U.S. Department of Homeland Security
Immigration and Customs Enforcement
Office of Professional Responsibility
Inspections and Detention Oversight
Washington, DC 20536-5501

Office of Detention Oversight
Compliance Inspection

Enforcement and Removal Operations
New Orleans Field Office
Etowah County Detention Center
Gadsden, Alabama

March 13- 15, 2012

FOR INTERNAL USE ONLY. This document may contain sensitive commercial, financial, law
enforcement, management, and employee information. It has been written for the express use of the
Department of Homeland Security to identify and correct management and operational deficiencies. In
reference to ICE Policy 17006.1, issued 09/22/05; any disclosure, dissemination, or reproduction of this
document, or any segments thereof, is prohibited without the approval of the Assistant Director, Office of
Professional Responsibility.

COMPLIANCE INSPECTION
ETOWAH COUNTY DETENTION CENTER
NEW ORLEANS FIELD OFFICE
TABLE OF CONTENTS
EXECUTIVE SUMMARY ............................................................................................... 1
INSPECTION PROCESS
Report Organization ................................................................................................. 5
Inspection Team Members ....................................................................................... 5
OPERATIONAL ENVIRONMENT
Internal Relations ..................................................................................................... 6
Detainee Relations ................................................................................................... 6
ICE NATIONAL DETENTION STANDARDS
Detention Standards Reviewed ................................................................................ 7
Detainee Grievance Procedures ............................................................................... 8
Food Service ............................................................................................................ 9
Funds and Personal Property ................................................................................. 10
Medical Care ......................................................................................................... 11
Staff-Detainee Communication ............................................................................ 14

EXECUTIVE SUMMARY
The Office of Professional Responsibility (OPR), Office of Detention Oversight (ODO) conducted
a Compliance Inspection (CI) of the Etowah County Detention Center (ECDC) in Gadsden,
Alabama, from March 13-15, 2012. ECDC is owned by Etowah County and is operated by the
Etowah County Sheriffs Office (ECSO). ECDC opened in March 1994. U.S. Immigration and
Customs Enforcement (ICE) began housing detainees at ECDC in November 2000 under an
Intergovernmental Service Agreement (IGSA). Currently, ICE uses ECDC to house male
detainees of all security classification levels for periods in excess of 72 hours. Female detainees
are not housed at ECDC. Additional bed space at ECDC is reserved for the U.S. Marshals Service
and inmates received from local area law enforcement jurisdictions. Food service is provided by
ECSO. Medical care is provided by Doctors' Care Physicians, P.C. ECDC is accredited by the
American Correctional Association (ACA) and the National Commission on Correctional Health
Care (NCCHC).
The ICE Office of Enforcement and Removal Operations (ERO), Field Office Director (FOD),
New Orleans, Louisiana (FOD/New Orleans) is responsible for ensuring ECDC is in compliance
with ICE policies and the ICE National Detention Standards (NDS). The Assistant Field Office
Director (AFOD) assigned to the ERO office in Birmingham, Alabama, maintains oversight of
ECDC. ICE staff consists of(b)(7)epermanent employees:(b)(7)eSupervisory Detention and
Deportation Officers (SDDO),(b)(7)eDeportation Officers (DO),(b)(7)e Supervisory Immigration
Enforcement Agent (SIEA), (b)(7)eImmigration Enforcement Agent (lEA), and (b)(7)eEnforcement
and Removal Assistants (ERA). All are located on-site at ECDC. Additionally, a Detention
Service Manager (DSM) is assigned to and co-located at ECDC. The total number of non-ICE
employees at ECDC is(b)(7)e The Sheriff is the highest ranking official at ECDC, and is
responsible for oversight of daily operations at the facility. In addition to the Sheriff, ECDC
supervisory staff includes the Chief Deputy of Detention and the Assistant Chief of Operations.
Currently, most of the detainees housed at ECDC have an order of removal and are considered
long-term cases due to difficulties obtaining travel documents from embassy and consular
officials. The total capacity for ECDC is 879 inmates and detainees. Of those 879 beds, 350 are
dedicated to ICE detainees. At the time of inspection, ECDC housed 302 ICE detainees. The
average length of stay for a detainee at ECDC is 49 days.
In November 2007, the OPR Detention Facilities Inspection Group (DFIG), predecessor to ODO,
conducted a Focus Review at ECDC following a letter sent to the DHS Office for Civil Rights and
Civil Liberties from an ECDC detainee citing complaints about facility services, including the law
library, medical care and recreation. The DFIG reviewed all NDS pertaining to the areas listed in
the complaint letter. Ofthe ten NDS reviewed, one standard was found to be in full compliance,
while nine others resulted in 23 deficiencies.
In August 2010 and July 2011, ERO Detention Standards Compliance Unit contractor MGT of
America, Inc. conducted annual reviews ofthe NDS at ECDC. Both reviews resulted in an
"Acceptable" rating, and ECDC was found compliant with all detention standards reviewed.
In October 2010, ODO conducted a Quality Assurance Review (QAR) at ECDC, reviewing 25
NDS. Ofthe standards reviewed, 12 were in full compliance. The remaining 13 standards
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accounted for 24 deficiencies. This CI was the first inspection by ODO since the October 2010
QAR.
During this CI, ODO reviewed a total of 17 NDS, with 12 standards found to be fully compliant.
A total of eight deficiencies were identified in the following five standards: Detainee Grievance
Procedures (1 deficiency), Food Service (1), Funds and Personal Property (3), Medical Care {1),
and Staff-Detainee Communication (2). ODO noted repeat deficienCies in the Food Service and
Staff-Detainee Communication standards.
This report details all deficiencies and refers to the specific, relevant sections of the ICE NDS.
OPR will provide ERO a copy ofthe report to assist in developing corrective actions to resolve the
eight identified deficiencies. Deficiencies were discussed with ECDC and ICE staff on-site during
the inspection, as well as during the closeout briefing conducted on March 15, 2012.
Overall, ODO found ECDC to be well managed and in compliance with the areas and standards
inspected, with the exception of several minor deficiencies in the Detainee Grievance Procedure
standard and the Funds and Personal Property standard. One deficiency each was identified in the
Food Service and Medical Care NDS. Both areas were found to be well managed. No areas of
concern or deficiencies were identified during the review of the Use of Force, Special
Management Unit (Administrative and Disciplinary), or Environmental Health and Safety
standards. Those areas were found to be well managed. ECDC and ERO management were
receptive to ODO observations and demonstrated cooperation throughout the CI. ODO noted an
improvement in the number of deficiencies from the October 2010 ODO QAR. ODO found two
repeated deficiencies during this CI from the October 2010 QAR; one each in both the Food
Service and Staff-Detainee Communication NDS.
Health care services are provided by medical personnel employed by Doctors' Care Physicians,
P.C. Nursing coverage is available 24 hours a day, seven days a week. Medical staff consists of a
full-time Health Services Administrator (HSA) who is also a registered nurse (RN), a Medical
Director who averages 30 hours per week at the facility, a nurse practitioner with a doctorate
degree in advanced nursing practice, a full-time mental health coordinator, (b)(7)e RNs,(b)(7)eLicensed
Practical Nurses (LPN), and(b)(7)emedical clerk technicians. A dentist comes to the facility once a
week on a fee-for-service contract. All medical staff credentials were reviewed and found current.
ODO reviewed the training records of all medical personnel and(b)(7)ecustody staff. Current
certifications in cardiopulmonary resuscitation (CPR) and first aid were verified.
The facility's food service program is staffed by the ECDC Food Service Manager (FSM), four
kitchen deputies, and an inmate work crew. No ICE detainees work in food service. ECDC uses a
satellite system of meal service, which involves meal preparation in the food service area and meal
delivery on trays to detainee housing areas. The menu has been certified nutritionally complete by
a registered dietician. Review of the food substitution log verified that substituted items are
selected from the approved master menu cycle. Review of required inspections and temperature
logs confirmed compliance with the NDS. Knives and utensils were properly controlled. ODO
identified a repeat deficiency from the October 2010 inspection ofECDC. The October 2010
QAR cited ECDC for maintaining only a four-day food supply rather than the 15-day food supply
required by the NDS. The facility has attempted to address the deficiency by rearranging space

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adjacent to the food service area and designating an additional room for food storage. ECDC now
maintains a six-day food supply, but is still below the 15-day requirement. ODO was informed,
and observation confirmed, that additional space is not available for the required food storage.
ODO notes the food vendor that services ECDC is located approximately a quarter mile from the
facility, and food supplies are ordered and received on Mondays and Thursdays each week. This
arrangement allows for prompt replenishment of food supplies.
Upon arrival and before being admitted into the general population, all detainees are properly
classified as Level 1 (lowest threat), Level 2 (medium threat), or Level 3 (highest threat). Security
classifications are based on past criminal history or behavior problems identified during the
evaluation process. ODO verified all detainees have reasonable and equitable access to
telephones, and are given emergency messages and allowed to return emergency telephone calls
without delay. Notification that telephone calls are subject to monitoring is addressed in the
detainee handbook and conspicuously posted near all telephones.
ECDC has a grievance system that allows detainees the opportunity to file formal and informal
grievances, and to appeal grievance decisions. Grievance forms are available within housing units.
ECDC lacks written policy and procedures addressing the ability of detainees to file emergency
grievances. An emergency grievance involves an immediate threat to detainee safety or welfare.
During the CI, ODO reviewed grievances filed from January 17,2012, through March 8, 2012.
During that period, 23 formal grievances were filed. The grievances were mostly related to
medical care and food service concerns. All grievances reviewed were responded to within two
days ofthe grievance being filed. At the time of the CI, there were no outstanding grievances.
Detainees have the opportunity to file requests with both ICE and ECDC staff. Request forms are
available within the housing units. ODO observed lEAs retrieving ICE request forms during daily
visits performed to address detainee concerns. ODO found the facility does not maintain a log,
electronic or otherwise, to record detainee requests. DOs make weekly scheduled visits with
detainees for case reviews. Visits by both lEAs and DOs are documented in logbooks found in the
housing units. Visitation schedules for ICE staff are conspicuously posted in the housing units.
Corrective action had been taken to resolve deficiencies identified in the previous October 2010
inspection. ECDC revised its Funds and Personal Property policy to include the inventory and
receipt of detainee property. All detainees sign a property receipt at admission and release.
Detainees are given a property receipt, and a copy is placed in the detention file. An ECDC officer
also signs the receipt during the detainee's admission and release. A review of 16 detention files
confirmed that properly executed Form I-203s, Orders to Detain or Release, were included in all
files; this verified revised policy and procedures are being followed.
ICE detainees at ECDC are afforded access to the law library up to five hours a week, with
additional time available upon request. Computers are available for detainee use and are equipped
with the most recent version ofLexis-Nexis. Detainees have access to daily recreation, reading
materials, and religious programs, and are able to send and receive mail. The ICE National
Detainee Handbook and the facility-specific handbook are provided and distributed in both English
and Spanish versions. ECDC makes other language versions of the facility-specific handbook
available, as needed.

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ODO identified and observed several best practices at ECDC. ECDC has developed multiple
voluntary programs for ICE detainees. ECDC has a program, Puppies without Borders (PWB),
which allows ICE detainees to socialize with and train puppies for obedience. Subsequently, the
puppies are adopted by members of the general public.
ECDC also sponsors the Feed the World Aquaculture Program. This volunteer program allows
ICE detainees to learn the science of raising fish (Tilapia, Catfish, and Koi). Detainees learn basic
water chemistry, the anatomy and physiology of fish, and other fish production concepts. ICE
detainees who are returned to their home countries will have the skills and knowledge to raise fish
from birth to harvest.
A third program at ECDC is known as Adventure Programming. Adventure Programming is a
volunteer program for ICE detainees to exercise the body and mind. Detainees use a rock
climbing wall as a therapeutic approach to relieve the pressure of detention.
ECDC has established educational opportunities for ICE detainees in barbering, horticulture, and
basic computer skills. These educational opportunities provide detainees with an outlet to relieve
the stress of being detained.

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INSPECTION PROCESS
ODO inspections evaluate the welfare, safety, and living conditions of detainees. ODO primarily
focuses on areas of noncompliance with the ICE NDS or the ICE Performance Based National
Detention Standards (PBNDS), as applicable. The NDS apply at ECDC. In addition, ODO may
focus its inspection based on detention management information provided by ERO Headquarters
(HQ) and ERO field offices, and on issues of high priority or interest to ICE executive
management.
ODO reviewed the processes employed at ECDC to determine compliance with current policies
and detention standards. Prior to the inspection, ODO collected and analyzed relevant allegations
and detainee information from multiple ICE databases, including the Joint Integrity Case
Management System (JICMS), the ENFORCE Alien Booking Module (EABM), and the
ENFORCE Alien Removal Module (EARM). ODO also gathered facility facts and inspectionrelated information from ERO HQ staff to fully prepare for the site visit at ECDC.

REPORT ORGANIZATION
This report documents inspection results, serves as an official record, and is intended to provide
ICE and detention facility management with a comprehensive evaluation of compliance with
policies and detention standards. It summarizes the NDS that ODO found deficient in at least one
aspect of the standard. ODO reports convey information to best enable prompt corrective actions
and to assist in the on-going process of incorporating best practices in nationwide detention facility
operations.
OPR classifies program issues into one of two categories: deficiencies and areas of concerns. OPR
defines a deficiency as a violation of written policy that can be specifically linked to the NDS, ICE
policy, or operational procedure. OPR defines an area of concern as something that may lead to or
risk a violation of the NDS, ICE policy, or operational procedure. When possible, the report
includes contextual and quantitative information relevant to the cited standard. Deficiencies are
highlighted in bold throughout the report and are encoded sequentially according to a detention
standard designator.
Comments and questions regarding the report findings should be forwarded to the Deputy Division
Director, OPR Office of Detention Oversight.

INSPECTION TEAM MEMBERS

(b)(6), (b)(7)c

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Special Agent (Team Leader)
Special Agent
Special Agent
Contract Inspector
Contract Inspector
Contract Inspector

5

ODO, Houston
ODO, Houston
ODO, Houston
Creative Corrections
Creative Corrections
Creative Corrections

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OPERATIONAL ENVIRONMENT
INTERNAL RELATIONS
ODO interviewed the ECDC ChiefDeputy ofDetention, the ECDC Assistant ChiefofOperations,
the ERO AFOD, an ERO SDDO, and an ERO DO. ERO personnel visit the detainee housing units
weekly to address questions and concerns of the detainees. The ERO AFOD visits the facility
weekly, while the FOD visits on a quarterly basis. During interviews, ECDC and ERO personnel
stated their working relationships are good and morale is high.
ERO staff stated they have the necessary resources to carry out their duties and responsibilities;
however,(b)(7)eERO staff member stated a need for an additional DO position and(b)(7)eadditional
ERA positions. Due to the congested office space at ECDC, on-site ERO staff is relocating to the
Etowah County Judicial Building in June 2012.

DETAINEE RELATIONS
ODO interviewed 15 randomly-selected detainees to assess the detention conditions at ECDC. All
detainees stated they were treated with dignity and respect by ECDC staff. Detainees are provided
access to medical care, the law library, recreation, and telephones.
Seven detainees (46 percent) complained about the lack of menu variety, portion sizes, and the
temperature of food. ODO verified all menus were approved by a certified dietician. ODO found
no deficiencies in the Food Service standard relating to the portion size or serving temperature of
food.
One detainee claimed to not know the identity of his respective DO. Three detainees (20 percent)
stated they did not know how to contact their DO via a request form. ODO observed a posting in
each housing unit regarding ICE visits and reviewed logs confirming visits by ICE staff were
conducted. ODO confirmed ERO personnel conduct weekly visits to the housing units.
Three detainees (20 percent) complained about medical care. One detainee claimed he was denied
psychotropic medication and another had requested a dental visit. ODO reviewed both of these
complaints and concluded both concerns were appropriately addressed by facility medical staff.
The detainee who claimed he was denied psychotropic medication was prescribed two antidepressant medications upon admission to the facility. The detainee requesting a dental visit
submitted a medical request and was seen by a dentist. A subsequent appointment was also
scheduled. Another detainee complained it took two weeks to see a nurse for cold symptoms.
ODO reviewed the detainee's medical file and reported the detainee put in two different medical
requests on two different days, and he was seen on the same day in both instances.

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ICE NATIONAL DETENTION STANDARDS
ODO reviewed a total of 17 NDS and found ECDC fully compliant with the following 12
standards:
Access to Legal Material
Admission and Release
Detainee Classification System
Detainee Handbook
Detainee Transfers
Environmental Health and Safety
Hunger Strikes
Special Management Unit- Administrative Segregation
Special Management Unit- Disciplinary Segregation
Suicide Prevention and Intervention
Telephone Access
Use ofForce
As these standards were compliant at the time ofthe review, synopses for these standards were not
prepared for this report.
ODO found deficiencies in the following five standards:
Detainee Grievance Procedures
Food Service
Funds and Personal Property
Medical Care
Staff-Detainee Communication
ODO findings for each of these standards are presented in the remainder ofthis report.

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DETAINEE GRIEVANCE PROCEDURES (DGP)
ODO reviewed the Detainee Grievance Procedures NDS at ECDC to determine if a process to
submit formal or emergency grievances exists, and responses are provided in a timely manner,
without fear of reprisal. In addition, the review was conducted to determine if detainees have an
opportunity to appeal responses, and if accurate records are maintained. ODO visited housing
areas, interviewed staff, and reviewed policies and procedures, the detainee handbook, and
grievance logs.
ECDC has a grievance system that allows detainees to file formal and informal grievances, and to
appeal grievance decisions. Grievance forms are available within the housing units. The ECDC
Unit Manager serves as the Grievance Coordinator, a position that places an emphasis on
informally resolving grievances. Interviews with ICE detainees confirmed detainees were familiar
with the grievance process. ECDC provides each detainee with the ICE National Detainee
Handbook and a comprehensive local supplement advising detainees ofthe grievance process.
ECDC maintains a paper grievance logbook. An electronic version of the grievance logbook is
being planned. ODO reviewed 23 grievances, filed between January 17, 2012, and March 2012.
Eighteen of the grievances involved medical care, four related to food service, and one concerned
access to legal material. All grievances reviewed were responded to within two days ofthe
grievance being filed. There is a clearly established appeal process in place at ECDC. Four of the
23 grievances filed were appealed. Responses to grievances were prompt and timely.
During a review of the detainee handbook and local policies, and interviews with facility staff,
ODO determined ECDC does not have a policy or procedure for identifying and handling an
emergency grievance (Deficiency DGP-1). An emergency grievance involves an immediate threat
to detainee safety or welfare.

STANDARD/POLICY REQUIREMENTS FOR DEFICIENT FINDINGS
DEFICIENCY DGP-1
In accordance with the ICE NDS, Detainee Grievance Procedures, section (III)(B), the FOD must
ensure each facility shall implement procedures for identifying and handling an emergency
grievance. An emergency grievance involves an immediate threat to a detainee's safety or welfare.
Once the receiving staff member approached by a detainee determines that he/she is in fact raising
an issue requiring urgent attention, emergency grievance procedures will apply.

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FOOD SERVICE (FS)
ODO reviewed the Food Service NDS at ECDC to determine if detainees are provided with a
nutritious and balanced diet, in a sanitary manner. ODO reviewed policy and documentation,
interviewed staff, observed meal service and tray delivery, and inspected food storage and
preparation areas.
The food service program is staffed by the ECDC Food Service Manager (FSM),(b)(7)e kitchen
deputies, and an inmate work crew. No ICE detainees work in food service. The facility uses a
satellite system of meal service, which involves meal preparation in the food service area, and
meal delivery on trays to detainee housing areas. The menu has been certified nutritionally
complete by a registered dietician. Review of the food substitution log verified that substituted
items are selected from the approved master menu cycle. Review of required inspections and
temperature logs confirmed compliance with the NDS. Knives and utensils are properly
controlled. ECDC uses an electronic key management system called ProxSafe, which requires a
PIN number and a matching fingerprint reading from a staff member to gain access to the area
where cooking instruments are maintained. ODO observed cleaning schedules posted throughout
the food service area.
The October 2010 QAR cited ECDC deficient for maintaining only a four-day food supply rather
than the 15-day supply required by the NDS. The facility has attempted to address the deficiency
by rearranging space adjacent to the food service area and designating an additional small room for
food storage. ECDC now maintains a six-day food supply, still below the 15-day requirement
(Deficiency FS-1). Since a 15-day food supply is required by the standards, ODO is citing this as
a deficiency. However, ODO was informed, and observation confirmed, that additional space is
not available for additional food storage. ODO notes the food vendor that services ECDC is
located approximately a quarter mile from the facility, and food supplies are ordered and received
on Mondays and Thursdays each week. This arrangement allows for prompt replenishment of
food supplies.

STANDARD/ POLICY REQUIREMENTS FOR DEFICIENT FINDINGS
DEFICIENCY FS-1
In accordance with the ICE NDS, Food Service, section (III)(J)(4), the FOD must ensure, while the
FSA shall base inventory levels on facility needs, each facility will at all times stock a 15-dayminimum food supply.

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FUNDS AND PERSONAL PROPERTY (F&PP)
ODO reviewed the Funds and Personal Property NDS at ECDC to determine if controls are in
place to inventory, receipt, store, and safeguard detainees' personal property. ODO interviewed
staff, reviewed policies and procedures, and observed the admission and release process.
ECDC has written policies and procedures for handling and safeguarding funds and personal
property. Funds and valuables are properly inventoried and logged by the facility. A dedicated
safe for cash and checks is maintained in a secure area, and access is restricted to supervisory staff.
ODO reviewed 16 detention files that contained a receipt for personal property, and found none
had a forwarding address. ECDC standard operating procedures do not include obtaining an
address from each detainee so that personal property recovered after a detainee is released,
transferred, or removed can be forwarded to the detainee (Deficiency F&PP-1). Obtaining
forwarding addresses facilitates the return of missing property to detainees through family
members or designated acquaintances.
The ECDC detainee handbook does not provide procedures for requesting an ICE-certified copy of
identity documents, such as a passports or birth certificates, which are located in the detainee's AFile (Deficiency F&PP-2). The ECDC detainee handbook does not provide procedures for filing
a claim for lost or damaged property (Deficiency F&PP-3). Providing detainees with clear and
comprehensive handbooks ensures familiarization with rules, policies, and procedures.

STANDARD/POLICY REQUIREMENTS FOR DEFICIENT FINDINGS
DEFICIENCY F&PP-1
In accordance with the ICE NDS, Funds and Personal Property, section (III)(C), the FOD must
ensure that all facilities shall have policies and procedures to account for and safeguard detainee
property at time of admission. Standard operating procedure will include obtaining a forwarding
address from every detainee who has personal property that could be lost or forgotten in the
facility after the detainee's release, transfer, or removal.
DEFICIENCY F&PP-2
In accordance with the ICE NDS, Funds and Personal Property, section (III)(J)(2), the FOD must
ensure the detainee handbook or equivalent shall notify the detainees of facility policies and
procedures concerning personal property, including: That, upon request, they will be provided an
[ICE]-certified copy of any identity document (passport, birth certificate, etc.) placed in their Afiles.
DEFICIENCY F&PP-3
In accordance with the ICE NDS, Funds and Personal Property, section (III)(J)(5), the FOD must
ensure the detainee handbook or equivalent shall notify the detainees of facility policies and
procedures concerning personal property, including: The procedures for filing a claim for lost or
damaged property.

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MEDICAL CARE (MC)
ODO reviewed the Medical Care NDS at ECDC to determine if detainees have access to
healthcare and emergency services to meet health needs in a timely manner. ODO reviewed
policies and detainee medical records, verified medical staff credentials, and observed intake
screening, sick call, and pill line procedures. In addition, ODO reviewed training records of all
medical and(b)(7)ecustody staff.
Health care services are provided by medical personnel employed by Doctors' Care Physicians,
P.C. The facility is currently accredited by the American Correctional Association (ACA) and the
National Commission on Correctional Health Care (NCCHC). Nursing coverage is available 24
hours a day, seven days a week. Medical staff consists of a full time Health Services
Administrator (HSA) who is also a registered nurse (RN), a Medical Director who averages 30
hours per week at the facility, a nurse practitioner with a doctorate degree in advanced nursing
practice, a full-time mental health coordinator, (b)(7)e RNs,(b)(7)eLicensed Practical Nurses (LPN),
and(b)(7)emedical clerk technicians. A dentist comes to the facility once a week on a fee-for-service
contract. Review of the dental roster reflects an average of 30 detainees receive dental
intervention weekly. The dentist conducts annual training at ECDC for nurses in dental
assessment and the proper way to describe dental conditions, including the level of acuity. Acuity
levels of dental referrals are also reviewed by the Medical Director. The dentist stated detainees
are seen in his off-site office for emergencies, if necessary. The average wait time for routine
dental appointments is two to three weeks.
Specialty health care services are provided by medical staff with privileges at the Riverview
Regional Medical Center (RRMC). There is a memorandum of understanding between ECDC and
RRMC for provision of emergency and inpatient care for detainees with medical needs beyond the
scope of services available at ECDC. The Medical Director also has privileges at RRMC. At the
time ofthe review, there were no medical staff vacancies; however, the Medical Director indicated
he is considering adding a mid-level provider for chronic care services. Emergency response
consists of911-EMS activation or contacting the Medical Director who is on call around-theclock. Emergency telephone numbers are clearly posted. Radiology services are provided by a
mobile service company that performs all non-invasive X-rays on-site. Laboratory specimens are
sent to a contract laboratory. Pharmacy licenses and a current Clinical Laboratory Improvement
Amendments (CLIA) certificate are clearly posted. ODO determined that staffing and services are
adequate for the size of the population and the acuity level of detainees.
All medical staff credentials were reviewed and found current. The providers had current Drug
Enforcement Administration licenses on file. ODO reviewed the training records of all medical
and(b)(7)ecustody staff, and verified current certification in cardiopulmonary resuscitation (CPR) and
first aid. Medical staff records included documentation of annual review ofthe nursing protocols,
and the conduct of physical examinations and dental assessments.
ECDC uses an electronic medical records (EMR) system accessible only to the medical staff
through restricted individual passwords. Appropriate documentation of consent and refusal of
medical treatment are documented in the EMR.

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Detainees are screened for symptoms of contagious diseases and tuberculosis (TB) during medical
intake screenings. All35 records reviewed reflected TB screenings were in accordance with the
NDS. A chest X-ray is performed for all detainees with a history of a positive skin test. Any
detainee with signs and symptoms of active TB is immediately isolated and admitted to RRMC for
evaluation and treatment until deemed non-contagious for housing at ECDC. Review of infection
control documents reflects immediate notification and involvement of the Etowah County Public
Health Department for all suspected cases ofTB. Etowah Public Health staff conducts contact
interviews and performs monitoring of all detainees receiving treatment for active TB. There were
no detainees with active TB at the time ofthis inspection.
Medical and mental health intake screening is conducted by nursing staff within eight hours of a
detainee's arrival. The Medical Director trains nursing staff in the screening function, and reviews
all completed screening forms. ODO confirmed intake screenings meet ICE Health Service Corps
(IHSC) Performance Improvement criteria. Review of 35 records confirmed screenings are
performed within eight hours and reviewed by the Medical Director. Detainees with complex or
chronic medical conditions are scheduled for physical examinations (PE) within 24 to 48 hours.
ODO notes this exceeds the NDS and is sound medical practice. During the medical intake
screening, detainees are asked to give signed permission when non-medical staff is used to
interpret. The medical staff also has access to the language line for translation assistance, if
needed. Access to medical services is explained to the detainee during the intake screening.
During the medical screening, a booking officer stands at the doorway within hearing distance of
the interview. This constitutes a violation ofthe NDS, because medical information is
communicated (Deficiency MC-1). This arrangement also potentially violates the Health
Information Portability and Accountability Act (HIPAA), which protects all "individually
identifiable health information held or transmitted by a covered entity or its business associate, in
any form or media whether electronic, paper or oral." Interviews of five booking officers
confirmed they completed annual training in HIPAA; however, the topic is not currently
designated as mandatory for all custody staff. The HSA and the ECDC Administrator indicated
they would take necessary corrective action to ensure compliance with the NDS and HIPAA.
Effective April2012, HIPAA will be included in initial and annual training for all staff.
In all 35 cases reviewed, ODO verified a physical examination (PE) is conducted by the RN or
Medical Director from 24 hours to seven days after a detainee's arrival at ECDC. As
administered, each PE met IHSC Performance Improvement criteria. Training in conducting a PE
is documented in the training records of each RN on staff. Every PE conducted by an RN is
submitted electronically to the Medical Director, who establishes the initial problem list/diagnosis
and treatment plan. All 35 PE records examined by ODO were reviewed by the Medical Director
within 24 hours of completion. The Medical Director schedules detainees for chronic care clinic
and regular monitoring with the nurse practitioner.
Medications are administered only by the nursing staff. The pharmacy is secure and accessible
only by medical staff. Pharmacy services are provided by a mail-order pharmacy, with a local
pharmacy available to provide medications ordered to start immediately. The local pharmacist has
a contract for quarterly review and monitoring of the ECDC pharmacy and pharmaceutical
practice.

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Etowah County Detention Center
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Medical staff makes daily rounds in the special management units. ODO observed the rounds and
noted medical staff inquired about detainee well-being, addressed any complaints, and provided
prescribed medications.
ODO determined that transfers of records and medical summaries met NDS requirements.

STANDARD/POLICY REQUIREMENTS FOR DEFICIENT FINDINGS
DEFICIENCY MC-1
In accordance with the ICE NDS, Medical Care, section (III)(M), the FOD must ensure all
medical providers shall protect the privacy of detainee's medical information to the extent possible
while permitting the exchange of health information required to fulfill program responsibilities and
to provide for the well being of detainees.

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Etowah County Detention Center
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STAFF-DETAINEE COMMUNICATION (SDC)
ODO reviewed the Staff-Detainee Communication NDS at ECDC to determine if procedures are
in place to allow formal and informal contact between detainees and key ICE and facility staff; and
if ICE detainees are able to submit written requests to ICE staff and receive responses in a timely
manner. ODO interviewed staff and detainees, and reviewed documentation relating to detainee
requests.
Detainees have the opportunity to file requests with both ICE and ECDC staff. Request forms are
available within housing units. ODO observed lEAs retrieving ICE request forms during daily
visits performed to address detainee concerns. DOs make weekly scheduled visits with detainees
for case reviews. Visits by both lEAs and DOs are documented in logbooks found in the housing
units, and visitation schedules for ICE staff are conspicuously posted in the housing units.
According to ECDC staff, the AFOD makes weekly visits to the facility and the FOD visits
quarterly. However, a review of facility logbooks and interviews with ECDC and ERO staff could
not support that ERO department heads, including the FOD and AFOD, conduct regular,
unscheduled visits to the housing units, food service area, recreation areas, special management
units, and the medical unit (Deficiency SDC-1). A deficiency in this area was previously cited in
the October 2010 ODO QAR when the facility fell under the area of responsibility of the Atlanta
Field Office Director; a similar deficiency was also cited during the DFIG Focus Review ofECDC
in November 2007.
ODO reviewed detention files and interviewed ERO and facility staff concerning the
documentation and recording of detainee request forms. ODO found the facility does not maintain
a log, electronic or otherwise, to record detainee requests (Deficiency SDC-2). Detainee requests
are maintained in detainee detention files. Facility staff advised ODO that an electronic log system
is being considered for recording detainee requests.

STANDARD/POLICY REQUIREMENTS FOR DEFICIENT FINDINGS
DEFICIENCY SDC-1
In accordance with the ICE NDS, Staff-Detainee Communication, section (III)(A)(l ), the FOD
must ensure policy and procedures shall be in place to ensure and document that the ICE Officer in
Charge (OIC}, the Assistant Officer in Charge (AOIC) and designated department heads conduct
regular unannounced (not scheduled) visits to the facility's living and activity areas to encourage
informal communication between staff and detainees and informally observing [sic] living and
working conditions. These unannounced visits shall include but not be limited to:
a.
b.
c.
d.

Housing Units;
Food Service preferably during the lunch meal;
Recreational Area;
Special Management Units (Administrative and Disciplinary Segregation); and Infirmary
rooms

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March 2012
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Etowah County Detention Center
ERO New Orleans

DEFICIENCY SDC-2
In accordance with the ICE NDS, Staff-Detainee Communication, section (III)(B)(2), the FOD
must ensure all requests shall be recorded in a logbook specifically designed for that purpose. The
log, at a minimum, shall contain:
a. The date the detainee request was received;
b. Detainee's name;
c. A-number;
d. Nationality;
e. Officer logging the request;
f. The date that the request, with staff response and action, is returned to the detainee; and
g. Any other site-specific pertinent information.
In IGSAs, the date the request was forwarded to ICE and the date it was returned shall also be
recorded.
All completed Detainee Requests will be filed in the detainee's detention file and will remain in
the detainee's detention file for at least three years.

Office of Detention Oversight
March 2012
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Etowah County Detention Center
ERO New Orleans