Preventable Deaths in Orange County Jails*

Failure to identify health threats at the Intake Release Center may lead to subsequent medical challenges that could be avoided. The respondent disagrees partially 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 the most accurate and thorough information. In addition to obtaining subjective information by interviewing the patient, CHS also gathers objective information from the Statement of the Booking Officer form, past incarceration medical chart (if applicable), outside pharmacy medication verification (if applicable), and observation and clinical assessment completed by the licensed healthcare professionals at Intake.

Because the Intake Release Center health assessment does not screen for drug or alcohol intoxication, some inmates have not been appropriately assigned to the Medical Observation Unit to monitor for potential overdose events. 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 history of drug and/or alcohol use. The screening contains multiple questions regarding the use of drugs and/or alcohol in order to best determine an individual's needs, including housing location, during incarceration. Additionally, healthcare staff review the Statement of the Booking Officer, which documents any known information on drug and/or alcohol use by the arrestee prior to arrival at the IRC. Finally, a section of the health screening and assessment includes clinical observations of the arrestee by healthcare staff, to include signs of drug and/or alcohol intoxication and/or abuse.

Failure to screen for mental illness at the Intake Release Center exposes other inmates to potential risk. The respondent disagrees wholly with finding. All arrestees receive a Response: comprehensive health screening conducted by licensed healthcare professionals. The initial screening covers mental health history, current medications, suicide risk, previous mental health hospitalizations, and past or current psychiatric care. Based on an individual's responses to the initial screening questions, a secondary, more in- depth, screening for mental health conditions follows, if clinically indicated. The CHS intake screening meets both State requirements and Immigration and Customs Enforcement's (ICE) Performance Based National Detentions Standards (PBNDS).

Failure to detect Hepatitis B, Hepatitis C, and HIV at the Intake Release Center puts the jail population and staff at risk for these diseases. The respondent disagrees wholly with finding. CHS routinely tests individuals Response: upon request and as clinically indicated. There is no community, industry, state, or federal standard for screening for these conditions upon intake. CHS routinely tests individuals upon request and as clinically indicated. Additionally, screening for HIV is routinely conducted on all patients at the time of any ordered lab work (unless the patient specifically "opts out" or declines the test).

Inmate health care is compromised when the Intake Release Center x-ray screening is limited to the detection of tuberculosis and not used to identify other significant abnormalities, such as artificial heart valves and aortic aneurysms. The respondent disagrees wholly with the finding. Tuberculosis has the ability to Response: be transmitted to others who share living spaces with someone who has the active disease, therefore, detecting tuberculosis in order to prevent an outbreak is a major priority for CHS. While the primary purpose of x-ray screening in the IRC is to identify active tuberculosis, significant abnormalities such as aortic aneurysms and artificial (mechanical) heart valves would be identified. Licensed Radiologists read every chest x-ray completed in the IRC and report significant abnormalities.

Appropriate health care may be delayed when drug and alcohol screening test results collected by outside law enforcement agencies are not provided to the Intake Release Center with the arrestee. The respondent disagrees partially with the finding. Outside law enforcement Response: agencies complete a Statement of Booking Officer form for each arrestee brought in for health screening in the IRC. This includes whether the arrestee exhibited signs of being under the influence of drugs or alcohol. Having actual drug and/or alcohol test results would provide more definitive data which could enhance the comprehensive evaluation process.

Appropriate health care is compromised when medical records, diagnoses, and treatment plans are not provided by the hospital when the inmate returns to the Intake Release Center. The respondent disagrees partially with the finding. If patients are returned to Response: the IRC without medical records, diagnoses, and treatment plans, CHS healthcare staff coordinate obtaining the health records with the appropriate hospitals at the time of screening. If needed, the patient signs an authorization to release records, which is forwarded to the hospital to then obtain this information. Hospitals do not always send this information without an authorized release from the patient based upon advice from their own counsel as it relates to federal HIPAA laws.

Inmate care may be compromised because of the lack of a timely referral to a healthcare professional. This is especially problematic on weekends and holidays. The respondent disagrees wholly with the finding. Registered nurses provide Response: health services 24 hours per day/7 days per week/365 days per year, and all weekends and holidays are covered by on-site nurse practitioners, physicians, and psychiatrists. Additionally, physicians, and psychiatrists provide 24/7 on-call availability.

There is no provision to administer intravenous fluids in the Medical Observation Unit, potentially subjecting patients to dehydration. The respondent disagrees wholly with the finding. Intravenous (IV) fluids are Response: readily available and initiated when medically necessary during emergency responses. When clinically indicated, patients requiring longer term IV therapy are sent to the hospital for treatment and care.

Timely receipt of autopsy and toxicology reports provides important information that could assist Correctional Health Services in implementing needed changes. The respondent agrees with the finding. Response:

The Orange County Correctional Health Service's performance is not accredited by any peer review agency; consequently, it lacks the benefits of accreditation as a process improvement tool. The respondent disagrees partially with the finding. While CHS does not have Response: accreditation by a peer review agency, there are routine and extensive reviews, audits, and inspections conducted by: California Board of State and Community Corrections, ICE Office of Detention Oversight, Nakamoto Group (sub-contracted by ICE), HCA Annual California Code of Regulations (CCR) Title 15 Audit (on behalf of the state of California), Department of Justice, Board of Pharmacy, and various other public interest, regulatory, and legal entities. Additionally, CHS has both internal and external processes to review quality management and clinical care. Furthermore, CHS models policies and practices cited by the National Commission on Correctional Healthcare (NCCHC). RECOMMENDATIONS AND RESPONSES: