Riverside County Sheriff’s Department Corrections Division Booking-Process – Clinical Assessments

The Initial Medical History/Suicide Assessment form lacks pertinent medical questions for clinical staff to determine medical concerns of the inmate/detainee screened for booking. The title of the form indicates that a medical history will be assessed. However, the form only addresses five medical issues: exposure to a contagious disease, current drug use and type, any withdrawal symptoms, suicidal ideations and if the inmate/detainee is transgender. There are no other comprehensive medical questions on the form pertaining to the health of the individual that identify any concerns clinical staff should be aware of during the inmate’s stay. The form contains a “Statement of Consent to Medical Treatment” which states: I (do) (do not) authorize the attending physician and medical staff to provide such services and treatments as deemed reasonable and necessary for my health and well-being while in the custody of the Sheriff. This form includes a place for the inmate/detainee’s signature with date and a place for a witness signature with date. There is a place for the inmate/detainee to print their name. There is no place for a witness to print their name. In several of these forms where the inmate/detainee refused to sign, the witness signature line contained a staff identification number, not a signature, meaning that the form was not completely filled out as designated. Because staff are not properly completing the form, it makes it difficult to determine who authenticated the form. On one form utilized by the Desert Regional Medical Center titled Leaving Hospital Against Medical Advice, it was noted that an inmate signed a refusal of medical treatment. There is no subsequent refusal form signed by the inmate at the jail that the Riverside County Grand Jury (Grand Jury) could locate. Per California Title 15, §3351 – Inmate Refusal of Treatment, the Inmate Refusal of Treatment form must be signed for each subsequent clinical treatment, or appointment, whether at a detention facility or at an outside hospital. Refusal of treatment forms are not universally transferable from one area to another. There is no statement on the form to inform the inmate/detainee that lifesaving measures will be performed to preserve life. Clinical staff has a mandate to intervene in performing lifesaving measures. There is no place for the inmate/detainee to print and sign their name acknowledging that they understand this information. The Medical Department does have a policy for refusal of treatment and the inmate is required to sign each time, but it is not reflected on this form. Supplemental Intake Questionnaire

The current Supplemental Intake Questionnaire form states: Swallowing or concealing any type of drug or substance inside your body poses a serious risk of harm and could lead to sudden death. We are concerned with your health and safety and want to provide you necessary medical attention if you are concealing any drug or substance inside your body. Are you concealing any drugs or other substances inside your body? 3 There is no acknowledgment section that the inmate/detainee read the statement and/or acknowledged that they understood. The form does not contain a statement informing the inmate/detainee that the Sheriff will, with medical intervention, take X-rays or perform a body cavity search if an inmate/detainee is suspected of smuggling a controlled substance or other contraband into the facility. The Sheriff must take all precautions to maintain safety and security of its facilities. There is no provision for a witness signature and printed name if the inmate refuses to sign the form. After reviewing several Intake Questionnaire forms, the inmate/detainee’s printed name with booking number was left blank. If this form was lost or detached from the booking file, it would be difficult to match the form with the correct inmate/detainee. DNA Tracking Worksheet

The DNA Tracking Worksheet provides for the tracking of DNA samples in compliance with California Penal Code §296.1(a)(2) and (3) and Riverside County Sheriff’s Policy 504.06 DNA Samples. Several DNA Tracking Worksheets in the booking packet were reviewed, but the form was left blank in all four sections except for the inmate/detainee’s name and booking number. Medical Attention/Observation

When an inmate/detainee is placed into a sobering cell for observation, the custody staff is required by Policy 502.10 – Security Logs/Checks, to conduct security checks at least once every thirty minutes. This was verified. However, there was no documentation obtained, from the Riverside County Correctional Health Care Administration, requiring clinical staff to make similar thirty minute checks for clinical observations. One report indicated that an inmate/detainee was placed in a sobering cell at 0740 hours (7:40 a.m.) but was not observed by clinical staff until 1200 hours (12:00 p.m.), which was more than four hours later. There was no recorded entry in the computer of any clinical observation of the inmate/detainee during this time period, found in the documents, reviewed by the Grand Jury. If clinical observations were conducted, it was not recorded in any documents provided to the Grand Jury. If the inmate was in distress during this time, custody staff may have missed pertinent medical symptoms. Custody staff is not typically medically trained to recognize less- obvious medical or critical symptoms such as an escalating fever or dehydration, which a clinician could more easily identify. There is no clinical protocol/policy provision the Grand Jury could find, nor any notation in submitted reports, requiring medical or psychiatric clinical staff to conduct routine rounds in holding/sobering cells, consistent or similar to custody staff mandates. Critical Incident Logs

Critical Incident Logs are designed to give a synopsis of critical information concerning issues with crime scenes, critical incidents, search and rescue missions, Special Emergency Response Team (SERT) incidents, and critical aid operations as described on the form. The current Critical Incident Logs do not contain this pertinent information and are not completed accurately as required. Personnel listed on the logs require their printed name (last, first) and rank, as well as other pertinent information. The rank of clinical staff is not properly annotated. Medical staff use a generic “medical staff” designation which is not in compliance with the form. Proper clinical rank or position such as LVN, RN, or MD must be properly annotated as required on the form, the same as required by custodial staff such as Sergeant (Sgt.) or Corporal (Cpl.). The form is not descriptive enough to give a true picture describing what the actual critical incident pertained to and the circumstances. The form only lists categories for staff, rank, ID, time in/out, name, and not the synopsis of the incident. In the incident section, it listed “non-responsive”; in another report in the incident section, it lists “10- 44”. This does not reflect why this incident required special response. Outside Hospitals “OK to Book”/Exclusion of Normal Medical Screenings

The standard booking protocol requires a non-correctional hospital to clear an inmate/detainee for formal booking at a detention facility if there is a medical concern, mental health concern, or injury at the time of arrest before the inmate/detainee will be accepted at a detention facility. However, in reviewing documents provided to the Grand Jury from medical and custody staff pertaining to the “OK to Book” clearance from a non-correctional hospital, there were no additional documents indicating that a more thorough comprehensive clinical screening was conducted. The non-correctional hospital may only focus on the immediate health issues to determine if the inmate/detainee is “OK” to be processed and accepted into the detention facility. If the detention clinical staff do not conduct a thorough medical screening in addition to the “OK to Book” clearance, the facility may not be aware of any 5 undiagnosed medical or mental health conditions or diseases until a later date. Sobering Cell Logs

A review of several Sobering Cell Logs revealed they were not properly completed according to protocol codes listed on the form. Some of the notations were not legible. The only annotation listed was C-4, commonly known as “Code 4”, meaning that everything is OK. However, this code is not one of the authorized codes listed on the form. Physician or Other Clinical Staff on Call

There is no process in place to identify the medical personnel or the physician on call for each shift in an easily accessible database. The Medical Director informed the Grand Jury that payroll would have to be contacted to ascertain this information. Critical Incident Reports Completed by Custody and Clinical Staff

All reports start out as “I” as the person “writing” the report. There is no way to identify the person actually writing, or authoring, the report because there is no signature line, printed name line, or employee ID number line to connect the report to the author. The word “I” does not identify who actually wrote the report. There is no indication a supervisor reviews any reports ensuring all information and issues of the incident are thoroughly addressed. There is no place for a supervisor to print and sign their name, affix their ID number and rank, or identify who reviewed the report. Reports Not Properly Screened for Content Continuity

In a Critical Incident Report reviewed, custody and clinical staff observed a plastic bag secured to an inmate/detainee and the clinician removed the bag. However, there was no further mention of the bag, the disposition of the bag in the original report, or any subsequent or supplemental reports. Continuity of information and “chain of custody” evidence, if it was deemed evidence, was lost in subsequent documentation. Supervisory review would have caught this discrepancy and had it addressed in a supplemental report. Automated External Defibrillators (AED)

In reviewing reports from the nursing staff, one report indicated that the AED was available and the AED electric pads were placed on the inmate to deliver a shock. However, the AED did not deliver a shock. There was no documentation clarifying whether the AED 6 malfunctioned or if the AED indicated a shock was not warranted and therefore did not deliver the shock. When reading the reports, it is not clear whether the AED was malfunctioning or if it was a proper reading by the machine.