Civil Rights Division

Office

(~t' rile AssiSTClIlf Auorlley

General

\·\f,lshillgfDll, D. C. 20035

The Honorable Darrell L. Link
County Judge Executive
lOI.N . MainSt.
Williamstown, KY 41097
Re:

Grant Countv Detention Center

Dear Judge Executive Link:
I write to report the findings of the Civil Rights
Division's investigation of conditions at the Grant County
Detention Centet' ("GCDe,).
On November 4, 2003, we notified you
of our intent to investigate conditions of confinement at the
GCDC pursuant to the Civil Rights of Institutionalized Persons
Act ("CRIPA"), 42 U.S.C. § 1997.
CRIPA gives the Department of
Justice authority tQ seek a remedy for a pattern or practice of
conduct that violates the constitutional right~ of jail inmates.
On February II-13, 2004, we conducted an on-site inspection
of GCDC with consultants in the fields of correctional management
and medical care.
While on-site, we interviewed the Jailer, jail
staff, medical care providers, a corrections consultant employed
by the jail, and inmates.
We also reviewed documents, including
state and county inspection records, jail policies and
procedures: incident reports, and individual inmate records.
At
---·---the·-e-nd-·-of"the--ins pe'eti o-n~--6iIr-- e-xperf -cons ulfaD t s
informal exit meetings with the Jailer and his staff in I,vhich our
experts conveyed their preliminary findings.
We appreciate the
full cooperition we received from county officials throughout our
investigation.
We also wish to extend our appreciation to the
Jailer and his staff, who extended every courtesy to us during
"'\JlSl'C, and prcvided all dccuments we requested .

--cc)nci'uct-e-Ci----

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- 2 inmates, and experience deliberate indifference towards their
serious medical needs.
I .

BACKGROuiID
A.

DESCRIPTION OF GCDC

GCDC is a 300-bed facility for men and women located in
Williamstown, Kentucky.
The jail was expanded from 28 beds to
300 beds in May 2000.
The jail houses pretrial detainees from
Grant and neighboring counties; federal detainees and adjudicated
prisoners housed under contract with the United 'States Marshals Service; and state-adjudicated prisoners who have been sent from
ins~i-'-u-'-ion'"
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of the inmates at GCDC were pretrial detainees, and approximately
20% were serving sentences.
Based on information provided during
our inspection, the population appears to be roughly equally
split between inmates serving less than 30 days, those serving
30-90 days and those serving more than 90 days.
Some inmates
have been incarcerated at GCDC for more than one year.
~_"

~.

~

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The new part of the facility, where most of the inmates are
now housed, consists of main corridors with cell blocks on each
side of the corridor.
The cells are visible through large
windows on the corridor, but officers are not permanently
stationed in the corridors.
In the old portion of the jail,
officers must stop at each cell door and lift a metal cover to
see into the cell,
Security rounds in both parts of the jail
consist of officers periodically walking up and down the
corridors.
Officers doing security rounds must make a conscious
effort to stop and observe activity in the individual cellblocks.
GCDC employs one full-time nurse who functions as a health
services administrator.
A correctional officer is assigned to
--------as-:~:ri-sr-the-_:.riur_s-e--i;.J
lth --s-che-duTTng-~--F.lIIIng-and- pat len t---fIo,~:-----T;,~o
additional correctional officers dispense medication to inmates.
A contract physician provides two to three hours per week of onsite mediccl care, and is ~v2ilable by phone the rest of the
week.
The local hospital is adjacent to the facility.

Accord~na

to

~he

.

I2iler,

~2ce~ves

:::e'.72:11ue.

Gr2~~

.

Countv Drevides no

compen5c~~on,

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B.

3 -

LE GAL FRZI.MEWORK

CRIPA authorizes the Attorney General to investigate and
take appropriate action to protect the constitutional rights of
inmates.
42 U.S.C. § 1997a. With regard to sentenced inmates,
the Eighth Arnendment pIeces an affirmetiveduty on prison
officiels to provide humane conditions of confinement and to
ensure that inmates receive adequate food, clothing, medical
care, and shelter.
Fermer v. Brennan, 511 U.S. 825, 832-33
(1994).
Jail officials have a duty to protect inmates from
violence at the hands of other prisoners.
Id. at 833; see also
Nelson v.Overbera, 999F.2d 16z, 166 (6 tn Cir. 1993) -(jailers
have "an obligation to take reasonable steps to protect [inmates]
from violence at the hands of other inmates rr ) .
The Eighth
F_mendment protects inmates not only from present and continuing
harm, but from future harm as well.
Bellina v. McKinnev, 509
U. S. 25, 33 (1993).
The Eighth F_TTlendment also requires j ail officials to provide
for the serious medical needs of convicted prisoners.
Estelle v.
Gamble, 429 U.S. 97, 104 (1976); NaDier v. Madison Countv, 238
F.3d 739, 742 (6 th Cir. 2001). A "prisoner's psychological needs
may constitute serious medical needs, especially when they result
in suicidal tendencies. rr Comstock v. McCrarv, 273 F.3d 693,703
(6';:h Cir. 2001) (internel citations and quotations omitted).
A
sufficiently serious failure to provide dental care also violates
a prisoner's constitutional rights.
Farrow v. West, 320 F.3d
1235, 1243-44 (11~ Cir. 2003); Chance v. Armstrona, 143 F.3d
698,702 (2d Cir. 1998); W-ilson v. Wilk-inson, 2001 WLS06496
(S.D. Qh. p.~pril 26, 2001) (citing ChaDman v. Rhodes, 434 F. SUpp_
1007, 1020 (S.D. ah. 1997) rev'd on other arounds, Rhodes v.
CheDman, 452 U.S. 337 (1981)).
The rna j 0 r lL: Y 0 r lnma t e s a ~ __ th_~_ t~iJ __ 3;r:e._px_et.r.i_al de..taine e s- ----ha:'iYe--n:ot---been-cc)D-v-rcEed"oT the criminal offenses with which
they have been charged.
The rights of pretrial deteinees are
protected under the Fourteenth ~TTlendment, which ensures thet
:.'__h.es.:::;
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L1'n o~e
conSL_LULlonc:._
enjoyed by convicted prisoners.
Bell v. vvol-Fish, 441 U.S. 520,
545 (1979).
In addition, the Fourteenth F~endment prohibits
punishment of ·pretr~al det~inees or the imposition of c8nditions
or pracLices nOL reasonably related to the legitimcte
....:.. '._t.
2: t:
governm2n~~1 obj~c~~v~s of s~=e~y: orde~ 2nd securl~Y.
5'25-37.

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- 4 IT.

FINDINGS
A.

SECURITY, SUPERVISION

&~

PROTECTION FROM

~JWl

GCDC appears to violate the constitutional rights of inmates
~/lany
by failing to protect them adequately from other inmates.
inmate-on-inmate assaults appear to have been reasonably
preventable by jail staff.
1.

-Examples of Inmate-on-Inmate Violence

lUthough hardly a comprehensl ve list of the problems we
identified, the incidents described below represent a snapshot of
some of the disturbing security deficiencies we uncovered.
On February 9, 2004, inmate N.R. 2 was assaulted by the same
inmate who had assaulted him one month previously. According to
the incident report, the assaultive inmate had been placed back
in the same cell as N.R. by mistake.
Further, although security
staff wer~ warned ahead of time that a fight was about to occur,
they only monitored the situation for a short time, then left the
area.
The assault occurred shortly after th~y left.
Similarly, on January IS, 2004, two cellmates were involved
in a fight in which one of the inmates suffered a fractured jaw
and a fractured wrist.
The inmates were separated and housed in
different cells.
On January 20, these same two inmates were
placed in the jail library together and another fight en~ued.
In December 2003, inmate W.L. ~as involved in an altercation
with GCDC staff during booking.
Several days later, he and
another inmate were moved together from temporary holding cells
to a cell in the segregation unit.
Allegedly several of the ten
inmates in the segrsg~~:i:~__ ,c:_el_l_~v.5:Xs_n:Lemhers_oL:-the--same--gang'.--------- ~\j~-L"·:---reporfea--tha-t--tJ1E other inmate iITLrnedia tely as ked to be moved
from the cell becau$e he feared for his safety.
Staff then moved
that inmate to another cell.
W.L. reported that he also asked to
be moved, bu~ an officer told him "you like to fight cops, let's
see how you do in here T..vi th these shcirks.
On December 17, W. L.
was assaulted by one of the'other inmates. 3 We inte~viewed an
fI

we u~e
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- 5 inmate who was in the same cell at the time of the assault.
corroborated W.L. IS story.

He

On August 7, 2003, an orrlcer making rounds ~noticed
everybody standing at the windows." He asked what was going on,
but no one would respond.
The guard left the ar~a rather than
continuina to monitor the situation.
When the auard returned a
short time later he again noticed all the inmates standing at the
windows.
This time he noticed inmates in one cell pointing t6
another cell, so he turned on the light and found an inmate
~ standing at the window crying and covered in blood.
P'cpparen tly
the~inmate had been-assaulted by another inrriateOr inmates.
~

~

If

2.

Management Deficiencies

GCDC also suffers from deficiencies in staIIlng, training,
and the classification of predatory and vulnerable inmates. q
These shortcomings have a clear correlation to the inmate-onviolence problem discussed above. s
a.

Inadequate Classification of Predatory and
Vuinerable Inmates

Many of the incidents of inmate assault at GCDC appear to
occur because GCDCfaiis to classify appropriately its
potentially predatory and vulnerable inmates.
Several months

us tbat the GCDC officer offered to assist him with sentencing on
another matter if he would drop his insurance claim, but W.L.
refused.
GCDC senior staff are aware of this incident, and the
fact that two GCDC officers inv61ved in the traffic ~ncident were
in routine contact with W.L. during his incarceration, but
-------apparen-t-l-y-ha\Te---rTot---taken--any--acCiol"l--a-s--a--r-eEfDTc-.--------------------There is also a security problem in the jail's kitchen,
where inmates assist, sometimes unsupervised, with food
preparation and clean-up.
The jail has no policy or procedure
for accounting for cutting instruments and other kitchen utensils
that could be used as weapons.
While we are not aware of any
incide~ts at GCDC resulting from an inmate using 2
kitchen LocI
as a weapon, we wanted to inform yOll of the risk' of not
-

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Cl2ssifica~ion,
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tr~~n~na

that inadeauate staffing,
are not bv themselves c~nstitution21

-

6 -

prior to our tour, the jail instituted a computerized inmate
classification system, the purpose of which is to assist jail
staff in identifying potentially violent inmates.
The jail has
no written policies or procedures in place for the system.
Further, the classification system does not adequately take into
account such issues as the severity of violent incidents in the
inmate's past r assaults cOffi.mitted during previous
incarcerationsrgang affiliation r and the likelihood that an
inmate will victimize other inmates or be victimized.
This is a
particular problem at GCDC because, unlike most Kentucky county
jails, where the inmates are largely local residents awaiting
trials or-serving sentences of less than one year rthe majOrity
of the inmates at GCDC come from other Kentucky counties r the
State of Kentucky, and from the United States Marshals Service.
Some of these inmates are serving long sentences or are facing
serious felony charges.
Thus there is a higher likelihood that
inmates at GCDC will have prior jail experience, gang
affiliations, or may be charged with very serious crimes.
In addition, GCDC uses dormitory-style celis to house some
of its inm_ates who r because of their violent histories, require
segregated housing.
These dormitory-style cells house as many as
ten inmates.
Housing potentially violent inmates together in
such large groups increases the possibility that violent
incidents will occur, partiCUlarly when the inmates are
unsupervised for large periods of time, as they are at GCDC.
b.

Staffing and Training

At least some inmate assaults at GCDC appear to result from
inadequate numbers of securlLy staIr.
Existing staff cannot
adequately monitor and supervise inmates given the physical
design of the facility.
During our tour we were told that there
are seven assigned security staff posts .lXQ;-_._sppro_~.;:iillgtely_3nO.-.._.
....- - 32S- iruf;ate-sT-·and ·t.hit-,-"·ond~y:-~~-all of-the se posts had an
officer assigned to them.
Further, we observed that the officers
assigned to supervise inmates are very busy during their shifts.
In addition to their security duties, they supervised delivery of
canteen items, trash collecLion, inmate movement, corridor
cleaning, and other activities." Our corrections expert
concluded that an additional three to five SEcurity S~~Ir are

-a:--goo-d

:,Jeekda::'is

is rli-\-;r!.e::c ctl.2':=

at

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of

GS2essi~g

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security

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C2nnot be cQun~ed fer purposes
Dec2use inmat2 sUDer7is~crr is net

~ndividu2:S

- 7 -

necessary for each shift in order to supervise adequately a
facility of this design housing approximately 300 inmates.
Security staff also lacks sufficient training and experience
to minimize inmate assaults by employing proper classification
techniques, conducting meaningful supervision, and co~municating
effectively with inmates.
In. fact! the current jail staff has
relatively little corrections experience.' All of the
supervisors and line staff that we interviewed acknowledged that
they need more training.
.
B.

MEDICALCARE

The provision of acute and chronic medical care aL GCDC
likewise appears to deviate from constitutionally minimum
Nor does GCGC offer any psychiatric care whatsoever,
standarcls .
even for those inmates who are identified as suicidal or who are
suffering from serious mental illness.
1.

Acute ·Care

GCDC consistently fails to provide reasonable medical
treatment to inmates with serious or potentially serious acute
medical conditions.
For example, in one of the incidents
Qlscussed above, an inmate suffered for six days from an
undiagnosed broken jaw and wrist fractures after being involved
in an altercation with another inmate. 8 Although the facility
was aware of the fight r no medical intervention was provided. A
policy requiring examination of inmates involved in altercations
would have detected these serious ~njuries, and ensured that the
inmate received treatment. Yet GCDC does not have such a policy.
Another inmate with a history of jaw fractures who complained of
jaw pain was given Prozac.
Prozac is a powerful prescription
.

------_ .. _- - -- - - -

- - - - -- -----_.

----

-------

-------

-- ---- -+--

-+

-

-

The current Jailer, Steve Kellam, began work at the jail in
August 2001.
We found Mr. Kellam to be dedicated to reforming
the jail to the extent possible given his resource constraints;
and he has already taken measures to improve conditions at the
jail.
However, Mr. Kellam and his management staff have no
previous corrections experience; their backgrounds are largely. in

law enforcement or che militarv.
_ .

~~~

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I

Many of the current line staff

•

~ne:~pe~lenCeQ.

T~e~e

al~e~caticn Wc~ caused,
phvsician's unexplai~ed decision ~8 reduce
~mcunL of aDL~-psychGtic medic2Lion one 0= the inmateS ~vas
~eCE~V~~C 2 fs~~ d2~.7S ~e£'~re ~~e ~ich~.
i~

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is

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t~e

~he

-

8 -

medication used mostly for major depressive disorders.
It is not
indicated for the treatment of fractures or pain.
In making this
diagnosis, there is no evidence that the doctor conducted a
physical or mental status examination of the patient.
Medical records we reviewed demonstrate that GCDC fails to
conduct reasonable diagnostic tests and provide required
treatment in regard to sywptoms that might indicate serious
medical conditions.
We reviewed the file of an inmate who
complained of passing blood in his stool.
While there are benign
causes for this condition, it can be a sign of serious
gastrointestinal disease such as colon cancer.
The inmate had
not received, nor. had he been scheduled for, diagnostic
examination or follow-up treatment in the week that had passed
between the inmate's complaint and our examination of his file.
In another case, an inmate was seen by the doctor for a rash
and swelling on his leg. Without documenting a history or
physical examination, or -inquiring into the source of the
swelling, the physician prescribed a diuretic medication.
A
patient with swelling of an extremity and a rash is at risk of
developing skin ulcerations:
The swelling might also be due to
heart failure, liver failure or vascular insufficiency.
The
failure to conduct a proper medical evaluation to determine the
cause of the swelling constitutes unreasonable treatment, and
creates a risk that the patient might lose his leg.
2.

Chronic Care

GCDC also fails to address the serious chronic medical
conditions of some of its inmates.
For a jail at which inmates
often stay for months (or even a year) at a time, managing
chronic conditions is an important part of providing adequate
medical care.
------_._-------- ---

----_ .._-----._------

---

----

--

------

--- --------

--------- - - - - - - - - - - - - - - - - -

- -----------~.

..

-.

_..... _.

We reviewed the case of an inmate with diabetes who suffered
from a foot ulcer (which is a high risk complication of
uncontrolled diabetes).
As an initial matter, it took three
weeks for the physician to see him.
Moreover, even though he was
referred for care for the foot ulcer, there was no indication
P.3.L.ients
that he actually received the care that was ordered.
with diabetes and under-treated foot ulcers risk eventual

inm2te

~c

me~sure

the

cGnt~cl

of his

diabe~es.

-

9 -

This diabetes patient is part of a larger pattern of GCDC
failing to reasonably monitor and treat chronic illnesses.
There
are no scheduled visits for chronic disease care or follow-up.
We reviewed the file of an i~mate with HIV who had never received
a physician visit.
Other than medication, he had none of the
follow-up monitoring and care proscribed by nationally accepted
guidelines.
Without this monitoring, it is impossible to tell if
the inmate is on the correct medication.
Similarly, an inmate
with hypertension had been in the facility for more than one year
without a physician visit.
He had also never received the blood
pressure monitoring that is standard practice to treat
." hyper.tensigD . . InmCitesi,Y--ith seizure disorder and asthma also do
not receive the kind of monitoring and treatment required by
nationally accepted guidelines.

Another chronic care deficiency at GeDe ~u ~ne failure to
ensure that inmates receive proper m~dically required diets.
Although GCDC makes medically required diets available to inmates
with certain medical conditions, GCDC does not ensure that these
diets conform to the standards for calories, fat content, salt,
and fiber that are required for treatment of inmates; medical
conditions.
For example, on one of the days of our visit to the
facility, the diabetic meals had more fat and calories than the
regular meals.
Diabetic meals should have lower fat content and
fewer calories than regular meals.
3.

Psychiatric Care

Other than medications, GCDC fails to provide any
psychiatric care for its inmates, even those identified as
suicidal or who are suffering from serious mental illness.
GCDC
has contracted for a service that allows the facility to call a
Master's level clinician for assistance in determining if an
inmate needs psychiatric services.
However L_~Y-0.eI}_-_th-i;;-_;;-~J;:s;;:J),il}g.---- ------iden-crfies--serTous rnenF2:1--neal ttl-needs, no follow-up is provided.
GCDC has a contract wifh a local mental health center that allows
the facility to pay for and receive psychiatric services, but our
review of files and facility budget information showed that these
services are not used.

As a result of these deficiencies, there are inm2tes at GCDC
who are suicidal but are not provided with the menLal health
Se2:'"'=1=-·.=2S GCS'C: s C.~/.jD. 3c':-2er~i::'lY.s h2~\J2 ich=ntifiGd a~ nec2:ssar:./t::j
t=eat the inm2t2~s se~ious mental illness.
During our visit! '~e
C;J:'5E:2:""":7~cl 3.11 inrrta.t::: ;'''it-.:.C h2.el been iclel1L.i.=iec~ si:.;: r..Jee](s· pre'ri,::'usl;./
At the

~ime

of our

- 10 visit, he was hearing voices, sUIIering from delusions and wa~
suicidal.
He was receiving inappropriate medication and no other
mental health services.
Two other inmates 0hose files we
reviewed were screened as suicide risks at least three months
previously, but neither had ever been seen by a psychiatrist or
any other mental health professional.
GCDCis contract physician prescribes psychotropic
medications for inmates.
However, we observed a nu~~er of
inmates who were being improperly medicated for serious mental
illnesses.
For example, an inmate diagnosed with paranoid .
schizophrenia was denied an~ti-psychotic medicationandwas~­
instead treated for depression. An inmate who was diagnosed with
adjustment disorder was given a powerful anti-psychotic drug that
would only be appropriate for a much more serious diagnosis of
An inrrl2.te \di th bipolar clisoJ;'der" ;;/Jas on a meclication
no longer indicated for that purpose.
These improper medication decisions appear to result, at
least in part, from inmates being prescribed psychotropic
medications or having their medication changed without a
psychiatric examination or documentation.
One inmate was
prescribed potent medications for depression and psychosis
without a mental health exam. Another inmate was given
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examination.
An inmate was switched from an antidepressant
medication to an anti-psychotic medication without a mental
health evaluation.
An inmate suffering from anxiety had her
medication changed without a recorded history or physical.
4.

Management Deficiencies

The deprivations of required medical and mental health
outlined above seem to resul~ from a host of manaqement
-------d-eflcle-rrcles-:---Wnire-no1:--:chems-er~les-c-onstlt-u
t Ionai--::~io la tio~:~-,-~- ---- ~
the management shortcomings directly contribute to the lack of
constitutionally adequate care.
Improvement of these management
problems will be key to correcting manv of the unconstitutional
conditions.
a.

Staffing

-

eX3mp~2r

~Dcears

to

resul~

--

much ot

primarily from

A physician is

~his

Sl=e typically

prov~dE

t~e

anl~;

shc~tage

cf

........ . . - . . - -

. _ ......

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HlC'......t.-'-'-Q.2.,.

on-site fer two to thre2

ten to twelve hours of phvsician

hou~s

-

11 -

coverage a week.
Similarly, the forty hours of nursing coverage
at GCDC, especially given the low number of physician hours and
the fact that the nurse also performs health services
administration duties, do not allo\'ithe provision of care in a
sufficiently timely fashion.
As noted earlier, there is no mental health staff at the
facility.
While the telephone triage system helps identify
inmates in need of mental health services, this lack of staff
makes it impossible for the facility to provide treatment to
those inmates it has identified.
Moreover, the deficiencies in
the administration-of psychotropic medications demonstrates-the
need for the involvement of a psychiatrist in the prescription of
such medications.
b.

Intake Screening and Evaluation

The failures in medical care described above also appear to
result in part from deficiencies in the intake screening and
evaluation of inmates,
While GCDC uses an intake screening
ins·trument, it does not mandate the collection of sufficient
information to ensure that serious medical issues are addressed.
For example, the general screening instrument asks only "Does the
[inmate] have any observable medical problem?" There is no
specific inquiry into non-observable current and past illnesses,
health conditions and special health requirements, including:
medication history; past serious infectious disease; recent
communicable disease symptoms; past or current mental illness;
drug withdrawal symptoms; and current or recent pregnancy.
The
suicide screening instrument is also limited to observable signs.
These troubling intake assessment procedures hinder the
facility1s ability to assure timely access to medical and mental
_________ b-_~al_~fl_ caf:§._JSJJ: iIlmat_e.s_wLth_-se-ri-o-us-medica-l--needs t --inc-luEl-ing---------acute conditions or chronic diseases that require continuity of
medication.
Further, because the questions are so vague, there
is a significant risk that inmates with active communicable
diseases such as tuberculosis will be placed in the general
population, thereby endangering both staff and other inmates.
screeni~gs

GCDC also fails to complete required
provide such evaluation in a timely

obvious suicide risks
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2r~

2ssessmen~.

fGshion~

~curs

On
.

For example,

~he

.

or to

~~~~cu~

d2y of our

tOQ~1

- 12 Inmates also do not receive a full initial health assessment
within a reasonable period after their arrival at GCDC.
Such an
assessment typically includes a review of the intake information
discussed above, the collection of a complete medical and mental
health history, a physical examination, and screening for
tuberculosis and sexually transmitted diseases.
Without this
assessment, inmates cannot be appropriately evaluated, and
thereby treated, for chronic disorders, communicable disease and
mental illness.
c.

Policies and Procedures

We also observed that many of facility's policies and
procedures lack the breadth and specificity to form an
infrastructure to ensure timely access t6 the appropriate level
of medical and mental health care.
Indeed, GCDC lacks policies
on, inter alia, timeliness of access to medical care, continuity
of medication, infection control, intoxication/detoxification,
record-keeping, disease prevention and special needs.
Deficient
policies also put staff and patients at risk of contracting
communicable dise'ases such as staph skin infections and hepatitis
A, both prevalent among jail inmates.
On the housing units,
inmates with headaches and other paiti are routinely given 800
milligrams of ibuprofen by custody staff, even though the maximum
allowable dose without a prescription is 400 milligrams.
A
policy regarding the dispensing of medicine would help to
eliminate such deficiencies.
In addition, there are no protocols for the nurse or the
correctional staff to use to ensure timely access to the
physician when-presenting sy~ptoms requiring physician care.
For
example, as discussed above, there is no regularly scheduled care
for inmates with chronic diseases such as HIV, hypertension,
diabetes, asthma, and elevated bl.9ocLlio_ii:Ls_,__£:sLeIl __thoJ..lob._-pa-tient£... _.-_·_·_~~i-t]~:-th-e·se-ccncrrtions-····s·hcuid--b;--~een
at-least every th~ee- months.
The facility lacks any clinical guidelines for tre~tment of these
conditions.
The facility should have guidelines based on
nationally accepted standards.
d.

Record Keeping

The failure LO keep adequate medlcal records contributes to
prQ1Tide 2d~quat~ ill~dic~l car~: t~caus~ defici~~~
ffiedlcal ~eCCrG3 ffiaJ(2 l~ Clr=lCU1~ rcr ~n2 mec~ca~ sta~= ~~ ensure

ens

~ai:urE5 ~G
-

•

•

•

•

•

__

I

..

-

S~mi~crlYf

•

••

-

__

GCDC does not have

~ogs

of

- 13 sick call requests or sick call visits to the nurse.
While the
facility has a chronic disease log book, it was blank when we
reviewed it during our visit.
The state of inmate medical charts at the facility also
compromises proper inmate medical care,' The sick call slip
functions as a' request form r a nurse assessment form, and a
physician progress note.
However, the space for the physician's
note is insufficient for a complete progress note.
Perhaps as a
result of this insufficient space, the physician does not record
the inmate's symptoms, nor does hel:'ecordhis find.i l1gs \"lhenl1e.
conducts a physical examination.
Nor do these notes provide
'sufficient information to other medical care providers who may be
involved in a patient's treatment:
Finally, the records are
disorganized, and records of outside care are not always included
iLl tr1e recorcls ~
III.

RECOMMENDED REMEDIAL MEASURES

In order to address the constitutional deficiencies
identified above and protect the constitutional rights of
inmates, we.suggest tht GCDC should implement, at a minimum, the
following measures:
A.

SUPERVISION OF INMATES AND PROTECTION FROM HARM

1.

Provide staffing and establish policies and procedures
sUJ::Llcient to ensure that inmates are appropriately
monitored and supervised at all times.

2.

Develop appropriate written policies, procedures and
protocols governing the classification process that
adequ~tely take into account such issues as the severity of
th.e. __incLden.Ls--- in--t-h e--.inma t e!s -p a s-tT -a,s-s'a'1::1.--±ts- C OITLTTl:i-tt ed- ---.--- ..--during previous incarcerations, gang affiliation, and the
likelihood that the inmate will victimize other inmates or
.be victimi zed.

_..__.. .

Provide appropriate staff training in general correctional
management, staff/inmate cOITLTTlunications, gang recognition!
and reFort -writing.

1.

Adoc~ ~nd ~mp12ment afprcpr~a~e
. .
scree~~~g ~~s~rumen~s

. .
~na~

medical

" , , .lQe~~lIY

~na

mental

.
_:..-. ...... ..,
ncn-ODser'/cLL2

heal~h
.;-ll~"-!_~ (-:.:::_:

_

cDC 3en~cl he~l~h needs, 2nd ensure ~iffielv access tc the
physici2D wnen pr~sen~~~g symp~oms ~h2t reau~re such carE.

- 14 -

2.

Promptly assess inmates for risk of suicide.

3.

Conduct a sufficient initial health assessment of all
inmates in a timely fashion.

4.

Adopt and implement appropriate clinical guidelines for
chronic diseases such as HIV r hypertension; diabetes;
asthma, and elevated blood lipids, and policies and
procedures on, inter alia, timeliness of access to medical
care, continuity of medication, infection control, medicine
dispensing, intoxication/detoxification, record-keeping,
disease· prevention, special needs, and providirlg, "ihere
appropriate, medical examinations to all inmates involved In
a fight or a use of force.

c:

When medicatly required, provide appropriate diets.

6.

Provide medical and mental health staffing sufficient to
address the serious medical needs of inmates.

7.

Conduct appropriate psychiatric evaluations when prescribing
or changing psychotropic medications.

8.

Maintain logs of pending or completed outside referrals and
sick call requests or sick call v~sits to the nurse.

9.

Ensure that all medical records include sufficient'
information (including symptoms, the results of physical
evaluations, and medical staff progress notes) to ensure
that medical staff has all relevant information available
when treating inmates.

10.

Institute appropriate medical quality assurance measures.

J.

---- - - - - - - ---- -- - - - - - - - - - --. - - - - - - - - - -

-*- -. ------- -

* * * * * * * * * *

*"

* * *

we hope to work with the County in an amicable and
cooperative fashion to resolve our outstanding concerns regarding
GCDC.
Assuming there is
5pirit of cooperation from the County
and GeDC, we also would be willing to send our expert
consultant's' eva~uations of the facility under se92~a~e C01Ter.
Althcugh the C~{p2rt consultants: evaluations and work do not
~ecess~r~lv r2£:ect the Q£~~Ci2: ccncl~sio~s cf the Department c·f

a

.

.:...n.
~e~~e~ ~nd cf~er cr~c~.:...c~~ ~ssis~ance

in

,

.

-ciJ.lS

addres'si~a t~em.

-

15 -

Although we certainly do not envision such a scenario, we
are obligated by statute to advise you that, in the unexpected
event that we are unable to reach a resolution regarding our
concerns, the Attorney General may institute a lawsuit pursuant
to CRIPA to correct deficiencies of the kind identified in this
letter 49 days after appropriate officials have been notified of
them,
42 O,S.c. § 1997b(a) (1),
It is our great preference to
resolve this matter by working cooperatively with you, and we are
confident that we will be able to do so in this case.
The
lawyers assigned to this investigation will be contacting the
facility's attorney to discuss this matter in further detail.
If
yo~- hav~ any quesilons regardin~ thIs ieiter, please call
Shanetta Y. Cutlar, Chief of the Civil Rights Division's Special
Litigation Section, at (202) 514-0195.
Sincerely,
I

,/Ill'
)
I .'

j/

4..
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/

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.

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••,..••••

R. Alexander Acosta
Assistant Attornev General

(

cc:

Edward Lorenz, Esquire
Grant County Attorney
Steve Kellam
Jailer
Grant County

Gregory F. Van Tatenhove r Esquire
Onited States Attorney
________ . -Ea.s.te.rn..Dist:r-l-ct ---o-f-Ke nt u cky.:.----------._---.---..--~- - ---------- .------ .-----. -----

I

•

Exhibit B·
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