HomeMy WebLinkAboutAgreement A-14-118-1 with Corizon Health Inc..pdf Agreement No. 14-118-1
1 AMENDMENT I TO AGREEMENT
2 THIS AMENDMENT, hereinafter referred to as "Amendment I", is made and entered into this
3 lT day of , 2015, by and between the COUNTY OF FRESNO, a Political Subdivision
4 of the State of California, hereinafter referred to as "COUNTY", and CORIZON HEALTH, INC., a
5 Delaware for-profit corporation, whose address is 103 Powell Court, Brentwood, Tennessee 37027,
6 hereinafter referred to as "CONTRACTOR" (collectively the "parties").
7 WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. A-14-118, effective June 23, 2014, hereinafter referred to as "Agreement", whereby
9 CONTRACTOR agreed to provide medical and behavioral health care services to the adult inmates
10 detained in COUNTY Sheriff s Office ("SHERIFF") Adult Detention Facilities ("JAIL") and juvenile
11 wards detained in COUNTY Probation Department ("PROBATION") Juvenile Justice Campus
12 ("JJC"), hereinafter collectively referred to as COUNTY's Detention Facilities for the COUNTY's
13 Department of Public Health(DPH) and the COUNTY's Department of Behavioral Health(DBH);
14 and
15 WHEREAS the parties now desire to amend the Agreement to expand the scope of work within
16 the Agreement to include certain changes in the Remedial Plan as a result of Hall, et. al. v. County of
17 Fresno, Case No. 1:11-CV-02047-LJO-BAM (E.D. Cal. January 25, 2012) in providing additional
18 medical and behavioral health care services and responsibilities as stated herein and restate the
19 Agreement in its entirety.
20 NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
21 hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows:
22 1. That the following subsection be inserted into the existing COUNTY Agreement No. A-
23 14-118, at Page Three (3), Line Eighteen(18),with the number"4":
24 "4. CONTRACTOR shall perform the medical and behavioral health care services
25 and responsibilities as underlined in the "Remedial Plan", Exhibit A3, effective August 1, 2015,
26 attached hereto and incorporated by this reference herein, whether any of the items underlined are
27 currently within the scope of work in Exhibits A 1 and A2, or in addition thereof.
28 CONTRACTOR shall work in cooperation with SHERIFF and/or other
1 - COUNTY OF FRESNO
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1 COUNTY Departments to implement the italicized sections identified in Remedial Plan, Exhibit A3,
2 referenced herein.
3 Additional monthly compensation will commence on August 1, 2015. Each additional position
4 in Revised Exhibit B is agreed to be essential for the efficient and effective operation of
5 CONTRACTOR's health care services as set forth herein; therefore, CONTRACTOR is expected to fill
6 all additional positions as soon as possible. Should CONTRACTOR not provide written notification to
7 County that on or before September 1, 2015 all additional positions have been filled, CONTRACTOR
8 shall reimburse COUNTY for any additional positions that remain unfilled after September 1, 2015 at a
9 fully loaded rate (salary plus fringe) until such time such additional position is filled. ."
10 2. That the following be added to existing COUNTY Agreement No. A-14-118, Page Ten
11 (10), Line Twelve (12) with the number"6":
12 "6. CONTRACTOR shall respond to and process all medical record requests and
13 subpoenas for records whether or not the Release of Information is directly addressed to COUNTY
14 and/or CONTRACTOR, so long as the Release of Information is otherwise lawful."
15 3. That the existing COUNTY Agreement No. A-14-118, Page Twenty (20), beginning
16 with Line Seventeen (17), with the letter "C" and ending on Page Twenty-Five (25), Line Twenty-Five
17 (25) with the word "notice" be deleted and the following inserted in its place:
18 "C. Additional Payments for Remedial Plan
19 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
20 compensation in accordance with"Payment Schedule 3 —Additional Compensation for Remedial Plan"
21 set forth in Exhibit G3, attached hereto and incorporated herein by this reference, for the additional
22 work identified in the Remedial Plan, Exhibit A3, which will be in addition to the base compensation
23 identified in Exhibit G1 and the additional emergency, inpatient hospitalization, and outpatient
24 specialty care services compensation identified in Exhibit G2 for services described in Exhibit A 1 and
25 Exhibit A2:
26 1. For the period of August 1, 2015 through June 30, 2016, the compensation
27 paid to CONTRACTOR for actual medical and behavioral health care services, identified in Remedial
28 Plan Exhibit A3, shall not exceed One Million, Six Hundred Thousand and No/100 Dollars
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1 ($1,600,000.00).
2 2. For the period of July 1, 2016 through June 30, 2017, the compensation
3 paid to CONTRACTOR for medical and behavioral health care services, identified in Remedial Plan
4 Exhibit A3, shall not exceed One Million Six Hundred Fifty Two Thousand Eight Hundred and No/100
5 Dollars ($1,652,800.00).
6 3. If performance standards are met and this Agreement is extended for an
7 additional one-year period pursuant to Section 3, TERM, herein, then for the period of July 1, 2017
8 through June 30, 2018, the compensation paid to CONTRACTOR for actual medical and behavioral
9 health care services, identified in Remedial Plan Exhibit A3, shall not exceed One Million Seven
10 Hundred Seven Thousand Three Hundred Forty Two and 40/100 Dollars ($1,707,342.40).
11 4. If performance standards are met and this Agreement is extended for a
12 second additional one-year period pursuant to Section 3, TERM, herein, then for the period of July 1,
13 2018 through June 30, 2019, the compensation paid to CONTRACTOR for actual medical and
14 behavioral health care services, identified in Remedial Plan Exhibit A3, shall not exceed One Million,
15 Seven Hundred Sixty Three Thousand Six Hundred Eighty-Four and 70/100 Dollars ($1,763,684.70).
16 D. Increases or Decreases in Inmate Population
17 The parties agree and acknowledge that the annual base compensation, the
18 additional costs for Emergency, Inpatient Hospitalization, and Outpatient Specialty Care Services, and
19 the additional compensation for the Remedial Plan services are calculated based upon an average daily
20 population (ADP) which includes adult inmate and juvenile ward populations (hereinafter"Combined
21 ADP") between 3,100 and 3,500, inclusive. If the Combined ADP, calculated and averaged over a
22 calendar month, falls above 3,500 or below 3,100, CONTRACTOR shall be compensated (whether an
23 increase or decrease) at the ADP rate, according to the rates outlined below, herein.
24 1. a) For the period of June 23, 2014 through June 30, 2015, if the
25 Combined ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is
26 only providing services identified in Exhibit Al, then the compensation payable to CONTRACTOR by
27 COUNTY shall be increased by a rate of$2.09 per day for the number of days in the identified calendar
28 month for each inmate/juvenile over 3,500. Conversely, should the Combined ADP decrease below
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Fresno, CA
1 ),100 inmates/juveniles in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate
2 of$2.09 per day for the number of days in the identified calendar month for each inmate/juvenile less
3 than 3,100.
4 b) For the period of June 23, 2014 through June 30, 2015, if the Combined ADP
5 exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is providing services
6 identified in both Exhibits Al and A2, then the compensation payable to CONTRACTOR by COUNTY
7 shall be increased by a rate of$4.79 per day for the number of days in the identified calendar month for
8 each inmate/juvenile over 3,500. Conversely, should the Combined ADP decrease below 3,100
9 inmates/juveniles in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate of
10 $4.79 per day for the number of days in the identified calendar month for each inmate/juvenile less than
11 3,100.
12 2. a) For the period of July 1, 2015 through June 30, 2016, if the Combined
13 ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is only
14 providing services identified in both Exhibits Al and A2, then the compensation payable to
15 CONTRACTOR by COUNTY shall be increased by a rate of$4.95 per day for the number of days in
16 the identified calendar month for each inmate/juvenile over 3,500. Conversely, should the Combined
17 ADP decrease below 3,100 inmates/juveniles in any given calendar month, CONTRACTOR shall rebate
18 COUNTY by a rate of$4.95 per day for the number of days in the identified calendar month for each
19 inmate/juvenile less than 3,100.
20 b) For the period of July 1, 2015 through June 30, 2016, if the Combined
21 ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is providing
22 services identified in Exhibits A1, A2 and A3, then the compensation payable to CONTRACTOR by
23 COUNTY shall be increased by a rate of$4.95 per day for the number of days in the identified calendar
24 month for each inmate/juvenile over 3,500. Conversely, should the Combined ADP decrease below
25 3,100 inmates/juveniles in any given calendar month, CONTRACTOR shall rebate COUNTY by a rate
26 of$4.95 per day for the number of days in the identified calendar month for each inmate/juvenile less
27 than 3,100.
28 3. For the period of July 1, 2016 through June 30, 2017, if the Combined
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1 ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is providing
2 services identified in Exhibits A1, A2 and A3, then the compensation payable to CONTRACTOR by
3 COUNTY shall be increased by a rate of$5.11 per day for the number of days in the identified calendar
4 month for each inmate/juvenile over 3,500. Conversely, should the Combined ADP decrease below
5 30im iei, any given calendar month, CONTRACTOR shall rebate COUNTY by a rate
6 of$5.11 per day for the number of days in the identified calendar month for each inmate/juvenile less
7 than 3,100. If performance standards are met and this Agreement is extended for an additional one-year
8 period pursuant to Section 3, TERM, herein, then for the period of July 1, 2017 through June 30, 2018,
9 if the Combined ADP exceeds 3,500 inmates/juveniles in any given calendar month and
10 CONTRACTOR is providing services identified in Exhibits Al, A2 and A3, then the compensation
11 payable to CONTRACTOR by COUNTY shall be increased by a rate of$5.28 per day for the number of
12 days in the identified calendar month for each inmate/juvenile over 3,500. Conversely, should the
13 Combined ADP decrease below 3,100 inmates/juveniles in any given calendar month, CONTRACTOR
14 shall rebate COUNTY by a rate of$5.28 per day for the number of days in the identified calendar month
15 for each inmate/juvenile less than 3,100.
16 5. If performance standards are met and this Agreement is extended for an
17 additional one-year period pursuant to Section 3, TERM, herein, then for the period of July 1, 2018
18 through June 30, 2019, if the Combined ADP exceeds 3,500 inmates/juveniles in any given calendar
19 month and CONTRACTOR is providing services in Exhibits Al, A2 and A3, then the compensation
20 payable to CONTRACTOR by COUNTY shall be increased by a rate of$5.45 per day for the number of
21 days in the identified calendar month for each inmate/juvenile over 3,500. Conversely, should the
22 Combined ADP decrease below 3,100 inmates/juveniles in any given calendar month, CONTRACTOR
23 shall rebate COUNTY by a rate of$5.45 per day for the number of days in the identified calendar month
24 for each inmate/juvenile less than 3,100.
25 6. The rates listed above are intended to cover additional costs in those
26 instances where minor, short-term increases in the inmate population result in the higher utilization of
2 7 routine supplies and services. However, the rates are not intended to provide for any additional fixed
2.9 costs (e.g., staffing positions or ancillary services costs), which might prove necessary if the inmate
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1 population changes significantly and if the population change is sustained. Accordingly, if the
2 Combined ADP exceeds 3,500 or falls below 2,800 for a period of ninety (90) consecutive days or more,
3 COUNTY and CONTRACTOR shall meet and negotiate in good faith regarding the impact to staffing
4 levels as a result of such population change on this Agreement; in the event, the parties are unable to
5 reach an agreement on staffing level and/or compensation adjustments to accommodate any such
6 population change within a thirty (30) day period following notice by the party requesting renegotiation,
7 then either party may terminate the Agreement with ninety (90) days advance written notice.
8 E. Maximum Compensation
9 In no event shall total compensation and any other payment for services performed under
10 this Agreement be in excess of Sixty Million, Seven Hundred Forty-Two Thousand, Four Hundred
11 Twenty-One and 73/100 Dollars ($60,742,421.73) for the entire three (3) year period of this Agreement.
12 If this Agreement is extended for an additional one (1) year period after the first three (3) years of this
13 Agreement, pursuant to Section 3, TERM, herein, in no event shall total compensation and any other
14 payment for services performed under this Agreement be in excess of Eighty-Two Million, Seven
15 Hundred Sixty-Five Thousand, Four Hundred Four and 57/100 Dollars ($82,765,404.57) for the entire
16 four (4) year period of this Agreement. If this Agreement is extended for an additional one (1) year
1-7 period after the first four (4) years of this Agreement, pursuant to Section 3, TERM, herein, in no event
18 shall total compensation and any other payment for services performed under this Agreement be in
19 excess of One Hundred Five Million, Five Hundred Fifteen Thousand, One Hundred Forty-Five and
20 85/100 Dollars ($105,515,145.85) for the entire five (5) year period of this Agreement.
21 It is understood that all expenses incidental to CONTRACTOR's performance of actual
22 services under this Agreement shall be borne by CONTRACTOR.
23 COUNTY does not pay, and is not subject to, any late charges, fees or penalties of any
24 kind. Notwithstanding the foregoing, COUNTY agrees to use best efforts to pay timely.
25 F. Affordable Care Act
26 Since the Affordable Care Act (ACA) went into effect on January 1, 2014, COUNTY's
27 DPH Director, or his/her designee, and CONTRACTOR shall coordinate and develop policies and
28 procedures to maximize the benefits of the ACA for the inmates and wards incarcerated in COUNTY's
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1 Detention Facilities, including reviewing current and future ACA statutes and regulations and
2 establishing protocols consistent with those laws to determine Medi-Cal eligibility and coverage for
3 eligible persons, when appropriate. At such time that CONTRACTOR commences services as
4 identified in Exhibit A2 and when additional details emerge pertaining to ACA, the parties will agree to
5 meet and negotiate in good faith any applicable reimbursable services that could be claimed under Medi-
6 Cal or other third party reimbursement.
7 To the extent that COUNTY is able to obtain any pertinent data during the booking-in
8 process; it shall cooperate fully with CONTRACTOR in its efforts to secure this information.
9 COUNTY understands and agrees that if an outside payment source is identified, the source of such
10 payment may be investigated by CONTRACTOR and pursued if appropriately available under the
11 applicable state and federal laws.
12 G. Change of Scope
13 The compensation identified in this Agreement reflects the scope of services as
14 outlined herein and the current community standard of care with regard to health care services. Should
15 there be any substantial or material change in inmate distribution (e.g., types of chronic care patients),
16 standards of care (including, but not limited to, changes in HIV/AIDS therapy or Hepatitis C therapy
17 standards or material changes to the current Title 15 requirements), or scope of services (i.e., as
18 described in Exhibits A1, A2, and A3), that result in additional material costs to CONTRACTOR,
19 including but not limited to any court order or decree, the costs related to such change or modification
20 are not contemplated herein and shall thus be negotiated with COUNTY in good faith. If the parties are
21 unable to reach a mutual agreement on these costs within thirty(30) days from either party's written
22 request to meet and negotiate in good faith, either party may terminate this Agreement by providing the
23 other party with ninety (90) days advance written notice."
24 4. That the existing COUNTY Agreement No. A-14-118, Page Twenty Five (25),
25 beginning with Paragraph Six (6), Line Twenty Six (26), with the word "Invoicing" and ending on Page
26 Twenty-Six (26), Line Fifteen (15) with the word "Agreement"be deleted and the following inserted in
27 its place:
28 "A. CONTRACTOR shall submit an invoice to COUNTY, in duplicate, by the
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1 fifteenth (15"') of each month after the month for which services will be rendered in accordance with
2 Payment Schedules 1, 2, and/or 3, as identified in Exhibits G1, G2, and G3, as applicable, described in
3 Section 5.A to 5.0 hereinabove.
4 If according to Section 5.1) there is an increase or decrease in Combined ADP,
5 calculated and averaged over a calendar month that falls outside of the range of 3,100 to 3,500,
6 inclusive, CONTRACTOR shall clearly identify any such increase or decrease in Combined ADP and
7 the applicable rate on said invoice.
8 Subject to CONTRACTOR's satisfactory performance of services identified in this
9 Agreement, COUNTY agrees to pay CONTRACTOR within thirty (30) to forty-five (45) days after
10 receipt and verification of CONTRACTOR's invoices. COUNTY shall verify all Combined ADP
11 population changes identified in CONTRACTOR's invoices prior to payment.
12 Invoices shall be submitted to County of Fresno, Department of Public Health, P.O. Box
13 11867, Fresno, CA 93775, Attention: DPH Director. Invoices shall include the amount due for base
14 compensation as identified in Exhibit G1, Emergency Inpatient Hospitalization, and Outpatient
15 Specialty Care Services identified in Exhibit G2, and additional compensation for the Remedial Plan
16 identified in Exhibit G3. This Agreement number must appear on all invoices and correspondence
17 relating to this Agreement."
18 5. That existing COUNTY Agreement No. A-14-118 Paragraph One (1), subsection A.
19 Four (4) through subsection A. Thirteen (13) be renumbered to read subsection A. Five (5) through
20 subsection A. Fourteen (14).
21 6. That existing COUNTY Agreement No. A-14-118 Paragraph Five (5), subsection E
22 through subsection F be re-lettered to read subsection F through G.
23 7. That Revised Exhibit B, Exhibits A3 and G3, be added to the list of exhibits identified in
24 COUNTY Agreement No. A-14-118, Page Forty-Eight (48), paragraph Twenty-Seven (27).
25 8. That all references in existing COUNTY Agreement No. A-14-118 to "Exhibit B" shall
26 be changed to read "Revised Exhibit B", where appropriate, attached hereto and incorporated herein by
27 reference.
28 9. Except as otherwise provided in this Amendment I, all other provisions of the
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1 Agreement remain unchanged and in full force and effect. This Amendment I shall become effective
2 upon execution.
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9 - COUNTY OF FRESNO
Fresno, CA
1 IN WITNESS WHEREOF,the parties hereto have executed this Amendment I as of the day and
2 year first hereinabove written.
3
4 CONTRACTOR: COUNTY OF FRESNO:
CORIZON HEALTH,INC.
5 1 a
5G.�
m9B
B y
Y
7 Woodrow A. Mye s Chairman, Board of Supervisors
Chief Executive Officer
8
Date: Z s Date: 14, 01015
9
10
BERNICE E. SEIDEL, Clerk
11 _} Board of Supervisors
12
By
13
Print Name: \J nei By
14 '
15 Title: secy-e+0y'l-) 5 Date: IA ) ?,yi
Secretary (of Co oration), or
16 any Assistant Secretary, or
Chief Financial Officer, or
17 any Assistant Treasurer
18 Date: (P ' S aU 1 S� PLEASE SEE ADDITIONAL
�
19 SIGNATURE PAGE ATTACHED
20
21
Mailing Address:
22 103 Powell Court
Brentwood, TN 37027
23 Phone #: (615) 660-6754
24 Contact: Scott Bowers
President and COO
25
26 Email: Scott.Bowers@corizonhealth.com
27
28
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Fresno, CA
1 APPROVED AS TO LEGAL FORM:
2 DANIEL C. CEDERBORG, COUNTY COUNSEL
4 By �Z
5
6 APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
7 TREASURER-TAX COLLECTOR
8
9
By
10
11
REVIEWED AND RECOMMENDED FOR APPROVAL:
12
13
By l
14
David Pomaville, Director
15 Department of Public Health
16
17 REVIEWED AND RECOMMENDED FOR APPROVAL:
18
1
19 Byf
20 Dawan Utecht, Director
Department of Behavioral Health
21
22
23 Fund/Subclass: 0001/10000
Organization: 56201683
24
25 Account #: 7295
26
JW
27
28
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Exhibit A3
Hall, et. al. v. County of Fresno
REMEDIAL PLAN
[DATE],2015
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
l. The County shall ensure that jail health care staff and the Sheriff s 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 elip-ible 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 Countv shall require that Jail health care staff are appropriately credentialed
accordin2 to the licensure, certification, and registration requirements for the State of
California.
6. Jail healthcare 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 A3
3. The County will provide a budget for 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 Screenin,:form that includes the following
a. Questions on the history of HIV/AIDS, Tuberculosis, and Kidnev Disease:
and
b. Questions re2ardin legal and illegal drug use (e.g.. type, time of last use and
quantities.)
2. The Count 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
z
Hall, et. al. v. County of Fresno, Consent Decree,Appendix A, Remedial Plan
Exhibit A3
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 Countv's policies and procedures revardinQ detoxification shall include the
followinz:
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 druy-s shall be conducted under medical supervision when performed
at the facility;
c. Inmates being detoxified shall be monitored byaphysician-,
d. Sr)ecific guidelines shall be followed for the treatment and observation of
inmates manifesting mild or moderate symptoms of intoxication or
withdrawal from alcohol and other dru"s;
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 Sheriff's 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 re�zardin 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 A3
b. Health record and health information both oral and documented is
confidential protected health information. The minimum necessaryb ealth
information is to be disclosed to health care staff providing health care or to
fail authorities when necessary for the protection of the welfare of the inmate
or others, management of the fail, or maintenance of jail security and order.
9. The Count 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) y-uidelines.
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 Count 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 A3
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 LVN under the supervision of a RN shall document vital
sins, 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 screeniny- 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-laammarelease
assays GGRAsI 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 thoroup-h nursinP 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 requestforms 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 A3
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 trig eg 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-ury-ent 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 A3
H. Chronic Care
1. Health care services shall include a chronic disease mana ement 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 mana ement 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 required 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:
Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
Exhibit A3
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 enteringnod, 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
Exhibit A3
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 veer review and systematically analyzing and improving processes and
the qualm of medical care.
5. Each quarter, the Quality Improvement Committee shall monitor several of the
following kev 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
MedicalBehavioral 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 A3
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 for all deaths, except for 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 Vroup
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, includiny- 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.
io
Hall, et. al. v. County of Fresno, Consent Decree, Appendix A, Remedial Plan
Exhibit A3
2. The County shall develop and implement a system that allows patients who are
prescribed 1sychiatric 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 antipsvchotie 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. Subsequent 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. Subsequent 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 question regarding an hey of
mental health problems or treatment, hospitalizations, and/or current or previous
thoughts of self-harm.
E. Suicide Prevention
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
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1. Mental health clinicians shall complete a comprehensive suicide risk assessment form
for all inmates who displaysigns of suicide risk to determine if the inmate presents a
low, moderate, or hip-h risk of suicide. Mental health clinicians shall complete a new
form if there are indications of any modification of risk 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.
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
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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 Sheriff's Office shall adopt and implement a policy of leaving 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 Sheriff's 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 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 (SMI) 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 SMI 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 housinf4 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 2D cells will be offered:
i. A minimum of three out-of-cell mental health contacts per week
consistine 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.
ii. 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.
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Hall, et. al. v. County of Fresno, Consent Decree, Appendix A,Remedial Plan
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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 SMI 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 housine 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:
i. A minimum of three out-of-cell mental health contacts per week
consisting of structured individual or group therapeutic/educational
treatment and programminta, each lasting approximately one hour with
appropriate duration to be determined by a mental health clinician.
ii. 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 SMI 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 SMI inmates should continue to be
housed in that unit.
H. Quality Improvement
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
Exhibit A3
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 followin4:
• 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 21) of the South Annex Jail and the A Pods and FF
cells in the Main Jail.
III.ACCOMMODATIONS 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 Sheriffs Office and medical staff shall communicate to determine appropriate
housing for inmates with disabilities. Medical staff shall make available all
information needed to make adequate housing decisions.
4. The Sheriff's 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.
S. 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
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A, Remedial Plan
Exhibit A3
restrictions, including but not limited to:
a. The need for an accessible shower and toilet;
b. The need for ground floor housing;
c. The need for no stairs in the path of travel;
d. The need for 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 SQ 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 Sheriff's 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 A3
immediate risk of bodily harm to inmates or staff, or threatens the security of the
facility.
4. The Watch Commander shall be responsible for 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
1. 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 Sheriff's 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 Sheriff s 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
l. 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.
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
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2. The Sheriff's Office shall post and disseminate ADA notices in alternative fonnats 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
j ail 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.
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A,Remedial Plan
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C. Use of Force and Quality Assurance
1. The Sheriff's 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 Sheriff's 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 staff's 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
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A, Remedial Plan
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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 Sheriff's 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 Sheriff's 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 for 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.
I 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.
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A, Remedial Plan
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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 Sheriff's 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 Sheriff's 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 Sheriff's 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
Sheriff's 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 Sheriff's Office.
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Hall, et. al. v. County of Fresno, Consent Decree,Appendix A, Remedial Plan
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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
Revised Exhibit B
MINIMUM STAFFING LEVELS
Additional Staffing
for Remedial Plan
Noah AnnexXalhlSouth Jails Fresno MainiNorth
Annex/South Jails
Increase TO--TAL
POSITION I Mon Tue Wed Thu Fri I Sat Sun TBS Hrsi Wk FTE of FTE FTE'S
RAssistant
am Administrator -HSA 8 8 8 8 8 4C� 1.000 0 1.000
or of Nursin 8 8 6 8 8 4C 1.000 0 1.00istrative Assistant/0A Su ervis 8 8 8 8 8 40 1.000 0 100n Su rvisor NorihWatnlSouth 16 16 16 16 16 80 2.000 0 2,00 24 24 24 24 24 241 24 1 1-68 4.200 1 5,20
Medical Director 8 8 8 8 $ 1 40 1,000 0 1.000
Physician Services MD 8 8 8 8 1 8 1 40 1.000 0 1,000
NP f PA 16 16 16 16 16 16 16 112 2.800 0 2.800
600
RN 12 HR Shifts d24
96 96 96 96. 60 60 15.000 1 16 000
LVN 72 72 72 72 72 72 504 12.600 0 12 600
Medical Assistant 24 24 2424 24 24 168 4200 1A 5.600
Dentist 4 8 4 8 32 0.800 0 O.Wo
Dental Asst 8 8 8 8 8 40 1.000 0 1,000
Clinical Supervisor-Psych LMHC 8 8 8 8 8 40 1.000 0 1.000
Community Mental Health Specialist 8 8 8 8 8 1 40 1,000 0 1.000
Office Assistant-Psych 8 8 8 8 8 40 1.000 0 1.000
Psychiatrist 8 8 8 24 0.600 0.8 1.400
Ps chiatric RN 8 i 8 8 8 1 8 40 1.000 1 2.000
Licensed Psychiatric LVN l Psych 8 8 8 8 8 8 8 56
ech 1.400 0 1400
Licensed Mental Health Counselor 16 16 16 16 16 16 16 112 2-800 1.5 4 300
TOTAL HOURS/FTE-De 2?58 56,400
NPtPA $ 8 8 81 8 6 N168
1.400 0 1400
LVN 72 72 72 72 72 72 72 12 600 0 12.600
Medical Assistant 24 24 24 24 24 24 24 4,200 t 5.200ttice Assistant 24 24 24 24 24 24 24 4.200 1 5200
Licensed Ps chiatric Tech-LVN 8 8 8 8 8 8 8 1.400 0 1.400
Licensed Mental Health Counselor 0 0 0 0 0 0 0 0.000 2A 2.400
TOTAL HOURSIFTE_Errenin WA 23.800
NIGHT SHIII
r-N 12 HR Shifts 36 38 3B 36 36 36 36 252 6.300 1 7.36 36 36 36 36 36 36 252 6.300 0 63ical Assistant 24 24 24 24 24 24 24 168 4,200 0 4,20nsed Mental Health Counselor 0 0 0 0 0 0 0 0 0 000 1 A 1400
TOTAL HOURSIF7E-Af ht 672 16.800
TOTAL HOURSIFTE pt week 3880 87,000 13.5 110,s00
*TBS=To be scheduled
Page 1 of 2
Revised Exhibit B
Remedial Plan not
applicable to JJC-
Juvenile Justice Center no change
POSITION Mon Tue Thu �W Sun
Director of Nursing(RN)-juv, 8 8 8 8 1 8 40 1.000 0
Office Assistant 8 8 8 B a 40 1000 0
Medical Dinactor-Juvi 4 4 a O�200 0
NH I PA a -4 8 4 8 32 0.800 (). 0.800
RN 8 8 8 6 -8 8 56 1400 01 1.400
LVN 8 8 8 8 8 8 8 56 1400 01 1400
Psychiatrist 8 8 16 OADD 0 0.400
Licensed Mental I ie7alth-Counselo, 16 16 16 16 16 16 112 2.800 0 1800
V
I
N
'8
0
N
c n
Wa
d
w T-r tF"E
Wd T 0 1
8 1 OOC) 0
a L
2)0 10200
8 C)800
Dentist 4 4 0 0.2GO
Dental
'a
ental Asst 6 6 12 0.301) 0 0300
tl
TOTAL HOURSIFTE-Day 380 9.500 9.500
RN 16 16 181 161 16 112 2.8W 0 2800
�V
WN 8 8 8 8 8 8 8 56 1.400 0 1.4001
Licensed Mental Health Counselor 8 8 8 8 a 8 8 56 1.400 0 1.400
RN Eval B B 8 24 0,600 01 0 600
TOTAL HOURSIFTE-Evening 248 6.2D0 6200
q) 0.000 0
0 0.000 0
TOTAL 14OURSIFT&Night V'4w'Argw'4rs'TI"i
TOTAL HOURSJFTE week =Veffl� 628 16-700 77
*TBS=To be scheduled
TOTAL CONTRACT HOURSIWEEK 4508
TOTAL CONTRACT FTEsIWEEK 112,700 126.200
Page 2 of 2
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