LA County Board

24.\nStrengthening Accountability to Significantly Decrease Jail Deaths in the\nLos Angeles County Jails\nRecommendation submitted by Supervisor Hahn: Request the Sheriff and\ninstruct the Directors of Correctional Health Services, Department of Health\nServices, Public Health, through its Substance Abuse Prevention and Control\nBureau, the Interim Inspector General, the Auditor-Controller and the Medical\nExaminer, to implement the directives listed below within 120 days, and report\nback to the Board in writing in 30 days after completion, unless noted\notherwise. The report back should also include potential need for funds and\nstaffing to implement. Request the Sheriff to report back to the Board on:\nThe recent efforts and how the current security equipment, such as\nscanners, can be utilized to consistently and thoroughly scan sworn and\ncivilian staff for narcotics and other prohibited items, including clear\nbags, lunch bags, and other property.\nIn consultation with County Counsel, report back on recent vulnerability\nassessments of each facility, recommendations made, and strategies to\nlimit the number of illicit substances and narcotics coming into the\nfacilities, including the installation of adequate number of cameras for\nfootage to be reviewed and ensuring scanners are available at all\nfacilities.\nAbide by Title 15 Safety Checks by ensuring staff are taking the\nappropriate time to thoroughly assess for “signs of life” before moving to\nthe next cell. This should include consistent supervisor’s walks and\naccurate and timely documentation of checks.\nThe details of Title 15 safety check policies related to quality and\ntimeliness, the accountability processes and system upgrades that allow\nfor it, including the BREAVA, a computerized logging system, and\npercentage of compliance, consistent application of security checks\nconducted at random intervals and/or staggered, and the work the\nDepartment is doing in partnership with the United States Department of\nJustice monitor to ensure quality safety checks are performed. This\nshould also include any recent updates to the Title 15 safety check\npolicies and accountability processes that were created or updated that\nwill specifically reduce the number of in-custody deaths.\nHow other classifications are used to support safety checks and escorts\nto medical appointments, including Custody Assistants, and other options\nexplored previously or being explored and mandatory overtime, including\nan evaluation on whether the current ratio needs to be updated to support\nthe Department’s efforts to reduce the number of in-custody deaths.\nConsistently monitor cameras and increase supervisor walks of the\nfacilities to increase the number of informal and formal safety and\nsecurity checks and that continual monitoring occurs.\nThe current use of Closed Circuit Television (CCTV) and body worn\ncameras and how it’s used currently to reduce in-custody deaths, in\naddition to the feasibility of doing consistent camera monitoring,\nincluding cost estimates and budget implications.\nCCTV installed in the jail facilities should be checked frequently and\nmonitored to ensure they are in working order, functional, and operable.\nCCTV cameras should be operable at all times. Policies should include,\nespecially in in-custody death cases and investigations, should there be\ncameras that were inoperable and/or footage deleted, a thorough\ninvestigation conducted.\nIn the interest of transparency and accountability, add the name of the\njail facility of where an individual was housed prior to their death on the\nSheriff’s Department In-Custody Death dashboard.\nEnsure Naloxone is more accessible to individuals, regardless of their\nhousing situation, especially those housed in specialized units or units\nwithout open program space.\nEnsure grievance forms, including Health Request forms are available\nand accessible to people who are incarcerated at all times.\nDevelop a periodic self-monitoring process as required by County Fiscal\nManual Section 1.0.2 and as mentioned in the Chief Executive Officer’s\nRisk Management report. Section 1.0.2 indicates that department\nmanagement has primary responsibility for designing, implementing, and\nmaintaining a system of preventative and detective internal controls on an\nongoing basis to ensure any weaknesses or non-compliance are\npromptly identified and corrected. In collaboration with the Director of\nCorrectional Health Services, Department of Health Services, establish\nkey performance indicators, monitor and escalate death review statuses,\nand develop a process to periodically review completed corrective action\nplans. 90 days upon implementation, the Auditor-Controller to conduct an\nindependent review and identify further recommendations.\nInstruct the Director of Correctional Health Services, Department of Health\nServices to report back to the Board on:\nAn analysis on the existing Medicated Assisted Treatment (MAT) delivery\nprocess, cost analysis of staffing involved in oral medications compared\nto the long-acting injectables (LAI), along with the identification of other\nalternatives and options. Additionally, an evaluation on current processes\nand identify areas of improvement in the identification of patients who\nneed MAT and delivery of MAT services.\nIn collaboration with the Director of Public Health’s Substance Abuse\nPrevention and Control, identify best practices and recommendations on\nhow to reduce substance use-related deaths inside the jails.\nThe Automated External Defibrillator (AED) inventory control and\ninspection mechanisms and make changes as needed to ensure\nemergency response equipment is available, inspected, in working order,\nand replaced if necessary.\nProvide the Office of Inspector General (OIG) monthly reports of\ncompassionate release efforts for the OIG to include in their quarterly\nreports to the Board. Additionally, identify ways with relevant\nstakeholders how to expedite compassionate releases, including\nlegislation similar to Assembly Bill 960, Penal Code 1172.2.\nIn collaboration with the Sheriff and the Interim Inspector General, report\nback on the recent changes to the death review process, including the\naddition of the mortality review process, and improvements to the\nCorrective Action Plan tracker.\nExplain and review the current process for submission of non-emergency\nhealth request forms and what would be needed to include daily\nwalkthroughs as part of Correctional Health Services staff duties,\naddressing delays in care, and setting medical appointments.\nIn collaboration with the Acting Chief Executive Officer, request funding\nfor the electronic health service request form along with the development\nof an evaluation process to ensure the investment is resulting in an\nincrease in accessibility and efficiency for medical staff and addresses\ndelays in the delivery of medical treatment; an electronic\nmovement/appointment system that can assist in properly tracking\nupcoming appointments for patients and flagging conflicts in scheduling;\nand unmet needs for MAT in the jails.\nTo address suicides in the County jails, provide a timeline of when the\nJoint Quality Improvement Committee will be evaluating the current court\nnotification process to review any gaps in the delivery of services,\ntimeliness of services, and dispatch of the Jail Mental Evaluation Team.\nIn collaboration with the Sheriff, Medical Examiner, the Interim Inspector\nGeneral, Executive Director of the Sheriff Civilian Oversight Commission,\nthe Sybil Brand Commission, Auditor-Controller, and Acting Chief\nExecutive Officer, through its Risk Management Branch, to report back\non a potential scope of work for Correctional Health Services to seek\nfunding to obtain an outside consultant to evaluate recent deaths, identify\ntrends, and provide recommendations and best practices to reduce\nin-custody deaths.\nDirect the Medical Examiner, in consultation with County Counsel, to identify\nopportunities to strengthen existing policy on the use of “security holds” on\nautopsies of individuals, including the need for delegated authority to enforce\nthe policy, especially in situations of dispute; and criteria that need to be met\nfor security holds to be lifted or waived.\nInstruct the Auditor-Controller to conduct an initial review of the Sheriff’s\nDepartment and the Department of Health Services’ Correctional Health\nServices’ corrective action processes and efficacy tools 60 days upon\ndevelopment; and annual reviews of the Sheriff’s Department and Correctional\nHealth Services’ corrective action plans, processes, and efficacy of their tools.\nInstruct the Interim Inspector General to include in their quarterly report backs\nto the Board information about the MAT program on the following, but not limited\nto: the number of people on the MAT waitlist, the number of unique individuals\nwho are participating in MAT per facility, and the type of MAT assistance that\nindividuals are receiving, and implementation status and brief summaries on\ndeath in custody corrective action plans. In collaboration with the Executive\nDirector of the Sheriff Civilian Oversight Commission and the Sybil Brand\nCommission monitor the accessibility and availability of Naloxone in the jail\nfacilities. (26-1247)\nMotion by Supervisor Hahn\nMotion by Supervisor Hahn (Updates Following Cluster)