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Agreement No.14-118-1
AMENDMENT I TO AGREEMENT
THIS AMENDMENT, hereinafter referred to as "Amendment I", is made and entered into this
14'1-hday of \:J ~ , 2015, by and between the COUNTY OF FRESNO, a Political Subdivision
ofthe State of California, hereinafter referred to as "COUNTY", and CORIZON HEALTH, INC., a
Delaware for-profit corporation, whose address is 103 Powell Court, Brentwood, Tennessee 37027,
hereinafter referred to as "CONTRACTOR" (collectively the "parties").
WHEREAS the parties entered into that certain Agreement, identified as COUNTY Agreement
No. A-14-118, effective June 23,2014, hereinafter referred to as "Agreement", whereby
CONTRACTOR agreed to provide medical and behavioral health care services to the adult inmates
detained in COUNTY Sheriffs Office ("SHERIFF") Adult Detention Facilities ("JAIL") and juvenile
wards detained in COUNTY Probation Department ("PROBATION") Juvenile Justice Campus
("JJC"), hereinafter collectively referred to as COUNTY's Detention Facilities for the COUNTY's
Department of Public Health (DPH) and the COUNTY's Department of Behavioral Health (DBH);
and
WHEREAS the parties now desire to amend the Agreement to expand the scope of work within
the Agreement to include certain changes in the Remedial Plan as a result of Hall, et. al. v. County of
Fresno, Case No. 1:11-CV-02047-LJO-BAM (E.D. Cal. January 25, 2012) in providing additional
medical and behavioral health care services and responsibilities as stated herein and restate the
Agreement in its entirety.
NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows:
1. That the following subsection be inserted into the existing COUNTY Agreement No. A-
2 3 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,
2 6 attached hereto and incorporated by this reference herein, whether any of the items underlined are
2 7 currently within the scope of work in Exhibits A 1 and A2, or in addition thereof.
2 8 CONTRACTOR shall work in cooperation with SHERIFF and/or other
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COUNTY Departments to implement the italicized sections identified in Remedial Plan,Exhibit A3,
referenced herein.
Additional monthlycompensationwill commenceon August 1,2015.Each additional position
in Revised Exhibit B is agreed to be essential for the efficient and effective operation of
CONTRACTOR'S health care services as set forth herein;therefore,CONTRACTOR is expected to fill
all additional positionsassoonas possible.Should CONTRACTOR notprovidewritten notification to
Countythat onor before September 1,2015 all additional positionshavebeenfilled,CONTRACTOR
shall reimburse COUNTY for any additional positions that remain unfilled after September 1,2015 at a
fully loaded rate (salary plus fringe)until suchtime such additionalpositionis filled. ."
2. That the following be added to existing COUNTY Agreement No.A-14-118,Page Ten
(10),Line Twelve (12) with the number "6":
"6. CONTRACTOR shall respond to and process all medical record requests and
subpoenas for records whether ornotthe Release of Information is directly addressed to COUNTY
and/or CONTRACTOR, so long as the Release of Information is otherwise lawful."
3. That the existing COUNTYAgreementNo.A-14-118,PageTwenty (20), beginning
withLine Seventeen (17), with the letter "C" and ending on Page Twenty-Five(25), LineTwenty-Five
(25)withthe word"notice" bedeletedandthe following inserted in its place:
"C.Additional Payments for Remedial Plan
COUNTYagreesto pay CONTRACTORand CONTRACTORagrees to receive
compensation in accordance with "Payment Schedule 3-Additional Compensation for Remedial Plan"
set forth in Exhibit G3, attachedhereto and incorporatedherein by this reference, for the additional
work identified in the Remedial Plan, Exhibit A3, which will be in addition to the base compensation
identified in Exhibit Gl and the additional emergency, inpatient hospitalization, and outpatient
specialty care services compensation identified in Exhibit G2 for services described in Exhibit Al and
Exhibit A2:
1.Forthe periodof August 1,2015 throughJune 30,2016,the compensation
paid to CONTRACTOR for actual medical and behavioral health care services,identified in Remedial
Plan Exhibit A3, shall not exceed One Million, Six Hundred Thousand and No/100 Dollars
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Fresno,CA
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($1,600,000.00).
2. Forthe period of July 1,2016through June 30, 2017, the compensation
paidto CONTRACTOR for medical and behavioral health care services,identified in Remedial Plan
Exhibit A3, shall not exceed One Million Six Hundred Fifty Two Thousand Eight Hundred and No/100
Dollars ($1,652,800.00).
3. If performance standardsaremetandthis Agreementisextendedforan
additionalone-yearperiodpursuantto Section 3, TERM, herein,then for the period of July 1,2017
throughJune 30,2018,the compensationpaid to CONTRACTORfor actual medicaland behavioral
health care services,identified in Remedial Plan Exhibit A3, shall not exceed One Million Seven
Hundred Seven Thousand Three Hundred Forty Two and 40/100 Dollars ($1,707,342.40).
4. If performance standards are met and this Agreement is extended fora
second additional one-year period pursuant to Section 3, TERM, herein, then for the period of July 1,
2018 through June 30, 2019, the compensation paid to CONTRACTOR for actual medical and
behavioral health care services,identified in Remedial Plan Exhibit A3, shall not exceed One Million,
Seven Hundred Sixty Three Thousand Six Hundred Eighty-Four and 70/100 Dollars ($1,763,684.70).
D.Increases or Decreases in Inmate Population
The parties agree and acknowledge that the annual base compensation, the
additional costs for Emergency, Inpatient Hospitalization,and Outpatient Specialty Care Services, and
the additional compensation for the Remedial Plan services are calculated based upon an average daily
population(ADP) which includesadult inmateandjuvenile wardpopulations (hereinafter"Combined
ADP") between 3,100 and 3,500, inclusive.If the Combined ADP, calculated and averaged over a
calendar month,falls above 3,500 or below 3,100,CONTRACTOR shall be compensated (whether an
increase or decrease) at the ADP rate, according to the rates outlined below, herein.
1. a) For the period of June 23, 2014 through June 30,2015,if the
Combined ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is
onlyprovidingservices identified in Exhibit Al,thenthe compensation payableto CONTRACTOR by
COUNTY shall be increased by a rate of $2.09 per day for the number of days in the identified calendar
monthfor each inmate/juvenileover 3,500. Conversely,should the CombinedADP decrease below
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3,100 inmates/juveniles inanygivencalendarmonth,CONTRACTOR shallrebateCOUNTYbyarate
of $2.09per day forthe number of days in the identifiedcalendarmonth for each inmate/juvenile less
than 3,100.
b) For the period of June 23,2014 through June 30,2015,if the Combined ADP
exceeds3,500 inmates/juvenilesinany given calendar monthand CONTRACTORis providing services
identified in both Exhibits Al and A2, then the compensation payable to CONTRACTOR by COUNTY
shall be increased by a rate of $4.79 per day for the number of days in the identified calendar month for
each inmate/juvenileover 3,500. Conversely,should the CombinedADP decreasebelow 3,100
inmates/juveniles in any given calendar month,CONTRACTOR shallrebate COUNTY by a rateof
$4.79 perdayforthe number of days inthe identified calendar monthforeach inmate/juvenile less than
3,100.
2. a) Forthe period of July 1,2015through June 30, 2016, if the Combined
ADP exceeds 3,500 inmates/juvenilesin any given calendarmonth and CONTRACTORis only
providing services identified in both Exhibits Al and A2,then the compensation payable to
CONTRACTOR by COUNTY shall be increased bya rateof $4.95 perdayforthe number of days in
the identifiedcalendar month for each inmate/juvenileover3,500. Conversely,shouldthe Combined
ADP decreasebelow 3,100 inmates/juvenilesin any givencalendarmonth, CONTRACTORshall rebate
COUNTY byarateof $4.95 per day forthe number of days inthe identified calendar month for each
inmate/juvenile less than 3,100.
b) Forthe periodof July 1,2015throughJune 30,2016,if the Combined
ADP exceeds 3,500 inmates/juveniles inanygiven calendar monthand CONTRACTOR is providing
services identified in Exhibits Al,A2 and A3, then the compensation payable to CONTRACTOR by
COUNTY shallbe increased bya rateof $4.95 perdayforthenumberofdaysinthe identified calendar
month foreach inmate/juvenile over 3,500.Conversely,should the Combined ADP decrease below
3,100 inmates/juveniles in any given calendar month,CONTRACTOR shallrebate COUNTY bya rate
of $4.95 per day for the number of days inthe identified calendar month for each inmate/juvenile less
than 3,100.
3. Fortheperiodof July 1,2016 through June30,2017,ifthe Combined
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ADP exceeds 3,500 inmates/juveniles in any given calendar month and CONTRACTOR is providing
services identified in Exhibits Al,A2 and A3, then the compensation payable to CONTRACTOR by
COUNTY shall be increased by a rate of $5.11 per day for the number of days in the identified calendar
month for each inmate/juvenile over 3,500.Conversely,should the Combined ADP decrease below
3,100 inmates/juveniles in any given calendar month,CONTRACTOR shall rebate COUNTY by a rate
of $5.11 per day for the number of days in the identified calendar month for each inmate/juvenile less
than 3,100.If performance standards are met and this Agreement is extended for an additional one-year
period pursuant to Section 3,TERM,herein,then for the period of July 1,2017 through June 30,2018,
if the Combined ADP exceeds 3,500 inmates/juveniles in any given calendar month and
CONTRACTOR is providing services identified in Exhibits Al,A2 and A3, then the compensation
payable to CONTRACTOR by COUNTY shall be increased by a rate of $5.28 per day for the number of
days in the identified calendar month for each inmate/juvenile over 3,500.Conversely,should the
Combined ADP decrease below 3,100 inmates/juveniles in any given calendar month,CONTRACTOR
shall rebate COUNTY by a rate of $5.28 per day for the number of days in the identified calendar month
for each inmate/juvenile less than 3,100.
5.If performance standards are met and this Agreement is extended for an
additional one-year period pursuant to Section 3,TERM,herein,then for the period of July 1,2018
through June 30,2019,if the Combined ADP exceeds 3,500 inmates/juveniles in any given calendar
month and CONTRACTOR is providing services in Exhibits Al,A2 and A3, then the compensation
payable to CONTRACTOR by COUNTY shall be increased by a rate of $5.45 per day for the number of
days in the identified calendar month for each inmate/juvenile over 3,500. Conversely, should the
Combined ADP decrease below 3,100 inmates/juveniles in any given calendar month,CONTRACTOR
shall rebate COUNTY by a rate of $5.45 per day for the number of days in the identified calendar month
for each inmate/juvenile less than 3,100.
6.The rates listed above are intended to cover additional costs in those
instances where minor,short-term increases in the inmate population result in the higher utilization of
routine supplies and services. However, the rates are not intended to provide for any additional fixed
costs (e.g., staffing positions or ancillary services costs), which might prove necessary if the inmate
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population changes significantly and if the population change is sustained.Accordingly,if the
Combined ADP exceeds 3,500 or falls below 2,800 for a period of ninety (90)consecutive days or more,
COUNTY and CONTRACTOR shall meet and negotiate in good faith regarding the impact to staffing
levels as a result of such population change on this Agreement;in the event,the parties are unable to
reach an agreement on staffing level and/or compensation adjustments to accommodate any such
population change within a thirty (30) day period following notice by the party requesting renegotiation,
then either party may terminate the Agreement with ninety (90)days advance written notice.
E.Maximum Compensation
In no event shall total compensation and any other payment for services performed under
this Agreement be in excess of Sixty Million,Seven Hundred Forty-Two Thousand,Four Hundred
Twenty-One and 73/100 Dollars ($60,742,421.73)for the entire three (3)year period of this Agreement.
If this Agreement is extended for an additional one (1) year period after the first three (3)years of this
Agreement,pursuant to Section 3,TERM,herein, in no event shall total compensation and any other
payment for services performed under this Agreement be in excess of Eighty-Two Million, Seven
Hundred Sixty-Five Thousand,Four Hundred Four and 57/100 Dollars ($82,765,404.57)for the entire
four (4) year period of this Agreement.If this Agreement is extended for an additional one (1) year
period after the first four (4) years of this Agreement,pursuant to Section 3,TERM,herein, in no event
shall total compensation and any other payment for services performed under this Agreement be in
excess of One Hundred Five Million,Five Hundred Fifteen Thousand,One Hundred Forty-Five and
85/100 Dollars ($105,515,145.85)for the entire five (5) year period of this Agreement.
It is understood that all expenses incidental to CONTRACTOR'S performance of actual
services under this Agreement shall be borne by CONTRACTOR.
COUNTY does not pay, and is not subject to, any late charges, fees or penalties of any
kind.Notwithstanding the foregoing,COUNTY agrees to use best efforts to pay timely.
F.Affordable Care Act
Since the Affordable Care Act (ACA)went into effect on January 1, 2014,COUNTY'S
DPH Director,or his/her designee,and CONTRACTOR shall coordinate and develop policies and
procedures to maximize the benefits of the ACA for the inmates and wards incarcerated in COUNTY'S
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Detention Facilities,including reviewing currentandfutureACAstatutesand regulations and
establishing protocols consistent with thoselawsto determine Medi-Cal eligibility and coverage for
eligible persons, when appropriate. At such time that CONTRACTOR commences services as
identified in ExhibitA2 andwhen additional detailsemergepertainingto ACA,the partieswill agreeto
meet and negotiate in good faith any applicable reimbursable services that could be claimed under Medi-
Cal or other third party reimbursement.
To the extent that COUNTYis able to obtain any pertinentdata duringthe booking-in
process;it shall cooperate fully with CONTRACTOR in its efforts to secure this information.
COUNTY understands and agrees that if an outside payment source is identified, the source of such
payment may be investigated by CONTRACTOR and pursued if appropriately available under the
applicable state and federal laws.
G.Change of Scope
The compensation identified in this Agreement reflects the scope of services as
outlined herein and the current community standard of care with regard to health care services.Should
there be any substantial or material change in inmate distribution (e.g., types of chronic care patients),
standards of care (including, but not limited to, changes in HIV/AIDS therapy or Hepatitis C therapy
standards or material changes to the current Title 15 requirements),or scope of services (i.e., as
described in Exhibits Al,A2, and A3), that result in additional material costs to CONTRACTOR,
including but not limited to any court order or decree, the costs related to such change or modification
are not contemplated herein and shall thus be negotiated with COUNTY in good faith.If the parties are
unable to reach a mutual agreement on these costs within thirty (30) days from either party's written
request to meet and negotiate in good faith,either party may terminate this Agreement by providing the
other party with ninety (90) days advance written notice."
4.That the existing COUNTY Agreement No.A-14-118,Page Twenty Five (25),
beginning with Paragraph Six (6), Line Twenty Six (26), with the word "Invoicing"and ending on Page
Twenty-Six (26),Line Fifteen (15)with the word "Agreement"be deleted and the following inserted in
its place:
"A.CONTRACTOR shall submit an invoice to COUNTY,in duplicate,by the
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fifteenth (15n)ofeach month after the month for which services willbe rendered in accordance with
Payment Schedules 1,2, and/or 3, as identified in Exhibits Gl,G2, and G3, as applicable,described in
Section 5.A to 5.C hereinabove.
If according to Section 5.D there is an increase or decrease in Combined ADP,
calculated and averaged over a calendar month that falls outside of the range of 3,100 to 3,500,
inclusive,CONTRACTOR shall clearly identify any such increase or decrease in Combined ADP and
the applicable rate on said invoice.
Subject to CONTRACTOR'S satisfactory performance of services identified in this
Agreement,COUNTY agrees to pay CONTRACTOR within thirty (30) to forty-five (45)days after
receipt and verification of CONTRACTOR'S invoices.COUNTY shall verify all Combined ADP
population changes identified in CONTRACTOR'S invoices prior to payment.
Invoices shall be submitted to County of Fresno,Department of Public Health,P.O. Box
11867,Fresno,CA 93775,Attention:DPH Director.Invoices shall include the amount due for base
compensation as identified in Exhibit Gl,Emergency Inpatient Hospitalization,and Outpatient
Specialty Care Services identified in Exhibit G2, and additional compensation for the Remedial Plan
identified in Exhibit G3. This Agreement number must appear on all invoices and correspondence
relating to this Agreement."
5.That existing COUNTY Agreement No.A-14-118 Paragraph One (1),subsection A.
Four (4)through subsection A.Thirteen (13)be renumbered to read subsection A. Five (5)through
subsection A.Fourteen (14).
6.That existing COUNTY Agreement No.A-14-118 Paragraph Five (5),subsection E
through subsection F be re-lettered to read subsection F through G.
7.That Revised Exhibit B,Exhibits A3 and G3,be added to the list of exhibits identified in
COUNTY Agreement No.A-14-118,Page Forty-Eight (48),paragraph Twenty-Seven (27).
8.That all references in existing COUNTY Agreement No.A-14-118 to "Exhibit B" shall
be changed to read "Revised Exhibit B", where appropriate,attached hereto and incorporated herein by
reference.
9.Except as otherwise provided in this Amendment I, all other provisions of the
COUNTY OF FRESNO
Fresno,CA
1 Agreement remain unchanged andin 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.
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CONTRACTOR:
CORIZON HEALTH, INC.
Woodrow A. Mye s
Chief Executive Officer
Date: ~jl;/r=>
By 1 ~~ v--a
Print Name: 'J . .J(Intf K;1
Title: --~~=-~=--+----------
Date: {p / j_ $ J dO I s-
1
Mailing Address:
1 03 Powell Court
Brentwood, TN 37027
Phone#: (615) 660-6754
Contact: Scott Bowers
President and COO
Email: Scott.Bowers@corizonhealth.com
-10 -
COUNTY OF FRESNO:
By~~~wo~~~--~~~~
Chairman, Board of Supervisors
Date:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By (f\U. ~'-!\~
Date: "'111'-f j1Pi~
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRESNO
Fresno, CA
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APPROVED AS TO LEGAL FORM:
DANIEL C.CEDERBORG,COUNTY COUNSEL
By .Ww^
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW,C.P.A.,AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
By Go*r>ih
REVIEWED AND RECOMMENDED FOR APPROVAL:
David Pomaville,Director
Department of Public Health
REVIEWED AND RECOMMENDED FOR APPROVAL:
By y^/g&3£24
Dawan Utecht,Director
Department of Behavioral Health
Fund/Subclass:
Organization:
Account #:
JW
0001/10000
56201683
7295
vcimu
ii COUNTY OF FRESNO
Fresno,CA
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
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 staffshall 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.
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Hall, et. al. v. County ofFresno,Consent Decree,Appendix A,Remedial Plan
Exhibit A3
3. The County willprovide 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 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
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Hall, et. al. v. County ofFresno,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 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 Sheriffs 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
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Hall,et.al.v.County ofFresno,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 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 Sheriffs 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 ofmalignant hyperthermiafrom extremely
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Hall, et. al.v.County ofFresno,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 bv
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
signs,mental status,and sensation of limbs within the first hour of placement,
and bv 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 staffshall 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
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Hall,et.al.v.County ofFresno,Consent Decree, Appendix A, Remedial Plan
Exhibit A3
completed health service request forms directlyfrom 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 experiencingsymptomsshallhave vital signstaken 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 andvital signs bv RNs:to be documented intheinmate's medical
record:
c. Physicians shall examine patients housed in the OHU no less frequently than
every 14 days:and
d.Correctionalofficersshall notify medical staff immediately whenan inmate
in the OHU is requesting medical assistance.
2. The OHU shall bemade compliantwith Americansfor DisabilitiesAct regulations.
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Hall,et.al.v.County ofFresno,ConsentDecree,AppendixA, RemedialPlan
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H.Chronic Care
1-Health care servicesshall includea chronicdiseasemanagementprogram.
2. The chronic diseasemanagementprogram shallconform to contemporarystandards
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 bv 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 bv the physician's order.
2.Nursing staffshall 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:
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Hall, et. al.v.County ofFresno,Consent Decree,Appendix A,Remedial Plan
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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 bv 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 appropriatelytrained clinician shalltriage dental care requeststo
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 papermedicalrecordsshallbe controlled viaa sign-out procedure,andpaper 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 screeningform.
Hall,et.al.v.County ofFresno,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 bv physicians shall be subject to peer review.
3.Physicians shall be evaluated annually bv 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 reviewand systematicallyanalyzingand improvingprocessesand
the quality of medical care.
5. Each quarter,the QualityImprovementCommitteeshall monitor severalof 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 bv 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 bva provider within twoweeksof incarceration.
6.The Medical Director shall ensure that any corrective action recommended bv the
Medical/Behavioral Health Quality Improvement Committee is implemented and
completedwithin30daysofthe reportmakingsuch recommendations,unlessthere
are extenuating circumstances preventing implementation and completion within such
timeframe in which case it shall occur as soon as reasonably practical.
N.Mortality Reviews
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Hall,et.al.v.County ofFresno,ConsentDecree, AppendixA, RemedialPlan
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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 performedfor 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 bv licensed
mental health clinicians (psychiatrists,psychologists,therapists,clinical social
workers,psychiatric nurses).Licensed mental health clinicians shall review and
cosign record entries made bv 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 continuityof care from admission to transferor 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,communitv-based housing,and/or
appropriate servicesperthe individual's need.The sameserviceswillbe provided to
unsentenced inmates provided adequate time is available prior to a legally mandated
release.
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Hall,et.al.v.County ofFresno,Consent Decree, Appendix A, Remedial Plan
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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 ofBehavioral Health (DBH)shall collaborate with mental health
staff to provide continuity of care with psychiatric medications and referrals to
DBH services,and mental health staffshall 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 antipsvchotic 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 bv the psychiatrist shall occur as needed,but at intervals of no more than
90 days.
3.Inmates who are prescribed psychiatric medications bv the psychiatrist (i.e.. not
"bridge"medications)shall receive follow-up face-to-face evaluations with a
psychiatristasneeded depending on theirclinical status,butno laterthan30days
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 any history 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 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 of risk factors,including but not
limited to any suicide attempts or expressions of suicidal ideation.
2. Inmates displaying signsofsuicideriskshallbe referredto a mentalhealthclinician
for an evaluation.
3.The Sheriffs Office and health carestaffshall develop and implement policies and
proceduresfor housingand monitoring inmates thatpresenta lowor moderate risk
ofsuicide.Low-risk inmates shall be monitored atleast monthly by mental health
staff andshall behoused with other inmates or,if they cannotbehoused with other
inmates,in housing where they can befrequently monitored by correctional staff
Moderate-risk inmates shall be monitored at least weekly by mental health staff and
shall be housed with otherinmates 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 bv a mental health clinician prior to their release to the community for
appropriate referralsor initiation of an involuntary psychiatric hold pursuantto
Welfare and Institutions Code Section 5150.The same services will be provided to
unsentenced inmates provided adequate time isavailablepriorto 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 andprevention training annually.All suchtraining shall
be provided bva licensed clinician having expertise in correctional suicide prevention
and the use of a suicide risk assessment form.
F.Behavior Management
1.TheSheriff's Office shallassistjail mental health staff in the development and
implementation of behavior management plansfor inmates with serious mental
illness who engagein repeated acts of misconduct with thegoal ofreducing their
placements,or shortening the length oftime 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 assignedtoPopulationManagementwhoarefamiliar withthe
housing ofinmates with serious mental illness shall be included in administrative
meetings wherebehaviormanagementplans aredevelopedand reviewed.
G.Administrative Segregation
1.The Sheriffs Office shall adoptand implementa policy of leavingopenall of the cell
door portal coveringsin 2D of the SouthAnnex 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 staffshall collaborate to adoptand
implementapolicy ofhousing no inmates with serious mentalillness in 2D ofthe
South Annex Jail or the A Pods and FF Units in the Main Jail unless those
inmates demonstratea currentthreatto jail security, inmate and/or officersafety,
as documented bycorrectional staff, thatprevents 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 staffshall ensure those inmates are offered to be
taken out of their cells for recreation a minimum of 7hoursper 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 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 2D 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 programming,each lasting approximately one hour with
appropriate duration to be determined bv a mental health clinician.
ii. At a minimum,one one-to-one structured therapeutic contact session will
be offered bv 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 ofFresno,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 staffshall ensure those inmates are offered to be
takenout of theircellsfor recreation a minimum of 7hoursper week and mental
health treatment shall be offered 3 times per week.
a.Inmates with SMI whoare placed in isolation in FF cells for more than 48
hours are to have their cases reviewed bya multidisciplinary team consisting of
corrections and mental health staff everytwo 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:
i. 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.
ii.At a minimum,one one-to-one structured therapeutic contact session will
be offered bv 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 andimplementapolicy of reviewingthestatus of
inmates with serious mental illness housed in A Pods in the Main Jail at least once
every 30 daysto determine iftheinmatecan bemovedtoless restrictive housing.
Jail mental health staffshall assess SMI inmates'housing requirements,which
shall be discussed at monthly administrative meetings with custody and health care
staff. Thisprovision is not intended to and does not requirea newmentalhealth
assessment ofall inmates with serious mental illness every30 daysso long as jail
mentalhealth staff have adequate information tomakean informedand
meaningful recommendation aboutwhetherSMI inmatesshould continueto 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 thatmeets quarterly shall collectandmanage
data to developcorrectiveactionplans in responseto mentalhealthprogram
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.
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 housingpossible,basedontheir disabilities.
2. The County shallprovide accessibletoilets and showersin unitswhere inmates
requiring special accommodations for access are housed nolaterthan24 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 topermit wheelchair/walker access,etc.Inthe 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 andmedical staffshall communicate to determine appropriate
housingfor inmates with disabilities.Medicalstaffshallmake 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.Thislist shall separately identify each cell in the
Outpatient Housing Unit,since thesevaryintheir accessible features.
5.The Sheriffs Office andmedicalstaff shall collaborate to implement theuseofa
systemthat 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
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restrictions,including but not limited to:
a. The needfor an accessible shower and toilet;
b. Theneed for ground floor housing;
c. The needfor no stairs in the path of travel;
d. Theneed 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 50 feet,whenever out ofcell/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 staffshall collaborate to develop
standardized procedures for theprescription, ordering, retention, and confiscation
of assistive devices.Policies shall be developedin a manner thatisprotective ofthe
safetyandsecurity ofinmatesand staff whileaffordingequal access to jail
programs, services, and activitiesfor inmates withdisabilities.
2. An inmate who arrives at the jail with an assistive device shall be allowed to retain
the device,or shall beprovided with a jail-issued equivalent device,so long as it
does not constitute an immediate risk of bodily harm or threaten the security ofthe
facility, unless a jailphysician documents thatthe deviceis not medically necessary
or reasonable to allow equal access to jail programs, services, or activities.
3.The Sheriffs Office shall provide assistive devicesprescribed bya jail physician to
inmates as soon as reasonablypractical, so long as the device does not constitutean
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Hall, et. al. v. County ofFresno,Consent Decree,Appendix A, Remedial Plan
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immediate risk of bodily harm to inmates orstaff,or threatens the security ofthe
facility.
4. The Watch Commander shall be responsible for determining if an assistive device
constitutesan immediate risk of bodily harmor threatens thesecurity of thefacility.
If the Watch Commander makes such a determination,correctional staffshall
consult withmedical staff to determinean appropriate alternativeaccommodation
thatshall be provided.Assistive devices shall not beconfiscated if another inmate
is the source ofthe security threat.
C.Training and Management
1. American withDisabilities Act (ADA)training shall beprovidedto all new health
care staff and correctional staff,andtoall otherexisting staff as neededon an
ongoing basis.
2. The Sheriffs OfficeADA Coordinator shall confer with medical staff monthlyto
review whether accommodations for inmates with disabilities continue to be
appropriate and necessary.
D.Grievances
1.The Sheriffs Office shall provide an inmategrievance systemthat inmates with
disabilitiesmayuseto contestany disability-based discrimination or violations ofthe
ADA,and willprovidea promptand equitable resolutionto eachissue 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 withDisabilitiesAct,""Disabilities,"andhow
to request "Reasonable Accommodations."The contact information ofthejail's
designated ADA coordinator andthe 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 canbe updated and printed,an
addendum shall be provided inside each handbook distributed.
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2. The Sheriffs Office shall post and disseminate ADA notices in alternative formats to
promote effective communication,and make available grievanceforms 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
complywiththis Remedial Planas outlinedinthe StaffingPlanwiththehiringof 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
officersspread overthree years, or as soon thereafteras 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 correctionalofficersto protect inmatesfrom an unreasonablerisk of harm from
violence and injuryfrom other inmatesand physical plant deficiencies.
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Hall,et.al.v.County ofFresno,ConsentDecree,AppendixA, RemedialPlan
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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
protocolsof theJail 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 sanitationcomplianceand contract oversight. This groupshall
also examine systems of control, Jail policies and procedures, incident trends, and
make appropriaterecommendationsfor correctiveactionto the Jail Administrator.
7. Uses of force incidents shall be reviewed by the Jail Sergeant and Watch Commander
as provided herein. Violationsof use-of-forcepolicies 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
necessaryand/or appropriate.As appropriate,incidents shallbe directed to Sheriffs
Internal Affairs for possiblepolicyviolations,or to the District Attorney's Officeif
investigation determines such referral is appropriate.
8. The Jail Command Staff (Captains and Lieutenants) shall evaluate the
appropriateness of all usesof force as a partof their scheduled agenda during their
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Hall,et.al.v.County of Fresno,ConsentDecree, 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 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 for all correctional staff on
how to recognize symptoms ofmental 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 staffshall notify the on-duty charge nurse ofthe 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 ofFresno,Consent Decree, Appendix A, Remedial Plan
Exhibit A3
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 emergencykeys shall be appropriatelymarked and identified,consistentlystored
in a quickly accessiblelocation,tested annually,and staff shall be adequatelytrained
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 CourseAcademy. 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/evacuationproceduresshall 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 implementwrittenpoliciesand procedures for the introduction andcontrolof
tools in all Jail facilities subject to review and approval by the Sheriffs Office.
21
Hall,et.al.v.County ofFresno,ConsentDecree, Appendix A, Remedial Plan
Exhibit A3
I.Policies and Procedures
1.The Sheriffs 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 ofthe Consent Decree,appropriate training shall be
formulated and conducted with all staff regarding the requirements ofthe Consent
Decree and Remedial Plan, as well as changes to policies,procedures and/or post
orders.
j.The Sheriffs 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 ofFresno,Consent Decree,Appendix A,Remedial Plan
MINIMUM STAFFING LEVELS
North Annex/Main/South Jails
Revised Exhibit B
Additional Staffing
for Remedial Plan
Fresno Main/North
Annex/South Jails
paiiiaMMiiOJiiiiiniii Miimmi'rTf'wg^gL,,;,,^-•
1 POSITION Mon Tue Wed Thu Fri Sat Sun TBS*Hrs/Wk FTE
Increase
ofFTE
TOTAL
FTE'S
Proqram Administrator - HSA
8 8 8 8 8 40 1.000 0 1.000
Director of Nursing 8 8 6 8 8 4C 1.000 0 1000
Administrative Assistant/OA Supervise 8 8 8 8 8 40 1.000 0 1 000
Nursinq Supervisor {North/Main/South 16 16 16 16
16 80 2.000 0 2.000
Office Assistant 24 24 24 24 24 24 24 168 4200 1 5.200
Medical Director 8 8 8 8 8 40 1.000 0 1.000
Physician Services (MD)8 8 8 8 8 40 1.000 0 1.000
NP /PA 16 16 16 16 16 16 16 112 2.800 0 2.800
RN (12 HR Shifts)96 96 96 96 96 60 60
600
15.000 1 16 000
LVN 72 72 72 72 72 72 72 504 12.600 0 12 600
Medical Assistant 24 24 24 24 24 24 24 168 4 200 14 5.600
Dentist 8 4 8 4 8 32 0,800 0
..
0.800
Dental Asst 8 8 8 8 8 40 1.000 0 1000
Clinical Supervisor -Psych LMHC 8 8 8 8 8 40 1.000 0 1.000
Community Mental Health Specialist 8 6 8 8 8 40 1.000 0 1.000
Office Assistant -Psych 8 8 8 8 8 40 1.000 0 1000
Psychiatrist 8 8 8 24 0.600 0.8 1.400
Psychiatric RN 8 8 8 8 8 40 1.000 1 2.000
Licensed Psychiatric LVN.'Psych
Tech
8 8 8 8 8 8 8 56
1.400 0 1400
Licensed Mental Health Counselor 16 16 16 16 16 16 16 112 2.800 1.5 4300
TOTAL HOUR&n&D*X.W/////A
EVE
•w/w//mmwA/////;y///AMEm
NING SHIFT
EZ3J ^^^
NPfPA
LVN
Medical Assistant
Office Assistant
Licensed Psychiatric Tech - LVN
72
24
24
8
72
24
24
8
72
24
24
72
24
24
8
72
24
24
72
24
24
72
24
24
8
Licensed Mental Health Counselor
TOTAL HOURS/FTE-Evimini
NIGHT SHIFT
RN {12 HR Shifts)
LVN
Medical Assistant
Licensed Mental Health Counselor
70T*t HOURS/FTe-Night
TOTAL HOURS/FTE per wee*
"TBS=To be scheduled
36
36
24
36 36 36 36 36 36
36 36 36 36 36 36
24 24 24 24 24 24
56 1.400 1400
504 12 600 12.600
168 4.200 5.200
168 4.200 5 200
56 1400 1.400
0000 2.4 2.400
23.800
252
252
168
6.300
6.300
4.200
0 000 1,4
7300
6 300
4 200
1400
16.800
13.5 110.500
Page 1 of 2
Revised Exhibit B
Remedial Plan not
applicable to JJC -
no changeJuvenileJusticeCenter
DAY SHIFT
FTE |^^^
Director of Nursinq (RN) -Juvi 8 8 8 8 8 40 1.000 0 1.000
Office Assistant 8 8 a B 8 40 1 000 0 1000
Medical Director •Juvi 4 4 li 0 200 0 0200
np;pa &4 8 4 8 32 0800 0 0.800
RN 8 8 8 8 8 8 8 56 1400 0 1.400
LVN 8 8 8 8 8 8 8 56 1400 0 1400
Psychialrlst 8 8 16 0.400 0 0.400
Licensed Mental Hoalth Counseluf 16 16 16 16 16 16 16 112 2.800 0 28O0
Dentist 4 4 8 0.200 0 0200
Dental Asst 6 6 12 0.300 0 0300
TOTAL HOURS/FTmftwyyyyy/yyyy/yyyyyyyy/yyyyyw/yyyyy/yyy/M ••n i •—i
EVENING SHIFT
9.500
RN 16 16 16 16 16 16 15 112 2.800 0 2 800
LVN 8 6 8 8 8 8 8 66 1.400 0 1.400
Licensed Mental Health Counselor 8 S 8 8 8 8 8 56 1.400 0 1400
RN Eval 8 a 8 24 0.600 0 0600
TOTAL HOURSffTE-Evi mzyyyyyyy/yyyy/yyyyy/yyyy/yyyy/yyy/y/yyy/yyyyy/Mim
NIGHT SHIFT
6.200
BUI™
(x20G
0 0.000 0 0.000
D 0.000 0 0000
TOTAL HOURS/FTE-Night
Y/////Mmmr,y///Mimmmm@mwsmTOTALHOURS/FTE per week 157001
'TBS=To be scheduled
TOTAL CONTRACT HOURS/WEEK
TOTAL CONTRACT FTEs/WEEK
4508
112.700 126.200
Page 2 of 2
PAYMENT SCHEDULE 3
Additional Compensation for Remedial Plan
ANNUAL TOTAL:
MONTHLY TOTALS:
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
YEARS 2-3 TOTAL:
YEARS 2-4"TOTAL:
YEARS 2-5*TOTAL:
YEAR 2
8/1/li-6/30/7016
YEAR 3
7/1/2016 6/30/2017
1,600,000.00 $1,652,800.00
YEAR 4
7/1/2037-6/30/201S
YEAR 5
7/3/7018 -G/30/2019
1,707,342.40 $1,763,684.70
$137,733.33 $142,278.53 $146,973.72
$145,454.00 $137,733.33 $142,278.53 S 146,973.72
$145,454.00 $137,733.33 $142,278.53 146,973.72
$145,454.00 s 137,733.33 S 142,278.53 146,973.72
$145,454.00 $137,733.33 s 142,278.53 $146,973.77
$145,454.00 $137,733.33 "5 142,278.53 $146,973.72
$145,455.00 $137,733.33 $142,278.53 $146,973.72
$145,455.00 $137,733.33 $142,278.53 $146,973.77
$145,455.00 $137,733.33 $142,278.53 $146,973.77
$145,455.00 $137,733.33 $142,278.53 $145,973.72
$145,455.00 $137,733.33 $142,278.53 $146,973.72
$145,455,00 s 137,733.33 $142,278.53 s 146,973.72
3,252,800.00
•1,960,142.40
6,723,827.10
"Years 4 and 5 are additional 12-month period extensions,if performance standards are met by the CONTRACTOR.
Exhibit Gl