Summary Response Statement:*

Inmates being booked will often have abnormal vital signs due to the stress of being handcuffed, being booked into jail and potentially being under the influence of various substances. The respondent disagrees partially with the finding. While stress and other Response: factors can affect vital signs, the degree to which they do so varies by individual.

Vital signs are attempted only on inmates being booked who self-identify as having hypertension, a heart-related disorder or a prior medical history. The respondent disagrees wholly with the finding. Vital signs are obtained on Response: individuals suspected of having any medical condition, including being under the influence of drugs and/or alcohol, whether through clinical observation, statement of the booking officer, review of previous incarcerations, or individual self-report.

Inmates have the right to refuse to disclose medical history as well as any medical interventions. The respondent agrees with the finding. Response: V 190 75

With the increasing number of inmates, their often poor health status, and the potentially incomplete diagnosing of inmates, the county is opening itself up to potential liability lawsuits. The respondent disagrees wholly with the finding. Each arrestee brought in to Response: the Intake Release Center (IRC) receives a comprehensive health screening conducted by licensed healthcare professionals, which includes obtaining information concerning health history, current conditions, medications, hospitalizations, mental health history, and various other health information. The goal is to identify as much information as possible; however, the cooperation, knowledge, and self-reporting of the patient is vital to obtaining to the most accurate and thorough information. In addition to obtaining subjective information by interviewing the patient, Health Care Agency's Correctional Health Services (CHS) also gathers objective information from the Statement of the Booking Officer form, past incarceration medical chart (if applicable), outside pharmacy verification (if applicable), and observation and clinical assessment completed by the licensed healthcare professionals at Intake.

Inmates are being transferred to outside hospitals for evaluation of chest pain and more than half are being admitted for care, increasing medical costs to Orange County taxpayers. The respondent disagrees wholly with the finding. The jail is not an acute care Response: facility capable of managing ongoing evaluation and treatment of acute cardiac chest pain beyond initial identification and interventions. The quick identification and transport of an individual with cardiac chest pain to an acute care medical facility can improve patient outcomes, thereby decreasing potential lawsuits which can lead to increased costs to the Orange County taxpayers. F. 6. CHS policy does not comply with generally accepted medical practices for monitoring and treating elevated blood pressure. The respondent disagrees wholly with the finding. The CHS policy on Response: "Hypertensive Emergencies: Acute Care Evaluation and Management" is consistent with accepted medical practices as outlined by the 8th Joint National Commission panel recommendations. Details available at the following link: 2014 Evidence-Based Guidelines from JNC 8 for the Management of High Blood Pressure in Adults

Electronic medical records currently in use by CHS provide no means to monitor how many and which inmates are having vital signs performed as a result of a nursing decision. The respondent disagrees wholly with the finding. The CHS electronic health Response: record creates comprehensive reports that allow CHS to identify how many and which inmates are ordered vital signs monitoring as a result of a clinical decision. F. 8. Inconsistencies between the CHS reports and the reports of OCFA paramedics appear in the custodial death reports issued by the OCDA Defer to OCDA. Response: F. 9. The current physical configuration at IRC is not conducive to conducting health screenings. Defer to OCSD. Response: RECOMMENDATIONS AND RESPONSES: