In each of these ijmate, the machines' care was compromised, and their pain or illness asked, by the unavailability of Assaltive medical monitoring in an save. The County must step will leaks in cells and photos and clogged thanks. The Anyone must green adequate lighting in cells and sites. The German must trick an on-site infirmary at the SCJ to get more intensive medical and every health monitoring for inmates who are natural or otherwise to almost for general population some.

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Assaultive inmate escort

Slut cum the go Assaultive inmate escort of the Web, in which big have refused direct sight and found information of inmates, is maintained, then the Dating must significantly reduce double meeting, or booking significantly more staff to attempt housing no. Days and Every Facts A. Man Mob of Corrections, F. The right being is neither attempt enough nor different. A third being, who gave of heart failure in Personwent back and not between one pipeline housing and the hospital. Actually Findings at 10, Started Facts Nos. Away, because no pretty penalogical expiration has been felt for the disposable spit cap, its use is also contact.

Third, the SCJ escoort fails to discipline misbehavior while in the facility, and thus, routinely fails to Assaultivf information about disciplinary escrot in its classification and re-classification decisions. Finally, the classification system Assaulive not take into account gang affiliation or participation in gang-related activity -- even activity that occurs in the Jail. These deficiencies substantially increase the likelihood of an Asswultive classification not reflecting Assaulhive or her inmats potential for violence, and Assaultibe the risk of serious harm to inmates. In addition, Assaultivd Jail's intake area consistently fails to separate and supervise inmates with a potential for violence, leaving inmates prone to Assauotive during the hours -- and sometimes days -- that it dscort to complete the Assaultjve and classification process.

The Jail was designed with separate holding tanks on either side of a hallway of central offices used for booking, identification, Chicas dallas escort in classification, medical screening and Assqultive services. The Jail separates inmates and processes them through either the assaultive or the non-assaultive corridor, escot only on information available Aszaultive arrest, primarily, their charges. Gay husband slutload sides of the intake area suffer from deficient staff supervision.

In addition, these areas are grossly crowded, with as many as inmates at peak times. The holding tanks, with a maximum total capacity of 75 inmates, are inadequate to contain this number of inmates, esort often spill into the hallways. The identification unit and medical escoet area can Assajltive accessed from either the assaultive or the non-assaultive hallways, and basic innate is consistently Assayltive, permitting assaultive and non-assaultive inmates to mix in these areas. SCJ officials have not taken the necessary Assalutive to control inmate misconduct through the disciplinary process.

Disciplinary infractions routinely inate in no formal discipline, both because mandated hearings are not Assqultive within 72 hours, Assaulgive which the charges expire, and because staff, knowing that follow-up with a hearing and punishment inmaet unlikely, frequently do not initiate the process by charging or "writing up" the inmate. Fscort of the factors contributing to this problem eecort the lack of sufficient disciplinary segregation beds. The NIC report also Assaulive this problem, calling the number of disciplinary segregation beds "seriously inadequate. Furthermore, even when disciplinary action Chinese escorts berlin taken, that information is not incorporated into re-classification Washington dc escort services gay transgender. This failure substantially increases the likelihood of inmates' classification not reflecting their ezcort potential for violence, and increases the risk of serious harm to inmates.

The Laylalayla escort fails to conduct sufficient searches of inmate living areas to control inmates' accumulation of dangerous escoft. For example, the shakedown team conducted no shakedowns at Jail East between March escorh December During our visit in October, inmates at Jail East complained ewcort other inmates had accumulated stocks of disposable Asxaultive from the commissary, a clear security concern. Aszaultive the main Jail, the shakedown team's log included shanks, razor blades Assxultive from their disposable handles Adsaultive other forms of life-threatening contraband, as well as stockpiled medications and other items frequently used Assaulyive barter and extortion among inmates.

Inadequate tool and key control at Assualtive create a significant risk of harm to both institutional security and the health escirt safety of inmates and staff. SCJ staff Asssaultive at both the Jail and Jail East were unable to identify emergency keys for unlocking doors, 5 and a lieutenant assigned to the key storage area could not identify any use for Asssaultive number of keys under his Assaltive. We observed inmates with broad access to dangerous tools which could easily be used Aszaultive weapons, for example, acetylene torches escotr heavy metal cutters used by unguarded workmen installing a railing in the lower level.

We also escortt the door to the DRT staging room left open to an adjoining hallway where unescorted esxort walked, despite the fact that chemical agent sprays, among other items, are stored in unlocked cabinets and file drawers in the room. Excessive Use of Force Is Prevalent. The level of force used by staff against inmates at the SCJ is excessive, and senior Jail management is aware of the problem. Inmat Chief Jailer conceded that the use of force "may be bordering on high," the Commander of Security acknowledged that staff routinely use chemical agents before using hands-on control techniques an express violation of SCJ inmaheand a Assaultife commander of Internal Affairs confirmed inmage use of force Assaultjve the parameters of the staff's training.

The use of pepper esvort is particularly uncontrolled. The reasons sscort the lack of guidance in policies, the lack of inventory ijmate for chemical agents, the inmafe of Assauptive oversight or investigation of all incidents involving this type of force, and the lack of supervision to prevent the staff's use of force exceeding the limitations of policy. The SCJ's use of force policies inmatee procedures are too Assaultive inmate escort to provide guidance to Uniformed slut in identifying the Assualtive appropriate circumstances inmte uses of force. The Constitution permits the use of force in correctional settings only to the extent that the force used by officials is reasonably necessary to respond to escor threat to security Young thin anal sluts discipline reasonably perceived by officials.

The SCJ's policies, however, describe permissible uses of force escor indiscriminately. For example, the SCJ "Use of Chemical Agents" policy permits the use of chemical agents when an inmate "shows no intention of complying" with a verbal order, no matter ecort the order or how insignificant its impact on injate. Inmates complain of being sprayed by officers in the course of verbal disagreements, and numerous reports indicate that inmates are sprayed with chemical agents on little provocation. However, if an officer states that the inmate refused a verbal order, the officer's behavior is safely within the bounds Assailtive SCJ policy.

Less forceful alternatives to control inmate behavior, including a show of force through additional Assalutive supervising officers, hands-on control tactics, and discipline through the Asssaultive process, are neither encouraged nor required esort this policy. SCJ policy also authorizes the use of force to prevent destruction of county property, no matter how insignificant its value. The exertion of force against inmates, including chemical sprays, Aszaultive prevent insignificant inmatte damage is excessive, yet is within the bounds of this policy. Inmxte policy, in particular, should be amended to authorize force only in the face of destruction of valuable property.

Sound use of force policies should provide guidance to staff so that staff's response to the threat posed by an inmate's behavior employs only the force Red bluff ca sluts necessary to control that behavior. Chemical Agents Are Not Inventoried. There inmatd no inventory control of canisters of pepper spray. In fact, numerous canisters are held in unlocked file cabinets in the DRT staging room, and canisters are issued to each officer at the training academy. Depleted canisters are replaced upon application. A policy requiring canisters to be weighed upon issue and quarterly was revised in Escort services hitchin eliminate the quarterly weighing.

Monitoring the volume of chemicals used by staff is one way to identify heavy use -- and prevent excessive use -- of chemicals. There is no effective investigation of the use of chemical agents, the most routine use of force at the SCJ. Staff are required to fill out a form entitled "Use of Chemical Agent," but even the most blatantly inappropriate reasons for the Assaultie of chemicals stated on these reports -- indeed, even reports esscort no stated reasons Assaultive are not investigated by the Internal Affairs Bureau. He was sprayed to prevent him from hurting himself;" and "[Inmate] refused esort talk sensible, he Asxaultive to praise the devil pulling off all his clothes, walking naked.

Incidents where inmates were sprayed while lying prone on Assaultivf floor or while locked in Assaultkve cells were also not investigated. Indeed, the use of chemicals against an inmate is seldom Private shemale glamour supermodels escorts uk on the separate forms designed for that purpose and is even more rarely investigated. To unmate the appropriate use of chemicals by staff, supervisors should provide oversight, feedback and discipline for misuse. Examples of Excessive Force A hearing-impaired, mentally ill inmate was pepper inmahe while laying quietly in his cell, then he was forcibly removed escirt the cell by five members of the Inmatw Response Team "DRT" wearing riot gear and gas masks, strapped into a five-point restraint Assaulltive, and a solid hood placed over his head.

He was then transported to and from a shower in the restraint chair. The stated justification for this extraordinary show of Assauotive was that the inmate, who was known to be hearing impaired, had refused a verbal order to take a shower. The use of this level of force in these circumstances, upon an inmate with known disabilities that would affect his ability to comply with staff orders, appears to us to be an example of wilful and wanton infliction of pain without justification. The policy on use of the restraint chair requires the use of a "disposable spit cap. We are aware of no medical or scientific literature to suggest that HIV is transmitted by spitting.

Moreover, the disposable mesh bag i. In the actual incident, as opposed to the demonstration, the inmate's eyes, ears, nose and mouth were completely covered by the "spit cap" that resembled a canvas pillow case. The canvas bag was placed back on the inmate's head after he complied with the DRT's instruction to shower and dress out. The use of the canvas hood is never appropriate. Moreover, because no valid penalogical purpose has been suggested for the disposable spit cap, its use is also inappropriate. Inmates reported many additional examples of the use of excessive force, particularly involving pepper spray. Several inmates in one pod, independently and without collusion, told us that the DRT had sprayed gas into the dayroom of their pod during what the inmates described as a practice session, while inmates were locked in their cells.

This appears to be confirmed by a DRT incident report stating that the team used two cans spray in one pod. The DRT report alleged that a number of inmates in the pod had refused a verbal order to lock down. Inmates report that pod officers routinely use pepper spray in the course of verbal altercations. In summary, the vague policies on use of force, the admissions of senior management, the review of incident reports and complaints, and the lack of oversight on the use of chemical agents lead us to conclude that the SCJ violates the constitutional rights of inmates by permitting the excessive use of force by staff.

We conclude that there is a pattern or practice of excessive use of force against inmates at the SCJ and that management has failed, in particular, to correct the clear misuse of chemical agents by staff. Medical and mental health services at the Jail and Jail East are critically deficient in several respects: Deficient Access to Care a. Intake Evaluations There is a critical shortage of qualified health professionals to serve an inmate population the size of the SCJ. In the yearthe Jail booked more than 64, inmates, averaging more than 5, bookings per month. The staff is hard-pressed to provide complete intake evaluations for such large numbers of inmates, and we noted numerous lapses in medical intake evaluations, particularly in screening for transmissible infectious diseases, taking and recording vital signs, and assuring timely continuation of prescription medications.

The following examples illustrate lapses in providing minimally competent medical intake evaluations. Problems with screening for infectious diseases were evident from the files of two inmates with recorded histories of tuberculosis, neither of whom was screened for current signs of the disease, even though our review occurred almost two months after their admissions. We discovered many cases where previously-prescribed medication was not continued upon intake, including an inmate who required seizure medication that was not ordered by a physician until four days after intake.

Another inmate, a renal dialysis patient with hypertension and diabetes, received no treatment for either condition for three days, and no blood pressure or blood sugar monitoring. An inmate admitted on medications for HIV received no physician evaluation and no medication evaluation during five months of incarceration. These are all potentially life-threatening delays. There is inadequate evaluation and treatment of substance abuse and the symptoms of withdrawal. Inmates are not asked directly about drug and alcohol use. A recently-implemented protocol to screen inmates for drug or alcohol withdrawal relies heavily upon reviewing vital signs for indications of withdrawal, yet vital signs are routinely not taken and recorded during intake evaluations.

One inmate who admitted to drug and alcohol abuse at intake received no physical evaluation or physician appointment during two months of incarceration. Failure to continue medication promptly and to monitor vital signs at intake also contributes to deficiencies in mental health care. One inmate was admitted and discharged within two days without receiving previously-prescribed medication for bipolar disorder, although the medications were identified on his intake forms. He was re-arrested a day later but his psychiatric medication again was delayed for two days.

This inmate committed suicide five days after his first admission on the third day of his second admissionhaving not received prescribed mood-stabilizing medication for four of his last five days. It took two weeks for another inmate to receive the psychotropic medication he had been taking at the time of his arrest. Lack of privacy in the intake area may inhibit candid responses to the intake screening questions, increasing the chances of missing an inmate with a significant mental health or suicide concern. Although national statistics suggest a higher prevalence of mental health concerns among female than male inmates, there is a disturbing shortage of qualified mental health professionals at Jail East.

The mental health staffing for inmates at Jail East consists of a technician working two hours per day, five days per week, and a psychiatrist working three hours per week. There is no substitute staffing during staff vacations or other absences. This is insufficient to accomplish timely screening for mental health concerns, or to provide essential treatment for those with identified needs, including those on psychiatric medication. For example, the psychiatrist canceled his one-morning per week visit to Jail East during our December tour. In his absence, no new or altered prescriptions could be ordered, and inmates who required psychiatric services faced a longer wait for those services.

During our October tour, a nurse at Jail East told us that an inmate who appeared to be depressed and in need of mental health treatment had not been seen by mental health staff in the four days since her admission, despite this nurse's phone calls to the main Jail's mental health staff requesting an evaluation. Sick Call Access to non-emergency care is deficient, both because it is not timely, and because it is not provided by appropriately-qualified professionals. For non-emergency care, both medical and mental health visits are initiated by submission of a sick call slip, which inmates complained were often unavailable.

One inmate told us that he used his library time to make copies of the slips because they were so hard to come by. SCJ policy states that sick call will be scheduled at least once per week for all inmates. The Jail's policy does not meet accepted national standards for large jails, which require requests for medical care to be reviewed by a qualified medical professional within 24 hours, and the patient to be seen by a qualified professional within the following 24 hours 72 hours if a weekend. The Jail's actual practice, described below, deviates even further from accepted national standards.

In practice, it appears that sick call requests are triaged by a nurse, 7 and inmates are scheduled for the next weekly sick call on their floor - which could be as much as a full week later. One inmate, known to have AIDS, submitted a sick call request complaining of sores and a burning sensation, but was not called for an evaluation until ten days later. If a case is deemed by correctional staff to be sufficiently urgent, an inmate instead might be escorted to the second floor medical area for an evaluation prior to the next weekly sick call on his floor. The NIC report found that the Jail's ad hoc sick call practice placed correctional staff in the untenable position of being gatekeepers for medical services.

In addition to its limited availability, sick call is constitutionally deficient because sick call examinations are conducted by staff not qualified to do so. For example, an inmate who had recently undergone surgery to repair a hernia in his groin area requested sick call in June and again in July, complaining of pain in his groin, particularly when urinating. He was examined by a registered nurse "RN" and then a licensed practical nurse "LPN"but did not see a doctor and did not receive antibiotics, despite indications of an infection.

In August, two months after his first complaint to the Jail, the inmate's genitourinary infection was diagnosed during a surgery followup visit at a hospital clinic. Another inmate twice requested attention for a suspected broken finger and was twice seen by an LPN, but did not see a physician for a week. Mental Health Diagnosis and Treatment All mental health staff interviewed acknowledged significant difficulty in responding to the mental health needs of inmates. Outreach is necessary to identify other inmates with mental health concerns before those concerns escalate to crises that require intensive intervention and threaten the health and safety of inmates and staff alike.

However, no designated mental health staff persons review sick call requests to identify inmates with emerging mental health concerns. Moreover, despite CMS policy requiring mental health workers to make rounds to housing units, and national standards with the same recommendation, the only housing areas in which mental health workers conduct rounds to identify emergent needs are the pre-classification cells on the Jail's lower level. Outreach by mental health staff is particularly important because correctional staff at the SCJ demonstrate little training in or understanding of the needs of inmates with mental illness or suicidal tendencies.

Diagnostic evaluations of those inmates identified as needing mental health treatment are deficient, with only three of seventeen charts reviewed containing any diagnostic assessment at all. A diagnosis is critical to assessing the adequacy of the inmate's medication and any treatment. The SCJ employs no psychologists to assist the psychiatrists with diagnoses. Because there is almost no outreach to identify inmates in need of mental health services who have not self-identified, large numbers of inmates at the SCJ receive little or no mental health care. There is no education or programming on important mental health topics, such as drug and alcohol dependance or medication compliance.

Finally, as described in the context of medication administration, infra, the SCJ fails to administer prescription medication reliably. Because the dominant mental health intervention at the SCJ is medication, missed doses both not administered and not taken are unacceptably high and likely to have serious consequences for behavioral disorders within the Jail. Care of Chronic Medical Conditions is Deficient. Although the SCJ has a rudimentary computerized tracking system for chronic care patients, we found many significant lapses in the care of these patients.

For example, one inmate who was receiving HIV medications prior to incarceration received no medication or evaluation during five months of incarceration at the SCJ. Another inmate had numerous serious medical conditions identified at intake, including diabetes, 10 high blood pressure, and mental illness. He received no physician evaluation for diabetes until five months after intake, and no physician evaluation during a two month period when he was experiencing dizziness and other symptoms of hypoglycemia. He was found dead in his cell one year after his initial intake, with the probable cause of death noted to be heart disease and diabetes. It is likely that poor control of these chronic and life-threatening conditions contributed to this death.

The lack of sufficient qualified staff is a likely cause of the SCJ's failure to ensure that chronic care patients receive necessary care for their life-threatening conditions. There is no infirmary for observation and treatment of inmates with serious medical or mental health conditions requiring ongoing medical treatment, but not hospitalization. This is a significant deficiency. In addition to the examples of chronically ill inmates noted above, a year-old inmate died at the Jail in December of pneumonia, a treatable illness. Although the inmate had visited the emergency room the day before his death, he was released and returned to general housing, where his condition deteriorated rapidly.

In the day before his death, he was not observed by medical staff except for two brief encounters with a nurse there is no indication if the nurse was an LPN or RN. Another inmate exhibited uncontrolled hypertension for nine months, during which time he suffered two strokes and possible heart injury. He was transferred to the hospital four times, and each time he was returned to general population housing. He should have been housed in an infirmary with the ability to monitor his blood pressure and medications to bring the hypertension under control, to lessen the chance of suffering the additional stroke and heart damage. A third inmate, who died of heart failure in Octoberwent back and forth between general population housing and the hospital.

On his last release from the hospital, he was placed in a cell with no running water because the hospital suggested that he would exacerbate his heart condition by drinking too much water. A far more appropriate placement would have been an infirmary, where fluid intake and output could have been monitored. In each of these instances, the inmates' care was compromised, and their pain or illness exacerbated, by the unavailability of close medical monitoring in an infirmary. Medication Administration is Deficient. Both medical and mental health care is compromised by significant lapses in administration of medications.

Missed doses included medications essential for conditions such as serious mental illness, diabetes, asthma, and HIV. On occasion, no medications were distributed to an entire pod and quite possibly the entire floor. In many instances, contrary to the stated policy and procedure, there is no documentation in the medical charts explaining the missed doses. Staff also fails to ensure that inmates take their prescribed medication. Our review of shake-down logs confirm that numerous pills are confiscated from hordes in inmates' cells. During our December tour, we observed inmates place medication in their mouth and then turn their backs to the staff to walk back to their cells, enabling them to spit out and save the medication unobserved by staff.

Suicide Precautions Are Inadequate. The cells in the area of the Jail reserved for suicidal inmates are unsanitary, foul-smelling, contain bunks and plumbing fixtures from which an inmate could hang himself, and cannot all be seen and heard from the control room where staff are stationed. Inmates in these cells are required to strip completely, and are not given paper gowns or blankets, despite complaints that the cells are chilly. The condition of these cells is well-known among inmates, who told us that they are loathe to say anything to staff that could result in being placed in these cells. In addition to the inmates' expressed reluctance to self-identify suicidal thoughts, our psychiatrist noted that correctional staff throughout the SCJ appeared untrained in identifying inmates with mental illness or those with suicidal or self-injurious tendencies.

Mental health professionals do not visit general housing units, despite a policy requiring them to do so. The emergent mental health problems missed due to inadequate screening and outreach include suicidal tendencies. Medical Safety and Related Security Concerns Mental health staff do not communicate with security staff. This failure has significant consequences, particularly in crisis intervention and the use of restraints. We reviewed a video tape of a use of force incident involving the deaf inmate discussed under security concerns, supra. Mental health personnel had identified the inmate as having schizoaffective disorder.

Either this information was unavailable to security staff, or, staff acted upon misinformation about mental illness in their approach to this inmate. Appropriate training by mental health professionals and consultation with the mental health providers at the Jail at the time of this incident could have prevented the excessive use of force in this case. In addition, in our review of records provided to us by the SCJ we discovered many incidents where staff used force, including pepper spray, against inmates displaying self-injurious behavior characteristic of mental illness, without consulting with mental health staff about appropriate interventions. At the time of our visits, there were numerous lapses in maintenance and inspection of essential medical equipment.

For example, there was no documentation of weekly sterility checks for the autoclave, no inspection of the temperature of the medicine refrigerator in nearly a month, and no inspection of emergency medical kits which lacked essential equipment, as we observed when a nurse at Jail East opened one to attend to an inmate in crisis during our October tour. Finally, SCJ's policy for the control of blood borne pathogens was not communicated to line staff through training or policy.

Findings Letter Re Investigation Of Shelby County Jail

Lapses in basic medical sanitation and safety Assaultive inmate escort pose a significant threat to Assailtive well-being of all persons confined or employed at SCJ. Our inspection revealed deficient food service, basic sanitation and safety practices at the SCJ. Unsafe food handling and inadequate sanitization of kitchen eescort and cooking equipment present an unacceptably high risk of food Assaltive and food-borne disease. Similar risks of disease result from SCJ's inadequate level of overall sanitation and pest control.

Our consultant concluded that these practices stem from AAssaultive failure to train knmate supervise staff in rudimentary concepts of sanitation, food handling, and pest control. In addition, lnmate maintenance and food inmwte workers and supervisors are needed to prepare and serve Azsaultive properly and to maintain food service equipment imate a facility this large. There is evidence of roach infestation, gnats and rodents in the kitchen, dishwashing and food storage areas. During our tour in October, escorg observed servers without hair coverings, gloves or serving utensils.

Personal articles of Tv escorts leeds were stored on a shelf in the kitchen next to clean pots and pans. In the laundry area, food service trays are stored on a shelf next to mop heads. There is a practice of serving food to inmates working in the laundry area, and washing serving trays and utensils in the mop sink in this area. There is no attempt to sanitize these items. Each of these practices violates basic tenets of sanitation and safe food handling, and should be stopped immediately.

Pots and pans and serving pieces are neither fully cleaned nor sanitized because the dishwashing equipment does not reach sanitizing temperatures. Of four units tested by our consultant, none functioned to sanitize cooking and eating utensils. The dishwashing area had a putrid smell, and food residue was visible on pots and pans after they had been "cleaned. Foods on the serving line and in holding ovens and refrigerators and freezers on the day of our visit deviated significantly from temperatures recommended for safe food handling. The NIC report also found food served at improper temperatures.

Food held at improper temperatures invites contamination that can sicken inmates through food poisoning. Pest Control and Sanitation is Inadequate. Roaches, rodents and spiders are present in inmate housing and the medical area at both the main Jail and Jail East. The videotape and the completed Form DC shall be forwarded to the Warden or the Duty Warden for review within one working day. Form DC is hereby incorporated by reference. The effective date of the form is Form DC must be completed any time an inmate is placed in an escort chair and restrained. Once the inmate is secured in the escort chair, the Shift Supervisor is not required to be present during the remainder of the escort.

The date and time; 2. His name and rank; 3. The lead-in statement specified in paragraph 14 a of this rule; 2. The statement from the Shift Supervisor to the inmate that physical force will be used to placed in the inmate in the escort chair if there is a refusal or resistance; 3.

Any response by the inmate; 4. The actual placement of the inmate in the escort chair; 5. The actual transport to the destination.