Emergency Medical Care of Inmates by Ocsd in Holding Cell Facilities

Summary The day-to-day business of county-operated, adult detention facilities in Orange County, under the Acronyms in this Report management of the Orange County Sheriff’s Department (OCSD), requires multiple programs to EMS Emergency Medical provide reasonable inmate care. Services - “911” An area reviewed by the Grand Jury was the OCSD’s IMS Institutional Medical care of inmates in Superior Court Justice Center Services holding cell facilities as related to reasonableness and timeliness of responses in emergency medical LVN Licensed Vocational situations. Based on our review, the 2005-2006 Orange Nurse County Grand Jury concluded that responses to MD Medical Doctor emergency medical needs were timely and reasonable. (Physician) NP Nurse Practitioner 2. Introduction and Purpose of the Study OCSD Orange County The OCSD is responsible to ensure inmates are Sheriff’s Department transported safely and in a timely manner Monday through Friday from the jail sites to all Justice Center RN Registered Nurse holding cell facilities in order to make court appearances. Deputy sheriffs are responsible for the care and safety of the inmates while being transported to and from the jails and courthouses and also while housed in the holding cell facilities awaiting court appearances. This study reviewed the timeliness and reasonableness of emergency medical care response to inmates maintained in holding cell facilities.

Method of Study In regard to Justice Center holding cell facilities, the Grand Jury: • Examined policy and procedure manuals • Analyzed inmate Medical Aid Reports • Interviewed OCSD personnel responsible for emergency medical care . Background 4.1 Jail Sites There are three jail locations, but five separate facilities in the Orange County detention facilities system. The Men’s Jail, the Women’s Jail and the Intake and Release Center are housed in the Central Jail Complex in Santa Ana. The James A. Musick facility is at the edge of Irvine near the former El Toro Marine Corps Air Station. Theo Lacy Jail is across the street from the Block of Orange. The OCSD also operates two holding cell facilities in the contract cities of San Clemente and Laguna Niguel. 4.2 Institutional Medical Services (IMS) IMS is the Health Care Agency organization that works within the county jails. IMS staff is responsible for medical, dental, nursing, pharmaceutical and behavioral services for all inmates in the county’s adult detention facilities. IMS staff includes: • Physicians (MDs)/Nurse Practitioners (NPs) • Dentists • Registered Nurses (RNs)/Licensed Vocational Nurses (LVNs) • Pharmacists 4.3 Justice Center Holding Cell Facilities The OCSD oversees the transporting of inmates as they leave the adult jail facilities before dawn and fan out to the five Superior Court Justice Centers throughout Orange County. They are transported in secured buses and vans to the various courthouses and then into holding cell facilities while waiting to appear before a judge. It is an intricate process to get all the inmates to the right courthouses at the right times. This job of transporting the inmates repeats itself again in the early evening as the inmates return to the jails. During this entire process, from leaving until returning to their assigned jail, total care of the inmate populations, including any emergency medical care, is the responsibility of deputy sheriffs. Emergency Medical Care in Holding Cell Facilities 5. Observations and Discussion 5.1 Number of Holding cell facilities Inmates The following table shows the total number of inmates processed through holding cell facilities in the five Justice Centers over the past two years. Number of Inmates Justice Center Processed 2004 2005 Central 50,235 50,255 Laguna Niguel 9,320 8,968 North 36,002 34,873 West 24,631 26,587 Harbor 11,746 12,183 Totals 131,934 132,866 As these numbers indicate, more than 500 inmates are transported every week day for court appearances at the Justice Centers. 5.2 Justice Centers Because holding facility characteristics vary by location, the Grand Jury selected the Central Justice Center in Santa Ana as an unique example. At this Justice Center, inmates seldom are seen outside of a courtroom because they are brought there via a labyrinth of sub-basements, tunnels, elevators, and holding cell facilities in the interior of the high-rise courthouse. There are holding cell facilities on several floors near courtrooms. 5.2.1 Care of Inmates Individuals taken into custody by the court or law enforcement all receive a medical evaluation when they are booked in the jails. Inmates sent to holding cell facilities from the jails have been medically cleared and appropriate medications, if necessary, sent with them. The deputy sheriffs interact with IMS to check inmate medical history should the need arise as a result of an emergency. Deputy sheriffs serve as the first line of care in medical emergencies within the holding cell facility, during vehicular transportation, and in courtroom settings. During our visits, the Grand Jury was told of some heroic, life-saving actions by some of the deputies reacting to unforeseen medical emergencies with inmates in their care. The deputies are trained in First Aid, Coronary Pulmonary Resuscitation, use of an Automatic Electronic Defibrillator, and other life-saving procedures. It is an important part of their training to be ready to respond to medical emergencies. If deputy sheriffs make the determination that the required medical need/care is beyond the scope of their training/ability, deputies dial “911” to call paramedics .2.2 Emergency Response Times The Grand Jury study reviewed the emergency care procedures and Medical Aid Reports for inmates in for years 2004 and 2005. The numbers of reports reviewed for each Center were: Superior Court Number of Medical Aid Reports Reviewed Justice Center 2004 2005 Total Central 10 11 21 Laguna Niguel 12 5 17 North 28 24 52 West 15 8 23 Harbor 12 5 17 Total 77 53 130 Based on the Reports provided, the Grand Jury concluded deputy sheriffs responded reasonably to medical emergencies. Given that timeliness is critical in responding to emergency medical needs, the Grand Jury also concluded that the deputies’ response times were reasonable. The Grand Jury study also reviewed the Emergency Medical System’s (EMS) records of response time to “911” calls from holding cell facilities for 2004 and 2005. The Grand Jury found these response times were also reasonable. 5.3 IMS During a visit to the Central Jail Complex, the Grand Jury reviewed IMS procedures, and obtained the following information about the services provided: Treatment of inmates reported in a year: • Medical screening assessments 64,589 • Sick call visits (medical and/or dental) 180,776 • Behavioral assessments 10,615 Triage of inmates: • All medical inmates are seen immediately, or within two hours by a MD/NP, or the inmate is placed on next-day “MD sick call” • All mental health inmates are seen by IMS Mental Health staff before being placed in a cell or other assigned area (“housing”) • Mini x-rays to rule out tuberculosis are performed before housing of inmates Emergency Medical Care in Holding Cell Facilities Medical housing of inmates (infirmary): • Critical care – beds for 18 males and 15 females, with 24 hours direct observation by RNs • General care - 205 medical beds without direct observation • MD/NP on site or on call 24/7 • Pharmacy available seven days a week • Deputy sheriffs referrals are seen immediately • All inmates are seen within 24 hours of the staff receiving a written request from an inmate • Inmates housed in the Infirmary are seen daily by a MD Dispensaries: • Staffed with RNs and LVNs 24/7 • MD/NP sick call daily • Dental clinic Monday – Friday • RN sick call daily • Diabetic care daily • HIV/STD testing and treatment • Dispensing of medication and treatment - 24 hours a day/twice a day 6. Findings In accordance with California Penal Code §933 and §933.05, each finding will be responded to by the government entity to which it is addressed. The responses are to be submitted to the Presiding Judge of the Superior Court. The 2005-2006 Orange County Grand Jury has arrived at the following findings: 6.1 Holding cell emergency medical care response: Based on Grand Jury observation and review of Orange County Sheriff’s Department information, deputy sheriffs appeared trained, experienced, and dedicated to providing timely and reasonable emergency medical responses for inmates in the Justice Center holding cell facilities. Response to Finding 6.1 is required from the Orange County Sheriff-Coroner.

Recommendations In accordance with California Penal Code §933 and §933.05, each recommendation will be responded to by the government entity to which it is addressed. The responses are to be submitted to the Presiding Judge of the Superior Court. Based on the findings, the 2005- 2006 Orange County Grand Jury makes the following recommendations: .1 Continue holding cell emergency medical care practices: Because reasonable practices, procedures and training are in place, the OCSD should continue to maintain and sustain this performance level when dealing with emergency medical care for inmates. (Finding 6.1.) Response to Recommendation 7.1 is required from the Orange County Sheriff- Coroner.

Acknowledgement The Grand Jury commends the dedication of deputy sheriffs working in the Superior Court Justice Centers’ holding cell facilities/jails and of the Institutional Medical Services staff working within the jail facilities of Orange County.