Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 1 of 58 Page ID #:25 1 2 3 4 5 6 7 8 9 LORETTA E. LYNCH Attorney General MARK J. KAPPELHOFF Deputy_ Assistant Attorney General Civil Rights Division JUDITifC. PRESTON ActjQg Chief SQecial Litigation Section LAURAL. COON, SQecial Counsel, SQecial Litigation Section LUISE. SAUCEDO, Counselor to the Chief, Special Litigation Section CATHLEEN S. TRAINOR Trial Attorneys U.S. Department of Justice Civil Rights Division, Special Lit!gation Section 950 Pennsylvania Avenue, N.W., PHB 5026 Washington, D.C. 20530 TeleP,hone: (202) 514-6255 Email: laura. coon@usdoj.gov; cathleen. trainor@usdoj .gov l O EILEEN M. DECKER 11 17 United States Attorney_ LEON W. WEIDMAN Assistant United States Attorney Chief Civil Division ROBYN-MARIE LYON MONTELEONE (State Bar No. 130005) Assistant United States Attorney Assistant Division Chief, Civil Rights Unit Chief, Civil Division JOANNA HULL (State Bar No. 2'17153) Assistant United States Attorney 300 North Los Angeles Street, Suite 7516 Los Angeles, California 90012 Telephone: (213) 894-2458/6585; Facsimile: (213) 894-7819 E-mail: Robby.Monteleone@usdoj.gov; Joanna.Hull@usdoj.gov 18 19 Attorneys for Plaintiff UNITED STATES OF AMERICA 12 13 14 15 16 20 21 22 23 24 25 26 27 28 MARY C. WICKHAM Interim County Counsel RODRIGO A. CASTRO-SILVA (SBN 185251) Senior Assistant County Counsel BRANDON NICHOLS (SBN 1871 88) Assistant Count_y Counsel KAREN JOYNT (SBN 206332) Depu!J' County Counsel 648 Kenneth R ahn Hall of Administration 500 West Temple Street Los Angeles California 90012 Tel: (2I3) 974-1811 Fax: (213) 626-7446 Email: rcastro-silva@counsel.lacounty.gov bnichols@counsel.lacounty.gov kjoynt@counsel.lacounty.gov 1 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 2 of 58 Page ID #:26 1 2 3 Attorne_ys for Defendants COUNTY OF LOS ANGELES and LOS ANGELES COUNTY SHERJFF JIM MCDONNELL, in his Official Capacity 4 UNITED STATES DISTRICT COURT 5 FOR THE CENTRAL DISTRICT OF CALIFORNIA 6 WESTERN DIVISION 7 8 9 10 Plaintiff, 11 v. 12 13 COUNTY OF LOS ANGELES AND LOS ANGELES COUNTY SHERIFF JIM MCDONNELL, in his Official Capacity, 14 JOINT SETTLEMENT AGREEMENT REGARDING THE LOS ANGELES COUNTY JAILS; AND STIPULATED fPROPOSED] ORDER OF RESOLUTION Defendants. 15 16 17 18 CV No. 15- 5903 UNITED STATES OF AMERICA, I. 1. INTRODUCTION The United States of America, acting through the United States 19 Department of Justice ("United States"), the County of Los Angeles ("County") 20 and Sheriff Jim McDonnell, in his official capacity ("Sheriff'), (collectively, the 21 "Parties") share a mutual interest in treating all members of the community with 22 respect, promoting safe and effective custodial care, protecting public safety, and 23 upholding the constitutional rights of prisoners. 24 25 2. 1 The Los Angeles County Jails ("Jails") are an integral part of the public safety system in Los Angeles County, California. Together, the Jails form 26 27 28 "Prisoners" is a defined term in Section III of this Agreement and includes pre-trial detainees and individuals convicted of a criminal offense. 2 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 3 of 58 Page ID #:27 1 the largest jail system in the nation and house among the highest populations of 2 prisoners with mental illness . .Maintaining these facilities is an immensely 3 complex enterprise -- approximately 15,500 to 19,500 prisoners are held in custody 4 daily, spread across multiple custody facilities, numerous patrol stations, and over 5 29 courthouses. These facilities' primary function is to incarcerate individuals 6 accused or convicted of committing a crime. In doing so, these facilities provide 7 food, shelter, and clothing, but must also address the serious medical and mental 8 health needs of the prisoners and ensure their reasonable safety. 9 3. The United States acknowledges that the County and the Sheriff have 10 demonstrated a renewed commitment to reforming the Jails and have begun to 11 implement improved policies and practices designed to enhance the treatment and 12 care of prisoners with mental illness. The County and the Sheriff are also 13 exploring strategies to safely divert individuals with mental illness from the 14 criminal justice system, whenever possible. The United States further 15 acknowledges that the number of suicides at the Jails decreased in 2014 from the 16 previous year. In addition, the County and the Sheriff have made significant 17 commitments to protect prisoners from abuse and excessive force by staff that 18 further the Parties' mutual interest. Finally, the United States acknowledges that 19 some of the needed changes the County and the Sheriff seek to implement through 20 this Agreement will require the allocation of additional resources to the Sheriffs 21 Department and the Los Angeles County Department of Mental Health ("DMH"). 22 4. Accordingly, this Joint Settlement Agreement Regarding the Los 23 Angeles County Jails ("Agreement") is intended to build upon measures that are 24 underway and to sustain systemic improvements that are designed to protect 25 prisoners from conditions in custody that place them at unreasonable risk of harm 26 from suicide, self-injurious behavior, or unlawful injury by others, in accordance 27 with their constitutional rights. This Agreement also is expected to have collateral 28 benefits that promote public safety, improve confidence in the County's criminal 3 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 4 of 58 Page ID #:28 1 justice system, and support the County's and the Sheriffs collaborative efforts to 2 expand comprehensive and effective mental health diversion and re-entry programs 3 that are designed to lead to more positive outcomes in the care and custody of 4 individuals with serious mental illness who are also participants in the criminal 5 justice system. II. 6 7 5. BACKGROUND The County owns and funds the operations of the Jails. The Sheriffs 8 Department is responsible for providing care, custody, and control of prisoners at 9 the Jails. The Sheriffs Department Medical Services Bureau provides medical 10 care within the.Jails. DMH is responsible for providing mental health care in the 11 Jails through its Jail Mental Health Services program. 12 13 14 6. The Sheriff is an elected official who is responsible for operating and exercising authority over the Jails. 7. In June 1996, the Department of Justice notified the County and 15 Sheriff that it was opening an investigation under the Civil Rights of 16 Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, to determine whether 17 the conditions in the Jails violate the constitutional rights of its prisoners. 18 8. In September 1997, the Department of Justice issued a findings letter 19 alleging that mental health care at the Jails violated prisoners' constitutional rights. 20 The letter further alleged that systemic deficiencies contributed to the violations, 21 including inadequate: (1) intake screening and evaluation; (2) diagnosis; (3) 22 referral to mental health professionals; (4) treatment plans; (5) administration of 23 medications; (6) suicide prevention; (7) tracking and medical record keeping; 24 (8) staffing; (9) communication; and (10) quality assurance. 25 9. In December 2002, following extensive negotiations and additional 26 site visits, the Parties entered into a Memorandum of Agreement (MOA) that 27 outlined a series of reforms to ensure that adequate and reasonable mental health 28 4 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 5 of 58 Page ID #:29 1 care services are provided at the Jails. The MOA also included measures to protect 2 3 prisoners with mental illness from abuse and mistreatment. 10. Under the MOA, the County and the Sheriff have made significant 4 improvements to the delivery of mental health care at the Jails, including 5 implementing electronic medical records, increasing mental health staffing, and 6 developing roving evaluation teams composed of mental health professionals and 7 specially-trained custody staff. Despite considerable progress, the United States 8 alleges that systemic deficiencies remain related to suicide prevention and mental 9 health care that violate prisoners' constitutional rights. The Department of Justice 10 notified the County and the Sheriff of these allegations in a letter dated June 4, 11 12 13 2014, following on-site evaluations with expert consultants. 11. In September 2013, the Department of Justice opened a separate investigation of the Jails under CRIPA and 42 U.S.C. § 14141("Section14141") 14 to address allegations of use of excessive force against all prisoners at the Jails, not 15 just prisoners with ment~l illness. During the course of the investigation, the 16 County and the Sheriff entered into a comprehensive settlement agreement to 17 resolve Rosas v. McDonnell, Case No. CV 12-0428-DDP (C.D. Ca. filed on Jan. 18 18, 2012) (hereinafter "Rosas"), a class action lawsuit alleging abuse and excessive 19 force by staff at certain Jails located in downtown Los Angeles. As part of the 20 Rosas settlement agreement, the County and the Sheriff have agreed to implement 21 significant measures to protect prisoners from excessive force by staff, including 22 improvements in policies, training, incident tracking and reporting, investigations, 23 resolution of prisoner grievances, prisoner and staff supervision, and 24 accountability. 25 12. This Agreement addresses remaining allegations concerning suicide 26 prevention and mental health care at the Jails resulting from the partial 27 implementation of the 2002 MOA and current conditions within the Jails. This 28 Agreement also extends the remedial measures in the Implementation Plan of the 5 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 6 of 58 Page ID #:30 1 Rosas settlement agreement to fully resolve the Department of Justice's CRIPA 2 findings regarding alleged mistreatment of prisoners with mental illness and claims 3 under Section 14141 regarding alleged excessive force against prisoners at all of 4 the Jails. 5 13. As indicated in Section VII of this Agreement, the Parties consent to a 6 finding that this Agreement complies in all respects with the provisions of the 7 Prison Litigation Reform Act, 18 U.S.C. § 3626(a). 8 9 14. Except to enforce, modify, or terminate this Agreement, this Agreement, and any findings made to effectuate this Agreement, will not be 10 admissible against either the County or the Sheriff in any court for any purpose. 11 Moreover, this Agreement is not an admission of any liability on the part of the 12 County or the Sheriff, and/or either of its employees, agents, and former employee 13 and agents, or any other persons, and will not constitute evidence of any pattern or 14 practice of wrongdoing. III. 15 DEFINITIONS 16 15. The following definitions will apply to terms in this Agreement: 17 (a) "Sheriffs Department" refers to the Los Angeles County Sheriffs 18 Department, which is responsible for all custody, corrections, and 19 security functions within the Los Angeles County Jails system, 20 including the provision of medical care to prisoners through the 21 Sheriffs Department Medical Services Bureau. 22 (b) "Jails" refers to the Los Ange.l es County Jails system, and shall 23 include Men's Central Jail ("MCJ"), Twin Towers Correctional 24 Facility ("TTCF"), Inmate Reception Center ("IRC"), Century 25 Regional Detention Facility ("CRDF"), North County Correctional 26 Facility ("NCCF"), Pitchess Detention Center ("PDC"), and other 27 facilities in which prisoners are detained or held in custody by the 28 County and the Sheriff, including lockup facilities and courthouse 6 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 7 of 58 Page ID #:31 1 holding areas as well as any visiting area in the facility, and any 2 facility that is built, leased, or otherwise used, to replace or 3 supplement the current Jails or any part of the Jails. 4 (c) "United States" or ''DOJ" refers to the United States Department of 5 Justice, specifically the Special Litigation Section of the Civil Rights 6 Division and the United States Attorney's Office for the Central 7 District of California, which represent the United States in this matter. 8 (d) 9 "The County" refers to the County of Los Angeles, the Los Angeles County Sheriffs Department, the Los Angeles County Department of 10 Mental Health, and the agents and erp.ployees of the Sheriffs 11 Department and the Department of Mental Health. The Department 12 of Mental Health ("DMH") includes any successor County departmen 13 that assumes the duties and responsibilities of DMH. 14 (e) "Sheriff' refers to the Los Angeles County Sheriff, currently Jim 15 McDonnell, an independently-elected constitutional officer, in his 16 official capacity, and any predecessors or successors in office, 17 including any designated acting or interim Sheriff. 18 (f) "Custody staff' means sworn deputy sheriffs and custody assistants. 19 (g) "Days" are measured in calendar days; weekend days and County 20 21 holidays are included. (h) 22 23 and County holidays. (i) 24 25 "Normal business work days" means all days ,except for weekend day "Describe" means provide a clear and detailed description of something done, experienced, seen, or heard. G) "Document" when used in this Agreement as a verb means 26 completing a record of information either in hard copy or in electronic . 27 format. 28 7 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 8 of 58 Page ID #:32 1 (k) "Effective Date" means the date the Court enters the signed 2 Agreement as an order of the Court, or July 1, 2015, whichever is 3 earlier. 4 (1) "Emergency maintenance needs" means a need that if left unattended 5 could result in imminent danger to the life, safety, or health of 6 prisoners. 7 (m) An "emergent" or "urgent" mental health need, as used in this 8 Agreement, is one which the Arrestee Medical Screening Form (SH- 9 R-422) or its equivalent and/or the Medical/Mental Health Screening 10 Questionnaire indicate that immediate action is required to preserve 11 life, prevent serious bodily harm, or relieve significant suffering. 12 (n) "Good cause" means fair and honest reasons, regulated by good faith 13 on the part of either party, that are not arbitrary, capricious, trivial, or 14 pretextual. 15 ( o) "Implement" or "implementation" means putting a remedial measure 16 into effect, including informing, instructing, or training impacted 17 personnel as required by this Agreement, and ensuring that policies or 18 procedures are in fact followed. 19 (p) 20 21 "Include," "includes," or ''including" means "include, but not be limited to" or "including, but not limited to." (q) "Jail Reception Centers" mean all Sheriffs Department processing 22 facilities that handle incoming bookings and arrests and that are 23 responsible for medical and mental health screenings and 24 · classification, including the Inmate Reception Center and the Century 25 Regional Detention Facility. This does not include Sheriff's 26 Department station jails. 27 28 8 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 9 of 58 Page ID #:33 1 (r) "Mental Health Housing" refers to prisoner housing areas in the Jails 2 that include only the Forensic In-Patient (FIP), High Observation 3 Housing (HOH), and Moderate Observation Housing (MOH) areas. 4 (i) "Correctional Treatment Center" or "CT C" refers to the 5 licensed health facility with a specified number of beds within 6 the Jails designated to provide health care to that portion of the 7 prisoner population that does not require a general acute care 8 level of services, but which is in need of professionally 9 supervised health care beyond that normally provided in the 10 community on an outpatient basis. 11 (ii) "Forensic In-Patient" or "FIP" can be used interchangeably 12 with Mental Health Unit of the Correctional Treatment Center 13 (MHU CTC). The FIP is located in the CTC and houses 14 prisoners who present an acute danger to self or others or are 15 gravely disabled due to a m.e ntal illness and require inpatient 16 care. (iii) 17 "High Observation Housing" or "HOH'' refers to designated 18 areas for prisoners with mental illness who require an intensive 19 level of observation and care and/or safety precautions. 20 (iv) "Moderate Observation Housing" or "MOH" refers to 21 designated areas for prisoners with a broad range of mental 22 health diagnoses and functioning whose mental health needs 23 can be cared for in a less intensive and more open setting than 24 the HOH areas, but preclude general population housing. 25 (s) "Monitor" or "Independent Monitor" means the individual selected by 26 the Parties whose duties, responsibilities, and authority are set forth in 27 Section VI of this Agreement. 28 9 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 10 of 58 Page ID #:34 1 (t) "Subject Matter Experts" or "SMEs" means the individuals selected 2 by the Parties whose duties, responsibilities, and authority are set fort 3 4 in Section VI of this Agreement. (u) "Prisoners" or "Prisoner" is construed broadly to refer to one or more 5 individuals detained at, or otherwise housed, held, in the custody of, 6 or confined at the Jails based on arrests, detainers, criminal charges, 7 civil contempt charges, or convictions. 8 (v) 9 health problems or mental illness and is capable of modifying mental 10 11 "Psychotropic medication" means any substance used to treat mental activity or behavior. (w) "Qualified Medical Staff' refers to physicians, physician assistants, 12 nurse practitioners, registered nurses, certified nursing assistants, and 13 licensed vocational nurses, each of whom is permitted by law to 14 evaluate and care for the medical needs of patients. 15 (x) "Qualified Mental Health Professiona]" or "QMHP" refers to 16 psychiatrists, psychologists, psychiatric social workers, psychiatric 17 nurses, and others who by virtue of their education, credentials, and 18 experience are permitted by law to evaluate and care for the mental 19 health needs of patients. 20 (y) "Clinical Restraints" is any device that limits a person's ability to 21 move freely and has been ordered or approved by a licensed 22 psychiatrist for the purpose of managing behavior that appears to be 23 symptomatic of a mental illness. 24 (z) "Security Restraints" is any device that limits a person's ability to 25 move freely and has not been ordered by a licensed psychiatrist or 26 Qualified Medical Staff. 27 28 (aa) "Serious mental illness" includes psychotic disorders, major mood disorders (including major depression and bipolar disorders), and any 10 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 11 of 58 Page ID #:35 1 other condition (excluding personality disorders, substance abuse and 2 dependence disorders, dementia, and developmental disability) that is 3 associated with serious or recurrent significant self-harm, suicidal 4 ideation, imminent danger to others, current grave disability, or 5 substantially impaired ability to understand routine instructions, or 6 that prevents access to available progr~ms. Although personality 7 disorders alone generally do not qualify as serious mental illness, 8 personality disorders associated with serious or recurrent significant 9 self-harm do qualify as serious mental illnesses. 10 (bb) "Suicide attempt" means any serious effort to commit an act of self- 11 12 harm that can result in death and involving definite risk. (cc) 13 14 "Serious suicide attempt" .means a suicide attempt that resulted in or could have resulted in significant and life-threatening injury. (dd) "Suicide Precautions" means any level of watch, observation, or 15 measures specifically intended to prevent suicide or self-harm and 16 includes both Suicide Watch and Risk Precautions as defined in this 17 Agreement. 18 (ee) "Suicide Watch" means the level of watch, observation, or measures 19 intended to identify and safely maintain prisoners who are imminently 20 suicidal and require admission to the Mental Health Unit of the 21 Correctional Treatment Center (MHU CTC or FIP) on a 72-hour hold, 22 in accordance with Califo1nia Welfare and Institutions Code Section 23 5150. 24 (ff) "Risk Precautions" means a level of watch, observation, or measures 25 used to identify and safely maintain those prisoners who require 26 27 heightened observation and daily re-evaluation, and require admission to HOH but are not considered to pose an imminent risk of suicide .. 28 11 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 12 of 58 Page ID #:36 1 (gg) "Suicide resistant location" means a housing assignment in which 2 known or apparent suicide hazards do not exist or have been removed. 3 (hh) "Self-injurious behavior" means any behavior that is self-directed and 4 deliberately results in injury or the potential for injury to oneself and 5 there is no evidence of suicidal intent. 6 (ii) "Serious self-injurious behavior" means self-injurious behavior where 7 the injury is significant enough that it could lead to loss of life or limb 8 or have serious medical complications. 9 (jj) "Direct constant observation" means continuous uninterrupted 10 observation of a prisoner within a proximity that ensures the observer 11 can both see and hear the prisoner to assure the prisoner's well-being, 12 absent extraordinary circumstances. 13 (kk) "Unobstructed visual observation" means continuous but not 14 necessarily uninterrupted observation within a reasonable physical 15 distance of the prisoner(s). 16 (11) "Train" means to instruct in skills to a level that the trainee has the 17 demonstrated proficiency, through an assessment or evaluation, to 18 implement those skills as and when called for. "Trained" means 19 proficient in the skills. 20 (mm) Throughout this Agreement, the following terms are used when 21 discussing compliance: substantial compliance, partial compliance, 22 and non-compliance. "Substantial Compliance" means that the 23 County and the Sheriff have achieved compliance with the material 24 components of the relevant provision of this Agreement in accordance 25 with the Monitor and SMEs' monitoring plan and compliance 26 measures. "Partial Compliance" means that the County and the 27 Sheriff have achieved compliance on some, but not all, of the material 28 components of the relevant provision of this Agreement. "Non12 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 13 of 58 Page ID #:37 1 compliance" means that the County and the Sheriff have not met most 2 or all of the material components of the relevant provision of this 3 Agreement. Non-compliance with mere technicalities, or temporary 4 failure to comply coupled with prompt and appropriate corrective 5 action during a period of otherwise sustained compliance, will not 6 constitute failure to maintain Substantial Compliance. At the same 7 time, temporary compliance during a period of otherwise sustained 8 Non-compliance will not constitute Substantial Compliance. 9 (nn) "Policy" or "Policies" mean regulations, directives, or manuals, 10 regardless of name, that have been approved by a senior executive 11 within the Sheriffs Department ("LASD") or DMH and that describe 12 the duties, functions, or obligations ofLASD or DMH staff and 13 provide specific direction in how to fulfill those duties, functions, or 14 obliigations. References to "existing" policies mean those policies in 15 effect on the Effective Date of this Agreement, and include any 16 subsequent revisions or changes made to those policies after the 17 Effective Date of this Agreement. IV. 18 19 16. OVERALL OBJECTIVES AND GOALS Consistent with constitutional standards, the County and the Sheriff 20 will provide prisoners at the Jails with safe and secure conditions and ensure their 21 reasonable safety from harm, including serious risk from self-harm and excessive 22 force, and ensure adequate treatment for their serious mental health needs. In orde 23 to achieve and maintain these objectives, the County and the Sheriff agree to 24 continue, and where appropriate enhance, their current policies and practices, and 25 to implement the additional measures set forth in this Agreement. 26 17. The Parties recognize that the County and the Sheriff have made 27 considerable progress to improve conditions and the delivery of mental health care 28 at the Jails, but that additional measures are necessary to provide prisoners at the 13 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 14 of 58 Page ID #:38 1 Jails with safe and secure conditions, ensure their reasonable safety from harm, 2 including serious risk from s.elf-harm and excessive force, and meet the serious 3 mental health needs of prisoners, in accordance with prisoners' constitutional 4 rights. The measures set forth in this Agreement address the following areas: ( 1) 5 training; (2) suicide hazard inspections; (3) intake; (4) medical records; (5) mental 6 health referrals; (6) mental health follow-up; (7) suicide risk procedures; (8) 7 staffing; (9) environmental conditions; (10) allowable property privileges; (11) 8 communication related to mental health; (12) safety checks; (13) quality 9 improvement plan; (14) mental health housing; (15) medication; (16) restraints; 10 (17) suicide death reviews and critical incident reviews; (18) mental health 11 treatment; and (19) use of force. The County and the Sheriff agree to maintain an 12 adequate system of mental health screening, assessment, treatment planning, and 13 record-keeping as specifically set forth in this Agreement. V. 14 15 16 SUBSTANTIVE PROVISIONS Training A. 18. Within three months of the Effective Date, the County and the Sheriff 17 will develop, and within six months of the Effective Date will commence 18 providing: (1) a four-hour custody-specific, scenario-based, skill development 19 training on suicide prevention, which can be part of the eight-hour training 20 described in paragraph 4.8 of the Implementation Plan in Rosas to all new 21 Deputies as part of the Jail Operations Continuum and to all new Custody 22 Assistants at the Custody Assistants academy; and (2) a two-hour custody-specific, 23 scenario-based, skill development training on suicide prevention to all existing 24 Deputies and Custody Assistants at their respective facilities, which can be part of 25 the eight-hour training described in paragraph 4.7 of the Implementation Plan in 26 Rosas, through in-service Intensified Formatted Training, which training will be 27 completed by December 31, 2016. 28 These trainings will include the following topics: 14 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 15 of 58 Page ID #:39 1 (a) supervision of prisoners at risk for suicide or self-injurious behavior; 2 3 suicide prevention policies and procedures, including observation and (b) 4 discussion of facility environments and staff interactions and why they may contribute to suicidal behavior; 5 (c) potential predisposing factors to suicide; 6 (d) high-risk suicide periods and settings; 7 (e) warning signs and symptoms of suicidal behavior; 8 (f) case studies of recent suicides and serious suicide attempts; 9 (g) emergency notification procedures; 10 (h) mock demonstrations regarding the proper response to a suicide 11 attempt, including a hands-on simulation experience that incorporates 12 the challenges that often accompany a jail suicide, such as cell doors 13 being blocked by a hanging body and delays in securing back-up 14 assistance; 15 (i) differentiating between suicidal and self-injurious behavior; and 16 (j) the proper use of emergency equipment. 17 19. Commencing July 1, 2015, the County and the Sheriff will provide: 18 (a) Custody-specific, scenario-based, skill development training to new 19 Deputies during their Jail Operations training, and to existing 20 Deputies assigned to Twin Towers Correctional Facility, Inmate 21 Reception Center, Men's Central Jail, the Mental Health Housing 22 Units at Century Regional Detention Facility, and the Jail Mental 23 Evaluation Teams ("JMET") at North County Correctional Facility as 24 follows: 25 (i) 32 hours of Crisis Intervention and Conflict Resolution as 26 described in paragraphs 4.6 and 4.9 of the Implementation Plan 27 in Rosas to be completed within the time frames established in 28 that case (currently December 31, 2016). Deputies at these 15 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 16 of 58 Page ID #:40 1 facilities will receive an eight hour refresher course consistent 2 with paragraph 4.6 of the Implementation Plan in Rosas every 3 other year until termination of court jurisdiction in that case and 4 then a four hour refresher course every other year thereafter. (ii) 5 Eight hours identifying and working with mentally ill prisoners 6 as described in paragraph 4.7 of the Implementation Plan in 7 Rosas to be completed by December 31, 2016. This training 8 requirement may be a part of the 32-hour training described in 9 the previous subsection. Deputies at these facilities will receive 10 a four hour refresher course consistent with paragraph 4.7 of the 11 Implementation Plan in Rosas every other year thereafter. 12 (b) Commencing July 1, 2015, the County and the Sheriff will ensure that 13 new Custody Assistants receive eight hours of training in the Custody 14 Assistant academy~ and that all existing Custody Assistants receive 15 eight hours of training, related to identifying and working with 16 mentally ill prisoners as described in paragraph 4. 7 of the 17 Implementation Plan in Rosas. This training will be completed by 18 .December 31, 2016. Custody Assistants will receive a four hour 19 refresher course consistent with paragraph 4.7 of the Implementation 20 Plan in Rosas every other year thereafter. 21 22 23 20. Commencing no later than July 1, 2017, the County and the Sheriff will provide: (a) Custody-specific, scenario-based, skill development training to 24 existing Deputies assigned to North County Correctional Facility, 25 Pitchess Detention Center, and the non-Mental Health Housing Units 26 in Century Regional Detention Facility as follows: 27 28 (i) 32 hours of Crisis Intervention and Conflict Resolution as described in paragraphs 4 .6 and 4.9 of the Implementation Plan 16 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 17 of 58 Page ID #:41 1 in Rosas to be completed by December 31, 2019. Deputies at 2 these facilities will receive an eight hour refresher course 3 consistent with paragraph 4.6 of the Implementation Plan in 4 Rosas every other year until termination of court jurisdiction in 5 that case and then a four hour refresher course every other year 6 thereafter. ·7 (ii) Eight hours identifying and working with mentally ill prisoners 8 as described in paragraph 4.7 of the Implementation Plan in 9 Rosas to be completed by December 31, 2019. This training 10 requirement may be a part of the 32-hour training described in 11 the previous subsection. Deputies at these facilities will receive 12 a four hour refresher course consistent with paragraph 4. 7 of th 13 Implementation Plan in Rosas every other year thereafter. 14 15 · 16 17 21. Consistent with existing Sheriffs Department policies regarding training requirements for sworn personnel, the County and the Sheriff will ensure that existing custody staff that have contact with prisoners maintain active certification in cardiopulmonary resuscitation and first aid. 18 22. Within six months of the Effective Date and at least annually 19 thereafter, the County and the Sheriff will provide instructional material to all 20 Sheriff station personnel, Sheriff court personnel, custody booking personnel, and 21 outside law enforcement agencies on the use of arresting and booking documents, 22 including the Arrestee Medical Screening Form, to ensure the sharing of known 23 relevant and available information on prisoners' mental health status and suicide 24 risk. Such instructional material will be in addition to the training provided to all 25 custody booking personnel regarding intake. 26 27 28 B. Suicide Hazard Inspections 23. Within three months of the Effective Date, the County and the Sheriff will commence a systematic review of all prisoner housing, beginning with the 17 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 18 of 58 Page ID #:42 1 Mental Health Unit of the Correctional Treatment Center, all High Observation 2 Housing areas, all Moderate -Observation Housing areas, single-person discipline, 3 and areas in which safety precautions are implemented, to reduce the risk of self- 4 harm and to identify and address suicide hazards. The County and the Sheriff will 5 utilize a nationally-recognized audit tool for the review. From this tool, the Count 6 and the Sheriff will: 7 (a) hazards identified by this review; and 8 9 (b) 10 13 14 prioritize planning and mitigation in areas where suicide precautions are implemented and seek reasonable mitigation efforts in those areas. 11 12 develop short and long term plans to reasonably mitigate suicide 24. The County and the Sheriff will review and inspect housing areas on at least an annual basis to identify suicide hazards. C. Intake 25. The County and the Sheriff will ensure that any prisoner in a Sheriffs 15 Department station jail who verbalizes or who exhibits a clear and obvious 16 indication of current suicidal intent will be transported to IRC, CRDF, or a medical 17 facility as soon as practicable. Pending transport, such prisoners will be under 18 unobstructed visual observation, or in a suicide resistant location with safety 19 checks every 15 minutes. 20 26. Consistent with existing Sheriffs Department policies, the County 21 and the Sheriff will follow established screening procedures to identify prisoners 22 with emergent or urgent mental health needs based upon information contained in 23 the Arrestee Medical Screening Form (SH-R-422) or its equivalent and! the 24 Medical/Mental Health Screening Questionnaire and to expedite such prisoners for 25 mental health evaluation upon arrival at the Jail Reception Centers and prior to 26 routine screening. Prisoners who are identified as having emergent or urgent 27 mental health needs, including the need for emergent psychotropic medication, will 28 18 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 19 of 58 Page ID #:43 1 be evaluated by a QMHP as soon as possible but no later than four hours from the 2 time of identification. 3 27. Consistent with existing Sheriffs Department policies, the County 4 and the Sheriff will ensure that all prisoners are individually and privately screened 5 by Qualified Medical Staff or trained custody personnel as soon as possible upon 6 arrival to the Jai]s, but no later than 12 hours, barring an extraordinary 7 circumstance, to identify a prisoner's need for mental health care and risk for 8 suicide or self-injurious behavior. The County and the Sheriff will ensure that the 9 Medical/Mental Health Screening Questionnaire, the Arrestee Medical Screening 10 FornY(SH-R-422) or its equivalent, and/or the Confidential Medical Mental Health 11 Transfer Form are in the prisoner's electronic medical record or otherwise 12 available at the time the prisoner is initially assessed by a QMHP. 13 28. The County and the Sheriff will ensure that any prisoner who has bee 14 identified during the intake process as having emergent or urgent mental health 15 needs as described in Paragraph 26 of this Agreement will be expedited through 16 the booking process. While the prisoner awaits evaluation, the County and the 17 Sheriff will maintain unobstructed visual observation of the prisoner when 18 necessary to protect his or her safety, and will conduct 15-minute safety checks if 19 the prisoner is in a cell. 20 29. The County and the Sheriff will ensure that a QMHP conducts a 21 mental health assessment of prisoners who have non-emergent mental health needs 22 within 24 hours (or within 72 hours on weekends and legal holidays) of a 23 registered nurse conducting an intake nursing assessment at IRC or CRDF. 24 30. Consistent with existing DMH policies, the initial mental health 25 assessment will include a brief initial treatment plan. The initial treatment plan 26 will address housing recommendations and preliminary discharge information. 27 During the initial assessment, a referral will be made for a more comprehensive 28 mental health assessment if clinically indicated. The initial assessment will 19 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 20 of 58 Page ID #:44 1 identify any immediate issues and determine whether a more comprehensive 2 mental health evaluation is indicated. The Monitor and SMEs will monitor 3 whether the housing recommendations in the initial treatment plan have been 4 followed. 5 D. 6 Medical Records 31. Consistent with existing DMH and Sheriffs Department policies, the 7 County and the Sheriff will maintain electronic mental health alerts in prisoners' 8 electronic medical records that notify medical and mental health staff of a 9 prisoner's risk for suicide or self-injurious behavior. The alerts will be for the 10 following risk factors: 11 (a) current suicide risk; 12 (b) hoarding medications; and 13 (c) prior suicide attempts. 14 32. Information regarding a serious suicide attempt will be entered in the 15 16 prisoner's electronic medical record in a timely manner. 33. The County will require mental health supervisors in the Jails to 17 review electronic medical records on a quarterly basis to assess their accuracy as 18 follows: 19 (a) 20 21 Supervisors will randomly select two prisoners from each clinician's caseload in the prior quarter; (b) Supervisors wil 1 compare records for those prisoners to corroborate 22 clinician attendance, units of service, and any unusual trends, 23 including appropriate time spent with prisoners, recording more units 24 of service than hours worked, and to determine whether contacts with 25 those prisoners are inconsistent with their clinical needs; 26 27 (c) Where supervisors identify discrepancies through these reviews, they will conduct a more thorough review using a DMl--I-developed 28 20 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 21 of 58 Page ID #:45 1 standardized tool and will consider detailed information contained in 2 the electronic medical record and progress notes; 3 ( d) Serious concerns remaining after the secondary review will be 4 elevated for administrative action in consultation with DMH's 5 centralized Human Resources. 6 34. The County and the Sheriff will conduct discharge planning and 7 linkage to community mental health providers and aftercare services for all 8 prisoners with serious mental illness as follows: 9 (a) 10 11 12 13 For prisoners who are in Jail seven days or less, a preliminary treatment plan, including discharge information, will be developed. (b) For prisoners who are in Jail more than seven days, a QMHP will also make available: (i) for prisoners who are receiving psychotropic medications, a 30- 14 day prescription for those medications will be offered either 15 through the release planning process, through referral to a re- 16 entry resource center, or through referral to an appropriate 17 community provider, unless clinically contraindicated; 18 (ii) in-person consultation to address housing, mental 19 health/medical/substance abuse treatment, income/benefits 20 establishment, and family/community/social supports. This 21 consultation will also identify specific actions to be taken and 22 identify individuals responsible for each action; 23 (iii) if the prisoner has an intense need for assistance, as described i 24 DMH policies, the prisoner will further be provided direct 25 linkage to an Institution for Mental Disease ("IMD11 ) , IMD- 26 Step-down facility, or appropriately licensed hospital; 27 28 (iv) if the prisoner has a moderate need for assistance, as described in DMH policies, and as clinically appropriate to the needs of 21 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 22 of 58 Page ID #:46 1 the prisoner, the prisoner will be offered enrollment in Full 2 Service Partnership or similar program, placement in an Adult 3 Residential Facility ("Board and Care") or other residential 4 treatment facility, and direct assistance accessing community 5 resources; and (v) 6 if the prisoner has minimal needs for assistance, as described in 7 DMH policies, the prisoner will be offered referrals to routine 8 services as appropriate, such as General Relief, Social Security, 9 community mental health clinics, substance abuse programs, 10 and/or outpatient care/support groups. 11 (c) The County will provide a re-entry resource center with QMHPs 12 available to all prisoners where they may obtain information about 13 available mental health services and other community resources. 14 15 E. Mental Health Referrals 3 5. Consistent with existing DMH and Sherifr s Department policies, the 16 County and the Sheriff will ensure that custody staff, before the end of shift, refer 17 prisoners in general or special populations who are demonstrating a potential need 18 for routine mental health care to a QMHP or a Jail Mental Evaluation Team 19 ("JMET") member for evaluation, and document such referrals. Custody staff will 20 utilize the Behavior Observation and Referral Form. 21 36. Consistent with existing DMH policies, the County and the Sheriff 22 will ensure that a QMHP performs a mental health assessment after any adverse 23 triggering event, such as a suicide attempt, suicide threat, self-injurious behavior, 24 or any clear decompensation of mental health status. For those prisoners who 25 repeatedly engage in self-injurious behavior, the County will perform such a 26 mental health assessment only when clinically indicated, and will, when clinically 27 indicated; develop an individualized treatment plan to reduce, and minimize 28 reinforcement of, such behavior. The County and the Sheriff will maintain ari on22 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 23 of 58 Page ID #:47 1 call system to ensure that mental health assessments are conducted within four 2 hours following the notification of the adverse triggering event or upon notification 3 that the prisoner has returned from a medical assessment related to the adverse 4 triggering event. The prisoner will remain under unobstructed visual observation 5 by custody staff until a QMHP has completed his or her evaluation. 6 37. Sheriffs Court Services Division staff will complete a Behavioral 7 Observation and Mental Health Referral Form and forward it to the Jail's mental 8 health and/or medical staff when the Court Services Division staff obtains 9 information that indicates a prisoner has displayed obvious suicidal ideation or 10 when the prisoner exhibits unusual behavior that clearly manifests self-injurious 11 behavior, or other clear indication of mental health crisis. Pending transport, such 12 prisoner will be under unobstructed visual observation or subject to 15-minute 13 safety checks. 14 15 38. Consistent with existing DMH policies and National Commission on Correctional Health Care standards for jails, the County and the Sheriff will ensure 16 that mental health staff or JMET teams make weekly cell-by-cell rounds in 17 restricted non-mental health housing modules (e.g., administrative segregation, 18 disciplinary segregation) at the Jails to identify prisoners with mental illness who 19 may have been missed during screening or who have decompensated while in the 20 Jails. In conducting the rounds, either the clinician, the JMET deputy, or the 21 prisoner may request an out-of-cell interview. This request will be granted unless 22 there is a clear and documented security concern that would prohibit such an 23 interview or the prisoner has a documented history of repeated, unjustified requests 24 for such out-of-cell interviews. 25 39. The County and the Sheriff will continue to use a confidential self- 26 referral system by which all prisoners can request mental health care without 27 revealing the substance of their request to custody staff or other prisoners. 28 23 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 24 of 58 Page ID #:48 1 40. The County and the Sheriff will ensure a QMHP will be available on- 2 site, by transportation of the prisoner, or through tele-psych 24 hours per day, 3 seven days per week (24/7) to provide clinically appropriate mental health crisis 4 intervention services. 5 6 F. Mental Health Follow Up 41. Consistent with existing DMH policies, the County and the Sheriff 7 will implement step-down protocols that provide clinically appropriate transition 8 when prisoners are discharged from FIP after being the subject of suicide watch. 9 The protocols willl provide: I0 (a) intermediate steps between highly restrictive suicide measures (e.g., 11 clinical restraints and direct constant observation) and the 12 discontinuation of suicide watch; 13 (b) 14 15 an evaluation by a QMHP before a prisoner is removed from suicide watch; (c) every prisoner discharged from FIP following a period of suicide 16 watch will be housed upon release in the least restrictive setting 17 deemed clinically appropriate unless exceptional circumstances 18 affecting the facility exist; and 19 (d) all FIP discharges following a period of suicide watch will be seen by 20 a QMHP within 72 hours ofFIP release, or sooner if indicated, unless 21 exceptional circumstances affecting the facility exist. 22 42. Consistent with existing DMH policies, the County and the Sheriff 23 will implement step-down protocols to ensure that prisoners admitted to HOH and 24 placed on risk precautions are assessed by a QJ\1.HP. As part of the assessment, the 25 QMHP will determine on an individualized basis whether to implement "step- 26 down" procedures for that prisoner as follows: 27 28 24 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 25 of 58 Page ID #:49 I (a) the prisoner will be assessed by a QMHP within three Normal 2 business work days, but not to exceed four Days, following 3 discontinuance of risk precautions; 4 (b) the prisoner is counseled to ameliorate the negative psychological 5 impact that any restrictions may have had and in ways of dealing with 6 this impact; 7 (c) the prisoner will remain in HOH or be transferred to MOH, as 8 determined on a case by case basis, until such assessment and 9 counseling is completed, unless exceptional circumstances affecting 10 11 the facility exist; and ( d) 12 13 the prisoner is subsequently placed in a level of care/housing as determined by a QMHP. 4 3. Within six months of the Effective Date, the County and the Sheriff 14 will develop and implement written policies for formal discipline of prisoners with 15 serious mental illness incorporating the following: 16 (a) Prior to transfer, custody staff will consult with a QMHP to determine 17 whether assignment of a prisoner in mental health housing to 18 disciplinary housing is clinically contraindicated and whether 19 placement in a higher level of mental health housing is clinically 20 indicated, and will thereafter follow the QMHP' s recommendation; 21 (b) If a prisoner is receiving psychotropic medication and is placed in 22 disciplinary housing from an area other than mental health housing, a 23 QMHP will meet with that prisoner within 24 hours of such placemen 24 to determine whether maintenance of the prisoner iil such placement i 25 clinically contraindicated and whether transfer of the prisoner to 26 mental health housing is clinically appropriate, and custody staff will 27 thereafter follow the QMHP's recommendation; 28 25 Case.2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 26 of 58 Page ID #:50 1 (c) A QMHP will participate in weekly walks, as specified in Paragraph 2 38, in disciplinary housing areas to observe prisoners in those areas 3 and to identify those prisoners with mental health needs; 4 (d) Prior to a prisoner in mental health housing losing behavioral credits 5 for disciplinary reasons, the disciplinary decision-maker will receive 6 and take into consideration information from a QMHP regarding the 7 prisoner's underlying mental illness, the potential effects of the 8 discipline being considered, and whether transfer of the prisoner to a 9 higher level of mental health housing is clinically indicated. · 10 G. 11 Suicide Risk Procedures 44. Within six months of the Effective Date, the County and the Sheriff 12 will install protective barriers that do not prevent line-of-sight supervision on the 13 second floor tier of all High Observation Housing areas to prevent prisoners from 14 jumping off of the second floor tier. Within six months of the Effective Date, the 15 County and the Sheriff will also develop a plan that identifies any other areas in 16 mental health housing where such protective barriers should be installed. 17 45. Consistent with existing Sheriffs Department policies, the County 18 and the Sheriff will provide both a Suicide Intervention Kit that contains an 19 emergency cut-down tool and a first-aid kit in the control booth or officer's station 20 of each housing unit. All custody staff who have contact with prisoners will know 21 the location of the Suicide Intervention Kit and first-aid kit and be trained to use 22 their contents. 23 46. The County and the Sheriff will immediately interrupt, and if 24 necessary, provide appropriate aid to, any prisoner who threatens or exhibits self- 25 injurious behavior. 26 27 28 H. Staffing 47. The County and the Sherfffwill ensure there are sufficient custodial, medical, and mental health staff at the Jails to fulfill the terms of this Agreement. 26 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 27 of 58 Page ID #:51 I Within six months of the Effective Date, and on a semi-annual basis thereafter, the 2 County and the Sheriff will, in conjunction with the requirements of Paragraph 92 3 of this Agreement, provide to the Monitor and DOJ a report identifying the steps 4 taken by the County and the Sheriff during the review period to implement the 5 terms of this Agreement and any barriers to implementation, such as insufficient 6 staffing levels at the Jails, if any. The County and the Sheriff will retain staffing 7 records for two years to ensure that for any critical incident or non-compliance 8 with this Agreement, the Monitor and DOJ can obtain those records to determine 9 whether staffing levels were a factor in that critical incident and/or non- 10 11 12 compliance. I. Environmental Conditions 48. Within three months of the Effective Date, the County and the Sheriff 13 will have written housekeeping, sanitation, and inspection plans to ensure the 14 proper cleaning of, and trash collection and removal in, housing, shower, and 15 medical areas, in accordance with California Code of Regulations ("CCR") Title 16 15 § 1280: Facility Sanitation, Safety, and Maintenance. 17 18 49. Within three months of the Effective Date, the County and the Sheriff will have a maintenance plan to respond to routine and emergency maintenance 19 needs, including ensuring that shower, toilet, sink, and lighting units, and heating, 20 ventilation, and cooling systems are adequately maintained and installed. The plan 21 will also include steps to treat large mold infestations. 22 50. Consistent with existing Sheriffs Department policies regarding 23 control of vermin, the County and the Sheriff will provide pest control throughout 24 the housing units, medical units, kitchen, and food storage areas. 25 51. Consistent with existing Sheriffs Department policies regarding 26 personal care items and supplies for inmates, the County and the Sheriff will 27 ensure that all prisoners have access to basic hygiene supplies, in accordance with 28 CCR Title 15 § 1265: Issue of Personal Care Items. 27 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 28 of 58 Page ID #:52 1 J. 2 3 Allowable Property Privileges 52. The County and the Sheriff will implement policies governing property restrictions in High Observation Housing that provide: 4 (a) 5 Except when transferred directly from FIP, upon initial placement in HOH: 6 (i) Suicide-resistant blankets, gowns, and mattresses will be 7 provided until the assessment set forth in section (a)(ii) below is 8 conducted, unless clinically contraindicated as determined and 9 documented by a QMHP. (ii) 10 Within 24 hours, a QMHP will make recommendations 11 regarding allowable property based upon an individual clinical 12 assessment. 13 (b) Property restrictions in H_O H beyond 24 hours will be based on 14 clinical judgment and assessment by a QMHP as necessary to ensure 15 the safety and well-being of the prisoner and documented in the 16 Electronic Medical Record. 17 53. If otherwise eligible for an education, work, or similar program, a 18 prisoner's mental health diagnosis or prescription for medication alone will not 19 preclude that prisoner from participating in said programming. 20 54. Prisoners who are not in Mental Health Housing will not be denied 21 privileges and programming based solely on their mental health status or 22 prescription for psychotropic medication. 23 24 K. Communication Related to Mental Health 55. Relevant custody, medical, and mental health staff in all High 25 Observation Housing units will meet on Normal business work days and such staff 26 in all Moderate Observation Housing units will meet at least weekly to ensure 27 coordination and communication regarding the needs of prisoners in mental health 28 housing units as outlined in Custody Services Division Directive(s) regarding 28 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 29 of 58 Page ID #:53 1 coordination of mental health treatment and housing. When a custody staff 2 member is serving as a member of a treatment team, he or she is subject to the 3 same confidentiality rules and regulations as any other member of the treatment 4 team, and will be trained in those rules and regulations. 5 56. Consistent with existing DMH and Sheriffs Department policies, the 6 County and the Sheriff will ensure that custody, medical, and mental health staff 7 communicate regarding any change in a prisoner's housing assignment following a 8 suicide threat, gesture, or attempt, or other indication of an obvious and serious 9 change in mental health condition. 10 11 L. Safety Checks 57. Within three months of the Effective Date, the County and the Sheriff 12 will revise and implement their policies on safety checks to ensure a range of 13 supervision for prisoners housed in Mental Health Housing. The County and the 14 Sheriff will ensure that safety checks in Mental Health Housing are completed and 15 documented in accordance with policy and regulatory requirements as set forth 16 below: 17 (a) Custody staff will conduct safety checks in a manner that allows staff 18 to view the prisoner to assure his or her well-being and security. 19 Safety checks involve visual observation and, if necessary to 20 determine the prisoner's well-being, verbal interaction with the 21 prisoner; 22 (b) 23 24 have pre-printed times; (c) 25 26 Custody staff will document their checks in a format that does not Custody staff will stagger checks to minimize prisoners' ability to plan around anticipated checks; (d) Video surveillance may not be used to replace rounds and supervision 27 by custodial staff unless new construction is built specifically with 28 constant video surveillance enhancements and could only be used to 29 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 30 of 58 Page ID #:54 1 replace 15 minute checks in non-FIP housing, subject to approval by 2 the Monitor; 3 (e) 4 5 A QMHP, in coordination with custody (and medical staff if necessary), will determine.mental health housing assignments. (t) Supervision of prisoners in mental health housing will be conducted at 6 the following intervals: 7 (i) FIP: Custody staff will perform safety checks every 15 8 minutes. DMH staff will perform direct constant observation o 9 one-to-one observation when determined to be clinically 10 appropriate; 11 (ii) High Observation Housing: Every 15 minutes; 12 (iii) Moderate Observation Housing: Every 30 minutes. 13 58. Within three months of the Effective Date, the County and the Sheriff 14 will revise and implement their policies on safety checks. The County and the 15 Sheriff will ensure that safety checks in non-mental health housing units are 16 completed and documented in accordance with policy and regulatory requirements 17 as set forth below: 18 (a) At least every 30 minutes in housing areas with cells; 19 (b) At least every 30 minutes in dormitory-style housing units where the 20 unit does not provide for unobstructed direct supervision of prisoners 21 from a security control room. 22 (c) Where a dormitory-style housing unit does provide for unobstructed 23 direct supervision of prisoners, safety checks must be completed 24 inside the unit at least every 60 minutes; 25 (d) At least every 60 minutes in designated minimum security dormitory 26 housing at PDC South, or other similar campus-style unlocked 27 dormitory housing; 28 30 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 31 of 58 Page ID #:55 1 (e) Custody staff will conduct safety checks in a manner that allows staff 2 to view the prisoner to assure his or her well-being and security. 3 Safety checks involve visual observation and, if necessary to 4 determine the prisoner's well-being, verbal interaction with the 5 prisoner; 6 (t) 7 Custody staff will document their checks in a format that does not have pre-printed times; 8 (g) Custody staff will stagger checks to minimize prisoners' ability to plan around anticipated checks; and 9 10 (h) 11 Video surveillance may not be used to replace rounds and supervision by custodial staff. 12 59. Consistent with existing Sheriff's Department policies regarding 13 uniform daily activity logs, the County and the Sheriff will ensure that a custodial 14 supervisor conducts unannounced daily rounds on each shift in the prisoner 15 housing units to ensure custodial staff conduct necessary safety checks and 16 document their rounds. 17 18 M. Quality Improvement Plan 60. Within six months of the Effective Date, the Department of Mental 19 Health, in cooperation with the Sheriff's Unit described in Paragraph 77 of this 20 Agreement, will implement a quality improvement program to identify and address 21 clinical issues that place prisoners at significant risk of suicide or self-injurious 22 behavior. 23 61. The quality improvement program will review, collect, and aggregate 24 data in the following areas and recommend corrective actions and systemic 25 improvements: 26 (a) Suicides and serious suicide attempts: 27 (i) 28 (ii) Prior suicide attempts or other serious self-injurious behavior Locations 31 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page·32 of 58 Page ID #:56 1 (iii) Method 2 (iv) Lethality 3 (v) Demographic information 4 (vi) Proximity to court date; 5 (b) Use of clinical restraints; 6 (c) Psychotropic medications; 7 (d) Access to care, timeliness of service, and utilization of the Forensic In-patient Unit; and 8 9 (e) Elements of documentation and use of medical records. 10 62. The County and the Sheriffs Unit described in Paragraph 77 of this 11 Agreement will develop, implement, and track corrective action plans addressing 12 recommendations of the quality improvement program. 13 14 N. Mental Health Housing 63. The County and the Sheriff will maintain adequate High Observation 15 Housing and Moderate Observation Housing sufficient to meet the needs of the jail 16 population with mental illness, as assessed by the County and the Sheriff on an 17 ongoing basis. The County will continue its practice of placing prisoners with 18 mental illness in the least restrictive setting consistent with their clinical needs. 19 64. Within six months of the Effective Date, the County and the Sheriff 20 will develop a short-term plan addressing the following 12-month period, and 21 within 12 months of the Effective Date, the County and the Sheriff will develop a 22 long-term plan addressing the following five-year period, to reasonably ensure the 23 availability of licensed inpatient mental health care for prisoners in the Jails. The 24 County and the Sheriff will begin implementation of each plan within 90 days of 25 plan completion. These plans will describe the projected capacity required, 26 strategies that will be used to obtain additional capacity if it is needed, and identify 27 the resources necessary for implementation. Thereafter, the County and the Sherif 28 will review, and if necessary revise, these plans every 12 months. 32 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 33 of 58 Page ID #:57 1 2 0. Medication 65. Consistent with existing Sheriffs Department policies, the County 3 and the Sheriff will ensure that psychotropic medications a:re administered in a 4 clinically appropriate manner to prevent misuse, hoarding, and overdose. 5 66. Consistent with existing DMH policies, prisoners in High Observation 6 Housing and Moderate Observation Housing, and those with a serious mental 7 illness who reside in other housing areas of the Jails, will remain on an active 8 mental health caseload and receive clinically appropriate mental health treatment, 9 regardless of whether they refuse medications. 10 67. Within three months of the Effective Date, the County and the Sheriff 11 will implement policies for prisoners housed in High Observation Housing and 12 Moderate Observation Housing that require: 13 (a) 14 documentation of a prisoner's refusal of psychotropic medication in the prisoner's electronic medical record; 15 (b) discussion of a prisoner's refusal in treatment team meetings; 16 ( c) the use of clinically appropriate interventions with such prisoners to 17 18 encourage medication compliance; ( d) levels of mental health housing; and 19 20 consideration of the need to transfer non-compliant prisoners to highe (e) individualized consideration of the appropriateness of seeking court 21 orders for involuntary medication pursuant to the provisions of 22 California Welfare and Institutions Code sections 5332-5336 and/or 23 California Penal Code section 2603(a). 24 68. Within six months of the Effective Date, the County and the Sheriff 25 will develop and implement a procedure for contraband searches on a regular, but 26 staggered basis in all housing units. High Observation Housing cells will be 27 visually inspected prior to initial housing of inmates with mental health issues. 28 33 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 34 of 58 Page ID #:58 1 2 P. Restraints 69. Consistent with existing DMH policies regarding use of clinical 3 restraints, the County and the Sheriff will use clinical restraints only in the 4 Correctional Treatment Center and only with the approval of a licensed psychiatris 5 who has performed an individualized assessment and an appropriate Forensic 6 Inpatient order. Use of clinical restraints in CTC will be documented in the 7 prisoner's electronic medical record. The documentation will include the basis for 8 and duration of the use of clinical restraints and the performance and results of the 9 medical welfare checks on restrained prisoners. When applying clinical restraints, 10 custody staff will ensure a QMHP is present to document and monitor the 11 condition of the prisoner being placed in clinical restraints. 12 70. Within three months of the Effective Date, the County and the Sheriff 13 will have policies and procedures regarding the use of Security Restraints in HOH 14 and MOH. Such policies will provide that: 15 (a) Security Restraints in these areas will not be used as an alternative to 16 mental health treatment and will be used only when necessary to 17 insure safety; 18 (b) Security Restraints will not be used to punish prisoners, but will be 19 used only when there is a threat or potential threat of physical harm, 20 destruction of property, or escape; 21 (c) Custody staff in HOH and MOH will consider a range of security 22 restraint devices and utilize the least restrictive option, for the least 23 amount of time, necessary to provide safety in these areas; 24 (d) Wh,e never a prisoner is recalcitrant, as defined by Sheriffs · 25 Department policy, and appears to be in a mental health crisis, 26 Custody staff will request a sergeant and immediately refer the 27 prisoner to a QMHP. 28 34 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 35 of 58 Page ID #:59 I 71. The County and the Sheriff will ensure that any prisoner subjected to 2 clinical restraints in response to a mental health crisis receives therapeutic services 3 to remediate any effects from the episode(s) of restraint. 4 5 Suicide Death Reviews and Critical Incident Reviews Q. 72. The County and the Sheriff will develop and implement policies and 6 procedures that ensure that incidents involving suicide and serious self-injurious 7 behavior are reported and reviewed to determine: (a) whetlher staff engaged in any 8 violations of policies, rules, or·laws; and (b) whether any improvements to policy, 9 training, operations, treatment programs, or facilities are warranted. These policies 10 and procedures will define terms clearly and consistently to ensure that incidents 11 are reported and tracked accurately by DMH and the Sheriffs Department. 12 73. Depending on the level of severity of an incident involving a prisoner 13 who threatens or exhibits self-injurious behavior, a custody staff member will 14 prepare a detailed report (Behavioral Observation and Mental Health Referral 15 Form, Inmate Injury Report, and/or Incident Report) that includes information 16 from individuals who were involved in or witnessed the incident as soon as 17 practicable, but no later than the end of shift. The report will include a description . 18 of the events surrounding the incident and the steps taken in response to the 19 incident. The report will also include the date and time that the report was 20 completed and the names of any witnesses. The Sheriffs Department will 21 immediately notify the County Office of Inspector General of all apparent or 22 suspected suicides occurring at the Jails. 23 74. The Sheriffs Department will ensure that there is a timely, thorough, 24 and objective law enforcement investigation of any suicide that occurs in the Jails. 25 Investigations shall include recorded interviews of persons involved in, or who 26 witnessed, the incident, including other prisoners. Sheriffs Department personnel 27 who are investigating a prisoner suicide or suspected suicide at the Jails will ensure 28 35 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 36 of 58 Page ID #:60 1 the preservation of all evidence, including physical evidence, relevant witness 2 statements, reports, videos, and photographs. 3 4 5 75. Within three months of the Effective Date, the County and the Sheriff will review every suicide attempt that occurs in the Jails as follows: (a) Within two working days, DMH staff will review the incident, the 6 prisoner's mental health status known at the time of the incident, the · 7 need for immediate corrective action if any, and determine the level o 8 suicide attempt pursuant to the Centers for Disease Control and 9 Prevention's Risk Rating Scale; 10 (b) · Within 30 working days, and only for those incidents determined to b 11 a serious suicide attempt by DMH staff after the review described in 12 subsection (a) above, management and command-level personnel 13 from DMH and the Sheriffs Department (including Custody Division 14 and Medical Services Bureau) will meet to review relevant 15 information known at that time, including the events preceding and 16 following the incident, the prisoner's incarceration, mental health, and 17 health history, the status of any corrective actions taken, and the need 18 for additional corrective action if necessary; 19 (c) The County and the Sheriff will document the findings that result 20 from the review of serious suicide attempts described in subsection (b 21 above; and 22 (d) 23 24 25 26 The County and the Sheriff will ensure that information for all suicide attempts is input into a database for tracking and statistical analysis. 76. The County and the Sheriff will review every apparent or suspected suicide that occurs in the Jails as follows: (a) Within no more than two working days, management and command- 27 level personnel from DMH and the Sheriffs Department (including 28 Custody Division and Medical Services Bureau) will meet to review 36 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 37 of 58 Page ID #:61 1 and discuss the suicide, the prisoner's mental health status known at 2 the time of the suicide, and the need for immediate corrective or 3 preventive action if any; 4 (b) Within seven working days, and again within 30 working days, 5 management and command-level personnel from DMH and the 6 Sheriffs Department (including Custody Division and Medical 7 Services Bureau) will meet to review relevant information known at 8 that time, including the events preceding and following the suicide, 9 the prisoner's incarceration, mental health, and health history, the 10 status of any corrective or preventive actions taken, and the need for 11 additional corrective or preventive action if necessary; 12 (c) Within six months of the suicide, the County and the Sheriff will 13 prepare a final written report regarding the suicide. The report_will 14 include: 15 (i) time and dated incident reports and any supplemental reports 16 with the same Uniform Reference Numiber (URN) from custody 17 staff who were directly involved in and/or witnessed the 18 incident; 19 (ii) 20 21 a timeline regarding the discovery of the prisoner and any responsive actions or medical interventions; (iii) copies of a representative sample of material video recordings 22 or photographs, to the extent that inclusion of such items does 23 not interfere with any criminal investigation; 24 (iv) 25 26 27 a reference to, or reports if available, from the Sheriff's Department Homicide Bureau; (v) reference to the Internal Affairs Bureau or other personnel investigations, if any, and findings, if any; 28 37 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 38 of 58 Page ID #:62 (vi) 1 a Coroner's report, if it is available at the time of the final 2 report, and if it is not available, a summary of efforts made to 3 obtain the report; (vii) 4 a summary of relevant information discussed at the prior review 5 meetings, or otherwise known at the time of the final report, 6 including analysis of housing or classification issues if relevant; 7 (viii) 8 (ix) 9 a Psychological Autopsy utilizing the National Commission on Correctional Health Care's standards; and 10 (x) 11 12 a clinical mortality review; a summary of corrective actions taken and recommendations regarding additional corrective actions if any are needed. 77. The County and the Sheriff will create a specialized unit to oversee, 13 monitor, and audit the County's jail suicide prevention program in coordination 14 with the Department of Mental Health. The Unit will be headed by a Captain, or 15 another Sheriffs Department official of appropriate rank, who reports to the 16 Assistant Sheriff for Custody Operations through the chain of command. The Unit 17 will be responsible for: 18 (a) Ensuring the timely and thorough administrative review of suicides 19 and serious suicide-attempts in the Jails as described in this 20 Agreement; 21 (b) Identifying patterns and trends of suicides and serious suicide 22 attempts in the Jails, keeping centralized records and inputting data 23 into a unit database for statistical analysis, trends, and corrective 24 action, if necessary; 25 (c) Ensuring that corrective actions are taken to mitigate suicide risks at 26 both the location of occurrence and throughout the concerned system 27 by providing, or obtaining where appropriate, technical assistance to 28 38 Case 2:15-cv-05903 . Document 4-1 Filed 08/05/15 Page 39 of 58 Page ID #:63 1 other administrative units within the Custody Division when such 2 assistance is needed to address suicide-risk issues; 3 (d) Analyzing staffing, personnel/disciplinary, prisoner classification, and 4 mental health service delivery issues as they relate to suicides and 5 serious suicide attempts to identify the need for corrective action 6 where appropriate; and recommend remedial measures, including 7 policy revisions, re-training, or staff discipline, to address the 8 deficiencies and ensure implementation; and 9 (e) Participating in meetings with DMH to develop, implement, and track 10 corrective action plans addressing recommendations of the quality 11 improvement program. 12 78. The County and the Sheriff will maintain a county-level Suicide 13 Prevention Advisory Committee that will be open to representatives from the 14 Sheriffs Department Custody Division, Court Services, Custody Support Services, 15 and Medical Services Bureau; the Department of Mental Health; the Public 16 Defender's Office; County Counsel's Office; the Office of the Inspector General; 17 and the Department of Mental Health Patients' Rights Office. The Suicide 18 Prevention Advisory Committee will meet twice per year and will serve as an 19 advisory body to address system issues and recommend coordinated approaches to 20 suicide prevention in the Jails. 21 22 23 R. . Mental Health Treatment 79. (a) Unless clinically contraindicated, the County and the Sheriff will offer prisoners in mental health housing: 24 (i) therapeutically appropriate individual visits with a QMHP; 25 (ii) therapeutically appropriate group programming conducted by a 26 QMHP or other appropriate provider that does not exceed 90 27 minutes per session; 28 39 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 40 of 58 Page ID #:64 1 (b) The County and the Sheriff will provide prisoners outside of mental 2 health housing with medication support services when those prisoners are 3 receiving psychotropic medications and therapeutically appropriate individual 4 monthly visits with a QMHP when those prisoners are designated as Seriously 5 Mentally Ill. 6 (c) The date, location, topic, attendees, and provider of programming or 7 therapy sessions will be documented. A clinical supervisor will review 8 documentation of group sessions on a monthly basis. 9 80. (a) The County and the Sheriff will continue to make best efforts to 10 provide appropriate out-of-cell time to all prisoners with serious mental illness, 11 absent exceptional circumstances, and unless individually clinically 12 contraindicated and documented in the prisoner's electronic medical record. To 13 implement this requirement, the County and the Sheriff will follow the schedule 14 below: 15 (i) By no later than six months after the Effective Date, will offer 16 25% of the prisoners in HOH ten hours of unstructured out-of- 17 cell recreational time and ten hours of structured therapeutic or 18 programmatic time per week; 19 (ii) By no later than 12 months after the Effective Date, will offer 20 50% of the prisoners in HOH ten hours of unstructured out-of- 21 cell recreational time and ten hours of structured therapeutic or 22 programmatic time per week; (iii) 23 By no later than 18 months after the Effective Date, will offer 24 100% of the prisoners in HOH ten hours of unstructured out-of- 25 cell recreational time and ten hours of structured therapeutic or 26 programmatic time per week. 27 28 (b) No later than six months after the Effective Date, the County and the Sheriff will record at the end of each day which prisoners in HOH, if any, refused 40 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 41 of 58 Page ID #:65 1 to leave their cells that day. That data will be presented and discussed with DMH 2 staff at the daily meeting on the following Normal business work day. The data 3 will also be provided to the specialized unit described in Paragraph 77 and to 4 DMH's quality improvement program to analyze the data :for any trends and to 5 implement any corrective action(s) deemed necessary to maximize out-of-cell time 6 opportunities and avoid unnecessary isolation. 7 8 S. Use of Force 81. Except as specifically set foM:h in Paragraphs 18-20 of this 9 Agreement, and except as specifically identified below, the County and the Sheriff 10 will implement the following paragraphs of the Implementation Plan in Rosas at all 11 Jails facilities·, including the Pitchess Detention Center and the Century Regional 12 Detention Facility, by no later than the dates set forth in the Implementation Plan 13 or as revised by the Rosas Monitoring Panel: Paragraphs 2.2-2.13 (use of force 14 policies and practices); 3.1-3.6 (training and professional development); 4.1-4.10 15 (use of force on mentally ill prisoners); 5.1-5.3 (data tracking and reporting of 16 force); 6.1-6.20 (prisoner grievances and complaints); 7.1-7.3 (prisoner 17 supervision); 8.1-8.3 (anti-retaliation provisions); 9.1-9.3 (security practices); 10.1- 18 10.2 (management presence in housing units); 11.1 (management review of force); 19 12.1-12.5 (force investigations, with the training requirement of paragraph 12.1 to 20 be completed by December 31, 2016); 13 .1-13 .2 (use of force reviews and staff 21 discipline); 14.1-14.2 (criminal referrals and external review); 15.1-15.7 22 (documentation and recording of force); 16.1-16.3 (health care assessments); 17 .1- 23 17.10 (use of restraints); 18.1-18.2 (adequate staffing); 19.1-19.3 (early warning 24 system); 20.1-20.3 (planned uses of force); and 21.1 (organizational culture). 25 82. With respect to paragraph 6.16 of the Rosas Implementation Plan, the 26 County and the Sheriff will ensure that Sheriffs Department personnel responsible 27 for collecting prisoners' grievances as set forth in that paragraph are also co- 28 located in the Century Regional Detention Facility. 41 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 42 of 58 Page ID #:66 1 83. The County and the Sheriff will install closed circuit security cameras 2 throughout all Jails facilities' common areas where prisoners engage in 3 programming, treatment, recreation, visitation, and intra-facility movement 4 ("Common Areas"), including in the Common Areas at the Pitchess Detention 5 Center and the Century Regional Detention Facility. The County and the Sheriff · 6 will install a sufficient number of cameras in Jails facilities that do not currently 7 have cameras to ensure that all Common Areas of these facilities have security- 8 camera coverage. The installation of these cameras will be completed no later than 9 June 30, 2018, with TTCF, MCJ, and IRC completed by the Effective Date; CRDF 10 completed by March 1, 2016; and the remaining facilities completed by June 30, 11 2018. The County and the Sheriff will also ensure that all video recordings of 12 force incidents are adequately stored and retained for a period of at least one year 13 after the force incident occurs or until all investigations and proceedings related to 14 the use of force are concluded. 15 84. The Sheriff will continue to maintain and implement policies for the 16 timely and thorough investigation of alleged staff misconduct related to use of 17 force and for timely disciplinary action arising from such investigations. 18 Specifically: 19 (a) Sworn custody staff subject to the provisions of California 20 Government Code section 3304 will be notified of the completion of 21 the investigation and the proposed discipline arising from force 22 incidents in accordance with the requirements of that Code section; 23 and 24 (b) All non-sworn Sheriffs Department staff will be notified of the 25 proposed discipline arising from force incidents in time to allow for 26 the imposition of that discipline. 27 28 42 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 43 of 58 Page ID #:67 1 85. The County and the Sheriff will ensure that Internal Affairs Bureau 2 management and staff receive adequate specialized training in conducting 3 investigations of misconduct. 4 86. Within three months of the Effective Date, the County andl the Sheriff 5 will develop and implement policies and procedures for the effective and accurate 6 maintenance, inventory, and assignment of chemical agents and other security 7 equipment. The County and the Sheriff will develop and maintain an adequate 8 inventory control system for all weapons, including OC spray. VI. 9 ENFORCEMENT, AND TERMINATION 10 11 12 IMPLEMENTATION, COMPLIANCE ASSESSMENT, A. Review and Implementation of Policies, Procedures, and Programs 87. The County and the Sheriff are committed to continuous quality 13 . improvement and have taken significant steps to review and update policies and 14 procedures to protect the constitutional and federal rights of prisoners at the Jails. 15 Where necessary, the County and the Sheriff will maintain existing policies, 16 procedures, and practices to support the substantive provisions in this Agreement. 17 88. The County and the Sheriff will review all relevant policies, 18 procedures, and other written executive-approved directives within four months of 19 the Effective Date to ensure that they are consistent with the terms of this 20 Agreement, unless they were reviewed and revised for such purposes within six 21 months preceding the Effective Date. 22 89. (a) If the County or the Sheriff create or materially revise a policy 23 related to this Agreement after the Effective Date, the following process will be 24 followed before implementation: 25 ( 1) the Monitor and DOJ prior to its implementation; 26 27 28 the County and Sheriff will provide a copy of the proposed policy to (2) the Monitor and DOJ will have 30 days to review the policy and submit comments, if any, to the County and the Sheriff; 43 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 44 of 58 Page ID #:68 1 (3) if the Monitor and DOJ do not submit any comments within the 30- 2 day period, the County and the Sheriff will begin implementation of 3 the policy no later than 180 days after the expiration of the 30 day- 4 review period or notice that no comments will be forthcoming; 5 (4) if the Monitor or DOJ objects to the proposed policy, the Monitor or 6 DOJ will note the objection in writing to all Parties within the 7 respective review period; 8 (5) Sheriff will have 30 days to address the objection(s); · 9 10 (6) 11 12 if there is any objection to the proposed policy, the County and the if the Monitor and the Parties cannot resolve the objection(s), either Party may ask the Court to resolve the matter; (7) the Monitor may extend any time frame within this paragraph by up to 13 15 additional days. Further extensions rriay be granted by the Monitor 14 with the agreement of both Parties when necessary to permit amicable 15 resolution of objections. 16 (b) If after the Effective Date, the County or the Sheriff is confronted with a 17 critical circumstance requiring immediate action, the County or the Sheriff may 18 create or substantially revise, and then implement, a policy related to this 19 Agreement without the prior review of the Monitor and DOJ, so long as the 20 review, comment, and objection procedures set forth above in subparagraph (a) are 21 followed immediately upon implementation. 22 90. The County and the Sheriff will provide relevant staff with any policy 23 that is created or materially revised after the Effective Date if it relates to the 24 provisions of this Agreement. The County and the Sheriff will further document 25 that any such policy has been received by that staff and that such staff has been 26 trained, instructed, or briefed, as appropriate, on that policy. 27 28 44 . Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 45 of 58 Page ID #:69 1 2 3 4 B. Compliance Coordination Unit · 91. The County and the Sheriff will establish and maintain a compliance coordination unit for the duration of this Agreement. The unit will: (a) serve as a liaison between the Parties and the Monitor and assume 5 primary responsibility for collecting information the Monitor requires 6 to carry out the duties assigned to the Monitor; 7 (b) maintain sufficient records to document that the requirements of this 8 Agreement are being properly implemented (e.g., census summaries, 9 policies, procedures, protocols, training materials, investigations, 10 11 incident reports, tier logs, use-of-force reports); (c) provide written answers by electronic mail or other format when 12 necessary and any documents requested by the Monitor or DOJ 13 concerning implementation of this Agreement in a timely manner; 14 (d) coordinate and monitor compliance and implementation activities, 15 including coordination between Custody and DMH staff, and assist 16 managers in assigning compliance tasks to County or Sheriff 17 personnel; and 18 (e) ensure that the County and the Sheriff notify DOJ and the Monitor of 19 any suspected or apparent suicide within 24 hours and make related 20 reports available to the Monitor and DOJ for inspection. 21 22 C. Self-Assessments and Reports 92. (a) Fifteen days before the end of the reporting period described in 23 Paragraph 109 of this Agreement, the County and the Sheriff will provide the 24 Monitor and DOJ a Self-Assessment Status Report that includes: 25 ( 1) the actions taken by the County and the Sheriff during the review 26 periled to implement this Agreement including the status of ongoing 27 and continuous improvement activities; 28 45 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 46 of 58 Page ID #:70 1 (2) 2 3 the Monitor; (3) (4) relevant trend ~ata including the information described in Paragraphs 61 and 77(a). 6 7 a summary of any audits related to the provisions of this Agreement that were completed in the reporting period; and 4 5 responses to concerns or recommendations made in prior r·eports by (b) Self-Assessment Status Reports prepared pursuant to this Paragraph will 8 be treated as confidential and not further disclosed or attached to any court 9 document, unless filed under seal with Court approval, without the consent of the 10 County and the Sheriff or by order of the Court. The Monitor, SMEs, and other 11 monitoring staff, however, will be permitted to use the information contained in 12 the Self-Assessment Status Reports to prepare the Monitor's reports to the Court. 13 14 D. Independent Monitor 93. In order to assess and report on the.implementation of this Agreement 15 and whether the implementation is having the intended beneficial impact on 16 conditions at the Jails, the Monitor, the SMEs, and their staff will: 17 (a) 18 19 conduct the audits, reviews, and assessments specified in this Agreement; (b) review County and Sheriff policies, procedures, training curricula, and 20 other documents related to this Agreement developed and 21 implemented pursuant to this Agreement; 22 (c) conduct such additional audits, reviews, and assessments consistent 23 with this Agreement as the Monitor and the Parties jointly agree are 24 appropriate, or in the case of a dispute which the Parties cannot in 25 good faith resolve, as ordered by the Court; and 26 (d) evaluate the implementation of Section V.S. of this Agreement 27 concerning use of force consistent with the Settlement Agreement and 28 Implementation Plan-approved in Rosas. 46 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 47 of 58 Page ID #:71 1 94. The Parties have selected Richard Drooyan as the Independent 2 Monitor. The Monitor and his staff will not, and are not intended to, replace or 3 assume the role and duties of the County or the Sheriff and will have only the 4 duties, responsibilities, and authority conferred by this Agreement. 5 To assess and report whether the provisions of this Agreement have been 6 implemented, and whether the County and the Sheriff are in compliance with the 7 substantive provisions of this Agreement, the Monitor will: 8 (a) 9 of this Agreement and, where applicable, the Settlement Agreement 10 11 eva]uate the implementation of Section V ("Substantive Provisions") and Implementation Plan approved in Rosas; (b) conduct specific audits, reviews, and assessments consistent with this Agreement or otherwise if the Parties agree in writing; and 12 13 (c) prepare reports as provided in this Agreement. 14 95. The Parties have also selected Bruce C. Gage, M.D., and Manuel 15 David Romero as Subject Matter Experts ("SMEs"). The SMEs and their staff will 16 not, and are not intended to, replace or assume the role and duties of the County or 17 the Sheriff and will have only the duties, responsibilities, and authority conferred 18 · by this Agreement. The SMEs will, in conjunction with the Monitor, assess 19 compliance with the substantive provisions of this Agreement by providing 20 expertise within the scope of their subject matters. 21 96. The Monitor and/or SMEs may hire or contract with additional 22 persons with knowledge or expertise not already provided by the SMEs, or where 23 delegation to a subordinate staff member would be appropriate, as reasonably 24 necessary to perform the tasks assigned by this Agreement. The Monitor will 25 notify the County, the Sheriff, and DOJ in writing when the Monitor or SMEs are 26 considering such additional persons. The Parties will have an opportunity, if 27 desired, to interview the candidate(s) and request reasonable information about the 28 candidate's background and experience. If the Parties agree to the Monitor's 47 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 48 of 58 Page ID #:72 1 proposal, the Monitor or SMEs will be authorized to hire or contract such 2 additional persons. If the Parties do not agree to the proposal, the Parties will have 3 ten business days to disagree with the proposal in writing. The Parties will not 4 unreasonably withhold approval. If the Parties are unable to reach agreement 5 within ten business days of receiving notice of this disagreement, the Court will 6 resolve the dispute. 7 97. If not already developed by the Monitor and SMEs and agreed-to by 8 the Parties before the execution of this Agreement, within three months of the 9 appointment of the Monitor and SMEs by the Court, the Monitor and S:MEs will 10 develop a plan for conducting the above audits, reviews, and assessments, and will 11 submit that plan to the Parties for review and approval. The plan will: 12 (a) set out a methodology for reviewing each of the substantive 13 provisions of this Agreement, including which provisions will be 14 assessed together, if any, and the thresholds for achieving Substantial 15 Compliance; and 16 (b) 17 set out a schedule for conducting the assessments required by this Agreement. 18 98. The Monitor, SMEs, and any person hired or contracted to assist the 19 Monitor or SMEs will be subject to (a) the supervision and orders of the Court 20 consistent with the terms of this Agreement; (b) the terms of this Agreement; (c) 21 any applicable law; and (d) any security protocols while in the Jails. 22 99. The County and the Sheriff will bear all reasonable fees and costs of 23 the Monitor, the SMEs, and their staff. Travel, lodging, and per diem expenses 24 will be reimbursed at the same rate as provided for County employees. In the 25 event that any dispute arises regarding the reasonableness or payment of the 26 Monitor's, SMEs', or their staffs fees and costs, the Parties and the Monitor will 27 attempt to resolve the dispute cooperatively before seeking the assistance of the 28 Court. 48 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 49 of 58 Page ID #:73 1 100. At the request of the County and the Sheriff, and with the consent of 2 the DOJ, the Monitor, SMEs, and their staff may provide technical assistance. 3 Such assistance may not interfere with the Monitor's or SMEs' duties under this 4 Agreement, create additional duties or obligations that are enforceable under this 5 Agreement, or otherwise alter or modify the terms of this Agreement. 6 Additionally, whenever the County or the Sheriff identifies and implements its 7 own quality improvement measures that are not related to any of the terms of this 8 Agreement, those quality improvement measures will not be monitored or enforced 9 under this Agreement. 10 101. Should all the Parties agree that the Monitor, a SivfE, or a member of 11 their staff has exceeded his or her authority or is not fulfilling his or her duties in 12 accordance with this Agreement, the Parties may petition the Court for the 13 immediate removal and replacement of the Monitor, SME, or staff person. After 14 good faith attempts to resolve such issues informally, any Party may petition the 15 Court for the removal of the Monitor, a SME, or any member of their staff, for 16 good cause, which may include, but is not limited to: gross neglect of duties; 17 willful misconduct; inappropriate personal relationship with a Party, any Party 18 emp[oyee, or prisoner; conflicts of interest; any criminal conduct; or any 19 significant violations of security protocols during the pendency of this Agreement. 20 102. The Parties recognize the Monitor and Sl\ffis may have existing 21 clients who may now be, or in the future may be, adverse to the County or the 22 Sheriff in transactions or litigation. For the duration of this Agreement, however, 23 unless such conflict is waived by all Parties, the Monitor, the SMEs, and their staff 24 will not accept any new employment or retention for consulting services regarding 25 alleged actions or inactions by the County or the Sheriff, or any County or Sheriff's 26 employee, including any actions or inactions involving any prisoner that present a 27 conflict of interest with the Monitor's, S:ME's, or staff member's responsibilities 28 under this Agreement, including being retained (on a paid or unpaid basis) by any 49 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 50 of 58 Page ID #:74 I current or future litigant or claimant, or such litigant's or claimant's attorney, in 2 connection with a claim or suit against the County, the Sheriff, or their 3 departments, officers, agents, or employees. Similarly, the Monitor, the SMEs, 4 and their staff will not accept employment or provide consulting services (on a 5 paid or unpaid basis) by any Defendant to this matter to act as a defense witness in 6 . connection with a private claim or suit against the County, the Sheriff, or their 7 departments, officers, agents, or employees. This provision does not apply to any 8 proceeding before a court related to performance of contracts or subcontracts for 9 monitoring this Agreement. 10 11 E. Access and Confidentiality 103. With the exception of documents within the attorney-client and 12 attorney-work-product privileges, and notwithstanding the confidentiality 13 restrictions of the Health Insurance Portability and Accountability Act·("HIPAA"), 14 the California Confidentiality of Medical Information Act (Civil Code§ 56, et 15 seq.), and California Welfare and Institutions Code§ 5328 (related to 16 confidentiality of mental health records), the Monitor, SMEs, their staff, and the 17 United States, its attorneys, consultants, and agents will have full and complete 18 access to the Jails and all relevant individuals, facilities, prisoner medical and 19 mental health records, documents, data, and meetings related to the provisions of 20 this Agreement. 21 104. Other than as expressly provided in this Agreement, the Monitor, the 22 SMEs, their staff, and DOJ will maintain confidential all, and will not distribute or 23 disclose any, non-public information provided by the County and the Sheriff 24 pursuant to this Agreement. This Agreement will not be deemed a waiver of any 25 privilege or right the County or the Sheriff may assert, including those recognized 26 at common law or created by statute, rule, or regulation, against any other person 27 or entity with respect to the disclosure of any document or information. 28 50 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 51 of 58 Page ID #:75 1 2 F. Public Statements, Testimony, and Records 105. Except as required by the terms of this Agreement, an order from the 3 .Court, the express written agreement of all Parties, or at meetings of the County of 4 Los Angeles Board of Supervisors, the Monitor, SMEs, and their staff will not 5 make any public or press statements (at a conference or otherwise), issue findings, 6 offer expert opinion, or testify in any other litigation or proceeding regarding any 7 matter or subject that he or she may have learned as a result of his or her 8 performance under this Agreement. If the Monitor, SMEs, or any of their staff 9 receive a subpoena, he or she will promptly notify the Parties and thereafter advise 10 11 12 the subpoenaing court of the terms of this Agreement. 106. The Monitor, SMEs, and their staff will be permitted to initiate and receive ex parte communications with all Parties. 13 107. The Monitor, SMEs, and their staff are not a State, County, or local 14 agency, or an agent thereof, and accordingly, the records maintained by them, or 15 any of them, will not be deemed public records subject to public inspection. If the 16 Monitor, SMEs, or any of their staff receive a request for inspection of their 17 18 records related to this Agreement, he or she will promptly notify the Parties. 108. This Agreement is enforceable only by the Parties. No person or 19 entity is intended to be a third-party beneficiary of the provisions of this. 20 Agreement for purposes of any civil, criminal, or administrative action, and 21 accordingly, no person or entity may assert any claim or right as a beneficiary or 22 protected class under this Agreement. 23 24 G. Monitoring Reports 109. Every six months, the Monitor will file public written reports with the 25 Court describing the steps taken by the County and the Sheriff to implement this 26 Agreement and evaluating the extent to which the County and the Sheriff have 27 complied with this Agreement. Specifically, the Monitor and SMEs will evaluate 28 the status of compliance for each substantive provision of this Agreement using the 51 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 52 of 58 Page ID #:76 1 following standards: (1) Substantial Compliance; (2) Partial Compliance; and (3) 2 Non-compliance. In order to assess compliance, the Monitor and SMEs will 3 review a sufficient number of pertinent documents to accurately assess current 4 conditions, interview all relevant staff, interview a sufficient number of prisoners 5 to accurately assess current conditions, and take other reasonable actions consistent 6 with this Agreement, as needed, to fulfill their responsibilities under this 7 Agreement. The Monitor, the SMEs, and their staff will be responsible for 8 independently verifying representations from the County or the Sheriff regarding 9 progress toward compliance, and examining supporting documentation. Each 10 monitoring report will describe the steps taken by members of the monitoring team 11 to analyze conditions and assess compliance, including reference to the documents 12 reviewed and individuals interviewed, and the factual basis for the Monitor's and 13 SMEs' findings. Such reports and findings will not be admissible by or against the 14 County or the Sheriff in any proceeding other than a proceeding related to the 15 enforcement of this Agreement initiated and handled exclusively by the County, 16 the Sheriff, or the United States. 17 110. At least 30 days before the anticipated filing of such reports, the 18 Monitor will provide the Parties with a draft copy and an opportunity to respond. 19 The Monitor will consider the Parties' responses and make appropriate changes, if 20 any, before filing. The Parties may file separate responses with the Court within 21 15 days after the filing by the Monitor although nothing in this Agreement will be 22 construed to require the filing of such responses. All public court filings by the 23 Monitor and any Party will be written with due regard for the privacy interests of 24 individual prisoners and staff and the interest of the County and the Sheriff in 25 protecting against disclosure of information not permitted by this Agreement. 26 111. Except for the provisions of Section V.S. of this Agreement that have 27 different Compliance Periods under the Settlement Agreement, Implementation 28 Plan, and Monitoring Protocols approved in Rosas, upon the Monitor's and SMEs' 52 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 53 of 58 Page ID #:77 1 conclusion that the County and the Sheriff have achieved and maintained 2 Substantial Compliance with a substantive provision of this Agreement for a perio 3 of twelve (12) consecutive months, the Monitor and SMEs will no longer be 4 required to assess or report on that provision. Where the Monitor and SMEs 5 conclude that the County and the Sheriff have achieved and maintained Substantial 6 Compliance with a substantive provision of this Agreement, as described 7 immediately above, at one Jail facility but not at other facilities, the Monitor and 8 SMEs will no longer be required to assess or report on that provision as it applies 9 to the facility found to be in sustained compliance. The Parties expect that there 10 will be multiple independent operative compliance periods under the supervision 11 of the Monitor. 12 13 112. If the Monitor identifies a critical and time sensitive issue that the County or the Sheriff should address during a six-month rejporting period and that · 14 should not be delayed until the time the Monitor must provide the Parties with a 15 draft copy of the monitoring report, the Monitor will provide the Parties with a 16 verbal report on the critical issue as soon as possible, and the Monitor will provide 17 a written report to the Parties within 30 days of the Monitor's identification of the 18 critical issue. 19 20 H. Court Jurisdiction, Modification, Enforcement, and Termination 113. The Court shall retain jurisdiction over the implementation of this 21 Agreement at the existing Jails or any other facility used to replace or supplement 22 the Jails for all purposes. 23 114. The: County and the Sheriff will ensure that all of the terms in this 24 Agreement are implemented. Unless otherwise provided in a specific provision of 25 this Agreement, the implementation of this Agreement wiH begin immediately 26 upon the Effective Date. 27 28 53 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 54 of 58 Page ID #:78 1 115. Unless otherwise agreed to under a specific provision of this 2 Agreement, the County and the Sheriff will implement all provisions of this 3 Agreement within six months of the Effective Date. 4 116. To ensure that the substantive provisions of this Agreement are 5 implemented in accordance with the terms of this Agreement, the Court will retain 6 jurisdiction to enforce this Agreement only until either: 7 (a) the County and the Sheriff have achieved and maintained Substantial 8 Compliance with each and every substantive provision of this 9 Agreement for a period of twelve (12) consecutive months (or other 10 time period provided in a specific provision of this Agreement or the 11 relevant Compliance Period under the Settlement Agreement, 12 Implementation Plan, and Monitoring Protocols approved in Rosas); 13 or 14 (b) the Monitor, with Court approv_al, determines that the overall 15 objectives and goals of this Agreement have been met even where the 16 specific requirements of substantive provisions of this Agreement ma 17 be only in Partial Compliance. 18 Either oftlhe conditions described in sub-paragraphs (a) or (b) above will be 19 deemed to fully satisfy this Agreement. At that time, the County and the Sheriff 20 may seek to terminate this Agreement with the Court consistent with the 21 requirements of the Prison Litigation Reform Act, 18 U.S.C. § 3626(b). 22 117. The. United States acknowledges the good faith of the County and the 23 Sheriff in committing to the reforms set forth in this Agreement. The United 24 States, however, reserves the right to seek enforcement of the provisions of this 25 Agreement with the Court if it determines that the County or the Sheriff has failed 26 to substantially comply with any substantive provisions of this Agreement. Before 27 pursuing any remedy with the Court, the United States agrees to give written notice 28 to the County and the Sheriff in accordance with the Local Rules of the Central 54 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 55 of 58 Page ID #:79 1 District of California. The County and the Sheriff will have 30 days from receipt 2 of such notice to cure the alleged failure (or such additional time as is reasonable 3 due to the nature of the issue and agreed upon by the Parties). During the 30-day 4 period, the Parties will meet and confer in good faith to resolve any disputes 5 regarding the alleged failure or to otherwise explore a joint resolution. The 6 Monitor and SMEs may assist the Parties in reaching a mutually agreeable 7 resolution to the alleged compliance failure, including facilitating conference 8 meetings and providing relevant factual assessments. 9 118. In case of an emergency posing an imminent and serious threat to the 10 health or safety of any prisoner or staff member at the Jails, the United States may 11 omit the notice and cure requirements set forth above and seek enforcement of the 12 Agreement with the Court. 13 119. The Parties may jointly stipulate to make cha11ges, modifications, and 14 amendments to this Agreement, which will be effective absent further action from 15 the Court, 30 days after a stipulation signed by all of the Parties has been filed with 16 the Court. Any Party may seek to modify this Agreement with the Court if that 17 Party establishes by a preponderance of the evidence that a significant change in 18 the law or factual conditions warrant the modification and that the proposed 19 modification is suitably tailored to the changed circumstances. 20 120. The Parties agree to defend the provisions of this Agreement. The 21 Parties will notify each other of any court or administrative challenge to this 22 Agreement. In the event any provision of this Agreement is challenged in any stat 23 court, removal to a federal court shall be sought by the Parties. 24 121. The County and the Sheriff agree to promptly notify DOJ if any term 25 of this Agreement becomes the subject of collective bargaining consultation and to 26 consult with DOJ in a timely manner regarding the position the County or the 27 Sheriff takes in any collective bargaining consultation connected with this 28 Agreement. 55 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 56 of 58 Page ID #:80 1 122. This Agreement will constitute the entire integrated agreement of the I 2 Parties and will supersede the 2002 Memorandum of Agreement Between the 3 United States and Los Angeles County, California, Regarding Mental Health 4 Services at the Los Angeles County Jail ("2002 MOA"). No prior or 5 contemporaneous communications, oral or written, will be relevant or admissible 6 for purposes of determining the meaning of any provisions herein, in this litigation 7 or in any other proceeding. 8 9 10 123. The Agreement will be applicable to, and binding upon, all Parties, their officers, agents, employees, assigns, and their successors in office. 124. Failure by any Party to enforce this entire Agrnement or any provision 11 thereof with respect to any deadline or any other provision herein will not be 12 construed as a waiver of the Party's right to enforce other deadlines or provisions 13 of this Agreement. 14 15 VII. STIPULATION PURSUANT TO THE PRISON LITIGATION REFORM ACT, 18 U.S.C. § 3626 16 125. The Parties stipulate and the Court finds, pursuant to 18 U.S.C. § 17 3626(a), that although this matter was not actually litigated or resolved on the 18 merits, the prospective relief in this Agreement is narrowly drawn, extends no 19 further than necessary to correct the violations of federal rights as alleged by the 20 United States in its Complaint, is the least intrusive means necessary to correct 21 those alleged violations, and will not have an adverse impact on public safety or 22 the operation of a criminal justice system. If the Court does not make the requisite 23 findings and the United States' Complaint is dismissed with prejudice, the Parties 24 agree that this Agreement will become a binding Memorandum of Agreement that 25 will supersede the 2002 MOA. Any admission made for purposes of this 26 Agreement is not admissible if presented by third parties in another proceeding. 27 28 56 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 57 of 58 Page ID #:81 1 Respectfully submitted this _ day of - -, 2015. 2 3 4 For the UNITED STATES OF AMERICA: 5 LORETTA E. LYNCH Attorney General 6 7 ~~07;~ 8 9 EILEEN ·M . DECKER United States Attorney lO 11 12 VZ116Z&v"- Acting Deputy Assistant Attorney General LEONW. WEIDMAN Assistant United States Attorney Chief, vil Division 13 14 15 16 -MARIE LYON MONTELEONE JUDITH C. PRESTON Assistant United States Attorney Acting Chief Assistant Division Chief Civil Rights Unit Chief, Civil Division 17 18 19 20 21 A L istant United States Attorney U.S. Attorney's Office for the Central Distnct of California 300 North Los Angeles Street, Suite 7516 Los Angeles, California 90012 22 23 24 25 26 27 28 57 L URAL. OON Special Counsel LUISE. SAUCEDO CATHLEEN S. TRAINOR Trial Attorneys U.S. Department of Justice · Civil Rights Division Special Litigation Section 950 Pe11!1Efvania Avenue, NW PHB 5026 Washington, D.C. 20530 Case 2:15-cv-05903 Document 4-1 Filed 08/05/15 Page 58 of 58 Page ID #:82 1 For the COUNTY OF LOS ANGELES and the LO 2 SHERIFF, in his official capacity: 3 4 5 6 7 8 9 10 11 Senior Assistant Co nty Counsel County of Los Angeles 12 13 14 15 SO ORDERED this _ _ day of _ _ __ _ _., 2015. 16 17 UN1TED STATES DISTRICT JUDGE 18 19 20 21 22 23 24 25 26 27 28 58