LA County Board

24. Strengthening Accountability to Significantly Decrease Jail Deaths in the Los Angeles County Jails Recommendation submitted by Supervisor Hahn: Request the Sheriff and instruct the Directors of Correctional Health Services, Department of Health Services, Public Health, through its Substance Abuse Prevention and Control Bureau, the Interim Inspector General, the Auditor-Controller and the Medical Examiner, to implement the directives listed below within 120 days, and report back to the Board in writing in 30 days after completion, unless noted otherwise. The report back should also include potential need for funds and staffing to implement. Request the Sheriff to report back to the Board on: The recent efforts and how the current security equipment, such as scanners, can be utilized to consistently and thoroughly scan sworn and civilian staff for narcotics and other prohibited items, including clear bags, lunch bags, and other property. In consultation with County Counsel, report back on recent vulnerability assessments of each facility, recommendations made, and strategies to limit the number of illicit substances and narcotics coming into the facilities, including the installation of adequate number of cameras for footage to be reviewed and ensuring scanners are available at all facilities. Abide by Title 15 Safety Checks by ensuring staff are taking the appropriate time to thoroughly assess for “signs of life” before moving to the next cell. This should include consistent supervisor’s walks and accurate and timely documentation of checks. The details of Title 15 safety check policies related to quality and timeliness, the accountability processes and system upgrades that allow for it, including the BREAVA, a computerized logging system, and percentage of compliance, consistent application of security checks conducted at random intervals and/or staggered, and the work the Department is doing in partnership with the United States Department of Justice monitor to ensure quality safety checks are performed. This should also include any recent updates to the Title 15 safety check policies and accountability processes that were created or updated that will specifically reduce the number of in-custody deaths. How other classifications are used to support safety checks and escorts to medical appointments, including Custody Assistants, and other options explored previously or being explored and mandatory overtime, including an evaluation on whether the current ratio needs to be updated to support the Department’s efforts to reduce the number of in-custody deaths. Consistently monitor cameras and increase supervisor walks of the facilities to increase the number of informal and formal safety and security checks and that continual monitoring occurs. The current use of Closed Circuit Television (CCTV) and body worn cameras and how it’s used currently to reduce in-custody deaths, in addition to the feasibility of doing consistent camera monitoring, including cost estimates and budget implications. CCTV installed in the jail facilities should be checked frequently and monitored to ensure they are in working order, functional, and operable. CCTV cameras should be operable at all times. Policies should include, especially in in-custody death cases and investigations, should there be cameras that were inoperable and/or footage deleted, a thorough investigation conducted. In the interest of transparency and accountability, add the name of the jail facility of where an individual was housed prior to their death on the Sheriff’s Department In-Custody Death dashboard. Ensure Naloxone is more accessible to individuals, regardless of their housing situation, especially those housed in specialized units or units without open program space. Ensure grievance forms, including Health Request forms are available and accessible to people who are incarcerated at all times. Develop a periodic self-monitoring process as required by County Fiscal Manual Section 1.0.2 and as mentioned in the Chief Executive Officer’s Risk Management report. Section 1.0.2 indicates that department management has primary responsibility for designing, implementing, and maintaining a system of preventative and detective internal controls on an ongoing basis to ensure any weaknesses or non-compliance are promptly identified and corrected. In collaboration with the Director of Correctional Health Services, Department of Health Services, establish key performance indicators, monitor and escalate death review statuses, and develop a process to periodically review completed corrective action plans. 90 days upon implementation, the Auditor-Controller to conduct an independent review and identify further recommendations. Instruct the Director of Correctional Health Services, Department of Health Services to report back to the Board on: An analysis on the existing Medicated Assisted Treatment (MAT) delivery process, cost analysis of staffing involved in oral medications compared to the long-acting injectables (LAI), along with the identification of other alternatives and options. Additionally, an evaluation on current processes and identify areas of improvement in the identification of patients who need MAT and delivery of MAT services. In collaboration with the Director of Public Health’s Substance Abuse Prevention and Control, identify best practices and recommendations on how to reduce substance use-related deaths inside the jails. The Automated External Defibrillator (AED) inventory control and inspection mechanisms and make changes as needed to ensure emergency response equipment is available, inspected, in working order, and replaced if necessary. Provide the Office of Inspector General (OIG) monthly reports of compassionate release efforts for the OIG to include in their quarterly reports to the Board. Additionally, identify ways with relevant stakeholders how to expedite compassionate releases, including legislation similar to Assembly Bill 960, Penal Code 1172.2. In collaboration with the Sheriff and the Interim Inspector General, report back on the recent changes to the death review process, including the addition of the mortality review process, and improvements to the Corrective Action Plan tracker. Explain and review the current process for submission of non-emergency health request forms and what would be needed to include daily walkthroughs as part of Correctional Health Services staff duties, addressing delays in care, and setting medical appointments. In collaboration with the Acting Chief Executive Officer, request funding for the electronic health service request form along with the development of an evaluation process to ensure the investment is resulting in an increase in accessibility and efficiency for medical staff and addresses delays in the delivery of medical treatment; an electronic movement/appointment system that can assist in properly tracking upcoming appointments for patients and flagging conflicts in scheduling; and unmet needs for MAT in the jails. To address suicides in the County jails, provide a timeline of when the Joint Quality Improvement Committee will be evaluating the current court notification process to review any gaps in the delivery of services, timeliness of services, and dispatch of the Jail Mental Evaluation Team. In collaboration with the Sheriff, Medical Examiner, the Interim Inspector General, Executive Director of the Sheriff Civilian Oversight Commission, the Sybil Brand Commission, Auditor-Controller, and Acting Chief Executive Officer, through its Risk Management Branch, to report back on a potential scope of work for Correctional Health Services to seek funding to obtain an outside consultant to evaluate recent deaths, identify trends, and provide recommendations and best practices to reduce in-custody deaths. Direct the Medical Examiner, in consultation with County Counsel, to identify opportunities to strengthen existing policy on the use of “security holds” on autopsies of individuals, including the need for delegated authority to enforce the policy, especially in situations of dispute; and criteria that need to be met for security holds to be lifted or waived. Instruct the Auditor-Controller to conduct an initial review of the Sheriff’s Department and the Department of Health Services’ Correctional Health Services’ corrective action processes and efficacy tools 60 days upon development; and annual reviews of the Sheriff’s Department and Correctional Health Services’ corrective action plans, processes, and efficacy of their tools. Instruct the Interim Inspector General to include in their quarterly report backs to the Board information about the MAT program on the following, but not limited to: the number of people on the MAT waitlist, the number of unique individuals who are participating in MAT per facility, and the type of MAT assistance that individuals are receiving, and implementation status and brief summaries on death in custody corrective action plans. In collaboration with the Executive Director of the Sheriff Civilian Oversight Commission and the Sybil Brand Commission monitor the accessibility and availability of Naloxone in the jail facilities. (26-1247) Motion by Supervisor Hahn (Updates Following Cluster)