17" May 2017' SUBJECT: ICE request for detainee timeline for Jean Carlos Jimenez Joseph, alien number 204603723, at Stewart Detention Center PURPOSE The purpose of this memorandum is to respond to the May 17', 2017 request from ICE for a time- line outlining the detainee?s medical care while housed at the Stewart Detention Center. BACKGROUND Mr. Jean Carlos Jimenez Joseph arrived at Stewart Detention Center on 7 March 2017, and was evaluated by a nurse. He was immediately placed on one on one observation and started back on Risperidone, a mental health medication. On 8 March 2017', the detainee was evaluated by a physician and a Licensed Clinical Social Worker (LCSW) and subsequently the one to one observation was stepped down until he was released to the general population on 9 March 2017'. On 20 March 2017, the detainee was evaluated by a via however, due to limited availability of the for the follow-up appointment had to be rescheduled in order to accommodate a detainee with a more acute mental health issue. The follow?up appointment was rescheduled for the morning of 15 May 2017; however, the detainee committed suicide on 15 May 2017, a few hours prior to the rescheduled appointment. Stewart Detention Center? 5 staffing plan currently calls for three mental health providers and one however, at the time of this incident only two LCSW were on staff and of those two, one was on maternity leave. The facility has available services to assist in the interim until the vacant positions can be filled. As of the time of this writing, Stewart Detention Center has two additional starting on 22 May 2017, and is in the process of revising a position description to allow for a nurse practitioner to fill the role of the vacant position on the current staf?ng plan. Prescribed Medications Albuterol Sulfate HFA Risperidone Docusate Sodium Flunisolide Nasal Solution Medieoi History Suicidal ideation Suicide attempt by history Schizoaffective disorder, bipolar type Cannabis abuse, uncomplicated For O?ic'ioi Use (Univ This document contains pre?riecisionoi arid/or rieiiberottve process information mandatory tiisetosore under the Freedom ofinfomiotiort Act, 5 US. C. 55209) 5 1. Do not reieose without prior oppro mi of U. S. immigration and Customs EtgForeemem, ICE Heoim Service Corps. 201 B-ICLI-00023 168 Unspeci?ed asthma, uncomplicated Allergic rhinitis DISCUSSION On 7 March 2017, Mr. Jimenez Joseph arrived at Stewan Detention Center and was screened in by a nurse who noted the detainee had a history of suicide attempts and had made a statement during the exam that he wanted to hurt himself. The note also indicates he had a history of at least one prior suicide attempt, and was on Risperidone 0.5mg at bedtime; however, he had not taken any medication on the date of arrival and did not arrive with any medication. The nurse called the on-call behavioral health provider who approved the detainee to be placed on one to one observation and given a suicide smock and blanket due to his voicing concerns of hurting himself. The detainee was also continued on Risperidone 0.5mg at bedtime by a nurse practitioner. The nurse also notified the medical doctor of the detainee?s condition. On 8 March 2017, the detainee was evaluated by a physician and provided a physical exam. The physician diagnosed him with suicidal ideations and asthma. The detainee was also evaluated by a Licensed Clinical Social Worker (LCSW) who noted the detainee had a history of suicide attempts, schizoaffective disorder, bipolar type, and history of Cannabis abuse, uncomplicated. The note indicates the detainee denied having any suicidal thoughts or wanting to harm himself on 8 March 2017. The one on one observation was discontinued and the detainee was placed on mental health observation. On 9 March 2017, the detainee was evaluated by a physician and a LCSW who noted the detainee was feeling really good and the absence of suicidal ideations and hallucinations (last voices heard "a few weeks ago"). The detainee stated that he had been sleeping and eating fine and was "ready to get out of here to the population and recreation today.? The mental health observation was discontinued and the detainee was released to general p0pulation. The note indicated the detainee would be followed?up with behavioral health. Onl4 March 2017, the detainee was followed up by the LCSW who noted the detainee was stable with unremarkable mental status exam. The detainee denied having any current thoughts of wanting to harm self or others or hallucinations. On 20 March 2017, the detainee was evaluated by a The indicted he would be followed up in three to four weeks. On 23 March 2017, the detainee requested a sick call appointment; however, did not report to the sick call area when called. On 6 April 2017, the detainee requested sick call for blisters on his feet from playing basketball without shoes. The detainee also requested copies of his medical records from other facilities. The detainee was examined and advised to check feet daily for signs of infection, wear shoes while playing basketball and to refrain from playing basketball until wounds were healed. For Of?oad Use Only. This documem contains pre-cfecfsionn.? andfor defiberarrve process mandatory disclosure under the Freedom offnfomzarron Act, 5 C. 552(1)) Do not rerease without prior oppro vat! of U. S. Immigran'on and Customs Ergforcemem, ICE Hermie Service Corps. 201 B-ICLI-00023 169 On 11 April 2017, the detainee was evaluated for a follow-up mental health check-up. The note indicates he was still experiencing intermittent auditory and visual hallucinations. The practitioner indicated he was stable with an unremarkable mental status examination as the detainee had denied having any current thoughts of wanting to harm self or others or hallucinations. The note indicates he was scheduled to have visit on 24 April 2017. On 13 April 2017, the detainee was evaluated by medical for a segregation clearance. The note indicates the detainee had been in an altercation with another detainee. The detainee was calm and cooperative. The detainee denied suicidal and homicidal ideations and auditory and visual hallucinations. The detainee was cleared for segregation. On 14 April 2017, the detainee was evaluated by a LCSW during weekly segregation rounds. The note indicates the detainee was not suicidal and had no current active On 19 April 2017, the detainee was evaluated by a nurse practitioner (NP) for the complaint of abdominal pain. The NP examined the detainee and diagnosed him with nausea, periumbilical pain, allergic rhinitis and schizoaffective disorder (bipolar type). The NP prescribed HCL, Docusate Sodium, Flunisolide Nasal Solution and one dose of Promethazine HCL. On 24 April 2017, the detainee was scheduled to be evaluated by a via video teleconference; however, the appointment was rescheduled to 13 June 2017, to accommodate a detainee with a more acute mental health issue. On 25 April 2017, the detainee was followed up by a NP for a medication check. The note indicates the detainee was seen sitting in the waiting area when he jumped up out of his seat repeatedly stating he was "Caesar of the Romans." The note also indicates the detainee reported ?hearing voices during the night which was voices of the Romans telling him to commit suicide.? Patient also indicted that the ?voices did not tell him what to do or how to kill himself.? The detainee stated he did ?not have a desire to harm himself or anyone else.? The patient indicted he thought he needed stronger medications. The note indicates he has a future appointment with follow-up appointment with the On 25 April 2017, the detainee was also followed up by a LCSW for the auditory hallucinations described above. The noted indicated the detainee stated that the voices were familiar female and male voices that ?usually tell me I am brilliant but, this time, they were telling me that I was basic like everybody else here and that I should just kill myself." The note also indicated the detainee ?vehemently denied active suicidal or homicidal ideation stating.? The detainee stated don?t want to hurt myself or anybody but 1 did have those thoughts during that dream." The note further states the detainee reported the last suicidal ideations were "a while ago, like when I ?rst got here." The note indicates the detainee was stable and not in need of MHU or acute care admission. The LCSW was able to reschedule the detainee?s 13 June 2017 to an earlier appointment on 15 May 2017. On 27 April 2017, the detainee was cleared by a nurse to be hosed in segregation. For Official Use Only. This docimiem contains pre-aecisional andfor deliberaiive Jorocess erempifrom mandoioiy disclosure under the Freedom Aci, 5 C. 55209) Do not release without? prior approval of US. immigraiion and Customs ErgForcemem, ICE Health Service Corps. 201 B-ICLI-00023 170 On 01 May 2017, the detainee was evaluated by a LCSW for weekly segregation mental health rounds. The note indicates the detainee was not suicidal and had no current active On 2 May 2017' the detainee was evaluated by a LCSW due to the detainee verbalizing a desire to cut self to detention staff in restricted housing area. The note indicates the detainee was ?laughing, talking and smiling inappropriately throughout this session endorsing having made the statement (?but I was referring to last week when I was brought to seg. I got wrote up for jumping off the second tier and, when she asked why I said I wanted to hurt The note also indicates the detainee was "being tormented by voices and sounds day in and day out. They know my thoughts, my sound and my every move. They know everything about me and they keep pushing me to do things but I?m not suicidal or homicidal." The note also indicated that the detainee stated was playing too much and really was hearing voices but I know I could have thought about what I was doing instead of just doing that stuf The note indicates the tele- list would be reviewed to determine if he could be seen sooner than 15 May 2017'. On 10 May 201?, during routine nursing rounds in segregation the nurse noted the ?detainee was observed standing on the toilet, beating on the wall. When approached and asked what was going on, detainee expressed hearing voices, stating ?They keep trying to control my every move, my drawing, my thinking, all of my actions.? When asked if they were wanting him to harm himself or others, he initially stated He stated, am just fucking tired of hearing these voices, they keep trying to control every fucking move and it is annoying as fuck.? Detainee also mentioned, told* that my medication needs to be increased, she has yet to get around to doing it.? In the midst of having this conversation, detainee began punching the wall again, yelling ?just leave me the fuck alone.? When asked again if the voices wanted him to harm himself or anyone, detainee stated, ?yeah, they want me to commit suicide because the peOple here are simple, but I don?t want to harm myself or anyone else.? The detainee was informed that a message would be sent to inquire more about having his medication dosage increased and to notify the nurse if suicidal thoughts gets worse or he began wanting to harm himself.? On 10 May 2017, following the above interaction with the nurse, the detainee was evaluated by a LCSW for weekly segregation rounds. The note indicated the detainee was ?lying in bed when this writer approached his cell.? The note also indicates the detainee was not suicidal and had no current active On 15 May 2017 the detainee was found in his cell unresponsive after he had hung himself with a sheet. CPR was started immediately and EMS was activated. EMS arrived and subsequently transported him to a local hospital where the detainee was pronounced deceased at 0215. The detainee was evaluated everyday by nurses while he was in segregation and all of the notes, except for 10 May 2017 (outlined above) indicated the detainee denied any suicidal thoughts, including nursing rounds on 14 May 2017. For Official Use Only. This documenr contains pre-clecisionol ondfor deliberorive process informoriorr mondorory disclosure under the Freedom oflnfomzorion Act, 5 US. C. 552(b) Do not release without prior oppro vol of U. S. lmmigrorion and Customs ErgForeemem, ICE Healrli Service Corps. 201 17"1 IMPRESSION Mr. Jean Carlos Jimenez Joseph arrived at Stewart Detention Center on 7 March 2017, and was evaluated by a nurse. He was immediately placed on one on one observation and started back on Risperidone. On 8 March 2017', the detainee was evaluated by a physician and a Licensed Clinical Social Worker (LCSW) and medical observation status stepped down until he was released to the general population on 9 March 2017. Since his arrival the detainee had been evaluated by a however, due to limited availability of the for tele- the follow-up appointment had to be rescheduled in order to make room for a detainee with a more acute mental health need. Additionally, there were missed opportunities to possibly provide additional intervention on 2 and 10 May 2017; however, even if interventions were taken on these dates they may or may not have altered the outcome. Stewart Detention Center?s staf?ng plan currently calls for three mental health providers and one however, at the time of this incident only two LCSW were on staff and of those two, one was on maternity leave. The facility has available services to assist in the interim until the vacant positions can be filled. As of this time, Stewart Detention Center has two additional starting on 22 May 2017 and is revising a position description on their current staffing plan to allow for a nurse practitioner to fill the role of the vacant position. For O?iciol Use Only. This corttaitts pre-clecisional andfor deliberative Jorocess mandatory disclosure antler the Freedom Act, 5 US. C. 552(b) 5 J. Do not release without prior approval of US. immigration and ICE Health Service Corps. 201 17"2