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Findings and Recommendations 3 findings
F4
A twice a day monitoring schedule is inadequate to monitor W class inmates for withdrawal symptoms. Medical checks at four-hour intervals are generally accepted as adequate in a hospital environment and in other detention environments. Requested Response to Finding #4 This Finding requires further evaluation. CFMG provides ambulatory outpatient care to those individuals incarcerated at the Main Adult Detention Facility. The medical environment at the Main Adult Detention Facility is not a hospital environment. CFMG's policy as well as the Sheriff's Department policy requires that inmates housed in the sobering cells be checked upon admission and every four hours. Once they are cleared to be housed in General Population, they are seen two times per day. The Sheriff's Department has designated specific housing locations for inmates who have the potential for withdrawal. This allows for increased monitoring of these individuals by both custody and medical staff.
Related Recommendations (1)
R4
The Sheriff's Department should require that CFMG consider the administration of widely held medication practices to AWS inmates as a seizure precaution. Requested Response to Recommendation #4 This Recommendation requires further evaluation. CFMG provides standard detoxification medication for the prevention of seizures and alcohol withdrawal. CFMG will again work with its Quality Assurance and Peer Review Committee, its external peer review consultants, and on the recommendations of a specialist in addiction medicine to address this recommendation.
F5
If a more frequent monitoring protocol were to be initiated in the first 48 hours of incarceration, it may be possible to deliver medication to prevent the onset of AWS, which would diminish the probability of potential fatal withdrawal incidents. Requested Response to Finding #5 CFMG disagrees with this Finding. CFMG does initiate monitoring protocols for those individuals who are identified as having alcohol and drug abuse habits, and who are potentially likely to go through withdrawal. CFMG has detox protocols for drugs as well as alcohol, which are initiated during the first 48 hours. As mentioned previously, the addition of the Alert system on the Criminal Justice computer allows for immediate identification of those patients who have been previously identified and/or treated for withdrawals.
Related Recommendations (1)
R5
Specific rounds procedures should be defined and followed by CO's for W class inmates until CFMG reviews AWS risk and determines that special attention is no longer necessary. The new W class procedure should require a verbal response from the inmate. Also that CO's must open the cell door and/or turn on the light to elicit response. Requested Response to Recommendation #5 This Recommendation requires further evaluation. California Forensic Medical Group will work with the Sheriff's Department and the custody division to address this recommendation.
F6
The primary responsibility for the medical welfare of an inmate resides with the medical staff. However, correctional officers observe inmates every half-hour. With the implementation of special observation criteria they could significantly diminish the risk of the most serious AWS candidates (opening the cell door and requiring a verbal response from high-risk inmates may be sufficient). Requested Response to Finding #6 This Finding requires further evaluation. Medical staff works closely with correctional staff to observe inmates who are placed in sobering cells. California Forensic Medical Group provides in-service training as part of custody staff's overall training on alcohol and drug-related conditions including signs and symptoms of drug and alcohol withdrawal. This frequency of this training has increased over the last year. As mentioned previously, the signs and symptoms of withdrawal are written on the "W" alert sign which is posted on the cell door. This will assist custody staff with the monitoring of these individuals. CFMG will continue to provide on-going training to both custody and medical staff regarding signs and symptoms of alcohol and drug withdrawal and will work collaboratively with the Sheriff's Department to make changes as necessary to increase the monitoring of these individuals. Finding#7 Two medical experts indicated that the high-risk inmates we identified would have benefited from blood alcohol testing prior to being placed in general population. Requested Response to Finding #7 CFMG partially disagrees with this Finding. CFMG would appreciate the opportunity to review the findings of the two medical experts who indicated that blood alcohol testing prior to being placed in general population is the standard of practice, and the rationale for it. CFMG is not aware of any detention facility that currently does this, but is certainly willing to explore that as a benefit to this population. . . . . .
No recommendations for this finding
Additional Recommendations 3
These recommendations are not explicitly linked to specific findings.
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R1The Sheriff's Department should require that the CFMG alcohol withdrawal risk assessment procedure be modified to more closely follow the CIWA-Ar, including all the parameters and rating scales in the formal procedure. Requested Response to Recommendation #1 CFMG partially disagrees with this Recommendation. CFMG has invited an expert in drug and alcohol withdrawal to review their current assessment tools and address the Grand Jury's recommendation. CFMG is not averse to following this recommendation.
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R2The Sheriff's Department should require that CFMG's assessment protocols identify chronic alcoholics who arrive intoxicated and have a medical history of AWS as a special class of inmates needing closer monitoring. Reassessment of AWS risk is required when BAC concentrations drop below .1%. Requested Response to Recommendation #2 CFMG partially disagrees with this Recommendation. CFMG has an assessment protocol to identify chronic alcoholics and those who arrive with a medical history of Alcohol Withdrawal Syndrome. In addition, the "Alert" system which has recently been implemented will identify inmates with a history of CFMG has worked in conjunction with the Sheriff's Department to withdrawal. implement polices which provide closer monitoring of this high-risk population. CFMG will look into the finding of reassessment of Alcohol Withdrawal Syndrome when BAC concentrations drop below .1%
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R3The Sheriff's Department should require that CFMG monitor W class inmates at least once every four hours. Requested Response to Recommendation #3 This Recommendation requires further evaluation. California Forensic Medical Group does provide four-hour monitoring of individuals who are placed in sobering cells. There are many inmates who are transported to the local emergency room after medical staff has done an assessment and determined the inmate needed a higher level of care. CFMG will explore with the Sheriff's Department the possibility of increasing nursing staff to monitor individuals on "W" class more frequently...
No Responses Found 1
Government entities assigned to respond to this report. No response documents have been linked in our database.
Sonoma County Sheriff
Elected County Office
* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.