HomeMy WebLinkAbout326621
2
Agreement No. 18-169
AGREEMENT
THIS AGREEMENT (•Agreemenr) is made and entered into this 3rd day of April,
3 2018, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
4 hereinafter referred to as "COUNTY", and California Forensic Medical Group, a California for profit
5 corporation, whose address is 2511 Garden Road~ SuiteA160, Monterey, CA 93940, hereinafter
6 referred to as "CONTRACTOR".
7
8
WIT N E S S ETH:
WHEREAS, COUNTY is required under Title 15 of the California Code of Regulations to
9 provide necessary medical and behavioral health care to incarcerated individuals;
10 WHEREAS, COUNTY, through its Sheriff-Coroner's Office ("SHERIFP), Department of
11 Public Health (•DPH"), and Department of Behavioral Health (•DBH"), has a need for a qualified
12 correctional health care organization to provide medical and behavioral health care services to the adult
13 incarcerated individuals (·inmates") detained in COUNTY Sheriff-Coroner's Office Adult Detention
14 Facilities identified as North Annex, Main and South Annex jails (uJAIL");
15 WHEREAS, on July 13, 2017, COUNTY's Board of Supervisors decided for COUNTY to
16 prepare and issue a Request for Proposal c•RFP•) for comprehensive medical and behavioral health
17 care services for adult inmates and youth juveniles detained in COUNTY's Detention Facilities to initiate
18 a competitive bidding process;
19 WHEREAS, on August 18, 2017, COUNTY, through its SHERIFF and DPH, issued RFP
20 No. 18-006, soliciting proposals for the provision of comprehensive medical and behavioral health care
21 services to COUNTY's Detention Facilities, including, but not limited to, medical and behavioral health
22 care services and responsibilities in the Remedial Plan, as described herein;
WHEREAS, on October 9, 2017, COUNTY through its SHERIF~, and DPH issued
24 Addendum One ( 1) to RFP No. 18-006;
25 WHEREAS, on November 9, 2017, CONTRACTOR submitted a response to COUNTY's ·
)
26 RFP No. 18-006 c•coNTRACTOR's Response•);
27 WHEREAS, CONTRACTOR represents that it has the necessary training, experience, .
28 expertise, competency and skilled personnel with the proper licensure, certification, education and work
-1-
1 experience for the provision of medical and behavioral health care services within California detention
2 facilities; and
3 WHEREAS, CONTRACTOR is willing and qualified to provide such services, pursuant to
4 the terms and conditions of this Agreement
5 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions
6 herein contained, the parties hereto agree as follows:
7
8
9
I. OBLIGATIONS OF THE CONTRACTOR
A. Commencing on 12:01 AM on the 1st day of July, 2018:
1 . CONTRACTOR shall perform all services and fulfill all responsibilities, as
10 identified in COUNTY's RFP No. 18-006 dated August 18, 2017, including Addendum No. One (1) to
11 RFP No. 18-006, dated October 9, 2017, (collectively, "COUNTY's RFP·), and CONTRACTOR's
12 Response, all incorporated herein by reference and made part of this Agreement.
13 2. CONTRACTOR shall perform all services and fulfill all responsibilities as
14 identified in Exhibit A, "Comprehensive Medical and Behavioral Health Care Services•, attached hereto
15 and incorporated by this reference herein.
16 a) CONTRACTOR shall be responsible for the medical and
17 behavioral health care services provided on-site (any service provided with the COUNTY JAIL) and off-
18 site (any service provided outside of the COUNTY JAIL) to the adult inmates at the JAIL, as defined in
19 this Agreement and the exhibits thereto.
20 b) CONTRACTOR will not be responsible for any hospital inpatient
21 healthcare costs. Hospital Inpatient healthcare costs or inpatient services shall only mean the costs for
22 any medical care during an admission to a general acute care hospital or acute psychiatric hospital.
23 CONTRACTOR will work with the COUNTY or the COUNTY's designee to facilitate the enrollment of
24 eligible inmates under the State of California's Medi-Cal County Inmate Program (aMCIP"). To the
25 extent the inmates are determined to be ineligible for the MCIP program, CONTRACTOR will initially
26 pay for Inpatient services but will bill the COUNTY for reimbursement of such costs.
27 c) CONTRACTOR shall provide all services in compliance with all
28 applicable laws and regulations, including, but not limited to, Title 15 of the California Code of
-2-
1 Regulations Minimum Standards for Local Detention Facilities, California Welfare & Institutions Code
2 Sections 5150, et seq., and 5600.4, California Penal Code Section 4011.6 and the California Education
3 Code.
4
5
3. Remedial Plan
Notwithstanding anything to the contrary herein this Agreement,
6 CONTRACTOR shall perform the medical and behavioral health care services and responsibilities and
7 all other duties and requirements underlined in the "Remedial Plan· rRemedial Plan Services/Duties·),
8 Exhibit B, attached hereto and incorporated by this reference herein, whether any of the Remedial Plan
9 Services/Duties are currently within the scope of the work or identified in Exhibit A. COUNTY
10 understands that the CONTRACTOR is not a party to the Hall, et al. v County of Fresno lawsuit and
11 under no circumstances shall the provisions of this Agreement be interpreted to subject
12 CONTRACTOR to the jurisdiction of the Court as a party in the Hall, et al. v County of Fresno lawsuit,
13 case number 1:11-CV-02047-LJO-BAM (E.D. Cal. January 25, 2012). CONTRACTOR shall work in
14 cooperation with SHERIFF, DPH, and DBH, or their designees, to implement the balded, italicized
15 sections in Remedial Plan, Exhibit B, referenced herein. For purposes of thie Agreement, the following
16 terms in the Remedial Plan shall have the meanings below:
17 "JAIL Medical Director-shall mean CONTRACTOR's Medical Director
18 assigned to JAIL;
19 ·JAIL health care staff' or "health care staff' shall mean CONTRACTOR
20 or CONTRACTOR's medical and/or behavioral health care staff assigned to JAIL.
21 4. Staffing
22 a) CONTRACTOR shall, in performing all services and duties under
23 this Agreement, provide only qualified personnel who are licensed, certified and/or registered, as
24 necessary, to practice in the State of California, that are not debarred, excluded or suspended by any
25 local, State or Federal regulatory agency from practicing and are acceptable to COUNTY's SHERIFF,
26 DPH Director or DBH Director, or their respective designees. This section shall apply to all
27 CONTRACTOR's subcontracted personnel pursuant to Section XXV, SUBCONTRACTORS herein.
28 b) Pursuant to all terms and conditions set forth in Section XIX,
-3-
1 LICENSES AND CERTIFICATION, herein, all licenses necessary for CONTRACTOR to render medical
2 and behavioral health care services as provided by this Agreement shall be maintained throughout the
3 term of this Agreement by CONTRACTOR, Its staff members, and subcontractors {pursuant to Section
4 XXV, SUBCONTRACTORS, herein), participating in this Agreement Such failure to maintain any said
5 license or any revocation or non-renewal of any said license will be grounds for termination of this
6 Agreement by COUNTY.
7 c) CONTRACTOR shall provide medical, technical, and support
8 personnel, as necessary, for the rendering of medical and behavioral health care services pncluding,
9 but not limited to Jail Psychiatric Services ("JPSa)] to adult inmates detained at COUNTY's JAIL and
1 O fulfilling all duties under this Agreement.
11 5. Minimum Staffing Plan
12 CONTRACTOR shall provide a plan to COUNTY's SHERIFF, DPH
13 Director, or designee, for minimum staffing levels for all three {3) COUNTY JAIL facilities: Main Jail:
14 1225 M. Street, Fresno, California 93721; North Annex Jail: 1265 M. Street, Fresno, California, 93721;
15 and South Annex Jail: 2280 Fresno Street, Fresno, California, 93721. CONTRACTOR's staffing plan
16 shall include staffing of the following positions: a medical director, physicians, psychiatrists,
17 optometrist, optician, medical and behavioral health clinicians, a dentist, nurses, medical/dental/psych
18 assistants and technicians, and management and administrative staff. Exhibit C, attached hereto and
19 incorporated herein by reference, includes the agreed-upon minimum staffing levels necessary to
20 provide health care services required for a total maximum capacity of 3,291 inmates.
21 CONTRACTOR shall maintain, at a minimum, the staff levels as set forth
22 in Exhibit C. CONTRACTOR's staffing levels shall be designed to be as cost-effective as possible
23 while still meeting COUNTY's needs, fulfilling all requirements under this Agreement, and maintaining
24 compliance with Title 15 of the California Code of Regulations. In the event the total adult inmate
25 population increases or decreases substantially so that changes to the staffing plan in Exhibit C are
26 necessary for CONTRACTOR to fulfill its obligations under this Agreement, upon COUNTY'S or
27 CONTRACTOR's request, the parties shall enter negotiations in good faith to determine a mutually
28
-4-
1 agreeable change to the staffing level in Exhibit C and compensation set forth in this Section V,
2 COMPENSATION, herein.
3 6. NCCHC Accreditation
4 CONTRACTOR, on behalf of COUNTY's JAIL, and in collaboration with
5 SHERIFF, DPH, and DBH shall commence the process, including application, within six (6) months of
6 commencement of services under this Agreement a preliminary audit of JAIL to be conducted by
7 National Commission on Correctional Health Care (NCCHC) for the purpose of achieving NCCHC
8 accreditation of the JAIL After a joint review of the findings of said audit, CONTRACTOR and
9 COUNTY shall mutually agree upon a reasonable timetable for achieving NCCHC accreditation. Once
1 O accredited by NCCHC, CONTRACTOR shall maintain said accreditation throughout the remainder of
11 the term of this Agreement, barring any obstruction from the physical design of the facility or for other
12 reasons that are beyond CONTRACTOR's control, and shall be responsible for the payment of
13 accreditation related application, inspection, and certification fees. CONTRACTOR shall promptly
14 supply SHERIFF, DPH Director, and DBH Director, and/or respective deslgnees, with a hard copy (and
15 electronic copy, if available) of subsequent updates or new publications made available of the NCCHC
16 accreditation standards, throughout the term of this Agreement. CONTRACTOR shall remain in good
17 standing with NCCHC throughout the term of this Agreement, barring any obstruction from the physical
18 design of the facility or for other reasons that are beyond CONTRACTOR's control.
19 7. Medi-Cal Inmate Program
20 CONTRACTOR will not be responsible for any inpatient hospitalization
21 costs. CONTRACTOR will work with the COUNTY or the COUNTY's deslgnee to facilitate the
22 enrollment of eligible inmates under California's Medi-Cal County Inmate Program eMCIP·). To the
23 extent the inmates are determined to be ineligible for the MCIP program, CONTRACTOR will initially
24 pay for Inpatient services but will bill the COUNTY for reimbursement of such costs.
25 8. Monthly Administrative Meetings
26 CONTRACTOR shall schedule, facilitate, and hold monthly administrative
27 meetings with designated COUNTY staff and/or their designees, to evaluated statistics, program needs,
28 address problems/issues that may arise, and interrelationships between Jail staff, medical and
-5-
1 behavioral health care services staff and relationships with providers of emergency, inpatient, or
2 outpatient specialty care services.
3 9. SAMHSA Grant Funding
4 CONTRACTOR acknowledges that COUNTY's DBH receives funding
5 under the Substance Abuse and Mental Health Service Administration (SAMHSA) grant to fund a
6 portion of the COUNTY's Jail Psychiatric Services (JPS). SAMHSA is a Community Mental Health
7 Services Block Grant that distributes federal funding through the State of Califomia, Department of
8 Health Care Services.
9 CONTRACTOR shall comply with the requirements of the SAMHSA
10 grant, attached hereto as Exhibit D, "Community Mental Health Block Grant Application,· and
11 incorporated herein by this reference, in providing JPS.
12 CONTRACTOR's requirements for JPS are outlined in the Program Description identified in Exhibit D
13 and are also defined in Exhibit A. COUNTY shall request input from CONTRACTOR in regards to
14 subsequent fiscal year SAMHSA grant funding applications and requirements.
15 For each successive year that CONTRACTOR continues to provide JPS
16 under the SAMHSA grant, CONTRACTOR shall provide said services in accordance with subsequent
17 fiscal year SAMHSA grant requirements, including any and all applicable modifications or amendments
18 to such grant requirements, incorporated and attached herein by reference.
19 10. Behavioral Health Services
20 a) Guiding Principles of Care Delivery
21 CONTRACTOR shall provide all behavioral health services, programs and practices with the vision,
22 mission, and guiding principles of COUNTY's DBH as further described in Exhibit E, "Fresno County
23 Department of Behavioral Health Guiding Principles of Care Delivery", attached hereto and
24 incorporated herein by reference.
25 b) California Department of Health Care Services
26 CONTRACTOR shall also provide all behavioral health services in
27 accordance with the California Department of Health Care Services requirements as imposed on
28 COUNTY and all its subcontractors as Included herein in Section XXV, SUBCONTRACTORS, and
-6-
1 Exhibit F, ·Fresno County Behavioral Health Mental Health Care Requirements,· attached hereto and
2 incorporated herein by reference.
3
4
c) Linkage to Care
Upon discharge of an inmate with serious mental illness (SMI)
5 diagnosis from incarceration, CONTRACTOR shall link said individuals with outside service providers,
6 such as COUNTY's DBH Adult Division, as indicated in Exhibit A and in compliance with Remedial Plan
7 (Exhibit B).
8 d) Second-Generation Long-Acting Injectable Anti-Psychotic
9 Medicatjons
10 CONTRACTOR's pharmacy subcontractor shall have available
11 second-generation long-acting injectable anti-psychotic medications c·second Gen LAI·) for use within
12 the JAIL by CONTRACTOR, at no cost to COUNTY. Said contract shall be solely CONTRACTOR's
13 responsibility and COUNTY shall bear no responsibility whatsoever for said contract.
14 CONTRACTOR's psychiatrists will maintain sole responsibility for
15 prescribing said Second Gen LAI medications, as clinically indicated. CONTRACTOR shall bridge
16 medication, as indicated in Exhibit A and in compliance with Remedial Plan (Exhibit B), for
17 Individuals/inmates who enter the facility on such prescribed Second Gen LAI medications.
18 Specifically, CONTRACTOR shall verify prescription medications and CONTRACTOR's psychiatrists
19 shall prescribe the same medication to maintain individuals on a stable dosage, if clinically appropriate.
20 Within seven (7) days of bridging medications, said individuals shall receive a face-to-face evaluation
21 by CONTRACTOR's psychiatrists who may then choose to continue said prescription or change
22 prescription, as clinically appropriate. At any time during incarceration, CONTACTOR's psychiatrists
23 may initiate the use of Second Gen LAI medications, as clinically indicated.
24 CONTRACTOR shall ensure Its subcontracted pharmacy will
25 coordinate for delivery of said Second Gen LAI medications to JAIL. As described herein,
26 CONTRACTOR will be solely responsible for the cost of said Second Gen LAI medication utilized by
27 CONTRACTOR.
28 11. Minimize Transportation Needs
-7-
1 CONTRACTOR shall minimize the transportation of adult inmates for off-
2 site health care treatment/services with the objective of reducing outpatient health care costs.
3 However, as necessary, CONTRACTOR shall arrange for emergency and non-emergency
4 transportation of any COUNTY adult inmate. CONTRACTOR shall coordinate between SHERIFF and
5 COUNTY's contracted emergency medical services ambulance provider for any health care emergency
6 that may arise. CONTRACTOR shall immediately notify the COUNTY JAIL Watch Commander on staff
7 at the JAIL, as applicable, when a medical or behavioral health care emergency or a critical illness
8 beyond CONTRACTOR's on-site capabilities has occurred. COUNTY will be responsible for the costs
9 of transportation, as described in Section II, OBLIGATIONS OF THE COUNTY, herein.
10 CONTRACTOR shall also notify the COUNTY JAIL Watch Commander if transportation off-site is
11 needed for any services provided under this Agreement, as listed in Exhibit A
12
13
12. Inmate Death Notification
CONTRACTOR shall immediately notify SHERIFF, DPH Director, DBH
14 Director and COUNTY's Health Officer of an inmate death, but in any case such notification shall be no
15 later than 8:00 am the morning following the inmate's death. CONTRACTOR shall provide to the
16 aforementioned persons/departments, information, including time of death and situation surrounding
17 said death, no later than 48 hours following the inmate's death.
18
19
13. Elective Medical Care
CONTRACTOR shall not be responsible for any inmate's elective medical
20 care. Elective medical care Is defined as medical care, which, if not provided would not, in the
21 reasonable medical opinion of CONTRACTOR's Medical Director, cause the inmate's health to
22 deteriorate or cause definite harm to the inmate's well-being. Examples of such elective medical care
23 may include, but are not limited to, the following: breast reduction, gastric bypass, facelift, or gender
24 reassignment surgery.
25
26
14. Janitorial Service
CONTRACTOR shall be responsible for providing its own janitorial
27 services for all designated work areas utilized by CONTRACTOR's staff at the JAIL.
28 15. Medical/Dental Equipment
-8-
1 CONTRACTOR, at its own cost, shall be responsible for the repair,
2 maintenance, housekeeping, and replacement (if necessary) of all COUNTY provided and/or owned
3 medical and dental equipment. In the event the CONTRACTOR determines additional medical and
4 dental equipment is necessary, CONTRACTOR shall be responsible for the full cost of such items.
5 CONTRACTOR shall reimburse COUNTY for all losses and damages resulting from the negligent or
6 careless use of COUNTY provided and/or owned medical and dental equipment or other COUNTY
7 property or facilities by CONTRACTOR's personnel.
8 B. Commencing upon the effective date of this Agreement
9 1. CONTRACTOR acknowledges that COUNTY JAIL facilities are operated
10 as no hostage facilities; therefore, all services provided in JAIL shall be performed in accordance with
11 Exhibit G ·No Hostage Facility" policy, attached hereto and incorporated herein by this reference.
12 2. CONTRACTOR's employees and subcontractors working within the JAIL
13 will be required to pass a background investigation by SHERIFF. CONTRACTOR's staff must obtain
14 mandatory security clearance from the SHERIFF, as applicable, prior to commencing work.
15 CONTRACTOR shall advise SHERIFF, as applicable, at a minimum of three (3) weeks in advance of
16 placement of a new employee/staff to provide adequate time for the background check process.
17 CONTRACTOR will be responsible for all costs to obtain security clearances for all of CONTRACTOR's
18 prospective employees/staff within JAIL. CONTRACTOR shall also provide adequate time for
19 CONTRACTOR's employees/staff to attend facility orientation and training by SHERIFF, as applicable.
20 3. COUNTY maintains the right to veto the use or employment of any of
21 CONTRACTOR's employees/staff on-site at JAIL provided by CONTRACTOR or any subcontractor
22 under the direction of CONTRACTOR. CONTRACTOR shall remove any of CONTRACTOR's
23 employees/staff on-site at JAIL and replace said employee/staff in a timely manner when requested,
24 without limitation, by SHERIFF, DPH, or DBH. Application for access to JAIL is attached hereto as
25 Exhibit H and incorporated herein by this reference. The SHERIFF's Sexual Misconduct and Abuse
26 Policy D-360, attached hereto as Exhibit I, incorporated herein by this reference, shall be read and
27 signed by all CONTRACTOR's employees/staff prior to commencing work.
28 4. CONTRACTOR shall observe all applicable SHERIFF policies and
-9-
1 procedures concerning the operation of the JAIL. CONTRACTOR's staff shall sign acknowledgments
2 of certain SHERIFF policies and procedures, as applicable and upon request. CONTRACTOR shall
3 also observe all DPH and DBH policies and procedures, as applicable. CONTRACTOR's personnel
4 shall abide by the security regulations of the JAIL. CONTRACTOR must inform its employees and
5 subcontractors of all such regulations.
6 5. SHERIFF, or designee, has provided to CONTRACTOR a site map with
7 floor plans identifying the designated health care areas within each of the JAIL to be occupied by
8 CONTRACTOR for CONTRACTOR'S use in performing all services and duties under this Agreement.
9 CONTRACTOR acknowledges that the designated health care areas are confidential and shall
10 maintain the confidentiality of those areas and the provided site map. As detailed in Section II,
11 OBLIGATIONS OF THE COUNTY, herein, COUNTY shall provide to CONTRACTOR in an •as-is•
12 condition office and clinic space, furniture, fixtures, facilities, medical and dental equipment, telephones
13 and other consumable and incidental medical and office supplies within the designated health care
14 areas in JAIL to utilize during the term of this Agreement.
15 a) CONTRACTOR shall utilize all COUNTY office and clinic space,
16 furniture, fixtures, facilities, medical and dental equipment, and telephones within the designated health
17 care areas in JAi L in a careful and proper customary manner.
18 b) CONTRACTOR shall not utilize COUNTY office and clinic space,
19 furniture, fixtures, facilities, medical and dental equipment, and telephones within the designated health
20 care areas: {a) in any manner that violates state or federal law; and (b) for any purpose other than in
21 the performance of its obligations under this Agreement. CONTRACTOR's licensed and qualified staff
22 are permitted to utilize COUNTY medical and dental equipment to which they are qualified to utilize.
23 c) CONTRACTOR, at its own cost, shall be responsible for the
24 repair, maintenance, housekeeping, and replacement {if necessary) of all COUNTY furniture, fixtures,
25 and office equipment. In the event the CONTRACTOR determines additional furniture, fixtures, and/or
26 office equipment is necessary, CONTRACTOR shall be responsible for the full cost of such items.
27 CONTRACTOR shall reimburse COUNTY for all losses resulting from the negligent or careless use of
28 COUNTY furniture, fixtures, and office equipment or other COUNTY property or facilities by
-10-
1 CONTRACTOR's personnel.
2 d) CONTRACTOR shall not make any installations, alterations,
3 replacements or improvements of any kind to COUNTY furniture, fixtures, facilities, and/or medical and
4 dental equipment without obtaining COUNTY's prior written consent. CONTRACTOR shall not remove
5 COUNTY furniture, fixtures, medical and dental equipment, or telephones from its location in JAIL.
6 e) At all times during the term of this Agreement and thereafter,
7 COUNTY shall be the sole owner of all furniture, fixtures, medical and dental equipment, and
8 telephones contained within JAIL, with the exception of additional (not replacement) furniture, fixtures,
9 medical and dental equipment, and telephones that CONTRACTOR purchases for on-site uses during
1 O the term of this Agreement. Notwithstanding the foregoing, upon contract termination/expiration, the
11 COUNTY reserves the right to purchase any equipment purchased by CONTRACTOR for on-site uses.
12 The purchase price shall be negotiated at such time that COUNTY requests to purchase
13 CONTRACTOR's equipment. CONTRACTOR shall not pledge, encumber, create a security interest in
14 or permit a lien to be attached to any of COUNTY's furniture, fixtures, facilities, and/or medical and
15 dental equipment.
16 f) At the termination of this Agreement, CONTRACTOR will return all
17 COUNTY furniture, fixtures, medical and dental equipment, and telephones to COUNTY in working
18 order, with the exception of reasonable wear and tear. If any of COUNTY's furniture, fixtures medical
19 and dental equipment, and/or telephones require replacement or repair, CONTRACTOR shall, at
20 CONTRACTOR's expense, replace with the same or comparable item or repair the item to working
21 order.
22 g) In regards to the fixed assets described in Section II,
23 OBLIGATIONS OF THE COUNTY, and Exhibit J •Jail Medical Equipment Inventory List", attached
24 hereto and incorporated herein by this reference, CONTRACTOR agrees to the following:
25 (1) To maintain all fixed assets in good working order and
26 condition, normal wear and tear excepted; and
27 (2) To label all fixed assets, to perform periodic inventories as
28 required by COUNTY and to maintain an inventory list showing where and how the fixed asset is being
-11-
1 used, in accordance with procedures developed by COUNTY. All such lists shall be submitted to
2 COUNTY within ten (10) calendar days of any requests therefore.
3 (3) To report in writing to COUNTY immediately after
4 discovery, the loss or theft of any fixed asset. For stolen items, the local law enforcement agency must
5 be contacted and a copy of the loss report submitted to COUNTY, within ten (10) calendar days of such
6 report.
7 (4) To maintain a policy of insurance for all risk personal
8 property coverage that shall be endorsed naming the COUNTY as an additional loss payee.
9 6. CONTRACTOR shall ensure that the management and operational
10 responsibilities for medical and behavioral health care services are transitioned as seamlessly as
11 possible from the previous COUNTY-contracted provider's management, to ensure continuity of care
12 and minimal disruption to services provided. CONTRACTOR's transition plan and timeline for such
13 transition is identified in CONTRACTOR's Response. It is understood by the parties that
14 CONTRACTOR shall have completed a "data migration" of the previous contractor's collected data to
15 CONTRACTOR prior to July 1, 2018 such that CONTRACTOR shall have in its data/records system all
16 inmate medical records/history/medication records from previous contractor no later than July 1, 2018.
17 CONTRACTOR acknowledges that the expectation and objective is that all such records/history shall
18 be 100% migrated, accurate and ready for use by CONTRACTOR on July 1, 2018. Notwithstanding
19 the foregoing, CONTRACTOR shall not be responsible for delays in the aforementioned transition
20 plan/duties due to the previous COUNTY-contracted provider's failure to promptly cooperate with
21 CONTRACTOR.
22 7. CONTRACTOR shall respond to and process all medical record requests
23 and subpoenas for records whether or not the Release of Information is directly addressed to COUNTY
24 and/or CONTRACTOR, so long as the Release of Information is otherwise lawful.
25 11. OBLIGATIONS OF THE COUNTY
26 A. Office Space, Equipment and Inventory
27
28
1. Office/Clinic Space & Equipment
a) COUNTY shall provide to CONTRACTOR in an "as-is· condition
-12-
1 office and clinic space, furniture, fixtures, facilities, medical and dental equipment and other
2 consumable and incidental medical and office supplies within the designated health care areas in JAIL
3 to utilize during the term of this Agreement. Such COUNTY-provided office furniture, medical and
4 dental equipment, and other inventoriable assets available for CONTRACTOR's use, are listed in
5 Exhibit J.
6 b) COUNTY shall provide CONTRACTOR with accessibility to
7 COUNTY's computer network, as appropriate via Virtual Private Network (VPN), Virtual Desktop
8 Infrastructure (VOi), or other mutually agreed upon secure connection, and COUNTY will coordinate
9 with CONTRACTOR, as needed, to maintain CONTRACTOR's cloud infrastructure's ability to operate
1 O and interface effectively with COUNTY's existing computer equipment and network. COUNTY shall
11 not be responsible for any damage whatsoever, including but not limited to claims and losses suffered
12 by CONTRACTOR, to CONTRACTOR's cloud infrastructure or external network resulting from
13 COUNTY providing CONTRACTOR with access to COUNTY's computer network.
14 COUNTY shall provide CONTRACTOR accessibility to the
15 abovementioned COUNTY computer infrastructure at no cost to CONTRACTOR for the first ninety (90)
16 days after the commencement of services on July 1, 2018. After the initial 90-day period, it is
17 understood that CONTRACTOR will no longer be utilizing COUNTY computer equipment;
18 CONTRACTOR will bring in its own computer equipment. COUNTY shall maintain responsibility for
19 CONTRACTOR's costs for intranet line charges and internet logon charges as COUNTY provided
20 services.
21 c) COUNTY shall provide only the equipment presently on-site as
22 well as any other equipment that COUNTY chooses to purchase and retain ownership of.
23 d) COUNTY shall provide CONTRACTOR with space to store
24 physical medical and behavioral health care records, as necessary, of adult inmates at the Main Adult
25 JAi L facility.
26 e) COUNTY shall pay for all building maintenance fees for the work
27 areas utilized by CONTRACTOR within the JAIL. However, as indicated hereinabove, COUNTY will
28 not be responsible to provide the janitorial services for the designated work areas utilized by
-13-
1 CONTRACTOR as indicated in Section I, OBLIGATIONS OF THE CONTRACTOR, herein.
2 d) The parties to this Agreement agree that no provision in this
3 Agreement, including without limitation all attached and incorporated documents, is intended to create a
4 possessory interest for CONTRACTOR in any property, building, facility and/or equipment owned or
5 possessed by COUNTY. Furthermore, no provision herein shall be interpreted as providing
6 CONTRACTOR a lease, license or possessory interest of any kind whatsoever in any property,
7 building, facility and/or equipment owned or possessed by COUNTY.
8 2. Consumable and Incidental Supplies
9 COUNTY shall allow CONTRACTOR to use all consumable and
10 incidental medical, dental and office supplies remaining within JAIL upon commencement of services
11 identified in Exhibit A. At such time as this Agreement ends, CONTRACTOR shall leave all existing
12 consumable and incidental medical, dental, and office supplies within the JAIL for impending use by
13 COUNTY. Such examples of consumable and incidental medical, dental and office supplies include the
14 following, but are not limited to: syringes, latex gloves, bandages, gauze, cotton balls, paper, folders,
15 envelopes, tape dispensers, trash cans, ink/toner cartridges, blood pressure cuffs, stethoscopes, etc.
16 3. Fixed Assets
17 All existing COUNTY equipment and/or additional equipment purchased
18 by CONTRACTOR purchased at a cost of Five Thousand and No/100 Dollars ($5,000.00) or over,
19 including sales tax, shall be identified as fixed assets and will be marked with an assigned COUNTY
20 Inventory Number {typically a FR# or a GR#). Such fixed assets are identified in Exhibit J. These fixed
21 assets shall be retained by COUNTY, as COUNTY property, in the event this Agreement is terminated
22 or upon the expiration of this Agreement. CONTRACTOR agrees to participate in an annual inventory
23 of all COUNTY fixed assets and shall be physically present when fixed assets are retumed to COUNTY
24 possession at the termination or expiration of this Agreement. CONTRACTOR will be responsible for
25 returning to COUNTY all COUNTY-owned fixed assets, or the fair market value of said fixed assets if
26 unable to produce the fixed assets at the expiration or termination of this Agreement, barring any
27 reasons that are beyond CONTRACTOR's control.
28 5. lnventorjable Assets
-14-
1 Said equipment listed hereinabove in Section II. OBLIGATIONS OF THE
2 COUNTY, A. Office Space, Equipment and Inventory, and other property to be provided by the
3 COUNTY, shall be inventoried at the beginning and at the end of the contract term by SHERIFF, DPH
4 Director, or designee, and CONTRACTOR's representative. Both parties shall participate in such
5 inventory and sign an acknowledgment of the final inventory result. All COUNTY's equipment identified
6 with a COUNTY Inventory Number (i.e., identified with a FR# or GR# and bar code) is required to be
7 inventoried annually by COUNTY staff. CONTRACTOR shall participate and make designated work
8 areas available to COUNTY staff for said inventory purposes.
9
10
6. COUNTY Telephone System
COUNTY shall allow CONTRACTOR to utilize COUNTY'S existing
11 telephones and telephone system. COUNTY currently has seventy-eight (78) phones placed within the
12 JAIL facilities for CONTRACTOR's use. COUNTY shall be responsible for CONTRACTOR's telephone
13 costs (including utilization and hardware) up to Thirty-Three Thousand and No/100 Dollars ($33,000.00)
14 annually throughout the term of this Agreement. Any additional costs above the Thirty-Three Thousand
15 and No/100 Dollars ($33,000.00) will be the responsibility of CONTRACTOR. CONTRACTOR will be
16 invoiced for the additional costs identified after each one-year period of this Agreement, pursuant to the
17 terms identified in Section VI, INVOICING, herein.
18
19
8. Security
COUNTY shall be exclusively responsible to provide security for the protection of
20 CONTRACTOR's employees and to enable CONTRACTOR to safely and adequately provide the
21 comprehensive medical and behavioral health care services described in this Agreement, specifically
22 Exhibit A and the Remedial Plan In Exhibit B. COUNTY shall provide all CONTRACTOR's staff with
23 security orientation. Nothing herein should be construed to make COUNTY's its deputies or employees
24 guarantors of the safety of CONTRACTOR's employees, agents, or subcontractors. Accordingly, in the
25 event of an unusual widespread disturbance (e.g., inmate riot) beyond the CONTRACTOR's control tha
26 t materially affects the cost to CONTRACTOR of providing health care services hereunder (and as
27 described in Exhibit A), the parties shall meet and negotiate In good faith to determine a mutually
28 agreeable contract modification, including, but not limited to, an adjustment to compensation set forth in
-15-
1 Section V, COMPENSATION, herein.
2 C. Utilities
3 COUNTY shall be responsible for all utilities costs ,including water, sewer, trash
4 disposal, and gas and electricity.
5
6
D. Average Daily Population
COUNTY shall record the average daily population ("ADP·) of JAIL inmates and
7 shall provide this information to CONTRACTOR to identify monthly fluctuations as described in Section
8 V, COMPENSATION, herein, no later than five (5) business days after the first (1st) of each month
9 immediately subsequent to the calendar month for which services are rendered.
10
11
E. Inmate Transportation
Immediately upon CONTRACTOR's request to COUNTY to transport adult
12 inmates due to a medical emergency or a critical illness pursuant to Section I, OBLIGATIONS OF THE
13 CONTRACTOR, herein, COUNTY shall provide emergency transportation by coordinating with its then
14 currently contracted emergency medical services ambulance provider. In addition, upon
15 CONTRACTOR's request and when necessary, COUNTY's SHERIFF shall provide non-emergency
16 transportation of adult Inmates to medical appointments. Transportation costs, including services
17 provided by COUNTY'S currently contracted emergency medical services ambulance provider, as well
18 as transports provided by SHERIFF for non-emergency off-site appointments, shall not be the
19 responsibility of CONTRACTOR.
20 F. Contract Administration
21 SHERIFF shall be responsible for contract administration, evaluation, and
22 oversight of the dally medical and behavioral health programs and operational services provided by
23 CONTRACTOR within the JAIL in close coordination with an interdisciplinary team from SHERIFF,
24 DPH, and DBH as applicable. SHERIFF will lead coordination efforts with CONTRACTOR to establish
25 standardized procedures In compliance with the Remedial Plan, identified in Exhibit 8.
26 Ill.
27 This Agreement shall become effective upon execution. The term of this Agreement
28 shall be for a period of three (3) years, commencing on July 1, 2018 through and Including June 30,
-16-
1 2021, unless sooner terminated as provided herein. The parties' obligations stated herein regarding
2 the provision of medical services shall begin upon the commencement of the term unless otherwise
3 provided.
4 This Agreement may be extended for two (2) additional consecutive twelve (12) month
5 periods upon the same terms and conditions herein set forth, and subject to the following provisions
6 within this Section Ill. Each such twelve (12) month extension period shall be contingent upon the
7 evaluation of CONTRACTOR's performance of its services under this Agreement during the then-
8 current period of this Agreement, by SHERIFF, DPH Director and DBH Director, or their respective
9 designees. If, upon each such evaluation, SHERIFF, DPH Director, or their respective designees,
1 O determine that the then-current term of this Agreement should be extended pursuant to this Section Ill,
11 herein, SHERIFF, DPH Director, or deslgnee, may provide a written notice of such extension to
12 CONTRACTOR ninety (90) days prior to each such subsequent twelve (12) month extension period.
13 Notwithstanding anything to the contrary in this Section Ill, if either party determines not to extend this
14 Agreement as provided in this Section Ill, then such party shall provide written notice of non-extension
15 of this Agreement not later than ninety (90) days prior to the expiration of the then-current term of this
16 Agreement.
17 IV. TERMINATION
18 A. Non Allocation of Funds -The terms of this Agreement, and the services to be
19 provided hereunder, are contingent on the approval of funds by the appropriating government agency.
20 Should sufficient funds not be allocated, the' services provided may be modified, or this Agreement
21 terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice.
22 B. Breach of Contract -The COUNTY may immediately suspend or terminate this
23 Agreement in whole or in part, where in the determination of the COUNTY there is:
24
25
26
27
28
1.
2.
3.
An illegal or improper use of funds;
A failure to comply with any term of this Agreement;
A substantially incorrect or incomplete report submitted to the COUNTY;
4. Improperly performed service.
Except for the foregoing, this Agreement may be terminated by either party
-17-
1 should the other party materially default in the performance of this Agreement for any reason other than
2 listed above. Upon a material breach, this Agreement may be terminated following the failure of the
3 defaulting party to remedy the breach to the satisfaction of the non-defaulting party within five (5)
4 COUNTY business days of written notice specifying the breach. If the breach is not remedied within
5 that five (5) COUNTY business day period, the non-defaulting party may terminate the Agreement on
6 further written notice specifying the date of termination. If the nature of the breach is such that it
7 cannot be cured within a ftve (5) COUNTY business day period, the defaulting party may, submit a
8 written proposal within that period which sets forth a specific means to resolve the default. If the non-
9 defaulting party consents to that proposal in writing, which consent shall not be unreasonably withheld,
10 the defaulting party shall immediately embark on its plan to cure. If the default is not cured within the
11 time agreed, the non-defaulting party may terminate upon written notice specifying the date of
12 termination.
13 In no event shall any payment by COUNTY constitute a waiver by COUNTY of
14 any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
15 Neither shall such payment impair or prejudice any remedy whatsoever, Including, but not limited to,
16 liquidated damages as provided herein, available to COUNTY with respect to the breach or default.
17 COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of any funds
18 disbursed to CONTRACTOR under this Agreement, which in the sound and reasonable judgment of
19 COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
20 promptly refund any such funds upon demand or, at COUNTY's option, such repayment shall be
21 deducted from Mure payments owing to CONTRACTOR under this Agreement
22 C. Without Cause -Under circumstances other than those set forth above, this
23 Agreement may be terminated by either party upon the giving of ninety (90) days advance written
24 notice of an intention to terminate to the other party. Notwithstanding the foregoing, CONTRACTOR
25 agrees to continue providing its services under this Agreement until a successor contractor has
26 commenced performing said services, provided COUNTY is engaging in a good faith effort to secure a
27 successor contractor. CONTRACTOR shall meet and confer with COUNTY to assist in the transition to
28 a successor contractor.
-18-
1 D. Dispute Resolution -If a dispute arises out of or relating to this Agreement, or the
2 breach thereof, and if said dispute cannot be settled through negotiation, the parties agree first to try in
3 good faith to settle the dispute by non-binding mediation before resorting to litigation or some other
4 dispute resolution procedure, unless the parties mutually agree otherwise. The mediator shall be
5 mutually selected by the parties, but in the case of disagreement, the mediator shall be selected by lot
6 from among two (2) nominations provided by each party. All costs and fees required by the mediator
7 shall be split equally by the parties; otherwise each party shall bear its own costs of mediation. If
8 mediation fails to resolve the dispute within thirty (30) days, either party may pursue litigation to resolve
9 the dispute.
10 E. In the event this Agreement is terminated in accordance with this Section IV,
11 TERMINATION, herein, COUNTY shall only be required to compensate CONTRACTOR for services
12 rendered prior to the effective termination date.
13
14
15
V. COMPENSATION
A. Base Compensation
COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
16 compensation in accordance with •payment Schedule -Base Compensation· set forth in Exhibit K,
17 attached hereto and incorporated herein by this reference, for providing the comprehensive medical
18 and behavioral health care services identified in Exhibit A and the Remedial Plan requirements in
19 Exhibit B.
20 1. For the period of July 1, 2018 through June 30, 2019, the base
21 compensation paid to CONTRACTOR .for actual services provided to COUNTY shall not exceed
22 Twenty-Two Million, Eight Hundred Fourteen Thousand, Three Hundred Fifty-Five and 00/100 Dollars
23 ($22,814,355.00). COUNTY shall pay CONTRACTOR in twelve (12) monthly payments [at one-twelfth
24 (1112th) of the annual contract amount], not to exceed One Million, Nine Hundred One Thousand, One
25 Hundred Ninety-Six and 25/100 Dollars ($1,901, 196.25).
26 2. For the period of July 1, 2019 through June 30, 2020, the base
27 compensation paid to CONTRACTOR for actual services provided to COUNTY shall not exceed
28 Twenty-Three Million, Four Hundred Ninety-Seven Thousand, Two Hundred Eighty Five and 65/100
-19-
1 Dollars {$23,497,285.65). COUNTY shall pay CONTRACTOR in twelve {12) equal monthly payments
2 [at one-twelfth {1112th) of the annual contract amount], not to exceed One Million, Nine Hundred Fifty-
3 Eight Thousand, One Hundred Seven and 14/100 Dollars ($1,958,107.14).
4 3. For the period of July 1, 2020 through June 30, 2021, the base
5 compensation paid to CONTRACTOR for actual services provided to COUNTY shall not exceed
6 Twenty-Four Million, Two Hundred Thousand, Seven Hundred Four and 22/100 Dollars
7 {$24,200,704.22). COUNTY shall pay CONTRACTOR in twelve (12) equal monthly payments [at one-
s twelfth (1112th) of the annual contract amount], not to exceed Two Million, Sixteen Thousand, Seven
9 Hundred Twenty-Five and 35/100 Dollars ($2,016,725.35).
10 If performance standards are met and this Agreement is extended for an
11 additional one-year period pursuant to Section Ill, TERM, herein, then for the period of July 1, 2021
12 through June 30, 2022, the base compensation paid to CONTRACTOR for actual services provided to
13 COUNTY shall not exceed Twenty-Four Million, Nine Hundred Twenty-Five Thousand, Two Hundred
14 Twenty-Five and 35/100 Dollars {$24,925,225.35). COUNTY shall pay CONTRACTOR in twelve {12)
15 equal monthly payments [at one-twelfth (1112th) of the annual contract amount], not to exceed Two
16 Million, Seventy-Seven Thousand, One Hundred Two and 11/100 Dollars ($2,077,102.11).
17 5. If performance standards are met and this Agreement is extended for a
18 second additional one-year period pursuant to Section Ill, TERM, herein, then for the period of July 1,
19 2022 through June 30, 2023, the base compensation paid to CONTRACTOR for actual services
20 provided to COUNTY shall not exceed Twenty-Five Million, Six Hundred Seventy-One Thousand, Four
'
21 Hundred Eighty-Two and 11/100 Dollars ($25,671,482.11). COUNTY shall pay CONTRACTOR in
22 twelve {12) equal monthly payments [at one-twelfth {1112th) of the annual contract amount], not to
23 exceed Two Million, One Hundred Thirty-Nine Thousand, Two Hundred Ninety and 18/100 Dollars
24 ($2, 139,290.18).
25
26
B. Increases or Decreases in Inmate Population
The parties agree and acknowledge that the annual base compensation for
27 calculated is based upon an average daily population C-ADP") which includes inmates {hereinafter ·JAIL
28 ADP") between 2,700 and 3,000, inclusive. The parties also agree and acknowledge that the ADP will
-20-
1 be calculated by SHERIFF on a daily basis and provided to CONTRACTOR on a monthly basis. If the
2 JAi L ADP, calculated and averaged over a calendar month, rises above 3,000 or falls below 2,700,
3 CONTRACTOR shall be compensated (whether an increase or decrease) at the ADP rate, according to
4 the rates outlined below, herein.
5 1. For the period of July 1, 2018 through June 30, 2019, if the JAIL ADP
6 exceeds 3,000 inmates in any given calendar month then the compensation payable to CONTRACTOR
7 by COUNTY shall be increased by a rate of $4.56 per day for the number of days in the identified
8 calendar month for each inmate over 3,000. Conversely, should the JAIL ADP decrease below 2,700
9 inmates in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate of $4.56 per day
1 O for the number of days in the identified calendar month for each inmate less than 2,700.
11 2. For the period of July 1, 2019 through June 30, 2020, if the JAIL ADP
12 exceeds 3,000 inmates in any given calendar month, then the compensation payable to
13 CONTRACTOR by COUNTY shall be increased by a rate of $4.56 per day for the number of days in
14 the identified calendar month for each inmate over 3,000. Conversely, should the JAIL ADP decrease
15 below 2,700 inmates in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate of
16 $4.56 per day for the number of days in the identified calendar month for each inmate less than 2,700.
17 3. For the period of July 1, 2020 through June 30, 2021, if the JAIL ADP
18 exceeds 3,000 inmates in any given calendar month, then the compensation payable to
19 CONTRACTOR by COUNTY shall be increased by a rate of $4.56 per day for the number of days in
20 the identified calendar month for each inmate over 3,000. Conversely, should the JAIL ADP decrease
21 below 2,700 inmates in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate of
22 $4.56 per day for the number of days in the identified calendar month for each inmate less than 2,700.
23 4. If performance standards are met and this Agreement is extended for an
24 additional one-year period pursuant to Section Ill, TERM, herein, then for the period of July 1, 2021
25 through June 30, 2022, if the JAIL ADP exceeds 3,000 inmates in any given calendar month, then the
26 compensation payable to CONTRACTOR by COUNTY shall be increased by a rate of $4.56 per day for
27 the number of days in the identified calendar month for each inmate over 3,000. Conversely, should
28 the JAIL ADP decrease below 2,700 inmates in any given calendar month, CONTRACTOR shall rebate
-21-
1 COUNTY by a rate of $4.56 per day for the number of days in the identified calendar month for each
2 inmate less than 2,700.
3 5. If performance standards are met and this Agreement is extended for an
4 additional orie-year period pursuant to Section Ill, TERM, herein, then for the period of July 1, 2022
5 through June 30, 2023, if the JAIL ADP exceeds 3,000 Inmates in any given calendar month, then the
6 compensation payable to CONTRACTOR by COUNTY shall be increased by a rate of $4.56 per day for
7 the number of days In the identified calendar month for each inmate over 3,000. Conversely, should
8 the JAIL ADP decrease below 2,700 inmates in any given calendar month, CONTRACTOR shall rebate
9 COUNTY by a rate of $4.56 per day for the number of days in the identified calendar month for each
10 inmate less than 2,700.
11 6. The rates listed above are intended to cover additional costs in those
12 instances where minor, short-term increases in the inmate population result in the higher utilization of
13 CONTRACTOR's routine supplies and services provided under this Agreement. However, the rates
14 are not Intended to provide for any additional fixed costs (e.g., staffing positions or ancillary services
15 costs), which might prove necessary if the inmate population changes significantly and If the population
16 change is sustained. Accordingly, if the JAIL ADP exceeds 3,000 or falls below 2,700 for a period of
17 ninety (90) consecutive days or more, COUNTY and CONTRACTOR shall meet and negotiate in good
18 faith regarding the impact to staffing levels as a result of such population change on this Agreement; in
19 the event, the parties are unable to reach an agreement on staffing level and/or compensation
20 adjustments to accommodate any such population change within a thirty (30} day period following
21 notice by the party requesting renegotiation, then either party may terminate the Agreement with ninety
22 (90} days advance written notice.
23 C. Maximum Compensation
24 In no event shall total compensation and any other payment for services
25 performed under this Agreement be in excess of Seventy Million, Five Hundred Twelve Thousand,
26 Three Hundred Forty-Four and 87/100 Dollars ($70,512,344.87} for the entire three (3) year term of this
27 Agreement.
28 If this Agreement is extended for an additional one (1} year period after the first
-22-
-
1 three (3) years of this Agreement, pursuant to Section Ill, TERM, herein, in no event shall total
2 compensation and any other payment for services performed under this Agreement be in excess of
3 Ninety-Five Million, Four Hundred Thirty-Seven Thousand, Five Hundred Seventy and 22/100 Dollars
4 ($95,437,570.22) for the entire four (4) year term of this Agreement.
5 If this Agreement is extended for an additional one ( 1) year period after the first
6 four (4) years of this Agreement, pursuant to Section Ill, TERM, herein, in no event shall total
7 compensation and any other payment for services performed under this Agreement be in excess of
8 One Hundred Twenty Million, One Hundred Nine Thousand, Fifty-Two and 32/100 Dollars
9 ($121,109,052.32) for the entire five (5) year term of this Agreement.
1 O It is understood that all expenses incidental to CONTRACTOR's performance of
11 services under this Agreement shall be borne by CONTRACTOR.
12 COUNTY does not pay, and shall not subject to any late charges, fees or
13 penalties of any kind. Notwithstanding the foregoing, COUNTY agrees to use best efforts to pay
14 compensation under this Agreement in a timely manner.
15 D. Medi-Cal County Inmate Program
16 Participation in the Medi-Cal County Inmate Program (MCIP) through the California
17 Department of Health Care Services (CDHCS} for Medi-Cal Covered Inpatient Hospitalization Services, is
18 approved by the County on an annual basis. Medi-Cal covered inpatient hospitalization services are
19 defined as allowable inpatient hospital care, of inmates in JAIL, for an expected period of 24 hours or longer
20 provided to a patient who may be deemed Medi-Cal eligible as determined by the COUNTY Department of
21 Social Services (DSS). COUNTY has chosen to participate in MCIP through June 2018. COUNTY has
22 applied to CDHCS to participate in the MCIP for 2018-2019. CDHCS has not released the MCIP
23 Agreement for 2018-2019.CONTRACTOR will assist and coordinate with designated COUNTY staff to
24 identify detained inmates requiring Medi-Cal eligibility determination.
25 If an inmate's MCIP eligibility is denied the CONTRACTOR will pay for inpatient
26 hospital services and will bill the COUNTY for reimbursement of costs; however, COUNTY will only
27 reimburse costs for services after DSS has made a final determination that the inmate is ineligible for MCIP.
28 If CONTRACTOR pays for services before eligibility is fully determined the COUNTY will not reimburse
-23-
,------1
1
2
CONTRACTOR for services paid to provider.
There is no guarantee that this program will be available or will continue to be
3 available during the term of this agreement. In the event the COUNTY does not participate in MCIP in
4 Mure years, the COUNTY and CONTRACTOR agree to renegotiate inpatient hospital costs.
5 Parties acknowledge and agree that cost of Medi-Cal Covered Inpatient
6 Hospitalization Services are not the financial responsibility of the CONTRACTOR and is hereby specifically
7 excluded from the scope of work within the Agreement, provided the CONTRACTOR complies in full with
8 the provisions of the Agreement.
9 CONTRACTOR shall manage the clinical process and adjudicate claims on behalf of
10 the COUNTY. COUNTY retains sole responsibility for the enrollment of youth into MCIP and hereby agrees
11 to timely application for and eligibility determination of all inmates who receive Medi-Cal Covered Inpatient
12 Hospitalization Services. It is CONTRACTOR's responsibility to promptly notify County of inmates
13 admission as an inpatient If the COUNTY is not notified timely, the CONTRACTOR may be responsible for
14 the costs of inpatient services.
15
16
F. Change of Scope
The compensation identified in this Agreement reflects the scope of services as
17 outlined herein and the current community standard of care with regard to health care services. Should
18 there be any substantial or material change in inmate distribution (e.g., types of chronic care patients),
19 standards of care {including, but not limited to, changes in HIV/AIDS therapy or Hepatitis C therapy
20 standards or material changes to the current Title 15 requirements), or scope of services (i.e., as
21 described in Exhibit A), that results in additional material costs to CONTRACTOR, including but not
22 limited to, any court order, decree, or otherwise stemming from the class action lawsuit, Hall et. al. v.
23 COUNTY et. al., Case No. 1:11-CV-02047-LJO-BAM {E.D. Cal. January 25, 2012), the costs related to
24 such change or modification are not contemplated herein and shall thus be negotiated with COUNTY in
25 good faith. If the parties are unable to reach a mutual agreement on these costs within thirty (30) days
26 from either party's written request to meet and negotiate in good faith, either party may terminate this
27 Agreement by providing the other party with ninety (90) days advance written notice.
28 VI. PHARMACY COSTS
-24-
1 CONTRACTOR is responsible for all inmate pharmacy costs capped at $25,000 per year
2 for each individual inmate. Additionally, on an annual basis, CONTRACTOR is responsible for the first
3 $150,000 of the annual aggregate of all inmate pharmacy costs exceeding $25,000 per year for each
4 individual inmate. COUNTY is responsible, on an annual basis, for all inmate pharmacy costs
5 exceeding the aforementioned first $150,000 of the annual aggregate.
6
7
VII. INVOICING
CONTRACTOR shall submit monthly invoices to COUNTY by the fifteenth (15th) of each
8 month in the· month in which services will be rendered in accordance with Payment Schedule, as
9 identified in Exhibit K, as described in Section V, COMPENSATION, hereinabove.
10 If according to Section V, COMPENSATION, herein, there is an increase or decrease in
11 JAi L ADP, calculated and averaged over a quarterly time period that falls outside of the range of 2,700
12 to 3,000, inclusive, CONTRACTOR shall clearly identify any such increase or decrease in JAIL ADP
13 and the applicable rate shall be applied in arrears for any such increase or decrease on said invoice.
14 Subject to CONTRACTOR's satisfactory performance of services identified in this
15 Agreement, COUNTY agrees to pay CONTRACTOR within forty-five (45) days after receipt and
16 verification of CONTRACTOR's invoices. COUNTY shall verify all JAIL ADP population changes
17 identified in CONTRACTOR's invoices prior to payment.
18
19
20
21
22
Invoices shall be submitted to:
County of Fresno, Sheriff-Coroner's Office
P.O. Box 1788
Fresno, CA 93717
Attention: Sheriff.
Invoices shall include the amount due for base compensation as identified in Exhibit K.
23 The Agreement number listed at the top right comer of page one (1) of this Agreement must appear on
all invoices and correspondence relating to this Agreement.
24
25
26
VIII. LIQUIDATED DAMAGES
Liquidated damages shall be as defined and specified herein this Section VII, and in
RFP No. 18-006. Liquidated damages for delay shall not apply in force majeure circumstances or when
27
the delay is caused by other circumstances beyond the control of the CONTRACTOR. If liquidated
28
-25-
1 damages are imposed by a COUNTY Department and the CONTRACTOR Is not in agreement, the
2 action can be appealed to the appropriate COUNTY Department Head who shall decide such dispute
3 within thirty (30} days prior written notice. Should the CONTRACTOR not agree with the decision of the
4 COUNTY Department Head, the CONTRACTOR may appeal such decision to the COUNTY's Board of
5 Supervisors. The Board of Supervisors shall decide the action within an additional thirty (30} days,
6 should CONTRACTOR not agree with the decision of the Board of Supervisors, the CONTRACTOR
7 shall have thirty (30} days to submit the decision to binding arbitration in accordance with the American
8 Arbitration Association, Commercial Arbitrative Rule. Each party shall pay for its own costs and
9 attorney fees for the arbitration.
10 CONTRACTOR agrees that it has carefully examined the nature of the tasks it shall
11 perform under this Agreement and acknowledges that such tasks involve medical and behavioral health
12 services and attendant duties/requirements that are essential to the health and welfare of incarcerated
13 persons (Inmates}. CONTRACTOR further agrees that time is of the essence in CONTRACTOR's
14 performance of its services under this Agreement. Furthermore, CONTRACTOR acknowledges that the
15 performance of its services under this Agreement according to the standards, requirements and
16 objectives delineated herein represent the reasonable acceptable limits of CONTRACTOR'S
17 performance; and that any failure or delay whatsoever to meet such performance standards,
18 requirements and objectives will result in damage to COUNTY. Therefore, this Agreement provides for
19 the payment of liquidated damages from CONTRACTOR to COUNTY for any failure by CONTRACTOR
20 to meet the performance standards as set forth in Performance Metrics (JAIL} Exhibit L (attached
21 hereto and incorporated herein by reference}, including, but not limited to, delay and/or failure to deliver
22 or perform Remedial Plan services and requirements as provided in Exhibit B; failure or delay in
23 providing or maintaining staffing levels as set forth in Exhibit C MINIMUM STAFFING LEVELS; and/or
24 failure to actively pursue and obtain NCCHC accreditation of the correctional facility(ies) as provided
25 herein.
26 The parties agree that such payment under this provision shall be considered as
27 liquidated damages, and not as penalties, and that while determining the exact amount of actual
28 damages is impractical and cannot be precisely calculated, such sums recited in this Agreement
-26-
1 represent a reasonable endeavor by COUNTY and CONTRACTOR to estimate a fair compensation for
2 the foreseeable damages to the COUNTY from CONTRACTOR's failure to meet performance
3 standards and requirements as specifically set forth is this Section VII. of the Agreement.
4 Liquidated damages will be assessed under this Agreement as follows:
5 (1) $2,500 per day against CONTRACTOR for each separate violation of any
6 requirement or performance standard(s) set forth in this Section VII, excluding staffing
7 violations; and,
8 (2) for each separate violation of any staffing level requirement, CONTRACTOR shall
9 issue reimbursement to COUNTY of fully loaded daily salary rate of any unfilled position
10 per day of violation.
11 The aforementioned Liquidated Damages shall be subject to the following procedure(s):
12
13
14
15
16
17
18
19
20
21
22
•
•
•
Contractor has 30 days to correct the violation following County's delivery
of initial written notice of a violation.
If CONTRACTOR fails to correct the violation within 30 days as provided
above, COUNTY shall issue a 2nc1 written notice for the same violation;
Contractor shall have an additional, and final, 30 days to correct the
violation following County's delivery of 2nd written notice for same
violation.
If CONTRACTOR falls to correct the violation following the 2nc1 written
notice, Liquidated Damages as indicated in (1) and/or (2) above will be
assessed against Contractor beginning on day 61 following County's
delivery of initial written notice to correct the violation.
23 If Liquidated Damages are assessed by COUNTY and CONTRACTOR is not in
24 agreement, the assessment of Liquidated Damages can only be appealed by CONTRACTOR
25 delivering written notice of appeal to the COUNTY Sheriff no later than 15 days following COUNTY's
26 assessment of Liquidated Damages as provided above. COUNTY Sheriff shall decide the appeal
27 within thirty (30) days of receiving CONTRACTOR's written notice of appeal. Should the
28 CONTRACTOR not agree with the decision on the appeal by the COUNTY Sheriff, the CONTRACTOR
-27-
1 may, no later than 15 days following receipt of the decision, appeal such decision to the COUNTY'S
2 Board of Supervisors. The Board of Supervisors shall decide the action within an additional thirty (30)
3 days, should CONTRACTOR not agree with the decision of the Board of Supervisors, the
4 CONTRACTOR shall have thirty (30) days from the date the Board of Supervisors issues its decision to
5 submit the decision to binding arbitration in accordance with the American Arbitration Association,
6 Commercial Arbitrative Rule. Each party shall pay for its own costs and attorney fees for the
7 arbitration. In the instance where there is a dispute regarding potential damage amounts, the county
8 may not withhold payment of the monthly base compensation.
9 IX. INDEPENDENT CONTRACTOR
1 O In performance of the work, duties and obligations assumed by CONTRACTOR under
11 this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of the
12 CONTRACTOR's officers, agents, subcontractors/subcontractor's employees and employees will at all
13 times be acting and performing as an independent contractor, and shall act in an independent capacity
14 and not as an officer, agent, servant, employee, joint venture, partner, or associate of the COUNTY.
15 Furthermore, COUNTY shall have no right to control or supervise or direct the manner or method by
16 which CONTRACTOR shall perform its work and function. However, COUNTY shall retain the right to
17 administer this Agreement so as to verify that CONTRACTOR is performing its obligations in
18 accordance with the terms and conditions thereof.
19 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
20 rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject
21 thereof.
22 Because of its status as an independent contractor, CONTRACTOR shall have
23 absolutely no right to employment rights and benefits available to COUNTY employees.
24 CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees all
25 legally required employee benefits. In addition, CONTRACTOR shall be solely responsible and save
26 COUNTY harmless from all matters relating to payment of CONTRACTOR'S employees and
27 subcontractors, including compliance with Social Security withholding and all other regulations
28 governing such matters. It is acknowledged that during the term of this Agreement, CONTRACTOR
-28-
1 may be providing services to others unrelated to the COUNTY or to this Agreement.
2 Consistent Federal Income Tax Position.
3 CONTRACTOR acknowledges that the Jail has been acquired, constructed, or improved
4 using net proceeds of governmental tax-exempt bonds (collectively, ·sand-Financed Facilities").
5 CONTRACTOR agrees that, with respect to this Agreement and the Bond Financed Facilities,
6 CONTRACTOR is not entitled to take, and shall not take, any position (also known as a iax position")
7 with the Internal Revenue Service ("IRS·) that Is inconsistent with being a ·service provider" to the
8 COUNTY, as a "qualified user" with respect to the Bond-Financed Facilities, as •managed property," as
9 all of those terms are used in Internal Revenue Service Revenue Procedure 2017-13, and to that end,
10 CONTRACTOR agrees that CONTRACTOR shall not, in connection with any federal income tax return
11 that it files with the IRS or any other statement or information that it provides to the IRS, (a) claim
12 ownership, or that it is a lessee, of any portion of the Bond Financed Facilities, or (b) claim any
13 depreciation or amortization deduction, investment tax credit, or deduction for any payment as rent with
14 respect to the Bond-Financed Facilities.
15 X. MODIFICATION
16 Any matters of this Agreement may be modified from time to time by the written consent
17 of all the parties without, in any way, affecting the remainder.
18
19
XI. NON-ASSIGNMENT
Unless otherwise provided in this Agreement, COUNTY is relying on the personal skill,
20 expertise, training, and experience of CONTRACTOR and CONTRACTOR's employees and no part of
21 this Agreement, including any right with respect to utilizing COUNTY office and clinic space, furniture,
22 fixtures, facilities, medical and dental equipment, and telephones, may be assigned, transferred,
23 serviced, delegated, or subcontracted by CONTRACTOR without the prior written consent of COUNTY,
24 which shall not be unreasonably withheld, except as otherwise provided in Section XXV,
25 SUBCONTRACTORS, herein.
26 XII. HOLD HARMLESS
27 CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
28 defend the COUNTY, its officers, agents, and employees from any and all costs and expenses,
-29-
1 damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection with the
2 performance, or failure to perform, by CONTRACTOR, its officers, agents, or employees under this
3 Agreement, and from any and all costs and expenses (including without limitation costs and fees of
4 litigation}, including attorney fees and court costs, damages, liabilities, claims,.and losses occurring or
5 resulting to any person, firm, or corporation who may be injured or damaged by the performance, or
6 failure to perform, of CONTRACTOR, its officers, agents, or employees under this Agreement.
7 Expiration or termination of this Agreement shall not terminate any of CONTRACTOR's obligations
8 under this Section XII, HOLD HARMLESS, herein.
9 The foregoing clause shall not obligate the CONTRACTOR to provide such protection,
10 indemnification, or defense to the extent of willful or negligent acts or omissions by the COUNTY, its
11 officers, employees, agents, or contractors.
12
13
XIII. INSURANCE
Without limiting the COUNTY1s right to obtain indemnification from CONTRACTOR or
14 any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the
15 following insurance policies or a program of self-insurance, including but not limited to, an insurance
16 pooling arrangement or Joint Powers Agreement (JPA} throughout the term of this Agreement:
17
18
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
19 Dollars ($1,000,000} per occurrence and an annual aggregate of Four Million Dollars ($4,000,000}. This
20 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
21 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
22 liability or any other liability insurance deemed necessary because of the nature of this contract.
23 B. Automobile Liability
24 Comprehensive Automobile Liability Insurance with limits for bodily injury of not
25 less than Five Hundred Thousand Dollars ($500,000.00) per person, One Million Dollars
26 ($1,000,000.00) per accident and for property damages of not less than Fifty Thousand Dollars
27 ($50,000.00), or such coverage with a combined single limit of One Million Dollars ($1,000,000.00}.
28 Coverage should include owned and non-owned vehicles used in connection with this Agreement.
-30-
1
2
C. Real and Personal Property
CONTRACTOR shall maintain a policy of insurance for all risk personal property
3 coverage. The personal property coverage shall be in an amount that will cover the total of the
4 COUNTY-owned property, at a minimum, as discussed in Section I, OBLIGATIONS OF THE
5 CONTRACTOR, and Section 11, OBLIGATIONS OF THE COUNTY, herein.
6 D. All Risk Property Insurance
7 CONTRACTOR will provide property coverage for the full replacement value of
8 the COUNTY's Personal Property in the possession of CONTRACTOR and/or used in the execution of
9 this Agreement. COUNTY will be identified on an appropriate certificate of Insurance as the certificate
10 holder and will be named as an additional loss payee on the Property Insurance Policy.
11 E. Professional Liability
12 If CONTRACTOR employs licensed professional staff, (e.g., PhD, MD, PA, NP,
13 RN, LCSW, LMFT, LPCC, MFCC) in providing services, Professional Liability Insurance with limits of
14 not less than Five Million Dollars ($5,000,000.00) per occurrence, Ten Million Dollars ($10,000,000.00)
15 annual aggregate.
16 This coverage shall be issued on a per claim basis. CONTRACTOR agrees that
17 it shall maintain, at its sole expense, in full force and effect for a period of five (5) years following the
18 termination of this Agreement, one or more policies of professional liability insurance with limits of
19 coverage as specified herein.
20 F. Worker's Compensation
21 A policy of Worker's Compensation insurance as may be required by the
22 California Labor Code.
23 CONTRACTOR hereby grants to COUNTY a waiver of any right to subrogation
24 which any insurer of said CONTRACTOR may acquire against the COUNTY by virtue of the payment of
25 any loss under such insurance. CONTRACTOR agrees to obtain any endorsement that may be
26 necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not
27 the COUNTY has received a waiver of subrogation endorsement from the insurer.
28 CONTRACTOR shall obtain endorsements to the Commercial General Liability
-31-
1 insurance naming the County of Fresno, its officers, agents, and employees, Individually and
2 collectively, as additional insured, but only insofar as the operations under this Agreement are
3 concerned. Such coverage for additional insured shall apply as primary Insurance and any other
4 insurance, or self insurance, maintained by COUNTY, its officers, agents and employees shall be
5 excess only and not contributing with insurance provided under CONTRACTOR's policies herein. Such
6 coverage and limits shall be the minimum coverage and limits specified in this Agreement; or the
7 broader coverage and maximum limits of the coverage available to the named Insured; whichever is
8 greater. This insurance shall not be cancelled or changed without a minimum of thirty (30) days
9 advance written notice given to COUNTY.
10 Within thirty (30) days from the date CONTRACTOR signs and executes this
11 Agreement, CONTRACTOR shall provide certificates of insurance and endorsement as stated above
12 for all of the foregoing policies, as required herein, to the County of Fresno, Department of Public
13 Health, P.O. Box 11867, Fresno, California, 93775, Attention: Contracts Section -6th Floor, stating that
14 such insurance coverage have been obtained and are in full force; that the County of Fresno, its
15 officers, agents and employees will not be responsible for any premiums on the policies; that such
16 Commercial General Liability insurance names the County of Fresno, its officers, agents and
17 employees, individually and collectively, as additional insured, but only insofar as the operations under
18 this Agreement are concerned; that such coverage for additional insured shall apply as primary
19 insurance and any other insurance, or self insurance, maintained by COUNTY, its officers, agents and
20 employees, shall be excess only and not contributing with insurance provided under CONTRACTOR'S
21 policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty
22 (30) days advance, written notice given to COUNTY.
23 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
24 herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
25 this Agreement upon the occurrence of such event.
26 All policies shall be issued by admitted insurers licensed to do business in the State of
27 California, and such insurance shall be purchased from companies possessing a current A.M. Best, Inc.
28 rating of A FSC VII or better.
-32-
1
2
XIV. HEAL TH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered
3 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
4 104-191{HIPAA) and agree to use and disclose protected health information as required by law.
5 COUNTY and CONTRACTOR acknowledge that the exchange of protected health information between
6 them is only for treatment, payment, and health care operations.
7 COUNTY and CONTRACTOR intend to protect the privacy and provide for the security of
8 Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
9 Information Technology for Economic and Clinical Health Act, Public Law 111-005 {HITECH), and
1 O regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
11 Regulations) and other applicable laws.
12 As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
13 CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
14 as setforth in, but not limited to, Title 45, Sections 164.314{a), 164.502{e) and 164.504{e) of the Code
15 of Federal Regulations {CFR).
16 XV. DATA SECURITY
17 For the purpose of preventing the potential loss, misappropriation or inadvertent access,
18 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
19 COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
20 into a contractual relationship with the COUNTY for the purpose of providing services under this
21 Agreement must employ adequate data security measures to protect the confidential information
22 provided to CONTRACTOR by COUNTY, including but not limited to the following:
23 A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
24 CONTRACTOR may not connect to COUNTY networks via personally-owned mobile, wireless or
25 handheld devices, unless the following conditions are met:
26 1. CONTRACTOR has received authorization by COUNTY for
27 telecommuting purposes;
28 2. Current virus protection software is in place;
-33-
1
2
3 B.
3.
4.
Mobile device has the remote wipe feature enabled; and
A secure connection is used.
CONTRACTOR-Owned Computers or Computer Peripherals
4 CONTRACTOR may not bring CONTRACTOR-owned computers or computer peripherals into
5 COUNTY for use without prior authorization from COUNTY's Chief Information Officer, and/or
6 designee(s}, including but not limited to mobile storage devices. If data is approved to be transferred,
7 data must be stored on a secure server approved by COUNTY and transferred by means of a Virtual
8 Private Network (VPN} connection, or another type of secure connection. Said data must be encrypted.
9 C. COUNTY-Owned Computer Equipment
10 CONTRACTOR or anyone having an employment relationship with COUNTY, may not
11 use COUNTY computers or computer peripherals on non-COUNTY premises without prior
12 authorization from COUNTY's Chief Information Officer, and/or designee(s}.
13 D. CONTRACTOR may not store COUNTY's private, confidential or sensitive data
14 on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
15 E. CONTRACTOR shall be responsible to employ strict controls to ensure the
16 integrity and security of COUNTY's confidential information and to prevent unauthorized access,
17 viewing, use or disclosure of data maintained in computer files, program documentation, data
18 processing systems, data files and data processing equipment which stores or processes COUNTY
19 data internally and externally.
20 F. Confidential client information transmitted to one party by the other by means of
21 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
22 BIT or higher. Additionally, a password or pass phrase must be utilized.
23 G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
24 breaches or potential breaches of security related to COUNTY's confidential information, data
25 maintained in computer files, program documentation, data processing systems, data files and data
26 processing equipment which stores or processes COUNTY data Internally or externally.
27 H. COUNTY shall provide oversight to CONTRACTOR's response to All Incidents
28 arising from a possible breach of security related to COUNTY's confidential client information provided
-34-
1 to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
2 as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
3 responsible for all costs incurred as a result of providing the required notification. As used herein, ·An
4 lncidentsn refers only to those incidents which are within CONTRACTOR's control {e.g., incidents
5 involving its employees and/or subcontractors).
6 I. The parties acknowledge and agree that, as between CONTRACTOR and COUNTY,
7 full ownership of all rights in and to all COUNTY data, whether in digital or paper form, including without
8 limitation printed output from the System, are the exclusive property of COUNTY. All COUNTY data
9 possessed by CONTRACTOR shall promptly and without delay be returned/provided to COUNTY by
10 CONTRACTOR upon expiration or termination of this Agreement.
11 XVI. NON-DISCRIMINATION
12 During the performance of this Agreement, CONTRACTOR and its subcontractors shall
13 not unlawfully discriminate against any employee or applicant for employment, or recipient of services,
14 because of race, religious creed, color, national origin, ancestry, physical disability, mental disability,
15 medical condition, genetic information, marital status, sex, gender, gender identity, gender expression,
16 age, sexual orientation, or military or veteran status, pursuant to all applicable State of California and
17 Federal statutes and regulations.
18 XVII. RECORDS
19 A. Medical and Behavioral Health Care Records
20 Upon CONTRACTOR's commencement of services on July 1, 2018,
21 CONTRACTOR shall maintain adequate medical and behavioral health care records, completely and
22 separately, on each individual patient which shall include diagnostic studies, indMdual treatment plan,
23 and records of services provided by the various professional personnel in sufficient detail to make
24 possible an evaluation of services, and contain all the data necessary in reporting to the State,
25 including records of patient interviews and progress notes.
26 All such records shall be maintained pursuant to applicable NCCHC accreditation
27 standards and laws concerning confidentiality and security of patient information. Subject to applicable
28 law regarding confidentiality of such records, CONTRACTOR shall comply with COUNTY's policy with
-35-
1 regard to access by inmates and CONTRACTOR's staff to medical and behavioral health care records.
2 No information contained in the medical records shall be released by CONTRACTOR except as
3 provided by COUNTY's policy, by a court order, or otherwise in accordance with applicable law. All
4 medical and behavioral health care records shall be considered the property of COUNTY and shall be
5 retained by COUNTY at the termination of this Agreement. All such health care records shall be
6 maintained for a minimum of ten (10) years from the date of termination of this Agreement.
7 CONTRACTOR shall maintain complete and accurate medical health, behavioral
8 health, optometry, and dental records separate from COUNTY JAIL confinement records of the
9 inmates.
10 In order to maintain continuity of care and promote patient safety, COUNTY shall
11 provide CONTRACTOR with reasonable access to medical and behavioral health care records, the first
12 day following the signatures of the Parties below.
13
14
B. Financial Records
Upon CONTRACTOR's commencement of services on July 1, 2018,
15 CONTRACTOR shall maintain complete and accurate financial records with respect to the services
16 rendered and the costs incurred under this Agreement, and to any payments to each of
17 CONTRACTOR's employees or subcontractors. All such records shall be prepared in accordance with
18 generally accepted accounting procedures, shall be clearly identified, shall be in compliance with all
19 applicable grant agreements and shall be kept readily accessible and available for inspection, as
20 described in Section XXVIII, AUDITS AND INSPECTIONS, herein. All such records shall be retained
21 by CONTRACTOR and kept accessible for a minimum of seven (7) years, or longer, as required by law,
22 following final payment and termination/expiration of this Agreement. Upon expiration of this
23 Agreement, CONTRACTOR shall prepare and submit to COUNTY a final cost report relative to
24 compensation provided by COUNTY to CONTRACTOR under this Agreement.
25 It is understood by COUNTY that certain financial records belonging to
26 CONTRACTOR are proprietary in nature and are confidential under State and Federal law. COUNTY
27 agrees to maintain the confidentiality of such financial records to the fullest extent of the law.
28 Expiration or termination of this Agreement shall not terminate any of
-36-
1 CONTRACTOR's obligations under this Section XVI, RECORDS, herein.
2 XVIII. REPORTS
3 A. Upon CONTRACTOR's commencement of services on July 1, 2018,
4 CONTRACTOR shall provide COUNTY's SHERIFF, DPH and DBH Directors, and/or their respective
5 designees, with monthly statistical reports on health care services utilization and costs, due on the
6 thirtieth (30th) of each month or by the monthly MAC meeting, whichever is earlier, for both medical and
7 behavioral health care services provided during the preceding month, and using the data set and report
8 formats approved by COUNTY. Reports shall Include, but not be limited to, the following information:
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
1.
2.
3.
4.
5.
Sick call requests from inmates
Sick call visits
Wait time (from sick call slip submittal to medical/behavioral visit)
Health appraisals/assessments/evaluations
Inmates treated by a physician (and/or PA, NP, or RN), including
psychiatrists
6. Intake screenings
7. Emergency department visits
8. Medical and Psychiatric inpatient hospitalizations
9. Mandatory physicals
10. Off-site clinic services
11. Crisis intervention and crisis stabilization
12. Chronic care clinic stats
13. Suicide precautions
14. Suicide attempts
15. Pharmaceutical utilization (types of prescribed medications and costs)
16. Dental services
17. Optometry/Optician services
18. Radiology services (utilization and costs)
19. Laboratory services (utilization and costs)
-37-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
20. Number of dialysis treatments
21. Case management/linkage services
22. Average number of inmates in the OHU
23. Inmates testing positive for HIV/AIDS
24. Inmates testing positive for Hepatitis C
25. Inmates testing positive for tuberculosis infection/disease
26. Incidences of any other communicable diseases
27. Inmate mortality review
28. Number of transports (ambulance/custody transport)
29. Behavioral health treatment services/program stats
30. Utilization of Second Gen LAI medication
31. Number of Behavioral Management Plans completed
32. Costs of services delivered to AB109 inmates
33. Performance Metrics as described in Exhibit L, attached hereto and
15 incorporated herein by this reference and made part of this Agreement.
16 B. Upon request by SHERIFF, DPH or DBH Directors, or their respective
17 designees, CONTRACTOR must provide reports within a reasonable period of time including, but not
18 limited to, additional information related to CONTRACTOR's performance of this Agreement, for
19 example, specific statistical information, such as medical malpractice incidents that may result in a
20 claim and/or litigation, or performance-based standards data reports that may be required.
21 C. CONTRACTOR shall also upon request by SHERIFF, DPH and/or DBH
22 Director(s), or their respective designee(s), provide financial cost reports and program information
23 regarding CONTRACTOR's or COUNTY's claims for/from third party payers, as needed for grant or
24 other funding requirements on behalf of the COUNTY (e.g., the SAMHSA grant reporting requirements
25 as described in Section I, OBLIGATIONS OF THE CONTRACTOR, herein.
26 If COUNTY must substantiate costs for the State or other agency for auditing or
27 other grant or funding purposes, CONTRACTOR shall submit financial reports, which shall include all
28 necessary and related costs regardir1g the provision of medical and behavioral health care to adult
-38-
1 inmates, upon request by SHERIFF, DBH and/or DPH Director(s}, or their designee(s}.
2 D. In addition to monthly data reports, quarterly and annual summaries shall also be
3 submitted relating to progress toward agreed upon objectives for COUNTY medical and behavioral
4 health care services. CONTRACTOR shall submit annual behavioral health services summaries
5 referred to as "Outcomes and Performance Reports· to the COUNTY's DBH Director, or designee.
6 E. CONTRACTOR shall comply with all reports, statistical information and
7 information of any kind whatsoever as may be requested by COUNTY and/or required for COUNTY's
8 compliance with the Remedial Plan.
9 F. CONTRACTOR shall provide an annual report to COUNTY no later than January
10 31st of each year for the previous calendar year of the Agreement of its compliance with current
11 California laws, regulations and codes, pursuant to Section XVIII, COMPLIANCE WITH FEDERAL,
12 STATE, AND LOCAL LAWS, herein, relating to the medical and behavioral health care programs at the
13 JAIL.
14 G. CONTRACTOR shall provide to COUNTY any applicable certifications and/or
15 reports obtained through CONTRACTOR's attainment of required accreditations, as set forth
16 hereinabove in Section I, OBLIGATIONS OF THE CONTRACTOR.
17 H. CONTRACTOR acknowledges that certain financial reports prepared and
18 provided by CONTRACTOR to COUNTY are proprietary in nature and confidential. CONTRACTOR
19 shall mark said reports as such. It is also understood that certain financial information will be required
20 from the CONTRACTOR in order for COUNTY to complete and submit reports, as may required by the
21 State and/or Federal government.
22 I. CONTRACTOR shall comply with the performance metrics as identified in
23 CONTRACTOR's RFP Response, including, but not limited to page 69 of the CONTRACTOR's
24 Response. If CONTRACTOR falls to deliver or fails to perform in accordance with the performance
25 metrics, liquidated damages will be assessed as per Section VII. LIQUIDATED DAMAGES herein.
26 J. CONTRACTOR shall submit, beginning on July 15, 2019 and every year
27 thereafter, the Annual Summary Report, Exhibit P, attached hereto and Incorporated herein by
28 reference.
-39-
1
2
XIX. COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS
A. CONTRACTOR shall provide all medical and behavioral health care services in
3 accordance with applicable Federal, State, and local laws, codes, regulations, and directives and in
4 compliance with the Remedial Plan.
5 B. With respect to CONTRACTOR's employees, CONTRACTOR shall comply with
6 all laws and regulations pertaining to wages and hours, state and federal income tax, unemployment
7 insurance, Social Security, disability insurance, workers' compensation insurance, and discrimination
8 and harassment in employment.
9 C. CONTRACTOR shall work with the COUNTY's Health Officer who, under the
10 Health and Safety Code Section 101045, shall investigate health and sanitary conditions in every
11 county detention facility.
12 D. CONTRACTOR shall work with COUNTY's DPH concerning communicable
13 disease screening, continuing medical surveillance, case management, reporting, and Inmate referral in
14 the community.
15 XX. LICENSES AND CERTIFICATION
16 Upon CONTRACTOR's commencement of services on July 1, 2018, CONTRACTOR
17 shall throughout the term of this Agreement, maintain all necessary licenses, certifications, and board
18 registrations necessary for the provision of the services hereunder and required by the laws and
19 regulations of the United States of America, State of California, Fresno County and any other applicable
20 government agencies and required by the Remedial Plan. CONTRACTOR shall ensure that its
21 professional health care employees are credentialed, maintain all required licenses, and have access to
22 continuing education units to continually update their skills and knowledge to meet California specific
23 requirements.
24 CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or
25 maintain such licenses, certifications, and board registrations, irrespective of the pendency of any
26 appeal related thereto. Copies of licensure and certifications required for each applicable staffing
27 position must be kept on-site at all times, according to Title 15 of the California Code of Regulations,
28 and made available for COUNTY to inspect, when requested. Additionally, CONTRACTOR shall
-40-
1 comply with all other applicable laws, rules or regulations and the provisions of the Remedial Plan to
2 the fullest extent, as any may now exist or be hereafter changed.
3 CONTRACTOR shall ensure all staff who may provide any behavioral health care
4 services to inmates at a level of RN certification and/or LMFT or LCSW (i.e., a licensed mental health
5 professional) shall be credentialed through COUNTY DBH's Managed Care DMsion. In addition,
6 CONTRACTOR shall provide COUNTY's DBH Director, or designee, monthly staffing reports of all
7 behavioral health care staff indicating staff licenses and/or certifications are valid and current
8 XXI. CULTURAL COMPETENCY
9 As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
10 A Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
11 Part 80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance
12 from discriminating against persons based on race, color, national origin, sex, disability or religion. This
13 is interpreted to mean that a limited English proficient (LEP) indMdual is entitled to equal access and
14 participation in federally funded programs through the provision of comprehensive and quality bilingual
15 services.
16 8. Policies and procedures for ensuring access and appropriate use of trained
17 interpreters and material translation services for all LEP consumers, including, but not limited to,
18 assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
19 procedures, and monitoring its language assistance program. The CONTRACTOR's procedures must
~O include ensuring compliance of any subcontracted providers with these requirements.
21
22
C.
D.
CONTRACTOR shall not use minors as interpreters.
CONTRACTOR shall provide and pay for interpreting and translation services to
23 persons participating in CONTRACTOR's services who have limited or no English language
24 proficiency, including services to persons who are deaf or blind. Interpreter and translation services
25 shall be provided as necessary to allow such participants meaningful access to the programs, services
26 and benefits provided by CONTRACTOR. Interpreter and translation services, including translation of
27 CONTRACTOR's ·vital documents· (those documents that contain information that is critical for
28 accessing CONTRACTOR's services or are required by law) shall be provided to inmates at no cost to
-41-
1 the inmate. CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who
2 interpret or translate for an inmate, or who directly communicates with an inmate in a language other
3 than English, demonstrate proficiency in the participant's language and can effectively communicate
4 any specialized terms and concepts specific to CONTRACTOR's services.
5 E. In compliance with the State mandated Culturally and Linguistically Appropriate
6 Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
7 COUNTY for approval, within sixty (60) days from date of contract execution, CONTRACTOR's plan to
8 address all fifteen national cultural competency standards as set forth in the "National Standards on
9 Culturally and Linguistically Appropriate Services (CLAS)9
10 (http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf). COUNTY'S annual on-site review of
11 CONTRACTOR shall include collection of documentation to ensure all national standards are
12 implemented. As the national competency standards are updated, CONTRACTOR's plan must be
13 updated accordingly. Cultural competency training for CONTRACTOR staff should be substantively
14 integrated into health professions education and training at all levels, both academic and functional,
15 including core curriculum, professional licensure, and continuing professional development programs.
16 CONTRACTOR on a monthly basis shall provide COUNTY DBH a monthly monitoring tool/report that
17 shows all CONTRACTOR staff cultural competency trainings completed.
18 XXII. AMERICANS WITH DISABILITIES ACT
19 CONTRACTOR agrees to ensure that deliverables developed and produced, pursuant to
20 this Agreement shall comply with the accessibility requirements of Section 508 of the Rehabilitation Act
21 and the Americans with Disabilities Act of 1973 as amended (29 U.S.C. § 794 (d)), and regulations
22 implementing that Act as set forth in Part 1194 of Trtle 36 of the Code of Federal Regulations. In 1998,
23 Congress amended the Rehabilitation Act of 1973 to require Federal agencies to make their electronic
24 and information technology (EIT) accessible to people with disabilities. California Government Code
25 Section 11135 codifies Section 508 of the Act requiring accessibility of electronic and information
26 technology.
27 Ill
28 Ill
-42-
1 XXIII. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
2 To the extent necessary to prevent disallowance of reimbursement under Section
3 1861(v)(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[1]),until the expiration offour
4 (4) years after the furnishing of services under this Agreement, CONTRACTOR shall make available,
5 upon written request to the Secretary of the United States Department of Health and Human Services,
6 or upon request to the Comptroller General of the United States General Accounting Office, or any of
7 their duly authorized representatives, a copy of this Agreement and such books, documents, and
8 records as are necessary to certify the nature and extent of the costs of these services provided by
9 CONTRACTOR under this Agreement. CONTRACTOR further agrees that in the event
10 CONTRACTOR carries out any of its duties under this Agreement through a subcontract, with a value
11 or cost of Ten Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period,
12 with a related organization, such Agreement shall contain a clause to the effect that until the expiration
13 of four (4) years after the furnishing of such services pursuant to such subcontract, the related
14 organizations shall make available, upon written request to the Secretary of the United States
15 Department of Health and Human Services, or upon request to the Comptroller General of the United
16 States General Accounting Office, or any of their duly authorized representatives, a copy of such
17 subcontract and such books, documents, and records of such organization as are necessary to verify
18 the nature and extent of such costs.
19 XXIV. PUBLICITY PROHIBITION
20 None of the funds, materials, property or services provided directly or indirectly under
21 this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing
22 of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
23 above, publicity of the services described in Section I, OBLIGATIONS OF THE CONTRACTOR, of this
24 Agreement shall be allowed as necessary to raise public awareness about the availability of such
25 specific services when approved in advance by COUNTY's SHERIFF, DPH Director, DBH Director, or
26 designees thereof, and at a cost to be provided for such items as written/printed materials, the use of
27 media (i.e., radio, television, newspapers) and any other related expense(s).
28 Ill
-43-
1
2
XXV. SUBCONTRACTORS
CONTRACTOR may engage certain health care professionals as independent
3 contractors rather than employees by subcontracting the performance of certain services to other third
4 party agents if CONTRACTOR obtains the prior written approval from SHERIFF, DPH Director, or
5 designee of each aforementioned public officer. Any transferee, assignee or subcontractor will be
6 subject to all applicable provisions of this Agreement, and all applicable State of California and Federal
7 regulations. CONTRACTOR will be responsible for informing any subcontractors, and requiring any
8 subcontractors to comply with all the terms and conditions of this Agreement, of all the Federal and
9 State of California law requirements and the Remedial Plan incorporated herein. CONTRACTOR shall
10 be primarily responsible to COUNTY for the performance of any transferee, assignee or subcontractor.
11 The use of subcontractors by CONTRACTOR shall not entitle CONTRACTOR to any additional
12 compensation or other payment than is provided for under this Agreement.
13 XX.VI. DISCLOSURE OF SELF-DEALING TRANSACTIONS
14 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
15 for-profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes
16 its status to operate as a corporation.
17 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
18 transactions that they are a party to while CONTRACTOR is providing goods or performing services
19 under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
20 is a party and in which one or more of its directors has a material financial interest. Members of the
21 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
22 and signing a ·self-Dealing Transaction Disclosure Form", attached hereto as Exhibit M and
23 incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the self-
24 dealing transaction or immediately thereafter.
25 XX.VII. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
26 This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
27 managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104,
28 and 455.106(a)(1 ),(2).
-44-
1 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
2 the following information must be disclosed by CONTRACTOR by completing Exhibit N, ·Disclosure of
3 Ownership and Control Interest Statemenf, attached hereto and by this reference incorporated herein
4 and made part of this Agreement. CONTRACTOR shall submit this form to the COUNTY's SHERIFF
5 within thirty (30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report
6 any changes to this information within thirty-five (35) days of occurrence by completing Exhibit N,
7 ·01sclosure of Ownership and Control Interest Statemenf.
8 CONTRACTOR is required to submit a set of fingerprints for any person with a five (5)
9 percent or greater direct or indirect ownership interest in CONTRACTOR. COUNTY may terminate this
10 Agreement where any person with a five (5) percent or greater direct or indirect ownership interest in
11 the CONTRACTOR and did not submit timely and accurate information and cooperate with any
12 screening method required in CFR, Trtle 42, Section 455.416. Submissions shall be scanned pelf
13 copies and are to be sent via email to SheriffJailAdministration@fresnosheriff.org, Attention: Contracts
14 Administration. COUNTY may deny enrollment or terminate this Agreement where any person with a
15 five (5) percent or greater direct or indirect ownership Interest in CONTRACTOR has been convicted of
16 a criminal offense related to that person's involvement with the Medicare, Medicaid, or Title XXI
17 program in the last ten (10) years.
18 XXVIII. DISCLOSURE-CRIMINAL HISTORY AND CIVIL ACTIONS
19 CONTRACTOR is required to disclose if any of the following conditions apply to them,
20 their owners, officers, corporate managers, and partners (hereinafter collectively referred to as
21 ·coNTRACToR·):
22 A. Within the three (3) year period preceding the Agreement award, they have been
23 convicted of, or had a civil judgment rendered against them for:
24 1. Fraud or a criminal offense in connection with obtaining, attempting to
25 obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction;
26 2. Violation of a federal or state antitrust statute;
27 3. Embezzlement, theft, forgery, bribery, falsification, or destruction of
28 records; or
-45-
1
2 B.
4. False statements or receipt of stolen property.
Within a three (3) year period preceding their Agreement award, they have had a
3 public transaction (federal, state, or local) terminated for cause or default.
4 Disclosure of the above information will not automatically eliminate
5 CONTRACTOR from further business consideration. The information will be considered as part of the
6 determination of whether to continue and/or renew this Agreement and any additional information or
7 explanation that a CONTRACTOR elects to submit with the disclosed information will be considered. If
8 it is later determined that the CONTRACTOR failed to disclose required information, any contract
9 awarded to such CONTRACTOR may be immediately voided and terminated for material failure to
10 comply with the terms and conditions of the award.
11 CONTRACTOR must sign a ·certification Regarding Debarment, Suspension,
12 and Other Responsibility Matters-Primary Covered Transactions· in the form set forth in Exhibit 0,
13 attached hereto and by this reference incorporated herein and made part of this Agreement.
14 Additionally, CONTRACTOR must immediately advise the COUNTY's Sheriff in writing if, during the
15 term of this Agreement: (1) CONTRACTOR becomes suspended, debarred, excluded or Ineligible for
16 participation in federal or state funded programs or from receiving federal funds as listed in the
17 excluded parties' list system (http://www.epls.gov); or (2) any of the above listed conditions become
18 applicable to CONTRACTOR. CONTRACTOR shall indemnify, defend and hold the COUNTY
19 harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineliglblllty or other
20 matter listed in the signed Certification Regarding Debarment, Suspension, and Other Responsibility
21 Matters.
22 XXIX. AUDITS AND INSPECTIONS
23 Upon CONTRACTOR's commencement of services on July 1, 2018, the CONTRACTOR
24 shall at any time during business hours, and as often as the COUNTY may deem necessary, make
25 available to the COUNTY for examination all of its records and data with respect to the matters covered
26 by this Agreement, including audit/inspection requirements of any grant agreement. The
27 CONTRACTOR shall, upon request by the COUNTY, permit the COUNTY to audit and inspect all of
28 such records and data necessary to ensure CONTRACTOR'S compliance with the terms of this
-46-
1 Agreement.
2 COUNTY understands that many of the systems, methods, procedures, written materials
3 and other controls employed by CONTRACTOR in the performance of its obligations hereunder are
4 proprietary in nature and will remain the property of CONTRACTOR. Information conceming such may
5 not, at any time, be used, distributed, copied or otherwise utilized by the COUNTY, except in
6 connection with the delivery of health care services hereunder, or as permitted or required by law,
7 unless such disclosure is approved in advance writing by CONTRACTOR.
8 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be
9 subject to the examination and audit of the Auditor General for a period of three (3) years after final
10 payment under contract (Govemment Code Section 8546. 7). Furthermore, CONTRACTOR shall be
11 subject to any examination and audit requirements for any grant agreement for which such grant funds
12 are used for the provision of any services connected with the Agreement.
13 Pursuant to Title 15 of the Califomia Code of Regulations, CONTRACTOR shall comply
14 with any request from the State of Califomla, Department of Public Health authority to perform an
15 annual health inspection. CONTRACTOR shall also assist with such inspection as needed.
16 Expiration or termination of this Agreement shall not terminate any of CONTRACTOR'S obligations
17 under this Section XXVIII, AUDITS AND INSPECTIONS, herein.
18
19
XXX. NOTICES
The persons and their addresses having authority to give and receive notices under this
20 Agreement include the following:
21
22
23
24
25
COUNTY OF FRESNO
Sheriff-Coroner Office
Attn: Sheriff-Coroner
P.O. Box 1788
Fresno, CA 93721
CONTRACTOR
Califomla Forensic Medical Group, Inc.
Attn: C.E.O.
2511 Garden Road
Suite A160
Monterey, CA 93940
All notices between the COUNTY and CONTRACTOR provided for or permitted under
26 this Agreement must be in writing and delivered either by personal service, by first-class United States
27 mail, by an ovemight commercial courier service, or by telephonic facsimile transmission. A notice
28 delivered by personal service Is effective upon service to the recipient. A notice delivered by first-class
-47-
1 United States mail is effective three (3) COUNTY business days after deposit in the United States mail,
2 postage prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier
3 service is effective one (1) COUNTY business day after deposit with the overnight commercial courier
4 service, delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the
5 recipient. A notice delivered by telephonic facsimile is effective when transmission to the recipient is
6 completed (but, if such transmission is completed outside of COUNTY business hours, then such
7 delivery shall be deemed to be effective at the next beginning of a COUNTY business day), provided
8 that the sender maintains a machine record of the completed transmission. For all claims arising out of
9 or related to this Agreement, nothing in this Section XXIX, NOTICES, herein, establishes, waives, or
10 modifies any claims presentation requirements or procedures provided by law, including but not limited
11 to the Government Claims Act (Division 3.6 of Title 1 of the Government Code, beginning with Section
12 810).
13 XXXI. NO THIRD PARTY BENEFICIARIES
14 None of the provisions contained in this Agreement are intended by the COUNTY and
15 CONTRACTOR, nor shall they be deemed, to confer any right or benefit on any person not a party to
16 this Agreement; hence, there shall be no third party beneficiaries whatsoever of this Agreement.
17 XXXII. GOVERNING LAW
18 Venue for any action arising out of or related to this Agreement shall only be in Fresno
19 County, California. The rights and obligations of the parties and all interpretation and performance of
20 this Agreement shall be governed in all respects by the laws of the State of California.
21
22
XXXIII. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any
23 one provision in the Agreement shall not affect the other provisions.
24
25
XXXIV. FORCE MAJEURE
Neither party shall be held responsible for any delay or failure in performance (other than
26 payment obligations) to the extent that such delay or failure is caused by fire, flood, hurricane,
27 explosion, war, strike, labor action, terrorism, embargo, government regulation, riot, civil or military
28 authority, act of God, acts or omissions of carriers or other similar causes beyond its control.
-48-
1
2
XXXV. ENTIRE AGREEMENT
This Agreement, including Exhibits A through O {listed below} along with COUNTY's
3 revised RFP No. 18-006, COUNTY's Addendum RFP and the CONTRACTOR'S Response thereto,
4 constitutes the entire agreement between the CONTRACTOR and COUNTY with respect to the subject
5 matter hereof and supersedes all previous Agreement negotiations, proposals, commitments, writings,
6 advertisements, publications, and understanding of any nature whatsoever unless expressly included in
7 this Agreement.
8 Exhibit A-
Exhibit 8-
9 Exhibit C-
10 Exhibit 0-
Exhibit E-
11 Exhibit F-
12 Exhibit G-
Exhibit H-
13 Exhibit I -
Exhibit J-
14 Exhibit K-
15 Exhibit L-
Exhibit M-
16 Exhibit N-
Exhibit 0-
17
Exhibit P-
18
Comprehensive Medical & Behavioral Health Care Services
Remedial Plan
Staffing Plan
Community Mental Health Block Grant Application/Requirements
Fresno County Department of Behavioral Health Guiding
Principles of Care Delivery
Fresno County Behavioral Health Care Requirements
No Hostage Facility
Sheriff Application for Facility Access
Sheriff 0-360 Policy Acknowledgment
Jail Medical Equipment Inventory List
Payment Schedule -Base Compensation
Performance Metrics
Self-Dealing Transaction Disclosure Form
Disclosure of Ownership and Control Interest Statement
Certification Regarding Debarment, Suspension, and Other
Responsibility Matters -Primary Covered Transactions
Annual Summary Report
In the event of any inconsistency among these documents, the inconsistency shall be resolved by
19
giving precedence in the following order of priority: (1) this Agreement, including all Exhibits (excluding
20
21
COUNTY's RFP and CONTRACTOR's Response) attached and incorporated by reference herein; {2)
COUNTY's RFP; and {3) CONTRACTOR's Response. A copy of COUNTY's RFP and
22
CONTRACTOR's Response shall be retained and made available during the term of this Agreement by
23
COUNTY'S Sheriff and Internal Services Department, Purchasing Division.
24
25
26
27
28
Ill
Ill
Ill
Ill
-49-
1 ///
2 IN WITNESS WHEREOF , the parties hereto have executed this Agreement as of the day and
3 year first hereinabove written .
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
CONTRACTOR
California Forensic Medic
Raymond Herr. MD
Print Name
President
Title (Chairman of Board, or President,
or CEO)
(Authorized Signature)
Print Name
Title (Secretary of Corporation, or
Chief Financial Officer/Treasurer, or
any Assistant Secretary or Treasurer)
Mailing Address:
California Forensic Medical Group, Inc.
2511 Garden Road , Suite A160
Monterey, CA 93940
(831) 649-8994
Attn : Briana Elvaiah
FOR ACCOUNTING USE ONLY:
ORG No .: 3111 , 5620 , 5630
28 Account No.: 7295
-50-
COUNTY OF FRESNO
ATTEST:
~~sb
Bernice E. Seidel , Deputy Dy
Clerk of the Board of Supervisors
County of Fresno, State of California
1 ///
2 IN W ITNESS W HEREOF, the parties hereto have executed this Agreement as of the day and
3 year first hereina bove written .
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
2 1
22
23
24
25
26
27
CONTRACTOR
California Forensic Medica l Group, Inc.
(Authorized Signature)
Print Name
Title (Chairman of Board , or President ,
or CEO)
~
Print Name
Gt D
Title (Secret ary of Corporation , or
Chief Financial OfficerfTreasurer, or
any Assistant Secretary or Treasurer)
Mailing Address :
California Forensic Medical Group, Inc.
2511 Garden Road , Suite A 160
Monterey, CA 93940
(831) 649-8994
Attn: Briana Elvaiah
FOR ACCOUNTING USE ON LY :
ORG No.: 3111 , 5620 , 5630
28 Account No .: 7295
-50-
COUNTY OF FRESNO
ATTEST :
airperson of the Board of
e County of Fresno
Bernice E . Seidel , Deputy
C lerk of t he Board of Supervisors
County of Fresno , State of California
SCOPE OF SERVICES
Comprehensive Medical and Behavioral
Health Care Services
Exhibit A
1. CONTRACTOR shall provide to COUNTY's adult inmates comprehensive medical and
behavioral health care services, including dental, optometric and optician, pharmaceutical,
diagnostic, and chronic care, that would typically be provided in a primary care or urgent care
internal medicine, family practice, behavioral health clinic, in-home patients, or community-
based setting.
2. CONTRACTOR shall be ready to implement and assume all responsibilities for on-site
comprehensive medical and behavioral health care services to the adult inmates at the JAIL,
identified herein and according to the terms and conditions of this Agreement, as of 12:01 AM
on the 1st day of July 2018.
3. CONTRACTOR shall not be responsible for inpatient off-site medical services defined as
"Inpatient Hospitalization Services." Psychiatric inpatient hospitalization will remain the
responsibility of the COUNTY; however, CONTRACTOR shall coordinate and cooperate with
COUNTY's DBH-contracted provider of psychiatric inpatient services for admittance of an
inmate.
4. All services provided by CONTRACTOR shall be carried out in conformity with all applicable
provisions of Title 15 of the California Code of Regulations and the NCCHC accreditation
guidelines, as described in this Agreement.
5. Specific services provided on-site by CONTRACTOR shall include, but may not be limited to:
Medical Health:
a. Chronic care
b. Communicable disease control
c. Dental
d. Detoxification and alcohol and other drugs (AOD) withdrawal management, including
Medication Assisted Treatment (MAT), when applicable
e. First aid and emergency response/minor trauma capabilities (e.g., sutures)
f. Fit for confinement and intake health screening
g. Health appraisals
h. Health education (including diabetic treatment education and other chronic disease
related information)
i. Laboratory
j. Medical and dental prosthetic devices, hearing aids, and durable medical equipment
k. Optometric and optician (including glasses)
I. Outpatient Housing Unit (OHU)
m. Physical therapy
n. Physician
Page 1 of 13
Exhibit A
o. Prenatal, pregnancy, obstetrical care, and family planning
p. Sick call
q. X-ray (radiological) and EKG (electrocardiogram)
Behavioral Health:
a. Case management, care coordination, discharge planning -including referrals and
linkage
b. Consistent monitoring, contact with, and treatment of all inmates with serious mental
illness (SMI); however, intensive services will be provided to those housed in
administrative segregation or single cell housing
c. Crisis intervention, crisis stabilization, and crisis de-escalation
d. Development and implementation of behavior management plans in coordination with
Jail staff for applicable inmates with SMI
e. Individual/group psychotherapy and psychoeducational groups
f. Mental health assessments and evaluations
g. Mental health treatment plan development
h. Participation in Behavioral Health Court
i. Coordination with SHERIFF to develop Behavior Management Plans for those inmates
housed in administrative segregation or single cell housing
j. Psychiatric medication evaluation, administration, and monitoring
k. Substance use disorder (SUD) services to include assessments, treatment plan
development, detoxification management, counseling, treatment of co-occurring/dual-
diagnosis disorders, psycho-education, and medication assisted treatment
I. Suicide prevention activities (risk assessment for suicidal ideation, training, and
monitoring of safety cells)
m. Care coordination involving DBH regarding inmates on LPS Conservatorship.
Other Services:
a. Collaborate with all care providers in the facility to determine the appropriateness of
services and establish efficiencies, where possible
b. Electronic health record (EHR) maintenance/data security/retention
c. Emergency on-call medical/psychiatric coverage 24/7
d. Environmental safety
e. Janitorial service for work areas staffed by CONTRACTOR
f. Medical waste disposal
g. Pharmaceutical distribution/monitoring
h. Pharmaceuticals (and pharmacist consulting services)
i. Quality assurance
j. Re-entry, discharge planning, and coordination of care
k. Response to health record requests and release of information
Page 2 of 13
Exhibit A
I. Staff training
m. Statistics and record keeping
6. CONTRACTOR shall operate a medical and behavioral health care program that meets the
local community standards of care.
7. CONTRACTOR shall operate health care programs at an adequate staffing level for 24-hour
coverage using only licensed, certified, and professionally trained personnel and shall ensure
that services are provided competently.
8. CONTRACTOR shall provide adequate staffing, including 24/7 coverage, provided at all times
to meet all demands for medical, behavioral, and other health care needs. This will include on-
call coverage 24-hours/day, ?-days/week (24/7) by a physician and psychiatrist. A nursing
supervisor and a licensed mental health clinician, are required to be scheduled 24/7 at the
Jail. Additionally, emergency medical, behavioral, and dental health care must be provided
24/7.
SERVICES PROVIDED
1. CONTRACTOR's responsibility for medical and behavioral health care services will begin at
intake screening and will end at the completion of the discharge process of the inmate from
the JAIL, including care coordination and linkage to care, as appropriate. Care coordination
shall also include care provided while incarcerated and must include discharge planning to
provide appropriate linkage to COUNTY-contracted or other community programs, upon
release. Care coordination and collaboration must include the sharing of treatment-required
information between providers essential to the provision of appropriate services and care.
2. CONTRACTOR shall be given timely notice, either written or verbal, by SHERIFF, of any
Bedside "Proxy" Bookings of adult inmates. Notwithstanding the foregoing, CONTRACTOR
shall not be financially responsible for the cost of any medical treatment or health care services
provided to any adult inmate prior to the inmate being formally booked and physically housed in
a COUNTY JAIL, until such time that CONTRACTOR commences services.
3. CONTRACTOR shall make accommodations within the JAIL in order to prevent unnecessary
use of outpatient/off-site specialty care service providers and inpatient hospitalizations,
thereby reducing the dependence on JAIL resources for transportation of inmates and
security.
4. CONTRACTOR shall staff a medical professional (i.e., Registered Nurse) to provide the
medical and behavioral health care intake screening conducted at the time of booking. Intake
screening shall be conducted 24-hours/day, including weekends and holidays. CONTRACTOR
shall provide staffing for intake screening 24-hours/day at all booking locations. Medical and
behavioral health care intake screening shall include identification of medical and behavioral
health needs (including suicidal ideation) and substance use disorders. No outside
medications will be utilized in the treatment of an inmate. Physicians must "bridge" all
verified, valid prescriptions for inmates entering the JAIL on prescribed medications, within 24
hours.
Page 3 of 13
Exhibit A
5. CONTRACTOR shall provide an initial health assessment that includes medical history,
physical, and mental health assessment. The history portion should also include a review of
COUNTY DBH's electronic health record (EHR) "Avatar" for mental health history. Health
assessments must be completed for all adult inmates within fourteen (14) days after booking.
The health assessment must be conducted by a mid-level practitioner, physician, or registered
nurse, using appropriate Standardized Nursing Protocol. Said Standardized Nursing Protocols
and Mid-Level Practitioner Protocols shall be made available for COUNTY's DPH and/or DBH
Director, or designee, and/or COUNTY's Health Officer for review. Additional health
assessments of the inmates shall be conducted annually after the initial health assessment is
completed.
6. CONTRACTOR shall ensure that there is a process for all adult inmates to initiate requests for
health care services on a daily basis and that those requests are readily available to all
inmates. CONTRACTOR shall use a priority system to triage requests within twenty-four (24)
hours, not to exceed seventy-two (72) hours. Triage of sick call requests will be conducted by a
registered nurse within their scope of practice.
7. CONTRACTOR shall be responsible for obtaining informed consent from adult inmates prior to
providing care and treatment as required by law, except in the case of an emergency.
Procedures to follow for obtaining informed consent from inmates are provided in the Policy
and Procedure Guideline of the Fresno County Department of Public Health.
8. CONTRACTOR shall provide for nursing sick call to be held seven (7) days a week at the
JAIL. Physician sick call (may be either physicians or mid-level practitioners) must be
provided seven days a week, at least two (2) of which must include evening clinics.
9. CONTRACTOR shall conduct sick call in designated areas of the clinics or housing units, in as
much privacy as security concerns will allow.
10. CONTRACTOR shall provide emergency response care for minor trauma incidents (i.e., on-site
medical care treatment for minor injuries such as sutures, sprains, etc.) in order to minimize
inmate transports.
11. CONTRACTOR shall provide psychiatric, psychotropic, and anti-psychotic medication
monitoring for the inmates, as well as court-ordered evaluations pursuant to Penal Code
4011.6. CONTRACTOR shall provide crisis coverage 24/7 at all COUNTY JAIL facilities
12. CONTRACTOR shall be responsible for all psychiatric emergency services including, crisis
intervention, crisis stabilization, and crisis de-escalation services for inmates within the JAIL.
13. CONTRACTOR shall provide emergency, medically necessary and non-emergency dental
services, including a dental screening upon admission, oral exam within twelve (12) months of
admission, routine x-rays and dental treatment (not limited to extractions) and oral hygiene
instruction and preventative education for adult inmates.
14. CONTRACTOR shall provide pharmaceutical services at all JAIL facilities, in accordance with
NCCHC Standards and Title 15 CCR, Section 1216, or may subcontract with a qualified, State
of California licensed on-site pharmacy to provide pharmacy services including, but not limited
to:
a. Medical and psychotropic pharmaceuticals
Page 4 of 13
b. Dispensing and delivery of medication
c. Over-the-counter medications
d. Pharmacist consulting services
e. Pharmaceutical electronic monitoring/ordering system
f. Pharmaceutical disposal services
g. Prescription medications for inmates on temporary authorized release
Exhibit A
15. CONTRACTOR shall provide on-site basic optometry services provided by a licensed
optometrist. Services shall include assessment, treatment, and consultation including
examination of eyes for health and vision problems, prescriptions for glasses, and diagnosis
and treatment of eye disease such as glaucoma, cataracts and retinal disorders. The
selected bidder must provide, repair, or replace glasses, when necessary. All optometry
equipment and supplies will be the responsibility of the CONTRACTOR.
16. CONTRACTOR shall identify and provide chronic care treatmenUtherapy to all inmates in
accordance with national medical standards and NCCHC Standards.
17. CONTRACTOR shall furnish and pay for the timely provision and repair of medical orthoses,
prostheses, and other aids to impairment including, but not limited to, the following: braces,
shoe inserts, splints, prostheses, prescription eyeglasses, hearing aids, corrective shoes,
canes, walkers, and wheelchairs that are deemed medically necessary.
18. CONTRACTOR shall provide prenatal and obstetrical (OB) services to the inmates. If the
need arises to refer an inmate to an off-site OB provider (depending on what type of
obstetrical care is necessary), then the CONTRACTOR will need to coordinate with JAIL staff
for transport for all off-site scheduled appointments. CONTRACTOR must coordinate care
with DPH Public Health Nurses for pregnant inmates. Before starting any medications,
CONTRACTOR will provide a pregnancy test to any inmate suspected of being pregnant to
confirm pregnancy. Any pregnant inmate will be provided timely and appropriate prenatal
care, counseling, specialized obstetrical services, postpartum care, when indicated. Care
should be within nationally accepted care guidelines and will include:
a. Pregnancy testing
b. Comprehensive counseling in accordance with inmates expressed desires
c. Routine and high-risk prenatal care
d. Advice on appropriate levels of activity, safety precautions, and nutritional guidance
e. Management of chemically addicted pregnant females
f. Dietary supplements
g. Observations for signs of toxemia
19. CONTRACTOR shall provide birth control, if medically necessary, and family planning
education. CONTRACTOR will coordinate with outpatient providers for pregnancy termination
services, in accordance with Title 15 and California Penal Code, Section 3405 requirements.
CONTRACTOR shall be responsible for the costs of all pregnancy termination services. For
women who are on a method of contraception at intake, continuation of contraception will be
considered on a case-by-case basis. Plan-B will be available at intake for women who report
the need for emergency contraception. Women desiring to initiate contraception, including
long-term options, will be scheduled with a provider to discuss available and clinically
appropriate options at the inmates request sixty (60) days prior to a scheduled release from
custody.
Page 5 of 13
Exhibit A
20. CONTRACTOR shall provide on-call professional radiological (x-ray) and electrocardiograph
(EKG) services. Said services must be made available at the COUNTY's JAIL facilities 24/7.
CONTRACTOR must comply with the Radiation Control Laws and Regulations, as well as
provide copies of resumes, licenses, and certifications of applicable staff.
21. CONTRACTOR shall be responsible for all laboratory services provided to inmates.
CONTRACTOR shall be responsible for all necessary supplies including, but not limited to,
supplies for specimen collections, phlebotomy services, specimen pick-up and delivery,
laboratory testing, critical test value reporting, and timely response for urgent and routine
laboratory orders. CONTRACTOR (or its subcontractor) must be CL/A (Clinical Laboratory
Improvement Amendments) certified. All laboratory services will be provided in accordance
with Fresno County, State, and Federal client confidentiality requirement. STAT service
requests must be made available and provided 24/7 by CONTRACTOR.
CONTRACTOR shall maintain standards and certification required by Clinical Laboratory
Improvement Amendments (CLIA) and shall maintain Clinical Laboratory Registration (CLR)
with the State. All CLIA and CLR certification and/or registration fees will be the responsibility
of CONTRACTOR.
22. CONTRACTOR shall obtain and maintain medical waste generator registration with the State of
California for the JAIL and develop a Medical Waste Management Plan, as required under the
Medical Waste Management Act. CONTRACTOR shall be responsible for all fees associated
with registration as a medical waste generator facility.
CONTRACTOR shall be responsible for the handling and disposal of medical and
contaminated waste in accordance with all applicable state and local regulations.
23. CONTRACTOR shall provide for ancillary services (including coordination for laboratory, MRI,
etc.) which can be performed off-site, but preferably shall be performed on-site.
CONTRACTOR shall attempt to provide services on-site, as much as possible.
24. CONTRACTOR shall be responsible for dialysis treatments to adult inmates in the JAIL that
require dialysis treatment. CONTRACTOR shall attempt to provide on-site in order to minimize
transportation and custody costs.
25. CONTRACTOR shall provide behavioral health services, referred to as jail psychiatric services
("JPS"), in accordance with the requirements of SAMHSA (as defined in Section I,
OBLIGATIONS OF THE CONTRACTOR of this Agreement and attached to this Agreement as
Exhibit D). Behavioral health treatment services under the JPS program shall include, but are
not limited to: evaluation and assessment, including dual-diagnosis; 24-hour crisis intervention;
medication management; referral for acute psychiatric hospital care; consultation with custody
to determine appropriate housing; assisting, coordinating, and participating with SHERIFF for
monitoring of safety and isolations cells; coordination with the Behavioral Health Court in
Fresno County to facilitate alternatives to incarceration; group treatment, specifically designed
to address dual-diagnosis issues; staff representation at Behavioral Health Court monthly
meetings to assist in continuity of care; development and implementation of behavioral plans to
change problematic behaviors.
26. CONTRACTOR may provide psychiatry services via tels-psychiatry, as appropriate.
Page 6 of 13
Exhibit A
27. CONTRACTOR shall provide appropriate care coordination and linkage to care, including
robust discharge planning, as appropriate. Care coordination shall include care provided while
the inmate is incarcerated beginning at intake screening through to discharge planning
including appropriate linkage to COUNTY-contracted or other community programs, upon
release. Care coordination and collaboration must include the sharing of treatment-required
information between providers essential to the provision of appropriate services and care, upon
release of an inmate from COUNTY's JAIL Facilities. Care Coordination will also include the
following:
a. Coordinating aftercare arrangements
b. Making referrals to appropriate community programs
c. Coordinating appointments with community providers
d. Ensuring medications are continued with a 14-day supply following release
e. Assisting inmates with applying for financial help
f. Linking inmates to programs such as COUNTY's DBH Adult Division or other
programs, as applicable
g. Assisting inmates with SMI in securing housing placements, scheduling appointments,
and/or providing transportation arrangements.
h. Coordinate with DPH Public Health Nurses upon release of pregnant female inmates
28. CONTRACTOR shall develop and maintain an adequate infectious disease control program.
The infectious disease control program must include testing all inmates for tuberculosis (TB)
within five days of intake. CONTRACTOR should also be able to identify and report
communicable disease (including HIV, AIDS, TB, Hepatitis and STDs). CONTRACTOR must
screen and treat for syphilis during periods when the Health Officer has designated the
County an area of high syphilis morbidity. This includes RPR (rapid plasma region) testing at
the time of booking of all male inmates under the age of 30 and all female inmates under the
age of 35. Positive RPR results must be confirmed with a treponemal test within 48 hours,
and initiation of treatment must ensue within 72 hours of receipt of confirmation.
CONTRACTOR shall also work closely with DPH on any significant emerging public health
events impacting the community.
29. CONTRACTOR shall assume responsibility for utilization management for all inmates that are
transported to an emergency department and/or are hospitalized for any length of time while in
custody. CONTRACTOR shall review and monitor the inmate's medical case and shall make a
good faith effort to actively pursue discharge of the inmate from the hospital and coordinate
transportation of the inmate at the earliest possible time at which CONTRACTOR has the ability
to resume appropriate treatment and medical care of said inmate within the JAIL.
CONTRACTOR shall obtain appropriate releases of information and coordinate discharge
planning with the hospital/provider.
30. CONTRACTOR may be requested to consult and collaborate with COUNTY's DBH on
competency matters. It is anticipated that the services related to restoration to competency for
misdemeanants (i.e., MIST -misdemeanor incompetent to stand trial) will be included in a
separate scope of work in a future RFP. If CONTRACTOR is not selected to provide such
services, CONTRACTOR shall be expected to work collaboratively with that selected provider
of MIST services and all parties involved in the defendant's competency case.
31. At this time, the JAIL facilities are not designated as treatment facilities for the purposes of
administering court-ordered involuntary psychotropic medications or for providing services for
restoration of competency for misdemeanor defendants. However it is the intention of the
COUNTY's SHERIFF and DBH to pursue such designation in the future to further assist
inmates in need. At such time, the selected bidder of such services shall be expected to
Page 7 of 13
Exhibit A
develop and implement policies and procedures for the administration of court-ordered
involuntary medications, when appropriate (such as for MIST services or persons on LPS
Conservatorship).
CLINIC AND RECORDS MANAGEMENT
1. CONTRACTOR will maintain all records in accordance with Section 1205 of Title 15 of the
California Code of Regulations and NCCHC accreditation guidelines.
2. CONTRACTOR shall implement its own clinic management system within the COUNTY's Jail
Facilities.
3. CONTRACTOR shall utilize an EHR system beginning on the contracted start date of services
for documentation, management, and monitoring of inmates' medical and behavioral health
care. The EHR utilized by the previous COUNTY-contracted provider in the JAIL is Electronic
Offender Management Information System (eOMIS). CONTRACTOR shall be expected to
transition systems in order to be operational by the contracted start date of services on the 1st
day of July, 2018.
CONTRACTOR must maintain complete and accurate medical health, behavioral health,
optometry and dental records separate from the JAIL inmate confinement records. In any
criminal or civil litigation where the medical or behavioral health condition of an inmate is at
issue, and/or upon written request of County Counsel or Risk Management, CONTRACTOR
must provide the DPH Director, DBH Director, and/or COUNTY Health Officer (and/or
designees) with access to such records. In the event of a possible HIPAA
violation/breach/allegation, CONTRACTOR will cooperate with the County's Privacy and
Security Officer(s), or designee(s).
CONTRACTOR must allow designated COUNTY staff electronic read-only access to health
records and to the full EHR system (including ability to view reports). Disclosure of medical
and/or behavioral health information to JAIL staff may be necessary for the health and safety
of the inmates and JAIL staff and to properly manage or plan for placement and
programming.
Existing health care records and all health care records prepared by CONTRACTOR will
remain the property of the COUNTY. During this Agreement term, CONTRACTOR will act as
the custodian of records for the COUNTY and shall respond to subpoenas regarding health
care records and/or treatment. At the termination of this Agreement, all health care records
will remain the property of the COUNTY.
CONTRACTOR will be responsible for responding to all records requests for medical and
behavioral health care services in a timely manner and as allowable by HIPAA or other
applicable laws, regulations, codes, and guidelines regarding medical and behavioral health
care information. An accounting of records released shall be provided to SHERIFF, DPH,
and DBH at least quarterly.
4. COUNTY's DBH currently utilizes an EHR system, "Avatar" for management of behavioral
health care records. CONTRACTOR must utilize this system to report all behavioral health
care services provided to inmates.
Page 8 of 13
Exhibit A
COUNTY'S DBH is required by the State Department of Health Care Services to collect data
pertaining to mental health clients and services provided. Therefore, CONTRACTOR shall be
responsible to report information regarding all inmates who received services and which
services were provided within the mental health treatment program. The required components
shall be uploaded into COUNTY's DBH EHR system, "Avatar". A client demographic record
shall be recorded at initial contact with the adult inmate during the booking/intake process (or
first applicable service provision) and then service records shall be recorded every time mental
health services are provided. Periodic records (which contain data elements that may change,
i.e., living arrangements) shall be updated and recorded at initial contact, annually, and at
discharge.
Documentation of the behavioral health services should occur immediately and entry into the
DBH EHR system should occur no later than 45 days after service has occurred. COUNTY's
preference is for CONTRACTOR's EHR system to have the capability to upload/enter the
services in real-time or at least daily. CONTRACTOR shall send any staff who enter records
of behavioral health care services into Avatar to COUNTY DBH's Documentation and Billing
Training as provided by COUNTY DBH's Managed Care Division
5. CONTRACTOR shall provide MCIP (Medi-Cal Inmate Program) reports to COUNTY regarding
the utilization for said services, treatment, and related costs.
6. CONTRACTOR shall develop and implement a written medical and behavioral health care plan
with clear goals, objectives and policies and procedures for the COUNTY's JAIL, including
services provided to adult inmates for both medical and behavioral health care services.
CONTRACTOR shall provide COUNTY with a copy of said written plan, including all policies
and procedures, upon completion. CONTRACTOR shall also provide COUNTY with any
updates to said written plan, policies and procedures, as developed, throughout the term of this
Agreement.
7. CONTRACTOR shall be expected to respond promptly to any and all requests by the courts,
via court order or subpoena, for medical or behavioral health care records.
8. CONTRACTOR shall work with DPH, DBH, and SHERIFF staff, as appropriate, to define the
CONTRACTOR's roles in case of a disaster. CONTRACTOR shall develop and implement
written procedures for a medical disaster plan in case of emergency or threat whether
accidental, natural, or man-made.
9. CONTRACTOR shall track and report all health care services delivered to AB 109 inmates.
PERFORMANCE AND OUTCOMES
1. CONTRACTOR shall submit annual program information regarding performance and
outcomes, including measures that have been tracked for these specific purposes, and
percentage of target met. All measures (i.e., performance metrics as identified in Exhibit L)
must meet the NCCHC standard as well as the requirements of the Remedial Plan as identified
in this Agreement, as well as the categories identified below:
a. Access to care: The ability of inmates to receive the right service at the right time.
Page 9 of 13
b.
C.
d.
Exhibit A
Effectiveness: Objective results achieved through health care services.
Efficiency: The demonstration of the relationship between results and the resources
used to achieve them.
Satisfaction and Compliance: The degree to which inmates, COUNTY, and other
stakeholders are satisfied with the services.
SHERIFF, DPH, and/or DBH may adjust the performance and outcome measures periodically
throughout the duration of this Agreement, as needed, to best measure the program as
determined by COUNTY. CONTRACTOR shall utilize a computerized tracking system with
which performance and outcome measures and other relevant inmate data, such as
demographics, will be maintained. The data tracking system may be incorporated into the
CONTRACTOR's EHR or be a stand-alone database. SHERIFF, DPH, and DBH must be
afforded read-only access to the data tracking system.
TRAINING/STAFF DEVELOPMENT
1. CONTRACTOR shall provide adequate orientation and training, at its cost, to all staff under
their direction, including all required annual HIPAA confidentiality training.
2. CONTRACTOR shall provide adequate annual training for JAIL staff in medical and behavioral
health observation of adult inmates.
3. CONTRACTOR shall require a skills and competencies assessment of staff annually and
include follow-up training, as required.
4. CONTRACTOR shall provide protocol and standardized procedures training, as appropriate.
5. CONTRACTOR shall assure the cultural competency of health care staff, which may be
accomplished through regular training activities made available to all personnel.
6. CONTRACTOR shall comply with Prison Rape Elimination Act (PREA) of 2003 and agree to
have all JAIL staff trained initially and every two (2) years thereafter, by the SHERIFF staff.
7. CONTRACTOR shall provide annual training for SHERIFF correctional officers concerning
various health care issues in the facilities. Such training will be jointly developed and
scheduled at a mutual convenience, and may include subjects such as symptoms and signs of
withdrawal, suicide prevention, seizures, diabetes, etc.
STAFFING/FACILITIES
1. CONTRACTOR shall ensure that all personnel employed in the performance of this Agreement
possess the required expertise, skill, and professional competence to perform their duties.
Page 10 of 13
Exhibit A
2. CONTRACTOR shall hire and maintain an on-site Medical Director and an on-site Director of
Psychiatry. The Medical Director will be responsible to assure the quality of health care
provided within COUNTY's JAIL Facilities and will provide clinical supervision to the mid-level
practitioners and other ancillary personnel who perform services pursuant to this Agreement.
The Medical Director must be a licensed physician. COUNTY prefers for the Medical Director
to be Board Certified in internal medicine or family practice, but this is not a requirement.
However, CONTRACTOR shall attempt to actively pursue recruiting a Board Certified Medical
Director. The Medical Director must have thorough knowledge of all current principles and
practices of medicine. The Director of Psychiatry will work closely with the Psychiatrist and will
coordinate the behavioral health activities in the JAIL
3. During the terms of this agreement, SHERIFF is building a new detention facility, known as the
West Annex Jail, to replace the South Annex Jail, which is one of the existing detention
facilities within the JAIL. If the project is completed within the term of this Agreement, it is
proposed that the West Annex Jail may have 200 fewer inmates, based on an ADP, than the
South Annex Jail. The potential decrease in ADP, and new services to be provided at the West
Annex Jail, may result in a necessary change in staffing levels, and services, and
compensation payments made by COUNTY to CONTRACTOR under this Agreement. The
parties agree to meet and negotiate in good faith an Amendment to this Agreement, in the
event the ADP decreases below 2,700.
ADMINISTRATION
1. CONTRACTOR shall maintain a collaborative and open relationship with the COUNTY's DPH,
DBH, and SHERIFF Departments in the provision of services and operations as well as future
planning and evaluation of services.
2. CONTRACTOR will provide medical and behavioral health care services as highlighted in the
Remedial Plan (Consent Decree Hall, et. al. v. County of Fresno), attached as Exhibit B.
COUNTY will work with CONTRACTOR to delineate CONTRACTOR's responsibilities
regarding the Remedial Plan.
3. CONTRACTOR will ensure their staff complete the Application for Facility Access and will be
responsible for payment of the Live Scan clearance fees (upon execution of this Agreement,
the fee is currently at $52 per person). CONTRACTOR will abide by COUNTY's requirement for
a background check on all personnel. COUNTY maintains the right to veto the use of any on-
site employee or subcontractor.
4. CONTRACTOR shall communicate and consult frequently with the local medical community
and other COUNTY-contracted providers, as well as family members of inmates in custody, as
allowable by HIPAA regulations, to provide the most complete evaluation and treatment of
incarcerated individuals.
5. CONTRACTOR shall coordinate with SHERIFF, and COUNTY's contracted emergency
response ambulance provider, as needed, for emergency transportation needs.
6. CONTRACTOR shall make every effort to minimize the need to transport inmates from the JAIL
to other providers for treatment by providing expanded services on-site or by other methods to
reduce outpatient costs as well as SHERIFF's staff transportation and custody costs.
CONTRACTOR shall perform utilization review and case management services to monitor the
Page 11 of 13
Exhibit A
necessity and appropriateness of inpatient hospital care and other outside medical services
provided.
7. CONTRACTOR's health care personnel shall be available for court inquiries and/or
appearances, when required. It will be CONTRACTOR's responsibility to compensate their staff
for court appearances, which shall be at no added cost to COUNTY.
8. In the event of a HIPAA breach, violation, or allegation, CONTRACTOR shall fully cooperate
with COUNTY Privacy and Security Officers, or designees.
9. CONTRACTOR shall provide appropriate and adequate bilingual services, including on-site
Spanish-speaking personnel for monolingual inmates. CONTRACTOR shall also make sign
language interpretation available, as needed.
10. CONTRACTOR shall provide appropriate and adequate interpreter services to include, but not
be limited to, the following COUNTY threshold languages: Spanish, Hmong, Laotian and
Cambodian/Khmer.
11. CONTRACTOR shall establish and make available a process for receiving, investigating, and
responding to and resolving any concerns relating to an adult inmate grievances concerning
medical or behavioral health care provided.
12. CONTRACTOR shall work with the COUNTY's Health Officer who, under Section 1208 of the
Penal Code, shall investigate health and sanitary conditions in every county detention facility.
CONTRACTOR shall prepare for, and participate in, said annual health inspections of the
COUNTY's JAIL Facilities. CONTRACTOR shall be responsible for the remediation of reported
non-compliance pertaining to the provision of medical or behavioral health care services.
13. CONTRACTOR shall cooperate fully in aiding COUNTY to investigate, adjust, settle, or defend
any claim, action, or proceeding, including writs of habeas corpus, brought in connection with
the provision of medical or behavioral health care with which CONTRACTOR may be
connected.
14. CONTRACTOR shall establish and facilitate a medical and behavioral health care audit
Continuous Quality Improvement (CQI) committee comprised of CONTRACTOR's medical
staff, and behavioral health staff as well as with active participation of the COUNTY's Health
Officer, or designee. Said CQI committee shall prepare and review monthly data and statistical
reports that will be provided to the COUNTY's DPH and DBH's Director, or their designees.
Statistical reports should include workload data on sick call visits, wait time (from sick call slip
submittal to sick call visit), health appraisals, etc.
15. CONTRACTOR must participate in monthly administrative audit meetings, along with the
COUNTY's DPH and DBH Director, or designees, to assist with reviewing reports and ensuring
compliance. The purpose of said meetings will be to evaluate statistics and program needs.
The meetings will also be used to evaluate and address problems/issues that may arise
internally and with interrelationships between custody, medical and behavioral health care
services personnel as well as the CONTRACTOR's relationships with providers of emergency,
inpatient, and outpatient specialty care services. Adult inmate grievances filed will also be
reviewed as well as any current high profile inmate cases.
Page 12 of 13
I ..
Exhibit A
16. CONTRACTOR must conduct monthly Suicide Prevention meetings to discuss inmates on
suicide precautions or that have been placed in the Safety Cell. This meeting may be
combined with the SMI meeting, discussed herein, if approved by all parties.
17. CONTRACTOR must conduct bi-weekly meetings to discuss inmates in the JAIL who have
been diagnosed with a SMI for care coordination for optimal quality of care and to address
behavioral issues. The bi-weekly SMI meetings will include a multidisciplinary team with
representatives from the SHERIFF, DPH, DBH, and CONTRACTOR's staff. The purpose of
the meetings will be to monitor the progress of inmates with SMI who are in administrative
segregation or single cell housing, to evaluate an inmate's housing situation, review the
inmate's behavior management plan, and to monitor adherence to the Remedial Plan for
inmates who are in administrative segregation or single cell housing. Minutes shall be taken,
recorded, and disseminated to all invitees and participants at the SMI meetings.
18. In the event of an inmate death, CONTRACTOR's physician, not involved in patients
treatment, will conduct a mortality review of the case and will present their findings in a
multidisciplinary mortality review meeting to be attended by SHERIFF, DPH, DBH, County
Counsel, and CONTRACTOR's staff. If inmate had a history of a mental illness, a
psychological autopsy must also be performed by the CONTRACTOR's psychiatrist, not
involved in patients treatment, and the results shall be presented at the mortality review.
Minutes shall be taken, recorded, and disseminated to all invitees and participants.
EXCEPTIONS TO TREATMENT
1. CONTRACTOR will not be financially responsible for:
a. Treatment costs incurred after an inmate is released from the COUNTY's physical
custody.
b. Elective medical care:
i. Examples of elective medical care include, but are not limited to: breast
reconstruction, gastric bypass, facelift, or gender reassignment surgery.
c. Psychiatric inpatient hospitalization.
d. Health care provided to an infant following birth
e. Any costs associated with smoking cessation treatment or classes.
c. Any medical testing or obtaining samples, which are forensic in nature.
d. Any experimental treatments.
e. Any care provided without CONTRACTOR's prior knowledge.
2. CONTRACTOR shall be responsible for all medical and behavioral health care according to the
terms of this Agreement while inmates are legally "in custody" of SHERIFF. Inmates are
considered "in custody" upon booking of the inmate until the time the inmate is legally released
from SHERIFF custody and will be maintained in the daily jail count regardless of where they
are physically. However, individuals on supervised probation, or those that may be housed in
an unidentified location (e.g., a witness or co-conspirator), shall not be included in the daily
population count, and shall not be the responsibility of CONTRACTOR with respect to any
claim, liability, cost, or expense for the payment and/or furnishing of health care services.
Page 13 of 13
Hall, et. al. v. County of Fresno
REMEDIAL PLAN
[DATE], 2015
Exhibit B
Pursuant to the Consent Decree entered on [DATE], the County of Fresno agrees to
implement the following measures.
I. MEDICAL CARE
A. Organizational Structure and Leadership
1. The County shall ensure that jail health care staff and the Sheriffs Office implement
an interagency agreement that addresses mutual responsibilities in the provision of
health care.
2. The Jail Medical Director shall be Board Certified or Board eligible in Internal
Medicine or Family Practice.
3. Jail health care staff shall meet with Sheriff's Office staff during monthly
administrative meetings that shall include an agenda and minutes.
4. Jail health care staff and the Sheriff's Office shall develop and implement
standardized procedures that provide coordination between correctional and
medical staff such that patients receive safe and timely access to care and
medications.
5. The County shall require that jail health care staff are appropriately credentialed
according to the licensure, certification, and registration requirements for the State of
California.
6. Jail health care staff shall participate in mock fire drills conducted by the Sheriff's
Office once a year.
B. Staffing
1. The County shall deliver adequate health care to comply with this Remedial Plan.
2. The County shall employ adequate numbers of correctional staff to assist with
medication administration and the movement of patients to receive health care
services.
1
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
3. The County will provide a budget/or jail health care services sufficient to finance
adequate health care and correctional staff to comply with this Remedial Plan.
C. Clinic Space
1. The County will provide an adequate number of clinic examination rooms to
deliver adequate health care and comply with this Remedial Plan.
2. Clinic examination rooms shall have standardized equipment and par levels of
supplies in a standardized presentation.
D. Policies and Procedures
1. The County's policies and procedures regarding medical intake shall require
completion of a Medical Intake Screening form that includes the following:
a. Questions on the history of HIV/ AIDS, Tuberculosis, and Kidney Disease:
and
b. Questions regarding legal and illegal drug use (e.g., type, time of last use and
quantities.)
2. The County's policies and procedures shall include that inmates with chronic illness
are identified and seen after intake based on acuity (on the day of arrival for patients
with high acuity and not to exceed 14 days for all others), and for follow-up
appointments in intervals that do not exceed 90 days unless such inmates are
clinically stable on at least two consecutive encounters, in which case not to exceed
intervals of 180 days.
3. The County's policies and procedures regarding Individualized Treatment Plans shall
include the following:
a. The minimum time period between intake screening and the first history and
physical examination shall be specified and based on acuity (not to exceed 14
days for all inmates):
b. Continuity of medications shall occur within 24 hours for inmates with
chronic illness, unless there are extenuating circumstances that prevent the
prescription of such medications, in which case the inmate shall be evaluated
2
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
by a physician or mid-level practitioner within 24 hours to determine an
alternative treatment plan: and
c. The minimum time period between physician evaluations shall be specified
based on acuity.
4. The County's policies and procedures shall include that prescription medications shall
only be prescribed by licensed physicians, physician's assistants, or nurse
practitioners, within the scope of their licensures.
5. The County's policies and procedures regarding detoxification shall include the
following:
a. Detoxification shall occur only under medical supervision in accordance with
local, state, and federal laws:
b. Detoxification from alcohol, opiates, hypnotics, other stimulants, and sedative
hypnotic drugs shall be conducted under medical supervision when performed
at the facility:
c. Inmates being detoxified shall be monitored by a physician:
d. Specific guidelines shall be followed for the treatment and observation of
inmates manifesting mild or moderate symptoms of intoxication or
withdrawal from alcohol and other drugs:
e. Monitoring shall be structured and documented in accordance with the
Clinical Institute Withdrawal Assessment or the Clinical Opiate Withdrawal
Scale: and
f. Inmates experiencing severe, life threatening intoxication (an overdose) or
withdrawal shall be transferred under appropriate security conditions to a
facility where specialized care is available.
6. The Sheriffs Office policies and procedures regarding Safety Cells shall include that
inmates may not be housed in safety cells for medical reasons.
7. The Sheriff's Office policies and procedures regarding disciplinary diets shall
include that physicians assess whether a disciplinary diet will affect a prisoner's
medical condition.
8. The County's policies and procedures regarding health records shall include the
following:
a. All medical records must comply with state and federal regulations pertaining
to access, disclosure and/or use of health information: and
3
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
b. Health record and health information, both oral and documented, is
confidential protected health information. The minimum necessary health
information is to be disclosed to health care staff providing health care or to
jail authorities when necessary for the protection of the welfare of the inmate
or others, management of the jail, or maintenance of jail security and order.
9. The County's policies and procedures shall separately identify the following
pharmaceutical procedures:
a. Procurement of pharmaceuticals:
b. Controlled substances:
c. Storage of medication:
d. Use of methadone:
e. Ordering and dispensing medication:
f. Medication administration:
g. Documentation of medication administration: and
h. Medication renewal.
10. The County's policies and procedures shall include that all tuberculosis screening and
management shall be conducted in accordance with the American Correctional
Association (ACA) and the National Commission on Correctional Health Care
(NCCHC), "Standards for Health Services", as endorsed under recommendations of
the Center for Disease Control (CDC) guidelines.
11. The County's policies and procedures shall include an Infection Prevention Plan that
includes procedures for identification, treatment, isolation, surveillance,
immunization (when applicable), prevention, education and follow-up related to
infectious diseases.
12. The County's policies and procedures shall include Nursing Encounter Protocols
/Tools that are appropriate to the level of skill and preparation of the nursing
personnel who will carry them out and comply with the relevant state practice acts.
13. The County's policies and procedures shall require that pregnant inmates receive
timely and appropriate prenatal care, postpartum care, counseling, and specialized
obstetrical services when indicated.
14. The Sheriff's Office policies and procedures shall include a procedure to monitor
temperatures in the facilities for the purpose of ensuring that inmates prescribed
psychotropic medications are not at risk of malignant hyperthermia from extremely
4
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
hot conditions, after consultation with medical/mental health staff, and that
inmates are provided with extra blankets as needed in extremely cold conditions.
15. The County's policies and procedures regarding restraints shall include the following:
a. Restraints shall not be used for medical purposes or during any medical
procedures:
b. Medical staff shall not participate in decisions to initiate use of restraints by
correctional staff:
c. Medical staff shall take all necessary measures to maintain proper peripheral
circulation during the use of restraints: and
d. A registered nurse or L VN under the supervision of a RN shall document vital
signs, mental status, and sensation of limbs within the first hour of placement,
and by medical staff at least every 60 minutes thereafter.
16. The County's policies and procedures shall be revised, as necessary, to reflect all of
the health care remedial measures described in the Remedial Plan, and the County
shall deliver healthcare pursuant to these revised policies and procedures.
E. Medical Intake and Screening
1. Tuberculosis screening shall include the following:
a. Screenings provided in accord with Centers for Disease Control and
Prevention guidelines:
b. Inmates shall receive either Mantoux skin testing or Interferon-gamma release
assays (IGRAs) within five days of intake:
c. Inmates who present with an initial positive tuberculosis screening result shall
receive a chest radiograph.
2. All inmates shall receive a thorough nursing intake screening to include vital signs,
capillary blood glucose testing for persons with diabetes, peak expiratory flow rate
for persons with asthma, and oxygen saturation for persons with emphysema.
F. Access to Care
1. Correctional officers shall make blank health service request forms available to
inmates, and only health care staff shall collect completed health service request
forms. Locked boxes shall be available in dorm and open-cell housing units for
inmates to submit health service request forms. Health care staff shall pick up
5
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
completed health service request forms directly from inmates in lockdown units
during medication passes twice a day.
2. The following procedures regarding completed health service request forms and
nursing triages shall be followed:
a. Health care staff shall collect and triage completed health service request
forms at least twice a day to determine the urgency based on the complaint:
b. All inmates with emergent issues shall be seen immediately, urgent issues
within 24 hours, and routine requests shall be scheduled within 72 hours:
c. All inmates experiencing symptoms shall have vital signs taken during their
face-to-face evaluations: and
d. Nurses shall review the charts of the inmates being evaluated during all
triages.
3. All nursing sick call encounters shall occur in a room with an examination table, sink,
proper lighting, proper equipment, and with a medical record.
4. When a nurse determines clinician follow-up is necessary for diagnosis and treatment
of an inmate's condition, the inmate shall be referred to a physician, physician's
assistant, or nurse practitioner for a face-to-face evaluation that takes place
immediately for emergent concerns, within 24 hours for urgent concerns, and within
14 days for non-emergent or non-urgent concerns.
G. Outpatient Housing Unit (OHU)
1. The following procedures for inmates housed in the OHU for medical treatment shall
be followed:
a. Physicians, Nurse Practitioners, or Physician's Assistants shall sign an
admittance order for patients housed in the OHU: to be followed by a
complete history and exam within 72 hours:
b. Inmates admitted to the OHU shall receive daily checks to include review of
symptoms and vital signs by RNs: to be documented in the inmate's medical
record:
c. Physicians shall examine patients housed in the OHU no less frequently than
every 14 days: and
d. Correctional officers shall notify medical staff immediately when an inmate
in the OHU is requesting medical assistance.
2. The OHU shall be made compliant with Americans for Disabilities Act regulations.
6
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
H. Chronic Care
1. Health care services shall include a chronic disease management program.
2. The chronic disease management program shall conform to contemporary standards
of care such as the National Health Lung and Blood Institute and asthma,
hypertension, and lipid guidelines and American Diabetes Association guidelines.
3. All inmates with chronic illness shall be tracked on a chronic illness roster.
4. The chronic disease management program shall measure the number of inmates with
chronic illness who receive their medication within a day of incarceration.
I. Specialty Care
1. Specialty care appointments shall be tracked in a log that identifies the referral date,
the date the referral was sent to the clinic, the date the appointment is confirmed, and,
if the appointment is rescheduled or canceled, the reason it was rescheduled or
canceled.
2. Inmates whose specialty appointment exceeds three months should be examined by a
physician, physician's assistant, or nurse practitioner monthly and evaluated to
determine if urgent evaluation is indicated.
3. Specialty consultant arrangements for pulmonology and ophthalmology shall be
developed.
J. Pharmacy and Medication Administration
1. Nursing staff shall observe patients taking medications, especially when Direct
Observation Therapy is reguired by the physician's order.
2. Nursing staff shall deliver medications with the lights on in administrative
segregation areas and observe patients ingest their medications.
3. Medication administration shall be documented immediately after administration,
with the exception of inmates housed on the second tier of the administrative
segregation areas. For those inmates housed on the second tier in the lockdown areas,
the nurses shall follow the following procedure:
7
if all, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
a. Prior to the start of each pill pass, while in the pharmacy, the nurse will put
the medications inside pill envelopes labeled with the patient's name and Jail
Identification Number:
b. Nurses will push the medication carts into the pods:
c. After entering the pod, the nurse will carry the envelopes in his/her hands or
pockets and will go cell door to cell door to administer the medications: and
d. Once the entire pill pass is completed, the nurse will return to the medication
cart and push the cart outside the housing unit to complete charting.
4. All hygiene practices while dispensing and administering medications shall conform
to nationally accepted professional standards.
5. All methadone treatment services for inmates shall conform with state and federal
regulations.
6. Access to pharmacy keys shall be limited only to health care staff assigned to work in
the pharmacy and the Director of Nursing. The pharmacy door shall remain closed
and locked when pharmacy staff is not present. All medication cabinets shall remain
locked at all times. Nursing Supervisors and Director of Nursing shall monitor control
of the pharmacy daily by direct observation.
K. Dental Care
1. The County shall employ sufficient numbers of dental staff to provide timely access
to adequate dental care.
2. A qualified or appropriately trained clinician shall triage dental care requests to
identify emergent or urgent issues that require treatment of pain or infection.
L. Medical Records
1. The County, through Corizon, shall implement an electronic health record for inmates
within the first year of Corizon' s contract.
2. All paper medical records shall be controlled via a sign-out procedure, and paper files
shall be centrally located to increase accountability.
3. Medical records paperwork shall be filed in a timely manner.
4. Correctional staff shall not have access to the completed intake screening form.
8
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
I
L_
Exhibit B
M. Self-Monitoring, Quality Improvement, and Reviews
1. The County shall train all nurses on appropriate nursing protocols during new
employee orientation, and Nurse Supervisors shall review nursing competencies
annually.
2. Any unorthodox treatment provided by physicians shall be subject to peer review.
3. Physicians shall be evaluated annually by peer review, and nurses shall be evaluated
annually by their supervisors.
4. A Medical/Behavioral Quality Improvement Committee that includes the Medical
Director, psychiatrist, registered nurse, pharmacy representative, Department of
Public Health representative, and correctional representative shall meet quarterly for
the purpose of peer review and systematically analyzing and improving processes and
the quality of medical care.
5. Each quarter, the Quality Improvement Committee shall monitor several of the
following key processes of care:
a. Numbers of inmates who missed intake screening:
b. Numbers of inmates who missed TB screening at intake:
c. Numbers of inmate health requests submitted daily, numbers triaged within 24
hours, and the numbers who received face-to-face evaluations within 72
hours:
d. The percent of inmates who received their first dose of medication within 24
hours of prescription:
e. The number of medical records that could not be located upon request:
f. The length of time to specialty appointment by service:
g. The number of inmates with chronic illnesses who received their medications
within a day of incarceration: and
h. The number of inmates with chronic illnesses who received a history and
physical examination by a provider within two weeks of incarceration.
6. The Medical Director shall ensure that any corrective action recommended by the
Medical/Behavioral Health Quality Improvement Committee is implemented and
completed within 30 days of the report making such recommendations, unless there
are extenuating circumstances preventing implementation and completion within such
timeframe in which case it shall occur as soon as reasonably practical.
N. Mortality Reviews
9
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
1. Mortality reviews shall include a written report.
2. Mortality reviews shall include identification of problems for which corrective action
is undertaken.
3. Autopsies shall be performed/or all deaths, except/or those caused by suicide or
homicide, or where the cause of death can be conclusively determined from the
facts known before the death.
II. MENTAL HEALTH CARE
A. Staffing
1. Clinical decisions, diagnoses, and treatment plans shall only be made by licensed
mental health clinicians (psychiatrists, psychologists, therapists, clinical social
workers, psychiatric nurses). Licensed mental health clinicians shall review and
cosign record entries made by Licensed Psychiatric Technicians (LPTs) and Licensed
Vocational Nurses (LVNs) when the LVNs and LPTs are providing behavioral health
services.
2. The County shall employ the number of mental health care providers necessary to
provide adequate mental health care and supervision.
3. The total psychiatrist time provided shall be a minimum of 50 to 55 hours per week.
4. In the event group sessions are conducted by unlicensed mental health staff, the group
shall be strictly educational, and staff shall provide participants with a handout
specifying that no discussion of personal issues may occur.
B. Continuity of Care
1. The County shall provide continuity of care from admission to transfer or discharge
from the facility, including referral to community-based providers, when indicated.
Jail health care staff shall provide discharge planning for sentenced inmates with
serious mental health disorders, including connecting such inmates to community
health care providers, community social services, community-based housing, and/or
appropriate services per the individual's need. The same services will be provided to
unsentenced inmates provided adequate time is available prior to a legally mandated
release.
10
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
2. The County shall develop and implement a system that allows patients who are
prescribed psychiatric medications to have access to these medications as soon as
possible following their release from jail.
3. The Department of Behavioral Health (DBH) shall collaborate with mental health
staff to provide continuity of care with psychiatric medications and referrals to
DBH services, and mental health staff shall have access to the DBH computerized
information database to facilitate such care.
4. The County shall coordinate transportation, as necessary, with outside agencies
and applicable community resources for inmates with serious mental illness who
are released from custody.
C. Psychiatry Services
1. Psychiatric medications, including but not limited to antipsychotic medications, shall
be prescribed to inmates with mental illness in accord with nationally accepted
professional standards for the treatment of serious mental illness.
2. Physicians shall "bridge" all verified, valid prescriptions for inmates who enter the
facility currently on psychiatric medications. Inmates who receive such bridge
medications shall receive a face-to-face evaluation with a psychiatrist within seven
days of initiation of the medication. Follow-up face-to-face evaluations shall occur as
needed, but within 30 days following the initial visit. Subseguent face-to-face
evaluations by the psychiatrist shall occur as needed, but at intervals of no more than
90 days.
3. Inmates who are prescribed psychiatric medications by the psychiatrist (i.e., not
"bridge" medications) shall receive follow-up face-to-face evaluations with a
psychiatrist as needed depending on their clinical status, but no later than 30 days
following the initial visit. Subseguent visits shall occur as needed but at intervals of
no more than 90 days.
D. Intake
1. The Health Care Screening Form shall include a guestion regarding any history of
mental health problems or treatment, hospitalizations, and/or current or previous
thoughts of self-harm.
E. Suicide Prevention
11
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
I. Mental health clinicians shall complete a comprehensive suicide risk assessment form
for all inmates who display signs of suicide risk to determine if the inmate presents a
low, moderate, or high risk of suicide. Mental health clinicians shall complete a new
form if there are indications of any modification ofrisk factors, including but not
limited to any suicide attempts or expressions of suicidal ideation.
2. Inmates displaying signs of suicide risk shall be referred to a mental health clinician
for an evaluation.
3. The Sheriffs Office and health care staff shall develop and implement policies and
procedures for housing and monitoring inmates that present a low or moderate risk
of suicide. Low-risk inmates shall be monitored at least monthly by mental health
staff and shall be housed with other inmates or, if they cannot be housed with other
inmates, in housing where they can be frequently monitored by correctional staff.
Moderate-risk inmates shall be monitored at least weekly by mental health staff and
shall be housed with other inmates unless they pose a safety and security threat to
other inmates. Moderate-risk inmates shall also be housed in locations that allow
custody staff to observe and communicate with these inmates on a daily basis.
4. Sentenced inmates who have been identified as a moderate or high level of suicide
risk on their most recent comprehensive suicide risk assessment form shall receive an
evaluation by a mental health clinician prior to their release to the community for
appropriate referrals or initiation of an involuntary psychiatric hold pursuant to
Welfare and Institutions Code Section 5150. The same services will be provided to
unsentenced inmates provided adequate time is available prior to a legally mandated
release.
5. All health care staff shall receive training regarding suicide prevention during new
employee orientation, and updated training annually. Correctional officers shall
receive suicide awareness and prevention training annually. All such training shall
be provided by a licensed clinician having expertise in correctional suicide prevention
and the use of a suicide risk assessment form.
F. Behavior Management
1. The Sheriffs Office shall assist jail mental health staff in the development and
implementation of behavior management plans for inmates with serious mental
illness who engage in repeated acts of misconduct with the goal of reducing their
placements, or shortening the length of time they spend, in lockdown administrative
segregation housing.
12
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
2. Correctional staff assigned to Population Management who are familiar with the
housing of inmates with serious mental illness shall be included in administrative
meetings where behavior management plans are developed and reviewed.
G. Administrative Segregation
1. The Sheriffs Office shall adopt and implement a policy ofleaving open all of the cell
door portal coverings in 2D of the South Annex Jail from 7:00 a.m. to 10:00 p.m.
unless an inmate requests that it remain closed or it is necessary to temporarily close
the portal for exigent circumstances related to jail security.
2. The Sheriffs Office and jail mental health staff shall collaborate to adopt and
implement a policy of housing no inmates with serious mental illness in 2D of the
South Annex Jail or the A Pods and FF Units in the Main Jail unless those
inmates demonstrate a current threat to jail security, inmate and/or officer safety,
as documented by correctional staff, that prevents them from being safely housed in
less restrictive locations.
3. In the event any inmates with serious mental illness (SM/) must be housed in 2D,
correctional and mental health staff shall ensure those inmates are offered to be
taken out of their cells for recreation a minimum of 7 hours per week and mental
health treatment shall be offered 3 times per week.
a. Inmates with SM/ who are placed in isolation in 2D cells for more than 48
hours are to have their cases reviewed by a multidisciplinary team consisting of
corrections and mental health staff every two weeks. Decisions for an
individual's continued housing in isolation includes input from a licensed mental
health clinician.
b. Out-of-cell structured behavioral health services for individuals with SMI held in
isolation in 20 cells will be offered:
1. A minimum of three out-of-cell mental health contacts per week
consisting of structured individual or group therapeutic/educational
treatment and programming, each lasting approximately one hour with
appropriate duration to be determined by a mental health clinician.
11. At a minimum, one one-to-one structured therapeutic contact session will
be offered by a mental health clinician. The remaining two contacts per
week may either be additional one-to-one structured therapeutic contacts
or group therapeutic/educational contact sessions.
c. Mental health contacts are to be documented indicating type and duration of
activity.
13
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
4. In the event any inmates with serious mental illness must be housed in FF Units,
correctional and mental health staff shall ensure those inmates are offered to be
taken out of their cells for recreation a minimum of 7 hours per week and mental
health treatment shall be offered 3 times per week.
a. Inmates with SM/ who are placed in isolation in FF cells for more than 48
hours are to have their cases reviewed by a multidisciplinary team consisting of
corrections and mental health staff every two weeks. Decisions for an
individual's continued housing in isolation includes input from a licensed mental
health clinician.
b. Out-of-cell structured behavioral health services for individuals with SMI held in
isolation in FF cells will be offered:
1. A minimum of three out-of-cell mental health contacts per week
consisting of structured individual or group therapeutic/educational
treatment and programming, each lasting approximately one hour with
appropriate duration to be determined by a mental health clinician.
11. At a minimum, one one-to-one structured therapeutic contact session will
be offered by a mental health clinician. The remaining two contacts per
week may either be additional one-to-one structured therapeutic contacts
or group therapeutic/educational contact sessions.
c. Mental health contacts are to be documented indicating type and duration of
activity.
5. Medical staff shall complete health checks on all inmates in 2D of the South Annex
Jail and the A Pods and FF Units in the Main Jail at least three times a week and
document the checks to include any verbal exchange allowing inmates to report any
health or mental health needs or concerns.
6. The Sheriffs Office shall adopt and implement a policy of reviewing the status of
inmates with serious mental illness housed in A Pods in the Main Jail at least once
every 30 days to determine if the inmate can be moved to less restrictive housing.
Jail mental health staff shall assess SM/ inmates' housing requirements, which
shall be discussed at monthly administrative meetings with custody and health care
staff. This provision is not intended to and does not require a new mental health
assessment of all inmates with serious mental illness every 30 days so long as jail
mental health staff have adequate information to make an informed and
meaningful recommendation about whether SM/ inmates should continue to be
housed in that unit.
H. Quality Improvement
14
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
1. The quality improvement committee that meets quarterly shall collect and manage
data to develop corrective action plans in response to mental health program
weaknesses that are identified. Areas that require recurrent review include, but are
not limited to, the following:
• Timely continuity of verified community prescriptions for psychiatric
medications:
• Continuity of care for inmates with serious mental illness leaving custody:
• Timely triage of health care service request forms describing mental health
symptoms: and
• Health checks of inmates in 2D of the South Annex Jail and the A Pods and FF
cells in the Main Jail.
111.ACCOMMODA TIO NS FOR INMATES WITH DISABILITIES
A. Housing
1. The Sheriffs Office shall house inmates with disabilities in facilities that
accommodate their disabilities no later than 24 months from issuance of the consent
decree. In the interim, the Sheriffs Office shall house inmates with disabilities in the
most integrated and appropriate housing possible, based on their disabilities.
2. The County shall provide accessible toilets and showers in units where inmates
requiring special accommodations for access are housed no later than 24 months from
issuance of the consent decree. Accessible toilets and showers shall have such
physical features as grab bars, shower seats, no shower curbs, no stairs, and pathways
wide enough to permit wheelchair/walker access, etc. In the interim, the Sheriffs
Office shall house inmates with disabilities in the most integrated and appropriate
housing possible, based on their disabilities.
3. The Sheriff's Office and medical staff shall communicate to determine appropriate
housing/or inmates with disabilities. Medical staff shall make available all
information needed to make adequate housing decisions.
4. The Sheriffs Office shall create and implement the use of a centralized list of
housing placements with accessible features to simplify housing decisions and
identify gaps in placement options. This list shall separately identify each cell in the
Outpatient Housing Unit, since these vary in their accessible features.
5. The Sheriff's Office and medical staff shall collaborate to implement the use of a
system that reflects an assessment of an inmate's functional limitations and
15
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
L_
Exhibit B
restrictions, including but not limited to:
a. The need for an accessible shower and toilet;
b. The need/or ground floor housing;
c. The need/or no stairs in the path of travel;
d. The need/or level terrain; and
e. The need for and description of assistive devices and the conditions in
which they are to be used (e.g., use of a wheelchair full time, for all
distances greater than 50 feet, whenever out of cell/bed area, etc.).
6. The following information shall be included in Offendertrak:
a. The need for an accessible shower or toilet;
b. The need for a lower bunk;
c. The need for assistive devices;
d. The need for ground floor housing;
e. The need for level terrain;
f. The need for no stairs in the path of travel.
7. The Sheriffs Office shall not place inmates with disabilities in the OHU unless they
are receiving medical care or treatment, or there is no other housing location where
they can be reasonably accommodated. Inmates with disabilities who are housed in
the OHU because they cannot be reasonably accommodated in other locations shall
receive equal access to services, programs, and activities.
B. Assistive Devices
1. The Sheriffs Office and jail health care staff shall collaborate to develop
standardized procedures for the prescription, ordering, retention, and confiscation
of assistive devices. Policies shall be developed in a manner that is protective of the
safety and security of inmates and staff while affording equal access to jail
programs, services, and activities for inmates with disabilities.
2. An inmate who arrives at the jail with an assistive device shall be allowed to retain
the device, or shall be provided with a jail-issued equivalent device, so long as it
does not constitute an immediate risk of bodily harm or threaten the security of the
facility, unless a jail physician documents that the device is not medically necessary
or reasonable to allow equal access to jail programs, services, or activities.
3. The Sheriffs Office shall provide assistive devices prescribed by a jail physician to
inmates as soon as reasonably practical, so long as the device does not constitute an
16
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
immediate risk of bodily harm to inmates or staff, or threatens the security of the
facility.
4. The Watch Commander shall be responsible/or determining if an assistive device
constitutes an immediate risk of bodily harm or threatens the security of the facility.
If the Watch Commander makes such a determination, correctional staff shall
consult with medical staff to determine an appropriate alternative accommodation
that shall be provided. Assistive devices shall not be confiscated if another inmate
is the source of the security threat.
C. Training and Management
I. American with Disabilities Act (ADA) training shall be provided to all new health
care staff and correctional staff, and to all other existing staff as needed on an
ongoing basis.
2. The Sheriff's Office ADA Coordinator shall confer with medical staff monthly to
review whether accommodations for inmates with disabilities continue to be
appropriate and necessary.
D. Grievances
1. The Sheriffs Office shall provide an inmate grievance system that inmates with
disabilities may use to contest any disability-based discrimination or violations of the
ADA, and will provide a prompt and equitable resolution to each issue raised.
2. The Sheriffs Office shall train all correctional staff assigned to screen or review
grievances to identify requests for reasonable accommodations and allegations of
disability-based discrimination or violations of the ADA.
3. The Sheriffs Office ADA coordinator shall review all ADA related complaints,
assign an ADA trained officer to investigate the complaints and provide substantive
responses.
E. Notice and Effective Communication
1. The inmate handbook shall be revised at the next printing (2016) to include additional
information regarding the "Americans with Disabilities Act," "Disabilities," and how
to request "Reasonable Accommodations." The contact information of the jail's
designated ADA coordinator and the disability complaint procedures shall be made
available in the inmate handbook. Inmates shall be provided jail inmate handbooks
during the intake booking process. Until the handbook can be updated and printed, an
addendum shall be provided inside each handbook distributed.
17
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
2. The Sheriffs Office shall post and disseminate ADA notices in alternative formats to
promote effective communication, and make available grievance forms to address
ADA related complaints.
3. The Sheriffs Office shall develop and implement policies such that inmates with
communication deficits are provided with reasonable accommodations ( e.g., reading
and writing assistance). This shall include both communications to the inmates (Jail
rules, policies, notices, etc.) and addressing needs for the inmate to communicate with
jail staff.
IV. JAIL SAFETY AND SECURITY
A. Staffing
1. The County shall employ adequate numbers of qualified correctional officers to
comply with this Remedial Plan as outlined in the Staffing Plan with the hiring of 127
Correctional Officers over a three year period, or as soon thereafter as the labor pool
permits.
2. The Sheriffs Office shall implement a staffing plan designed to reduce inmate-on-
inmate violence in the jails. This plan includes the hiring of 127 new correctional
officers spread over three years, or as soon thereafter as the labor pool permits. These
127 Correctional Officer positions shall be formally added to the County's Salary
Resolution upon Court approval of the Consent Decree.
3. Correctional staff shall conduct appropriate rounds with sufficient frequency to
provide inmates with adequate supervision and reasonable safety. More frequent
rounds shall be conducted for inmates requiring more intensive supervision for safety
and security reasons.
B. South Annex Jail
1. The South Annex Jail is an antiquated facility, and shall be considered for being taken
off-line as soon as practicable.
2. While the South Annex Jail remains in use, there shall be assigned adequate numbers
of correctional officers to protect inmates from an unreasonable risk of harm from
violence and injury from other inmates and physical plant deficiencies.
18
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
C. Use of Force and Quality Assurance
1. The Sheriffs Office shall reintroduce de-escalation tactics and techniques into the
annual training plan to reinforce the importance of communication skills in
relationship to a correctional facility environment. This training shall be introduced
to staff in fiscal year 2014/2015.
2. The Sheriffs Office shall document all incidents (including those that are serious)
involving inmates that include suicides, suicide attempts, inmate-on-inmate violence,
use of force by staff, fires, escapes and deaths.
3. All documented incidents of the use of force shall be reviewed by the Jail Sergeant
and Watch Commander within 24 hours of the report being submitted, and by facility
commanders on a monthly basis.
4. All pre-planned uses of force shall be video recorded.
5. Jail Command Staff shall conduct quality assurance reviews on a monthly basis of all
documented incidents involving suicides, suicide attempts, inmate on inmate
violence, use of force by staff, sexual assaults, fires, escapes, and deaths, and
information developed during those reviews shall be incorporated into improving
policies, procedures, and practices to remedy any deficiencies identified.
6. Quality Assurance criteria, policies and procedures shall be developed to guide the
protocols of the Jail Command staffs monthly meetings and review, to include
assaults, fights, deaths, fires, use of force, escapes, sexual assaults, physical plant
safety concerns, control of flammables/caustics, emergency preparedness, emergency
key testing, facility sanitation compliance and contract oversight. This group shall
also examine systems of control, Jail policies and procedures, incident trends, and
make appropriate recommendations for corrective action to the Jail Administrator.
7. Uses of force incidents shall be reviewed by the Jail Sergeant and Watch Commander
as provided herein. Violations of use-of-force policies shall be properly addressed
via the chain of command and necessary Supervisor Incident Reports. Remedial
training shall be directed by supervisory/management staff if it is determined to be
necessary and/or appropriate. As appropriate, incidents shall be directed to Sheriffs
Internal Affairs for possible policy violations, or to the District Attorney's Office if
investigation determines such referral is appropriate.
8. The Jail Command Staff (Captains and Lieutenants) shall evaluate the
appropriateness of all uses of force as a part of their scheduled agenda during their
19
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
monthly meetings. A Jail Sergeant shall be assigned the collateral duty as Use of
Force Review Coordinator and be responsible to produce the reports, data and
necessary videos for review at these meetings. The findings of this group shall be
forwarded up the chain of command to the Sheriff, with any use of force suspected to
be outside of law and/or policy directed to Internal Affairs for additional
investigation, as necessary.
D. Classification
1. The Sheriffs Office shall maintain an appropriate classification system to protect
inmates from unreasonable risk of harm. Inmates shall be timely classified and
placed in housing appropriate for security and safety. The system shall include
consideration of an inmate's security level, suicide risk, and past behavior.
E. Inmates with Mental Illness
1. The Sheriffs Office shall gather statistical and comparative data on the uses of force
involving inmates with serious mental illness.
2. The County shall conduct initial and periodic training/or all correctional staff on
how to recognize symptoms of mental illness and respond appropriately. Such
training shall be conducted by a registered nurse and shall include instruction on how
to recognize and respond to mental health emergencies.
F. Restraint Chairs
1. Inmates shall not be placed in restraint chairs unless there is sufficient justification for
such placement that is documented in an incident report.
2. Correctional staff shall review whether the inmate can be removed from the restraint
chair no later than two hours after the time of initial placement in the chair.
3. Inmates shall not be held in restraint chairs for longer than four hours.
4. Correctional staff shall notify the on-duty charge nurse of the use of a restraint
chair at the time of initial placement.
5. Correctional staff shall provide proper nutrition, hydration, and toileting as safely as
possible during the duration of restraint chair placements.
6. Correctional staff shall observe inmates placed in restraint chairs at least two times
each successive half hour after the time of initial placement.
20
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
G. Physical Plant
1. The County shall maintain the physical plant of the facility, with special emphasis on
security door maintenance. All security doors and locks shall be in proper working
order in a manner that maintains appropriate security and safety for jail staff and
inmates.
2. The Sheriffs Office shall maintain in working order all cameras, alarms and other
monitoring equipment at the jail.
H. Fire, Emergency, and Tool Safety
1. The County's Internal Services Department Facility Services Division shall maintain
the jail in a manner that provides adequate fire safety. The Sheriffs Office shall take
all reasonable measures to provide that: (a) inmates can be evacuated in a safe and
timely manner during an emergency; (b) emergency exit routes are free of obstacles,
maintained in a safe manner, and available for use; ( c) emergency keys are readily
available to staff; and ( d) fire exit plans are posted and clearly labeled.
2. The Sheriffs Office shall develop and implement a written comprehensive fire and
safety emergency/disaster plan and appropriately train staff in implementing the plan.
Mock fire drills shall also be conducted to make staff familiar with safety procedures
and evacuation methods.
3. All emergency keys shall be appropriately marked and identified, consistently stored
in a quickly accessible location, tested annually, and staff shall be adequately trained
in the use of these keys.
4. All correctional staff shall receive basic Fire and Life Safety training during their first
year of training in the Basic Correctional Officer Core Course Academy. The
Sheriffs Training Unit shall conduct supplemental Fire Suppression and Evacuation
Procedure training during the 2014/2015 fiscal year training cycle. Additional Fire
and Life Safety/evacuation procedures shall be conducted on each shift, by shift
supervisors on an as-needed basis.
5. The County's Internal Services Department Facility Services Division shall develop
and implement written policies and procedures for the introduction and control of
tools in all Jail facilities subject to review and approval by the Sheriffs Office.
21
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit B
I. Policies and Procedures
1. The Sheriff's Office shall develop and implement new policies, procedures and post
orders as needed to comply with the provisions of this Remedial Plan, including but
not limited to the implementation of proper policies, procedures, post orders and
corrective action plans to address problems uncovered during the course of quality
assurance review activities.
2. Upon Court approval of the Consent Decree, appropriate training shall be
formulated and conducted with all staff regarding the requirements of the Consent
Decree and Remedial Plan, as well as changes to policies, procedures and/or post
orders.
3. The Sheriff's Office will review and update all facility policies and post orders as
appropriate to reasonably provide adequate safety and security in the jails.
22
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
MINIMUM STAFFING LEVELS
North Annex/Main/South Jails
Health Services Administrator
Medical Director
Ph sician
NP/PA
Assistant Health Services Administrator
Director of Nursing
RN -Care Manager
RN -Nurse Supervisor
RN -Booking
RN -H&P/Sick Call/Emergencies/Detox
RN -Outpatient Housing Unit (Infirmary)
L VN -Medication Pass
L VN -Orders/Diabetics/Labs/Treatments
LVN-Bookin
Medical Assistant
Administrative Assistant -Medical
Medical Records Clerk
Dentist
Dental Hygienist
Dental Assistant
Optometrist
Total Day Shift
EVENING SHIFT
NP/PA
RN -Nurse Supervisor
RN -Booking
RN -H&P/Sick Call/Emergencies/Detox
RN -Outpatient Housing Unit (Infirmary)
L VN -Medication Pass
LVN -Orders/Diabetics/Labs/Treatments
L VN -Booking
Medical Assistant
Medical Records Clerk
Total Evening Shift
NIGHT SHIFT
RN -Nurse Supervisor
RN -Booking
RN -Emergencies/Detox
RN -Outpatient Housing Unit (Infirmary)
L VN -Diabetics/Labs/Court
Medications/SchedulinQ
L VN -Booking
Total Night Shift
TOTALS
*These positions may be
subcontracted.
8 8 8 8 8
8 8 8 8 8
8 8 8 8 8
16 16 16 16 16 16 16
8 8 8 8 8
8 8 8 8 8
32 32 32 32 32
8 8 8 8 8 8 8
24 24 24 24 24 24 24
24 24 24 24 24 24 24
8 8 8 8 8 8 8
40 40 40 40 40 40 40
24 24 24 24 24 24 24
8 8 8 8 8 8 8
24 24 24 24 24 24 24
8 8 8 8 8
32 24 24 24 24 16 24
8 8 8 8 8
8
8 8 8 8 8
8 8
304.0 304.0 296.0 312.0 296.0 192.0 200.0
8 8 8 8 8 88 8
8 8 8 8 8 8 8
24 24 24 24 24 24 24
24 24 24 24 24 24 24
8 8 8 8 8 8 8
40 40 40 40 40 40 40
24 24 24 24 24 24 24
8 8 8 8 8 8 8
24 24 24 24 24 24 24
32 24 32 24 16 16 24
200 192 200 192 184 184 192
8 8 8 8 8 8 8
24 24 24 24 24 24 24
24 24 24 24 24 24 24
8 8 8 8 8 8 8
24 24 24 24 24 24 24
8 8 8 8 8 8 8
96 96 96 96 96 96 96
600 592 592 600 576 472 488
Exhibit C
40 1.000
40 1.000
40 1.000
112 2.800
40 1.000
40 1.000
460 4.000
56 1.400
168 4.200
168 4.200
56 1.400
280 7.000
168 4.200
56 1.400
168 4.200
40 1.000
168 4.200
40 1.000
8 0.200
40 1.000
16 0.400
1904.0 47.600
56 1.400
56 1.400
168 4.200
168 4.200
56 1.400
280 7.000
168 4.200
56 1.400
168 4.200
168 4.200
1344 33.600
56 1.400
168 4.200
168 4.200
56 1.400
168 4.200
56 1.400
672 16.800
3920 98.000
Page 1 of 2
Exhibit C
Mental Health Director 8 8 8 8 8 40 1.000
Psychiatrist 8 8 8 24 0.600
Psychiatrist (telepsych) 8 8 8 8 32 0.800
Psych NP 8 8 8 8 8 40 1.000
LCSW/LMFT 24 24 24 24 24 24 24 24 168 4.200
Discharge Planner 8 8 8 8 8 8 8 56 1.400
Psych Tech/LVN 8 8 8 8 8 8 8 56 1.400
Administrative Assistant -Mental Health 8 8 8 8 8 40 1.000
Total Day Shift 72 72 72 72 72 48 48 456 11.400
EVENING SHIFT
LCSW/LMFT 16 16 16 16 16 16 16 112 2.800
Psych Tech/LVN 8 8 8 8 8 8 8 56 1.400
Total Evening Shift 24 24 24 24 24 24 24 168 4.200
NIGHT SHIFT
LCSW/LMFT 8 8 8 8 8 8 8 56 1.400
Total Night Shift 8 8 8 8 8 8 8 56 1.400
TOTALS 104 104 104 104 104 80 80 680 17.000
Care Manager 8 8 8 8 8 40 1.000
Group Facilitator 16 16 16 16 16 80 2.000
LCSW/LMFT -Assessments 8 8 8 8 8 40 1.000
Substance Abuse Counselor 8 8 8 8 8 40 1.000
Total Day Shift 40 40 40 40 40 200 5.000
TOTALS 40 40 40 40 40 200 5.000
Page 2 of 2
Community Mental Health Block Grant
Application (MHBG)
FY2017-18
Presented to:
State of California
Department of Health Care Services
Dawan Utecht, Director
Department of Behavioral Health
August 2017
Exhibit D
Table of Contents
Exhibit D
Page 2 of 34
1. Signed Planning Estimate Worksheet DHCS 1750 (Enclosure 1) 3
2. Signed Agreements (Enclosure 4) 4
3. Signed Certifications (Enclosure 5) 8
4. Completed MHBG Per Program Data Sheet DHCS 1751 (Enclosure 6)
• Jail Psychiatric Services Program 10
• Juvenile Justice SEO Dual Diagnosis Outpatient Program 11
5. Federal Grant Detailed Per Program Budget DHCS 1779 (Enclosure 7)
• Summary 12
• Jail Psychiatric Services Program 13
• Juvenile Justice SEO Dual Diagnosis Outpatient Program 14
6. Program Narrative
• Jail Psychiatric Services Program (A-H) 15
• Juvenile Justice SEO Dual Diagnosis Outpatient Program (A-H) 24
Exhibit D
Page 3 of 34
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 1
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
CENTER FOR MENTAL HEALTH SERVICES (CMHS)
BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH SERVICES (MHBG)
SFY 2017-18 PLANNING ESTIMATE WORKSHEET
COUNTY: FRESNO
DUNS NUMBER:
DATE: June23,2017
-----
PROPOSED ALLOCATION $ 2,012,097
Base Allocation
Dual Diagnosis Set-Aside
$ 1,593,198
$ 418,899
The County Mental Health Department requests continuation of the SAMHSA, CMHS Block
Grants for Community Mental Health Services (MHBG). These funds will be used in accordance with
Public Law 102-321 (42 U.S.C., Sections 300x through 300x-13), and Public Law (PL) 106-310,
and will be used as stated in the enclosed Community Mental Health Services Block Grant Funding
Agreements with Federal Requirements on Use of Allotments, and the Certification Statements.
The estimate is the proposed total expenditure level for SFY 2017-18. The estimate above is subject to
change based on the level of appropriation approved in the State Budget Act of 2017.
In addition, this amount is subject to adjustments for a net reimbursable amount to the county. The
adjustments include, but are not limited to, Gramm-Rudmann-Hollings (Federal Deficit Reduction Act)
reductions, prior year audit recoveries, federal legislative mandates applicable to categorical funding,
augmentations, etc. The net amount reimbursable will be reflected in reimbursable payments as the
specific dollar amounts of adjustments become known for each county.
The county will use this estimate to build the county's SFY 2017-18 budget for the provision of mental
health services for adults with serious mental illness (SMI) and children with serious emotional
disturbance (SED).
Chairman, County of Fresno, Board of Supervisors
Brian Pacheco, Chairman, Board of Supervisors
Print Name
Date
DHCS 1750 (04/14)
Exhibit D
Page 4 of 34
FY 2017-18 MHBG Renewal Application
Enclosure 4
Page 1 of 4
COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT FUNDING
AGREEMENTS
Public Law 106-310 (Children's Health Act of 2000)
Public Law 102-321; Title II-Block Grants to States Regarding
Mental Health & Substance Abuse
Part B of Title XIX of the Public Health Service Act [42 U.S.C. 300x-1 et seq.]
The county, as recipient of grant funds, acknowledges and agrees that the county and its
subcontractors shall provide services in accordance with all applicable federal and State statutes
and regulations including the following:
Section 1911
Subject to Section 1916, the State/County involved will expend the grant only for the purpose of:
(1) Carrying out the plan submitted under Section 1912(a) [State Plan for Comprehensive
Community Mental Health Services] by the State for the fiscal year involved;
(2) Evaluating programs and services carried out under the plan; and
(3) Planning, administration, and educational activities related to providing services under the plan.
Section 1912
( c )(1) & (2) [ As a funding agreement for a grant under Section 1911 of this title the Secretary
establishes and disseminates definitions for the terms "adult with a serious mental illness" and
"children with a serious emotional disturbance" and the State/County will utilize such methods
[ standardized methods, established by the Secretary] in making estimates [ of the incidence and
prevalence in the County of serious mental illness among adults and serious emotional disturbance
among children].
Section 1913
(a)(l )(C) the County will expend for such system [ of integrated services described in Section
1912(b )(3)] not less than an amount equal to the amount expended by the County for fiscal year
1994.
[ A system of integrated social services, educational services, juvenile services, and substance abuse
services that, together with health and mental health services, will be provided in order for such
children to receive care appropriate for their multiple needs (which includes services provided
under the Individuals with Disabilities Education Act)].
(b )(1) The County will provide services under the plan only through appropriate qualified
community programs (which may include community mental health centers, child mental health
programs, psychosocial rehabilitation programs, mental health peer-support programs, and mental
health primary consumer-directed programs).
Exhibit D
Page 5 of34
Exhibit D
Page 6 of 34
FY 2017-18 MHBG Renewal Application
Enclosure 4
Page 2 of 4
(b )(2) The State agrees that services under the plan will be provided through community mental
health centers only if the centers meet the criteria specified in subsection ( c ).
( c )( 1) With respect to mental health services, the centers provide services as follows:
(A) Services principally to individuals residing in a defined geographic area (hereafter
in the subsection referred to as a "service area").
(B) Outpatient services, including specialized outpatient services for children, the
elderly, individuals with a serious mental illness, and residents of the service areas
of the centers who have been discharged from inpatient treatment at a mental
health facility.
(C) 24-hour-a-day emergency care services.
(D) Day treatment or other partial hospitalization services, or psychosocial
rehabilitation services.
(E) Screening for patients being considered for admission to state mental health
facilities to determine the appropriateness of such admission.
(2) The mental health services of the centers are provided, within the limits of the capacities of
the centers, to any individual residing or employed within the service area of the center
regardless of ability to pay for such services.
(3) The mental health services of the centers are available and accessible promptly, as
appropriate and in a manner which preserves human dignity and assures continuity and high
quality care.
Section 1916
(a) The County involved will not expend the grant--
(1) to provide inpatient services;
(2) to make cash payments to intended recipients of health services;
(3) to purchase or improve land, purchase, construct, or permanently improve (other than
minor remodeling) any building or other facility, or purchase major medical equipment;
(4) to satisfy any requirement for the expenditure of non-federal funds as a condition for the
receipt of federal funds; or
(5) to provide financial assistance to any entity other than a public or nonprofit private entity.
(b) The County involved will not expend more than ten percent of the grant for administrative
expenses with respect to the grant.
Section 1946 PROHIBITIONS REGARDING RECEIPT OF FUNDS
(a) Establishment -
(1) Certain false statements and representation - A person shall not knowingly and willfully
make or cause to be made any false statement or representation of a material fact in
connection with the furnishing of items or services for which payments may be made by a
State from a grant made to the State under Section 1911 or 1921.
FY 2017-18 MHBG Renewal Application
Exhibit D
Page 7 of 34
Enclosure 4
Page 3 of 4
(2) Concealing or failing to disclose certain events - A person with knowledge of the
occurrence of any event affecting the initial or continued right of the person to receive any
payments from a grant made to a State under Section 1911 or 1921 shall not conceal or
fail to disclose any such event with an intent fraudulently to secure such payment either in
a greater amount than is due or when no such amount is due.
(b) Criminal Penalty for Violation of Prohibition -Any person who violates any prohibition
established in subsection (a) shall for each violation be fined in accordance with Title 18,
United States Code, or imprisoned for not more than five years, or both.
Section 1947 NONDISCRIMINATION
(a) In General -
( 1) Rule of construction regarding certain civil rights laws -For the purpose of applying the
prohibitions against discrimination on the basis of age under the Age Discrimination Act
of 1975, on the basis of handicap under Section 504 of the Rehabilitation Act of 1973, on
the basis of sex under Title IX of the Education Amendments of 1972, or on the basis of
race, color, or national origin under Title VI of the Civil Rights Act of 1964, programs and
activities funded in whole or in part with funds made available under Section 1911 or
1921 shall be considered to be programs and activities receiving federal financial
assistance.
(2) Prohibition -No person shall on the grounds of sex (including, in the case of a woman, on
the grounds that the woman is pregnant), or on the grounds of religion, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under, any
program or activity funded in whole or in part with funds made available under Section
1911 or 1921.
(b) Enforcement -
( 1) Referrals to Attorney General after notice: Whenever the Secretary finds that a state, or an
entity that has received a payment pursuant to Section 1911 or 1921, has failed to comply
with a provision of law referred to in subsection (a)(l ), with subsection (a)(2), or with and
applicable regulation (including one prescribed to carry out subsection (a)(2), the
Secretary shall notify the Chief Executive Officer of the state and shall request the Chief
Executive Officer to secure compliance. If within a reasonable period of time, not to
exceed 60 days, the Chief Executive Officer fails or refuses to secure compliance, the
Secretary may--
(1 )(A) refer the matter to the Attorney General with a recommendation that an appropriate
civil action be instituted;
( 1 )(B) exercise the powers and functions provided by the Age Discrimination Act of 197 5,
Section 504 of the Rehabilitation Act of 1973, Title IX of the Education
Exhibit D
Page 8 of 34
Amendment of 1972, or Title VI of the Civil Rights Act of 1964, as may be
applicable; or
FY 2017-18 MHBG Renewal Application
(l)(C) take such other actions as may be authorized by law.
Enclosure 4
Page 4 of 4
(2) Authority of Attorney General -When a matter is referred to the Attorney General
pursuant to paragraph (1 )(A), or whenever the Attorney General has reason to believe that
a State or an entity is engaged in a pattern or practice in violation of a provision of law
referred to in subsection (a)(l) or in violation of subsection (a)(2), the Attorney General
may bring a civil action in any appropriate district court of the United States for such
relief as may be appropriate, including injunctive relief.
Chairman, County of Fresno, Board of Supervisors
Brian Pacheco, Chairman, Board of Supervisors
Printed Name
Date
Fresno
County
FY 2017-18 MHBG Renewal Application
CERTIFICATIONS
CERTIFICATION REGARDING LOBBYING
Exhibit D
Page 9 of 34
Enclosure 5
Page 1 of 2
1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any federal contract, the making of any federal grant, the making of
any federal loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is prerequisite for making or
entering into this transaction imposed by Section 1352,
Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000 and not more than $100,000 for each such failure.
SALARY CAP
The undersigned certifies that no grant funds will be used to pay an individual salary at a rate in excess of
$187,000 per year, not including benefits.
DRUG FREE WORK ENVIRONMENT
The undersigned certifies that reasonable efforts are made to maintain a drug-free work place in all
programs supported by the Federal Block Grant funds.
Exhibit D
Page 10 of 34
FY 2017-18 MHBG Renewal Application
Enclosure 5
Page 2 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY AND
VOLUNTARY EXCLUSION -LOWER TIER COVERED TRANSACTIONS
1) The prospective lower tier participant certified, by submission of this proposal, that neither it nor its
principals or contracted providers is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by any Federal
department or agency.
2) Where the prospective lower tier participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal/application.
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be
permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used
routinely or regularly for the provision of health, day care, early childhood development services,
education or library services to children under the age of 18, if the services are funded by Federal
programs either directly or through State or local governments, by Federal grant, contract, loan, or loan
guarantee. The law also applies to children's services that are provided in indoor facilities that are
constructed, operated or maintained with such federal funds. The law does not apply to children's
services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment;
service providers whose sole source of applicable Federal funds is Medicare or Medicaid; or facilities
where WIC coupons are redeemed. Failure to comply with the provisions of the law may result in the
imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an
administrative compliance order on the responsible entity.
By signing this certification, the offer or contractor (for acquisitions) or applicant/grantee (for grants)
certifies that the submitting organization will comply with the requirements of the Act and will not allow
smoking within any portion of any indoor facility used for the provision of services for children as
defined by the Act.
The submitting organization agrees that it will require that the language of this certification be included
in any subawards which contain provisions for children's services and that all subrecipients shall certify
according! y.
Chairman, County of Fresno, Board of Supervisors
Brian Pacheco, Chairman, Board of Supervisors
Printed Name
L_ _______ _
Date
Fresno
County
II
State of California -Health and Human Services Agency
2017-18
Exhibit D
Page 11 of 34
Department of Health Care Services
Enclosure 6
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: _F_R~E~S_N~O-------------------------
PROGRAM TITLE: Corizon Mental Health Psychiatric Services -Jail Psychiatric Services
PROGRAM CONTACT/TITLE: Caroline Ahlstrom LMFT Mental Health Supervisor
Phone#: _(559) 600-9354 FAX: (559) 442-5277 E-Mail: caroline.ahlstrom@corizonhealth.com
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $1,672,097
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
$Ml ADULT (18-59) 2424 SMI OLDER ADULT (60+) 73 SEO CHILD (0-17) __ 0
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
• Check all categories that are applicable
• Please elaborate in the narrative portion of the application
II
Is MHBG funding
used to support this
goal?
Transformational Categories If yes, Please check
(-V)
Americans Understand that Mental Health is Essential to Overall Health
Mental Health Care is Consumer and Family Driven
Disparities in Mental Health Services are Eliminated '1
Early Mental Health Screening, Assessment, and Referral to Services are Common Practice '1
Excellent Mental Health Care is Delivered and Research is Accelerated
Technology is Used to Access Mental Health Care and Information '1
ADDITIONAL COMMENTS:
DHCS 1751 (02/15)
II
State of California -Health and Human Services Agency
6
2017-2018
MHBG PROGRAM DATA SHEET
Exhibit D
Page 12 of34
Department of Health Care Services
Enclosure
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY:
Fresno
PROGRAM TITLE: CONTRACT-Juvenile Justice SED Dual Diagnosis Outpatient Program
PROGRAM CONTACT/TITLE: Susan Murdock, Program Manager
Phone#: (559) 600-4876 FAX: (559) 600-7645 E-Mail: smurdock@co.fresno.ca.us
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost)$ 340,000
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) ___ _ SMI OLDER ADULT (60+) __ _ SED CHILD (0-17) .11:.
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
• Check all categories that are applicable
• Please elaborate in the narrative portion of the application
II
Is MHBG funding used
to support this goal?
Transformational Categories If yes, Please check
( ,J)
Americans Understand that Mental Health is Essential to Overall Health ,/
Mental Health Care is Consumer and Family Driven ,/
Disparities in Mental Health Services are Eliminated ,/
Early Mental Health Screening, Assessment, and Referral to Services are Common Practice ,/
Excellent Mental Health Care is Delivered and Research is Accelerated ,/
Technology is Used to Access Mental Health Care and Information ,/
ADDITIONAL COMMENTS:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
DHCS 1751 (02/15)
State of California -Health and Human Services Agency
FEDERAL GRANT DETAILED PROGRAM BUDGET
TYPE OF GRANT: MHBG
COUNTY: FRESNO
FISCAL CONTACT: Kirk Hill
TELEPHONE NUMBER: (559) 600-4655
EMAIL ADDRESS: khill@co.fresno.ca.us
PROGRAM NAME: SUMMARY ALL PROGRAMS
STAFFING
TITLE OF POSITION
TOT AL STAFF EXPENSES (sum lines 1 thru 11)
Consultant I Contract Costs (Itemize):
Jail Psvchiatric Svcs Proa -Contract Corizon Health, Inc.
Exhibit D
Page 13 of 34
Department of Health Care Services
Enclosure 7
Page 1 of 3
STATE FISCAL YEAR: 2017 -2018
SUBMISSION DATE: August 20, 2017
PROGRAM CONTACT: Janell Sidney
TELEPHONE NUMBER: (559) 600-6831
E-MAIL ADDRESS: jsidney@co.fresno.ca.us
1 2
LAST
3
ANNUAL GRANT APPROVED REQUEST OR
SALARY FTE BUDGET CHANGE TOTAL
$ -
$ -
$ -
$-
$-
$ -
$-
$-
$-
$ -
$ -
$ -0.00 $ -$ -$ -
$ 1,672,097 $ 1,672,097
JJ SEO Dual Diaqnosis Proq -Contract Mental Health Systems, Inc. $ 340,000 $ 340,000
$
Eauipment (Where feasible lease or rent) (Itemize):
$ -
$-
$-
$ -
Supplies (Itemize):
$-
$-
$-
$-
$ -
Travel -Per diem, Mileage, & Vehicle Rental/Lease
$ -
Other Expenses (Itemize):
$ -
$ -
$ -
$ -
$ -
$ -
COUNTY ADMINISTRATIVE COSTS (10% MHBG) $-
NET PROGRAM EXPENSES (sum lines 12 thru 37) $ -$ 2,012,097 $ 2,012,097
OTHER FUNDING SOURCES: Federal Funds
Non-Federal Funds
Exhibit D
Page 14 of 34
41 TOTAL OTHER FUNDING SOURCES sum lines 39 & 40
42 GROSS COST OF PROGRAM (sum lines 38 and 41) $ -
$ -
$ 2,012,097 $ 2,012,097
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 2 of 3
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2017 -2018
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: 8/20/17 -----------------------FISCAL CONTACT: Jennifer Pardo PROGRAM CONTACT: Caroline Ahlstrom LMFT
TELEPHONE NUMBER: (559) 600-6437 TELEPHONE NUMBER: (559) 600-9354
EMAIL ADDRESS: jpardo@co.fresno.ca.us E-MAIL ADDRESS: caroline.ahlstrom@corizonhealth.com
PROGRAM NAME: Jail Psychiatric Svcs Prog -Contract Corizon Health, Inc.
STAFFING 1 2 3
LAST
ANNUAL GRANT APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
Psychiatrist (DDX) $ 187,000 1.00 $ 187,000 $ 187,000
Mental Health Supervisor (DDX) $ 112,000 0.88 $ 98,271 $ 98,271
Mental Health Counselors (DDX) $ 95,668 7.02 $ 671,530 $ 671,530
Mental Health RNs (DDX) $ 69,888 2.19 $ 153,303 $ 153,303
Mental Health Specialist (DDX) $ 53,352 .88 $ 46,812 $ 46,812
Office Assistants (2) $ 39,000 1.75 $ 68,439 $ 68,439
Medical Assistants (2) $ 32,510 1.75 $ 57,050 $ 57,050
BENEFITS $ 256,482 $ 256,482 $ 256,482
TOTAL STAFF EXPENSES (sum lines 1 thru 11) $ 845,900 15.48 $-$ 1,538,887 $ 1,538,887
Consultant/ Contract Costs (Itemize):
$-
$-
$-
Equipment (Where feasible lease or rent) (Itemize):
$-
$-
$-
$-
Suoolies (Itemize):
$-
$-
$-
$-
$-
Travel -Per diem, Mileage, & Vehicle Rental/Lease
$-
Other Expenses (Itemize):
$-
$-
$-
$-
$-
COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 133,210 $ 133,210
NET PROGRAM EXPENSES (sum lines 12 thru 37) $-$ 1,672,097 $ 1,672,097
OTHER FUNDING SOURCES: Federal Funds
Non-Federal Funds
Exhibit D
Page 15 of 34
41 TOTAL OTHER FUNDING SOURCES sum lines 39 & 40
42 GROSS COST OF PROGRAM (sum lines 38 and 41)
$-
$-
$-$-
$ 1,672,097 $ 1,672,097
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 3 of 3
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2017 -2018
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: August 20, 2017
FISCAL CONTACT: Laurentius Harlan Theng PROGRAM CONTACT: Susan Murdock, Program Director
TELEPHONE NUMBER: (559) 600-4619 TELEPHONE NUMBER: (559) 600-4876
EMAIL ADDRESS: lharlantheng@co.fresno.ca.us E-MAIL ADDRESS: smurdock@co.fresno.ca.us
PROGRAM NAME: Juvenile Justice SEO Dual Diagnosis Outpatient Program -Contract Mental Health Systems, Inc.
STAFFING 1 2 3
LAST
ANNUAL GRANT APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
Proqram Manaqer $ 62,920 0.34 $ 21,393 $ 21,393
Administrative Assistant-FFSAU $ 31,616 0.30 $ 9,485 $ 9,485
Clinical Supervisor -LCSW $ 75,005 0.56 $ 42,003 $ 42,003
Unlicensed MH Clinician -Girls $ 39,520 1.00 $ 39,520 $ 39,520
Unlicensed MH Clinician -Boys $ 29,640 1.00 $ 29,640 $ 29,640
Unlicensed MH Clinician -Boys $ 38,480 1.00 $ 38,480 $ 38,480
Vice President $ 89,898 0.05 $ 4,495 $ 4,495
Program Analyst $ 58,510 0.07 $ 4,097 $ 4,097
Benefits (State Unempl Ins., OASDI, Life, Health Ins., Worker's Comp) $ 32,198 $ 32,198
Payroll Taxes (F.I.C.A.) $ 14,467 $ 14,467
$-
TOTAL STAFF EXPENSES (sum lines 1 thru 11) $425,598 4.32 $-$ 235,777 $ 235,777
Consultant/ Contract Costs (Itemize):
Interpreter Services $ 5,000 $ 5,000
Equipment (Where feasible lease or rent) (Itemize):
Equipment Purchases< or= to $1,000 $ 355 $ 355
Equipment Repair/Maintenance $ 650 $ 650
Suoolies (Itemize):
Postage & Freiqht $ 1,800 $ 1,800
Office Suoolies $ 1,150 $ 1,150
Proqram Suoolies -client education & snacks $ 5,350 $ 5,350
Travel -Per diem, Mileage, & Vehicle Rental/Lease
Staff Mileaqe / Vehicle Maintenance $ 525 $ 525
Staff Travel (Out of County) I $ 2,000 $ 2,000
Other Expenses (Itemize):
Communications/Cell phones/Internet $ 42 $ 42
Staff Training/Registration $ 1,000 $ 1,000
Licenses & Taxes $ 6,200 $ 6,200
Prof. Fees/ Acctnq / Bank Charqes / Other Business Svcs (new hire screen, etc.) $ 410 $ 410
Software Expenses $ 100 $ 100
Indirect Costs/ Administrative Overhead $ 37,991 $ 37,991
Professional & General Liability Insurance $ 1,650 $ 1,650
Utilities, Janitorial, Security, and Janitorial Supplies (incurred in County's Budqet) $ 10,000 $ 10,000
COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 30,000 $ 30,000
NET PROGRAM EXPENSES (sum lines 12 thru 37) $-$ 340,000 $ 340,000
OTHER FUNDING SOURCES: Federal Funds
Non-Federal Funds
TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $-$-$-
Exhibit D
Page 16 of 34
40 I GROSS COST OF PROGRAM (sum lines 38 and 41) I $-I $ 340,000 I $
DHCS APPROVAL BY:
DHCS 1779 (06/16)
TELEPHONE:
DATE:
PROGRAM NARRATIVE
County of Fresno Department of Public Health
Jail Psychiatric Services Program
By Corizon Health, Inc. -Contractor
FY 2017-2018
A. STATEMENT OF PURPOSE
Fresno County has a population of over 979,915 people and encompasses almost 6,000
square miles. It has one of the most culturally and ethnically diverse populations in
California with over 105 different languages spoken in its homes (Fresno County United
Way 1998). Unemployment in the County in the past year averaged 9.4%, which is the
lowest it has been in seven years yet still exceeds the State (4.8%) and National (4.3%)
average. In 2015, the Fresno-Madera Continuum of Care Point-in-Time (PIT) count found
1,745 homeless individuals in Fresno County. The County of Fresno Adult Detention
Facilities has an average daily population of 2,714 inmates. On any given day, an
estimated 25% of the jail population suffers from a severe mental illness with around 75%
to 85% of these inmates having a co-occurring substance use disorder problem.
340,000 I
" ... studies indicate that rates of serious mental illness are at least 3 to 4 times higher than
the rates of serious mental illness in the general population [in jails]. Many of the mentally
ill inmates are in jail because of their symptoms. When incarcerated, people with untreated
mental illness are especially vulnerable to assault or other forms of intimidation by
predatory inmates." (Criminal Justice/Mental Health Consensus Report 2002). Also, the
County jail environment can itself exacerbate the symptoms of the mentally ill, which
increases the likelihood of further impairment of functioning as well as physical risk.
The need for a jail-based mental health program is evident. Jail Psychiatric Services (JPS)
provides a 24-hour, 7-day a week mental health service delivery system. The program is
designed to identify and stabilize mentally ill inmates, and to identify and stabilize those
inmates that have co-occurring mental illness and substance use problems.
B. MEASURABLE OUTCOME OBJECTIVES
The mission of the Jail Psychiatric Services program is to provide a jail-based 24-hour, 7-
day a week mental health program in the County of Fresno Adult Detention Facilities.
Objectives for FY 2017-18:
1. Serve 3,258 unique inmates between July 1, 2017 and June 30, 2018.
a. Provide psychiatric staff for medication management services as well as other clinical
nursing staff to successfully treat this population.
b. Provide psychiatric evaluations for an average of 271 inmates per month.
Exhibit D
Page 17 of 34
c. Enroll 348 unique inmates in group treatment specifically for individuals with co-
occurring disorders of mental illness and substance use.
d. Provide discharge plans for 405 unique inmates.
2. Serve 792 unique inmates identified as having co-occurring disorders of mental illness
and substance use.
a. JPS will document the number of inmates that will receive dual diagnosis
treatment.
3. Work with other county programs to link 30 inmates to intensive case management
follow up programs either through the Behavioral Health Court in Fresno County, or to
treatment programs for dual diagnosis.
JPS monitors program operations and goals on an ongoing basis. Program objectives are
monitored by assigned staff. Client information stated in the Measurable Outcome
Objectives section is tracked through computer database and Microsoft Excel software.
Staff monitor: 1) inmates treated in all programs, 2) inmates diagnosed as having co-
occurring disorders of mental illness and substance abuse, and 3) referrals to Behavioral
Health Court and other programs in the community. The information is kept in a de-
identified manner for review by the Program Administrator on an ongoing basis. Qualified
translators will be used to augment bilingual/bicultural delivery of services when
appropriate. Program activities are monitored during quarterly onsite multidisciplinary
meetings. In the event there are program problems or barriers to care identified, the
committee and assigned staff are responsible for developing a plan of resolution.
Objectives Achieved by JPS for FY 2016 -2017:
1. About 2,773 unique inmates were provided services when 3,000 were projected to be
served in the FY 16-17 application period. This did not meet the expected outcome. An
average of 231 inmates per month were evaluated by psychiatrists working with the
program when 250 were projected. This figure is lower than predicted. As in FY 2015-
16, it appears that due to reduced bed capacity and variable turnover (i.e., inmates with
more serious charges being held, while inmates with less serious charges tend to be
released due to overcrowding), some inmates are staying longer in the jail. This may be
a causative factor in the lower number of assessments, since each inmate is only given
one assessment per incarceration, and further services by a psychiatrist are considered
to be follow-up sessions.
2. During FY 2016-2017, approximately 348 inmates were enrolled in group treatment,
which exceeded the objective of 270. All SMI patients in isolation and semi isolation
attend two different therapeutic groups each week. This increase in group participation is
a continuing result of the purchase and installation of safety equipment in order to
conduct effective group therapy.
3. Future year's objectives take into account the increasing population in the jail, despite
the continuing pattern of releases due to overcrowding. Additional effort will be made in
the coming year to reach all objectives, given the budget resources available.
Exhibit D
Page 18 of 34
4. About 729 unique inmates were identified as having co-occurring disorders of mental
illness and substance use, an increase over the objective of 662.
5. Programs in the community continued to face downsizing and resource reduction during
the year, resulting in some loss of programs altogether. Funding cuts affecting the
Department of Behavioral Health necessitated closure of programs, outsourcing of
inpatient capacity, and restriction of services to a target population carrying only those
diagnoses meeting the criteria of Serious Mental Illness. At the same time, jail
overcrowding prompted a move towards cite and release of arrestees with non-violent
crimes, putting many of the dual diagnosed individuals with lesser charges back out into
the community at booking. These factors contributed to the reduction of appropriate
placements into treatment programs directly from the jail. However, approximately 180
inmates were referred to Turning Point Full Service Partnerships, Department of
Behavioral Health Urgent Care Wellness Center, Co-Occurring Disorders Treatment
Program, and Veteran's Administration.
Going forward into FY 2017 -2018, it is clear that the stability and availability of residential
dual diagnosis programs continues to be limited. Therefore, it is not likely to yield useful
information as an outcome measure. Continued effort will be focused on working with
structures such as the Behavioral Health Court to develop alternative placements to
incarceration that include dual diagnosis treatment, regardless of whether this is residential
or "outpatient" treatment. Continued effort with effective Discharge Planning will be made
for those who do meet the criteria for a dual diagnosis program on a case by case basis.
C. PROGRAM DESCRIPTION
The Jail Psychiatric Services program provides a variety of treatment options in the jail
setting based on community standards for outpatient services. These include the following:
• Evaluation and assessment, including dual diagnosis
• 24-hour crisis intervention
• Medication management, including management of dual diagnosis issues
• Referral for acute psychiatric hospital care
• Consultation with correctional officers to determine appropriate housing
• Monitoring of the safety and isolation cells for the mentally impaired inmates
• In-house dual diagnosis program and coordination with the Behavioral Health Court
to facilitate alternatives to incarceration.
• Group treatment specifically designed to address dual diagnosis issues
• Referrals from Behavioral Health Court. Staff representation in BHC Monthly
meetings to assist with continuity of care.
• Development and implementation of behavioral plans to change problematic
behaviors
All inmates are initially screened at booking by medical staff to determine their immediate
mental health needs. Many of the inmates referred to Jail Psychiatric Services come from
this initial screening at booking. However, inmates can refer themselves directly. Other
referral sources are family, courts, and correctional officers.
Exhibit D
Page 19 of 34
The modified in-house dual diagnosed program provides treatment through the multiple
activities involving identification, assessment, medication management, dual diagnosis
groups, and linkage to other resources when possible. The treatment is coordinated by JPS
staff through a team approach. The team meets daily to provide coordination and
consistency in treatment which are highly recommended in dealing with dual diagnosis
issues. By maintaining a coordination of care through the team approach, treatment goals
can be identified and achieved efficiently.
JPS continues the policy and procedure for providing a contact line to be exclusively used
by the community to provide information pertaining to the care and welfare of inmates. In
2006, members of the Mental Health Board of Fresno County identified a need for family
members to be able to relate information to JPS staff regarding incarcerated family
members and JPS responded to this need by installing two contact lines (one telephone and
one facsimile) for this purpose. The use of this line has expanded over the years, and
attorneys now leave messages of concern regarding health of their clients and requests for
assistance with possible dual diagnosis issues.
The need for continued identification and linkage to alternatives to incarceration is evident.
Once discharged, detainees can be referred directly to the Department of Behavioral
Health's outpatient treatment programs or can be placed in other appropriate levels of care
for those inmates diagnosed with Serious Mental Illness (Schizophrenia, Bipolar Disorder,
Major Depression with Psychotic Features and Schizoaffective Disorder). JPS has
advocated for inmates who have participated in the program to attend dual diagnosis
programs outside of the jail (such as West Care in the Fresno area) once they are
discharged. Many of these programs are struggling with budget issues, and are no longer
available as resources. Identification of new program resources is a continuing effort.
Additional resources, both residential and outpatient are priorities for development for the
Department of Behavioral Health this year, which may provide opportunities for linkage in
the future.
JPS staff and management have collaborated with the local Superior Court, the District
Attorney's office, the Public Defender's office, the Probation Department and the
Department of Behavioral Health in operating a Behavioral Health Court in Fresno County.
The Jail Psychiatric Services Community Mental Health Specialist attends the pre-court
multidisciplinary meetings twice a month, to promote continuity of care, provide technical
assistance, and discuss referrals to the court. This specialized court began operations in
the summer of 2008. This court works with multiple resources, including Full Service
Partnerships that can provide intensive case management and "whatever it takes"
approaches to maintaining individuals in the community rather than in jail. These resources
may also be able to provide levels of care that formerly were only available in residential
settings. The court has accepted referrals of mentally ill inmates who have non-violent
felonies, for consideration of sentencing to probation in the community, with court monitored
involvement in treatment, education, and intervention for dual diagnosis issues. In 2011, the
court has expanded its acceptance criteria to include some misdemeanor cases. This
approach may provide more positive outcomes for dually diagnosed individuals who would
otherwise have repeated contacts with law enforcement, may reduce costs, and may
increase the likelihood of successful integration into long term, self-sufficiency. The court is
currently in its seventh full year of operation.
Clients at the jail receive individualized treatment by a multi-disciplinary team based on the
existence of co-occurring disorders and the need for simultaneous treatment of the
Exhibit D
Page 20 of 34
symptoms presented (Integrated Treatment Model). The management of clients through the
program includes the following processes: 1) referral, 2) engagement of client, 3)
assessment procedure, 4) psychiatrist evaluation, 5) case manager assignment (clinician or
nursing staff), 6) completion of paperwork, and 7) follow-up.
Fresno County began group treatment programs in November of 2008 for the dually
diagnosed inmates. The target population is those individuals incarcerated that have a
history of/or can be diagnosed with co-occurring disorders. The groups consist of up to 15
individuals who have been screened and meet the admissions criteria to participate in the
group sessions. The groups are co-facilitated by JPS staff who have knowledge of co-
occurring disorders and who are able to effectively provide the specific intervention. The
groups are available on "open-ended" enrollment. This allows for qualified individuals to
receive the services without a lengthy delay. Length of stay in the Fresno County jail is quite
variable, depending upon numerous factors such as level of offense, bail amount, releases
due to overcrowding, and other factors beyond the control or prediction of JPS. Therefore, it
is important to provide prompt access to treatment for this fluid population.
Referral
Referrals within the jail system usually come from custody officers, self-referral at booking,
requests for service by inmates in the general jail population, attorneys, judges, or by
program staff working with the inmates in regard to known medical and/or psychiatric issues
The clients are then assessed for suitability by the JPS staff, and accepted into treatment if
their diagnosis indicates that need.
Engagement
Program staff goes to the inmate, either within the jail pod setting, booking area, or infirmary
areas in order to engage the inmate into dual diagnosis services. This process is often in
combination with, or as a direct result of, assessment of the inmate.
Assessment Procedure
Multidisciplinary staff uses structured interview, clinical interview, and inmate history to
establish diagnosis and need for services. Assessment can be ongoing during an inmate's
stay at the jail. Engagement into services is often initiated as part of the assessment
process. All referrals that appear to be willing and appropriate for services receive an
assessment by a psychiatrist.
Psychiatrist Evaluation
Upon referral from custody, mental health, or medical staff, psychiatric evaluation is
provided within the jail setting. Psychiatric evaluation may include chart review, face-to-face
interview, tele-medicine interview, multidisciplinary consultation, and review of information
from custody. Based on the results of evaluation, the inmate with dual diagnosis issues may
be started and/or maintained on appropriate medications and follow up support from mental
health staff and psychiatric staff. Options range from ongoing supportive contacts to
medication support, to placement in safety cell or higher level of care outside the jail,
depending upon the needs of the inmate. Inmates who present at the jail with existing
medication treatment programs are evaluated as a priority by the psychiatrists, and existing
Exhibit D
Page 21 of 34
medication programs may be continued, modified, or discontinued as determined by the
psychiatrists.
Case Manager Assignment and Follow-up
Consumers who are willing to be engaged into treatment are assigned a case manager who
is responsible for providing follow up contacts within the jail setting. Depending upon the
treatment needs, inmates may continue to follow-up with a psychiatrist for
monitoring/adjustment of medications and with a staff clinician or mental health worker for
supportive contacts, including development and implementation of discharge plans.
D. CULTURAL COMPETENCY
Fresno County is a multicultural community. Threshold languages are English, Spanish,
Lao, Cambodian, and Hmong. Historically, there has been a consistent request and
demonstrated need for dual diagnosis services for Spanish monolingual consumers. The
design of JPS includes multicultural concepts. Threshold language services will be
available through multicultural staff and interpreters.
Consumers entering JPS will be assessed by licensed mental health staff. Part of that
assessment will include focus on natural support systems and cultural strengths that can be
interwoven with treatment. Ongoing assessment of individuals will focus on functioning in
the program and relating to the ethnic and social support systems appropriate for recovery.
Title VI of the Civil Rights Act of 1964 clearly specifies the efforts required for providing
culturally and linguistically appropriate services for consumers accessing health systems
such as JPS. Providing language assistance or having program staff with language
capability, involving natural support systems, maintaining a cultural focus during the
assessment and treatment planning and carefully evaluating each consumer's cultural
strengths will go hand in hand with outreach to the culturally diverse target populations. The
objectives of Title 15 of the California Code of Regulations also indicate that those in a
detention facility should be afforded the same opportunity for treatment as those not
incarcerated, to the extent that resources allow.
E. TARGET POPULATION
It is expected that the program will serve approximately 2,004 unduplicated inmates in FY
2017-2018. Of this number, 685-750 will be provided services to address dual diagnosis
issues. MHBG funding will be used to provide treatment to this population. The inmates
treated in this program must have a primary mental diagnosis that impairs their ability to
function and a secondary substance-related disorder. The co-occurring disorders must
prevent the individual from benefiting from traditional mental health services and chemical
dependency services.
An inmate who is actively psychotic or in a current mood episode to the extent that it would
prohibit them from participating in the dual diagnosis program, will be stabilized on
medications before participation is permitted.
Exhibit D
Page 22 of 34
All services will be inclusive of cultural and language capabilities to engage and maintain
treatment populations that have been historically underserved. JPS staffing includes
bilingual staff, providing linguistic and culturally competent services in Spanish and Hmong.
The program has interpreter resources available to insure that language barriers are
addressed in assessment and treatment. Every effort will be made to provide psycho-
education and individual treatment programming options with staff that are competent in the
culture and language of the treatment population.
F. STAFFING
Outside Provider of Service -Corizon Health, Inc.
Licensed Psychiatrist, Licensed Mental Health Worker Supervisor, Licensed Mental Health
RN, Unlicensed Mental Health Specialist, Office Assistant 111, Medical Assistant, Licensed
Professional Counselor.
G. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Behavioral Health.
H. IMPLEMENTATION PLAN
The Jail Psychiatric Services dual diagnosis program was completely staffed and fully
implemented in January 2002. As of June 23, 2014 staffing levels were changed to meet
Corizon/Fresno County Agreement for services and has been fully staffed for the FY 2016-
2017. Ongoing review of needed staffing levels continues based on the needs of the facility
and the increasing severity as well as number of those with SMI being incarcerated as well
as the request by custody to have mental health staff on site 24 hours a day and 365 days a
year.
The current JPS contract with Fresno County expires on June 30th, 2018 and is subject to a
Request for Proposal process to select a provider(s) for services to continue effective July 1,
2018.
I. PROGRAM EVALUATION PLAN
JPS monitors program operations and goals on an ongoing basis. Program objectives are
monitored by assigned staff. Client information stated in the Measurable Outcome
Objectives section is tracked through computer database and Microsoft Excel software.
Staff monitor: 1) inmates treated in all programs, 2) inmates diagnosed as having co-
occurring disorders of mental illness and substance abuse, and 3) referrals to Behavioral
Health Court and other programs in the community. The information is kept in a de-
identified manner for review by the Program Administrator on an ongoing basis. Qualified
translators will be used to augment bilingual/bicultural delivery of services when appropriate.
Program activities are monitored during quarterly onsite multidisciplinary meetings. In the
event there are program problems or barriers to care identified, the committee and assigned
staff are responsible for developing a plan of resolution.
J. OLMSTEAD MANDATE and the MHBG
Exhibit D
Page 23 of 34
Typically the most formal method of aftercare planning for SMI inmates is for those that
have been identified through the Behavioral Health Court. These individuals are brought to
the attention of Mental Health staff while incarcerated as being eligible to receive services
as a function of sentencing or alternative planning. The Mental Health Specialist works
closely with case managers, attorneys and probation officers through the court to arrange
post incarceration treatment for both residential or outpatient programs. These individuals
are typically picked up upon order of the court by probation or program officials and
transported to the designated program. This also affords the program officials to pick up the
7 day supply of medications from the pharmacy in the event the patient/inmate is receiving
medications.
When an inmate comes into custody the booking nurse does their best attempt to bridge any
medications the inmate may have been taking over the past 30 days. If medications are
bridged the inmate is scheduled to see the psychiatrist within 7 days.
Inmates will receive psychiatric care while in care if they alert booking staff that they have
been taking mental health meds in the last 30 days or if they request to be seen by mental
health staff to evaluate if they need to be placed on medications. Staff reviews the medical
record to see if the inmate had previously been receiving mental health
services/medications the last time they were in custody. If the inmate had previous mental
health services the inmate would be referred to see a mental health staff.
SMI inmates that are in isolation or semi isolation are offered three visits per week with a
licensed mental health therapist. They are typically offered two mental health groups and
one individual therapy appointment. Therapists are working with custody staff in having
good communication and working on moving SMI inmates to the least restrictive housing
possible. A way to accomplish this goal is by using the "Behavior Management Plans". The
"BMP" is a plan created by custody and mental health staff. The Plan is reviewed by the
inmate so they are aware of the goals they are working on in order to transition to a less
restrictive unit (if possible). The BMP discusses what are some of the inmate's behaviors
and issues as to why they are placed in the restrictive housing unit. The inmate's mental
health symptoms and ways to deescalate the inmate. These plans are discussed between
the therapist and the inmate as well as the therapist and custody staff at least biweekly.
In the case of inmates who are receiving medications while incarcerated whether or not they
are SMI; a 7 day supply of medications is available to them for pick up through CVS they are
also able to get a 30 day prescription of their medication that can be filled at the patient own
expense.
Jail health care staff provides Discharge Planning for sentenced inmates with serious mental
health disorders every time they complete a Mental Health Evaluation. A discharge plan is
discussed with these patients focusing on the patient's strengths, particular needs, their
main concerns when being released from custody. The discharge plan can include a
summary of intended services when they are being released from custody, appointments
are identified or arranged for pertaining to medical and psychiatric services prior case
arrangement and major concerns upon release, natural resources are also identified as well
as inmate desires for setting up appointments in areas such as housing, shelter needs, food
resources, anger management, job assistance, education or recovery programs and include
important contacts such as probation or parole officers as well as attorneys. The discharge
plan could include connecting such inmates to community health care providers, community
Exhibit D
Page 24 of 34
social services, community-based housing, and/or appropriate services per the individual's
need.
When SMI inmates are released during 7 and 7:30 pm mental health clinicians will complete
an exit interview with the patient. During this interview they are completing a mental status
exam making sure the inmate is appropriate to be released to the street and are not
currently a danger to themselves or others. (Therapist would speak to watch commander
immediately if they felt the inmate was a danger to self or others and place a 5150 on the
inmate.) The inmate is educated on where to go to get their meds that Corizon will pay for
them to get a 7 day supply in order to help them have continuity of care with having to
transition to an outside provider. Lastly, contact information is provided to the Urgent Care
Wellness Center in a pamphlet inmates receive upon discharge.
MULTI-AGENCY ACCESS PROGRAM (MAP) POINTS
The County's Department of Behavioral Health seeks to streamline access processes to
ensure that all individuals in need of behavioral health care have a timely, personal,
relevant, clear and understandable path to care. By integrating behavioral health into other
systems such as physical health settings, justice settings including courts and probation,
schools and other service delivery organizations, the County can significantly increase
access to care and improve the total health and wellness in the community.
Effective January 10, 2017, Fresno County entered into a Master Agreement with three
community service providers to operate Multi-Agency Access Program (MAP) Points. The
MAP Point operators provide an integrated screening process connecting individuals and
families facing challenges such as mental health, substance use disorder, physical health,
housing/homelessness, social service and other related challenges to the right resources at
the right time in the right location. This is accomplished through an established and
formalized screening process, collaboration of service providers, leveraging existing
community resources, eliminating barriers and assisting clients' access to supportive
services. Goals of the program include less utilization of more costly crisis services, and
minimization or avoidance of more severe outcomes such as substance use disorder,
hospitalization or incarceration. MHBG funds are not be used for the Justice MAP Point. In
critical access points such as such as the Adult Detention Facility, MAP services may
supplement the discharge planning services provided by Corizon's Jail Psychiatric Services
program as well as continuity of care after discharge.
PROGRAM NARRATIVE
Fresno County Department of Behavioral Health (DBH)
Children's Mental Health Division
Juvenile Justice SEO Dual Diagnosis Outpatient Program
By Mental Health Systems Inc. (MHS) -CONTRACTOR
FY 2017-2018
A. STATEMENT OF PURPOSE
Exhibit D
Page 25 of 34
The Juvenile Justice Campus (JJC) both detention and commitment was opened on July 22,
2006. The JJC is located on the southwest corner of Freeway 99 and American Avenue and
consists of a 180 bed detention facility for those minors going through the court process; and a 21 O
bed commitment facility for those minors formally sentenced by the Juvenile Court to a specific
treatment program. The design and philosophy of the JJC has provided the opportunity for new
programs and approaches to detention and commitment programs. The JJC receives minors in
custody from numerous different agencies in the County of Fresno. This includes minors transferred
to Fresno County from other jurisdictions and state agencies. The facility has allowed the flexibility
to house its population in specialized groupings according to criminal sophistication, age, gender,
and court status. The result has been an ability to more easily target and manage populations within
the facility.
It is well documented that a majority of the youth entering juvenile halls have mental health problems
and many have co-occurring mental health and substance abuse issues. In fact, facility personnel
say it is uncommon to see mentally ill youth in local custody who are not also using some substance
or substances. Trauma is also a significant issue for probation youth since most if not all have
experienced critical incidents of one sort or another at some point in their lives. (MENTALLY ILL
JUVENILES IN LOCAL CUSTODY ISSUES AND ANALYSIS JUNE, 2011)
Youth are assessed and referred to the Floyd Farrow Substance Abuse Unit (SAU) through the
Fresno County Juvenile Court and/or Fresno County Probation. MHS provides each youth and
his/her family with a multi-disciplinary team, including a mental health clinician, substance abuse
specialist and a family support partner. This program combines the most effective aspects of
therapeutic community with a curriculum proven effective with incarcerated substance abusers.
MHS provides life-enhancing recovery options that include integrated services related to alcohol and
drug addiction and other behavioral health disorders. The goal is to maintain treatment components
that are empathic, ethical, trauma-informed, culturally competent and gender-responsive, while
delivering a professional attitude in all phases of care and remaining dedicated to creating an
environment of opportunity, choice, and hope. Services include group therapy, individual therapy,
multi-family groups, psycho-education, life skills, anger management, art and recreational therapy,
case management and family therapy. Adolescent and their family are transitioned as needed to
MHS post-release services for an additional 120 to180 days out of custody. MHS goal is to involve
the whole family in the treatment process to enhance the probability of sustained success.
2500 -,---~~~~~~~~~-=-.,--~~~~~~~~~~~-
JJC Bookings 2015 -2016
2000
1500
1000
500
0
2013 2014
B. MEASURABLE OUTCOME OBJECTIVES
CLIENT OUTCOME OBJECTIVES
2015 2016
• Males
• Females
Exhibit D
Page 26 of 34
During FY 2016-2017, 66 Adolescents were served. It is anticipated 72 adolescents will be served
during FY 2017-2018.
Program objectives for adolescent participants of the SAU and Post-Release Out Patient Services
(PROPS) program in FY 2017-2018 are:
• Participants will be drug free six months after completion of in-custody program;
• Participants will have no new convictions during first six months after completion of in-custody
program; and
• Participants will be attending school, working, or engaged in a vocational program six months
after completion of in-custody program.
PROGRAM DATA
Data for each fiscal year includes provision of services by MHS July 1 through June 30.
SUBSTANCE ABUSE UNIT: IN-CUSTODY
Outcome /: Participants will be drug free six months after the 2015-16 2016-17
completion of in-custody program
1. Number of Participants that Reached Six Month Marker 56 66
2. Number who are Clean DurinQ Last Three Months 50 60
3. Percent of Clean Participants at Six Months 90% 91%
Outcome II: Participants will have no new convictions during 2015-16 2016-17
first six months after completion of in-custody program
1. Number of Participants that Reached Six Month Marker 56 66
2. Number who have No Convictions the First Six Months 54 63
3. Percent of Participants with No Convictions 97% 97%
Outcome /II: Participants will be attending school, working, or 2015-16 2016-17
engaged in a vocational program six months after completion
of in-custody program
1. Number of Participants that Reached Six Month Marker 56 66
2. Number of Adolescents in Ed. ProgNoc. Prag./ Working 54 63
3. Percent of Participants WorkinQ or In EdNoc ProQram 97% 97%
Projected
2017-18
72
66
92%
Projected
2017-18
72
69
97%
Projected
2017-18
72
69
97%
SUBSTANCE ABUSE UNIT: PROPS (POST RELEASE OUTPATIENT SERVICES)
Outcome I: Participants will be drug free at completion of 2015-16 2016-17
PROPS program
1. Number of Participants that reached completion of 7 6
program
2. Number who are Clean During Last Three Months 7 6
3. Percent of Clean Participants at Six Months 100% 100%
Outcome II: Participants will have no new convictions during 2015-16 2016-17
first six months after completion of PROPS program
1. Number of Participants that Reached Six Month Marker 7 6
2. Number who have No Convictions the First Six Months 7 6
3. Percent of Participants with No Convictions 100% 100%
Outcome Ill: Participants will be attending school, working, or 2015-16 2016-17
engaged in a vocational program six months after completion
of PROPS proaram.
1. Number of Participants that Reached Six Month Marker 7 6
2. Number who are attending school, a vocational program, 7 6
or working the First Six Months
3. Percent of Participants attending school, a vocational 100% 100%
program, or working
Exhibit D
Page 27 of 34
Projected
2017-18
7
6
86%
Projected
2017-18
7
6
86%
Projected
2017-18
7
6
86%
MHS made progress towards our goals this year by achieving a 100% success rate with our one
year graduates in achievement of their long term outcomes (for 2 years in a row).
C. PROGRAM DESCRIPTION
Intensive services by Mental Health Systems, Inc. (MHS) targets adolescents who are in-custody at
the County's Juvenile Justice Campus (JJC). Post-release services are also provided upon
completion of the in-custody program as adolescent's transition back into the community. There is
capacity at the JJC to serve 40 in-custody adolescents at any given time.
FLOYD FARROW SUBSTANCE ABUSE UNIT (SAU)
In-custody treatment consists of dual diagnosis services for thirty (30) males and ten (10) females, a
distribution reflective of the target population, in a full scope gender-responsive therapeutic
community treatment model. In-custody program duration is a maximum of six (6) months.
Progress and completion of the program is based upon a level and phase system.
While in the SAU a range of services is provided to every adolescent and family incorporating the
following elements:
1. Completion of a comprehensive mental health assessment by a clinician upon intake. If needed,
referrals for psychotropic medication evaluation are made to Corizon Staff at the Fresno County
Juvenile Justice Campus. Corizon is responsible for evaluation, prescription, administration, and
oversight of psychotropic medications.
2. Treatment services that are centered on a multidisciplinary treatment team of mental health and
substance abuse, school, and probation staff that coordinates the treatment plan to address the
multiple needs of adolescents and family.
Exhibit D
Page 28 of 34
3. Family involvement is crucial to the adolescent's success, especially because most adolescents
return home after incarceration or live at home during outpatient treatment. As such, the
multidisciplinary team engages the family upon their adolescent's intake to the program with a
welcome phone call from MHS Family Support Partner, who provides the family with information
on all the program's many opportunities for family support, including transportation to and from
weekly family groups and bi-weekly family therapy sessions. MHS Family Support Partner also
provides referrals to all family members for any available resource in the Fresno community that
would strengthen and benefit the family.
4. Curriculum is adjusted to the adolescent's developmental needs and to meet educational,
cultural, and gender specific requirements. Certain values and structures must be maintained to
support the effect of group-based programs, but each treatment plan is individualized.
5. Integration of extracurricular and therapeutic activities is offered to stimulate interest while
supporting the message that sobriety can be fun and meaningful. These activities may include
talent shows, holiday celebrations, after-care field trips, family potlucks and barbeques as a
means of engaging clients and families. Adolescents in the SAU and their families experience
an atmosphere of acceptance and trust, demonstrated by the number of families involved in the
program.
6. Commitment to teams of mental health clinicians and MHS substance abuse counselors with a
low client-to-staff ratio and a wide range of diversity and expertise to improve client outcomes,
including staff gender and ethnic/cultural diversity, is consistently demonstrated in staffing.
Further, MHS requires that all staff participate in ongoing cultural competence staff training.
7. MHS provides a PROPS program to address the mental health and substance abuse issues of
the adolescents after discharge from the Juvenile Justice Campus.
A challenge for clients participating in an in-custody program is the transition back into the
community. Moving from a highly structured, secured setting like the JJC to an environment that
supported addiction and delinquent behavior can be stressful and highly problematic. Many times
adolescents return to homes in which family members are engaged in behaviors that the adolescent
is trying to avoid, or to gang activities that do not foster newly developing healthy, crime-free
lifestyles. To help assure post-release stability, in-custody treatment services are designed to help
adolescents build and internalize skill sets that will sustain their commitment to sobriety during and
after the transition phase. Program structure and proven interventions at the SAU include:
• Therapeutic Community (TC): True recovery is a process that occurs within a healing
community. This approach puts participants in a setting that teaches, rewards, and reinforces the
pro-social skills and outlooks necessary for successful reintegration into society. It also
addresses negative attitudes and behaviors by a series of interventions, learning experiences
and possible disciplinary measures including temporary exclusion from the community,
depending on the severity of the conduct. The SAU in-custody program combines strong and
intensive treatment with the tools of the TC to affect cognitive, emotional, and behavioral
restructuring of participating adolescents. Only by such a complete restructuring of beliefs,
attitudes, and behaviors is it possible to avoid relapse and recidivism. Through the TC
adolescents also learn how to develop positive relationships supportive of a drug-free, crime-free
lifestyle; these acquired skills can then be successfully used once released from custody.
• Motivational Interviewing (Ml): In addition to Therapeutic Community, MHS also utilizes Ml, as a
means of engaging and motivating adolescents and families. Ml is an evidence-based
interactive counseling approach proven effective in assisting individuals and families to mobilize
internal resources for change by enhancing intrinsic motivation. Program staff are trained in Ml
counseling style, including interviewing and brief intervention techniques, and use of the stages
Exhibit D
Page 29 of 34
of change theory (which include stages of pre-contemplation, contemplation, preparation, action,
and maintenance).
• Gender-Responsive Services: MHS recognizes that gender makes a difference and gender
responsive treatment is a critical component of success in all aspects of substance abuse and
mental health treatment. To this end, females participate in a specialize treatment program
designed to deal with the complex familial and relationship issues unique to adolescent females
with substance abuse and mental health issues. To help female adolescents admitted to the in-
custody program explore their unique traits, strengths, and self-images, MHS incorporates Brene
Brown's curriculum, "Shame Resiliency," and Stephanie Covington's curriculum, "Voices." Every
effort is made to identify an exclusive sustainable environment especially for female's treatment
and supportive activities as a means of enhancing gender responsiveness. At every level of
care, specific treatment interventions are utilized to meet both male and female gender-based
needs. For instance, during the in-custody treatment phase, Hazelden's curriculum, "Young
Men's Work" equips adolescent males with the ability to form positive relationships with both men
and women with all creeds and colors.
• Screening and Assessment: SAU continues to use the Adolescent Assessment of Severity
Index (Y-ASI) for adolescents admitted to the program. In collaboration with Fresno's Juvenile
Court, SAU performs this screening to expedite availability of the information. SAU counselors
also administer the ASAM PPC II for each client. The mental health clinician completes a
comprehensive mental health assessment upon placement in the program, and conducts a Child
and Adolescent Needs and Strengths (CANS) Assessment at intake, 6 month reassessment,
Transition/Discharge, and Plan of care update.
• Dual Services Team: Each group of 15 minors in the SAU has a professional team composed of
MHS Mental Health Clinician and MHS Substance Abuse Counselor. The team provides
coordinated treatment and case management during the in-custody phase of the program. This
team co-facilitates therapy groups that address substance abuse and mental health issues.
• Treatment Team: The team consists of individuals significantly involved in the adolescent's
treatment, including the adolescent, family, mental health and substance abuse counselors,
probation officer, JJC and education staff, MHS Family Support Partner, and others who may be
involved in the adolescent's aftercare plan. The treatment team approves the treatment plan
within 30 days of admission and reviews and modifies plan every 90 days, or as needed. The
treatment team reviews progress in the program on a bi-weekly basis.
• Treatment Plan: The initial treatment plan is developed by the adolescent, adolescent's family,
the clinician, and counselor within the first 30 days of admission, integrating information from the
mental health assessment. The plan is reviewed by the full treatment team for approval and is
updated as needed or at least every 90 days.
• Treatment Services: Treatment components include individual mental health therapy, family
therapy and counseling, process groups, community groups and psycho educational groups,
discharge planning, case management, and recreational and social activities.
• Transition Planning: Discharge planning truly begins at intake where all of the treatment team
works towards the successful planning to meet the Individual needs of each youth to successfully
transition back into the community. 30 days prior to release a transition meeting takes place
where each youth and their guardians are given Individualized transition meeting which
includes, referrals and a face to face meeting with Probation, the Court Schools, Our treatment
team members, collaborative who provide additional support services such as mentoring and
tutoring.
Exhibit D
Page 30 of 34
Progress in the SAU program is demonstrated through movement through a level and phase system.
Movement from one level to the next requires passing milestones, including peer panel interviews.
This ensures that the adolescent feels that he/she has earned the promotion, and that his/her
achievements have been acknowledged. Successful completion of the program is finalized with a
graduation ceremony, which is a positive, re-affirming event that includes family members, the
treatment team, and others in the adolescent's community.
POST-RELEASE OUT PATIENT SERVICES (PROPS)
Upon successful completion of the in-custody SAU program adolescents are returned home to their
families and those identified as needing post-release out-patient services begin the second phase
process of recovery. The six-month post-release program provides intensive out-patient services.
The continuity of service allows clinicians to develop a consistent and longer term therapeutic
relationship with the adolescents and their family (6 months in-custody, 6 months post-release). This
consistent and stable relationship between client and clinician assists in maintaining stability, family
participation and treatment compliance as the client reintegrates into their community and peer
culture.
The PROPS program provides the following services:
• Intensive substance abuse treatment services
• Individual and family therapy and mental health services as needed;
• Crisis intervention;
• Case management provided by the multidisciplinary team;
• Process and family groups, ancillary referrals, educational/vocational assistance, Life Skills
curriculum, coordination of clean and sober activities, educational forums, and family centered
activities;
• Information and referral to community-based 12-Step programs;
• Opportunities for community service work; and
• Clean and Sober social and recreational activities.
SAMHSA MHBG FY 2016-17 funds co-occurring mental health and substance use disorder
contracted services which are provided by a community provider, MHS, at the Juvenile Justice
Campus. The amount of $300,000.00 will fund salaries and benefits and operating expenses
associated with the provision of the co-occurring disorder program provided by MHS. The amount of
$40,000.00 will fund County costs for utilities, janitorial, security and supplies at JJC as well as
administration of the program and MHBG.
D. CULTURAL COMPETENCY
MHS realizes that, in order to adhere to our founding values, we must tailor the way we provide
services, based on the culture and beliefs of each participant and his/her family. We also understand
that diversity includes gender identity, religious and/or cultural beliefs, family values, as well as
ethnic, linguistic, and cultural traditions. Due to the fact that minorities are overrepresented in the
criminal justice system, we also prepare for the need to have and train representative and
experienced staff. Every new participant enters our programs with a world-view, cultural
perspective, and personal beliefs that are unique. Their belief systems may be further complicated
by the manifestation of substance abuse, trauma and mental illness. In order to treat this diverse
population, staff is trained to the fullest extent in order to welcome and accept each new client,
viewing them from a "whole person" perspective. MHS provides on-going training opportunities as
well as sharing training calendar of interest and relevance for all employees. Staff that attends
trainings also bring the information back to share with their respective programs so everyone can
benefit from the material. Every MHS employee also maintains an Individual Training Plan that is
Exhibit D
Page 31 of 34
evaluated at each annual review to ensure professional development and quality skill enhancement
as it relates to cultural competency and proficiency.
MHS has encouraged programs to become more self-evaluative about their respective levels of
cultural competence and as such, MHS has adopted the following Culturally Competent Clinical
Practice Standards:
1. MHS will engage in a culturally competent community needs assessment and use the results to
plan and implement services that respond to the cultural and diversity of the population in our
service area.
2. MHS will engage in community outreach to diverse communities based on the needs
assessment.
3. MHS will collect and maintain accurate and reliable demographic data to evaluate and monitor
our CLAS impact on health equity and outcomes to inform our service delivery.
4. MHS will create a culturally and linguistically welcoming environment for the diverse
communities served.
5. MHS will ensure that staffing at all levels are representative of the community served, both
culturally and linguistically.
6. MHS will ensure linguistic capacity and proficiency to communicate effectively with the
population served, and ensure the competence of the Individuals providing language
assistance, recognizing that untrained individuals and use of minors as interpreters shall be
avoided.
7. MHS will use interpreter services appropriately and staff will be able to demonstrate ability to
work with interpreters as needed.
8. MHS staff will demonstrate knowledge of diversity within ethnic and cultural groups in terms of
social class, assimilation, and acculturation.
9. MHS staff will demonstrate knowledge about a) specific cultural features that may be present in
various disorders; b) culture-bound syndromes; c) cultural explanations of illness; d) help
seeking behaviors, including faith-based, in diverse populations; and e) appreciation for
traditional ethnic and cultural healing practices.
10. MHS will ensure consideration of cultural factors are integrated into our clinical assessments.
11. MHS staff will take into consideration the potential bias present in clinical assessment
instruments and critically interpret findings within the appropriate cultural, linguistic, and life
experiences context of the client.
12. MHS staff will afford culture-specific consideration consistent with the cultural values and life
experiences of the client throughout the intervention and will be reflected in progress notes,
treatment planning and discharge planning.
13. MHS will ensure that Psychiatrists in our programs consider the role of cultural factors
(ethnopsychopharmacology) in providing medication services.
14. MHS will promote an environment that encourages staff to conduct self-assessment as a
learning tool.
15. MHS will ensure staff actively seeks out educational, consultative and multicultural
Exhibit D
Page 32 of 34
experiences, including a minimum of four hours of cultural competence training annually.
MHS is committed to the implementation of more culturally and linguistically competent assessments
and services that are responsive to culture, race, ethnicity, age, gender, sexual orientation, and
religious/spiritual beliefs. As such, MHS participated in the Comprehensive Continuous Integrated
System of Care (CCISC) initiative which utilizes eight practice principles that directly impact services
for the dually diagnosed (mental health and substance abuse disorders) individuals.
E. TARGET POPULATION
The target populations are adolescents diagnosed as severely emotionally disturbed (SEO) who
have a co-occurring substance use disorder diagnosis, and are either in-custody at the Juvenile
Justice Campus or are in the Post-Release Outpatient services component. Mental health staff
works very closely with the substance abuse counselors. Each juvenile is assigned to a team
consisting of both clinician and a substance abuse counselor. This team is responsible for providing
services to the juvenile and his/her family throughout treatment. The assigned team follows the
family through all phases of treatment, including PROPS, and is available as needed during periods
of crisis, instability and challenges. Part of the Clinical Supervisor's time, not funded by SAMHSA
Community Mental Health Services Block Grant (MHBG), involves oversight of substance abuse
staff, ensuring effective, coordinated and integrated delivery of treatment services.
F. STAFFING
Outside Provider of Service: Mental Health Systems (MHS)
Total grant FTE: 4.32
Vice President is responsible for overall oversight.
Program Manager reports to the Vice President and is responsible for program oversight.
Program Analyst is responsible for financial, support services, project coordination, and program's
budget maintenance.
Administrative Assistant is responsible for administrative and clerical support to the clinical team.
Clinical Supervisor reports to the Program Manager and is responsible for the clinical supervision of
the three unlicensed clinicians and four mental health interns (this program has become a teaching
program, providing the opportunity for several Master's interns MSW and MFT from Fresno State
University, University of Phoenix, National University, and University of Southern California to
complete their internship). In addition, the Clinical Supervisor manages a case load of five
adolescents, assists in monitoring SAMHSA MHBG funded positions, data collection and evaluation,
treatment planning, assessments, crisis, collaboration, and provides hands-on supervision.
Unlicensed clinicians report to the Clinical Supervisor and each carries a case load of 10-15
adolescents (in-custody) and up to 10 adolescents in PROPS (post-release). Each provides case
management, aftercare, home visits and linkages necessary for community transition.
G. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County Department
of Behavioral Health.
H. IMPLEMENTATION PLAN
Exhibit D
Page 33 of 34
The co-occurring disorder treatment program is fully implemented. MHS contract with Fresno County
expires on June 30 1h of 2018, MHS plans to respond to the RFP for another contract period, they
have been the contracted provider for the Substance Abuse portion of the Floyd Farrow SAU since
1999.
I. PROGRAM EVALUATION PLAN
Monthly service reports include the number of minors served and services provided. Monthly
outcome reports delineate number of minors' outcome while completing the program. Program staff
continues to identify and resolve problems as encountered by the program through communication
and collaboration internally, as well as with community partners.
J. OLMSTEAD MANDATE and the MHBG
The goal of MHS is to assist youth with co-occurring disorders (COD) who spend the initial phase of
their treatment in-custody to be transitioned successfully back to their families and care-givers with
services that meet their individualized needs. Additionally, the goal is to prevent them from being
institutionalized and to assist them with on-going services and referrals to services that will provide
them and their families with the resources to be successful in all areas of their life.
IMPLEMENTATIONS
• Housing services: The majority of youth participating in the program live with parents or
caregivers. MHS' team of clinicians works very closely with the youth and their family from entry
into custody to transition back to their home. MHS clinicians continue to provide services to the
youth and their families 6 months post-release. For youth who are placed in group homes or
foster care, when possible, MHS will continue to offer therapy to the youth, and make appropriate
referrals as needed. Youth who have turned 18 and are facing homelessness are connected to
transitional housing services.
• Home and community-based services and peer support services: MHS provides an out-patient
program, Family and Youth Alternatives which is conveniently located in a central location across
from social services and on the direct bus route. MHS provides bus tokens to the youth to
eliminate transportation problems. Each youth has the opportunity for post-release substance
abuse counseling and the primary clinician for each youth continues in the therapeutic milieu that
has been established with the youth and their family while in custody. MHS has a family support
partner who is available to the youth and their families to link them to any resources in the
community that would benefit the youth and their family. A peer support group, Adolescents in
Motion (AIM) is available at MHS's out-patient location.
• Employment services: The focus with youth is on education, and successfully completing a High
School Diploma or GED and going on to Vocational School or College. However, youth are
encouraged to get summer jobs, and MHS provides them with opportunities and resources in the
community. This would include summer youth work programs, local job postings and youth
programs. Boys and Girls Club and Job Corps are invited to give presentations at MHS programs
to allow the youth to hear what opportunities are available to them. MHS also provides, as part of
the program, life-skills training opportunities consisting of filling out applications, developing a
resume and mock interviews to practice communication skills and help develop their opportunities
to secure employment.
Exhibit D
Page 34 of 34
• Transition from hospitals to community settings: The need for youth in the program to be
hospitalized for a Mental Health Crisis has been very rare. MHS staff works very hard with youth
and families to keep them stable. In the event hospitalization becomes necessary, MHS will offer
support to the youth and their families to ensure appropriate care and referrals.
COUNTY MHBG FUNDING PLANS
Although many incarcerated individuals may be financially eligible for Medi-Cal, their incarceration
prevents Federal Medicaid payments for their health care because federal law prohibits Federal
Financial Participation (FFP) for services provided to inmates of public institutions. The prohibition
excludes individuals, including incarcerated individuals, who are patients in medical institutions, which,
under regulations, includes individuals who are patients for at least 24 hours in a medical institution not
run by the correctional system (42 USC§ 1396d(a)((29)(A) & 45 CFR § 435.1009). Excluding for when
the use of FFP fund is available for eligible inmates to receive inpatient hospital or nursing home care
off-site, the County plans to continue using the MHBG funds to provide mental health services to
inmates and juveniles during their incarceration. Inmates and juveniles will be eligible for health care
coverage or apply for coverage upon their release.
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
rev 01-02-2018
1
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two -Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three -Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four -Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five -Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
rev 01-02-2018
2
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six -Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture{s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture{s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight -Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine -Stages of Change, Motivation. and Harm Reduction
o Interventions are motivation-based and adapted to the client's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
rev 01-02-2018
3
Exhibit E
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten -Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven -Health and Wellness Promotion, Illness and Harm Prevention. and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
rev 01-02-2018
4
FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEAL TH
MENTAL HEAL TH REQUIREMENTS
Exhibit F
Page 1 of 12
COUNTY's Department of Behavioral Health (DBH) is firmly committed to full
compliance with all applicable laws, regulations, rules and guidelines that apply to the provision and
payment of mental health care services. Any of CONTRACTOR's employees and/or its
subcontractors who provide behavioral health care services to inmates shall comply with the specific
areas of requirements included within this Exhibit F.
CONTRACTOR CODE OF CONDUCT AND ETHICS
The manner in which providers of behavioral health care services conduct themselves
is a vital part of this commitment to the compliance of all applicable requirements. COUNTY's DBH
has established this Contractor Code of Conduct and Ethics with which CONTRACTOR, its
employees, and its subcontractors shall comply. CONTRACTOR shall require any of its employees
and subcontractors who provide mental health care services to attend a compliance training that will
be provided by COUNTY's DBH. After completion of this training, CONTRACTOR's employee(s)
and/or subcontractor(s) must sign the Contractor Acknowledgment and Agreement form and return
this form to the COUNTY's DBH Compliance Officer, or designee.
CONTRACTOR, its employees, and its subcontractors shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing any
behavioral health care service.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the COUNTY and avoid any conduct that
could reasonably be expected to reflect adversely upon the integrity of the COUNTY.
3. Treat COUNTY employees, clients, and other behavioral health providers fairly and with
respect.
4. NOT engage in any activity in violation of the COUNTY's Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline.
Exhibit F
Page 2 of 12
5. Take precautions to ensure that behavioral health service information is prepared and
submitted accurately and timely in the COUNTY's DBH electronic health record (EHR),
"Avatar" and that all documented information is consistent with all applicable laws, regulations,
rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims of any kind are submitted.
7. Submit only eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
8. Act promptly to investigate and correct problems if errors in services submitted are
discovered.
9. Promptly report to the COUNTY's DBH Compliance Officer any suspected violation(s) of this
Code of Conduct and Ethics by COUNTY employees or other behavioral health care
providers, or report any activity that they believe may violate the standards of the COUNTY
Compliance Program, or any other applicable law, regulation, rule or guideline. COUNTY
prohibits retaliation against any person making a report. Any person engaging in any form of
retaliation will be subject to disciplinary or other appropriate action by the COUNTY.
Contractor may report anonymously.
10. Consult with the COUNTY's DBH Compliance Officer if you have any questions or are
uncertain of any COUNTY Compliance Program standard or any other applicable law,
regulation, rule or guideline.
11. Immediately notify the COUNTY Compliance Officer if they become or may become an
"Ineligible Person" and therefore excluded from participation in the Federal Health Care
Programs.
L
Fresno countv Mental Health Compliance Program
Contractor Acknowledgment and Agreement
Exhibit F
Page 3 of 12
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print): _______________ _
Discipline: D Psychiatrist D Psychologist D LCSW D LMFT
Signature: Date: --------------I I
For Group or Organizational Providers
Group/Org. Name (print): ________________ _
Employee Name (print): ________________ _
Discipline: D Psychiatrist D Psychologist D LCSW D LMFT
D Other: -------------------
Job Title (if different from Discipline): ------------
Signature: ______________ _ Date: / /
DOCUMENTATION STANDARDS FOR CLIENT RECORDS
Exhibit F
Page 4 of 12
The documentation standards, as required by the State Department of Health Care Services, are
described below under key topics related to client care. All standards must be addressed in the client
mental health record; however, there is no requirement that the record have a specific document or
section addressing these topics. All medical records shall be maintained for a minimum of ten (10)
years from the date of the end of this Agreement.
A. Assessments
1. The following areas will be included as appropriate as a part of a comprehensive client record.
• Relevant physical health conditions reported by the client will be prominently identified
and updated as appropriate.
• Presenting problems and relevant conditions affecting the client's physical health and
mental health status will be documented, for example: living situation, daily activities, and social
support.
• Documentation will describe client's strengths in achieving client plan goals.
• Special status situations that present a risk to clients or others will be prominently
documented and updated, as appropriate.
• Documentations will include medications that have been prescribed by psychiatrists,
dosage of each medication, dates of initial prescriptions and refills, and documentations of
informed consent for medications.
• Client self-report of allergies and adverse reactions to medications, or lack of known
allergies/sensitivities, will be clearly documented.
• A mental health history will be documented, including: previous treatment dates,
providers, therapeutic interventions and responses, sources of clinical data, applicable family
information, and results of relevant lab tests and consultation reports.
• Documentations will include past and present use of tobacco, alcohol, and caffeine, as
well as illicit, prescribed and over-the-counter drugs.
• A relevant mental status examination will be documented.
• A DSM-5 diagnosis, or a diagnosis from the most current ICD, will be documented,
consistent with the presenting problems, history mental status evaluation and/or other
assessment data.
2. Timeliness/Frequency Standard for Assessment
• An assessment will be completed at intake and updated, as needed, to document
changes in the client's condition.
• Client conditions will be assessed at least annually and, in most cases, at more frequent
intervals.
B. Client Plans
1. Client plans will:
• have specific observable and/or specific quantifiable goals
• identify the proposed type(s) of intervention
• have a proposed duration of intervention(s)
• be signed (or electronic equivalent) by:
o the person providing the service(s), or
o a person representing a team or program providing services, or
Exhibit F
Page 5 of 12
o when the client plan is used to establish that the services are provided under the
direction of an approved category of staff, and if the below staff are not the approved
category,
o a physician
o a licensed/ "waivered" psychologist
o a licensed/ "associate" social worker
o a licensed/ registered/marriage and family therapist or
o a registered nurse
• In addition,
o client plans will be consistent with the diagnosis, and the focus of intervention will be
consistent with the client plan goals, and there will be documentation of the client's
participation in and agreement with the plan. Examples of the documentation
include, but are not limited to: reference to the client's participation and agreement
in the body of the plan, client signature on the plan, or a description of the client's
participation and agreement in progress notes.
o client signature on the plan will be used as the means by which the CONTRACTOR
documents the participation of the client
o when the client's signature is required on the client plan and the client refuses or is
unavailable for signature, the client plan will include a written explanation of the
refusal or unavailability.
• CONTRACTOR will give a copy of the client plan to the client upon request.
2. Timeliness/Frequency of Client Plan:
• Will be updated at least annually
• CONTRACTOR will establish standards for timeliness and frequency for the individual
elements of the client plan described in item 1 above.
C. Progress Notes
1. Items that must be contained in the client record related to the client's progress in treatment
include:
• The client record will provide timely documentation of relevant aspects of client care
• Mental health staff/practitioners will use client records to document client encounters,
including relevant clinical decisions and interventions
• All entries in the client record will include the signature of the person providing the
service (or electronic equivalent); the person's professional degree, licensure or job title; and the
relevant identification number, if applicable
• All entries will include the date services were provided
• The record will be legible
• The client record will document follow-up care, or as appropriate, a discharge summary
2. Timeliness/Frequency of Progress Notes:
Progress notes shall be documented at the frequency by type of service indicated below:
• Every Service Contact
o Mental Health Services
o Medication Support Services
o Crisis Intervention
STATE DEPARTMENT OF HEAL TH CARE -MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
Exhibit F
Page 6 of 12
The COUNTY and its subcontractors shall provide services in accordance with all applicable
Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health Program (directly or
through contract) providing Short-Doyle/Medi-Cal services have met applicable professional
licensure requirements pursuant to Business and Professions and Welfare and Institutions
Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all State of
California and Federal statutes and regulations regarding confidentiality, including but not
limited to confidentiality of information requirements at 42, Code of Federal Regulations
Sections 2.1 et seq; California Welfare and Institutions Code, Sections 14100.2, 11977, 11812,
5328; Division 10.5 and 10.6 of the California Health and Safety Code; Title 22, California Code
of Regulations, Section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil
Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the inmates all
eligibility requirements to receive behavioral health care services as set forth in this
Agreement. No person shall, because of ethnic group identification, age, gender, color,
disability, medical condition, national origin, race, ancestry, marital status, religion,
religious creed, political belief or sexual preference be excluded from participation, be
denied benefits of, or be subject to discrimination under any program or activity receiving
Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal Employment
Opportunity Commission guidelines, which forbids discrimination against any person on
the grounds of race, color, national origin, sex, religion, age, disability status, or sexual
preference in employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates of pay or
other forms of compensation, use of facilities, and other terms and conditions of
employment.
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further funds, until
CONTRACTOR can show clear and convincing evidence to the satisfaction of COUNTY
that funds provided under this Agreement were not used in connection with the alleged
discrimination.
D. Nepotism
Exhibit F
Page 7 of 12
Except by consent of COUNTY's Department of Behavioral Health Director, or designee,
no person shall be employed by CONTRACTOR who is related by blood or marriage to,
or who is a member of the Board of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but not limited to,
laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE:
CONTRACTOR has, unless exempted, complied with the non-discrimination program
requirements. (Gov. Code§ 12990 (a-f) and CCR, Title 2, Section 111 02) (Not applicable to public
entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS:
CONTRACTOR will comply with the requirements of the Drug-Free Workplace Act of 1990
and will provide a drug-free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and specifying actions to be
taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works under the terms and conditions of this Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and,
2) agree to abide by the terms of the company's statement as a condition of employment
under this Agreement.
Failure to comply with these requirements may result in suspension of payments under this
Agreement or termination of this Agreement or both and CONTRACTOR may be ineligible for award of
any future State agreements if the department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing to carry out the
requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION:
CONTRACTOR certifies that no more than one (1) final unappealable finding of contempt of
court by a Federal court has been issued against CONTRACTOR within the immediately preceding two
(2) year period because of CONTRACTOR's failure to comply with an order of a Federal court, which
Exhibit F
Page 8 of 12
orders CONTRACTOR to comply with an order of the National Labor Relations Board. (Pub. Contract
Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50.000 OR MORE-PRO BONO REQUIREMENT:
CONTRACTOR hereby certifies that CONTRACTOR will comply with the requirements of
Section 6072 of the Business and Professions Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the
number of full time attorneys in the firm's offices in the State, with the number of hours prorated on an
actual day basis for any contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for legal
services, and may be taken into account when determining the award of future contracts with the State
for legal services.
5. EXPATRIATE CORPORATIONS:
CONTRACTOR hereby declares that it is not an expatriate corporation or subsidiary of an
expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is
eligible to contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORs contracting for the procurement or laundering of apparel, garments
or corresponding accessories, or the procurement of equipment, materials, or supplies, other than
procurement related to a public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or supplies furnished to the state
pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor,
forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in
sweatshop labor. The CONTRACTOR further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The CONTRACTOR agrees to cooperate fully in providing reasonable access to the
CONTRACTOR's records, documents, agents or employees, or premises if reasonably required by
authorized officials of the contracting agency, the Department of Industrial Relations, or the Department
of Justice to determine the contractor's compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS:
For contracts of $100,000 or more, CONTRACTOR certifies that CONTRACTOR is in
compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY:
For contracts of $100,000 or more, CONTRACTOR certifies that CONTRACTOR is in
compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of California.
1. CONFLICT OF INTEREST:
Exhibit F
Page 9 of 12
CONTRACTOR needs to be aware of the following provisions regarding current or former
state employees. If CONTRACTOR has any questions on the status of any person rendering services
or involved with this Agreement, the awarding agency must be contacted immediately for clarification.
a. Current State Employees (Pub. Contract Code §10410):
1) No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and which is sponsored
or funded by any state agency, unless the employment, activity or enterprise is required as a condition
of regular state employment.
2) No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
b. Former State Employees (Pub. Contract Code §10411):
1) For the two (2) year period from the date he or she left state employment, no former
state officer or employee may enter into a contract in which he or she engaged in any of the
negotiations, transactions, planning, arrangements or any part of the decision-making process relevant
to the contract while employed in any capacity by any state agency.
2) For the twelve (12) month period from the date he or she left state employment, no
former state officer or employee may enter into a contract with any state agency if he or she was
employed by that state agency in a policy-making position in the same general subject area as the
proposed contract within the 12-month period prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for preparatory
time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION:
CONTRACTOR needs to be aware of the provisions which require every employer to be
insured against liability for Worker's Compensation or to undertake self-insurance in accordance with
the provisions, and CONTRACTOR affirms to comply with such provisions before commencing the
performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT:
CONTRACTOR assures the State that it complies with the Americans with Disabilities Act
(ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE:
Exhibit F
Page 10 of 12
An amendment is required to change the CONTRACTOR's name as listed on this
Agreement. Upon receipt of legal documentation of the name change the State will process the
amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the CONTRACTOR is currently qualified to do business in California in
order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory
exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the
franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will determine
whether a corporation is in good standing by calling the Office of the Secretary of State.
6. RESOLUTION:
A county, city, district, or other local public body must provide the State with a copy of a
resolution, order, motion, or ordinance of the local governing body, which by law has authority to enter
into an agreement, authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION:
Under the State laws, the CONTRACTOR shall not be: (1) in violation of any order or
resolution not subject to review promulgated by the State Air Resources Board or an air pollution
control district; (2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3)
finally determined to be in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204:
This form must be completed by all CONTRACTORs that are not another state agency or
other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities:
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of CONTRACTOR or its
subcontractors, and may, at any time, inspect the premises, physical facilities, and equipment where
Medicaid-related activities or work is conducted. The right to audit under this section exists for ten (10)
years from the final date of the contract period or from the date of completion of any audit, whichever is
later.
Exhibit F
Page 11 of 12
Federal database checks. Consistent with the requirements at§ 455.436 of this chapter,
the State must confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or who is an agent or
managing employee of CONTRACTOR through routine checks of Federal databases. This includes
the Social Security Administration's Death Master File, the National Plan and Provider Enumeration
System (NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award Management
(SAM), and any other databases as the State or Secretary may prescribe. These databases must be
consulted upon contracting and no less frequently than monthly thereafter. If the State finds a party
that is excluded, it must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this part is
not located outside of the United States and that no claims paid by a CONTRACTOR to a network
provider, out-of-network provider, subcontractor or financial institution located outside of the U.S. are
considered in the development of actuarially sound capitation rates.
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• An Incident Report shall be completed for all incidents involving inmates receiving behavioral
health care services. The staff person who becomes aware of the incident shall complete this
form, and their supervisor shall co-sign the form.
• When more than one (1) inmate is involved in an incident, a separate form shall be completed for
each inmate.
Where the forms should be sent -within 24 hours from the time of the incident:
• Incident Report should be sent to:
DBH Deputy Director (or designee)
INCIDENT REPORT WORKSHEET
When did this happen? (date/time)
Name/DMH #
-------
1. Background information of the incident:
Where did this happen?
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people involved. (witnesses, visitors, physicians, employees)
Exhibit F
Page 12 of 12
3. Preliminary findings: How did it happen? Sequence of events. Be specific. If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severity: Nonexistent D inconsequential consequential D death D not applicable D unknown D
4. Response: a) corrective action, b) Plan of Action, c) other
Completed by (print name)
Completed by (signature)
Reviewed by Supervisor (print name)
Supervisor Signature
Date completed
Date
Exhibit G
EFFECTIVE DATE: 12-18-89 REVISED: 08-06-90, 12-25-94, 05-06-96, 09-01-99,
12-01-10
APPROVED BY: Sheriff M. Mims BY: Assistant Sheriff T. Gattie
AUTHORITY: California Code of Regulations, Title 15, Section 1029(a)(7)(B) and
Penal Code Section 236.
PURPOSE:
The purpose of this policy is to establish procedures which provide for the resolution of a
hostage-taking incident while preserving the safety of staff, public, inmates, and hostages,
and maintaining facility security.
POLICY:
The Fresno County Sheriff's Office Jail Division maintains a NO HOSTAGE FACILITY and
will not consider bargaining with hostage takers for ANY reason.
It is the policy of the Fresno County Sheriff's Office Jail Division that once any staff
member is taken hostage, they immediately lose their authority and any orders issued by
that person will not be followed regardless of their rank or status.
It is the policy of the Fresno County Sheriff's Office Jail Division that the primary
responsibility of all staff members in a hostage situation is to protect every person involved,
if possible, from serious injury or death.
PROCEDURES:
I. DEFINITION
11.
HOSTAGE SITUATION: any staff member, citizen or inmate held against their will
by another person for the purpose of escape, monetary gain or any reason
which may place an individual in danger of losing life or suffering serious injury.
NOTIFICATIONS, CONTAINMENT AND CONTROL OF THE SITUATION
A. Emergency procedures and notifications shall be implemented as per
Emergency Planning procedures (B-101/FILE: EMERGENCY).
B. The Watch Commander will notify the Patrol Watch Commander and
Page 1 of 4
Exhibit G
apprise them of the incident. The Patrol Watch Commander may be
requested to activate the Crisis Negotiations Team (CNT), outside support
agencies, equipment, personnel, and dispatch a detective to the scene for
the crime report.
Ill. DURING NEGOTIATIONS
A. While at the scene, the CNT members will conduct all verbal or written
communications between the hostage taker(s) and the Incident
Commander. CNT will immediately notify the Incident Commander of any
changes in the following situations:
1 . Hostage status
2. Incident changes and developments
3. Hostage taker demands
4. Any and all pertinent information concerning the incident
B. Staff members at the scene not actively involved with negotiations will not
act or speak out to the hostage taker(s) or hostages.
C. The Tactical Commander will formulate a plan to take the necessary
actions, using the appropriate force, to terminate the hostage situation in the
event negotiations fail. Hostage safety will be of paramount concern.
IV. HOSTAGE SURVIVAL STRATEGIES
A. If taken hostage, it is important to make the transition from being a victim to
being a survivor. The following are not strict rules that must be rigidly
followed, but rather general guidelines. There will always be exceptions.
1. Regain/maintain composure. Try to be calm, focused and clear-headed
at all times. Do not stand out from other hostages. Drawing
unnecessary attention increases the chance of being singled out and
victimized.
2. Maintain a low-key, unprovocative posture. Overt resistance is usually
counterproductive in a hostage situation.
a. Remain calm and follow instructions. Comply with the hostage
takers when at all possible.
b. Be stoic. Maintain an outward face of acceptance of adversity with
Page 2 of 4
Exhibit G
dignity. Avoid open displays of cowardice and fear. Inmates will
view frailty and feebleness as weakness, which may lead to
victimization.
c. Do not antagonize, threaten or aggravate the hostage takers. Avoid
saying "no", or arguing with the hostage takers. Do not act
authoritative. The hostage takers must make it known that they are
in charge.
d. Eye contact may be regarded as a challenge; make eye contact with
the hostage takers sparingly.
e. Fight off basic instincts, such as anger and hostility. Be polite and
remain alert. Speak normally and don't complain.
3. Hostages should try to establish a level of rapport or communication
with their captors in attempt to get the captors to recognize them as
human beings.
a. Find a mutual ground, an association with the hostage takers.
Foster communication on non-threatening topics (e.g., family,
hobbies, sports, interests).
b. Use the captors' first names, if known. However, if hostage takers
are attempting to conceal their identity, do not give any indication
that they are recognized.
c. Listen actively to the captors' feelings and concerns, but never
praise, participate in, or debate their "cause". If they want to talk
about their cause, act interested in their viewpoints. Avoid being
overly solicitous, which may be viewed as patronizing or insincere.
d. Do not befriend the inmates; such an attempt will likely result in
exploitation.
e. Try asking for items that will increase personal comfort. Make
requests in a reasonable, low-key manner.
4. Be prepared to be isolated and disoriented.
a. Do not talk to other hostages. The hostage takers may think a plot
is being formed.
b. Develop mind games to stimulate thinking and maintain mental
alertness.
5. Be tolerant of fellow hostages. Just as each person has different
reactions to stress, each individual will have different methods of coping
as a hostage. Some methods are not effective and may endanger the
Page 3 of 4
Exhibit G
group, or be annoying to other hostages (e.g., constant talking). Try to
help these people cope in other ways.
6. Gather intelligence. Hostages should take in and store as much detail,
about their captors as possible without drawing attention to their
efforts. Make mental notes and attempt to gather the following
information: identification of the ring leader, the number of hostage
takers, the type of weapons they are using, their tactics, location within
the area, etc.
7. Maintain hope. Depending on the circumstances, resolution of hostage
situations can be a lengthy process.
B. Stay away from doors and windows through which rescue teams may enter
or shoot. If a rescue is attempted, drop to the floor and keep hands in view.
C. If there is a chance to escape, the hostage should be certain of their
success.
1. Balance the likely payoff of any behavior with the possible
consequences. Hostage takers may use violence or death to teach a
lesson.
2. Realize that Central Control will not open any doors for anyone.
D. Hostages should be aware of the "Stockholm Syndrome", whereby hostages
begin to show sympathy toward their captors. Hostages who develop
Stockholm Syndrome often view the captor as giving life by simply not
taking it. Such hostages often misinterpret a lack of abuse as kindness and
may develop feelings of appreciation for the perceived benevolence.
Page 4 of 4
Name:
FRESNO COUNTY SHERIFF-CORONER'S OFFICE
JAIL DIVISION
APPLICATION FOR FACILITY ACCESS TO
THE FRESNO COUNTY DETENTION FACILITIES
Agency/Firm/Organization Represented:
Agency/Firm/Organization Address:
Agency/Firm/Organization Telephone:
Immediate Supervisor: --------------------------
Your Job Title:
Exhibit H
For Office Use Only
JAIL PASS
ISSUED D
DID NOT ISSUE D
Processed by: __ _
Initials
------------------------------
Reason requesting authorization for Jail Clearance: (Interviews, Assessments, Lead Groups/ Classes, Volunteer, etc.)
After completing this form and the attached "Personal History Statement," immediately have your fingerprints
taken at the Main Jail Fingerprints Room, located on the first floor of the Main Jail Detention Facility at 1225 "M"
Street.
The review of clearance for approval will take place after fingerprints are researched in Sacramento for any
criminal history. Notification will be made when the review is complete.
Temporary clearances are not granted.
Revised 04/16
Exhibit H
Instructions to the Applicant
• The information provided in this Personal History Statement (PHS) will be used in the background investigation to
determine suitability for clearance to enter the Fresno County Sheriff-Coroner's Office Detention Facilities.
• Fill out the form completely and accurately.
• Type or legibly print (in ink) all required information.
• If a question does not apply, enter N/A (not applicable) in the space provided for your response.
• If more space is needed for responses, attach additional pages and identify the information by the question number.
Accurate and Full Disclosure
Keep in mind that:
1. The completion of a Personal History Statement is mandatory.
2. All statements are subject to verification.
3. Inaccuracies or incomplete statements may bar or remove you from consideration for clearance.
4. All required time periods in your background must be accounted for.
5. Attach copies of any required certificates, letters, transcripts, etc. as proof that you meet requirements for the
position/clearance level applying for.
6. If self-employed as an interpreter, please attach a copy of your business license.
7. If employed by a law firm or social services agency, attach a letter from your immediate supervisor, on appropriate
letterhead, verifying full-time employment and credentials.
8. If licensed, attach a photocopy of your license and/or credentials.
9. If representing a court approved program, provide a letter of verification from the Courts and the District Attorney's
Office.
10. If applying as a Volunteer with Religious Programs, Alcoholics Anonymous, or Narcotics Anonymous, provide a
letter of recommendation from the agency you are representing.
It is to your advantage to respond openly. All factors in your background will be evaluated in terms of the circumstances
and facts surrounding their occurrence, and their degree of relevance. For example, having an arrest record is not in itself
grounds for disqualification. During the investigation, the investigator will inquire into the facts surrounding such an
occurrence. An evaluation will then be made of the relevance of these facts to the requirements for clearance.
Disclosure of Arrests and Convictions
As an applicant, you are required to disclose any of the following which occurred on or after your 181
h birthday (even if the
records are sealed):
1. All arrests, whether they result in a conviction or not.
2. All convictions.
3. All diversion programs, whether completed or not (unless medically related).
Revised 04/16
1 YOUR FULL NAME
LAST
SECTION 1: PERSONAL
FIRST
2 OTHER NAMES, INCLUDING NICKNAMES, YOU HAVE USED OR BEEN KNOWN BY
3 ADDRESS WHERE YOU RESIDE
STREET
CITY
4 MAILING ADDRESS. IF DIFFERENT FROM RESIDENCE
5 CONTACT NUMBERS
HOME (
6 EMAIL ADDRESS
HOME
WORK ( EXT OTHER (
BUSINESS
7 BIRTHDATE 8. SOCIAL SECURITY NUMBER 9. DRIVER'S LICENSE
10. PHYSICAL DESCRIPTION
HEIGHT
A) NAME
RELATIONSHIP
WEIGHT LBS
ISTREET
HAIR COLOR EYE COLOR
SECTION 2: EMERGENCY NOTIFICATION
!HOME
I (
·········r-"-··--··-
!WORK
MIDDLE
APT/UNIT
STATE ZIP
D CELL D FAX D PAGER
10. PLACE OF BIRTH
SEX M D FD
; --·· .. --··--···-····-·-·-··-·-·-·-·--· J ( ____ _). ---------·---·-.. ·-·--·-·----.. -.... -·-....................................... --·--·-·--
!STATE ZIP
!HOME
-----__ I( ____ )
B) NAME
' ······----····-·-·-········-·-·········-------= -······-·····-·-·
RELATIONSHIP !CITY !WORK
I ____ _ ---------... ----------------IL __
!STATE ZIP jEXT
C) DOCTOR/MEDICAL SERVICES STREET HOME
I ) -\ -------·-······-·-·-···
CITY WORK
( ) -
EXT
STATE ZIP
SECTION 3: Certification/License
11
D I possess a certificate or license from the following institution:
Revised 04/16
SECTION 4: LEGAL
12. HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF ANY MISDEMEANOR OR FELONY OFFENSE IN THIS OR ANY OTHER STATE OR COUNTRY?
0 YES ONO IF YES, LIST ALL OFFENSES, INCLUDING THOSE PUNISHABLE UNDER THE UNIFORM CODE OF MILITARY JUSTICE
ARRESTS / CONVICTIONS
A APPROX DATE LAW ENFORCEMENT AGENCY
·---·-··---·-···-·-······-····-·---.. --------··-······· -·········-····-·······-·-----···· .... 1 ........ -... ·····-·····-···-··-···························-·····-······-······--··-····-·----.. ··················---···-·························-·-··-·····-··-···-····--·---················--·-···----------·········-··------·-·---··-·--·-················-·········-··-······-
EXPLAIN CIRCUMSTANCES
B APPROX DATE LAW ENFORCEMENT AGENCY
EXPLAIN CIRCUMSTANCES
C APPROX DATE LAW ENFORCEMENT AGENCY
EXPLAIN CIRCUMSTANCES
D APPROX DATE LAW ENFORCEMENT AGENCY
EXPLAIN CIRCUMSTANCES
13 Have you ever been placed on court probation as an adult?
0 YES ONO IF YES, EXPLAIN THE CIRCUMSTANCES AND INCLUDE WHEN, WHERE AND WHY.
14 Have you ever been denied access to any other detention facilities?
0 YES ONO IF YES, EXPLAIN THE CIRCUMSTANCES AND INCLUDE WHEN, WHERE AND WHY.
·········-·············-····· ········-· ·················-·---··--···························-···-· .. ·--·-····· -•
Revised 04/16
FRESNO COUNTY SHERIFF-CORONER'S OFFICE
No Hostage Acknowledgment
You are requesting permission to enter a no hostage facility. It is the policy of the Fresno
County Sheriff-Coroner's Office that employees will not recognize hostages for bargaining
purposes or permit inmates or others to use hostages to escape from custody. This policy will
be applied in all cases without regard to the sex, age, or employment status of any hostage.
It is the policy of the Fresno County Sheriff-Coroner's Office that all persons entering this facility
may be subject to search.
The undersigned acknowledges that working or performing any activities within the Fresno
County Sheriff-Coroner's Jail facilities can be dangerous. The dangers include the risk of
personal injury and the damage to personal property. It is understood that the Fresno County
Sheriff-Coroner's Office maintains a NO HOSTAGE FACILITY.
SECTION 5. Applicant Signature
I hereby certify that I have read and understand all rules and statements contained in this application and that I
personally completed each page of this form and any supplemental page(s) I have attached, and that all statements
made on each and every page are true and complete to the best of my knowledge and belief. I understand that any
misstatement of material fact may subject me to disqualification, or, if I have been appointed, may disqualify me from
attaining clearance.
SIGNATURE IN FULL DATE
Revised 04/16
****************** FOR OFFICIAL USE ONLY******************
Fingerprints taken: -------------------
Date Initials Comp ID#
Warrant/Offendertrak/NAMS Check: Active Negative __
Professional License: Verified
Expires:-------------
Active
Date
Date
Initials
SERGEANT'S REVIEW
Approved: Yes __
Contact Level: Red __
Expiration Date:
No __
Yellow __ Green __ White __
Initials Comp ID#
Comp ID#
Orange __ Blue
Signature:----------------------------Date: ________ _
LIEUTENANT'S REVIEW
Approved: Yes No __
Signature:----------------------------Date: ________ _
Individual Received Pass ----------------------------------
Clearance Revoked: ---------Reason: -----------------------
Revised 04/16
FRESNO COUNTY Sheriff-Coroner's OFFICE
JAIL DIVISION
DETENTION FACILITIES IDENTIFICATION CARD
You have received a Jail identification card that will allow you to enter the Fresno County Detention
Facilities. Your ID card has been issued with an expiration date (located beneath your photo). It is each
individual's responsibility to renew their ID card prior to the expiration date. The Sheriffs Office will not
issue a reminder.
If your badge expires prior to renewal, you will need to reapply and could be required to pay a fee to be
re-fingerprinted.
If your ID card is lost, stolen or misplaced, it is your responsibility to report the loss to both the Sheriff's
Office and your employer. IMMEDIATELY call and notify the Jail Pass Coordinator at (559) 600-8241.
In order to facilitate replacement of an ID card, you will need to submit the following:
• A letter addressed to the Jail Operations Bureau Commander explaining the circumstances of the
loss, and if applicable, the steps you will take to prevent reoccurrence.
• A letter from your employer requesting replacement of the ID card (to include the telephone
number and signature of your supervisor).
Without these documents, the ID card will not be reissued.
If you separate employment from your current employer, you are required to return your ID card within ten
(10) business days to:
Ida Chapa
Fresno County Sheriff's Office
Jail Operations Bureau
1225 "M" Street
Fresno, CA 93721
The ID card is the property of the Fresno County Sheriffs Office. If you fail to return your ID card, it could
prohibit you from being able to receive another ID card in the future.
Identification cards are not to be altered in any way.
I have read and understand the above conditions associated with maintaining a Fresno County Detention
Facility ID card. I agree to comply with the conditions as set forth herein.
Printed Name
1gna ure Date
Witnessed by
Ida Chapa-(559) 600-8241 2955
Computer Number
Revised 04/16
NEW BADGE REQUEST:
You will need the following:
1) Live scan/Fingerprints: Fee for Live scan: $52
(Cash or Company/Cashier's Check or Money Order)
(Made payable to: Fresno County Sheriff)
2) Completed Application for Facility Access
3) Letter from Supervisor or Department Head (letter's need to indicate that the
'employee works for your department/business' for the specific purpose stated. Also the
following sentences must also be added to every letter:
We are aware and understand that (specify company name here) and
(Specify full employee name here) are both responsible for the return of the
jail pass to the Sheriff's Department upon separation of employment.
4) Copy of your professional license w/ expiration date (when applicable)
Fingerprinting location and hours: Main Jail: 1225 "M" Street, Fresno, CA 93721
(corner of Fresno Street and M Street) hours Monday thru Friday 7am to 2:00pm NO
APPIONTMENT NEEDED.
After fingerprinting, this process may take days or up to several months. I will contact you,
for an appointment to have your photo taken when your request has been approved.
Faxed copies will not be accepted.
Please make sure to fill out every question on this application. If you have no answer
for a question please indicate so with N/A so that we know you acknowledge that
question. Thank you.
NEW BADGE REQUEST:
You will need the following:
1) Fingerprints: (Fingerprint Authorization form)
Revised 04/16
2) Completed Application for Facility Access
3} Letter from Supervisor or Department Head (letter's need to indicate that the
'employee works for your department/business' for the specific purpose stated. Also the
following sentences must also be added to every letter:
We are aware and understand that (specify company name here) and
(Specify full employee name here) are both responsible for the return of the
jail pass to the Sheriff's Department upon separation of employment.
Fingerprinting location and hours: Main Jail: 1225 "M" Street, Fresno, CA 93721
(corner of Fresno Street and M Street) hours Monday thru Friday 7am to 2:00pm NO
APPIONTMENT NEEDED.
After fingerprinting, this process may take days or up to several months. I will contact you,
for an appointment to have your photo taken when your request has been approved.
Faxed copies will not be accepted.
Please make sure to fill out every question on this application. If you have no answer
for a question please indicate so with N/A so that we know you acknowledge that
question. Thank you.
BADGE RENEWAL REQUEST:
The following will be needed:
1) Completed Application for Renewal Access
2} Letter from Supervisor or Department Head requesting a renewal be issued (letter's
need to indicate that the 'employee works for your department/business' for the
specific purpose stated. Also the following sentences must also be added to every
letter:
We are aware and understand that (specify company name here) and
(Specify full employee name here) are both responsible for the return of the
jail pass to the Sheriff's Department upon separation of employment.
3) Copy of your professional license w/ expiration date (when applicable)
They will need to call (600-8241) or email (lda.Chapa@fresnosheriff.org to make an
appointment at least 1 month or so BEFORE they expire. Appointments are done Monday
Revised 04/16
thru Friday between 7:00am to 2:00pm. JAIL PASS RENEWALS WILL NOT BE DONE
WITHOUT A LETTER OR EXPIRING JAIL PASS
Please make sure to fill out every question on this application. If you have no answer
for a question please indicate so with N/A so that we know you acknowledge that
question. Thank you.
BADGE RENEWAL REQUEST:
The following will be needed:
1) Completed Application for Renewal Access
2} Copy of your Professional license w/ expiration date
They will need to call (600-8241) or email (lda.Chapa@fresnosheriff.org to make an
appointment at least 1 month or so BEFORE they expire. Appointments are done Monday
thru Friday between 7:00am to 2:00pm. JAIL PASS RENEWALS WILL NOT BE DONE
WITHOUT A LETTER OR EXPIRING JAIL PASS
Please make sure to fill out every question on this application. If you have no answer
for a question please indicate so with N/A so that we know you acknowledge that
question. Thank you.
EXPIRED BADGE:
Will need:
l} Completed Application for Renewal Access
2) Letter from Supervisor or Department Head requesting a renewal be issued (letter's
need to indicate that the 'employee works for your department/business' for the
specific purpose stated. Also the following sentences must also be added to every
letter:
We are aware and understand that (specify company name here) and
(Specify full employee name here) are both responsible for the return of the
jail pass to the Sheriff's Department upon separation of employment.
Revised 04/16
3) Copy of your professional license w/ expiration date (when applicable)
All paper work will need to be turned in to Ida Chapa (Monday thru Friday between 7am
and 2pm) along with their expired jail pass. They will be without their jail pass until they are
re-approved. Once they are re-approved they will be notified by either phone call or email
to let them know to set an appointment for their photo. FAXED COPIES WILL NOT BE
ACCEPTED.
Please make sure to fill out every question on this application. If you have no answer for a
question please indicate so with N/A.
**No arrest with in the last 2 years please indicates so with NIA. Thank you.
Revised 04/16
Exhibit I
Fresno County Sheriff's Office
Jail Division Policies and Procedures
Addendum D-360E2 Policy Acknowledgement -Contractor
FRESNO COUNTY SHERIFF'S OFFICE
POLICY ACKNOWLEDGEMENT
#D-360 -SEXUAL MISCONDUCT AND ABUSE
As part of the National Standards to Prevent, Detect, and Respond to Prison Rape, the Sheriff's
Office is required to ensure that all employees, contractors, and volunteers who have contact
with inmates are aware of their responsibilities under the Sheriff's Office sexual abuse
prevention, detection, and response policy and procedure.
ZERO-TOLERANCE
The Fresno County Sheriff's Office maintains a ZERO-TOLERANCE policy regarding sexual
abuse and sexual harassment. Not only does this include inmate-on-inmate sexual assault, but
also sexual abuse, sexual misconduct, and sexual harassment of an inmate by a staff member,
contractor, or volunteer. Definitions of each are provided under Section II of the policy.
SEXUAL ABUSE -IMMEDIATE RESPONSE
If the inmate was sexually abused within a time period that still allows for the collection of
physical evidence, request that the victim not take any actions that could destroy the evidence
(e.g., showering, brushing teeth, changing clothes, using the restroom, eating, drinking), and
then immediately notify correctional staff.
REPORTING ALLEGATIONS
An inmate may report sexual abuse* to any employee, volunteer, or contractor. If the inmate
reports the sexual abuse to you, you are required to immediately notify your supervisor and
report the information to the on-duty Jail Watch Commander (600-8440).
*Inmates may report any aspect of sexual abuse, sexual misconduct, and sexual harassment; retaliation by other inmates or
staff for reporting sexual abuse and sexual harassment; and staff neglect or violation of responsibilities that may have
contributed to an incident of sexual abuse.
Any allegation is a very serious situation and shall be treated with discretion and confidentiality.
Apart from reporting to your supervisor and the Jail Watch Commander, do not reveal any
information related to the sexual abuse to anyone other than those who "need to know" (i.e.,
those who need to make treatment, investigation, and other security and management
decisions).
SENSITIVITY
Victims of sexual abuse may be seriously traumatized both physically and mentally. You are
expected to be sensitive to the inmate during your interactions with him/her.
SEXUAL DISORDERLY CONDUCT
By choosing to work in a jail environment, you have accepted the possibility that you may face
inappropriate and socially deviant behavior. While it is not possible to stop all obscene
comments and conduct by inmates, neither shall it be accepted; acts of indecent exposure,
sexual disorderly conduct and exhibitionist masturbation will not be tolerated. Any inmate who
engages in indecent exposure or sexual disorderly conduct shall be reported immediately to
correctional staff, with a follow-up advisement to your supervisor.
Sexually hostile conduct shall not be ignored.
If you have any questions, please contact--------------------
Please sign and return the attached Policy Acknowledgement form to your supervisor.
NO: D-360E2 Page 1 of 2
Rev. 03/15
Exhibit I
Fresno County Sheriffs Office
Jail Division Policies and Procedures
Addendum D-360E2 Policy Acknowledgement -Contractor
FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION
POLICY ACKNOWLEDGEMENT
#D-360 -SEXUAL MISCONDUCT AND ABUSE
I hereby acknowledge that I received a copy of the Sexual Misconduct and Abuse policy for the
Jail Division of the Fresno County Sheriff's Office and that I have read it, understand its
meaning, and agree to conduct myself in accordance with it.
Signed: ____________________ _ Date: _________ _
Print Name: --------------------------------
Name of Employer: ____________________________ _
Name of Supervisor: ___________________________ _
NO: D-360E2 Page 2 of 2
Correctional Health
Org # Assigned Div/ Prog/ Agency
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
1 of 12
Asset
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Other Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Office Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Appliance
Appliance
Jail Active -In Inventory
Inv# FR/GR# Description
5382 Large Metal Shelving Unit
5383 Large Metal Shelving Unit
5376 Large Metal Shelving Unit
5377 Large Metal Shelving Unit
5381 Large Metal Shelving Unit
5373 Large Metal Shelving Unit
5374 Large Metal Shelving Unit
5378 Large Metal Shelving Unit
5379 Large Metal Shelving Unit
5380 Large Metal Shelving Unit
5375 Large Metal Shelving Unit
4999 Dental Tool Tray (Chair
Attachment)
5079 Reichert Scientific 150
Dual Optical Microscope
5086 Oxygen Cart
5446 Fellows Shredder
4996 Amalgamator
4997 Pelton & Crane Dental
Exam Chair w/Water
Reservoir
5022 Peri Pro Transport
Cleaninq Kit
5023 Source-Ray Inc SR-130
Rollinq X-Rav Stand
5028 Welch Allyn Suretemp
5033 X-Ray Viewer/Light Box
5034 Haines Refreigerator lXl
5035 Haines Refrigerator
18"X18"
Exhibit J
Model# Serial# Room# Location Status Own/Rent
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Medical South Jail In Inventory Own
Storaqe Area Dunqeon
Dental Exam Main Jail 2nd Active Own
Room #1 Floor
BD306144 OHU Medical Main Jail 2nd Active Own
Supplu Closet Floor
Oxygen Closet Main Jail 2nd Active Own
Floor
Secretary Main Jail 2nd Active Own
Office Floor
Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
2479601 Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
Dispensary Main Jail 2nd In Inventory Own
Floor
Dispensary Main Jail 2nd In Inventory Own
Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
2 of 12
Lab/Medical 5006
Eauioment
Lab/Medical 5007
Eauioment
Lab/Medical 5009
Eauioment
Lab/Medical 5040
Eauioment
Lab/Medical 5042
Eauioment
Appliance 5043
Lab/Medical 5003
Eauioment
Lab/Medical 5004
Eauioment
Lab/Medical 5005
Eauioment
Lab/Medical 5054
Eauioment
Lab/Medical 5055
Eauioment
Lab/Medical 5058
Eauioment
Lab/Medical 5010
Eauioment
Lab/Medical 5011
Eauioment
Lab/Medical 5021
Eauioment
Lab/Medical 5062
Eauioment
Lab/Medical 5064
Eauioment
Lab/Medical 5065
Eauioment
Lab/Medical 5030
Eauioment
Lab/Medical 5031
Eauioment
Lab/Medical 5032
Eauioment
Lab/Medical 5069
Eauioment
Lab/Medical 5070
Eauioment
Lab/Medical 5071
Eauioment
Lab/Medical 5036
Eauioment
Jail Active -In Inventory
Delta Autoclave
Steris Amsco Eagle
Autoclave
Pelton & Crane Dental
Chair
Horizon Autoclave
DeVilbiss Pulmomate
Nebulizer
Kenmore
Refrigerator/Freezer 14
X-Ray Viewer/Light Box
So nix IV Ultrasonic
Sterilizer
X-Ray Viewer/Light Box
Elite Vascular Ultrasound
Exam Lamp
Welch Allyn Eye
Soectrometer and Liaht
Dentist Chair
Various Dental Tools
( Autoclavable)
Exam Table
Laerdal LCSU Compact
Suction Unit
Mayo Stand
Mayo Stand
Welch Allyn Suretemp
Welch Allyn Suretemp Plus
Welch Allyn Suretemp
Probe Attachment
Oxygen Cart
Concor Oxygen Regulator
Oxygen Tank Stand
Narcotic Box lXl
Dental Office
Dental Office
Dental Office
Laboratory
Laboratory
Laboratory
Dental Exam
Room #1
Dental Exam
Room #2
Dental Exam
Room #2
OHU Exam
Room
OHU Exam
Room
OHU Exam
Room
Dental Office
Dental Office
Dental X-Ray
Room
OHU Exam
Room
OHU Exam
Room
OHU Exam
Room
2895254 Dental X-Ray
Room
2895251 Dental X-Ray
Room
Dental X-Ray
Room
OHU Exam
Room
OHU Exam
Room
OHU Exam
Room
Dispensary
Exhibit J
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
3 of 12
------------
Appliance
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Eauipment
Jail Active -In Inventory
5037 Kenmore
Refrigerator/Freezer 14
5039 X-Ray Viewer/Light Box
5078 Wheelchair
5081 Detecto Weight Scale
5082 Exam Lamp
5045 Autoclave
5046 Spencer Microscope
5052 Doctor Stool
5088 Oxygen Regulator
5089 Oxygen Regulator
5090 Oxygen Tank Stand
5059 First Aid Bag, BP Cuff,
Stethoscope
5060 First Aid Bag, BP Cuff,
StehoscoPe
5061 Floor Health-0-Meter
Scale
5094 Concor Oxygen Regulator
5095 Welch Allyn Suretemp
Probe Attachement
5096 Welch Allyn Suretemp
Probe Attachment
5066 Neck Stabilizer Collar
5067 Oxygen Canister
5068 Oxygen Canister
5102 Narcotic Box lXl
5103 Narcotic Box lXl
5104 Narcotic Box lXl
5072 Precision Xtra Diabetic
Meter
5073 Privacy Curtain
Exhibit J
Dispensary Main Jail 2nd In Inventory Own
Floor
Head Nurse Main Jail 2nd In Inventory Own
Office Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Closet Floor
Medical Main Jail 2nd In Inventory Own
Director Office Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
2367426 Oxygen Closet Main Jail 2nd In Inventory Own
Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
Utility Room Main Jail 2nd In Inventory Own
Floor
Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
Dental X-Ray Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
Dispensary Main Jail 2nd In Inventory Own
Floor
Dispensary Main Jail 2nd In Inventory Own
Floor
Dispensary Main Jail 2nd In Inventory Own
Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
I
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
4of 12
Appliance 5075
Lab/Medical 5108
Eauioment
Lab/Medical 5109
Eauioment
Lab/Medical 5111
Eauioment
Lab/Medical 5083
Eauioment
Lab/Medical 5085
Eauioment
Lab/Medical 5087
Eauioment
Lab/Medical 5115
Eauioment
Lab/Medical 5116
Eauioment
Lab/Medical 5117
Eauioment
Lab/Medical 5091
Eauioment
Lab/Medical 5092
Eauioment
Lab/Medical 5093
Eauioment
Lab/Medical 5121
Eauioment
Lab/Medical 5122
Eauioment
Lab/Medical 5124
Eauioment
Lab/Medical 5097
Eauioment
Lab/Medical 5100
Eauioment
Lab/Medical 5101
Eauioment
Lab/Medical 5128
Eauioment
Lab/Medical 5129
Eauioment
Lab/Medical 5131
Eauioment
Lab/Medical 5105
Eauioment
Lab/Medical 5106
Eauioment
Lab/Medical 5107
Eauioment
Lab/Medical 5155
Eauioment
Jail Active -In Inventory
Kenmore
Refrigerator/Freezer 16
Narcotic Box lXl
Narcotic Box lXl
Horizon Autoclave
First Aid Bag, BP Cuff,
Stethoscope
Oxygen Cart
Oxygen Cart
Horizon Autoclave
Horizon Autoclave
Horizon Autoclave
Single Cylinder Oxygen
Cart
Wheelchair
Stryker Cast Saw
DeVilbiss Pulmomate
Nebulizer
DeVilbiss Pulmomate
Nebulizer
Precision Xtra Diabetic
Meter
Welch Allyn Suretemp
Probe Attachment
Narcotic Box lXl
Narcotic Box lXl
Privacy Curtain
Privacy Curtain
Oxygen Cart
Narcotic Box lXl
Narcotic Box lXl
Narcotic Box lXl
Victor Oxygen Regulator
OHU Exam
Room
Dispensary
Dispensary
Laboratory
Oxygen Closet
Oxygen Closet
Oxygen Closet
Laboratory
Laboratory
Laboratory
Oxygen Closet
Oxygen Closet
Utility Room
Laboratory
4650D Laboratory
OHU Exam
Room
Dental X-Ray
Room
Dispensary
Dispensary
OHU Exam
Room
OHU Exam
Room
Oxygen Closet
Dispensary
Dispensary
Dispensary
Utility Room
Exhibit J
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
5 of 12
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Lab/Medical
Eauioment
Jail Active -In Inventory
5156 Victor Oxygen Regulator
5157 Victor Oxygen Regulator
5112 Horizon Autoclave
5113 Horizon Autoclave
5114 Horizon Autoclave
5163 GE Wall Mount X-Ray
Holder
5164 Gendex Dental X-Ray
Machine
5166 Medical Scissors
5118 Horizon Autoclave
5119 Horizon Autoclave
5120 Moore Medical Blood
Pressure Gauae
5170 Welch Allyn 3.5v Locking
Collar
5171 Welch Allyn 3.5v Locking
Collar
5172 Welch Allyn 3.5v Locking
Collar
5125 Precision Xtra Diabetic
Meter
5126 Precision Xtra Diabetic
Meter
5127 Privacy Curtain
5176 Welch Allyn 3.5v Locking
Collar
5177 Welch Allyn 3.5v Locking
Collar
5178 Welch Allyn 3.5v Locking
Collar
5132 Oxygen Cart
5133 Oxygen Regulator
5134 Single Cylinder Oxygen
Cart
5182 Welch Allyn 3.5v Locking
Collar
5183 Welch Allyn 3.5v Locking
Collar
5184 Welch Allyn 3.5v Locking
Collar
Exhibit J
Utility Room Main Jail 2nd In Inventory Own
Floor
Utility Room Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
X-Ray Room Main Jail 2nd In Inventory Own
Floor
X-Ray Room Main Jail 2nd In Inventory Own
Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
Laboratory Main Jail 2nd In Inventory Own
Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
76700 X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
OHU Exam Main Jail 2nd In Inventory Own
Room Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
Oxygen Closet Main Jail 2nd In Inventory Own
Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
6 of 12
----
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Equipment
Lab/Medical
Eouioment
Jail Active -In Inventory
5158 Victor Oxygen Regulator
5159 Victor Oxygen Regulator
5160 Victor Oxygen Regulator
5188 Welch Allyn 3.5v Locking
Collar
5189 Welch Allyn 3.5v Locking
Collar
5190 Welch Allyn 3.5v Locking
Collar
5167 Miltex Dermal Punch Set
5168 Handheld Oxinet System
5169 Welch Allyn 3.5v Locking
Collar
5194 Welch Allyn 3.5v Locking
Collar
5195 Welch Allyn 3.5v Locking
Collar
5196 Welch Allyn 3.5 Locking
Collar
5173 Welch Allyn 3.5v Locking
Collar
5174 Welch Allyn 3.5v Locking
Collar
5175 Welch Allyn 3.5v Locking
Collar
5203 Welch Allyn 3.5v Rechg
Handle
5204 Welch Allyn 3.5v Rechg
Handle
5205 Welch Allyn 3.5v Rechg
Handle
5179 Welch Allyn 3.5v Locking
Collar
5180 Welch Allyn 3.5v Locking
Collar
5181 Welch Allyn 3.5v Locking
Collar
5209 Welch Allyn 3.5v Rechg
Handle
5210 Welch Allyn 3.5v Rechg
Handle
5211 Welch Allyn Suretemp
5185 Welch Allyn 3.5v Locking
Collar
5186 Welch Allyn 3.5v Locking
Collar
Exhibit J
Utility Room Main Jail 2nd In Inventory Own
Floor
Utility Room Main Jail 2nd In Inventory Own
Floor
Utility Room Main Jail 2nd In Inventory Own
Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
3399122 X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
7 of 12
Lab/Medical 5187
Equipment
Lab/Medical 5197
Equipment
Lab/Medical 5201
Equipment
Lab/Medical 5202
Equipment
Lab/Medical 5191
Equipment
Lab/Medical 5192
Equipment
Lab/Medical 5193
Equipment
Office Equipment 5392
Office Equipment 5397
Lab/Medical 5212
Equipment
Lab/Medical 5206
Equipment
Lab/Medical 5207
Equipment
Lab/Medical 5208
Equipment
Other Equipment 5414
Office Equipment 5399
Other Equipment 5404
Other Equipment 5405
Other Equipment 5406
Appliance 5387
Other Equipment 5418
Other Equipment 5419
Other Equipment 5420
Other Equipment 5407
Office Equipment 5412
Other Equipment 5413
Other Equipment 5424
Exhibit J
Jail Active -In Inventory
Welch Allyn 3.5v Locking X-Ray Room-Main Jail 2nd In Inventory Own
Collar Cabinet Floor
Welch Allyn 3.5v Locking 76700 X-Ray Room-Main Jail 2nd In Inventory Own
Collar Cabinet Floor
Welch Allyn 3.5v Rechg X-Ray Room-Main Jail 2nd In Inventory Own
Handle Cabinet Floor
Welch Allyn 3.5v Rechg X-Ray Room-Main Jail 2nd In Inventory Own
Handle Cabinet Floor
Welch Allyn 3.5v Locking X-Ray Room-Main Jail 2nd In Inventory Own
Collar Cabinet Floor
Welch Allyn 3.5v Locking X-Ray Room-Main Jail 2nd In Inventory Own
Collar Cabinet Floor
Welch Allyn 3.5v Locking X-Ray Room-Main Jail 2nd In Inventory Own
Collar Cabinet Floor
Desk Chair Dental Office Main Jail 2nd In Inventory Own
Floor
Electric Pencil Sharpener Dispensary Main Jail 2nd In Inventory Own
Floor
Welch Allyn Thermoscan X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
Welch Allyn 3.5v Rechg X-Ray Room-Main Jail 2nd In Inventory Own
Handle Cabinet Floor
Welch Allyn 3.5v Rechg X-Ray Room-Main Jail 2nd In Inventory Own
Handle Cabinet Floor
Welch Allyn 3.5v Rechg X-Ray Room-Main Jail 2nd In Inventory Own
Handle Cabinet Floor
Cubical Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Locking Cabinet 5 Drawer Head Nurse Main Jail 2nd In Inventory Own
Office Floor
6 Shelf Shelving Unit Main Medical Main Jail 2nd In Inventory Own
Supply Closet Floor
6 Shelf Shelving Unit Main Medical Main Jail 2nd In Inventory Own
Supply Closet Floor
6 Shelf Shelving Unit Main Medical Main Jail 2nd In Inventory Own
Supply Closet Floor
Frigidaire Gallery Break Room Main Jail 2nd In Inventory Own
Refriqerator/Freezer Floor
Cubical Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Cubical Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Cubical Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
6 Shelf Shelving Unit Main Medical Main Jail 2nd In Inventory Own
Supply Closet Floor
Fellows Shredder Medical Main Jail 2nd In Inventory Own
Director Office Floor
Cubical Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Cubical Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
! -----------
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
8 of 12
Other Equipment 5425
Other Equipment 5426
Other Equipment 5415
Electronics 5402
Other Equipment 5403
Other Equipment 5430
Other Equipment 5431
Other Equipment 5432
Other Equipment 5421
Other Equipment 5408
Other Equipment 5410
Office Equipment 5440
Office Equipment 5441
Office Equipment 5442
Other Equipment 5427
Other Equipment 5416
Other Equipment 5417
Office Equipment 5449
Office Equipment 5450
Other Equipment 5451
Other Equipment 5433
Other Equipment 5422
Other Equipment 5423
Other Equipment 5455
Other Equipment 5456
Other Equipment 5457
Jail Active -In Inventory
Double Locker Men's Locker
Room
Double Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
Polaroid Camera Main Medical
Office
6 Shelf Shelving Unit Main Medical
Supply Closet
Double Locker Men's Locker
Room
Double Locker Men's Locker
Room
Double Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
6 Shelf Shelving Unit Main Medical
Supply Closet
Supply Closet 2 Door Main Medical
Supply Closet
Metal Wall Mounted OHU Exam
Shelvino Unit Room
Metal Wall Mounted OHU Exam
Shelvino Unit Room
Metal Wall Mounted OHU Exam
Shelvino Unit Room
Double Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
Under Desk Cabinet 3 Secretary
Drawer Office
Under Desk Cabinet 3 Secretary
Drawer Office
Cubical Locker Women's
Locker Room
Standing Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
Cubical Locker Men's Locker
Room
Cubical Locker Women's
Locker Room
Cubical Locker Women's
Locker Room
Double Lockers 2 Tall Women's
Locker Room
Exhibit J
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
Main Jail 2nd In Inventory Own
Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
Report total items:
286
9 of 12
Office Equipment 5443
Other Equipment 5428
Other Equipment 5429
Other Equipment 5461
Other Equipment 5462
Other Equipment 5463
Other Equipment 5452
Other Equipment 5434
Other Equipment 5435
Other Equipment 5469
Electronics 5472
Lab/Medical 5639
Equipment
Other Equipment 5458
Office Equipment 5447
Office Equipment 5448
Lab/Medical 4998
Equipment
Lab/Medical 5000
Eauipment
Lab/Medical 5001
Eauipment
Other Equipment 5464
Other Equipment 5453
Other Equipment 5454
Lab/Medical 5002
Eauipment
Other Equipment 5465
Furniture 5468
Lab/Medical 5646
Eauipment
Other Equipment 5459
Exhibit J
Jail Active -In Inventory
Metal Wall Mounted OHU Exam Main Jail 2nd In Inventory Own
Shelvina Unit Room Floor
Double Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Double Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Cubical Locker Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Standing Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Standing Locker Men's Locker Main Jail 2nd In Inventory Own
Room Floor
Metal Shelving Unit 4 Tier X-Ray Room Main Jail 2nd In Inventory Own
Floor
Kodak Carousel Projector X-Ray Room-Main Jail 2nd In Inventory Own
Cabinet Floor
Dexcowin High DX3000 DA161207139 Main Jail 2nd In Inventory Own
Performance Portable X-Floor
Rav
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Under Desk Cabinet 3 Secretary Main Jail 2nd In Inventory Own
Drawer Office Floor
Under Desk Cabinet 3 Secretary Main Jail 2nd In Inventory Own
Drawer Office Floor
Dental Exam Light Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Oxygen Canister Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Oxygen Regulator Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Cubical Locker Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Cubical Locker Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Oxygen Tank Stand Dental Exam Main Jail 2nd In Inventory Own
Room #1 Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Round Table Women's Main Jail 2nd In Inventory Own
Locker Room Floor
Narcotic Box lX 1 Dispensary Main Jail 2nd In Inventory Own
Floor
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own
Locker Room Floor
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201685 Jail Medical Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
Report total items:
286
10 of 12
Other Equipment 5460
Lab/Medical 5213
Equipment
Lab/Medical 5214
Equipment
Lab/Medical 5218
Equipment
Lab/Medical 5219
Equipment
Lab/Medical 5215
Equipment
Lab/Medical 5216
Equipment
Lab/Medical 5217
Equipment
Office Equipment 5353
Office Equipment 5354
Office Equipment 5355
Office Equipment 5346
Office Equipment 5347
Office Equipment 5348
Office Equipment 5286
Office Equipment 5294
Office Equipment 5289
Furniture 5298
Appliance 5299
Office Equipment 5300
Office Equipment 5285
Office Equipment 5302
Office Equipment 5288
Office Equipment 5305
Office Equipment 5306
Office Equipment 5307
Exhibit J I Jail Active -In Inventory
Double Locker 2 Tall Women's Main Jail 2nd In Inventory Own !
Locker Room Floor
Wall Mount Blood Pressure Exam Room Main Jail 3rd In Inventory Own
Cuff Floor
Blood Pressure Cuff Exam Room Main Jail 3rd In Inventory Own
Floor
Welch Allyn Suretemp Plus 12070107 Exam Room Main Jail 3rd In Inventory Own
Floor
Welch Allyn Wall Mount Exam Room Main Jail 3rd In Inventory Own
Otoscope Floor
Detecto Weight Scale Exam Room Main Jail 3rd In Inventory Own
Floor
Exam Table Exam Room Main Jail 3rd In Inventory Own
Floor
Mayo Stand Exam Room Main Jail 3rd In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Under Cabinet File 2 JPS Doctors South Jail 1st In Inventory Own
Drawer Office Floor
Locking Cabinet JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
Wall Mounted Fan JPS Hallway South Jail 1st In Inventory Own
Floor
Round Wooden Table JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
Sanyo Refrigerator JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
Under Cabinet File JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
Under Cabinet File 2 JPS Doctors South Jail 1st In Inventory Own
Drawer Office Floor
Under File Cabinet JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
Wire Basket 3 Drawer JPS Doctors South Jail 1st In Inventory Own
w/Wheels Office Floor
Chart File Cabinets JPS Offices South Jail 1st In Inventory Own
Floor
Chart File Cabinet JPS Offices South Jail 1st In Inventory Own
Floor
Chart File Cabinet JPS Offices South Jail 1st In Inventory Own
Floor
------
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
56201687 Jail Psychiatric Services
Report total items:
286
11 of 12
Office Equipment
Office Equipment
Other Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Other Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Other Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Office Equipment
Jail Active -In Inventory
5291 2 Drawer Cabinet
5310 Desk Chair
5296 Desk Shelf 3-Tier
5312 Wood Desktop Shelf
5313 Wood Desktop Shelf
5314 Wood Desktop Shelf
5301 Under File Cabinet
5324 Wall Mounted Organizer
Svstem
5304 Metal Accordian File Desk
System
5326 Wall Mounted Ocillating
Fan
5327 Wall Mounted Ocillating
Fan
5328 Wall Mounted Ocillating
Fan
5309 Desk Chair
5330 Wall Mounted Ocillating
Fan
5311 Plastic Desktop Shelf
5332 Wall Mounted Ocillating
Fan
5337 Under Cabinet File 3
Drawer
5339 Under File Cabinet 3
Drawer
5315 Wood Dessktop Shelf
5341 Under File Cabinet 3
Drawer
5325 Wall Mounted Ocillating
Fan
5343 Wire Wall Hanging Unit
5344 Wire Wall Hanging Unit
5345 Wire Wall Hanging Unit
5329 Wall Mounted Ocillating
Fan
5342 Under File Cabinet 3
Drawer
Exhibit J
JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Head South Jail 1st In Inventory Own
Nurse Office Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
JPS Offices South Jail 1st In Inventory Own
Floor
56201687 Jail Psychiatric Services Office Equipment
56201687 Jail Psychiatric Services Office Equipment
56201687 Jail Psychiatric Services Office Equipment
56201687 Jail Psychiatric Services Office Equipment
56201687 Jail Psychiatric Services Office Equipment
Correctional Health items: 286
Report total items:
286
12 of 12
5331
5350
5351
5352
5340
Exhibit J
Jail Active -In Inventory
Wall Mounted Ocillating JPS Offices South Jail 1st In Inventory Own
Fan Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Wire Wall Hanging Unit JPS Offices South Jail 1st In Inventory Own
Floor
Under File Cabinet 3 JPS Offices South Jail 1st In Inventory Own
Drawer Floor
CFMG PAYMENT SCHEDULE 1
YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5
7/1/2018 -6/30/20E7 /1/2019 -6/30/202( 6/1/2020-5/31/20216/1/2021 -5/31/202;6/1/2022 -5/31/2023
Base Amount•
SUD Services
Healthcare Subtotal
Additional Insurance•••
s
s
s
s
21,891,733
872,622
22,764,355
50,000
s 22,548,485
s 898,801
s 23,447,286
s 50,000
s 23,224,940 s 23,921,688 s 24,639,338
s 925,765 s 953,538 s 982,144
s 24,150,704 s 24,875,225 s 25,621,482
s 50,000 s 50,000 s 50,000
ANNUAL TOTAL: $ 22,814,355.00 $ 23,497,285.65 $ 24,200,704.22 $ 24,925,225.35 $ 25,671,482.11
MONTHLY TOTALS:
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
s
s
s
s
s
s
s
s
s
s
s
$
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
1,901,196.25
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 $
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
s 1,958,107.14 s
$ 1,958,107.14 $
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 $ 2,077,102.11 $ 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 s 2,077,102.11 s 2,139,290.18
2,016,725.35 $ 2,077,102.11 $ 2,139,290.18
ANNUAL TOTAL: $ 22,814,355.00 $ 23,497,285.65 $ 24,200,704.22 $ 24,925,225.35 $ 25,671,482.11
YEARS 1-3 TOTAL: $ 70,512,344.87
YEARS 1-4 TOTAL: $ 95,437,570.22
YEARS 1-5** TOTAL: $ 121,109,052.32
Year 2-5 Healthcare subtotal Includes 3.00% increase.
*Base amount does not includes in-patient costs
**Years 4 and 5 are additional 12-month period extensions, if performance standards are met by the CONTRACTOR.
***3.00% increase does not pertain to extra insurance coverage
Exhibit K