make a request. Spray attachments should be stored close to shower areas, immediately available to staff and in working order at all times.
General Assumptions
1. Safe Harbor Provision - The survey and citations applied are based upon whether a particular element complied with the 1991 ADAAG; if so, then compliance with the 2010 ADAS is not required even if the ADAS is more stringent than the 1991 ADAAG. This is referred to by the United States Department of Justice (USDOJ) as the “Safe Harbor Provision”. However, if an element did not comply with the 1991 ADAAG then it is now required to comply with the 2010 ADAS. One example would be a wall switch or control used by inmates; if the height of such an element was 52” and a front approach is possible, this complies with the 1991 ADAAG and would not be cited. However, if the height of this item was 56”, it would not be in compliance with the 1991 ADAAG and would now have to be lowered to 48” in conformance with the 2010 ADAS.
2. Plumbing Fixture Counts – Some solutions may result in a reduction of the fixture count in a restroom. The SCSD should verify if this is compliant with applicable building codes and operational requirements.
3. No Testing of Hidden Conditions - No testing of operational systems such as fire alarms or review of building, fire or health codes was undertaken as part of this inspection.
4. Visual Fire Alarms – ADAAG require that visual alarms be located 80” above the floor or 6” below the finish ceiling, whichever is lower. We did
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
not perform an inspection of visual alarm device locations as part of our services. We recommend that the SCSD employ the services of a licensed fire protection engineer to survey both Jail facilities to determine if the visual alarms comply in all locations.
5. Drinking Fountains – If a building has multiple drinking fountains within 200 feet of each other and both are accessible to the same inmate population, our recommendation is to make one a wheelchair accessible fixture (36” maximum spout height and knee space below) and one for individuals with difficulty bending or stooping (spout height 38” – 43”) and to provide directional signage indicating the location of the companion fixture. The assumption is that the travel time to go to the other fixture is acceptable accommodation.
6. Braille / tactile exit signage – The 2010 ADAS requires Braille / tactile exit signage where illuminated exit signs are provided at doors. We did not verify if illuminated exit signs are actually required by the building code at any doors; if one was provided we recommend that a Braille / tactile exit sign be provided. Also see Item 5 under Technical Assumptions below.
7. Furnishings, Fixtures & Equipment (F,F & E) – Both the 1991 ADAAG and 2010 ADAS apply to fixed or built-in elements of buildings, structures & site improvements. Therefore, non-fixed elements such as classroom desks would not be covered by technical requirements. However, since the lack of accessibility of these elements can limit or prevent access to programs, activities and services at Sacramento County Jail we strongly urge that these elements be reviewed for compliance with the most relevant technical criteria.
Technical Assumptions:
Detectable Warnings Requirement - Barriers were not cited requiring the use of detectable warnings on curb ramps and other areas as a warning to visually impaired individuals that they are about to enter a hazardous area. Detectable warnings with truncated domes, as specified in the 1991 ADAAG have been controversial due to issues of maintainability, safety for those with various impairments, including vision, and locational requirements. A Joint Final Ruling issued by the USDOJ, the U.S. Access Board and the U.S. Department of Transportation called for temporary suspension of the requirement pending further study until July 26, 2001. The suspension expired and detectable warnings were again made a requirement. However, the 2010 ADAS removed the requirement for detectable warnings so we have opted to apply the most current standard. It is anticipated that the USDOJ will adopt the requirements for detectable warnings for Public Rights-of-Way when the final rule is approved, but detectable warnings will not be required within private or public property. The CBC still requires that a 36” deep band of truncated domes be provided at the
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
bottom of all curb ramps and where a pedestrian way is adjacent to a vehicular way and not separated by a curb.
1. Slip Resistance – ADAS Section 302.1 require floors on accessible routes and accessible room areas to be "slip-resistant". The Access Board recommends a coefficient of friction (COF) of 0.6. Ramps require a higher COF of 0.8.
SCSD detention facilities should be aware that some VCT (vinyl composition tile) and sealed concrete slab floors may not have a Coefficient of Friction (COF) of 0.6, and therefore would not be considered slip-resistant. Floors like polished vinyl are very slippery. Furthermore, water, contaminants and floor treatments lessen slip-resistance from the cited coefficients. Detailed product information is only now being documented and made available. However, the actual testing to determine slip resistance requires expensive equipment and is not easily performed in place. Therefore, testing was not included in the scope of work.
2. Door Closers –the 1991 ADAAG and 2010 ADAS do not have a requirement for maximum opening force for exterior hinged doors. However, most building codes require the maximum opening force to be no greater than 8.5 pounds and the CBC requires that exterior and interior doors along an accessible route not require an opening force exceeding 5 pounds. Although the ADA does not contain a similar requirement, it has been our experience that this requirement is extremely necessary for many individuals to enter a building. It has been our experience that existing door closers can only be adjusted to within approximately 3 pounds of their current operating force. Accordingly, at doors operated by inmates, we recommend replacement of door closers as opposed to simply adjustment where the opening pressure exceeds 5 pounds.
3. Dimensional Tolerances – Section 3.2 of the 1991 ADAAG states that all dimensions are subject to conventional building industry tolerances for field conditions. Although many studies have been performed to determine what are acceptable dimensional tolerances, there are relatively few widely-accepted tolerances. The 2010 ADAS Section 104.1.1 Construction and Manufacturing Tolerances which reads “All dimensions are subject to conventional industry tolerances except where the requirement is stated as a range with specific minimum and maximum end points.” One example would be a toilet centerline dimension from an adjacent wall; whereas the 1991 ADAAG required an absolute 18” dimension and the 2010 ADAS allows a range of 16” – 18”, a toilet located 18-1/2” from the side wall might have been considered within conventional industry tolerances under the old regulations but not the new ones.
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
It should be noted that in the case of new construction, design documents can often lead to dimensions that exceed 1991 ADAAG /2010 ADAS/CBC maximums and minimums, such as a ramp that is designed with a 1:12 slope. The contractor may construct the ramp with a slight field tolerance, which results in a ramp that slightly exceeds the 1:12 slope, which is actually the maximum slope allowed, not a desired slope. Therefore, design documents should specify maximums and minimums where applicable and also allow for field tolerances. Advisory 104.1.1 of the 2010 ADAS states that “recognized tolerances are not intended for design work.” 4. Building, Fire & Health Codes – Our scope of services did not include verifying items such as the required number of exits in a facility and their location, areas of refuge, if visual fire alarms are required or design requirements in areas where food is prepared. We recommend that SCSD detention facilities consult with qualified consultants in each discipline to determine if any barrier removal required by the ADA affects these other code requirements. 5. Call Buttons – Although the ADA nor the CBC include any requirements for call buttons in standard housing cells, SCSD detention facilities might consider inclusion of a system when performing alterations of existing cells and the construction of new housing units. Call buttons are provided in cells so that inmates can contact staff in the event of an emergency. 6. Signage – Section 216.1 of the 2010 ADAS / 11B-216.1 of the 2013 CBC contains an exemption for compliance for signage in detention and correctional facilities that is not located in public use areas. Although the exception is provided, it is our recommendation that compliant tactile and visual signage be provided if possible to ensure program accessibility
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
List of Polices Reviewed
The Assessment Team reviewed the following list of the Sheriff’s Department County of Sacramento Correctional Services Operations Orders and the Correctional Health Services Policies and Procedures. Although the majority of these policies are addressed within this report (based on their applicability to disabled inmates and to the overall assessment), some of the policies listed below were not pertinent to inmates with disabilities. However, the Assessment Team did an exhaustive review of all of the listed policies to be certain.
01/01 Introduction 01/02 Command and Responsibilities 01/03 Employee Conduct 01/04 Employee Assignments, Attendance / Daily Schedules, Time Off,
Time Sheets 01/05 Training Program / Training Requests 01/06 Correctional Services Identification Cards 01/07 Volunteer Program 01/08 Intelligence Unit 01/09 Prisoner and Video Monitoring Requests 01/10 Operational Video System 01/11 Line-Ups 01/12 Concealed Weapon Permits 01/13 Supply Requisition 01/14 Division Safety Program 01/15 Reporting of Incidents and Crimes 01/16 Public Information Plan 01/17 Operations Orders Review and Update 02/01 Use of Force 02/02 Use of Restraint Devices 02/03 Use of Pro-Straint Chair 02/04 Weapons, Tactical Weapons, and Specialized Equipment 02/05 CERT and Cell Extraction Procedures 02/06 Prisoner Searches 02/07 Access to Facilities 02/08 Access to Facilities - Deliveries and Services 02/09 Metal Detector and X-ray Machine Operation 02/10 Key Control and Equipment Issuance 02/11 Communications Equipment 02/12 Transportation of Prisoners 02/13 Inter-Facility Transportation and Court Appearances 02/14 Evidence and Contraband Disposition 02/15 Perimeter Patrols 03/01 Critical Incident Response Plan 03/02 Fire Prevention - Main Jail
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
03/03 Fire Suppression - Main Jail 03/04 Fire Prevention - RCCC 03/05 Fire Suppression - RCCC 03/06 Emergency Systems and Equipment 03/07 Medical Emergencies 03/08 First Aid Kits 03/09 Fights, Riots, Hostage and Minor Disturbances 03/10 Death or Serious Injury of a Prisoner 03/11 Natural Disasters 03/12 Evacuation Plan - Main Jail 03/13 Evacuation Plan - RCCC 03/14 Bomb Threats, Suspicious Items, or Explosions 03/15 Escape Response 03/16 Crimes Occurring Within Correctional Facilities 04/01 Intake, Search, Reception and Holding 04/02 Evidentiary/ Exposure Blood Draws 04/03 Prisoner Clothing, Property, and Funds 04/04 Use of Sobering Cell 04/05 Use of Safety, Segregation, North Holding #2, and Multipurpose
Rooms 04/06 Identification Process 04/07 Dress-In/Dress-Out Procedures 04/08 Prisoner Orientation 04/09 Release Procedures 04/10 Property and Money Return and Release Procedures 04/11 Mass Arrests 04/12 Missing Property and Property Claims 04/13 Housing of Juveniles -Main Jail 05/01 Arrest Types and Bookings 05/02 Cal ID/ ID Hold/ Merging X-Reference Numbers 05/03 Prisoner File System/ Teletypes/Information Requests 05/04 DNA Samples 05/05 Pre-Trial Release Program 05/06 Bail & Surrender 05/07 Sentence Computation 05/08 Work Project Assignment 05/09 Weekenders 05/10 Service of Processes on Prisoners 05/11 Classified Documents 05/12 Archives 06/01 Log Books 06/02 Housing Plan 06/03 Classification Process 06/04 Count and Lockdowns
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

06/05 06/06 06/07 06/08 06/09 06/10 06/11 06/12 06/13 06/14 06/15 06/16 06/17 06/18 06/19 06/20 07/01 07/02 07/03 08/01 08/02 08/03 08/04 08/05 08/06 08/07 08/08 08/09 08/10 08/11 09/01 09/02 09/03 09/04 09/05 09/06 09/07 09/08 09/09 09/10 10/01 10/02 10/03 10/04

Housing Unit Checks Organized Searches in a Housing Unit (SHAKEDOWNS) Processing Prisoners Out of a Housing Unit Court Pull Procedures Prisoner Movement Within a Facility Recreation, Exercise and Showering Laundry, Clothing & Linen Hair Care and Cosmetology Services Telephone/TDD/TTY Equipment Access Interpreter Services Prisoner Correspondence Publications Social and Media Visits Confidential Visits Inmate Workers Court Holding Area and Courtroom Security Inmate Message Requests (KITE’s) Grievances Discipline Plan Inmate Welfare Trust Fund Debits and Credits Inmate Trust Fund Debits and Credits Corrections Cashier Educational Services Commissary Operations Prisoner Services Law Library In-Propria Persona (Pro-Per) Cost Recovery for Housing of Prisoners Jail Industries Religious Services Housing Unit Inspections and Cost Recovery Facility Sanitation and Cleanliness General Waste Disposal Hazardous Materials Controls Infectious Waste Disposal Pest Control Vermin Infestation Smoking Ordinance Maintenance Equipment Accountability Maintenance Requests and Equipment Repair Health Care Services Psychiatric Services Health Care Treatment Access Medical Intake Screening

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

10/05 10/06 10/07 10/08 10/09 10/10 10/11 11/01 11/02 11/03 11/04

Suicide Prevention Program Blood and Body Fluid Exposure Communicable Disease Management Medicine Distribution "Pill Call" Dental Services Health Equipment and Control Health Records Food Services Meal Counts and Services Staff Meals Culinary Equipment Control

1000 1001 1002 1003 1004 1100 1101 1102 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 1116 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126

Department and Division Overview Mission Statement Organizational Chart Staffing Information Program Descriptions Responsible Health Authority Medical Autonomy Administrative Meetings and Reports Quality Improvement Program External Medical Peer Review Policies and Procedures Public Advisory Committee Decision Making - Special Needs Support Services First Aid Kits Access to Diagnostic Services Notification of Next of Kin Medical Review of In-Custody Deaths Medical Research Inmate Workers Utilization of Volunteers Direct Orders Health Care Philosophy Female Reproductive Services Individualized Treatment Plans Continuity of Care Health Promotion and Disease Prevention Hospital Care Exercising Personal Hygiene Prosthesis Health Care Maintenance

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
1127 Notification of Inmate Death or Impending Death 1128 Reading Glasses for Inmates 1129 ICE Detainee Procedural Considerations 1130 Transfer Medications 1302 Staff Development and Training 1303 Basic Training for Correctional Personnel 1304 Medication Administration Training 1305 Licensure 1306 Credentialing and Privileging-Adult Medical 1306.1 Credentialing and Privileging-Adult Mental Health 1307 Medical Assistant – Scope of Practice 1400 Medical Transportation 1401 Transfer of Patients with Acute Illnesses 1403 Emergency Services 1404 Receiving Screening 1405 Detoxification – Management of Intoxicated Patients 1406 Heroin Detoxification – Intake Protocol 1407 Access to Treatment 1409 Clinic Care – Sick Call 1410 Medical Services Provided in the Medical Housing Unit 1411 Mental Health Services 1412 Suicide Prevention – 2M – Joint Policy with JPS 1413 Use of Restraints and the Pro-Straint Chair 1414 Restraint Check Method 1415 Patients in Safety Cells 1416 Patients in Segregation 1417 Adult Developmental Disability 1418 Health Inventory and Communicable Disease Screening 1419 Chemically Dependent Patients 1420 Court Orders 1421 Hunger Strike 1422 Special Needs Patients 1423 Post Release Medical Care Planning 1424 Sexual Assault 1425 Patients in Segregation Cells in Intake 1426 Incident Reporting 1427 Pregnant Diabetics 1428 Management and Removal of Taser Probes 1429 Emergency Response 1430 Hyperthermia 1431 Footwear in the Jails 1433 Admission to Jail Acute Psychiatric Inpatient Unit 1434 Evaluation and Care of Inmates Subject to Disciplinary Diet 1435 Inmate Health Care Grievances
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
1436 Two East Inmate Transfers 1437 Bedtime Snack (HS Snack) 1438 Advanced Directives / DNR 1439 Reports of Disabilities or Impairments 1440 Emergency Mode 1600 Management of Pharmaceuticals 1601 Medication Administration 1604 Over-the-Counter Medications 1605 Over-the-Counter – indigent Patient 1700 Communicable Disease Plan 1701 Diseases and Conditions Reportable to Public Health 1702 Communicable Disease Outbreak Investigation 1703 Employees with Communicable Infections 1704 Immunocompromised Patients 1705 Transport of Patients with Communicable Infection 1706 Transmission Based Isolation 1707 Blood-borne Pathogen Exposure Control Plan 1708 Standard Precautions 1709 First Aid Following Exposure to Blood and/or Body Fluids 1710 Care of Respiratory Therapy Equipment 1711 Cleaning and Disinfection of Hand or Foot Care Instruments 1712 Handwashing 1713 Disposal of Used Needles and Syringes 1714 Personal Protective Equipment 1715 Tube and Draining Wound Care 1716 Use of Sterile Disposable Items 1717 Microbiological Cultures of the Environment and Personnel 1718 Waste Management Policy 1719 Airborne Pathogen Exposure Control Plan 1719.1 Employees with Unprotected Exposure to Patients with TB 1720 Respiratory Isolation 1721 Varicella Zoster 1724 Pertussis 1725 Rubella Infection 1726 Rubeola Infection 1727 Amebiasis 1728 MRSA Infections 1729 Conjunctivitis 1730 Coxsackie Virus 1731 Gastroenteritis (Viral) 1731.1 Gastroenteritis (Bacterial) 1732 Influenza Vaccine 1733 Meningitis 1736 Streptococcal (Group A) Infections
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016

1737 1738 1739 1740 1741 1800 1801 1802 1803 1900 1901 1902 1903 1904 2000 2100 2101 2300 2301 2302

West Nile Virus Ecto-Parasites Pediculosis Infestation Scabies Infestation Hepatitis C Collection of Forensic Evidence Informed Consent Body Cavity Searches DNA Procedure at MJ and RCCC Health Records Format and Contents Confidentiality of the Health Record Transfer of Health Records and Information Records Retention Modifications to Medical Records Dental Care Tear Gas Usage Disaster Plan Food Service Inmate Medical Clearance for Food Handling Health and Hygiene Requirements – Food Service Workers

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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
List of Forms, Notices and Documents Reviewed
The Assessment Team conducted an exhaustive review of the following SCSD detention facilities forms, notices and documents as part of the assessment. Some of the items listed below are mentioned throughout the report as related to the review. Many of the forms, notices and documents reviewed were applicable to inmates with mobility disabilities and/or were relevant to the overall assessment, while others were found not to be pertinent.
 Agreement to Appear  Authorization for Release of Medical /Health Information  Classification Checklist - ICE Detainees  Classification PF4  County Jail Message Request  Correctional Health Services Special Medical Intake  Correctional Health Services Special Needs Form  Correctional Services Inmate/Detainee Handbook  Correctional Services Property and Clothing Record  Community Resource Guide  EGACE Registration Form  EGUSD General Rules  EGUSD Orientation Sign-up  EGUSD Student Interest Form  Foreign Warrant Arrests/Defendant's Rights  HALT/RSAT Program Information  Health Services KITE  ICE Classification Worksheet  ICE Physical Examination/Health Appraisal  Inmate Booking Information Receipt  Inmate Information Request  Inmate Reclassification Notice  Inmate Rule Code Violation Schedule  Inmate/Detainee PREA Attestation Form  Intake Screening Form JPS Clinical Assessment  Jail Psychiatric Services Outpatient Referral  JBCT Group Schedule  JPS Frequency of Services  Main Jail Division COMPAS Classification Housing Plan  Main Jail Division Intake Classification  Main Jail Division Request for Reclassification  Main Jail Division Classification Worksheet  Outdoor Recreation Schedules  Personal Jewelry Waiver and Release of Liability
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
 Property Receipt Report  RCCC Classification Worksheet  RCCC Detainee Orientation  RCCC Master Schedule  Reentry Client Admit Data Sheet  Reading Glasses Policy  Reentry Services  Reinstatement of Probation  Release from Custody Information  Release Screening Form  Reply to Inmate Grievance Suggestion
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AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
Abbreviations and Acronyms Used
AA – Alcoholics Anonymous AB – Assembly Bill ABE – Adult Basic Education AD - Assistive Device ADA – Americans with Disabilities Act ADAAG – Americans with Disabilities Act Accessibility Guidelines ADAS – Americans with Disabilities Act Standards ADL- Assistance with Daily Living ADSEG – Administrative Segregation AFF – Above Finished Floor ASL – American Sign Language BiPAP – Bilevel Positive Airway pressure BPH – Board of Parole Hearings BTBL – State of California Braille and Talking Book Library CAFM – County Automated Facility Maintenance CASAS – Comprehensive Adult Student Assessment System CASE – Clark Adaptive Support Evaluation CBC – California Building Code CBF – Christopher Boone Facility CBJT – Competency Based Jail Treatment CCR – California Code of Regulations CDC – California Department of Corrections CDCR – California Department of Corrections and Rehabilitation CDO – Chief Disciplinary Officer (CDCR) CENAPS –Center of Applied Sciences CERT – Custody Emergency Response Team CHS – Correctional Health Services CIT – Crisis Intervention Team (training) CJ – County Jail COF – Coefficient of Friction
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L8S5ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
COPD – Chronic Obstructive Pulmonary Disease CPAP – Continuous Positive Airway pressure CBF –Christopher Boone Facility CPR – Cardiopulmonary Resuscitation CPS – Child Protective Services DD – Disciplinary Detention DDP – Developmental Disability Program (CDCR) DD1 – No acronym (code means mild intellectual disabled CDCR inmate with
mild cognitive deficits/adaptive supports DD2 – No acronym (code means moderate intellectual disabled CDCR inmate
with moderate cognitive deficits/adaptive support needs, and/or victimizations concerns DD3 – No acronym (code means severe intellectual disabled CDCR inmate with severe cognitive deficits/adaptive support needs, and/or victimization concerns DME – Durable Medical Equipment DPH – No acronym (code means permanent deaf/hearing impaired CDCR inmate) DPM – No acronym (code means permanent mobility impaired CDCR inmate, non-wheelchair user) DPO – No acronym (code means intermittent CDCR wheelchair user) DPP – Disability Placement Program (CDCR) DPV – No acronym (code means permanent vision impaired CDCR inmate) DPW – No acronym (code means permanent full-time CDCR inmate wheelchair user) DVHU – Domestic Violence Housing Unit EC – Effective Communication EGACE – Elk Grove Adult and Community Education EGUSD – Elk Grove Unified School District EKG – Electrocardiogram ELA – English Language Arts EMR – Electronic Medical Record ESL – English Second Language FAF – Facility and Fleet (Maintenance)
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L8S6ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
FATRNS – Inter-Facility Transfers FOSS – Frequency of Services Scale GED – General Educational Development GP – General Population H – High HALT – Housing for Accountable Living Transitions (Substance Abuse
Treatment) HCA – Health Care Appliance HCSD – Health Care Services Division (CDCR) HiSET – High School Equivalency Test HF – Honor Facility HMU – Health Management Unit HS – Health Services ICE – Immigration and Customs Enforcement ID – Identification IDEF – Inmate Disability Identification Form IE – Investigative Employee (CDCR) IEP – Individual Education Plan IMAP – Incarcerated Men’s Accountability Program IQ – Intelligence Quotient IWF – Inmate Welfare Fund JBCT – Jail Based Competency Treatment JIMS –Jail Inmate Management System JKF – Joseph Kievernagel Facility JPS – Jail Psychiatric Services KBF – Kevin Blount Facility L – Low LB/LT – Lower bunk/Lower Tier LCSW – Licensed Clinical Social Worker LPS – Lanterman-Petris-Short LVN – Licensed Vocational Nurse
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L8S7ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
M – Medium MD – Medical Doctor M Dorm – Medical Dorm MFT – Marriage and Family Therapist MH – Mental Health MHU – Medical Housing Unit MJ – Main Jail MOCA – Montreal Cognitive Assessment MS – Medium Security NA – Narcotics Anonymous NCCT – Northern California Construction Training NP – Nurse Practitioner OPP – Outpatient Psychiatry PA – Public Address PC – Protective Custody PDQ – Position Description Questionnaire PHH – Personal Health History POHR – Problem Oriented Health Record POST – Peace Officer Standards and Training PPD – Purified Protein Derivative PREA - Prison Rape Elimination Act QUEST – Question, Understand, Evaluate, Succeed, Transform (in-custody gang
diversion program) RBF – Roger Bauman Facility RC – Reception Center RCCC – Rio Cosumnes Correctional Center REACT (Belt) – Remote Electronically Activated Control Technology RMS – Records Management System RN – Registered Nurse ROC – Restoration of Competency RSAT – Residential Substance Abuse treatment
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Case 2:18-cv-02081S-HTELRNIF-FK’SJDNEPADRToMcEuNmT CeOnUt N1T-Y5OFFSAileCRdA0M7E/N3T1O/1CO8RREPCaTgIOeNA4L8S8ERoVfIC4E8S8
AMERICAN WITH DISABILITIES ACT ASSESSMENT DECEMBER 22, 2016
SA – Staff Assistant (CDCR) SBF – Stewart Baird Facility SCGS- Sacramento County General Services SCSD – Sacramento County Sheriff’s Department SCMHC – Sacramento County Mental Health Center SLI – Sign Language interpreter SLF – Sandra Larson Facility SMI – Serious Mental Illness SMU – Special Management Unit SOAP – Subjective Objective Assessment Plan SOB – Shortness of Breath SRN – Senior Registered Nurse SVPA – Sexually Violent Predator Act SWP – Sheriff’s Work Project TDD – Telecommunications device for the Deaf TSEP – Total Separation TST – Tuberculin Skin Test TTY – Tele-Typewriter UCD – University of California, Davis UFAS – Uniform Federal Accessibility Standards US – United States USDOJ – United States Department of Justice VCT – Vinyl Composition Tile WebJPF – Web based Jail Person File W&I – Welfare and Institutions XREF – X Reference (inmate jail number)
Page 485

 
 Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 1 of 75
REPORT ON SUICIDE PREVENTION PRACTICES WITHIN THE SACRAMENTO COUNTY JAIL SYSTEM Sac ame , Calif ia
b
Lind a M. Ha e
40 La e La e Ma field, MA 02048
(508) 337-8806 e-mail: Lha e a@m .c m
N embe 22, 2016
CONFIDENTIAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 2 of 75 2

TABLE OF CONTENTS
A. In rod c ion
B. Q alifica ion
C. Finding and Recommenda ion
1) S aff Training 2) Iden ifica ion/Screening/A e men 3) Comm nica ion 4) Ho ing 5) Le el of S per i ion/Managemen 6) In er en ion 7) Repor ing 8) Follo - p/Mor ali -Morbidi Re ie
D. S mmar of Recommenda ion
E. Concl ion
Appendice

3-5
..6-7
.......8-9
..10-15 16-25 ..26-27 28-37 ..38-51 .52-53
..54 ...55-59
60-66
....67

CONFIDENTAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 3 of 75 3
REPORT ON SUICIDE PREVENTION PRACTICES WITHIN THE SACRAMENTO COUNTY JAIL SYSTEM Sac ame , Calif ia
A. INTRODUCTION

The f ll i g i a mma f he b e a i , fi di g , a d ec mme da i f

Li d a M. Ha e f ll i g a a e me f icide e e i ac ice i hi he Sac ame

C

Jail S em e a ed b he Sac ame C

She iff De a me i Sac ame ,

Calif ia. Al h gh he Sac ame C Jail S em ha had a ela i el l a e f icide

d i g he a e e al ea ( ee bel ), i ligh f a 2015 i e iga i e e b Di abili Righ

Calif ia i he me al heal h ea me f i ma e i h di abili ie i he Sac ame C

Jail S em,1 he C

C el Office f Sac ame C

e e ed hi i e e ice

i de e de l a e c e icide e e i ac ice , a ell a ffe a a

ia e

ec mme da i

he e i i f icide e e i licie a d ced e .

I c d c i g he a e me , hi i e me i h a d/ i e ie ed me

c ec i al, medical, a d me al heal h fficial a d aff f m he Sac ame C She iff

De a me (SCSD), C ec i al Heal h Se ice (CHS), a d Jail P chia ic Se ice (JPS);2

e ie ed me

licie a d ced e ela ed icide e e i , c ee i g/a e me

c l , a d ai i g ma e ial ; e ie ed a i medical cha , i cide e , a d a ailable

i e iga i e e ie f h ee (3) i ma e icide be ee 2014 a d 2016, a ell a a e i

icide a em i Oc be 2016; e ie ed a i medical cha f i ma e

icide

1See R

I

S

C J , Oc be 15, 2015,

.di abili igh ca. g/ b /702701. df

2Medical e ice a e ided i ma e b he SCSD C ec i al Heal h Se ice di i i , he ea me al

heal h e ice a e ided i ma e b Jail P chia ic Se ice h gh a c ac al ag eeme i h he

U i e i f Calif ia-Da i .

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Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 4 of 75 4
eca i d i g he - i e a e me ; a d ed b h he Sac ame C Mai Jail a d Ri C m e C ec i al Ce e (RCCC). The - i e a e me a c d c ed Se embe 19 h Se embe 23, 2016.3

A f N embe 3, 2016, he Sac ame C Mai Jail had a ea l a e age dail

la i f 2,083 i ma e , he ea he Ri C m e C ec i al Ce e a e aged 1,822

i ma e . C mbi ed, he jail facili ie held a ima el 3,905 i ma e , maki g he

Sac ame C

Jail S em e f he la ge i Calif ia a d am g he 15 h la ge c

jail em i he U i ed S a e . A h b Table 1, he Sac ame C Jail S em had

h ee (3) i ma e icide d i g he 6- ea e i d f 2011 h gh N embe 2016, all cc i g

a he Mai Jail. Ba ed

he a e age dail

la i d i g hi ame ime e i d, he icide

a e i hi he Sac ame C Jail S em a 12.3 dea h e 100,000 i ma e -- a a e ha

i b a iall l e ha ha f c

jail f a i g i e h gh he U i ed S a e .4 The

icide a e a he Mai Jail d i g hi ime e i d a 23.8 dea h e 100,000 i ma e (al a

e l icide a e), he ea he Ri C m e C ec i al Ce e did ha e a icide

d i g hi 6- ea ime e i d, b ai ed a e e i icide a em i Oc be 2016.

TABLE 1

3I i im a

e ha , i h he e ce i f he i ma e icide i 2014-2015, he a e me e c m a ed

e ie f icide e e i ac ice

i e a i i hi he Sac ame C Jail S em a f

Se embe -Oc be 2016, a d did i cl de e ie f ac ice i ha da e.

4Acc di g He , M. (2016), Dea h : Leadi g Ca e f 2013, N

V S

R , 65 (2),

H a ille, MD: Na i al Ce e f Heal h S a i ic , he icide a e i he ge e al la i i a ima el 13

dea h e 100,000 ci i e . Acc di g he m ece da a jail icide, he icide a e i c jail

h gh he c

i a ima el 46 e 100,000 i ma e , N a , M., R hl ff, H. a d Gi de , S. (2015),

M

L J

S P , 2000-2013 - S

T , Wa hi g , DC: B ea f J ice

S a i ic , U.S. De a me f J ice, Office f J ice P g am .

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Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 5 of 75 5

AVERAGE DAILY POPULATION, YEARLY ADMISSIONS, SUICIDES, AND SUICIDE RATE
WITHIN THE SACRAMENTO COUNTY JAIL SYSTEM 2011 THRU 2016*

Year 2011

ADP 4,019

Yearl Admi ion 50,846

S icide 0

S icide Ra e5 0

2012

4,053

47,679

0

0

2013

4,155

49,101

0

0

2014

4,279

51,485

1

23.3

2015

4,047

44,946

1

24.7

2016 (N ) 3,905

30,745

1

25.6

_____________________________________________________________________________

2011-2016 (N ) 24,458

274,802

3

12.3

*S ce: Sac ame C She iff De a me

5The jail icide a e i calc la ed b di idi g he mbe f icide b he ADP a d he m l i l i g a mbe b 100,000.
CONFIDENTAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 6 of 75 6

B. QUALIFICATIONS

Thi i e i a P jec Di ec f he Na i al Ce e I i i a d Al e a i e ,

i h a ffice i Ma field, Ma ach e . Thi i e i a i all ec g i ed a a e e i

he field f icide e e i i hi jail , i a d j e ile facili ie , a d ha bee a i ed

a a Fede al C M i (a d e e

ecial ma e /m i ) i he m i i g f icide

e e i ac ice i e e al ad l a d j e ile c ec i al em de c j i dic i .

Thi i e ha al e ed a a icide e e i c l a he U.S. J ice De a me

Ci il Righ Di i i (S ecial Li iga i Sec i ) a d elec i el f he Office f Ci il Righ

a d Ci il Libe ie f he U.S. De a me f H mela d Sec i (Immig a i a d C m

E f ceme ) i hei i e iga i f c di i f c fi eme i b h ad l a d j e ile

c ec i al facili ie h gh he c . Thi i e al e e a a e e

i e /c l a i i ma e icide li iga i ca e , a ell a e i g a a ech ical a i a ce

c l a /e e b c d c i g ai i g emi a a d a e i g i ma e a d j e ile icide

e e i ac ice i a i a e a d l cal j i dic i h gh he c .

Thi i e ha c d c ed he l fi e a i al die f jail, i , a d j e ile icide

(A D

C I ...N

S

J S

i 1981, N

S

J S

:

S

L i 1988, P S : A O

G

P

i 1995, J

S

C

: A N

S i 2004, a d N

S

J S : 20

L i 2010). The jail a d i icide die e e c d c ed h gh c ac i h he

Na i al I i e f C ec i (NIC), U.S. J ice De a me ; he ea he fi a i al d

f j e ile icide i c fi eme a c d c ed h gh a c ac i h he Office f J e ile

J ice a d Deli e c P e e i , U.S. J ice De a me .

CONFIDENTAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 7 of 75 7

Thi i e e ed a edi / jec di ec f he J S /M H U , a

a e l e le e de ed e ea ch, ai i g, e e i , a d li iga i ha a f ded b

NIC f m 1986 h 2008; a d a a c l i g edi a d edi ial b a d membe f S

L -T

B

, he fficial cie ific j al f he Ame ica A cia i f

S icid l g , a ell a c e edi ial b a d membe f C : T J

C

I

S

P

, he fficial cie ific j al f he I e a i al A cia i

f S icide P e e i . Thi i e ha a h ed e 70 blica i i he a ea f icide

e e i i hi jail, i a d j e ile facili ie , i cl di g m del ai i g c ic la b h

ad l i ma e a d j e ile icide e e i . Thi i e T

C

P

G

S

D

P

J

D

/C

F

R

P

: I

M

a elea ed i A il 2013; he ea he T

C

P

G

S

D

P

J

P F

:

I

M

a elea ed i Ma ch 2016.

A a e l f e ea ch, ech ical a i a ce, a d e e i e c l a k i he a ea

f icide e e i i c ec i al facili ie , hi i e ha e ie ed a d/ e ami ed e 3,500

ca e f icide i jail, i , a d j e ile facili ie h gh he c

d i g he a 37

ea . Thi i e a a a eci ie f he Na i al C mmi i C ec i al Heal h Ca e

A a d f E celle ce f

a di g c ib i i he field f icide e e i i c ec i al

facili ie . Thi i e

k ha bee ci ed i he icide e e i ec i f a i a e a d

a i al c ec i al heal h ca e a da d , a ell a me

icide e e i ai i g

c ic la. Thi i e c ic l m i ae i a ached i he A e dice .

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C. FINDINGS AND RECOMMENDATIONS

De ailed bel i hi i e a e me f icide e e i ac ice i hi he

Sac ame C

Jail S em. I i f ma ed acc di g hi i e eigh (8) c i ical

c m e f a icide e e i lic : aff ai i g, ide ifica i / c ee i g, c mm ica i ,

h i g, le el f e i i /ma ageme , i e e i , e i g, a d f ll - /m ali -

m bidi e ie . Thi

c l a e i l de el ed b hi i e a d i c i e i h

a i al c ec i al a da d , i cl di g h e f he Ame ica C ec i al A cia i

P

-B S

AL D

F

(2004); S a da d J-G-05 f he

Na i al C mmi i C ec i al Heal h Ca e S

H S

J (2014);

S icide P e e i a d I e e i S a da d f he U.S. De a me f H mela d Sec i

O

M

ICE P

-B N

D

S

(2011),6 Calif ia

B a d f S a e a d C mm i C ec i M

S

L D

F

(2012) a li ed i Ti le 15 a d 24, Calif ia C de f Reg la i ,7 a d 312: S icide

P e e i ec i f he Calif ia I i e f Medical Q ali H C A

S

A D

F

(2013).8 Whe e i dica ed, ec mme da i a e al

ided.

6Ame ica C ec i al A cia i (2004), P

-B S

AL D

F

, 4h

Edi i , La ham, MD: A h ; Na i al C mmi i C ec i al Heal h Ca e (2008), S

H

S

J , 8 h Edi i , Chicag , IL: A h ; a d U.S. De a me f H mela d Sec i (2011), Immig a i

a d C m E f ceme , O

M ICE P

-B N

D

S

, Wa hi g ,

DC: A h .

7I h ld be ed ha Ti le 15 i

e hel f l i li i g ecific c m e

a icide e e i lic ,

im l e i i g j i dic i

adhe e he f ll i g i i Sec i 1219: The facili admi i a a d he

heal h a h i hall de el a i e la f a icide e e i

g am de ig ed ide if , m i , a d

ide ea me h e i ma e h e e a icide i k.

8Calif ia I i e f Medical Q ali (2013), H C A

S

A D

F

,

Sa F a ci c , CA: A h . U f a el , he I i e f Medical Q ali

icide e e i a da d im l

a a h a e Ti le 15 e i eme .

CONFIDENTAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 9 of 75 9

Fi all , hi i e e ie ed a i Sac ame C

She iff De a me ,

C ec i al Heal h Se ice , a d Jail P chia ic Se ice licie , i cl di g:

Sac ame C She iff De a me O e a i O de

x 3/07-Medical Eme ge cie ; x 3/08-Fi -Aid Ki /T a ma Bag ; x 4/05-U e f Safe Cell / Seg ega i x 6/05-H i g U i Check ; x 10/02-P chia ic Se ice ; x 10/04-Medical I ake Sc ee i g; x 10/05-S icide P e e i P g am;

Cell /M l i

e R m /N h H ldi g #2;

C ec i al Heal h Se ice , Admi i a i e P licie

x 1404-Recei i g Sc ee i g; x 1411-Me al Heal h Se ice ; x 1412-S icide P e e i 2M-J i P lic ; x 1415-Pa ie i Safe Cell ; x 1433-Limi a i f Admi i i Jail Ac e P chia ic I -Pa ie U i ;

Jail P chia ic Se ice P licie :

x 1006-I cide Re i g;

x 1009-S icide P eca i : Ac e I -Pa ie U i ;

x 1010-Safe S i P ced e f I ma e-Pa ie

Ac e I a ie U i ;

x 1022-O e ie f S aff Re ibili ie : O -Pa ie De a me ;

x 1029-O -Pa ie De a me T iage;

x 1033-2M S icidal Pa ie ;

x 1049-S icide P e e i P g am.

CONFIDENTAL AND PRIVILEGED ATTORNEY WORK PRODUCT: EXPERT REPORT ON SUICIDE PREVENTION PRACTICES

Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 10 of 75 10

1) S aff Training

All correc ional, medical, and men al heal h aff ho ld recei e

eigh (8) ho r of ini ial icide pre en ion raining, follo ed b

o (2) ho r of ann al raining. A a minim m, raining ho ld

incl de g iding principle o icide pre en ion, a oiding

nega i e a i de o icide pre en ion, inma e icide

re earch, h correc ional en ironmen are cond ci e o

icidal beha ior, po en ial predi po ing fac or o icide,

high-ri k icide period , arning ign and mp om ,

iden if ing icidal inma e de pi e he denial of ri k,

componen of he agenc

icide pre en ion polic , and

liabili i e a ocia ed i h inma e icide.

The ke a icide e e i g am i e l ai ed c ec i al aff, h f m

he backb e f a c ec i al em. Ve fe icide a e ac all e e ed b me al

heal h, medical he fe i al aff. Beca e i ma e a em icide i hei h i g i ,

f e d i g la e af e

e e i g, a ell a

eeke d , he a e ge e all ide he

ie f g am aff. The ef e, he e i cide m be h a ed b c ec i al aff h

ha e bee ai ed i icide e e i a d a e able dem a e a i i i e e e ega di g

he i ma e de hei ca e. Sim l a ed, c ec i al ffice a e f e he l aff a ailable

24 h a da ; h he f m he f li e f defe e i icide e e i .

B h he Ame ica C ec i al A cia i (ACA) a d Na i al C mmi i

C ec i al Heal h Ca e (NCCHC) a da d e he im a ce f ai i g a a c i ical

c m e a icide e e i

g am. ACA S a da d 4-ALDF-7B-10 e i e ha all

c ec i al aff ecei e b h i i ial a d a al ai i g i he ig f icide i k a d icide

eca i ; hile S a da d 4-ALDF-4C-32 e i e ha aff be ai ed i he im leme a i

f he icide e e i g am. A e ed i NCCHC S a da d J-G-05 -- All aff membe

h k i h i ma e a e ai ed ec g i e e bal a d beha i al c e ha i dica e e ial

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Case 2:18-at-01259 Document 1-4 Filed 07/31/18 Page 11 of 75 11

icide, a d h

e da

ia el . I i ial a d a lea bie ial ai i g a e ided,

al h gh a al ai i g i highl ec mme ded. Fi all , he U.S. De a me f H mela d

Sec i O

M ICE P

-B N

D

S

e i e ha all

aff ecei e b h e- e ice a d a al ai i g i he f ll i g a ea : ec g i i g e bal a d

beha i al c e ha i dica e e ial icide; dem g a hic, c l al, a d eci i a i g fac f

icidal beha i ; e di g icidal a d de e ed de ai ee ; effec i e c mm ica i be ee

c ec i al a d heal h ca e e el; ece a efe al ced e ; c a b e a i a d

icide- a ch ced e ; f ll - m i i g f de ai ee h ha e al ead a em ed icide;

a d e i g a d i e d c me a i ced e .

FINDINGS: Ti le 15 e i e ha all e l hi ed c ec i al ffice

ki g i

Calif ia c jail c m le e a 176-h Ad l C ec i Office C e C e i hi e

ea f em l me . The c e c e i cl de 4-h i c i

S icide I e . Nei he he

Sac ame C She iff De a me (SCSD) S icide P e e i P g am lic (N .

10/5) Jail P chia ic Se ice (JPS) S icide P e e i P g am lic (N . 1049)

ided ade a e de c i i

he icide e e i ai i g e i eme f c d ,

medical, a d me al heal h e el, i h he SCSD lic im l a i g ha JPS aff ill

ide ai i g ega di g icide e e i c d aff a lea a all , i addi i i -

e ice ffice ai i g.

D e he ag e la g age c ai ed i hi he e age c di ec i e , hi i e c fe ed i h e e al c d a d me al heal h fficial e ible f he i i f icide e e i ai i g i hi he SCSD, a ell a e ie ed a i ai i g c ic la. The e ie f d ha ,
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i ac ice, he SCSD e a ed i

T ai i g Academ a d c d c ed a 23- eek pre- er ice

i c i al c e all e la e f ceme /jail de em l ee . The c e i cl ded a a e

C mmi i

Peace Office S a da d a d T ai i g (POST) c e e i led Pe le i h

Di abili ie (Lea i g D mai 37). Thi c e had a e limi ed di c i

icide

e e i . H e e , immedia el af e c m le i f he mai T ai i g Academ , jail de ie

e e e i ed c m le e a 66-h Jail O e a i c e ha i cl ded he 4-h i c i

S icide I e (M d le 15.3). Thi i e e ie ed M d le 15.3 a d f d i be ade a e.

Medical a d me al heal h e el e e e i ed c m le e hi e- e ice ai i g

c e, a he e- e ice ai i g ela ed icide e e i .

I addi i , he SCSD bega ffe i g C i i I e e i Team (CIT) ai i g i Feb a

2014. CIT i a a i all -k

g am m del f c mm i lici g ha b i g ge he la

e f ceme , me al heal h ide , h i al eme ge c de a me a d i di id al i h

me al ill e a d hei familie im e e e e le i c i i . CIT g am e ha ce

c mm ica i , ide if me al heal h e ce f a i i g e le i c i i a d e e ha

ffice ge he ai i g a d

ha he eed. The 24-h e i f he CIT ai i g a

ffe ed SCSD e el a l a ba i , a d a 8-h e i f he ai i g had ece l

bee ma da ed f all jail de ie .

Wi h ega d ann al in- er ice icide e e i ai i g, he e ha e bee me a ia i f ai i g ided jail de ie e he a e e al ea , i cl di g a 16- lide P e P i e e a i e i led A al Office T ai i g: S icide P e e i f C ec i a d a 27- lide P e P i e e a i e i led S icide P e e i T ai i g. The e P e P i
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lide e e a i e e de el ed b de ie ki g i hi he SCSD Jail O e a i

Di i i . I addi i , JPS had e i l de el ed a 27- lide P e P i e e a i e i led

S icide P e e i T ai i g. U il a ima el 2013, JPS ided a al icide

e e i ai i g jail de ie . The begi i g i 2013 a d c i i g h gh Feb a 2016,

de ie f m he Jail O e a i di i i

ided he ai i g h gh m l i le 20-30-mi e

hif b iefi g . Si ce Feb a 2016, a al icide e e i ai i g had bee ided jail

de ie h gh a eb-ba ed ai i g ide ha e c m a ed a P e P i e e a i . Wi h

ega d heal h ca e e el, b h medical (CHS) a d me al heal h (JPS) e el ecei e

ai i g h gh eb-ba ed i c i f m JPS ab e-de c ibed P e P i e e a i .

Acc di g ai i g ec d , alm all c d , medical, a d me al heal h e el had

ecei ed me f m f eb-ba ed icide e e i ai i g d i g 2016.

I c cl i , al h gh he SCSD a d JPS migh e ell be i c m lia ce i h ag e

Ti le 15 e i eme ega di g icide e e i ai i g, a d m e el had ecei ed me

f m f ai i g, ai i g i i ia i e d i g he a e e al ea c ld l be de c ibed a

e e . The lack f a cla m e i me , a d elia ce e i dic a d b ief hif b iefi g

i c i , a ell a eb-ba ed i c i

icide a blema ic. I a e h ha

he hi i e a - i e a d b e ed a S icide P e e i Ta k F ce mee i g Se embe

20, 2016, c ec i al leade hi a he SCSD had al ead made a c mmi me ei i e he

m e adi i al cla m ai i g f ma i he ea f e.

RECOMMENDATIONS: Se e al ec mme da i a e ffe ed e g he b h he c e a d deli e abili f icide e e i ai i g ffe ed b h c d a d heal h ca e
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e el h k i hi he Sac ame C Jail S em. F , i i gl ec mme ded

ha b h he SCSD a d JPS e i e i e ec i e icide e e i licie i cl de a m e

b de c i i f he e i eme f b h e- e ice a d a al icide e e i ai i g,

i cl de a e ie f he e i ed ic , a ell a e i eme ha all c d , medical, a d

me al heal h e el ecei ed ch ai i g a a al ba i . S , i i

gl

ec mme ded ha he SCSD a d JPS l ili e cla m-i c ed icide e e i ai i g.

I ha bee hi i e e e ie ce ha icide e e i e c m a e -ac i e a i de a d

c llab a i , i ci le ha a e l he a em l ee i i i g al e i a chai a a c m e

e mi al. De k i c i migh c m l i h a acc edi a i a d/ eg la e i eme ,

b i i a mea i gf l a cla m-i c ed ai i g.

T ,i i

gl ec mme ded ha he SCSD a d JPS c llab a e he de el me

f a 4 8 h e- e ice icide e e i c ic l m f e em l ee (i cl di g c d ,

medical, a d me al heal h aff) ha i cl de he f ll i g ic :

x g idi g i ci le

icide e e i

x a idi g b acle ( ega i e a i de ) e e i

x i ma e icide e ea ch

x h facili e i me a e c d ci e icidal beha i

x ide if i g icide i k de i e he de ial f i k

x e ial edi i g fac

icide

x high- i k icide e i d

x a i g ig a d m m

x c m e f he SCSD/JPS icide e e i

g am

x liabili i e a cia ed i h i ma e icide

P e e a i h ld be i a P e P i lide f ma . The e a d he e i e

i hi i e T

C

P

G

S

D

ic a e a ailable P

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J

P F

f c ide a i .9

(Ma ch 2016), a c f hich a e i l f a ded he SCSD

F , i i gl ec mme ded ha he SCSD a d JPS c llab a e he de el me

f a 2-h a al icide e e i c ic l m f all c d , medical a d me al heal h aff)

ha i cl de a abb e ia ed di c i he ab e ic . The 2-h a al ef e he ai i g

h ld i cl de a e ie f: 1) a idi g b acle ( ega i e a i de )

e e i , 2)

edi i g i k fac , 3) a i g ig a d m m , 4) ide if i g icidal i ma e de i e

he de ial f i k, a d 5) e ie f a cha ge he SCSD/JPS icide e e i licie . The

a al ai i g h ld al i cl de ge e al di c i f a ece icide a d/ e i icide

a em i he jail em. P e e a i h ld be i a P e P i lide f ma .

F , a ill be di c ed la e i hi e , i i

gl ec mme ded ha all JPS

e el (i cl di g chia i ) ecei e addi i al ai i g h

de el a ea able

ea me la ha c ai ecific a egie i ed ci g f e icidal idea i , i cl de

e am le f ade a e a d i ade a e ea me la .

2) In ake Screening/A e men
In ake creening for icide ri k m ake place immedia el pon confinemen and prior o ho ing a ignmen . Thi
proce ma be con ained i hin he medical creening form or a a epara e form, and m incl de inq ir regarding: pa
icidal idea ion and/or a emp ; c rren idea ion, hrea , plan; prior men al heal h rea men /ho pi ali a ion; recen ignifican lo (job, rela ion hip, dea h of famil member/ clo e friend, e c.); hi or of icidal beha ior b famil member/clo e
9See . cia e . g/c imi al-j ice- e ice / icide- e e i -i -c d
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friend; icide ri k d ring prior confinemen ; ran por ing officer( ) belie e inma e i c rren l a ri k. The in ake creening proce ho ld incl de proced re for referral o men al heal h and/or medical per onnel. An inma e a igned o a egrega ion ni ho ld be creened o en re ha here are no medical and/or men al heal h con raindica ion for ch placemen .

I ake c ee i g/a e me i al c i ical a c ec i al em icide e e i

eff . A i ma e ca a em icide a a i d i g i ca ce a i -- begi i g immedia el

f ll i g ece i a d c i i g h gh a e f l a ec f c fi eme . Al h gh he e i

di ag eeme i hi he chia ic a d medical c mm i ie a

hich fac a e m

edic i e f icide i ge e al, e ea ch i he a ea f jail a d i

icide ha ide ified a

mbe f cha ac e i ic ha a e gl ela ed icide, i cl di g: i ica i , em i al

a e, famil hi

f icide, ece ig ifica l , limi ed i i ca ce a i , lack f cial

em, chia ic hi , a d a i

e

f c fi eme . 10 M im a l ,

i e ea ch ha c i e l e ed ha a lea

hi d f all icide ic im c mm ica e

hei i e me ime i dea h, a d ha a i di id al i h a hi

f e m e icide

a em i a a m ch g ea e i k f icide ha h e h ha e e e made a a em .11 I

addi i , acc di g he m ece e ea ch i ma e icide, a lea e- hi d f all i ma e

icide ic im had i hi ie f b h me al ill e a d icidal beha i .12 The ke

ide if i g e iall icidal beha i i i ma e i h gh i i d i g b h he i ake

c ee i g/a e me ha e, a ell a he high- i k e i d f i ca ce a i .

10B e , R. (1992), I la i , Secl i , a d P ch l gical V l e abili a Ri k Fac f S icide Behi d

Ba , i R. Ma i e . al. (Edi ) A

P

S , Ne Y k, NY: G ilf d P e , 398-419.

11Cla k, D. a d S.L. H -De ch (1992), A e me i Ab e ia: The Val e f he P ch l gical A

Me h d f S d i g A ecede f S icide a d P edic i g F e S icide , i R. Ma i e . al. (Edi )

A

P

S , Ne Y k, NY: G ilf d P e , 144-182.

12Ha e , L.M. (2012), Na i al S d f Jail S icide : 20 Yea La e , J

C

H C , 18 (3).

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Fi all , gi e he g a cia i be ee i ma e icide a d ecial ma ageme (e.g.,

di ci li a a d/ admi i a i e eg ega i , e c.) h i g i laceme , a i ma e a ig ed

ch a ecial h i g i h ld ecei e a b ief a e me f icide i k b heal h ca e aff

admi i

ch laceme . F e am le, b h he ACA a d NCCHC a da d add e

he i e f a e i g i ma e a ig ed eg ega i . Acc di g ACA S a da d 4-ALDF-2A-

45: Whe a i ma e i a fe ed eg ega i , heal h ca e e el a e i f med immedia el

a d ide a e me a d e ie a i dica ed b he c l a e abli hed b he heal h

a h i . NCCHC S a da d J-E-09 a e ha U

ifica i ha a i ma e i laced i

eg ega i , a alified heal h ca e fe i al e ie he i ma e heal h ec d de e mi e

he he e i i g medical, de al, me al heal h eed c ai dica e he laceme e i e

acc mm da i .

FINDINGS: The Sac ame C

She iff De a me (SCSD) S icide

P e e i P g am lic (N . 10/5) ided ge e al ced e ega di g he i ake c ee i g

ce ide if icidal i ma e , he ea he Jail P chia ic Se ice (JPS) S icide

P e e i P g am lic (N . 1049) ided li le g ida ce he i e, im l a i g ha

All i ma e b ked i he Mai Jail a d RCCC ill ha e a i ake c ee i g c m le ed b

CHS aff hich i cl de e i ela ed icidal i k fac . I ma e h c ee ed i i e

f icide i k fac a d/ he chia ic c ce ill be efe ed JPS. The CHS

Recei i g Sc ee i g lic (N . 1401) ided a ade a e de c i i f he i ake c ee i g

e ibili ie .

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I ac ice, alm all e l admi ed i ma e i he Sac ame C Jail S em

e e ce ed h gh he b ki g a d i ake a ea f he Mai Jail. O e 40,000 i ma e e e

b ked i he Mai Jail each ea .13 U admi i , a e i g ffice e e e i ed

c m le e a SCSD I ake Sc ee i g f m

he de ai ee bei g acce ed i SCSD

c d . The f m c ai ed e e al e i ega di g medical blem , a ell a he

f ll i g icide i k i i : A e c e l icidal, d feel like h i g elf

me e el e? O ce c m le ed, he a e i g ffice a e i ed e e he f m e f

he CHS e a ig ed he b ki g a d i ake a ea. Thi f m ided a e celle

i f a e i g ffice c mm ica e a medical, me al heal h, a d icide i k

c ce medical a d/ c d aff.

N i g aff a a ig ed he b ki g a ea 24 h a da c d c i ake c ee i g,

ih

h ee a i l ca ed ide-b - ide i a N e Office. A Medical I ake f m a

ili ed b

i g aff b h medicall clea he de ai ee i c d , a ell a c llec

medical, me al heal h, a d icide i k i f ma i . The f m, hich a embedded i he

elec ic medical ec d called E-Cha , c ai ed he f ll i g e i ega di g me al

heal h a d icide i k ( ha e e li ed de JPS E al a i

he f m):

x A e c e l icidal, d feel like h i g elf me e

el e? x I he a e ee me all di abled a d/ a da ge x F Female : Ha e gi e bi h i hi he la

elf he ? ea . A e cha ged

i h m de a em ed m de f child? x Wi hi he la 2 eek ha e fel icidal?

x Ha e bee h i ali ed f me al heal h ea me i hi he a 30

da ?

13A ima el 3,687 e e b ked i he RCCC each ea , m l f m l cal la e f ceme age cie i he Elk G e a ea, a ell a he US De a me f H mela d Sec i Immig a i a d C m E f ceme (ICE).
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x A e c e l aki g bee e c ibed chia ic medica i i hi

a 30 da ?

x D

ha e a hi

f i ellec al di abili ( lea i g di abili )?

x Ha e bee ea ed a Al Regi al Ce e ?

x D

ha e a c e a ?

The f m al all ed i g aff e a b e a i al c ce .

Thi i e e e e al h

e he c e f da ( Se embe 20 a d

Se embe 22) b e i g i g aff c m le e i ake c ee i g e l admi ed de ai ee .

S ch b e a i f d e e al e

bli g ac ice . F ,

h ee (3) e c ld be

a i ed i he ffice a e ime, e a a ed l b mall a i i . The ef e, de ai ee e e

l e a a ed f m each he b a fe fee . I addi i , each de ai ee a acc m a ied b a

lea e a e i g ffice h a a i ed i hi a m le g h f he de ai ee. D e he

cc e ce f m l i le i ake c ee i g a he ame ime, i l i g m l i le e , de ai ee ,

a d a e i g ffice , c fide iali a e e el c m mi ed.14 I addi i , d e i mall

i e, he N e Office a l d a d cha ic a ime , i h a e i g ffice ciali i g i h he

medical e el. S , hi i e b e ed fi e (5) diffe e

e c d c i ake c ee i g

e he c e f he da . D i g hi ime,

e e a ked all he e i ed JPS

E al a i

e i ega di g me al heal h a d icide i k. The he e e e b e ed

im l a k:

x D

feel like h i g

elf? a d Recei ed a me al heal h

ea me i hi he a 30 da ? (1 N e)

14I h ld be ed ha he hield f i ac a d c fide iali e e d i ma e a d -heal h ca e e el (e.g., c d aff ).

l be ee i ma e a d i ma e, b

F he , he N e Office i hi he b ki g a ea a RCCC a al i ec ed b hi i e a d f d c ai

imila blem f i ac a d c fide iali . Al h gh i ake c ee i g a

b e ed b hi i e , c d

e el e lai ed he i ake c ee i g ce a f ll : he e emai ed i a ed i he ffice i h he

de ai ee a di g i he d a , addled b he a e i g ffice . The d f he N e Office emai ed e .

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x D

feel icidal ha e

N e)

bee i i hi he la

eek ? (2 d

x Feeli g icidal ? S icidal i la he egi al ce e ? (3 d N e)

eek ? a d E e bee

x Feel like h i g

elf a e el e? a d A e aki g a

ch

med ? (4 h N e)

The b e a i f m l i le e faili g c i e l a k all me al heal h a d icide i k e i eflec ed a emic deficie c he i ake c ee i g ce .

T , a a f m he fac ha he e e e c i e l a ki g he e i ed i ake c ee i g e i , he e i hem el e e e limi ed i b h c e a d imef ame. F e am le, icide i k i i a limi ed c e idea i a d idea i i hi he
. Me al heal h ea me a d ch ic medica i a limi ed he 30 .15

F , hile b e i g he i ake c ee i g ce , hi i e iced a laca d each

f he h ee a i i ha a ed: Plea e I f m N e If Y Ha e A Of The F ll i g

C di i : alc h l/d g ab e, de al/de e , dial i , gla e /c ac , gla c ma, hea i g

aid , hea di ea e, he a i i , HIV/AIDS, high bl d e e, ga a la , chia ic hi ,

ece eg a c , ei e , kele al def mi ie , STD , ke, TB, ca ce . Thi i e

b e e l b e ed a fe , b

all, f he e a k de ai ee l k a he laca d a d

15Al h gh ide hi i e a ea f e e i e, he efficac f a ki g a de ai ee ab hei hi di abili a d he he he ha e a c e a a ea ed e i able.

f i ellec al

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i f m hem if he had a f he li ed medical i e . D e mall f i e, he laca d a diffic l ead a d he e all efficac f ch a ac ice a highl e i able.16

F , al h gh i g aff had acce he E-Cha a b ki g ia de k c m e

a

f he a i , e e e b e ed be a el acce i g he E-Cha . Whe a ked b hi

i e if he c ld de e mi e he he

a e l admi ed de ai ee a

icide eca i

d i g a i SCSD c fi eme , e e al e e ded ha he e e a a e a he he

ch i f ma i a a ailable. A ch, i ake e did i de e de l e if a de ai ee

i laceme

icide eca i i he SCSD. Thi i e a b e e l i f med ha

he P blem a d C di i c ee f he E-Cha c ai ed he F e e c f Se ice Scale

(FOSS) f each i ma e iaged b JPS aff. If a i ma e a laced icide eca i a d

h ed a he e i hi he jail em, he ld be cla ified a a FOSS Le el 1 a d ee dail

b JPS aff. I ma e ecei i g a FOSS Le el 2 de ig a i e e h e h e e di cha ged f m

icide eca i a d/ had a e i me al ill e e i i g f ll - ( i hi 30 da ).

S , he e did a ea be a lic , ced e, di ec i e g ide i g aff

i iagi g me al heal h efe al . I ac ice, i g aff e e i c ed iage a de ai ee

c e icidal idea i a a ge JPS efe al a d c m le e a g ee f lde ha a

f a ded JPS. I addi i , i g aff e e e i ed c ac he JPS - a ie g am

(OPP) ffice b ele h e d i g eg la b i e h

he 2P-U i i - a ie g am ffice

d i g -b i e h . A OPP cli icia 2P-U i e he had f h

ed

16Thi i e a al b e e l i f med ha i ake e had bee i c ed i i ia e JPS efe al f a de ai ee admi ed he f ll i g cha ge : m de , child e al ab e, a d/ a he high file ffe e. S ch a ac ice c ld be c fi med beca e hi i e did b e e a de ai ee b ked he e cha ge , a ell a ld ha i g aff e e a el made a a e f ecific b ki g ffe e .
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a d a e he i ma e. All he JPS efe al e e de ig a ed a - ge

ie ad

f a ded a JPS Sched le a d e ded i hi i (6) da . The ef e, me al heal h

efe al e e i e a d e ded ei he i hi f (4) h

i hi i (6) da .

The f ll i g ca e mma e em lified he c ce ega di g b h he i abili

ide if e l admi ed de ai ee h had e i l bee laced icide eca i d i g

a i SCSD c fi eme a d a i efficie me al heal h iage ce :

The i ma e (Ca e No. 1) a admi ed i he Mai Jail Se embe 7, 2016.

D i g he i ake ce , he elf- e ed aki g ch ic medica i , b

a e ed

all JPS E al a i

e i . The e ge e a ed a i e JPS

efe al (i dica i g he i ma e ld be ee b a OPP cli icia i hi 6 da ).

The i ma e a

ee b JPS, e e ed icidal idea i

eek la e

Se embe 21 a d laced icide eca i . Thi i e had ed a OPP

cli icia e ible f a e i g icidal i ma e Se embe 21. The cli icia

a e ed he i ma e i he afe cell f he 2P-U i . The i ma e a ea ed

de e ed, a c i g, a d e ed feeli g icidal f he a h ee eek . The

OPP cli icia decided c i e he icide eca i . A b e e e ie f

he E-Cha b hi i e f d ha he i ma e had e i l bee c fi ed i

he Mai Jail a fe m h ea lie Ma 13, 2016, e e ed icidal idea i

d i g he i ake c ee i g ce , a d a laced icide eca i f 3

da . Had ch i f ma i bee acce ed b he i ake e Se embe 7,

2016, he i ma e he e icall c ld ha e bee a e ed ea lie a d he me al

heal h c i i e iall a e ed.

Fi all , hi i e a i f med ha ei he medical me al heal h e el e ie

he E-Cha a d/ c ee a i ma e laced i a eg ega ed h i g i de e mi e he he

e i i g medical a d/ me al heal h eed c ai dica e he laceme

e ie

acc mm da i . I addi i , medical a d me al heal h e el d

i el c d c

eg la d i eg ega ed h i g i , a d l e e ch i a medica i

ee a

i di id al i ma e.

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I c cl i , he i ake c ee i g ce i hi he Sac ame C Jail S em a

e blema ic. P i ac a d c fide iali e e e e el c m mi ed, i g aff a he

Mai Jail e e b e ed

be c i e l a ki g all he e i ed c ee i g e i , icide

i k a d me al heal h i i a c m ehe i e, a de e mi a i f icide eca i

d i g i c fi eme

e f med, a d he me al heal h iage em a i eed f

eii .

RECOMMENDATIONS: Se e al ec mme da i a e ffe ed im e he i ake

c ee i g/a e me ce i hi he Sac ame C

Jail S em. F , i i

gl

ec mme ded ha SCSD a d CHS fficial l k a i

be e e e ea able d

i ac i he b ki g a ea he m l i le e a e c d c i g i ake c ee i g a he ame ime

e i d. O e i

ld be i alla i f i e ie b h imila i de ig c e i i i g

b h a e b h f d ha he RCCC. S , i i

gl ec mme ded ha he

c e icide i k i i c ai ed he c e CHS Medical I ake f m embedded i he

E-Cha be e i ed i cl de he f ll i g:

x Ha e e e a em ed icide?

x Ha e e e c ide ed icide?

x Ae

ha e e e bee ea ed f me al heal h em i al

blem ?

x Ha e ece l e e ie ced a ig ifica l ( ela i hi , dea h f famil

membe /cl e f ie d, j b, e c.)?

x Ha a famil membe /cl e f ie d e e a em ed c mmi ed icide?

x D

feel he e i hi g l k f a d i he immedia e f e

(i ma e e e i g hel le e a d/ h ele e )?

x A e hi ki g f h i g a d/ killi g

elf?

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F ll - i i (e.g., he did e i i de iage he a
( ee bel ).

la a em icide? e c.) h ld be added each f he e ia e le el f me al heal h efe al a de e mi ed b JPS

T , i i gl ec mme ded ha CHS fficial i i ia e a c i

ali a a ce

la e i dicall a di he i ake c ee i g ce e e ha i g aff a e a ki g all

ei

e l admi ed de ai ee a e i ed.

F , ega dle f he de ai ee beha i a e gi e d i g i ake c ee i g, a me al heal h efe al h ld al a be i i ia ed ba ed d c me a i eflec i g ible e i me al ill e a d/ icidal beha i d i g a i ma e i c fi eme i hi he Sac ame C Jail S em. A ch, he P blem a d C di i c ee f he E-Cha c ai he F e e c f Se ice Scale (FOSS) f each i ma e iage b JPS aff. If a i ma e
a laced icide eca i a d h ed a he e i hi he jail em, he ld be cla ified a a FOSS Le el 1. I ma e ecei i g a FOSS Le el 2 de ig a i a e h e h e e di cha ged f m icide eca i a d i eed f f ll - ela ed hei e i me al ill e . A ch, he f ll i g ced e h ld be i c a ed i hi b h CHS a d JPS licie :

A i ma e laced

icide eca i h ld be de ig a ed a ei he a

FOSS Le el 1 FOSS Le el 2 i he P blem a d C di i c ee f he

E-Cha b JPS aff;

N i g aff c d c i g i ake c ee i g h ld al a e ie he de ai ee

P blem a d C di i c ee f he E-Cha e if he he he e e

e i l c fi ed i he SCSD a d had a hi

f icidal

beha i / laceme

icide eca i d i g a i c fi eme ; a d

Rega dle f he de ai ee beha i a e gi e d i g i ake c ee i g, f he a e me b JPS aff h ld al a be i i ia ed ba ed

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d c me a i eflec i g ible e i me al ill e a d/ beha i d i g a de ai ee i c fi eme i hi he SCSD.

icidal

F ,i i

gl ec mme ded ha he c e me al heal h iage ac ice f JPS

e di g i ma e e e i g icidal idea i i hi 4 h a a ge efe al, a d

e di g all he me al heal h efe al i hi 6 da a

ge

i e efe al

be e i ed. Al h gh he e i a da d f ca e ha c i e l ecifie ime f ame e d

me al heal h efe al , e gge ed ched le ld be a f ll : Eme ge -

i hi

4 h ; U ge - i hi 24-48 h ; a d R i e - i hi 7 da . I addi i , JPS fficial h ld

de el a me al heal h iage lic ha defi e e e le el , e ime c ai f each

le el, a d defi e he ac i f beha i ( ) ha dic a e a ecific e e le el. Of c e, a

c e l ac ice i hi he SCSD, a i ma e e e i g c e icidal idea i a d/ c e

icidal/ elf-i j i beha i h ld e l i a eme ge JPS efe al.

S , gi e he g a cia i be ee i ma e icide a d ecial ma ageme (e.g,

di ci li a a d/ admi i a i e eg ega i , al e a a i , e c.) h i g i laceme , i

i gl ec mme ded ha medical e el e ie he E-Cha de e mi e he he e i i g

medical a d/ me al heal h eed c ai dica e he laceme e i e acc mm da i . I

addi i , a be ac ice ld be ha a i ma e a ig ed ch a ecial ma ageme

h i g i ecei e a b ief a e me f icide i k b i g aff admi i

ch

laceme .

3) Comm nica ion Proced re ha enhance comm nica ion a hree le el : 1) be een he ending in i ion/arre ing- ran por ing officer( ) and correc ional aff; 2) be een and among aff (incl ding medical and men al heal h per onnel); and 3) be een aff and he icidal inma e.
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Ce ai ig e hibi ed b he i ma e ca f e f e ell a ible icide a d, if de ec ed

a d c mm ica ed he , ca e e ch a i cide . The e a e e e iall h ee le el f

c mm ica i i e e i g i ma e icide : 1) be ee he e di g i i i /a e i g-

a i g ffice a d c ec i al aff; 2) be ee a d am g aff (i cl di g me al heal h

a d medical e el); a d 3) be ee aff a d he icidal i ma e. F he , beca e i ma e

ca bec me icidal a a i i hei i ca ce a i , c ec i al aff m mai ai a a e e ,

ha e i f ma i a d make a

ia e efe al me al heal h a d medical aff.

FINDINGS: Effec i e c mm ica i be ee c ec i al, medical, a d me al heal h

aff i a i e ha ca be ea il i e a a lic di ec i e, a d i f e deal i h m e

effec i el h gh e am le f m l idi ci li a blem- l i g. Al h gh - i e f l fi e

da , hi i e e ed ha c ec i al, medical, a d me al heal h e el had a g d ki g

ela i hi . The e e e me e am le f effec i e c mm ica i i hi he Sac ame

C Jail S em. F e am le, a e i l de ailed i hi e , a e i g ffice c m le ed

a I ake Sc ee i g f m each e l admi ed de ai ee a d ided a c f he f m

e f he CHS e a ig ed he b ki g a ea. Thi f m ided a e celle

i

f a e i g ffice c mm ica e a medical, me al heal h, a d icide i k c ce

medical a d/ c d aff. F he , he E-Cha a f ll i eg a ed a d c ai ed b h medical

a d me al heal h ec d ha be e e ed he c i i f ca e a d e ha ci g c mm ica i

be ee heal h ca e aff. Me al heal h efe al f i ma e ide ified a e iall icidal e e

d c me ed i a a ie f a , i cl di g a S ecial Need f m b CHS e . I addi i ,

he SCSD S icide P e e i P g am lic (N . 10/5) ided ge e al ced e

ega di g he c mm ica i ce f c d e el efe i g e iall icidal i ma e

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JPS cli icia . I addi i , al h gh he JPS g am di ec me i h he CHS e ec i e eam ice a m h, a ell a me i f mall i h he Mai Jail c mma de alm a dail ba i , hi i e a a a e f a eg la l ched led ma ageme mee i g ha i cl ded c d , medical aff, me al heal h e el. F he , he SCSD e abli hed a i ma e- a ie ca e h li e ha a ma aged b CHS. C ce ed a ie , i cl di g famil membe , c mm i
ide , e c., c ld c ac he h li e b e-mail, ele h e, SCSD eb i e, a d ela hei heal h ca e c ce ab ecific i ma e . JPS fficial e ima ed ha he ecei ed be ee 5 a d 10 me al heal h efe al e eek, m f a -eme ge c a e. Thi a a e celle i i ia i e. Fi all , a e lai ed i m e de ail la e i hi e , a S icide P e e i Ta k F ce had bee e-e abli hed a d me a lea a a e l ba i . The m l idi ci li a c mmi ee i cl ded e e e a i f m he c d , CHS, a d JPS.

RECOMMENDATION: O l e ec mme da i i ffe ed. T he e e ha a

f mali ed mee i g d e c e l e i , i i

gl ec mme ded ha he SCSD e abli h

eg la l ched led ma ageme mee i g be ee c d , CHS, a d JPS e el. S ch

mee i g , ched led ei he a eekl bi- eekl ba i , ld ide a e celle

i

f m l idi ci li a blem- l i g f diffic l ma age i ma e- a ie , i cl di g icidal

i ma e .

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4) Ho ing
I ola ion ho ld be a oided. Whene er po ible, ho e in general pop la ion, men al heal h ni , or medical infirmar , loca ed in clo e pro imi o aff. Inma e ho ld be ho ed in
icide-re i an , pro r ion-free cell . Remo al of an inma e clo hing (e cl ding bel and hoelace ), a ell a e of ph ical re rain (e.g. re rain chair /board , rai jacke , lea her rap , e c.) and cancella ion of ro ine pri ilege ( ho er , i i , elephone call , recrea ion, e c.), ho ld be a oided hene er po ible, and onl ili ed a a la re or for period in hich he inma e i ph icall engaging in elfde r c i e beha ior.

I de e mi i g he m a

ia e l ca i h e a icidal i ma e, he e i f e he

e de c f c ec i al fficial i ge e al h icall i la e he i di id al. Thi e e

ma be m e c e ie f aff, b i i de ime al he i ma e. The e f i la i

l

e cala e he i ma e e e f alie a i , b al f he e e em e he i di id al f m

e aff e i i . Na i al c ec i al a da d e ha , e e e e

ible,

icidal i ma e h ld be h ed i he ge e al la i , me al heal h i , medical

i fi ma , l ca ed i cl e imi

aff.

Of c e, h i g a icidal i ma e i a ge e al la i i he hei ec i le el

hibi ch a ig me ai e a diffic l i e. The e l , f c e, ill be he a ig me f

he icidal i ma e a h i g i c mme a e i h hei ec i le el. Wi hi a c ec i al

em, hi a ig me migh be a ecial h i g i , e.g., e ic i e h i g, di ci li a

c fi eme , admi i a i e eg ega i , e c. H e e ,

-

,

-

. F he , ca cella i

f i e i ilege ( h e , i i , ele h e call , ec ea i , e c.), em al f cl hi g

(e cl di g bel a d h elace ), a ell a he e f h ical e ai (e.g., e ai

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chai /b a d , ai jacke , lea he a , e c.) h ld be a ided he e e ible, a d l ili ed a a la e f e i d i hich he i ma e i h icall e gagi g i elf-de c i e
beha i . H i g a ig me h ld be ba ed deci i ha heigh e de e ali i g a ec f i ca ce a i , b he abili ma imi e aff i e ac i i h i ma e .

FINDINGS: The SCSD S icide P e e i P g am lic (N . 10/5) ided

ge e al ced e ega di g he h i g f icidal i ma e , he ea JPS S icide P e e i

P g am lic (N . 1049) ided li le g ida ce he i e. JPS S icide P eca i -

Ac e I a ie U i (N . 1009) a limi ed laceme f icidal i ma e i he 2P-U i .

CHS S icide P e e i 2M - J i P lic (N . 1412) ided ge e al ced e ega di g

he h i g f icidal i ma e i he Medical H i g U i (2M-U i ). SCSD U e f Safe

Cell /Seg ega i Cell /M l i

e R m /N h H ldi g N . 2 lic (N . 4/05) ided

ge e al ced e ega di g he laceme f i ma e , i cl di g h e ide ified a icidal, i

a i em a h i g l ca i . The e m em a a

he i e defi ed i he

lic .

I ac ice, hi i e f d ha i ma e ide ified a icidal e e laced i e m e
f he f ll i g l ca i :
Safe Cell : The e e e 4 afe cell l ca ed a he Mai Jail; 2 i he male b ki g a ea, 1 i he female b ki g a ea, 1 i he 2P-U i ; a ell a 1 afe cell l ca ed a RCCC. All f he e e e added, d cell (i.e., c ai i g a i k
ile ). The e e e b k i he cell .
Segrega ion Holding Cell : The e e e 6 eg ega i h ldi g cell a he Mai Jail, 5 l ca ed i he male b ki g a ea a d 1 l ca ed i he female b ki g a ea. All f he e e e e cell (c ai i g a i k a d ile ). The e a a mall be ch i each cell.

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M l i-P rpo e Room : The e m , c mm l a d he eaf e efe ed a cla m , e e l ca ed all f he h i g fl . A ima el 10 cla m e e a ailable em a il h e icidal i ma e . The e la ge, gla -e cl ed a ea , did ha e bed , i k , ile .
Nor h Holding Cell No. 2: Thi h ldi g cell a l ca ed a RCCC. I had a ai ed ceme lab a a b k, a ell a a i k a d ile .
2P-Ac e In-Pa ien Uni : Thi h i g i c ai ed 18 bed (16 i gle cell a d 1 d ble cell). All cell had b k , i k , a d ile .

Wi h ega d icide e i a ,

i -f ee h i g f icidal i ma e , hi i e

f d ha cell i hi he 2P-U i e e icide- e i a , a d did c ai a b i

i ha c ld be ili ed b a i ma e a em icide b ha gi g. I fac , alm all

cell i hi he Sac ame C Jail S em, a ic la l he Mai Jail, i ec ed b hi i e

did c ai ma f he b i

i (e.g., ligh fi e , e ila i g a e , cl hi g

h k , b k h le , e c.) f d i he c m a abl - i ed c ec i al facili ie . Of e, hi

i e e ie f ece i ma e icide , a ell a e i

icide a em , i hi he

Sac ame C Jail S em f d ha e fe i cide i l ed i ma e h affi ed a

liga e a b i

i i hei cell.17

Wi h he e ce i f he 2P-U i , h i g icidal i ma e i

f he afe cell ,

eg ega i h ldi g cell , a d N h H ldi g Cell be d a fe h

ld be e blema ic.

The e cell , a ic la l he d cell , e e de ig ed f l g- e m e. The cla m e e

ce ai l de ig ed f i ma e h i g, a d h ld e e be ili ed f he h i g f icidal

17Thi da a d i c a a i al e ea ch i ma e icide i dica i g ha he e helmi g maj i

(93%) f dea h e e b ha gi g, i h i ma e ili i g

i ch a ligh fi e , cell d , a d e ila i

g a e , ee Ha e , L.M. (2012), Na i al S d f Jail S icide : 20 Yea La e , J

C

H

C , 18 (3).

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i ma e (f a d a i ). Ye , hi i e b e ed ha i a

c mm f i ma e be

h ed de he e c di i f ell e 24 h i he Mai Jail.

While - i e, i h he e ce i f he N h H ldi g Cell a RCCC,18 hi i e

b e ed i ma e

icide eca i i all f he e l ca i . Al h gh SCSD lic did

ecificall hibi all i g a i ma e f m e ai i g hei cl hi g, i ac ice, all i ma e e e

cl hed l i a afe m ck a d ided a afe bla ke . I ma e h ed i he afe cell

a d cla m e e f ced lee he fl , a d had a k c d e el e a ile

ide he a ea. I ma e i all l ca i e e

ided h e . The e e l cked d 24-

h a da de he e c di i . Cli ical a e me e e ided cell- ide, i h he OPP

cli icia a di g i he e d a , he i ma e i i g a be ch fl , a d a ffice

a di g i he a ea.

S i i gl , c di i f i ma e h ed icide eca i i he 2P-U i e e a eciabl be e . Al h gh each cell c ai ed a b k, i k, a d ile , m i ma e e e cl hed l i a afe m ck af e bei g di cha ged f m icide eca i a d emai i g
he i . The e i ma e emai ed cl hed l i hei afe m ck e e if he e e all ed ce ai e al e i . (Thi i e ill be di c ed i m e de ail i he e ec i ). Al h gh h e e e aid be ffe ed a dail ba i , 2P-U i i ma e e e ill l cked d m e ha 23 h a da . Si ce Se embe 2016 he a ec d ffice a a ig ed he 2PU i , i ma e e e ffe ed 30 mi e f da m ime e da . (P i ha , - f-

18I h ld be ed ha RCCC N h H ldi g Cell N . 2 a ili ed i f e e l f c e ac ice a f RCCC i ma e be a fe ed he Mai Jail i hi a h
icidal.

icide eca i , a d he f bei g ide ified a

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cell da m ime a ffe ed l a e i dic ba i .) Tele h e a d i i i g i ilege e e

hibi ed. Cli ical a e me e e al c d c ed cell- ide. A ec ea i al he a i a

a ailable 2P-U i i ma e ce a eek, b hei e ice e e limi ed he cell- ide i i

f eadi g ma e ial. G

ea me e ice e e a ailable. Al h gh m , if all, f he e

hibi i e e a ic la ed i lic , he e e i ac ice.

I ma a , he c di i f all i ma e laced icide eca i e e ha he

ha f h e eg ega i a , a d i ld be hi i e i i ha c e ma ageme

f i ma e laced icide eca i i hi he Sac ame C Jail S em a ge e all

e l e ic i e a d eemi gl i i e. C fi i g a icidal i ma e hei cell f

24

h a da l e ha ce i la i a d i a i- he a e ic. U de he e c di i , i i al

diffic l , if im ible, acc a el ga ge he ce f a i ma e icidal idea i . Take,

f e am le, he ce a i f a cli icia i e ie i g a i ma e icide eca i . The i ma e

ha bee i he cell cla m f a da

, cl hed l i a afe m ck. The cli icia

a ache he i ma e cell- ide a d a k : A e

icidal? Gi e he ci c m a ce he he

fi d hem el e i , he likelih d f a i ma e a e i g affi ma i el ha e i , he e l

f hich ill be hi c i ed laceme de he e c di i , i highl e i able.

Rece e ea ch gge ha icidal i ma e a e f e el c a di c hei icidal

h gh beca e f he likelih d f bei g e ed he ha h c di i f icide eca i ,

i h alm 75 e ce f i ma e e i g ha he did

a be a fe ed a

b e a i cell. Acc di g he a h :

P ible ea i ma e di like b e a i cell a e me . F GP a ie he ca ffe a i g f m he i ma e i h he ide ifica i f bei g i a

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me al heal h c i i af e he e f m he OB ( b e a i ). F he , a i ma e-

a ie i em ed f m hi m e familia

di g f a i gle cell i h hi

b k , i i g ma e ial, a d cl he , a d hi mal i e f ec ea i a d

k a ig me . I he OB he f e ca l ge ea hi cl he , a d b k a d

ec ea i a e limi ed. I a OB cell a a ie f e i d e ed i a ecial g a d

he m ma l c ai a ecial ma e . P i ac i limi ed, i ce f e all f

ide f he OB a e a ailable f b e a i he ea i hi cell l e ide

i e f b e a i . Fi all , admi i i a OB ca c ea e a ie a d fea f

he a ie a i ma be a k e i me , a d beca e he OB i he lace

he chia i decide if a ie i be i l a il a fe ed he di a i a ie i . 19

Ma SCSD a d JPS fficial i f med hi i e ha he c di i f icide

eca i e e i e i all i i e, b d i e b c ce f he afe f he i ma e. The

c mmi me afe a bei g challe ged he e. Safe f he i ma e i , f c e, f m

c ce he de el i g a icide e e i lic . B he mbe a d e f e ic i

(e.g., e elia ce afe m ck , de i g i i a i a d ele h e i ilege , e c.) im ed i

he ame f afe m be ea able a d c mme a e i h he i ma e le el f icide i k.

Official migh al ha e a g ed (al h gh he did

hi i e ) ha he a i ale f he e

e ic i a ha icidal i ma e e e edic able a d bad e ecei ed d i g a famil

i i ele h e call migh igge icidal idea i a d e l i a i c ea ed i k f icide.

Thi a i ale, h e e , ig e he b i -- ha be e

i a he e b e e a

i ma e eac i

e iall ega i e e he he he e e icide eca i , a ell

a he fac ha i e ac i i h he ide ld ca be he a e ic a d ed ce i la i -- a

leadi g ca e f icidal beha i . S aff migh al ha e a g ed (al h gh he did

hi

i e ) ha m i ma e h e e me all ill a d icide eca i e e debili a ed b

hei ill e ha he did ca e h he e e ea ed (i.e., he i hh ldi g f ba ic

19See Wa , B., Ka fma , A., K ll, J., a d Chleb ki, S. (2013), S icidal Idea i Am g I ma e-Pa ie i

S a e P i : P e ale ce, Rel c a ce Re , a d T ea me P efe e ce , B

S

L , 30:

230-238.

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i ilege ). Of c e, hi a m i a

l

ed b ig ed he eal ibili

ha he e mea e e e c ib i g a i ma e debili a i g me al ill e .

F he , me migh al a g e ha he e highl e ic i e mea e e e effec i e i

ma agi g h e i ma e ec ed a bei g ma i la i e mali ge i g. A h ld be di c ed

d i g icide e e i ai i g k h , al h gh di i g i hable, ma i la i e beha i

a d icidal beha i e e m all e cl i e. B h e f beha i c ld cc ( e la )

i he ame i di id al a d ca e e i i j a d dea h. Se e al die f elf-ha m a d icide

i he c ec i al e i me ha e f d b a ial c -e i e ce f ma i la i e m i e i h

b h icidal i e a d e iall high le hali f elf-ha mi g beha i . A e b e e ha

a ed, The e a e eliable ba e

hich e ca diffe e ia e ma i la i e icide

a em

i g h ea he i ma e life f m h e e, -ma i la i e a em hich

ma e d i dea h. The e m ma i la i e i im l ele i de a di g, a d de c i e i

a em i g ma age, he icidal beha i f i ma e ( f a b d el e). Self-ha m i f e a

c m le , m l iface ed beha i , a he ha im l ma i la i e beha i m i a ed b ec da

gai . A a mi im m, a i ma e h ld g he e eme f h ea e i g icide e gagi g

i elf-ha mi g beha i i ffe i g f m a lea a em i al imbala ce ha e i e ecial

a e i . The ma al be e i l me all ill. Sim l a ed, i ma e labeled a ma i la i e

ill c mmi icide.

Fi all , i i e im a

e ha SCSD fficial e e c e l i he la i g

age f c e i a d e a i f he 300 P d f he 3-We U i . Thi i c e l

h ed OPP i ma e . P elimi a la e e f 20 l e ie cell i he i be ili ed f

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leme al h i g f i ma e

icide eca i a d/ a e -d f m 2P-U i

di cha ge. Thi i e i ec ed he h i g i a d f d ha , i h a fe e ce i , i a

m l icide- e i a a d

i -f ee. Ba ed

hi i e ec mme da i , he

f ll i g fi e e e be em ed f m each f he e 20 l e ie cell : e b k, able,

h k lef ide f i k, a d a i- i li i fa ce . I addi i , a ima el f c e cell

i he i h ld be ili ed f icide eca i beca e f hei i e de ig ha i cl ded

a bli d

hich b c ed i ibili i he cell . Of e, he e e e al la c e he

cla m he 3-We U i i ffice ace f OPP cli icia . The e ece i i ia i e e e

e c mme dable.

RECOMMENDATIONS: The f ll i g ec mme da i a e ffe ed im e he

h i g a d ma ageme f i ma e

icide eca i i hi he Sac ame C Jail

S em. F , hi i e

gl

he SCSD deci i c e a d e a e he 300

P d f he 3-We U i f

leme al h i g f i ma e

icide eca i a d/ a

e -d f m 2P-U i di cha ge, a ell a c e i f he cla m he 3-We U i i

ffice ace f OPP cli icia . A ed ab e, i i

gl ec mme ded ha he f ll i g

fi e be em ed f m each f he 20 l e ie cell : e b k, able, h k lef ide f

i k, a d a i- i li i fa ce . I addi i , a ima el f c e cell i he i h ld

be ili ed f icide eca i beca e f hei i e de ig ha i cl de a bli d

hich b c e i ibili i he cell . S , hi i e a i f med ha he SCSD i

emba ki g e c c i jec a he RCCC ha ill i cl de he ibili f em a

h i g f icidal i ma e . A ch, i i

gl ec mme ded ha hi i e Checkli f

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he S icide-Re i a De ig f C ec i al Facili ie , i cl ded a A e di A f hi e , be ili ed a a g ideli e.

T ,i i

gl ec mme ded ha , a

a he e l e a ed 300 P d f he

3-We U i i ac i a ed, SCSD fficial i e a mem a d m ha : 1) ic l hibi he e f

a m l i-

e m cla m f he h i g f i ma e f a d a i f ime, a d

2) ic l limi he e f afe cell , eg ega i h ldi g cell , he h ldi g cell f he

h i g f icidal i ma e f f (4) h . I addi i , SCSD, CHS, a d JPS lic h ld

be e i ed acc di gl .

F ,i i

gl ec mme ded ha JPS fficial i c hei cli ical aff he

a

ia e e f afe m ck , i.e., he h ld be ili ed a a defa l , a d

be ed

a a l i a beha i ma ageme la (i.e.,

i h a d/ a em cha ge e cei ed

ma i la i e beha i ). Ra he , afe m ck h ld l be ili ed he a cli icia belie e

ha he i ma e i a high i k f icide b ha gi g. Sh ld a i ma e be laced i a afe m ck,

he g al h ld be e f ll cl hi g he i ma e i

hei di cha ge f m icide

eca i . Fi all , c d e el h ld

lace a i ma e i a afe m ck le i

had bee e i l a ed b medical a d/ me al heal h e el.

F , c e SCSD a d JPS icide e e i licie d add e ced e f

decidi g hich e i a d i ilege e e ided i ma e

icide eca i . A

ch, i i

gl ec mme ded ha licie be e i ed i cl de he f ll i g e i eme :

x All deci i ega di g he em al f a i ma e cl hi g, beddi g, e i (b k , li e / a dal , e egla e , e c.) a d i ilege hall be

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c mme a e i h he le el f icide i k

--

JPS

E-C ;

x If JPS aff de e mi e ha a i ma e cl hi g eed be em ed f ea f afe , he i ma e hall al a be i ed a afe m ck a d afe bla ke ;

x A ma e hall be i ed all i ma e i ma e ili e he ma e i a i a em i g am e i h/de , ili e e c.);

icide eca i

le he

hich i a

i e ded (i.e.,

b c i ibili i he cell,

x All i ma e

icide eca i hall be all ed all i e i ilege (e.g.,

famil i i , ele h e call , ec ea i , e c.), le he i ma e ha l h e

i ilege a a e l f a di ci li a a c i ; a d

x I ma e

icide eca i hall a ma icall be l cked d . The

h ld be all ed da m a d/ - f-cell acce c mme a e i h hei

ec i le el a d cli ical j dgme f JPS aff.

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5) Le el of S per i ion/Managemen

T o le el of per i ion are generall recommended for icidal inma e -- close obser ation and constant obser ation.
Close Obser ation i re er ed for he inma e ho i no ac i el icidal, b e pre e icidal idea ion and/or ha a recen
prior hi or of elf-de r c i e beha ior. In addi ion, an inma e ho denie icidal idea ion or doe no hrea en icide, b demon ra e o her concerning beha ior ( hro gh ac ion , c rren circ m ance , or recen hi or ) indica ing he po en ial for elf-inj r , ho ld be placed nder clo e ob er a ion. Thi inma e ho ld be ob er ed b aff a
aggered in er al no o e ceed e er 10-15 min e . Constant Obser ation i re er ed for he inma e ho i ac i el icidal, ei her b hrea ening or engaging in elf-inj r . Thi inma e ho ld be ob er ed b a aff member on a con in o ,
nin err p ed ba i . O her per i ion aid (e.g., clo ed circ i ele i ion, inma e companion / a cher , e c.) can be ili ed a a pplemen o, b ne er a a b i e for, he e ob er a ion le el . Inma e on icide preca ion ho ld be rea e ed on a dail ba i .

E e ie ce ha h ha m , effec i e eme ge c medical e ice ca a e li e .

Re ea ch i dica e ha he e helmi g maj i f icide a em i c d i b ha gi g.20

Medical e e a ha b ai damage f m a h ia i ca cc i hi f mi e , i h

dea h f e e l i g i hi fi e i mi e . I i ma e icide a em , he m e f he

e e i f e d i e b he le el f e i i aff ded he i ma e. B h he ACA a d

NCCHC a da d add e

, al h gh he deg ee f ecifici a ie . ACA

S a da d 4-ALDF-2A-52 ag el e i e ha icidal i ma e a e de c i

b e a i , hile NCCHC S a da d J-G-05 e i e h ical b e a i a gi g f m

c a e ii

e e 15 mi e m e f e e l if ece a . Acc di g he

S icide P e e i a d I e e i S a da d f m he U.S. De a me f H mela d Sec i

O

M ICE P

-B N

D

S

, S icidal de ai ee ill

20Ha e , L.M. (2010), Na i al S d f Jail S icide : 20 Yea La e , J

C

H C , 18 (3).

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be m i ed b he a ig ed ec i ffice h mai ai c a e- - e i al b e a i , 24 h a da , il he de ai ee i elea ed f m icide a ch. The a ig ed ec i ffice make
a i e e 15 mi e he beha i al b e a i checkli .

I addi i , he c m e f Le el f S e i i e c m a e he e all

ma ageme f he i ma e

icide eca i a d i cl de he a

ia e le el f

b e a i , imel a d c m ehe i e icide i k a e me , d g adi g he le el f

b e a i f ll i g a e i d f abili , a d idi g e i dic f ll - a e me

f ll i g di cha ge f m icide eca i ba ed a i di id ali ed ea me la .

FINDINGS: The SCSD S icide P e e i P g am lic (N . 10/5) ided

limi ed g ida ce ega di g he b e a i f icidal i ma e , im l a i g ha c d

e el e e e i ed

ide di ec i al b e a i f icidal i ma e a lea ice

e e hi (30) mi e . JPS S icide P eca i - Ac e I a ie U i (N . 1009) li ed

he f ll i g le el f b e a i f icidal i ma e :

S icide Ri k: 15-Min e Check : Thi le el f b e a i i e i ed f i ma e h ha e bee de e mi ed be a m de a e icide i k. A e am le f a i ma ea ie e i i g 15-mi e check h ld be a i ma e- a ie e e i g icidal
idea i i h me ambig i a d ei he la a l f med la .

High S icide Ri k: Camera Moni oring: Thi le el f b e a i i e i ed f i ma e h ha e bee de e mi ed be a high i k, a e ac i el icidal, a d e i e c a b e a i b i g aff. O e i g aff ill emai i he
e a i all ime a d i e ible f came a m i i g. The e i ma e c ld al be 15-mi e check . The e( ) f beha i e em lif i g high- i k beha i a defi ed i he JPS lic .

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I addi i , acc di g he JPS lic , i a ical ca e , a d i c j c i i h came a m i i g, me i ma e ma e i e 1:1 affi g, hich e l ed i a aff e i i g ide he cell a d mai ai i g c a b e a i .

I ac ice, al h gh he SCSD lic a ag el i e e i e b e a i a lea

ice e e hi (30) mi e , mea i g a ffice c ld c cei abl c d c check i hi

10 mi e a d he lea e he i ma e b e ed f he emai i g 20 mi e , hi i e f d

ha he a maj i f i ma e laced icide eca i e e b e ed a a ima e 15-

mi e i e al . Wi hi he 2P-U i , afe a d h ldi g cell , aff a e i ed alk ,

a d l k h gh, he cell d e e 15 mi e e if he ell-bei g f i ma e

icide

i k a . Whe icidal i ma e e e laced i he cla m, b e a i a e f med

f m he ffice c l a i . Thi e f b e a i a blema ic beca e he c l

a i e e e cl ed, i a ed a ima el 20-30 a d a a f m cla m , a d he e a

limi ed abili f i e ac i be ee c d aff a d he i ma e beca e cell- ide check e e

e i ed.

Al h gh ed i f e e l i hi he 2P-U i , hi i e did b e e cl ed-ci c i

ele i i m i i g (CCTV) bei g b e ed a he ima le el f b e a i f a fe high

i k icidal i ma e d i g he - i e i i . Thi ac ice ca be e blema ic. The e f

CCTV a a al e a i e aff b e a i i

ed b a i al c ec i al a da d ,

a d hi i e ha i e ab i e ial da ge i he af eme i ed icide e e i

ai i g ma al:

U ili ed ima il a a al e a i e a ig i g aff he icidal i ma e, cl ed ci c i ele i i (CCTV) i a la , e deadl f m f e i i . Wi hi he

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a ea f jail icide, he e a e me e am le f i ma e c mmi i g icide i

f ll ie f CCTV e i me . Al h gh facili ie ha ili e CCTV f e limi he

mbe f h ha a e aff membe ca ie a m i , i i

al

f aff ffe f m m i h i b

d i g hei a ig me .

O he e i

blem i cl de f

di ed CCTV ece i , e i me

b eakd , a d aff bei g di ac ed f m m i ie i g b he

e ibili ie .

Remi de : De i e i i e ded e, CCTV d e

e e a icide, i l

ec d a icide a em i g e . I fac , he me e e e ce f CCTV ma

e c age icidal he ac i g- beha i , a ic la l f m i ma e

belie e be ma i la i e. If ili ed, m e e ag ee ha CCTV h ld be

ed l a a

( a a b i e) f aff b e a i , a d a aff

membe h ld be a ig ed ie a m i f m e ha e h i h bei g elie ed b he aff. 21

Ba ed

he b e a i f hi i e , a ell a c e a i i h JPS fficial a d

aff, a ell a e ie f e e al medical cha , c e ac ice i hi he Sac ame C

Jail S em e e ha i ma e

icide eca i e e ee

b JPS cli icia . I ma e-

a ie

icide eca i i 2P-U i e e a e ed b chia i a d/ a chia ic e

ac i i e .22 I ma e

icide eca i i h i g i

ide f he 2P-U i e e a e ed

b OPP cli icia . A b e ed b hi i e , i ma e

icide eca i i b h he 2P-U i

a d el e he e e e ee cell- ide, h ad e el affec i g b h i ac a d c fide iali .

The a da d f ca e e i e ha d c me a i f a c m ehe i e a e me f icide i k i cl de fficie de c i i f he c e beha i a d j ifica i f ei he laceme
, di cha ge f m, icide eca i . F e am le, he a e me h ld i cl de a b ief me al a e ami a i (MSE), li i g f ch ic a d ac e i k fac (i cl di g i hi

21Ha e , L. (2016), T

C

P

G

S

D

P

J

P F

, Ma field, MA: Na i al Ce e I i i a d Al e a i e .

22I addi i , h ee b a d eligible f e ic chia ic fell f m he U i e i f Calif ia-Da i , Sch l f

Medici e, De a me f P chia a d Beha i al Scie ce , a i ed i b h he 2P-U i a d OPP.

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f icidal beha i ), li i g f a

ec i e fac , le el f icide i k (e.g., l , medi m,

high), a d a ea me la .23 Acc di g a i al c ec i al a da d , a me al heal h

cli icia h ld de el a ea me la f a i ma e di cha ged f m icide eca i ha

de c ibe ig , m m , a d he ci c m a ce i hich he i k f icide i likel ec ,

h ec e ce f icidal h gh ca be a ided, a d ac i he a ie

aff ca ake if

icidal h gh d cc ( ee NCCHC, 2014).

Wi hi he Sac ame C Jail S em, a JPS Cli ical A e me f m a ili ed d c me icide i k e al a i . The f m, embedded i he E-Cha , c ai ed f mai ec i : me al heal h hi , me al a e am, icide a e me , a d ca e di i i . The icide a e me ec i a e c m ehe i e a d i cl ded i i ega di g: e ide ce f icidal idea i ; icide a em ; la e ed a em ; le hali f la a em ; c e e ce f la a em ; e ed le el f icidal i e ; ima me h d f la ed icide; i ma e e f a icide la ; ea , mea i g a d cial c e f a a em ; i ca ce a i fac ela ed
icidali ; c e icide i k fac ; ec i e fac ; a a i e e lai i g e la a i f i i e fi di g ; a d ea me la .

Thi i e cha e ie f d ha OPP cli icia d c me ed hei icide i k a e me fi di g he JPS Cli ical A e me f m, b chia aff i he 2P-U i d c me ed hei fi di g a a g e e (albei i f e e l ) a d Ph icia O de f m. The ea h chia aff e e e i ed c m le e a Cli ical A e me f m a clea .

23See Ame ica P chia ic A cia i (2003), P ac ice G ideli e f he A e me a d T ea me f Pa ie

i h S icidal Beha i , A

J

P

, (160) 11: 1-60 (S leme ).

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Fi all , c e SCSD a d JPS licie did e i e a ecific f e e c f f ll -

b me al heal h aff f ll i g a i ma e di cha ge f m icide eca i [al h gh JPS had

a F e e c f Se ice Scale (FOSS) c l ha e i ed i ma e di cha ged f m icide

eca i be ee agai b a cli icia i hi e m h

e if cli icall i dica ed. A

e lai ed la e i hi ec i , ch a f e e c f f ll - fa e ceeded he a da d f ca e.

Thi i e e ie ed he cha f e e al i ma e h e e laced , a d b e e l

di cha ged f m, icide eca i . Wi h c i i i g he cli ical j dgme ili ed b a JPS

cli icia , hi i e f d ha al h gh alm all i ma e e e ee a eg la ba i b a

cli icia a e i ed, m f he e ie ed cha i cl ded d c me a i ha : 1) did

ide

a fficie de c i i f he c e beha i a d j ifica i f di cha ge f m icide

eca i

he 2P-U i ( he ha he i ma e de ial f icidal idea i ), 2) i cl ded de

f c i ed i a ce f a afe m ck de i e he fac ha he i ma e a clea ed f m icide

eca i , 3) i cl ded de f f ll - ha e e f e i c i e i h he FOSS cale,

a d 4) did

ide a iable ea me la f ed ci g f e icidal idea i . The f ll i g

ca e mma ie e e ill a i e f he blem:

x I Ca e No. 2, he i ma e a admi ed i he Mai Jail Ma 30, 2016.

He had a hi

f Schi h e ia a d Bi la Di de a d a

b e e l ee b JPS cli icia e i dicall ba ed

cd

efe al f del i al beha i . O J l 25, 2016, he i ma e a b e ed

mea i g f d a d fece he all f hi cell. He had beg ef i g

ch ic medica i . The i ma e a laced he 2P-U i f g a e

di abili , b all ed ha e hi

cl hi g a d b e ed a 30-mi e

i e al . Hi beha i abili ed a d he a di cha ged f m he 2P-U i

e e al da la e J l 31 (al h gh he chia ic e a h i i g he

di cha ge a

i e il 12 da la e A g 12). The e a ed:

T-Se . e c d , JPS - a ie f ll i he cli ic, eadmi if

c i e ia e e .

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D i g he m h f A g , he i ma e a ee e e al ime b b h OPP

cli icia a d a chia i ba ed

efe al f m c d aff f

de e i a d fail e f ll di ec i e . He c i ed ef e

medica i , b did mee he 2P-U i admi i c i e ia f g a e

di abili . Fi all , Se embe 9, he i ma e a ee agai b a

chia i a d c e ed i i ia e ch ic medica i .

O Se embe 16, he i ma e a efe ed JPS b c d aff ba ed

icidal idea i a d g a e di abili . Whe a e ed b a OPP

cli icia ha m i g, he a cl hed i a afe m ck i a eg ega i

cell l ca ed i he b ki g a ea. A Cli ical A e me f m a

c m le ed, hich i cl ded a icide i k a e me . The i ma e c i ed

ice icidal idea i i h a la . He a mai ai ed

icide

eca i i he eg ega i cell a d laced he ai li f he 2P-

U i . The i ma e emai ed i he eg ega i cell f e e al da a d a

ee dail b a OPP cli icia . O Se embe 19, he a admi ed i he

2P-U i , a d emai ed i a afe m ck i h a e i eme f b e a i

a 15-mi e i e al . The f ll i g da (Se embe 20), chia ic a d

i g e a ed ha he i ma e a d g aded 30-mi e check

a d emai ed i he afe m ck. The e a j ifica i i he e a

h he i ma e a bei g di cha ged f m icide eca i .

A e a a e N i g P blem Li /Ca e Pla da ed Se embe 20 a ed: P blem 1 - Al e a i i h gh ce a d/ di ga i ed beha i ela ed ch i c g i i e im ai me ; P blem 2 - P e ial f elfdi ec ed i le ce ela ed icidal idea i , ge e beha i .

N i g e da ed Se embe 21 a d 22 did add e a g al

a egie add e he

blem a ea , a d a chia ic e da ed

Se embe 21 im l c i ed a de f 30-mi e check a d a afe

m ck. A f Se embe 22, he i ma e emai ed he 2P-U i 30-

mi e check a d cl hed i a afe m ck.

I m, he e a j ifica i i he e a h he i ma e a

bei g di cha ged f m icide eca i

Se embe 20,

a

ea abl a ic la ed ea me la . The i ma e a deemed a icide

i k, b c i ed be cl hed i a afe m ck.

x I Ca e No. 3, he i ma e a b ked i he Mai Jail Se embe 17,

2016. He a i ica ed a d e e ed icidal idea i , b h c e l

a d i hi he a

eek . He a laced icide eca i b

c d e el a d he a e ed b a OPP cli icia he f ll i g

m i g (Se embe 18), he a cl hed i a afe m ck i a eg ega i

cell l ca ed i he b ki g a ea. A icide i k a e me a c m le ed

ha i dica ed ha he i ma e had bee ecei i g chia ic ea me a d

ch ic medica i f e e al ea , a d had e i l a em ed

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icide i 2015 b e d e. He c i ed e e icidal idea i i h a la , a d a ea ed h ele . S icide eca i e e c i ed a d he i ma e a laced he 2P-U i ai li . The f ll i g da (Se embe 19), he i ma e a ee agai b a OPP cli icia i he eg ega i cell a d de ied icidal idea i , a i g I m be e . The cli icia la e c l ed i h a chia i a d he i ma e a di cha ged f m icide eca i . The ea me la ec i f he cli ical a e me f m a ed: 1) C d ad i ed a ie clea ed, 2) Cli ic, 3) FOSS III.

I m, he e a d c me a i i he cli ical a e me f Se embe

19 i dica e h he i ma e a l ge icidal, he e a ea me

la , a d a de f FOSS III (i.e., f ll - i hi 90 da ) g ea l

e ceeded he e abli hed

c l f 30-da f ll - f i ma e

di cha ged f m icide eca i .

x I Ca e No. 4, he i ma e a eadmi ed i he Mai Jail J e 30,

2016 a d e ed a i hi

f chia ic ea me , b de ied a

c e icidal idea i . (U bek

i g aff a i ake, he

i ma e had e i l bee h ed i he 2P-U i f m Ja a h gh

A il 2016 f icidal idea i .) A ima el 10 da la e J l 10,

he e e ed icidal idea i i h a la ha g him elf a d a laced

icide eca i i a cla m b c d e el. The f ll i g

da (J l 11), a OPP cli icia c m le ed a icide i k a e me a d he

i ma e c i ed e e icidal idea i . He a mai ai ed icide

eca i a d laced he 2P-U i ai li . The i ma e a ee dail

b a OPP cli icia i he cla m a d, ba ed

a icide i k

a e me c m le ed J l 14, a i i iall clea ed f m icide

eca i i h he f ll i g ea me la : Clea ed b JPS, JPS PRN,

FOSS III.

The i ma e, h e e , c i ed e e icidal idea i a d emai ed icide eca i i he cla m f m J l 15 h gh J l 19. O
J l 20, he i ma e a em ed a h ia e him elf b i g a la ic bag a d hi eck. He a b e e l a fe ed he 2M-U i icide
eca i . T da la e J l 20, he a b e ed be ba gi g hi head agai he cell all a d c eami g. The f ll i g da (J l 23), a he icide i k a e me a c m le ed a d he i ma e de i g a c e icidal idea i . He a di cha ged f m icide eca i i h he f ll i g ea me la : Clie ched led f cli ic. JPS elfa e check ched le, FOSS II.

A fe eek la e A g 17, a chia ic e i dica ed ha he i ma e a eadmi ed i he 2P-U i f icidal idea i . The f ll i g da
(A g 18), a he chia ic e i dica ed ha icide eca i

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e e di c i ed, i h he i ma e laced 30-mi e check a d cl hed i a afe m ck.

The i ma e a a e l emai ed i he 2P-U i il Se embe 13 he he

a di cha ged. The f ll i g da (Se embe 14), h e e , he agai

h ea e ed icide a d a efe ed JPS. A OPP cli icia c m le ed a

icide i k a e me a d he a laced back

icide eca i i

a cla m. He a ee dail b a OPP cli icia f m Se embe 15 h

19. The f ll i g da (Se embe 20), he i ma e a admi ed i he 2P-

U i i h a Ph icia O de , b

chia ic e. He emai ed i a

afe m ck a d e i ed be b e ed a 15-mi e i e al . The

f ll i g da (Se embe 21), a Ph icia O de a ed ha i ma e a

di cha ged f m icide eca i a d laced 30-mi e b e a i

i a m ck. The e a

chia ic e.

A N i g P blem Li /Ca e Pla , al da ed Se embe 21, li ed he

f ll i g ea me la : P blem 1 - P e ial f elf-di ec ed i le ce

ela ed icidal idea i , ge e beha i . The Pla did add e

a g al

a egie add e he blem. A he i g e da ed

Se embe 21 a ed e c age a ie

e c i g kill , b did

ide if a c i g kill . The f ll i g da (Se embe 22), a i g e

ed he i ma e a a i g I hi k I am icidal. De i e hi elf-

e ed icidal idea i , he i ma e emai ed 30-mi e b e a i

i a m ck.

I m, he i ake e J e 30, 2016 did acce he E-Cha

de e mi e ha he i ma e had e i l bee h ed i he 2P-U i e e al

m h ea lie . The i ma e had e e al icide i k a e me c m le ed

b OPP cli icia , b

e b chia ic aff he h ed i he 2P-

U i . Se e al Ph icia O de e e c m le ed i h

chia ic e

j if i g he de . The i ma e a i a

ia el gi e a FOSS III

f ll - af e di cha ge f m he 2P-U i J l 14. O Se embe 22,

he i ma e a a e l e e ed icidal idea i a e, b emai ed

30-mi e b e a i . A ime he he i ma e a deemed be

icidal, he emai ed cl e i a afe m ck. The e a

ea me

la i g.

x I Ca e No. 5, he i ma e a eadmi ed i he Mai Jail A g 23,

2016 a d e ed me al heal h ea me , ch ic medica i ,

c e icidal idea i , a ell a idea i f he a

eek . (The E-

Cha d c me ed hi i icidal idea i i he Mai Jail d i g J e

2012 ha a

ed he i ake c ee i g f m.) The i ma e a

laced icide eca i a d laced i a eg ega i cell i hi he

b ki g a ea. The e da (A g 24), a OPP cli icia c m le ed a

icide i k a e me a d he a gi e a i i ial diag i f R le-O

Schi h e ia a d O he P ch ic Di de . The i ma e elf- e ed

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f i icide a em f l le hali i hi he la m h. The

a e me ed ha a e e , clie i able eliabl c ac f

afe . S icide eca i e e c i ed a d he i ma e a laced

he 2P-U i ai li . He a ee he f ll i g da a d he A g 26,

a d OPP cli icia c m le ed a he icide i k a e me . The i ma e

de ied a c e icidal idea i a d, f ll i g c l a i i h a

chia i , a di cha ged f m icide eca i . The ea me la

a ed: e ie ed afe

c l , clea ed, efe cli ic, FOSS III.

A fe eek la e Se embe 15, he i ma e e e ed icidal idea i

c d e el, laced

icide eca i i a cla m, a d

efe ed JPS. The f ll i g da (Se embe 16), a d OPP cli icia

c m le ed a he icide i k a e me , i h he i ma e c i i g

e e icidal idea i . He emai ed

icide eca i i a

cla m a d a laced he 2P-U i ai li . OPP cli ical e da ed

Se embe 17 a d 18 a ed ha he i ma e c i ed mee he c i e ia

f a 2P-U i ba ed

c i ed icidal idea i , i h he i ma e

a i g ha he ha a a l f hi g g i g . O Se embe 19, he i ma e

a admi ed he 2P-U i i h a Ph icia O de f icide eca i

a 15-mi e i e al a d a afe m ck. A N i g P blem Li /Ca e

Pla , al da ed Se embe 19, li ed he f ll i g ea me la :

P blem 1 - P e ial f elf-di ec ed i le ce a e ide ced b hi

f

icide a em , feeli g de e ed, mi i g famil . The Pla did

add e a g al

a egie add e he blem. The f ll i g da

(Se embe 20), a Ph icia O de di c i ed he icide eca i a d

laced he i ma e 30-mi e b e a i i a afe m ck. The e a

chia ic e j if he deci i . S b e e h icia de

da ed Se embe 21 a d 22 a ed ha he i ma e ld emai i a afe

m ck 30-mi e b e a i .

I m, he ea me la b h A g 26 a d Se embe 19 did

c ai a g al

a egie add e he ide ified blem a ea

blem. A FOSS III f ll - a i a

ia el de ed A g 26

b he OPP cli icia . The e a d c me a i j if he i ma e

di cha ge f m icide eca i

Se embe 20, a d he i ma e

emai ed i a afe m ck af e bei g di cha ged f m icide eca i .

A i dica ed ab e, hi i e b e ed ha ma , b all, i ma e laced i he 2P-

U i e e cl hed i afe m ck de i e he fac ha he e e 30-mi e b e a i . Thi

a a a a e c adic i i de beca e afe m ck h ld be ili ed f i ma e ha

a e a e ed a icidal, hile 30-mi e b e a i h ld be ili ed f i ma e ha a e

a e ed a

icidal. Thi i e al b e ed he e i able ac ice he 2P-U i . F

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e am le, b e a i f m d c me he f e e c f check a ei he 15- 30-mi e i e al e e ke a cli b a d i he N e Office, a he ha he cell d f each i ma e. Al h gh b e ed b hi i e , ch a ac ice c ea ed he ibili ha i g
aff ld d c me he check a ha i g cc ed i h lea i g he N e Office a d b e i g each i ma e cell- ide. I addi i , a e i l ed, al h gh ed i f e e l , hi
i e did b e e CCTV bei g b e ed a he ima le el f b e a i f a fe high i k icidal i ma e i hi he 2P-U i , a d chia i f e e l de ed CCTV b e a i a a
leme al mea e f l e i k i ma e . F he , all i ma e h e e admi ed he 2PU i emai ed i afe m ck h gh hei a , e e if Ph icia O de g a ed hem he e al e i . Al h gh i ma e e e ffe ed h e a dail ba i , e f he da m
a limi ed a ima el 30 mi e each da e i ma e.24 Al h gh add e ed i a SCSD JPS lic , i ma e e e hibi ed b ac ice f m maki g ele h e call a d ha i g ii .

RECOMMENDATIONS: Thi i e

ld ffe e e al ec mme da i

e g he he b e a i a d ma ageme f i ma e ide ified a icidal a d/ e hibi i g elf-

i j i beha i i hi he Sac ame C

Jail S em. F , i i

gl ec mme ded

ha b h he SCSD a d JPS icide e e i licie be e i ed i cl de le el f

b e a i ha ecif de c i i f beha i a a i g each le el f b e a i . A

ed

e i i i ffe ed a f ll :

Close Obser ation i e e ed f he i ma e h i ac i el

icidal, b e e e icidal idea i a d/ ha a ece i

hi

f elf-de c i e beha i a d ld be c ide ed a l

24Acc di g 2P-U i c d e el, a i ma e acce he da m a dail ba i a cc e ce d e he i g f de ie d i g he da hif . P e i l , he l e de he U i , i ma e e e l ffe ed 30-mi e da m a c le ime e eek.

l a ece a a ig ed

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i k f icide. I addi i , a i ma e h de ie icidal idea i

de

h ea e icide, b dem a e he c ce i g

beha i ( h gh ac i , c e ci c m a ce , ece hi )

i dica i g he e ial f elf-i j , h ld be laced de cl e

b e a i . Thi i ma e h ld be b e ed b aff a agge ed

i e al

e ceed e e 10-15 mi e , a d h ld be

d c me ed a i cc .

Constant Obser ation i e e ed f he i ma e h i ac i el icidal, ei he b h ea e i g e gagi g i elf-i j ,
c ide ed a high i k f icide. Thi i ma e h ld be b e ed b a a ig ed aff membe a c i , i e ed ba i . The b e a i h ld be d c me ed a 15-mi e i e al .

S ,i i

gl ec mme ded ha CCTV be ili ed l a a leme , a d

a e laceme f , he e al b e a i f high i k icidal i ma e . A ch, a i ma e

c ide ed high i k a defi ed b c e JPS lic h ld be a ig ed a aff membe h

ld be h icall a i ed ide he i ma e cell

ide c i , i e ed

b e ai .

T ,i i

gl ec mme ded ha he SCSD e lace he a a i e f ice e e 30

mi e c e l c ai ed i hi i licie i h agge ed i e al ha d e ceed 10-

15 mi e .

F , i i gl ec mme ded ha all OPP a d

aff c m le e a Cli ical

A e me f m ( hich i cl de he icide i k a e me ) each ime he a e d g adi g

a d/ di cha gi g a i ma e f m icide eca i i he 2P-U i 3-We U i . A ch, all

JPS cli icia h ld c m le e he Cli ical A e me f m a lea ice, i.e., f i i ia i f

icide eca i , a ell a j ifica i f di cha gi g he i ma e f m icide eca i .

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F ,i i

gl ec mme ded ha c m le i f he Cli ical A e me , a ell a

he cli ical e c e , h ld cc i a i a e e i g a d cell- ide le he i ma e

ef e a i a e i e ie . Ref al f a i a e i e ie h ld be d c me ed i he E-Cha .

S , i i he gl ec mme ded ha a i ma e h ld e e be cl hed i a afe

m ck if he a e bei g b e ed a 30-mi e b e a i . If a JPS cli icia belie e ha a

i ma e beha i ece i a e a afe m ck, he h ld be icide eca i . If a JPS

cli icia belie e ha 30-mi e b e a i a e a a ed, he he i ma e i

icidal a d

h ld ha e hei f ll cl hi g a d e i .

S ,i i

gl ec mme ded ha , c i e i h NCCHC a d he a i al

c ec i al a da d , JPS cli icia ( ) de el ea me la f i ma e di cha ged f m

icide eca i ha de c ibe ig , m m , a d he ci c m a ce i hich he i k f

icide i likel ec , h ec e ce f icidal h gh ca be a ided, a d ac i he

a ie

aff ca ake if icidal h gh d cc ( ee NCCHC, 2014).

E ,i i

gl ec mme ded ha , i de afeg a d he c i i f ca e f

icidal i ma e , all i ma e di cha ged f m icide eca i h ld emai me al heal h

ca el ad a d ecei e eg la l ched led f ll - a e me b JPS cli icia il hei

elea e f m c d . JPS c e f ll - ched le f i ma e elea ed f m icide

eca i f i hi 30 da i ell bel he a da d f ca e. A ch, le a i ma e

i di id al ci c m a ce di ec he i e (e.g., a i ma e i a

ia el laced

icide

eca i b -me al heal h aff a d elea ed le ha 24 h la e f ll i g a

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a e me ), i i ec mme ded ha he FOSS II cale f i ma e di cha ged f m icide eca i be d ama icall e i ed a f ll : f ll - i hi 24 h , agai i hi 72 h ,
agai i hi 1 eek, a d he e i dicall il elea e f m c d .

N , gi e he g a cia i be ee i ma e icide a d eg ega i laceme (e.g.,

2 f 3 f he m ece i ma e icide e e

al e a a i a he ime f hei dea h ),

i i gl ec mme ded ha c d e el i c ea e hei d f ch h i g i f m

60-mi e 30-mi e i e al . I addi i , a be ac ice ld al be f

i g aff

c d c e dail d each da f all cell i he e eg ega i i hile he a e di e i g

medica i , a ell a f OPP cli icia c d c eekl d i he e i .

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6) In er en ion

A facili polic regarding in er en ion ho ld be hreefold: 1) all aff ho come in o con ac i h inma e ho ld be rained in andard fir aid and cardiop lmonar re ci a ion (CPR); 2) an aff member ho di co er an inma e a emp ing icide ho ld immedia el re pond, r e he cene o en re he emergenc i gen ine, aler o her aff o call for medical per onnel, and begin andard fir aid and/or CPR; and 3) aff ho ld ne er pre me ha he inma e i dead, b ra her ini ia e and con in e appropria e life- a ing mea re n il relie ed b arri ing medical per onnel. In addi ion, all ho ing ni ho ld con ain a fir aid ki , pocke ma k or mo h hield, Amb bag, and re c e ool ( o q ickl c hro gh fibro ma erial). All aff ho ld be rained in he e of he emergenc eq ipmen . Finall , in an effor o en re an efficien emergenc re pon e o icide a emp , mock drill ho ld be incorpora ed in o bo h ini ial and refre her raining for all aff.

F ll i g a icide a em , he deg ee a d m e f i e e i

ided b aff

f e f e ell he he he ic im ill i e. Al h gh b h ACA a d NCCHC a da d

add e he i e f i e e i , ei he a e elab a i e i ffe i g ecific c l . F

e am le, ACA S a da d 4-ALDF-4D-08 e i e ha -- C ec i al a d heal h ca e e el

a e ai ed e d heal h- ela ed i a i i hi a f -mi e e e ime. The ai i g

g am...i cl de he f ll i g: ec g i i f ig a d m m , a d k ledge f ac i

e i ed i e ial eme ge c i a i ; admi i a i f ba ic fi aid a d ce ifica i i

ca di lm a e ci a i (CPR)... NCCHC S a da d J-G-05 a e -- I e e i : The e

a e ced e add e i g h ha dle a icide a em i g e , i cl di g a

ia e fi -

aid mea e .

FINDINGS: The SCSD S icide P e e i P g am lic (N . 10/5) ided a ade a e de c i i f he e eme ge c e e f m c d e el a icide a em . I addi i , fi aid ki e e l ca ed i all h i g i ed b hi i e . Each ki
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c ai ed a c -d

l ( ili ed ickl c h gh fib ma e ial) a d CPR ma k. I

addi i , a ma ed e e al defib illa (AED ) e e f d i a i l ca i i b h he

Mai Jail a d RCCC. Acc di g ece ai i g da a e ie ed b hi i e , a ima el 100

e ce f b h c d a d i g e el e e c e l ce ified i ca di lm a

e ci a i (CPR) a d AED. Thi i e e ie f i e iga i e file f he h ee (3) i ma e

icide be ee 2014 a d 2016, a ell a a e i icide a em i Oc be 2016, f d ha

e eme ge c e e e e f d i each ca e.

RECOMMENDATIONS: N e

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7) Repor ing
In he e en of a icide a emp or icide, all appropria e correc ional official ho ld be no ified hro gh he chain of command. Follo ing he inciden , he ic im famil ho ld be immedia el no ified, a ell a appropria e o ide a hori ie . All aff ho came in o con ac i h he ic im prior o he inciden ho ld be req ired o bmi a a emen a o heir f ll kno ledge of he inma e and inciden .

FINDINGS: Thi i e e ie f i e iga i e e a d he d c me a i f m

he h ee (3) i ma e icide be ee 2014 a d 2016, a ell a he e i

icide a em i

Oc be 2016, f d ha all e i g e i eme a ea ed ha e bee a

ia el f ll ed.

RECOMMENDATIONS: N e

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8) Follo - p/Mor ali -Morbidi Re ie
E er comple ed icide, a ell a erio icide a emp (i.e., req iring ho pi ali a ion), ho ld be e amined b a morbidi mor ali re ie . (If re o rce permi , clinical re ie hro gh a p chological a op i al o recommended.) The re ie , epara e and apar from o her formal in e iga ion ha ma be req ired o de ermine he ca e of dea h, ho ld incl de: 1) re ie of he circ m ance rro nding he inciden ; 2) re ie of proced re rele an o he inciden ; 3) re ie of all rele an raining recei ed b in ol ed aff; 4) re ie of per inen medical and men al heal h er ice /repor in ol ing he ic im; 5) re ie of an po ible precipi a ing fac or ha ma ha e ca ed he ic im o commi icide or ffer a erio icide a emp ; and 6) recommenda ion , if an , for change in polic , raining, ph ical plan , medical or men al heal h er ice , and opera ional proced re . F r her, all aff in ol ed in he inciden ho ld be offered cri ical inciden re debriefing.

E e ie ce ha dem a ed ha ma c ec i al em ha e ed ced he likelih d

f f e icide b c i icall e ie i g he ci c m a ce

di g i cide a he cc .

While all dea h a e i e iga ed ei he i e all b ide age cie e e im a iali ,

he e i e iga i a e mall limi ed de e mi i g he ca e f dea h a d he he he e a

a c imi al gd i g. T

-

-:

?

T be cce f l, he m bidi -m ali e ie eam m be m l idi ci li a a d i cl de

e e e a i e f b h li e a d ma ageme le el aff f m he c ec i , medical a d me al

heal h di i i .

FINDINGS: Nei he he Sac ame C She iff De a me (SCSD) S icide P e e i P g am lic (N . 10/5) Jail P chia ic Se ice (JPS) S icide P e e i P g am lic (N . 1049) ided ade a e de c i i ega di g he m ali a d/
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admi i a i e e ie ce f ll i g a i ma e icide, i h he JPS lic im l a i g ha The JPS Ma ageme Team (i cl di g Medical Di ec , P g am Di ec a d a de ig ee ) ill e ie a em ed a d c m le ed icide a d e a fi di g he UC- Da i De a me f P chia . I addi i , SCSD Dea h Se i I j f a P i e lic (N . 3/10) li ed he c l f e di g he ce e f he i cide b c d e el, a ell a he ifica i a d i e iga i e ce e . The i cide e i g f m f JPS I cide Re i g lic (N . 1006) im l e i ed ha he Me al Heal h Di ec c m le e he f m i a ma e ha De c ibe i cide a d ca e ided a ie b Jail P chia ic Se ice . I cl de a licable da e f a ie c ac , e e a i , FOSS Le el a d a la f f ll - ca e. De c ibe i cide , aff i l ed (if a licable), a d c me f i cide .

I ac ice, all i ma e dea h (i cl di g icide ) e e e ed he SCSD H micide

B ea , b i ma e icide e e a el i e iga ed b he B ea . I ead, i ma e icide e e

i e iga ed b he SCSD C ec i al Se ice B ea hich c m le ed a I -C d Dea h

Re c m iled b e i c dial e el h e e a ig ed he facili a he ime

f he i cide . The e i cl ded all ele a c d - ela ed d c me e ai i g he

i ma e, i cl di g, b

limi ed , a e , cla ifica i , c d ec d , i cide e b

c d aff, he i ma e i e ie , a d h i g i l g b k . O ce c m le ed, he Re

e e e ie ed d i g a I -C d Dea h Re ie Team, hich a c m i ed f he facili

admi i a a d/ ma age , he heal h admi i a , e ible h icia , a d he heal hca e

a d e i aff h a e ele a he i cide . F he , i addi i he i cide e

f m c m le ed b JPS, JPS ma ageme aff c e ed i h chia ic leade hi f m he

U i e i f Calif ia-Da i ega di g he i cide .

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I i bee hi i e e e ie ce ha c d i e iga i (i cl di g H micide B ea

a d/ I e al Affai ) f i ma e icide mall f c

a i i g he medical e ami e i

de e mi i g he ca e f dea h, he he a c imi al gd i g a c mmi ed, a d de e mi i g

he he

em l ee c i e l f ll ed c d licie a d ced e . Heal h ca e

e ie

mall a e limi ed a de ig a ed ide e ie f he i ma e medical cha . O

he he ha d, a iable m ali e ie ce i cl de : 1) e ie f he ci c m a ce

di g he i cide ; 2) e ie f ced e ele a he i cide ; 3) e ie f all ele a

ai i g ecei ed b i l ed aff; 4) e ie f e i e medical a d me al heal h

e ice / e i l i g he ic im; 5) e ie f a

ible eci i a i g fac ha ma ha e

ca ed he ic im c mmi icide ffe a e i icide a em ; a d 6) ec mme da i ,

if a , f cha ge i lic , ai i g, h ical la , medical me al heal h e ice , a d

e a i al ced e . The ce d e

fc

i di id al em l ee c d c

mi c d c , b a he i l k a emic i e im ac i g f e e e i eff . F ll i g a

di c i i h b h SCSD a d JPS fficial ega di g he e ie ce e , a ell a e ie f

e e al i ma e icide , i ld be hi i e i i ha he Sac ame C Jail S em

d e c e l e gage i a iable m ali e ie ce , did i ha e a f mal m bidi

ce e ie e i icide a em .

I addi i , a e i l di c ed i hi e , a S icide P e e i Ta k F ce had ece l bee e-e abli hed a d me a lea a a e l ba i . The m l idi ci li a c mmi ee i cl ded e e e a i f m he c d (a b h he Mai Jail a d RCCC), CHS, a d JPS. Al h gh i had me l ce da e a d ecific g al a d e ibili ie had e be

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a ic la ed, he c mmi ee a aid be e ible f e ie i g he ali a d a i f icide e e i a d me al heal h ai i g; e abli hi g be e c mm ica i be ee c d ,
medical, a d me al heal h e el; a d -g i g e ie f icide e e i licie a d ac ice .

Fi all , acc di g JPS fficial , al h gh b h SCSD a d JPS c llec ed e a a e da a

all i ma e icide a em (i cl di g e i

icide a em a d delibe a e elf-ha m

i cide ), he

e f ch da a c llec i a clea hi i e . The diffe e e f

icide a em e e defi ed a d he e did eem be a a em a al e he da a a d

e e i i a fa hi ha ld be hel f l c i

ali im eme eff b ei he

age c . H e e , f me i e e hi i e a d a e i l efe e ced i hi e ( ee

age 31), e ie f icide a em i cide f d ha e fe i cide i l ed i ma e h

affi ed a liga e a b i

i i hei cell, he ible e l f he fac ha m cell

did c ai ma f he b i

i (e.g., ligh fi e , e ila i g a e , cl hi g

h k , b k h le , e c.) f d i he c m a abl - i ed c ec i al facili ie . The ili f

c llec i g da a

icide a em a di c ed d i g he Se embe 2016 mee i g f he

S icide P e e i Ta k F ce a e ded b hi i e .

RECOMMENDATIONS: A fe ec mme da i a e ffe ed im e he m ali -

m bidi e ie ce f i ma e icide . F , i i

gl ec mme ded ha he S icide

P e e i Ta k F ce be e ible f c d c i g m ali e ie f a i ma e icide. S ch

e ie h ld i cl de: 1) e ie f he ci c m a ce

di g he i cide ; 2) e ie f

ced e ele a he i cide ; 3) e ie f all ele a ai i g ecei ed b i l ed aff; 4)

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e ie f e i e medical a d me al heal h e ice / e i l i g he ic im; 5) e ie f

a

ible eci i a i g fac ha ma ha e ca ed he ic im c mmi icide ffe a

e i icide a em ; a d 6) ec mme da i , if a , f cha ge i lic , ai i g, h ical

la , medical me al heal h e ice , a d e a i al ced e . The c mmi ee h ld al

c d c imila m bidi e ie f a e i

icide a em (i.e., i cide e l i g i

h i ali a i ). T a i he S icide P e e i Ta k F ce i he e ce e , hi i e

M ali -M bidi Re ie f I ma e S icide /Se i S icide A em Checkli i ffe ed

f c ide a i i A e di B.

S ,i i

gl ec mme ded ha he S icide P e e i Ta k F ce be e ible

f de el i g a c ec i e ac i la im leme he ec mme da i c ai ed i hi hi

ie e .

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D. SUMMARY OF RECOMMENDATIONS

S aff Training

1) I i

gl ec mme ded ha b h he SCSD a d JPS e i e i e ec i e

icide e e i licie i cl de a m e b de c i i f he e i eme

f b h e- e ice a d a al icide e e i ai i g, i cl de a e ie

f he e i ed ic , a ell a e i eme ha all c d , medical, a d me al

heal h e el ecei ed ch ai i g a a al ba i .

2) I i

gl ec mme ded ha he SCSD a d JPS l ili e cla m-

i c ed icide e e i ai i g. I ha bee hi i e e e ie ce ha

icide e e i e c m a e -ac i e a i de a d c llab a i , i ci le

ha a e l he a em l ee i i i g al e i a chai a a c m e e mi al.

De k i c i migh c m l i h a acc edi a i a d/ eg la

e i eme , b i i a mea i gf l a cla m-i c ed ai i g.

3) I i

gl ec mme ded ha he SCSD a d JPS c llab a e he

de el me f a 4 8 h e- e ice icide e e i c ic l m f e

em l ee (i cl di g c d , medical, a d me al heal h aff) ha i cl de he

f ll i g ic :

x g idi g i ci le

icide e e i

x a idi g b acle ( ega i e a i de ) e e i

x i ma e icide e ea ch

x h facili e i me a e c d ci e icidal beha i

x ide if i g icide i k de i e he de ial f i k

x e ial edi i g fac

icide

x high- i k icide e i d

x a i g ig a d m m

x c m e f he SCSD/JPS icide e e i

g am

x liabili i e a cia ed i h i ma e icide

P e e a i h ld be i a P e P i lide f ma . The e a d he e i e

ic a e a ailable i hi i e T

C

P

G

S

D

P

J

P F

(Ma ch 2016), a

c f hich a e i l f a ded he SCSD f c ide a i .

4) I i

gl ec mme ded ha he SCSD a d JPS c llab a e he

de el me f a 2-h a al icide e e i c ic l m f all c d ,

medical a d me al heal h aff) ha i cl de a abb e ia ed di c i he ab e

ic . The 2-h a al ef e he ai i g h ld i cl de a e ie f: 1) a idi g

b acle ( ega i e a i de ) e e i , 2) edi i g i k fac , 3) a i g

ig a d m m , 4) ide if i g icidal i ma e de i e he de ial f i k, a d

5) e ie f a cha ge he SCSD/JPS icide e e i licie . The a al

ai i g h ld al i cl de ge e al di c i f a ece icide a d/ e i

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icide a em i he jail em. P e e a i h ld be i a P e P i lide f ma .

5) I i

gl ec mme ded ha all JPS e el (i cl di g chia i )

ecei e addi i al ai i g h

de el a ea able ea me la ha

c ai ecific a egie i ed ci g f e icidal idea i , i cl de e am le

f ade a e a d i ade a e ea me la .

In ake Screening/A e men

6) I i gl ec mme ded ha SCSD a d CHS fficial l k a i be e e e

ea able d i ac i he b ki g a ea he m l i le e a e c d c i g i ake

c ee i g a he ame ime e i d. O e i

ld be i alla i f i e ie b h

imila i de ig c e i i i g b h a e b h f d ha he RCCC.

Sec d, i i

gl ec mme ded ha he c e icide i k i i c ai ed he

c e CHS Medical I ake f m embedded i he E-Cha be e i ed i cl de he

f ll i g:

x Ha e e e a em ed icide?

x Ha e e e c ide ed icide?

x Ae

ha e e e bee ea ed f me al heal h

em i al blem ?

x Ha e ece l e e ie ced a ig ifica l ( ela i hi , dea h

f famil membe /cl e f ie d, j b, e c.)?

x Ha a famil membe /cl e f ie d e e a em ed c mmi ed

icide?

x D

feel he e i hi g l k f a d i he immedia e

f e (i ma e e e i g hel le e a d/ h ele e )?

x A e hi ki g f h i g a d/ killi g elf?

F ll - i i (e.g., he did la a em icide? e c.) h ld be added each

f he e e i i de

iage he a

ia e le el f me al heal h efe al a

de e mi ed b JPS ( ee bel ).

7) I i

gl ec mme ded ha CHS fficial i i ia e a c i

la e i dicall a di he i ake c ee i g ce e e ha

all e i

e l admi ed de ai ee a e i ed.

ali a a ce i g aff a e a ki g

8) Rega dle f he de ai ee beha i a e gi e d i g i ake c ee i g, a me al heal h efe al h ld al a be i i ia ed ba ed d c me a i eflec i g ible e i me al ill e a d/ icidal beha i d i g a i ma e i c fi eme i hi he Sac ame C Jail S em. A ch, he P blem a d C di i c ee f he E-Cha c ai he F e e c f Se ice Scale (FOSS) f each i ma e iage b JPS
aff. If a i ma e a laced icide eca i a d h ed a he e i hi he jail em, he ld be cla ified a a FOSS Le el 1. I ma e ecei i g a FOSS Le el 2
de ig a i a e h e h e e di cha ged f m icide eca i a d i eed f f ll -

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ela ed hei e i me al ill e . A ch, he f ll i g ced e h ld be i c a ed i hi b h CHS a d JPS licie :

x A i ma e laced icide eca i h ld be de ig a ed a ei he a FOSS Le el 1 FOSS Le el 2 i he P blem a d C di i c ee f he E-Cha b JPS aff;

x N i g aff c d c i g i ake c ee i g h ld al a e ie he

de ai ee P blem a d C di i

c ee f he E-Cha

e if

he he he e e e i l c fi ed i he SCSD a d had a hi

f

icidal beha i / laceme

icide eca i d i g a i

c fi eme ; a d

x Rega dle f he de ai ee beha i

a e gi e d i g i ake

c ee i g, f he a e me b JPS aff h ld al a be i i ia ed ba ed

d c me a i eflec i g ible e i me al ill e a d/ icidal

beha i d i g a de ai ee i c fi eme i hi he SCSD.

9) I i

gl ec mme ded ha he c e me al heal h iage ac ice f JPS

e di g i ma e e e i g icidal idea i i hi 4 h a a ge efe al,

a d e di g all he me al heal h efe al i hi 6 da a

ge

i e efe al be e i ed. Al h gh he e i

a da d f ca e ha c i e l

ecifie ime f ame e d me al heal h efe al , e gge ed ched le ld

be a f ll : Eme ge -

i hi 4 h ; U ge - i hi 24-48 h ; a d R i e

- i hi 7 da . I addi i , JPS fficial h ld de el a me al heal h iage lic ha

defi e e e le el , e ime c ai f each le el, a d defi e he ac i f

beha i ( ) ha dic a e a ecific e e le el. Of c e, a c e l ac ice i hi

he SCSD, a i ma e e e i g c e icidal idea i a d/ c e icidal/ elf-

i j i beha i h ld e l i a eme ge JPS efe al.

10) Gi e he g a cia i be ee i ma e icide a d ecial ma ageme (e.g,

di ci li a a d/ admi i a i e eg ega i , al e a a i , e c.) h i g i

laceme , i i

gl ec mme ded ha medical e el e ie he E-Cha

de e mi e he he e i i g medical a d/ me al heal h eed c ai dica e he

laceme

e i e acc mm da i . I addi i , a be ac ice

ld be ha a

i ma e a ig ed ch a ecial ma ageme h i g i ecei e a b ief a e me f

icide i k b i g aff admi i

ch laceme .

Comm nica ion

11) T he e e ha a f mali ed mee i g d e

c e l ei ,i i

gl

ec mme ded ha he SCSD e abli h eg la l ched led ma ageme mee i g be ee

c d , CHS, a d JPS e el. S ch mee i g , ched led ei he a eekl bi-

eekl ba i , ld ide a e celle

i f m l idi ci li a

blem-

l i g f diffic l ma age i ma e- a ie , i cl di g icidal i ma e .

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Ho ing

12) Thi i e

gl

he SCSD deci i c e a d e a e he

300 P d f he 3-We U i f

leme al h i g f i ma e

icide

eca i a d/ a e -d f m 2P-U i di cha ge, a ell a c e i f

he cla m he 3-We U i i ffice ace f OPP cli icia . A ed

ab e, i i gl ec mme ded ha he f ll i g fi e be em ed f m each

f he 20 l e ie cell : e b k, able, h k lef ide f i k, a d a i- i

li i fa ce . I addi i , a ima el f c e cell i he i h ld be

ili ed f icide eca i beca e f hei i e de ig ha i cl de a bli d

hich b c e i ibili i he cell . Sec d, hi i e a i f med ha

he SCSD i emba ki g e c c i jec a he RCCC ha ill i cl de

he ibili f em a h i g f icidal i ma e . A ch, i i

gl

ec mme ded ha hi i e Checkli f he S icide-Re i a De ig f

C ec i al Facili ie , i cl ded a A e di A f hi e , be ili ed a a

g ideli e.

13) I i

gl ec mme ded ha , a

a he e l e a ed 300 P d f

he 3-We U i i ac i a ed, SCSD fficial i e a mem a d m ha : 1) ic l

hibi he e f a m l i-

e m cla m f he h i g f

i ma e f a d a i f ime, a d 2) ic l limi he e f afe cell ,

eg ega i h ldi g cell , he h ldi g cell f he h i g f icidal i ma e

f f (4) h . I addi i , SCSD, CHS, a d JPS lic h ld be e i ed

acc di gl .

14) I i

gl ec mme ded ha JPS fficial i c hei cli ical aff he

a

ia e e f afe m ck , i.e., he h ld be ili ed a a defa l , a d

be ed a a l i a beha i ma ageme la (i.e.,

i h a d/

a em cha ge e cei ed ma i la i e beha i ). Ra he , afe m ck h ld

l be ili ed he a cli icia belie e ha he i ma e i a high i k f icide

b ha gi g. Sh ld a i ma e be laced i a afe m ck, he g al h ld be

e f ll cl hi g he i ma e i hei di cha ge f m icide eca i .

Fi all , c d e el h ld e e lace a i ma e i a afe m ck le i

had bee e i l a ed b medical a d/ me al heal h e el.

15) C e SCSD a d JPS f decidi g hich e i
eca i . A ch, i i he f ll i g e i eme :

icide e e i licie d add e a d i ilege a e ided i ma e
gl ec mme ded ha licie be e i ed

ced e icide
i cl de

x All deci i ega di g he em al f a i ma e cl hi g, beddi g, e i (b k , li e / a dal , e egla e , e c.) a d i ilege hall be c mme a e i h he le el f icide i k a de e mi ed a ca e-b -ca e ba i b JPS aff a d a d c me ed i he E-Cha ;

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x If JPS aff de e mi e ha a i ma e cl hi g eed be em ed

f ea

f afe , he i ma e hall al a be i ed a afe

m ck a d afe bla ke ;

x A ma e hall be i ed all i ma e

icide eca i

le he i ma e ili e he ma e i a i hich i a

i e ded (i.e., a em i g am e i h/de , ili e b c

i ibili i he cell, e c.);

x All i ma e

icide eca i hall be all ed all i e

i ilege (e.g., famil i i , ele h e call , ec ea i , e c.),

le he i ma e ha l h e i ilege a a e l f a

di ci li a a c i ; a d

x I ma e

icide eca i hall a ma icall be l cked

d . The h ld be all ed da m a d/ - f-cell acce

c mme a e i h hei ec i le el a d cli ical j dgme f JPS

aff.

Le el of S per i ion/Managemen

16) I i

gl ec mme ded ha b h he SCSD a d JPS icide e e i

licie be e i ed i cl de le el f b e a i ha ecif de c i i f

beha i a a i g each le el f b e a i . A

ed e i i i ffe ed a

f ll :

x Close Obser ation i e e ed f he i ma e h i ac i el

icidal, b e e e icidal idea i a d/ ha a ece i

hi

f elf-de c i e beha i a d ld be c ide ed a l

i k f icide. I addi i , a i ma e h de ie icidal idea i

de

h ea e icide, b dem a e he c ce i g

beha i ( h gh ac i , c e ci c m a ce , ece hi )

i dica i g he e ial f elf-i j , h ld be laced de cl e

b e a i . Thi i ma e h ld be b e ed b aff a agge ed

i e al

e ceed e e 10-15 mi e , a d h ld be

d c me ed a i cc .

x Constant Obser ation i e e ed f he i ma e h i ac i el icidal, ei he b h ea e i g e gagi g i elf-i j , a d
c ide ed a high i k f icide. Thi i ma e h ld be b e ed b a a ig ed aff membe a c i , i e ed ba i . The b e a i h ld be d c me ed a 15-mi e i e al .

17) I i

gl ec mme ded ha CCTV be ili ed l a a leme , a d

a e laceme f , he e al b e a i f high i k icidal i ma e . A

ch, a i ma e c ide ed high i k a defi ed b c e JPS lic h ld be

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a ig ed a aff membe h ld be h icall a i ed ide he i ma e

cell

ide c i , i e ed b e a i .

18) I i gl ec mme ded ha he SCSD e lace he a a i e f ice e e 30 mi e c e l c ai ed i hi i licie i h agge ed i e al ha d e ceed 10-15 mi e .

19) I i

gl ec mme ded ha all OPP a d chia ic aff c m le e a

Cli ical A e me f m ( hich i cl de he icide i k a e me ) each ime

he a e d g adi g a d/ di cha gi g a i ma e f m icide eca i i he

2P-U i 3-We U i . A ch, all JPS cli icia h ld c m le e he Cli ical

A e me f m a lea ice, i.e., f i i ia i f icide eca i , a ell

a j ifica i f di cha gi g he i ma e f m icide eca i .

20) I i

gl ec mme ded ha c m le i f he Cli ical A e me , a ell

a he cli ical e c e , h ld cc i a i a e e i g a d cell- ide

le he i ma e ef e a i a e i e ie . Ref al f a i a e i e ie h ld

be d c me ed i he E-Cha .

21) I i he gl ec mme ded ha a i ma e h ld e e be cl hed i a

afe m ck if he a e bei g b e ed a 30-mi e b e a i . If a JPS

cli icia belie e ha a i ma e beha i ece i a e a afe m ck, he h ld

be icide eca i . If a JPS cli icia belie e ha 30-mi e b e a i

a e a a ed, he he i ma e i

icidal a d h ld ha e hei f ll cl hi g

ad e i .

22) I i

gl ec mme ded ha , c i e i h NCCHC a d he a i al

c ec i al a da d , JPS cli icia ( ) de el ea me la f i ma e

di cha ged f m icide eca i ha de c ibe ig , m m , a d he

ci c m a ce i hich he i k f icide i likel ec , h ec e ce f

icidal h gh ca be a ided, a d ac i he a ie

aff ca ake if icidal

h gh d cc ( ee NCCHC, 2014).

23) I i

gl ec mme ded ha , i de afeg a d he c i i f ca e f

icidal i ma e , all i ma e di cha ged f m icide eca i h ld emai

me al heal h ca el ad a d ecei e eg la l ched led f ll - a e me b

JPS cli icia il hei elea e f m c d . JPS c e f ll - ched le

f i ma e elea ed f m icide eca i f i hi 30 da i ell bel he

a da d f ca e. A ch, le a i ma e i di id al ci c m a ce di ec

he i e (e.g., a i ma e i a

ia el laced

icide eca i b -

me al heal h aff a d elea ed le ha 24 h la e f ll i g a a e me ),

i i ec mme ded ha he FOSS II cale f i ma e di cha ged f m icide

eca i be d ama icall e i ed a f ll : f ll - i hi 24 h , agai

i hi 72 h , agai i hi 1 eek, a d he e i dicall il elea e f m

c d.

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24) Gi e he g a cia i be ee i ma e icide a d eg ega i laceme

(e.g., 2 f 3 f he m ece i ma e icide e e

al e a a i a he

ime f hei dea h ), i i

gl ec mme ded ha c d e el i c ea e

hei

d f ch h i g i f m 60-mi e 30-mi e i e al . I

addi i , a be ac ice ld al be f

i g aff c d c e dail d

each da f all cell i he e eg ega i i hile he a e di e i g medica i ,

a ell a f OPP cli icia c d c eekl d i he e i .

In er en ion

Ne

Repor ing

Ne

Follo -Up/Mor ali -Morbidi Re ie

25) I i

gl ec mme ded ha he S icide P e e i Ta k F ce be

e ible f c d c i g m ali e ie f a i ma e icide. S ch e ie

h ld i cl de: 1) e ie f he ci c m a ce

di g he i cide ; 2) e ie

f ced e ele a he i cide ; 3) e ie f all ele a ai i g ecei ed b

i l ed aff; 4) e ie f e i e medical a d me al heal h e ice / e

i l i g he ic im; 5) e ie f a

ible eci i a i g fac ha ma ha e

ca ed he ic im c mmi icide

ffe a e i

icide a em ; a d 6)

ec mme da i , if a , f cha ge i lic , ai i g, h ical la , medical

me al heal h e ice , a d e a i al ced e . The c mmi ee h ld al

c d c imila m bidi e ie f a e i

icide a em (i.e., i cide

e l i g i h i ali a i ). T a e he icide e e i a k f ce c mmi ee

a d he e ce e , hi i e M ali -M bidi Re ie f I ma e

S icide /Se i S icide A em Checkli i ffe ed f c ide a i i

A e di B.

26) I i

gl ec mme ded ha he S icide P e e i Ta k F ce be

e ible f de el i g a c ec i e ac i la

im leme he

ec mme da i c ai ed i hi hi i e e .

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E. CONCLUSION

I i h ed ha he icide e e i a e me

ided b hi i e , a ell a he

ec mme da i c ai ed i hi hi e , ill be f a i a ce b h he Sac ame C

She iff De a me a d Jail P chia ic Se ice f he U i e i f Calif ia-Da i . Thi

i e me me SCSD a d JPS fficial a d e i , a ell a ffice , e , a d

me al heal h cli icia , h a ea ed ge i el c ce ed ab i ma e icide a d c mmi ed

aki g ha e e ac i e e ece a ed ce he

i f ch aged i he f e.

Al h gh he e a e me ec mme da i c ai ed i hi hi e , a ell a he eed

e i e e e al SCSD a d JPS licie , hi i e f d ha he Sac ame C Jail S em

had he f da i f a g d icide e e i

g am. Fi all , ba ed

he -ac i e

a i de a d high calibe - i e ma ageme f m he e c e fficial , h e e al membe

f he S icide P e e i Ta k F ce, hi i e i c fide ha f ll im leme a i f he

ec mme da i c ai ed i hi hi e ill e l i cce f l c i i g eff

ee

i ma e icide a d mai ai i g a l a e f icide i hi he Sac ame C Jail S em.

Re ec f ll S bmi ed B :
/ Li d a M. Ha e Li d a M. Ha e N embe 22, 2016

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APPENDIX A

CHECKLIST FOR THE SUICIDE-RESISTANT DESIGN OF CORRECTIONAL FACILITIES

Lind a M. Ha e Na i al Ce e I i i a d Al e a i e , 2016

The afe h i g f icidal i ma e i a im a c m e a c ec i al facili

c m ehe i e icide e e i lic . Al h gh im ible c ea e a icide- f cell

e i me i hi a c ec i al facili , gi e he fac ha alm all i ma e icide cc

b ha gi g, i i ce ai l ea able e e ha all cell ili ed h e e iall icidal

i ma e a e f ee f all b i

i . A d hile i i m e c mm f liga e be affi ed

ai e a d i d ba ( g a e ), cell fi e h ld be c i i ed, i ce bed

f ame /h le , hel e i h cl hi g h k , i kle head , d hi ge/k b , el ack , a e

fa ce li , a d ligh fi e ha e bee ed a a ch i g de ice i ha gi g a em . A ch,

e e ha i ma e laced icide eca i a e h ed i icide- e i a cell , facili

fficial a e gl e c aged add e he f ll i g a chi ec al a d e i me al i e :

1) Cell d h ld ha e la ge- i i a el f Le a ( l -ab a i l ca b a e)

all f

b c ed ie f he e i e cell i e i a all ime . The e i d

h ld

be c e ed (e e f ea

f i ac , di ci li e, e c.) If d lide a e

ed, d i e i h ld ha e ha dle /k b ; a he he h ld ha e ece ed

d ll . A d c ai i g a f d a h ld be cl ed a d l cked.

I e i d hi ge h ld be el d

a

e mi bei g ed a a a ch i g

de ice. D f ame h ld be ded a d m h he edge . The f ame h ld

be g ed i he all i h a li le edge e ed a ible.

I lde , a i a ed facili ie i h cell f , all a d/ cell d made f eel ba ,

Le a a eli g ( l -ab a i l ca b a e) ec i c ee i g ( ha ha h le ha

a e ideall 1/8 i che ide a d m e ha 3/16 i che ide 16-me h e a e

i ch) h ld be i alled f m he

f he cell.

S lid cell f m be m dified i cl de la ge- i i Le a a el ec i c ee i h mall me h;

2) Ve , d c , g ille , a d ligh fi e h ld be

i -f ee a d c e ed i h

c ee i g ha ha h le ha a e ideall 1/8 i che ide, a d m e ha 3/16 i che

ide 16-me h e a e i ch;

3) If cell ha e fl d ai , he h ld al ha e h le ha a e ideall 1/8 i che ide, a d m e ha 3/16 i che ide 16-me h e a e i ch (i ma e ha e bee k
ea e e e d f a liga e h gh he fl d ai i h he he e d ied a d hei eck, he la he fl a d i i a ci c la m i a he liga e igh e );

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4) Wall-m ed c ded ele h e h ld be laced i ide cell . Tele h e c d f a i g le g h ha e bee ili ed i ha gi g a em ;

5) Cell h ld c ai a cl hi g h k . The adi i al, ll-d

c lla ible

h k ca be ea il jammed a d/ i ide

ili ed a a a ch ;

6) A ai le eel c mb ile - i k ( i h c cealed l mbi g a d ide c l al e) h ld be ed. The fi e h ld c ai a a i- i li , hb h h lde , ile a e d, a d/ el ba ;

7) Bed h ld ideall be ei he hea m lded la ic lid c c e e lab i h ded edge , all e cl ed de ea h.

If me al b k a e ili ed, he h ld be b l ed fl h he all i h he f ame c c ed e e i e a a a ch i g de ice. B k h le h ld be c e ed; ladde h ld be em ed. (T adi i al me al bed i h h le i he b m, b il fl h he all a d e de ea h, ha e f e bee ed a ach icide e . L i g fla he fl , he i ma e a ache he e f m ab e, i de hi eck,
e hi mach a d a h ia e him elf i hi mi e .);

8) Elec ici h ld be ed ff f m all le ide f he cell;

9) Ligh fi e h ld be ece ed i he ceili g a d am e - f. S me fi e ca be ec el a ch ed i ceili g all c e he em deli g hibi ece ed ligh i g. All fi e h ld be ca lked g ed i h am e - e i a ec i g ade ca lki g g .

Am le ligh f eadi g (a lea 20 f -ca dle a de k le el) h ld be ided. L a age igh ligh b lb h ld be ed (e ce i ecial, high- i k h i g i he e fficie ligh i g 24 h e da h ld be ided all cl ed-ci c i ele i i
(CCTV) came a ide if m eme a d f m ).

A al e a i e i i all a i f a ed fil e e he ceili g ligh

d ce al da k e ,

all i g i ma e lee a igh . Va i came a a e he able ha e al

b e a i a if i e e da ligh . Thi fil e h ld be ed l a igh beca e

e i i i ca he i e de el a d d ce af e effec ;

10) CCTV m i i g d e

e e a icide, i l ide ifie a icide a em i

g e . If ili ed, CCTV m i i g h ld

leme he h ical b e a i

b aff. The came a h ld b i l be e cl ed i a b ha i am e - f a d d e

c ai a ch i g i . I h ld be laced i a high c e l ca i f he cell a d

all edge a d he h i g h ld be ca lked g ed.

Cell c ai i g CCTV m i i g h ld be ai ed i a el c l all f be e i ibili . T ed ce came a gla e a d ide a c a i m i i g, he heade ab e
cell d h ld be ai ed black me he da k c l .

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CCTV came a h ld ide a clea a d b c ed ie f he e i e cell i e i , i cl di g f c e f he m. Came a le h ld ha e he ca aci f b h
igh l ligh le el i i ;

11) Cell h ld ha e a m ke de ec m ed fl h i he ceili g, i h a a dible

ala m a he c l de k. S me cell ha e a ec i c ee i g me h

ec he m ke

de ec f m a dali m. The ec i e c e i g h ld be high e gh be ide

he each f a i ma e a d fa e gh a a f m he ile ha he fi e c ld

be ed a a ladde acce he m ke de ec a d c ee . Ceili g heigh f e

c c i h ld be 10 fee make ch a ea able acc mm da i . E i i g

facili ie i h l e ceili g h ld ca ef ll elec he ec i e de ice make e i

ca be am e ed i h, ha e me h e i g la ge e gh h ead a e h gh.

Wa e i kle head h ld be e ed. S me ha e ec i e c e ; he a e

fl h i h he ceili g a d d d

he e ff; me a e he b eaka a e;

12) Cell h ld ha e a a di m i i g i e c m f li e i g call f di e (

a a leme

h ical b e a i b aff). While he i ma e i

icide

eca i , i e c m h ld be ed high (a ha gi g ic im ca f e be hea d

be g gli g, ga i g f ai , hei b d hi i g he all/fl , e c.);

13) Cell ili ed f icide eca i h ld be l ca ed a cl e a de k all f addi i al a di a d i al m i i g;

ible a c l

14) If m de l ig fee ;

all hield a e ili ed, he h ld ha e ia g la , ded e e a ch i g. The all h ld all i ibili f b h he head a d

15) S me i ma e ha g hem el e de de k , be che , able

l / ll- ea .

P e ial icide- e i a emedie a e: (a) E e di g he bed lab f e a a ea ; (b)

C li de - ha ed c c e e ea a ch ed fl , i h ded edge ; (c) T ia g la

c e de k a ch ed he

all ; a d (d) Rec a g la de k , i h ia g la

e d la e , a ch ed he all. T el ack h ld al be em ed f m a de k

a ea;

16) All helf a d e ed hi ge h ld ha e lid, ia g la e d- la e hich ecl de a liga e bei g a lied;

17) Cell h ld ha e ec i i d i h a ide ie . The abili ide if ime f da ia ligh hel e-e abli h e ce i a d a al hi ki g, hile mi imi i g
di ie a i .

If cell i d c ai ec i ba ha a e c m le el fl h i h i d a el ( h all i g a ga be ee he gla a d ba f e a a a ch i g de ice), he

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h ld be c e ed i h Le a ( l -ab a i l ca b a e) a eli g e e acce he ba , he ga , h ld be cl ed i h ca lki g, gla i g a e, e c.

If i d c ee i g g a i g i ed, c e i g h ld ha e h le ha a e ideall 1/8 i che ide, a d m e ha 3/16 i che ide 16-me h e a e i ch;

18) The ma e h ld be fi e e a da a d

d ce ic m ke. The eam h ld

be ea - e i a ha i ca be ed a a liga e;

19) Gi e he fac ha he i k f elf-ha m ili i g a la d bag i g eigh i ef l e f h ldi g di cl he ff he fl , la d bag i g h ld be em ed
f m he cell;

20) Mi h ld be f b hed, li hed me al, a ached i h am e - f c e ;

21) Paddi g f cell all i hibi ed i ma a e . Check i h

e mi ed, added all m be f fi e- e a da ma e ial ha a e

d

d ce ic ga e ; a d

fi e ma hal. If c mb ible a d

22) Ceili g a d all j i h ld be ealed i h e e e bbe ga ke ealed i h am e - e i a ec i g ade ca lki g g f e e i g he a achme f a a ch i g de ice h gh he j i .

NOTE: A i f hi checkli a igi all de i ed f m R. A la (1989), Red ci g he

O

i f I ma e S icide: A De ig G ide, P

Q

, 60 (2): 161-171.

Addi i a d m difica i e e made b Li d a M. Ha e , a d da ed b Ra dall A la ,

Ph.D., a egi e ed a chi ec . See al Ha e , L.M. (2003), S icide P e e i a d P i -

F ee De ig f C ec i al Facili ie , J S /M H U , 12 (3): 1-5. La

e i ed Li d a M. Ha e i Feb a 2016.

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APPENDIX B

MORTALITY/MORBIDITY REVIEW OF INMATE SUICIDES/ SERIOUS SUICIDE ATTEMPTS CHECKLIST*
Lind a M. Ha e Na i al Ce e I i i a d Al e a i e , 2016

1) Training
x Had all c ec i al, medical, a d me al heal h aff i l ed i he i cide ecei ed b h ba ic a d a al ai i g i he a ea f icide e e i i he i cide ?
x Had all aff h e ded he i cide ecei ed ai i g (a d e e c e l ce ified) i a da d fi aid a d ca di lm a e ci a i (CPR) i he i cide ?

2) Iden ifica ion/Referral/A e men

x U hi i ma e i i ial e i he facili , e e he a e i g/ a

i g ffice ( )

a ked he he he belie ed he i ma e a a i k f icide? If , ha a he

e e?

x Had i ma e bee c ee ed f e iall icidal beha i

e i he facili ?

x Did he c ee i g f m i cl de i i ega di g: a icidal idea i a d/ a em ;

c e idea i , h ea , la ; e e f immedia e f e (i ma e e e i g hel le e

a d/ h ele e ); i me al heal h ea me /h i ali a i ; ece ig ifica l

(j b, ela i hi , dea h f famil membe /cl e f ie d, e c.); a d hi

f icidal

beha i b famil membe /cl e f ie d?

x If he c ee i g ce i dica ed a e ial i k f icide, a i ma e e l efe ed me al heal h/medical e el?

x Had i ma e ecei ed a

-admi i me al heal h c ee i g/a e me ?

x Had i ma e e i l bee c fi ed i he facili / em? If , had he i ma e bee icide eca i d i g a i c fi eme i he facili / em? Wa ch
i f ma i a ailable aff e ible f he c e i ake c ee i g a d me al heal h a e me ?

_____________________

*A

e ie h ld be c d c ed a e i

elf-i j e i i g h i ali a i .

icide a em , defi ed he e a efe i g a i cide f

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3) Comm nica ion

x Wa he e i f ma i ega di g i ma e i a d/ c e icide i k f m ide age cie ha a c mm ica ed he facili ?

x Wa he e i f ma i ega di g i ma e i a d/ c e

c ec i al, me al heal h a d/ medical e el ha a

h gh he facili a

ia e e el?

icide i k f m c mm ica ed

x Did i ma e e gage i a

e f beha i ha migh ha e bee i dica i e f a e ial

i k f icide? If , a hi b e ed beha i c mm ica ed h gh he facili

a

ia e e el?

4) Ho ing

x Whe e a i ma e h ed a d h e e he a ig ed hi h i g i ?

x If he i ma e a

icide eca i a he ime f he i cide , a he i ma e

h ed i a icide e i a ,

i -f ee cell?

x Wa i ma e eg ega i a a he ime f he i cide ?

x If laced a

eg ega i

a

ecial ma ageme (e.g., di ci li a a d/

admi i a i e eg ega i ) a , had he/ he ecei ed a i e a e me f icide

i k b me al heal h a d/ medical aff d e hi a ?

x Wa he e a hi g ega di g he h ical de ig f i ma e cell ha c ib ed he

i cide (e.g.,

i ibili ,

i c d ci e ha gi g a em , e c.)?

5) Le el of Ob er a ion/Managemen

x Wha le el a d f e e c f e i i a i ma e de immedia e i he i cide ?

x Gi e i ma e b e ed beha i i

a

ia e?

he i cide , a he le el f e i i

x Whe a i ma e la h icall b e ed b aff i i cide ?

x Wa he e a ea

e i he acc ac f he la e ed b e a i b aff?

x If i ma e a

h icall b e ed i hi he e i ed ime i e al i he

i cide , ha ea ( ) a de e mi ed ca e he dela i e i i ?

x Wa i ma e a me al heal h a d/ medical ca el ad? If , ha a f e e c f c ac be ee i ma e a d me al heal h a d/ medical e el?

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x Whe a i ma e la ee b me al heal h a d/ medical e el?

x Wa he e a ea

e i he acc ac f he la e ed b e a i b me al

heal h a d/ medical e el?

x If i ma e a
x If i ma e a bee ?

a me al heal h a d/ medical ca el ad, h ld he/ he ha e bee ? icide eca i a he ime f he i cide , h ld he/ he ha e

6) In er en ion

x Did aff membe ( ) h di c e ed he i ma e f ll

e i e e i ced e ,

i.e., e ed he ce e e e he eme ge c a ge i e, called f back-

,

e ed ha medical e el e e immedia el ified, a d i i ia ed a da d fi aid

a d/ CPR?

x Did aff i i ia e a da d fi aid a d/ CPR i hi f (4) mi e f ll i g di c e f he i cide ?

x Did he i ma e h i g i c ai

e eme ge c e i me f aff

effec i el e d a icide a em , i.e., fi aid ki , gl e , cke ma k Amb

bag, a d e c e l ( ickl c h gh fib ma e ial)?

x We e he e a dela i ei he c ec i al medical e el immedia el

e di g he i cide ? We e medical e el e l ified a a e f

eme ge c a d did he e d i h a

ia e e i me ? Wa all he medical

e i me ki g e l ?

7) Repor ing x We e all a

ia e fficial a d e el ified f i cide i a imel ma e ?

x We e he ifica i , i cl di g i ma e famil a d a made i a imel ma e ?

ia e ide a h i ie ,

x Did all aff h came i c ac i h i ma e i he i cide bmi a e a d/ a eme a hei f ll k ledge f i ma e a d i cide ? Wa he e a ea e i he acc ac a d/ c m le e e f a e a d/ a eme ?

8) Follo -Up/Mor ali -Morbidi Re ie
x We e all affec ed aff a d i ma e ffe ed c i i i e e i i cide ?

e ice f ll i g he

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x We e he e a he i e iga i c d c ed ( ha h ld be a h i ed) i i cide ha ma be hel f l he m ali -m bidi e ie ?

x A a e l f hi m ali -m bidi e ie , e e he e a

ible eci i a i g

fac (e.g., ci c m a ce hich ma ha e ca ed ic im c mmi icide e gage

i he e i icide a em ) ffe ed a d di c ed?

x We e he e a fi di g a d/ ec mme da i f m e i m ali -m bidi e ie ha a e ele a hi e ie ?

x A e l f hi e ie , ha ec mme da i (if a ) a e ece a f e i i i lic , ai i g, h ical la , medical me al heal h e ice , a d e a i al ced e ed ce he likelih d f f e i cide .

x Wha a e ecific c ec i e ac i e la (CAP) f each ec mme da i , h i e ible a f each CAP, a d ha i e ec ed imef ame c m le e each CAP?

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Bruce C. Gage, M.D.
General and Forensic Psychiatry
EVALUATION OF MENTAL HEALTH SERVICES
SACRAMENTO COUNTY JAILS
June 8, 2016
Introduction
This evaluation was completed by the undersigned at the request of the Sacramento Sheriff’s Department (SSD). Mental health services are rendered by contract with the University of California at Davis (UCD). The charge is “…to conduct an evaluation of mental health care in the Sacramento County jails” and “…make recommendations to the COUNTY to remedy any deficiencies including violations of state and federal law.” Further, the report will include the following areas at a minimum:
x Intake x Access to care x Quality of care x Medication administration x Policies and procedures x Clinical facilities x Patient privacy x Record-keeping x Quality assurance x Staffing x Suicide prevention x Clinical restraint/pro-straint
It is important to note that the focus of this report was not to detect or evaluate actual harm. As such, the emphasis was on systems issues and service delivery more than an assessment of the care provided to individual inmates. Individual cases were reviewed in order to evaluate services but were not selected based on a concern regarding adequacy of services and potential harm to that individual. However, it is clear that delivering adequate services is necessary for the prevention of harm.
The opinions rendered in this report are those of the undersigned alone and are rendered within a reasonable medical probability and certainty. My opinions are based on my background, education, training, clinical practice and other professional experience; my review of the materials; and my knowledge of the relevant medical and scientific literature. Resource documents include, but are not limited to, National Commission on Correctional Health Care standards and the American Psychiatric Association’s Correctional Guidelines. However, the recommendations are not designed to meet accreditation standards but to use these as a guide to adequacy of correctional mental health services.

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Page 2

Qualifications I am a board certified psychiatrist licensed to practice in the State of Washington. I am certified in General Psychiatry and Forensic Psychiatry by the American Board of Psychiatry and Neurology. I completed my undergraduate training at the Massachusetts Institute of Technology, receiving a degree in chemistry. I then went to medical school at the University of Washington, completing my degree in 1983. Following a year of post-doctoral fellowship training in physiology, I completed an internship and general psychiatry residency at Cambridge Hospital/Harvard Medical School, where as chief resident I did specialty training in forensic psychiatry.
After two years in a clinical and teaching position with UCLA at the Sepulveda Veterans Hospital, I joined the faculty at the University of Washington (UW) at The Washington Institute for Mental Health Research and Training located at Western State Hospital (WSH). I remained at these institutions in various roles until 2008 when I became Chief of Psychiatry for the Washington State Department of Corrections (WA DOC). I was the founder and Program Director of the UW Forensic Psychiatry Fellowship until 2008. I hold an appointment as Clinical Associate Professor at the UW.
Throughout my career, I have evaluated and treated thousands of patients for behavioral disorders, including numerous mood and psychotic disorders. Currently, I do limited direct care, consult on challenging clinical cases for WA DOC, conduct forensic evaluations (including private cases), provide monitoring services and consultation, and teach residents and other trainees in the areas of mental illness and forensics. I am a member of the Psychopharmacology Committee of the American Academy of Psychiatry and the Law.
A copy of my curriculum vitae is attached, which includes a listing of all publications I authored in the past ten years.
Trial Testimony and Deposition Testimony in the Last Four Years
Trial Testimony: 2015 State of Alaska v. Karan Clifton (Superior court of Alaska, Third Judicial District)
2014 State of Washington v. Isaac Zamora (Skagit County Superior Court, Washington) Sheard v. Daniel Habeeb and Robert Polakoff (King County Superior Court, Washington)
2013 Lashawn Jones, et al., and the United States of America v Marlin Gusman, Sheriff In the Estate of Akagi, (Snohomish County Superior Court, Washington)
Deposition Testimony: 2015 In re the Estate of Bernard (King County Superior Court, Washington)
2014 Sheard v. Daniel Habeeb and Robert Polakoff (King County Superior Court, Washington)
2013 In the Estate of Akagi, (Snohomish County Superior Court, Washington) Watson v Dyncorp International and The Continental Insurance Company (U.S. Department of Labor,
Office of Administrative Law Judges)

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TABLE OF CONTENTS

The major topic headings are in bold. Beneath each is a listing of minor topic headings within each section. These minor headings may have further subdivisions in the text such as differentiating Main Jail and Rio Consumnes Correctional Center findings.

Page Title

4

Database

Description Listing of sources for the report

6

Summary of Salient Information

Discussion of findings from sources

6

Jail General Information

Basic data about the jail

7

Organizational Structure

Mental health organizational structure

9

Mental Health Data

Data provided by JPS

11 Staffing

Overall staffing per the JPS contract

11 Intake Screening

Observations, policies, and procedures

13 Access to Care

Observations, policies, and procedures

22 Quality of Care

Observations and summary of chart reviews

30 Suicide Prevention

Observations, policies, and procedures

34 Restraint and Seclusion

Observations, policies, procedures, chart reviews

36 Reentry Services

Observations, policies, procedures, chart reviews

36 Patient Privacy

Observations, policies, procedures, chart reviews

37 Record Keeping

Observations, policies, procedures, chart reviews

37 Training

Review of training materials

38 Policy and Procedures

Policies and procedures not covered elsewhere

39 Quality Assurance and Quality Improvement Policy, procedure, review of materials provided

40 Opinions and Recommendations 42 Specific Deficiencies
51 Recommendations Regarding Specific Deficiencies
64 Recommendations for Creating a Basic System of Care
75 Recommendations for Creating a Robust System of Care
Appendix 1 Appendix 2

Discussion of opinions and recommendations Discussion of deficiencies arranged by the
general topic areas under Summary of Salient Information Targeted recommendations for deficiencies
Components and capacity of a basic system of care, including some staffing Recommendations
Potential enhancements with high yield
Clinical case reviews Evaluating suicide-resistance of facilities

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DATABASE
The following constitutes the database for this report. The staffs of the SSD and UCD were uniformly helpful; they provided information and access to both staff and inmates and were candid in their responses and reports. Their professionalism was notable and appreciated.
1. Multiple interviews (individually and in groups) of mental health, nursing, and custody staff and leadership
2. Job shadows of several mental health staff including crisis, outpatient follow-up, and psychiatry 3. Interviews and chart reviews of patients at both jails 4. Visits to representative parts of all facilities with a special focus on intake, mental health special
management units (OPP), and the LPS-Certified unit (2P) 5. Descriptions of jail programs 6. Health care forms 7. Protocols and pre-printed plans and orders 8. Death reviews numbered as follows: 44856640, 3545179, 4851556, 2678178, 4821356 9. UC Davis Jail Psychiatric Services (UCDJPS) policies, procedures, and forms including:
a. UCDJPS Policy & Procedure Manual dated January 2014 b. UCDJPS Inpatient Unit forms for auditing charts, admissions, and discharge/transfer c. Initial Psychiatric Attending Assessment d. Clinical Assessment e. Initial Psychiatric Evaluation f. JPS-2P Admission Orders g. JPS-2P Orders h. Discharge Planning Request/Documentation Form i. Attending Psychiatrist Discharge Summary j. Patient Discharge Resource List k. Denial and Reinstatement of Patient’s Rights l. Patients’ Rights Denial-Monthly Tally m. Restraint Documentation Record n. Restraint Reporting Form o. JPS Patient Observation Record p. Various template nursing care plans 10. Sacramento County Sheriff’s Department policies and procedures including: a. Operations Orders
i. Bomb Threats, Suspicious Items, or Explosions ii. Evacuation Plans – Main Jail & RCCC iii. Fire Suppression – Main Jail & RCCC iv. Natural Disasters v. Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2 vi. Suicide Prevention Program 11. Sacramento County Sheriff’s Department Correctional Health Services (CHS) policies and procedures including: a. Mission Statement b. Organizational Chart c. Staffing Information d. Program Descriptions

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e. Medical Autonomy

f. Quality Improvement Program

g. Decision Making – Special Needs

h. Support Services

i. Direct Orders

j. Health Care Philosophy

k. Continuity of Care

l. Hospital Care

m. Staff Development and Training

n. Medication Administration Training

o. Licensure

p. Credentialing and Privileging Adult Mental Health Practitioners

q. Credentialing and Privileging

r. Medical Assistant – Scope of Practice

s. Receiving-Screening

t. Access to Treatment

u. Clinic Care

v. Outpatient Housing Unit

w. Mental Health Services

x. Suicide Prevention 2M – Joint Policy

y. Use of Restraints and the Prostraint Chair

z. Patients in Safety Cells

aa. Adult Developmental Disability

bb. Hunger Strike

cc. Special Needs Patients

dd. Patients in Segregation Cells in Intake

ee. Incident Reporting

ff. Management and Removal of Taser Probes

gg. Emergency Response

hh. Limitations for Admission to the Jail Acute Psychiatric Inpatient Unit

ii. Inmate Health Care Grievances

jj. Management of Pharmaceuticals

kk. Medication Administration

ll. Over-the-Counter Medications

mm.

Over-the-Counter Medications – Indigent Patient Procurement

nn. Informed Consent

oo. Health Record Format and Contents

pp. Transfer of Health Records and Information

qq. Records Retention

rr. Pharmacy Policy and Procedure Manual

12. CHS forms, including:

a. Medical Intake

b. Medical Intake – Detox Evaluation

c. Miscellaneous Medical Needs

d. Special Needs

13. Jail-based competency treatment program forms and documents, including:

a. Competency Training Record

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b. Social Services Discharge Summary and Recommendations for Aftercare c. Group schedule revised 1/11/16 d. Initial Intake Assessment e. Treatment Plan f. Patient-Inmate Workbook g. Court Competency Information and Training Guide h. Recreation and Leisure Assessment i. Scope of Work j. Screening Assessment 14. Training materials including the following: a. Suicide Prevention Training dated 2015 15. Jail Psychiatric Services Statistics from 2014-2015 and 2015-2016 16. Title 15 Adult Type I, II, III and IV Facilities: Local Detention Facility Health Inspection Report, Health and Safety Code Section 101045 – for the Rio Consumnes Correctional Center dated 4/23/15 17. Title 15 Adult Type I, II, III and IV Facilities: Local Detention Facility Health Inspection Report, Health and Safety Code Section 101045 – for the Main Jail dated 4/10/15
SUMMARY OF SALIENT INFORMATION
Jail General Information
The average census at the Main Jail (MJ) for fiscal year 2015 – 2016 (through March 2016) was 2131. The average census at the Rio Consumnes Correctional Center (RCCC) for fiscal year 2015 – 2016 (through March 2016) was 1913.78. RCCC staff reported that for the year 2015 the average census was 2018, 208 of which were women. Women are housed at both the MJ and RCCC. Jail leadership reported there are typically about 250 women at the MJ and 150 at RCCC (there were 173 women at RCCC the day I visited).
About 300-400 inmates are ICE or US Marshall detainees.
There are between 50,000 and 60,000 annual bookings at the jails.
There are male general population mental health residential units referred to as Outpatient Psychiatry (OPP) at both RCCC and the MJ. There is no dedicated mental health residential housing for women. There is a unit within the jail that is certified for Lantermann-Petris-Short (LPS) commitments that serves both men and women.
Almost all custody supervision is indirect supervision. Even in dormitory settings, custody is generally in a secure station and is on the living units only for hourly checks and other required functions.
The MJ is a large, traditional urban jail. It is generally set up in two-tiered pods with a day room having large glass fronts and keyed entry. Typically, two pods share what is referred to as an indoor recreation area. Above and behind this area with a view into the pods is the control station, typically housing one or two custody staff. Programming space and interview rooms are very limited at the MJ.
RCCC serves primarily those who are sentenced, though the number of pretrial detainees has increased and is now about 500. RCCC has a much longer average length of stay than the MJ but I was unable to get clearly accurate statistics. It is divided into numerous smaller units. Programming space and interview rooms are generally much more available at this facility. Many of these units have classrooms

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(high security) or portables and a recreation hall (low security) available to them. The exception is the medium custody areas which have no dedicated classroom space and provide even less activities than in the high security areas; they house primarily short stay, pretrial males. Most areas have large yards associated with them. Most areas also have day rooms with the exception of the women’s maximum area, Ramona, which has no dayroom. Other than those housed in Ramona, inmates eat at a common dining area. Work and program participation are much more emphasized at this facility; most inmates have been sentenced, especially the women. On the day of my visit, the following census information was provided by RCCC leadership:

x Male

o High security (typical two-tiered pods with jump barriers on the second tier)  CBF 111  SBF 144

 JKF 306

 KBF 297

o Medium security  RBF 221

 JK 150 (this is a barracks)

o Low security (all barracks, generally quite crowded)  M 66

 C

74

 H

106

 D

64

 G

90

x Female

o SLF (3 dorms, all low security)  54  35

 48

o Ramona (high security) 36

o Medium security females are housed in both of the above units

AB 109 has resulted in a substantial increase in length of stay for many inmates. RCCC custody staff reported that there are about 245 AB 109 inmates at that facility with an average length of stay over six years. Inmates at RCCC generally report much more extensive access to yards and day rooms than at the MJ. In higher custody settings such as CBF, inmates report getting out to the yard about three hours per week and into the day room about three hours per day. Those in disciplinary housing on SBF get much less time out.

Organizational Structure

There is no identified Director of Mental Health. Andrea Javist of UCD has the title “Program Director”. This title appears on the JPS organizational chart as reporting to the Chief Administrative Officer (also of UCD) who then reports to the Chair of the Department of Psychiatry, UCD but there is no specification of the relationship of this position to the Sheriff’s Department or Custody Health Services (CHS). Psychiatrists do not report to the Program Director or the Chief Administrative Officer but to the Chair of the Department of Psychiatry, UCD.

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There is no mention of mental health or psychiatric services with regard to administrative functions in the CHS policies except “Credentialing and Privileging Adult Mental Health Practitioners” that speaks to UCD credentialing “all psychiatrists, psychologists and midlevel practitioners…. “
There is a formal contract between JPS and the County of Sacramento regarding Correctional Psychiatric services for the jail. This contract was reportedly reduced following the economic downturn of 2008, resulting in the loss of about 50% of the mental health staff. For the fiscal year 2012 2013 the contract amounted to $5,285,388; the 2008-2009 contract amounted to $7,793,603. Amongst other things, the contract includes the following provisions:
x UCD will “make fiscal, program evaluation, progress, and other such reports as may be reasonably required” by the Sheriff.
x Specified clinical services include: o “[O]utpatient services including assessment, treatment, medication support and crisis intervention services as required for inmates in both the main jail and Rio Consumnes Correctional Center”  “Non-urgent request will be seen within 14 days with a face to face contact from a licensed healthcare professional.”  “Requests for crisis intervention and urgent evaluations will be provided 24/7 at the Main Jail and weekdays 7:00 to 17;30 at RCCC” o “JPS will provide appropriate staffing and services to operate an 18 bed locked inpatient psychiatric unit at the Main Jail.” o “JPS will provide one hour annually [sic] suicide prevention risk assessment and training for custody staff.” o “JPS will participate in regular management meetings with both CHS executive staff and SSD custodial staff.” o “UCD JPS shall assist County in obtaining and maintaining appropriate licensing, certification and accreditation of County, to include inpatient and outpatient psychiatric units and will cooperate with County and provide all assistance necessary to obtain such certification, licensure and accreditation.” o “UCD JPS will meet and maintain Institute for Medical Quality (IMQ) and title 15 standards in providing services pursuant to this agreement.”
x “County DHHS-MH shall examine Jail Psychiatric Services records and perform quarterly medical record reviews as part of County external peer review process.”
x “UCD JPS shall be responsible for providing monthly statistics in a manner and format determined by County. The details of this reporting are to be developed cooperatively between UCD JPS and County.”
x “UCD JPS shall participate in a process for handling of incident reports in accordance with procedures defined by County. This shall include a process for evaluating incidents uniquely involving jail psychiatric services, reviewing the outcomes of all such incidents with County and providing a summary of these incident reports to County DHHS-MH QI Committee in a format defined by County DHHS-MH. In addition, UCD JPS will participate with County and regularly scheduled reviews of incidents that concern both medical and psychiatric services.”
x “UCD JPS shall participate in administrative, strategic planning and operational committees as necessary and as requested by County.”
x There are specifications for quality improvement as well (UCD declined to provide QI data to me):

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o “UCD JPS shall maintain a Program Performance Improvement Committee whose activities shall be reported to County DHHS-MH QI Committee. Quality improvement activities related to psychiatric inpatient care shall also be reported to County’s DHHSMH QAI Committee.”
o “Representatives from UCD JPS shall participate in County DHHS-MH QI committees upon County’s request.”
Mental Health Data
Mental Health Population
Per JPS statistics for fiscal year 2015 – 2016 (through March 2016) there was an average of 469.11 inmates at the MJ and 316.56 at RCCC receiving psychotropic medications each month; this amounts to 469.11/2131 ADP = 22% of the MJ population and 316.56/1913.78 ADP = 17% of the RCCC population (amounting to 19% of the overall population of the jails). The average number of cases open on the last day of each month was 944 at the MJ and 653 at RCCC or about 40% of the jail population.
The pharmacist reported that about 23% of the jail population was on antipsychotics or lithium. The pharmacist reported that antidepressant and mood stabilizer use for psychiatric reasons is not tracked because the pharmacy does not track the prescriber or diagnosis and thus cannot be sure of whether these medications are being used for psychiatric purposes. However, JPS reports that the above numbers reflect all psychotropic orders; JPS identifies psychotropic use by virtue of the medication being ordered by a psychiatric prescriber. Thus the pharmacist’s estimate of the number on antipsychotics and lithium must be high.
The pharmacist also noted that those on medical medications had increased from about 30% in the past to over 50%.
Mental Health Encounters
The JPS Program Director reported that mental health staff do about 450 intakes per month. Patients are seen in the booking area only for emergencies, which vary widely in number from about 4 to 20 per day. These booking emergencies are not tracked separately from other emergencies.
Main Jail
For fiscal year 2014 - 2015 the following encounter information was provided by JPS:
x New/open cases averaged 482.17 per month x Follow-up contacts average 346.75 per month x After hours follow-up contacts by nurses averaged 27.08 per month x Discharge planning contacts averaged 80.33 per month x Medication clinic visits averaged 266.08 per month
For fiscal year 2015 – 2016 (through March 2016) the following encounter information was provided by JPS:
x New/open cases averaged 497.56 per month x Follow-up contacts average 495.22 per month’s x After hours follow-up contacts by nurses averaged 18.56 per month x Discharge planning contacts averaged 73.56 per month

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x Medication clinic visits averaged 302.33 per month
RCCC
RCCC has no patients at the highest utilization level (FOSS I); the FOSS II-IV population is typically about 500, about 300 of whom are on psychotropic medications.
For fiscal year 2014 - 2015 the following encounter information was provided by JPS:
x New/open cases averaged 190.83 per month x Follow-up contact’s average 136.75 per month’s x Discharge planning contacts averaged 48.17 per month x Medication clinic visits averaged 285.17 per month
For fiscal year 2015 – 2016 (through March 2016) the following encounter information was provided by JPS:
x New/open cases averaged 161.67 per month x Follow-up contacts average 143.89 per month’s x Discharge planning contacts averaged 49.78 per month x Medication clinic visits averaged 267 per month
LPS-Certified Unit Data
There were 736 admissions to the LPS-certified unit in fiscal year 2014 to 2015. There were slightly over 60 admissions and discharges per month. The average census was 15.5 and the average length of stay 6.25 days. The number pending admission (waiting list) averaged 25.33 per month.
For the current fiscal year there are about 40 admissions and discharges per month. The average census has been about 17.5 and the average length of stay about 9.5 days. The number of pending admissions has gone up dramatically since October 2015. The average per month is 146.89; the actual number was 200 and 238 in February and March 2016 respectively. The length of stay has also continued to increase.
Mental Health Incident Reports
I inquired about data related to the following contract provision:
“UCD JPS shall participate in a process for handling of incident reports in accordance with procedures defined by County. This shall include a process for evaluating incidents uniquely involving Jail Psychiatric services, reviewing the outcomes of all such incidents with County and providing a summary of these incident reports to County DHHS-MH QI Committee in a format defined by County DHHS-MH. In addition, UCD JPS will participate with County and regularly scheduled reviews of incidents that concern both medical and psychiatric services.”
I was informed by the JPS Program Manager in a 4/28/16 email that:
“[UCDJPS does] not provide a summary of incidents to the County. We have a process for reviewing JPS related incidents. Please see the attached Policy and Procedure that describes our Incident Review process. However, as with the other requests for CQI, the Department does not provide this information to outside individuals or entities.”

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Staffing
It is important to begin by noting recent history with regard to funding in the county in general. As noted above, with the financial crisis of 2008 and 2009 there was a substantial reduction in staffing in the jails. The mental health contract was reduced, resulting in an approximately 50% reduction in clinical staff (per CHS and JPS leadership). The 2012-2013 contract (the most recent I received) provides for the following staffing:
x One program director x Two LCSW supervisors x Three Clinical Nurse II x Eight LCSW x One Senior Psychiatric Technician x Seven Licensed Vocational Nurses x Three HUSC III x On-call nursing (the contractual amount for this is $420,000) x Psychiatrists and on-call MDs (the contractual amount for this is $860,696) x Resident (the contractual amount for this is $72,200) - providing for approximately one resident x Fellow (the contractual amount for this is $93,438) - providing for approximately one fellow
Prescribers are both psychiatrists and psychiatric nurse practitioners. There are no psychologists on staff.
The jails psychiatric nurses are provided, as detailed above, under the JPS contract. They are primarily assigned to cover the LPS-certified unit 24/7 but render some crisis services after hours and give psychotropic injections to some patients in general population.
On-Call Psychiatric Services
UCD psychiatrists are assigned to take call 24/7. They are reliably available according to nursing staff. They can give telephone orders, including emergency medications, and orders for restraint for the LPScertified unit.
Intake Screening
The vast majority of booking and intake screening is done at the MJ. There is some limited booking at RCCC (about 150 cases per month) primarily from outlying jurisdictions, California Highway Patrol, and US Marshals.
The MJ booking area includes tanks, safety cells, segregation cells, and areas dedicated to various other intake functions. Nursing staff conduct full intakes at three desk stations in a common area without visual or auditory privacy barriers; these stations have marginal privacy.
The RCCC booking area is smaller. It includes two holding cells, a safety cell, an officers’ station, and changing areas. There is also a tiny nursing station that the nurse and perhaps one inmate could fit into. However, the nurse reports that the nursing screening is typically done in an open area with the inmate sitting on a bench with custody standing by. This booking area and the limited medical infirmary noted below are slated to be replaced by a new facility. The current area provides for minimal privacy if the nursing station is not used.
The CHS policy “Receiving-Screening” governs CHS intakes. Prior to acceptance, a nurse conducts a basic “Receiving Screening” and diverts any arrestees with substantial health care needs for emergency

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medical treatment; JPS may be “requested to evaluate arrestee’s mental status,” with two options following: “Arrestee(s) may be housed in the Outpatient Housing Unit” or “Arrestees may be referred for follow-up psychiatric care.” There is no mention of hospitalization, referral to an emergency room, or civil commitment.
After the arrestee is accepted, the full nursing intake screening is done. When I watched a nurse conduct a screening, custody was standing nearby and the conversation was semi-private in that others could hear anything but a very quiet conversation. RNs and LVNs do the intake screenings; there is a nurse supervisor on site 24/7 as well. Nurses also originate a plan of care during the intake process for those needing medical services.
The policy “Adult Developmental Disability” directs medical personnel and Sheriff’s Department employees to “be alert to the possibility of developmental disability” and if there is “suspicion of a developmental disability” there is to be “a notation on the Receiving Screening medical form and a referral made to the JPS Outpatient Department.” JPS is then charged with notifying the Regional Center whose staff are to “play a consultative role in the management of incarcerated clients.”
The Medical Intake form includes the following mental health screening information. Questions, in yes/no format, addressed to the arrestee include:
x *Are you currently suicidal, or do you feel like hurting yourself or someone else? x *Have you given birth within the last year? (If no, stop here!) Are you charged with murder or
attempted murder of your child? x Within the last two weeks have you felt suicidal? x Have you been hospitalized for mental health treatment within the past 30 days? x Are you currently taking or been prescribed [sic] psychiatric medications within the past 30 days? x Do you have a history of developmental disabilities? Have you been treated at Alta Regional
Center? Information that the screening nurse is asked to provide include:
x *Is the arrestee mentally disabled and/or a danger to self or others?
Those questions marked with an asterisk require an emergent referral to JPS. Other positive responses are directed to yield a routine referral. Other questions that are pertinent to mental illness but asked in other sections include:
x Does the arrestee have physical/developmental disabilities that prevent them from caring for themselves?
x Have you had any significant injuries, hospitalizations, or illnesses within the last three weeks?
The nurse is also to make some specific observations regarding possible withdrawal that may be relevant to mental health status including whether the nurse notes the presence of tremor, anxiety, agitation, hallucinations, or problems with orientation.
The CHS policy “Receiving-Screening” specifies that receiving health screening should include inquiry into “History or appearance of suspected mental illness, including suicidal ideation or behavior” and “Appearance or history of developmental disability.” It also directs observation of “Behavior, which includes state of consciousness, mental status, appearance, conduct, tremors, and sweating” and “Slowness in speech or lack of comprehension of questions suggestive of developmental disabilities.” This is the only mention of mental health screening in policies. With regard to disposition, this policy mentions “referral to an appropriate … Mental Health Service” and “Isolation or special observation in the facility” but nothing else specific to mental health. The CHS policy “Mental Health Services” adds

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that, “On-site mental health staff will be consulted whenever signs of mental illness are noted or suspected.”
The nurse screened an inmate with mental illness while I was watching. The arresting officer form was completed and was all negative. She asked most of the questions on the form as required though not some of the substance abuse questions, presumably because the inmate was coming from a prison rather than the community. The nurse instructed the inmate on how to access services through a kite at pill call or asking a deputy. The nurse also had the inmate sign a release of information. The inmate came with a medication list from a prison. The nurse planned to call JPS, normally only done for urgent or emergent referrals, because the inmate reported having a Keyhea (involuntary medication) order in place but noted that she would normally have made a routine referral given that he seemed stable.
The policy “Patients in Segregation Cells in Intake” states these cells “may be used for arrestees who must be separated from the rest of the population within intake due to their charges, sexual orientation, physical or mental condition, behavior, age, gang affiliation or custody status.” It specifies that mental health and medical must be notified within one hour of placement. Those so placed must also be assessed by medical staff “within the first six hours and at least every six hours thereafter to assess their medical condition.” This is to be accompanied by a note in the medical record and an entry in the custody log outside the cell. Custody is directed to perform 30 minute checks on this population.
The intake area has an Accudose for dispensing medications and the emergency medication kit was fully stocked. Nurses note that on rare occasions, emergency psychotropics are given but this is done by the psychiatric nurses who come to intake from 2P, the LPS-certified unit where they are stationed. Haloperidol, lorazepam, and diphenhydramine are the typical agents given in this situation.
There is a phlebotomy station in the intake area and labs are routinely collected. Stat (immediate) labs are not available and anybody needing stat labs is sent to the emergency room.
8E is used to place inmates from intake pending classification. 7E is used for overflow if necessary. Classification is usually done within 24 hours but may take longer for inmates who are placed on 2P or in medical; for these settings classification is typically not done until they depart.
Inmates were being processed during my site visit; there were few waiting. I saw no evidence that the booking process was unreasonably lengthy when staff are available. However, staff on 8E report that inmates may be in booking up to a few days though are supposed to be out in 12 hours per a consent decree. Despite this consent decree, there is, reportedly, no formal time frame for moving through booking. Inmates with medical needs can be expedited and are typically out within two hours.
There are two male and one female safety cells in the booking area as well as segregation cells and a sobering tank. The safety cells have a floor grate and no furniture or sink. The segregation cells have a bench, sink, and toilet. The sobering tank has a sink and toilet; officers were unsure of its capacity, offering that while they did not know, they had “never reached it.”
There were no intakes in booking when I was at RCCC and I did not visit the intake unit at RCCC, which reportedly has a capacity of 92. Most on this unit reportedly are sentenced and either return for weekends or are being processed in for a longer stay.
Access to Care
I begin with a general overview of avenues of access to care. I then consider deployment of staff as this should really be considered in the context of access to care as how staff are arrayed and at what hours is at

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least as important to access as are the mechanisms for activating care. Lastly, I explore specific settings and services.
In addition to identification at intake, there are several other pathways to mental health services. The CHS policy “Clinic Care” notes:
“1. Medical Health Services (HS) Kites (request for medical attention) are available in the Housing Units, from the pill call nurses and from custody officers.
2. HS Kites are triaged by an RN within 24 hours of being received and an appropriate appointment(s) are scheduled.”
The CHS policy “Mental Health Services” describes “In-patient and out-patient services for the detection, diagnosis, and treatment of mental illness”; that include:
“1. Screening for mental health problems on intake during the booking process; 2. Crisis intervention and management of acute psychiatric episodes; 3. Stabilization of the mentally ill and the prevention of psychiatric deterioration in the jail
setting; 4. Provision for referral and admission to licensed mental health facilities for patients whose
psychiatric needs exceed the treatment capability of the facility.”
It goes on to provide:
“With the exception of involuntary short term in-patient treatment in the Acute In-Patient Unit, admission for mental health services is voluntary. Inmates that are referred are given an assessment interview to determine whether they would benefit from mental health treatment. Patients who are determined to be inappropriate for the program are referred to alternative care such as for substance abuse, alcoholism, and social services. Patients who meet criteria for involuntary psychiatric treatment, per ‘Welfare and Institutions Code 5150’, are admitted to the Acute In-Patient Unit. Those patients for whom brief supportive contacts are felt to be appropriate will receive such assistance through the Jail Psychiatric Services (JPS) Out-Patient Program. Inmates may be referred for care from any source within the jail.”
It states further:
“2. Request forms (kites) for mental health services, are made available to inmates. Inmates are informed of the availability of mental health services, both verbally and in writing. "Mental Health Request" forms are available on each floor at central dayroom locations.
3. Crisis intervention and management of acute psychiatric episodes are available 24 hours a day. Correctional Officer(s) are trained in the early recognition of signs and symptoms of mental illness, emotional disturbances and suicide prevention.
4. Mentally disordered patients shall be admitted for acute or sub-acute services as authorized by the Jail Psychiatric Services staff.
5. The Health Record must document discussion with the inmate’s attending physician concerning the inmate’s condition and include an appropriate consent for treatment. The patient must be examined by the facility psychiatrist prior to the initiation of medication.
6. No new or renewal psychotropic medications shall be ordered without an on-site evaluation completed by the prescribing facility psychiatrist which is documented in the Health Record.
7. Psychotropic medications are not to be unilaterally discontinued without consultation with the facility psychiatrist.”
The CHS policy “Special Needs Patients” specifies that those with intellectual disability are required to have a treatment plan. This is a CHS policy and does not reference JPS.

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I met with classification who informed me that they use the Northpointe classification system. Classification statuses include: high, medium, low, total separation, administrative segregation, restriction, discipline, OPP, and inpatient. Those on total separation, even if intellectually disabled or mentally ill, are generally not housed at lower custody levels (including OPP settings) unless they have a medical problem. Females are placed on the seventh floor and males are placed on the eighth floor of the MJ; these are essentially restrictive housing settings.
Inmate kites for mental health reasons are sent to 2P where night shift nursing staff triage cases. Those designated “must see” result in electronic notice to JPS staff. These kites are triaged again by social work the next day to assure that any potentially serious problems are not missed.
The JPS policy “Overview of Staff Responsibilities – Outpatient Department” indicates that crisis intervention calls may come from a variety of sources including “custody and medical staff…family members, friends, legal staff, and other community members.” Ordinary referrals may also come from “Correctional Health Services, custody staff, inmates, external agencies, or family member.” Routine referrals are generally made electronically. Triage of such referrals is governed by the JPS policy “Outpatient Department Triage” which provides for categorization into emergencies, referral to a psychiatrist, referral to other jails services, and no services indicated (The JPS policy “Outpatient Intake” also provides for follow-up visits with mental health clinicians). While this policy indicates that the assigned Outpatient Department triage clinician is to triage kites, as noted in the preceding paragraph this is reportedly being done by night shift 2P nurses and then reviewed by the triage clinician the following morning.
Cases are prioritized according to the following designations: must see, new, and follow-up. Those designated “must see” typically have suicidal ideation, certain charges considered to put the person at risk, and/or bizarre behavior. There are typically 10 to 20 of these “must-see” patients per day at the MJ, about half or slightly less are in the booking area. Notification about this group comes usually both by telephone call and electronic notification.
Clinicians have the option to designate follow-ups to themselves or to a generic pool of clinicians They rarely follow up with the same patient as courses of treatment are uncommon.
Frequency of follow-up is driven by “FOSS” level: “I. Follow-up / Daily by clinical staff II. Follow-up / At least once per month III. Follow-up / Per MD, at least every 90-days IV. Initial Assessment with no planned follow-up”
The levels are defined as follows: “Level I - Patients are those who meet criteria for W&I 5150 and are either on 2P, on the wait list for 2P, or are 2M suicidal.
Level II - Patients that are discharged from 2P, cleared from 2M suicidal status, cleared from 2P wait list prior to admission, or in need of follow-up related to significant psychiatric history at this jail. Follow-up visit after discharge from 2P, or last clinical contact must be within onemonth or sooner if clinically indicated.
Level III - Patients are open to JPS and receiving medication management services. Follow-up will be determined by JPS physician or clinician if not on medications. This follow-up will be no more than 90-days from MD contact.
Level IV - Patients are assessed by a clinician and are not in need of additional JPS services at this time. These patients are advised to kite for services as needed.”

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JPS policy provides for access to an interpreter service. Clinicians report that this service is generally available and adequate. JPS policy “Interpreting Services” provides that custody can be used to interpret except for “psychiatric evaluations” in consideration of “confidentiality.” It is not clear whether this extends to other mental health contacts.
There is a mechanism for developing behavior management plans conjointly with custody but this is virtually never done.
There is no provision for group programming in restraint chairs or other secure arrangement.
There are no special management units for the intellectually disabled, cognitively impaired, personality disordered or other mental health populations other than those described below which serve all populations but primarily focus on the seriously mentally ill, though often house many other populations as described in Access to Residential Care below. Sometimes the frail mentally ill (e.g., those with dementia) are placed in the medical infirmary.
While clinicians have schedules of when they are slated to see assigned patients, the rooms are not scheduled and visits are frequently cancelled or delayed, though this is not tracked. It was common during my visits in all locations. With regard to scheduled patient encounters, mental health clinicians at both facilities come to units with a list of patients they hope to see. There is no advance appointment or call out. They give this list to the booth officer and a custody staff invites the patient out. If the patient does not come out, clinicians normally ask the booth officer what happened but generally do not go to the cell to encourage participation, though social workers do this more commonly for those they are concerned about. They do track refusals (though I did not receive any data on refusals) but not cancelled or delayed appointments. A JPS psychiatrist reported a no-show frequency of about 10% at the MJ. It is reportedly higher at RCCC.
I note here that custody operations have a substantial impact on access to care, including provision for escorts, opportunities for confidential clinical interactions, and provision of space for clinical service delivery. It is expected that custody considerations of safety and security will have an impact on access to care but such limitations must be reasonable safety and security concerns, not simply a matter of convenience, or driven by lack of resources. Observations regarding these limitations are detailed in the following sections and are discussed under SPECIFIC DEFICIENCIES.
Deployment of Staff
In order to properly examine access to care it is important to consider how staff are arrayed and the kinds of services they are expected to deliver. The JPS policy “Overview of Staff Responsibilities – Outpatient Department” provides that services will be provided at both the MJ and RCCC from 0700 to1730 Monday through Friday. It goes on to add “Hours may be extended at either site depending on emergencies that may arise with new crisis referrals or with inmate-patients on existing caseloads. Afterhours, holiday and weekend crisis evaluations are provided by the Inpatient Unit’s staff.” As noted below, some mental health staff are assigned to work outside of normal weekday working hours as allowed by this policy.
The UCDJPS Mental Health Policy and Procedure Manual specifies that the following services are provided:
“In-custody Services Currently Provided: • Crisis intervention • Medication evaluation and follow-up • Brief supportive contacts

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• Release planning and community referrals • Psychiatric hospitalization and stabilization • Consultation and education to Sheriff’s Department and Correctional Health Services staff. • Consultation, education and information to community partners/agencies. • Patient education • Suicide prevention In-custody Services NOT currently provided: • Conservatorship investigation • Court testimony • Forensic evaluations • Long term psychotherapy”
Current staffing deployment (reported as full time equivalents or FTE) is as follows.
Main Jail
There are 4-5 mental health staff assigned to work on weekdays. Hours vary so that coverage extends a little beyond normal working hours. On weekends there is usually just one mental health staff on site in addition to the 2P psychiatric nurses.
One psychiatric nurse works in the MJ from 1130-2400 Friday through Sunday, assisting with weekend coverage. Another works Sunday through Thursday 1800-0230, assisting with evening coverage. They can also help on 2P if necessary. There is no mental health coverage outside of 2P nurses from 02300700.
There is one psychiatrist assigned to 2P and one psychiatrist and one psychiatric nurse practitioner assigned to the remainder of the jail, splitting it up geographically. Trainees also run small clinics at assigned units under supervision of the psychiatrist.
On 2P, RNs and LVNs work 12 hour shifts. There is psychiatric nursing on 2P 24/7. There is one LVN and one RN on from 0630 to 1830 each day. From 1130 to 2400 there is an additional LVN. From 1830 to 0630 there is a night shift LVN. From 1800 to 2400 or 0230 the above mentioned general population nurses assist if needed. There is also a medical assistant on site from 2300 to 0700 but this person can do very little unless there is a doctor on site, which is never the case during this time.
When there are insufficient psychiatrists and social workers to manage after-hours mental health crises, the UCDJPS Mental Health Policy and Procedure Manual includes policy “After Hours Emergency Psychiatric Evaluations” providing that inmates may be sent to 2P for JPS nursing staff to perform an evaluation. Nurses will also come to the booking area to do evaluations. They have access to psychiatrists on call. But subsequent mental health evaluations may not occur for several days afterwards. Mental health staff are able to see some patients on weekends but this is limited owing to the light weekend coverage.
RCCC
There is one psychiatric nurse practitioner assigned to RCCC. A psychiatrist from the MJ is assigned one day per week to the Jail Based Competency Restoration Program. They are currently seeking a 0.5 FTE psychiatrist to accommodate the intended expansion of this program from 16 to 32 beds.
There are two full-time and one halftime social workers working Monday through Friday. The JPS Program Director also works there about one day per week. Most of the clinical work is routine followup as the mentally ill population at RCCC is more stable than at the MJ.

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CHS nurses are responsible for responding to crises after hours and on weekends and holidays. A nurse will typically do a brief medical assessment and ask questions about suicidal ideation and psychotropic medication taking behavior. If the case is considered an emergency or urgency, the inmate is placed in a safety suit and returned to the MJ for assessment, typically by the 2P nurses.
Access to Residential Care
Placement in residential settings, referred to as Outpatient Psychiatry (OPP), is ultimately the decision of classification. These settings exist only in male units, though one female unit is unofficially considered OPP (see below). CHS policy “Decision Making – Special Needs” also provides that:
“Consultation between the Facility Commander and the Medical Director is required for actions regarding patients who are diagnosed as having significant medical or mental health disorders, as follows: 1. Housing assignments. 2. Program assignments. 3. Disciplinary measures. 4. Admissions to and transfers from institutions.”
Such consultation rarely occurs with regard to the mentally ill. Classification staff told me that placements in OPP are done by classification using information from the nursing booking screening, special-needs form, history of placements, and inmate requests to determine who to place on OPP. As the classification staff put it, they “use judgment” to decide who to place on OPP. Unlike admission to OPP, release from OPP is primarily driven by inmate or mental health requests for reclassification to general population. OPP males are typically placed on 3W or 3E and females on 7W 300, though the latter also houses PC, transgendered inmates, and general population overflow. There is an OPP waitlist at times. There is no mechanism for triaging acuity and access to OPP is according to time on the waiting list, though mental health sometimes requests that a more acute inmate be placed in OPP.
The UCDJPS Mental Health Policy and Procedure Manual provides that JPS may make recommendations to custody about placement. The JPS policy “Outpatient Intake” has the related following provision, which mental health stated they regularly invoked but classification staff stated was occasional:
“Based upon clinical presentation and if indicated, the clinician will submit a request for reclassification for male inmate-patients who meet the following criteria for Outpatient Psychiatric Pod housing (OPPH) in the 3-East, 300 Pod:
• Recent County RST, ISA, SCMHTC patients • State Hospital or other Psychiatric hospital patients with verifiable treatment within one (1) year. • Patients with a diagnosis of:
1. Schizophrenia 2. Delusional disorder 3. Psychotic Disorder NOS, Mood Disorder NOS, Bipolar Disorder 4. Major Depression Recurrent 5. Paranoid Personality Disorder 6. Schizoaffective”
I saw occasional instances of such requests in the medical records but many more qualifying cases where no such request was in the record.
Those found committable under LPS are placed on 2P once a bed is available. Patients may be voluntarily admitted to this unit if they meet admission requirements for acuity.

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The policy “Limitations for Admission to Jail Acute Psychiatric Inpatient Unit” provides for appropriate limitations on the placement of medically ill inmates on the LPS-certified unit. It specifically excludes those with delirium and need for substance abuse detoxification.
The CHS policy “Adult Developmental Disability” provides that this population “may require special consideration in the classification process” but provides no specific guidance and, as noted previously, there are no residential settings specified for this population. The 2P psychiatrist reported that some with intellectual disability (ID) are placed on 2P. He also noted generally good coordination with community ID services. There are limited options for placement of this population in the jail; they are often placed in the mental health housing areas. The problem is similar for those with dementia, who sometimes end up on 2P or in the medical infirmary due to lack of other placement option in the jails for these vulnerable populations.
I was told that there is regularly a waiting list of 5-10 patients for the LPS-certified unit. Patients often wait two weeks for a bed but the waiting list is not formally tracked in terms of time. Note that even though those on the list are felt to meet 5150 criteria for civil commitment, this paperwork is not filed until a bed becomes available. These patients are seen daily by a mental health clinician. The JPS policy entitled “Outpatient Referral for Admission to the Acute Unit” provides for delayed admission and filing of LPS paperwork only for gravely disabled. The JPS policy “Medical Director Consult List (Prior to 2P Admission)” provides for special review of certain patients, designed to limit inappropriate use of 2P beds, who must have medical director review prior to being admitted to 2P:
“1. Multiple prior 2P admission, without therapeutic benefit, and/or 2. History of well documented malingering of psychiatric symptoms, and/or 3. Other clinical considerations which render 2P admission ineffective for behavioral symptoms (i.e. reinforcing negative jail behaviors, including deliberate self harm, not directly attributable to active symptoms of a major mental illness).”
The psychiatrist noted that about half the population (2P has an 18-bed capacity) on the unit really did not need the level of service provided or were otherwise needlessly occupying a bed. This included patients awaiting a bed for competency restoration at Napa State Hospital, those found non-restorable (competency to stand trial could not be restored) and pending LPS conservatorship, and those not acutely ill but on 2P because of recurrent self-harm or threats of self-harm. The problem is that there are limited general population services available to manage those with behavioral problems such as self-harm. Release is not blocked; rather, the patients often bounce back quickly. Some of these repeat admissions are then retained because of the likelihood they will commit self-harm or make suicidal statements and be returned.
Access to the jail-based competency restoration program at RCCC is governed by court order.
Thus, there are provisions for mental health staff to participate in special needs placement but their use is inconsistent at best. Mental health staff report that their recommendations to classification are generally honored. It is, however, also clear that patients are sometimes transferred into and out of OPP without the knowledge of the local mental health staff. It is important to observe once again that the population on these units is highly mixed and includes many without serious mental illness as well as many with profound mental illness, cognitive deficits, and personality disorders.
Psychiatric Services
Inmates who have psychotropic medications verified at intake have their medications ordered either by a psychiatrist or a CHS medical provider. Record review demonstrated that verified medications are

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usually ordered within one or two days following admission and documentation demonstrates that prescriptions are being verified.
The wait time for initial psychiatric assessment varies widely but can be over a month. Many patients have initial medications ordered by a psychiatric prescriber but are then not seen for weeks.
Psychiatric prescribers commonly change and start medications both without ever seeing the patient and in response to patient and social worker requests. I saw numerous instances of this, sometimes with the patient not being seen for months after the change.
Note that policy specifies that renewal of an order requires “a clinical evaluation of the patient which may include a review of the documented effectiveness of the medication in the medical record.” This does not address the starting of a new medication, which would require even more careful clinical evaluation. There is no specified minimum frequency of visits with a psychiatric provider. Recall also that the CHS policy “Mental Health Services” specifies that “No new or renewal psychotropic medications shall be ordered without an on-site evaluation completed by the prescribing facility psychiatrist which is documented in the Health Record.”
MJ
I job shadowed a MJ psychiatrist who had several years’ experience at the Sacramento jails. He reported typically seeing 20 patients per day and that this was typical for all other psychiatric prescribers. Psychiatric assessments are typically 30 minutes and medication follow-ups are 15 or 20 minutes.
He had a computer with network access and was able to review records and enter orders during the encounter. Visits were in the indoor recreation area, which was public and, at times, very loud. I was able to hear the conversation between the psychiatrist and a patient from a pill line being held about 15 feet away.
The psychiatrist noted that he receives communications from a variety of sources, including custody, medical, social workers, outside sources, and kites. He also regularly reviews and responds to patient grievances.
Observations of some of the patients seen during these encounters are found in Appendix 1.
RCCC
I job shadowed a RCCC psychiatric nurse practitioner who had several years’ experience at the Sacramento jails. Each day’s patient schedule is sent by an administrative assistant at the MJ (they lost their local administrative support in 2009); the schedule is driven by the psychiatrist at the MJ directing a follow-up and by recommended follow-up periods. New patient visits (psychiatric assessments) are typically 30 minutes. Prior to walking to the units to make patient contacts, the nurse practitioner reviews the electronic record and may bring printed records along as well. The nurse practitioner typically sees about 300 patients each month (about 15-20 per day), including about 6 new (most days) and follow-up cases; if the nurse practitioner is unable to see all of them, they are bumped to the future. The nurse practitioner reported seeing follow-up cases about every 8 to 10 weeks in routine situations. If clinical need requires she may see people as often as weekly. Most of the patients she sees are in the OPP and are typically long stay inmates.
The nurse practitioner is not provided clinic space, both because of lack of space and difficulty getting patients to the clinic, so goes to the units to see patients, taking handwritten notes due to lack of network access. Patient encounters are typically off the unit in an examination room or other group or office

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space. The nurse practitioner is not supposed to see patients without a custody staff in the room with her (presumably this was not necessary at the MJ because the psychiatrist was seeing patients in a public space). She sometimes has difficulty finding staff to help; medical is provided a dedicated custody staff and the nurse practitioner will sometimes “borrow” this officer. For two of our patients, there was no custody staff in attendance though custody did let the patient out of the unit living area to go into the interview room situated between the living areas. The nurse practitioner estimates 70% of each day is spent providing direct service; the primary problem is access to patients due to lack of custody availability to assist as required.
The nurse practitioner notes that it can be difficult to order release medications prior to an inmate releasing due to lack of notice. Release prescriptions are normally for 30 days and she estimates about 30% of patients actually obtain their release medications. She also noted difficulty with release planning, commonly learning of release the day of or a few days prior to the actual release, if she hears at all. This occurred when we were visiting a patient who was slated to leave homeless the following day. The nurse practitioner attempted to contact the discharge planner to try to link the person up for services without success.
Observations of some of the patients seen during these encounters are found in Appendix 1.
Restrictive Housing
Mental health does not do intake screening of those in restrictive housing and does not do rounds. They may see referrals from these settings but in general have very little contact with this population and are unable to see these inmates in a private setting. There is also no standard nurse intake screening or rounds in restrictive housing.
Medication Administration
I shadowed a nurse conducting pill call. The nurse placed a medication cart in the open doorway to a living unit dayroom and patients lined up in the dayroom. The policy “Medication Administration” specifies that nursing staff is to “verify the patient has taken the medication” and “with custody’s help verify the medication has been swallowed (mouth checks).” It was not a confidential setting. There was no discussion of efficacy of medications or side effects. The nurse gave a kite to a patient who wanted to discontinue medication and also received kites from inmates. The nurse did not do any mouth checks. Custody supervised the pill call and did mouth checks. The nurse reports that deputies are supposed to do mouth checks but may not and that she does them if she is concerned about adherence.
The nurse did identification checks with a scanner, scanning both the patient and the unit dose packaging. The nurse reported that she does wrist band checks and verbal name queries when the scanner is not functioning.
There were numerous reports that the pill lines at the MJ are frequently not on time. Evening pill line might come very late, even after midnight though that is uncommon; but several hours late is not uncommon. The morning pill line I attended began at 1030, several hours later than it is supposed to be. When reviewing the MAR, there were instances of evening medications being given after midnight and other less egregious instances of late pill lines was common.
Pill lines at RCCC reportedly run more on time, typically between 0700 and 1000 in the morning and1900 to 2000 in the evening. At RCCC there are three pill call nurses for the whole facility drawn from the four on duty for the general facility.

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The CHS policy “Medication Administration” includes a section on medication refusal that appears to be incomplete and not to specify what nursing staff is supposed to do in the face of the refusal, likely because of exclusion of a portion of the intended policy. Psychiatric prescribers reported that they got regular electronic notice of non-adherence designated as “JPS Chart Review.” However, they were unclear how often they were not notified.
As all psychotropic medications are administered at pill line, I did not review the keep on person program.
Call Buttons
Call buttons that I tested were in working order and officers responded.
Institutional Transfers
When inmates are transferred between facilities I saw rare instances where they were screened by nursing or other clinical staff upon arrival. There is no formal provision for clinical screening upon transfer but scheduled appointments reportedly reliably follow patients to the next facility.
Because the pharmacy system is computerized and there are medication packaging machines at both facilities, there is no problem with medications following patients at the time of transfer.
Quality of Care
General Population Mental Health Services
General population mental health treatment services at both jails consist almost entirely in the provision of medication, crisis response, and limited supportive services. Consistent with this level of services, the JPS policy “Overview of Staff Responsibilities – Outpatient Department” states that, “The role of Outpatient Services is to provide crisis intervention, suicide prevention, supportive counseling, consultation, case management, medication monitoring, and medication clinics to inmates in general population.”
Correspondingly, there are no mental health groups and no courses of individual therapy; clinicians report they will occasionally provide brief supportive therapy. Most follow-up is case management is done on a monthly basis and consists of limited assessment, referral to a psychiatric prescriber or other services (e.g. detoxification), and limited release planning. The encounter information reported above is also consistent with this constellation of services.
The clinical staff consists of a small pool of mental health clinicians (primarily licensed social workers, nurses, psychiatric nurse practitioners, and psychiatrists) who respond to crises (chiefly done by the social workers) on a rotating basis and conduct follow-up. Continuity of care (follow-up by the same provider) is not a priority but is accommodated to some degree on a case-by-case basis. The JPS policy “Overview of Staff Responsibilities – Outpatient Department” refers to “assigning an inmate the appropriate Frequency of Service Scale (FOSS) number.” This drives frequency of visits as noted in Access to Care Above. Those who are FOSS I (“Patients are those who meet criteria for W&I 5150 and are either on 2P, on the wait list for 2P, or are 2M suicidal”), who are to be seen daily, the minimum expectation is monthly for FOSS II and every 90 days for FOSS III.
Mental health staff have limited administrative support. Despite limitations, mental health services are generally well-organized and efficient; mental health resources are being used maximally.

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Initial contact is almost always with a JPS social worker either in response to a crisis or referral. Formal assessments may ensue and are supposed to be done prior to psychiatric referral. Assessments are highly variable in quality. Some are thorough both in history, mental status examination, and diagnostic assessment. Others are very minimal and do not provide a foundation for diagnosis or treatment considerations. Consistent with the defined mission of JPS, documentation is primarily observational in nature with very little evidence of supportive treatment or more active intervention. Correspondingly, mental health staff do not develop treatment plans in any setting other than the LPS-Certified unit (see below for information on the LPS-Certified unit and see Appendix 1 for clinical case reviews).
Some mental health clinicians try to help their patients by giving them workbooks, puzzles, and journaling assignments but this is done inconsistently. They do not have a supply of treatment workbooks or similar materials and rely on donations, which are minimal and inconsistent. Note that the UCDJPS Mental Health Policy and Procedure Manual would seem to permit this practice if such material is considered “necessary” for care:
“Staff will be alert at all times regarding potential weapons such as pens, paper clips, hairpins, staples, clipboards, stethoscopes, blood pressure cuffs, tourniquets, etc. Control of these items will be maintained at all times. Staff will not give any items to inmates except community resource lists, informed consents, or other necessary paperwork related to the inmates care. Paperwork shall not contain staples or paperclips. If staff becomes aware that an inmate possesses contraband, an officer will be notified immediately.”
In the majority of records reviewed, psychiatric assessments do not include thorough histories and mental status examinations. Visits and their associated notes are both brief, including initial visits that would provide the foundation for an assessment. There are no treatment plans and rarely is there a medication plan. Medical record documentation of medication monitoring (primarily laboratory studies) is inconsistent; levels of medications requiring such monitoring are typically present but metabolic studies, baseline laboratories, and other routine examinations are inconsistent and often absent. Some clinicians do routine testing for movement disorders (typically done with the Abnormal Involuntary Movement Scale) but others do not document having completed these examinations. In instances when psychiatrically relevant laboratory studies are done, often ordered by medical prescribers, the results are rarely documented in the chart. In short, psychiatric documentation tends to be very limited.
As noted above, mental health clinicians have little involvement with restricted housing inmates. For the mentally ill, this is primarily medication management and limited crisis response as access to patients is very limited. Further, mental health staff rarely work with custody, or on their own, to develop behavior management plans to assist custody in managing mentally ill and behaviorally disruptive inmates, usually those with severe personality disorders. [Note that the UCDJPS Mental Health Policy and Procedure Manual includes provisions for behavior management plans on 2P but not for general population inmates.]
There are physical plant limitations at the MJ but there is sufficient space to provide active treatment. At present, the area designated as the “classroom” is used almost entirely for suicide watches. These rooms provide for limited privacy as they are quite publicly visible (mostly glass walls) but allow confidential communication and are adequate for individual and group sessions. Mental health staff sometimes meet with patients here, though none did during my visit, except for an interview of an inmate placed there in a safety suit by custody the previous evening. At present, most patient contacts are in the open indoor recreation area, the public and highly visible space in front of the officers’ station.
The situation is better at RCCC with more access to programming space in most areas. There are limited programming spaces in some of the dorm areas, but these inmates have more freedom of movement and

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could easily be seen at a more central location, though this is not done. As noted in the appendix detailing clinical case reviews, mental health staff will even conduct interviews in outdoor public areas through a chain link fence owing to lack of space or ability to move patients to clinics.
At present, engagement in jail programming does not affect classification status; the jails are currently looking at creating incentive-based programs that would allow for privileges to be tied to program participation. The new differential out of cell time for low medium and high classification statuses is a part of this initiative.
Residential Mental Health in the Jails
Treatment on these units is no different than in other general population settings. There are no chemical dependency (CD) services available on the residential units (OPP or 2P). Referral for most jail programs is based on inmate self-referral through classification. Certain charges such as domestic violence lead to referral by classification to program such as anger management. Those in residential units typically have no or very little engagement in jail programs.
Officers assigned to the residential mental health units have no required special training. Some have received CIT training.
Officers report there are no standard schedules or provisions for routine cell searches. It is up to the Sergeant or Lieutenant. Similarly, there are no standard approaches to hoarding, whether of medications or other items.
While job shadowing mental health providers, we saw some seriously mentally ill with profound functional deficits who were housed in the OPP units; see Appendix 1 for details. These units also contained a diversity of inmates with widely varying conditions including personality disorders, cognitive deficits, and both mild and serious mental illness.
MJ
On floor 3E, the lower tier of the 300 pod is identified as mental health housing (OPP) and houses low, medium, and high classification risk levels. This is a classic 2-tier pod with jump bars preventing ready jumping from the upper tier, but they are not a complete barrier. There is a large, open dayroom with 4person spider tables.
The upper tier is for PC. The two groups do not come out together, limiting their access to time out of cell compared to others in similar settings. According to a new scheme just instituted, inmates are to come out to the dayroom twice daily; those who are high risk level come out for 30 minutes, medium for 60 minutes, and low for 90 minutes. While these are the expected times, it is still up to local custody staff to determine when inmates come out. Data is just starting to be collected and shows a great deal of inconsistency across units but the sergeant reviewing this data with me questioned the accuracy of some of the data and doubted that it was a good reflection of actual practice.
As in other GP units, between pods there is a so-called “classroom” that is primarily used for temporarily placing inmates that custody puts on watch pending JPS evaluation, usually for danger to self. At the time I was there, an inmate (#3969024) was in this space in a safety suit. This inmate had reportedly gotten outside the jump bars the previous evening and was threatening to jump from the upper tier but was talked down by custody staff. He had not yet been seen by JPS and it was well over 12 hours after the event. Custody staff told me that they did 15 minute checks by camera only, as long as the inmate was moving, and hourly physical checks but would do a physical check if the inmate was not moving.

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The inmate gets a bathroom break by pushing an intercom button but there are no regularly scheduled breaks. They get meals when served but otherwise get no additional food or fluids. The log for this case showed 15 minute checks, food and fluid intake, and restroom breaks.
There is a non-contact visiting area above the classroom but it is for visitors coming from outside and must be accessed from the first floor so is not easily accessed from inside the secure jail areas and thus is not readily usable for clinical interviews; community social workers and new discharge navigators will sometimes use this area for patient encounters. There is limited space for clinical interviews other than the (rarely used) classroom. As in GP settings, most patient contacts occur in the very noisy and public large indoor recreation area outside the pods and just in front of the officer’s station. It was being used as an exercise space and a number of people passed though while we were meeting with patients. This is also where pill lines are typically held.
There are at least three deputies, as there were when I visited, assigned to cover 3E and 3W. Normally there are four deputies from 0630-1830. 3W houses inmate workers and is slightly larger. Each houses about 80. Sometimes “overflow” mentally ill will be housed on 3W.
There is an examination room shared by the two units. This is used only for medical visits, not by JPS though it was unclear why.
These units share the outdoor recreation area serving floors 2-4. This recreation area is quite large but has very limited equipment. There are three such areas. Each floor gets a block of time but the same restrictions apply in terms of conjoint programming of different classification security levels and PC; thus the mentally ill tend to get less time than others. Recreation therapists do some structured activities in these areas but nothing specifically designed for the mentally ill.
RCCC
Staff at RCCC reported that CBF, which is a high security unit, houses the OPP for RCCC on the 400 pod with a capacity of 32 (the census was 26 the day of my visit). The policy “Special Psychiatric Housing at RCCC” indicates that this is on the 600 pod. Presently, JPS runs a residential competency restoration program for the mentally ill on the CBF 600 pod. This program treats up to 16 patient-inmates and is about to expand to 32. This program is staffed robustly and has an active group program, typically holding 3 to 4 hours of groups per day. I attended one of the groups and observed staff interacting effectively with seriously mentally ill patients in the dayroom area. They were unrestrained and all engaged in recreational therapy using art as the organizing activity. Three custody staff were embedded along with two mental health staff serving seven patients. Some individual treatment is also provided. Cells were generally clean and in good order except for one patient they are having difficulty getting to come out. This population is provided regular outdoor recreation and has an active program of morning stretching as well. While they have access to a classroom, it is set up in typical classroom style and staff find dayroom more conducive to running groups.
The disciplinary process works differently on this unit, reportedly only administering infractions or discipline for serious misbehavior such as assaults.
LPS-Certified Unit
This unit is not licensed owing both to inadequate staffing provisions and physical plant limitations. The facility is somewhat decrepit. It can house up to 18 and is virtually always at capacity.

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One custody officer is on the unit during day shift on weekdays but this is the only posted position on 2P. There is always an officer just off the unit, available to both the medical and mental health unit at the medical desk. There used to be three officers assigned to 2P.
Men and women are not segregated by area but by cell with men and women right next door to each other.
There is one two-person cell. JPS staff on 2P report that they recommend who should be placed together but it is ultimately a custody determination. The JPS policy “Use of Cell 2P-1” states that “The Treatment Team will … Not place two patients on active assault precautions together in this cell.” It also specifies that the Treatment Team will “consult with custody staff to assure a thorough review of the inmate-patients’ classifications prior to placing two inmate-patients together.” This language indicates that it is intended for this decision to fall to the Treatment Team rather than custody.
Meals are eaten in their cells. There is a small dayroom with an 8-person table. There is no yard access for this population.
Inmate-patients have very limited time out of their cells, typically one hour out 2-3 days each week per custody staff. Time out of cell does not vary based on inmate classification risk level. Review of medical records (see appendix) demonstrates a great deal of variability with some patients coming out 2 to 3 days per week but others going weeks without ever being in the dayroom. There is no progressive privilege or level system. Patients spend 23 to 24 hours per day in their cells in almost all most cases.
Sometimes inmate-patients are allowed out together; custody determines whether this will be done and it is not dependent on their classification risk level though nursing staff report that custody generally prevents mixing different classification security levels. Those who are on protective custody status (PC) can only come out alone. Those in a safety suit may only be brought out with others in a safety suit.
The psychiatrist or custody staff may place inmate-patients in a safety suit. On this unit, JPS staff determine whether to discontinue use of a safety suit.
The JPS policy “Accessing Patients on the Inpatient Unit” states that “when direct access is required for certain duties including vital signs, lab work, school examinations, assessments, or treatments, staff shall request custody officers to provide access to the inmate-patients. Custody staff will open the inmatepatient’s cell door and stand by while the treatment is performed. For dayroom or group activities, custody staff will be present on the unit if staff are in the dayroom area with inmates-patients.” However, the same policy goes on to state “Attempts to gain direct access to inmate-patients that are denied by custody will be referred to a supervisor for resolution and will be documented in the inmate-patient record. The Sheriff’s Department and JPS chain of command will be followed as necessary to resolve patient care issues involving access to inmate-patient’s.” It was the understanding of custody and staff on 2P that it was custody’s decision whether or not to provide direct access to patients, including through the cuff port. I saw numerous instances of custody denying access but no evidence of any attempt to access the chain of command.
Inmate-patients are sometimes brought out for meetings with clinicians but a good deal of interaction takes place at cell front; virtually all of the patient contacts documented in the medical records were at cell front. I was told by custody and nursing staff on 2P that custody staff determines whether or not the cuff port will be opened to allow more ready conversation. The basis for this decision was unclear.

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Inmate-patients get a standard kit of belongings regardless of classification risk level. Those in safety suits are not allowed any additional items. Items can be differentially restored based on risk but conditions of confinement are set by custody who typically consults with JPS staff.
There are two pill lines a day; a third is conducted if necessary. Medications are delivered to the cell front.
The UCDJPS “Mental Health Policy and Procedure Manual” specifies that the following services are to be provided on this unit:
“Jail Psychiatric Services Acute Inpatient Unit provides 24-hour care to those inmates requiring an acute level of psychiatric care and treatment. The treatment program consists of the following elements. • Assessment, diagnosis, and treatment planning • Stabilization • Safe housing • Suicide prevention • Crisis counseling and brief individual psychotherapy • Behavior management • Patient education • Psychosocial milieu including supervision of activities of daily living • Socialization and recreational activities • Medication and medication monitoring • Referral, discharge planning, and continuity of care
Treatment modalities emphasize coping skills, self help skills, assertiveness, anger management, establishment of interpersonal boundaries and limit setting, relaxation, enhanced self esteem, and adjustment to incarceration.”
There are no groups and virtually no individual therapy. There used to be groups including coping skills, symptom management, discharge planning, health and wellness, depression and anxiety, and medication education. They had a recreation therapist as well who ran groups both on 2P and the residential mental health unit (OPP) at the MJ. There is no social work support. There are no jail programs or chemical dependency services on 2P either.
There are no typical treatment plans. Treatment plans consist of nursing care plans rather than physician directed treatment plans. Treatment teams do discuss treatment but most treatment plans are aggregations of template nursing care plans. Documentation reflects virtually no active treatment. Treatment consists primarily of psychotropic medications, monitoring, and crisis response.
The JPS policy “Special Treatment-Inpatient Unit” provides for formal behavioral management using limited behavioral plans that allow reinforcement of desirable behaviors and sanction of undesirable behaviors. However, the rewards are extremely limited (an hour of reading material or playing cards for each day free of “unacceptable behavior and engaging in only acceptable behavior”) and the sanctions substantial (e.g., restraints, safety suit, loss of some visiting privileges, loss of commissary). It also provides that the sanctions are permanent until the individual leaves 2P. I saw no cases where this or any other behavior management plan for assisting custody in their interactions was put in place.
Nurses do checks on all patients every 30 minutes. Nurses also conduct cell front rounds at least twice a day. They do a brief mental status examination and suicide check. Nurses report that after-hours psychiatrists are responsive to calls and will provide emergency medication orders when needed. Nurses report that restraint episodes are rare, perhaps occurring every other month; I saw few instances of

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restraint in the records. This is primarily for self-harm rather than danger to others. Custody conducts the restraint after a physician gives an order, except in emergencies when nursing staff may initiate restraint. Custody always honors these orders but after hours response to emergency situations such as selfinjurious behavior can be slow. Emergency response can also be difficult when there are only two nurses on the unit as one nurse will typically be on the telephone with the doctor and the other getting medications prepared or otherwise coordinating emergency response, leaving nobody to run the floor.
Cells on 2P are not well suicide-proofed. There are number of anchor points and nurses reported watching a patient climb on top of a light fixture on video and, before custody arrived, saw him dive headfirst onto the floor from over 6 feet up. Lights are also easily destroyed and used to create instruments for selfharm.
Length of stay on 2P is variable but 10 days is typical, consistent with data on length of stay reported above. There are some long term patients, primarily voluntary patients and those already on a conservatorship. Temporary conservatorships are almost never sought. There is about one Riese hearing (to obtain permission for administering medications involuntarily) weekly, on average, and 1-4 patients on involuntary medications on the unit at any one time. Those who remain on an LPS hold at the time of release from jail are sent to the emergency room for evaluation. No data on recent hearings or LPS commitments are conservatorships was provided.
The unit was fairly clean though there was a distinct smell of urine and one of the showers was not clean. Some storage areas were piled with supplies in a somewhat haphazard manner and a number of safety suits were spread on the floor. Several occupied cells had a good deal of garbage in them. The officer told me that inmate-patients are encouraged to clean their own cells by nurses and custody but when it gets bad, they are removed and an inmate worker cleans the cell.
Medical Infirmaries
I visited the medical infirmary, which is contiguous with 2P. At the time of my visit, there were no 2P patients or 2P waiting list patients on the unit but this reportedly occurs commonly.
Detoxification protocols are done in the infirmary.
This area of the facility was also somewhat decrepit. The medical area was in some degree of disarray. The dental area was clean and well-organized.
There was a patient with an IV who has lying on a mattress on the floor, reportedly because of being unsteady on his feet. Those who are suicidal also have their mattresses placed on the floor.
I also visited the 2E step-down area. There are 5 cells primarily for those in wheelchairs. There are 15 two-person cells.
There is a limited infirmary at RCCC that can do intravenous therapy but not much beyond that. It has 17 beds in open barracks and four single and two double cells contiguous with the barracks (I was given a slightly different count by leadership but close to the same number). Those with any significant medical needs are either sent to a hospital or returned to the MJ. There is a small clinic with two exam rooms in a different area of the facility. There is one RN, one medical assistant, and one doctor on site in the clinic five days per week during normal working hours. Nurses are on site 24/7. They work in 12 hour shifts. Four nurses are on at night.
Medical equipment inspected in the infirmaries and other areas was functional.

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Restrictive Housing
As noted above, mental health has very little contact with this population.
In the main jail restrictive housing is on the eighth floor. These are single cells with varying degrees of additional security placed on the doors, primarily to prevent throwing. The cells have furniture and fixtures with numerous anchor points and are far from suicide proof.
On the eight floor, which is essentially restrictive housing, JPS may only see their patients at cell front either through the cuff/food port, occasionally with the door open, or through the door. Which mode is determined by custody, who stands by during the interview. Pill lines are cell-to-cell on this unit.
8W 400 is for discipline, 300 is for Surenos and Crips, 200 for Nortenos and Bloods, and 100 is mixed. There was one patient (#1618829) in the classroom in a safety suit. I interviewed him (see Appendix 1).
The female restrictive housing is in RCCC consists of old-style linear cells. It is quite dingy, but the area was clean, including most cells. There are only two single cells; the rest are doubles. They contain desks, bunks, toilet and sink, and bookshelf. Lights are not recessed; many cells had televisions (considered a privilege). There are numerous anchor points. Cells in this restrictive housing would not be considered suicide proof.
Psychotropic Medication
Jail psychiatric prescribers have access to the same formulary as medical providers. The formulary emphasizes generic medications but is adequate. The formulary for antipsychotics is generally reasonable and includes clozapine. Mood stabilizing medications are also well represented. Medications for Attention Deficit Disorder with Hyperactivity (ADHD), benzodiazepines, soporifics, and antidepressants are also sufficient, though it is surprising escitalopram is not included given its efficacy and tolerability. Medications for opiate addiction used in medication assisted therapy (MAT) are also available.
Long-term benzodiazepine use is formally discouraged but is available. If a patient comes into the jail on a verified long-term benzodiazepine, this will generally be ordered rather than automatically tapered though the patient will be assessed for discontinuation as well.
The pharmacy uses computerized unit-dose packaging. There are packaging machines at both facilities with access to the pharmacy database, assuring that medications are promptly available when an inmate transfers. Patients reported that medications were rarely missed upon transfer for more than one dose.
There are supplies of emergency and Acudose access to medications for times when the pharmacy is closed. This includes antipsychotics and benzodiazepines.
Pill lines are run by CHS except on the LPS-certified unit where JPS psychiatric nurses administer medications at cell front.
As required by California law, there is no provision for self-administered (keep on person) psychotropic medications.
The JPS policy “Outpatient Medication Verification” directs JPS clinicians to verify outpatient medications “prior to submitting an eChart request for a physician order to continue a particular medication prescribed by another agency.” This is done fairly consistently as noted above.

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The policy “Management of Pharmaceuticals” specifies that orders for psychotropics may not exceed 30 days whereas other medications may be ordered for up to 90 days, however this does not seem to be enforced as I saw psychotropic orders lasting longer than 30 days.
The psychiatric prescribers noted no significant formulary challenges. There is also provision for nonformulary drug requests; psychiatric prescribers conveyed that when such requests are necessary, they are readily honored.
Ancillary Services
Laboratory services are readily available and psychiatrists can order special studies if needed. Psychiatrists can get imaging and electrophysiology studies if needed but these must be cleared by medical; they are not permitted to order these on their own. This is reportedly the same process medical providers must go through.
Suicide Prevention
In fiscal year 2014 – 2015, there were no completed suicides in the jails. JPS statistics report that there were 19 suicide attempts at the MJ and none at RCCC. In fiscal year 2015 – 2016 (through March 2016), there has been one completed suicide at the MJ. JPS statistics report that there were 2 suicide attempts at the MJ and two at RCCC. It is not clear how data on suicide attempts is captured or classified.
There are four safety cells at the MJ, three in booking (two male, one female) and one on 2P serving the LPS-Certified unit housed there. RCCC has one female safety cell in the Ramona wing of the Sandra Larson Facility but no male safety cells; males needing a safety cell are transferred to the MJ. I visited all of these cells. In general, they were clean but their suicide-proofing was mixed. The fixtures in these cells are not recessed and some of them are reachable. Some lack a call intercom and some had grates over vents that had holes larger than they should be. Safety cells had padded walls but it was in good order. The two in the male booking area had cameras but these cameras are not routinely monitored at the officer’s station, though they are functional. The Ramona safety cell had a floor grate and while it had external fixtures the ceilings were high enough that the fixtures were not reachable. There was no furniture in this safety cell either but padding was again used and was in fair condition.
Cells in 2P were not adequately suicide-proof for this type of unit. OPP cells and restricted housing settings had numerous anchor points in cells and some restricted housing cells had poor visibility.
Phone cords have been removed in the booking area, limiting the opportunity for hanging in these areas.
Suicide prevention is largely driven by custody policies except on the LPS-certified unit where JPS policies have more governance.
With regard to suicide prevention at intake, the Sheriff’s Department Operations Order “Suicide Prevention Program” directs arresting officers to document “any observations related to suicidal statements and/or behavior displayed prior to arrival at the custody facility on the intake screening form.” The intake nurse then completes the receiving screening form and if there are any concerns about suicidality must contact JPS “immediately during duty hours” and during nonduty hours at RCCC must “conduct a preliminary evaluation of the prisoner to determine if there are indications the prisoner may be suicidal” and subsequently consult with JPS.
The Sheriff’s Department Operations Order “Suicide Prevention Program” policy statement directs custody staff to immediately contact JPS whenever a prisoner is “exhibiting or verbalizing suicidal

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behavior.” The prisoner is to “be kept under direct visual observation until medical or psychiatric staff evaluates the prisoner.”
When the intake nurse detects any suicidal concerns they must notify custody staff as well, who either places the prisoner “in an occupied holding cell in the booking area” or “[i]f the prisoner displays behavior which may result in the prisoner harming him/her or others, custody staff shall place the prisoner in an unoccupied cell in accordance with [Sheriff’s Department] Operations Order 4/05, Use of Safety Cells, Segregation Cells, North Holding #2, and Multipurpose Rooms” (discussed below). Custody staff must then “make direct visual observation of suicidal prisoners at least twice every 30 minutes.” JPS and custody staff then consult “to determine the appropriate housing location for the prisoner.” This section on intake seems inconsistent with the policy statement above that the prisoner is to “be kept under direct visual observation until medical or psychiatric staff evaluates the prisoner.” The intent may be to cover this by referral to “Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2.”, but the policy is constructed ambiguously and is inconsistent across sections.
The CHS policy “Patients in Safety Cells” provides for the use of safety cells for those who are “uncontrollably violent, gravely disabled or displaying behavior which could result in harm to themselves or others.” This policy mandates contacting on-site medical and mental health staff and specifies that medical staff “are required to assess the patient within the first six hours of placement and at least every six hours thereafter to assess the inmates medical condition.” For those remaining in the safety cell more than 24 hours, they must be seen by a physician within 48 hours of placement. Though there is a requirement to initially contact mental health, there is no specific requirement for mental health evaluation. Custody staff must contact medical staff within 15 minutes after placing a prisoner in a safety or segregation cell, even when the placement is not related to medical or mental health, such as gang affiliation. The custody and medical staff are then directed “to address the nutritional, fluid, and hygiene needs of the prisoner.”
“Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2” states that those prisoners placed for danger to self or others are provided Styrofoam cups “in place of eating utensils for offering food to prisoners.” It further states that “prisoners will be offered meals except when the situation exists which prevents custody staff from offering a meal.” The reason for not offering meal must be documented. Custody staff are also directed to “make reasonable accommodations to provide prisoners access to restroom facilities.” None of these policies specify frequencies for meals, fluids, hygiene, or toileting.
With regard to Housing Unit Referrals in Sheriff’s Department Operations Order “Suicide Prevention Program,” custody staff contacts JPS or medical after identifying potentially suicidal persons and, more consistent with the initial policy language, is to place the prisoner “in a secured area where the prisoner can be continuously observed while awaiting a JPS evaluation.” Custody is also to conduct a cell search. But then it reads that custody staff “Monitor the prisoner by performing direct visual observation at least twice every (30) minutes,” which seems inconsistent with the above language regarding being “continuously” observed. JPS or medical staff then determine whether referral to the acute psychiatric unit is necessary (this is not mentioned for intake). There are other provisions for placement in a single cell for monitoring at RCCC in “Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2” (see below).
There is also procedure language about using video but that video is not a substitute “for direct visual observation”, though it is unclear if this applies to the twice every 30 minutes checks and/or the continuous observation.

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The practice is to place inmates on 15 minute checks, such as the inmate who had climbed outside the jump bars and had been pending JPS evaluation for 12 hours and inmate in the safety cells in the booking area.
Per Sheriff’s Department Operations Order “Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2”, in order to place an inmate in a safety cell a watch commander or division commander must give prior approval except in “the most volatile of circumstances” when “custody staff may place a prisoner in a safety…in order to keep the prisoner or others from being injured.” Those in restraints “may be placed in a safety cell.” It also provides that “Prisoners placed in a safety cell shall be allowed to retain enough clothing or be provided with a suitably designed ‘safety garment’, to provide for the prisoners personal privacy unless specific identifiable risks to the prisoners safety or to the security of the facility exist and are documented.” The use of a safety garment requires either direction by JPS or authorization by a sworn supervisor. If a safety garment is not used prisoners may “retain personal clothing except for shoe laces, shoes, belts, or any other clothing articles which could threaten his/her safety or damage property.”
“Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2” also speaks to using segregation cells for, amongst other things, “sexual orientation/transgender status,” “behavior which disrupts facility operations,” or “placement into restraints as a result of combative or violent behavior, physical attempt to harm self or others, or the destruction of property.”
“Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2” provides that “prisoners in housing units who are in need of immediate mental health services referral and/or have been placed in restraints may be temporarily placed in a multipurpose room or North Holding #2 at RCCC for observation.” These rooms “may be used to temporarily hold prisoners identified to be a threat to self or others until he/she is evaluated by medical or mental health staff or transported to the Main Jail.” Custody staff are directed to “conduct direct visual observations on prisoners at least twice every 30 minutes.” But there is no clear provision for continuous observation, as mentioned above. The duty to provide visual observations is shared with psychiatric staff on unit 2P. A custody supervisor is also supposed to do a “direct visual observation of the prisoner every two hours. A watch commander shall conduct a review for continued retention in the safety cell, including P13 [on P2], at least every eight hours.”
The Operations Order goes on to specify that for all those in safety cells, segregation, and multipurpose rooms, a “medical assessment shall be completed within 12 hours of placement or the next daily sick call, whichever is earliest. The prisoner must be medically cleared for continued retention every 24 hours thereafter.” Mental health evaluation is also required within 24 hours. These provisions are not consistent with the previously noted CHS policy “Patients in Safety Cells” regarding medial assessments for these cells and JPS policy does not specifically provide for mental health evaluation within 24 hours of those placed in these cells.
The policy “Suicide Prevention 2M – Joint Policy” provides for suicide assessment and monitoring of those in the medical infirmary. It provides for appropriate suicide-prevention strategies prior to JPS evaluation. This policy appears to provide for continuous observation but it is not entirely clear.
The JPS policy “Suicide Prevention Program” is a relatively barren policy. It provides for assessment and treatment in general terms. It does not speak to the content of suicide assessment, provisions for monitoring those who are suicidal, or establishment of conditions of confinement.
The JPS policy entitled “Suicide Prevention-Acute Inpatient Unit” states:

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“Staff may use the following categories as a guide to implementing observations. A. SUICIDE RISK: 15 MINUTE CHECKS
Inmate-patients who have been determined to be a moderate suicide risk require every 15minute checks. The nursing staff will perform the checks by going to the inmate-patient’s cell door and observing the inmate-patient. The check also includes a brief survey of the cell environment for safety purposes. The nursing staff will document the check on the flow sheet and make at least one entry in the eChart clinical notes section each shift. Camera monitoring may also be indicated for inmate-patients identified as a moderate risk. An example of inmate-patient requiring 15-minute checks should be a patient expressing suicidal ideation with some ambiguity and either no plan or a poorly formed plan. B. HIGH SUICIDE RISK: CAMERA MONITORING Inmate-patients determined to be a high-risk are actively suicidal and require constant observation by nursing staff. One nursing staff will remain in the nurses’ station at all times and is responsible for camera monitoring. Inmate-patients on camera monitoring may also be on 15-minute checks. Nurses must complete the checks at the inmate/patients cell door and will not complete checks via the camera monitor. These checks will be documented on an observation record and will include a minimum of one progress note each shift. Camera monitoring requires an immediate order from the psychiatrist, and the telephone order must be signed within 24- hours. Cameras should not remain on for any length of time if there is no physician’s order. Nurses may turn a camera on to view a patient, but if the camera remains on, the physician must write an order. If no camera cell is available and an inmate-patient is a high-risk for suicide, 1:1 staffing may be used. The Inpatient Unit charge nurse will consult with the Inpatient psychiatrist and the supervisor or administrator-on-call if necessary. The charge nurse will arrange for a sitter and may accomplish this by utilizing a JPS staff person who will monitor the inmate-patient by sitting outside the cell and maintaining constant observation. If two patients require constant direct observation, one staff may be assigned to sit outside the cell to observe two patients.”
The JPS policy entitled “Safety Suit Procedures for Inmate-Patients on Acute Psychiatric Unit” specifies that those in safety suits will be allowed “attorney visits (at custody discretion), court-ordered psychiatric/psychological evaluations, reading material (all staples removed), telephone calls, showers, court appearances (at custody discretion).” Clinical staff may also limit access to reading material, telephone calls, and showers. This policy also provides for safety suit use in the general population as follows:
“Safety Suits for inmates in general population are used at the discretion of custody staff on a case-by-case basis. A JPS physician or an outpatient clinician may recommend the use of a safety suit if clinically or behaviorally indicated. Recommendation for use of the safety suit should be justified in the clinician’s assessment of the inmate-patient. The Medical Director or his designee must approve each case.”
The JPS policy “Monitoring of P 13” speaks to the use of the safety cell on 2P. This policy refers to the Sheriff’s Department policy “Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2”. The two policies together appear to indicate there is provision for monitoring only up to checks twice every 30 minutes.
In the medical infirmary (2M), the JPS policy entitled “2M Suicidal Patient” states that JPS provides:
“Recommendations for suicidal medical patients generally include safety suit and blanket, nonhospital style bed, no regular jail issued blankets, restriction of unnecessary items such as

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utensils, a cell closer to nurse’s station, and frequent observation as determined by medical nursing staff.
[and]
The CHS physician will determine appropriate orders and treatment plans, taking into consideration the recommendations of Jail Psychiatric Services staff. The psychiatrist will address follow-up plans in the progress note.”
Policy and procedure are not clear about who has the authority to set conditions of confinement outside 2P and 2M (other than the use of a safety suit and conditions related to its use as noted above) or to determine the release of those placed in safety cells for suicidality.
The observations, interventions, and visits by health staff are to be documented in a custody log. When I reviewed these logs on site (none were included in the medical records I received) they did not report on a good deal of the required information. They consistently indicated times of checks but did not consistently demonstrate the offering of food, fluids, toilet, or visits by healthcare staff.
All agreed that whenever an inmate expressed thoughts of self-harm that this led to an automatic referral to mental health, even if the inmate had been seen just an hour before. Behavior plans are not used to help manage those expressing recurrent self-harm ideation.
In review of records (see Appendix 1) and direct observation, I noted the following general patterns:
x Those in safety cells, segregation, and classrooms are not monitored by medical staff as specified by policy. Medical staff does monitoring but the visits are less frequent than specified and the required physician visits were uncommon.
x There was no clear distinction between those placed in safety cells and other settings (e.g. segregation cells or the classrooms) that was discernible in the records. This may reflect the fact that this is a custody determination.
x Reasons for establishing levels of checks were absent from the record except for those on 2P. This may reflect the fact that this is a custody determination.
x Suicide assessments usually addressed relevant clinical issues (e.g., signs and symptoms of mental illness) but usually did not address suicide risk factors and protective factors.
x Safety suits are used a great deal and for long periods of time in all settings, including 2P. o Reasons for using safety suits are often absent or poorly documented outside of 2P. o Those in safety suits outside of 2P may be seen as infrequently as monthly by JPS.
x There was almost no documentation on conditions of confinement outside of checks and safety suits in any setting.
x 15-minute checks are documented and reflect random times but logs frequently do not include notations regarding food, fluids, toilet, limb rotations, or clinician visits.
Restraint and Seclusion
Behavioral restraint is not ordered by mental health staff within the jails. Custody staff can place individuals in restraint chairs for behavioral reasons for up to one hour. A Watch Commander may authorize additional time; no maximum is indicated in policy.
The CHS policy “Use of Restraints and the Prostraint Chair” speaks to custody ordered restraint. The policy states, “Except as defined separately under Jail Psychiatric Services Policy, the application of restraints is not initiated by medical staff.” It goes on to state: “Mentally disordered inmates and/or other

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inmates who display bizarre behavior which results in the destruction of cell furnishings or reveals an intent to cause physical harm to themselves or to others may need physical restraint devices to protect themselves and others from harm. When such a situation arises, the inmates can be placed in restraints ONLY with the approval of the Sergeant.” The policy specifies that medical or JPS staff “shall monitor the inmate’s vital signs and circulation.” It further provides that “a medical evaluation shall be requested within the first 15 minutes and every two hours thereafter” and that “inmates in restraints shall be hydrated and their extremities exercised at least every two hours. Medical staff shall document this in the inmates Health Record.” Those placed in a Prostraint chair must be evaluated by medical within the first 15 minutes and JPS must consult within eight hours of placement. The medical evaluations are to consist of “checking vital signs, circulation, sanitation needs, possible dispensation of fluids and nutrients as medically indicated.” Inmates restrained for longer than eight hours “require a medical and mental health examination prior to continuance of such restraints.” Inmates placed in restraint must be placed in a safety or segregation cell. Direct visual observation is required twice every 30 minutes.
“Use of Safety Cells/Segregation Cells/Multipurpose Rooms/North Holding #2” directs that “custody staff shall conduct restraint checks and/or evaluations in addition to the requirements outlined in this order and in accordance with Operations Order 2/02, Use of Restraint Devices.”
The policy “Patients in Safety Cells” provides for the use of safety cells for those who are “uncontrollably violent, gravely disabled or displaying behavior which could result in harm to themselves or others.” Thus, they are used both for suicide monitoring and prevention and, essentially, for seclusion. This policy mandates contacting on-site medical and mental health staff and specifies that medical staff “are required to assess the patient within the first six hours of placement in at least every six hours thereafter to assess the inmates medical condition.” For those remaining in the safety cell more than 24 hours, they must be seen by a physician within 48 hours of placement. Though there is a requirement to initially contact mental health, there is no requirement for mental health evaluation.
Restraints on 2P may be physician ordered but custody can also order restraint on 2P. The 2P psychiatrist estimates episodes of restraint occur about once every two months. Restraint is rarely needed in large part because inmate-patients are rarely out of their cells. The JPS policy entitled “Use of Restraints in the Acute Inpatient Psychiatric Unit” provides for typical psychiatric restraint procedures. Physician orders are for up to 12 hours. The policy provides for either supine or prone restraint; it specifies contraindications to prone restraint as “pregnancy, severe obesity, and chest or abdominal wounds.” Psychiatrists may order use of the ProStraint chair when there are medical contraindications to restraint in the supine and prone position. Monitoring provisions are vague, stating that “nursing staff will assess the inmate/patient and include documentation of the initial respiratory and circulatory check, evidence of any injuries, and the general condition of the inmate-patient. Nursing staff will also check placement of restraints and ensure proper application and inmate-patient comfort. The nurse will advise officers of restraint builds or cuffs should be adjusted to provide adequate circulation and movement.” The policy goes on to specify 15 minute visual nursing checks that must be documented. Nursing staff are also required to “complete an assessment which includes the inmate/patient’s overall physical condition, circulation, and skin check” every hour at which time the nurse is also directed to offer food, fluids and toileting needs. Vital signs are to be done “as indicated.” Range of motion of all extremities is to be done every two hours for 10 minutes unless the patient is asleep or too combative. All monitoring provisions apply to custody ordered restraint as well. The policy precludes progressive release from restraint.
The ProStraint chair is reportedly rarely used at either facility but I did not receive any data on use; there was nobody in a ProStraint chair during my visit. The Director Nursing reported that nursing regularly does checks of those in the chair and only one time in the last year was the initial check done outside of

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required time frames. None of the cases I reviewed included episodes of restraint in the ProStraint chair. One case included several hours in restraint on 2P. Nurse checks were complete except for one that was missed owing to unavailability of custody staff. Range of motion was offered (and accepted all but once) by custody every two hours as specified by policy.
Reentry Services
The UCDJPS Mental Health Policy and Procedure Manual specifies that: “A. All inmate-patients open to JPS should be assessed for the following: 1. Housing needs post-incarceration 2. Current or prior providers of community mental health or psychiatric care services 3. Post-incarceration medical and psychiatric care needs B. Inmate-patients identified as needing discharge planning services will be referred to the Discharge Planner via an electronic referral form. C. The assigned staff will meet with the inmate-patient to more fully assess discharge planning needs and will complete the Discharge Planning Referral form and Patient’s Discharge Resource List. The inmate-patient will be provided a copy of the Resource List and any other information related to their specific discharge planning needs. D. A copy of the Patient’s Discharge Resource List and the Discharge Planning Referral form will be submitted for scanning into the inmate-patient’s eChart record.”
Those releasing to the community are not given a supply of medications. The patient typically goes to a pharmacy and the pharmacy calls the psychiatrist who calls in a telephone order to the pharmacy. The county pays for a 30-day supply. Release medication acquisition is not tracked. The RCCC ARPN estimates that only about 30% of patients get their release medications.
The county recently hired community navigators to assist in transition from the jail to the community. Their focus is primarily on those staying in jail for less than 12 hours. JPS handles release planning for others. Encounters for reentry services were about 50 per month at RCCC and 75 per month at the MJ. Given that there are over 4000 releases per month and 40% of the population has an open mental health case (and 19% are on psychotropics), a very small fraction of the mentally ill are getting reentry services.
Linkage to County mental health is very limited. The homeless must report on their own to the “Guest House” where they must stand in line in order to register for services. Those with an address can call a telephone number to request services and if they qualify they get an appointment. Mental health is unable to make appointments prior to release except for those who have been incarcerated less than 90 days. Those incarcerated for more than 90 days have their services discontinued and have to reapply through the preceding process.
Records and direct observation demonstrated limited release planning.
Patient Privacy
The policy “Health Care Philosophy” states:
“All health care, including medical interviews, examinations and procedures will be conducted in private in a manner designed to encourage the patient’s subsequent utilization of health services.”
“There will be no counseling or examining patients at cell side, or in other non-medical settings, for reasons of convenience and efficiency. Such an approach fails to provide for adequate confidentiality, tends to discourage discussion of unstated complaints of a sensitive nature, and provides a sub-optimal examination setting.

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This does not preclude clinicians from responding to the site of an emergency, performing status evaluations of patients in safety or detoxification cells, or from cell-side evaluations when there are overriding security concerns. It is expected, however, that routine medical and mental health services shall be provided in a clinical setting in a manner assuring the dignity and respect of the individual.”
The UCDJPS Mental Health Policy and Procedure Manual specifies that clinicians “[s]crupulously maintain confidentiality as it relates to the nature of the work that we perform.” It also directs that “JPS staff shall not enter any inmate cell without custody staff directly outside for backup and safety reasons.” On 2P, the JPS policy “Accessing Patients on the Inpatient Unit” states that “Staff will request officer presence whenever face to face contact is necessary within inmate-patient outside of the inmate-patient’s cell.” This is reinforced by the JPS policy “Assault Precautions-Inpatient Unit” which states:
“Assault Risk - Universal safety measures will be utilized for all inmate-patients which include: requesting officer stand-by for face to face and direct patient care, the avoidance of being isolated alone with inmates, and constant vigilance regarding potential safety and environmental hazards.”
There is no policy guidance as to how these apparently conflicting policies and principles are to be resolved or reconciled. Practice, as witnessed and documented in the record, is that almost all contacts on 2P are at cell front. In general population and intake, as documented above, privacy is clearly not maintained and it is clear that it is accepted practice to have patient visits in highly public areas. In short, the policy “Health Care Philosophy” is by no means observed with regard to the mentally ill.
Record-Keeping
The jails use an electronic record system that integrates mental health, medical, and dental records. There is also provision for electronic physician order entry and electronic Medication Administration Record (MAR). The system is adequate.
The CHS policy “Health Record Format and Contents” specifies that “documentation of all healthcare services rendered to inmates,” including care provided off-site, be placed in the medical record with the exception of the initial health screening which is only included in the record if there is subsequent healthcare delivered.
Policies provide for access to archived medical records though it may take several days for them to arrive from storage (which becomes less important the longer electronic medical records are in place). Policy also provides for relevant health information to be communicated to any receiving facilities outside of the Sacramento County jails.
JPS policies and forms regarding expected documentation are generally sufficient, though treatment planning provisions are limited. As noted elsewhere, actual documentation is variable and at times very minimal and not consistent with policy expectations.
Clinicians have limited access to county community mental health records, essentially just encounters and placements rather than access to actual records; diagnostic and medication information is generally available. Mental health staff take full advantage of available information.
Training
The CHS policy “Staff Development and Training” states: “CHS will provide a comprehensive orientation and continuing education program for all new employees.” Among specific training topics

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included are: “Psychiatric emergencies” and “Suicide prevention techniques” but no other mental health training topics. I did not receive related training materials.
Custody
Officers noted that they get little training in mental health and mental illness other than the suicide training. The only location where custody staff are required to have any mental health related training is on the jail based competency treatment program at RCCC, for which they must have a 24 hour CIT training.
Academy Training
I received no information on Academy training.
Other Training
I reviewed the suicide training provided by UCD to correctional staff. The information provided is accurate but limited. More importantly, it provides very little guidance about how to interact with suicidal inmates and nothing about crisis intervention strategies.
Custody staff all get 8 hours of CIT training. A 24 hour CIT elective is available but must be requested and authorized or officers can pay for it themselves. Staff were unclear but believed this was a law enforcement CIT rather than a custody-oriented CIT.
Mental Health
I received no information on training for mental health staff.
Policies and Procedures
In general, policies are comprehensive, as attested by the Title 15 review done for both facilities in 2015. Most policies were sound with the exception of policies around suicide prevention, safety/segregation/classroom cell use, seclusion/restraint, and those that specify very limited mental health service provision. The following are some salient observations regarding other salient policy content, some of which have minor gaps.
There are JPS policies and procedures regarding LPS commitment, admission and treatment on the LPScertified unit, Tarasoff duties, voluntary treatment, infection control, patient information, patient rights, release planning, documentation, incident reporting, patient complaints, laboratory specimens, and staff responsibilities, among others.
The CHS policy “Informed Consent” states that “any competent patient can refuse treatment.” It goes on to say that “any competent patient may refuse in writing both emergency and nonemergency medical and psychiatric care.” It also states that informed consent is not necessary for “an emergency which requires immediate medical intervention for the safety of patients” and “emergency psychiatric intervention in circumstances where the patient is a danger to self or others.” It also refers to more extensive policies and procedures with regard to involuntary psychotropics “for the Jail Psychiatric Services Program.” It does not speak to involuntary treatment for grave disability per se.
The JPS policy entitled “Informed Consent and Riese Hearing” provides for obtaining informed consent from competent inmates under most circumstances. The policy allows emergency medications to be given without informed consent but mandates that “one staff person and the MD must concur that an emergency exists and provide documentation in the inmate-patient’s chart.” The policy goes on to specify

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how to obtain a Riese hearing. An additional policy entitled “Management of Inmate-Patient’s Determined to Lack Capacity to Give Informed Consent for Medications” gives detailed instructions about obtaining a Riese hearing for LPS-committed patients who are incompetent.
There is no direction in JPS policy about how to manage incompetent patients who are not LPScommitted.
The “Pharmacy Policy and Procedures Manual,” amongst other things, establishes a Pharmacy Services Committee. There is no expectation of or provision for psychiatric representation on this committee.
Custody PREA policies are adequate but JPS does not have corresponding policy specifying their role.
Quality Assurance And Quality Improvement (QA/QI)
I was not permitted access to UCD QA information regarding JPS. They reportedly provide quarterly reports of frequency of encounters, response time, and self-harm. I received only encounter information. Encounter types include: new, follow-up, emergent, initial psychiatric assessment, and psychiatric follow-up. Consistent with this report, the UCDJPS Mental Health Policy and Procedure Manual includes a “Quality Improvement Plan” that specifies:
“Jail Psychiatric Services uses quarterly monitors to collect data for evaluations of quality care. These indicators and measurable variables are used to monitor aspects of care and are developed by the Clinical Director or designee and in conjunction with the JPS Leadership Team and the Department of Psychiatry and Behavioral Science CQI Committee.
The Clinical Director or designee prepares quarterly reports of these monitors and forwards reports to the Department of Psychiatry CQI Committee. The results of these monitors are reviewed on a quarterly basis by the Leadership Team and the UCD Department of Psychiatry QI Committee. Recommendations by this committee are implemented as necessary.”
The CHS Quality Improvement policy, which includes an Executive Committee, Patient Care Policy Committee, Infection Control Committee, and Pharmacy and Therapeutics Committee, speaks to health care generally but does not speak to mental health or psychiatry specifically. Much of what this committee does would appear to have a direct impact on mental health and psychiatry but they are not represented on this committee.
The policy “Incident Reporting” specifies that certain incidents are to be forwarded to CHS administration “for review, analysis, and appropriate action. When a pattern of adverse events is identified, the matter will be forwarded to the appropriate quality improvement or administrative committee to be addressed through corrective policy and procedure.” The policy gives examples of the sorts of things that should be reported but does not include any mandatory reporting. I received no such reports.
The policy “Inmate Health Care Grievances” specifies a grievance process for inmates. However it is primarily administered by custody rather than CHS or JPS. As noted above, grievances are routed to mental health and reviewed.
The “Pharmacy Procedure Manual” provides for medication error reporting. It also specifies, “Each pharmacy shall establish or participate in an established quality assurance program which documents and assesses medication errors to determine cause and an appropriate response….”

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Other than the JPS statistics reported previously, I received no other QA/QI information. While on site I inspected several death reviews.
Death Reviews
I examined five death reviews (enumerated in the database above). Of these, two involved an inmate being killed by another inmate, one of which led to the reprimand of the deputy and suspensions of others. One was a suicide.
None of the death reviews I saw included any analysis of policy or systems issues and there were no associated corrective action plans. They were primarily just collections of data on the deaths; some were incomplete even though quite old (for instance awaiting a coroner’s report). Several of the death reviews contained information that suggested corrective action may have been indicated, including the inmate killings.
In the case of the suicide, there was evidence that suggested this inmate’s problems could have been detected substantially prior to the suicide. Had he come to the attention of JPS staff, the suicide might have been averted. However, no analysis was done with regard to whether staff was aware of the inmate’s functional decline or to for consideration of approaches that might promote access to data that was subsequently revealed that might have identified this inmate prior to death.
In another case involving the fall of an inmate in a wheelchair, there was no analysis of the conditions under which this occurred or the time it took to respond to his condition.
OPINIONS AND RECOMMENDATIONS
There are numerous deficiencies in mental health care at the Sacramento jails. These include organizational structure, the intake process, conditions of confinement (in that they contribute to inadequate care), access to care, quality of care, medication monitoring, medication administration, medico-legal considerations, patient privacy, suicide prevention, clinical restraint, restrictive housing, reentry services, training, and QA/QI. I will address the deficiencies in each of these areas and specific recommendations within each area. These are detailed below. Then I will offer recommendations for overall system change designed to provide constitutionally adequate basic care. I make some general recommendations regarding staffing needs and provide a more detailed set of recommendations in a separate report which the jail is free to use or not; the only important outcome is that mental health services are adequate, not any particular staffing model.
I will also provide recommendations for additional services if the county wishes to go beyond a merely adequate mental health system for the jails. I can offer information on such additional services if desired. Mostly, however, it would consist in strengthening the services detailed below and expanding the mental health benefit to more patients. Specific areas where services should be considered for expansion beyond basic care are development of specialized services for the severely personality disordered (beyond behavioral management plans, crisis intervention, and supportive services which will be necessary for adequate basic care), those with cognitive disorders (those with intellectual disabilities, traumatic brain injury, autism-spectrum disorders (PDD), and dementia – some of whom will be receiving mental health services regardless of any expansion), trauma-related services (including complex trauma related to childhood abuse), and co-occurring disorders (for mental health and substance abuse).
Before proceeding it is important to make some comments and general observations. Jail mental health services clearly suffered substantial setbacks owing to staffing reductions during the recent economic

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crisis and have not recovered from those losses. When staff are lost, programs and systems of care are also lost or degraded. The County faces the challenge of restoring program infrastructure while hiring new staff. It is vitally important to take the time to carefully plan the services; this requires a systematic approach:
x Establish the organizational elements needed to support change and maintenance of change o An organizational structure that recognizes the essential distinction and substantial volume of mental health work in the jail setting (correctional mental health needs represent a larger proportion of services than in the community or general hospital setting)  Establish a stronger reporting relationship between JPS, CHS, and the SSD  Participation of mental health in jail executive leadership o Assure a strong QI/QA process to track implementation and assure program fidelity in addition to traditional functions
x Assess the population o Determine the diagnostic distribution (below, I offer estimates based on research as no diagnostic information was provided)  Diagnostic distribution by custody level o Functional limitations within the mentally ill population (as this drives treatment needs)
x Work with custody to establish logistical limitations o Physical plant  Options for placement of the mentally ill  Access to treatment space x Group x Individual o Inmate movement o Custody level  What role will mental health staff have in placement decisions and/or custody overrides if classification decisions?
x Based on the foregoing, establish a model of care for the program o Develop a staffing plan o Determine funding  Which may require reconsideration of the model and/or staffing plan
x Train staff x Implement in stages
o Attend to the order of roll out as this will determine the success of cultural change o Ensure fidelity to each change before rolling out the next stage
With regard to cultural change, it is important to state that at the present time, the system does not demonstrate a valuation of mental health treatment. This occurs at both a structural level (e.g., lack of resources, inadequate settings and custody resources to permit mental health staff to see their patients in an efficient and structured manner) and at an attitudinal level in that mental health staff are not seen as integral parts of the team. They are also expected to function almost exclusively as a crisis response service, which should be more of a joint function between custody and mental health. The primary function of mental health is to treat mental illness just as is the case for medical staff who treat medical illnesses. In order to do so, mental health staff must have protected time to provide structured services. Crisis response should be a more limited component and it must be recognized that it is a marginally

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effective treatment for serious mental illness (it is almost ineffective as a treatment modality), which treatment must be the focus of mental health. Further, when access to service is driven by crisis, then crisis is reinforced and necessarily escalates. It is essential for this latter point to be deeply recognized if the system is to be both effective and efficient.
Specific Deficiencies
It is important to repeat that this analysis does not address harm. Clearly, gaps in service represent the potential for harm but I make no attempt to connect gaps with specific instances of harm.
Organizational Structure
It is reasonable for the jail to contract services as it does with UCD for mental health services. However, as health services, including mental health, are a necessary part of jail function, mental health needs to be represented at executive levels. The coordination needs between custody, medical, and mental health are substantial. In fact, the coordination of mental health services is much more difficult in that mental health has elements of both behavioral and medical management; medical services are more discrete and are less embedded in the daily management of the jail milieu.
The jail mental health system needs a Director of Mental Health that oversees all jail mental health, coordinates with other clinical services, participates in executive leadership, and has robust connections to the community. See specific recommendations below for details. But it is important to emphasize that the lack of a Director of Mental Health is identified as a deficiency.
The current position of JPS Program Director does not oversee all of jail mental health services and has limited engagement with executive leadership and CHS. The JPS Medical Director has some engagement with CHS leadership but it is notable that there is no provision for the JPS Medical Director to sit on committees such as Pharmacy and Therapeutics.
Intake
While I did not see evidence that the screening process was taking undue time, review of records demonstrates that some inmates remain in booking much longer than the 12 hour target. This is especially true for those with mental health concerns and is consistent with 8E staff reports. I was not provided QA/QI data on the timeliness of services. Case reviews and observations demonstrate a great deal of variability but without more data it is difficult to assess the timeliness of responses to intake by JPS.
Confidentiality at the nursing screening station is marginally adequate and would benefit from enhancement. This could be done by providing camera monitoring of the nurses and/or asking custody to remain out of earshot during intakes and the addition of sound screens between nursing stations.
As I received no data on the number of positive nurse screenings resulting in JPS referrals, it is not possible to comment in any detail on the adequacy of screening at a population level. It can be expected based on research that 15-25% of the inmate population is seriously mentally ill (SMI). JPS statistics show that, on average for this fiscal year, (944 + 653)/(2131 + 1913.788) = 39.5% of the population had open cases and (469.11 316.56)/(2131 + 1913.788) = 19.4% were on medications. Thus it is clear that JPS is likely identifying the vast majority of SMI. However, it is not clear how well these cases are being detected at intake. I saw a good deal of evidence in record review that many cases of SMI, even those with psychosis at admission, were not detected at screening, even when available jail medical records demonstrated a clear history of SMI.

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The county is to be commended for having nursing staff conduct the health intake screening rather than officers. However, the mental health screening questions in the nursing intake assessment are inadequate to screen well for high risk and high acuity problems. The questions should seek to detect potential suicidal ideation, risk for self-harm, danger to others due to mental illness, acute psychosis, and cognitive deficits and to identify those on psychotropic medications. This screening should at a minimum address: present suicidal ideation, history of suicidal behavior, current psychotropic medication (prescribed and whether taking) and other mental health services, current mental health complaints, presence of psychosis, evidence of cognitive deficits, past history of inpatient or outpatient treatment, substance abuse history (current use is generally considered part of the medical assessment), history of sexually aggressive behavior, and risk/history of victimization, especially sexual victimization. It is probably apparent why it is important to ask about any current mental health complaints; in short, such a question increases the likelihood that conditions highly associated with danger to self and others will be detected. For instance, many may deny current suicidality but yet represent a substantial risk owing to their current level of distress, psychosis, or depression. It is also important that all questions be asked consistently and no assumptions made about what an inmate would respond if asked. There should also be a number of nurse observations pertinent to mental illness.
Specific problems with the Medical Intake form include:
x It combines questions about danger to self and others x It includes conclusory and combinatorial questions such as “Is the arrestee mentally disabled
and/or a danger to self or others?” but provides no direction or questions that would underlie such a finding. x It limits questions about past suicidality to the last two weeks. x It limits questions about past psychiatric hospitalizations to the last 30 days. x It limits questions about past psychiatric medications to the last 30 days. x It asks questions such as “Do you have a history of developmental disabilities?” which is an unreasonable way to assess cognitive limitations. x It only asks for important observations such as anxiety, agitation, hallucinations, and orientation if the inmate has a high likelihood of sedative-hypnotic withdrawal. x There are no questions or observations regarding the level of disorganization of the inmate.
Conditions of Confinement
The general conditions of confinement in the Sacramento jails are typical of a system this size and do not represent a substantial problem. Dayroom facilities and recreation yards are each adequate in terms of space but have limited facilities. It is encouraging that there are plans to augment yard equipment as it is quite limited.
The biggest problem for the mentally ill is access, especially to dayrooms and the large recreation area. Exercise is a valuable mental health intervention and the mentally ill have limited access to reasonable quality exercise opportunities. Programming space is often limited (especially in the MJ) but, if scheduled and fully utilized, is generally adequate. Access to mental health services is also impeded by conditions of confinement in that mental health staff are sometimes not allowed access, access is delayed, or gaining access is so challenging to effect that clinicians meet at cell front and other public spaces.
The general conditions for the mentally ill are unnecessarily restrictive. This is a result of several factors. First, it is unreasonable to presume that all patients on LPS commitment require a restrictive level of security. For many who are suicidal, isolation is deleterious to their condition and exacerbates risk of

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suicide and many of these patients represent no risk to others. Those who are acutely suicidal must sometimes be contained but this cannot be the sole management and treatment approach for this population. Similarly, those who are seriously mentally ill and are not a danger to others, usually those who are gravely disabled, often need to be engaged in activities rather than isolated, sinking further into despair or psychosis. Further, it is generally not possible to determine whether a patient represents a danger to others if they are not allowed gradual exposure to congregate programming under controlled conditions. While some of this function could be provided in OPP after release from the LPS-Certified unit, it must nonetheless begin prior to step-down in order to ascertain readiness for a less restrictive setting.
On the mental health special management units (OPP), the mentally ill end up being limited in their access to the dayroom as they are not allowed to come out with other groups; these units house populations that should not mix for legitimate reasons or are not allowed to mix for reasons that could be overcome. Further, most of the OPP beds are in relatively restrictive units. This affects access to patients and access to care in ways that are in many cases not justifiable. Clearly patients who pose a substantial and imminent risk to others must be limited in their contact with others, including clinicians. However, absent such a clear and present risk, mental health clinicians need to have access to their patients just as any other health provider does. While it is certainly appropriate to limit face-to-face contact with those properly identified as presenting a substantial and imminent risk to others, no effort is made to formally distinguish the dangerous mentally ill from the non-dangerous.
It is also highly desirable to examine the classification system. The mentally ill present unique challenges to classification because their risk is easily over and under-estimated. It is beyond the scope of this analysis to address classification but I encourage the county to seek the advice of a recognized expert in this area if not addressed by Mr. Vail in his report.
Isolation is deleterious to many mentally ill as is a lack of structure, especially for those with more serious illnesses. In the absence of proper assistance, they are often impaired in their ability to perform such tasks as activities of daily living, particularly when under stressful conditions such as incarceration. Isolation also creates a greater need for the use of suicide watches and commitment to the LPS-Certified unit owing to the associated deterioration in their condition and the increased likelihood that many with limited coping skills will feel suicidal, self-harm, or claim to be suicidal in order to get a housing change or simply to access contact with others, including custody and mental health, that comes with such protestations. And, as noted above, the lack of physical activity is also problematic, not to mention the lack of important treatment modalities as discussed below.
The cleanliness of the housing for the mentally ill was mixed. In most cases it was adequate. Assistance with cell cleanliness is necessary for some mentally ill. General jail cleanliness was mixed as well.
It is also important to make regular, but random, cell searches to assure that the mentally ill do not hoard medications or possess contraband items that might be used to harm themselves or others. It should not be solely at the discretion of custody supervisors and should be driven by policy.
In summary, the conditions of confinement unique to the mentally ill not only impede access to care but are themselves dangerous to the mentally ill. Those with psychotic disorders can be expected to become more psychotic under conditions of relative isolation and unstructured time. Those who are depressed, suicidal, or self-destructive are similarly placed at greater risk of harming themselves under these conditions.

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Access to Care
Access to care contemplates not only ultimate access but timely access. Both are necessary to provide adequate care and associated risk reduction that mental health services can deliver. It also entails access to the right service setting.
As the system is very crisis focused, emergency calls receive a prompt response by mental health clinicians most of the time though there are problems after hours and on weekends. Officers make frequent calls to mental health to refer for these services, primarily driven by suicidal statements and overt behavioral problems that may be related to mental illness (which are also responded to promptly) even when not clinically necessary, as this is an expectation of the system. Similarly, mental health promptly reviews and responds to computer generated mental health referrals. In short, mental health is responding promptly to crisis calls, when on site and available, and many referrals are viewed as crises.
As discussed under Intake, many inmates in need of services are likely missed at reception. Data suggests that they are detected later but even so, services are unreasonably delayed. It is also not clear whether the quietly mentally ill are being detected at screening or by custody.
As noted in the observations, access to psychiatric prescribers is frequently delayed. This occurs both following intake and in response to routine referrals.
Another issue best captured under access to care is placement in the appropriate setting. Mental health staff must be able to secure placement in settings that are dedicated to the seriously mentally ill, other than the LPS-Certified unit, and not excessively admixed with other populations. This is not just because it is necessary for adequate treatment but also because it will limit the numbers of patients cycling in and out of the LPS-Certified unit, reducing costs and increasing efficiency, assuming they are provided adequate treatment and conditions of confinement that are not unduly restrictive.
I saw clear evidence of patients that were in OPP who were much sicker than some of patients on the LPS-Certified unit. It is clear that the system is challenged to place patients at the appropriate level of service. Many patients cycle in and out of the LPS-Certified unit both because they cannot be sustained by the limited services available in GP and even in OPP and also because many are forbidden placement in OPP for custody reasons, often being placed in restrictive housing due to behavioral problems which in some instances were related to their mental illness. JPS has created the Medical Director Consult to try to address this. It has not been terribly effective. I would also note that the provision for review of those with “Multiple prior 2P admission, without therapeutic benefit” must be interpreted carefully as the seriously ill who are a danger to self or others or are gravely disabled who not benefit from treatment should nonetheless be in a treatment setting. Again, if the OPP settings were actual treatment settings, this would provide a reasonable location for this population.
An important deficiency best characterized under access to care is the lack of an OPP setting for women. Thus must be remedied.
The mentally ill who are capable of availing themselves of custody programs (groups, education, work) must also be afforded such opportunities. There are many mentally ill who are capable, with appropriate supports, of being in minimum custody settings where they can engage in work, education, and programs to address substance abuse, criminal thinking, anger management, and so on. It is not reasonable to exclude the mentally ill from these programs by virtue of their mental illness. If they can be in these settings with appropriate supports, they must have this opportunity. Of course, those too ill or dangerous to others or who are an imminent risk to themselves need not, and should not, be in such programs.

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A related problem is transfers that either preclude access to care or needlessly disrupt care. Transfer into and out of residential settings (absent an emergency or clear and present safety and security concern) should be done with mental health assent. When inmates must be moved to a higher security level, mental health should be notified and the inmate should generally be moved to an OPP unit at that higher security level.
Access to care is also an issue because of challenges clinicians have in gaining access to patients as noted in Conditions of Confinement. In addition, the lack of provision for custody escorts when such are provided to medical (at least at RCCC) is a clear marker of a problem. Whether such escorts are necessary or not is a decision for custody (based on a reasonable classification scheme) but when identified as necessary, escorts must be provided. The inability to schedule spaces and patients (whether in a clinic setting or on the units) also creates barriers to access.
Similarly, lack of reasonable spaces to see patients is a barrier to access. Asking mental health to see patients in public areas or at cell front is not only a problem in terms of privacy, but also represents a substantial barrier to access in that many mentally ill will refuse such public treatment and/or be unwilling to share important clinical information.
Quality of Care
Treatment services within the Sacramento jail system essentially consist of crisis response, assessment, monitoring, and psychotropic medication. There are virtually no groups, no rehabilitative services, and no structured activities, especially for the most ill. This includes the OPP units and the LPS-certified unit.
What services are provided are efficient and sound, though assessment is uneven both by social workers and psychiatric prescribers (in part a resource issue). The JPS does a tremendous amount of work for the limited resources at its command.
JPS is very clear that it is not providing any substantial individual or group treatment. As such, there is limited effort to assure continuity of care by having the same practitioners see patients, though there is some continuity with psychiatric prescribers and social workers occasionally see patients in a series of follow-up visits.
There are no meaningful CD services available on the residential mental health units (none at all on 2P).
In short, other than psychotropic medications, the jails have no meaningful treatment. While medications alone are sometimes adequate for minor conditions such as uncomplicated depression or anxiety, it is not sufficient for major mental illness and many minor conditions as well.
Psychotropic medications are prescribed on a regular basis and to a sufficiently large portion of the population to suggest that most needing medications are getting them. Medication follow-up appointments were not sufficiently frequent owing to lack of resource, resulting in the ordering of medications without seeing patients. Some patients also have medications ordered upon admission but may not be seen for weeks. Prescribing patterns in the records reviewed were reasonable.
The County’s formulary restrictions, for instance emphasizing generics first, are also reasonable, especially since non-formulary requests are granted in critical situations. I did not see any cases where clozapine was used which may have been a problem of case selection. It is important that this highly effective, but difficult to use, medication be considered in refractory patients.

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Lastly, as noted elsewhere, but it bears repeating, crisis response is not treatment. It may avert an immediate disaster in some cases but without formal treatment, the risk is not diminished. And, again, it reinforces crisis behavior, driving further ineffective resource utilization.
Medication Monitoring
Psychiatric monitoring of patients on antipsychotics is inadequate. With the exception of one prescriber, I did not see a single Abnormal Involuntary Movement Scales (AIMS), even those who had been on first generation antipsychotics for extended periods. Laboratory studies to monitor for metabolic syndrome were rarely done and seemed generally to be ordered by medical providers. Even when ordered, I rarely saw the results in the record or reference to the results or consideration of such findings in medication choice.
These tests are the standard of care because antipsychotics can cause an unremitting movement disorder (Tardive Dyskinesia) and metabolic syndrome that can lead to substantial weight gain, diabetes mellitus, and complications associated with hyperlipidemia (e.g. heart disease and stroke). Patients with hyperlipidemia are started or continued on medications that pose a high risk of complicating these conditions with no mention of this in the medical record.
Baseline laboratories were almost universally absent. These are studies that should be ordered and reviewed prior to initiation of certain medications.
Levels for drugs such as Depakote or lithium were usually obtained but not universally. However, associated laboratory examinations such as renal and liver function tests or EKG were often absent. It may be that they are done, but they are not being included or referenced in the medical record.
It is important to note that those on involuntary medications should be subject to involuntary blood draws in order to properly monitor their medical condition.
Further, monitoring for side effects and efficacy of treatment was inconsistent. Most records, but not all, had general statements about side effects but there was rarely documentation of specific side effects and sometimes problems were noted in the medical record that might have been side effects but this was not discussed. More importantly, targets for treatment with medication are rarely established and, correspondingly, progress in treatment was frequently poorly documented. There were often statements about general functioning, but specific symptoms were rarely addressed.
Medication Administration
Other than substantial problems with timeliness and privacy, I did not see major problems with medication administration. The scanning system and computerized pharmacy make patient identification and accurate medication administration much more reliable than other methods. It also assures much more reliable continuity of care when patients transfer.
Timeliness of medications is important for their efficacy. It is also entirely unreasonable to offer patients medications late at night, hours after they were supposed to be delivered and at a time when patients are expected to be sleeping, sometimes even after midnight.
Lack of privacy is a general problem as noted above. At pill lines, it impairs the nurse’s ability to get information about efficacy of treatment, side effects, and any new medical problems.
There also needs to be greater clarity about mouth checks. Mouth checks done for the purpose of determining medication adherence should be done by nursing as this is a clinical function. Mouth checks

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done for the purpose of safety and security should be done by custody. When custody detects lack of adherence, it is essential that they notify clinical staff. Clinical staff should notify custody if the lack of adherence raises concerns regarding safety and security, such as diversion of medication.
Reports of patient medication non-adherence were often noted in the record and prescribers reported being notified on a regular basis.
Medico-Legal Considerations
There is no direction about how to manage incompetent patients who are not LPS-committed. As an incompetent patient can neither refuse nor accept treatment, this population must be addressed in policy. I saw a number of patients of dubious competence who were allowed to consent for care. This is a general problem with regard to the mentally ill but some effort must be made to address this issue.
The practice of releasing patients at the expiration of their 5270 commitment and then readmitting them is unreasonable. The fact that JPS indicates that it does not do conservatorships does not absolve them of responsibility to use whatever legal means are at their disposal to assure that patients get their needs met. This must be rectified. Given the growing length of stay in the jails, this is of growing importance.
While the jail PREA policy is comprehensive, there are no JPS policies addressing PREA and the jail policies lack specificity with regard to expectations of mental health staff. I saw no evidence of JPS responding to PREA referrals and yet saw a number of cases where a PREA referral was likely indicated.
In short, medico-legal considerations related to competency, LPS commitment, conservatorship, and PREA need attention.
Use of emergency medications and other involuntary orders (outside of the above) seemed to be done when necessary.
I also note that a number of patients in the jail who had been found incompetent to stand trial and were waiting placement in the state hospital for extended periods of time, often months. I recognize that the jail is not responsible for this but note that the OAC v Mink decision from the Ninth Circuit demands that these admissions occur within one week based on substantive and procedural due process rather than simply state statute (see also the Trueblood case from Washington).
Patient Privacy
While confidentiality has important limitations in correctional settings, they primarily contemplate breaching confidentiality when there is a current identified risk or other “need to know” situation, in which case there is no expectation of confidentiality. Limiting confidentiality because a risk might emerge is not reasonable. Thus, the routine expectation should be that clinical communication is confidential. This applies at intake, pill call, clinic visits, and in written communications such as grievances and requests for services.
It is expected and necessary that non-clinicians are privy to personal health information in the natural course of business such as administrative staff processing records. But staff who do this work should be formally bound by clinical confidentiality and sign appropriate statements of confidentiality. This might also apply to specially trained officers who are supporting clinical services; that is an option the County could consider.
The chilling effect that non-confidential clinical interactions have on the free and complete exchange of information between patients and clinicians must be minimized, especially if that includes custody staff.

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Suicide Prevention
The figures presented by JPS for suicide attempts at the jails seem very low. It is not clear how this data is captured or what definition is being used. However, it is highly likely that this data excludes events of non-suicidal self-injurious behavior, which was noted to be quite frequent by clinicians. This needs to be more thoroughly monitored and assessed through QA/QI processes.
Mental health should have a more thoroughgoing role in determining conditions of confinement (suicide precautions) and monitoring for all patients on suicide status; JPS plays a fairly passive role in this function outside of 2P. It is unreasonable to ask custody or medical staff to set suicide prevention conditions. This is the area of expertise of mental health clinicians and they need to be the ones that take responsibility for this function in all jail settings, though recognizing that other classification-based risk considerations also have an impact on conditions. It is rarely reasonable for mental health to set conditions that are less restrictive than classification-based risk conditions with the exception that for some mentally ill, it is so deleterious to their mental condition that relative isolation substantially elevates their suicide risk. [Note: Consistent with Federal case law, the NCCHC has recently come out with a position statement recommending elimination of solitary confinement for the mentally ill in general, and juveniles and pregnant women, and strictly limiting the time anyone is placed in solitary confinement to 15 consecutive days.]
Monitoring of patients in safety cells is not being done per policy. Notably, nursing assessments of those who are remaining in safety cells for extended periods of time, primarily those awaiting placement on 2P, are often late. Custody is sometimes not allowing these assessments for reasons such as serving meals, which is unreasonable. The physician checks that are supposed to be done after 48 hours in the safety cell do not appear to be regularly done.
Placement of inmates in the MJ classrooms for suicide monitoring exposes these inmates to public scrutiny and has a punitive quality. It is also not an efficient use of space that should be used for more constructive purposes. More rapid assessment and determination of what conditions are actually necessary for assuring safety and provision of more treatment generally will likely eliminate the need to use these spaces, such as the inmate waiting 12 hours in the classroom for a JPS crisis assessment. It may be that custody staffing plays a role here in that it is an easy place for limited custody staff to watch these inmates; please see Mr. Vail’s report in that regard.
Further, there are deficiencies in monitoring policies. Mental health emergencies should be responded to within four hours. Anything necessitating placement in a safety suit should be considered such an emergency and placement in a safety cell should almost always be considered at least an emergency or at least an urgency. It is reasonable for nursing staff to do an initial assessment in an emergency situation and then consult with on-call mental health staff. At this point, conditions of confinement should be established, for instance whether or not a safety suit is truly indicated. It is not reasonable to delay any changes or reductions of conditions of confinement pending evaluation by another JPS clinician which may occur days later. If the County wishes to have those determinations made by a non-nursing JPS staff following in-person assessment, then those staff need to be available 24/7.
Equally important, there is no provision for constant, direct monitoring of those who are imminently suicidal (even on 2P, this is not offered unless the camera cell is not available). Such monitoring should rarely be needed after initial JPS assessment and in such cases could be restricted to the LPS-certified unit if immediate admission was possible for any patient who was imminently suicidal. However, constant visual observation should be expected for any inmate pending mental health evaluation for suicidality, whether during intake or on the units. Fifteen minute checks are sufficient in most cases needing long-

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term monitoring but that decision should rest with JPS after conducting an assessment which, as above, could be done by JPS nurses in consultation with an on-call mental health staff.
Safety suits, as well as other restrictions to reduce the risk of self-harm, are being utilized for unduly extended periods of time, in many cases even months. This is likely related to the absence of active treatment opportunities both in OPP and on the LPS-certified unit. It may also reflect a punitive use in some instances but here again, this is likely attributable to a lack of availability of more constructive approaches to behavioral problems including mental health treatment and behavior management plans.
Lastly, it is important that policies be made internally consistent and that there is a more clear designation of who has decisional authority at what points in the process over conditions of confinement, use of safety suits, and placement in safety cells and similar settings. At present, policies are inconsistent and less than clear.
Clinical Restraint and Pro-Straint Chair
Restraint seems to be little used and I did not see or receive evidence of any prolonged restraint. Restraint monitoring appears adequate though I only saw one instance of restraint in the records I reviewed.
Restraint in the prone position, provided for in policy, is known to be very risky and generally contraindicated. It is reasonable to restrain those who might vomit in a non-supine position but I question whether even these patients should be placed prone. With those at risk of seizure, there is variable opinion but I also question whether prone, as opposed to on the side, is preferable in this population either.
I did not receive data on the use of restraint chairs so cannot comment on its frequency of use, appropriateness, or duration though all reported rare usage. Restraint chairs should only be used for a maximum of four hours and require the same review as clinical restraint. Current policy does not specify a maximum time but does provide for appropriate medical monitoring. However, policy specifies that mental health be consulted within eight hours of placement in restraints. Given that the restraint chair should not be used longer than 4 hours, mental health should be consulted at that point to consider whether mental health treatment is indicated, a behavior management plan is needed, and/or placement in a restraint bed is necessary. It is reasonable for restraint decisions outside of 2P to be a custody decision as it is now but mental health should be consulted earlier in the process as mental health placement should be considered whenever prolonged restraint is necessary.
Restrictive Housing
The jails do not provide mental health or medical assessment of those entering restrictive housing or mental health rounds for those in restrictive housing. These are essential functions for this high risk population. See below for recommendations.
Reentry Services
This is an area of current focus. Plans to develop greater boundary-spanning functions such as discharge navigators should strengthen the ability to successfully transition patients into community services. However, at present reentry services are very limited. At present, reentry services are being provided at a very low rate that is identified as a deficiency.
There are two primary gaps in the reentry services that are being provided. The first is that there is no provision for direct placement of the seriously mentally ill from the jail into supported housing and no

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conduit to locked community facilities for those leaving the jail, though these facilities are available to the mentally ill leaving hospitals.
The other gap has to do with release medications. As the county does not give a supply of medications to patients when they leave, patients have to take a prescription to a pharmacy and then try to secure a prescription from the jail prescribers after the fact (they are not provided prescriptions at release). The only estimate I heard was that “about 30%” got their release prescriptions. But this information is not tracked so it is difficult to ascertain the scope of the problem.
I will also note that the barriers in the community to accessing services described in the body of this report impact the jails but I recognize the jails and UCD have limited ability to impact these systems.
Training
I only received the annual suicide training by UCD. This is an extremely limited training, though conveyed accurate information. It cannot be considered adequate suicide training.
As I did not get any materials on the training deputies receive at the academy, I cannot comment further. Solid training in mental illness and crisis intervention are critical parts of custody training.
The lack of training requirements for custody staff working on residential mental health units is problematic. These are unique populations requiring different approaches. In this regard, it is important that custody staff receive training that focuses on correctional issues rather than general law enforcement. For instance, CIT training for law enforcement is quite different than that for custody settings.
Quality Assurance and Quality Improvement
As UCD would not provide any QA/QI data, it is difficult to assess this area. However, all evidence points to a substantial lack in this regard. It may be that this is one of the most important deficiencies but without the necessary data from UCD, it is difficult to be certain.
This is a substantial and vitally important function for jail mental health services. In this regard, I note that the data I was provided is inadequate to create a clear picture of the services being delivered, let alone their adequacy. Thus the only way to evaluate services is through a chart review and patient interview, as provided in this report. That is an extremely inefficient methodology, though an important adjunct to general QA/QI data collection. As a simple example, mental health intake assessments are not tracked.
The poor quality of death reviews also stands as a marker of the inadequacy of QA/QI. None of these demonstrated any analysis of the cause of death or identified any corrective action plan, let alone followup of completion of such a plan.
Recommendations Regarding Specific Deficiencies
In this section, I offer some targeted suggestions for the specific deficiencies. I offer a more global set of recommendations for developing an overarching system of care in RECOMMENDATIONS FOR CREATING A SYSTEM OF CARE.
Organizational Structure
A Director of Mental Health should oversee all mental health in the jail, including psychiatric prescribers and psychiatric nurses. I understand that mental health services are contracted with UCD, which places some limitations on organizational structures. However, the Direct of Mental Health should have strong reporting requirements to the Sheriff and the Chief Medical Officer and should also participate in jail

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executive management. This position should not be an administrator but a clinical manager. The exact discipline is not critical, but in general it should be someone with a doctoral degree in a mental health field with clinical experience and a robust clinical administration background and correctional (or at least institutional) experience. This is a very difficult and vital position that requires knowledge of clinical services, the law, and administration. A person with additional forensic training would be ideal.
The Director of Mental health should be responsible for overseeing program development, clinical practice, and policy as well as interfacing with jail and medical leadership and community mental health.
Intake
The intake screening form for nurses needs to be reworked. Part of the reason these changes are important is that a mental health professional should be using this information to prioritize cases. These questions must be designed to identify the most acute and risk-laden mental health conditions to allow the most rapid identification of these conditions both by the nurse and the mental health clinician reviewing the form.
There are many existing screening forms in the public domain and it is up to the county to decide whether to use one of these or create its own. A checklist format with some narrative options is preferred. Several process and content requirements bear mentioning. The content should be directed to no higher than a sixth grade reading level and must be available in foreign languages commonly encountered in the jails. The mental health component should take less than 5 minutes in the vast majority of cases, about 1-2 minutes if all negative. At a minimum, the following must be included (not necessarily asked in this order or using this exact language):
x Current psychotropic medications (to be verified per existing processes) o Medication and dosage o Adherence, including last dose
x Mental health treatment history o Current treatment, if yes  Most recent visit  Location (clinic name)  Provider name(s) o Past treatment, if yes  Inpatient (y/n)  Outpatient (y/n)
x Ever in special education classes problems with learning (y/n) x Use drugs or alcohol? If yes,
o Which o How often o How much o Last use x Mental status questions o Orientation o Have you been feeling sad or depressed? If yes,
 How long? o Are you hearing/seeing things others do not? If yes,
 What is the content? (brief summary) o Do you have any mental concerns or need mental health help? If yes,

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 What is bothering you? (brief summary) x Observations
o Level of consciousness (alert, somnolent, obtunded) o Agitated (y/n) o Responsiveness/demeanor/level of cooperation (give options) o Self-care (good, adequate, poor, malodorous) o Responding to internal stimuli or distracted/inattentive (y/n) o Affect (give options, for example: euthymic, tearful, depressed, labile, elated, irritable,
sullen, angry, fearful, anxious) o Any delusional content (y/n – specify) o Evidence of intellectual or cognitive limitations (y/n) Referral to mental health should be based on responses. Certain responses or combinations of responses should lead to an automatic referral. The nurse should always have discretion to refer other cases as well.
The mental health intake assessment should build on the information collected by the nurse. Note that
some of the below repeats the above – and should. This can be based on a checklist with narrative
specifiers or based on an outline and entered in the record. Referring to the nursing assessment and verifying the patient’s responses is legitimate and encouraged. It should take 15-30 minutes. At a minimum, the following must be included (but not necessarily asked in this order or exactly this way):
x Explain why referred x General question about current concerns x Mental health treatment history
o Current treatment, if yes  Most recent visit  Location (clinic name)  Provider name(s)
o Past treatment, if yes  Inpatient x How many times (grouped) x Where (types of hospitals) x What for x Last admission  Outpatient x What clinic x Provider name x What for x Last visit
o History of self-harm  Suicide attempts x How many x Most serious x Most recent x Ever hospitalized  Other self-harm
x Current psychotropic medications (to be verified per existing processes)
o Medication and dosage schedule

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o Adherence, including last dose x Any recent losses
o Characterize x Highest grade completed
o If in special education classes, what grades o If special services for learning or presentation suggests intellectual limitations inquire
about enrollment in programs for intellectual disability x Use drugs or alcohol? If yes (verify report to nurse),
o Which o How often o How much o Last use o Ever in treatment x Mental Status Examination
o Orientation (if not fully oriented with nurse) o Mood
 Ask questions to characterize
o Are you hearing/seeing things others do not? If yes,  What is the content x If auditory hallucinations,
o Where do they come from? o What do you think they are? o Do they tell you to do things? If yes,
 What?  Are you able to resist?  How long
o Do you feel that you are in danger? If yes,  How come
o Have you considered ending your life or harming yourself?  When  How  Means
x Observations
o Level of consciousness o Responsiveness/demeanor/level of cooperation o Agitated (y/n) o Characterize psychomotor state o Characterize affect o Responding to internal stimuli or distracted/inattentive o Delusional content, if yes
 Characterize
o Evidence of intellectual or cognitive limitations, if yes  Characterize
x Potential for victimization

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In terms of data collection and the ability to report out and audit the intake process, computerized systems that can readily be queried for positive screens (or standing reports) should be utilized. Utilization of the EHR should readily facilitate this process.
Conditions of Confinement
I discuss conditions of confinement related to self-harm below. Here, I emphasize the need to have provisions for addressing the conditions of confinement for the mentally ill in consideration of their illness. Just as medical illness requires modifications of conditions in some instances, and within limits, so too does mental illness.
I recommend considering adoption of an internal classification scheme (or similar process) that is based on behavior change in a formal way and that allows input from mental health but that is beyond the scope of this report. Regardless, it is essential to have formal mental health input into conditions of confinement for the mentally ill and those at risk of self-harm or who are gravely disabled.
The jails must allow change of security level based on behavior and clinical needs (in this case, mental health needs). This should include a process for custody overrides (or whatever terminology is chosen), that still considers static risk and current behavior, but allows some flexibility in the placement of the SMI population into the appropriate level of services and in the least restrictive environment. This should include the capacity to both ease and tighten conditions of confinement. Easing of conditions of confinement should be based only on demonstrated behavioral improvement and can include a formal reduction in security level or other process allowing placement into less restrictive mental health housing. For instance, an inmate who had been acutely manic and agitated at admission and required high levels of security (e.g. 1668040) should have the opportunity to move to lower levels of security once stabilized. Mental health should have a formal role in these determinations for inmates with SMI and danger to self. Clearly, there must be limitations on such reductions and inmate static risk (classification) must be given its proper emphasis. At times static risk is so high that any consideration of reduction in security level should be precluded.
It is also vitally important to recognize that some mentally ill that score at low security levels may nonetheless be quite dangerous, especially until treated, and this must be accommodated as well – but not through the vehicle of infraction and sanction. Tightening of conditions of confinement for increased risk related to mental illness should not contemplate infraction or a permanent increase in security level as this amounts to punishing patients for being mentally ill. This requires mental health input into the infraction process, sometimes not infracting when the behavior is driven by mental illness; but tighter conditions of confinement might nonetheless be necessary by virtue of their present risk. In short, they are not infracted but they are placed in what amounts to a higher security setting because their clinical condition necessitates such limitation. Sometimes, there may be no infractable behavior but elevated risk is still present; this requires mental health staff to have some ability to drive custody overrides and/or be able to place the mentally ill under more restrictive conditions or in more restrictive housing other than by the sole vehicle of LPS commitment. For instance, an inmate might be admitted in stable condition and with no mental health symptoms and then decompensate and become agitated but not commit an infraction; but a higher degree of confinement might nonetheless be clinically indicated but still short of LPScommitment. This both responds to the clinical needs of the individual and serves to meet the jails’ responsibility to keep the inmate-patient and others safe.
In other cases, mental health input may be important to establish the type of sanction; in such cases sanctions would be designed to both limit the chances of worsening the mental illness and, when possible, to help the inmate (e.g., completion of a program module such as anger management or workbook is

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given as the sanction). As the mentally ill are not immune from instrumental and other problem behavior not related to their mental illness, it is also unreasonable to preclude sanction of the mentally ill; it must be considered in light of the relationship, or lack thereof, between the illness and the behavior.
In short, mental health staff can provide input that will help the decision-maker assess the degree of contribution of mental illness to the problem behavior and help generate conditions that are most likely to mitigate risk. In this regard, it bears emphasizing that treatment does reduce risk to self and others.
Those on LPS commitment also need to have the opportunity to progress in privileges as permitted by their clinical condition (within their classification security level), rather than all being placed at the highest level of confinement as it is at present. This allows a determination of their readiness to stepdown from an acute level of care. Without being able to assess the inmate-patient’s ability to handle greater privileges, it is not possible to make a sound judgement about a change in placement to a less intensive and well-supervised setting. It is also unreasonable to presume that those who are LPScommitted are necessarily dangerous to others and require a restrictive housing setting. Privileges should track their classification security level absent the types of considerations noted in the preceding paragraphs.
The current initiative to provide differential privileges (in this case, out of cell time) tied to their classification security level is closely related. But on 2P and OPP, it needs to permit differentiation of privileges within their security classification level based on the inmate-patient’s behavior and clinical stability. A formal level system is the best vehicle for doing this. There should be such a program in place at least on 2P.
Requiring more uniform conditions throughout the jails for each security level that are driven by policy and limit local interpretation of conditions is also essential. In this regard, it is also important to provide for regular, random cell searches of OPP units (and perhaps for all units) at an established frequency that is not discretionary. This should specifically include attention to hoarding and potentially dangerous contraband.
Lastly, minimizing admixing of incompatible populations that reduce the now disproportionate impact borne by the mentally ill is also necessary. In short, mixing the mentally ill with other populations that have their own intrinsic limitations is resulting in restrictions on their privileges that unfairly and disproportionately affect them. This may require rethinking how PC functions (and its co-placement with mental health residential settings), which may also be considered in the context of modifying the classification system.
Access to Care
Because this is a global problem and touches on so many aspects of the system, including custody operations, it is better addressed below in RECOMMENDATIONS FOR CREATING A SYSTEM OF CARE.
Quality of Care
In addition to the general provisions articulated below in RECOMMENDATIONS FOR CREATING A SYSTEM OF CARE, some more specific recommendations are in order. I will note here that the Jail Based Competency Restoration Program has many of the features needed in a residential mental health setting and can be used, to some degree, as a template for OPP though OPP will not require as much staffing to provide adequate care.

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The most important populations to treat are those with severe illness and those who represent a danger to self or others by virtue of their mental illness. Thus, services should be designed to address these types of disorders. While crisis response is an important first step, it is only a first step, just as is the case in the treatment of a medical condition. Continued care is necessary.
In order to provide appropriate care, good assessment in all cases is an indispensable first step. There must be sufficient resource and access to allow for a thorough assessment prior to initiation of treatment, absent an emergency (in which case an assessment must ensue). Once identified at intake or through subsequent referral, a thorough assessment is needed in order to determine the setting and type of service needed both according to diagnosis and level of functioning.
For those with psychotic disorders, highly structured activities and treatment, avoidance of isolation (while also limiting over-stimulation), and medication are the key elements of adequate care. Psychosis itself is a destructive condition, literally damaging the brain, that must be alleviated. These patients cannot organize themselves and readily fall more deeply into their psychotic thinking when isolated and become more agitated or disorganized when overstimulated. Such treatment does not seek deep psychological insight but to reduce symptoms, develop self-management skills (e.g. symptom and emotion management), develop social skills sufficient to get needs met and limit conflict, provide education about mental illness and medications, and expand basic living skills (activities of daily living, self-care, accessing jail and community services, etc.). These are not highly technical interventions and do not take extensive resources. They are most efficiently delivered in group settings.
Those with serious mood disorders often need much of the preceding. Those with depression may also require some individual or group treatment focused specifically on depression. There are many “off the shelf” short-term group and individual treatment modules that are readily run in correctional settings. Many of these employ cognitive behavioral therapy but other methods are also effective.
Those with recurrent and severe self-injurious behavior and some other recurrent behavioral problems require different approaches. It is essential to be able to develop and implement behavior management plans to decrease the inadvertent reinforcement of such behavior as often occurs in correctional setting. One of the most common dynamics is that when the system is crisis-driven, crises are reinforced as they are the only sure way to get both correctional and clinical staff to respond, whether negatively or positively. Developing plans to limit this dynamic is important. This population, especially the selfinjurious, also needs interventions focused on self-management rather than the development of insight or addressing personal psychological traumas, which is beyond the reasonable scope of what a correctional setting must offer.
Those with cognitive deficits will also require some degree of mental health care. While such services can be offered in residential mental health settings, this is not optimal. While developing a formal program for this population should be considered, it would not be required for a basic system of care as long as their needs are met and their presence in mental health settings does not prevent meeting the treatment needs of the mentally ill.
Medication Monitoring
Medication monitoring must correspond to the standard of care in the community. While this need not be specified in policy or procedure, that is one approach some systems use to set a formal standard that can then be audited or peer-reviewed.

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Medication monitoring can be roughly grouped into four categories, all of which must be consistently done:
x Baseline studies o Studies that must be done prior to initiating treatment  May include ECG, blood, urine and sometimes other studies
x Medication monitoring o Monitoring levels of medications  To assure levels are within a therapeutic window  To evaluate different rates of metabolism in a particular patient  To assess patient adherence o Monitoring for adverse effects  Routine monitoring x Antipsychotics for metabolic syndrome and movement disorders x Certain medications for known risks, e.g. o Renal and thyroid function for lithium o Liver function for valproic acid  Monitoring in light of evidence of possible adverse effect x This is highly situation-specific
x Monitoring for side effects o Side effects should be assessed and documented at each visit
x Monitoring for efficacy o Targets for treatment need to be established  Progress towards targets should be assessed and documented at each visit
Medication Administration
There needs to be sufficient resource (nursing and custody) to administer medications timely. It is reasonable for medications to be delivered an hour before or after the designated time under routine conditions, thereby providing a two-hour window.
Further, checks of adherence (such as mouth checks) should be done by clinical staff as this is a clinical function. Custody may also conduct mouth checks for safety and security reasons but these need to be recognized as different functions.
As mentioned elsewhere, routine cell searches are important as well. Being clear about what inmatepatients are allowed in light of consideration of pharmacy functions (e.g., how long it takes for refills of KOP medications to be processed), expected adherence problems (70% adherence is typical in the community), and store orders. This requires being clear about how many OTC medications may be possessed, when KOP refills need to be obtained and how much additional medication this will necessarily place in the inmate-patient’s possession, and how many excess pills should be allowed (given that some non-adherence is normal).
Medico-Legal Considerations
The three areas that stand out as needing attention are competency and consent, LPS commitment and conservatorship, and PREA.
Policies must clearly differentiate and address the following (for medical and mental health):

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x Emergency treatment o Competent patient  When treatment may be refused  When treatment may not be refused o Incompetent patient  When an attempt to contact a surrogate must be made before treating x What to do when a surrogate cannot be contacted  When treatment should be rendered prior to any attempt to contact a surrogate
x Incompetent patient o Process for determination of incompetency o Mechanisms for establishing a surrogate decision-maker  What to do prior to the establishment of a surrogate
The practice of putting those who are committable under LPS on a 2P pre-admit list and then later, when a bed becomes available, submitting commitment paperwork is deeply problematic. If a patient is committable, they must be committed and treated and housed in a location that corresponds to their level of need. While improvements in the OPP and other mental health services may reduce the need for 2P beds, it is possible that more LPS-certified beds will be required to meet this need. Systems of this size typically need about 40 beds, though it varies a good deal based not only on other jail services but also on the adequacy of community services and the behavior of law enforcement and courts. Regardless, the County must provide access to LPS-certified or licensed beds for any who meet commitment criteria.
The limited use of temporary and permanent LPS-conservators also needs to be reviewed and addressed. There are too few being placed on these statuses. Given the sometimes long stays in the jails, it is essential to have this tool; it is unreasonable to release a patient in need of LPS commitment from 2P only to immediately re-admit them when the law provides for other mechanisms.
PREA policies and procedures also need to be examined for conformity and, if necessary, corrected; the SSD policies are generally sufficient. JPS policies, and probably CHS policies, need to be developed to correspond to the existing SSD policies.
Patient Privacy
Provide for confidentiality in all settings to the maximum degree possible. Confidentiality is essential to mental health treatment. The default position must be that all clinical interactions are private absent an identified present risk.
All written documents including personal health information should be processed by health care staff, which includes health service administrative staff, or custody staff who are bound by the same confidentiality strictures as health care providers. Sealed materials can be handled by any staff, e.g., for the purposes of transport. In the case of grievances, they should be marked as medical or mental health and should be so directed and not reviewed by any custody staff.
Patient-clinician encounters should be confidential to the maximum extent possible, absent an identified (not potential) risk. It is reasonable and desirable for deputies to be able to observe intake screenings but the content of the conversation should remain confidential. It is possible to provide for confidential medical and mental health screening at intake by allowing visual observation by custody staff who cannot hear the content of the interaction, restraining the inmate if necessary.

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It is also legitimate to provide close custody monitoring of clinical interactions when there are no other reasonable options for providing for safety and security but, again, on a case-by-case basis, not as a routine practice. There should be provision for restraining dangerous inmates to allow a private clinical interaction when appropriate.
The county could develop specialized deputies who serve dual roles of treatment and custody as a way of maximizing safety and security and ensuring confidentiality; many systems have developed such positions. But this is an option, not a need or a formal recommendation.
It is a recommendation that custody staff assigned to OPP and 2P have special training in mental health which should include confidentiality training and signing confidentiality statements regarding protected health information.
HIPAA regulations, often the most restrictive, provide for disclosure of protected health information on a need to know basis. The determination of the need to know is the responsibility of clinical staff on a case-by-case basis, though policy can certainly set guidelines for the type of information that rises to that level. It is especially important that policy direct clinical staff to disclose current risks to the safety and security of the jail and future risks in compliance with Tarasoff laws. Clinician disclosure of past criminal or other salient behaviors (e.g. sexual abuse of a minor) should be done only in accordance with laws governing statutory disclosure.
Suicide Prevention
Comprehensive review and restructuring of suicide assessment and monitoring is necessary. As noted above, mental health staff should have the responsibility to assess risk of self-harm and, within classification security level limitations, establish conditions of confinement related to the potential for self-harm. This means that mental health staff should have the responsibility and authority to determine clothing, other items, and the degree of monitoring and privileges a suicidal inmate-patient may have, within the limitations of their classification security level.
Custody and medical staff must have the authority to immediately initiate full precautions (including the most suicide-proof cells and initial placement in a safety suit) in the face of an imminent risk of self-harm such as actual self-harm behavior, expressions of suicidal ideation with a plan, or behavior that indicates an intent to self-harm. This exists in current policy and properly results in an immediate JPS referral; this mechanism should be retained. Pending JPS assessment in such cases, such inmates should be under constant, direct visual monitoring.
Safety cells vary in the degree to which they are suicide-proof. These cells should be maximally suicideproof. General standards for evaluating and eliminating suicide hazards are included as an attachment in Appendix 2. The County should evaluate its safety cells and other high suicide risk locations in light of these standards. The so-called “seg cells” in the booking area, restrictive housing areas, OPP, and 2P should also be evaluated in light of these standards and make reasonable efforts to remediate any deficiencies.
The use of the segregation cells in the booking area or placement in any setting other than a safety cell for those on suicide monitoring should only be allowed once mental health has assessed and cleared inmatepatients to be in these cells given that they are not suicide-proof. These cells may be used for other forms of behavioral disruption at the discretion of custody as provided for in current policy. Mental health should be able to recommend placement of the behaviorally disordered or agitated mentally ill in these

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cells as well but only be able to direct their use (or an equivalent setting) for those who are a danger to self in the process of stepping down from more intensive suicide monitoring.
The use of the so-called “classrooms” holding inmates pending evaluation or on monitoring needs to be halted. These are not living spaces, have no toileting provisions, are publicly visible spaces, and are not suicide-proof. These spaces should be used for programming and treatment.
In terms of monitoring standards, it is essential to have at least four levels of monitoring: constant 1:1 monitoring, direct visual observation, 15 minute checks, and routine checks (usually every 30 or 60 minutes). While the latter is not technically suicide monitoring, it is of course a check that would include attention to self-harm. Constant 1:1 monitoring should only be employed as a short term measure for the imminently suicidal prior to mental health assessment and pending transfer to 2P after mental health assessment; longer term constant 1:1 monitoring must be available at least on 2P (as long as there are always beds available). Those not imminently suicidal but where there is a concern about possible selfharm can be under direct visual observation pending assessment; the County could choose to provide this on all units or move such inmates to a location where such observation is readily available. 15-minute checks should be available in booking, OPP, restrictive housing, and 2P and as a temporizing measure in other settings for those not suicidal, pending mental health assessment.
Video monitoring is never a substitute for direct observation but can be used to supplement it. For instance, video monitoring can be used to supplement periodic checks but is not a substitute for constant 1:1 monitoring or conducting direct visual observation or checks.
Assessments for the suicidal should be viewed as emergencies and responded to within 4 hours. It is reasonable for nursing staff to conduct such assessments after hours and on weekends and holidays as long as they have special training in mental health and, if not qualified to conduct such assessment independently, have access to a mental health clinician for consultation.
Mental health must also provide treatment designed to reduce suicide risk and should develop a corresponding treatment plan and/or behavior management plan for every inmate-patient that mental health assesses as requiring any level of suicide monitoring as these patients are presumably at imminent risk of self-harm.
When patients are taken off suicide monitoring, they should be seen by mental health within 72 hours at the most. Mental health should be expected to do daily assessments (which may include providing treatment) of anybody on constant 1:1 monitoring or in a safety suit.
As mentioned above, safety suits are being used excessively. The provision of more active treatment and improving conditions on OPP units is likely to substantially reduce the need for safety suits by addressing unmet clinical needs. However, a small population of inmate-patients who engage in recurrent selfinjurious behavior will almost certainly remain. These individuals need carefully developed behavior management plans and appropriately targeted treatment designed for harm reduction. Again, the decision to continue a safety suit for danger to self or other clinical reasons is a decision that must be made by mental health staff who are the experts in this arena.
There also needs to be more robust data collection on suicide and self-injurious behavior. The figures provided to me are highly unlikely to reflect a true picture of self-harm in the jails. This data should include tracking of all instances of self-harm and categorization of those instances, preferably using a method of categorization such as the Centers for Disease Control and Prevention’s Risk Rating Scale.

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Training in suicide prevention also needs to be strengthened. This will be addressed in the Training section.
Clinical Restraint and Pro-Straint
Those in restraints, whether in the restraint chair for behavioral reasons or clinical restraints on the LPSCertified unit, should be on constant watch rather than periodic checks (or constant video monitoring with direct visualization every 15 minutes). They must be in areas inaccessible to other inmates. Those in restraints must be checked at least every two hours by a nurse for vital signs, neurovascular assessment, and limb range of motion that includes the legs (which may be done by custody) and offered an opportunity for toileting. Fluids should be offered at least every four hours and meals at least at meal times. Every four hours there should be a more thorough clinical assessment to determine the need for continued restraint and whether there are new or previously undetected health problems. In general, current policy provides for the preceding except for constant monitoring and specification of more detailed assessment every four hours. This assessment can be done by nursing staff with mental health available for consultation if needed.
Restraint chairs should be utilized for no more than four hours. When custody staff intend to use behavioral restraint for longer than 4 hours, this should prompt a mental health assessment for consideration for placement of the inmate in a mental health setting, development of a behavior management plan, and/or recommendation regarding continued restraint in a restraint bed. As noted in the previous paragraph, if the decision is to continue behavioral restraint, subsequent assessment of the inmate’s condition should be done every four hours (in addition to the more limited restraint checks done every two hours).
While there is no well-defined standard for timelines of clinical restraint orders in correctional settings, clinical restraint on 2P should be ordered every four hours for the first twelve hours (which may be done by a nurse consulting with the ordering physician and obtaining a telephone order as is done now) and then at least every 24 hours thereafter.
The monitoring of clinical restraint is the same as behavioral restraint.
Restrictive Housing
It is reasonable for nursing staff to conduct the initial screening of those admitted to restrictive housing in order to identify a possible emergency but mental health staff should screen new arrivals by the next working day. Mental health consultation must also be available to the nursing staff doing the initial assessments for consideration of emergent mental health needs such as commitment to 2P or medication orders. Mental health should also do at least weekly rounds in restrictive settings. At a minimum, those identified as suicidal must be appropriately treated and managed and those needing commitment identified and admitted to the LPS-Certified unit. Others may be treated in place but the option to divert the seriously mentally ill to an OPP unit is something the county should consider. It is especially important to consider this when those with mental illness are deteriorating in this isolated setting prior to becoming so ill that they must be committed. Once the jail staff become aware of their deteriorating condition, a meaningful response of some sort is obligatory.
The county could consider developing a formal residential mental health program in a restrictive setting that has enhanced treatment that could include conducting groups in restraint chairs and similar enhanced treatment access. But this would be something that they county could elect and is not a formal recommendation. It is important to state that this option is distinct from discussion below about a

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behavior management unit which would be designed more for inmates with personality disorders than for those with SMI.
Reentry Services
This is identified as an essential function for an adequate system of care. But here again, these services need not be provided to all those with a mental illness or even all those who are receiving treatment. The key is to identify those who, by virtue of their serious mental illness, are unable to arrange aftercare themselves. It is also unreasonable to expect jails to provide robust reentry services to those who are incarcerated for short periods of time. One simple way to conceptualize this is that the longer the patient is in jail, the further down the following list the reentry services need to extend. Reentry services for the seriously mentally ill must:
x Assure medication continuity until community services take over (in all cases) o This will almost certainly require that medications are given to releasing patients who do not have their own supply of medications in the community
x Assure that a mental health appointment is in place within a period of time that will allow medications not to lapse (those incarcerated for more than two weeks)
x Assist in applying for or restoring benefits (those incarcerated for more than one month) o Medical insurance o Money benefits
x Assist in securing housing (those incarcerated for more than two months) o This should include access to secure settings as well as traditional board and cares and similar settings.
Training
Custody staff should receive formal training on mental illness, crisis response, and suicide prevention in their academy training and annual training on at least suicide prevention. The academy training should include at least a one-day training on mental illness and another day on suicide prevention. Crisis intervention training (CIT) is also vitally important (which may include sufficient training on mental illness and suicide, depending on how it is conducted). There are a variety of options for crisis training, but most good correctional CIT is 3 to 5 days. It is important that it be custody-oriented CIT as those designed for law enforcement address different needs.
The training for all custody staff should include identification of markers for potentially serious problems in addition to suicidality such as psychosis, depression, mania, delirium, catatonia, cognitive disorders, and serious adverse medication reactions. It is important to note that this training is to identify markers for these conditions and then make an appropriate referral, not to diagnose. They should also have specific training in the differences between personality disorders and mental illness with an emphasis on Cluster B personality disorders and psychopathy. Training in behavior management plans and the basic behavioral principles that underlie them is also critical. As noted above, the CIT training they receive should be specifically tailored to custody settings: crisis interviewing, verbal interventions over use of force, techniques for interacting with the mentally ill in a custody setting where there is almost always more time (less urgency), and how to access and use additional help (other officers, mental health, etc.). This must be done in light of the fact that long-term management of this population is the rule which necessitates a different approach.

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All deputies that work on residential mental health settings should be required to have additional training. If the county elects to provide a robust training experience in the academy that includes correctional crisis intervention training, the enhanced training for deputies on the residential mental health units may only need to be 1-2 days to provide additional information on severe mental illness, providing relevant observations, special medico-legal considerations, specialized management techniques, and information about the unit program. But if they have not received correctional crisis intervention training, this should be an additional requirement.
Mental health staff need robust on-boarding. The correctional environment is unique and community experience does not prepare clinicians for work in the custody setting. The training needs to cover confidentiality (and its limits), reporting requirements, safety and security requirements, civil commitment and emergency treatment, competency and informed consent, referral to other health providers, behavior management, and reentry.
Quality Assurance and Quality Improvement
Good QA/QI is essential and must not be an afterthought. It is a central and essential part of a wellfunctioning system. Sufficient resources must be dedicated to QA/QI. This means staff resources, IT support, and analytic support.
There must be a robust review of sentinel events. This must not be limited to death reviews but should also include near miss events, serious self-harm, assaults involving injury on OPP units and the LPScertified unit, injuries during episodes of restraint, and emergent use of force involving the mentally ill (controlled use of force should be reviewed through standard processes for use of force review). The review must be prompt, involve QA/QI staff and leadership from custody, mental health, and medical (and any other pertinent staff). There should be an analysis of the case and any systems issues identified addressed through a corrective action plan with specific tasks assigned to individuals with due dates that are tracked to completion.
Routine monitoring of other problems such as medication errors and a variety of other standard surveillance is also a part of basic QA/QI. The QA/QI program should include formal provision for clinical supervision and/or peer review.
QA/QI also needs to be tasked with monitoring service provision such as encounters (broken down by different types of service such as intake, crisis response, assessment, suicide review, case management, re-entry services, medication monitoring, and individual and group therapy), referrals and their sources, patterns of psychotropic medication administration, numbers of LPS commitments and other LPS statuses, length of stay in various units, diagnostic categorization of the mentally ill population, adherence to the mental health plan or benefit (if established), and so on.
QA/QI is also essential to implementation of system change. When a program is implemented, QA/QI processes must be developed to assure the fidelity of the implementation.
Recommendations for Creating a Basic System of Care
The Sacramento County jails do not have a system of care. Staff at local facilities respond to crises, conduct limited assessments, monitor those on suicide watch and other special statuses, and provide medications. There is limited continuity of services. The only structured services are those provided for competency restoration.

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I will offer recommendations in two realms: system components and system capacity. The components are the elements of the system while capacity looks at physical plant and staffing needs. The former is based in well-established principles of care and in light of standards emerging from legal requirements and published standards. The latter is based on population data from Sacramento County Jails considered in the context of national studies regarding the prevalence of mental illness. Recommended caseloads are based on analysis and experience with systems that provide care sufficient to reasonably prevent harm.
It is important to recognize that jails both have more rapid turnover and are much more acute psychiatric settings than prisons. As such, they will require more resources for initial assessment and more frequent patient contact. The clinical needs of jail intake share more with emergency rooms than outpatient clinics. And residential mental health settings in jails handle a good deal more acute disturbance as well.
In order to achieve a number of the recommendations, clinicians need to have greater access to patients and greater control over who they serve and their level of service, which includes having substantial control over placement in residential settings (OPP units as well as 2P), subject to classification limitations and other legitimate safety and security concerns; the simplest way to describe this is that those going into and leaving these units should have the assent of mental health. It is important to recognize that the intensity of mental health service needs often bears little relationship to classification level. This means that there needs to be provision for custody overrides to assure access to services only available at a specific classification security level and/or an array of services needs to be provided at each classification security level.
While adequate treatment could be provided without using groups, it would require far more staffing; the below is predicated on the assumption that such groups will be available, at least in the residential mental health units.
System Components
The following are my recommendations for providing a constitutionally adequate and basic level of mental health care. By comprehensively developing the mental health system, many of the specific deficiencies will be addressed and the system will be more cost effective. The County is clearly providing some elements of an effective correctional mental health system but is missing many as well. The essential general features of such a system include:
x Systematic screening and evaluation using valid and reliable methods o Intake screening o Mental health evaluation o Mental health screening and rounds in restricted housing units
x Referral systems (including routine and emergency) o Custody staff o Health staff o Inmate self-referral
x Treatment that is more than mere seclusion or close supervision o Outpatient level services o Residential mental health housing that is available regardless of custody level  Entry into such residential settings must be authorized by mental health to assure appropriateness of the referral and that acuity is properly managed across the system
x Crisis response

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x A suicide prevention program x Mechanisms to minimize the placement of the mentally ill into restrictive housing settings x Reentry planning x Involuntary treatment including the use of seclusion, restraint, involuntary medications, and
involuntary hospitalization x Provisions for medico-legal mandates, including
o Informed consent o Privacy of protected health information (with pertinent limitations described) o The right to refuse treatment x Participation in treatment by trained mental health professionals x Adequate out of cell time on residential mental health units (for both structured and unstructured activities) o Generally, a minimum of 10 hours of unstructured and 10 hours of structured (treatment)
out of cell time per week x Accurate, complete, and confidential records x Safeguards against psychotropic medication prescribed in dangerous amounts, without adequate
supervision, or otherwise inappropriately administered x A grievance program x Training for mental health staff regarding correctional and security issues x Training of correctional staff regarding mental health issues x Quality improvement program x Policies to support the preceding
In order to accomplish the above a system must provide:
x Adequate physical resources including treatment program space and supplies x Adequate numbers of properly trained and/or experienced mental health staff who will identify
and/or provide treatment to inmates with serious mental illness x Adequate access for inmates to treatment within a reasonable period of time considering the
nature of the problem
The same services should be available for women. But the smaller numbers of women create problems with economy of scale. It may be reasonable to have a single OPP for women. It would have to be more flexible to achieve the necessary out of cell time owing to housing of women with wider variations in classification security levels and acuity.
An array of services and actual treatment must be provided in accordance with the principles laid out above. It is also necessary to focus resources in a manner that assures that the sickest are identified and treated. Not everybody who would benefit from treatment needs to be offered treatment. It is completely reasonable for the County to have what amounts to a mental health “benefit” or, more strongly, the County may limit its services to those who are most in need and whose conditions place themselves and others at risk for mortality or morbidity. Unfortunately, it is not possible to do this solely on the basis of diagnosis as some mental health disorders can vary so widely in the associated functional limitations and symptom severity that some measure of severity and functional limitations must guide the decision to treat in those cases. Clearly, diagnosis can be used to identify the most seriously ill that will always be treated: psychotic disorders, major depression (moderate or more severe), and bipolar disorder (properly diagnosed). Further, it will be necessary to treat those who have made suicide attempts, have suicidal

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ideation, or have engaged in recurrent and/or severe self-injurious behavior. Beyond this, the primary consideration should be for those whose mental illness (excluding personality disorders) is directly related to their continuing stay in segregation or maximum security settings. This reaches the Constitutional minimum for a basic mental health system but the County may find it to its advantage for additional correctional interests to be drivers of mental health service delivery. Infractions, criminal recidivism, and ability to program are important interests that mental health treatment can help address in many cases. This may include direct treatment and/or collaboration with custody to develop behavior management plans. The County must also provide sufficient services to the cognitively impaired to assure their safety and to provide access to programs, health care, and reentry services.
Part of the reason these types of mental health services are necessary is longer lengths of stay; crisis response and other strategies appropriate for exclusively short stay settings are, by themselves, inadequate. It is in the County’s interest to rapidly identify, treat, and stabilize those who are going to remain sometimes for years. Preventive and maintenance care are cost-effective when properly organized and delivered.
A correctional system of care that can accomplish these ends has the following components:
x Articulation of a mental health benefit (or scope of care) that communicates clearly to inmates, staff, and the community what the jail does and does not provide in terms of mental health treatment o This entails a mechanism to identify three populations  Those not identified as needing or having needed treatment  Those receiving treatment  Those who have received treatment but now need only surveillance or case management (monthly check-in)
x Provision for confidential interactions between mental health staff and patients absent a clear and present danger o Includes explicit recognition of the limits of confidentiality in correctional settings
x Initial screening that does not miss important conditions and needs and makes referrals accordingly o The imminently suicidal or self-destructive o Those who are a danger to others by virtue of mental illness o Those with psychotic disorders o Those who are admitted on psychotropic medications
x A reliable mechanism for assuring continuation of medications upon admission, throughout incarceration, and into the community
x A robust system of detection that responds to intake referrals and seeks to identify those who were missed at initial screening or who have decompensated while in jail o A mechanism for inmate-declared emergencies o A mechanism for staff-declared emergencies o A self-referral process (request for service or “kite”)  Kites must be prioritized (triaged) within 24 hours x Emergent – to be seen ASAP (generally, within four hours) x Urgent – to be seen the next working day (within 72 hours) x Routine – to be seen within two weeks x Response – require only a written or verbal response (e.g. “your refill has been ordered”) but no formal clinical assessment or intervention

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o A staff referral process (custody and medical)  These may be prioritized (triaged) within 24 hours or the next working day (staff
should be expected to be able to identify true urgencies and emergencies) x Emergent – to be seen ASAP x Urgent – to be seen the next working day x Routine – to be seen within two weeks x Response – require only a written or verbal response (e.g. “the inmate’s
refill has been ordered”) but no formal clinical assessment or
intervention x A robust suicide assessment and management system
o Training (initial and annual) o Suicide screening o Suicide assessment o Suicide monitoring o Conditions of confinement o Treatment designed to reduce the risk of harm x A system of care that provides several levels of care with non-medication treatments focused on
the residential mental health settings
o LPS-certified unit  Provides acute care to those under LPS commitment and some voluntary patients  Out of cell time determined on a case-by-case basis and/or a level system x Expectation of minimum of 10 hours of unstructured time and 10 hours
of structured time out of cell daily
o Exceptions require formal determination and documentation as to why they are not permitted this access (e.g. imminent danger
to others) x Treatment (individual and/or group), structured recreation, rehabilitation
(e.g., psycho-education, supervised ADLs, cell cleaning)
o May necessitate development of the ability to hold groups with restrained participants
x Progression through the system prepares the patient for a less acute
settings and demonstrates readiness to move to a less acute setting
o A restrictive and/or high security housing level of care  For the dangerous mentally ill who do not meet LPS-commitment criteria  Progression through levels or steps as a measure for readiness to step-down to a
less restrictive setting  10 hours of out of cell unstructured time each week
x Solo progressing to group  10 hours of out of cell structured activities
x With staff x Treatment (individual and/or group), structured recreation, rehabilitation
(e.g., psycho-education, supervised ADLs and cell cleaning), education,
work, programs x May necessitate development of the ability to hold groups with restrained
participants on these units only

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o A step-down level of care (should be a larger number of beds than the restrictive and/or high security settings)  For those who do not need restrictive housing and those who step down from
restrictive housing  Expanded out of cell time
x The added time can be primarily unstructured but additional structured
time with an emphasis on correctional programming, education, and
work is beneficial x Structured treatment designed to maintain stability and develop self-
management skills rather than to explore or address long-standing
psychological problems
o Develop special housing units or at least differentiate residential settings by pod to separate, as much as possible, those with:  Major mental illness  Personality disorder  Cognitive impairment
o Outpatient (general population) services  Emphasize primarily medication management and case management services  Other brief treatment focused on self-management skills and support rather than
exploring or addressing long-standing psychological problems
o Placement  A system for placement in residential mental health settings that has the
following elements: x No placement in residential mental health without mental health assent x No transfer out of a residential setting without mental health assent
(absent an emergency) x Mental health recommendation for placement in residential mental health
housing is implemented directly unless a determination is made that
safety and security demands preclude such placement
o Adequate treatment must still be provided to those denied such placement
x Ready access to the LPS-certified unit or a licensed level of care  Mechanisms to divert the seriously mentally ill from maximum custody settings
whenever possible
o Medication management  Provide for emergency involuntary medication in the jails  Consider providing long-term, non-emergent involuntary medication x This can be provided at only the LPS-certified unit but allowing it to
occur in jails under specified conditions introduces efficiencies into the
system
o Restraint  Provision for clinical restraint x Directed by appropriately credentialed clinician x Must be available on LPS-certified unit
o There must be provision for restraint while awaiting transport and during transport to the LPS-certified unit

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x Consider making available in jail residential mental health settings;
provides options that introduce efficiencies into the system  Provision for behavioral restraint
x Custody directed x Mental health assessment for those in prolonged behavioral restraint  Medical monitoring of clinical and behavioral restraint
o Reentry services  Focused on those in residential mental health settings (in a tiered manner as
detailed above) x Medications provided until care can be resumed or initiated in the
community x Community follow-up appointments x Housing to the extent possible x Assistance in securing medical insurance and money benefits  General population x Medications provided until care can be resumed or initiated in the
community x Provide information about community resources
o Training  Mental health staff x Correctional mental health system x Correctional mental health policies x Suicide assessment and intervention x Treatment modalities to be offered in the jails  Correctional staff x Mental health policies x Critical incident response x Recognizing different types of mental illness x Interacting with the mentally ill x Suicide and self-harm detection and prevention
o Chemical dependency services  The mentally ill must have access to appropriate CD services regardless of
location x Mental health must be able to refer to or provide CD services x May require the development of dual diagnosis approaches
o Quality Assurance and Quality Improvement processes sufficient to support the above o Policies and procedures to support the above plus other important medico-legal issues,
including  Competence and consent  Right to refuse  Confidentiality and release of information x Including provisions for information exchange for the purposes of
continuity of care

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System Capacity
Prevalence of Mental Illness
While there are varying ways of establishing the prevalence of mental illness in correctional settings, it is beyond the scope of this report to detail the extensive literature on this topic. The numbers I cite are generally accepted and, if anything, conservative (in the sense of reliably detecting true cases while minimizing the detection of false cases and emphasizing serious illness over the mere presence of a diagnosable disorder, which is present in the vast majority of the incarcerated population).
Those with serious mental illness that are likely to need some level of service is 15-25% of the jail population (this does not include those with cognitive deficits or personality disorders). Those with illness so severe that they require residential or licensed level of service are 2-4% (note that the quality of services available in the general population setting determines how many beds will be needed; this number is for a well-developed system). Most developed systems treat about 25% of the male population and 30-50% of the female population.
Using these figures and a jail census rounded to 4000, this gives approximately the following:
x 600-1000 with illness needing some level of service x 80-160 requiring residential or inpatient level of care
These are consistent with figures provided by JPS who reports that 39.5% or about 1600 inmates have open cases and 19.4% or about 800 are on psychotropic medications at any one time.
It is difficult to get a clear picture of the actual numbers in OPP settings as these beds are somewhat fluid with spill-over into other settings. The populations are also highly admixed with no data on the percentage that re actually SMI. But there are about 80 OPP beds at the MJ and 32 and RCCC. There are 18 LPS-certified beds. Thus, total residential beds are about 130.
Residential Beds
There are many in residential settings who do not suffer from serious mental illness but from personality disorders, cognitive disorders, and even medical disorders. The county may choose to provide residential services to those with personality disorders and cognitive disorders but this would necessitate provision of beds in addition to the needs enumerated in this section (except for a small number with recurrent and severe self-injury, who will sometimes need to be in residential mental health housing).
Those with cognitive disorders are often housed in residential mental health settings when more than mild deficits are present. But they have very different needs, typically requiring special housing, separated from general population inmates, with services primarily directed at structured activities and skill development (self-care and self-management) rather than mental health treatment. The data provided do not allow a reliable estimate of these numbers. In the community, the prevalence of dementia is very low under age 65 but is about 14% for those aged 71 and above. The prevalence is higher in correctional settings but it does not represent a substantial number in the jails as there are few inmates over 70. But the prevalence of intellectual disability in corrections is 4-10%, again higher than in the community. Prevalence estimates of TBI vary widely and have been found to be as high as 60% in correctional populations. In 2010, about 1% of the US population had a disability following hospitalization for a traumatic brain injury, providing a conservative estimate. In short, it is virtually certain that a good deal of cognitive disorder is going undetected in the Sacramento jail system. Using a lower estimate, 4% + 1% = 5% (200) of the population can be expected to have intellectual disability or disability due to TBI

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that are serious enough to result in functional and/or behavioral deficits. A substantial portion of these are expected to need residential or special housing, conservatively about half or about 100. A much higher proportion of these patients will also have a diagnosable and sometimes serious mental health disorders than those without these cognitive disorders, meaning some will still need to be housed on mental health residential units.
Taken together with the mental health residential needs from above (80-160), a conservative estimate is that around 200 residential beds are needed. The jails currently have about 130 residential mental health beds but as noted, not all these beds are occupied by those with SMI.
Thus, the current number of OPP beds is likely sufficient to manage the mentally ill population, assuming OPP and general population services are sufficient to maintain the stability of those seriously mentally ill residing in those settings. While the number of beds may be sufficient, they are not properly arrayed or utilized. As mentioned previously, it is important to have residential beds at both high and low levels of custody; presently OPP settings are operated under high security. And the above-mentioned problem of mixing diverse populations needs to be addressed as well. Unless those populations are removed from the residential mental health settings, the numbers of beds for the mentally ill would not be sufficient. Those with cognitive disorders will require a separate housing unit or at least differentiated program opportunities designed more for the habilitative and rehabilitative needs resulting from the functional limitations of this population which, to reiterate, are quite different from the needs of the mentally ill. If they remain co-housed, there will need to be clear programmatic differentiation and bed-capacity adequate to serve both populations. A female OPP must also be developed, though as noted previously, it may not be possible to have more than one, necessitating greater flexibility to assure access to care and full privileges in accordance with their classification security level and clinical acuity.
While these improvements are likely to reduce the need for LPS commitments, in my opinion the current 18 beds will remain insufficient. It is difficult to make a firm estimate of the number of beds needed given the interdependence with the quality and breadth of services provided in the jail, but a unit of about 40 beds would be more typical of a system this size.
An optimal arrangement, assuming the current 130 mental health residential beds, would be approximately:
x 40 LPS-certified beds o Serving both men and women but allowing better separation of the sexes
x 20-bed male restrictive OPP x 50-bed male less restrictive OPP x 20-bed female OPP
There will then need to be sufficient housing for the cognitively limited and any other identified special populations, such as the behaviorally disordered. This is estimated at 70, for a total of 200 beds of missioned housing with a strong mental health component.
Staffing
Staffing needs to be sufficient to provide the services described above. It is beyond the scope of this report to generate a staffing model in large part because it depends on what the jail decides to do; a simple example would be the extent to which the mental health treatment will provide treatment in groups (more efficient for mental health but more challenging for custody) versus individual (less efficient for mental

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health but easier for custody). Some general comments and an example may assist in estimating staffing needs.
It is reasonable for a psychiatrist to manage 50 residential patients in an acute correctional setting and 100 in a chronic setting. The LPS unit has high turnover, very high acuity, and requires a good deal of additional work related to medico-legal functions; one psychiatrist can manage about 25 patients. The female and male restrictive units will be more acute than the less restrictive male unit. It can be estimated that 1 psychiatrist can cover the male restrictive and female units. It will take a 0.5 psychiatrist to cover the less restrictive male unit and another 0.5 for the special management residential settings. Thus, 3 psychiatrists are needed just for residential services currently and about 3.5 to 4 if the LPS-certified beds are expanded.
But to look at overall psychiatric need, it is important to assess the relevant functions psychiatrists must serve. Intake or initial psychiatric evaluations take a minimum of one hour and 30 minutes is reasonable for medication follow-up (including all charting and record review and accommodating the logistics of meeting patients in the correctional setting). Thus, if we assume that 25% of the jail population will receive psychotropic medications and remove an estimated 30% of 50,000 bookings that stay a day or less, we can estimate that there will be 0.25 X 35,000 = 7500 intakes (each taking an hour) at the high end (some of those staying between 1 and 7 days may have psychiatric need but not serious enough to warrant attention if only in for a short time). This figure seems to be in line with the JPS report of over 650 “New/Open” cases each month. The actual need could be half that but since initial psychiatric assessment is not being well tracked and often not done at all, this is the best estimate available. This amounts to just short of 2-4 full time equivalents (FTE). This is a very conservative estimate of time as it assumes that 100% of 2000 hours of annual working time is dedicated to patient care. Attaining 70% clinical productivity would be outstanding in a correctional setting, yielding FTE estimates of 2.5 - 5. In addition, follow-up will be necessary. At present, there are about 800 on psychotropic medications at any one time. Removing the 130 in residential settings, that leaves 670. Assuming an average of visits every 90 days (a low frequency because presumed to be stable), that requires 670/3 visits/month * 0.5 hours/visit = 112 hours per month or about 5800 hours per year, or about 4 FTE. A half hour is provided to allow for record review, patient interview, charting, and the logistical challenges inherent in correctional settings.
Thus, conservatively, 9.5-12.5 psychiatrists are needed to provide sound basic services. Right now the jails have about 4 FTE of psychiatric prescriber time. It is thus surprising that they are able to provide medications to a reasonable portion of the inmate population (and with no obvious problem prescribing patterns) but no surprise that there are almost no psychiatric assessments, patients are often prescribed medications without being seen by a psychiatric prescriber, documentation is thin, and medication monitoring is inconsistent.
In my opinion, psychiatric nursing is marginally sufficient for the current number of LPS-certified beds. Night coverage is especially marginal given that they are the crisis response for the jails during some periods. As pointed out by the nurses, it is also a problem when there is a crisis on 2P as there may not be a nurse to monitor the remaining population. In my opinion, there should either be three nursing staff on 2P at nights or two nurses on 2P with an additional nurse always available to either back-up 2P nurses and/or to provide crisis response; this would amount to about 1.7 FTE nursing (to cover weekends and leave). During the day, the additional treatment staff that need to be hired for treatment should make it unnecessary to enhance daytime nursing staff. The lack of custody staff on location at nights and weekends is also a problem that contributes to the challenges nursing faces at these times; in my opinion custody should have a deputy posted on this unit at all times but would defer to Mr. Vail in that regard. If

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LPS-certified beds are added, nursing staff will need corresponding enhancement (maintain staff to patient ratios).
While similar calculations can be made for mental health clinicians, this is much more difficult as they serve a wide range of functions that would be difficult to enumerate and estimate the time each takes. The needs represented by treatment requirements of residential settings can be estimated as can approximate general population caseloads for on-going services. As these functions are not being served effectively at this time, these can be considered as a starting conservative estimate of additional staff requirements. At present, the jails are managing crisis calls and referrals, responding to intake, and providing limited case-management in general population. Overall staffing is sufficient for those functions, though is marginal on weekends and may need to be re-arrayed once additional treatment staff are hired.
As noted above, I will presume that groups are the preferred modality as they are, all things considered, the most cost-effective treatment modality for the kinds of services required.
Structured residential programming for a minimum of 10 hours per week for 200 patients begins by establishing group size. While up to 15 is reasonable in community and hospital settings, it is very difficult to run groups of this size in corrections. Most systems find that on average 10 is achievable. We can also assume that up to 25% will refuse groups or not be sufficiently stable for groups, leaving 150. We can further assume that at least 4 of the 10 hours can be achieved by education and other correctional programs, though it is important to note that this is not occurring at all at the present time and may require additional resources. Another hour per week of individual contact with a clinician for reentry planning, treatment planning, and limited individual intervention brings the group treatment load to 5 hours per week. 150 patients in groups of 10 for five hours per group amounts to 75 hours per week. Each hour of group requires an hour of preparation and documentation, bringing the total to 150 hours per week or 7800 hours/year, amounting to 5.5 FTE (at 70% efficiency). In addition, an hour a week of individual contact for each of the 200 residential patients is another 200 hours or 10,400/year or 7.5 FTE (at 70% efficiency).
For general population settings, I make the following assumptions. JPS reports that 39.5% or 0.4 * 4000 = 1600 inmates in the jail have open cases. Subtracting the 200 residential beds, this leaves about 1400 being served in general population. Assuming that existing resources can serve crisis and case management functions for the majority of that population, it remains to estimate the number that would need some form of active treatment. Conservatively, about 10% of this population will need some form of on-going treatment. If half of this can be done in weekly groups and half in weekly individual treatment, this amounts to 70 hours of individual treatment hours and 140 hours of group (one hour group, one hour preparation and charting) each week. This amounts to 210 * 50 = 10,500 hours. At 70% efficiency, this is 7.5 FTE.
Lastly, to provide reentry services will require the addition of two FTE in order to serve the 200 in residential settings, who require dedicated resources. Present reentry services are extremely limited but should be able to serve the remainder of the population.
Thus, in order to provide minimally adequate mental health services (assuming a reduction in existing mental health clinician duties and requirements as described above), an additional 17 FTE of mental health clinician time is required. Virtually all of these resources would be focused on residential mental health (which in this basic model would also house those with cognitive disorders) and some limited shoring up of general population treatment.

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But I must emphasize that the only important outcome is not staffing numbers but the provision of services. If the Sacramento County jail system can provide the needed services through different staffing approaches, that is entirely reasonable. Again, these staffing numbers are offered as a way to quantitatively estimate needs. They are only estimates, though informed by data.
In closing my recommendations for a sound basic mental health system, I note that it would be beneficial to consider hiring other job classes such as Recreational and/or Occupational Therapists (for residential groups). Another strong recommendation is for the county to hire at least one doctoral level, licensed psychologist at each of the two facilities in order to oversee the system of care and to provide more robust clinical oversight to frontline clinicians.
It is also important to note that many of the functions detailed in this report are non-clinical functions for which I have not provided staffing estimates, most notably QA/QI and the administrative support that will be required to implement and support these programmatic enhancements. It is even more important to recognize that to do this well will also require enhancements in custody staffing. How much will depend on the specific model and approach selected. These staff enhancements add much more to efficiency than is generally recognized and it is money well spent given that it is improving the efficiency of high cost clinical staff. The county would do well to develop its treatment model prior to finalizing its staffing enhancements.
Recommendations for Creating a Robust System of Care
I offer the following recommendations for developing a robust mental health system within the jails. These programs would be in addition to the above basic system.
A few prefatory comments are in order. The most important point to make is that the infrastructure to support the basic system described above is, for the most part, sufficient to support a more robust system. In short, adding additional treatment would not require additional staff other than a modest number of treatment staff, their administrative support, and possibly a few officers, depending on the size and type of the program.
The main additional treatment components that should be considered (after fully implementing the basic system) are: intensifying services for the cognitively impaired, establishing a behavior management program for the personality disordered, providing trauma-informed treatment in the general population, and lastly expanding treatment of less severe mental illness in GP settings. Some of those targeted by the specialized services below will end up in residential mental health and the LPS-certified unit without such service enhancements but will be poorly served in those settings. As noted repeatedly, the needs of the SMI are very different than those of these other populations. The populations also do not mix well together, creating additional management and custody problems.
Treatment of those with Cognitive Impairment
Those with intellectual disabilities (ID), pervasive developmental disorders (autism spectrum – while not technically a cognitive disorder, services needed are similar), and traumatic brain injury (TBI), more than those with non-TBI dementia (who are few and should be targeted for rapid release), constitute the cognitively impaired group. It need not be a large program as only the most severe would need such services. As noted above, there will be up to about 100 with TBI and ID likely to need special management. There are no good studies of PDD in corrections. The program herein recommended would only be for a small portion of this 100 plus PDD. Of the remainder, some would have SMI that

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could be managed on the mental health units and others can be managed with limited additional supports; without such a unit, more would have to be managed on residential mental health units.
The size of the unit would depend on physical plant but 20-40 would be in the range needed. While even this sub-group is certainly not homogeneous, they share enough similarities in terms of treatment needs to be housed together. The program should be a behavioral program with skill-building training. Such a program would include a simple reinforcement scheme and the teaching and practicing of skills. The behavioral scheme should include on the spot reinforcement if possible (possibly a token economy) or at the very least something like a today-tomorrow reinforcement scheme where tomorrow’s privileges are driven by today’s behavior. With this population, the former is likely to be more effective as many in this population will have difficulty connecting what they have today with what they did yesterday. But the main point is that there needs to be a sound, if basic, behavioral program that provides as much immediate reward for desired behaviors (and absence of undesirable behaviors) as possible. The skills component is very basic (and some are the same as those needed by at least a portion of the SMI population) and targeted at function: self-care (grooming instruction and practice, medication taking), cell care (cleaning together), social skills (basic instruction, practicing in structured activities), surviving in the jail (how to communicate with officers, how to get basic needs met – practicing these on the unit), accessing community services, and community living skills (what to eat, how to travel, basic budgeting). There are more options but these are good examples of the types of things that could be done. These types of programs can be offered by mental health staff but other job classes are more appropriate such as recreation therapists and occupational therapists.
Behavior Management Program
A behavior management program should be exclusively for those with personality disorders (though they may have other conditions if well compensated) who engage in repeated disruptive behavior, often violence and/or self-harm. I would recommend a program for the recurrently violent and behaviorally disruptive that is run in a high custody setting. It could be run as a program using mental health trained staff rather than as treatment that inmates can refuse. If that is not desirable, one option would be to offer it as a pathway out for those who are stuck in restrictive settings, or even as an option when facing a serious infraction.
The intention would not be to address gang-related behavior; many who are gang-entrenched would not be ready or able to benefit from such a program. It should use standard approaches to violence reduction such as groups to target anger management, aggression reduction training, criminogenic thinking, and the impact of life trauma. It would benefit from specialized classroom restraint chairs for group programming (though such a program can be done without such facilties) and have a level advancement system that slowly exposed these individuals higher risk situations as they proved themselves ready for the next step, for example: congregate treatment in restraint chairs, then congregate treatment and structured activities without restraint, then congregate unstructured activities. Each stage is accompanied by an advancement in privileges that mean something to the population. The goals of such a program are three-fold: return to GP, harm-reduction (in jail and in the community), and minimization of isolation.
Those with recurrent self-harm are likely to be too few to warrant a separate program. Many will also qualify for the additional treatment programs recommended in this section. This should also be a modestsized program of about 30.
Trauma Treatment

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The number of inmates with trauma histories is substantial. While studies vary, it is safe to say that the majority have suffered some serious trauma and a substantial number have suffered from childhood physical and/or sexual abuse, both men and women. Some systems are beginning to think of trauma like exposure to body fluids – take universal precautions. In short, presume that all inmates have trauma histories. As such, treatment focused on trauma is of great value. The biggest challenge is getting men to accept such treatment. It may be offered indirectly through treatment program such as Acceptance and Commitment Therapy (ACT), which also serves other purposes and is much more palatable to men. For women, ACT is certainly an option as is Dialectical Behavior Therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS), and other evidence-based treatments. I would recommend STEPPS as it is a strong group-based approach that is not as technical as DBT. It is manualized and relatively easy to implement. Stephanie Covington has also put together some good packages for trauma work that are readily implemented.
Additional Outpatient Mental Health
I put this last because the jails are more challenged by problems related to the previous three categories. Routine outpatient mental health care is the simplest and easiest piece of the mental health system and it is very tempting to focus resources here and many providers would prefer this kind of work. But in my opinion, the other populations present far more risk to the jails and to the community; further, mental health has the technology to render effective services to these populations. But there is also no doubt that those with anxiety disorders, obsessive-compulsive disorder, depression, PTSD, and other common conditions would benefit from additional services. As it is, the jails are providing a great deal of psychotropic medication for these disorders but other treatment is limited. There are many evidencebased non-pharmacologic treatments for these populations, many based in CBT and other psychotherapeutic modalities. There are group and individual approaches to many. If the jails do go in this direction, I would recommend targeting depression and PTSD because they are common and potentially debilitating and therapies are well-known to augment psychopharmacologic approaches and sometimes even provide better efficacy without medications.
CONCLUDING REMARKS
It is important to make a few crucial points. The first is that the conclusions of this report are necessarily limited due to the fact that UCDJPS QA/QI information was not made available to me. Were that information available, it could substantially impact a variety of opinions and recommendations.
I have repeatedly noted that crisis response is not treatment and, especially in the absence of treatment, a system oriented towards crisis response generates crisis. This is because when crisis is the only way to get attention, crisis is constantly being reinforced.
Another point that it is crucial to emphasize is that mental health treatment varies substantially depending on the population being treated. As a result, mixing populations such as the cognitively impaired, those traditionally considered seriously mentally ill (primarily inmates with psychotic and serious mood disorders), and inmate with personality disorders necessarily limits the efficacy of treatment. As such, it is prudent to provide different services and different settings for these populations to the maximum extent possible. In this regard, I would add that mental health treatment is most effective for those with serious mental illness as opposed to cognitive disorders and personality disorders. Those with cognitive disorders can be more safely managed and habilitated in dedicated settings. Those with personality disorders, especially certain types, are the most challenging to manage and while I recommend consideration of a

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behavioral management unit, it is vital to be cognizant of the challenge and the expertise necessary to run such a program.
It should be apparent from the preceding that parsing (whether for placement or services) of inmates with some form of mental illness should be done carefully and with mental health serving a gate-keeping function embedded within the larger classification system. In short, for placement and treatment to be the most effective, mental health must be able to have the ability to decline inmates to settings and treatments designed for specific populations.

This concludes my report.

Respectfully submitted,

Bruce C. Gage, M.D.

 
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Sacramento County Jail Mentally Ill Prisoners and the Use of Segregation: Recommendations for Policy, Practice and Resources
Eldon Vail June 2016
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TABLE OF CONTENTS
Introduction………………………………………………...1
Summary of Findings……………………………………...5
Overview of the Jail………………………………………..7
Types of Segregation in the Jail…………………………...8
Housing the Mentally Ill in Segregation………………….9
Housing the Non-mentally ill in Segregation……………..13
Administrative Segregation……………………………....14 Protective Custody and Total Separation…......................17 Disciplinary Detention…………………………………...17 Conditions of Confinement in the Segregation Units……18
Correctional Policies and Practices…………………….....21
Segregation Policy……………………………………….21 Protective Custody and Total Separation………………..21 Classification Process…………………………………....21 Inmate Discipline Plan…………………………..………22 Use of Force, CERT & Cell Extractions……………..….24 Use of Restraint Devices………………………………....25 Employee Conduct & Prisoner Services…………..…….26
Suicide Prevention Measures……………………………..27
Custody Staffing in the Jail………………………….……29
Staffing Recommendations………………………….…….32
Deputy Staffing Recommendations.…………..................33 Civilian Staffing Recommendations……………..………36 Policy and Practice Recommendations………………………..38
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Conclusion…………………………………………………41 Appendix A…………………………………………Main Jail Days Appendix B…………………………………………Main Jail Nights Appendix C…………………………………………Main Jail Weekends Appendix D…………………………………………RCCC Days Appendix E…………………………………………RCCC Nights Appendix F…………………………………………RCCC Weekends Appendix G…………………………………………Civilian Staffing
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INTRODUCTION In August of 2015 the Sacramento County Sheriff’s Department (SCSD)
received a Report on Inspection of the Sacramento County Jail by Disability Rights California (DRC). The report found evidence of violations of the rights of prisoners with disabilities as follows:
a) Undue and excessive isolation and solitary confinement;
b) Inadequate mental health care; and
c) Denial of rights under the Americans with Disabilities Act (ADA)1
As a result of that report, in January of 2016 the county entered into a Structured Negotiations Agreement with the DRC and the Prison Law Office as an alternative to litigation. In February of 2016, based on my experience as a correctional administrator successfully managing these issues and as an expert/consultant working on them in multiple jurisdictions, I was contracted to conduct my own inspection of the SCSD jail and report on items (a) and (b) above.
During the past four years I have been retained in a number of cases regarding the treatment of mentally ill inmates in jails and prisons and the overuse of solitary confinement in the state prison systems of California, Arizona, Mississippi, New York, Alabama, Illinois and Delaware and in county jails in New Jersey and Arizona.2 My work experience includes 35 years in adult and juvenile corrections in the State of Washington, retiring in 2011 as the Secretary of the Washington Department of Corrections. Much of my focus as a correctional practitioner was on responding to the increasing numbers of the mentally ill
1 Disability Rights California, Report on Inspection of the Sacramento County Jail, April 13-14, 2015, page 1 and 2 2 Settlements were achieved in New York, Arizona, and Illinois. Settlement discussions are ongoing in Delaware and New Jersey. California has been under the jurisdiction of the court on this same set of issues for over 2 decades.
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coming into our prison system and finding ways to provide them with appropriate care, including decreasing use of segregation.3
My contract with the SCSD goes somewhat further than the findings of the DRC report. The contract adds additional detail and specifies the following:
• Evaluation of maximum security, administrative segregation, protective custody, and other lockeddown units
• Evaluation of dayroom use, programs, recreation, and other out-of-cell time for all prisoners
• Suicide prevention measures of the facilities
• Correctional officer staffing vs. workload • Correctional policies and practices I will respond to each of these items in this report. Dr. Bruce Gage was contracted to report more specifically on mental health issues and has issued a separate report. I have read a variety of documents regarding the operation of the SCSD jails, including previous studies and current SCSD Operations Orders or policies. I visited the jails on two occasions, for three days each time. On my first trip in February of this year I spent three days inspecting conditions at the jails and interviewing jail staff. On my second trip in April I concentrated on interviewing inmates and conducted twenty-four confidential interviews in order to understand their experience of condition at the jails. I found the jail staff to be professional, candid and open to the exploration of any issue related to my assignment. I also found them to be dangerously understaffed and struggling to meet even the minimal requirements of their current policies.
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Sacramento County is not alone in their struggle to provide constitutional care for the mentally ill in their jail without an over reliance on the use of segregation. Corrections agencies all over the country are faced with this same set of problems and resources are always a problem. Following the de-institutional movement away from mental health hospitals and the corresponding lack of funding provided for community treatment resources for the mentally ill that began about 1970, prisons and jails have seen a growing influx of the mentally ill into corrections facilities.4
It was not the choice of our profession to see so many mentally ill come into our jails and prisons. But that is the reality of corrections today. While it may not have been our choice, it is now our moral and legal obligation to find ways to appropriately respond and provide for the humane and constitutional care for this vulnerable population. Judge Karlton in one of his many ruling in the Coleman case said:
The court finds that placement of seriously mentally ill inmates in the harsh, restrictive and non-therapeutic conditions of California’s administrative segregation units for non-disciplinary reasons for more than a minimal period necessary to effect transfer to protective housing or a housing assignment violates the Eighth Amendment. . . . Defendants shall commence forthwith to reduce the number of Coleman class members housed for non-disciplinary reasons in any administrative segregation unit that houses disciplinary segregation inmates. Commencing sixty days from the date of this order, defendants will be prohibited from placing any Coleman class member in any administrative segregation unit that houses inmates for a period of more than seventy-two hours if the placement is for non-disciplinary reasons including but
4 The Treatment of Persons with Mental Illness in Prisons an Jails: A State Survey, April 8, 2014, A Joint Report, Treatment Advocacy Center and the National Sheriffs’ Association, page 6
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The Sacramento County Sheriff’s Department is to be applauded for their response to seek solutions to the findings of the DRC and improve the treatment of mentally ill and all inmates incarcerated in their jails.
25 Order at 55, Coleman v. Brown, No. CIV. S-90-520 LKK/DAD (PC) (E.D. Cal. Apr. 10, 2014)
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SUMMARY OF FINDINGS The use of segregation6 in the Sacramento County Jails is dramatically out
of step with emerging national standards and practices and with what the research tells us about the dangers of segregation regarding placing mentally ill inmates in segregated housing. The SCSD jails make no provision to exclude the mentally ill from segregation despite the mounting evidence that this population is particularly vulnerable to serious risk of significant harm from such placement. The SCSD overuses segregation both for the mentally ill and the non-mentally ill. Because of the lack of sufficient out of cell time and programming opportunities, conditions in the jails for segregated inmates are very stark and unlikely to meet constitutional standards.
Jail Psychiatric Services (JPS) provide mental health services in the SCSD jails. While JPS staff are dedicated and hard working, the authorized staffing levels are so meager that little treatment of the incarcerated mentally ill actually takes place. Services are primarily limited to medication management and crisis intervention. There is a near total lack of individual or group therapy, elements that in my experience as a correctional administrator over a state prison system are critical for the care of this vulnerable population.
The level of custody staffing for both jails is startlingly and dangerously low for even their current operation and as a result they operate in a state of near perpetual emergency. Absent a significant reduction in the population of the jail, there is no way they could achieve compliance with the applicable standards for managing the mentally ill and segregated inmates with their current staffing levels. There must be a sizable increase in both mental health and custody staffing to properly provide treatment to the mentally ill and avoid what would likely be successful litigation should this matter go before the Federal court.
6 The practice of placing inmates in a cell, with or without a cell-mate for 22 or 23 hours a day without access to the programs and activities available to the rest of the prison or jail population goes by many names—solitary confinement, restricted housing, isolation, etc. For purposes of simplicity in this report I use the word “segregation”.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 9 of 45 The jail is in need of an updated Housing Plan. Currently, inmates with different custody levels and mental health needs are housed in units or pods that are not clearly defined by these important factors. It is possible that some of the recommended increases in custody staffing (included later in this report) could be reduced with a Housing Plan that houses maximum inmates with maximum inmates, medium with medium, etc. in the same pods or units. The same is true for levels of mental health acuity. Not all mentally ill inmates require maximum custody or restrictive housing. Some can do quite well in medium or minimum custody treatment units. It is recommended that the jail’s classification system be reviewed and updated as part of establishing an improved Housing Plan. A complete list of recommendations is at the end of this report.
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OVERVIEW OF THE JAIL The Sacramento County Jail is split into two jail sites. The Main Jail is in
downtown Sacramento and the Rio Consumes Correctional Center (RCCC), is in a rural area about a half an hour outside the city. The Main Jail has a population cap set by a Federal court in 1989 at 2,432 inmates and RCCC has held as many as 2,400 inmates. On April 22, 2016 the Main Jail held 2,089 inmates and RCCC held 1,639 inmates.
The Main Jail consists of 8 floors, seven of which house inmates in fourteen different units. Each unit is divided into separate pods. Women are housed on the 7th floor. The original design of the units was for direct supervision, with the officers working inside the housing pods on each floor having constant contact with the inmates, monitored by an officer in a control booth. However, the jail was never appropriately staffed to allow for this excellent design to be utilized and officers are not consistently in the pods. This decision, made more than thirty years ago, has dramatically impacted the operation of this facility and severely limited the county’s ability to properly supervise both mentally ill and nonmentally ill inmates.
The RCCC consists of multiple designs of living units for inmates. This includes two maximum-security units with a similar design as the Main Jail; two units, originally called the “448” facility, which consists of three pods of dormitories in each unit with an elevated control booth and no cells; and, a series of barracks type dormitories which also have no cells. The latter are problematic for the type of inmates being held in the dormitories and the current staffing levels makes it difficult for proper supervision of the inmate population. The Sandra Larsen Facility (SLF) houses women, has a separate perimeter and is comprised of three dormitories and a small segregation unit.
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TYPES OF SEGREGATION IN THE JAIL Inmates, including mentally ill inmates, can be placed in segregation in the
following categories: Disciplinary Detention—Following a disciplinary hearing, inmates can be placed in Disciplinary Detention for a specified amount of time as a result of a sanction for acts of misbehavior that took place within the jail. Administrative Segregation—Although the SCSD uses the term “Administrative Segregation” they have no workable definition or process for such placement in their current policies. This is a significant problem, which I will address later in this report. The only policy reference to Administrative Segregation I have been able to find is in the Classification Policy and it says, “Administrative Segregation considerations including prior peace officer or corrections officer employment, gravely disabled status, and/or case notoriety”.7 Total Separation—These inmates are determined to be unable to be in the presence of any other inmate in the facility. Once again there is no workable definition or process to describe how inmates are placed into this status. The phrase is also simply mentioned once in their Classification Policy. Protective Custody—Some inmates who are classified as requiring protective custody are placed into segregation. Others are not placed in segregation and instead are allowed to live together in a medium security environment separate from general population inmates. Outpatient Psychiatric Pod (OPP)—Each of the jails has an OPP that function essentially as a segregation unit even though they don’t call it that.8 While some inmates who are mentally ill do require secure housing, these units are not operated as treatment units and inmates assigned suffer essentially the same conditions of confinement as those in segregation.
7 SCSD Operations Order 6-03, Classification Process 8 They also have an inpatient acute unit at the main jail. I will defer to Dr. Gage on the operation of this unit except to say that it is not staffed by a dedicated officer 24 hours a day and it should be.
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HOUSING THE MENTALLY ILL IN SEGREGATION It is widely recognized that placing mentally ill inmates in segregation
creates a significant risk of harm for that vulnerable population. This has been firmly stated by the American Psychiatric Association:
Prolonged segregation of adult inmates with serious mental illness, with rare exceptions, should be avoided due to the potential for harm to such inmates. If an inmate with serious mental illness is placed in segregation, out-of-cell structured therapeutic activities (i.e., mental health/psychiatric treatment) in appropriate programming space and adequate unstructured out-ofcell time should be permitted. Correctional mental health authorities should work closely with administrative custody staff to maximize access to clinically indicated programming and recreation for these individuals.9
Dr. Terry Kupers, one of the countries foremost psychiatric experts on the impacts of segregation on the mentally ill prisoner has said,
It is stunningly clear that for prisoners prone to serious mental illness, time served in isolation and idleness exacerbates their mental illness and too often results in suicide. This is the main reason that federal courts have ruled that prisoners with serious mental illness must not be subjected to long-term isolation.10
There is no question the SCSD routinely houses mentally ill inmates in segregated confinement. In order to avoid the significant risk of harm from such placements the SCSD should convert their OPP’s from segregation like units to treatment units and dedicate more beds and pods solely for the treatment and housing of the mentally ill. It would be unthinkable to fail to treat an inmate in the
9 APA Statement on Segregation of Prisoners with Mental Illness, 2012 10 Kupers, T., 2013, Isolated Confinement: Effective Method for Behavior Change or Punishment for Punishment’s Sake? The Routledge Handbook of International Crime and Justice Studies, page 4
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jail who had a broken leg. The same applies to those suffering from mental illness—they require treatment.
The consensus understanding shared with me is that 30% of the inmates in the Main Jail are mentally ill and are taking psychotropic medication. During my interviews of inmates in the jail I met with several individuals who were on psychotropic medications and who shared with me their mental health diagnosis and were on the mental health caseload but they were not housed in the OPP’s. Instead they were living in segregation on some type of segregation status. Others are undoubtedly scattered throughout the jail population. Both mentally ill inmates and non-mentally ill inmates were unanimous in the opinion that these two groups need to be housed in separate pods for the safety and well being of all concerned. I agree. When untreated mentally ill inmates are housed with non mentally ill inmates they are more likely to be victimized by other prisoners and more likely to struggle with the demands and challenges expected of inmates who are not mentally ill—which can sometimes erupt in disturbances and violence.
At the Main Jail there is a lack of sufficient number of OPP beds for men. OPP beds for men are housed in all or part of 3 pods in different units. OPP beds for women at the Main Jail are in two pods where they are mixed in with inmates on Administrative Segregation, Protective Custody and Total Separation. OPP beds for men at the RCCC are confined to one pod in the segregation unit and any women who meet the criteria for OPP at RCCC live in the segregation unit. Nowhere in either facility is there an opportunity for inmates to step-down from a high security treatment unit to a lower custody treatment or special needs unit where they would not suffer the restrictions associated with segregated confinement.
An unused advantage of the existing secure units in both jails is that the pods are relatively small. That means that different pods in the same unit can be used for graduated levels of placement and privileges for the mentally ill based on behavior and progress in treatment. This is especially possible at the Main Jail and
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likely possible at the RCCC. That is not the practice today but it is an opportunity. The design of the pods in the SCSD makes it possible to change current housing practices to provide for better treatment and protection of the mentally ill.
The SCSD should seek to concentrate the mentally ill in the same pods and units and infuse those units with additional mental health staff to share their operation in partnership with custody staff. Different pods for the mentally ill could provide for increased level of privileges based on the individual’s risk and treatment progress as determined by clinicians. This is a fundamental paradigm shift for jail officials but the powerful combination of mental health staff working together with the Deputies to manage the secure treatment units where mentally ill reside will result in dramatic improvements in behavior and treatment progress for the mentally ill. This should include mental health staff input into housing decisions base on the treatment progress of individual inmates. Medium and minimum-security treatment beds should be available to mentally ill inmates that do not require a more secure bed.
It is absolutely critical that custody staff assigned to mental health treatment units should receive additional training for this assignment and should not be rotated out of those units without the new officers first receiving similar training. This is not the practice today.
During my interviews with inmates I did not find a single prisoner who had individual (other than for medication management) or group sessions with clinicians. In my experience as a corrections administrator overseeing treatment programs for the mentally ill, treatment must include more than medication management and crisis intervention. JPS staff reported that in the past they provided group treatment but lost the resources to do so in 2009 during the global financial crisis. Inmates should regularly have individual out of cell sessions with a treatment provider and should participate in group therapy and psychoeducational programs.
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The consensus minimum standard for getting mentally ill inmates out of their cells in every jurisdiction that I am aware of that has faced this challenge through litigation is ten hours a week for individual and group treatment, plus ten hours a week for recreation, structured or unstructured. I recommend the SCSD establish these as requirements in their facilities. It is clear that such significant changes in treating the mentally ill in the SCSD jail will require more mental health and more custody staff.
The SCSD must establish in policy and in practice that their OPP’s are not segregation units but are treatment units. This will require both additional mental health and custody staff and a fundamental re-thinking of how those units are to be managed to decrease the risks to mentally ill prisoners. When revising that policy, the SCSD should require that mentally ill inmates should not be placed in segregation, absent exigent circumstances, similar to the current practices in the states of California, Arizona, Ohio, Pennsylvania, Massachusetts, New York and Colorado, to mention just a few jurisdictions where this is the policy driven norm.
Additionally, all inmates placed in any type of segregated housing should be assessed by a mental health professional prior to or shortly after a placement occurs to make certain the placement is not contra-indicated. Mental health staff should do rounds in segregation at least weekly to monitor inmates in segregation. Neither one of these routine and common correctional practices are in place in the jail today.
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HOUSING THE NON-MENTALLY ILL IN SEGREGATION
Dr. Craig Haney, a professor and attorney from the University of
California—Santa Cruz, who has been involved with several landmark cases
related to the impacts of inmates in segregation has said, based on the results of
several decades of research that,
There is not a single published study of solitary or supermax-like confinement in which non-voluntary confinement lasting for longer than 10 days, where participants were unable to terminate their isolation at will, that failed to result in negative psychological effects. The damaging effects ranged in severity and included such clinically significant symptoms as hypertension, uncontrollable anger, hallucinations, emotional breakdowns, chronic depression, and suicidal thoughts and behavior. Of course, it is important to emphasize that not all supermax prisons are created equal, and not all of them have the same capacity to produce the same number and degree of negative psychological effects.11
Writing specifically about the effects of segregation on the non-mentally ill,
Dr. Kupers has said,
It is predictable that prisoners' mental state deteriorates in isolation. Human beings require at least some social interaction and productive activities to establish and sustain a sense of identity and to maintain a grasp on reality. In the absence of social interactions, unrealistic ruminations and beliefs cannot be tested in conversation with others, so they build up inside and are transformed into unfocused and irrational thoughts. Disorganized behaviors emerge. Internal impulses linked with anger, fear and other strong emotions grow to overwhelming proportions.12
11 Haney, C. 2003, Mental Health Issues in Long-term Solitary and “Supermax” Confinement, Crime & Delinquency, 49 12 Kupers, T., 2013, Isolated Confinement: Effective Method for Behavior Change or Punishment for Punishment’s Sake? The Routledge Handbook of International Crime and Justice Studies, page 5
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Administrative Segregation The SCSD lacks a coherent policy that defines the reason and process that
inmates can be placed into Administrative Segregation. Based on best practices and emerging legal trends, the Segregation Policy must contain the following elements:
o A criteria and process for placing inmates in Administrative Segregation
o An assumption that, absent exigent circumstances, the mentally ill will not be housed in segregation
o A review by mental health staff review to determine any contra-indications.
o Regular rounds by mental health staff of segregation units.
o Periodic review of inmates in segregation to determine if it needs to be continued or if the inmate can be released to general population.
o A level system so that inmates in Administrative Segregation can achieve additional privileges for compliant behavior and participation in available programs.
o A limitation on Disciplinary Detention of no more than 30 days.
o Conditions of confinement that mirror best practices and current standards for inmates held in segregation.
The inference from these recommendations is that inmates in Administrative Segregation need to have incentives for positive behavior and need access to programs to help them gain control of their behavior. It is a simple carrot and stick approach. As behavior improves, so do privileges and the conditions of confinement. Like all of us, inmates respond to incentives. “Step-down” programs are common in segregation units throughout the country and both facility and
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community safety would be improved if the SCSD established them in their jails.13 In my own state, University of Washington researchers found that inmates
who had spent time in segregation had higher felony recidivism rates than those who did not. But more importantly, they found that inmates released directly from segregation to the streets were far more likely to reoffend, thus there is a clear public safety need for step-down programs to get inmates out of segregation before being released to the community.14
Cognitive Behavioral Therapy (CBT) is very frequently utilized in stepdown programs and is generally considered the most cost effective intervention.
Again to quote Dr. Kupers, In fact, when enlightened correctional managers devise programs in their prisons' supermax units whereby prisoners can earn incrementally greater amenities and freedoms by exhibiting acceptable behavior, and the increments are short enough and the required behaviors reasonable and attainable, most prisoners in isolation are willing to cooperate and earn their way out of "the hole."15
Many step-down programs for inmates in segregation begin group CBT sessions for inmates who require restraints when out of the cell. As the inmate progresses in the program there comes a time when restraints are removed. This allows the staff to test the inmate’s progress in a controlled environment before returning them to general population. The SCSD may want to consider this option for their step-down program.
13 Although not as robust, the Restoration of Competency program at the RCCC is closer to what a step-down program might look like. Corrections and mental health staff both told me that they consider it a success. 14 See Lovell, D., Recidivism of Supermax Prisoners in Washington State, Crime and Delinquency, September 2007 15 Kupers, T., 2013, Isolated Confinement: Effective Method for Behavior Change or Punishment for Punishment’s Sake? The Routledge Handbook of International Crime and Justice Studies, page 10
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I would note, however, that of the 24 inmates I interviewed, most of whom were in segregation, none of them required restraints when out of their cells to meet with me. While I was encouraged by this practice, it may simply reflect the reality that many of the inmates in the Sacramento jails do not actually require segregation.
Like programs for the mentally ill, step-down programs would require additional custody staff for the movement and supervision of inmates out of their cells as well as staff to deliver the program content. In my own jurisdiction, custody officers sometimes deliver the programs. This has a profound impact on the acceptance of the programs by other officers. Education and mental health staff also deliver the programs.
The SCSD should include in their Segregation Policy a process for placement and review of inmates in Administrative Segregation. The SCSD should establish a step-down program to assist inmates to earn their way out of segregation placement. As I explain later in this report, SCSD also needs to revise their Classification Policy to make a distinction between a classification score of maximum custody and segregation placement. General population maximum
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custody pods should be operated with more privileges and out of cell time than segregation pods.
Protective Custody and Total Separation While it is sometimes difficult to achieve, inmates who require Protective
Custody should have the same programs and privileges as general population inmates. A Protective Custody policy should establish this expectation. But my larger concern is with the practice of Total Separation.
In my experience the need for complete separation of one inmate from all others is very rare. It does occur but usually just a small handful of inmates ever meet this threshold. Keeping an individual separate at all times from all other inmates is a drastic limitation on normal social interaction that creates risk for the individual prisoners.
I recommend that SCSD create a separate policy that describes the process and criteria for placement of inmates into Protective Custody. After that policy and a new Segregation Policy are established, I also recommend they review the Total Separation population in an effort to reduce the number of inmates currently assigned to this category.
Disciplinary Detention Disciplinary Detention should be limited to a maximum of 30 days. Current
policy imposes this limitation but allows for it to be exceeded with the approval of the division commander. If an inmate requires segregation for more than 30 days they should be transferred to Administrative Segregation status so that the inmate can benefit from the programs described above.
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CONDITIONS OF CONFINEMENT IN THE SEGREGATION UNITS Unfortunately the conditions of confinement in the SCSD segregation units
today are very stark and violate contemporary standards. For example, regarding exercise and recreation for prisoners in segregated housing, the American Bar Association says,
Correctional authorities should provide all prisoners daily opportunities for significant out-of-cell time and for recreation at appropriate hours that allows them to maintain physical health and, for prisoners not in segregated housing, to socialize with other prisoners. Each prisoner, including those in segregated housing, should be offered the opportunity for at least one hour per day of exercise, in the open air if the weather permits.16
This is in stark contrast with the current policy in the SCSD jails, which allow recreation for all inmates, including those in segregation, only 3 hours per 7-day period. In my interviews with staff and inmates often times even this low standard is not met. Some inmates get out only one half hour a day and this includes their only opportunity to take a shower or make a phone call. I did not find an inmate at the Main Jail who told me they participated in outdoor recreation more than once a month. Very rarely do the inmates get to go outside, especially at the Main Jail, despite secure outdoor areas that are more than adequate.17
Today inmates in Disciplinary Detention are explicitly denied any recreation at all and this must be changed. Absent a specific and documented threat by an individual inmate, the opportunity of at least a full hour a day outside the cell and outdoors if weather permits should not be denied for any inmate. Time for a shower should be in addition to the hour out of the cell.
16 American Bar Association Standard, 23-3.6 17 The outdoor recreation areas at both jail locations are very good compared to those I have seen in other facilities. The Main Jail should consider interior fencing of their outside yards to create 2 smaller areas in order to allow more inmates access to the outdoor area.
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Today inmates in Disciplinary Detention are not allowed to make personal phone calls. This should change as well. Maintaining contact with family and friends is a known protective factor and is associated with reduced recidivism.
In the Main Jail the windows of the cell doors in the disciplinary pod are all covered with a flap. Apparently this modification was done as an overreaction when some inmates attempted to throw liquids and bodily fluids at the staff. The unfortunate result is that the isolation in those cells is even more profound as there is no view into the dayroom from the cell itself. These flaps should be removed and SCSD should manage individual inmates who throw or attempt to throw by using a freestanding cell shield, a common practice in multiple jails and prisons around the country.
For inmates held in all types of segregation there is a notable lack of activities to help inmates improve their behavior and to help them manage the burden of so much idle time. Books are hard to come by in the SCSD segregation units (except for the units for females who appear to be getting a level of service that the men should receive as well). The SCSD should expand their source of books for prisoners, including connecting with volunteer organizations that will collect and bring them to the jail. This is a very common practice at jails and prisons around the country and though there are obvious security concerns, other jurisdictions have found solutions. This would go a long ways towards improving the conditions of inmates in the SCSD segregation units.
During my interviews with inmates I used a prepared list of questions to interview the inmates. Nearly every inmate that I interviewed at the Main Jail raised issues that were not on my list of prepared questions. One of those issues came from inmates who were in Disciplinary Detention or recently had been. They universally told me that upon their first entry into the Disciplinary Detention cell that they were dirty, sometimes contained smeared feces, and that they were not allowed access to cleaning supplies until they demanded them. In most cases it took considerable time for cleaning supplies to be provided. Also, and again not
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on my prepared list of questions, they all told me that they had to wait a few days to receive a mattress. Multiple inmates informed me, again without me asking, that food is sometimes withheld as punishment for inmates in Disciplinary Detention.
To the extent that these are actual practices at the jail, they should cease. Properly trained inmates can clean any cell and should be employed to do so, even in a segregation unit. No inmate should go without a mattress as a matter of routine practice and food should never be withheld as punishment. It is likely that if this is happening it is a result of inadequate staffing and supervision of the segregation units in the Sacramento County Jails. The staffing levels in the segregation units are so low (including the supervisory levels) that Deputies struggle to meet the demands of current policy requirements. For those requirements to expand in order to improve the conditions of confinement for the mentally ill and the non-mentally ill in segregation, there must be an increase in custody staffing and better supervision for those units.
The SCSD needs to establish in their Segregation Policy conditions of confinement that mirror best practices and current standards for inmates held in segregation. The county will then need to staff the segregation units with enough employees to meet these standards.
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CORRECTIONAL POLICIES AND PRACTICES The lack of a consistent correctional administrative staff overseeing the jail
does not give their overall policy structure the importance it deserves. In fact, due to the frequent movement of jail administrators and line staff between patrol and jail responsibilities, the existence of policies that are explicit, current and audited are even more critical for the safe, secure and constitutional operation of the jail. I recommend that a civilian staff member be assigned the responsibility for reviewing and updating all the SCSD jail policies and be assigned that responsibility on an ongoing basis.
This section will not be a comprehensive review of all SCSD policies. Instead I focus my comments on areas where policies should be reviewed and updated to accommodate for the needs of the mentally ill and the inmates housed in segregation.
Segregation Policy The Segregation Policy must be revised to be consistent with the discussion
and recommendations I make in an earlier section of this report.
Protective Custody and Total Separation SCSD should create a separate policy that describes the process and criteria
for placement of inmates into Protective Custody. After that policy and a new Segregation Policy are established, I also recommend they review the Total Separation population in an effort to reduce the number of inmates currently assigned to this category.
Classification Process The SCSD makes the mistake of conflating a maximum or high security
classification score as requiring the same conditions of confinement as a
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segregation unit. This is significant error on their part and reflects a lack of understanding of effective corrections practices. Some inmates who score maximum custody on a classification instrument can also do well in a maximum custody general population unit. However, a maximum custody general population unit requires a level of staffing that the SCSD currently does not have, explaining, I believe, why the maximum units are basically operated too much like segregation units. While maximum custody units allow less freedom of movement and privileges than medium or minimum units, they typically allow much more than a segregation unit, for example having access to the dayroom during most of the regular waking hours. Doing so avoids the risks associated with segregated confinement for a population who does not need that level of security. In a well functioning system, inmates who wind up in segregation have demonstrated specific behavior(s) or have a documented risk that requires such secure confinement, not simply because they scored maximum custody on a classification instrument. The SCSD must revise their Classification Policy and prohibit any inmate from being placed into segregation based solely on their classification score.
Officials at the RCCC from top to bottom were adamant that the Northpointe classification product currently in use at both jails does not work for them. They described the need for overrides of the instrument as much as 50% of the time. Reportedly the instrument does not account for gang membership, a major management issue for any incarcerated population in the State of California. One Deputy told me that about a year ago about 18% of the inmates housed in the minimum units at RCCC actually scored maximum custody. If accurate, this is a clear issue of potential liability for the county and deserves a much closer look. I recommend that the SCSD bring in an outside expert to interview staff at both jails to see how their classification system could be improved.
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Inmate Discipline Plan I make three recommendations regarding the current SCSD disciplinary
policy: 1. The current policy makes no accommodation for attention to the nexus between behaviors that might result in a disciplinary violations and a prisoner’s mental illness. To state it as simply as possible, inmates should not be punished for symptoms of their mental illness. The current policy should change so that any inmate on the mental health caseload who has received an alleged disciplinary violation has that allegation reviewed by mental health staff before the hearing occurs. The review needs to be documented in writing and include whether or not the mental illness was related to the alleged violation behavior and if there are particular sanctions that the Hearing Officer should avoid if the inmate is found guilty so that the inmate’s mental illness will not be exacerbated. That written report should be shared with the Hearing Officer and included as part of the final disciplinary report. Consideration of the information from mental health, including how it was considered, must be included in the Hearing Officer’s disposition of the hearing. If the guidance from mental health was not followed, Hearing Officers must explain in writing why it was not followed. 2. Currently Sergeants in the SCSD jail conduct disciplinary hearings. This impacts the workload of a group of staff that is already stretched too thin to adequately supervise the line staff who run the jails. Additionally, the legal requirements of the disciplinary process continue to grow in complexity, such as the first recommendation I make in this section. I strongly recommend that the SCSD establish one Hearing Officer for each jail site. Doing so will bring greater consistency to the process and allow the Sergeants to provide better supervision of the line staff and will help make sure that policy compliance is being achieved. I
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see no reason that such full time positions need to be fully commissioned Deputies. I recommend civilian staff fill these positions. 3. Current policy allows that a disciplinary diet, “the loaf”, as a potential sanction for, “major violations of institutional rules”.18 This is wrong. Any reference to a disciplinary diet should be removed from the disciplinary policy. Contrary to what their current policy suggests, it does not work to modify behavior and serves no legitimate penological objective. Food should never be withheld as punishment. An alternate diet should be available for inmates who act out by throwing food or misusing eating utensils but that alternate diet is typically a sack lunch with no utensils and is authorized only as long as necessary to control the inmate’s behavior. An alternate diet must be authorized by a supervisory staff member, include a medical and mental health review and be reviewed every 24 hours to see if it is still necessary.
Use of Force, CERT and Cell Extraction Procedures While the current Use of Force policy would benefit from a comprehensive
review to bring it up to date with similar policies that have been litigated in the 9th Circuit, I will address the most glaring omissions here. While the current policy does make reference of the need to de-escalate the level of force, there is insufficient detail regarding what the de-escalation needs to look like when dealing with a mentally ill inmate and there is an insufficient review to make sure there is compliance with that practice.
Absent an imminent threat of physical harm to a person or a threat so serious that an escape from the facility might be possible, physical force should not be used against a mentally ill person without first attempting to de-escalate the situation. In a planned use of force, such as a cell extraction, there should be a
18 SCSD Operations Order, Inmate Discipline Plan, IX
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required cooling down period and a structured attempt by mental health staff to attempt to de-escalate the need for use of force.
In another jurisdiction, in a facility larger than the SCSD, I made this same recommendation to the judge a couple of years ago and the judge ordered it be implemented. I have recently reviewed records for that facility for compliance with this policy requirement. My review showed that 60% of the times that mental health professionals conducted de-escalation attempts no use of force was required. Any day officers don’t have to put their hands on an inmate is a good day in corrections.
Policy should be amended so that supervisory reviews of use of force reports specifically examine to see if an attempt to de-escalate a potential use of force with a mentally ill inmate was attempted.
I recommend that the cell extraction portion of the policy on CERT and Cell Extraction Procedures be moved to the policy on Use of Force. Keeping this information in separate policies creates the possibility that, over time, the language become disconnected and conflicting. A better practice is to include it all in the same policy.
The Use of Force policy must include a definition and a protocol for a planned use of force. The protocol must require that a hand held video camera document any planned use of force. Video evidence of a planned use of force and supervisory reviews of those videos and related paperwork must be required to ensure that unnecessary or excessive use of force incidents are not occurring in the jail.
Use of Restraint Devices The policy needs to be revised to include more involvement of mental
health staff for inmates on the mental health caseload. Current policy requires the involvement of the psychiatrist or designee only for inmates in the Acute
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Psychiatric Unit. I recommend this requirement be expanded to apply to all inmates on the mental health caseload.
Current policy says that spit nets may be used “when appropriate”.19 I recommend additional detail be included in the policy to clarify when it is appropriate to use a spit net.
Employee Conduct Policy and Prisoner Services I am concerned about the following language in the Employee Conduct
Policy, “Non-sworn personnel will not intervene in any prisoner versus prisoner or prisoner versus sworn staff dispute”.20 To the degree that this language could be construed to silence mental health or medical staff from representing the interests and needs of inmates, it is problematic. I recommend this language be removed from the policy or clarified to not silence mental health or medical staff from expressing concerns based on their professional judgment.
There is similar language in the Prisoner Services policy, “Social workers will not intercede with security or logistics considerations within the facility.”21 For the same reasons referenced in the above, I recommend this language be removed or clarified.
19 SCSD Operation Order 2-02, Use of Restraint Devices-III. A. 1. b 20 SCSD Operations Order 1-03, Employee Conduct--III. C. 1 21 SCSD Operations Order, 8-06, Prisoner Services--II. C.
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SUICIDE PREVENTION MEASURES
It is my understanding that Dr. Gage was also tasked with reviewing this issue and any comments I make on current on the current policy and practice should be tempered by his conclusions on the subject.
A recent study of suicides and suicide attempts in the New York City jail said, “We found that acts of self-harm were strongly associated with assignment of inmates to solitary confinement. Inmates punished by solitary confinement were approximately 6.9 times as likely to commit acts of self-harm”.22 Given the overuse of segregation in the SCSD this is clear evidence of the importance that jail officials pay attention to the risk of suicide segregation can create.
SCSD officials have informed me that their rate of completed suicides have gone down over the last decade due to additional staff training, a critical component of any suicide prevention program, and the removal of items such as sheets and tube socks from authorized inmate property. According to JPS administrators they frequently receive referrals from concerned Deputies in all parts of the jails, from the court and from a hotline that family members can call. These are important accomplishments and should not go unnoticed. However, any policy can be improved and the SCSD’s policy on suicide prevention is no exception.
The current policy lacks specific detail regarding the frequency and authority for the timing of checks of inmates on suicide watch. Dr. Lindsay Hayes, one of the country’s foremost authorities on prevention of suicides in jails and prisons, recommends two levels, close observation and constant observation.
1. Close observation is reserved for the inmate who is not actively suicidal but expresses suicidal ideation (e.g., expressing a wish to die without a specific threat or plan) or has a recent prior history of self-destructive behavior. In addition, an inmate who denies suicidal
22 Venters, et al, Solitary Confinement and Risk of Self-Harm Among Jail Inmates, Research and Practice, American Journal of Public Health, March 2014
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 31 of 45
ideation or does not threaten suicide but demonstrates other concerning behavior (through actions, current circumstances, or recent history) indicating the potential for self-injury should be placed under close observation. Staff should observe such an inmate in a protrusion-free cell at staggered intervals not to exceed every 10 minutes (e.g., 5, 10, 7 minutes).
2. Constant observation is reserved for the inmate who is actively suicidal, either threatening or engaging in suicidal behavior. Staff should observe such an inmate on a continuous, uninterrupted basis. In some jurisdictions, an intermediate level of supervision is used with observation at staggered intervals that do not exceed every 5 minutes.23
I recommend that SCSD adopt these or similar definitions and change their policy accordingly and that the decision of which type of observation is necessary in an individual case, as well as the conditions under which the observation occur, be the authority of mental health, not custody staff. The current policy is not clear on these issues.
I also observed and was informed that the secure classrooms in each unit of the Main Jail are sometimes used as watch cells. In my opinion this practice should cease for two reasons. First, this location is in clear view of many inmates and staff in the living units and creates the possibility for personal observation and humiliation of an inmate experiencing a serious mental health crisis. During my first inspection of the jail I witnessed a woman in a suicide smock in a mixed gender unit, in full view of male inmates in some pods and by anyone walking through the unit. Second, this is premium space for program activities. The priority and sole use of this space, absent a significant emergency, should be reserved to provide additional program opportunities in the unit.
23 Hayes, L., Guide to Developing and Revising Suicide Protocols Within Jails and Prisons © 2013 National Center on Institutions and Alternatives
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 32 of 45
CUSTODY STAFFING IN THE JAIL The dangerously low custody staffing levels of the jail has been the subject
of multiple studies and reports in the past 10 years. I want to emphasize that these reviews did not contemplate expanding the duties of the officers in order to provide for better supervision and treatment of the mentally ill and inmates held in segregation. Instead, they focused on establishing sufficient staffing levels to simply meet the minimal requirements of the policies in place at the time.
In 2006 the Braun Study found, “Concerns were identified regarding insufficient staffing levels, supervision and security in jail facilities”.24 The primary concerns of this study were for the Honor Farm section of the RCCC and the vacancy rate at both jails. While the vacancy rate is no longer a problem I have serious concerns about staffing at the RCCC and especially at the Honor Farm section of that part of the facility.
Shortly thereafter the county conducted their own internal study of the staffing needs of their jails. The study contained many recommendations, including the following staffing needs that remain largely the same set of problems that exist for the jails today:
• Increase the Deputy staffing on the Honor Facility
• Increase the Deputy staffing in maximum security
• Increase the level of supervision, particularly in maximum security
• Increase the Deputy staffing in the medium security facilities
• Increase the Deputy staffing in SLF (Sandra Larson Facility)
• Increase the Deputy staffing available for emergency medical runs
24 Sheriff’s Department Assessment, Executive Summary and Key Findings and Recommendations, Joseph Brann & Associates, LLC, page 7
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• Increase the Deputy staffing level to ensure that relief can be provided to critical assignments25
Although this internal study made most of these recommendations about the RCCC, I believe that they all apply to both facilities today
During my interviews with jail administrators they described a significant reduction in the number of Deputies assigned to the jails as a result of the global financial crisis of 2008. The impacts of those reductions were detailed in the 2011 Sacramento Grand Jury report. Their report regarding the main jail said:
Budget cuts have had a severe impact. In the past two years, 139 full-time staff positions were eliminated, including 122 Deputy positions. Currently, only 38 Deputies are available per shift; this is a ratio of 1 Deputy for 63 inmates. Staff shortages and Deputy reassignments back to the jail cause safety issues and low morale, along with the increased use of sick leave.26
That report goes on to describe the impact of similar reductions at the RCCC and highlights concerns about staffing in the maximum security units, the lack of a roving response team and the increasing number of gang members housed in the minimum security section of that facility.27
While I understand and agree with the conclusions made by both external and internal studies that the RCCC is dangerously understaffed, I believe previous work on staffing levels has not emphasized that serious custody staffing deficits also exist in the Main Jail as well. The result is that inmates confined at both jails, especially those in some level of segregated confinement, experience conditions that are likely to cause harm for some inmates and create dangerous working conditions for the staff.
25 Sacramento County Sheriff’s Department, Staffing Analysis for Corrections, pages 43 & 73 26 Sacramento County Under Duress: Problems and Opportunities, Superior Court of Sacramento Grand Jury, January 12, 2011, page 3 27 ibid, page 4
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 34 of 45 The conditions described in this report for inmates in segregation are being driven by the lack of Deputies assigned to supervise those units. In my inspections and interviews for this report I found no lack of understanding of the need to get segregation inmates out of their cells more frequently and of the need for programs for this group. But given today’s level of staffing they struggle to meet even the miniscule demands of their current policies, for example, time out of cell for exercise and recreation. Absent a dramatic reduction in the total population of the SCSD jails with the staff re-deployed to respond to these issues, there is no way for the jail to implement the changes necessary and come into compliance with humane and constitutional practices for inmates held in segregation without a significant increase in Deputy staffing levels.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 35 of 45
STAFFING RECOMMENDATIONS Staffing in correctional facilities is driven by 2 primary factors. One is the
design of the physical plant and the second is the custody level of the inmates. Generally speaking, minimum-custody inmates require less physical plant control and fewer staff. Medium custody inmates require more of both. Maximum custody inmates require more secure housing units and more staff to monitor the activities of the inmates. Special populations such as inmates and those in OPP status also require more staff because of the need to get them out of their cells with proper supervision during clinical encounters, programs and recreation time. My recommendations for custody staffing are consistent with these principles.
As I said earlier in this report, it is possible that implementing a new Housing Plan that houses like inmates in the same units or pods could reduce the need for some of these additional staff. However, the staffing recommendations in this report are based on the current Housing Plans in the 2 jail locations. They assume the present configuration of the type of inmates housed in the living units remains the same. I strongly recommend that the SCSD consider implementing a new Housing Plan in order to achieve efficiency in staffing the living units in the jail.
For example, at the Main Jail, there are 5 pods that houses maximumsecurity inmates in five different units and in 2 pods in another unit. If some of these maximum-security inmates could be consolidated in fewer units there would be less need for additional staff.
Similarly, at the Main Jail there are male OPP beds in 2 different units. Consolidating them into one unit would save some of the need for additional staff.
Like the males, the female OPP’s and segregation inmates in the Main Jail are spread between 3 pods in 2 different units. It may be possible to reduce the need for some of the recommended Deputy increases if those units could be “resorted” to create one without OPP or segregation inmates.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 36 of 45
At the end of this report I have included revised rosters for both jail locations for day and night shifts and well as for the weekend but they are based on the current Housing Plans. It is likely that if new Housing Plans were implemented the specific additions to staff that I recommend would at least shift their location, if not be reduced. The principles embedded in the narrative of this report should be applied whether or not a new Housing Plan is implemented.
Deputy Staffing Recommendations: OPP’s—The OPP’s have no dedicated Deputy staffing today. For regular individual and group therapy programs to be established in each unit that contains OPP inmates, it will require an additional 2 Deputies during program hours to assist with the escort and supervision of inmates. The direct supervision unit design at both jail locations needs to finally be utilized so that the Deputies are stationed in the units when inmates are out of their cells. Segregation Units—The segregation unit Deputy staffing today has one officer in the booth and 2 on the floor at the Main Jail. Deputies and supervisors report that one of these officers is gone to respond to other jail duties and emergencies about 90% of the time. This is not an acceptable practice and the expectation must be that the 3rd officer is available to perform the duties required in the unit. Deputy staffing in the RCCC segregation unit is 1 in the booth and 2 on the floor. These staffing levels are not sufficient to regularly accomplish the duties currently required today.
For a step-down program and increased out of cell time to be implemented the staffing in the segregation units must add 2 officers on the floor in the Main Jail and RCCC segregation units during the day shift.
Some units contain segregation pods and OPP pods. Dedicated Deputy staff must be added for both functions to ensure adequate out of cell time can be achieved. For example, currently 7 West has OPP and segregation inmates in the same units and the same pods. For that reason I recommend 2 additional Deputies
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 37 of 45
to perform the functions associated with segregated inmates and 2 additional Deputies to perform the functions associated with the OPP inmates during the day shift. The same is true for CBF at the RCCC. RCCC Barracks—These units are medium security and lack the structural and physical plant controls necessary for this population. Today a single Deputy supervises them. I recommend staffing be increased to 2 in each unit for the safety of the staff and the inmates. RCCC Honor Units—The level of sophistication of the inmates living in these barracks and the physical plant makes for a potentially volatile situation. I recommend that 2 officers be added per shift to constitute the roving response team called for in the previous mentioned Grand Jury report. Acute Psychiatric Unit—Current Deputy staffing for this unit is for coverage 8 hours a day. For safety of the prisoners it needs to be increased to 24 hours a day, 7 days a week. On the day shift there should be a second officer added so that this group of inmates can get out of their cells to participate in therapy, programs and increased opportunities for recreation. Sergeant Supervision—Accountability in a correctional facility is a combination of good policies, good supervision and good training. The Sergeants that supervise the segregation units and OPP’s in the SCSD are stretched too thin to provide proper oversight and direction to the Deputies. Currently Sergeants are assigned multiple units to supervise. In order to implement the changes recommended in this report a dedicated Sergeant must be assigned for each segregation and OPP unit that the jail operates. If there are OPP’s, segregation inmates or a combination in a unit, those units need Sergeant supervision 24 hours a day, 7 days a week.
Today, at the Main Jail there are two Sergeants assigned to supervise all of the living units. One Sergeant has booking and the units on floors 2-5. The other Sergeant has the units on floors 6-8. As I have said throughout this report, the critical needs of the OPP and segregation populations require closer supervision of the officers than they currently receive. But, the current Housing Plan makes
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 38 of 45
determining recommendations for Sergeants more difficult. It is clear that the programs currently offered on the 3rd, 7th and 8th floors at the Main Jail demand a dedicated Sergeant for each floor for a total of 3 new Sergeants on both the day and night shifts.
At the RCCC unit CBF should have 1 dedicated Sergeant on both the day and night shifts.
I recommend that a total 8 Sergeants be added to provide for proper supervision of both jails. Emergency Medical Trips and Hospital Watch—By all accounts and by the data there are an insufficient number of Deputies on duty to manage unscheduled but predictable emergency medical runs at the Main Jail.28 Jail administrators and Deputies report that with great frequency Deputies are pulled away from their mandatory posts in living units or overtime is used to provide escort for emergency medical trips and inmates who need to be seen in an emergency room or outside hospital. I witnessed such emergencies during my tours of the jail. If the officers are not available to supervise the unit, inmates will be left in their cells, exacerbating the problems that this report is trying to correct. Typically, adding full time employees to handle these unscheduled events can reduce costs.
The data about the frequency and cost of these emergency medical runs has been collected and shared with me from April of 2015 through March of 2016. This data reveals a monthly high in January of 2016 of 1,479 hours of straight time at the Main Jail. The monthly high for overtime costs at the Main Jail (which are paid at time and a half) is 2,101 hours. The lowest number of hours per month for emergency medical runs is 557 hours at straight time in September of 2015 and 183 hours of overtime in February of 2016.
Depending on the jurisdiction, a full time employee usually works and is budgeted between 170 and 180 hours per month. It is very clear that adding some additional Deputies for emergency medical runs would be a wise move for the 28 The data shows this is not currently a problem at the RCCC.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 39 of 45
county. Even at the lowest number of hours required in the last year there is sufficient justification to add additional Deputies on a full time basis. I recommend that 2 additional Deputies be added on the day shift at the Main Jail 7 days a week. Even at 180 hours for each Deputy, an additional 2 will cost well below the September 2015 low-end total of 557 hours a month and will reduce the need to pull Deputies off the floor of the living units.
The Main Jail cannot routinely continue to take officers off of the floor and send them on these runs. Today it puts the Deputies that remain behind without proper backup at risk. It makes it impossible to properly supervise the inmates and keep the inmates or the Deputies safe. Failing to add additional Deputies for emergency medical runs will make it impossible to achieve the primary objectives of this report to get the OPP and segregation inmates out of their cells for treatment, programs and recreation.
I further recommend that the jail continue to track the emergency medical runs after these Deputies are added to determine if additional Deputies might also be added to further reduce costs.
Civilian Staffing Recommendations Hearing Officers—I recommend that one full time civilian hearing officer be assigned to each jail to conduct inmate disciplinary hearings. Policy Support—I recommend that one full time civilian employee be added whose sole function is to maintain jail policies so that they are current and regularly updated to remain consistent with current standards. Classification—I recommend the county consider adding civilian staff to perform classification duties at the jails. While the Deputies I met who are doing classification are hardworking and knowledgeable of the process and overall operation of the jails, these are functions that can be and are performed by civilians in other jurisdictions. It is likely that civilian employees assigned to perform classification duties would, over time, add a level of consistency to this important
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 40 of 45 process particularly maintaining the integrity of a revised Housing Plan and would avoid the disruption that occurs when Deputies are transferred from jail to patrol duties.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 41 of 45
POLICY AND PRACTICE RECOMMENDATIONS 1. Establish in a new Segregation Policy:
o A criteria and process for placing inmates in Administrative Segregation
o An assumption that, absent exigent circumstances, the mentally ill will not be housed in segregation
o A review by mental health staff review to determine any contra-indications.
o Regular rounds by mental health staff of segregation units.
o Periodic review of inmates in segregation to determine if it needs to be continued or if the inmate can be released to general population.
o A level system so that inmates in Administrative Segregation can achieve additional privileges for compliant behavior and participation in available programs.
o A limitation on Disciplinary Detention of no more than 30 days.
o Conditions of confinement that mirror best practices and current standards for inmates held in segregation.
2. Revise the Classification Policy to prohibit placing inmates into segregation based solely on their classification score.
3. Engage an independent classification expert to review the current classification instrument to make sure it is useful for the RCCC.
4. Create a new Housing Plan that houses like inmates with like inmates. This will likely reduce the impact of my recommendations for Deputy staffing and provide better treatment environments for the mentally ill.
5. As part of that Housing Plan, concentrate the mentally ill in treatment units that are operated by both custody and mental health staff that
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include incentives and programs that lessen the impact of segregation and allow inmates to gain additional privileges based on improved behavior and progress in treatment. Individual and group counseling should be provided. Inmates should receive ten hours of week out of cell treatment and ten hours a week of recreation with the opportunity to earn more time out of cell.
6. Provide Crisis Intervention Training (CIT) and training in managing mentally ill inmates prior to assigning Deputies to those units
7. Create a step-down program for non-mentally ill inmates that include incentives and programs that lessen the impact of segregation and allow inmates to gain additional privileges and out of cell time based on improved behavior and program participation.
8. Create a policy that describes the process and criteria for placement of inmates into protective custody that provides for the same conditions of confinement as inmates in general population, whenever possible. Review the Total Separation population in an effort to reduce the number of inmates currently assigned this category.
9. Improve conditions of confinement in segregation to include:
a. The opportunity for exercise out of the cell and outdoors when weather permits 7 days a week for all prisoners with the opportunity to earn additional hours
b. Allow phone calls for all inmates in segregation, including Disciplinary Detention
c. Remove the flaps on the doors of segregation cells d. Provide additional reading material to inmates e. Allow inmates to have radios with headphones in
their cells f. Establish procedures so that cells are searched and
cleaned prior to placement of an inmate in the cell.
10. Stop using the classrooms in the Main Jail as watch cells.
11. Revise the Disciplinary Policy to involvement mental health in the hearings process.
12. Do not allow food to be used as punishment and eliminate “the loaf” as an alternate diet.
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 43 of 45 13. Revise the Use of Force Policy so that, absent an imminent threat, to
require an attempt to de-escalate the situation for inmates on the mental health caseload prior to authorizing use of force against mentally ill inmates. Add a protocol for planned use of force situations including the use of hand held video cameras to document the event. Move cell extraction procedures to the Use of Force Policy. 14. Revise the Use of Restraint Devices policy to involve mental health staff in decisions regarding restraints. 15. Provide additional clarity about when spit masks are appropriate.
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CONCLUSION Once again I will say the SCSD is to be commended for confronting the
problems of the mentally ill in their jails and the overuse of segregated confinement but these problems cannot be solved within current resources. Increases in mental health staff, as recommended by Dr. Gage, and increases in Deputy staffing of the jail must occur if change is to be successful.
But adding more staff will not be enough. Success in treating the incarcerated mentally ill comes when custody staff and mental health staff work together. This requires confronting the problem of the frequent movement of jail administrators and line staff between jail and patrol responsibilities. Consistency can be improved by adding some civilian staff to the jail, increasing line level supervision, keeping policy and procedures current with national standards and making sure custody staff are properly trained to work with mentally ill inmates.
The question of funding is absent from this report and so is not addressed. However, the solution found in other jurisdictions is to closely examine the jail population in an effort to finds ways to reduce the numbers currently confined so that the total population can be reduced and resources redirected to improve services. Sentencing alternatives and mental health courts have strong records of achieving success in other jurisdictions and should be explored by Sacramento County officials.
I was also recently informed that the County has contracted with Carter Goble Lee (CGL) to conduct a comprehensive study of the current criminal justice system. That study is expected to produce specific recommendations on policies that could be reasonably implemented to significantly reduce the current jail population. Specifically policies and programs that would reduce the size of the pretrial population, sentenced inmates and ICE inmates now housed under a contract with the Department of Justice. These recommendations, if implemented, would serve to reduce the current shortage in security staff now assigned to the jail
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Case 2:18-at-01259 Document 1-2 Filed 07/31/18 Page 45 of 45 and the need for medical and mental health staff to manage these special populations.
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 Case 2:18-at-01259 Document 1-6 Filed 07/31/18 Page 1 of 23
Evaluation of the Sacramento County Jail Inmate Classification and T-SEP Systems
Prepared by James Austin Emmitt Sparkman Robin Allen
May 2017

Case 2:18-at-01259 Document 1-6 Filed 07/31/18 Page 2 of 23
Introduction
Dr. James Austin was asked to assess the Sacramento County Jail inmate classification system and the T-SEP (or Total Separation) housing system. The larger inmate classification system is used to house prisoners within the jail’s general population. Inmates are typically scored on a number of objective factors that are related to the current charges/offenses, prior criminal record, escape history, prior institutional conduct, demographic (age and gender), and several stability factors (education, residency, employment). Inmates assigned to the T-SEP status are so assigned based on other security factors that are intended to identify and house inmates who pose a significant and on-going threat to other inmates, staff and perhaps themselves.
There are two dominant jail classification systems that are operational within the U.S. One is referred to as the National Institute of Corrections (NIC) Objective Jail Classification system (OJC). It is based on the NIC prison classification system, which is the dominant inmate classification system in the U.S. All but two state prison systems have a version of the NIC objective prison classification system. The NIC Objective Jail Classification is an additive point system that is used for both initial and reclassification purposes. A system of over-rides is used to depart from the scored system. Because the NIC system was developed by NIC, there is no cost to the agency to implement it. A correctional agency is also able to customize the factor’s weights, scale, and over-ride factors. Versions can also be developed for male and female inmates based on validation results.
The other jail classification system was designed by the Northpointe company and is known as the decision-tree model. While using many of the same factors found in the NIC system, the format for scoring an inmate is much different. As the name implies, rather than using an additive point format, the Northpointe system uses a decision-tree format. The important difference is all the scoring items are not used in each assessment. Rather, only those items needed for each security level are sequentially applied. The early version of the Northpointe system had no reclassification component. Finally, because the system is owned by Northpointe, the user is not allowed to make any changes or customize the instrument. Also, no models have been developed specifically adapted for female inmates.
Part of the inmate classification and housing system is what is referred to as the T-SEP (or Total Separation) housing unit where inmates are confined to single cells for extensive periods of time. At the time that study was initiated on January 11, 2017, there were approximately 172 inmates assigned to TSEP at the Main Jail out of 3,948 inmates (or about 4%). Significantly, by the end of April 2017 the T-SEP population had declined to 120. There is a much smaller T-SEP unit at the Rio Cosumnes Correctional Center (RCCC) which houses about 15-16 T-SEP male inmates at any given time
The concept of “T-SEP” is unique to Sacramento County. In other jail and prison systems, inmates who are classified as highly disruptive, a threat to other inmates or staff are typically
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assigned to the status of “administrative segregation”. In this status, they are separated from the general population and receive limited access to recreation, showers, services, visits and other aspects afforded other inmates.
The remainder of this report summarizes the evaluation results of these two separate, but closely related classification and housing systems.
T-SEP Evaluation
Although inmates assigned T-SEP are also housed at the RCCC, the main focus of this assessment was the Main Jail. A site visit was made to the RCCC but no inmate interviews were conducted. It is noteworthy that the RCCC T-SEP unit operates differently than the Main Jail TSEP unit in regard to out of cell time. At the RCCC unit, inmates are offered daily time out of their cells in the one to two hour range. As described below the Main Jail out of cell time is much more restricted.
In evaluating the Main Jail T-SEP program three site visits were conducted at the Main Jail where most of the T-SEP inmates are housed on the 7th and 8th floors. During these site visits, structured interviews were conducted with a random sample of inmates assigned to the units. Interviews were also conducted with staff responsible for and assigned to the T-SEP Units. The evaluation also included touring jail areas, observing jail operations, and, reviewing policies/documents. A TSEP Inmate Interview Questionnaire was developed and utilized for all the inmate interviews. Dr. Austin and Emmitt Sparkman, an associate of Dr. Austin, conducted all of the inmate and staff interviews.
Assisting in the inmate interviews were Sheriff Deputies Cristine Jackson and Richard Dunlap (Compliance Officer). Either one or both were present for all inmate interviews that were conducted in a private setting. Both were very helpful in ensuring access to the T-SEP Inmates, touring needed areas of the Main Jail, providing jail operation information, and obtaining documents/policies needed for the assessment. All inmates who were interviewed walked from their cells to the interview room unescorted and without any restraints.
The Sheriff’s Department, County of Sacramento, Operations Order Classification identifies TSEP as Special Housing used to house inmates at the Main Jail or RCCC. Inmates assigned to TSEP have special separation needs per Sheriff’s Department Operations Order 6/2-Housing. State of California Title 15 Minimum Standards for Local Detention Facilities establishes the guidelines for operation of the Sacramento Main Jail including T-SEP.
T-SEP Attributes
The Sacramento Sheriff’s Department provided a data file of all prisoners who were classified as a T-SEP inmate as of January 11, 2017at the Main Jail. That file contained 172 inmates. Of that number, eight inmates had been released by the time the site visits were initiated. There were another four inmates where the key data elements were incomplete. Table 1 shows the key
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attributes of the 162 T-SEP inmates for which there were complete data. The key attributes of the T-SEP inmates at the Main Jail can be summarized as follows:
1. Primarily male (92%);
2. Largely Black (47%) followed by White (29%) and Hispanic (20%);
3. Average age of 36 years with the youngest being 18 years and the oldest being 81 years;
4. The average total amount of time served in the jail system, including time in T-SEP, to date was 262 days with a median time served to date of 166 days;
5. There was one T-SEP person who has been in custody in the jail for over six years and over 5 years in T-SEP housing;
6. In terms of time in T-SEP status, the average time served was 180 days with a median of 106 days;
7. Overall, Main Jail T-SEP inmates have spent 73% of their jail time in a T-SEP housing unit; and,
8. 41 (25%) of the T-SEP inmates have spent their entire period of jail time in a T-SEP unit.
By way of comparison the RCCC T-SEP male inmates had much shorter periods of time in the jail (average of 196 days and a median of 55 days) and in T-SEP status (average of 48 days and median of 26 days). Based on the interviews with staff, the RCCC T-SEP inmates tended to be those who manifested management issues at the RCCC after being admitted to the jail system and not at admission.
Table 1 also shows the mental health status of the T-SEP population. The University of California, Davis is responsible for providing mental health services for the Main Jail inmates including those on T SEP status. The UC Davis staff use the following four FOSS Levels to assess an inmate’s mental health status:
FOSS 1: Anyone who is in Inpatient Psych (2P) or is in a classroom or safety cell awaiting admission to 2P. They are seen daily by a qualified mental health professional;
FOSS 2: These patients are seen every 30 days or less by a qualified mental health professional. Most have a diagnosed mental illness;
FOSS 3: These patients are seen every 90 days or less by a qualified mental health professional. Most are on some sort of psychotropic medication and need occasional ongoing follow up; and,
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FOSS 4: Those that are open to JPS, but aren’t actively being seen or treated.

Most (54%) T-SEP inmates are assessed at the FOSS 3 level with 15% at the higher FOSS 2 level. There was only one inmate who was assessed at the highest level of mental health care.

Table 1. T-SEP Population January 11, 2017

Attribute Total Gender
Male Female Race White Black Hispanic Other Age Average Youngest Oldest Time In Custody Average Median More than 1 yr. Longest Time Time in T-SEP Average Median More than 1 yr. Longest Time % of Jail Time in T-SEP Inmates 100% in T-SEP FOSS Level
1 2 3 4 Other

Inmates 162

% 100%

149

92%

13

8%

47

29%

76

47%

33

20%

6

4%

36 yrs. 18 yrs. 81 yrs.

262 days 166 days 31 inmates 2,350 days

180 days

106 days

22 inmates

1,970 days

73%

41

25%

1

1%

25

15%

94

58%

30

19%

12

7%

4

Case 2:18-at-01259 Document 1-6 Filed 07/31/18 Page 6 of 23

T-SEP Housing
The Main Jail houses T-SEP male inmates in the following locations: Housing 8 East PODs 100, 200, 300, 8 West PODS 100, 200, 300, and 400. Housing 8 West 400 POD is utilized to house inmates on disciplinary status for the most serious violations. T-SEP for female inmates is located in Housing 7 West 400 POD. Female inmates on Administrative Segregation, Protective Custody, Outpatient Psychiatry and Disciplinary are also housed in Housing 700 West 400 POD. Male and Female inmates on T-SEP and Disciplinary status are single celled.

It is important to note that the only difference between T-SEP and Administrative Segregation is T-SEP is single-celled and Administrative Segregation is double-celled. Thus, a T-SEP inmate, by definition, is believed unsuitable for double-celling.

The Main Jail has the following other special/restrictive housing units:

Medical Unit Acute Psychiatric Unit Disability Unit Medical Sub Acute Units

10 cells 18 cells 5 cells 32 cells (2) Units 16 cells per unit

The total number of acute psychiatric beds is quite low for a nearly 4,000 inmate population. The lack of acute and step-down/sub-acute beds is no doubt contributing to the creation and expansion of the T-SEP population.

A Medical Exam Room is located on the Main Jail Floors 3, 4, 5, 6, 7, and 8, and is shared by
Housing East and West Housing Units on each floor. The Medical Unit, where medical and acute psychiatric cells are located, is on the Main Jail 2nd Floor.

The Main Jail has three recreation areas for the inmate population. The recreation areas are located between Main Jail Floors 3 and 4, 5 and 6 and 7 and 8. Housing located on 2nd, 3rd, and 4th Floors share the 3/4 Recreation Area. Housing located on the 5th and 6th Floors share the 5/6 Recreation Area, and Housing on the 7th and 8th Floors share the Housing 7/8 Recreation Area.
Recreation Areas shared by floors limits inmate access. Housing 7/8 Recreation Area
accessibility is very limited because it is shared by male and females. Another factor limiting
accessibility is that inmates requiring separation assigned to T-SEP, Administrative Segregation.
Protective Custody and Disciplinary Housing status are housed on these main jail floors.

Each housing unit has a common area adjacent to each POD and another common area inside each POD. The Housing Units have a large classroom, nine non-contact visitation booths with three designed for confidential visits. Inmate cells have intercoms connected to the Housing Unit Control Booth allowing inmates to communicate with staff from their cell. Showers for the inmates are located in each of the POD Units. T-SEP inmates are not allowed to participate in any group congregate activities.

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The following policy related documents were provided by the Sheriff to review T-SEP housing procedures and policies:
1. County of Sacramento Inter-Department Correspondence dated October 21, 2015 Subject: Discipline Period Review;
2. Sheriff’s Department, County of Sacramento, Operations Order, Classification Process; 3. Sheriff’s Department, County of Sacramento, Post Order 8 West 400 POD
Disciplinary Housing Unit; 4. Sheriff’s Department County of Sacramento, Operations Order, Housing Plan; 5. Sheriff’s Department County of Sacramento, Outdoor Recreation Schedule; and, 6. State of California Title 15 Minimum Standards for Local Detention Facilities.
Custodial Deputies are to perform one (1) hour cell checks for inmates on T SEP status. Most correctional systems require 30-minute cell checks for inmates in Special Housing Units. T-SEP is identified as a Special Housing Unit by the Sheriff’s Department, County of Sacramento, Operations Order, Classification Process. A serious concern is the number of T-SEP inmates with mental health issues, isolated in a Special Housing Unit and receiving one (1) hour cell checks.
Inmate Interviews
From the T-SEP spreadsheet, random samples of the current T-SEP population were drawn for the purpose of being interviewed. Over three site visits, a total of 52 inmates were selected to be interviewed. Of that number, ten inmates refused to be interviewed with 42 being completed. Three interviews were conducted cell side due to these inmates initially refusing to participate but later agreeing to an interview without leaving their cells. An additional classified T-SEP inmate was on suicide watch housed in a classroom of Housing Unit 5 East. The inmate was on suicide watch in the Housing Classroom until a bed became available in the 2P Acute Psychiatric Unit that was at capacity. His interview was not completed due to the inmate’s inability to understand and answer the questions, as well as difficulty conversing through a solid door.
Consistent with the data in Table 1, the majority of the interviewed inmates had mental health issues varying from mild, controlled by psychotropic medication to serious issues impacting their ability to perform in the general population. Interviews revealed 75% of the inmates were currently receiving mental health treatment, or had previously received mental health treatment involving taking psychotropic medication and being seen by mental health staff. The interviews also revealed a number of the inmates had significant mental health issues that contributed to their placement and retention in T-SEP. Staff and interviewed inmates reported T-SEP inmates frequently threaten self-harm, and are often placed on suicide watch. As indicated, one of the interviewed T-SEP inmates during the assessment was on suicide watch awaiting bed space in the Main Jail Acute Psychiatric Unit.
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In terms of the basis for placement in T-SEP, the primary reasons cited in these cases were as follows:
1. Negative Institution Adjustment Problems/Violations (63%); 2. Inmate’s Safety (32%); and, 3. Criminal Charges (5%).
Within reason #1, a factor that often applied was prior placement in the CDCR SHU units. For these inmates, they were immediately assigned to the T-SEP unit and will remain there until they are released from the jail. Included in reason #2 are inmates who require protection from other inmates and, who otherwise would be designated as a protective custody inmate if it were not for the single cell requirement.
Also, consistent with the data in Table 1, the length of time the interviewed inmates had been on T-SEP status varied, with most having been on the status for less than one (1) year. The longest time identified was one (1) inmate on T-SEP status for approximately two and one half years. Here again we noted that about 1/4th of the interviewed cases were admitted to T-SEP upon booking and had spent their entire period of custody in a T-SEP unit.
The vast majority (over 90%) of the interviewed inmate records did not reveal significant disciplinary violations while they were on T-SEP status. Inmates did frequently incur rule violations for Failure to Rise for Count. The rule violation is not a formal write-up and deputies can impose immediate sanctions without a due process hearing. Disturbingly, the sanction imposed was to forfeit the inmate’s 30 minute out of cell time for the day if he/she fails to rise for count.
All of the interviewed inmates reported that there had been no formal hearing or interview by classification staff prior to their placement in T-SEP status. This is not to say that they were not interviewed by the classification staff as part of the mandatory initial classification process. What the inmates consistently reported was they did not have a formal interview or hearing where the basis for placement in T-SEP was explained to them as in normally done in other jail and prison systems. They have not received any formal document explaining or justifying their T-SEP status nor have they had their current status formally reviewed and justified. Finally, none of them have received any information on how they request or secure release from T-SEP.
It should also be noted that most of the interviewed inmates cannot be immediately released to the general population due to well documented security issues. But continued placement in the current T-SEP status and under the severe conditions of confinement that exist in these units is also unwarranted.
T-SEP Classification Process
Inmates are classified to T-SEP status by Main Jail Classification Staff. As noted above, interviewed inmates reported their involvement in T-SEP placement is either non-existent or
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Case 2:18-at-01259 Document 1-6 Filed 07/31/18 Page 9 of 23
extremely limited. None of the inmates reported having a face to face classification interview prior to T-SEP placement.
Classification reviews for inmates on T-SEP status occur every 30 days after initial placement. Until recently, the classification reviews were paper reviews without any inmate participation. Approximately three weeks prior to the T SEP Assessment, classification staff begin conducting reviews at the “cell side”. The classification reviews conducted at the cell side are done communicating through the inmate’s cell door. The quality of these cell side classification reviews is questionable based on confidentiality concerns and the difficulty this consultant had interviewing inmates at cell side.
Out of Cell Activities and Privileges
The Main Jail T-SEP inmates maximum amount of time out of cell is three (3) hours per week provided in 30 minute sessions per day. Interviewed inmates also reported their out of cell time is primarily the 30 minute sessions totaling a maximum of three (3) hours per week. Other noted, but less frequent, out of cell activities were revealed as visits and advanced medical treatment. Main Jail staff confirmed T-SEP inmates rarely exit their cell except for the 30minute daily session when it is offered. T-SEP inmates receive limited privileges mirroring those of inmates on Administrative Segregation while Protective Custody inmates receive increased privileges similar to those received by General Population inmates. As indicated earlier, Failure to Rise for Count violations result in the inmate forfeiting the out of cell time for the day. Interviewed inmates reported the out of cell time is occasionally offered during sleeping times (i.e. 2:00 a.m., 3:00 a.m. or missed due to staffing shortages). The 30 minute out of cell time is given in the POD common area. None of the interviewed inmates reported being able to utilize the shared 7/8 Housing Unit Recreation area.
Inmates described utilizing the 30 minutes to shower, talk on the telephone, and if time permitted, visit with other inmates outside their cell door or watch the television mounted on the POD common area wall. Access to showers is only provided during the 30 minutes out of cell time. When the 30 minutes out of cell is not provided or the inmate declines the out of cell time he/she is not afforded a shower. A number of inmates reported going days without a shower. Meals are served to T-SEP inmates in their cells. Inmates complained about the amount of commissary received while on T SEP status.
Medical
T-SEP inmate medical access is primarily in the Housing Unit POD at the cell or at the Medical Exam Room on the Housing Unit Floor. Medication is provided by nurses coming on the unit and administering medication through the cell door. Higher level medical treatment and after hours medical treatment is provided T-SEP inmates at the Main Jail 2nd Floor Medical Unit. The Main Jail Physician provides sick call for T-SEP inmates one to two times per week in the Housing Unit Floor Medical Exam Room.
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Mental Health
Interviewed inmates reported their contacts with mental health staff are almost always cellside, including the psychiatrist, and rarely received out-of-cell face to face assessments. Inmates threatening self-harm are typically left on the Housing Unit until assessed by Medical Services staff. Custodial staff do not provide one to one supervision until the individual is assessed by a qualified mental health professional for inmates threatening self-harm. The inmate is given suicide prevention clothing and placed in the Housing Unit Classroom and observed by staff from the Control Room and/or during cell checks.
Rehabilitation Programs
Education is the only rehabilitation program available for T-SEP inmates to participate. T-SEP inmates can request to participate in education programs by writing the Main Jail Education Department. Once approved to participate, the inmate is given in cell education materials and periodically meets with an instructor in the non-contact visitation rooms located in the housing unit.
Visitation
T-SEP inmates can receive two non-contact visits weekly in the visitation booths located in the housing unit. A number of the interviewed T-SEP inmates reported receiving visits. There were no complaints regarding ability to receive visits while on T-SEP status.
Conclusions and Recommendations
There are a number of issues that need to be addressed regarding the Sacramento Sheriff’s T-SEP housing unit as it operates at the Main Jail. These can be separated into the three major categories of due process, conditions of confinement, and mental health services.
Due Process. There is not a credible or transparent process by which inmates are assigned to the T-SEP status. Further, there is no structured review process which determines whether the inmate should be retained or released from T-SEP status. Finally, there are no structured criteria by which inmates can secure release based on their compliant behavior.
Conditions of Confinement. Inmates are placed in harsh conditions of solitary confinement and isolated from direct contact with other inmates for excessive periods of time. Inmates are limited to a maximum three (3) hours per week out of cell time, 30 minutes a day. Routinely, custodial staff deny Main Jail T-SEP inmates 30 minutes out of cell time for a Failure to Rise for Count, or due to staffing shortages. Out of cell time is also occasionally offered during inmate sleeping times. Custodial staff performing the one hour cell checks for T-SEP inmates is problematic based on our observations of the units during the evaluation.
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Mental Health Care. Most Main Jail T-SEP inmates have mental health issues with staff reporting frequent episodes of threatened self-harm. However, inmates threatening self-harm are not placed on one-to-one observation until evaluated by a qualified mental health professional. Further, out-of-cell assessments and treatment does not occur.
Based on these findings and recommendations, the following recommendations are made;
1. Terminate the term of T-SEP and re-assign the current population to either the general population or one of the following three special population statuses:
A. Administrative Segregation; B. Protective Custody; or C. Mental Health (acute or step-down).
2. The elimination of the T-SEP status and re-assignment of the current T-SEP population would be completed by the Special Population Committee (SPC) that consists of the following people: A. Classification (Chair) B. Mental Health C. Security
3. The SPC would conduct a face to face interview with each T-SEP inmate unit during which the basis for placement in one of the designated special populations would be explained to him/her and documentation provided to the inmate.
4. It is expected that most of the existing T-SEP population would need to be placed in Administrative Segregation or a Mental Health Step Down unit.
5. Within the Administrative Segregation status, a two-phased program would be established that would allow most inmates to receive greater amounts of out of cell time and privileges consistent with a case plan developed by the SPC (see Table 2). The proposed Administrative Segregation Phase 2 privileges should be commensurate with the privileges received by inmates in the general population.
6. Inmates placed in the Administrative Segregation units will continue to receive face to face interviews every 60 days to assess the inmate’s progress and compliance with the case plan and the need to continued placement in a SPC unit.
7. Inmates in Administrative Segregation Phase 1 should be afforded the opportunity to participate in In-Cell Self Improvement Programs.
8. Phase 2 inmates should be afforded the opportunity to participate in Self Improvement Programs 1 hour per day, 5 days a week in a congregate setting; unless, the inmate poses a significant and on-going threat to other inmates, staff and perhaps themselves.
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9. The Mental Health Step Down Unit would be for inmates assigned to FOSS level 2 and who do not pose a security threat to other inmates and staff. The basic attributes of this program are shown in Table 3.
10. Inmates in the Mental Health Step Down Unit would be single or double-celled based on their SPC Case Plan.
11. The Mental Health Step Down Program privileges should be commensurate with the privileges received by inmates in the general population. Inmates in the Mental Health Step Down Program should be afforded the opportunity to participate in 1 hour per day, 5 days per week out of cell structured activities as determined by the SPC Case Plan.
12. Today’s technology provides an opportunity to offer inmate programs on computer tablets that are not connected to the internet. The tablets can be loaded with education and rehabilitation programs that will assist the inmate both while he/she is confined and after release. Consideration should be given to explore offering education and rehabilitation programs to inmates through this delivery system.
13. In both units, mental health staff would be required to make visits to the unit on a daily basis to tend to basic casework tasks, and to be available to any inmate requiring any emergency request.
14. In both units, custody staff to provide one to one observation when an inmate threatens self-harm until he/she is evaluated by a qualified mental health professional;
15. In both units, require classification, medical, and mental health discontinue cell side assessments and require face to face interviews/reviews in a private setting;
16. In both units, prohibit custodial staff from taking structured out of cell events without a due process hearing. Out of cell sessions should only be scheduled and offered during normal waking hours.
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Attribute

Table 2 Recommended Administrative Segregation Housing

Phase 1

Phase 2

Celling Recreation Showers Visitation Telephone
Programs Status Review Mental Health Review On Floor Security Staffing Cell Checks
Privileges

Single Daily 1 hr. Three times per week Restricted Restricted
In Cell Self Improvement Programs 30 days 30 days Yes 30 minutes
Current Jail Administrative Segregation Privileges

Mixed Daily 2 hrs. Five times per week Un-restricted Un-restricted Group Congregate Self Improvement Programs Out of Cell 1 hour per day 5 days a week
60 days 60 days
Yes Hourly General Population Like Privileges

Table 3 Recommended Mental Health Step Down Program

Attribute

Celling Recreation Showers Visitation Telephone
Programs Status Review Mental Health Review On Floor Security Staffing Cell Checks
Privileges

Mixed 2 hrs. Daily Un-Restricted Un-Restricted 1 hour per day 5 days a week structured activities provided by mental health staff 30 days 30 days Yes 30 minutes General Population Like Privileges Unless Modified in by the SPC in the Case Plan

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Classification Evaluation
In order to evaluate the current classification system a number of tasks were undertaken. The initial task was to conduct analysis of the Northpointe system in terms of how it is classifying the current inmate population of approximately 3,947. The Northpointe Decision Tree initial instrument separates inmates into nine levels which can then be collapsed into three traditional custody levels of Close, Medium, and Minimum. As shown in Table 4, the majority of the inmates are assigned to the generic medium custody level (57%) followed by minimum custody (28%) and close/high (11%). Another 78 inmates who had been recently booked were “unclassified”. There were 127 inmates who were classified under the ICE classification system which is an additive point system that is similar to the one developed by the NIC.
In general, the distribution of the population by these three custody levels is pretty consistent with other jail systems with two slight exceptions. Both the percent of inmates classified as close/high, or, minimum custody is slightly lower that one would expect. Generally, the close/maximum population is in the 20-25% range while the minimum custody population is in the 30 -40% range.
Classification Process
In 2013, the Sheriff implemented the Decision-Tree system at the main jail. Prior to that year, the classification system was un-structured and based on just a few criteria. The RCCC implemented the system in 2016. Most of the classifications at the RCCC are reclassifications while the Main Jail staff conduct most of the initials as well as reclassifications.
The Sheriff’s Department maintains a dedicated classification unit that has 12 deputies assigned to classification functions. Eight of the 12 staff are assigned to the Main Jail while the other four are assigned to the RCCC. The larger number of staff at the MJ is appropriate given the large number of bookings that must be classified at the Main Jail.
Appropriately, not all newly booked inmates are classified. Those that are to be cited and released within a few hours are not classified. The remaining new bookings are labeled as “keepers” and are assessed using the “Primary Screen” Decision Tree instrument. The initial classification includes a face-to-face interview with the inmate. Over-rides can be applied to deviate from the scored classification level.
Reclassifications can be done under Northpointe every 30, 60, or 90 days. The 30-day interval is a departure from the NIC system which only allows for 60 or 90 day intervals. The 30-day interval was selected by Sacramento because it wanted to have the T-SEP inmates reviewed every 30 days. So, it was important to the Department (but not necessary) for the rest of the inmates to have their population reclassified every 30 days.
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Table 4. Sacramento Classification Levels
Current Jail Population

Class Level 1 2 3 4 5 6 7 8 9
ICE 1 ICE 2 ICE 3 ICE PC Unclassified Total

Custody Level High Close
Medium
Minimum

Inmates

Score Level %

201

5%

246

6%

734

19%

862

22%

613

16%

558

14%

52

1%

336

9%

141

4%

6

0%

58

1%

33

1%

30

1%

78

2%

3,947

100%

Custody Level %
11%
57%
28%
0% 1% 1% 1% 2% 100%

There are two problems with the 30-day review cycle standard as opposed to a 60 or 90-day interval. First, it produces twice or three times the number of reclassifications that must be completed by staff. This excessive workload also contributes to the fact that only the T-SEP inmates are being interviewed for a reclassification event. All of the other inmates are not interviewed which is contrary to NIC standards. The reasons for the interview are as follows:
1. Allows the inmate to convey any information that might impact the staff’s decision to classify and/or house an inmate;
2. Gain a better basis for either using or not using an over-ride;
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3. Develop intelligence from the inmate about any threatening situation that may be occurring in a housing unit;
4. Verifying that all current charge and bail amount data are accurate and up-to date; and, 5. Convey to the inmate the basis for his/her reclassification level and how subsequent
behavior may impact his/her future custody level.
Over-rides can also be employed by the classification staff to over-ride or depart from a scored classification level. Unlike the NIC OJC system, these over-rides are not structured by either non-discretionary and discretionary types of over-rides. The latter would reflect departmental policy that would restrict placement of an inmate in minimum custody regardless of the inmate’s classification score. The former can be applied at the discretion of the classification staff to either increase or decrease a scored custody level. Unlike the NIC OJC system, whenever an over-ride is applied it does not need to be approved by a supervisor.
Listed below is the complete list of 29 reasons that one can use to override someone up or down on the scored Decision Tree classification level. For each over-ride, the NIC OJC criteria for an over-ride have been applied (mandatory-up, discretionary-down, discretionary–up). There were some over-ride reasons where it was not clear on the use of the over-ride and how it would be applied to an inmate.
1. Assaultive threats toward staff (discretionary – up) 2. Increased risk of escape (discretionary – up) 3. Serious institutional behavior history (discretionary – up) 4. Inmate under investigation for additional crimes (mandatory – up) 5. New charges may be added (discretionary – up) 6. Hold, detainer for assaultive felony offense (mandatory – up) 7. Known gang leader (mandatory –up) 8. Suspected drug trafficker (discretionary – up) 9. Inmate faced with lengthy prison term (20+ yrs.) (mandatory – up) 10. Mentally unstable (discretionary – up) 11. Lengthy street time since last assaultive offense (discretionary – down) 12. Notorious/particularly heinous offense (discretionary – up) 13. Inmate well known to staff (discretionary – down) 14. Developmentally disabled (discretionary – up) 15. Administrative (unknown) 16. Threats towards other inmates (discretionary up) 17. Hired workers (discretionary – down) 18. Does not meet TSEP criteria (unknown) 19. Sentenced (unknown) 20. Claims enemies in PC (unknown)
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21. Assaulted by other inmates (unknown) 22. Court dismissed charges (discretionary – down) 23. Employed/Former law enforcement (unknown) 24. Refusing to cell with anyone (unknown) 25. No problems in past 30 days (discretionary down) 26. Prison gang member (discretionary – up) 27. PREA suspect (discretionary – up) 28. Felony hold added (mandatory – up) 29. Resisted/Assaulted arresting officer (discretionary – up).
Statistical Analysis of the Decision Tree Versus the NIC OJC systems
As noted earlier, a random sample of 348 inmates was drawn from a snapshot of the jail population. For each inmate sample, the current Decision Tree instrument data were copied and forwarded to the consultant for data entry. Also, for each sampled case, either the initial or reclassification instrument was completed by Cris Jackson who was trained by the consultant on how to complete it. Based on NIC OJC standards, inmates who had been in custody for less than 60 days had the initial classification form completed and for those in custody for 60 days or more a reclassification form was completed. These data were then key-entered into a data base and formatted for statistical analysis.
Table 5 shows the Decision Tree results for both the entire jail population and the random sample. There were 3 cases where a custody level was missing. That aside, there are two points to be made here. First, the sample is representative of the entire jail population as the distribution of the major custody levels for the sample are equivalent to the entire jail population. This means the results of the pilot test can be applied to the entire jail population. Second, one can also see that under the Decision Tree system, the vast majority of the inmates are classified as medium custody (61%) followed by the minimum custody category (26%).
Table 6 shows how the same random sample of inmates would be classified under the NIC OJC system. Two important differences emerge in this scenario: Under the NIC OJC system, significantly higher numbers of inmates score as minimum custody or maximum custody. In other words, the large medium custody population under the Decision Tree system is being reassigned to either minimum or maximum custody. However, when the various over-rides are applied to the NIC OJC scored cases, the number assigned to minimum custody drops to the same levels as the Northpointe derived levels.
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Table 5. Decision Tree Custody Levels Random Sample and Total Jail Population

Class Levels
High Close Medium Minimum Total

Random Sample

Inmates

%

16

5%

22

6%

211

61%

96

28%

345

100%

Total Jail

Inmates

%

201

6%

246

7%

2,209

61%

946

26%

3,602

100%

Custody Levels
Maximum Medium Minimum Total

Table 6. NIC OJC Custody Levels Scored versus Final

NIC Scored

Inmates

%

82

24%

94

27%

172

49%

348 100%

NIC Final

Inmates

%

99

28%

151

43%

98

28%

348 100%

A closer review of the over-rides is presented in Table 7. Here one can see that most of the over-rides are occurring on the reclassification instrument for which 56% of the inmates are under having been in custody for at least 60 days or more. The two dominant over-ride reasons were holds/detainers and gang affiliation. The former is a mandatory over-ride that takes a minimum custody inmate and re-assigns them to medium custody. The latter is a discretionary over-ride that usually takes a scored minimum custody inmate and re-assigns to them to medium custody.

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The overall over-ride rate is 24% while the one based only on discretionary factors alone is 11%. This rate is within the standard of 5-15% for discretionary over-rides. However, there were no discretionary over-rides employed that would serve to lower the inmate’s scored custody level.
Another way to look at the over-ride phenomena is to compare the scored and final levels for the NIC OJC initial and the reclassification instruments (Tables 8 and 9). For the initial classifications, the largest movement is for the 76 inmates who were scored as minimum but for whom 20 were over-ridden to medium custody for the reasons cited earlier. For the reclass cases, it is the same pattern but with higher numbers of inmates being over-ridden from minimum to medium custody.
The reclassification instrument allows one to test the validity of the NIC OJC classification system. For those inmates so classified, the number of major and minor disciplinary reports were recorded allowing one to see the association between the scored and final custody levels. As shown in the Table 10, there is a strong statistical relationship between the scored and final classification levels. It is noteworthy that the statistical relationships between the “Final” scored custody levels are not as strong as the “Scored” custody levels. This is because the “Final” medium custody level has a lot of inmates who scored minimum but were over-ridden to medium due to a hold or being designated as a gang member.
When compared to the same custody levels provided by the Decision Tree one can see that the results are similar. Both systems are sorting inmates by their disciplinary behavior. However, as noted earlier, the NIC OJC is identifying a higher number of inmates for close and minimum custody who have behaved in a manner consistent with their designated risk level. Using the metric of percent of inmates receiving a disciplinary report of some kind, the NIC OJC scored version does the best job.
Finally, a test was completed on the accuracy of the scoring process. Known as an inter-rate reliability test, this was done by having a second person trained in the Decision Tree to rescore a random sample of 20 cases selected by Dr. Austin. There were ten initial and ten reclass cases so tested. While there were no errors for the ten initial class cases there were three errors in the ten reclass cases. Two of the errors centered around the “positive attitude” item and the other was an error on the presence of a warrant. Due to the high number of errors on the reclass instrument another ten cases were selected for testing. For these cases, another five cases were found to have errors in them. Two were again related to the “positive attitude” item and another was on the “warrant” item. The other two were related to the “family ties” and the “serious assaultive behavior problem.” This level of scoring error is unacceptable and needs to be corrected immediately.
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Table 7. Over-Rides by Initial and Reclassification Instruments

Inmates Over-Rides Total Over-Ride %
Discretionary % Mandatory
Detainer Discretionary Gang Member Management Problem Prior Record Severe Offense Severity Others

Initial 153 21 14% 5%

Reclass 195 62 32% 15%

Total 348 83 24% 11%

15

19

34

3

22

25

0

3

3

3

2

5

2

0

2

0

2

2

Table 8. Scored vs. Final Initial Classification

Scored Level Maximum Medium Minimum Total

Final Level

Maximum Medium Minimum Total

32

0

0 32

3

42

0 45

1

20

55 76

36

62

55 153

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Table 9. Scored vs. Final Re-Classification

Scored Level Maximum Medium Minimum Total

Final Level

Maximum Medium Minimum Total

50

0

0 50

12

37

0 49

1

52

43 96

63

89

43 195

Table 10. Misconducts for Re-Classified Inmates by NIC OJC Scored and Final Custody Levels, and, Tree

Scored NIC OJC Inmates % Misconducts Past 60 days
Final NIC OJC Inmates % Misconducts Past 60 days
Tree Final Inmates % Misconducts Past 60 days

Maximum Medium Minimum

50

49

96

70%

45%

17%

63

89

43

65%

29%

14%

24

127

41

62%

37%

22%

Total
195 37%
195 37%
195 37%

Recommendations
There are two major options that the Sheriff can pursue regarding its classification system. First, it can retain its use of the Northpointe Decision Tree, or second, it can adopt the NIC OJC system. Switching to the NIC OJC system would produce higher numbers of inmates classified for minimum and maximum custody without jeopardizing staff or inmate safety. It would also
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allow the Sheriff to completely control the criteria for classification as the NIC OJC system is in the public domain and can be used at no-cost to the user.
However, there are logistical issues underpinning such a change. In particular, the current jail management information system would have to be modified to accommodate any new application. Our experiences with other jurisdictions is that this not a difficult or significant expensive undertaking but it must be recognized as a new task to be completed.1
If the Sheriff elects to keep the Northpointe Decision Tree system, the following operational recommendations are made that, if implemented, would enhance the Decision Tree and classification in general:
1. Shift from a 30-day to 60-day time frame for conducting a reclassification review. Rationale: The 30-day period is not sufficient time to monitor inmate behavior. The 30day period allows aggressive and violent inmates to have their custody level lowered after only 30 days of compliant behavior. Finally, the 30-day review adds an unnecessary workload to the classification staff. If the 60-day review is implemented, it would serve to increase the number of close custody inmates and decrease the number of medium custody.
2. Require a face-to-face interview with inmates who are being reclassified every 60 days. Rationale: Computer or paper reviews for the critical reclassification decision do not allow the classification staff to have sufficient information to make a reliable and valid classification decision. It’s also important that, like the initial classification event, the inmate have an opportunity to be told the basis for the re-classification decision and offer any information that may be relevant to the security and safety of the unit he/she is assigned to. If the Sheriff feels the 60-day face to face interview is too burdensome, the requirement could be waived for minimum custody inmates who would still have a 60-day “computer” review.
3. Remove the factor of pre-trial status as a factor in the Decision Tree (initial and reclass). Rationale: Legal status is not a predictor of inmate conduct or escape risk. It is not used in other jail classification systems and serves to unnecessarily increase the number of medium custody inmates.
1 Santa Clara County and Clark County (Las Vegas), have recently completed such installations at minimal costs and time frames.
21

Case 2:18-at-01259 Document 1-6 Filed 07/31/18 Page 23 of 23
4. Develop more precise definitions of what constitutes “less serious behavior problem, serious behavior problem, marked improvement in compliance, positive attitude change, no behavior problem, and court/staff compliance” factors used on the Decision Tree reclassification instrument. Rationale: By definition, these items are subjective in nature. Classification staff need guidance and testing on these items to ensure they are being assessed in a reliable manner. These items also underscore the need for a face-to-face interview to make such an assessment.
5. Using the existing over-reasons, sort them into the following three categories: a. Non-discretionary overrides that restrict placement in minimum custody; b. Higher Discretionary over-rides that allows placement of an inmate scored as medium or minimum to upgraded one level. c. Lower Discretionary over-rides that allows placement of an inmate scored as close or medium custody to down-grade one level.
6. All such over-rides must be reviewed and approved by a supervisor. Rationale: The current list of over-rides is not structured and should be formalized along the lines set forth above and adopted by the NIC OJC system.
7. Conduct a “refresher” training session on the current Decision Tree system to reduce the number of scoring errors.
Rationale: The pilot test effort found unacceptable levels of coring errors by staff in the use of the Decision Tree system. A one-day training session should be conducted for all classification staff to test them on their knowledge of the “business rules” that underpin the scoring process and the use of structured over-rides. This training class would consist of staff undergoing a reliability exercise on ten standardized test cases (five initial and five reclass) to see if different staff make the same classification decision on each case.
22

 
 LEGAL AD CAC I 1330 B ad a , S e. 500 Oa a d, CA 94612 Te : (510) 267-1200 TTY: (800) 719-5798 Fa : (510) 267-1201 .d ab gh ca. g

Vae a
Ma ch 18, 2020
Rick He e S pe i ing Co n Co n el P.O. Bo 988 Sac amen o, CA 95812-0988
e e @ acc . e

Chief Dep San o Ramo Co ec ional Se ice Sac amen o Co n She iff
a @ ac e .c

Office

R : Ma s . Count of Sacramento (E.D. C .), N . 2:18- -02081-TLN-KJN

N

A

C

J

COVID-19 P

Dea M . He e and Chief Ramo :

We i e a cla co n el in Ma . C

Sac a e (E.D. Cal., Ca e

No. 2:18-c -02081-TLN-KJN), ep e en ing people held in c od a he

Sac amen o Co n Jail ( he Jail ). The Ma ca e eek o emed ell-

doc men ed and long anding deficiencie in he condi ion and acce o heal h

ca e ha people inca ce a ed a he Jail e pe ience. A o kno , a fede al co

app o ed he pa ie e lemen , incl ding a Con en Dec ee and de ailed emedial

plan, in Jan a 2020.

We ecogni e ha effo o implemen p o i ion of he emedial plan ill be impac ed b he COVID-19 pandemic. A he ame ime, hi p blic heal h c i i po e e ao dina i k o he heal h and afe of Ma cla membe . The Con en Dec ee in he Ma li iga ion add e e deficiencie add e ed in he Ma la i , ome of hich di ec l appl o hi pandemic. See, e. ., Remedial Plan VI.B.3 ( e i emen fo ade a e medical in ake c eening con i en i h comm ni anda d ); VI.K.1 ( e i emen o add e i e of cleanline and ani a ion ha ad e el impac heal h); VIII.A.3 ( e i emen o end p olonged oli a confinemen fo people i h ac e medical need ha e i e an inpa ien ca e); VI.G ( e i emen o en e ha pa ien in ac e medical o a an ine placemen ha e app op ia e acce o p ope and p i ilege ).

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COVID-19 i e emel dange o fo people in ce ain pop la ion g o p ha a e ema kabl p e alen in he Jail. People o e he age of fif a e con ide ed o be a b an ial i k, and people o e 70 a e a he mo e io i k. The Cen e fo Di ea e Con ol and P e en ion (CDC) ha i ed g idance ha ce ain medical condi ion and di abili ie inc ea e he i k of COVID-19 fo people of an age, incl ding: l ng di ea e, hea di ea e, diabe e , condi ion ha make a pe on imm nocomp omi ed (e.g., cance , HIV/AIDS, a oimm ne di ea e), blood di o de (incl ding ickle cell di ea e), ch onic li e o kidne di ea e, me abolic di o de , oke, de elopmen al dela , and p egnanc .
The CDC ha iden ified COVID-19 a p eading ea il f om pe on- ope on. I ha a ned ha he i k of e po e i g ea e in c o ded, confined pace i h limi ed en ila ion and ai ci c la ion. The fede al go e nmen ha indica ed ha c o d of mo e han en people ho ld be a oided fo he ne e e al eek , a a minim m.
The Jail c o ded, confined, and limi ed- en ila ion facili ie c ea e a g a e i k of COVID-19 an mi ion o a Jail pop la ion i h high i k fac o . The i k of ma an mi ion i heigh ened b he n mbe of Jail aff coming in and o of he facili and he poo ani a ion and h giene in he facili ie .
The Co n i a a e ha he Jail heal h ca e facili ie a e ill-e ipped e en in no mal ime . The fo me chief of co ec ional e ice a ed ha he facili ie a e e e el o da ed and inade a e fo p o iding e ice o o inma e pop la ion. No abl , a pa of he Ma e lemen , he Co n ag eed o con l i h an En i onmen of Ca e e pe o e al a e facili ie he e pa ien a e ho ed and/o ecei e clinical ea men , and o make i en ecommenda ion o add e i e of cleanline and ani a ion ha ma ad e el impac heal h. Remedial Plan VI.K.1. Unfo na el , hi En i onmen of Ca e e al a ion and an con e en emedia ion effo ha e no e occ ed.
The Jail al o lack ade a e facili ie o a an ine o medicall i ola e people ho ha e mp om of COVID-19 o epo ecen e po e o he i . We a e a a e of m l iple people in c od a he Sac amen o Co n Jail in ecen da ho ha e been bjec o To al Sepa a ion in non-medical i ola ion
ni ba ed on po ible COVID-19 e po e. While e do no endo e e po ing po en ial COVID-19 pa ien o o he people de ained o o king in he Jail, i i impo an o no e ha p olonged and ha h oli a confinemen p ac ice e e among he mo e io con i ional iola ion a i e in he Ma la i . To he e en ha i ola ion i nece a in he Jail o ed ce he likelihood of

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an mi ion i ho ld be in line i h medical i ola ion p o ocol and ba ed on an indi id ali ed clinical de e mina ion. (O c en nde anding i ha people a e held in i ola ion if he a e iden ified a ha ing mp om of o po ible e po e o he i and a e a ai ing COVID-19 e e l , hich can ake p o fo da . Fo an one ho ecei e a nega i e e e l , he a e e ned o no mal ho ing. If an one ecei e a po i i e e e l , he ill be placed in a de igna ed a an ine ho ing ni ha allo fo dail and eg la o -of-cell ime.)

S aff ho ld en e ha i ola ed indi id al ha e addi ional p ope and p i ilege , ch a iPad , book , and i ing ma e ial , o compen a e fo he ocial i ola ion.

In ho , he con e ence of COVID-19 p eading h o gh he Jail pop la ion o ld be de a a ing. If he i doe p ead h o gh he Jail, he likelihood ha n me o Ma cla membe o ld e i e ac e medical ca e i
b an ial. S ch ca e o ld nece a il e i e an po o eme genc medical facili ie in he comm ni , i king ignifican ain on heal h ca e e o ce ha
o ld ad e el impac he gene al p blic.

I i c i ical o he p o ec ion of Ma cla membe , Jail aff, and he b oade comm ni o ake bold ac ion no . Thi e i e ed cing he e i ing Jail pop la ion (in pa ic la , of people in high- i k g o p ), limi ing he flo of ne people in o Jail c od , and aking p oac i e mea e in he Jail o en e people heal h and ell-being.

S R

J P

. We e e plea ed o ee ha he

She iff Depa men ecei ed a ho i a ion f om he Sac amen o S pe io Co

o g an accele a ed elea e of p i one , p o hi da ea l on a pe on

en ence, effec i e h o gh Ma 31, 2020. 3/17/20 S anding O de , No. SSC-20-

__. We ongl enco age he Co n o e plo e and implemen o he

mechani m o afel ed ce he jail pop la ion, incl ding h o gh (1) a b oade

ea l elea e o de , (2) o k elea e a angemen ( ee, e. ., Penal Code 4024.2,

incl ding b ec ion (b)(1)(F) add e ing people i h pecial need ela ed o

medical condi ion, ph ical di abili , o age), and (3) e panded p e ial elea e.1

1 The Califo nia Con i ion allo co o elea e people on hei o n ecogni ance in he co di c e ion. A icle 1, Sec ion 12. Sec ion 1275 of he Califo nia Penal Code a e he con ide a ion in e ing bail, and make clea ha

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P oced e akin o compa iona e elea e ho ld be ongl con ide ed fo people in high- i k g o p .

The Ma Con en Dec ee and Remedial Plan e p e l ecogni e ha Jail pop la ion ed c ion mea e de igned o p omo e p blic afe a e a co effec i e mean o achie e con i ional and a o anda d . Remedial Plan I.B. The c en p blic heal h c i i e e onl o accen a e hi fac .

L

F

N P

J C

. The Co n ho ld di ec

la enfo cemen o ci e and elea e all ho e ho a e eligible p an o Penal

Code 853.6, a he han booking hem and po en iall in od cing COVID-19

in o he Jail em.

Inca ce a ion fo echnical o o he non- iolen pa ole o p oba ion iola ion ho ld al o cea e.

P

M

JE H

W -B . The

mo ba ic a pec of infec ion con ol i h giene, incl ding ead acce o oap

(fo hand a hing and fo cleaning) and hand ani i e , imel acce o medical

ad ice and ca e, and comp ehen i e ani a ion and cleaning of facili ie . The e

p od c ho ld be p o ided o all people inca ce a ed in he Jail, f ee of cha ge,

ab en an indi id ali ed de e mina ion ega ding b an ial likelihood of mi e.

An plan o add e hi c i i m p o ide fo addi ional p eca ion fo ho e people ho emain in he Jail and a e a high i k if infec ed b he i ,

[i]n e ing, ed cing, o den ing bail, a j dge o magi a e hall ake in o con ide a ion he p o ec ion of he p blic and ha p blic afe hall be he p ima con ide a ion. Unde he e ao dina ci c m ance e face oda , p blic afe e i e ha a fe people a po ible ci c la e h o gh he Jail
em. We enco age p e mp i e elea e on ecogni ance fo a man people a po ible, pa ic la l fo lne able pop la ion , a de c ibed abo e.
The Hon. Na hanael Co in of he Uni ed S a e Co fo he No he n Di ic of Califo nia, fo e ample, ha i ed a anding o de (a ached) in e pon e o he COVID-19 pandemic, follo ing analogo fede al la . The o de a ho i e he eopening of p e ial de en ion hea ing o econ ide he app op ia ene of elea e pending ial fo people ba ed on hei heal h condi ion a ell a p blic afe .

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ch a olde ad l , p egnan omen and people i h ch onic illne e , comp omi ed imm ne em , o di abili ie .
People ho ed in he jail m be info med abo he i and he mea e he can ake o minimi e hei i k of con ac ing o p eading he i . The Califo nia S a e p i on em Califo nia Co ec ional Heal h Ca e Se ice (CCHCS) ha c ea ed a Co ona i /COVID-19 Fac and FAQ doc men (a ached) ha can be di ib ed and po ed in a manne acce ible o all people in c od a he Sac amen o Co n Jail. Ve bal o o he mean of comm nica ion of hi info ma ion ho ld be p o ided fo people i h di abili o o he indi id al need ( i al o in ellec al di abili ie , e c.). The e ma e ial offe a
ef l model fo o o e.
Finall , e nde and ha he She iff Depa men ha aken he ep o pend in-pe on i i a ion a he Jail o p e en he p ead of COVID-19. While in-pe on i i a ion ai e i an mi ion i k, inca ce a ed people m be able o comm nica e i h hei familie , lo ed one , and legal co n el, pa ic la l nde he e e f l and con an l e ol ing ci c m ance . We ongl enco age he Co n o p o ide all people in Jail c od phone and/o ideo call f ee of co d ing hi c i i . O he j i dic ion , ch a CDCR, Shelb Co n , Tenne ee and o he , ha e al ead aken hi imple and impo an ep. (Ne Yo k Ci ha hif ed o f ee phone call pe manen l .)
A he Co n of Sac amen o and he She iff Depa men con ide he ep e ge in hi le e , e a k ha o p o ide a e pon e o he follo ing e ion a oon a po ible. We a e a ailable fo a phone call o di c he e impo an ma e .
1. Ha e he She iff Depa men and Ad l Co ec ional Heal h (ACH) de eloped pecific COVID-19 i en policie o p o ocol ? If e , plea e p o ide a cop .
2. Wha ep , in addi ion o he S pe io Co Ma ch 17 anding o de a ho i ing ea l elea e , ha e been aken o ill be aken in ligh of he COVID-19 pandemic o ed ce he Jail pop la ion and o limi he flo of ne people in o he Jail?
3. Wha mea e i he Jail aking o p o ec people i h ele a ed COVID-19ela ed heal h i k , incl ding p egnan omen and people i h ch onic illne e , comp omi ed imm ne em , o di abili ie ?

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4. Wha mea e i he Jail aking o iden if people i h COVID-19 e po e, bo h a booking/in ake and in ide he Jail ho ing ni ?
5. Wha ep ha e been aken o en e ha Jail facili ie ha e ade a e oap, hand a hing a ion , e ipe , and ani i e eadil a ailable o people in c od a ell a aff? A e he e an e ic ion o co ela ed o he p o i ion of he e pplie ? If o, doe he Jail in end o modif ho e policie ?
6. Wha pda e ha he Jail made o cleaning p ac ice ( iping do n of face a ea , d able medical e ipmen /a i i e echnolog , hand ail ,
g ab ba , doo handle , phone , able , e c.)?
7. Ho i info ma ion abo COVID-19 being p o ided o people in c od a he Jail? I he info ma ion p o ided in acce ible loca ion and fo ma ?
8. Wha i he She iff Depa men and ACH capaci o e fo COVID19? Ho man people in Jail c od ha e been a an ined ba ed on po ible COVID-19 e po e? Ho man ha e ecei ed COVID-19 e ing? Ha e an COVID-19 ca e among people ho a e o ecen l ha e been in ide he Jail been confi med? If o, ho man , and ha ep e e aken in e pon e? (We e e pda ed info ma ion on he e ma e a e en nfold.)
Thank o , a al a , fo o a en ion and ongoing effo .

Since el , / / Aa J. F c e
Aa on J. Fi che Di abili Righ Califo nia

/ / Ma Me de
Ma go Mendel on P i on La Office

Encl .: CCCHS COVID-19 FAQ , S anding O de of he Hon. Na hanael Co in
Cc: Sand Damiano, Ad l Co ec ional Heal h Ale McCam , Sac amen o Co n She iff Depa men Timo h Zindel, Fede al Defende S e en Ga e , Sac amen o Co n P blic Defende Office Anne-Ma ie Sch be , Sac amen o Co n Di ic A o ne

Case 2:12-cv-00601-ROS Document 3521-1 Filed 03/16/20 Page 22 of 53
tŚĂƚ ŝƐ Ă ĐŽƌŽŶĂǀŝƌƵƐ ĂŶĚ ǁŚĂƚ ŝƐ Ks/Ͳϭϵ͍ ŽƌŽŶĂǀŝƌƵƐĞƐ ĂƌĞ Ă ůĂƌŐĞ ĨĂŵŝůǇ ŽĨ ǀŝƌƵƐĞƐ ƚŚĂƚ ĐĂƵƐĞ ŝůůŶĞƐƐĞƐ ƌĂŶŐŝŶŐ ĨƌŽŵ ƚŚĞ ĐŽŵŵŽŶ ĐŽůĚ ƚŽ ŵŽƌĞ ƐĞǀĞƌĞ ĚŝƐĞĂƐĞƐ ŝŶĐůƵĚŝŶŐ ^ĞǀĞƌĞ ĐƵƚĞ ZĞƐƉŝƌĂƚŽƌǇ ^ǇŶĚƌŽŵĞ ;^ Z^Ϳ ĂŶĚ DŝĚĚůĞ ĂƐƚ ZĞƐƉŝƌĂƚŽƌǇ ^ǇŶĚƌŽŵĞ ;DZ^Ϳ͘ Ks/Ͳϭϵ ŝƐ ƚŚĞ ŝŶĨĞĐƚŝŽƵƐ ĚŝƐĞĂƐĞ ĐĂƵƐĞĚ ďǇ ƚŚĞ ŵŽƐƚ ƌĞĐĞŶƚůǇ ĚŝƐĐŽǀĞƌĞĚ ĐŽƌŽŶĂǀŝƌƵƐ͘ dŚŝƐ ŶĞǁ ǀŝƌƵƐ ĂŶĚ ĚŝƐĞĂƐĞ ǁĞƌĞ ƵŶŬŶŽǁŶ ďĞĨŽƌĞ ƚŚĞ ŽƵƚďƌĞĂŬ ďĞŐĂŶ ŝŶ tƵŚĂŶ͕ ŚŝŶĂ͕ ŝŶ ĞĐĞŵďĞƌ ϮϬϭϵ͘
,Žǁ ĚŝĚ ƚŚŝƐ ǀŝƌƵƐ ŐĞƚ ŝƚƐ ŶĂŵĞ͍ KŶ &Ğď͘ ϭϭ͕ ϮϬϮϬ͕ ƚŚĞ tŽƌůĚ ,ĞĂůƚŚ KƌŐĂŶŝǌĂƚŝŽŶ ĂŶŶŽƵŶĐĞĚ ƚŚĞ ŽĨĨŝĐŝĂů ŶĂŵĞ ĨŽƌ ƚŚĞ ŶĞǁ ĐŽƌŽŶĂǀŝƌƵƐ ǀŝƌƵƐ ǁŽƵůĚ ďĞ Ks/Ͳϭϵ͘ ΗKΗ ƐƚĂŶĚƐ ĨŽƌ ΗĐŽƌŽŶĂ͕Η Ηs/Η ƐƚĂŶĚƐ ĨŽƌ ΗǀŝƌƵƐ͕Η  ƐƚĂŶĚƐ ĨŽƌ ΗĚŝƐĞĂƐĞΗ ĂŶĚ ϭϵ ŝŶĚŝĐĂƚĞƐ ƚŚĞ ǇĞĂƌ ƚŚĞ ǀŝƌƵƐ ǁĂƐ ĨŝƌƐƚ ĚŝƐĐŽǀĞƌĞĚ͘ ĞĨŽƌĞ ƚŚŝƐ͕ ƚŚĞ ǀŝƌƵƐ ǁĂƐ ƌĞĨĞƌƌĞĚ ƚŽ ĂƐ ƚŚĞ ΗϮϬϭϵ ŶŽǀĞů ĐŽƌŽŶĂǀŝƌƵƐ͕Η ǁŚŝĐŚ ŵĞĂŶƐ ŝƚ ǁĂƐ Ă ŶĞǁ ƐƚƌĂŝŶ ŶŽƚ ƉƌĞǀŝŽƵƐůǇ ŝĚĞŶƚŝĨŝĞĚ ŝŶ ŚƵŵĂŶƐ͘
tŚĞƌĞ ĚŝĚ Ks/Ͳϭϵ ĐŽŵĞ ĨƌŽŵ͍ dŚĞ tŽƌůĚ ,ĞĂůƚŚ KƌŐĂŶŝǌĂƚŝŽŶ ƐƚĂƚĞƐ ƚŚĂƚ ĐŽƌŽŶĂǀŝƌƵƐĞƐ ĂƌĞ ǌŽŽŶŽƚŝĐ͕ ǁŚŝĐŚ ŵĞĂŶƐ ƚŚĞǇ ĂƌĞ ƚƌĂŶƐŵŝƚƚĞĚ ĨƌŽŵ ĂŶŝŵĂůƐ ƚŽ ƉĞŽƉůĞ͘ ƐƉĞĐŝĨŝĐ ĂŶŝŵĂů ƐŽƵƌĐĞ ŽĨ Ks/Ͳϭϵ ŚĂƐ ŶŽƚ ďĞĞŶ ŝĚĞŶƚŝĨŝĞĚ͕ ďƵƚ ƚŚĞ ǀŝƌƵƐ ŚĂƐ ďĞĞŶ ůŝŶŬĞĚ ƚŽ Ă ůĂƌŐĞ ƐĞĂĨŽŽĚ ĂŶĚ ůŝǀĞ ĂŶŝŵĂů ŵĂƌŬĞƚ͘
tŚĂƚ ĂƌĞ ƚŚĞ ƐǇŵƉƚŽŵƐ ŽĨ Ks/Ͳϭϵ͍ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ĞŶƚĞƌ ĨŽƌ ŝƐĞĂƐĞ ŽŶƚƌŽů ;Ϳ͕ ŝŶĚŝǀŝĚƵĂůƐ ĚŝĂŐŶŽƐĞĚ ǁŝƚŚ ƚŚŝƐ ĐŽƌŽŶĂǀŝƌƵƐ ĞǆƉĞƌŝĞŶĐĞ Ă ŵŝůĚ ƚŽ
ƐĞǀĞƌĞ ƌĞƐƉŝƌĂƚŽƌǇ ŝůůŶĞƐƐ͘ ^ǇŵƉƚŽŵƐ ŝŶĐůƵĚĞ ĨĞǀĞƌ͕ ĐŽƵŐŚ ĂŶĚ ƐŚŽƌƚŶĞƐƐ ŽĨ ďƌĞĂƚŚ͘ /ŶĚŝǀŝĚƵĂůƐ ǁŝƚŚ ƐĞǀĞƌĞ ĐŽŵƉůŝĐĂƚŝŽŶƐ ĨƌŽŵ ƚŚĞ ǀŝƌƵƐ ŽĨƚĞŶ ĚĞǀĞůŽƉ ƉŶĞƵŵŽŶŝĂ ŝŶ ďŽƚŚ ůƵŶŐƐ͘
,Žǁ ĚŽĞƐ ƚŚĞ ǀŝƌƵƐ ƐƉƌĞĂĚ͍ dŚĞ ǀŝƌƵƐ ŝƐ ƐƉƌĞĂĚ ƉĞƌƐŽŶͲƚŽͲƉĞƌƐŽŶ͘ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ͕ ƐƉƌĞĂĚ ŝƐ ŚĂƉƉĞŶŝŶŐ ŵĂŝŶůǇ ďĞƚǁĞĞŶ ƉĞŽƉůĞ ǁŚŽ ĂƌĞ ŝŶ ĐůŽƐĞ ĐŽŶƚĂĐƚ ;ǁŝƚŚŝŶ ϲ ĨĞĞƚͿ ŽĨ ĞĂĐŚ ŽƚŚĞƌ ǀŝĂ ƌĞƐƉŝƌĂƚŽƌǇ ĚƌŽƉůĞƚƐ ƉƌŽĚƵĐĞĚ ǁŚĞŶ ĂŶ ŝŶĨĞĐƚĞĚ ƉĞƌƐŽŶ ĐŽƵŐŚƐ Žƌ ƐŶĞĞǌĞƐ͘ dŚĞ ĚƌŽƉůĞƚƐ ůĂŶĚ ŽŶ ƚŚĞ ŶŽƐĞƐ ĂŶĚ ŵŽƵƚŚƐ ŽĨ ŽƚŚĞƌ ƉĞŽƉůĞ͕ ǁŚŽ ƚŚĞŶ ŝŶŚĂůĞ ƚŚĞŵ͘ dŚĞ  ƐĂǇƐ ŝƚ ŵĂǇ ďĞ ƉŽƐƐŝďůĞ ĨŽƌ ƚŚĞ ǀŝƌƵƐ ƚŽ ƐƉƌĞĂĚ ďǇ ƚŽƵĐŚŝŶŐ Ă ƐƵƌĨĂĐĞ Žƌ ŽďũĞĐƚ ǁŝƚŚ ƚŚĞ ǀŝƌƵƐ ĂŶĚ ƚŚĞŶ Ă ƉĞƌƐŽŶ ƚŽƵĐŚŝŶŐ ƚŚĞŝƌ ŵŽƵƚŚ͕ ŶŽƐĞ Žƌ ĞǇĞƐ͕ ďƵƚ ƚŚŝƐ ŝƐ ŶŽƚ ƚŚŽƵŐŚƚ ƚŽ ďĞ ƚŚĞ ŵĂŝŶ ŵĞƚŚŽĚ ŽĨ ƐƉƌĞĂĚ͘ Ɛ ƚŚĞ ǀŝƌƵƐ ǁĂƐ ĚŝƐĐŽǀĞƌĞĚ ũƵƐƚ Ă ĨĞǁ ŵŽŶƚŚƐ ĂŐŽ͕ ŵŽƌĞ ƌĞƐĞĂƌĐŚ ŝƐ ƌĞƋƵŝƌĞĚ ƚŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ƐƉƌĞĂĚ ƉĂƚƚĞƌŶ ŽĨ ƚŚĞ ǀŝƌƵƐ͘ dŚĞ ŝŶĐƵďĂƚŝŽŶ ƉĞƌŝŽĚ ƌĂŶŐĞƐ ĨƌŽŵ Ϯ ƚŽ ϭϰ ĚĂǇƐ ĂĨƚĞƌ ĞǆƉŽƐƵƌĞ ;ŵŽƐƚ ĐĂƐĞƐ ŽĐĐƵƌƌŝŶŐ Ăƚ ĂƉƉƌŽǆŝŵĂƚĞůǇ ϱ ĚĂǇƐ͘Ϳ WĞŽƉůĞ ĂƌĞ ƚŚŽƵŐŚƚ ƚŽ ďĞ ŵŽƐƚ ĐŽŶƚĂŐŝŽƵƐ ǁŚĞŶ ƚŚĞǇ ĂƌĞ ŵŽƐƚ ƐǇŵƉƚŽŵĂƚŝĐ ;ƚŚĞ ƐŝĐŬĞƐƚ͘Ϳ ^ŽŵĞ ƐƉƌĞĂĚ ŵŝŐŚƚ ďĞ ƉŽƐƐŝďůĞ ďĞĨŽƌĞ ƉĞŽƉůĞ ƐŚŽǁ ƐǇŵƉƚŽŵƐ͘
Ž / ŶĞĞĚ ƚŽ ǁĞĂƌ Ă ƉƌŽƚĞĐƚŝǀĞ ŵĂƐŬ͍ dŚĞƌĞ ŝƐ ŶŽ ŶĞĞĚ ĨŽƌ ŚĞĂůƚŚǇ ŝŶĚŝǀŝĚƵĂůƐ ƚŽ ǁĞĂƌ ƐƵƌŐŝĐĂů ŵĂƐŬƐ ƚŽ ŐƵĂƌĚ ĂŐĂŝŶƐƚ ĐŽƌŽŶĂǀŝƌƵƐ͘ /ŶĚŝǀŝĚƵĂůƐ ƐŚŽƵůĚ ŽŶůǇ ǁĞĂƌ Ă ŵĂƐŬ ŝĨ ƚŚĞǇ ĂƌĞ ŝůů Žƌ ŝĨ ŝƚ ŝƐ ƌĞĐŽŵŵĞŶĚĞĚ ďǇ Ă ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂů͘ DĂƐŬƐ ŵƵƐƚ ďĞ ƵƐĞĚ ĂŶĚ ĚŝƐƉŽƐĞĚ ŽĨ ƉƌŽƉĞƌůǇ ƚŽ ďĞ ĞĨĨĞĐƚŝǀĞ͘
/Ɛ ƚŚĞƌĞ Ă ĐƵƌĞ ĨŽƌ ƚŚĞ ǀŝƌƵƐ͍ dŚĞƌĞ ŝƐ ŶŽ ƐƉĞĐŝĨŝĐ ŵĞĚŝĐĂƚŝŽŶ ƚŽ ƚƌĞĂƚ Ks/Ͳϭϵ͖ ƐƵƉƉŽƌƚŝǀĞ ĐĂƌĞ ŝƐ ƉƌŽǀŝĚĞĚ ƚŽ ƚƌĞĂƚ ƐǇŵƉƚŽŵƐ͘ dŚĞƌĞ ŝƐ ĐƵƌƌĞŶƚůǇ ŶŽ ǀĂĐĐŝŶĞ ƚŽ ƉƌŽƚĞĐƚ ĂŐĂŝŶƐƚ Ks/Ͳϭϵ͘ /ŶĚŝǀŝĚƵĂůƐ ƐŚŽƵůĚ ƚĂŬĞ ĐĂƌĞ ƚŽ ĂǀŽŝĚ ďĞŝŶŐ ĞǆƉŽƐĞĚ ƚŽ ƚŚĞ ǀŝƌƵƐ ƚŚƌŽƵŐŚ ŚǇŐŝĞŶĞ ĂŶĚ ƐĂŶŝƚĂƌǇ ƉƌĂĐƚŝĐĞƐ͘ WůĞĂƐĞ ƐĞĞŬ ŝŵŵĞĚŝĂƚĞ ŵĞĚŝĐĂů ĐĂƌĞ ƚŽ ƌĞůŝĞǀĞ ƐǇŵƉƚŽŵƐ ŝĨ ŝŶĨĞĐƚĞĚ ǁŝƚŚ ƚŚĞ ǀŝƌƵƐ͘

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,Žǁ ĚŽ / ƉƌŽƚĞĐƚ ŵǇƐĞůĨ ĂŶĚ ŽƚŚĞƌƐ͍ dŚĞƌĞ ŝƐ ĐƵƌƌĞŶƚůǇ ŶŽ ǀĂĐĐŝŶĞ ƚŽ ƉƌĞǀĞŶƚ Ks/Ͳϭϵ Žƌ ŵĞĚŝĐĂƚŝŽŶ ƚŽ ĚŝƌĞĐƚůǇ ƚƌĞĂƚ Ks/Ͳϭϵ͘ dŚĞ ďĞƐƚ ǁĂǇ ƚŽ ƉƌŽƚĞĐƚ ǇŽƵƌƐĞůĨ ŝƐ ƚŽ ĂǀŽŝĚ ďĞŝŶŐ ĞǆƉŽƐĞĚ ƚŽ ƚŚĞ ǀŝƌƵƐ ƚŚĂƚ ĐĂƵƐĞƐ Ks/Ͳϭϵ͘ dŚĞ  ƌĞĐŽŵŵĞŶĚƐ ŵĂŝŶƚĂŝŶŝŶŐ ƉĞƌƐŽŶĂů ƉƌĞǀĞŶƚĂƚŝǀĞ ĂĐƚŝŽŶƐ ƐƵĐŚ ĂƐ͗
x ǀŽŝĚŝŶŐ ĐůŽƐĞ ĐŽŶƚĂĐƚ ǁŝƚŚ ƚŚŽƐĞ ǁŚŽ ĂƌĞ ƐŝĐŬ x EŽƚ ƚŽƵĐŚŝŶŐ ǇŽƵƌ ĞǇĞƐ͕ ŵŽƵƚŚ Žƌ ŶŽƐĞ͕ ĞƐƉĞĐŝĂůůǇ ǁŝƚŚ ƵŶǁĂƐŚĞĚ ŚĂŶĚƐ x tĂƐŚŝŶŐ ǇŽƵƌ ŚĂŶĚƐ ŽĨƚĞŶ ǁŝƚŚ ƐŽĂƉ ĂŶĚ ǁĂƌŵ ǁĂƚĞƌ ĨŽƌ ůĂƐƚ ůĞĂƐƚ ϮϬ ƐĞĐŽŶĚƐ x ůĞĂŶ ŽďũĞĐƚƐ ĂŶĚ ƐƵƌĨĂĐĞƐ ƚŚĂƚ ĂƌĞ ĨƌĞƋƵĞŶƚůǇ ƚŽƵĐŚĞĚ x >ŝŵŝƚ ǇŽƵƌ ĞǆƉŽƐƵƌĞ ƚŽ ŽƚŚĞƌƐ ŝĨ ǇŽƵ ĂƌĞ ƐŝĐŬ x ŽǀĞƌ ǇŽƵƌ ĐŽƵŐŚƐ ĂŶĚ ƐŶĞĞǌĞƐ ǁŝƚŚ Ă ƚŝƐƐƵĞ x Ž ŶŽƚ ƐŚĂƌĞ ĨŽŽĚ͕ ĚƌŝŶŬƐ͕ ƵƚĞŶƐŝůƐ͕ Žƌ ƚŽŽƚŚďƌƵƐŚĞƐ
tŚĂƚ ƐŚŽƵůĚ / ĚŽ ŝĨ / ƚŚŝŶŬ / ŚĂǀĞ Ks/Ͳϭϵ͍ ǀŽŝĚ ĚŝƌĞĐƚ ĐŽŶƚĂĐƚ ǁŝƚŚ ŽƚŚĞƌ ƉĞŽƉůĞ ĂŶĚ ŝŵŵĞĚŝĂƚĞůǇ ƌĞƋƵĞƐƚ ƚŽ ďĞ ƐĞĞŶ ďǇ ŚĞĂůƚŚ ĐĂƌĞ ŝĨ ǇŽƵ ĨĞĞů ƐŝĐŬ ǁŝƚŚ Ă
ĨĞǀĞƌ͕ ĐŽƵŐŚ Žƌ ĚŝĨĨŝĐƵůƚǇ ďƌĞĂƚŚŝŶŐ͘ DĂŬĞ ƐƵƌĞ ƚŽ ŐŝǀĞ ǇŽƵƌ ƉƌŽǀŝĚĞƌ ĚĞƚĂŝůƐ ŽĨ ĂŶǇ ƐǇŵƉƚŽŵƐ ĂŶĚ ƉŽƚĞŶƚŝĂů ĐŽŶƚĂĐƚ ǁŝƚŚ ŝŶĚŝǀŝĚƵĂůƐ ǁŚŽ ŵĂǇ ŚĂǀĞ ƌĞĐĞŶƚůǇ ƚƌĂǀĞůĞĚ͘
tŝůů / ďĞ ƚĞƐƚĞĚ ĨŽƌ Ks/Ͳϭϵ͍ zŽƵ ǁŝůů ďĞ ƚĞƐƚĞĚ ŝĨ ǇŽƵƌ ƉƌŽǀŝĚĞƌ ƐƵƐƉĞĐƚƐ ǇŽƵ ŚĂǀĞ Ks/Ͳϭϵ͘
tŚĂƚ ŝƐ Zͬ,^ ĚŽŝŶŐ ƚŽ ƉƌĞƉĂƌĞ ĨŽƌ Ă ƉŽƚĞŶƚŝĂů ŽƵƚďƌĞĂŬ͍ Z ĂŶĚ ,^ ĂƌĞ ĚĞĚŝĐĂƚĞĚ ƚŽ ƚŚĞ ƐĂĨĞƚǇ ŽĨ ĞǀĞƌǇŽŶĞ ǁŚŽ ůŝǀĞƐ͕ ǁŽƌŬƐ͕ ĂŶĚ ǀŝƐŝƚƐ ŽƵƌ ƐƚĂƚĞ ƉƌŝƐŽŶƐ͘ tĞ ŚĂǀĞ ůŽŶŐƐƚĂŶĚŝŶŐ ĞŵĞƌŐĞŶĐǇ ƌĞƐƉŽŶƐĞ ƉůĂŶƐ ŝŶ ƉůĂĐĞ ƚŽ ĂĚĚƌĞƐƐ ĐŽŵŵƵŶŝĐĂďůĞ ĚŝƐĞĂƐĞ ŽƵƚďƌĞĂŬƐ ƐƵĐŚ ĂƐ ŝŶĨůƵĞŶǌĂ͕ ŵĞĂƐůĞƐ͕ ŵƵŵƉƐ͕ ŶŽƌŽǀŝƌƵƐ͕ ĂƐ ǁĞůů ĂƐ ĐŽƌŽŶĂǀŝƌƵƐ͘ ĂƐĞĚ ŽŶ ŐƵŝĚĂŶĐĞ ĨƌŽŵ ƚŚĞ ͕ ĂŶĚ ƚŽ ĞŶƐƵƌĞ ǁĞ ĂƌĞ ĂƐ ƉƌĞƉĂƌĞĚ ĂƐ ƉŽƐƐŝďůĞ ƚŽ ƌĞƐƉŽŶĚ ƚŽ ĂŶǇ ĞǆƉŽƐƵƌĞ ƚŽ Ks/Ͳϭϵ ƐƉĞĐŝĨŝĐĂůůǇ͕ ǁĞ ĂƌĞ ďƵŝůĚŝŶŐ ƵƉŽŶ ƚŚĞ ƌŽďƵƐƚ ŝŶĨůƵĞŶǌĂ ŝŶĨĞĐƚŝŽŶ ĐŽŶƚƌŽů ŐƵŝĚĞůŝŶĞƐ ĂůƌĞĂĚǇ ŝŶ ƉůĂĐĞ Ăƚ ĞĂĐŚ ŝŶƐƚŝƚƵƚŝŽŶ͘ dŚĞƐĞ ŐƵŝĚĞůŝŶĞƐ ĐůĞĂƌůǇ ĚĞĨŝŶĞ ƉƌŽĐĞĚƵƌĞƐ ĨŽƌ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ƚƌĂŶƐŵŝƐƐŝŽŶ͕ ŵĂŶĂŐĞŵĞŶƚ ŽĨ ƐƵƐƉĞĐƚĞĚ ĂŶĚ ĐŽŶĨŝƌŵĞĚ ĐĂƐĞƐ ŝŶĐůƵĚŝŶŐ ŝƐŽůĂƚŝŽŶ ĂŶĚ ƋƵĂƌĂŶƚŝŶĞ ƉƌŽƚŽĐŽůƐ͕ ƐƵƌǀĞŝůůĂŶĐĞ ŽĨ ƉĂƚŝĞŶƚƐ͕ ĂŶĚ ƌŽƵƚŝŶĞ ĐůĞĂŶŝŶŐ ĂŶĚ ĚŝƐŝŶĨĞĐƚŝŽŶ ƉƌŽĐĞĚƵƌĞƐ͘
/Ĩ ƚŚĞƌĞ ŝƐ Ă ƐƵƐƉĞĐƚĞĚ ĐĂƐĞ ŽĨ Ks/Ͳϭϵ͕ ǁĞ ǁŝůů ĨŽůůŽǁ ƚŚĞ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŽĐĞĚƵƌĞƐ ĂůƌĞĂĚǇ ŝŶ ƉůĂĐĞ ĨŽƌ ŵŽĚŝĨŝĞĚ ƉƌŽŐƌĂŵŵŝŶŐ ĨŽƌ ĂŶǇ ĂĨĨĞĐƚĞĚ ŚŽƵƐŝŶŐ ƵŶŝƚƐ ĂŶĚ ĂƌĞĂƐ͘ tĞ ǁŝůů ĐŽŶƚŝŶƵĞ ƚŽ ƵƉĚĂƚĞ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ Ks/Ͳϭϵ ƌĞƐƉŽŶƐĞ ďĂƐĞĚ ŽŶ  ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĂŶĚ ǁŝůů ŵĂŝŶƚĂŝŶ ĐŽŽƉĞƌĂƚŝŽŶ ǁŝƚŚ ůŽĐĂů ĂŶĚ ƐƚĂƚĞ ŚĞĂůƚŚ ĚĞƉĂƌƚŵĞŶƚƐ ĂŶĚ ƚŚĞ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĐŽŵŵƵŶŝƚǇ͘
Ks/Ͳϭϵ ŝƐ ŶĞǁ͕ ďƵƚ ƚŚĞ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ĂƐƉĞĐƚ ŽĨ ƉƌĞƉĂƌĞĚŶĞƐƐ ŝƐ ƌĞŵĂŝŶŝŶŐ ĐĂůŵ͘ ŽŶ͛ƚ ƉĂŶŝĐ͘ tĞ ƵŶĚĞƌƐƚĂŶĚ ƐƚĂĨĨ͕ ĨĂŵŝůŝĞƐ͕ ĂŶĚ ƚŚŽƐĞ ǁŚŽ ǀŝƐŝƚ ƐƚĂƚĞ ƉƌŝƐŽŶƐ ĂƐ ƉƌŽŐƌĂŵ ƉƌŽǀŝĚĞƌƐ Žƌ ǀŽůƵŶƚĞĞƌƐ ŵĂǇ ŚĂǀĞ ĐŽŶĐĞƌŶƐ ĂŶĚ ĂŶǆŝĞƚǇ ĂďŽƵƚ Ks/Ͳϭϵ͕ ďƵƚ ƉůĞĂƐĞ ďĞ ĂƐƐƵƌĞĚ ƚŚĂƚ ƚŚĞƌĞ ŝƐ ŶŽ ŶĞĞĚ ĨŽƌ ĂůĂƌŵ͘ ůů ƐŚŽƵůĚ ĨŽůůŽǁ ƚŚĞ ƉƌĞĐĂƵƚŝŽŶƐ ƌĞĐŽŵŵĞŶĚĞĚ ďǇ ͕ ǁŚŝĐŚ ĞǆƉĂŶĚ ƵƉŽŶ ƉƌĞĐĂƵƚŝŽŶƐ ĂĚǀŝƐĞĚ ĚƵƌŝŶŐ ĐŽůĚ ĂŶĚ ĨůƵ ƐĞĂƐŽŶ͘ dŚĞ ƐƉƌĞĂĚ ŽĨ Ks/Ͳϭϵ ĐĂŶ ďĞ ƐŝŐŶŝĨŝĐĂŶƚůǇ ƌĞĚƵĐĞĚ ǁŝƚŚ ƉƌŽƉĞƌ ŝŶĨĞĐƚŝŽŶ ĐŽŶƚƌŽů ŵĞĂƐƵƌĞƐ ĂŶĚ ŐŽŽĚ ŝŶĚŝǀŝĚƵĂů ŚǇŐŝĞŶĞ ƉƌĂĐƚŝĐĞƐ͘
t ^, zKhZ , E^ &ZYhEd>z

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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7 CRIMINAL CASE STANDING ORDER
RE: PROCEDURE FOR REVIEW OF
8 DETENTION ORDERS IN LIGHT OF
CORONAVIRUS PANDEMIC
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Magistrate Judge Nat Cousins Effective March 16, 2020

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I am issuing this criminal standing order on March 16, 2020, in response to the
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coronavirus pandemic. It applies to every open criminal case in which I have ordered a
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criminal defendant to be detained and that defendant is presently held in custody awaiting
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trial. Most detainees in this District are presently housed at Santa Rita Jail in Alameda
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County, California. Defendants detained by other judges are not covered by this standing
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order. A copy of this order will also be provided to the offices of the Federal Public
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Defender, the United States Attorney, the CJA attorney coordinator, U.S. Pretrial Services,
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and posted publicly on the Court s web page.
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Under the Bail Reform Act, 18 U.S.C. § 3145(f)(2), a detention hearing may be
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reopened at any time before trial if the judicial officer finds that information exists that was
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not known to the movant at the time of the detention hearing and that has a material bearing
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on the issue whether there are conditions of release that will reasonably assure the
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appearance of such person as required and the safety of any other person and the
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community. Two of the detention or release factors (among others) to be considered by the
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judicial officer are (1) the person s “physical and mental condition” (3145(g)(3)(A)) and (2)
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the nature and seriousness of the danger to any person or the community that would be
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posed by the person s release (3145(g)(4)).
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The Crime Victims Rights Act, 18 U.S.C. § 3771, also provides crime victims the
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1 statutory right to be reasonably protected from the accused, to reasonable notice of any

2 public court proceeding involving the crime or release of the accused, the right to be

3 reasonably heard and not excluded from public court proceedings, the right to be treated

4 with fairness and respect, the right to confer with the attorney for the Government in the

5 case, the right to proceedings free from unreasonable delay, and the right to be informed of

6 the rights under the Act. The Court shall ensure the crime victim is afforded the rights

7 described in the Act. 18 U.S.C. § 3771(b)(1).

8

This standing order sets forth the procedure for any request to reopen a detention

9 hearing on the basis of the physical and mental condition of the accused. This public health

10 crisis is serious and urgent. Counsel should not delay in evaluating whether any defendant

11 should have his or her detention hearing reopened.

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1. Counsel for the Government and accused must confer first in an effort to

13 determine if they agree.

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2. The Government must provide notice and an opportunity to confer and be

15 reasonably heard to any crime victim.

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3. Any stipulation or motion to reopen must be filed in the ECF system.

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4. The motion should state whether the defendant waives personal presence at the

18 hearing.

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5. Copies of the motion to reopen must be provided to Pretrial Services and to

20 Clerk s Office Manager Snooki Puli at Snooki_Puli@cand.uscourts.gov. This may be by

21 email.

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6. Unless otherwise ordered, no hearing will be held in person. Counsel, clients, and

23 crime victims will be allowed to participate by telephone or video to the extent practicable.

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IT IS SO ORDERED.

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Date: March 16, 2020

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_________________________ Nathanael M. Cousins United States Magistrate Judge

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 Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 16 of 119
EXHIBIT A
Consent Decree
Mays v. County of Sacramento

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MAYS V. COUNTY OF SACRAMENTO
REMEDIAL PLAN
Definitions “Chief Disciplinary Officer” is the individual who is responsible for overseeing the disciplinary system and ensuring consistency in disciplinary practices and procedures.
“County” refers to Sacramento County.
“Designated Mental Health Units” refers to any specialized units specifically operated to house and serve prisoners requiring mental health treatment, including the inpatient unit (2P), the Intensive Outpatient Program (IOP), the Outpatient Psychiatric Pods.
“Disciplinary Hearing Officer” includes any sergeant, officer, or other individual who has responsibility for adjudicating a disciplinary report and/or imposing disciplinary measures.
“Discipline” is the imposition of penalties for prisoner misconduct that violates Jail facility rules.
“Disability” means any physical or mental impairment that substantially limits one or more major life activities. These include, but are not limited to, any disability that would substantially limit the mobility of an individual or an impairment of vision and/or hearing, speaking or performing manual tasks that require some level of dexterity. Additionally, disability includes a physical or mental impairment that would inhibit a person's ability to meet the rules and regulations of the facility.
“Effective Communication” means that any written or spoken communication must be as clear and understandable to people with disabilities as it is for people who do not have disabilities.
“Intellectual Disability” is a disability characterized by significant limitations in intellectual functioning (such as learning, reasoning, and problem-solving) and in adaptive behavior (conceptual skills such as language, literacy, money, time, and selfdirection; social and interpersonal skills; and practical skills such as personal care and schedules/routines). This includes people for whom the onset of the disability occurred before age 18 (developmental disabilities) and people for whom events later in life resulted in similar limitations (for example, head injury, stroke, or dementia).
“Medical Staff” means medical personnel including physicians, dentist, pharmacist, nurse practitioners, supervising registered nurses, registered nurses, registered dental hygienists, licensed vocational nurses, pharmacy technicians, medical assistants, registered dental assistants, certified nursing aids and other medical personnel.

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“Medical services,” “medical treatment” and “medical staff” includes dental services, dental treatment and dental staff, as well as medical pharmacy services and pharmacy staff.
“Mental health caseload” means all prisoners in the jail with a current need for any mental health services.
“Out-of-cell activities” are activities which occur out of the inmates’ cell. Examples of such activities include but are not limited to games, the use of tablets and other socialization among inmates.
“Provider” means physician, dentist, pharmacist, physician’s assistant, or nurse practitioner.
“Qualified Mental Health Professional” means psychiatrists, psychologists, master’s level social workers, licensed professional counselors, licensed nurses, or others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide mental health care to patients.
“Qualified Health Care Professional” means physicians, physician assistants, nurses, nurse practitioners, dentists, qualified mental health professionals, and others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide health care to patients.
“Qualified Sign Language Interpreter” (“SLI”) is an individual, available on-site or through a VRI service, who is adept at American Sign Language and has passed a test and qualified in one of the categories established by the National Association for the Deaf (NAD) or one of the categories established by the Registry of Interpreters for the Deaf (RID).
“Segregation” means the confinement in a locked room or cell, with or without a cellmate, with limited social contact as compared with the general population, in conditions characterized by substantial isolation, whether pursuant to disciplinary, administrative, or classification action. If a housing unit or location does not meet the above definition, the unit will not be considered a segregation unit, regardless of name.
“Serious Mental Illness” (“SMI”) means a mental, behavioral, or emotional disorder of mood, thought, or anxiety that significantly impairs judgment, behavior, capacity to recognize reality, or substantially interferes with primary activities of daily living.
“Temporary Suicide Precautions Housing” refers to any non-inpatient unit where the Jail houses prisoners requiring suicide precautions and/or inpatient level of psychiatric care, including but not limited to safety cells, holding cells, North Holding Cell No. 2 at RCCC, Main Jail booking segregation cells, and the classrooms/multipurpose rooms adjacent to the Main Jail housing units.
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“TTYs” or “TDDs” means devices that are used with a telephone to communicate with persons who are Deaf by typing and reading communications.
“Videophone” means a device with a video camera that can perform bi-directional video and audio transmissions between people in real-time.
“Video-Relay Services” or “VRS” is a video telecommunications relay service that enables persons with hearing-related disabilities who use Sign Language to communicate with voice telephone users through video equipment, such as a Videophone, rather than through typed text.
“Video Remote Interpreting service” or “VRI service” means an interpreting service that uses video conference technology over dedicated lines or wireless technology offering clear, delay-free, full-motion video and audio over high-speed connection that delivers high-quality video images as provided in 28 § 35.160(d).
GENERAL PROVISIONS The County shall maintain sufficient medical, mental health, and custody staff to meet the requirements of this Remedial Plan. The parties agree that the custodial and health care staff must be increased to meet minimal constitutional and statutory standards. Presently, there are insufficient deputies to supervise out-of-cell activities for people in the general population and administrative segregation, and to provide security for health-related tasks. The parties agree that reduction in jail population is a cost-effective means to achieve constitutional and statutory standards. 1. The County intends to hire additional custodial and health care staff. The parties agree that population reduction of the jails will facilitate compliance with this Remedial Plan. All population reduction measures should be designed to promote public safety through evidence-based programs. 2. If through the monitoring process it is determined that the County is not fulfilling the provisions of this Remedial Plan due to staffing deficiencies, the parties will meet and confer regarding what steps to take to reduce the population of the jail, including available resources to facilitate population reduction. The parties agree to meet and confer regarding the gathering and posting of data related to the Jail population. The parties agree that the categories of information to be gathered and publicly posted on a quarterly basis are the following: a) the number of people with mental illness booked into jail; b) their average length of stay; c) the percentage of people connected to treatment; d) their recidivism rates;
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e) the total number of people in jail with a mental health need; f) the number of people who were receiving mental health services at the
time of booking; and g) the number of sentenced and unsentenced inmates in custody. h) For sentenced people in the jail, the nature of the commitment
convictions, length of sentence(s), and level of mental health care (e.g., Acute, IOP, OPP). i) For unsentenced people in the jail, the nature of the charges, length of pre-trial detention, and level of mental health care (e.g., Acute, IOP, OPP). AMERICANS WITH DISABILITIES ACT (ADA) COMPLIANCE Policies and Procedures 1. It is the County’s policy to provide access to its programs and services to prisoners with disabilities, with or without reasonable accommodation, consistent with legitimate penological interests. No prisoner with a disability, as defined in 42 U.S.C. § 12102 shall, because of that disability, be excluded from participation in or denied the benefits of services, programs, or activities or be subjected to discrimination. The County’s policy is to provide reasonable accommodations or modifications where necessary, consistent with 28 C.F.R. §§ 35.150 & 35.152, and other applicable federal and state disability law. 2. The County shall, in consultation with Plaintiffs’ counsel, revise its Operations Order to establish standard and consistent procedures for the Jail to ensure compliance with the ADA and the remedial provisions outlined herein. 3. The County shall, within 12 months from court approval of the Settlement and in consultation with Plaintiffs’ counsel, revise policies, procedures, and inmate orientation materials (e.g. Inmate Handbook), in accordance with the revised Operations Order and the remedial provisions outlined herein. A list of policies which the County will revise consistent with the provisions outlined herein, as appropriate and in consultation with Plaintiffs’ counsel, is attached as Exhibit A-1. 4. All staff will receive training appropriate to their position on policies and procedures related to compliance with the Americans with Disabilities Act (ADA) and related disability laws. ADA Tracking System 1. The County shall develop and implement a comprehensive system (an “ADA Tracking System”) to identify and track screened prisoners with disabilities as well as accommodation and Effective Communication needs. 2. The ADA Tracking System shall identify:
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a) All types of disabilities, including but not limited to psychiatric, intellectual, developmental, learning, sensory, mobility, or other physical disabilities, and special health care needs;
b) Prisoners with disabilities that may pose a barrier to communication, including but not limited to learning, intellectual, or developmental disabilities, and hearing, speech, or vision impairments;
c) Accommodation needs, including as to housing, classification, Effective Communication, adaptive supports, and assistive devices;
d) Prisoners who require specific health care appliances, assistive devices, and/or durable medical equipment (HCA/AD/DME);
e) Prisoners who are class members in Armstrong v. Newsom (N.D. Cal. No. 94-cv-02307), with their applicable disability classification(s) and accommodation need(s).
3. The ADA Tracking System’s prisoner disability information will be readily accessible to custody, medical, mental health, and other staff at the Jail who need such information to ensure appropriate accommodations and adequate program access for prisoners with disabilities.
ADA Coordinator 1. The County shall have a dedicated ADA Coordinator at each facility. 2. The ADA Coordinator position shall be dedicated to coordinating efforts to
comply with and carry out ADA-related requirements and policies, shall have sufficient command authority to carry out such duties, and shall work with the executive management team regarding ADA-related compliance, training, and program needs. 3. The County shall clearly enumerate, in consultation with Plaintiffs’ counsel, the job duties and training requirements for the ADA Coordinator position and for ADA Deputies assigned to support the ADA Coordinator position. 4. The County shall ensure that ADA Coordinators and ADA Deputies possess requisite training to implement and ensure compliance with the Jail’s disability program and services, including operation of the ADA Tracking System. Screening for Disability and Disability-Related Needs. 1. The County shall conduct adequate screening of prisoners to be housed in the Jail in order to identify disabilities and disability-related accommodation, housing, classification, and other needs. All individuals detained at the Jail for any period of time will be assessed for Effective Communication needs, consistent with the provisions herein. 2. The County shall take steps to identify and verify each prisoner’s disability and disability-related needs during medical intake screening, including based on:
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a) The individual’s self-identification or claim to have a disability; b) Documentation of a disability in the individual’s health record; c) Staff observation that the individual may have a disability that affects
placement, program access, or Effective Communication; or d) The request of a third party (such as a family member) for an evaluation
of the individual for an alleged disability. Orientation 1. The County shall ensure that, for the population to be housed in the Jails,
prisoners with disabilities are adequately informed of their rights under the ADA, including but not limited to:
a) Accommodations available to prisoners; b) The process for requesting a reasonable accommodation; c) The role of the ADA coordinator(s) and method to contact them; d) The grievance process, location of the forms, and process for getting
assistance in completing grievance process; e) Instructions on how prisoners with disabilities can access health care
services, including the provision of Effective Communication and other accommodations available in accessing those services. 2. Upon processing and classification, prisoners with disabilities shall receive, in an accessible format, the jail rulebook; orientation handbook; and a verbal orientation or orientation video regarding rules or expectations. 3. The County shall accommodate individuals with disabilities in the orientation process through the use of alternative formats (e.g. verbal communication, large print, audio/video presentation), when necessary for Effective Communication of the information. 4. The County shall develop an Americans with Disabilities Act Inmate Notice. The Notice shall be prominently posted in all prisoner housing units, in the booking/intake areas, in medical/mental health/dental treatment areas, and at the public entrances of all Jail facilities. Health Care Appliances, Assistive Devices, Durable Medical Equipment 1. The County shall establish a written policy to ensure provision of safe and operational HCA/AD/DME, with a process for repair and replacement. 2. The County shall timely provide HCA/AD/DME to prisoners with disabilities who require such assistance. The County shall ensure an individualized assessment by medical staff to determine whether HCA/AD/DME is warranted to ensure equal and meaningful access to programs, services, and activities in the Jail.
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3. The County shall allow prisoners to retain personal HCAs/ADs/DME (which will include reading glasses), unless there is an individualized determination that doing so would create an articulated safety or security risk. a) Where Jail staff determine it is necessary to remove a prisoner’s personal HCA/AD/DME for security reasons, the County shall provide an equivalent Jail-issued device unless custody staff, with supervisory review, determine and document, based on an individualized assessment, that the device constitutes a risk of bodily harm or threatens the security of the facility. b) If such a determination is made, the ADA coordinator or supervisorylevel designee shall document the decision and reasons for it, in writing, and shall consult with medical staff to determine an appropriate alternative accommodation.
4. The County shall, in consultation with Plaintiffs’ counsel, implement a written policy governing the release of prisoners who need assistive devices upon release. a) The County will ensure that any personal mobility device belonging to a prisoner is returned to the prisoner prior to release from custody. b) If a prisoner does not have a personal mobility device, but is ambulatory with the assistance of a cane, crutch, or walker, the prisoner will be permitted to retain such device that was used while in custody upon release, or will be provided a comparable device, upon release. c) If a prisoner who is due for release requires a wheelchair, but does not have a personal wheelchair, Jail staff shall coordinate with the prisoner, the prisoner’s family or friends, and other County agencies as needed to secure a wheelchair or take other steps to address the individual’s needs upon release. The County shall document this process in the ADA Tracking System for purposes of individual tracking and quality assurance.
Housing Placements 1. The County shall house prisoners with disabilities in facilities that
accommodate their disabilities. 2. The County shall implement a housing assignment system that includes an
individualized assessment of each individual’s functioning limitations and restrictions, including but not limited to:
a) The need for ground floor housing; b) The need for a lower bunk; c) The need for grab bars in the cell and/or shower;
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d) The need for accessible toilets; e) The need for no stairs in the path of travel; and f) The need for level terrain. 3. Prisoners with disabilities shall be housed in the Jail consistent with their individual security classification. Prisoners prescribed or possessing HCAs/ADs/DME will not automatically be housed in a medical housing unit. Placement in a medical housing unit will be based on individualized clinical determination of need for treatment. 4. Classification staff shall not place prisoners with disabilities in: a) Inappropriate security classifications simply because no ADA-
accessible cells or beds are available; b) Designated medical areas unless the prisoner is currently receiving
medical care or treatment that necessitates placement in a medical setting; or c) Any location that does not offer the same or equivalent programs, services, or activities as the facilities where they would be housed absent a disability. Access to Programs, Services, and Activities 1. The County shall ensure prisoners with disabilities, including those housed in specialized medical units or mental health units (e.g., OPP, IOP, Acute) have equal access to programs, services, and activities available to similarly situated prisoners without disabilities, consistent with their health and security needs. Such programs, services, and activities include, but are not limited to: a) Educational, vocational, reentry and substance abuse programs b) Work Assignments c) Dayroom and other out-of-cell time d) Outdoor recreation and fitted exercise equipment e) Showers f) Telephones g) Reading materials h) Social visiting i) Attorney visiting j) Religious services k) Medical, mental health, and dental services and treatment
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2. The County shall provide reasonable accommodations and modifications as necessary to ensure that prisoners with disabilities have equal access to programs, services, and activities available to similarly situated prisoners without disabilities.
3. The County shall develop and implement a written policy for staff to provide appropriate assistance to prisoners with psychiatric, developmental, or cognitive disabilities so that they can fully participate in programs, services, and activities provided at the Jail.
4. The County shall implement a written policy for staff to provide assistance to prisoners with disabilities in reading or scribing documents.
5. The County shall provide equal access to library, recreational, and educational reading materials for prisoners with disabilities, including easy reading and large print books for individuals who require such accommodations.
6. The County shall ensure equitable inmate worker opportunities for prisoners with disabilities, including by: a) Ensuring clear job duty statements, with essential functions and specific criteria, for each Worker position; b) Ensuring that medical staff conduct an individualized assessment to identify work duty restrictions and/or physical limitations to facilitate appropriate work/industry assignments and to prevent improper exclusions from work opportunities; c) Providing reasonable accommodations to enable prisoners with disabilities to participate in inmate worker opportunities.
Effective Communication 1. The County shall assess all individuals detained at the Jail for any period of
time for Effective Communication needs, and shall take steps to provide Effective Communication based on individual need. 2. The County’s ADA policies shall include comprehensive guidance to ensure Effective Communication for prisoners with vision, speech, hearing, intellectual, learning, or other disabilities. The County shall, in consultation with Plaintiffs’ counsel, ensure that sufficient guidance on the provision of Effective Communication is included in Jail custody and health care policies and procedures. 3. Standard for Provision of Effective Communication in Due Process Events and Clinical Encounters
a) A higher standard for the provision of Effective Communication shall apply in the following situations: i. Due Process Events, including the following:
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 Classification processes  Prisoner disciplinary hearing and related processes  Service of notice (to appear and/or for new charges)  Release processes  Probation encounters/meetings in custody ii. Clinical Encounters, including the following:  Determination of medical history or description of ailment or
injury  Diagnosis or prognosis  Medical care and medical evaluations  Provision of mental health evaluations, rounds, group and
individual therapy, counseling and other therapeutic activities  Provision of the patient’s rights, informed consent, or
permission for treatment  Explanation of medications, procedures, treatment, treatment
options, or surgery  Discharge instructions b) In the situations described in subsection (a), above, Jail staff shall: i. Identify each prisoner’s disability where there may be a barrier to comprehension or communication requiring reasonable accommodation(s); ii. Provide effective reasonable accommodation(s) to overcome the communication barrier; and iii. Document the method used to achieve Effective Communication and how the staff person determined that the prisoner understood the encounter, process, and/or proceeding. 4. Effective auxiliary aids and services that are appropriate to the needs of a prisoner with Effective Communication needs shall be provided when simple written or oral communication is not effective. Such aids may include bilingual aides, SLIs, readers, sound amplification devices, captioned television/video text displays, Videophones and other telecommunication devices for deaf persons (TDDs), audiotaped texts, Braille materials, large print materials, writing materials, and signage. 5. In determining what auxiliary aid service to provide, the County shall give primary consideration to the request of prisoner with Effective Communication needs.
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6. Education providers (e.g., Elk Grove Unified School District) at the Jail will ensure Effective Communication for prisoners participating in education programs, including by providing necessary assistive equipment and take steps to accommodate learning strategies of those prisoner-students who have special needs, such as those with developmental, learning, vision, hearing, and speech disabilities.
7. The County shall assist prisoners who are unable to complete necessary paperwork (e.g., related to health care, due process, Jail processes) on their own with reading and/or writing as needed.
8. The County shall permit prisoners, including those who are illiterate, nonEnglish speaking, or otherwise unable to submit written or electronic sick call requests, to verbally request care. Such verbal requests shall immediately be documented by the staff member who receives the request on an appropriate form and transmitted to a qualified mental health or medical professional for response in the same priority as those sick call requests received in writing.
9. The County shall post and disseminate notices, policies, job announcements, and other written material in alternative formats to promote Effective Communication.
Effective Communication and Access for Individuals with Hearing Impairments 1. The County shall develop and implement a policy for newly arrived and newly
identified prisoners with hearing disabilities to determine each prisoner’s preferred method of communication. 2. Qualified Sign Language Interpreters (SLIs) will be provided during intake and for due process functions, health care encounters, and Jail programming, when sign language is the prisoner’s primary or only means of Effective Communication, unless the prisoner waives the assistance of an interpreter and/or delay would pose a safety or security risk.
a) The County shall maintain a contract or service agreement with interpreter services in order to provide such services for deaf or hearing impaired prisoners. Jail staff will be informed of the availability of contract interpreter services.
b) Lip reading will not be the sole method of Effective Communication used by staff, unless the prisoner has no other means of communication.
c) In cases where the use of an SLI is not practicable, or is waived by the prisoner, Jail staff shall employ the most effective form of communication available.
d) The County will maintain a log of (a) when, for whom, and for what purpose an SLI was used; and (b) when, for whom, and why a SLI was
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not used for a prisoner with an identified need for SLI services (e.g., prisoner waived SLI or delay would have posed safety or security risk). e) When a prisoner waives an SLI, the log must document (a) the method of communication of the waiver, and (b) the method staff used to determine that the waiver was knowing and freely given. 3. Jail Staff shall effectively communicate the contents of the Inmate Handbook and other materials providing information on Jail rules and procedures to all prisoners to be housed in the Jail who are deaf or hard of hearing. For those prisoners for whom written language is not an effective means of communication, Jail Staff may meet this obligation by providing a video of an SLI signing the contents of the Inmate Handbook, along with appropriate technology for viewing, or by providing an SLI to interpret the contents of the Inmate Handbook to the prisoner who is deaf or hard of hearing. 4. The County shall, within 12 months from court approval of the Settlement, make Videophones available for deaf and hard of hearing prisoners. The Videophones shall provide for calls through the use of Video-Relay Services (VRS) at no cost to deaf and hard of hearing prisoners or for calls directly to another Videophone. 5. Deaf/hard of hearing prisoners who use telecommunication relay services, such as Videophone or TDD/TTY machine, in lieu of the telephone shall receive equal access to the Videophone or TDD/TTY services as non-disabled prisoners are afforded for regular telephone usage. 6. The County shall provide deaf/hard of hearing prisoners with additional time for calls using telecommunication relay services, such as a Videophone or TDD/TTY, to account for the fact that signed and typed conversations take longer than spoken conversations. The County shall document the time that each prisoner uses and has access to such equipment. 7. Prisoners who require an SLI as their primary method of communication shall be provided an SLI for education, vocational, or religious programs and services. 8. Public verbal announcements in housing units where individuals who are deaf or hard of hearing reside shall be delivered on the public address system (if applicable) and by flicking the unit lights on and off several times to alert prisoners that an announcement is imminent. This includes announcements regarding visiting, meals, recreation release and recall, count, lock-up, and unlock. Verbal announcements may be effectively communicated via written messages on a chalkboard or by personal notification, as consistent with individual need. These procedures shall be communicated to prisoners during the orientation process and also shall be incorporated into relevant policies and post orders.
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Disability-Related Grievance Process 1. The County shall implement a grievance system for prisoners with disabilities
to report any disability-based discrimination or violation of the ADA, this Remedial Plan, or Jail ADA-related policy, and shall provide a prompt response and equitable resolution in each case. 2. The County shall ensure that the grievance procedures are readily available and accessible to all prisoners.
a) The County shall make reasonable efforts to ensure all prisoners are aware of the disability grievance procedures, including the availability of accommodations and staff assistance to submit a grievance and/or appeal.
b) The County shall ensure the prisoners with disabilities have meaningful access to grievance forms, including through provision of staff assistance and large print materials.
3. Response to Grievances a) The County shall develop and implement an ADA grievance process that includes (1) a reasonable timeline for response to ADA-related grievances and appeals, including an expedited process for urgent ADA grievance (e.g., involving prisoner safety or physical well-being); and (2) provision for interim accommodations pending review of the individual’s grievances/appeals. b) The County shall ensure that prisoners with communication needs are interviewed and provided assistance as part of the grievance/appeal process where necessary to ensure meaningful access and Effective Communication. c) The County shall document each denial of a reasonable accommodation request and shall record the basis for such determination. d) The County shall provide in writing a copy of the grievance (or appeal) response to the prisoner, including the resolution, the basis for a denial (if applicable), and the process for appeal. e) The County shall ensure that completed grievance responses are effectively communicated to prisoners with disabilities.
4. The submission, processing, and responses for disability-related grievances and complaints shall be tracked.
Alarms/Emergencies 1. The County shall ensure that all written policies regarding alarms and
emergencies contain mandatory provisions to accommodate prisoners with disabilities.
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2. The County shall implement written policies regarding the expectations of staff as to prisoners with identified disabilities during emergencies and alarms, including as to disabilities that may affect prisoners’ ability to comply with orders or otherwise respond to emergencies and alarms. For example, the policies shall ensure appropriate handling of prisoners with mobility-related disabilities who are unable to prone or take a seated position on the ground during an alarm or emergency. Such policies shall be communicated to staff, incorporated into the relevant Operations Orders, and communicated to prisoners with disabilities using Effective Communication.
3. The County shall implement written policies for staff regarding communicating effectively and appropriately with prisoners who have disabilities that may present barriers to communication during emergencies or alarms.
4. In order to facilitate appropriate accommodations during alarms or emergencies, the County shall offer, but shall not require, individuals who have disabilities visible markers to identify their disability needs (e.g., identification vests). The County shall maintain a list, posted in such a way to be readily available to Jail staff in each unit, of prisoners with disabilities that may require accommodations during an alarm or emergency.
5. The County shall install visual alarms appropriate for individuals who are deaf or hard of hearing, which shall comply with relevant fire code regulations.
6. All housing units shall post notices for emergency and fire exit routes. Searches, Restraints, and Extractions 1. The County shall modify its written policies to ensure that prisoners with
mobility impairments, including those with prosthetic devices, receive reasonable accommodations with the respect to the following: (1) Pat searches and unclothed body searches; (2) Application of restraints devices, including Pro-Straint Chair; and (3) Cell extractions. Transportation 1. The County shall provide reasonable accommodations for prisoners with disabilities when they are in transit, including during transport to court or outside health care services. 2. Prescribed HCAs/ADs/DME, including canes, for prisoners with disabilities shall be available to the prisoner at all times during the transport process, including in temporary holding cells, consistent with procedures outlined in Part VII. 3. The County shall use accessible vehicles to transport prisoners in wheelchairs and other prisoners whose disabilities necessitate special transportation, including by maintaining a sufficient number of accessible vehicles. (295)
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4. Prisoners with mobility impairments shall be provided assistance onto transport vehicles.
Prisoners with Intellectual Disabilities 1. The County shall, in consultation with Plaintiffs’ counsel, develop and
implement a comprehensive written policy and procedure regarding prisoners with an Intellectual Disability, including:
a) Screening for Intellectual Disabilities; b) Identification of prisoners’ adaptive support needs and adaptive
functioning deficits; and c) Monitoring, management, and accommodations for prisoners with
Intellectual Disabilities. 2. A multidisciplinary team that includes appropriate health care staff will
monitor and ensure appropriate care for prisoners with an Intellectual Disability. The multidisciplinary team will develop an individualized plan for each prisoner with an Intellectual Disability, which addresses: (1) safety, vulnerability, and victimization concerns, (2) adaptive support needs, (3) programming, housing, and accommodation needs. The multidisciplinary team’s plan will be regularly reviewed and updated as needed. 3. Prisoners with an Intellectual Disability assigned to a work/industry position will be provided additional supervision and training as necessary to help them meet the requirements of the assignment. ADA Training, Accountability, and Quality Assurance 1. The County shall ensure all custody, health care, facility maintenance, and other Jail staff receive ADA training appropriate to their position.
a) The County shall provide to all staff appropriate training on disability awareness, including the use and purpose of accommodations and modifications in accordance with the ADA.
b) The ADA training shall include: formalized lesson plans and inclassroom or virtual training for staff (including managers, supervisors, and rank-and-file staff) provided by certified or otherwise qualified ADA trainers.
2. ADA instructors shall have appropriate ADA training and subject matter expertise necessary to effectively provide ADA training to staff.
3. The County shall, in consultation with Plaintiffs’ counsel, develop and implement written policies and procedures regarding monitoring, investigating, and tracking staff violations (or allegations of violations) of ADA requirements and Jail ADA policies.
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4. The County shall develop an ADA accountability plan that will ensure quality assurance and establish staff accountability for egregious, serious, or repeated violations of the ADA and Jail ADA-related policies and procedures.
Accessibility Remedial Plan to Address Physical Plant Deficiencies 1. The County shall, within 24 months from court approval of the Settlement and
in consultation with Plaintiffs’ counsel, develop and fully implement an Accessibility Remedial Plan to address Jail physical plant deficiencies that result in access barriers for prisoners with disabilities. In the interim, the Sheriff’s Office shall house prisoners with disabilities in the most integrated and appropriate housing possible, providing reasonable accommodations and assistance where necessary to ensure appropriate accessibility to Jail programs, services, and activities. 2. The Accessibility Remedial Plan shall ensure the following:
a) Adequate provision of accessible cells and housing areas with required maneuvering clearances and accessible toilet fixtures, sanitary facilities, showers, dining/dayroom seating, and recreation/yard areas.
b) Accessible paths of travel that are compliant with the ADA. c) Equal and adequate access for all prisoners with disabilities to Family
and Attorney Visiting areas in reasonable proximity to their housing location. MENTAL HEALTH CARE Policies and Procedures 1. The County shall establish policies and procedures that are consistent with the provisions of this Remedial Plan and include the following: a) A written document reflecting the complete spectrum of mental healthcare programming and services provided to prisoners; b) Minimum and maximum timeframes for when each type of mental healthcare service will be completed, including but not limited to laboratory tracking and psychiatry follow-up services, in accordance with prevailing community and professional standards; c) An intake and referral triage system to ensure timely and effective resolution of inmate requests and staff referrals for mental healthcare; d) Specific credentialing requirements for the delivery of mental healthcare services, including but not limited to only qualified mental health professionals may make critical treatment decisions. e) Clinical monitoring of inmates, including but not limited to those who are involuntarily medicated, clinically restrained or secluded, segregated, or on suicide watch;
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f) Descriptions of specialized mental health programming that specifically identify admitting and discharge criteria and the staff members who have the authority to place inmates in specialized mental health housing;
g) Procedures for involuntary medications and other appropriate measures for the management of inmates with serious mental illness who lack the capacity to give informed consent, in accordance with relevant state law;
h) Training for all staff members who are working with inmates with mental illness in all aspects of their respective duty assignments.
2. The County’s policies and procedures shall be revised, as necessary, to reflect all of the remedial measures described in this Remedial Plan.
3. The County shall continue to operate its acute inpatient program and its Outpatient Psychiatric Pod (OPP) program. The County shall establish a new Intensive Outpatient Program (IOP) for inmates who require a higher level of outpatient psychiatric care than what is provided in the OPP program.
4. The County shall operate its non-acute mental health programs – IOP, OPP, and General Population-Mental Health – consistent with the JPS Psychiatric Services overview, attached as Exhibit A-2.
Organizational Structure 1. The County shall develop and implement a comprehensive organizational chart
that includes the Sheriff’s Department (“Department”), Correctional Health Services (“CHS”), Jail Psychiatric Services (“JPS”), Chief Administrative Officer, Medical Director of the JPS Program, and any other mental health staff, and clearly defines the scope of services, chains of authority, performance expectations, and consequences for deficiencies in the delivery of mental health care services. 2. A Medical Director of Jail Psychiatric Services shall be designated and shall oversee all mental health care functions in the jails, including psychiatric prescribers and psychiatric nurses. The Director shall possess clinical experience and a doctoral degree. 3. The Medical Director of Jail Psychiatric Services shall participate in jail executive leadership and shall be responsible for overseeing program development, clinical practice, and policy, as well as interfacing with jail and medical leadership and community mental health. Patient Privacy 1. All clinical interactions shall be private and confidential absent a specific, current risk that necessitates the presence of custody staff. In making such determination, custody and clinical staff shall confer and review individual case factors, including the patient’s current behavior and functioning and any
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other security concerns necessary to ensure the safety of medical staff. Such determinations shall not be based on housing placement or custodial classification.
a) For any determination that a clinical interaction with a patient requires the presence of custody staff, staff shall document the specific reasons for the determination. Such decisions shall be reviewed through the Quality Assurance process.
b) If the presence of custody staff is determined to be necessary to ensure the safety of medical staff for any clinical counter, steps shall be taken to ensure auditory privacy of the encounter.
c) The County’s patient privacy policies, as described in this section, shall apply to contacts between inmates and Triage Navigator Program staff and/or other staff that provide mental health-related services on site at the Jail.
2. Jail policies that mandate custody staff to be present for any mental health treatment in such a way that disrupts confidentiality shall be revised to reflect the individualized process set forth above. Custody and mental health staff shall be trained accordingly.
3. It shall be the policy of the County that mental health clinicians shall not conduct their patient contacts at cell front except pursuant to documented refusals or specific, documented security concerns that warrant cell front contacts.
4. For each clinical contact, mental health staff shall document whether the encounter was confidential, including whether it took place at cell front. If the contact occurred at cell front or otherwise was non-confidential, the reasons shall be clearly documented in the individual patient record and for purposes of Quality Assurance review procedures.
5. A process shall exist for sick call slips or other mental health treatment-related requests to be collected without the involvement of custody staff.
Clinical Practices 1. Mental health staff shall develop and maintain at each jail facility an accurate
case list of all prisoners requiring mental health treatment services at the jail (“caseload”) which, at a minimum, lists the patient’s name, medical chart number, current psychiatric diagnoses, date of booking, date of last appointment, date of next appointment, and the name of the treating prescriber. 2. Qualified mental health professionals shall have access to the patient’s medical record for all scheduled clinical encounters.
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3. Qualified mental health professionals shall provide individual counseling, group counseling, and psychosocial/psychoeducational programs based on individual patients’ clinical needs.
4. A qualified mental health professional shall conduct and document a thorough assessment of each individual in need of mental health care following identification.
5. The County shall ensure prompt access to psychiatric prescribers following intake and in response to referrals and individual patient requests in accordance with the referral and triage timelines defined in the Access to Care provisions, below.
6. The County shall, in consultation with Plaintiffs’ counsel, implement an electronic system for tracking mental health evaluation, treatment, and other clinical contacts, as well as sick call slips and other mental health treatmentrelated requests or referrals.
7. The County shall develop and implement an electronic tracking system with alert and scheduling functions to ensure timely delivery of mental health services to individual patients.
8. Treatment planning: a) The County shall ensure that each prisoner on the mental health caseload receives a comprehensive, individualized treatment plan based on the input of the Multi-Disciplinary Treatment Team (MDT). The MDT shall include multiple clinical disciplines with appropriate custody and counseling staff involvement. b) The treatment plan shall reflect individual clinical need, and the County shall ensure that all clinically indicated services are available and provided. c) The treatment plan shall include, at a minimum, the frequency of follow-up for clinical evaluation and adjustment of treatment modality, the type and frequency of diagnostic testing and therapeutic regimens (which may include clinical contacts more frequent than the minimum intervals described herein), and instructions about adaptation to the correctional environment. d) This treatment plan shall include referral to treatment after release from the facility when recommended by treatment staff. e) Custody staff shall be informed of a patient’s treatment plan where appropriate to ensure coordination and cooperation in the ongoing care of the patient. f) The County shall, in consultation with Plaintiffs’ counsel, develop and implement a Treatment Plan Form that will be used to select and
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document individualized services for prisoners who require mental health treatment. g) The County shall implement guidelines and timelines for the initiation and review of individual treatment plans, consistent with the JPS Psychiatric Services overview, attached as Exhibit A-2. Medication Administration and Monitoring 1. The County shall develop and implement policies and procedures to ensure that all medications are appropriately prescribed, stored, controlled, dispensed, and administered in accordance with all applicable laws and through the following: a) The County shall ensure that initial doses of prescribed medications are delivered to inmates within 48 hours of the prescription, unless it is clinically required to deliver the medication sooner; b) The County shall make best efforts to verify a patient’s prescribed medications and current treatment needs at intake, including outreach to pharmacies and community providers to request prescriptions and other health care records relating to ongoing care needs. The policy shall ensure that any ongoing medication, or a clinically appropriate alternative, shall be provided within 48 hours of verification of the prescription or from a determination by a physician that the medication is medically necessary. Any orders that cannot be reconciled or verified, such as those with conflicting prescriptions from multiple prescribers, shall be referred to a health care provider for reconciliation or verification the next clinic day after booking. c) The County shall ensure that medical staff who administer medications to inmates document in the inmate’s Medical Administration Record (1) name and dosage of each dispensed medication, (2) each date and time medication is administered, and (3) the date and time for any refusal of medication. 2. Qualified mental health professionals shall, for each individual patient, establish targets for treatment with respect to the use of psychotropic medication and shall assess and document progress toward those targets at each clinical visit. 3. Qualified mental health professionals shall, for each individual patient, monitor and document the following with respect to psychotropic mediations: (1) levels of medications, (2) adverse impacts (including through renal and liver function tests where indicated), (3) side effects, and (4) efficacy. 4. Qualified mental health professionals shall, for each individual patient, conduct and document baseline studies, including ECG, blood, urine, and other studies, as clinically appropriate, prior to the initiation of treatment.
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5. The County shall provide sufficient nursing and custody staffing to ensure timely delivery and administration of medication.
6. Medication adherence checks that serve a clinical function shall be conducted by nursing staff, not custody staff. Custody staff shall conduct mouth checks when necessary to ensure institutional safety and security.
7. Psychiatric prescribers shall consider clinically indicated considerations and conduct an in-person consultation, with the patient prior to changing or initiating medications. In the event there is no in-person consultation before prescribing or changing medications the psychiatric prescriber shall note and document the reasons for why there was not an in-person consultation with the patient.
Placement, Conditions, Privileges, and Programming 1. Placement:
a) It shall be the policy of the County to place and treat all prisoners on the mental health caseload in the least restrictive setting appropriate to their needs.
b) Placement in and discharge from Designated Mental Health Units shall be determined by qualified mental health professionals, with consultation with custody staff as appropriate.
c) Absent emergency circumstances, the County shall obtain the assent of qualified mental health professionals before transferring prisoners with SMI into or out of Designated Mental Health Units.
d) It shall be the policy of the County to place prisoners with SMI in appropriate settings that ensure provision of mental health services, patient safety, and the facilitation of appropriate programs, activities, and out-of-cell time. Co-housing with other populations shall be avoided to the extent that such a practice prevents or hinders any of the above.
e) All patients requiring placement in a Designated Mental Health Unit shall be provided access to such placement and care based on current clinical need and without any requirement for director-level approval.
2. Programming and Privileges a) All Designated Mental Health Units shall offer a minimum of 7 hours of unstructured out-of-cell time per week and 10 hours of structured outof-cell time per week for each prisoner. While out-of-cell hours per prisoner may vary from day to day, each prisoner will be offered some amount of out-of-cell time every day of the week. All treatment and outof-cell time shall be documented for each prisoner, and reviewed as part of Quality Assurance procedures.
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b) The County shall ensure that prisoners on the mental health caseload have access and opportunity to participate in jail programming, work opportunities, and education programs, consistent with individual clinical input.
c) The County shall develop and implement, in the 2P inpatient unit and the IOP unit, a program for progressive privileges (including time out of cell, property allowances, etc.) for patients as they demonstrate behavioral progress. A patient’s level of privileges and restrictions shall be based on both clinical and custody input regarding current individual needs. The County shall ensure a process to review custody classification factors when necessary, so that placement, privileges, and restrictions match current individual circumstances and needs.
d) Individuals on a mental health caseload shall receive, at minimum, privileges consistent with their classification levels, absent specific, documented factors which necessitate the withholding of such privileges. Clinical staff shall be informed of the withholding of privileges and the reasons for the withdrawal shall be documented and regularly reviewed by clinical and custody staff. The restoration of privileges shall occur at the earliest time appropriate based on individual factors.
e) Where a prisoner in a Designated Mental Health Unit is subject to any restrictions of property, privileges, or out-of-cell time, the mental health treatment provider and Multi-Disciplinary Treatment Team will, on a weekly basis, assess and discuss with the prisoner progress and compliance with the prisoner’s individual case plan. This process will include clinical contact in a private, face-to-face, out-of-cell setting. The Multi-Disciplinary Treatment Team will provide input to classification staff regarding the prisoner’s mental health and appropriateness for removal of imposed restrictions. Classification staff will follow the recommendation of the Multi-Disciplinary Treatment Team to remove restrictions unless there is a clear, documented security reason to maintain the restriction.
3. Conditions: a) Staff shall provide prisoners in Designated Mental Health Units with the opportunity to maintain cell cleanliness and the opportunity to meet their hygiene needs. Custody and clinical staff shall provide assistance to prisoners on these matters, as appropriate to individual patient needs b) The County shall ensure uniformity of practice with respect to cell searches, such that searches are not done for punitive or harassment reasons. The County shall monitor whether cell search practices may be serving as a disincentive for prisoners in Designated Mental Health
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Units to leave their cells for treatment or other out-of-cell activities, and shall take steps to address the issue as appropriate. 4. Bed planning: a) The County shall provide a sufficient number of beds in Designated Mental Health Unit, at all necessary levels of clinical care and levels of security, to meet the needs of the population of prisoners with SMI. b) The County shall conduct a bed needs assessment, to be updated as appropriate, in order to determine demand for each category of Designated Mental Health Unit beds and shall ensure timely access to all levels of mental health care, consistent with individual treatment needs. c) The County shall establish mental health programming for women that ensures timely access to all levels of care and is equivalent to the range of services offered to men. 5. General Exclusion of Prisoners with Serious Mental Illness from Segregation a) Prisoners with Serious Mental Illness will not be housed in Segregation units, except in rare cases where the prisoner presents an immediate danger or significant disruption to the therapeutic setting, and there is no reasonable alternative, in which cases the provisions of Section VIII.D of the Segregation/Restrictive Housing Remedial Plan shall apply. b) Where prisoners with a mental health condition meeting criteria for placement in a Designated Mental Health Unit are assessed a Disciplinary Segregation term, they will serve the term in a Designated Mental Health Unit, except in rare cases where the prisoner presents an immediate danger or significant disruption to the therapeutic setting, and shall receive structured out-of-cell time and programming as determined by the Multi-Disciplinary Treatment Team. 6. Access to Care a) The County shall designate and make available custody escorts for mental health staff in order to facilitate timely completion of appointments and any other clinical contacts or treatment-related events. b) The County shall ensure sufficient and suitable treatment and office space for mental health care services, including the Triage Navigator Program and other mental health-related services provided on site at the Jail. c) Locations shall be arranged in advance for all scheduled clinical encounters.
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d) The County shall track and document all completed, delayed, and canceled mental health appointments, including reasons for delays and cancelations. Such documentation shall be reviewed as part of the Quality Assurance process.
e) Referrals and triage: i. The County shall maintain a staff referral process (custody and medical) and a kite system for prisoners to request mental health services. Referrals by staff or prisoners must be triaged within 24 hours. ii. Referrals and requests for mental health services shall be handled in accordance with the following timeframes, and based on the definitions and guidance in Exhibit A-2:  Prisoners with “Must See” (Emergent) mental health needs shall be seen for assessment or treatment by a qualified mental health professional as soon as possible, and within six (6) hours. Prisoners with emergent mental health needs shall be monitored through continuous observation until evaluated by a mental health professional.  Prisoners with Priority (Urgent) mental health needs shall be seen for assessment or treatment by a qualified mental health professional within 36 hours.  Prisoners with Routine mental health needs shall be seen for assessment or treatment by a qualified mental health professional within two (2) weeks;  Prisoners whose requests do not require formal clinical assessment or intervention shall be issued a written response, with steps taken to ensure effective communication.
Medico-Legal Practices 1. The County shall provide access to appropriate inpatient psychiatric beds to all
patients who meet WIC § 5150 commitment criteria. At the time a patient’s need for inpatient care is identified, commitment paperwork shall be initiated immediately. Placement in an inpatient unit shall occur at the earliest possible time, and in all cases within 24 hours. For individual prisoners placed on a pre-admit or wait list for inpatient placement, affirmative steps to process and place them shall begin immediately. 2. The County shall not discharge patients from the LPS unit and immediately readmit them for the purpose of circumventing LPS Act requirements. For patients with continuing need for LPS commitment, the County shall follow all required procedures under the LPS Act.
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3. The County shall review all County and JPS policies and procedures for PREA compliance, and revise them as necessary to address all mental health-related requirements.
Clinical Restraints and Seclusion 1. Generally:
a) It is the policy of the County to employ restraints and seclusion only when necessary and to remove restraints and seclusion as soon as possible.
b) It is the policy of the County to employ clinical restraints and seclusion only when less restrictive alternative methods are not sufficient to protect the inmate-patient or others from injury. Clinical restraint and seclusion shall not be used as punishment, in place of treatment, or for the convenience of staff.
c) The placement of a prisoner in clinical restraint or seclusion shall trigger an “emergent” mental health referral, and a qualified mental health professional shall evaluate the prisoner to assess immediate and/or longterm mental health treatment needs.
d) When clinical restraints or seclusion are used, Jail staff will document justification for their application and the times of application and removal of restraints.
e) There shall be no “as needed” or “standing” orders for clinical restraint or seclusion.
f) Individuals in clinical restraints or on seclusion shall be on constant watch, or on constant video monitoring with direct visualization every 15 minutes. All checks will be documented.
g) Fluids shall be offered at least every four hours and at meal times. 2. Clinical Restraints
a) The opinion of a qualified health care professional or qualified mental health professional on placement and retention in restraints will be obtained within one hour from the time of placement.
b) A thorough clinical assessment shall be conducted by qualified health care professional or qualified mental health professional every four hours to determine the need for continued restraint.
c) Individuals in restraints shall be checked every two hours by a nurse for vital signs, neurovascular assessment, and limb range, and offered an opportunity for toileting.
3. Reentry Services
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 42 of 119 a) The County shall provide a 30-day supply of current psychotropic medications to inmates on the mental health caseload, who have been sentenced and have a scheduled released date, immediately upon release. b) Within 24 hours of release of any inmate who is on the mental health caseload and classified as pre-sentence, the County shall transmit to a designated County facility a prescription for a 30-day supply of the inmate’s current psychotropic medications. c) The County, in consultation with Plaintiffs’ counsel, develop and implement a reentry services policy governing the provision of assistance to prisoners on the mental health caseload, including outpatient referrals and appointments, public benefits, medical insurance, housing, substance abuse treatment, parenting and family services, inpatient treatment, and other reentry services. d) The County agrees that, during the course of the implementation of the remedial plans contained in this agreement, it will consider Plaintiffs’ input on measures to prevent unnecessary or avoidable incarceration of individuals with serious mental illness.
Training 1. The County shall develop and implement, in collaboration with Plaintiffs’
counsel, training curricula and schedules in accordance with the following: a) All jail custody staff shall receive formal training in mental health, which shall encompass mental health policies, critical incident response, crisis intervention techniques, recognizing different types of mental illness, interacting with prisoners with mental illness, appropriate referral practices, suicide and self-harm detection and preventions, relevant bias and cultural competency issues, and confidentiality standards. Training shall be received every two years, at minimum. b) Custody staff working in Designated Mental Health Units shall receive additional training, including additional information on mental illness, special medico-legal considerations, de-escalation techniques, working with individuals with mental health needs, relevant bias and cultural competency issues, and the jail’s mental health treatment programs. c) Mental health staff shall receive training on the correctional mental health system, correctional mental health policies, suicide assessment and intervention, relevant bias and cultural competency issues, and treatment modalities to be offered in the jails.
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 43 of 119 DISCIPLINARY MEASURES AND USE OF FORCE FOR PRISONERS WITH MENTAL HEALTH OR INTELLECTUAL DISABILITIES
Role of Mental Health Staff in Disciplinary Process 1. The County’s policies and procedures shall require meaningful consideration
of the relationship of a prisoner’s behavior to any mental health or intellectual disability, the efficacy of disciplinary measures versus alternative interventions, and the impact of disciplinary measures on the health and wellbeing of prisoners with disabilities. 2. Prisoners who are alleged to have committed a rules violation shall be reviewed by a qualified mental health professional if any of the following apply:
a) Prisoner is housed in any Designated Mental Health Unit; b) Jail staff have reason to believe the prisoner’s behavior was unusual,
uncharacteristic, or a possible manifestation of mental illness; c) Prisoner is on the mental health caseload and may lose good time credit
as a consequence of the disciplinary infraction with which he or she is charged. 3. If any of the above criteria is met, the qualified mental health professional shall complete the form attached as Exhibit A-3 (JPS-Rules Violation Mental Health Review) and indicate: a) Whether or not the reported behavior was related to mental illness, adaptive functioning deficits, or other disability; b) Whether the prisoner’s behavior is, or may be, connected to any of the following circumstances:
i. An act of self-harm or attempted suicide ii. A cell extraction related to transfer to a medical/mental health
unit or provision of involuntary treatment iii. Placement in clinical restraints or seclusion. c) Any other mitigating factors regarding the prisoner’s behavior, disability, and/or circumstances that should be considered and whether certain sanctions should be avoided in light of the prisoner’s mental health disability or intellectual disability, treatment plan, or adaptive support needs.
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Consideration of Mental Health Input and Other Disability Information in Disciplinary Process 1. The County shall designate one Chief Disciplinary Hearing Officer for each
jail facility, who shall be responsible for ensuring consistency in disciplinary practices and procedures. 2. The Disciplinary Hearing Officer shall ensure that prisoners are not disciplined for conduct that is related to their mental health or intellectual disability. 3. The Disciplinary Hearing Officer shall consider the qualified mental health professional’s findings and any other available disability information when deciding what, if any, disciplinary action should be imposed. 4. The Disciplinary Hearing Officer shall consider the qualified mental health professional’s input on minimizing the deleterious effect of disciplinary measures on the prisoner in view of his or her mental health or adaptive support needs. 5. If the Disciplinary Hearing Officer does not follow the mental health staff’s input regarding whether the behavior was related to symptoms of mental illness or intellectual disability, whether any mitigating factors should be considered, and whether certain sanctions should be avoided, the Disciplinary Hearing Officer shall explain in writing why it was not followed. 6. Prisoners will not be subjected to discipline which prevents the delivery of mental health treatment or adaptive support needs, unless necessary for institutional safety. 7. Prisoners shall not be subject to discipline for refusing treatment or medications, or for engaging in self-injurious behavior or threats of selfinjurious behavior. Accommodations for Prisoners with Mental Health or Intellectual Disabilities During the Disciplinary Process 1. The County shall provide reasonable accommodations during the hearing process for prisoners with mental health or intellectual disabilities. 2. The County shall take reasonable steps to ensure the provision of effective communication and necessary assistance to prisoners with disabilities at all stages of the disciplinary process. Use of Force for Prisoners with Mental Health or Intellectual Disabilities 1. The County’s Correctional Services Operations Orders shall include language that ensures meaningful consideration of whether a prisoner’s behavior is a manifestation of mental health or intellectual disability.
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2. For prisoners with a known mental health or intellectual disability, and absent an imminent threat to safety, staff shall employ de-escalation methods that take into account the individual’s mental health or adaptive support needs.
3. The County’s Correctional Services Use of Force policies shall include a definition and a protocol for a planned Use of Force that provides appropriate guidance for a planned Use of Force that involves a prisoner with mental health or intellectual disability.
4. Prior to any planned Use of Force, such as a cell extraction, against a prisoner with mental health or intellectual disabilities, there will be a “cooling down period,” consistent with safety and security needs. This period includes a structured attempt by mental health staff (and other staff if appropriate), to deescalate the situation and to reach a resolution without Use of Force. Such efforts, including the use of adaptive supports, will be documented in writing. Medical and/or mental health staff should be consulted if the purpose of the cell extraction is related to the delivery of treatment.
5. The County shall require video documentation for any planned Use of Force, absent exigent circumstances. Jail staff shall endeavor to record the specific actions, behavior, or threats leading to the need for Use of Force, as well as efforts to resolve the situation without Use of Force.
6. The County shall ensure the completion of supervisory review of Use of Force incidents, including video (for any planned Use of Force), interviews, and written incident documentation, in order to ensure appropriateness of Use of Force practices including de-escalation efforts. The County shall take corrective action when necessary.
7. The County shall review and amend as appropriate its policies on Use of Force, including its policies on Custody Emergency Response Team (CERT) and Cell Extraction Procedures.
Training and Quality Assurance 1. All custody staff, and mental health staff, shall be trained on the policies and
procedures outlined herein that are relevant to their job and classification requirements. Custody staff will receive periodic training on identifying behaviors that may be manifestations of mental illness and other situations warranting a referral to mental health staff, including for a Rules Violation Mental Health Review or other mental health assessment. 2. All custody staff shall be trained on the identification of symptoms of mental illness, the provision of adaptive supports, and the use of de-escalation methods appropriate for prisoners with mental health or intellectual disabilities. 3. The County shall track the outcomes of all disciplinary hearings for prisoners who are on the mental health caseload or who have intellectual disabilities,
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including whether the recommendation of the mental health professional was followed. 4. The County shall track all Uses of Force (planned and reactive) involving prisoners who are on the mental health caseload or who have intellectual disabilities, including the number of Uses of Force and the number of cell extractions by facility. 5. The County shall implement a continuous quality assurance/quality improvement plan to periodically audit disciplinary and Use of Force practices as they apply to prisoners who are on the mental health caseload or who have intellectual disabilities. MEDICAL CARE Staffing 1. The County shall provide and maintain sufficient staffing to meet professional standards of care and to execute the requirements of this Remedial Plan, including clinical staff, office and technological support, QA/QI units, and custody staff for escorts and transportation. 2. Provider quality shall be evaluated regularly to ensure that relevant quality of care standards are maintained. This review shall be in addition to the peer review and quality improvement processes described in this plan. The parties shall meet and confer regarding any deficiencies identified in the evaluation. Should the parties disagree regarding matters of provider quality, the Court Expert shall evaluate the quality of provider care and to complete a written report. Intake 1. All prisoners who are to be housed shall be screened on arrival in custody by Registered Nurses (RNs). RN screening shall take place prior to placement in jail housing. 2. Health care intake screening shall take place in a setting that ensures confidentiality of communications between nurses and individual patients. Custody staff may maintain visual supervision but may not be close enough to overhear communication, unless security concerns based on an individualized determination of risk that includes a consideration of requests by the health care staff require that custody staff be closer at hand. There shall be visual and auditory privacy from other prisoners. 3. The County shall, in consultation with Plaintiffs, revise the contents of its intake screening, medical intake screening, and special needs documentation to reflect community standards and ensure proper identification of medical and disability related needs.
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4. Nurses who perform intake screening shall consult any available electronic health care records from prior incarcerations or other County agencies. The form shall include a check box to confirm that such a review was done.
5. The County shall make best efforts to verify a patient’s prescribed medications and current treatment needs at intake, including outreach to pharmacies and community providers to request prescriptions and other health care records relating to ongoing care needs. The policy shall ensure that any ongoing medication, or a clinically appropriate alternative, shall be provided within 48 hours of verification of the prescription or from a determination by a physician that the medication is medically necessary. Any orders that cannot be reconciled or verified, such as those with conflicting prescriptions from multiple prescribers, shall be referred to a health care provider for reconciliation or verification the next clinic day after booking.
6. The County shall follow a triage process in which intake nurses schedule patients for follow-up appointments based on their medical needs and acuity at intake, and shall not rely solely on patients to submit Health Services Requests once housed. The policy shall, in consultation with Plaintiffs’ counsel, establish clear protocols that include appropriate intervals of care based on clinical guidelines, and that intake nurses shall schedule follow-up appointments at the time of intake based on those protocols.
7. All nurses who perform intake screenings will be trained annually on how to perform that function.
Access to Care 1. The County shall ensure that Health Services Requests (HSRs) are readily
available to all prisoners, including those in segregation housing, from nurses and custody officers. 2. The County shall provide patients with a mechanism for submitting HSRs that does not require them to share confidential health information with custody staff. The County shall install lockboxes or other secure physical or electronic mechanism for the submission of HSRs (as well as health care grievances) in every housing unit. Designated health care staff shall collect (if submitted physically) or review (if submitted electronically) HSRs at least two times per day in order to ensure that CHS receives critical health information in a timely manner. Designated health care staff shall also collect HSRs during pill call and shall go door to door in all restricted housing units at least once a day to collect HSRs. HSRs and health care grievances will be promptly date- and time-stamped. The County may implement an accessible electronic solution for secure and confidential submission of HSRs and health care grievances. 3. The County shall establish clear timeframes to respond to HSRs:
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a) All patients whose HSRs raise emergent concerns shall be seen by the RN immediately on receipt of the HSR. For all other HSRs, a triage RN shall, within 24 hours of receipt of the form (for urgent concerns) or within 72 hours of receipt of the form (for routine concerns): i. conduct a brief face-to-face visit with the patient in a confidential, clinical setting; ii. take a full set of vital signs, if appropriate; iii. conduct a physical exam, if appropriate; iv. assign a triage level for a provider appointment of emergent, urgent, routine, or written response only; v. inform the patient of his or her triage level and response time frames; vi. provide over-the-counter medications pursuant to protocols; and vii. consult with providers regarding patient care pursuant to protocols, as appropriate.
b) If the triage nurse determines that the patient should be seen by a provider: i. patients with emergent conditions shall be treated or sent out for emergency treatment immediately; ii. patients with urgent conditions shall be seen within 24 hours of the RN face-to-face; and iii. patients with only routine concerns shall be seen within two weeks of the RN face-to-face.
c) Patients whose requests do not require formal clinical assessment or intervention shall be issued a written response, with steps taken to ensure effective communication, within two weeks of receipt of the form.
d) The County shall permit patients, including those who are illiterate, non-English speaking, or otherwise unable to submit written or electronic HSRs, to verbally request care. Such verbal requests shall immediately be documented by the staff member who receives the request on an appropriate form and transmitted to a qualified medical professional for response in the same priority as those HSRs received in writing.
4. The County shall designate and make available custody escorts for medical staff in order to facilitate timely and confidential clinical contacts or treatmentrelated events.
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5. The County shall track and regularly review response times to ensure that the above timelines are met.
6. The County shall discontinue its policy of prohibiting patients from reporting or inquiring about multiple medical needs in the same appointment.
7. When a patient refuses a medical evaluation or appointment, such refusal will not indicate a waiver of subsequent health care. a) When a patient refuses a service that was ordered by medical staff based on an identified clinical need, medical staff will follow up to ensure that the patient understands any adverse health consequences and to address individual issues that caused the patient to refuse the service. b) Any such refusal will be documented by medical staff and must include (1) a description of the nature of the service being refused, (2) confirmation that the patient was made aware of and understands any adverse health consequences by medical staff, (3) the signature of the patient, and (4) the signature of medical staff witness. In the event that obtaining the signature of a patient is not possible, medical staff shall document the circumstances.
Chronic care 1. Within three months of the date the Consent Decree is issued by the Court, the
County shall, in consultation with Plaintiffs’ counsel, develop and implement a chronic disease management program that is consistent with national clinical practice guidelines. The chronic disease program will include procedures for the identification and monitoring of such patients and the establishment and implementation of individualized treatment plans consistent with national clinical practice guidelines.
a) The chronic disease management program shall ensure that patients with chronic illness shall be identified and seen after intake based on acuity (on the day of arrival for patients with high acuity and not to exceed 30 days for all others). The County will timely provide clinically indicated diagnostic testing and treatment, including prior to this post-intake appointment. Follow-up appointments will be provided in intervals that do not exceed 90 days unless such patients are clinically stable on at least two consecutive encounters, in which case follow-up appointment intervals will not exceed 365 days (and sooner if clinically indicated), subject to a chart review by a clinician at least every six (6) months.
b) The chronic disease management program shall ensure that patients are screened for Hepatitis C at intake. If medical staff recommend Hepatitis testing based on screening results, such testing shall be offered on an “opt-out” basis for those individuals who remain in custody long enough to receive a housing unit assignment. If the individual declines
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the testing, the refusal shall be documented in the health record. Patients found to have Hepatitis C shall be offered immunizations against Hepatitis A and Hepatitis B. c) The chronic disease management program shall include a comprehensive diabetic management protocol that conforms to the guidance of the ADA’s Diabetes Management in Correctional Institutions. The protocol shall be developed in coordination with custody administration to address normal circadian rhythms, food consumption times, and insulin dosing times. d) The chronic disease management program shall ensure that patients who take medications for their chronic conditions shall have the medications automatically renewed unless the provider determines that it is necessary to see the patient before renewing the medication. In that case, the patient shall be scheduled to be seen in a reasonable time period to ensure medication continuity. 2. The County shall track compliance with the chronic disease management program requirements for timely provision of appointments, procedures, and medications. The County shall ensure that its electronic medical record system is adequate to support these critical functions. 3. The County shall review its infection control policies and procedures for dialysis treatment to ensure that appropriate precautions are taken to minimize the risk of transmission of blood-borne pathogens, given the proximity of HCV+ and HCV- patients receiving dialysis in the same room. Specialty care 1. The County shall develop and implement policies regarding specialty referrals using an algorithm with evidence-based referral criteria and guidelines. 2. Within three months of the date the Consent Decree is issued by the Court, the County shall develop and implement policies and procedures to ensure that emergency consultations and diagnostic and treatment procedures, as determined by the medical provider, are provided immediately; high priority consultations and procedures, as determined by the medical provider, are seen within 21 calendar days of the date of the referral; and routine consultations and procedures, as determined by the medical provider, are seen within 90 calendar days of the date of the referral. 3. Patients whose routine specialty consultation or procedure do not take place within 90 calendar days from the date of the referral shall be examined by a clinician monthly and evaluated to determine if urgent specialty care is indicated. 4. Within 5 calendar days of the completion of a high priority specialty consultation or procedure or within 14 calendar days of a routine specialty
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consultation or procedure, patients returning to the Sacramento jails shall have their specialty reports and follow up recommendations reviewed by a jail nurse practitioner, physician’s assistant or physician. A nurse practitioner, physician’s assistant or physician will review this information with the patient within 14 calendar days of the receipt of the specialist’s report. 5. Specialty care consultations and outside diagnostic and treatment procedures shall be tracked in a log that identifies the referral request date, the date the referral was sent to the specialty care provider, the appointment date for the consultation or procedure is scheduled, the date the appointment takes place, and, if the appointment is rescheduled or cancelled, the reason it was rescheduled or canceled. 6. Requests for specialty consultations and outside diagnostic and treatment procedures shall also be tracked to determine the length of time it takes to grant or deny the requests and the circumstances and reasons for denials. 7. At least twice a year, the County shall conduct an audit of specialty care referral logs described in subsections (5) and (6), above, and complete a report as to whether each category of specialty care is provided in a reasonable timeframe, consistent with established timeframes. If any specialty care area has a record of untimely appointments as determined by the Correctional Health Service Continuous Quality Improvement Committee, the County shall report to Plaintiffs and the parties shall meet and confer to take prompt steps to address the issue. The County will provide Plaintiffs access to the specialty care referral logs and audit reports periodically and upon written request. The parties will work to resolve issues with untimely specialty care in individual patient cases and with respect to systemic trends, including through the dispute resolution process. 8. The County shall consider implementing an e-referral system to reduce delays and facilitate communication between specialists and primary care providers, as well as reducing unnecessary transportation costs and unnecessary specialist appointments by ensuring that the specialist has all the information he or she needs before an appointment takes place. 9. The County shall ensure that utilization management and/or scheduling staff provides notification of whether a patient’s specialty care appointment is scheduled to occur within the timeline pursuant to the referral and/or clinical recommendation, including as follows:
a) Medical staff may request and obtain information as to whether any patient’s specialty care appointment is scheduled, and as to the general timing of the appointment (e.g. within a one-week’s date range).
b) If a specialty care appointment is denied or is not scheduled to occur within the timeline pursuant to the referral and/or clinical
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recommendation, such information will be affirmatively provided to the treatment team and to the patient. c) If a previously scheduled specialty care appointment is postponed to a date that is outside the timeline pursuant to the referral and/or clinical recommendation, such information will be affirmatively provided to the treatment team and to the patient. 10. The County shall consider creating a physical therapy clinic at the jail to more efficiently meet the significant demand for this service. Medication administration and monitoring 1. The County shall develop and implement policies and procedures to ensure that all medications are appropriately prescribed, stored, controlled, dispensed, and administered in accordance with all applicable laws and through the following: a) ensuring that initial doses of prescribed medications are delivered to patients within 48 hours of the prescription, unless it is clinically required to deliver the medication sooner; b) ensuring that medical staff who administer medications to patients document in the patient’s Medical Administration Record (1) name and dosage of each dispensed medication, (2) each date and time medication is administered, (3) the date and time for any refusal of medication, and (4) in the event of patient refusal, documentation that the prisoner was made aware of and understands any adverse health consequences by medical staff. 2. The County shall provide sufficient nursing and custody staffing to ensure timely delivery and administration of medication. 3. The County shall provide pill call twice a day in each housing unit, at regular times that are consistent from day to day, except as may be required by nonroutine facility security concerns. The County shall develop and implement policies and procedures to ensure that prescribed medications are provided at therapeutically appropriate times as determined by the ordering physician. Any patient who requires administration of medications at times outside the regular pill call shall be provided that medication at the times determined by the ordering physician. 4. The County shall develop and implement policies and procedures to ensure that patients are provided medications at therapeutically appropriate times when out to court, in transit to or from any outside appointment, or being transferred between facilities. If administration time occurs when a patient is in court, in transit or at an outside appointment, medication will be administered as close as possible to the regular administration time.
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5. The County shall develop and implement policies and procedures to ensure that medication efficacy and side effects are monitored by staff and reviewed by appropriate clinicians at appropriate intervals.
6. The County shall explore the expansion of its Keep-on-Person medication program, (especially for inhalers and medications that are available over-thecounter in the community) and to facilitate provision of medications for people who are out to court, in transit, or at an outside appointment.
Clinical space and medical placements 1. The County shall provide adequate clinical space in every facility to support
clinical operations while also securing appropriate privacy for patients. Adequate clinical space includes visual and auditory privacy from prisoners and auditory privacy from staff, the space needed reasonably to perform clinical functions as well as an examination table, sink, proper lighting, proper equipment, and access to health care records. 2. The County shall ensure that any negative pressure isolation rooms meet community standards, including an antechamber to ensure that the room remains airtight, appropriate pressure gauges, and regular documented checks of the pressure gauges. 3. The County shall ensure that absent individualized, documented safety and security concerns, patients in acute medical or quarantine placements shall be allowed property and privileges equivalent to what they would receive in general population based on their classification levels. 4. The County shall ensure that patients in medical placements are not forced to sleep on the floor, including by providing beds with rails or other features appropriate for patients’ clinical needs and any risk of falling. 5. The County shall not discriminate against patients in medical placements solely because of their need for C-Pap machines, but instead shall provide access to programs and services in accordance with their classification level, as set forth in the ADA Remedial Plan. Patient privacy 1. The County shall develop and implement policies and procedures to ensure that appropriate confidentiality is maintained for health care services. The policies shall ensure confidentiality for clinical encounters, including health care intake screening, pill call, nursing and provider sick call, specialty appointments, and mental health treatment. The policies shall also ensure confidentiality for written health care documents, such as health care needs requests and grievances raising medical care or mental health care concerns, which shall not be collected by custody staff.
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2. The County shall provide adequate clinical space in each jail to support clinical operations while also securing appropriate privacy for patients, including visual and auditory privacy from prisoners and auditory privacy from staff.
3. All clinical interactions shall be private and confidential absent a specific, current risk that necessitates the presence of custody staff. In making such determination, custody and clinical staff shall confer and review individual case factors, including the patient’s current behavior and functioning and any other security concerns necessary to ensure the safety of medical staff. Such determinations shall not be based on housing placement or custodial classification. The issuance of pills does not constitute a clinical interaction. a) For any determination that a clinical interaction with a patient requires the presence of custody staff, staff shall document the specific reasons for the determination. Such decisions shall be reviewed through the Quality Assurance process. b) If the presence of a correctional officer is determined to be necessary to ensure the safety of staff for any clinical counter, steps shall be taken to ensure auditory privacy of the encounter. c) The County’s patient privacy policies, as described in this section, shall apply to contacts between patients and all staff who provide healthrelated services on site at the Jail.
4. Jail policies that mandate custody staff to be present for any medical treatment in such a way that disrupts confidentiality shall be revised to reflect the individualized process set forth above. Custody and medical staff shall be trained accordingly.
Health care records 1. The County shall develop and implement a fully integrated electronic health
record system that includes medical, psychiatric, and dental records and allows mental health and medical staff to view the medical and mental health information about each patient in a single record. This shall be accomplished within 12 months of the date the Consent Decree is issued by the Court. 2. Until such a system is implemented, the County shall develop and implement policies and procedures to ensure that medical staff have access to mental health information and mental health staff have access to medical information, as needed to perform their clinical duties. This information shall include all intake records. Medical and mental health staff shall be trained in these policies and procedures within one month of the date the Consent Decree is issued by the Court. 3. The County shall develop and implement policies and procedures to monitor the deployment of the CHS Electronic Health Records to ensure the records system is modified, maintained, and improved as needed on an ongoing basis,
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including ongoing information technology support for the network infrastructure and end users. Utilization management 1. The County shall revise its utilization management (UM) system to ensure that critical health decisions about patients’ access to care are made with sufficient input from providers and a thorough review of the health care records. 2. The County shall ensure that decisions about a patient’s access to, timing of or need for health care are made by a physician, with documented reference to the patient’s medical record. Nurses may gather information and coordinate the UM process, so long as it does not interfere with that requirement. All decisions by the UM committee shall be documented, including the clinical justification for the decision. 3. The UM system shall ensure that providers and patients are promptly informed about decisions made by the UM committee, including denial of a specialist referral request. 4. The UM system shall include an appeal process to enable patients and providers to appeal a decision denying a referral request. Sanitation 1. The County shall consult with an Environment of Care expert to evaluate facilities where patients are housed and/or receive clinical treatment, and to make written recommendations to address issues of cleanliness and sanitation that may adversely impact health. Reproductive and Pregnancy-Related Care 1. The County shall ensure that pregnant patients receive timely and appropriate prenatal care, specialized obstetrical services when indicated, and postpartum care (including mental health services). 2. The County will provide pregnant patients comprehensive counseling and timely assistance in accordance with their expressed desires regarding their pregnancies, whether they elect to keep the child, use adoptive services, or have an abortion. 3. The County shall provide non-directive counseling about contraception to female prisoners, shall allow female prisoners to continue an appropriate method of birth control while incarcerated (with consideration given to the patient’s preference and/or current method of birth control), and shall provide access to emergency or other contraception when appropriate. Transgender and gender nonconforming health care 1. The County shall implement policies and procedures to provide transgender and intersex prisoners with care based upon an individualized assessment of
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the patient’s medical needs in accordance with accepted standards of care and prevailing legal and constitutional requirements, including, as appropriate:
a) Hormone therapy b) Surgical care c) Access to gender-affirming clothing d) Access to gender-affirming commissary items, make-up, and other
property items 2. The County shall ensure that medical and mental health staff have specific
knowledge of and training on the WPATH Standards of Care. Detoxification protocols 1. Within three months of the date the Consent Decree is issued by the Court, the
County shall develop and implement protocols for assessment, treatment, and medication interventions for alcohol, opiate, and benzodiazepine withdrawal that are consistent with community standards. 2. The protocols shall include the requirements that (i) nursing assessments of people experiencing detoxification shall be done at least twice times a day for five days and reviewed by a physician; (ii) nursing assessments shall include both physical findings, including a full set of vital signs, as well as psychiatric findings; (iii) medication interventions to treat withdrawal syndromes shall be updated to provide evidence-based medication in sufficient doses to be efficacious; (iv) the County shall provide specific guidelines to the nurses for intervention and escalation of care when patients do not respond to initial therapy; and (v) patients experiencing severe, life-threatening intoxication (an overdose) or withdrawal shall be immediately transferred under appropriate security conditions to a facility where specialized care is available. Nursing protocols 1. Nurses shall not act outside their scope of practice. 2. To that end, the County shall revise its nursing standardized protocols to include assessment protocols that are sorted, based on symptoms, into low, medium, and high risk categories.
a) Low-risk protocols would allow RNs to manage straightforward symptoms with over-the-counter medications;
b) Medium-risk protocols would require a consultation with a provider prior to treatment; and
c) High-risk protocols would facilitate emergency stabilization while awaiting transfer to higher level of care.
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Reviews of in-custody deaths 1. Preliminary reviews of in-custody deaths shall take place within 30 days of the
death and shall include a written report of the circumstances and events leading to the death, with the goal to identify and remedy preventable causes of death and any other potentially systematic problems. 2. Mortality reviews shall include an investigation of the events occurring prior to the death, an analysis of any acts or omissions by any staff or prisoners which might have contributed to the death, and the identification of problems for which corrective action should be undertaken. Reentry Services 1. The County shall provide a 30-day supply of current medications to patients who have been sentenced and have a scheduled released date, immediately upon release. 2. Within 24 hours of release of any patient who receives prescription medications while in custody and is classified as pre-sentence, the County shall transmit to a designated County facility a prescription for a 30-day supply of the patient’s current prescription medications. 3. The County, in consultation with Plaintiffs, shall develop and implement a reentry services policy governing the provision of assistance to chronic care patients, including outpatient referrals and appointments, public benefits, inpatient treatment, and other appropriate reentry services. Training 1. The County shall develop and implement, in collaboration with Plaintiffs’ counsel, training curricula and schedules in accordance with the following:
a) All jail custody staff shall receive formal training in medical needs, which shall encompass medical treatment, critical incident response, crisis intervention techniques, recognizing different types of medical emergencies, and acute medical needs, appropriate referral practices, relevant bias and cultural competency issues, and confidentiality standards. Training shall be received every two years, at minimum.
SUICIDE PREVENTION Substantive Provisions 1. The County recognizes that comprehensive review and restructuring of its suicide assessment, monitoring, and prevention practices are necessary to address the risk of suicide and self-harm attendant to detention in a jail setting. 2. The County shall establish, in consultation with Plaintiffs’ counsel, a new Suicide Prevention Policy that shall be in accordance with the following:
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Training 1. The County shall develop, in consultation with Plaintiffs’ counsel, a four- to
eight-hour pre-service suicide prevention curriculum for new Jail employees (including custody, medical, and mental health staff), to be conducted in person in a classroom or virtual classroom setting, that includes the following topics:
a) avoiding obstacles (negative attitudes) to suicide prevention; b) prisoner suicide research; c) why facility environments are conducive to suicidal behavior; d) identifying suicide risk despite the denial of risk; e) potential predisposing factors to suicide; f) high-risk suicide periods; g) warning signs and symptoms; h) components of the jail suicide prevention program i) liability issues associated with prisoner suicide; j) crisis intervention. 2. The County shall develop, in consultation with Plaintiffs’ counsel, a two-hour annual suicide prevention curriculum for all custody, medical, and mental health staff, to be conducted in person in a classroom or virtual classroom setting, that includes: a) review of topics (a)-(j) above b) review of any changes to the jail suicide prevention program c) discussion of recent jail suicides or attempts 3. Custody officers assigned to Designated Mental Health Units shall receive additional specialized training on suicide prevention and working with prisoners with serious mental illness. 4. All mental health staff, including nurses, clinicians, and psychiatrists, shall receive additional training on how to complete a comprehensive suicide risk assessment and how to develop a reasonable treatment plan that contains specific strategies for reducing future suicidal ideation. 5. All mental health staff and custody officers shall be trained on the appropriate use of safety suits—i.e., not to be utilized as a default, not to be used as a tool in behavior management, not to be utilized for patients being observed at 30minute observations. 6. The County shall ensure that all staff are trained in the new Suicide Prevention Policy.
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Nursing Intake Screening 1. Intake screening for suicide risk will take place at the booking screening and
prior to a housing assignment. If clinically indicated, JPS will then perform an additional clinical assessment after the inmate is placed in a housing assignment. 2. All nursing intake screening shall be conducted in an area that provides reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk. 3. The County shall revise its nursing intake assessment procedures and screening forms to ensure timely identification of acute and high-risk mental health conditions, consistent with the recommendations made by Lindsey Hayes. Intake screening, as documented on screening forms, shall include:
a) Review of suicide risk notifications in relevant medical, mental health, and custody records, including as to prior suicide attempts, self-harm, and/or mental health needs;
b) Any prior suicidal ideation or attempts, self-harm, mental health treatment, or hospitalization;
c) Current suicidal ideation, threat, or plan, or feelings of helplessness and/or hopelessness;
d) Other relevant suicide risk factors, such as: i. Recent significant loss (job, relationship, death of family member/close friend); ii. History of suicidal behavior by family member/close friend; iii. Upcoming court appearances;
e) Transporting officer’s impressions about risk. 4. Regardless of the prisoner’s behavior or answers given during intake
screening, a mental health referral shall always be initiated if there is a documented history related to suicide or self-harm, including during a prior incarceration. 5. The County shall develop and implement a written policy and procedure for referrals to mental health by intake staff. The policy shall correspond with the triage system and timeframes set forth in the Mental Health Remedial Plan. 6. Any prisoner expressing current suicidal ideation and/or current suicidal/selfinjurious behavior shall be designated as an emergent referral and immediately referred to mental health staff.
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Post-Intake Mental Health Assessment Procedures 1. All mental health assessments shall be conducted in an area that provides
reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk. 2. Mental health staff shall conduct assessments within the timeframes defined in the mental health referral triage system. 3. The County shall revise its mental health assessment procedures and related forms to ensure identification of historical and current patient mental health and suicide risk information, consistent with the recommendations of the subject matter expert. Response to Identification of Suicide Risk or Need for Higher Level of Care 1. When a prisoner is identified as at risk for suicide and placed by custody staff in a safety cell, on suicide precautions, and/or in a safety suit, mental health staff shall be contacted immediately. A qualified mental health professional, or other appropriately trained medical staff in consultation with mental health staff, shall complete a confidential in-person suicide risk assessment as soon as possible, consistent with the “must-see” referral timeline. 2. Consistent with current RCCC policy, if there is no mental health staff on site at RCCC at the time that an emergent mental health need is identified, the prisoner shall be transported to the Main Jail for emergency evaluation within two hours of the initial report. 3. The County shall revise its JPS suicide risk assessment procedures and forms in consultation with Plaintiffs. The County shall ensure that its JPS suicide risk assessment process, policies, and procedures consider and document the following:
a) Review of suicide risk notifications and records from any previous incarcerations at the Jail, including records pertaining to suicide attempts, self-harm, and/or mental health needs;
b) Other prior suicide ideation or attempts, self-harm, mental health treatment or hospitalization;
c) Current suicidal ideation, threat, or plan, or feelings of helplessness and/or hopelessness;
d) Suicide risk factors and protective factors, such as: i. Recent significant loss (job, relationship, death of family member/close friend); ii. History of suicidal behavior by family member/close friend;
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iii. Upcoming court appearances; e) Transporting officer’s impressions about risk; f) Suicide precautions, including level of observation. 4. The County shall ensure that the meal service schedule or other custody-related activities cause no delay in the completion of suicide risk assessments for prisoners. Housing of Inmates on Suicide Precautions 1. The County’s policy and procedures shall direct that prisoners, including those identified as being at risk for suicide, be treated in the least restrictive setting appropriate to their individual clinical and safety needs. Inpatient Placements 1. The County shall ensure that prisoners who require psychiatric inpatient care as clinically indicated are placed in the 2P unit within 24 hours of identification, absent exceptional circumstances. In all cases, the provision of clinically indicated treatment to any prisoner requiring inpatient level of care shall be initiated within 24 hours. Temporary Suicide Precautions 1. No prisoner shall be housed in a safety cell, segregation holding cell, or other Temporary Suicide Precautions Housing for more than six (6) hours. If mental health or medical staff determine it to be clinically appropriate based on detoxification-related needs, this time limit may be extended to no more than eight (8) hours. If exceptional circumstances prevent transfer within these timelines, those circumstances shall be documented, and transfer shall occur as soon as possible. This does not preclude the housing of a prisoner in the IOP unit if clinically indicated. 2. The County shall ensure, including by revising written policies and procedures where necessary, the timely and adequate completion of medical assessments for prisoners in need of suicide precautions, as required under Operations Order 4/05 (i.e., within 12 hours of placement of the next daily sick call, whichever is earliest, and then every 24 hours thereafter). 3. The County shall ensure that any cell used for holding prisoners on suicide precautions is clean prior to the placement of a new prisoner, as well as cleaned on a normal cleaning schedule. 4. The County shall create and implement a written policy ensuring adequate frequency for meals, fluids, hygiene, showers, prescribed medications, and toileting when a prisoner is in cell used for holding prisoners on suicide precautions.
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5. Inmates on suicide precautions shall not automatically be on lockdown and should be allowed dayroom or out-of-cell access consistent with security and clinical judgments.
6. The classrooms or multipurpose rooms adjacent to the housing units in the Main Jail are designed for, and should be made available for, prisoner programs and treatment. Absent an emergency, the County shall not use the classrooms and multipurpose rooms to hold prisoners pending a mental health evaluation or on suicide precautions. Where such emergency occurs, the County shall document the reasons for retention and move the prisoner, within six (6) hours, to the inpatient unit or other appropriate housing location for continued observation, evaluation, and treatment.
Suicide Hazards in High-Risk Housing Locations 1. The County shall not place prisoners identified as being at risk for suicide or
self-harm, or for prisoners requiring IOP level of care, in settings that are not suicide-resistant as consistent with Lindsay Hayes’s “Checklist for the ‘Suicide-Resistant’ Design of Correctional Facilities.” 2. Cells with structural blind spots shall not be used for suicide precaution. Supervision/Monitoring of Suicidal Inmates 1. The County shall ensure adequate visibility and supervision of prisoners on suicide precautions. 2. The County shall not cover cell windows with magnetic flaps or any other visual barrier preventing visibility into any cell that is housing a prisoner on suicide precautions or awaiting an inpatient bed, unless there is a specific security need and then for only a period of time necessary to address such security need. 3. The County shall revise its policies regarding the monitoring of prisoners on suicide precautions to provide for at least the following two defined levels of observation:
a) Close observation shall be used for prisoners who are not actively suicidal but express suicidal ideation (e.g., expressing a wish to die without a specific threat or plan) or have a recent prior history of selfdestructive behavior. Close observation shall also be used for prisoners who deny suicidal ideation or do not threaten suicide but are engaging in other concerning behaviors indicating the potential for self-injury. Staff shall observe the prisoner at staggered intervals not to exceed every 15 minutes and shall document the observation as it occurs.
b) Constant observation shall be used for prisoners who are actively suicidal, either threatening or engaging in self-injury, and considered a high risk for suicide. An assigned staff member shall observe the
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prisoner on a continuous, uninterrupted basis. The observation should be documented at 15-minute intervals. Staff should be physically stationed outside of the prisoner’s cell to permit continuous, uninterrupted observation. 4. For any prisoner requiring suicide precautions, a qualified mental health professional shall assess, determine, and document the clinically appropriate level of monitoring based on the prisoner’s individual circumstances. Placement in a safety cell shall not serve as a substitute for the clinicallydetermined level of monitoring. 5. Video monitoring of prisoners on suicide precaution shall not serve as a substitute for Close or Constant observation. Treatment of Inmates Identified as at Risk Of Suicide 1. Qualified mental health professionals shall develop an individualized treatment plan and/or behavior management plan for every prisoner that mental health staff assesses as being a suicide risk. 2. Treatment plans shall be designed to reduce suicide risk and shall contain individualized goals and interventions. Treatment plans shall be reviewed following discharge from suicide precautions and updated as clinically indicated. 3. All assessments, treatment, and other clinical encounters shall occur in an area that provides reasonable sound privacy and confidentiality. If a custody officer is present, the officer should be positioned in a place that allows for observation of the prisoner but maintains sound privacy, unless there is a clearly identified security or safety risk. Conditions for Individual Inmates on Suicide Precautions 1. The County’s Suicide Prevention Policy shall set forth clear and internally consistent procedures regarding decisional authority for determining the conditions for individual inmates on suicide precautions. Mental health staff shall have primary authority, consistent with individualized classification and security needs, with respect to the following: Property and Privileges 1. Qualified mental health professionals shall have the primary responsibility to determine, based on clinical judgment and on a case-by-case basis in consultation with custody staff, depending on suicide risk, the removal and/or return of routine privileges (e.g., visits, telephone calls, recreation) that are otherwise within the limitations of a prisoner’s classification security level. Any removal of privileges shall be documented with clinical justification in the prisoner’s medical/mental health record and reviewed on a regular basis.
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2. Qualified mental health professionals shall have the primary responsibility to determine, based on clinical judgment and on a case-by-case basis in consultation with custody staff depending on suicide risk, the removal and/or return of a prisoner’s clothing and possessions (e.g., books, slippers/sandals, eyeglasses) that are otherwise within the limitations of a prisoner’s classification security level. The removal of property shall be documented with clinical justification in the prisoner’s medical/mental health record and reviewed on a regular basis.
3. Cancellation of privileges should be avoided whenever possible and utilized only as a last resort.
Use of Safety Suits 1. Decisions about the use of a safety suit (smock) or removal of normal clothing
will be under mental health staff’s authority, based on individualized clinical judgment along with input from custody staff. 2. Custody staff may only temporarily place an inmate in a safety suit based on an identified risk of suicide by hanging until the qualified mental health professional’s evaluation, to be completed within the “must see” referral timeline. Upon completion of the mental health evaluation, the mental health professional will determine whether to continue or discontinue use of the safety suit. 3. If an inmate’s clothing is removed, the inmate shall be issued a safety suit and safety blanket. 4. As soon as clinically appropriate, the provision of regular clothing shall be restored. The goal shall be to return full clothing to the inmate prior to discharge from suicide precautions. 5. A qualified mental health professional shall conduct daily assessments of any prisoner in a safety suit and document reasons for continued use when clinically indicated. 6. If a qualified mental health professional determines that 30-minute (or less frequent) observations are warranted for a prisoner, safety suits shall not be used on that prisoner. 7. Safety suits shall not be used as a tool for behavior management or punishment. Beds and Bedding 1. All prisoners housed for more than four hours on suicide precautions and/or in an inpatient placement shall be provided with an appropriate bed, mattress, and bedding unless the prisoner uses these items in ways for which they were not intended (e.g., tampering or obstructing visibility into the cell). Such a determination shall be documented and shall be reviewed on a regular basis.
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Discharge from Suicide Precautions 1. A qualified mental health professional shall complete and document a suicide
risk assessment prior to discharging a prisoner from suicide precautions in order to ensure that the discharge is appropriate and that appropriate treatment and safety planning is completed. 2. Treatment plans shall be written for all prisoners discharged from suicide precautions. The treatment plan shall describe signs, symptoms, and circumstances in which the risk for suicide is likely to recur, how recurrence of suicidal thoughts can be avoided, and actions the patient or staff can take if suicidal thoughts do occur. 3. Qualified mental health professionals shall provide clinical input regarding clinically appropriate housing placement (e.g., whether isolation is contraindicated for the prisoner) upon discharge. Custody and classification shall consider such clinical input in determining post-discharge placement and conditions of confinement. Once clinically discharged from suicide precautions, the prisoner shall be promptly transferred to appropriate housing. 4. Prisoners discharged from suicide precautions shall remain on the mental health caseload and receive regularly scheduled clinical assessments and contacts. Unless a prisoner’s individual circumstances direct otherwise, a qualified mental health professional shall provide follow-up assessment and clinical contacts within 24 hours of discharge, again within 72 hours of discharge, again within one week of discharge. Emergency Response 1. The County shall keep an emergency response bag that includes appropriate equipment, including a first aid kit, CPR mask or Ambu bag, and emergency rescue tool in close proximity to all housing units. All custodial and medical staff be trained on the location of this emergency response bag and shall receive regular training on emergency response procedures, including how to use appropriate equipment. 2. All custody and medical staff shall be trained in first aid and CPR. 3. It shall be the policy of the County that any staff who discovers an inmate attempting suicide shall immediately respond, survey the scene to ensure the emergency is genuine, and alert other staff to call for medical personnel. Trained staff shall begin to administer standard first aid and/or CPR, as appropriate. Quality Assurance and Quality Improvement 1. The County shall establish regularly scheduled multidisciplinary meetings related to treatment, and plan of care issues, on a monthly basis, between medical, and mental health personnel.
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2. The County shall, in consultation with Plaintiffs’ counsel, revise its in-custody death review policy and procedures. Reviews shall be conducted with the active participation of custody, medical, and mental health staff. Reviews shall include analysis of policy or systemic issues and the development of corrective action plans when warranted.
3. For each suicide and serious suicide attempt (e.g., requiring hospitalization), the County’s Suicide Prevention Task Force shall review: 1) the circumstances surrounding the incident; 2) the procedures relevant to the incident; 3) all relevant training received by involved staff; 4) pertinent medical and mental health services/reports involving the victim; and 5) any possible precipitating factors that may have caused the victim to commit suicide or suffer a serious suicide attempt. Where applicable, the Review Team shall generate recommendations for changes in policy, training, physical plant, medical or mental health services, and operational procedures.
4. The County will track all critical incidents which include prisoner suicides, attempted suicides, and incidents involving serious self-harm. The County shall review critical incidents and related data through its quality assurance and improvement processes.
5. The County shall implement a continuous quality assurance/quality improvement plan to periodically audit suicide prevention procedures that include, but are not limited to: intake screening (to include audits to ensure that staff ask and record all suicide screening questions), mental health assessments, suicide risk assessments, crisis response, and treatment plans/behavior management plans for prisoners identified as being at risk of suicide or self-harm.
SEGREGATION/RESTRICTIVE HOUSING General Principles 1. Prisoners will be housed in the least restrictive setting necessary to ensure their own safety, as well as the safety of staff, other prisoners, and the public. a) The County shall not place prisoners in more restrictive settings, including Segregation, based solely on a mental illness or any other disability. Prisoners will be housed in the most integrated setting appropriate to their individual needs. b) The County shall not place prisoners into Segregation units based solely on classification score. c) The County shall review the housing and restrictions of female prisoners classified as high security to ensure that this population is not subject to Segregation conditions of confinement.
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d) Specialized medical units (e.g., Main Jail 2 West Med/Psych, Main Jail 2 East) and mental health units (e.g., OPP, IOP, MHU, 2P) are not Segregation housing units. The County shall ensure that prisoners housed in these units receive daily access to out-of-cell time, telephones, showers, and other programs, services, and activities consistent with their classification and treatment plan.
2. The County shall not place a prisoner in Segregation units without first determining that such confinement is necessary for the safety of the staff, other prisoners, or the public. The County shall clearly document in writing the specific reason(s) for a prisoner’s placement and retention in Segregation housing. The reason(s) shall be supported by clear, objective evidence. Prisoners will remain in Segregation housing for no longer than necessary to address the reason(s) for placement.
3. The County shall not place the following prisoners in a Segregation setting unless necessary to address a serious risk of physical harm, and in such cases only for the minimum time necessary to identify an alternative appropriate placement: a) Prisoners with acute medical needs that require an inpatient level of care and/or daily nursing care; b) Prisoners who are pregnant, post-partum, who recently had a miscarriage, or who recently had a terminated pregnancy.
Conditions of Confinement 1. The County will provide at least 17 hours of out-of-cell time per week for all
prisoners, with the exception of prisoners subject to Administrative Segregation Phase I and Disciplinary Segregation in accordance with this remedial plan. The County will monitor out-of-cell time, and if minimum outof-cell time requirements are routinely not being met at a particular facility or in a particular housing unit, the Sheriff’s Department division commander or designee will review the situation and take appropriate steps to resolve the issue.
a) The County shall implement a policy to document out-of-cell time provided to each prisoner. The County shall conduct monthly audits to ensure that prisoners have been provided the required treatment and recreation time out of cell. This data will be regularly reviewed as part of the County’s Quality Assurance procedures.
2. Out-of-cell time with the opportunity to exercise shall be provided to each prisoner seven (7) days per week, including outdoors/recreation time when feasible. The County shall offer out-of-cell time at appropriate times of day.
3. The County shall modify its non-disciplinary Segregation policies and procedures to allow reasonable access to the following: (1) Personal phone
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calls for all prisoners, including at least five hours or three weekdays per week of phone access during normal business hours; (2) Education, rehabilitation, and other materials (e.g. writing implements, art supplies, tablets), for in-cell activities; (3) Personal and legal visiting; (4) Religious services; and (5) Commissary.
a) The conditions and privileges described above shall be provided unless there is a specific safety or security issue preventing provision of such materials or the prisoner is subjected to disciplinary action.
4. Cell windows shall not be covered with magnetic flaps, towels, sheets, or any other visual barrier preventing visibility into and out of the cell, unless there is a specific security or privacy need that is documented, and then for only a period of time necessary to address such security or privacy need. This provision shall apply to all cells housing prisoners.
5. The County shall establish procedures so that all housing unit cells are searched and cleaned prior to a prisoner’s placement in the cell.
6. The County shall establish procedures to ensure that no prisoner is placed in a Segregation housing cell without a mattress and appropriate bedding.
Mental Health Functions in Segregation Units 1. Segregation Placement Mental Health Review
a) All prisoners placed in a non-disciplinary Segregation housing unit and all prisoners housed in a Disciplinary Detention unit shall be assessed by a qualified mental health professional within 24 hours of placement to determine whether such placement is contraindicated. All prisoners subjected to Disciplinary Segregation conditions for 72 hours in their general population housing unit (i.e., confined to cell 23 hours per day) shall also be assessed by a qualified mental health professional no later than the fourth day of such placement.
b) Any decision to place prisoners with Serious Mental Illness in Segregation shall include the input of a qualified mental health professional who has conducted a clinical evaluation of the prisoner in a private and confidential setting (absent a specific current risk that necessitates the presence of custody staff), is familiar with the details of the available clinical history, and has considered the prisoner’s mental health needs and history.
c) Mental Health Staff shall consider each prisoner’s age and cognitive functioning as part of the Segregation Placement review. Staff shall receive training regarding the features of youth and brain development of young adults (i.e., 24 years old and younger) and the needs of individuals with intellectual disabilities.
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d) If mental health or medical staff find that a prisoner has a Serious Mental Illness or has other contraindications to Segregation, that prisoner shall be removed from Segregation absent exceptional and exigent circumstances.
e) The County shall document and retain records of all Segregation Placement mental health evaluations, as described above. The County shall consult with Plaintiffs regarding such documentation, including the development of new forms where necessary.
2. Segregation Rounds and Clinical Contacts a) Cell checks (to ensure that prisoners are safe and breathing) shall be conducted for all prisoners in Segregation at least every 30 minutes, at staggered intervals. Completion of cell checks will be timely documented. b) A qualified mental health or medical professional shall conduct checkins at least once a week, to assess and document the health status of all prisoners in Segregation, and shall make referrals as necessary. The check-in shall include a brief conversation with each prisoner, a visual observation of the cell, and an inquiry into whether the prisoner would like to request a confidential meeting with a mental health or medical provider. Steps shall be taken to ensure effective communication, as well as auditory privacy consistent with security needs. When a prisoner in Segregation requests a confidential meeting with a mental health or medical provider, or the medical or mental health professional identifies a mental health or medical need, staff shall make appropriate arrangements to include triage, examination and treatment in an appropriate clinical setting. In such cases, staff shall give the prisoner the opportunity to complete a health care request but will otherwise initiate a referral without requiring the prisoner to complete a request form.
3. Response to Decompensation in Segregation a) If a prisoner in Segregation develops signs or symptoms of mental illness where such signs or symptoms had not previously been identified, suffers deterioration in his or her mental health, engages in self-harm, or develops a heightened risk of suicide, the prisoner shall immediately be referred for appropriate assessment and treatment from a qualified mental health professional who will recommend appropriate housing and/or programming. b) Jail staff shall follow a mental health recommendation to remove a prisoner from Segregation unless such removal poses a current safety risk that is documented. In such a case, the Commander or management-
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level designee shall be notified and staff shall work to remove the prisoner from Segregation and secure a placement in an appropriate treatment setting at the earliest possible time. Placement of Prisoners with Serious Mental Illness in Segregation 1. Prisoners with a mental health condition meeting criteria for placement in a Designated Mental Health Unit (2P, IOP, OPP) will not be placed in Segregation, but rather will be placed in an appropriate treatment setting – specifically, the inpatient unit or other Designated Mental Health Unit providing programming as described in Exhibit A-2. 2. In rare cases where a prisoner with a mental health condition meeting criteria for placement in a Designated Mental Health Unit presents an immediate danger or significant disruption to the therapeutic milieu, and there is no reasonable alternative, such a prisoner may be housed separately for the briefest period of time necessary to address the issue, subject to the following: a) The prisoner shall receive commensurate out-of-cell time and programming as described in Exhibit A-2 (including for IOP and OPP, 10 hours/week of group treatment/structured activities, 7 hours/week unstructured out-of-cell time, weekly individual clinical contact) with graduated programming subject to an individualized Alternative Treatment Program. b) The prisoner shall receive the following:
i. As part of the weekly confidential clinical contact, the clinician shall assess and document the prisoner’s mental health status and the effect of the current placement on his or her mental health, and determine whether the prisoner has decompensated or is at risk of decompensation.
ii. The weekly check-ins described in Section VIII.C.2.b shall supplement, and not be a substitute for, the weekly treatment session described herein.
iii. Treatment provided in the least restrictive setting that is appropriate based on the prisoner’s circumstances.
iv. Privileges commensurate with the Designated Mental Health Unit program, unless modified in an Alternative Treatment Program based on individual case factors that are regularly reviewed.
v. Daily opportunity to shower. 3. A prisoner with Serious Mental Illness requiring restraints (e.g., handcuffs,
belly chains, etc.) shall not be denied clinically indicated group or individual treatment due to security factors, absent exceptional circumstances that are
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documented. Prisoners with Serious Mental Illness housed in Segregation who require restraints when out of cell shall have the opportunity to work their way out of restraints through graduated programming subject to an individualized Alternative Treatment Program. Administrative Segregation 1. Use of Administrative Segregation
a) Only the Classification Unit can assign a prisoner to Administrative Segregation.
b) The County may use Administrative Segregation in the following circumstances: i. Objective evidence indicates that a prisoner participated in a recent assault and the assaultive behavior involved an assault on staff or visitors, serious injury, use of a weapon, gang removals, or multiple prisoner assaults. Mutual combat situations that do not otherwise qualify for Administrative Segregation are excluded. ii. During a brief investigative period not to exceed ten days while Classification staff attempts to verify the need for Protective Custody or while the prisoner is awaiting transfer to another facility.
c) The Compliance Commander shall have the authority to place prisoners in Administrative Segregation under the following circumstances: i. The prisoner poses an extraordinary safety risk and no other housing unit is sufficient to protect the prisoner from harm; ii. The prisoner has failed to integrate into a lesser restrictive housing setting because of repeated and recent history of assaultive behavior or current threats of violence associated with being in a lesser restrictive setting; or iii. Objective evidence indicates that the prisoner attempted to escape or presents an escape risk.
2. Notice, Documentation, and Review of Administrative Segregation Designations a) The Classification Unit shall document the rationale for designating a prisoner for Administrative Segregation in the classification file using objective evidence. For prisoners younger than 24, the Classification Unit shall consider the prisoner’s age as a mitigating factor when assigning the prisoner to Administrative Segregation.
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b) Classification shall attempt to down-class prisoners to a lesser restrictive housing setting at the earliest possible opportunity, consistent with safety and security.
c) County shall provide prisoners in Administrative Segregation with a written notice within 72 hours of the prisoner’s initial placement in Administrative Segregation, explaining the reasons for the prisoner’s Administrative Segregation designation and how the prisoner may progress to a lesser restrictive housing setting.
d) Prisoners housed in Segregation units will, at least every thirty (30) days, receive face-to-face interviews in a private out-of-cell setting, consistent with individual security needs, to discuss progress and compliance with their individual case plan as part of a classification review. Consideration will be given to their mental health and to their appropriateness for transfer to a less restrictive setting.
e) The Compliance Commander or higher-ranked officer will review and approve the decision to designate a prisoner for Administrative Segregation for longer than 15 days.
f) The County shall document the reason the prisoner is retained in the same Administrative Segregation Phase. The prisoner will be given written notice of the reasons the prisoner is being retained in the same Phase of Administrative Segregation and what conduct the prisoner is required to exhibit to progress to a lesser restrictive housing setting.
g) The Compliance Commander or higher-ranked officer must approve the continued retention of a prisoner in Administrative Segregation for longer than 90 days, and the Compliance Commander or higher-ranked officers must reauthorize such placement at least every 90 days thereafter.
3. Administrative Segregation Phases a) The County shall develop and implement a phased system for prisoners designated as Administrative Segregation to achieve a lesser restrictive housing setting. b) Administrative Segregation Phase I: i. This is the most restrictive designation for prisoners in Administrative Segregation. ii. Prisoners shall be offered a minimum of one hour per day out of cell time for a total of seven hours per week. iii. Prisoners shall be offered an opportunity for Out-of-Cell Activities for at least five of the seven hours per week.
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iv. Prisoners shall not remain in Phase I for longer than 15 days unless the prisoner engages in new conduct warranting retention in Administrative Segregation as specified in Section VIII.E.1.b.
c) Administrative Segregation Phase II: a) Prisoners shall be offered a minimum of 17 hours of out of cell time per week. b) Prisoners shall be offered an opportunity for Out-of-Cell Activities for at least 10 of the 17 hours per week. c) Prisoners shall be offered the opportunity to program in groups of two to four prisoners, unless pairing with another prisoner is not possible for safety or security reasons, and those reasons are documented by the County. d) The County shall develop a program of incentives for good behavior. e) Prisoners shall not remain in Phase II for longer than 30 days unless the prisoner commits a serious behavioral violation while in Administrative Segregation: fighting; threatening staff or other prisoners; resisting or delaying an order from staff that impedes Jail operations (e.g., failure to lock down); refusing to submit to a search of person or property; destroying or damaging Jail property (excluding property issued to a prisoner and/or minor defacing of property or destruction of low-value property) or facilities; possessing contraband that implicates safety or security (e.g., weapons, razors, unauthorized medication, but not extra clothing, commissary items, or food); cell flooding; tampering with cell locking mechanisms or other security features (e.g., cameras); and/or sexual activity/harassment. In the event a prisoner engages in a serious behavioral violation, the conduct will be referred to the Classification Sergeant or higher-ranking officer, who shall have the discretion to extend the prisoner’s Phase II time by 15 days, and shall develop an individual behavioral management plan, if one does not yet exist, for the prisoner.
Protective Custody 1. When a prisoner faces a legitimate threat from other prisoners, the County will
seek alternative housing, by transferring the threatened prisoner to the general population of another facility or unit, or to a special-purpose housing (Protective Custody) unit for prisoners who face similar threats. 2. The County will not operate Protective Custody units with Segregation-type conditions of confinement. Prisoners placed in Protective Custody shall have
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the same programs and privileges as general population prisoners, absent exceptional circumstances that are documented. 3. The County shall create a policy that describes the process and criteria for placement of prisoners into Protective Custody. The County shall consult with Plaintiffs to develop such a policy. 4. Prisoners who are lesbian, gay, bisexual, transgender, or intersex (LGBTI) or whose appearance or manner does not conform to traditional gender expectations should not be placed in Segregation or Protective Custody solely on the basis of such identification or status, or because they are receiving gender dysphoria treatment.
a) When a prisoner who is LGBTI or gender nonconforming faces a legitimate threat, the County shall identify alternative housing, with conditions comparable to those of general population. Privileges and out-of-cell time for this population will be documented and regularly reviewed by supervisory level staff to ensure appropriate housing, outof-cell-time, and related conditions for this group of prisoners.
b) In deciding whether to assign a transgender or intersex prisoner to a facility or program for male or female prisoners, the County shall consider on a case-by-case basis whether a placement would ensure the prisoner’s health and safety, and the health and safety of other prisoners, giving serious consideration to the prisoner’s own views.
c) Jail staff will receive training on the unique issues of managing transgender prisoners, with refresher training at least bi-annually.
5. For prisoners who are LGBTI or whose appearance or manner does not conform to traditional gender expectations, the County shall identify the prisoner’s preferred gender of jail staff who will perform searches of the prisoner. The County shall honor the request except in exigent circumstances when doing so is not possible.
Disciplinary Segregation 1. The County will not place a prisoner in disciplinary housing pending
investigation of, and due process procedures for, an alleged disciplinary offense unless the prisoner’s presence in general population would pose a danger to the prisoner, staff, other prisoners or the public. 2. The County will adhere to a discipline matrix, developed in consultation with Plaintiffs, that clearly defines when disciplinary housing may be imposed. 3. Prisoners who are found to have violated disciplinary rules following due process procedures will be placed in Segregation only after the County has determined that other available disciplinary options are insufficient, with reasons documented in writing.
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4. The denial of out-of-cell time for more than four (4) hours will not be imposed as a sanction absent a formal disciplinary write-up and due process hearing.
5. Prisoners serving a Disciplinary Segregation term shall receive at least seven (7) hours per week of out-of-cell time. Out-of-cell time with the opportunity to exercise shall be provided to each prisoner one (1) hour a day, seven (7) days per week.
6. Prisoners in Disciplinary Segregation shall, absent an individualized assessment of security risk that is documented be provided at least one book (which prisoners may regularly exchange), legal documents, hygiene materials, legal phone calls, and legal visits.
7. No Disciplinary Segregation term for non-violent rules violations will exceed 15 days.
8. The County will, in consultation with Plaintiffs’ counsel, modify its inmate discipline policy and practice to limit placements in Disciplinary Segregation conditions to no more than 15 days, absent cases of serious violations stemming from distinct incidents and with Watch Commander-level approval.
9. No prisoner shall be placed in Disciplinary Segregation for more than 30 consecutive days.
10. If after a Disciplinary Segregation term, Jail staff, with the input of a mental health clinician, determine that the prisoner cannot safely be removed from Segregation, placement on Administrative Segregation status may occur only subject to the process set forth in Section VIII.E.
11. Once a prisoner has been moved out of Disciplinary Segregation, that prisoner shall not be placed back into Disciplinary Segregation absent (a) a new incident warranting discipline, and (b) completion of all mental health review procedures required for new Segregation placements.
Avoiding Release from Jail Directly from Segregation 1. The County will avoid the release of prisoners from custody directly from
Segregation-type housing, to the maximum extent possible. 2. If a sentenced prisoner housed in Segregation has an upcoming expected
release date (i.e. less than 120 days), the County will take and document steps to move the prisoner to a less restrictive setting, consistent with safety and security needs. If Segregation becomes necessary during this time, the County will provide individualized discharge planning to prepare the sentenced prisoner for release to the community. No Food-Related Punishment 1. The County shall modify its policy and take steps to ensure that the denial or modification of food is never used as punishment. The County shall eliminate
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use of “the loaf” as a disciplinary diet. Nothing in this paragraph shall be read to preclude the County from denying a prisoner use of the commissary. Restraint Chairs 1. Restraint chairs shall be utilized for no more than six hours. 2. The placement of a prisoner in a restraint chair shall trigger an “emergent” mental health referral, and a qualified mental health professional shall evaluate the prisoner to assess immediate and/or long-term mental health treatment needs. 3. The opinion of a qualified medical professional on placement and retention in a restraint chair will be obtained within one hour from the time of placement. QUALITY ASSURANCE SYSTEMS FOR HEALTH CARE TREATMENT Generally 1. The County shall develop and implement, in collaboration with Plaintiffs’ counsel, a quality assurance (“QA”) plan to regularly assess and take all necessary measures to ensure compliance with the terms of this Remedial Plan. 2. The QA/QI Unit shall meet regularly and include representatives from all levels of the organization and from all facilities. The meeting shall include custody representatives for topics that are relevant to custody operations. 3. The County shall provide sufficient resources to the QA/QI program. Quality Assurance, Mental Health Care 1. The JPS Medical Director, the JPS Program Manager, jail administrators, and the medical psychiatric, dental, and nursing directors, or appropriate designees, will attend and participate in this process at a minimum of every quarter. Formal minutes will be taken and maintained whenever the committee convenes. 2. The mental health care quality assurance plan shall include, but is not limited to, the following:
a) Intake processing; b) Medication services; c) Screening and assessments; d) Use of psychotropic medications; e) Crisis response; f) Case management; g) Out-of-cell time; h) Timeliness of clinical contacts;
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i) Provision of mental health evaluation and treatment in confidential settings;
j) Housing of inmates with SMI, including timeliness of placements in higher levels of care and length of stay in various units;
k) Number of commitments pursuant to Welf. & Inst. Code § 5150, et seq.; l) Use of restraint and seclusion; m) Tracking and trending of agreed upon data on a quarterly basis; n) Clinical and custody staffing; o) Morbidity and mortality reviews with critical analyses of causes or
contributing factors, recommendations, and corrective action plans with timelines for completion; and p) Corrective action plans with timelines for completion to address problems that arise during the implementation of this Remedial Plan and prevent those problems from reoccurring. 3. The County will conduct peer and supervisory reviews of all mental health staff and professionals at least annually to assess compliance with policies and procedures and professional standards of care. Quality Assurance, Medical Care 1. The County shall establish a Quality Assurance/Quality Improvement (QA/QI) Unit to develop accurate tracking mechanisms and monitor the timeliness and effectiveness of the following processes of health care, ensuring that all are reviewed at least annually, and shall recommend corrective action for all deficiencies: a) intake screenings; b) emergent, urgent, and routine requests from patients and staff referrals for health care, including Health Service Request availability; c) clinical monitoring of patients, including the delivery of chronic care services to those patients who qualify as chronic care patients; d) prescriptive practices by the prescribing staff; e) medication administration, including the initiation of verified medications, the first doses of medications, medication errors, patient refusals, and patterns of medication administration; f) grievances regarding healthcare; g) specialty care (including outside diagnostic tests and procedures); h) clinical caseloads;
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Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 78 of 119 i) coordination between custody staff and medical staff, including escorts to medical appointments and delivery of care.
2. The studies shall be done with sufficient sample numbers to arrive at statistically valid conclusions. The studies shall include (a) a clearly articulated goals, objective, and methodology to determine if standards have been met, including a sampling strategy; (b) data collection; (c) analysis of data to identify trends and patterns; (d) analysis to identify the underlying causes of problems; (e) development of remedies to solve problems; (f) a written plan that identifies responsible staff and establishes a specific timeline for implementing remedies; (g) follow-up data collection; and (h) analysis to determine if the remedies are effective.
3. The QA/QI Unit study recommendations shall be published to all staff. 4. The County will conduct peer and supervisory reviews of all medical staff and
professionals at least annually to assess compliance with policies and procedures and professional standards of care.
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EXHIBIT A-1
Consent Decree
Mays v. County of Sacramento

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EXHIBIT A-1 ADA COMPLIANCE REMEDIAL PLAN Sacramento County Jail – Policies Warranting ADA-Related Revisions
SHERIFF’S DEPARTMENT OPERATIONS ORDERS 02/01 Use of Force
Effective Communication Procedures for Prisoners Manifesting Serious Mental Illness 02/02 Use of Restraint Devices Effective Communication Mobility-Related Disability Accommodations 02/03 Use of Pro-Straint Chair Effective Communication Mobility-Related Disability Accommodations 02/05 CERT and Cell Extraction Procedures Effective Communication Identification and Tracking of ADA Needs and Accommodations Procedures for Prisoners Manifesting Serious Mental Illness 02/06 Prisoner Searches Effective Communication Identification and Tracking of ADA Needs and Accommodations 02/12 Transportation of Prisoners Mobility-Related Disability Accommodations, HCA/AD/DME 03/12 Evacuation Plan - Main Jail Provision of ADA Reasonable Accommodations 03/13 Evacuation Plan – RCCC Provision of ADA Reasonable Accommodations

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04/01 Intake, Search, Reception and Holding Identification and Tracking of ADA Needs and Accommodations Effective Communication
04/08 Prisoner Orientation Effective Communication ADA Coordinator and Disability-Related Grievance and Accommodation Process
04/09 Release Procedures HCA/AD/DME, Provision of ADA Reasonable Accommodations Effective Communication
06/02 Housing Plan Identification and Tracking of ADA Needs and Accommodations Equal Access
06/10 Recreation, Exercise and Showering Equal Access Mobility-Related Disability Accommodations Staff Assistance of Inmates with Disabilities
06/13 Telephone/TDD/TTY Equipment Access Equal Access Effective Communication Video Relay Services/Videophones
06/14 Interpreter Services Identification and Tracking of ADA Needs and Accommodations Updates as to Provision of Sign Language Interpreter Procedures
07/01 Inmate Message Requests (KITE’s)

SacCraasme e2n:1t8o-cCv-o0u2n0t8y1-JTaLiNl –-KPJNolicDieoscutmoeRnte8v5is-1e rFeilAedD0A6/20/19 Page 82 of 119 Page | 3
ADA Coordinator and Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 07/02 Grievances ADA Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 07/03 Discipline Plan Effective Communication Coordination with JPS, Consideration of Mental Health/Intellectual Disability Factors Identification and Tracking of ADA Needs and Accommodations 08/04 Educational Services Equal Access. Reasonable Accommodations Effective Communication 08/06 Prisoner Services Equal Access 10/01 Health Care Services Identification and Tracking of ADA Needs and Accommodations Effective Communication 10/04 Medical Intake Screening Identification and Tracking of ADA Needs and Accommodations Effective Communication

SacCraasme e2n:1t8o-cCv-o0u2n0t8y1-JTaLiNl –-KPJNolicDieoscutmoeRnte8v5is-1e rFeilAedD0A6/20/19 Page 83 of 119 Page | 4
CORRECTIONAL HEALTH SERVICES POLICIES AND PROCEDURES 1107 Decision Making-Special Needs
Identification and Tracking of ADA Needs and Accommodations Prisoners with ID/DD 1302 Staff Development and Training General ADA Requirements Identification and Tracking of ADA Needs and Accommodations Effective Communication ADA Coordinator and Disability-Related Grievance and Accommodation Process 1400 Medical Transportation Mobility-Related Disability Accommodations, HCA/AD/DME 1404 Receiving Screening Identification and Tracking of ADA Needs and Accommodations Effective Communication Prisoners with ID/DD 1407 Access to Treatment ADA Coordinator and Disability-Related Grievance and Accommodation Process Effective Communication 1409 Clinic Care Equal Access Staff Assistance of Inmates with Disabilities 1413 Use of Restraints and the Pro-Straint Chair Identification and Tracking of ADA Needs and Accommodations Effective Communication

SacCraasme e2n:1t8o-cCv-o0u2n0t8y1-JTaLiNl –-KPJNolicDieoscutmoeRnte8v5is-1e rFeilAedD0A6/20/19 Page 84 of 119 Page | 5
Mobility-Related Disability Accommodations 1417 Adult Developmental Disability
Updates to Policy Consistent with Remedial Plan 1423 Post Release Medical Care Planning
HCA/AD/DME 1435 Inmate Health Care Grievances
Disability-Related Grievance and Accommodation Process Staff Assistance of Inmates with Disabilities 1436 Two East Inmate Transfers Equal Access Disability-Related Grievance and Accommodation Process 1439 Reports of Disabilities or Impairments Identification and Tracking of ADA Needs and Accommodations

SacCraasme e2n:1t8o-cCv-o0u2n0t8y1-JTaLiNl –-KPJNolicDieoscutmoeRnte8v5is-1e rFeilAedD0A6/20/19 Page 85 of 119 Page | 6
JAIL PSYCHIATRIC SERVICES POLICIES 800 Discharge Planning
Effective Communication 1022 Overview of Staff Responsibilities
Updates Pursuant to Mental Health Remedial Plan, ADA Remedial Plan, Mental Health/Disciplinary Measures Remedial Plan Effective Communication 1025 Interpreters for the Hearing Impaired Identification and Tracking of ADA Needs and Accommodations Updates as to Provision of Sign Language Interpreter Procedures 1037 Outpatient Intake Identification and Tracking of ADA Needs and Accommodations Effective Communication 1049 Suicide Prevention Program Effective Communication

 
 Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 86 of 119
EXHIBIT A-2
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 87 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
INTENSIVE OUTPATIENT PROGRAM (Projected - 85 to 120 beds)
Caseload of 10 per LCSW/MSW
I. Admission Criteria x The presence of suicidal ideations without a plan or intent and requiring enhanced observation and safety measures; x 2P Pre-Admissions who require 1:1 observation for acute suicidal ideations and/or attempts (with placement in inpatient unit within 24 hours of identified inpatient need); x Discharge from the Acute Inpatient Unit upon recommendation of discharging Psychiatrist; x Acute onset or significant decompensation of a serious mental illness characterized by increased delusional thinking, hallucinatory experiences, marked changes in affect, and vegetative signs with definitive impairment of reality testing and/or judgment; and/or x Inability to function in General Population (GP) or Outpatient Psychiatric Pod (OPP) and, i. The presence of dysfunctional or disruptive social interaction including withdrawal, bizarre or disruptive behavior, inability to respond to staff directions, provocative behavior toward others, inappropriate sexual behavior, etc., as a consequence of serious mental illness; and/or ii. A significant impairment in the activities of daily living including eating, grooming and personal hygiene, maintenance of housing area, and ambulation, as a consequence of serious mental illness.
II. Service Components x Case Management provided by LCSW or MSW. x Two (2), one (1)-hour Group Therapy Sessions per day, 5 days a week, will be offered to each inmate-patient, unless clinical indicators or Alternative Treatment Plan (see below) precludes participation. x At least seven (7) hours of unstructured out-of-cell time per week x 1:1 confidential contact with a mental health professional every 7 days or more often if clinically indicated. x Psychological testing as clinically indicated. x Graduated Programming for inmate-patients requiring restrictive housing and/or restriction of privileges due to severity of symptoms and/or behaviors and/or classification. Alternative Treatment Program (ATP) will be initiated and documented in Treatment Plan. ATP will address barriers to treatment, ATP goals and progress toward least restrictive housing and/or privileges. ATP will provide clear system of opportunities for inmate-patients to gain additional
1|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 88 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
privileges based on progress in program. x Multi-Disciplinary Treatment Team (MDT) Meetings (Initial 14 day and then
every 60 days or sooner if clinically indicated). x Treatment Plan initiated within 14 days of IOP placement and then every 60 days
or sooner if clinically indicated. x Initial MD or NP assessment within 5 days of admit and then every 30 days
thereafter (or more often if clinically indicated). x Staggered 30-minute cell checks performed by Custody for all inmate-patients
participating in the program. x Designated Custody Staff who participate as part of the MDT. x Treatment planning when moving to less intensive level of mental health care. x Discharge planning and continuity of care with community providers
III. Treatment Goals Treatment goals will address mental health conditions which are limiting an inmate's ability to adjust to incarceration and focus on symptom reduction and management, coping skills and stress reduction. Treatment goals may include: x Medication compliance (if applicable) x Substance Abuse Recovery/Prevention x Activities of Daily Living (ADL) Skill Development x Crisis intervention/Adjusting to incarceration x Symptom reduction x Socialization and recreation x Behavior management (if applicable) x Coping skills x Stress reduction x Return to GP-MHC or OPP-MHC
IV. IOP Officers (24/7 Coverage)
Designated IOP Officers will be active members of the treatment team. In order for the Officers to take active roles in treatment, dayshift Officers must participate in weekly (or more often if needed) treatment team meetings with JPS staff and contribute information on inmate-patient behavior (both directly observed, and communicated by night shift deputies).

Duties and Responsibilities of the IOP Officers include:

2|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 89 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)
x Staggered 30-minute safety checks of all inmate-patients housed in the IOP. x Daily security checks. Inmate movements to, from, and within the facility. x Oversight of food delivery. x Oversight of medical, dental, and psychiatric requests/services. x Oversight of daily indoor and outdoor recreation. x Housing moves and inmate conflict mediation. x Incident investigation/documentation for both jail and criminal level offenses. The IOP Officer also has additional program specific duties which include: x Ensuring the safety and security of the JPS/IOP civilian staff. x Inmate-patient movement to/from groups and individual contacts with JPS/IOP
staff. If needed, Officers will stand by while the civilian staff conducts daily group therapy (two to three hours each day) and separate one-to-one therapy/education sessions. x Daily cell inspections. x Provide IOP inmate-patients with the opportunity or assistance needed to meet their basic hygiene needs and the opportunity to maintain clean cells and activity/housing areas. V. Discharge Criteria x Able to function in a GP-MHC or OPP-MHC setting. x Stabilization of the crisis behavior and the ability to function in a less clinically structured environment. x Has clinically decompensated to the extent that placement into the Acute Inpatient Unit is required. x Has reached release date, and clinical services will be transferred to community service provider.
3|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 90 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

OUTPATIENT PSYCHIATRIC POD (PROJECTED - 200 BEDS)

Caseload of 25 per LCSW/MSW

I.

Admission Criteria

x Qualifying diagnosis (see below) and are unable to house in general population

due to severity of symptoms, potential for victimization and/or significant

difficulty maintaining ADLs.

x Diagnosed with a serious mental illness (SMI): 1. Schizophrenia (all subtypes)

2. Delusional Disorder 3. Schizophreniform Disorder

4. Schizoaffective Disorder 5. Brief Psychotic Disorder

6. Intellectual Disability with prior Regional Center Services and/or with a cooccurring serious mental illness

7. Other Specified and Unspecified Schizophrenia Spectrum and other Psychotic

Disorder 8. Major Depressive Disorder

9. Bipolar Disorders I and II

10. Other Specified and Unspecified Bipolar and Related Disorders

11. Borderline Personality Disorder

II.

Service Components

x Case Management provided by LCSW or MSW.

x One (1) 1-hour Group Therapy Sessions per day, 7 days a week, will be offered to

each OPP-MHC inmate-patient. Three (3) additional hours of structured out-of-

cell time will be offered to each OPP-MHC inmate-patient by recreational

technicians or other service providers.

x At least seven (7) hours of unstructured out-of-cell time per week

x Psychological testing as clinically indicated.

x 1:1 confidential contact with mental health professional at least every 14 days or

more often if clinically indicated.

x Treatment Plan initiated within 30 days of placement in OPP-MHC and updated

every 6 months or sooner if clinically indicated.

x Evaluation by psychiatrist or psychiatric nurse practitioner every 30-90 days (or

more often if clinically indicated).

x Treatment planning when moving to less intensive level of mental health care.

x Discharge planning and continuity of care with community providers

III.

Treatment Goals

4|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 91 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

x Stabilization of mental health symptoms and overall improvement in functioning x Medication compliance (if applicable) x Substance Abuse Recovery/Prevention x Activities of Daily Living (ADL) Skill Development x Crisis intervention/Adjusting to incarceration x Symptom reduction x Socialization and recreation x Behavior management (if applicable) x Hygiene skills x Coping skills x Stress reduction x Discharge planning and continuity of care with community providers

IV.

Discharge Criteria

x Able to function in a GP-MHC.

x Stabilization/resolution of mental health symptoms and ability to function in a

less clinically structured environment.

x Clinically decompensates and requires higher level of care and placement in IOP.

x Clinically decompensates to the extent that placement into the Acute

Inpatient Unit is required.

x Has reached release date, and clinical services will be transferred to community

service provider.

5|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 92 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

GENERAL POPULATION – MENTAL HEALTH CASELOAD

Caseload of 28-30 per LCSW/MSW

I.

Admission Criteria

x Diagnosed mental health disorder

x Exhibits symptom control or partial remission as result of treatment

II.

Service Components

x Case Management provided by LCSW or MSW.

x Individual or group treatment provided as clinically indicated.

x Psychological testing as clinically indicated.

x 1:1 confidential contact by mental health professional at least every 90 days or

more often if clinically indicated.

x Treatment Plan initiated within 30 days of placement in GP-MHC and updated

every 12 months or sooner if clinically indicated.

x Evaluation by psychiatrist or psychiatric nurse practitioner every 90 days (if

prescribed psychotropics), or more often if clinically indicated.

x Treatment planning when moving off mental health caseload.

x Discharge planning and continuity of care with community providers

III.

Treatment Goals

x Symptom management

x Medication monitoring

x Crisis intervention/Adjusting to incarceration x Preventing decompensation

IV.

Discharge Criteria

x Remission of symptoms, no longer requires medication monitoring or mental health services.
x Clinically decompensates and requires higher level of care and placement in IOP or OPP.
x Clinically decompensates to the extent that placement into the Acute Inpatient Unit is required.
x Has reached release date, and clinical services will be transferred to community

service provider.

6|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 93 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES)

INTAKE & CRISIS RESPONSE TEAM

Current JPS staff will continue to manage all new intakes, priority referrals and must-sees. These staff will not carry a caseload and will be available to respond to new intakes and crisis referrals on a 24/7 basis.

Must-See Referrals

DEFINITIONS

Referrals for currently suicidal (i.e., attempt, ideation, or self-injurious behavior), homicidal or gravely disabled inmate-patients (5150 evaluations), acute crisis related to nature of charges or other arrest factors, alleged Prison Rape Elimination Act victim assessments, and/or custody or administration requests urgent evaluation.

Priority Referrals

Referrals for inmate-patients reporting recent psychiatric hospitalization, intellectual disability with observed poor adaptive functioning, suicidal ideation within past two weeks, demonstrating worsening of mental health symptoms, identified as a possible suspect per Prison Rape Elimination Act, or other significant mental health symptoms that staff may have reason to be concerned about inmate’s mental stability.

Routine Referrals

Referrals for inmate-patients reporting current or prior mental health treatment, currently prescribed psychiatric medication or reporting to receive medication in community. May have complaints of adjustment or other mental health issues, and/or significant AVATAR history, but are stable.

Mental Health Caseload (MHC)

Inmate-patients open to JPS and receiving mental health services in General Population-Mental Health Caseload (GP-MHC), Outpatient Psychiatric Pod (OPP-MHC), Intensive Outpatient Program (IOP-MHC), or on the Acute Inpatient Unit (2P).

General Population (GP-MHC)

Inmate-patients classified as GP-MHC meet the following criteria:

x Stable, on psychotropics, or x Stable, not receiving psychotropics but may require time-limited services to address
mental health symptoms.

7|Page

Case 2:18-cv-02081-TLNM-KEJNNTADL oHcEuAmLeTnHt 8T5R-E1ATFMileEdN0T6/20/19 Page 94 of 119 OVERVIEW OF SACRAMENTO COUNTY JAIL NON-ACUTE-MENTAL HEALTH
PROGRAMS/SERVICES (JAIL PSYCHIATRIC SERVICES) DEFINITIONS
Intensive Outpatient Unit (IOP-MHC) Inmate-patients classified as IOP-MHC meet any of the following criteria:
x The presence of suicidal ideations without a plan or intent and requiring enhanced observation and safety measures;
x 2P Pre-Admissions who require 1:1 observation for acute suicidal ideations and/or attempts;
x Discharge from the Acute Inpatient Unit upon recommendation of discharging Psychiatrist;
x Acute onset or significant decompensation of a serious mental illness. Outpatient Psychiatric Pod (OPP) Inmate-patients classified as OPP-MHC meet the following criteria:
x Diagnosed with serious mental illness and are unable to be housed in general population due to severity of symptoms, potential for victimization and/or significant difficulty maintaining ADLs.
Acute Inpatient Unit (2P) 18-bed LPS designated facility.
x Inmate-patients meet criteria for either voluntary or involuntary acute inpatient psychiatric treatment
8|Page

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 95 of 119
EXHIBIT A-3
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 96 of 119
Sacramento CountySheriff’s Department
Correctional Health Services JPS –Rules Violation Mental Health Review

Name: X-Ref:

DOB:

Date of Incident: __________ Rules Violation Charge(s): __________________________________________________

Type of Review:

 Record Review and Clinical Evaluation

 Record Review Only

(The clinician will complete an in-person interview with the inmate unless there are specific reasons why an interview

is not necessary or appropriate.)

For Clinical Evaluations: Inform the inmate of purpose of evaluation and that information is

not confidential and will be used for purposes discipline review/hearing.

Is the inmate currently receiving mental health services?

 Yes  No

  Level of MH services:

2P Pre-Admit

2P

 IOP

 OPP  GP  JBCT

1a) Is there a possibility of a nexus between the inmate’s mental illness/symptoms and/or developmental disability/functioning deficits and the behavior(s)?

 Yes

 No

1b) Was the inmate’s behavior connected to any of the following? (If any are checked, Rule Violation should be cancelled.)
 An act of self-harm or attempted suicide  A cell extraction related to transfer to a medical/mental health unit or provision of involuntary treatment  Placement in mental health restraints or seclusion

2) If the inmate is found guilty of the offense(s), what mental health factors and/or developmental disability/cognitive or adaptive functioning deficits should the hearing officer consider when assessing the penalty? (Check all that apply):

 N/A

 Dementia

 Difficulty maintaining/performing ADLs

 Poor social skills and/or peer interactions

 Psychotic symptoms

 Difficulty processing information/verbal commands

 Intellectual disability

 Traumatic Brain Injury

 Poor impulse control (must be related to mental health diagnosis)

 Other Mitigating Factors: ___________________________________________________________

3) If the inmate is found guilty of the offense(s), what penalties may have an adverse impact on inmate’s mental

health condition or functioning (Check all that apply):

 N/A

 Loss of commissary privileges

 Loss of social visits

 Loss of dayroom/outdoor recreation

 Loss of tablet privileges

 Loss of telephones

 Housing Relocation

 Loss of good time

 Loss of work time

 Disciplinary housing unit

 Isolation Housing (Full restriction)

 Lockdown for less than 24 hours

 Assigned Extra Work Duty

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 97 of 119 6) Provide narrative of findings that should be considered by the hearing officer, regarding: (1) whether there is a nexus between the inmate’s behavior and mental illness and/or developmental disability, (2) any relevant mitigating circumstances, and (3) penalties that should be avoided. (If no in-person interview/clinical evaluation was completed, please explain.)

Reviewer’s Name

Signature __________________________________________________
Date of Review

 
 Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 98 of 119
EXHIBIT B
Consent Decree
Mays v. County of Sacramento

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 99 of 119
MAYS v. COUNTY OF SACRAMENTO D UTIES OF RULE 706 EXPERTS
Pursuant to Rule 706(b) of the Federal Rules of Evidence, the parties set forth the duties of the Court Experts.
1. The Court Experts shall advise the parties and the Court on Defendant’s compliance or non-compliance with the medical care, mental health care, and suicide prevention provisions of the Remedial Plan, to assist with dispute resolution matters, and to provide testimony, if required, in any proceedings before the Court.
2. Within 180 days after entry of this Consent Decree, and then every 180 days thereafter during the term of this Consent Decree, the Court Experts shall each complete comprehensive reviews and reports (“180-Day Reports”) to advise the parties and the Court on Defendant’s compliance or non-compliance with the Remedial Plan.
3. In each 180-Day Report, the Court Experts shall state their opinion as to whether Defendant is or is not in substantial compliance with each material component of the Remedial Plan within the expert’s area of expertise. These opinions are referred to in the Consent Decree as “Substantial Compliance Determinations.” The 180-Day Reports shall be considered separate and apart from any evaluations and reports prepared as part of the dispute resolution process set forth in the Consent Decree and shall be admissible in evidence in any proceedings before the Court.
4. The Court Experts shall be entitled to reasonable expenses incurred plus reasonable hourly and/or daily rates, which shall be paid by Defendant.
5. With appropriate notice, the Court Experts shall have reasonable access to all parts of any Sacramento County jail facility. Access to the facilities will not be unreasonably restricted. The Court Experts shall have access to correctional and health care staff and people incarcerated in the jails, including confidential and voluntary interviews as they deem appropriate. The Court Experts shall also have access to documents, including budgetary, custody, and health care documents, and institutional meetings, proceedings, and programs to the extent the Court Experts determine such access is needed to fulfill their obligations. The Court Experts’ tours shall be undertaken in a manner that does not unreasonably interfere with jail operations as reasonably determined by jail administrators.
6. The Court Experts may engage in ex parte communications with the parties, as requested. However, all of the Court Experts’ findings and recommendations shall be set forth in writing in their reports.
7. Pursuant to the dispute resolution procedures set forth in the Consent Decree, either party may request that the relevant Court Expert evaluate the issue in dispute and prepare a
1 of 2

Case 2:18-cv-02081-TLN-KJN Document 85-1 Filed 06/20/19 Page 100 of 119 report. The expert must provide the report regarding the area of disagreement to the parties and the Mediator within 45 days of the request. Defendant will pay the Court Experts’ reasonable fees for any reports prepared by a Court expert at the request of a party about a disputed issue, as contemplated by this paragraph.
2 of 2

 
 Case 2:18-cv-02081-TLN-KJN Document 118 Filed 04/27/20 Page 1 of 3

1

Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org

2

Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org

3

DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500

4

Oakland, CA 94612 Telephone: (510) 267-1200

5 Fax: (510) 267-1201

6 Attorneys for Plaintiffs

7

Donald Specter (SBN 83925) dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) sophieh@prisonlaw.coom PRISON LAW OFFICE 1917 Fifth Street Berkeley, California 94710 Telephone: (510) 280-2621 Fax: (510) 280-2704 Attorneys for Plaintiffs

8

9

UNITED STATES DISTRICT COURT

10

EASTERN DISTRICT OF CALIFORNIA

11

SACRAMENTO DIVISION

12

13 LORENZO MAYS, RICKY

14

RICHARDSON, JENNIFER BOTHUN, ARMANI LEE, and

15

LEERTESE BEIRGE on behalf of themselves and all others similarly

16 situated,

17

Plaintiffs,

18

v.

19 COUNTY OF SACRAMENTO,

20

Defendant.

21

) )

Case No. 2:18-cv-02081 TLN KJN

) )

CLASS ACTION

) )

STIPULATION

) )

Judge: Hon. Kendall J. Newman

) )

Complaint Filed: July 31, 2018

)

)

)

)

)

22

23

24

25

26

27

28

1

Stipulation re: Monitoring

Case 2:18-cv-02081-TLN-KJN Document 118 Filed 04/27/20 Page 2 of 3

1

The Consent Decree in this matter, approved by the Court on January 13, 2020,

2 calls for specific intervals in which the parties and the Court’s appointed experts will

3 report on the County of Sacramento’s compliance with the Consent Decree. Doc. No.

4 110. In particular, the Court Experts are required by the terms of the Consent Decree

5 to produce reports advising the Court and the parties on Defendant’s compliance with

6 each provision relating to the mental health, medical, and suicide prevention

7 components of the Remedial Plan. Id., ¶ 15. The Consent Decree provides that the 8 first such expert report be filed within 180 days of the entry of the Decree. Id. 9 Similarly, Defendant is required to produce a status report on its progress toward

10 compliance with the Consent Decree no sooner than 120 days and no later than 180

11 days after entry of the Consent Decree. Id., ¶ 12. Plaintiffs’ counsel is entitled to 12 monitor the facilities three times per year, and is charged with monitoring and

13 reporting on Defendant’s compliance with the components of the Remedial Plan

14 pertaining to restrictive housing, ADA/disability, and discipline and use of force for

15 people with mental health and intellectual disabilities. Id., ¶¶ 23-24.

16

In the past two months, the COVID-19 pandemic has disrupted operations in

17 the Sacramento County Jails. For the safety of Jail staff and the incarcerated

18 population, the parties have agreed to postpone all scheduled site visits by the Court

19 Experts and Plaintiffs’ counsel. The parties have further agreed to seek the Court’s

20 leave to extend the deadlines for the 180-Day Reports by the Court Experts.

21

It is not clear when it will be safe for the Court Experts’ and Plaintiffs’

22 counsel’s on-site monitoring to resume. Consequently, in lieu of seeking a specific

23 deadline for the submission of the 180-Day Reports, the parties request leave to file a

24 status report on or before June 24, 2020 providing further information to the Court

25 about the status of their monitoring and proposing a modification to deadlines

26 described in the Consent Decree.

27

The parties acknowledge that while it is necessary to delay on-site monitoring

28

2

Case 2:18-cv-02081-TLN-KJN Document 118 Filed 04/27/20 Page 3 of 3

1 activity for some period of time, compliance with the provisions of the Remedial Plan

2 in the Consent Decree has not been reached. Defendant has not demonstrated

3 compliance with the terms of the Remedial Plan, including in the areas of medical

4 care, mental health care, suicide prevention, the use of restrictive housing, disciplinary

5 measures/use of force, and compliance with disability law. The parties continue to

6 work collaboratively to review and revise the jail’s operational policies to ensure that

7 they reflect the requirements of the Remedial Plan. However, substantial and

8 sustained effort and resources will be required to bring Defendant into compliance

9 with the Remedial Plan.

10

Defendant agrees that other aspects of monitoring and Remedial Plan

11 implementation described in the Remedial Plan can and should continue. Defendant

12 will continue to produce requested data and information consistent with the Consent

13 Decree, to allow for monitoring to proceed in a manner consistent with precautions

14 necessary during the current public health emergency. Defendant further agrees to

15 continue to provide requested data and information to, and confer regularly with,

16 Plaintiffs’ counsel regarding Defendant’s response to the COVID-19 pandemic as it

17 relates to the health, safety, and rights of Mays class members.

18

IT IS SO STIPULATED.

19

20 Dated: April 27, 2020

21

22
23 Dated: April 27, 2020

24

25
26 Dated: April 27, 2020

27

/s/ MMaarrggoott MMeennddeellssoonn (SBN 268583) PRISON LAW OFFICE Attorney for Plaintiffs
/s/ AAaarroonn FJ.isFcihscehrer (SBN 247391) DISABILITY RIGHTS CALIFORNIA Attorney for Plaintiffs
/s/ RRiicckkHJ.eHyeeryer (SBN 216150) Attorney for Defendants

28

3

Case 2:18-cv-02081-TLN-KJN Document 118-1 Filed 04/27/20 Page 1 of 2

1

Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org

2

Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org

3

DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500

4

Oakland, CA 94612 Telephone: (510) 267-1200

5 Fax: (510) 267-1201

6 Attorneys for Plaintiffs

7

8

Donald Specter (SBN 83925) dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) sophieh@prisonlaw.coom PRISON LAW OFFICE 1917 Fifth Street Berkeley, California 94710 Telephone: (510) 280-2621 Fax: (510) 280-2704 Attorneys for Plaintiffs

9

UNITED STATES DISTRICT COURT

10

EASTERN DISTRICT OF CALIFORNIA

11

SACRAMENTO DIVISION

12

13 LORENZO MAYS, RICKY

14

RICHARDSON, JENNIFER BOTHUN, ARMANI LEE, and

15

LEERTESE BEIRGE on behalf of themselves and all others similarly

16 situated,

17

Plaintiffs,

18

v.

19 COUNTY OF SACRAMENTO,

20

Defendant.

21

22

) )

Case No. 2:18-cv-02081 TLN KJN

) )

CLASS ACTION

) )

[PROPOSED] ORDER

) )

Judge: Hon. Kendall J. Newman

) )

Complaint Filed: July 31, 2018

)

)

)

)

)

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25

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27 28

1

[PROPOSED] ORDER

Case 2:18-cv-02081-TLN-KJN Document 118-1 Filed 04/27/20 Page 2 of 2

1

Having considered the parties’ stipulation and good cause appearing, it is

2 hereby ordered that:

3

(1) The deadline for the Court Experts’ first compliance reports, set forth in the

4 Consent Decree in this matter (Doc. No. 110), is extended in light of the COVID-19

5 pandemic.

6

(2) The parties shall file a status report on or before June 24, 2020 providing

7 further information to the Court about the status of monitoring compliance with the

8 Consent Decree and proposing a modification to the reporting deadlines.

9

10

IT IS SO ORDERED.

11
12 Dated: ___________
13 14

__________________________________ Hon. Kendall J. Newman UNITED STATES MAGISTRATE JUDGE

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20

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2

[PROPOSED] ORDER

 
 Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 1 of 10

1 Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201
6 Donald Specter (SBN 83925) dspecter@prisonlaw.com
7 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
8 Sophie Hart (SBN 321663) sophieh@prisonlaw.coom
9 PRISON LAW OFFICE 1917 Fifth Street
10 Berkeley, California 94710 Telephone: (510) 280-2621
11 Fax: (510) 280-2704

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

12 Attorneys for Plaintiffs

13

14

UNITED STATES DISTRICT COURT

15

EASTERN DISTRICT OF CALIFORNIA

16

SACRAMENTO DIVISION

17

LORENZO MAYS, RICKY

)

18 RICHARDSON, JENNIFER BOTHUN, )

ARMANI LEE, LEERTESE BEIRGE, and )

19 CODY GARLAND, on behalf of themselves )

and all others similarly situated,

)

20

)

Plaintiffs,

)

21

)

v.

)

22

)

COUNTY OF SACRAMENTO,

)

23

)

Defendant.

)

24

)

)

25

)

Case No. 2:18-cv-02081 TLN KJN
CLASS ACTION
JOINT MOTION FOR FINAL APPROVAL OF CLASS ACTION SETTLEMENT
Date: December 6, 2019 Time: 11:00 a.m. Judge: Hon. Kendall J. Newman

26

27

28
JOINT MOTION FOR FINAL APPROVAL OF CLASS ACTION SETTLEMENT CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 2 of 10

1

INTRODUCTION

2

In June 2019, after engaging in extensive settlement negotiations, the parties entered into a

3 Consent Decree to settle class claims for injunctive relief in this suit concerning conditions in the

4 Sacramento County Jails (“Jails”). The Court granted preliminary approval of the Consent Decree

5 on August 13, 2019. Doc. No. 88. Plaintiffs and Defendant, by and through their counsel, now

6 respond to class member comments about the settlement and request final approval of the Consent

7 Decree. If the Court grants final approval, the Consent Decree will resolve all class claims in the

8 case.

9

The Court should grant final approval of the Consent Decree because, as the Court has

10 already ruled, “the proposed settlement is the product of arms-length, serious, informed, and non-

11 collusive negotiations between experienced and knowledgeable counsel who have actively

12 prosecuted and defended this litigation.” Order Granting Prelim. Approval of Consent Decree and

13 Class Notice at 2, Doc. No. 88. Further, the Consent Decree adequately addresses the class claims

14 for injunctive relief. It includes a detailed 62-page Remedial Plan addressing medical and mental

15 health care, suicide prevention, disability accommodations, restrictive housing, and mental health

16 input into the Jails’ disciplinary and use of force practices. See Consent Decree, Doc. No. 85, Ex. 1.

17 The Remedial Plan requires Defendant to remedy the deficiencies alleged in the class action

18 complaint. See Complaint, Doc. No. 1.

19

The Court has received four letters commenting on the proposed settlement. The comments

20 support the need to settle this case and provide timely relief to address the conditions of confinement

21 in Defendant’s Jails. None of these comments show that the Consent Decree is not the product of

22 good-faith negotiations conducted at arm’s length.

23

There is also no evidence that the Consent Decree will fail to achieve the primary objectives

24 of the class claims for injunctive relief — constitutionally adequate medical and mental health care,

25 adequate measures for suicide prevention, provision of access and reasonable accommodations for

26 people with disabilities, limits to the use of solitary confinement, and expanded mental health input

27 into the Jails’ disciplinary and use of force practices. Moreover, Plaintiffs’ counsel will vigorously

28

JOINT MOTION FOR FINAL APPROVAL

1

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 3 of 10

1 enforce the terms of the Consent Decree. The Court should therefore grant final approval of the

2 settlement.

3

BACKGROUND

4

As explained in the Motion for Preliminary Approval of Consent Decree, Plaintiffs are

5 people who are or have been incarcerated in the Sacramento County Jails representing a class of

6 “[a]ll people who are now, or in the future will be, incarcerated in the Sacramento County jails” and

7 a subclass of “[a]ll qualified individuals with disabilities, as that term is defined in 42 U.S.C. §

8 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m), who are, or will

9 be in the future, incarcerated in the Sacramento County jails.” Order Certifying Action as Class

10 Action, filed December 28, 2018, Doc. No. 49, at 2. Defendant is the County of Sacramento, which

11 is responsible for the operation of the Jails.

12

In 2015, Disability Rights California (DRC), the protection and advocacy system for the

13 State of California charged under federal and state law to protect the rights of people with

14 disabilities, issued a public report on conditions in Jails regarding findings of policies, practices, and

15 conditions that harm people incarcerated in the Jails, in particular those with serious mental illness,

16 medical conditions, and physical, sensory, and mental health disabilities. The Prison Law Office

17 (PLO), serving as DRC’s authorized agent, participated in the investigation.

18

In January 2016, DRC, PLO, and the County of Sacramento entered into a Structured

19 Negotiations Agreement as an alternative to imminent litigation. The parties agreed to utilize joint

20 neutral experts to inspect the Jails and issue reports and recommendations. The five experts were:

21 Bruce Gage, M.D. (mental health care), Lindsay M. Hayes, M.S. (suicide prevention), Eldon Vail

22 (custody and solitary confinement), Sabot Consulting (disability discrimination), and James Austin,

23 Ph.D. (classification). Plaintiffs’ counsel, with the assistance of a correctional medical care expert,

24 inspected the facilities and reviewed documents related to medical care, which formed the basis of

25 the medical care component of the remedial plan.

26

This action was filed on July 31, 2018. Doc. No. 1. The complaint alleged that conditions in

27 the Jails violated the constitutional rights of people in the jail, under the Eighth and Fourteenth

28

JOINT MOTION FOR FINAL APPROVAL

2

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 4 of 10

1 Amendments to the United States Constitution. Specifically, Plaintiffs alleged that the County does

2 not provide people in the jails with access to adequate medical or mental health care; imposes the

3 harmful and excessive use of solitary confinement; fails to implement adequate or appropriate

4 measures to prevent suicide; fails to adequately account for people’s mental health needs and

5 disabilities in the disciplinary process and when using force; and discriminates against people with

6 disabilities in violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation

7 Act.

8

On October 2, 2018, Defendant filed its answer to the complaint, denying the material

9 allegations and asserting affirmative defenses. Doc. No. 24. The parties filed a Joint Motion for

10 Class Certification (Doc. No. 28), which was granted on December 28, 2018 (Doc. No. 49).

11

The parties then engaged in limited discovery. On February 12, 2019, Plaintiffs filed a

12 motion for Partial Summary Judgment or in the Alternative Preliminary Injunction regarding access

13 to mental health care and the use of solitary confinement in the Jails. Doc. No. 62. While the

14 motion was pending, the parties continued to negotiate the terms of a proposed Consent Decree,

15 which incorporates the Remedial Plan. The Board of Supervisors approved the Consent Decree on

16 June 4, 2019. Plaintiffs subsequently withdrew their motion. Doc. No. 82.

17

On August 13, 2019, the Court granted the parties’ joint motion seeking preliminary approval

18 of the Consent Decree and found that “the proposed settlement is the product of arms-length,

19 serious, informed, and non-collusive negotiations between experienced and knowledgeable counsel

20 who have actively prosecuted and defended this litigation.” Order Granting Prelim. Approval of

21 Consent Decree and Class Notice at 2, Doc. No. 88. The Court directed Defendant “to post the

22 Notice in English and Spanish in all housing units in such a manner as to make the notice visible to

23 all people incarcerated in the Jails.” Id. at 2. The Court set a hearing regarding final approval of the

24 Consent Decree for December 5, 2019, id. at 3, and later continued the hearing to December 6, 2019.

25 Doc No. 101.

26

On September 6, 2019, Lieutenant Alex McCamy filed a declaration affirming the

27 Defendant’s compliance with the Court’s August 13, 2019 order. See Doc. No. 91. The Class

28 Notice described the key terms of the settlement and the proposed agreement regarding attorneys’

JOINT MOTION FOR FINAL APPROVAL

3

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 5 of 10

1 fees and advised class members that the Court would consider written comments when deciding

2 whether to approve the settlement. See Doc. No. 90, Ex. A. Defendant also established a process to

3 provide copies of the full Consent Decree, the Remedial Plan, and Plaintiffs’ Unopposed Motion for

4 Attorneys’ Fees and Expenses to people in the jail who requested them.

5

To date, four letters have been filed with the Court. See Doc. Nos. 96-98, 100. One is from a

6 non-class member. Doc. No. 100. Each letter is addressed below.

7

SUMMARY OF KEY PROPOSED SETTLEMENT TERMS

8

The following are some of the key terms of the Consent Decree:

9

1. Utilizing the reports of the joint experts, the subject matter knowledge of class

10 counsel and Jail services leadership, and the extensive information and input gathered by class

11 counsel from class members, the parties have agreed on a detailed Remedial Plan that Defendant will

12 be required to implement. The Remedial Plan provisions cover all the substantive areas in dispute:

13 medical care, mental health care, suicide prevention, the use of solitary confinement, discrimination

14 against people with disabilities, and mental health input into disciplinary and use of force practices.

15 The Remedial Plan is attached to the Consent Decree as Exhibit A. Doc. No. 85-1. Among many

16 other provisions, the Remedial Plan requires the County to: (a) expand its programs and services to

17 meet the treatment needs of people with mental health needs, (b) provide constitutionally adequate

18 medical care, (c) implement appropriate suicide prevention policies and procedures, (d) identify

19 people with disabilities and ensure that they receive reasonable accommodations and can access

20 programs and services in the Jails, (e) limit the use and duration of solitary confinement, including

21 by curbing the placement of people with serious mental illness in solitary confinement; and (f)

22 expand mental health input into the Jails’ disciplinary and use of force practices.

23

2. The parties have implemented a process, set forth in the Consent Decree, to select

24 joint neutral experts, to be appointed by the court to monitor implementation of and compliance with

25 the Remedial Plan and to assist in dispute resolution. The experts will complete comprehensive

26 reviews of Defendant’s progress and will have reasonable access to all parts of the Jails, including

27 confidential, voluntary interviews with any staff and class members, and documents on request.

28

JOINT MOTION FOR FINAL APPROVAL

4

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 6 of 10

1

3. Prison Law Office and Disability Rights California, as Plaintiffs’ counsel, also will

2 monitor compliance with the Consent Decree and the Remedial Plan. Plaintiffs’ counsel will be able

3 to inspect the Jails up to three times per year and have reasonable access to relevant information,

4 including documents as well as interviews with staff and class members.

5

4. In the event of a dispute, the parties have agreed on a dispute resolution process,

6 including involvement of the experts and a mediator as appropriate. The Court will retain

7 jurisdiction to address motions to enforce compliance should the dispute resolution process fail.

8

5. The County has agreed to pay Plaintiffs’ counsel $2,100,000 for merits fees and

9 expenses and $250,000 per year for monitoring fees and expenses. See Pls.’ Notice of Motion and

10 Unopposed Motion for Attorneys’ Fees and Expenses, Doc. No. 92.

11

ANALYSIS

12

A. The settlement is fair, reasonable, and adequate.

13

The Ninth Circuit maintains a “strong judicial policy” that favors the settlement of class

14 actions. In re Syncor ERISA Litig., 516 F.3d 1095, 1101 (9th Cir. 2008); Class Plaintiffs v. City of

15 Seattle, 955 F.2d 1268, 1276 (9th Cir. 1992). Courts must give “proper deference to the private

16 consensual decision of the parties.” Hanlon v. Chrysler Corp., 150 F.3d 1011, 1027 (9th Cir. 1998).

17 “[S]ettlement [is] the preferred means of dispute resolution” and that “is especially true in complex

18 class action litigation.” Officers for Justice v. Civil Serv. Comm’n, 688 F.2d 615, 625 (9th Cir.

19 1982).

20

In reviewing a proposed class action settlement agreement, there is an initial presumption of

21 fairness when a proposed class settlement was negotiated at arm’s length by counsel for the class.

22 Harris v. Vector Mktg. Corp., No. C-08–5198 EMC, 2011 WL 1627973, at *8 (N.D. Cal. Apr. 29,

23 2011). “Although Rule 23 imposes strict procedural requirements on the approval of a class

24 settlement, a district court’s only role in reviewing the substance of that settlement is to ensure that it

25 is ‘fair, adequate, and free from collusion.’” Lane v. Facebook, Inc., 696 F.3d 811, 819 (9th Cir.

26 2012) (citation omitted).

27

Other factors courts consider in assessing a proposed class settlement include: “[1] the

28 strength of the plaintiffs’ case; [2] the risk, expense, complexity, and likely duration of further

JOINT MOTION FOR FINAL APPROVAL

5

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 7 of 10

1 litigation; [3] the risk of maintaining class action status throughout the trial; [4] the amount offered

2 in settlement; [5] the extent of discovery completed and the stage of the proceedings; [6] the

3 experience and views of counsel; [7] the presence of a governmental participant; and [8] the reaction

4 of the class members to the proposed settlement.” Hanlon, 150 F.3d at 1026; see also In re Oracle

5 Sec. Litig., 829 F. Supp. 1176, 1179 (N.D. Cal. 1993). The district court must explore these factors

6 comprehensively to satisfy appellate review, but “the decision to approve or reject a settlement is

7 committed to the sound discretion of the trial judge.” Hanlon, 150 F.3d at 1026.

8

“[T]he court’s intrusion upon what is otherwise a private consensual agreement negotiated

9 between the parties to a lawsuit must be limited to the extent necessary to reach a reasoned judgment

10 that the agreement is not the product of fraud or overreaching by, or collusion between, the

11 negotiating parties, and that the settlement, taken as a whole, is fair, reasonable and adequate to all

12 concerned.” Hanlon, 150 F.3d at 1027 (citing Officers for Justice, 688 F.2d at 625). Thus, a district

13 court’s decision to approve a class-action settlement may be reversed “only upon a strong showing

14 that the district court’s decision was a clear abuse of discretion.” Id. (citation omitted).

15

Here, the Court already found that the settlement is “the product of arms-length, serious,

16 informed, and non-collusive negotiations between experienced and knowledgeable counsel who

17 have actively prosecuted and defended this litigation.” Order Granting Prelim. Approval of Consent

18 Decree and Class Notice at 2, Doc. No. 88. Thus, the Consent Decree is entitled to a presumption of

19 fairness. Harris, 2011 WL 1627973, at *8.

20

The Court should grant final approval of the Consent Decree because it provides substantial

21 equitable relief to class members. Defendant has agreed to settlement terms that directly address the

22 class claims in this case, including the delivery of minimally adequate medical and mental health

23 care, implementation of adequate suicide prevention measures, reforms to the identification of and

24 provision of reasonable accommodations and access for people with disabilities, substantial

25 limitations to the use of solitary confinement, and expanded mental health input into the Jails’

26 disciplinary and use of force practices. See Remedial Plan, Doc. No. 85-1, Ex. A. The settlement

27 was reached after several years of negotiations between the parties, who were zealously represented

28 by their experienced counsel throughout this litigation. See Decl. of Aaron Fischer in Supp. of Pls.’

JOINT MOTION FOR FINAL APPROVAL

6

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 8 of 10

1 Unopposed Mot. for Attorneys’ Fees and Expenses ¶¶ 2-7, Doc. No. 93; Decl. of Donald Specter in

2 Supp. of Pls.’ Unopposed Mot. for Attorneys’ Fees and Expenses ¶¶ 2–5, Doc. No. 94; Decl. of

3 Jessica Valenzuela Santamaria in Supp. of Pls.’ Unopposed Mot. for Attorneys’ Fees and Expenses ¶

4 2, Doc. No. 95. The settlement was also reached after neutral experts inspected Defendant’s jails

5 and opined on the adequacy of medical and mental health care, classification and solitary

6 confinement practices, suicide prevention, and compliance with federal and state disability law.

7

Further, the outcome of the litigation and the extent of any relief that the class might be

8 awarded if the case went to trial is uncertain. Plaintiffs faced substantial burdens in demonstrating a

9 current and ongoing violation of individuals’ constitutional rights on a system-wide basis.

10 Proceeding through pre-trial motions, trial, and probable appeal would impose risks, costs, and a

11 substantial delay in the implementation of any remedy in this matter. Given the relief achieved and

12 the risks and costs involved in further litigation, the Consent Decree represents a fundamentally

13 “fair, reasonable, and adequate” resolution of the disputed issues and should be given final approval.

14 See Fed. R. Civ. Pro. 23(e)(2).

15

B. None of the comments refute the presumption that the settlement is fair,

reasonable, and adequate.

16

Four letters were submitted to the Court. Doc. Nos. 96-98, 100. Most letters did not provide

17 substantive comments on the terms of the Consent Decree or Remedial Plan. Two of the letters

18 described concerns with the health care and disability accommodations in the Jails and requested

19 individual damages. Doc. Nos. 96, 97. One letter described concerns about the delivery of health

20 care in the Jails and requested that the Court impose fines on the Defendant to induce compliance.

21 Doc. No. 98. The fourth letter, which came from a non-class member,1 raised concerns about

22 solitary confinement practices and inadequate suicide prevention measures in the Jails. Doc. No.

23 100. The letter also objected to a provision of the Consent Decree limiting the reliance on the

24 Consent Decree in other cases or claims. Id. at 4.

25

None of these letters provides any basis for rejecting the settlement. The letters that reported

26 problems with conditions at the jails underscore the need for the agreed-upon remedy in this case. In

27 1 The objector states that he was incarcerated in the Sacramento County Jail from September 2015
28 through May 2017, before the class was certified in December 2018 (see Doc No. 49).

JOINT MOTION FOR FINAL APPROVAL

7

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 9 of 10

1 addition, the letters requesting damages to be paid to class members should not prevent approval of

2 the settlement here: the class and disability subclass sought only declaratory and injunctive relief

3 pursuant to Federal Rule of Civil Procedure 23(b)(2), and the settlement does not bar class members

4 from pursuing individual damage claims. See Hiser v. Franklin, 94 F.3d 1287, 1291 (9th Cir. 1996)

5 (“[T]he general rule is that a class action suit seeking only declaratory and injunctive relief does not

6 bar subsequent individual damage claims by class members, even if based on the same events.”).

7 With respect to the concerns about the provision of the Consent Decree that limits its use in other

8 claims or proceedings, nothing limits any litigant from accessing or referencing the policies and

9 procedures adopted by the County in connection with or in response to the Consent Decree, or the

10 evidence submitted in support of Plaintiffs’ claims.

11

In sum, the settlement here is fair, reasonable, and adequate and this Court should approve it.

12

C. Plaintiffs’ Unopposed Motion for Attorneys’ Fees and Expenses Should Be

Granted.

13

Defendant has agreed to pay Plaintiffs’ attorneys’ fees and out of pocket expenses in the

14 amount of $2,100,000. This amount — which reimburses Plaintiffs’ counsel for some but not all of

15 their actual hours spent and out-of-pocket expenses — is fair and reasonable in light of the

16 extraordinary results obtained through this litigation, the lengthy and detailed settlement

17 negotiations, and the difficulty and complexity of the issues involved. There have been no

18 objections from class members to the proposed attorneys’ fees and expenses. Accordingly, the Court

19 should grant Plaintiffs’ pending Unopposed Motion for Attorneys’ Fees and Expenses, Doc. No. 92,

20 pursuant to Federal Rule of Civil Procedures 23(h).

21 CONCLUSION

22

As the Court has already ruled, the Consent Decree is the product of arm’s length, serious,

23 informed, and non-collusive negotiations between experienced and knowledgeable counsel who

24 have actively prosecuted and defended this litigation. Thus, it is entitled to a presumption of

25 fairness. Further, the comments by class members do not demonstrate that the Consent Decree does

26 not fairly, reasonably, and adequately resolve the class’s or disability subclass’s claims for injunctive

27 relief. Accordingly, the parties request that the Court grant final approval of the Consent Decree and

28

JOINT MOTION FOR FINAL APPROVAL

8

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102 Filed 11/12/19 Page 10 of 10

1 grant Plaintiffs’ pending Unopposed Motion for Attorneys’ Fees. A proposed order on final

2 approval of the class action settlement is filed herewith. The proposed order on Plaintiffs’

3 unopposed motion for attorneys’ fees was previously filed. Doc. 92-1.

4 5 Dated: November 12, 2019
6
7 Dated: November 12, 2019
8
9
10 Dated: November 12, 2019
11
12
13

Margot Mendelson___________ Margot K. Mendelson (SBN 268583) PRISON LAW OFFICE Attorney for Plaintiffs
Aaron Fischer (as authorized 11/12/19) Aaron J. Fischer (SBN 247391) DISABILITY RIGHTS CALIFORNIA Attorney for Plaintiffs
Jessica Valenzuela Santamaria (as authorized 11/11/19) Jessica Valenzuela Santamaria (SBN 220934) COOLEY LLP Attorney for Plaintiffs

14 Dated: November 12, 2019 15 16

Todd Master (as authorized 11/12/19) Todd H. Master (SBN 185881) HOWARD ROME MARTIN & RIDLEY Attorney for Defendant

17

18

19

20

21

22

23

24

25

26

27

28

JOINT MOTION FOR FINAL APPROVAL

9

OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102-1 Filed 11/12/19 Page 1 of 4

1 Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201
6 Donald Specter (SBN 83925) dspecter@prisonlaw.com
7 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
8 Sophie Hart (SBN 321663) sophieh@prisonlaw.coom
9 PRISON LAW OFFICE 1917 Fifth Street
10 Berkeley, California 94710 Telephone: (510) 280-2621
11 Fax: (510) 280-2704

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

12 Attorneys for Plaintiffs

13

14

UNITED STATES DISTRICT COURT

15

EASTERN DISTRICT OF CALIFORNIA

16

SACRAMENTO DIVISION

17

LORENZO MAYS, RICKY

)

18 RICHARDSON, JENNIFER BOTHUN, )

ARMANI LEE, LEERTESE BEIRGE, and )

19 CODY GARLAND, on behalf of themselves )

and all others similarly situated,

)

20

)

Plaintiffs,

)

21

)

v.

)

22

)

COUNTY OF SACRAMENTO,

)

23

)

Defendant.

)

24

)

)

25

)

)

26

)

Case No. 2:18-cv-02081 TLN KJN
CLASS ACTION
[Proposed] Order Granting Final Approval of Class Action Settlement
Date: December 6, 2019 Time: 11:00 a.m. Judge: Hon. Kendall J. Newman

27

28
[PROPOSED] ORDER GRANTING FINAL APPROVAL OF CLASS ACTION SETTLEMENT
CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102-1 Filed 11/12/19 Page 2 of 4

1

On November 12, 2019, Plaintiffs and Defendant County of Sacramento (“Defendant”) filed

2 a Joint Motion for Final Approval of Class Action Settlement. The matter came before the Court for

3 a hearing on December 6, 2019. Having considered the briefing in support of the motion, responses

4 from class members, relevant legal authority, and the record in this case, the Court GRANTS the

5 motion.

6

1. Under Federal Rule of Civil Procedure 23(e), “claims, issues, or defenses of a

7 certiﬁed class may be settled . . . only with the court’s approval.” The Ninth Circuit has instructed

8 district courts to consider and balance multiple factors when assessing whether a settlement is “fair,

9 adequate, and free from collusion” under Rule 23(e). See Hanlon v. Chrysler Corp., 150 F.3d 1011,

10 1027 (9th Cir. 1998). These factors include:

11

the strength of the plaintiffs’ case; the risk, expense, complexity, and likely duration of

12

further litigation; the risk of maintaining class action status throughout the trial; the

amount offered in settlement; the extent of discovery completed and the stage of the

13

proceedings; the experience and views of counsel; the presence of a governmental

participant; and the reaction of the class members to the proposed settlement. 14

15 Id. at 1026. “This list is not exclusive and different factors may predominate in different factual

16 contexts.” Torrisi v. Tucson Elec. Power Co., 8 F.3d 1370, 1376 (9th Cir. 1993).

17

2. The Court finds that consideration of the factors favors settlement, and that the

18 settlement is fair, reasonable, and adequate.

19

a. Strength of Plaintiffs’ Case and the Risk, Expense, and Complexity of Further

20 Litigation: The Plaintiffs’ case is strong, as shown by the evidence that has been submitted and the

21 serious ongoing settlement discussions that began even before the complaint was filed. However,

22 Plaintiffs face substantial burdens in demonstrating a current and ongoing violation of individuals’

23 constitutional rights on a system-wide basis. Proceeding through pre-trial motions, trial, and

24 possible appeal would impose risks, costs, and a substantial delay in the implementation of any

25 remedy in this matter.

26

b. Risk of Maintaining a Class Action Status Through Trial: Plaintiffs face little

27 or no risk of maintaining class action status throughout the trial. The Court approved the parties’

28

[PROPOSED] ORDER GRANTING FINAL

1.

APPROVAL OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102-1 Filed 11/12/19 Page 3 of 4

1 joint application for class action status on December 28, 2018, Doc. No. 49, and it is unlikely that

2 Defendant would contest class certification if the Court rejects the proposed Consent Decree. See

3 Fed. R. Civ. P. 23(c)(1)(C) (allowing court to revisit certification before final judgment).

4

c. Extent of Discovery Taken in the Case: Settlement discussions began even

5 before the filing of this case, and were informed by considerable information-sharing as well as the

6 investigation conducted through class counsel Disability Rights California’s statutory access

7 authority. The parties also engaged in targeted discovery after the case was filed. Throughout,

8 Plaintiffs’ counsel had access to the jails, personnel who worked there, and people incarcerated

9 there. The settlement also was informed by the opinions of five neutral experts who had access to

10 the jails.

11

d. Experience and Views of Counsel: Plaintiffs’ counsel has extensive experience

12 in prisoners’ rights litigation and complex class action litigation and believe that the settlement here

13 is in the best interest of all plaintiffs. Defendant is represented by counsel who similarly is

14 experienced and knowledgeable in this type of litigation. The Court has already found that

15 “experienced and knowledgeable counsel . . . have actively prosecuted and defended this litigation.”

16 Doc. No. 88 at 2.

17

e. Reaction of the Class Members to the Settlement: The reaction of class

18 members to the settlement further supports final approval. Defendant complied with the Court’s

19 order regarding the provision of notice to the class. Doc. No. 91. Class members were afforded an

20 opportunity to comment or object to the settlement, and this Court held a hearing on the matter.

21 Though approximately 3,700 individuals are incarcerated at Defendant’s jails, the Court received

22 only four letters about the settlement, including one from a non-class member. See Doc. Nos. 96-98,

23 100. The letters detailed individual experiences with the deficiencies for which Plaintiffs seek a

24 remedy in this case; these letters weigh in favor of approving the Consent Decree.

25

The Court is satisfied that the concerns in the comments are adequately addressed by

26 the Consent Decree. The Court also notes that the settlement will not bar individual damage claims

27 by class members. See Hiser v. Franklin, 94 F.3d 1287, 1291 (9th Cir. 1996) (“[T]he general rule is

28 that a class action suit seeking only declaratory and injunctive relief does not bar subsequent

[PROPOSED] ORDER GRANTING FINAL

2

APPROVAL OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

Case 2:18-cv-02081-TLN-KJN Document 102-1 Filed 11/12/19 Page 4 of 4

1 individual damage claims by class members, even if based on the same events.”). Overall, the

2 reaction to the Consent Decree therefore weighs in favor of approval.

3

f. Whether the Settlement Appears Non-Collusive: As this Court has previously

4 found, “the proposed settlement is the product of arms-length, serious, informed, non-collusive,

5 negotiations.” Doc No. 88 at 2. The parties have presented no reason for the Court to reconsider

6 this previous finding. Accordingly, this factor weighs in favor of approval.

7

3. The Court further finds that the Consent Decree meets the requirements of the Prison

8 Litigation Reform Act at 18 U.S.C. § 3626(a). In so doing, the Court finds that the relief contained

9 therein is narrowly drawn, extends no further than necessary to ensure the protection of the federal

10 constitutional and statutory rights of Plaintiffs, and is the least intrusive means necessary to

11 accomplish those objectives.

12

Accordingly, the Court hereby GRANTS the Joint Motion for Final Approval of the Class

13 Action Settlement. The Court therefore approves and adopts the Consent Decree as the Order of the

14 Court, orders the parties to comply with all its terms, and orders Defendant to implement the

15 Remedial Plan and accompanying policies pursuant to the schedule set forth therein.

16

17 IT IS SO ORDERED.

18 Dated: December __, 2019 19
20

_____________________________________ The Honorable Kendall J. Newman United States Magistrate Judge

21

22

23

24

25

26

27

28

[PROPOSED] ORDER GRANTING FINAL

3

APPROVAL OF CLASS ACTION SETTLEMENT

CASE NO.: 2:18-cv-02081 TLN KJN

 
 Case 2:18-cv-02081-TLN-KJN Document 104 Filed 12/09/19 Page 1 of 5

1 Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201
6 Donald Specter (SBN 83925) dspecter@prisonlaw.com
7 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
8 Sophie Hart (SBN 321663) sophieh@prisonlaw.coom
9 PRISON LAW OFFICE 1917 Fifth Street
10 Berkeley, California 94710 Telephone: (510) 280-2621
11 Fax: (510) 280-2704

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

12 Attorneys for Plaintiffs

13

14

UNITED STATES DISTRICT COURT

15

EASTERN DISTRICT OF CALIFORNIA

16

SACRAMENTO DIVISION

17

LORENZO MAYS, RICKY

)

18 RICHARDSON, JENNIFER BOTHUN, )

ARMANI LEE, LEERTESE BEIRGE, and )

19 CODY GARLAND, on behalf of themselves )

and all others similarly situated,

)

20

)

Plaintiffs,

)

21

)

v.

)

22

)

COUNTY OF SACRAMENTO,

)

23

)

Defendant.

)

24

)

)

25

)

)

26

)

Case No. 2:18-cv-02081 TLN KJN
CLASS ACTION
Findings and Recommendations
Recommending Final Approval of Class Action Settlement be Adopted
Date: December 6, 2019 Time: 11:00 a.m. Judge: Hon. Kendall J. Newman

27

28

Case 2:18-cv-02081-TLN-KJN Document 104 Filed 12/09/19 Page 2 of 5

1

On November 12, 2019, Plaintiffs and Defendant County of Sacramento (“Defendant”) filed

2 a Joint Motion for Final Approval of Class Action Settlement. The matter came before the Court for

3 a hearing on December 6, 2019. Having considered the briefing in support of the motion, responses

4 from class members, relevant legal authority, and the record in this case, the Court GRANTS the

5 motion.

6

1. Under Federal Rule of Civil Procedure 23(e), “claims, issues, or defenses of a

7 certiﬁed class may be settled . . . only with the court’s approval.” The Ninth Circuit has instructed

8 district courts to consider and balance multiple factors when assessing whether a settlement is “fair,

9 adequate, and free from collusion” under Rule 23(e). See Hanlon v. Chrysler Corp., 150 F.3d 1011,

10 1027 (9th Cir. 1998). These factors include:

11

the strength of the plaintiffs’ case; the risk, expense, complexity, and likely duration of

12

further litigation; the risk of maintaining class action status throughout the trial; the

amount offered in settlement; the extent of discovery completed and the stage of the

13

proceedings; the experience and views of counsel; the presence of a governmental

participant; and the reaction of the class members to the proposed settlement. 14

15 Id. at 1026. “This list is not exclusive and different factors may predominate in different factual

16 contexts.” Torrisi v. Tucson Elec. Power Co., 8 F.3d 1370, 1376 (9th Cir. 1993).

17

2. The Court finds that consideration of the factors favors settlement, and that the

18 settlement is fair, reasonable, and adequate.

19

a. Strength of Plaintiffs’ Case and the Risk, Expense, and Complexity of Further

20 Litigation: The Plaintiffs’ case is strong, as shown by the evidence that has been submitted and the

21 serious ongoing settlement discussions that began even before the complaint was filed. However,

22 Plaintiffs face substantial burdens in demonstrating a current and ongoing violation of individuals’

23 constitutional rights on a system-wide basis. Proceeding through pre-trial motions, trial, and

24 possible appeal would impose risks, costs, and a substantial delay in the implementation of any

25 remedy in this matter.

26

b. Risk of Maintaining a Class Action Status Through Trial: Plaintiffs face little

27 or no risk of maintaining class action status throughout the trial. The Court approved the parties’

28

Case 2:18-cv-02081-TLN-KJN Document 104 Filed 12/09/19 Page 3 of 5

1 joint application for class action status on December 28, 2018, ECF No. 49, and it is unlikely that

2 Defendant would contest class certification if the Court rejects the proposed Consent Decree. See

3 Fed. R. Civ. P. 23(c)(1)(C) (allowing court to revisit certification before final judgment).

4

c. Extent of Discovery Taken in the Case: Settlement discussions began even

5 before the filing of this case, and were informed by considerable information-sharing as well as the

6 investigation conducted through class counsel Disability Rights California’s statutory access

7 authority. The parties also engaged in targeted discovery after the case was filed. Throughout,

8 Plaintiffs’ counsel had access to the jails, personnel who worked there, and people incarcerated

9 there. The settlement also was informed by the opinions of five neutral experts who had access to

10 the jails.

11

d. Experience and Views of Counsel: Plaintiffs’ counsel has extensive experience

12 in prisoners’ rights litigation and complex class action litigation and believe that the settlement here

13 is in the best interest of all plaintiffs. Defendant is represented by counsel who similarly is

14 experienced and knowledgeable in this type of litigation. The Court has already found that

15 “experienced and knowledgeable counsel . . . have actively prosecuted and defended this litigation.”

16 ECF No. 88 at 2.

17

e. Reaction of the Class Members to the Settlement: The reaction of class

18 members to the settlement further supports final approval. Defendant complied with the Court’s

19 order regarding the provision of notice to the class. ECF No. 91. Class members were afforded an

20 opportunity to comment or object to the settlement, and this Court held a hearing on the matter.

21 Though approximately 3,700 individuals are incarcerated at Defendant’s jails, the Court received

22 only four letters about the settlement, including one from a non-class member. See ECF Nos. 96-98,

23 100. The letters detailed individual experiences with the deficiencies for which Plaintiffs seek a

24 remedy in this case; these letters weigh in favor of approving the Consent Decree.

25

The Court is satisfied that the concerns in the comments are adequately addressed by

26 the Consent Decree. The Court also notes that the settlement will not bar individual damage claims

27 by class members. See Hiser v. Franklin, 94 F.3d 1287, 1291 (9th Cir. 1996) (“[T]he general rule is

28 that a class action suit seeking only declaratory and injunctive relief does not bar subsequent

Case 2:18-cv-02081-TLN-KJN Document 104 Filed 12/09/19 Page 4 of 5

1 individual damage claims by class members, even if based on the same events.”). Overall, the

2 reaction to the Consent Decree therefore weighs in favor of approval.

3

f. Whether the Settlement Appears Non-Collusive: As this Court has previously

4 found, “the proposed settlement is the product of arms-length, serious, informed, non-collusive,

5 negotiations.” Doc No. 88 at 2. The parties have presented no reason for the Court to reconsider

6 this previous finding. Accordingly, this factor weighs in favor of approval.

7

3. The Court further finds that the Consent Decree meets the requirements of the Prison

8 Litigation Reform Act at 18 U.S.C. § 3626(a). In so doing, the Court finds that the relief contained

9 therein is narrowly drawn, extends no further than necessary to ensure the protection of the federal

10 constitutional and statutory rights of Plaintiffs, and is the least intrusive means necessary to

11 accomplish those objectives.

12

Accordingly, IT IS HEREBY RECOMMENDED that the Joint Motion for Final Approval of

13 the Class Action Settlement (ECF No. 102) be GRANTED. The undersigned finds that the Consent

14 Decree should be approved and adopted as the Order of the Court, the parties should be ordered to

15 comply with all its terms, and the Defendant should be ordered to implement the Remedial Plan and

16 accompanying policies pursuant to the schedule set forth therein.

17

These findings and recommendations are submitted to the United States District Judge

18 assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within ten days after being

19 served with these findings and recommendations, any party may file written objections with the

20 court and serve a copy on all parties. Such a document should be captioned “Objections to

21 Magistrate Judge’s Findings and Recommendations.” Any response to the objections shall be filed

22 and served within ten days after service of the objections. The parties are advised that failure to file

23 objections within the specified time may waive the right to appeal the District Court’s order.

24 Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

25 ////

26 ////

27 ////

28 ////

Case 2:18-cv-02081-TLN-KJN Document 104 Filed 12/09/19 Page 5 of 5

1

The parties are advised that if they do not object to these recommendations, each counsel

2 shall file a statement of non-opposition or statement of no objections, to shorten the objection period

3 and facilitate the adjudication of this motion by the district court.

4 Dated: December 9, 2019

5

6

7
/mays2081.fair
8

9

10

11

12

13

14

15

16

17

18

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 Case 2:18-cv-02081-TLN-KJN Document 110 Filed 01/13/20 Page 1 of 2

1

2

3

4

5

6

7

8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

11 LORENZO MAYS, RICKY

No. 2:18-cv-02081-TLN-KJN

RICHARDSON, JENNIFER BOTHUN, 12 ARMANI LEE, LEERTESE BEIRGE, and

[CLASS ACTION]

CODY GARLAND, on behalf of 13 themselves and all others similarly situated, ORDER GRANTING FINAL

14

Plaintiffs,

APPROVAL OF CLASS ACTION SETTLEMENT

15

v.

16 COUNTY OF SACRAMENTO,

17

Defendant.

18

19

Plaintiffs Lorenzo Mays, Ricky Richardson, Jennifer Bothun, Armani Lee, Leertese

20 Beirge, and Cody Garland (collectively, “Plaintiffs”) are state prisoners, proceeding through

21 counsel. The matter was referred to a United States Magistrate Judge pursuant to 28 U.S.C. §

22 636(b)(1)(B) and Local Rule 302.

23

On December 9, 2019, the magistrate judge filed findings and recommendations herein

24 which were served on all parties and which contained notice to all parties that any objections to

25 the findings and recommendations were to be filed within ten days. (ECF No. 104.) On

26 December 19, 2019, the parties filed a joint statement of non-opposition to the findings and

27 recommendations. (ECF No. 109.)

28 /// 1

Case 2:18-cv-02081-TLN-KJN Document 110 Filed 01/13/20 Page 2 of 2

1

Accordingly, the Court presumes that any findings of fact are correct. See Orand v.

2 United States, 602 F.2d 207, 208 (9th Cir. 1979). The magistrate judge’s conclusions of law are

3 reviewed de novo. See Britt v. Simi Valley Unified School Dist., 708 F.2d 452, 454 (9th Cir.

4 1983); see also 28 U.S.C. § 636(b)(1).

5

Having reviewed the file under the applicable legal standards, the Court finds the Findings

6 and Recommendations to be supported by the record and by the magistrate judge’s analysis.

7

Accordingly, IT IS HEREBY ORDERED that:

8

1. The Findings and Recommendations filed December 9, 2019 (ECF No. 104), are

9 adopted in full;

10

2. The Joint Motion for Final Approval of the Class Action Settlement (ECF No. 102) is

11 GRANTED;

12

3. The Consent Decree (ECF No. 85-1) is APPROVED and adopted as the Order of the

13 Court; all parties shall comply with all its terms; Defendant shall implement the Remedial Plan

14 and accompanying policies pursuant to the schedule set forth therein;

15

4. The Clerk of the Court shall separately file and docket the “Final Class Notice” (ECF

16 No. 89-1);

17

5. The Clerk of the Court shall separately file and docket the “Consent Decree” (ECF No.

18 85-1) after striking “proposed” from the title; and

19

6. The Clerk of the Court shall enter judgment and terminate this action.

20

IT IS SO ORDERED.

21 Dated: January 8, 2020

22

23

24 Troy L. Nunley

25

United States District Judge

26

27

28 2

 
 Case 2:18-cv-02081-TLN-KJN Document 111 Filed 01/13/20 Page 1 of 2

1

2

3

4

5

6

7

8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

11 LORENZO MAYS, RICKY

No. 2:18-cv-02081-TLN-KJN

RICHARDSON, JENNIFER BOTHUN, 12 ARMANI LEE, LEERTESE BEIRGE, and

[CLASS ACTION]

CODY GARLAND, on behalf of 13 themselves and all others similarly situated, ORDER GRANTING PLAINTIFFS’

14

Plaintiffs,

UNOPPOSED MOTION FOR ATTORNEYS’ FEES AND

15

v.

EXPENSES

16 COUNTY OF SACRAMENTO,

17

Defendant.

18

19

Plaintiffs Lorenzo Mays, Ricky Richardson, Jennifer Bothun, Armani Lee, Leertese

20 Beirge, and Cody Garland (collectively, “Plaintiffs”) are state prisoners, proceeding through

21 counsel. The matter was referred to a United States Magistrate Judge pursuant to 28 U.S.C. §

22 636(b)(1)(B) and Local Rule 302.

23

On December 9, 2019, the magistrate judge filed findings and recommendations herein

24 which were served on all parties and which contained notice to all parties that any objections to

25 the findings and recommendations were to be filed within ten days. (ECF No. 105.) On

26 December 19, 2019, the parties filed a joint statement of non-opposition to the findings and

27 recommendations. (ECF No. 108.)

28 /// 1

Case 2:18-cv-02081-TLN-KJN Document 111 Filed 01/13/20 Page 2 of 2

1

Accordingly, the Court presumes that any findings of fact are correct. See Orand v.

2 United States, 602 F.2d 207, 208 (9th Cir. 1979). The magistrate judge’s conclusions of law are

3 reviewed de novo. See Britt v. Simi Valley Unified School Dist., 708 F.2d 452, 454 (9th Cir.

4 1983); see also 28 U.S.C. § 636(b)(1).

5

Having reviewed the file under the applicable legal standards, the Court finds the Findings

6 and Recommendations to be supported by the record and by the magistrate judge’s analysis.

7

Accordingly, IT IS HEREBY ORDERED that:

8

1. The Findings and Recommendations filed December 9, 2019 (ECF No. 105), are

9 adopted in full;

10

2. Defendant shall pay Plaintiffs’ counsel $2,100,000.00 for reasonable attorney’s fees,

11 expenses, and costs. Payment shall be made in two installments: (1) the first installment in the

12 amount of $1,050,000.00 by no later than January 31, 2020, and (2) the second installment in the

13 amount of $1,050,000.00 by no later than July 31, 2020; and

14

3. Defendant shall pay Plaintiffs’ counsel reasonable attorneys’ fees and expenses up to

15 $250,000.00 per year for monitoring of implementation of the Consent Decree and Remedial

16 Plan.

17

IT IS SO ORDERED.

18 Dated: January 8, 2020

19

20

21 Troy L. Nunley

22

United States District Judge

23

24

25

26

27

28 2

 
 Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 1 of 6

1 Aaron J. Fischer (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 Anne Hadreas (SBN 253377) anne.hadreas@disabilityrightsca.org
3 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
4 Oakland, CA 94612 Telephone: (510) 267-1200
5 Fax: (510) 267-1201
6 Donald Specter (SBN 83925) dspecter@prisonlaw.com
7 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
8 Sophie Hart (SBN 321663) sophieh@prisonlaw.coom
9 PRISON LAW OFFICE 1917 Fifth Street
10 Berkeley, California 94710 Telephone: (510) 280-2621
11 Fax: (510) 280-2704

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

12 Attorneys for Plaintiffs

13

UNITED STATES DISTRICT COURT

14

EASTERN DISTRICT OF CALIFORNIA

15

SACRAMENTO DIVISION

16

17 LORENZO MAYS, RICKY RICHARDSON, JENNIFER
18 BOTHUN, ARMANI LEE, and LEERTESE BEIRGE on behalf of
19 themselves and all others similarly situated,
20
Plaintiffs,
21
v.
22
COUNTY OF SACRAMENTO,
23
Defendant.
24

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) [PROPOSED] ORDER ON ) APPOINTMENT OF COURT ) EXPERTS ) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) ) ) )

25

The Consent Decree, Doc. No. 85-1, approved by the Court on January 13,

26 2020, Doc. No. 110, provides for the appointment of Court Experts to carry out certain

27 enumerated duties. The duties of the Court Experts are set forth in Paragraphs 13

28 through 20 and in Exhibit B of the Consent Decree. Doc. No. 85-1 at 5-6; 98-100.

1

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 2 of 6

1

In accordance with the Consent Decree and its remedial purposes, and pursuant

2 to the Court’s inherent power, IT IS HEREBY ORDERED that the following

3 individuals are appointed as Court Experts, to be compensated by Defendant at the

4 rates set forth below:

5

The Court approves the appointment of Michael B. Rowe, M.D., as Court

6 Expert regarding Medical policies, procedures, and practices to be paid by Defendant

7 in the amount of $350 per hour for work performed and $175 per hour for time spent

8 traveling, and to be reimbursed by Defendant for reasonable associated costs of

9 professional services, including travel expenses.

10

The Court approves the appointment of Madeleine LaMarre, MN, FNP-BC, as

11 Court Expert regarding Medical policies, procedures, and practices to be paid by

12 Defendant in the amount of $250 per hour for work performed and $125 per hour for

13 time spent traveling, and to be reimbursed by Defendant for reasonable associated

14 costs of professional services, including travel expenses.

15

The Court approves the appointment of Dr. Mary Perrien as Court Expert

16 regarding Mental Health policies, procedures, and practices, to be paid by Defendant

17 in the amount of $250 per hour for work performed, and to be reimbursed by

18 Defendant for reasonable associated costs of professional services, including travel

19 expenses.

20

The Court approves the appointment of Lindsay Hayes as Court Expert

21 regarding Suicide Prevention policies, procedures, and practices to be paid by

22 Defendant in the amount of $250 per hour for work performed, and to be reimbursed

23 by Defendant for reasonable associated costs of professional services, including travel

24 expenses.

25

The Court Experts shall provide Defendant with a written itemization of the

26 claimed fees and costs, itemized by date, amount of time spent, and task, as well as

27 records and bills evidencing the costs claimed, on a quarterly basis or at an alternative

28

2

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 3 of 6

1 interval as agreed upon by Defendant and the Court Expert. Invoices will be provided

2 to all parties for their review before payment.

3

Rule 706(b) of the Federal Rules of Evidence requires the Court to “inform the

4 expert of the expert’s duties.” IT IS HEREBY ORDERED that the Court Experts

5 shall have the responsibilities, powers, and protections set forth in the Consent Decree

6 and in this Order, including as follows:

7

1. Pursuant to Rule 706 of the Federal Rules of Evidence, the Court Experts

8 shall advise the parties and the Court on Defendant’s compliance or non-compliance

9 with each material component of the Remedial Plan within their respective area of

10 expertise, will assist with dispute resolution matters, and will provide testimony, if

11 required, in any proceedings before the Court.

12

2. Within 180 days from the Court’s entry of the Consent Decree, and then

13 every 180 days thereafter, during the term of the Consent Decree, the Court Experts

14 shall each complete a comprehensive review and report (“180-Day Report”) to advise

15 the parties and the Court on Defendant’s compliance or non-compliance with each

16 material component of the Remedial Plan within the expert’s subject matter area.

17

3. In each 180-Day Report, the Court Experts shall state their opinion as to

18 whether Defendant is or is not in substantial compliance with each material

19 component of the Remedial Plan within their area of expertise (i.e., “Substantial

20 Compliance Determinations”). The 180-Day Reports shall be considered separate and

21 apart from any evaluations and reports prepared as part of the dispute resolution

22 process set forth in the Consent Decree and shall be admissible in evidence in any

23 proceedings before the Court.

24

4. Each Court Expert will prepare a draft written report on Defendant’s efforts

25 to meet the terms of the Consent Decree within thirty (30) days of the later of the

26 expert’s site inspection and the expert’s receipt of all requested documents and

27 information, and in no case later than forty-five (45) days after the inspection. The

28

3

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 4 of 6

1 draft report will be delivered to all parties. If the Court Expert concludes that

2 Defendant has not substantially complied with any provision or provisions of the

3 Consent Decree, the Court Expert shall make recommendations as to actions they

4 believe to be necessary to achieve substantial compliance.

5

5. The parties will have thirty (30) days to provide written comments or

6 objections, or to cure identified issues, and seven (7) days to reply. The Court Expert

7 may re-inspect facilities or documents, or conduct additional interviews, before

8 issuing a final report. Final reports shall be due twenty (20) days after the later of the

9 Court Expert’s receipt of any comments, objections or replies, or any additional

10 assessments.

11

6. In preparing reports, the Court Experts shall identify all sources of

12 information relied upon for facts and recommendations. If the source of information

13 is an interview or conversation, whether with staff, another Court Expert, or any other

14 person, the Court Expert shall identify the person who is the source of the

15 information. If the source of information is a class member, the Court Expert shall

16 identify the class member in a separate confidential document that is provided to

17 counsel for the parties. If the source of the information is a document, the Court

18 Expert shall make the document(s) available to counsel for all parties, or identify the

19 document(s) in a manner that makes it accessible to all parties.

20

7. With appropriate notice, the Court Experts shall have reasonable access to

21 all parts of any Sacramento County jail facility. Access to the facilities will not be

22 unreasonably restricted. The Court Experts shall have access to custody and health

23 care staff and people incarcerated in the jails, including confidential and voluntary

24 interviews as they deem appropriate. The Court Experts shall also have access to

25 documents, including budgetary, custody, and health care documents, and institutional

26 meetings, proceedings, and programs to the extent the Court Experts determine such

27 access is needed to fulfill their obligations. The Court Experts’ tours shall be

28

4

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 5 of 6

1 undertaken in a manner that does not unreasonably interfere with jail operations as

2 reasonably determined by jail administrators.

3

8. The Court Experts shall have reasonable access to individual health records,

4 including mental health records, and custody records.

5

9. If the Court Experts request to review any documents in conjunction with a

6 site visit, Defendant will provide these documents to the extent feasible no later than

7 twenty (20) days prior to the visit.

8

10. During each Court’s Expert’s first site inspection of the Jail, the parties

9 shall have the right to have counsel present during the tour. All subsequent tours

10 conducted by the Court Experts shall be conducted without counsel present, unless the

11 parties agree good cause exists for counsel to observe the subsequent tours. If the

12 parties cannot agree on the necessity for counsel to be present on subsequent tours by

13 the Court Experts, they shall submit the matter to Magistrate Judge Cousins (or his

14 designee) for decision.

15

11. The Court Experts shall be provided with and agree to be bound by any

16 protective or Court orders entered in this case.

17

12. The Court Experts may engage in ex parte communications with the parties.

18 However, all of the Court Experts’ findings and recommendations shall be set forth in

19 writing in their reports.

20

13. The Court Experts may engage in ex parte communications with each other.

21 The Court Experts may engage in ex parte communications with the designated

22 dispute resolution judge, Magistrate Judge Cousins, or his designee if he is not

23 available. The Court Experts shall not engage in ex parte communications with the

24 Court.

25

14. Pursuant to the dispute resolution procedures set forth in the Consent

26 Decree, either party may request that the relevant Court Expert evaluate an issue in

27 dispute and prepare a report. The expert must provide the report regarding the area of

28

5

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

Case 2:18-cv-02081-TLN-KJN Document 117 Filed 03/10/20 Page 6 of 6

1 disagreement to the parties and Magistrate Judge Cousins (or his designee) within

2 forty-five (45) days of the request. Defendant will pay the Court Expert’s reasonable

3 fees for any reports prepared at the request of a party about a disputed issue.

4

15. The Court Experts shall be available to meet jointly with the parties in

5 person or by telephone in a manner that is reasonable and convenient for the purpose

6 of resolving disputes between the parties.

7

16. At the request of the Court, the Court Experts shall attend any negotiations,

8 mediation sessions, or court hearings.

9

17. If a Court Expert becomes unavailable to fulfill the duties set forth in this

10 Order, the parties will meet and confer, and propose to the Court a new expert to

11 monitor compliance with the Consent Decree for the respective areas of expertise.

12 The parties may agree at any time to remove and replace a Court Expert.

13

IT IS SO ORDERED.

14 Dated: March 9, 2020
15

16
mays2081.ct.exp
17

18

19

20

21

22

23

24

25

26

27

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6

[PROPOSED] ORDER RE: JOINT REQUEST FOR APPOINTMENT OF

COURT EXPERTS

 
 Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 1 of 6

Aaron J. Fischer (SBN 247391) 1 Aaron.Fischer@disabilityrightsca.org
Anne Hadreas (SBN 253377) 2 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 3 1330 Broadway, Suite 500
Oakland, CA 94612 4 Telephone: (510) 267-1200
Fax: (510) 267-1201 5
Donald Specter (SBN 83925) 6 dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) 7 mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) 8 sophieh@prisonlaw.coom
PRISON LAW OFFICE 9 1917 Fifth Street
Berkeley, California 94710 10 Telephone: (510) 280-2621
Fax: (510) 280-2704 11

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

Attorneys for Plaintiffs 12

UNITED STATES DISTRICT COURT
13

EASTERN DISTRICT OF CALIFORNIA
14

SACRAMENTO DIVISION
15

16

17

LORENZO MAYS, RICKY RICHARDSON, JENNIFER

18

BOTHUN, ARMANI LEE, and LEERTESE BEIRGE on behalf of

19

themselves and all others similarly situated,

20

Plaintiffs,

21

v.

22 COUNTY OF SACRAMENTO,

23

Defendant.

24

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) JOINT STATUS REPORT ) ) ) Judge: Hon. Kendall J. Newman ) ) ) Complaint Filed: July 31, 2018 ) ) ) )

25

26

27

28

Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 2 of 6

1

On April 27, 2020, the parties filed a Stipulation informing the Court that, in

2 light of the disruption to operations in the Sacramento County Jail facilities (the

3 “Jail”) caused by the COVID-19 pandemic, the parties agreed to postpone scheduled

4 on-site monitoring visits by the Court Experts and Plaintiffs’ counsel. The parties

5 jointly sought the Court’s leave to extend the deadlines for the Court Experts’ first

6 reports on Defendant’s compliance with the mental health, medical, and suicide

7 prevention components of the Remedial Plan. The parties requested leave to

8 subsequently file a status report that would provide further information to the Court

9 about the status of monitoring and would propose a modification to the Court Expert

10 reporting deadlines described in the Consent Decree.

11

The Court granted the request to extend the deadlines and directed the parties to

12 file a status report on or before June 24, 2020, as to the issues above. Dkt. 119. The

13 parties, having conferred and, with input from the Court Experts, provide the

14 following status report.

15 I. Framework and Deadlines to Apply to First Monitoring Report

16

1. The COVID-19 pandemic made it unfeasible for the Court Experts to

17 complete their monitoring duties and to produce their first monitoring reports on the

18 timeline contemplated in the Consent Decree.

19

2. Based on current circumstances relating to the COVID-19 pandemic, the

20 Sheriff’s Department anticipates that it will be feasible to arrange for on-site

21 monitoring by Court Experts who are able to travel to the Jail and Plaintiffs’ counsel.

22 However, one or more of the Court Experts who reside out of state have indicated that

23 depending on how the circumstances of the COVID-19 pandemic develop in the

24 coming weeks and months, they may not be able to travel to the Jail to conduct on-site

25 monitoring in the near-term.

26

3. The parties and the Court Experts have conferred regarding a modified

27 monitoring process for purposes of the Court Experts’ first monitoring reports.

28

1

JOINT STATUS REPORT

Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 3 of 6

1 Accordingly, the parties jointly seek the Court’s approval of the following parameters

2 for completion of the first monitoring reports by the Court Experts:

3

a. The Court Experts and Plaintiffs’ counsel who are able to travel to the

4

Jail for on-site monitoring will be permitted to do so, within modified

5

parameters as agreed upon by the parties and as consistent with

6

operational and public safety needs related to the COVID-19 pandemic.

7

b. Defendant will provide the Courts Experts and Plaintiffs’ counsel with

8

remote access to class members’ Jail electronic health records (including

9

medical and mental health records) to allow for remote individual records

10

review.

11

c. The Court Experts and Plaintiffs’ counsel will request production of

12

individual class member Jail custody records as they deem necessary for

13

their monitoring role. Defendant will produce such records within seven

14

(7) calendar days of the request.

15

d. Defendant will arrange for a virtual tour of the facilities to accommodate

16

the Court Experts who are unable to do an on-site monitoring visit. The

17

virtual tour will be made available to all Court Experts and Plaintiffs’

18

counsel.

19

e. Defendant will timely produce documents, data, and other information

20

requested by the Court Experts and Plaintiffs’ counsel.

21

f. The parties will work cooperatively to ensure that the Court Experts and

22

Plaintiffs’ counsel are able to conduct interviews of custody and health

23

care staff and confidential, voluntary interviews of class members.

24

g. The Court Experts will prepare a draft written report on Defendant’s

25

efforts to meet the terms of the Consent Decree, as set forth in the

26

Court’s Order re: Joint Request for Appointment of Court Experts (Dkt.

27

117, ¶ 4) no later than October 7, 2020.

28

2

JOINT STATUS REPORT

Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 4 of 6

1

h. The parties will provide written comments or objections to the Court

2

Experts’ draft reports no later than October 21, 2020.

3

i. The Court Experts will issue their final reports no later than October 28,

4

2020. The parties will promptly file a Joint Status Report with the final

5

reports.

6

j. Where there is a conflict between the aforementioned provisions and the

7

provisions in the Court’s Order re: Joint Request for Appointment of

8

Court Experts (Dkt. 117), the provisions set forth above shall control for

9

purposes of the first monitoring report. All other provisions in the

10

Court’s previous orders remain in effect.

11

k. Absent further court order, the monitoring and reporting provisions set

12

forth in the Consent Decree and the Court’s Order re: Joint Request for

13

Appointment of Court Experts (Dkt. 117) will apply to all monitoring

14

after completion of the first monitoring reports.

15

4. Defendant will complete and file its first status report on its progress

16 toward compliance with the Consent Decree by July 20, 2020, as consistent with

17 Paragraph 12 of the Consent Decree.

18

5. Plaintiffs’ counsel, consistent with their monitoring authority under the

19 Consent Decree and their role in reporting on Defendant’s compliance with the

20 components of the Remedial Plan pertaining to restrictive housing, ADA/disability,

21 and discipline and use of force for people with mental health and intellectual

22 disabilities (Consent Decree ¶¶ 23-24), will complete their first report on or before

23 October 28, 2020.

24 II. Dispute Resolution Process and Agreement Reached on Certain COVID-19

25

Policies

26

6. Since the filing of the parties’ last report to the Court (Dkt. 118, Apr. 27,

27 2020), Defendant has continued to provide regular updates and data to Plaintiffs’

28

3

JOINT STATUS REPORT

Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 5 of 6

1 counsel. The parties have conferred by teleconference on a regular basis to discuss

2 the County’s response to the COID-19 pandemic as it relates to the health, safety, and

3 rights of Mays class members. The parties agree that the issues set forth in the Mays

4 Complaint and the Mays Consent Decree generally cover the County’s response to the

5 COVID-19 pandemic as it impacts Mays class members.

6

7. On May 27, 2020, Plaintiffs’ counsel sent to Defendant a Notice of

7 Dispute about two alleged deficiencies regarding Defendant’s COVID-19 response:

8 first, the failure to require custody staff to wear face coverings in the Jail facilities;

9 and second, the denial of showers and access to phones to class members subject to

10 the mandatory seven-day intake quarantine period for new arrivals and to the fourteen-

11 day quarantine period for people who live in celled housing and have symptoms or

12 possible exposure to COVID-19.

13

8. Consistent with the Dispute Resolution provisions set forth in the

14 Consent Decree (Section G), the Court Experts on medical care (Michael Rowe, M.D.

15 and Madeleine LaMarre MN, FNP-BC) prepared an expert report, dated June 8, 2020,

16 regarding the face coverings dispute.

17

9. Following a video conference mediation with Magistrate Judge Cousins,

18 the designated dispute resolution mediator (Consent Decree ¶ 34) on June 15, 2020,

19 the parties reached an agreement resolving the face coverings dispute and providing a

20 framework for further discussions on the conditions for class members in COVID-19-

21 related quarantine. The Memorandum of Agreement is attached to this Joint Status

22 Report.

23

10. Defendant will continue to provide regular updates and data regarding the

24 COVID-19 situation and response at the Jail, and the parties will confer on the matter

25 on a regular basis. Defendant will provide all relevant policies and procedures, and

26 COVID-19 class member data, to Plaintiffs’ Counsel and the Court Experts. The

27

28

4

JOINT STATUS REPORT

Case 2:18-cv-02081-TLN-KJN Document 120 Filed 06/24/20 Page 6 of 6

1 Court Experts will participate in conferences between the parties regarding these

2 matters, as appropriate.

3 III. Other Remedial Plan Implementation Activities

4

11. Defendant continues to produce requested data and information pursuant

5 to the Consent Decree, to allow for monitoring to proceed in a manner consistent with

6 precautions necessary during the current public health emergency.

7

12. The parties continue to confer regarding the revision and development of

8 Defendant's operational policies to ensure that they reflect the requirements of the

9 Remedial Plan. The parties agree to invite the participation of the Court Experts in

1O that process, in order to enhance efficiency in the Remedial Plan implementation 11 process.

12

13

The parties request the Court approve the modified framework and deadlines

14 for the first monitoring reports of the Court Experts, as set forth in Paragraph 3(a)-(k) 15 herein and in the Proposed Order, attached herewith.

16

Respectfully submitted,

17

18 Dated: June 24, 2020
19 20

p Aaron J. Fischer (SBN 24739
DISABILITY RIGHTS CALI ORNIA Attorney for Plaintiffs

21
22 Dated: June 24, 2020
23
24

Margot Mendelson-JrBN 268583)
PRISON LAW OF CE Attorney for Plaintiffs

25 Dated: June 24, 2020 26

27

28

5 JOINT STATUS REPORT

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 1 of 20
MEMORANDUM OF AGREEMENT Face Coverings for Staff as Precaution Against COVID-19 Transmission in
Sacramento County Jail Facilities, and Other COVID-19 Matters Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-KJN)
Whereas, Plaintiffs’ class counsel and Defendant County of Sacramento (the “Parties”) reached a settlement agreement in Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-KJN), with a Consent Decree approved by the Court on January 13, 2020; and
Whereas, the novel coronavirus (COVID-19) pandemic has posed significant challenges to protect the health and well-being of incarcerated persons in criminal detention facilities like the Sacramento County Jail’s Main Jail and Rio Cosumnes Correctional Center (RCCC) (together, “the Jail”); and
Whereas, pursuant to the Parties’ agreement (Stipulation, Dkt. 118, Apr. 27, 2020), the County has provided regular updates and data to Plaintiffs’ class counsel, and the Parties have conferred by teleconference on a regular basis to discuss the County’s response to the pandemic as relevant to Jail operations; and
Whereas, the Parties agree that the issues set forth in the Mays Complaint and the Mays Consent Decree, including with respect to the provision of health care, environmental health/safety conditions, and custody operations generally cover the County’s response to the COVID-19 pandemic as it impacts Mays class members; and
Whereas, Plaintiffs’ class counsel sent a Notice of Dispute letter (attached as Exhibit A), dated May 27, 2020, regarding two alleged deficiencies regarding the County’s COVID-19 response vis-à-vis Jail operations: first, the failure to require custody staff to wear face coverings in the Jail facilities; and second, the denial of showers and access to phones to class members subject to the mandatory seven-day intake quarantine period for new arrivals and to the fourteen-day quarantine period for people who live in celled housing and have symptoms or possible exposure to COVID-19; and
Whereas, consistent with the Dispute Resolution provisions set forth in the Consent Decree (Section G), the Parties notified by written correspondence dated May 30, 2020, the designated Dispute Resolution mediator, the Hon. Nathanael Cousins, as to the dispute; and

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 2 of 20
MEMORANDUM OF AGREEMENT – Face Coverings for Staff Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-KJN) Page 2 of 4
Whereas, consistent with the Dispute Resolution provisions set forth in the Consent Decree (Section G), the Court-appointed experts on medical care (Michael Rowe, M.D. and Madeleine LaMarre MN, FNP-BC) prepared an expert report entitled Report Regarding the Sheriff’s Department Face Mask Policy at the Sacramento County Jail in the Setting of the COVID-19 Pandemic, dated June 8, 2020 (attached as Exhibit B); and
Whereas, by Sacramento Sheriff’s Office Inter-Departmental Correspondence dated June 1, 2020, the County issued a directive stating that class members will be provided an opportunity to a shower at the start of any quarantine period and that, where an entire housing unit pod is quarantined due to symptoms or potential exposure, the showering of inmates will be coordinated on a case-bycase basis with medical and custody input to achieve the most efficient and safe method of offering showers; and
Whereas, the Parties and the Court-appointed experts on medical care participated in a video conference mediation with Magistrate Judge Cousins on June 15, 2020, as part of the Dispute Resolution process;
Now therefore, the Parties agree as follows:
1. All Sacramento County Sheriff’s Department Jail custody deputies (“Deputies”) will be required to carry a Department-issued face covering at all times while on their shift.
2. All Deputies will be required to wear a Department-issued face covering when in elevators, day rooms, dorm housing units, transport vehicles, health care treatment areas, and classrooms whenever one or more class member(s) are present in that area.
3. All Deputies will be required to wear a Department-issued face covering in any location when they are within six feet of a class member without a physical barrier.
4. All Deputies will be required to wear a Department-issued face covering in the Intake area during all periods when an arrestee or any class member otherwise being housed is present in an unsecured portion of the intake loop (i.e. not behind holding cell doors).

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 3 of 20
MEMORANDUM OF AGREEMENT – Face Coverings for Staff Mays v. County of Sacramento (Case No. 2:18-cv-02081-TLN-KJN) Page 3 of 4
5. Within five (5) business days of execution of this Agreement, the Sheriff’s Department will issue a clear directive, via written policy and InterDepartmental Correspondence, to all Jail staff regarding the requirements set forth above, including articulated public health reasons for the new directive and provision for its enforcement.
6. The Jail’s Adult Correctional Health staff’s existing COVID-19 staff guidance for all mental health and medical staff – which provides that “universal masking is a requirement and the mask is considered part of work attire” – shall remain in place.
7. Jail staff will continue to offer face coverings to all class members (in the intake area and in all housing units), and will provide face coverings upon request by any class member.
8. The County will review its policies regarding face coverings periodically. Should relevant federal or state governmental public health guidance regarding COVID-19 precautions be updated, the County may seek to modify its policies. In such case, the County agrees to notify Plaintiffs’ class counsel and the Court experts on medical care prior to any modification to the policy. If Plaintiffs’ class counsel objects to the change in policy in whole or in part, the Parties will meet and confer – with the assistance of Magistrate Judge Cousins, if available – before any disputed component(s) of the policy change is implemented.
9. Notwithstanding the above, deputies will not be required to wear a mask in situations where there is an immediate safety threat such that donning a mask would compromise physical safety.
10.Plaintiffs’ class counsel may bring concerns regarding reports of alleged Jail staff non-compliance with the face covering directives described herein. The Sheriff’s Department will promptly investigate any such reports, and will provide an update to Plaintiffs’ class counsel as to any identified noncompliance and the steps taken to address such non-compliance.
11.The Parties will continue to meet and confer through the Dispute Resolution process, with the assistance of Magistrate Judge Cousins as appropriate, regarding the provision of showers and access to phones for class members during the seven- and fourteen- day quarantine periods discussed herein.

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 4 of 20
MEMORANDUM OF AGREEMENT - Face Coverings for Staff Mays v. County ofSacramento (Case No. 2:18-cv-02081-TLN-KJN) Page 4 of 4
12.The terms of this Agreement are subject to the monitoring and enforcement provisions set forth in the Mays Consent Decree.
This Agreement shall be deemed fully executed and effective when all Parties have executed it by signature.

Dated: June 18, 2020

�- .P. ?«,::.A-
DISABILITY RIGHTS CALIFORNIA Attorney for Plaintiffs

Dated: June 18, 2020 Dated: June i..k,2020

PRISON LAW OFFICE Attorney for Plaintiffs

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 5 of 20
EXHIBIT A
exhibits to notice omitted
EXHIBIT A
exhibits to notice omitted

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 6 of 20

PRISON LAW OFFICE
General Delivery, San Quentin, CA 94964
Telephone (510) 280-2621  Fax (510) 280-2704
www.prisonlaw.com

Rick Heyer Supervising County Counsel P.O. Box 988 Sacramento, CA 95812-0988 heyerr@saccounty.net

May 27, 2020

Director: Donald Specter
Managing Attorney: Sara Norman
Staff Attorneys: Rana Anabtawi Patrick Booth Steven Fama Alison Hardy Sophie Hart Corene Kendrick Rita Lomio Margot Mendelson

Re: Mays v. County of Sacramento, 2:18-cv-02081-TLN-KJN (E.D. Cal.) Notice of Dispute

Dear Rick:

We write regarding serious concerns about the Sacramento Sheriff’s Department’s response to the COVID-19 pandemic. In the course of the parties’ ongoing discussions about COVID-19 prevention and containment measures in the jails, two serious deficiencies have emerged: (1) the Department’s failure to require custody staff to wear face coverings when interacting with incarcerated people, and (2) the extreme and harsh conditions of confinement for people during the mandatory seven-day intake observation period for new arrivals and the fourteen-day quarantine for people who live in celled housing and have symptoms or possible exposure to COVID-19. We previously have expressed our concerns about these harmful practices, including that they are out of step with other California county jail systems. As the Sheriff’s Department has not acted to resolve these problems, we write pursuant to Paragraphs 32-34 of the Consent Decree to give notice of our initiation of the dispute resolution process.

We acknowledge and appreciate the steps the County has taken to respond to this crisis. In
particular, we recognize the hard work of custody staff to manage new housing arrangements and of Adult Correctional Health to implement strategies to address the serious threat posed by COVID-19. However, the magnitude of the present public health crisis cannot be overstated. As of May 26, 2020, there have been over five million confirmed cases of COVID-19 worldwide, and more than 340,000 people have died.1 There is no vaccine, and there is no proven treatment.2

1 World Health Organization, Coronavirus Disease (COVID-19) Pandemic,
https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (last accessed May 26, 2020). 2 Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19): Frequently
Asked Questions, https://www.cdc.gov/coronavirus/2019-ncov/faq.html (last accessed May 26,
2020).
Board of Directors Penelope Cooper, President  Michele WalkinHawk, Vice President • Marshall Krause, Treasurer
Harlan Grossman • Christiane Hipps  Margaret Johns • Cesar Lagleva  Jean Lu Laura Magnani  Michael Marcum  Ruth Morgan  Seth Morris  Vishal Shah

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 7 of 20
The virus that causes COVID-19 is highly transmissible: it spreads from person to person through small droplets when a person coughs or exhales,3 and people can spread the virus without knowing they are sick.4 And, because this is a new virus, most people lack immunity. It can also cause severe illness: roughly 20% of people who contract COVID-19 will require hospitalization.5 People who are older or who have underlying health conditions are more likely to become severely ill or die from COVID-19.6
People incarcerated in the Sacramento County Jails face a substantially higher risk of serious health consequences from COVID-19 than the general population. Many people in the jails are older or in poor health, and thus are at greater risk of severe illness or death if they contract COVID-19. Hundreds of people in Sacramento County Jail custody have conditions that render them vulnerable to COVID-19, including asthma, heart conditions, lung disease, severe obesity, chronic kidney disease, liver disease, and diabetes.7
Moreover, infectious diseases like COVID-19 spread more rapidly in congregate settings, where people share sleeping areas, dining facilities, and bathrooms. In the Sacramento County Jails, many people live in crowded dorms where they are unable to achieve social distancing. People with high-risk medical conditions and people in high-risk age categories live in these dorms, where they share common surfaces and routinely come within six feet of other people.
Nationwide, prisons and jails have been an epicenter of viral transmission. “Of the nation’s top twenty-five clusters of COVID-19 cases, all but three are congregate living environments (jails and prisons, nursing and veteran’s homes, and the U.S.S. Theodore Roosevelt).”8 A recent analysis identified more than 47,000 coronavirus infections and 485 deaths in inmates and staff at state prisons, federal prisons and local jails.9 “Nearly every state
3 Id. 4 Centers for Disease Control and Prevention, Social Distancing, Quarantine, and Isolation, https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html (last updated May 26, 2020) (“CDC Social Distancing”). 5 Centers for Disease Control and Prevention, Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19), https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidancemanagement-patients.html (last accessed May 26, 2020). 6 Centers for Disease Control and Prevention, People Who Are at Higher Risk for Severe Illness, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html (last accessed May 26, 2020). 7 Id. 8 Brie Williams, Cyrus Ahalt, David Sears, & Stefano M. Bertozzi, Limiting COVID-19 Transmission and Mitigating the Adverse Consequences of a COVID-19 Outbreak in Correctional Settings: RELEASE · COHORT · TEST, Apr. 26, 2020, https://amend.us/wpcontent/uploads/2020/05/Cohorting-Guidance.Amend_.UCB_.pdf . 9 Coronavirus in the U.S.: Latest Map and Case Count, New York Times (last updated May 27, 2020), https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html#hotspots.
2

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 8 of 20
prison system has at least one infection among either inmates or staff. Many of the infections have been asymptomatic, suggesting that the problem is more common than is understood.”10
ISSUES IN DISPUTE
1. Use of Face Coverings by Custody Staff
The Sacramento Sheriff’s Department has taken the position that it will not require custody officers to wear face coverings—an essential, well-accepted practice to limit the risk that staff will unknowingly transmit the virus to incarcerated people. This position is indefensible and stands in stark contrast to public health recommendations and standard practices in California county jails and prisons.
The U.S. Centers for Disease Control and Prevention (CDC) have established that face coverings are an essential component of an adequate program for limiting the transmission of COVID-19. Because “the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing,” the CDC recommends “the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”11 Face coverings are of particular importance because of the documented asymptomatic spread of the virus. The Los Angeles Times recently reported that, according to the CDC, “there’s a 20%-to-50% chance that those infected with the coronavirus do not show symptoms. Yet even those asymptomatic people may be just as capable of transmitting the disease as other infected people who eventually become visibly sick . . . . That’s why it’s so important to adhere to social distancing and wearing masks, experts say.”12
The CDC expressly endorses the use of face coverings in correctional settings. The CDC has recognized that “because staff members move between correctional facilities and their communities daily,” they may constitute “an important source of virus introduction into facilities.”13 The CDC has concluded that staff screening measures, such as temperature checks,
10 Id. Sacramento County Jail has had one confirmed case of COVID-19 among its incarcerated population, identified on May 6, 2020. While the County conducts COVID-19 tests for all people entering the jail, it does not conduct asymptomatic testing of the existing jail population. Consequently, there is reason to believe that this represents an undercount. 11 Centers for Disease Control and Prevention, Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission, April 3, 2020, https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html. 12 Rong-Gong Lin II, Coronavirus ‘silent spreaders’ become a bigger risk as California reopens, L.A. Times, May 26, 2020, https://www.latimes.com/california/story/2020-05-26/coronavirussilent-spreaders-bigger-risk-as-california-reopens. 13 Centers for Disease Control and Prevention, COVID-19 guidance for correctional and detention facilities, COVID-19 in Correctional and Detention Facilities — United States, February–April 2020, Mortality and Morbidity Weekly Report (MMWR), May 15, 2020, https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm.
3

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 9 of 20
are “inadequate” to identify affected persons and prevent transmission of the virus.14 Consequently, the CDC endorses “[a]dditional strategies, including . . . use of cloth face coverings . . . to prevent and manage spread within correctional and detention facilities.”15
Sacramento County public health officials themselves have recognized the critical importance of face coverings to limit viral transmission. On May 22, 2020, the Health Officer of Sacramento County issued a Public Health Order stating that “it is critical . . . to adhere to important public health recommendations to reduce the transmission of COVID-19.”16 The order directs that “people should wear face coverings when in public places where social distancing of six feet or more can’t be achieved by persons of separate households.”17 The Sheriff’s Department has elected not to abide by that guidance in the high-risk jail environment where social distancing has not been facilitated.
Indeed, the Sheriff’s Department’s refusal to require custody staff to wear masks conflicts with the County’s own correctional health department policy. A directive by Sacramento County’s Adult Correctional Health Department observes that “[a]n employee may harbor COVID-19 but have no symptoms. In light of this, Adult Correctional Health implemented universal masking for its employees.”18 “[U]niversal masking is a requirement and the mask is considered part of work attire. If staff report to work without a personal mask, s/he will need to use leave balances to return home to get the mask.”19 In other words, while correctional health staff in the jail must wear face coverings, custody staff who interact directly with incarcerated people are subject to no such requirement.20 We are aware of no reasoned basis for this position.
14 Id. 15 Id. The CDC’s guidance is consistent with its recommendations for other congregate living settings, in which it has directed that “[a]ll staff and residents should wear a cloth face covering when in shared areas of the facility and maintain social distancing to slow the spread of the virus.” Centers for Disease Control and Prevention, COVID-19 Guidance for Shared or Congregate Housing, April 25, 2020, https://www.cdc.gov/coronavirus/2019ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html (emphasis in original). 16 Order of the Health Officers of the County of Sacramento Directing All Individuals Living in the County to Continue to Stay at Home or at their Place of Residence, Recommend Wearing Face Coverings and Relaxing Restrictions on Low-Risk Businesses Consistent with Direction From the State of California, May 22, 2020, https://www.saccounty.net/COVID19/Documents/2020-05-22%20Health%20Order%20Stay%20at%20Home%20SIGNED.pdf. 17 Id. 18 Sacramento County Adult Correctional Health, COVID-19 Staff Guidance, Mar. 2, 2020 (rev. May 18, 2020) (attached hereto as Exhibit A). 19 Id. (emphasis in original). 20 Although the use of face coverings by custody staff is not prohibited, responses to a survey sent by Plaintiffs’ counsel to class members at both jails indicate that custody staff frequently do not wear face coverings in the jail. Forty-six of 57 class members reported that custody staff do not wear face masks in the jails.
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The Sheriff’s Department’s failure to require custody officers to wear masks diverges sharply from the practices of other California county jails and the California state prisons. Alameda County, Yuba County, Riverside County, Fresno County, Contra Costa County, Santa Clara County, Santa Barbara County, and San Bernardino all require custody staff to wear masks when in proximity to incarcerated people. The Fresno County Sheriff’s Department recent directive speaks for itself:
EFFECTIVE IMMEDIATELY MASKS ARE REQUIRED IN ALL JAIL FACILITIES The Fresno County Sheriff’s Office requires facial masks for everyone that enters the Fresno County Detention Facilities. Amid the coronavirus outbreak and in order to protect the health of our staff and the public, wearing a face mask in now mandatory. Wearing a face mask is not a substitute for social distancing. This applies to everyone.
The California Department of Corrections and Rehabilitations also requires staff to wear face coverings while working on institutional grounds. A court in the Central District of California just this week ordered Orange County to require that all jail staff wear masks “when interacting with any person or when touching surfaces in cells or common areas.”21
The Sheriff’s Department’s refusal to require the use of face coverings for custody staff in the jails is contrary to public health recommendations and established practices in peer counties. This position is reckless and dangerous in the face of what we all recognize as a serious risk of harm and human suffering.
We understand that the Sheriff’s Department is proud of the fact that just one incarcerated person has tested positive for COVID-19 to date. The County should follow the clearly established and widespread practice of required face coverings for all staff so as not to undermine its other prevention measures.
2. Conditions of Confinement in Initial Observation Period
The Sheriff’s Department’s current practice is to place all people entering the jail into a seven-day initial observation period to monitor for symptoms of COVID-19. From the time they are booked into the jail until the end of that seven-day period, incarcerated people cannot use the showers. Their only means to clean their bodies is to use the sink in their cells. They also cannot leave their cells to recreate or exercise, and they cannot use the telephones except for certain, limited phone legal phone calls with a pre-approved list of attorneys. We understand that similar restrictions apply to the fourteen-day quarantine period for people living in celled housing who have symptoms or possible exposure to COVID-19.
21 Melissa Ahlman v. Don Barnes, No. SACV 20-835 JGB at 21 (C.D. Cal. May 26, 2020) (attached hereto as Exhibit B).
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Showers are critical for hygiene and mental health, especially in the often tumultuous period following arrest and booking in the jail. Showering also promotes good sanitation practices, which are essential to preventing the transmission of COVID-19. Title 15 expressly requires jails to provide showers at least every other day. See 15 Cal Code Regs § 1266. Similarly, the American Correctional Association requires that even where movement on a housing unit is restricted, people shall be able to showers three times per week.22 The American Bar Association’s Standards on the Treatment of Prisoners state that even in cases of institutional lockdowns, incarcerated people should be afforded access to showers.23
Plaintiffs recognize that some circumstances may justify deviations from normal shower schedule in the jails. However, standards governing access to showers may not be abandoned without a legitimate justification. The Sheriff’s Department has failed to provide any legitimate reason for denying the right to shower to people entering the jail—many of whom may be entering the jail in states of uncleanness and/or from circumstances of homelessness. The Sheriff’s Department has offered two rationales for the ban on showers: (1) the burden of disinfecting the showers after use, and (2) the possibility of viral transmission associated with shower use. Neither objection is credible. Showers can be disinfected after each use, as they are elsewhere in the jail during this time of heightened attention to sanintation. Moreover, the movement of one individual through a locked down jail pod to and from the shower does not pose a significant risk of transmission. If the Sheriff’s Department is concerned about viral transmission during the short movement to and from the showers, it could choose to provide face masks to those individuals.
In this regard, too, the Sacramento Sheriff’s Department’s practices are an outlier. In the California prison system, all people in observation, quarantine, or medical isolation status receive showers and yard time. People in medical isolation for suspected or confirmed COVID-19 are required to have access to showers at least every other day, as well as yard and dayroom time, phone calls, and personal property. We are aware of multiple other county jails that provide showers and out-of-cell time for people on observation or quarantine status. A court recently granted a preliminary injunction ordering Orange County Jail to provide daily showers to people in its custody.24
The blanket denial of showers to people in the intake observation period and or in quarantine is inhumane, unjustified, and counterproductive to the important objectives of maintaining hygiene and sanitation in the jails. Likewise, the Department should modify its complete ban on access to phones for calls to loved ones, in a manner that appropriately balances public health needs and the rights of Mays class members to humane conditions of confinement.
22 American Correctional Association, Restrictive Housing Performance Based Standards, (Aug. 2016), 4-RH-0017. 23 American Bar Association Standards for Criminal Justice, Treatment of Prisoners, 2011 (3d ed.), Standard 23-3.9 24 See Order, Exhibit B at 20.
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Next steps

Given the significant harm at stake, we are initiating the Dispute Resolution process pursuant to Paragraphs 32-34 of the Consent Decree. Pursuant to those provisions, we are providing a copy of this letter to Judge Cousins and requesting that he schedule a mediation session at his soonest availability.

The Consent Decree also calls for the parties to meet and confer about this dispute. The parties have discussed these issues before and are scheduled to do so again tomorrow, May 28, at 11 am, with the presence and assistance of the Court’s health care experts.

Sincerely,

/s/ Margot Mendelson

/s/ Aaron J. Fischer

Margot Mendelson Prison Law Office

Aaron J. Fischer Disability Rights California

cc: Judge Nathanael Cousins Chief Santos Ramos Lt. Alex McCamy Deputy Director Sandy Damiano Director Tammy Morin Michael B. Rowe, M.D. – Mays Court Expert, Medical Care Madeline LaMarre, MN, FNP-BC – Mays Court Expert, Medical Care

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EXHIBIT B
EXHIBIT B

Case 2:18-cv-02081-TLN-KJN Document 120-1 Filed 06/24/20 Page 14 of 20
Report Regarding the Sheriff’s Department Face Mask Policy at the Sacramento County Jail in the Setting of the COVID-19 Pandemic
Introduction
Pursuant to the Consent Decree in this matter, we have been requested to provide expert medical testimony on the matter of the decision by Sacramento County to not require Sheriff’s Department staff to comply with public health recommendations for universal face masks at the Sacramento County Jail during the COVID-19 global pandemic. A Notice of Dispute on this issue was filed by the Plaintiffs. On 5/28/2020 a “meet and confer” conference was held between the parties and, without agreement being reached, the matter is proceeding to mediation.
Coronavirus Disease 2019 (COVID-19)
In late 2019, an unusual cluster of cases of pneumonia resulting in a number of deaths was identified in China. Subsequently, the cause of this outbreak was identified as a novel coronavirus that became known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease it causes is commonly known as COVID-19. As this is a new coronavirus, there is no preexisting immunity in the population and due to its highly infectious nature, the virus has spread rapidly around the globe. On March 19, 2020 the World Health Organization (WHO) declared COVID-19 to be a worldwide pandemic.
According to the Johns Hopkins University Coronavirus Dashboard, as of June 3, 2020 there have been over 6 million confirmed COVID-19 cases globally with more than 380,000 deaths. In the United States, there have been more than 1,800,000 cases and 106,000 deaths.1
California ranks among the top 10 states in number of cases with more than 118,000 confirmed cases and 4,360 deaths. As of May 29, 2020, according to the Sacramento County Department of Health Services COVID-19 Dashboard there have been 1,373 cases and 56 deaths in Sacramento County. Due to the number of asymptomatic infections and lack of widely available testing early in the pandemic, the number of reported COVID-19 infections can be presumed to be lower than the number of actual infections. 2
1 https://coronavirus.jhu.edu 2 For example, a study recently done in Los Angeles County for antibodies to the virus concluded that approximately 4.65% of the community had been infected suggesting as many as 55 times the reported number of cases. Sacramento County can also be presumed to have much higher numbers of cases than confirmed cases reported to the health department. Sood N, Simon P, Ebner P, et al. Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020. JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8279.
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Clinical Features of COVID-19 Infection
Many patients exhibit no symptoms but are capable of transmitting infection. The spectrum of symptomatic infection ranges from mild to critical with approximately 20% of patients experiencing severe disease.
Symptoms of mild COVID-19 infection include fatigue, fever, chills, headache, muscle aches, cough, shortness of breath, nasal congestion, sore throat, loss of taste and smell, skin rash, and diarrhea. Severe disease is primarily characterized by respiratory failure requiring mechanical ventilation, multiple organ failure, and death. COVID-19 also results in damage to the heart, kidney and vascular systems. There have been increasing reports of clotting disorders causing venous thromboembolism and stroke, sometimes in young adults with no other health problems. There have also been reports of a multi-system inflammatory response syndrome (MIS-C) in children which has resulted in deaths.
Severe illness can occur in otherwise healthy individuals at any age, but predominantly occurs in older adults or those with underlying medical conditions. These conditions include chronic lung disease, asthma, cardiovascular disease, hypertension, diabetes, severe obesity, end-stage renal disease on dialysis, or liver disease such as chronic Hepatitis C infection. Any condition which compromises the ability of the immune system to fight infection including cancer, HIV/AIDS, smoking, a prior bone marrow or organ transplantation, or a requirement for any medications which weaken the immune system will increase the risk of complications and death. Having more than one of these conditions increases the risk even more significantly.3 In New York City, which has had the most experience to date in the U.S. with the care of critically ill patients with COVID19 infection, if a patient required mechanical ventilation, there was a 76% chance of dying in the group that was 18-65 years of age and a 97% of chance of dying if older than 65.
The population of almost all jails and prisons includes a large number of individuals with one or more of these types of chronic medical conditions which can increase their risk of severe disease and death from COVID-19. It has been estimated by the US Department of Justice that 40% of incarcerated persons have at least one chronic medical condition and 24% reported two conditions. In addition, correctional facilities house many older individuals whose age alone increases their risk for severe complications and death.4
Transmission of COVID-19
Coronavirus is primarily spread through direct person-to-person respiratory transmission of infectious droplets when an infected person coughs, sneezes, or talks.5 These droplets can remain suspended in the air for between 8-14 minutes for the larger droplets to more than an hour for the smallest ones. All of these droplets can cause infection. This enables transmission between persons through inhalation of air containing suspended virus even when the original
3 https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html 4 https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf 5 J Aerosol Sci 2009; 40:122-133) (https://www.pnas.org/cgi/doi/10.1073/pnas.2006874117
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source is no longer near the recipient.6 In addition, since these droplets settle on surfaces, a person can also get coronavirus by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes.
Recent epidemiologic data supports the concept of common transmission of coronavirus from individuals who are asymptomatic (will never develop symptoms) or pre-symptomatic (have not yet developed symptoms). Reported cases of infected persons who transmitted the virus to others while asymptomatic or presymptomatic have occurred within families or households, during shared meals or during visits with hospitalized family members. The Centers for Disease Control and Prevention (CDC) estimates that 35% of coronavirus cases are asymptomatic and that these cases are as likely to be as infectious as cases that are symptomatic.7 Asymptomatic transmission reinforces the inadequacy of symptom monitoring alone for limiting the spread of the virus and reinforces the value of measures that prevent the spread of COVID-19 by infected persons who may not exhibit illness despite being infected. These measures include social distancing, use of face cloths in public, and universal masking in health care facilities.8
COVID-19 in US Jails and Prisons
Coronavirus outbreaks have been reported in jails and prisons throughout the country. An ongoing register of COVID-19 cases in correctional facilities in the U.S. currently shows 45,026 cases among residents as well as 517 deaths and 10,808 cases among staff including 50 deaths as of 6/4/2020. 9 In a CDC report, more than half of affected facilities reported cases only among staff members.10 This speaks to the extent to which correctional staff acquire COVID-19 infection in the community and subsequently introduce it into a correctional facility.
Correctional institutions face significant challenges in controlling the spread of highly infectious pathogens such as COVID-19. These include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multi-person vehicles for court-related, medical, or security reasons.11 The risks of COVID-19 transmission apply to both staff and inmates.
The nature of correctional facilities is that it is generally not possible to socially distance between inmates, and between staff and inmates. The correctional environment contributes to the spread of several communicable diseases (e.g. tuberculosis, influenza), including COVID-19.
Rapid and large-scale transmission of COVID-19 in correctional institutions is illustrated by the following recent examples. In April 2020, at Marion State Prison in Ohio, 2,000 (80%) of 2,500
6 https://www.scientificamerican.com/article/how-coronavirus-spreads-through-the-air-what-we-know-so-far1/ 7 https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html. 8 https://wwwnc.cdc.gov/eid/article/26/7/20-1595_article 9 UCLA COVID-19 Behind Bars Data Project 10 https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm 11 https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm
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inmates tested positive for COVID-19. 12 At nearby Pickaway Correctional Institution, 1,500 (75%) of 2,000 inmates also tested positive for COVID-19. The Ohio Department of Corrections reports 19 inmate and 2 staff deaths to date.13 In May 2020, at Wayne County Jail in Detroit, 206 Sheriff’s Office employees and 89 inmates tested positive for COVID-19. This was following the deaths of two physicians including the Medical Director, as well as 2 correctional staff and a recently released detainee.14
As of May 31, 2020, the California Department of Corrections (CDCR) reported that there were 1,688 incarcerated persons with active cases of COVID-19, and 9 deaths. In addition, they reported 148 cases and 1 death among custody staff. Although cases have clustered in large numbers at certain institutions, other institutions have not yet had outbreaks. 15 As of May 31, 2020, the Federal Bureau of Prisons reported 1,629 cases and 67 deaths among federal inmates and 177 staff are infected. As in the CDCR, these cases have clustered in a number of facilities. 16
As of May 29, 2020, Orange County Jail in California reported a large outbreak with 377 cases.17 Around the same time, Cook County Jail in Chicago reported 547 cases and 7 deaths.18 By early April 2020, Rikers Island Jail in New York City, reported over 700 cases among inmates and over 440 among staff.19 Though official statistics are not available, several inmates as well as staff have died.
Jail populations are characterized by rapid turnover with release of detainees back into the community. Therefore, in cases of COVID-19 outbreaks, this poses significant risk to the communities to which they return. Therefore, prevention of transmission of COVID-19 within correctional institutions substantially contributes to the public health.
Reducing transmission of COVID-19 in Correctional Institutions
On 3/23/2020 the Centers for Disease Control and Prevention (CDC) published interim guidance on management of coronavirus disease 2019 in correctional and detention facilities.20 Prevention strategies focused on reinforcing hygiene practices, intensifying cleaning and disinfection of the facility, screening (new intakes, visitors and staff), continued communication with incarcerated persons, and staff and social distancing. At that time, these recommendations did not recommend the use of face masks or testing except when staff or inmates demonstrated symptoms of COVID-19.
12 https://www.ideastream.org/news/inside-marion-correctional-with-covid-19-we-just-passed-it-around 13 https://fox8.com/news/coronavirus/nurse-at-pickaway-correctional-institution-dies-of-covid-19/ 14 https://www.clickondetroit.com/news/local/2020/05/09/206-wayne-county-sheriffs-office-employees-29-jailinmates-test-positive-for-covid-19/ 15 https://www.cdcr.ca.gov/covid19/ 16 https://www.bop.gov/coronavirus/index.jsp 17 https://www.ocsd.org/documents/sheriff/COVIDStats5.29.20.pdf 18 https://www.cookcountysheriff.org/covid-19-cases-at-ccdoc/ 19 https://www.newsweek.com/rikers-island-covid-19-new-york-city-1496872 20 https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctionaldetention.html
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Face masks have been found to be effective in reducing transmission of communicable respiratory infections such as tuberculosis and influenza. Face masks have also been found to be effective for reducing the spread of COVID-19. For example, one recent study that evaluated household transmission showed a 79% reduction in transmission of infection when everyone in the household wore a mask. This degree of protection was only the case when masks were worn prior to the onset of symptoms in any individual. 21
In April 2020, in light of mounting evidence of asymptomatic transmission of COVID-19, CDC published additional guidance to the public recommending wearing face cloth coverings in public settings where social distancing measures were difficult to maintain, especially in areas of significant community-based transmission.22
On May 15, 2020, CDC published a report of COVID-19 cases in correctional institutions that noted that symptom screening alone was inadequate to promptly identify and isolate infected persons in congregate settings such as correctional and detention facilities. Additional strategies including physical distancing, movement restrictions, use of face cloth coverings, intensive cleaning, infection control for staff members, and disinfection of high touch surfaces in shared spaces were recommended to prevent and manage spread within correctional and detention facilities.23
The CDC guidance was specific that to “prevent introduction of COVID-19 into facilities from the community” it is recommended that cloth face coverings be worn by incarcerated or detained persons and staff members”. It is also noted that “consistent application of prevention measures within correctional and detention facilities are critical to protecting incarcerated or detained persons, staff members, and the communities to which they return.”24
Recommendations and requirements for the consistent use of masks by individuals in all settings of potential spread of this infection is no longer understood primarily as a means of selfprotection, though that is an ancillary benefit, but is considered one of the most critical strategies to try and decrease further spread of the virus, protect vulnerable populations, and shorten the duration of the epidemic.
Universal staff mask/face covering policies have been implemented in many other correctional settings. These include the Federal Bureau of Prisons, the California Department of Corrections, and the New York City Department of Corrections. These policies apply to all institutions even those which have not yet had cases or outbreaks. 25
21 https://pubs.acs.org/doi/abs/10.1021/acsnano.0c03252; https://www.foxnews.com/health/wearing-face-maskreduce-coronavirus-transmission-75-percent-study-shows; https://gh.bmj.com/content/bmjgh/5/5/e002794.full.pdf 22 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html 23 https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm 24 https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e1.htm 25 https://www.bop.gov/coronavirus/docs/correcting_myths_and_misinformation_bop_covid19.pdf https://www1.nyc.gov/site/doc/media/coronavirusap.page
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COVID-19 Prevention and Management at the Sacramento County Jail
COVID-19 can be transmitted into Sacramento County Jail in several ways; from admission of an infected detainee; infected visitors and volunteers26, and from infected staff members. Once introduced, subsequent transmission between inmates and staff is likely.
To its credit, Sacramento County Jail has taken measures to detect and prevent transmission of COVID-19 into the jail. This includes implementation of symptom screening of newly arriving inmates, COVID-19 testing for newly arriving and symptomatic inmates, quarantine of new arrivals, and medical isolation of infected inmates.
There is a “universal requirement” for healthcare staff at the Sacramento County Jail to wear masks in both patient care areas as well as in all non-patient care areas. This requirement is defined as “wearing a cloth face covering” (or surgical mask). Other, more extensive personal protective equipment is expected in some settings when greater risk is perceived. Face masks are considered part of “work attire” and healthcare staff are sent home to obtain their personal mask if they report without one (and are expected to use leave balance for the time involved). CDC guidance is cited in this policy.27
As of May 22, 2020, the Sacramento County Department of Health Services continued to recommend that the public wear face coverings outside of the home when adequate social distancing cannot be maintained.28
However, at the Sacramento County Jail there is currently no universal requirement for custody staff to wear face coverings. This ignores CDC recommendations and data from correctional facilities around the United States that correctional staff have been infected with COVID-19 and likely contribute to transmission within correctional facilities. It is also not consistent with practices of CDCR and other county jails (e.g., Alameda, Yuba, Riverside, Fresno, Contra Costa, Santa Clara, Santa Barbara, and San Bernardino).29
Sacramento County Jail asserts that “….CDC guidance on masking is that it should be done when social distancing is not possible….social distancing or separation by barriers is maintained between custody staff and the inmate population or the contacts are fleeting. Because this is the case, the Department is being consistent with the CDC guidance.”30 However, daily activities such as transporting inmates in vehicles, applying and removing handcuffs, unplanned use of force, etc. cannot assure that only “fleeting” encounters occur between staff and inmates. In addition, custody staff congregate together during shift changes and other activities that present a risk of infection to other staff. As noted earlier in this report, infectious particles can linger in the air for periods of time and the use of face masks has been demonstrated to reduce transmission. Consequently, CDC recommends social distancing and the use of face masks.
26 Currently, there are restrictions to visitors and volunteers. 27 Sacramento County Adult Correctional Health COVID-19 Staff Guidance, revised May 18, 2020 28 https://www.saccounty.net/COVID-9/Documents/2020-05-22 29 Letter to Rick Heyer re: Notice of Dispute. May 27, 2020. 30 Email correspondence from Rick Heyer to medical experts, 6/8/2020.
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Discussion and Opinions
COVID-19 is a highly infectious disease that is known to cause serious illness and death, particularly among persons with underlying medical conditions and those of older age. The Centers for Disease Control and Prevention have made recommendations to reduce transmission that include the use of face masks by inmates and staff. While CDC guidelines are not legal mandates, they represent expert, evidence-based medical recommendations regarding measures needed to limit the spread of COVID-19. There is no reasonable justification for lack of adherence to the recommendations.
The failure of Sacramento County Jail to require custody staff to wear masks presents a risk of correctional staff acquiring and transmitting COVID-19 infection within the jail and the community. This presents an immediate and ongoing risk of serious harm, including serious illness and death, to detainees and correctional staff at Sacramento County Jail, as well as the community at large.
Recommendations
1. The Sacramento County Jail should immediately come into compliance with the current CDC recommendations for Correctional and Detention Facilities regarding use of face masks/coverings by all staff in the facility.
2. The Sacramento County Jail should continue to implement other strategies to prevent introduction of COVID-19 infection into the facilities. They should also engage in an ongoing process of formal review and revision of their policies in regard to the COVID-19 epidemic in order to improve current practice and incorporate new expert recommendations as they become available.
3. The Sacramento County Jail should also ensure that appropriate face coverings are made available to all incarcerated persons in their custody at all times.
Respectfully Submitted,

Michael Rowe MD Date: June 8, 2020

Madeleine LaMarre MN, FNP-BC

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Aaron J. Fischer (SBN 247391) 1 Aaron.Fischer@disabilityrightsca.org
Anne Hadreas (SBN 253377) 2 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 3 1330 Broadway, Suite 500
Oakland, CA 94612 4 Telephone: (510) 267-1200
Fax: (510) 267-1201 5
Donald Specter (SBN 83925) 6 dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) 7 mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) 8 sophieh@prisonlaw.coom
PRISON LAW OFFICE 9 1917 Fifth Street
Berkeley, California 94710 10 Telephone: (510) 280-2621
Fax: (510) 280-2704 11

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com
Mark A. Zambarda (SBN 314808) mzambarda@cooley.com
Addison M. Litton (SBN 305374) alitton@cooley.com
COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

Attorneys for Plaintiffs 12

UNITED STATES DISTRICT COURT
13

EASTERN DISTRICT OF CALIFORNIA
14

SACRAMENTO DIVISION
15

16
LORENZO MAYS, RICKY 17 RICHARDSON, JENNIFER
BOTHUN, ARMANI LEE, and 18 LEERTESE BEIRGE on behalf of
themselves and all others similarly 19 situated,

20

Plaintiffs,

21

v.

22 COUNTY OF SACRAMENTO,

23

Defendant.

24

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) [PROPOSED] ORDER ) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) ) ) ) ) )

25

26

27

28

Case 2:18-cv-02081-TLN-KJN Document 120-2 Filed 06/24/20 Page 2 of 3

1

In light of the disruption to operations in the Sacramento County Jail facilities

2 (the “Jail”) caused by the COVID-19 pandemic, the parties previously agreed that it

3 was necessary to postpone scheduled on-site monitoring visits by the Court Experts

4 and Plaintiffs’ counsel as consistent with the Consent Decree and related orders in this

5 case. On April 30, 2020, the Court granted the parties’ request to extend the Court

6 Experts’ first monitoring report deadlines and directed the parties to file a status report

7 on or before June 24, 2020. Dkt. 119.

8

The parties have now submitted a Joint Status Report updating the Court as to

9 the status of monitoring pursuant to the Consent Decree given current circumstances,

10 and have proposed modifications to the timeline and parameters for completion of the

11 first monitoring reports by the Court Experts.

12

Having considered the parties’ Joint Status Report and good cause appearing, it

13 is hereby ordered that:

14

a) The Court Experts and Plaintiffs’ counsel who are able to travel to the

15 Jail for on-site monitoring will be permitted to do so, within modified parameters as

16 agreed upon by the parties and as consistent with operational and public safety needs

17 related to the COVID-19 pandemic.

18

b) Defendant will provide the Courts Experts and Plaintiffs’ counsel with

19 remote access to class members’ Jail electronic health records (including medical and

20 mental health records) to allow for remote individual records review.

21

c) The Court Experts and Plaintiffs’ counsel will request production of

22 individual class member Jail custody records as they deem necessary for their

23 monitoring role. Defendant will produce such records within seven (7) calendar days

24 of the request.

25

d) Defendant will arrange for a virtual tour of the facilities to accommodate

26 the Court Experts who are unable to do an on-site monitoring visit. The virtual tour

27 will be made available to all Court Experts and Plaintiffs’ counsel.

28

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1

e) Defendant will timely produce documents, data, and other information

2 requested by the Court Experts and Plaintiffs’ counsel.

3

f) The parties will work cooperatively to ensure that the Court Experts and

4 Plaintiffs’ counsel are able to conduct interviews of custody and health care staff and

5 confidential, voluntary interviews of class members.

6

g) The Court Experts will prepare a draft written report on Defendant’s

7 efforts to meet the terms of the Consent Decree, as set forth in the Court’s Order re:

8 Joint Request for Appointment of Court Experts (Dkt. 117, ¶ 4) no later than October

9 7, 2020.

10

h) The parties will provide written comments or objections to the Court

11 Experts’ draft reports no later than October 21, 2020.

12

i) The Court Experts will issue their final reports no later than October 28,

13 2020. The parties will promptly file a Joint Status Report with the final reports.

14

j) Where there is a conflict between the aforementioned provisions and the

15 provisions in the Court’s Order re: Joint Request for Appointment of Court Experts

16 (Dkt. 117), the provisions set forth above shall control for purposes of the first

17 monitoring report. All other provisions in the Court’s previous orders remain in

18 effect.

19

k) Absent further court order, the monitoring and reporting provisions set

20 forth in the Consent Decree and the Court’s Order re: Joint Request for Appointment

21 of Court Experts (Dkt. 117) will apply to all monitoring after completion of the first

22 monitoring reports.

23

IT IS SO ORDERED.

24

25 Dated: ___________
26 27

__________________________________ Hon. Kendall J. Newman UNITED STATES MAGISTRATE JUDGE

28

2

 
 Case 2:18-cv-02081-TLN-KJN Document 121 Filed 06/26/20 Page 1 of 3

Aaron J. Fischer (SBN 247391) 1 Aaron.Fischer@disabilityrightsca.org
Anne Hadreas (SBN 253377) 2 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 3 1330 Broadway, Suite 500
Oakland, CA 94612 4 Telephone: (510) 267-1200
Fax: (510) 267-1201 5
Donald Specter (SBN 83925) 6 dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) 7 mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) 8 sophieh@prisonlaw.coom
PRISON LAW OFFICE 9 1917 Fifth Street
Berkeley, California 94710 10 Telephone: (510) 280-2621
Fax: (510) 280-2704 11

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

Attorneys for Plaintiffs 12

UNITED STATES DISTRICT COURT
13

EASTERN DISTRICT OF CALIFORNIA
14

SACRAMENTO DIVISION
15

16
LORENZO MAYS, RICKY 17 RICHARDSON, JENNIFER
BOTHUN, ARMANI LEE, and 18 LEERTESE BEIRGE on behalf of
themselves and all others similarly 19 situated,

20

Plaintiffs,

21

v.

22 COUNTY OF SACRAMENTO,

23

Defendant.

24

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) [PROPOSED] ORDER ) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) ) ) ) ) )

25

26

27

28

Case 2:18-cv-02081-TLN-KJN Document 121 Filed 06/26/20 Page 2 of 3

1

In light of the disruption to operations in the Sacramento County Jail facilities

2 (the “Jail”) caused by the COVID-19 pandemic, the parties previously agreed that it

3 was necessary to postpone scheduled on-site monitoring visits by the Court Experts

4 and Plaintiffs’ counsel as consistent with the Consent Decree and related orders in this

5 case. On April 30, 2020, the Court granted the parties’ request to extend the Court

6 Experts’ first monitoring report deadlines and directed the parties to file a status report

7 on or before June 24, 2020. (ECF No. 119.)

8

The parties have now submitted a Joint Status Report updating the Court as to

9 the status of monitoring pursuant to the Consent Decree given current circumstances,

10 and have proposed modifications to the timeline and parameters for completion of the

11 first monitoring reports by the Court Experts.

12

Having considered the parties’ Joint Status Report and good cause appearing, it

13 is hereby ordered that:

14

a) The Court Experts and Plaintiffs’ counsel who are able to travel to the

15 Jail for on-site monitoring will be permitted to do so, within modified parameters as

16 agreed upon by the parties and as consistent with operational and public safety needs

17 related to the COVID-19 pandemic.

18

b) Defendant will provide the Court Experts and Plaintiffs’ counsel with

19 remote access to class members’ Jail electronic health records (including medical and

20 mental health records) to allow for remote individual records review.

21

c) The Court Experts and Plaintiffs’ counsel will request production of

22 individual class member Jail custody records as they deem necessary for their

23 monitoring role. Defendant will produce such records within seven (7) calendar days

24 of the request.

25

d) Defendant will arrange for a virtual tour of the facilities to accommodate

26 the Court Experts who are unable to do an on-site monitoring visit. The virtual tour

27 will be made available to all Court Experts and Plaintiffs’ counsel.

28

1

Case 2:18-cv-02081-TLN-KJN Document 121 Filed 06/26/20 Page 3 of 3

1

e) Defendant will timely produce documents, data, and other information

2 requested by the Court Experts and Plaintiffs’ counsel.

3

f) The parties will work cooperatively to ensure that the Court Experts and

4 Plaintiffs’ counsel are able to conduct interviews of custody and health care staff and

5 confidential, voluntary interviews of class members.

6

g) The Court Experts will prepare a draft written report on Defendant’s

7 efforts to meet the terms of the Consent Decree, as set forth in the Court’s Order re:

8 Joint Request for Appointment of Court Experts (ECF No. 117, ¶ 4) no later than

9 October 7, 2020.

10

h) The parties will provide written comments or objections to the Court

11 Experts’ draft reports no later than October 21, 2020.

12

i) The Court Experts will issue their final reports no later than October 28,

13 2020. The parties will promptly file a Joint Status Report with the final reports.

14

j) Where there is a conflict between the aforementioned provisions and the

15 provisions in the Court’s Order re: Joint Request for Appointment of Court Experts

16 (ECF No. 117), the provisions set forth above shall control for purposes of the first

17 monitoring report. All other provisions in the Court’s previous orders remain in

18 effect.

19

k) Absent further court order, the monitoring and reporting provisions set

20 forth in the Consent Decree and the Court’s Order re: Joint Request for Appointment

21 of Court Experts (ECF No. 117) will apply to all monitoring after completion of the

22 first monitoring reports.

23

IT IS SO ORDERED.

24 Dated: June 25, 2020
25

26

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 Case 2:18-cv-02081-TLN-KJN Document 128 Filed 10/07/20 Page 1 of 4

Aaron J. Fischer (SBN 247391) 1 Aaron.Fischer@disabilityrightsca.org
Anne Hadreas (SBN 253377) 2 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 3 1330 Broadway, Suite 500
Oakland, CA 94612 4 Telephone: (510) 267-1200
Fax: (510) 267-1201 5
Donald Specter (SBN 83925) 6 dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) 7 mmendelson@prisonlaw.com
Sophie Hart (SBN 321663) 8 sophieh@prisonlaw.coom
PRISON LAW OFFICE 9 1917 Fifth Street
Berkeley, California 94710 10 Telephone: (510) 280-2621
Fax: (510) 280-2704 11

Jessica Valenzuela Santamaria (SBN 220934) jvs@cooley.com Mark A. Zambarda (SBN 314808) mzambarda@cooley.com Addison M. Litton (SBN 305374) alitton@cooley.com COOLEY LLP 3175 Hanover Street Palo Alto, CA 94304-1130 Telephone: (650) 843-5000 Facsimile: (650) 849-7400
Attorneys for Plaintiffs

Attorneys for Plaintiffs 12

UNITED STATES DISTRICT COURT
13

EASTERN DISTRICT OF CALIFORNIA
14

SACRAMENTO DIVISION
15

16
LORENZO MAYS, RICKY 17 RICHARDSON, JENNIFER
BOTHUN, ARMANI LEE, and 18 LEERTESE BEIRGE on behalf of
themselves and all others similarly 19 situated,

20

Plaintiffs,

21

v.

22 COUNTY OF SACRAMENTO,

23

Defendant.

24

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) [PROPOSED] ORDER ) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) ) ) ) ) )

25

26

27

28

Case 2:18-cv-02081-TLN-KJN Document 128 Filed 10/07/20 Page 2 of 4

1

On April 27, 2020, the parties filed a Stipulation informing the Court that, in

2 light of the disruption to operations in the Sacramento County Jail facilities (the

3 “Jail”) caused by the COVID-19 pandemic, the parties agreed to postpone scheduled

4 on-site monitoring visits by the Court Experts and Plaintiffs’ counsel. The Court

5 granted the request to extend the deadlines and directed the parties to file a status

6 report on or before June 24, 2020. Dkt. 119.

7

On June 24, 2020, the parties filed a Joint Status Report, in which they

8 proposed a modified schedule for the Court Experts’ first Remedial Plan monitoring

9 reports, such that these reports would be submitted to the Court no later than October

10 28, 2020. On June 26, 2020, the Court issued an order approving the modified

11 schedule. Dkt. 121.

12

The parties have now submitted a Status Report and Stipulation on Court

13 Expert Monitoring Reports, informing the Court about their agreement for the Court

14 Experts on medical and mental health care to complete reports specifically related to

15 COVID-19 and about one medical expert’s resignation from the position of Court

16 Expert. In light of these developments, the parties have proposed further

17 modifications to the timeline and parameters for completion of the Court Experts’

18 monitoring reports.

19

Having considered the parties’ Status Report and Stipulation, and good cause

20 appearing, it is hereby ordered that:

21

1. COVID-19 Jail Assessment Reports

22

a) The Court Experts will prepare a draft written report on COVID-19

23

issues at the Jail no later than October 16, 2020.

24

b) The parties will provide written comments or objections to the Court

25

Experts’ draft reports no later than October 21, 2020.

26

27

28

1

Case 2:18-cv-02081-TLN-KJN Document 128 Filed 10/07/20 Page 3 of 4

1

c) The Court Experts will issue their final reports no later than October

2

26, 2020. The parties will promptly file a Joint Status Report

3

appending the final reports.

4

2. First Remedial Plan Monitoring Reports

5

a) The Court Experts will prepare a draft written report on Defendant’s

6

efforts to meet the terms of the Consent Decree, as set forth in the

7

Court’s Order re: Joint Request for Appointment of Court Experts

8

(Dkt. 117, ¶ 4) no later than December 16, 2020.

9

b) The parties will provide written comments or objections to the Court

10

Experts’ draft reports no later than December 30, 2020.

11

c) The Court Experts will issue their final reports no later than January

12

20, 2021. The parties will promptly file a Joint Status Report

13

appending the final reports.

14

3. Where there is a conflict between the aforementioned provisions and the

15

provisions in the Court’s Order re: Joint Request for Appointment of Court

16

Experts (Dkt. 117), the provisions set forth above shall control for purposes

17

of the first Remedial Plan monitoring report. All other provisions in the

18

Court’s previous orders remain in effect.

19

4. Absent further court order, the monitoring and reporting provisions set forth

20

in the Consent Decree and the Court’s Order re: Joint Request for

21

Appointment of Court Experts (Dkt. 117) will apply to all monitoring after

22

completion of the first Remedial Plan monitoring reports.

23

5. Plaintiffs’ counsel, consistent with their monitoring authority under the

24

Consent Decree and their role in reporting on Defendant’s compliance with

25

the components of the Remedial Plan pertaining to restrictive housing,

26

ADA/disability, and discipline and use of force for people with mental

27

health and intellectual disabilities (Consent Decree ¶¶ 23-24), will complete

28

2

Case 2:18-cv-02081-TLN-KJN Document 128 Filed 10/07/20 Page 4 of 4

1

and submit their first report on or before January 20, 2021. The report will

2

contain analysis regarding the seven class members who submitted letters to

3

the Court about their experiences in restrictive housing, as the Court has

4

directed (Dkt. 122).

5

6. Defendant will complete and file its first status report on its progress toward

6

compliance with the Consent Decree, as consistent with Paragraph 12 of the

7

Consent Decree, no later than October 5, 2020.

8
IT IS SO ORDERED.
9
10 Dated: October 6, 2020

11
/mays2081.ord5
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 Case 2:18-cv-02081-TLN-KJN Document 138 Filed 01/25/21 Page 1 of 3

Aaron J. Fischer (SBN 247391) 1 Aaron.Fischer@disabilityrightsca.org
Anne Hadreas (SBN 253377) 2 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 3 1330 Broadway, Suite 500
Oakland, CA 94612 4 Telephone: (510) 267-1200
Fax: (510) 267-1201 5
Donald Specter (SBN 83925) 6 dspecter@prisonlaw.com
Margot Mendelson (SBN 268583) 7 mmendelson@prisonlaw.com
PRISON LAW OFFICE 8 1917 Fifth Street
Berkeley, California 94710 9 Telephone: (510) 280-2621
Fax: (510) 280-2704 10
Attorneys for Plaintiffs 11
UNITED STATES DISTRICT COURT
12
EASTERN DISTRICT OF CALIFORNIA
13
SACRAMENTO DIVISION
14

15
LORENZO MAYS, RICKY 16 RICHARDSON, JENNIFER
BOTHUN, ARMANI LEE, and 17 LEERTESE BEIRGE on behalf of
themselves and all others similarly 18 situated,

19

Plaintiffs,

20

v.

21 COUNTY OF SACRAMENTO,

22

Defendant.

23

) Case No. 2:18-cv-02081 TLN KJN ) ) CLASS ACTION ) ) [PROPOSED] ORDER ) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) ) ) ) ) )

24

On April 27, 2020, the parties filed a Stipulation informing the Court that, in

25 light of the disruption to operations in the Sacramento County Jail facilities (the

26 “Jail”) caused by the COVID-19 pandemic, the parties agreed to postpone scheduled

27 on-site monitoring visits by the Court Experts and Plaintiffs’ counsel. The Court

28

Case 2:18-cv-02081-TLN-KJN Document 138 Filed 01/25/21 Page 2 of 3

1 granted the request to extend the deadlines and directed the parties to file a status

2 report on or before June 24, 2020. (ECF No. 119.)

3

On June 24, 2020, the parties filed a Joint Status Report, in which they

4 proposed a modified schedule for the Court Experts’ first Remedial Plan monitoring

5 reports, such that these reports would be submitted to the Court no later than October

6 28, 2020. On June 26, 2020, the Court issued an order approving the modified

7 schedule. (ECF No. 121.)

8

Given the urgency of the issues presented by the COVID-19 pandemic, the

9 parties subsequently jointly requested that the Court Experts on medical and mental

10 health care conduct “COVID-19 Jail Assessments” and produce reports with findings

11 and recommendations regarding risks, policies, and practices related to the COVID-19

12 pandemic before turning to their first monitoring reports. Those COVID-19 reports

13 were filed on October 27, 2020. (ECF No. 127-1.) Defendant filed a response on

14 December 8, 2020. (ECF No. 134.)

15

The parties have now submitted the first monitoring reports by the Court

16 Experts in this matter regarding medical care, mental health care, and suicide

17 prevention. (ECF Nos. 136-1, 136-2, 136-3.) The parties also have jointly requested

18 a modification to the deadlines for Plaintiffs’ class counsel monitoring reports

19 regarding compliance with the Remedial Plan’s restrictive housing and

20 ADA/disability provisions. (ECF No. 136.)

21

Having considered the parties’ joint Status Report and Stipulation, and good

22 cause appearing, IT IS HEREBY ORDERED that:

23

Plaintiffs’ counsel, consistent with their authority under the Consent Decree and

24 their role in monitoring Defendant’s compliance with the components of the Remedial

25 Plan pertaining to restrictive housing and ADA/disability, shall file their monitoring

26 reports as follows:

27

• Restrictive housing report to be filed by Feb. 26, 2021

28

1

Case 2:18-cv-02081-TLN-KJN Document 138 Filed 01/25/21 Page 3 of 3

1

• ADA/Disability report to be filed by March 26, 2021

2

IT IS SO ORDERED.

3 Dated: January 24, 2021
4

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/mays2081.exp.mon.1
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 Case 2:18-cv-02081-TLN-KJN Document 142 Filed 03/17/21 Page 1 of 5

1 Donald Specter (SBN 83925) dspecter@prisonlaw.com
2 Margot Mendelson (SBN 268583) mmendelson@prisonlaw.com
3 PRISON LAW OFFICE 1917 Fifth Street
4 Berkeley, California 94710 Telephone: (510) 280-2621
5 Fax: (510) 280-2704
6 Aaron J. Fischer (SBN 247391) ajf@aaronfischerlaw.com
7 2001 Addison Street, Ste. 300 Berkeley, CA 94704
8 Telephone: (510) 806-7366 Fax: (510) 694-6314
9
Anne Hadreas (SBN 253377) 10 anne.hadreas@disabilityrightsca.org
DISABILITY RIGHTS CALIFORNIA 11 1330 Broadway, Suite 500
Oakland, CA 94612 12 Telephone: (510) 267-1200
Fax: (510) 267-1201 13
Attorneys for Plaintiffs 14
UNITED STATES DISTRICT COURT 15
EASTERN DISTRICT OF CALIFORNIA 16
SACRAMENTO DIVISION 17

18

LORENZO MAYS, RICKY

) Case No. 2:18-cv-02081 TLN KJN

19 RICHARDSON, JENNIFER BOTHUN, )

ARMANI LEE, and LEERTESE BEIRGE ) CLASS ACTION

20 on behalf of themselves and all others

)

similarly situated,

)

21

) [PROPOSED] Order Appointing Court

Plaintiffs,

) Expert

22

)

v. 23
COUNTY OF SACRAMENTO, 24
Defendant. 25

) ) Judge: Hon. Kendall J. Newman ) ) Complaint Filed: July 31, 2018 ) )

) 26

27

28

Case 2:18-cv-02081-TLN-KJN Document 142 Filed 03/17/21 Page 2 of 5

1

The Consent Decree approved by the Court on January 13, 2020 (ECF No. 110), provides

2 for the appointment of Court Experts to carry out certain enumerated duties. The duties of the

3 Court Experts are set forth in Paragraphs 13 through 20 and in Exhibit B of the Consent Decree.

4

On March 9, 2020, the Court issued an order appointing four experts to advise the Court

5 on compliance with the Consent Decree. (ECF No. 117.) One of the medical experts has since

6 resigned the role, and the parties now seek the appointment of Karen Saylor, M.D., as a Court

7 Expert on medical care. Dr. Saylor and the previously appointed Court expert Madeline

8 LaMarre, MN, FNP-BC, will jointly monitor and report on medical care policies, procedures,

9 and practices.

10

In accordance with the Consent Decree and its remedial purposes, and pursuant to the

11 Court’s inherent power, IT IS HEREBY ORDERED that the motion for appointment of court

12 expert (ECF No. 141) is granted. The Court approves the appointment of Karen Saylor, M.D.,

13 as Court Expert regarding medical policies, procedures, and practices. Defendant will pay Dr.

14 Saylor in the amount of $350 per hour for work performed and $175 per hour for time spent

15 traveling, and will reimburse reasonable associated costs of professional services, including

16 travel expenses.

17

The Court Expert shall provide Defendant with a written itemization of the claimed fees

18 and costs, itemized by date, amount of time spent, and task, as well as records and bills

19 evidencing the costs claimed, on a quarterly basis or at an alternative interval as agreed upon by

20 Defendant and the Court Expert. Invoices will be provided to all parties for review before

21 payment.

22

Rule 706(b) of the Federal Rules of Evidence requires the Court to “inform the expert of

23 the expert’s duties.” Id. IT IS FURTHER ORDERED that the Court Expert shall have the

24 responsibilities, powers, and protections set forth in the Consent Decree and in the Court’s

25 previous Order appointing experts (ECF No. 117). The Court Expert’s powers and

26 responsibilities include the following:

27

1. Pursuant to Rule 706 of the Federal Rules of Evidence, the Court Expert shall advise

28

Case 2:18-cv-02081-TLN-KJN Document 142 Filed 03/17/21 Page 3 of 5

1 the parties and the Court on Defendant’s compliance or non-compliance with each material

2 component of the Remedial Plan within their respective area of expertise, will assist with dispute

3 resolution matters, and will provide testimony, if required, in any proceedings before the Court.

4

2. In intervals of 180 days, during the term of the Consent Decree, the Court Expert shall

5 complete a comprehensive review and report (“180-Day Report”) to advise the parties and the

6 Court on Defendant’s compliance or non-compliance with each material component of the

7 Remedial Plan within the expert’s subject matter area.

8

3. In each 180-Day Report, the Court Expert shall state their opinion as to whether

9 Defendant is or is not in substantial compliance with each material component of the Remedial

10 Plan within their area of expertise (i.e., “Substantial Compliance Determinations”). The 180-Day

11 Reports shall be considered separate and apart from any evaluations and reports prepared as part

12 of the dispute resolution process set forth in the Consent Decree and shall be admissible in

13 evidence in any proceedings before the Court.

14

4. Each Court Expert will prepare a draft written report on Defendant’s efforts to meet

15 the terms of the Consent Decree within thirty (30) days of the later of the expert’s site inspection

16 and the expert’s receipt of all requested documents and information, and in no case later than

17 forty-five (45) days after the inspection. The draft report will be delivered to all parties. If the

18 Court Expert concludes that Defendant has not substantially complied with any provision or

19 provisions of the Consent Decree, the Court Expert shall make recommendations as to actions

20 they believe to be necessary to achieve substantial compliance.

21

5. The parties will have thirty (30) days to provide written comments or objections, or to

22 cure identified issues, and seven (7) days to reply. The Court Expert may re-inspect facilities or

23 documents, or conduct additional interviews, before issuing a final report. Final reports shall be

24 due twenty (20) days after the later of the Court Expert’s receipt of any comments, objections or

25 replies, or any additional assessments.

26

6. In preparing reports, the Court Expert shall identify all sources of information relied

27 upon for facts and recommendations. If the source of information is an interview or

28

Case 2:18-cv-02081-TLN-KJN Document 142 Filed 03/17/21 Page 4 of 5

1 conversation, whether with staff, another Court Expert, or any other person, the Court Expert

2 shall identify the person who is the source of the information. If the source of information is a

3 class member, the Court Expert shall identify the class member in a separate confidential

4 document that is provided to counsel for the parties. If the source of the information is a

5 document, the Court Expert shall make the document(s) available to counsel for all parties, or

6 identify the document(s) in a manner that makes it accessible to all parties.

7

7. With appropriate notice, the Court Expert shall have reasonable access to all parts of

8 any Sacramento County jail facility. Access to the facilities will not be unreasonably restricted.

9 The Court Expert shall have access to custody and health care staff and people incarcerated in

10 the jails, including confidential and voluntary interviews as they deem appropriate. The Court

11 Expert shall also have access to documents, including budgetary, custody, and health care

12 documents, and institutional meetings, proceedings, and programs to the extent the Court Expert

13 determines such access is needed to fulfill their obligations. The Court Expert’s tours shall be

14 undertaken in a manner that does not unreasonably interfere with jail operations as reasonably

15 determined by jail administrators.

16

8. The Court Expert shall have reasonable access to individual health records, including

17 mental health records, and custody records.

18

9. If the Court Expert requests to review any documents in conjunction with a site visit,

19 Defendant will provide these documents to the extent feasible no later than twenty (20) days

20 prior to the visit.

21

10. During the Court Expert’s first site inspection of the Jail, the parties shall have the

22 right to have counsel present during the tour. All subsequent tours conducted by the Court

23 Expert shall be conducted without counsel present, unless the parties agree good cause exists for

24 counsel to observe the subsequent tours. If the parties cannot agree on the necessity for counsel

25 to be present on subsequent tours by the Court Expert, they shall submit the matter to Magistrate

26 Judge Cousins (or his designee) for decision.

27

11. The Court Expert shall be provided with and agree to be bound by any protective or

28

Case 2:18-cv-02081-TLN-KJN Document 142 Filed 03/17/21 Page 5 of 5

1 Court orders entered in this case.

2

12. The Court Expert may engage in ex parte communications with the parties. However,

3 all of the Court Expert’s findings and recommendations shall be set forth in writing in their

4 reports.

5

13. The Court Expert may engage in ex parte communications with each other. The

6 Court Expert may engage in ex parte communications with the designated dispute resolution

7 judge, Magistrate Judge Cousins, or his designee if he is not available. The Court Expert shall

8 not engage in ex parte communications with the Court.

9

14. Pursuant to the dispute resolution procedures set forth in the Consent Decree, either

10 party may request that the relevant Court Expert evaluate an issue in dispute and prepare a

11 report. The expert must provide the report regarding the area of disagreement to the parties and

12 Magistrate Judge Cousins (or his designee) within forty-five (45) days of the request. Defendant

13 will pay the Court Expert’s reasonable fees for any reports prepared at the request of a party

14 about a disputed issue.

15

15. The Court Expert shall be available to meet jointly with the parties in person or by

16 telephone in a manner that is reasonable and convenient for the purpose of resolving disputes

17 between the parties.

18

16. At the request of the Court, the Court Expert shall attend any negotiations, mediation

19 sessions, or court hearings.

20

17. If a Court Expert becomes unavailable to fulfill the duties set forth in this Order, the

21 parties will meet and confer, and propose to the Court a new expert to monitor compliance with

22 the Consent Decree for the respective areas of expertise. The parties may agree at any time to

23 remove and replace a Court Expert.

24 Dated: March 17, 2021 25

26 /mays2081.exp.141 27

28