-, 

US. Department of Justice
Civil Rights Division

 

 


DJ 168?30?22

Special Litigation Seam): - PHB
- 950 Pewlvanfa Avenue, NW
DC 20530

January 30, 2009

Via Electronic and Regular Mail

The Honorable Joe Taylor

Grant County Attorney

101 North Main Street
Williamstown, KY 41097

Re: Resolution of the Grant Countv Detention
Center CRIPA Investigation

Dear 1r. Taylor:

We appreciate the opportunity we had to meet with you, and
then?County Attorney Jack Gatlin, during our November l2?13, 2008

'tour of the Grant County Detention Center As you know,

the Special Litigation Section has been conducting an ongoing
investigation of the Grant County Detention Center under
the Civil Rights of Institutionalized Persons Act 

42 U.S.C. 1997. We notified Grant County (?County?) of our
intent to investigate the conditions of confinement at GCDC on
November 4, 2003, and issued our first findings on May 18, 2005.
Since issuing our findings, we.have been engaged in-the process
of cooperatively working with the County to fashion an 
appropriate resolution to outstanding issues-from the
investigation. Indeed one of the purposes of our most recent .
tour was to further facilitate that process. In this letter, we
write to recommend further technical assistance (through the
provision of our expert?s report (attached)) and to set forth a
proposed resolution to the Department of Justice?s 
investigation. - -

 

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As an initial matter, we wish to express our appreciation to
you and other County officials for the hospitality and
professionalism we received during our tour. We likewise
received complete cooperation from.GCDC staff and administrators
while we were on.site, and are pleased to see a number of
important improvements at GCDC.1

As we discussed during our exit debriefing with you and GCDC
officials, notwithStanding the improvements noted above, we have
a few areas of_remaining concern regarding the County?s provision
of medical care. During our Nevember 2008 tour, the County
indicated that it had assessed its medical care practices,
considering, in part, our recommendations, and found areas that
require remedial improvement. The County further indicated that
it was in the process of correcting those deficiencies. We
applaud the County for this effort. Based on the County?s good
faith assurances to remediate these areas, we believe these areas
require limited future oversight. To that end, we believe that
two additional tours, one per year, will be sufficient to
determine that all of our remaining concerns are met. Should the
County address our concerns sooner than two years it can notify
us and we will verify the County?s compliance. We will 
thereafter consider this matter closed.

We are confident that memorializing our agreement in this
letter, coupled with your affirmative reply, will adequately suit
both our concerns. We believe that the implementation of the
following remedial measures will assist in our mutual goal of
ensuring that the County provides constitutional medical care to.
those it is entrusted to protect:

la The County will continue to ensure the adequate I
identification of, and provide adequate services to addressL
the serious medical and mental health needs of all inmates
regardless of ability to pay.

The County will continue to provide sufficient onwsite
physician, mental health care provider, and nursing staff to
ensure adequate medical care (including chronic and acute

 

1 For example, we were pleased to find that the County
has developed and implemented comprehensive written policies and
procedures governing medical, dental and mental health care that
conform with generally accepted correctional standards. In
addition, we were pleased to confirm that, with few, isolated
exceptions, the County conducts initial clinical health screens
of all inmates within 14 days after intake.

 

 

3 

care). The County also will continue to provide sufficient
on?site physician staffing to adequately supervise nursing
staff.

The County will continue to evaluate the adequacy of all
medical and mental health policies and procedures on a
regular basis and, where necessary, make revisions to
address any gaps identified.

The~County will continue to provide for initial clinical
health screenings by health services staff for new inmates
and inmates transferring from other correctional'
institutions within twenty four (24) hours of each inmate's
arrival at the facility. The County will ensure that health
services staff performing initial health screenings are
trained to complete the assessments. For this initial
health screening, health services staff record and seek the
inmates' cooperation to obtain: (1) medical, surgical, and
mental health history, including current or recent
medications; (2) current injuries, illnesses, evidence of
trauma, and vital signs, including recent alcohol and 
substance use; (3) history of substance abuse and treatment;
(4) pregnancy; (5) history and of communicable
disease; (6) suicide risk history; and (7) history of mental?
health treatment, including medication and hospitalization.
Health services staff also will attempt to elicit the
amount, frequency and time of the last dosage of medication
from every inmate reporting that he or she is currently or
recently on medication, including medication.
This initial health screening information will be made a
part of an inmate?s medical record.

The County will continue to conduct fourteen-day health
assessments and examinations and will make appropriate
referrals for treatment or evaluation. As part of the
fourteen?day health assessment, the County will screen
inmates for infectious diseases. The health assessment will.
include a review of the results of the intake screening, the
collection of a complete medical and mental health history,
a physical examination, and testing for tuberculosis and
sexually transmitted diseases, if warranted, unless a
physician determines that this testing is not necessary.

The County will continue to ensure that inmates are seen by
health services staff in a timely manner after submission of
a sick call slip.

 

10.'

ll.

12.

13.

4 -

The County will continue to ensure that all inmates with
serious or potentially serious acute medical conditions
receive necessary examination, diagnosis, monitoring, and--
treatment, including referrals to appropriate outside
medical professionals when clinically indicated.

The County will continue to implement appropriate clinical
guidelines for chronic diseases such as HIV, hypertension,
diabetes, asthma, elevated lipids, and mental illnesses.

The County will continue to ensure that inmates with chronic
illnesses, including mental illnesses, receive necessary
examination, diagnosis,'monitoring, and treatment. The
County will provide and document routine tests and follow-up
appointments.

The County will continue to provide appropriate special
medical diets when medically required. -

The County has contracted with a mental health care provider

- to provide all services for inmates' mental health

.treatment. The County will continue to ensure that the?
mental health'care provider will continue to 
perform a comprehensive mental health evaluation of any
inmate whose history or responses to initial screening
questions indicate a need for such an evaluation. The
County will continue to ensure that all other inmates
receive a comprehensive mental health evaluation within
thirty (30) days of arrival. The comprehensive mental
health evaluation shall include, if indicated, a recorded
diagnosis section Conforming to generally accepted
professional standards.

The County will continue to provide appropriate mental
health treatment to any inmate whose evaluation indicates a
serious mental health condition that requires such
treatment. The County will continue to make timely and
appropriate referrals for speciality care. Where possible,
and.where consistent with security concerns, the County will
provide an appropriate confidential environment for
testing and counseling. 

The County will continue to provide sufficient on?site

staffing by mental health care providers to ensure adequate
mental health care, including having a 
appropriately involved in the presdribing of 
medications:

 

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o_5_ 

14. The County will continue to ensure that appropriate
evaluations are conducted any 
medications are prescribed or changed. 

15. The County will continue to ensure that an appropriate
individual mental health treatment plan is prepared in a
timely manner by a mental heath care provider for each
inmate requiring treatment for mental illness.

16. The County will continue to maintain on?site complete,
confidential, and appropriately organized medical and mental
health records for each inmate. The County will continue to
ensure that such records include sufficient information
(including the results of physical'evaluations,
and medical staff progress notes) to ensure that health
services staff have all relevant information available when
treating inmates. 

stir-k 

. We wish to remind the County, as we have previously

discussed, that no person or entity is intended to be a

third?party beneficiary of the provisions of this Agreement for

purposes of any civil, criminal, or administrative action.

Accordingly, no person or entity may assert any claim or right as

a beneficiary or protected class under this Agreement. This?

Agreement is not intended to impair or expand the right of any

person or organization to seek relief against Grant County or its

officials, employees, or agents for their conduct; accordingly,
this Agreement does not alter legal standards governing any such
claims, including those under Kentucky law. 

To facilitate the efficient conclusion of this
investigation, we request that the County maintain sufficient
records to document its compliance with all requirements of this
agreement. If you have any questions or concerns, please do not
hesitate to contact me at 202?514?0195, or Section attorneys 
Cathleen Trainor at (202) 616-9009, or Sheridan England at
(202) 616u2249. 

?l


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If you agree, we would appreciate a response within two
weeks of your receipt of this letter. Please indicate you
acceptance of this Agreement signing below. 

   
  

494/07?

Hanetta Y. Cutlar - DATE
Chief

Special Litigation Section
202-514-0195

 

AGREED:

 

Joe Taylor DATE
Grant County Attorney 

Enclosure