Maricopa County Correctional Health Services Ncchc Assessment Documents 2008
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Maricopa County Correctional Health Services • Dorinne L. Gray Manager, Quality/Utilization 3250 W. Lowcr Buckeye Rd. Suite 2100 phoeniX, Arizona 85009 Phone: (602) 876-7109 Fax: (602) 506·2577 Management & Clinical Diagnostics .. June 21, 2007 Judith Stanley National Commission on Correctional Health Care 1145 West Diversey Parkway Chicago, Illinois 60611 This document responds to the NCCHC's accreditation report review of findings dated Mar~h 16, 2007, in which NCCHC requested subsequent documentation of compliance with Essential Standard J-E-04, on or before July 02, 2007. . . Maricopa CoUnty Co~ectional ;H~alth" Services inaintains a robust' comprehensive pro~am for continual quality improvement. Enclosed in report fonnat and graphical representation, is Maricopa County Sheriffs Office and Correctional Health Services corrective .action and evidence of compliance with the NCCHC standard. :. Maricopa County Correctional Health Services anticipates the remaining standard, J-E-04, will be found in full compliance at the next NCCHC review meeting. Thank you for the opportunity to respond to the March 16,2006 findings. Best regards, kwiktag '" 032 907 765 1/1 III/It /I tl/III /I IlitItl/" MC Confidential (June 08) 001097 MARICOPA COUNTY CORRECTIONAL-HEALTH SERVICES 3250 W. Lower Buckeye Rd., Suite 2100 Phoenix, AZ ·85009 (602) 876-7109 FAJ«(602)442-86~9 Confidential pursuant to A.R.S. §§ 36-2401 to 36-2404 , . In their March 16, 2007 meeting, the Accreditation Committee of the National Commission on Correctional Health Care (NCCHC) voted to continue Maricopa County Sheriff's OfficeDetention Bureau on Continuing Accreditation upon Verification to allow Maricopa County time to complete corrective action for one remaining essential standard, J-E-04 Health Assessment. Notification of this decision was dated May 2, 2007, and received by Maricopa County shortly thereafter. The notification from NCCHC instructed Maricopa County to forward a report of corrective action to NeCHC on or before July 2,2007. As·reported in the NCCHe Accreditatiol). Report Revised03/1612007~ the following standards required corrective action: Essential Standards in Partial Compliance J-E-04 Health Assessment Maricopa County CHS Report of Accreditation Co~pliance . J-E-04 Health Assessment June 2007: CHS' robust initiatives for health assessment completion continue as described previously. Training of healthcare support staffto verify existence of prior incarcerations through patient identification numbers was completed. The overall health assessment completion rate has remained greater than 90% for 6_ consecutive months, rising to a high of 96.2% in June 2007. Maricopa County Correctional Health Ser:vices has also demonstrated 9 months of continual improvement in health assessment completion within 14 days of booking, and has reached a high of 82.8% compliance as ofJune 25, 2007. This improvement has continued even with a recent rise in inmate population, reaching over 10,000 on 6-11-07. Maricopa County Correctional Health Services maintains that the intent of J-E-04 Health Assessment is met, and that CHS complies with this standard. Confidential Pursuant to A.R.S. §§ 36·2401 to 36-2404 Me Page 1 of4 Confidential (June 08) 001098 Maricopa County Correctional Health Servlc!!s Health Assessment Overall Completion Rate- All Facilities JMS dala. All inmates with LOS>!= 10 15 days, n=avg. . . . approx. 9900 each monh Confidential Pursuant to A.R.S. 100 2<Il ~ 90 / a. E 0 U 80 / C § <Il a- 70 """ 36~2401 - et. sea. . 4 ~ 60 50 Aug-De Sep-06 Oct-06 Nov-OS Dec-OS Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-D7 Maricopa County Correctional Health Scrviccs Hcalth Asscssment ~ompletion witJtin 14 days~ All Facilities FY2007 JMS data, Inmates with LOS greater than or equal to 15 days, n ~ 9,900 Confidential Pursuant to A.R.S. 36-2401, et. seq.. 1.00 90 ~. c 80 Jl1 E 70 o u "E 60 jY Co A A Q) e 50 ./r £ 40 -.F y- 30 y /"" ....... / -v / Jul-OB Aug- Sap-OB Oct-OB Nov-OB Dec-OB Jan-07 Feb-07 IVIar·07 Apr-07 lVIay- 00 ~ Jun~ ~ partial mo Confidential Pursuant to AR.S. §§ 36-2401 to 36-2404 Page 2 of4 MC Confidential (June 08) 001099 Previou~ly reported'February 2007: CHS' new initiatives for health assessments have continued from September 2006 to present. Health Assessments have been brought current and are being maintained current at all Maricopa County Jail facilities. An extensive effort to validate and make current the documentation of physical exam, serology, and tuberculin skin testing completion dates in JMS Gail management system) was completed: Thorough training on the use of JMS was developed and implemented. ' The ongoing process for maintaining ,compliance with 14 day Health Assessments, is to schedule trained nurses to perfonn health assessments at LBJ 5 days per week, at Intake 24 ho~rs 'per , day/7 days per week, at Durango 3 days per week and at 41h Avenue 2 days per week, utilizing a ' "power squad" methodology. Maricopa County Sheriff's Office has contributed to the success of this project by providing sufficient detention officer staff to accompany medical personnel for power squads. Medical providers are completing health assessments dl,1ring sick call at all facilities. To ensure the health assessments are completed within 14 days, ininates needing physical exams are placed on the sick call roster for completion of their physical exam at day 8-9 of incarceration. Additional training for healthcrn:e support staffto verify existence of prior incarcerations (especially within the last twelve months) through patient identification numbers is currently being rolled out. . The health assessment completion rate rose to 91.6% in January 2007, and 92.6% in midFebruary 2007. Maricopa County Correctional Health Services contends the intent of J-E-04 Health Assessment is met, and that CRS is in compliance with this stan~ard. Previously reported September 2006: CHS hired 8 Traveler nurses to perform physical exams; working 12 hour shifts at both LBJ and 4th Avenue locations. Nurses are scheduled to provide 24/7 coverage at 4th Ayenue Intake in an ' effort to complete health assessments upon inmate's entrance to the jail system. CHS continue to hire up to a total of 15 Traveler nurses, as needed for improvement efforts, along with ongoing recruitment of regular staff. CHS staffing plan, based on Maricopa County Managing for Results program, was approved by the Maricopa County Office ofManagement and Budget, and the Maricopa County Board of Supervisors. The approved,staffing plan provides the following increases in positi()ns: Medical Records Technicians - 6 new FTEs, Mental Health Professionals - 10 new FTEs, MDs (Medical) - 7 new FTEs, MDs (Psycl1iatrist) 3 new FTEs, Correctional Health Techs - 13 new FTEs, Licens'ed'Practical Nurses - 7 new FTEs, Registered Nurses - 26 new FTEs, Health' Unit Coordinators - 31 new FTEs, Nursing , Supervisors - 4 new FTEs, Quality Coordinator - 1 new FTE ' will , CHS has continued system-wide efforts to complete past due health assessments, in an effort to improve inter-facility transfer of inmates to Department Of Corrections, and to decrease the number of inmates needing a health assessment. Future improvement emphasis will be on the completion of the health assessments in the earlier days ofincarceratiori (within 14 days of booking) CHS documentation forms have been reviewed and revised to improve the collection of health infonnation~ Methods of data collection and reporting have been reviewed. Previously reported May 2006: , CHS focused effort at Durango jail to complete the health history, vital signs, and lab/diagnostic' testing portion of the 14 day health assessment. ' Medical Providers changed practice for every inmate requesting sick call to include 9ssessment and treatment of the condition requiring sick call and to also include the physical exam, when applicable. eRS continues to actively recruit and retain medical providers and nursing Confidential Pursuant to A.R.S. §§ 36-2401 to 36·2404 Page 3 of4 MC Confidential (June 08) 001100 RI7.~"~ Maricopa County Correctional Health Services .A . '!r: • . Dorinne L. Gray Manager, Quality/Utilization Management & Clinical Diagnostics 3250 W. Lower Buckeye Rd. Suite 2100 l'hoenix. Arizona 85009 Phone: (602) 876-7109 Fax: (602) 506-2577 June 21, 2007 Judith Stanley National Commission on Correctional Health Care 1145 West Diversey Parkway Chicago, Illinois 60614 This document responds to the NCCHC's accreditation report review of findings dated March 16, 2007, in which NCCHC requested subsequent documentation of compliance with Essential Standard J-E-04, on or before July 02, 2007. Maricopa County Correctional Health Services ni\iintains a robust comprehensive program for continual quality improvement. Enclosed in report format and graphical representation, is Maricopa County Sheriff s Office and Correctional Health Services corrective action and evidence of compliance with the NCCHC standard. Maricopa County Correctional Health Services anticipates the remaining standard, J-E-04, will be found in full compliance at the next NCCHC review meeting. Thank you for the opportunity to respond to the March 16, 2006 findings. Best regards, I!tl~tfr 'Orime 1. cit Manager of Q ality / Utllization Management & Clinical Diagnostics Maricopa County Correctional Health Services MC Confidential (June 08) 001101 MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES 3250 W. L.ower Buckeye Rd., Suite 2100 Phoenix, AZ 85009 . (602) 876-7109 FAX (602) 442-8659 Confidential Pursuant to A.R-S. §§ 36-2401 to 36-2404 In their March 16,2007 meeting, the Accreditation Committee of the National Commission on Correctional Health Care (NCCHC) voted to continue Maricopa County Sheriffs OfficeDetention Bureau on Continuing Accreditation upon Verification to allow Maricopa County time to complete corrective action for one remaining essential standard, J-E-04 Health Assessment. Notification of this decision was dated May 2,2007, and received by Maricopa County shortly thereafter. The notification from NCCHC instructed Maricopa County to forward a report of corrective action to NCCHC on or before July 2,2007. As reported inthe NCCHC Accreditation Report Revi'sed 03/16/2007, the following standards required corrective actio:!).: Essential Standards in Partial Compliance J-E-04 Health As.sessment Maricopa County CHS Report of Accreditation Compliance J-E-04 Health Assessment June 2007: CHS' robust initiatives for health assessment completion continue as described previously. Training of healthcare support staff to verify existence of prior incarcerations through patient identification numbers was completed. The overall health assessment completion rate has remained greater than 90% for 6 consecutive months, rising to a high of 96.2% in June 2007. Maricopa County Correctional Health Services has also demonstrated 9 months of continual improvement in health assessment completion within 14 days of booking, and has reached a high of 82.8% compliance as ofJune 25, 2007. This improvement has continued even with a recent rise in inmate population, reaching over 10,000 on 6-11-07. Maricopa County Correctional Health Services maintains that the intent of J-E-04 Health Assessment is met, and that CHS complies with this standard. Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 1 of4 MC Confidential (June 08) 001102 Maricopa County Correctional Health Services Health Assessment Overall Completion Rate- All Faciliti s JM Sdala, All inmafes wi!h LOS >/= 10 15 days, n=avg. approx. 9900 each monlh Confidential Pursuant to A.R.S. 36-2401 et, seq. . 100 90 .$ / Ql C. E 0 80 () / 1: Ql e 70 Ql 0.. r --- -- ~ 60 50 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Maricopa County Correction.al Health Services Health Assessme'nt Completion'within 14 days,A11 Facilities.FY2007 JMS data, Inmates with LOS greater than or equal to 15 days, n - 9,900 Confidential Pursuant to A.R.S. 36-2401, et. seq. " Q) <.) c .!!! C. E 0 () c Q) 0 (j) 0.. 100 90 - - - - - - - - - - - - - - - - - - - - - - - - - _ . - - - - - . - 80 70 ...... 60 50 40 30 ---------_.------~------ .. Jul-D6 --.- -_--&._-.....- - ¥ ' / . / - - - - - . -.... -- - - - - - - - - - - 1 ._- - - - - - - - - - - - - - - - - - - - - - - - - _ . - Aug- Sep-D6 Oct-D6 Nov-D6 Dec-D6 Jan-D7 Feb-D7 Mar-07 Apr-07 May- 00 W Jun~ partial mo Confidential Pursuant to A,R.S. §§ 36-2401 to 36-2404 Page 2 of4 MC Confidential (June 08) 001103 Previously reported February 2007: CHS' new initiatives for health assessments have continued from September 2006 to present. Health Assessments have been brought current and are being maintained. current at all Maricopa County Jail facilities. An extensive effort to validate and make current the documentation of physical exam, serology, and tuberculin skin testing completion dates in JMS Gail management system) was completed. Thorough training on the use of JMS was developed and implemented. The ongoing process for maintaining compliance with 14 day Health Assessments, is to schedule trained nurses to perform health assessments at LBJ 5 days per week, at Intake 24 hours per dayl7 days per week, at Durango 3 days per week and at 4th Avenue 2 days per week, utilizing a "power squad" methodology. Maricopa County Sheriffs Office has contributed to the success of this project by providing sufficient detention officer staff to accompany medical personnel for power squads. Medical providers are completing health assessments during sick call at all facilities. To ensure the health assessments are completed within 14 days, inmates needing physical exams are placed on the sick call roster for completion oftheir physical exam at day 8-9 of incarceration. Additional training for healthcare support staff to verify existence of prior incarcerations (especially within the last twelve months) through patient identification numbers is currently being rolled out. The health assessment completion rate rose to 91.6% in January 2007, and 92.6% in midFebruary 2007. Maricopa County Correctional Health Services contends the intent of J-E-04 Health Assessment is met, and that CHS is in compliance with this standard. . Previously reported $eptember 2006:. CHS hired 8 Traveler nurses to perform physical exams, working 12 hour shifts at both LBJ and 4th Avenue locations. Nurses are scheduled to provide 2417 coverage at 4th Avenue Intake in an effort to complete health assessments upon inmate's entrance to the jail system. CHS will continue to hire up to a total of 15 Traveler nurses, as needed for improvement efforts, along with ongoing recruitment of regular staff. CHS staffing plan, based on Maricopa County Managing for Results program, was approved by the Maricopa County Office of Management and Budget, and the Maricopa County Board of Supervisors. The approved staffing plan provides the following increases in positions: Medical Records Technicians - 6 new FTEs, Mental Health Professionals - 10 new FTEs, MDs (Medical) -7 new FTEs, MDs (Psychiatrist)3 new FTEs, Correctional Health Techs - ]3 new FTEs, Licensed Practical Nurses - 7 new FTEs, Registered Nurses - 26 new FTEs, Health Unit Coordinators - 31 new FTEs, Nursing Supervisors - 4 new FTEs, Quality Coordinator - 1 new FTE CHS has continued system-wide efforts to complete past due health assessments, in an effort to improve inter-facility transfer of inmates to Department Of Corrections, and to decrease the number of inmates needing a health assessment. Future improvement emphasis will be on the completion of the health assessments in the earlier days of incarceration (within 14 days of booking) CHS documentation forms have been reviewed and revised to improve the collection of health information. Methods of data collection and reporting have been reviewed. Previously reported May 2006: CHS focused effort at Durango jail to complete the health history, vital signs, and lab/diagnostic testing portion of the 14 day health assessment. Medical Providers changed practice for every inmate requesting sick call to include assessment and treatment of the condition requiring sick call and to also include the physical exam, when applicable. CHS continues to actively recruit and retain medical providers and nursing Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 3 of 4 MC Confidential (June 08) 001104 personnel. CHS revised the training curriculum for Nurses to perform physical exams. CHS plans to expand the training program with the recruitment of nurses. Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 4 of4 MC Confidential (June 08) 001105 Maricopa County Correctional Health Services 3250 W. Lower Buckeye Rd. Suite Dorinne L. Gray Director, Quality/Utilization Phoenix, Arizona 85009 Phone: (602) 876-7109 Fa:,:: (602) 506-2577 Management & Clinical Diagnostics February 16,2007 Judith Stanley National Commission on Correctional Health Care 1145 West Diversey Parkway Chicago Illinois 60614 This document responds to the NCCHC's accreditation report review of findings dated December 11, 2006, in which NCCHC requested subsequent documentation of compliance with applicable Esseritial·and Important Standards on or before Fe1;>ruary 22 1 2007.. Maricopa County Correctional Health Services ril~ntains a robust comprehensive program for continual quality improvement. Enclosed in report format and graphical representation, is Maricopa County Sheriff s Office and Correctional Health Services corrective action and evidence of compliance with NCCHC standards.:' Maricopa County Correctional Health Services anticipates the remaining standards, J-E-04, JE-OS, and J-E-09, will be found in full compliance at the next NCCHC review meeting. Thank you for the opportunity to respond to the December 11, 2006 findings. Best regards, Dorinne L. Gr Manager of Quality I Utilization Management & Clinical Diagnostics Maricopa County Correctional Health Services MC Confidential (June 08) 001106 MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES 3250 W. Lower Buckeye Rd., Suite 2100 Phoenix, AZ 85009 (602) 876-7109 FAX (602) 442-8659 Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 In their November 17,2006 meeting, the Accreditation Committee of the National Commission on Correctional Health Care (NCCHC) voted to continue Maricopa County Sheriffs OfficeDetention Bureau on Continuing Accreditation Upon Verification with the qualification that compliance with all of the Essential Standards and at least 85% of the applicable Important Standards be demonstrated in a report to the NCCHC on or before February 22, 2007. As reported in the NCCHC Accreditation Report Revised 12/11/2006, the following standards . required corrective action: Essential Standards in Partial Compliance J~E-04 Health Assessment Important Standards in Partial Compliance* *note: Prior to this rep~rt, 35 of37 applicable important standards (94.6%) have been cleared and/or found in comp'liance by NCCHC, which exceeds the required 85%. J-E-05 Mental Health Screening and Evaluation J-E-09 Segregated Inmates Maricopa County CHS Report of Accreditation Compliance J-E-04 Health Assessment Previously reported May 2006: CHS focused effort at Durango jail to complete the health history, vital signs, and lab/diagnostic testing portion of the 14 day health assessment. Medical Providers changed practice for every inmate requesting sick call to include assessment and treatment of the condition requiring sick call and to also include the physical exam, when applicable. CHS continues to actively recruit and retain medical providers and nursing personnel. CHS revised the training curriculum for Nurses to perform physical exams. CHS plans to expand the training program with the recruitment of nurses. Previously reported September 2006: CHS hired 8 Traveler nurses to perform physical exams, working 12 hour shifts at both LBJ and 4th Avenue locations. Nurses are scheduled to provide 24/7 coverage at 4th Avenue Intake in an effort to complete health assessments upon inmate's entrance to the jail system. CHS will continue to hire up to a total of 15 Traveler nurses, as needed for improvement efforts, along with ~>ngoing recruitment of regular staff. CBS staffing plan, based on Maricopa County Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 1 of5 MC Confidential (June 08) 001107 ". Managing for Results program, was approved by the Maricopa County Office of Management and Budget, and the Maricopa County Board of Supervisors. The approved staffing plan provides the following increases in positions: Medical Records Technicians - 6 new FTEs, Mental Health Professionals - 10 new FTEs, MDs (Medical) - 7 new FTEs, MDs (psychiatrist) . 3 new FTEs, CQrrectiona1 Health Techs - 13 new FIEs, Licensed Practical Nurses - 7 new FTEs, Registered Nurses - 26 new FTEs, Health Unit Coordinators - 31 new FTEs, Nursing Supervisors - 4 new FTEs, Quality Coordinator - 1 new FTE CBS has continued system-wide efforts to complete past due health assessments, in an effort to improve inter-facility transfer of inmates to Department Of Corrections, and to decrease the number of inmates needing a health assessment. Future improvement emphasis will be on the completion of the health assessments in the earlier days of incarceration (within 14 days of booking) CBS documentation forms have been reviewed and revised to improve the collection of health information. Methods of data collection and reporting have been reviewed. February 2007: CHS' new initiatives for health assessments have continued from September 2006 to present. Health Assessments have been brought current and are being maintained current at all Maricopa County Jail facilities. An extensive effort to validate and make current the documentation of physical exam, serology, and tuberculin skin testing completion dates in JMS Gail management system) was completed. Thorough training on the use of JMS was developed and implemented. The ongoing process for maintaining compliance with 14 day Health Assessments; i~ to schedule trained 'nurses to perform health assessm'ents at LBJ 5 days per week; at Intake 24 hours per dayl7 days per week, at Durango 3 days per week and at 4th Avenue 2 days per week, utilizing a "power squad" methodology. Maricopa County Sheriff's Office has contributed to the success of this project by providing sufficient detention officer staff to accompany medical personnel for power squads. Medical providers are completing health assessments during sick call at all facilities. To ensure the health assessments are completed within 14 days, inmates needing physical exams are placed on the sick call roster for completion of their physical exain at day 8-9 of incarceration. Additional training for healthcare support staff to verify existence of prior incarcerations (especially within the last twelve months) through patient identification numbers is currently being rolled out. The health assessment completion rate rose to 91.6% in January 2007, and 92.6% in midFebruary 2007. Maricopa County Correctional Health Services contends the intent of J-E-04 Health Assessment is met, and that CHS is in compliance with this standard. Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 2 of5 MC Confidential (June 08) 001108 Maricopa County Correctional Health 5 rvic s Health Assessment Completion ~ All Facilities JMS data, All inmates with LOS >/= 10 15 days, n=avg. approx. 9000 each roonlh Con dential Pursuant to A.R.S. 36-2401, et. se "100 " * 8 90 -I- -=-=---~~~==~.6 .9 c.. E 80 § ~ 70 60 + - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 50 +--------,-----.,------,------,------,.....--------r--' Aug-06 Sep-06 Oct-06 Nov-D6 Dec-D6 Jan-07 Feb-07 J-:E-05 Mental Health Screening and Evaluation Previously reported September 2006: Mental Health Screening is completed on all detainees at time of booking. All persons are then compared to Value Options database (Maricopa County state-contracted Regional Behavioral Health Authority for Medicaid, non-Medicaid and Title XXI eligible residents). CHS is notified of persons receiving services from Value Options; mental health information is obtained from case managers; and continuity of care is achieved. At the time of classification, inmates are further screened for violent behavior, victimization, special education placement, andlor sex offenses. CHS Mental Health Professionals are notified via the electronic Jail Management System or referral of inmates with positive mental health screens needing further evaluation. Mental Health Professionals (MHP's) perform a face-to-face assessment on these inmates in the intake area. MHP's obtain outside records and treatment plans for those that are seriously mentally ill, track inmate movement, and alert the clinic, where the inmate will be housed, to the status of the inmate. MHP's at the housing facility perform a Mental Health Assessment within 14 days. The CHS Mental Health Assessment Form was developed and implemented in April 2006. September 2006: The dynamic process stated above is ongoing with sustained effectiveness. February 2007: In June 2006, the NCCHC accreditation committee requested one additional month of data demonstrating compliance with J-E-05, Mental Health Screening and Evaluation standard. Maricopa County CHS submitted further data in September 2006. In the NCCHC revised report dated 12-11-06, there was no mention of evidence of compliance that was submitted. Maricopa County Correctional Health Services respectfully submits additional documentation of compliance, totaling 4 months, as evidence that this standard should be found in full compliance. Compliance that Mental Health Screening and Evaluations were completed within 14 Days of Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 3 of5 MC Confidential (June 08) 001109 · '. booking are as follows: May 2006 = 100%, July 2006 = 93.3%, August 2006 = 94.1%, December 2006 = 94.1 %. Maricopa County CHS intends to continue quarterly monitoring of this standard as part of the Continuous Quality Improvement Program. Maricopa CountyCorrectionalHeahh Services Mental Heahh Screen &Evaluatio n AllFacilities 2006 ConfidentialPursuant to ARS 36-2401et. seq. 100 100 100 100 100 100 90 80 70 60 50 40 30 20 10 o Mental Helath, SCreen ' Mental Health Evaluation ,I_ May-06 • Jul-06 i:::J Aug-06 tJ Dec'-06 'I J-E-OO Segregated Inmates Previously reported September 2006: Plan developed to revise policy and documentation practice. Process in place: Inmates in segregation are checked by detention every 25 minutes. Segregation checks by nursing staff are entered on the housing roster. Any inmate with a healthcare complaint is offered an Inmate Request for Medical Services form. Any inmate with any issue of questionable urgency is brought to the attention of the clinic RN, so that timely triage and sick call evaluation can be completed. A nursing note is documented in the individual inmate's medical record, progress note section. February 2007: The CHS policy and procedure entitled Segregated Inmates was revised on 12/15/06 and implemented 2/15/07, which addresses: • MCSO notification to medical staff of initial inmate placement in segregation • Review of inmate health information to determine contraindications to segregation • Frequency of medical staff monitoring of segregated inmates based on degree of isolation in accordance with NCCHC standards • Documentation methodology • Reference to MCSO policy and procedure for segregated inmate safety and well being through detention security walks • Reference to MCSO policy and procedure for segregated inmate access to programs and services • Treatment of segregated inmates with non-urgent, urgent, and emergency health care needs Confidential Pursuant to A.R.S. §§ 36-2401 to 36-2404 Page 4 of 5 MC Confidential (June 08) 001110 ", • " . In June 2006, the NCCHC accreditation committee requested confinnation that the CHS plan was implemented in order to be found in compliance. Maricopa County Correctional Health Services has revised and implemented its Policy & Procedure and processes to comply with the NCCHC standards as stated above. This report serves as the requested confirmation. Madcop!l County CHS contends this standard is in full compliance. Confidential Pursuant to A.R.S. §§ 36·2401 to 36-2404 Page 5 of5 MC Confidential (June 08) 001111 Maricopa County Correctional Health Services 3250 W. Lower Buckeye Rd. Suite Dorinne L. Gray Director, Quality/Utilization Management & Clinical Diagnostics Phoenix, Arizona 85009 Phone; (602) 876-7109 Fax; (602) 506-2577 September 29,2006 Judith Stanley National Commission on Correctional Health Care 1145 West Diversey Parkway Chicago Illinois 60614 This document responds to the NCCHC's accreditation report review of findings dated July 20, 2006, in which NCCHe requested subsequent documentation of compliance with . app~icable Essential and Important Standards.onorbefore Octob~r 15,2006.. Maricopa County Correctional Health Services maintains a robust comprehensive program for continual quality improvement. Enclosed in tabular format and graphical representation, is Maricopa County Sh~riffs Office and Correctional Health Services corrective action and evidence of compliance with NCCHC standards. Maricopa County Correctional Health Services anticipates areas needing corrective action will be cleared at the next NCCHC review meeting on November 17, 2006. Thank you for the opportunity to respond to the July 20, 2006 findings. Best regards, Dorinne L. a Director of Qu lity / Uti lzation Management & Clinical Diagnostics Maricopa County Correctional Health Services MC Confidential (June 08) 001112 Maricopa County Correctional'Health ServiceS September 2006 Response to the NCCHC Accreditation SurveY.-conducted December 2005, NCCHC final Report dated February 24, 2006 Ell I 'Standard I Compliance PENDING COMPLIANCE ASSESSMENT E I J-E-04 Health Assessment I Partial Confidential Pursuant to A.RS. 36-2401, et. seq. I NCCHC Recommendation I' CHS Resolution HA be completed within 14 days Immunization provided as necessary While this represents significant progress, for full compliance, a compliance rate of at least 90% is required, provided the 10% non-compliance is due to random events and not aspecific pattern. The facility remains in partial compliance. (NCCHC June 2006). ::s: o ::J t-h 1-" 0.. (l) ::J It 1-" PJ f--' ~ ::J (l) o co f-l f-' f-l W Medical Providers have changed practice for every inmate requesting sick call to include assessment and treatment of the condition 'requiring sick call and to also include the ,physical exam, when applicable. CHS continues to actively recruit and retain medical ',providers and nursing personnel. CHS has r~vised the training curriculum for Nurses to ,perfonm physical exams. CHS plans to expand the training program with the recruitment of nurses. September 2006: CHS has hired 8Traveler nurses to perform physical exams, working 12 hour shifts at both LBJ and 4lh Avenue 'locations. Nurses are scheduled to provide 24/7 coverage at 4lh Avenue Intake In'an effort to complete health assessments upon inmate's entrance to 'the jail system. CHS will continue to hire lip to a total of 15 Traveler nurses, as n!'leded for improvement efforts, along with 'ongoing recruitment of regular staff. CHS staffing plan, based on Maricopa County Managing for Results program, has been 'approved by the Maricopa County Office of Management and Budget, and'the Maricopa County Board of Supervisors. The approved staffing plan provides the ,following increases in positions: Medical Records Technicians - 6 new FTEs Mental Health Professionals -10 new FTEs n n o o May 2006: 'Focused effort at Durango jail to complete the health history, vital signs, and lab/diagnostic testing portion of the 14 day health 'assessment. 11/9/2006 CHS Evidence of Compliance Significant improvement In the percent of Health Histories, vital signs, and lab/diagnostic tests completed within fourteen days at Durango: February 2006 = 65%, May 2006 = 82%, June = 79%, July = 82%, August = 77% Compliance with health assessment completion (all components of health assessment, all inmates. based on JMS) has improved: January 2006 =69.4%, March 2006 = 70.7% (revised Sept. 2006) The method for getermining health assessment data using the MCSO Jail Management System (JMS) was found to have inherent variations and inaccuracies. CHS perfonned a random chart audit of 152 charts In all facilities on Inmates booked between January and August 2006. Please note, audit denominator data does not account for inmates that may not have had a medical record generated, (i.e. passed through intake without TST, serology testing, or physical exam AND who had never requested medical services). Results of Health Assessment Overall Completion, chart audit August 2006: Recording of Vital Signs = 97.4% Collection of health history 98.0% TB testing = 99.3% Communicable Disease testing = 98.0% Physical Exam =95.4% HA completed within 14 days = = Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Corifidential Pursuant to 4.ft.S. 36-2401, et. seq Ell Standard Compliance NCCHC Recommendation CHS Resolution MOs.(Medical) - 7 new FTEs MOs (Psychiatrist) - 3 new FTEs Correctional Health Techs - 13 new FTEs Licensed Practical Nurses - 7 new FTEs Registered Nurses - 26 new FTEs Health Unit Coordinators - 31 new FTEs Nursing Supervisors - 4 new FTEs Quality Coordinator - 1 new FTE CHS Evidence of Compliance 48.7% CHS has continued system-wide efforts to templete past due health assessments, in an effort to improve lnter·facility transfer of inmates to Department Of Corrections, and to decrease the number of inmates needing a health assessment. Future improvement emphasis will be on the completion of the health assessments in the earlier days of incarceration (within 14 days of booking) s:: . n n C.HS documentation forms have been reviewed and revised to improve the collection of health Information. .Methods of data collection and reporting have been reviewed. o ~ H1 }-'- 0.. (j) ~ rt }-'- OJ f-' ~ ~ (j) o (X) o o f-' I-' f-' ,.)::> 11/9/2006 2 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401, et. seq. Ell I I Standard Compliance I NCCHC Recommendation I. . CHS Rii3otution - - T CHS EvTdence of ComDliance Maricopa County Correctional Health Services Health Assessment Completion - All Facilities lrunates booked 1/06 • 8/06 with LOS >/= to 15 days Medical Chart Audit Conducted August 2006, n=152 Confidential Pursuant to ARS 36-2401 et.seq. C o 100.0 'iI 80.0 T. _. I 97.4 I . P.. S 60.0 o U .... c<l) Poe .. -: 20.0 0.0 I . ~:: ',; n n o ::s H1 : IC. I 1"' ". i '-" , Recording of Vital Signs 8: 1-" "'-;}. 40.0 () .... <l) •.••. : • • . ..-----.-"0-'- J-E-05 Mental Health Screen & Evaluation 0.. (]) ::s It 1-" IlJ f-' ~ ::s (]) o CO o Partial I ~. '.' '! Collection of Health History TB Testing MH evaluations completed within . Communicable Disease testing Physical Examination Completed within 14 days of arrival September 2006: Mental Health Screening is 'completed on all detainees at time of booking. Need two months of data All persons are then compared to Value Options database (Maricopa County stateIn subsequent documentation. the contracted Regional Behavioral Health Authority for Medicaid, non-Medicaid and Title facility submitted results of their corrective action since the XXI eligible residents). CHS is notified of February 2006 Accreditation persons receiving services from Value Committee meeting. It reports Options; mental health information is obtained results of the CQI stUdy of mental from case managers; and continuity of care is health evaluations completed at· . achieved. At the time of classification, all locations in May 2006 to be at inmates are further screened for violent 100%. While this represents 'behavior, victimization, special education significant progress, 'placement, and/or sex offenses. CHS Mental confirmation of at least one .Health Professionals are notified via the 14 days CQI Audit. all locations 2006: Mental Health Screens: May =100%, July =100%, August = 100% Mental Health Evaluations within 14 days: May 100%, July = 93%, = = August 94% . o I-' I-' I-' (J1 11/9/2006 3 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.K8. 36-2401, et. se.... Ell Standard CHS Resollition . NCCHC Recommendation more month of compliance is needed. The facility remains in partial compliance. (NCCHC June 2006). 'CHS Evidence of Compliance electronic Jail Management System or referral of inmates with positive mental health screens needing further evaluation. Mental Health Professionals (MHP's) perform aface-to-face assessment on these inmates in the intake area. MHP's obtain outside records and treatment plans for those that are seriously mentally ill, track inmate movement, and alert the clinic, where the inmate will be housed, to t~e status of the inmate. MHP's at the housing facility perform a Mental Health . Assessment within 14 days. The CHS Mental Health Assessment Form was developed and implemented in April 2006. .September 2006: The dynamic process stated above is ongoing with sustained effectiveness. Maricopa CountyCorrectionalHealth Services Mental Health Screen &Evaluatio n AU Facilities 2006 Cor1fTdentia/ Pursuant to ARS 36-240Iet. seq. :s;: n n 100 100 100 100 100 90 o :::J '" <> ~ l-I) f-'. t 0.. 8 (j) :::J <: rt ~ f-'. ~ III 0... I-' 80 70 60 50 40 30 20 10 o y C :::J Mental He lath Screen Mental Health Evaluatio n (j) o ex> o o I-' I-' I-' Gl 1119/2006 4 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401, et. sea. Ell Standard Comp~ance I NCCHe Recommendation I CHS Resolution . C.t'1S"·E'Iid~nce of Compliance E J-E-07 Non-Emergency Health Care Requests & Services Partial I I Estrella: Triage tank orders within 24 hours Estrella May 2006 : Process for triage and scheduling of sick call · reviewed and revised NO NCCHC RESPONSE DOCUMENTED, June 2006. Per September 2006: LBJ OP has implemented a robust process phone conversation with Judy · fbr face·to·face nurse triage. A nurse Stanley, CHS must document compliance at LBJ OP. dedicated to this process has been hired and trained. At time of triage, any inmate determined to be priority level one (needs to be seen within 24 hours) are seen by a . '.. provider in the main LBJ OP medical clinic that day, or within 24 hours. Any inmate determined to need emergency medical .treatment is transported to the Emergency · Room. CHS is working closely with MCSO .detention officers to ensure flawless ~elivery of sick call and triage. Triage and .sick call processes at Estrella are ongoing (1 o :::J H1 f-'. 0., (]) :::J rt- f-'. PJ I-' Cj C :::J ~lOO ~ 90 .~ 80 0.. 70 s 60 50 40 ~ 30 ;: 20 ~ ~ 10 o CD f-l f-l -.J '.: .. 100 t~j_~~··: :-: ~.. '~~~~~~ >".: ~ . .. ~' -,:. -. . ~,J':;:'~.~5:...~.~.!·. :~~:!<,., 11/9/2006 CQI Audit LBJ OP 2006: Medical Requests lriaged within 24 hours: August 100% Applicable inmates scheduled for sick call within 24 hours: August = 100% Applicable inmates received sick call services as scheduled within 24 hours: August = 100% = 100 ',1':: P- El o ~ 'i't; ;;;.-;- ~:'f'.~ c: ..:;.., Cl> U :l~-·~~:7· ...... ._;;.:..... Cl> P-< Medical Requests Triaged within 24 hours o l-' ;~t?-~·. ;~~~:': ~ (]) o o 100 = Maricopa County Correctional Health SeIVices Non-Emergency Health Care Requests & Services Estrella Confidential Pursuant to ARS 36·2401 eL seq. Maricopa County Correctional Health Services Non-Emergency Health Care Requests &Services LBJ OP August 2006 Confidential PlIrsuonllo ARS 36-2401 el. seq. 8: (1 CQI Audit Estrella 2006: Medical Requests triaged within 24 hours: April = 100%, May 93%, August = 100% Applicable inmates scheduled for sick call within 24 hours: April =100%, May 2006 =100%, August =100% Applicable inmates received sick call services as scheduled within 24 hours: .April = 100%, May 2006 = 100%, August = 100% Applicable Inmates Scheduled for Sick Call within 24 Hours Applicable Inmates Received Sick Call within 24 Hours Medical Requests Triaged Applicable Inmates Applicable Inmates within 24 hours Scheduled for Sick Call Received Sick Callwithin within 24 Hours 24 Hours 5 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S..36-2401, et. seq Ell I Standard J-E-09 Segregated Inmates Compliance Partial NCCHC Recom~ndation 4th Avenue - extreme isolation inmates to be seen daily; segregated inmates to be seen 3X per week (staffing sited) CHS Resolution .Plan developed to revise policy and documentation practice. J-H-04 Availability of health record Partial Record is not always available at the time of the medical or mental health encounter - staffing cited NO NCCHC RESPONSE, June 2006. 8: o o o of Compliance Process in place: Inmates in segregation are checked by detention every 25 minutes. Segregation checks by nursing staff are entered on the housing roster. Any Inmate with a healthcare complaint is offered an Inmate Request for Medical Services form. Any inmate with any Issue of questionable urgency Is brought to the attention of the clinic RN, so that timely triage and sick call evaluation can be completed. A nursing note is documented In the individual inmate's medical record, progress note section. In subsequent documentation, the facility reports developing a plan to provide the daily health checks in the maximum security segregation ("Super Max") cells. Confirmation that the plan has been implemented is required for full compliance (NCCHC June 2006). I CHS..Evidence Plan developed ·CHS continues to pursue EMR. CHS has hired 4 additional Medical Record Technicians ·since January 2006. As of May 24, 2006, only .1·Medical Record Tech vacancy remains. ·CHS implemented a process to transfer medical records to on-site specialty clinics on ·day of clinic so that medical records are ai.iailable to the provider prior to appointment. COl audit all sites 2006: Medical record available' at time of the encounter: May 2006 = 100% August 2006 =97.6% September 2006 = 98.6% ::J rn September 2006: As delineated in the CHS staffing plan, CHS has increased the number of Medical Record Technician FTE's by 6full-time positions. f-'. 0.. ([) ::J rt f-'. PJ f-' An RFP for an electronic medical record has been published. The first bidders' .conference will be on October 18,2006. y C ::J ([) . o CO o o t-' f-' f-l CO 11/9/2006 6 Maricopa County Correctionai Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S 36-2401, et. seq. Ell I Standard I ComQliance I NCCHC Recommendation I __ ~SHS Resolution I G.H.S,E'=Videlice of Coml)liance Maricopa County Correctional Health Services Medical Record Available at Time ofFncounter All Facilities 2006 Confidential Pursuant to ARS 36-2401 100 100 -.~.~. '~': v (,) s::: .~ P.. 8 0 I 8Q) P-. '~'.: • • ,;,- ..~...:'.:: .·~:··~:.i·· 60 /::': '~:"::':i~ ~.':..:~.l ! :'?~:";' ~?~-~: . +' s::: • •' . :~ 80 U Q) . " 40 20 .:. ;,,(:.'::f;', t~". .:... .. ~ , ',' :~.~~•• =.;, --..:,: ~ ... . ~ .; 0 May Aug Sept 8:: (1 (1 o COMPLIANT PER NCCHC JUNE 2006 I I J-C-07 Staffing Plan ::J I-!) 1-" 0- (I) ::J rt 1-'- P.J I-' Cj C ::J (I) o CO o o f-' I-' I-' \.0 11/9/2006 y See individual standards 'CHS has implemented strategies to aggressively recruit and retain necessary staff. CHS has completed athorough evaluation of the tasks to deliver necessary health care and The other standards cleared by 'tlie staffing needs to complete those tasks. A corrective action subsequent to report of this evaluation is being developed the survey indicate that the and will be presented to the Maricopa County facility is now in compliance , Office of Management and Budget. with the intent of this standard (NCCHC June 2006). This standard will be met when Sick Call, Triage, Chronic Care and Consultant Care standards are met Sick CallI Triage standards met. See J-E07 Evidence of Compliance Management of Chronic Disease intent of standard met. See J-G-02 Consultant Car~ intent of standard met: Utilization Management processes referrals for Consultant Care on adaily basis M-F. Appointments for authorized consultant care are scheduled per priority designated by referring provider. Statistics are kept regarding appointment status and monitored by the Quality Improvement Committee and Executive Leadership. Statistics were available to NCCHC Surveyors at time of survey. Between January 2006 and May 2006, Maricopa County CHS has hired 2 7 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24,2006 Confidential Pursuant to A.R.S. 36-2401, NCCHC Recommendation CHS Resolution - Ell E 8: n n o I Standard J-O-01 Pharmaceutical Operation J-O-03 Clinic Space, Equipment & Supplies :::J t-n Compliance y Y , /-'. g. :::J n/-'. PJ f-' ~ ::J CD o <Xl o o I-' f-' N o I J-O-05 Hospital and Specialty Care 11/9/2006 Y Subsequent to the February 2006 Accreditation Committee meeting, the facility submitted the results of CQI studies that confirmed their corrective action has improveCl the medication renewal process. The facility reports that timely renewals for April 2006 were at 92% compliance; and for May 2006, at 97%. The facility is in compliance with the standard. (NCCHC June 2006). In documentation of corrective action taken after the survey, the survey reported that sharps counts were implemented at the 4lb Avenue Jail. Subsequent audits indicate that in February, March and April 2006, compliance with weekly sharps count was 100% at 4th Avenue Intake, and 100% at 41h Avenue Outpatient Clinic in May. The facility is in compliance with the std. (NCCHC June 2006). - · Medication Renewal Process Medication process redesigned to discontinue use of dual MAR. All medication administration documentation has been ·unified to one MAR, which is maintained by nurses, The method for notifying' the provider ·of upcoming medication expiration has been standardized throughout the jail system. Sharps counts implemented at 4th Avenue jail .. The facility needs certifiCation, . . . from SAMHSA. or must obtain an exemption CHS' Evidence of Compliance Psychiatrists, 1 Forensic Psychologist, 3 Mental Health Professionals, 2 Psych RNs, 1 Psychometrist, 7 Correctional Health Technicians,4 Health Unit Clerks, 1 Health Care Administrator, 4 LPNs, 9 RNs, 1 Nursing Supervisor, 1 Physician Assistant, 1 Service . Worker, and 4 Medical Record Technicians. cal Audit April 2006: Medication renewed timely =92% cal Audit May 20.06: Medication renewed timely =97% Continued monitoring: Medication renewed timely: july 2006 =89% August 2006 =.100% cal Audit 4th Avenue Intake, Sharps count completed at feast weekly 2006: January =100%; February = 100%; March = 100%; April 10P% CQI Audit 4th Avenue Outpatient Clinic, Sharps count completed at least weekly 2006: May =100% = Continued Monitoring 4th Avenue Intake: Sharps count completed at least weekly 2006: May =100%; June =100%, July = 100%; August =100% CHS maintains it does not prescribe methadone to pregnant inmates to treat substance abuse disorders. Methadone is 8 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC fmal Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401 - Ell E Standard J-E-12 Continuity of Care Compliance Y ::s: n n o ::J t-h 1-'- 0.. (]) ::J rt 1-'- OJ I-' ~ ::J (]) o CD I J-E-13 Discharge Planning o o I-' f--l N I-' 11/9/2006 Y NCCHC Recommendation NCCHC has been copied on correspondence between the SAMHSA representative and the facility regarding the need for OTP clinic accreditation leading to federal certification...However, the dialogue continues and the facility remains in compliance with this standard in every other aspect. The intent of the standard is met. (NCCHC June 2006). Care ordered by prOViders is transcribed and prOVided as ordered CHS Resolution CHS:Evidence 'of Compliance only administered to prevent spontaneous abortion of the developing fetus, thus the administration of methadone is regulated by the physician's DEA number. 'Process for transcription, implementation and documentation of provider orders was reviewed. Documentation education delivered iii February 2006. The process for transcription, implementation and documentation of provider .. orders was reviewed and reo education given to involved health staff during February 2006. In April, a 901 audit confirmed significant progress and confirmation that actioris take had addressed the issues. The review included all clinical sites. The facility reports that 97% of the orders were transcribed in a timely manner and 90% were initiated in a timely manner. The audit was repeated in May with 97% and 96% results respectively. The intent of the standard is now met (NCCHC June 2006). Inmates who have serious health ·Keep-on-person medication procedure in needs are oiven a supply of place CQI Audit April 2006 - All Clinical sites, includes laboratory, medication, other diagnostic testing, and treatment orders: Orders transcribed timely =97% Orders initiated timely =90% COl Audit May 2006 - All Clinical sites, includes laboratory, medication, other diagnostic testing, and treatment orders: Orders transcribed timely =97% Orders initiated timely = 96% Continued Monnoring: COl Audit July 2006 - All Clinical sites: Orders transcribed timely = 97% Orders initiated timely =89% COl Audit August 06- All Clinical sites: Orders transcribed timely =92% Orders initiated timely = 90% Maricopa County has implemented one of the most liberal Keep-on-Person proorams 9 Maricopa County Correctional'Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC fmal Report dated February 24,2006 -_ Ell Standard Compliance •• ---- ••• ---. - _F _ _ _ • __ • • • -- ••• -_._~ NCCHC Recommendation necessary medications sufficient to last until the inmate is seen by community providers. _- - ._-~ - ... .... --.l. . CHS Resolution Reviewed prescription practice with providers The facility is meeting the intent of this standard. (NCCHC June 2006). , E J-G-01 SNTP Y 8: , Use of treatment plans for medical problems Mental Health plans to outline and guide treatment were missing The intent of the standard is met (NCCHe June 2006). Medical treatment plan forms re-implemented; Providers re-educated. MH SNTP form revised, educated and im'plemented April 2006. (1 (1 Continued monitoring: o ~ I-h 1-'- 0.. (j) I J-G-02 Management of Chronic Y Disease ~ rt 1-'- OJ I-' y c ~ (j) o CO o o I-' I-' tv tv CHS Evideil,ce of Compliance in the nation, which is an important element in our service. Inmates, who receive keepon-person medications and are released, are permitted to take all remaining medications with them. Inmates, who receive direct-observation medications and are due to be released, will have prescriptions written for their medications, upon request by the inmate. CHS works in partnership with Value Options Case Managers for inmates with serious mental health needs to ensure continuity of care at release. The VO Case manager receives notification of the Inmate release and the patient is handed over to Value Options, who continues prescribed medications. COl Audit April 2006 inpatient psych unit: The SNTP includes treatment goals, methods to meet goals and expected completion dates = 89%; The needs of the inmate are substantially met, consistent with their SNTP = 100%; Combined score = 95% E J-G-03 Infirmary Care 11/9/2006 Y Effective system of tracking chronic disease Regularly scheduled clinics Consistent use of chronic care f10wsheet Care consistent with current national guidelines The intent of the standard is met (NCCHC June 2006). Admitting notes to include diagnosis, medication, diet, activity, diagnostic tests required, CHSutilized a consultant firm to develop a database to track chronic care inmates. Chronic care database allows the capability to monitor frequency of appointments in line with guidelines, so that appointments may be regularly scheduled as necessary. Chronic care form re-implemented; Providers educated to complete and consistent use, Plan developed for identification of high-risk patients for influenza vaccine, Re-implemented use of in-patient admission order form to include diagnosis, medication, diet, activity, diagnostic tests required, and Audit scheduled every 6 months, next audit October 2006 Influenza vaccine ordered May 2006. Database designed. Continued Monitoring April- Sept 2006, Infirmary: Admission orders include - 10 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC flnal Report dated February 24, 2006 "1. Confidential Pursuant to A.R.S. 36-2401 Ell Standard Compliance - ' :s:: n n o ::J .. (]) ::J rt 1-'- (li f-' y C ::J (]) o CO o o I-' f-' N W 11/9/2006 1J ..... frequency of vital sign monitoring and frequency of vital sign Discussed documentation of discharge plan I monitoring notes with provider In-patient record to inCI(Jde .. .P.erry & Potter Nursing manual on unit discharge plan or discharge notes. Providers to round on patients per policy Manual of nursing care to be available The facility is in compliance with the standard. (NCCHC June 2006). I-h 1-'Q., ..... i<. CHS Resolution NCCHC Recommendation eMS Evidence of Compliance Diagnosis = April-100% May ·100% Aug-93% Sept-100% VS frequency = April- 94% May- 94% Aug-BO% Sept-100% Activity = April-97% May- 94% Aug-93% Sept-100% Diet = April-100% May-100% Aug-93% Sept-100% Lab I diagnostic testing = April- nla May-100% Aug-100% Sept- nla Medications = April- 90% May-100% Aug-93% Sept-100% DIG plan documented = April-100% May-100% Aug -100% Sept- nla Discharge Order = April- 100% May-100% Aug -100% Sept- nla 11 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant t(J A.R.S.. 36-2401, et. seq Ell Compliance NCCHC Recommendation Standard CHS. ReSQlution QI:J~:~vidence of Compliance Physician round per policy = April- 97% May-100% Aug-100% Sept-100% Nursing round per policy = April-100% May -100% Aug-100% Sept-100% E J-G-05 Suicide Prevention Y Documentation required that shows Corrective action is identified and implemented for 2005 suicides · None Required - documentation available Documentation available. All Corrective Actions completed and implemented. Continued Monitoring: No suicides have occurred 1-1-06 through 9-18-06. The intent of the standard is met (NCCHC June 2006). COMPLIANT PER NCCHC FEBRUARY 2006 8:: n n o ::::l t-h 1-'- J-A-01 Access to Care J-A-02 Health Authority J-A-03 Medical Autonomy J-A-04 Administrative meetings J-A-05 Policies & Procedures J-A-06 COl Program J-A-O? Emergency Response Y y y y y y Y E J-A-08 Communication of Special Needs Patients J-A-09 Privacy of Care J-A-1O Inmate Death J-A-11 Grievance Mechanism y None Required y y y None Required ·None Required None Required 0.. (]) ::::l rt 1-'- PJ f-' y ~ I I I ::::l (]) o 0) o o I--' f-' tv ~ ·None Required None Required None Required ·None Required None Required ·None Required None Required E E E E E E E 11/9/2006 See J-E-O? Involve correctional staff and community agenciesIn Emergency Response Plan Monitor grievances by types, sites, time of day, etc. as part of COl program Mock emergency scenarios are conducted in Training Academy; MCSO officers involved in Mass Disaster Drills, Man-Down Drills and critiques of both. External grievances monitored by type and site. CHS receives reports from MCSO on all grievances by descriptor and location. MCSO is looking into possibility of updating their system to allow for enhanced monitorinq and trendinq capabilities. 12 Maricopa County Correction~l Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 .. Ell Standard Compliance I E J-A-12 Sexual Assault reportinq J-B-01Infection Control Program Y y - -----, - .. - -.-_.-.- -- ------_. -- NCCHC Recommendation Comment: MRSA - high prevalence, significant local attention ._-,-_._--- CHS rtesolution None Required None Required . 8: o o E J-B-02Environmental Health & Safety Y Cleaning schedules doubled. Showers renovated. Issues corrected. H1 :::J I I y y 0- E J-B-03 Kitchen Sanitation J-B-04 Ectoparasite Control J-C-01 Credentialino J-C-02 Clinical Performance Enhancement J-C-03 Continuino Education J-C-04 TFaining for Correction J-G-05 Medication Administration Trainina J-C-OB Inmate Workers J-C-OB Health Care Liaison J-e-09 Orientation J-D-02 Medication Services J-D-04 Diaonostic Services J-E-01 Information on health Y Y None Required None Required .None Required None Required Y Y Y None Required None Required None Required y .None Required None Required None Required None Required None Required None Required o 1-'- ro :::J rT 1-'- PJ I-' C-j ~ :::J ro o CD o o f-' I-' N (Jl I E E E E \. I E I E 11/9/2006 N/A y Y Y Y GHS:Evide.ncQ of Compliance Infection Control data do not support the conclusion that "there is a high prevalence of this disease at this jail". Infection Control monitors all available laboratory reports, and all hospitalized inmate reports for positive MRSA cultures In CHS patients. Medical records of patients with positive MRSA cultures are reviewed, and a determination is made regarding probable community versus jail acquisition of infection. Reports are presented to the quarterly CHS Infection Control Subcommittee, which include aline listing of specific cases and graphic representation of monthly MRSA rate. Approximately 40 50% of identified MRSA cases are determined to be community-acquired. Occasional inquiries have been received from local news media. However, this is not frequent nor a "focus of significant local attention." CHS submitted subsequent documentation to NCCHC. NCCHC has found the facility to be in compliance with the standard 13 Maricopa County Correctional Health Services September 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 C .--- .. ----, -----J Ell Standard Compliance E E E E I services J·E-02 Receiving Screening J-E-03 Transfer Screening J-E-OB Oral Care J-E-08 EmefQency Services J-E-10 Patient Escort y y Y Y Y I I J-E-11 Nursing Protocols J-F-01 Health Education Y Y I I I I E J-F-02 Nutrition &Medical Diets J-F-03 Exercise J-F·04 Personal Hygiene J-F-05 Use of Tobacco J-G-04 Mental Health Services J-G-06 Intoxication & Withdrawal J-G-07 Pregnant Inmate care J-G-OB Inmates with Alcohol or other drug problems Y y y y E E I o ::> I-h 1-'0.. (]) ::> {T 1-'- OJ I--' C.j ~ ::> (]) o OJ I I I I E E I I I E E I I I I I J·G-09 Sexual Assault procedure J·G-10 Pregnancy counseling J·G-110rlhoses & aids J·G-12 Care of terminally ill J·H-01 Health record format J·H·02 Confidentiality of records J·H-03 Access to custody info J·H-05 Transfer of records J·H-06 Retention of records J-J·01 Use of restraint & seclusion J·I-02 Emergency Psychotropics J-)-03 Forensic information J-I·04 End of Life decision making J-I-05 Informed Consent J-I-06 Right to Refuse treatment J-I-07 Medical or other research - Y Y Y Y y Y y Y Y Y Y y y y y Y Y Y Y -- - COl study to determine if delayed access to diabetic pt due to escort not available is a system-wide problem 4th Ave & LBJ - i opportunities for the GP to receive health educ. Y 8: n n _.-- NCCHC Recommendation Enhance substance abuse program at 4th Ave &LBJ. Estrella has strona proaram Would likely beneijt from EMR - CH$ Resolution CH$"Evidei1ce of Compliance · None Required None Required None Required ·None Required None Required ·None Required ·None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required . .None Required .None Required None Required None Required None Required None Required None Required None Required None Required None Required None Required o o I--' I--' N CY\ 11/9/2006 14 • Maricopa County Correctional Health Services Administration May 26, 2006 234 N. Centro! Ave. 5"'F1""" Phoenix, Arizona 85004 Phone: (601) 506-2906 F"", (601) 506-2577 Ms. Judith Stanley National Commission on Correctional Health Care 1145 West Diversity Parkway Chicago, III 60614 Re: May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC Final Report dated February 24, 2006 Dear Ms. Stanley: This letter responds to the NCCHC Final Report described above. NCCHC reports that Maricopa County meets 28 of the 35 essential Standards. 1 The attached audit summary shows that Maricopa County has complied with the intent of all remaining Essential Standards. Statistically valid audits of Maricopa Countis compliance indi~tors demonstrate· that it has achieved 90% to 100%· compliance in 6 of the remaining Essentiaf Standards: In" addition, Ci-is has . demonstrated improvement in achieving compliance with J-E-04, Health Assessments. CHS invites the Commission's attention to the improvements listed in the Evidence of Compli;:lnce column in the attached Resolution Document. NCCHC reports that Maricopa County meets 29 Important Standards. Given the 85% goal for meeting Important Standards, Maricopa County must comply with an additional 3 Important Standards, for a total of 32. The attached Resolution Document shows that Maricopa County meets at least 4 additional Important Standards, particularly J-D-03 (Clinic Space, Equipment and Supplies); J-E-05 (Mental Health Screen and Evaluation; J-E-13 (Discharge Planning); and J-H-04 (Availability of Health Records). Furthermore, Maricopa County has demonstrated improvement in achieving compliance with J-G-02 (Management of Chronic Disease). The NCCHC survey report contains a number of statements that are not supported by the facts. In my previous discussions with NCCHC leadership, i explained how the survey and report impact Maricopa County's risk management and litigation interests. This means that Maricopa County has a significant financial stake in the accuracy of NCCHC pronouncements. The listing of errata in this letter is not exhaustive and Maricopa County reserves the right to challenge, contradict or disclaim other incorrect or unsubstantiated statements by NCCHC at any time. Maricopa County requests that NCCHC correct the report to reflect the following: 1 The original survey found compliance with 27 Essential standards. NCCHC later found compliance with J-B-02, Environmental Health and Safety, based upon documentation submitted by the Maricopa County Sheriffs Office. MC Confidential (June 08) 001127 Ms. Judith Stanley Response to NCCHC Findings May 26,2006 Page 2 of3 County governance should be properly noted• . Th~ Maricopa County correctional health services are under the aegis of ·the Maricopa County Manager, not a city manager. The CHS Director reports to the Deputy County Manager, not the deputy city manager. References to the "CEO" should be the "CHS Director." More importantly, the responsible health authority, Correctional Health Services, is a department of Maricopa County, not a separate corporation. The report should accurately state the chronological record. State that the NCCHC Accreditation Committee met in 2006, instead of 2005 and that the response is due in 2006, instead of 2005. NCCHC should state the correct standards when asking for correctlv action. For example, the report demands corrective action, citing J-E-13(2)(b), which applies to follow-up services with community providers. However, the narrative direction for corrective action requires CHS to supply a sufficient amount of medication to discharged inmates, which is a different standard under J-E-13(2)(a). Maricopa County's. Infection .control data contradic;t the report's conclusion· .that "there is a high prevalence of this disease at this jail." ... . Maricopa County searches for positive MRSA cultures in all laboratory results from Sonora Quest, the Maricopa County Public Health Laboratory, and all hospital .reports collected by CHS Utilization Management. For the calendar year 2005, . . Maricopa County identified a total of 40 inmates with MRSA. Approximately 15 of those inmates acquired the infection in the community. rather than in the jail. The report does not correctly describe·the facilities. Correct descriptions are below in regular type. The main campus consists of Estrella Jail, Estrella Support (Tents). Lower Buckeye Jail (LBJ), Towers Jail and Durango Jail. The 4 n Avenue jail processes all male and female inmates with the exception of self surrenders. The jail performs many functions that are not related to intake, such as maximum security housing, IA Court, Bonds and Forfeitures, and probation violations. LBJ has serviced since April 2005 a 60-bed capacity infirmary and a 260-bed inpatient psychiatric facility. The reference to "Estrella Support Jail" should be "Estrella Jail". Estrella jail does not perform intake functions. It also does not house male inmates. The report's discussion regarding corrective action under J-A-01 and J-E-07 confuses Estrella Support Jail with Estrella Jail. "Estrella Tent City" is known as "Estrella Support (Tent City)". Also, Estrella Support (Tent City) is adjacent to the Estrella Jail, not Estrella Support. The report misstates staff titles of persons interviewed. MC Confidential (June 08) 001128 Ms. Judith Stanley Response to NCCHC Findings May26,2006 Page 30f3 Reference to "2 unit directors of nurses" should be "2 Nurse Supervisors." Reference to the "director of mental health services, two psychiatrists, the outpatient mental health director" should be "the inpatient mental health professional supervisor, two psychiatrists, the outpatient mental he.alth professional supervisor." The Director of Mental Health performs psychological autopsy. not the chief psychologist. The report misstates the process and documentation regarding disaster drills. The survey team members were given unlimited access to file cabinets replete with documentation proving an annual disaster drill was held at each facility as reqUired. The documentation also showed that all required man-down drills were performed in every facility and included participation by both MCSO officers and CHS health staff. Nevertheless, the report states that this documentation was unavailable. The report .cites to interviews of 25 of the over 2000 detention officers as confirming that mandown drills have not occurred at 4th avenue jail, and that documentation was not available that man-down drills were performed at other jails. The report should correctly describe Maricopa County's grievance procedure. The Clinical liaison I Risk Manager and Director of Quality Management review all of initial and institutional grievances~ external grievances and..aggregate data . . . '. .., . .'. . Nursing, mental health or dental staff typically performs the initial review of grievances. The nurse supervisor, MHP supervisor or dentist responds to institutional grievances. External grievances are always reviewed and trended by the Clinical liaison I Risk Manager and Director of Quality Management. The report should correctly describe the inmate co-pay system. The detention bureau provides each inmate with a copy of "Inmate Rules and Regulations," which sets out rules of the jail and describes the co-pay system. The information is provided at intake during the pre-booking health screening process. Co-pay is $10.00, not $5.00. We would be pleased to provide a copy of these rules if the survey team failed to obtain them. If you have any questions regarding this response, please do not hesitate to contact me at (602) 690-7610. Best regards, lsI Lindy Funkhouser, Director Maricopa County Department of Correctional Health Services MC Confidential (June 08) 001129 o (Y) rl .-I o o ro o QJ >=: ~ I-) rl tU ·rl EXHIBITS .j.J >=: QJ 'D ·rl 4-l >=: o l'-,.V.. 1iCO I ~. 'I,~~., ./JJ. u 1~~I~il (",~1fj I .. u :8 . 0 [11-4''\ I' , ,I , I ~. .,, _ _ •••• ~ . ~ ... .. YO. Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401, et. seq. rl (Y) rl rl I . o o J-D-Ol Pharmaceutical Operatt~~~ ~ CD o (j) ~ ~ ~ ~ rl Maricopa County Correctional Health Services Medication Renewed Timely PJI Facilities 2006 C\i -r! .j...l ~ (j) 'D -r! LH ~ o u u 100 90 c G,) ~ If ::8 80 70 60 50 ( 40 30 20 10 o April May _ _ _ _ _ _ _ _ _ _ _ _ _- ' - - - . ••••• _ •• _._ . _• • • • • • _ •••••• • _L _ Source: Maricopa·County 2006 QI Audit Results 2 N (V) ri· M J-D-03 Clinic Space) Equipment ~ndS~pplies- I o o CD o (]) i=: ::J IJ ri m .r! +J i=: Maricopa County Co.rrectional Health Services SHARPS Inventory weekJ.y compliance - 4th Ave Intake Tune Period:1/23/06 to 412106 (]) 'D .r! 4-i i=: o Confidential Pursuant to ARS 36-2401 Et Seq. U u ~ .... .~ ]= U .... i ~ t ~ ::8 100.0% ...,....,--, 90.0% +1--1 80.0% -tl---:t 70.0% +1- - I 60.0% +1---1 50.0% -+-1- - - I 40.0% 1 1 30.0% 20.0% +1--, 10.0% +1-0.0% +1_-' Week 1 Week 2 Week 3 Week 4' Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 .•. Source: Maricopa County 2006 QI Audit Res'ults -- - --_.- -_ _._._------. 3 (Y) (Y) r-l r-l a J-E-04 Health Ass~~s~e~~-·--w_.~ I o - CD a (1) ~ ::J t-:J ,...., Health Assessment CQmpliance Within 14 Days All Facilities cd 'r! .j.J ~ (1) '0 -..-I lH ~ o 77.5 u .~~~""'""""""""""·.; ... _.._... __ "~""-,,,;".• n'>'._~-=~f~~ot:l. .......... ~...- -"~~=~":":.:".L'-'~·"""M ",~_.-.~~; "_-,-',·0_' _._ . .:. . U :8 (1) (,) c .-cu - 77 Q. E 0 0 ....c (1) (,) 76.5 76 s.. (1) 0. 75.5 If!.o.... .. Jan-06 - f~~~~~g .' J_jll~J~)&~;'Y;_ '. l' ~ :~~ .;~:.... ~~ ."' .... . , .. Feb-06 Mar-06 _- _----- -.._.. .... Source: Maricopa County 2006 QI Audit Results .. 4 <;t' (Y) rl ...-1 o I J-E-05 Mental Health Screen &Evalu~tion o ~ ro o Q) ~ :::J I-) rl rD -..-I -I-l Maricopa County Correctional Health Services Mental Health Sc.reen & Evaluation All Facilities May 2006 ~ Q) 'D -..-I 4-J s:::: o u u :8 CI> 100 c.> c co .- 80 S 60 - 0- 0 0 C Q) . c.> CI> .c.. .:.;:. :". '= ~ ...; i ;1 40 .. "". : .... .....:.. 20 ~ .::.: .. :~ ...... 0 fv1ental·Helath Screen IVIental Health Evaluation ._-_.,--_ -..-........... .... Source: Maricopa County 2006 QI Audit Results 5 U} (Y) rl .---i o o I j-E-07 Non-Emergenqy Health Care R~quests - en o (]) ~ & Services ::J - IJ rl rtl 'r! Maricopa County Correctional Health Services Non-Emergency Health'Care Requests & Services Estrella .j.J ~ (]) '(j 'r! 4-i I:: o U u (1) ~ (,) 100 ~s8 Q. 70 8E 4g~ ..... i ~ &. IiI April • May 3 t8a Medical Requests Triaged within 24 Applicable Inmates Applicable Inmates Scheduled for Sick Call Received Sick Call hours within 24 Hours within 24 Hours ---'~"'-"-~.- Source: Maricopa'County 2006 QI Audit . Results .." ....-. -"-' ~~-_._"---- 6 ~ (Y) rl rl o o I J-E-12 Continuity of Care---'--- ~ OJ o (J) ~ g Maricopa County Corre·ctio..nal Health Services Continuity of Care All Fa ci lities rl ru -w •.-1 ~ (J) --0 •.-1 \H ~ o u 100 CD c.> c .- W'-·-l~ 80 C'CS Q. E ~t~::;,;;':'·:, 4~~"~!-'(,': 60 40 ~ I- '20 ....c .,: .:. ,~}:~:" .~ff.·' :· .... r ~. ". ~%;i~i;;;/ ....... 0 0 ..:..-:- ...,' u :8 II!iI Orders. Transcnbed TImely • Orders Initiated TImely 0 May-De Apr-De .._, --_., -.- ._., ~- _---- Source: Maricopa County 2006 QI Audit Results 7 r(Y) rl .---1 o o I J-G-Ol Special Needs Treatm~~;"PI~ns ~ co o (J) ~ ;::J I-J Maricopa County Correctional Health Services Special Needs' Treatment Plan April 2006 rl ru 'M +J ~ (J) 'U 'M 4--i ~ o u w () u "~.~:~.~-~-. ::.:~.;;~ c: .co 0. ~ E o o C ~ CD 0.. SNTP Includes Treatment Goals, Needs of Inmate are . Substantially Met Cormined Score Methods Expected Corrpletion Dates I Source: Maricopa County 2006 QI Audit Results 8 ro M rl .--1 J-G-03 Infirmary Care---·-----~·-- I o o ro o (]) ~ ;::J tJ Maricopa County Co.rrectional Health Services Infirmary Care lr-a- A-p-r-O-6-.-M-a-Y--O-6! rl co 'r! +J ~ (]) '0 'r! 100 4-i ~ o 90 8c 80 'Q.. 70 8 60 ,m u u Z 50 40 I 30 20 ~~o~~ <>,'8 ~' ~ .~ t>..o~ r- ~ ~e~ ~Cb ~ ~ora .~a ~e~v~ ~~~ oe~ ~ ()~ ~ ,~ ~e~ .~(j ~ ~ ,~,~. ~e~~ ~.. ~~ : '0& ,~. ~~J> ~-s # ~~eo ~-s &<::f5 ~V' ~ . c:f~ ~ &~ ~ ~'8 ~ ~ ~ra .~(j . ~ . J>0~~ ~ £, ~~ '6''8 ~ J ~, ¢ ()~ «~v'\ J «~o\ ;;f~ ()~ ~' &~<;:l ~ . .P--.. . . . . . . .--... Source: Maricopa County 2006 QI Audit 'Results 9 m (Y) rl rl I J"-H-04 Availability of Health o o R~c~;d CD o ([) l=: ;:j h rl co 'rl ~ l=: ([) Maricopa County Correctional Health Services Medical Record Available at Time ofEncomter May 06 'D ·rl lj...j l=: o U u ~ ~ g '..-l l :l. S o u ~aJ ~ 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Durango Towers. LBJ 4th Ave Psych --------------------------=---------------_._--.. - . __._.. _--Source: Maricopa County 2006 Q I Audit Results . . :. 10 o <::t' rl rl o o ~ CO o .ls~~:~~f~I.) f~~~' I ~~ (l~ \!i \ OVN'\""" I1J s:: g ~ rl cd ·rl +J s:: I1J '"d ·rl 4-l s:: o u May 2006 Response to the NeCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Maricopa County Correctional Health Services Confidential Pursuant to A.R.S. 36-2401, et. seq. u :8 r-J <;t' fat May 2006 Response to the NCCHC Accreditation Maricopa County Correctional Health Services Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.KS. 36-2401, et. seq. r-J r-I o o co o (j) Ell E E E E E E E Standard J·A.Q1 Access to Care J·A.Q2 Health Authority J·A.Q3 Medical AutonoolY J·A.Q4 Administrative meetings J.A-05 Policies &Procedures J.A.QS cal ProQram J·A.Q7 Emergency Response ComDUance Y NCCHe Recoinmendatii:m see J-E.Q7 Y Y y Y y Y Involve correctional staff and community agencies in Emergency Response Plan CHS Resolution None Required None Required None ReQuired None Required None ReQuired None ReQuired None Required Y None Required I I I J·A.Qa Communlcation of Special Needs Patients J.A.Q9 Privacy of Care J·A·10 Inmate Death J.A·11 Grievance Mechanism Y Y y None Required None ReQuired None ReqUired I E J·A·12 Sexual Assault reoortina J·S.Q1 Infection Control Program Y E 6/1/2006 Monitorgnevancesby.types, sites, time of day, etc. as part of cal program None ReQuired None Required Y Comment: MRSA _. high prevalence, significant local a~ention . CHS Evidence of Compliance i=: g r-J (1j -rl .j.J i=: (j) Mock emergency scenarios are conducted i Training Academy; Meso officers involved Mass Disaster Drills, Man-Down Drills and critiques of both. 'C "rl 4-i I=l o o o :;s External grievances monitored by type and site. CHS receives reports from MCSO on ! grievances by descriptor and location. MCE is looking into possibility of updating their system to allow for enhanced monitoring an· trending capabilities. Infection Control data do not support the conclusion that "there is a high prevalence c this cisease at this jail". Infection Control monitors all available laboratory reports, anc all hospitalized Inmate reports for positive MRSA cultures In CHS patients. Medcal records of patients with positive MRSA cultures are reviewed, and a determination i made regarding probable community versus jail acquisition of infection. Reports are presented to the quarterly CHS Infection Control Subcommittee, which include a line listing of specific cases and graphic representation of monthly MRSA rate. 2 N <:j" e rl .----I Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 co o Confidential Pursuant to A.R.S. 36-2401, et. seq. En Standard Compliance CHS Resolution NCCHe Recommendation -. E I I E I E E E E I J·B-02 Environmental Health & Safety Y J-B-03 Kitchen Sanitation J·B-04 Eotoparasite Control J·C-01 Credentlallng J-C-02 Clinical Performance Enhancement J-C-03 Continuing Education J·C-04 Traininafor Correction J-C-05 Medication Administration Tralning J·C-06 Inmate Worners J-C-07 Staffing Plan Y Y y Cleaning schedules doubled. Showers renovated. Issues corrected. None Reauired None Required None Required None Required .. Y y Partial This standard will be .rnet when Sick Call, Triage, Chronic Care and Consultant Care standards are met . 6/1/2006 CHS Evidence of Compliance Approximately 40 - 50% of Identified MRSA cases are determined to be communityacquired. Occasional inquiries have been received fro local news media. However, this is not frequent nor a "focus of significant local attention: CHS submitted subsequent documentation' NCCHC. NCCHC has found the facility tc be in compliance with-the standard None Required See incividual standards CHS has implemented strategies to aggressively recruit and retain necessary staff. CHS has completed athorough evaluation of the tasks to deliver necessary health care and the staffing needs to complete those tasks. Areport of this evaluation is being developed and will be presented to the Maricopa County Office of Management and BUdget. QJ ~ g rl nj ",-j +J ~ QJ "C5 ",-j 4--J C o u U :8 None Required None Reauired None Required Y Y y o o Sick CallI Triage standards met See J-E-O Evidence of Compliance Management of Chronic Disease intent of standard met. See J-G.Q2 Consultant Care intent of standard met Utilization Management processes referrals for Consultant Care on a dally basis M·F. Appointments for authorized consultant care are scheduled per priority designated by referring provider. Statistics are kept regarding appointment status and monitorec by the Quality Improvement Committee and Executive Leadership. Statistics were available to NCCHC Surveyors at time of survey. Between January 2006 and May 2006, Maricopa County CHS has hired 2 3 (Y) e ""'r-I Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401, et. seq. r-J o o co o Ell Standai'd Compliance NeCHC RecOmmendation CHS Resolution CHS Evidence of Compliance Psychiatrists, 1Forensic Psychologis~ 3 Mental Health Professionals, 2 Psych RNs, Psychometrist, 7 Correctional Health Technicians, 4 Health Unit Clerks, 1Health Care Administrator, 4LPNs, 9 RNs, 1Nursil Supervisor, 1Physician Assistant, 1 Service Worker, and 4 Medcal Record Technicians. I I E E I J-C..Q8 Health Care Uaison J·C..Q9 Orientation J·O-D1 Pharmaceutical Operation J·O-D2 Medication Services J·O..Q3 Clinic Space, Equipment & Supplies None Required None Required Medication Renewal Process Medication process redesigned to discontinue use of dual MAR All medication administration documentation has been unified to one MAR, which is maintained by nurses. The method for notifying the provider of upcoming medication expiration has been standardized throughout the jail system. None Required Sharps counts implemented at41h N/A Y Partial Y Partial Avenu~jail .' o • 00 .. I I J·D..Q4 Diaonostio Services J·D..Q5 Hospital and Specialty Care 6/1/2006 y Partial g r-I ru .w .r! l=: (1) '"d cal Audit April 2006: Medication renewed timely =92% cal Audit May 2006: Medication renewed timely = 97% cal Audit41h Avenue Intake, Sharps count completed at least weekly 2006: January = 100%; February = 100%; March = 100%; April = 100% ; cal Audit 4111 Avenue Outpatient Clinic, Sharps count completed at least weekly 2006: May = 100% None Required The facility needs certification from SAMHSA, or must obtain an exemption (1) l=: CHS maintains it does not prescribe methadone to pregnant inmates to treat substance abuse dsorders. Methadone is only administered to prevent spontaneous abortion of the developing fetus, thus the administration of methadone is regulated by the physician's DEA number. 4 or! 4-i l=: o U u Z <:j1 <:j1 e rl rl Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 ConfidentialPursuant to A.R.S. 36-2401, et. seq. en E o o StandaFd J-E-01 Information on health Compfiance NeCHC Recommendation Y CHS Resolution OJ o CHS Evidence of Compliance None Required I-) services E E E I J.E..Q2 ReceivinQ SCreenlna J·E..Q3 Transfer SCreeolno J-E-04 Health Assessment J·E-05 Mental Health Screen & Evaluation 6/1/2006 y Y Partial Partial HA be completed within 14 days Immunization provided as necessary None Required None Required Focused effort at Durango jail to complete the health history, vital . signs. and latVdiagnostic testing portion of the 14 day health . assessment. Medical Providers have changed practice for every inmate requesting sick call to include assessment and treatment of the condition requiring sick call and to also include the physical exam, when applicable. CHS continues to actively recruit and retain medical providers and nursing personnel. CHS has revised the training curriculum for Nurses to perform physical exams. CHS plans to expand the training program with the recruitment of nurses. MH evaluations completed within 14 days Mental Health Screening is completed on all detainees and is Need two months of data required prior to acceptance for booking. Mental Health Professionals are notified by the electronic Jail Management System of all inmates with positive mental health screens. Mental Health .. Professionals (MHP's) perform a face-ta-face assessment on these inmates in the intake area. MHP's .. .. obtain outside records and treatment plans for those that are Q) s::; ::J .--1 Significant improvement in the percent of Health Histories, vital signs, and Iabldagno! tests completed within fourteen days at Durango: February 2006 65%, May 200 =82% = Compliance with health assessment completed within 14 days (all components a health assessment all inmates) has improvI January 2006 76.1%, March 2006 = 77.3% = COl Audit. all locations 2006: Mental Health Screens, May 100% Mental Health EvaluatIons, May 100% = 5 = ru 'r! +J s::; Q) '"D -r! 4-l s::; o u u ~ Lf) <:;j' e rl rl Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey cOnducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.R.S. 36-2401, et. seq. Standard. En Compliance CHS Resolution NeCHC Recommendation seriously mentally ill, track inmate movement and alert the clinic, where the inmate will be housed, to the status of the inmate. MHPs at the housing facility perfonn aMental Health Assessment within 14 days. The CHS Mental Health Assessment Form was developed and implemented in April 2006. .. E E J·E-DS Oral Care J.E-D7 Non-Emergency Health Care Requests & Servtces Y Partial CHS Evidence of Compliance . Estrella: Triage tank orders wiihin 24 hours None Required Estrella: Process for triage and scheduling of sick call reviewed and revised I J·E-1O Patient Escort 6/112006 Y Partial Y 4th Avenue - extreme isolation inmates to be seen daily; segtegated inmates to be seen 3X Perweek (staffing sited) CQI study to determine if delayed access to diabetic patient due to escort not available is a system-wide problem None Required Plan developed to revise policy and documentation practice. OJ ~ ;j rl reJ .r! +J ~ OJ 'D .r! 4--1 ~ o u CQI Audit Estrella April 2006: Medical Requests triaged within 24 hours = 100% Applicable Inmates scheduled for sic call within 24 hours = 100% Applicable Inmates received sIck call services as scheduled within 24 hour =90% = J·E-Qa Ememency Services J·E-Q9 Segregated Inmates 0:> o iJ CQI Audit Estrella May 2006: Medical Requests triaged wlthln24 hours = 93% Applicable Inmates scheduled for sic call within 24 hours 1000/0 Applicable Inmates received sick call services as scheduled within 24 hour = 100% E I o o Plan developed None Required 6 U :8 \.D q< e Ell I E rl rl o o Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 ConjidentialPiJrst!qnt toA.1J..S. 36-2401, et. seq. Stand~ J-E·11 Nursing Protocols J-E·12 Contlmily of Care Compliance y Partial NCCfiC Recommendation Care ordered by providers is transcribed and provided as Ordered CHS Resolution None ReQuired Process for transcription, implementation and documentation of provider orders was reviewed. Documentation education delivered in February 2006. OJ o CHS Evidence of Compliance COl Audit April 2006 - All Clinical sites, includes laboratory, medication, othSr diagnostic testing, and treatment orders: Orders transcribed timely =97% Orders Initiated timely 90% = includes laboratory, medication, other diagnostic testing, and treatment orders: Orders transcribed timely =97% Orders Initiated timely =96% : I J·E·13 Discharge Planning Partial Inmates who have serious health needs are given a supply of necessary medications sufficient to last untllthe inmate is seen by community providers. Keep-on-person medication procedure in place Reviewed prescription practice with providers . I J.F.Q1 Health Education y I I I J.F.Q2 Nutrition &Medcal Diets J-F.Q3 Exercise J-F-04 Personal Hygiene Y y y 6/1/2006 41!l Ave &LBJ - more Opportunities be given for the general population to receive health education Maricopa Counly has implemented one of tt moslliberal Keep-on-Person programs in th nation, which is an Important elemen! in our service. Inmates, who receive keep-onperson medications and are released; are permitted to take !ill. remaining mecications with them. Inmates, who receive directobservation mecications and are due to be released, will have prescriptions written for their medications upon request by the inma! CHS works in partnership with Value Option Case Managers for inmates with serious mental health needs to ensure continuity of care at release. The VO Case manager receives notification of the inmate release al the patient is handed over to Value Options, who continues prescribed medications. None ReqUired None Required None Required None Required 7 I=: ~ rl co ·rl +J I=: (J) cal Audit May 2006 - All Clinical sites, .. (J) "d ·rl lH I=: o U u :8 r- e '" rl rl o o Maricopa County Correctional Health Services May 2006 Response to the NeCHC Accreditation Survey conducted December 2Q05, NCCHC final Report dated February 24, 2006 Confidential Pursuant to A.RS. 36-2401. et. seq. Ell Standard' I E J·F-QS Use of Tobacco J·G-01 SNTP Compliance Y Partial NCCHe Re~mmendation Use of treatment plans for medical problems Mental Health plans 10 outline and guide treatment were missing CHS Resolution None Required Medical treatment plan forms reimplemented; Providers reeducated. MH SNTP form revised. educated and implemented April 2006. ex> o CHS Evidence of Compliance COl Audit April 2006 inpatient psych unit: The SNTP Includes treatment goals, methods to meet goals and expected completion dates =89%; The needs of th inmate are substantially met, consistent with their SNTP =100%; Combined score 95% Influenza vaccine ordered May 2006. Database designed. = I J-G-Q2 Management of Chronic Disease Partial Effective system of trackiQ9,chronic .. disease Regularly scheduled clinics Consistent use of chronic care flcwsheet Care consistent with current national guidelines CHS utilized a consultant firm to develop a database to track chronic care inmates. Chronic care database allows the capability'to monitor frequency of appointments in line with guidelines, so that appointments may be regularly scheduled as necessary. Chronic care form re-implemented; Providers educated to complete and consistent use, Plan developed for identification of high-risk patients for influenza vaccine. Admitting notes to include diagnosis, ,medication. diet, activity. ciagnostic tests required, and frequency of vital sign monitoring In-patient record to include discharge plan or discharge notes. Providers to round on patients par policy Manual of nursing ~re to be available Re-implemented use of in-patient admission order form to include diagnosis. medcation, ciet activity. diagnostic tests required, and frequency of vital sign monitoring Discussed documentation of discharge plan I notes with provider Peny &Potter Nursing manual on unit ' E J-G-Q3Inflrmary Care Partial ' , 6/1/2006 Q) s:: ::J ~ rl ({j -.-1 .j.J s:: Q) 'U -.-1 4-i s:: o u u :8 .'. COl audit April 2006, Infirmary: Admission orders include Diagnosis 100% VS frequency 94% ActiVity 97% Diet 100% Labs / diagnostic testing none applicable Medications ordered & on MAR 9(0) Discharge plan documented 100% Discharge Order = 1000!o Physician round per policy 97% Nursing round per policy 100% = = = = = = = = 8 = OJ <:ji e rl rl o o Maricopa County Correctional Health Services May 2006 Response to the NCCHC Accreditation Survey conducted December 2005, NCCHC final Report dated February 24, 2006 Confidential Puriuant to A.RS. 36-2401, et. seq. . Standard EJI CompJiance NeCHe RecOmmendation CHS Resolution OJ o CHS Evidence of Compliance = = = J-G..Q4 Mental Health SeNices J-G-OS Suicide Prevention E E I J-G..()S Intoxication &Withdrawal J-G..Q7 Pregnant Inmate care J-G..Q8 Inmates with Alcohol or other clrua Problems J-G..Q9 Sexual Assault procedure J·G-10 Pregnancy counseling J-G-11 Orthoses &aids J-G-12 Care of tenninally III J·H.Q1 Health record format J-H.Q2 Confidentiality of records J-H..Q3 Access to custody info J-H..Q4 Availability of health record I I I I E E I I 6/1/2006 Y Partial Documentation required that shows Corrective action is identified and Irrplemented for 2005 suicides Y y y y Y y y y y y Partial .. Enhance substance· abuse program'at 4.111 Ave &LBJ. Estrella has strong program ~ ;:J cal audit May 2006, Infinnary: Admission orders Include Diagnosis = 100% VS frequency =94% Activity = 94% Diet 10oolo Labs I diagnostic testing = 100% Medications ordered &on MAR = 100 Discharge plan documented 100% Discharge Order 100% Physician round per policy = 100% Nursing round per polley =100% E E Q) None Required None Required - documentation available Documentation available, All Corrective Actions completed and implemented, None Required None ReQUired None Required None Required None Required None Required None Required None Required SYStem would Iikelv benefit from EMR None Required None Required Record is not always. available at the time CHS continues to pursue EMR. of the medical or mental health encounter CHS has hired 4additional Medical Record Technicians since January - staffing cited 200S. As of May 24, 2006, only 1 Medical Record Tech vacancy remains, cal audit all sites 2006: Medical record available at time of thl encounter, May 2006 = 10oolo 9 IJ rl m -.--/ +-J ~ Q) 'D ..--/ LH ~ o u u :8 CJ\ i <j1 rl H • Maricopa County Correctional Health Services May 2006 Response to the NCCHe Accreditation Survey·conducted Deaember 2005, NCCHC final Report dated February 24, 2006 Confidential PursiJant to A.R.S. 36-2401, et. seq. o o co o an StanQlard , Compli~nce NeCHC Recommendation .# i , ! ! II :1 E E ;1 d Ii :1 ,I "" J·H-05 Transfer of records J-H-06 Retention of records J·I-01 Use of restraint & seclusion J·I-02 Ememencv Psvchotrooics J·I.Q3 Forensic Information J·I.Q4 End of Life decision maklna J·I-05 Informed Consent J-I.Q6 RIght to Refuse treatment J·I.Q7 Medical or other research Y Y Y y Y Y Y Y y .. " " CHS Resolution CHS Evidence of Compliance CHS implemented aprocess to transfer medeal records to on-site specialty clinics on day of clinic so that medical records are available to the provider prior to aPPOintment None Required None Required None Required None Required None Required None Required None Required None Required None Required ::J I-) rl Cd .,-j -i-J i=: Q) 'D .,-j lH i=: o U U ::8 :~~ I 6/1/2006 Q) i=: 1 10 Maricopa County Correctional Health Services . 111 W. Monroe, Suite 900 Phoenix, Arizona 8500~ Phone: (602) 506-2906 Fax: (602) 506-2577 CONFIDENTIAL February 20, 2006 Judith Stanley National Commission on Correctional Health Care 1145 West Diversey Parkway Chicago, Illinois 60614 This letter responds to the NCCHC's accreditation survey report draft ("Draft") dated February 7, 2006. The Draft contains findings and recommendations of the most recent accreditation review meeting with the Maricopa County Sheriff s Office and Correctional Health Services ("County"). TI..is letter responds to the findings and . appraises NCCHe of Maricopa County's plan of action to address areas of deficiency. The County thanks the auditors for a very thorough review. Their comments were very perceptive and valuable for the County's ongoing process of restructuring correctional health care in the Coul.lty jails..Since the exit interView, ~taffhas been .. addressing areas 'of ~bnceinthattIie: sUrvey team expressed 'during the audit pro·cess. This letter is to inform NCCHC of the County's progress and future plans. This letter also clarifies some items regarding the County's practices. Listed be.lDw in tabular format are standards sited in the draft of February 7,2006, as weB as our plans to address the area of concern for each standard that is sited to bring us into full compliance: J-A-07 Emergency Response Plan The County is surprised that the Draft finds partial compliance with this standard, since the County's pre-audit checklist indicated full compliance. Moreover, the exit conference did not cite this standard as an area of concern. The County's record of emergency drills also indicates compliance with this standard. Appendix 1 is a summary sheet of emergency drill dates for the calendar year 2005 along with evaluation write-upsJor the emergency responses. This information was available during the audit. Please review the documentation of compliance and provide additional guidance as appropriate. The emergency drill evaluations have been widely circulated at staff meetings and the County has developed administrative corrective action plans as a result of these disaster drills. The County agrees that correctional officers should be included in a mass disaster drill and expects to have such a drill later this year. J-B-OI The Draft finds partial compliance with this standard based on a MC Confidential (June 08) 001150 Mancopa County Corrcction:U Health Service. 111 W. Monroe, ::iUlte 900 Phoeni.". Arizona 85003 Phone: (602) 5ll6-2906 F:Lx: (602) 506-2577 Judith Stanley National Commission on Correctional Health Care February 20,2006 Page 2 of8 Infection Control Program statement that clinical staff does not culture abscesses for MRSA. This statement is inaccurate. The County's 1vlRSA program is quite active given the high prevalence of this condition. The County treats the more complex MRSA patients through the Maricopa Medical Center. .As part of that treatment many of the cultures that are obtained for patients with complicated wounds are obtained at the hospital. The County shares in that clinical data and uses the information to manage these complex patients. The evolving knowledge base with regard to methicillin resistant staphylococcus aureus includes recognition that there are two very distinctive clinical entities involved. These entities are genetically separate and are treated very differently based on their virulence. Hospital Acquired MRSA (HA-MRSA) does require very sophisticated management including culture and sensitivity to optimize treatment. The County actively participates in this program and, uses the data t~ :provide appropriate'treatmeilt plans for 'patients., . . ~ ."..".....',.. . . . ' ! Community Acquired MRSA (CA-MRSA) is a distinctly different clinical entity from Hospital Acquired MRSA. The County's clinical guidelines with respect to infections have been developed with the assistance offellowship-trained infectious disease physicians in the County's practice environment. Those guidelines currently do not recommend culturing of skin abscesses at initial presentation. If the wounds do not respond to initial irrigation, debridement and appropriate wound care then culturing is appropriate and is performed within the County's facility. The County's infectious disease nurse monitors the culture results of patients with wounds and maintains an ongoing surveillance of this disease entity. MRSA has been the focus of significant attention locally. The County frequently uses the disease surveillance data and clinical observations to monitor any significant deviations in the prevalence ofthese infections within our jail population. Historical MRSA surveillance data is presented in Appendix 2. Perhaps the audit team did not have sufficient time to fully investigate the scope of the County's disease surveillance for MRSA. A complicating factor might be that the surveillance system occurs in conjunction with the local hospital. The County maintains that it fully complies with the standard and practices at the cutting edge of the evidence in the infectious disease treatment commW1ity. MC Confidential (June 08) 001151 Judith Stanley M:U1Clll'" County CorrtCI"m.J lle.lth Semce$ 111 W. Mnnroe. Suit,· <)IKI Phoenix., An~()n. 85003 Phone: (602) 506-2906 )0":1.<: (602} 50(,·2577 National Commission on Correctional Health Care February 20, 2006 Page 30f8 J~B-02 Environmental Health ;md Safety J-C-04 Training for Correctional Officers J-C-07 Staffing Plan The findings under this standard have been forwarded to the Mfuicopa County Sheriff's Office. Their Facilities Division and the Sheriff's Office have addressed these issues and a report indicating their compliance is contained in Appendix 3. The Maricopa County Sheriff's Office is aware of this standard and is proactively addressing the CPR training. Evidence of compliance with this standard is included in Appendix 4. The County has devoted considerable activity to improving staffing levels. The County has initiated a concerted hiring effort, supported by an improved salary structure. Staffing gains, to date, since the audit are summarized below: • 6 RN's • 4 LPN's • 4 medical records clerks • ,1 0 cori:~ctiQnaf healthcare tec1lliici,ans • 2 psychiatrists 2 mental health professionals • 6 new medical providers requested Q Staffmg is the County~s top priority and many of the corrective action plans identified in this document are dependent upon that effort's success. This effort is ongoing and the County will periodically update NCCHC on its progress. Evidence of the County's staffing and recruitment plan is in Appendix 5. 1-.-------. J-D-01 Pharmaceutical Operations The County agrees that the medication renewal process must be improved. The Draft indicates that corrective action is not required for this standard. The County has redesigned the medication process since the auditors were on site. The County discontinued the use of dual medication administration records (MAR). All records have been unified into one MAR, which is maintained now exclusively by nurses. This improvement will enhance continuity of care in the administration and renewal of medications. This revision began on February 1, 2006, and the improvements in the process are evident. The County will perform a quality assurance study on the medication renewal process after the new procedures have run for several weeks. The County expects to document full compliance shortly. MC Confidential (June 08) 001152 Maricopa County Judith Stanley National Commission on Correctional Health Care February 20, 2006 Page 4 of8 Corr~cti()n"1 Health SL"TVicc." 11\ W. Monroe. SUttc 'JOO Phoenix, An:!ona 85003 Phone: (602) 506-2906 1',,-,,: (602) 50(,..2577 J-E-04 Health Assessment The County acknowledges ongoing difficulty with this standard. The limitations in the past have been staffing. The County is improving staffing, as noted in the comments to J-C-07. The County expects to implement a sustainable solution once the additional staff is on board and oriented. The County plans to perform health assessments in the Booking area because of the movement dynamics within the Maricopa County Jail System as a whole. The solution for fixing the health assessment requires multiple changes within our operation. Those changes have been identified and are enumerated below: . 1. Increased clinical staffing (ongoing). 2. Appropriate training and credentialing of staff to perform assessments (curriculum designed, staffwill be trained once they are hired). 3. .Adequate officer support to facilitate the ·flow thro\lgh the. .. . . Booking Clinic (the h..iring of additional corr"ecti ona] health· technicians to perform the intake screening w~ll enable the officers to be freed from the pre-intake area to assist with clinic flow in the back. This process will begin on March 1, 2006, and the County expects to have the officers freed up within one months' time). 4. Better data to eliminate repeat exams. A study of the health assessment process demonstrates that many patients are receiving duplicate exams while others are receiving none. The County is working to control the infoDnation and to generate more reliable data. 5. Improve the documentation process. The County is redesigning the health assessment to be more efficient and user-friendly. The goal is to improve productivity and remove unnecessary documentation. .The corrective action suggests that additional clarification is needed for the STD and TB testing programs. The County designed the current STD and TB testing program in co~iunctjon with the County Health Department and the Arizona State Health Department. These agencies are fully aware of the County's screening activities and symptomatic testing. The agencies assisted in identifying the highest risk populations and designing the current program. The County MC Confidential (June 08) 001153 Mancop" County Corrcctiollnl Health Sen·icc. III W. Monroe. SUltC 'J()() Phoenix, Ari>.ona 8S(](J} Judith Stanley National Commission on Correctional Health Care Phone: (602) SOG-2906 Fox: (602) 506-2577 February 20,2006 Page 5 of8 respectfully requests that NCCHC remove this corrective action since the issue has been addressed. The County is revising its corrective action plan for immunizations. The immunizations will be provided through chronic care clinics. Immunizations are available through the County's pharmacy vendor. The flu season is currently over in Arizona and flu vaccines will not be pertinent until next season. The County does not foresee any difficulty in implementing this plan. The County will initiate the process of identifying asthmatics and supplying them with Pneumovax immunization as part of the forthcoming chronic care plan. J-E-05 Mental Health Screening and Evaluation' The Mental Health Screening and Evaluation is tied to the health assessment process that the County is designing. Many of the limitations in the health assessment also pertain to the mental health screening and evaluation.. The action plan for mental health assessment.will identical t(dhe acti(Ynplanfor-heaHh assessment. The County will document compliance as the program takes shape. b.e _._------- J--E-07 l'lonemergency Healt.hcare Requests and Services CBS agrees with the auditors' findings. The County has formulated a plan to fully comply wit~1 this standard. The County will devote new nursing and provider staff to this process. The COlmty will triage all patients within 24 hours of a sick call request. The triage acuity that is assigned will drive the schedule so that the sickest patients will be seen first. The County will produce an aging repo'lt of the time between submission of sick call requests and a provider encounter. This will assist greatly in modifying staffing to ensure that patients are seen in a timely manner for medical> mental health and dental encounters. The County is revising the process of rotating clinics. The variance in access to care has particularly been a problem at the Lower Buckeye Jail. The plan is to centralize the LBJ outpatient clinic and all prisoners who need to be seen, regardless of their housing location, will be brought to that clinic for their sick call encounter. This change will occur within the next two to four weeks. The County expects to achieve full compliance with the standard. The County will submit additional evidence of our compliance as these processes come online. J-E-09 th The 4 Avenue Jail l1as become operational within the past 12 MC Confidential (June 08) 001154 Judith Stanley National Commission on MosicllP' County Correcn"n,l Health Serv,ces 111 W. Monm<:. SUIre 900 Phoeni:<. Arizonll 85003 Phone: «(,02) 506-2906 Fll.-":: (602) 506-2577 Correctional Health Care February 20, 2006 Page 60f8_ Segregated Inmates months. The County has had to revise monitoring of segregated inmates to comply with this standard and to work within the correctional daily schedule. Some of the County's modifications occurred since the audit and Appendix 6 contains documentation of the new practices. The County believes that it is in full compliance with the requirement to check segregated inmates 3 times per week. Joanne Dorman assisted the County in pre-survey preparations. She .reviewed_our isolation practices and determined through consultation with Judith Stanley that none of our areas qualified as «extreme isolation" because of the ability of prisoners to interact with each other through the windows between cells. J-E-12 Continuity of Care During - -Incarceration "I-E-l3 Discharge Planning Compliance with this standard relates to clinical staffing. The County is increasing staffing with the goal of cowplying with this standard. The County will conduct CQI reviews of this standard and forward that infonnation to NCCHC. The- County maiiltains tllat its disd1arge-plaJ.lIiirig-nleets theihtended goals of this standard. The County maintains that it directs resources toward patients with significant health needs. For example: ,. The infectious disease staff follows all patients with communicable diseases and coordinates hand-off care with the Maricopa County Public Health Department. • The County internally tracks patients who are identified as Seriously Mentally III by the community mental health vendor (Value Options). Care is coordinated through on-site visits from Value Options case workers prior to prisoner release This degree of discharge plam1ing for the mentally ill exceeds other jails. • The County coordinates discharge planning for HIV patients with the Maricopa County Public Health Department. HIV caseworkers come to the jail, visit with the patients, and malce plans for discharge medications, housing, food, and healthcare benefits. • The County has two full-time caseworkers who provide discharge planning for any hospitalized patient. Patients are transitioned to assisted living environments, skilled nursing environments, rehabilitation units, or the jail infirmary. MC Confidential (June 08) 001155 Mnnwp" County Judith Stanley National Commission on Cnrrcct",ml Health &;TV1CCS 111 W, MontelL'. SUite l)(Hl An,,,,m,, Ph"eni.". 8500:\ Phone: (602) 506-2906 Fa,,; (602) 501>-2577 Correctional Health Care February 20, 2006 page 7 of8 • The COlUlty supplements resources for the seriously mentally ill via the County's Restoration to Competency Program. This program comdinates and tracks care of mentally incompetent patients. The program fosters good discharge planning to ensure that these fragile patients receive optimal care as they move from inpatient to step-down status, and into general population. Planning is critical as patients move from the Arizona State Hospital back to the jail environment. The Draft does not fully appreciate the tight interdigitation of the County's care with the available community resources. The County maintains that its discharge planning is robust for individuals with serious health needs. J-0-01 Special Needs Treatment Plans , I , . The County is redesigning the chronic care encounters for medical and mental health patients. The plan is to add providers for dedicated chronic care clinics at all facilities: Patients will then be identified. and:sC:h~dO:Ied 'into'"these dediCated'clinics and the sl;e'ciai 'needs: ' treatment plans for these patients will be initiated and followed. Compliance with this standard will be forthcoming as this program is launched. Additional data will be provided to NCCHC as it becomes available. f-. J-G-.Q3 lnfilmary Care The County uses the Perry arid Potter.Nursing textbook as its manual of nursing care. This text was selected by a committee of nurses and has been in place for over a year. Copies of this manual are located in all clinical areas. Internal policies and practices are being addressed to standardize the charting practices in all inpatient units. The County will complete CQI studies focused on compliance with this standard. The studies will be sent to NCCHC as they are completed. The provider staffmg enhancements will address the weekend coverage of the infirmaries. Once staff positions are hired, providers will be expected to round daily (weekends included) in the medical and mental health infim1aries. J-G-06 Intoxication and Withdrawal Scott Chavez provided the County with the federal code related to this standard. The County researched this issue with its pharmacists and providers. The best available information demonstrates that national guidelines are evolving for methadone treatment for pregnan1 women. The available federal law is not clear. The core issue Me Confidential (June 08) 001156 Judith Stanley National Commission on Correctional Health Care February 20, 2006 Page 8 of8 Manc()p;1 Ccmnty Corr~cl;"nol Health Scrvlces 111 W. Monroe, Suit" 900 Pho~~,Ari7.ona85003 Phone: (602) 506-2906 p",,: (602) 506-2577 focuses on the reason for using methadone and the identity of the patient. T'ne County does not admiJP.ster methadone for substance abuse therapy of pregnant women. The <;ounty administers mefuadone to prevent a spontaneous abortion. The fetus, not the mother, is the patient. Therefore, the guidelines for OTP therapy and the need for CSAT certification do not apply. , . The County maintains that administration of methadone to prevent spontaneous abortion isregu!ated by a physician's DEA number, not a substance abuse DEA number. This practice accords with hospital and correctional healthcare practices nationwide. More developed federal guidelines are necessary before NCCHC requires corrective action. The County respectfully requests full credit for standard J-G06. . Thank you for the opportunity to respond to the Draft. TIle COUllty believes that it has achieved cODlpliaq'ce in.several m:eas ~d is hopd;'u.I that those will be ~l~ared pdor to tlle final accreditation report. The County is working diligently to perfonn action plans that will clear the m'eas needing corrective action. If you have any questions regarding this response, please do not hesitate to contact me at (602) 690-7610. Best regards, Lindy Fu mouser, Director Maricopa County Department of Correctional Health Services MC Confidential (June 08) 001157 AP·PENDIX'·l MC Confidential (June 08) 001158 Maricopa County Correctional Health Services 234 N. CL-ntral Ave, 5th Fl. Phoenix, AIi~ona 85004 Phone: (602) 50(;"2906 Fax: (602) 506-2577 . TO: NCCHC The source documents for these emergency drill summaries are voluminous and will be made available upon request at Maricopa County's Lower Buckeye Jail, Administration Building, Suite 2100, in Phoenix Arizona.' . Me Confidential (June 08) 001159 EmergehCY D.rill Dafes CY 2005' '. Date Facility Shift CHS Observers Remarks: Man - Down Madison - Closed 1 2 RN Smitherman Man - pawn. Inmate fell off his bunk and complaining of back pain. Madison Man· Down 3 Madison - Closed Mass Casualty 2 Madison - Closed Man - Down Non-Responsive inmate, CPR. 1 Rigo Quiroz, LPN 01/22/05 Estrella M~n - Down Inmate fell down stairs causing back Iniury. None 2 06/26/05 Estrella Man· Down Actual Event; Attempted suicide by strangulation. None 3 08/25/05 Estrella Mass Casualty Fire in F dorm, cause a cigarette tossed into laundN. Ruth PhilJiben, Teresa Cannon 2 10/27/05 Estrella Man· Down Slip and fall on the parade deck. RN Kathi Harris Durango 1 11/29/05 RN Carol Taborda, LPN Lisa Saunders Man - Down Stabbing in rest room. 2 Durango 07/08/05 Man.- Down Inmate collapse to the floor. RN Adaku Friday 3 07/01/05 Durango Mass Casualty Strange 6dor and smoke comlna out of vents, 20 inmates affected. Ruth Philliben, LeAnn Bethel 11/30105 Durango 2 Man.- Down Inmate found on floor, fall from top bunk. Towers 1 Ruth Philliben, RN, HCA 08/22/05 2 03/07/05 Towers Toni Malinchalk, RN Man - Down Actual Ev~nt: Inmate clammed shut cell door cutting off 3 fingers. 06/10/05 Towers 3 Howard Wilkinson, RN; W. Clark, LPN Man· Down Attempted suicide by hanging. 07/23/05 Towers 2 (1,3) Robert Lake RN, Ruth Philliben, RN HC Mass Casualty Power Outage, Pod C disruptive/altercation. 04/22/05 ESB-Tents 2 Robert Spears.,RN; Janet Smith, LPN Mandown Due to electrical shock; lighting a cigarette from electical outlet. 8/22/05 ESB-Tents 1 Robert Speares RN, Jan Flaes LPN Man - Down Inmate lying on floor in dayroom not coherent, violent with staff. 06/30/05 RNs Roberts and Goettman ESB-Tents 3 Man - Down Attempted suicide by ham~ing and lacerated wrists. 05/06/05 1 Wanda LaPoint, RN HCA Mass Casualty Micro burst in the Tent area. Tents destroYed, 10 injured. ESB-Tents XXXXXXXXX ( Opened April 2005) XXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXX)()txXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 07/19/05 Lower Buckeye 1 Laurie S1. Louis, RN; E Sheima, RN Man - Down Actual Event; CHS RN slipped and Iniured himself. 07/17/05 Lower Buckeye Louie Dira, RN 2 Man - Down Officer down due to asthma attack inside P5 crossover. 08/06/05 Lower Buckeye 3 LeAnn Bethel Mah - Down Inmate found unconscious lying face down In a larQe pool of blood. Lower Buckeye 08/29/05 2 Mass Casualty Phone call regarding suspicious package and explosion in P-6. Roberto Escobar, RN 07/12/05 4th Avenue Wanda LaPoint, RN HCA 1 Ma.ri· Down Inmate in SMU-20 set mattress on fire. Second inmate acting out. 07/11/05 4th Avenue 2 Wanda LaPoint, RN HCA Man - Down Inmate lying on floor of his cell with blood around his head. 07/13/05 4th Avenue 3 Laura Roberts, RN Man - Down Inmate in holding tank found with cut wrist and unresponsive. 12/01/05 4th Avenue 1 Wanda LaPoint, RN HCA Mass Casualty Hazardous gas tanker involved in a collicion @ 4th & Madison. 01/17/05 3:: n n o ~ H1 1-'- p.. (j) ~ rt 1-'- P! f-' y C ~ (j) o co o o I-' f-' OJ o As of: 12/7/2005 Green: Completed Black: Scheduled Red: Not yet scheduled or accomplished lUi!!!1 ,••• I 46 p' CHS/MCSO Disaster Drill Exercises " .II CY2005 OBSERVERS RECOMMENDATIONS Madison: Man Down, Shift 2,1/17/05 Response/Recommendations: MCSO: Detention staff secured the pod. They had the inmate lay in initial position until medical arrived. Once medical staff determined the inmate needed to be placed in a neck brace and back board, officers assisted medical staff as directed such as moving him to a position to allow him to be placed on the back board. Detention staff then escorted the inmate to the hospital. CHS, RN Smitherman: RNSmitherman and a CNA arrived on scenewith the gurney, backboard and "man down"bag. RN. $milh,erm;:lri"did ah .initiC))· assessment, th'en placec\"arieck.brace QD inmate:. She then I.og rolled"the inmate into a position so he could be placed on backboard. This was done with the help of the' . CNA and detention staff, Once in the clinic the medical staff made the arrangements for the inmate to be transported. a .:' Debriefing/Recommendations: Action Plan: Estrella: Man Down", Shift 3,1/22/05 * (Actual Incident) MCSO, No Input; CHS, Rigo Quiroz, LPN Man Down - Non-Responsive Inmate. All officers responded in a timely manner and offered to assist with CPR. The initial radio call was a general call for assistance for an inmate down. DebriefinglRecommendations: 1. It would be helpful in the future if radio call for assistance would be more informative (ie fall from top bunk, head injury, cutting on self, eel.) This would enable the medical staff to respond with more equipment and facilitate everyones critical role. 2. A triage area should have adequate lighting, accessibility and space to perform all necessary activities to enhance performance by responding personnel. Action Plan: 02/21/06 MC Confidential (June 08) 001161 Towers: Man Down Drill! Shift 2, 3/7105 MCSO - Officer Bagshaw A8039, called for Medical assistance, and Officer Sutton G. A8191 placed the detached finger tips into a bag and then that bag was placed into a bog containing ice. They were transported to medical by Officer Coble. A8640 who assisted in gathering the severed fingers and by wrapping the injured hand with a towel and instructing Cobb to apply constant pressure. Officer Means A9146 kept Cobb's attention focused and instructed him to sing, talk whatever to maintain consciousness. . CHS - RN Malinchalk arrived with LPN Candy they were will prepared with'the "Man Down" cart, as will as providing the ice, and bags to transport the severed fingers. Phownix Fire was called at 1710 hours per PAC Avalos; they arrived at about 1720 hours. RN Malinchalk called to verify which hospital had a had surgeon so sho could direct the ALS ambulance to that Emergency room. Cobb was transported via ambula~ce #431, escourted by Officer Botello A8410 to St. Josephs hospital at 1735 hours. Debriefing/Recommendations: To include small, clear, Bio-Hazard bags in the Emergency Kits in each tower. .Action Plan:· Estrella Support Clinic!: Man Down Drill, Shift 1, 4/22/05 Response: MCSO,: Mandown and request tor medical assistance was dearly stated on the radio. There was no officer in the clinic for approx 30 seconds, so the medical staff could not leave the locked clinic to respond to the emergency. The officer unlocked the clinic door specifically told the RN the nature of the emergency (shock from an electrical outlet). Detention did not move the inmate. CHS: The RN instructed the MA to contact Estrella clinic for backup and to remain in the clinic. An LPN and MA accompanied the RN to the designated site. The RN asked,if "someone had a wheelchair or streacher". Sgt Coler was very good about instructing one of his officers to obtain a streacher and backboard af1d bring it to the site. DebriefinglRecommendations: 1. Must have an officer present at all times to allow the nurse out of the clinic to respond to emergencies. 2. Need a Stryker cotlstreacher with large wheels. The wheels on the current cot got stuck all the way to the clinic due to the thick layer of gravel in the yard. Some tents are so far out into the yard that it would take a long time and several very strong officers to carry a letter to the clinic. Action Plan: 2 02/21/06 MC Confidential (June 08) 001162 Estr lIa Support Clinic: Mass Casualty, Shift 2, 5/6/05 Response: MCSO: Patients were brought to the clinic. Officers were present while the· patients were evaluated. MCSO transportation t?rrived within the 30 minute window allowed by the on call provider. CHS: Phone call to staffing office was a little unclear, calls were made to the clinic by the HCA to clarify the situation. Estrella Clinic nurse manager sent Hector Molina, LPN, to assist with the routine clinic work (completing accuchecks and administering Insulin). The staffing office called the Durango clinic and had Vicki Woods, MA, sent to assist with the clerical work (creating charts, answering the phones, ect.). DebriefingIRecommendations: 1. HCA will assess/evaluate the situation with the staff involved to determine if having the LPN deal with the more critical patients was the o.ptimal use of nursing resources. Action Plan: Towers: Man Down, Shift 3, 6/10/2005 MCSO; 3 dayshift detention officers were reporting to work. One officer began to enter to control tower and noticed the inmate swinning from the top tier rails in the corner of the pod. He called out to the 2 other officers and they entered the pod. One officer grabbed the inmate's legs and reduced tension on the sheet. The second officer retrieved the "911" tool and went up the stairs to cut the noose. The inmate struggled against the officers. CHS, Name; Response by Medical: W. Clark, LPN applied a C-collar to the patient. H. Wilkinson, RN started an IV. The patient was conscious and responsive. Phoenix fire was called. DebriefinglRecomrnendations: Detention: The officer stated that he used the "911" tool for about 20 seconds to saw the noose. He became tired and a second officer took over. The tool was very dull. The officer stated that the "911" tool in Tower 6 is also dull. Medical: The clinic is routinely staffed for 12 hours only (0700-1930 hours) An LPN frequently works the 11-7 shift. In IV line could not have been started if the incident had occurred on the night shift Action Pian: 3 02/21/06 MC Confidential (June 08) 001163 Estrella Jail: Man Down Drill, Shift 2. 6/26105 Inmate Michell walking down steps had fallen causing back pain and left unable to move. Cause of the incident was the .inmate stepping onto a plastic lunch bag on the steps. MCSO - From the time the initial call was placed by Security Control four officers, medical team and Sgt Responded to the scene within sixty seconds. The first officer on the scene ordered the inmates in the pod to lockdown and secured the area. The other officers arrived to assist securing the area. House officers advised to stop all radio transmission until the emergency was cleared. Sg1. Tenny notified security control and advised the officers to contact MCSO radio to contact Phoenix Fire. CHS· Medial arrived with backboard and C- collar to examine without moving the inmate. It was determined that Phoenix Fire Paramedics needed to be contacted due to the unknown nature of the inmates condition. Medical Staff stayed with the inmate until they arrived keeping her from moving. The paramedics arrived and examined the inmate, placed her in a C-collar then placed her onto a backboard for. transportation to the hospital. Debriefing/Recommendations: Medical and responding offic.ers were not aware that an inmate had fallen off the steps and medical help arrived without the proper equipment to treat the injured. Medical staff had to retrievethe ,,!dditional supplies from the Estrella clinic.· The house .officers needed to clearly. .. advis·e respo·nding the type df medical·errlEirgehcy.·· Action Plan: Durango: Man Down Drill, Shift 3, 7/1/05 MCSO Inmate was observed to collapse and fall to the floor. Officer quickly radioed for assistance and numerous officers responded and secured the area. CHS Medicals response time was 4 minutes from initial radio call at 0100. Nurse arrived with guerney and medical emergency pack. Debriefing/Recommendations: - None Action Plan: 4 02/21/06 Me Confidential (June 08) 001164 Durango: Man Down Drill, Shift 2,7/8105 MCSO - Inmate exited from restroom with a towel draped over his left arm. Officers immediately locked down the inmates and notified other officers of the situation. Supervisors were immediately notified. CHS " - Officers radioed for medical assistance and LPN arrived on the scene and removed the inmate to medical. RN 'assessed the inr:nate and made the decision to send him to MMC for evaluation and treatment. Debriefing/Recommendations: None Action Plan: 4th Ave. Jail: Man Down Drill, Shift 2, 7/11/05 Unresponsive inmate lying on cell floor, to be discovered MCSO; . . "qfficers."entered the c~ll fir.st and .the iniTIate was secured with handcuffs ahd leg shackles.. 'The S9t:: . controlled the number of officers in the cell and surrounding area. One of the officers asked the nursing staff if a gurney was needed, It was brought to the site along with a backboard. CHS; J. VanEvery, RN assessed the pat.ient. P. Brooks, LPN took vital signs. Instruction was given to detention to log roll the patient, pyt him on a backboard and place him on the gurney. Debriefing/Recommendations: The nursing staff did not put on stab proof vests. Was this indicated in this situation? To be discussed with detention supervision. The nursing staff did not have an ambu bag or c-collar with the man down bag. There were no straps on the gurney. Nursing/medical staff need to determine the necessity of having a bag, collar, and/or straps on each gurney. The clinic currently does not have a disaster bag for a mass casualty. Gurney is difficult to raise and lower. Detention officers present practiced (after the drill) raising and lowering the gurney with a patient on the cot. Action Plan: 5 02/21/06 MC Confidential (June 08) 001165 th 4 Ave. Jail: Man Down Drill, Shift 1, 7/12105 Response: MCSO; - Officers entered the smoke filled area with 8CBA's. Nursing was advised to remain in the main hall. Two inmates were brought out to the hall for evaluation, Officers re~ponded to medical questions appropriately. CHS; - D. Rogers, RN assessed the patients. P. Smith, LPN stood by for assistance. R. Hinzman, MA retrieved the vital sign monitor and checked the patients. T. Colpitts arrived at the scene from the clinic. She immediately went to the 8gt in charge and asked questions about the inmates and sustained injuries. She then proceeded to each patient and completed a brief history. The first inmate was placed on the gurney and wheeled to the clinic. Instruction was given to detention staff about the workings of the gurney. The second inmate was walked to the clinic. T. Colpitts did instruct R. Hinzman to contact CHS administration and other nursing staff in the facility for assistance. Debriefing/Recommendations: ,. The nursing staft did not put on stab proof vests. Was this inpicated in this situation? To be discussed with detention supervision'. . . " • Ther.e were no straps on the gu~neY.· N'ursing/medical staff need to deter~ine the necessity of haVing straps on each gurney. • The clinic currently does not have a disaster bag for a mass casualty. GurQey is difficult to raise and lower. Detention officers present practiced (after the drill) • raising and lowering the gurney with a patient on the cot. • Nursing/medical needs to consider an SVN machine in each mini clinic for breathing treatments. th W. laPoint, HCA waited 5 minutes for the elevator to get to the 4 floor. (2 minutes for the elevator to arrive at the basement and appx 3 minutes for the door to open). Action Plan: 6 0212J/06 MC Confidential (June 08) 001166 Fourth Avenue Jail: Man Down Drill, Shift 3, 7/13/05 Inmate found in the medical holding tank who appeared to have cut his wrists and was unresponsive. The cutting device was on t~e floor in plain sight. MCSO - MUltiple officers responded to the area, more than were needed. Sgt Heathcock directed several officers to return to their dUty posts. The responding house offic~rs were ready to go in and remove the inmate wearing nothing more than latex gloves. The offic~rs had to be given a verbal command to put on PPE. After putting on the PPE the officers took extra care to cover the inmate's cuts with towels to attempt to stop the bleeding. Officers were a little hesitant to put on protective equipment and some officers entered the area not fully protected. Officers conducted. proper first aid. They also properly secured the cutting device. Sgt Layton saw officers remove contaminated PPE without using proper techniques. CHS - None Debriefing/Recommendations: The PPE kits are secured with nylon zip ties. These ties cannot be removed by hand, they must be cut off. Officers askeq the nurse if she had scissors to cut off the- zip tie to the PPE kits.. Finding scissors', cHppers or some other tool- to cut.off the zipties may b.e difficult and . may certainly delay officers from accessing the PPE. I recommend thatahothet type 'ortiEr be used to secure these boxes. The beaded nylon ties that are commonly used on fire extinguishers will work well. A reversible zip tie that can be loosened by pressing a tab will also work. Action Plan: Lower Buckeye Jail: Man Down Drill, Shift 2,7/17/05 Officer down due to asthma attack inside P5 crossover. MCSO - Detention staff was prompt to arrive and safely able to secure the scene making it safe for officers and medical staff. Because the call came through as an Officer Down call several Sgt.s and officers from LBJ responded as well. CHS - Psych Medical staff was stationed in the house and were there in seconds. Psych medical placed Helseth on oxygen. LBJ medical staff responded and brought down the machine to give Helseth a breathing treatment, they also responded in very good time for the size of the facility and from their area that they deployed from. Debriefing/Recommendations: Add gurney training to the mandatory First Aid Training. Write a memorandum to Training and Development to add gurney training to the mandatory First Aid Training conducted by Meso Training staff. Action Plan: 7 02/21/06 MC Confidential (June 08) 001167 Towers = Mass Casualtv*, Shift 2 (1,3), 7/23105-7124/05 ~ (Actual Incident) . Scenario: • Power outage 7/23/05 @ 1845. Nurse Manager notified. No backup generator outlet located in clinic area. Clinic wlo power I function. Inmates in Tower 4, C Pod became disruptive secondary to heat, led to altercation @ 2200: Pod Pepper Sprayed @ 2200 by MCSO Night shift MCSO decontaminated pod and showered inmates, unknown change of clothing 12 inmate mandowns on night shift related to Pepper Spray starting 2300 • Inmates cIa heat and humidity in pods: Night RN requested ice water for pods shortly after the altercation. MCSO contacted facilities maintenance to repair swamp cooler not working in two pods: Tower 4: C &0 • • • Day shift requested ice water for pods beginning @ 0830 and notified nurse manager MCSO Response to nursing staff was that it was against health department rules to provide ice water in containers wlo spigots and that they were unable to reach kitchen to obtain ice water in appropriate containers (am of 7/24/05) 1 inmate brought to medical @ 1200 related to dehydration I heat exhaustion: transported to ER via 911 Potential for heat exhaustion 1 heat stroke high in these pods: 1200 RN called HCA for assistance: 2 RN's deployed from other clinics to help assess • RNs & MA to pod to triage victims ... .. HCA notified Manager: 1;>oth went to sce"ne to assi.st with .inmate evaluation 1 triage for.potential. heat . victims 1300· . .. . . . • • • • Day shift staff in pods obtained exposure to Pepper Spray: some with physical consequences Ice water provided to pod C by detention around 1600 Fans installed around same time Was the working relationship between Medical and Detention staff smooth, effective, and professional, achieving the goal of a positive outcome? There is no 'formal mechanism for identifying this type of situation as a potential disaster. CHS identified the potential for medical complications secondary to prolonged heat exposure (heat exhaustion, dehydration, medication complications etc). , Once the potential for disaster was identified by CHS and communicated with MCSO 8gt on duty, ice was obtained and provided for inmates. MCSO prOVided assistance in triaging inmates in Tower 4, Pod C. Worked together to respond to respiratory difficulties rlt Pepper Spray DebriefingJRecommendations: Develop CHS 1 MeSO mechanism for identification of and response to heat exposure Clarify CHS I MCSO protocol for multi-inmate Exposure to Pepper Spray Action Plan: 8 02/2J/06 MC Confidential (June 08) 001168 Lower Buckeye Jail: Man Down Drilll, Shift III, 8106105 MCSO: Officer Brown - Officers responded safely, secured the scene prior to medicals arrival. ASsisted in getting EMS in and out of the facility in a timely fashion. CHS, None Debriefing/Recommendations: Spoke to 2 officers at 2 core about the incident. Briefed Security Control Officers about the need for them to call communications instead of calling 911 themselves. Gave everyone the extension of Radio (61030). Action Plan: . Towers: Man Down Drill, Shift I, 8122105 MCSO, None; - Response by Detention "CHS, Ruth PhiJliben, RN, HCA - b SpIne; Backboard applied: "Transported to"clinic via gurney. Eval by RN and MD. -IV Normal Saline. " " transported to rviMC ER for evalualio"n." " ". "" Debrll:lfing/Recommendations: -None Action Plan: • ESBlTent5: Man Down Drill, Shift 1; 8/22105 MCSO - Radio call made by Officer Terresa Goodwin that an inmate was down in the dayroom. Inmate was lying on floor not coherent to his surroundings. While being evaluated became violent with staff and refused to follow orders. CHS - Medical staff responded promptly giving detention support in safely transporting the inmate to the medical clinic so the inmate could be treated. Upon arriving at the clinic medical staff stayed on scene and followed their protocol to insure the inmate received the treatment needed. Debriefing/Recommendations: The only thing that would have made the scenario smoother would be if Estrella Support Building had a restraint chair on site. A restraint chair had to be retrieved from Estrella Jail. Action Plan: Agencies involved were notified of the recommendation with request to evaluate and obtain chair if feasible. 9 02/21/06 MC Confidential (June 08) 001169 Estrella Jail: Man Down Drill, Shift 3, 8/25105 Attempted suicide with strap around the neck. . MCSO - Inmates in Tower A 200 summoned officer that something was srong in the pod. As officer entered pod her was called to cell 205 where he found an inmate covered with a blanket. When he removed the blanket he saw that the inmate had a strap around her neck. At that point he called for officer assistance in A Tower. Control then relayed the call for officer assistance in Tower A and asked if medical assistance was needed and called the clinic. CHS - When the medical staff arrived they were prepared to deal with the situation. They responded with a stretcher and the needed items to do a quick assessment on the inmate prior to taking to the clinic. Officer went with the inmate to the Estrella Clinic where it was determined that the injuries were not serious and was sent to LBJ to be evaluated by councilors.' Debriefing/Recommendations: . In this situation, an authorized item (Velcro strap from a splint/boot) was placed around the inmate . S neck by the inmate in an effort to commit suicide. This revealed a potential problem. with this type splint device that would allow the strap to be removed from the boot. . Action Plan: 10 02/2]/06 MC Confidential (June 08) 001170 Lower Buckeye Jail: .Mass Casualty Drill, Shift 2, 8/29105 Response: MCSO, Sgt. James Seibert Sgt Rosales responded as soon as the radio call came out. He directed his officers to the scene. The Officers responded with their air packs and fire extinguishers. They entered the house and began their search, they immediately started removing the inmates from the smoke filled room and took them to the triage area. Overall the drill was a tremendous success. The supervisors and officers along with CHS did an outstanding job working together. The FMO's we're right there after the drill filling all the air packs that were utilized dUring the drill. Sgt Rosales did a nice job; his radio transmissions were precise and accurate. The officers assigned to the Medical Services Division are to be commended; they responded and carried out the drill in a professional manner. The Drill was executed with no injuries to the officers or volunteers. One officer during the evacuation was overcome with "heat exhaustion". He was seen by medical and was released back to work after the drill· was completed. CHS, Roberto Escobar Medical Staff on scene; RN Escobar, Dr. Drapeau, MD and other RN's along with Medical Assistants responded with their equipment, set up the triage area and promptly assessed the inmates as they were brought to them from the housing unit. Debriefing/Reco~mendations;. ' . . .'. .' . It was mentioned during the briefing a few areas of improvement needed to be addressed. The Incident Commander could have responded directly to the housing unit instead of directing an Officer to radio him as to what was happening. CHS willlJ.ot set up the triage area in the middle of the hallway that needs to be kept open. We had two equipment malfunctions; one airpack was missing the face mask, one fire extinguisher was missing a pin. FMS Hector Osuna took the fire extinguisher out of service and replaced the air pack and mask. We need to work on being a little more diligent and expedite the task at hand. It was discussed that an initial assessment of the situation should be made and then formulate a plan of action. With this plan in place it will help expedite any future emergencies Action Plan: 11 02/2]/06 MC Confidential (June 08) 001171 Estrella Jail: Mass Casualty Drill, Shift 2,10/27105 MCSO - From the time the initial call was placed by Security Control, eight officers responded to the scene within ninety seconds. The first officers on scene arrived with air-packs and fire extingUishers and went straight into the dorm. They entered and began to direct the inmates out of the dorm. The house officer had gotten the inmates up, put her air-pack on and secured the logbook, roster and keys (the door cards were not secured). Other officers remained in the hallway during the evacuation process and directed the inmates to the rec yard. There were ten inmates identified as "injured" and were directed to a triage area for evaluation. The entire evacuation process took less than four minutes. Once all inmates were safely placed in the recreation yard, two officers entered the house to look for anyone who ad been left behind. An additional officer began an ID headcount of all the inmates in the ' recreation yard. CHS - The Security Officer delayed in notifying Medical. When they were notified medical responded in a . timely manner. The only issue that came up in the response was the arrival directly a "F" dorm. Detention staff should have diiected them to a "safer" area initially. A medical liaison officer would have prevented this from occurring. The medical staff responded with the proper equipment to triage and treat injuries. Debriefing/Recommendations: The Security Control Officer should have included Medical in their radio transmission to . "ensure .p·roper response.. . : . " .' . ' .. ' . ..... . . . Officers failed to'arrive at the scene with air' packs and fire extinguishers. As~cond call was made to remind them to bring the necessary equipment. This hindered their actions in so far. as entering the affected area. Wen the "injured" inmates were evacuated some of them were directed to the recreation yard rather than the triage area. Action Plan: The Nurse Manager and Jail Commander were contacted concerning the need for additional radios in the area set to iTIonitor channel 1, the detention channel. The information returned indicated that the problem with this partiCUlar exercise was not related to the lack of radios but to the initial radio calls not clearly indicating that medical should be involved and where to report to. These officers were debriefed on correct radio transmissions and what to include. Durango: Man Down, Shift 1, 11/29/05 Meso - Inmate was returning to Durango Jail from LBJ medical when he slipped off his crutch on the parade deck and landed on his tail bone. Officer witnessed the inmate fall and responded. Officers spoke with the inmate until medical arrived keeping him still on the ground. CHS - RN and Officer assisted the inmate into a wheel chair. There were no problems identified and the transition was smooth getting the inmate to medical. The inmate was awake, responsive and able to communicate his injuries. He was taken to the Durango Medical Clinic for further evaluation. He was seen by the Provider and returned to his housing unit. Debriefing/Recommendations: - None Action Plan: 12 02/21/06 MC Confidential (June 08) 001172 Durango: Mass Casultv Drill, Shift 2,11/30105 MCSO - Responding officers donned MSA air packs and responded with fire fighting equipment. Security Control simulated the calling of Phoenix Fire and dispatched an officer to open the perimeter gates when they arrived. Incident supervisor established a Command Post and placed the facility on security override at 1615 hours. The officers were paired up as they entered the warehouse to evacuate the inmates. CHS - Injured inmates were taken to the triage area set up south of the 0-8 and the other inmates were secured in the Recreation Yard. Officers searched the dorm for any injured or unconscious inmates. Officer spoke to each inmate in the recreation yard asking if they needed medical attention. The officer working the dorm also did not give the names and booking numbers of the inmates which would have allowed the medical staff to pull the inmates medical files. ~. Debriefing/Recommendations: The inmates were removed from the affected area, but there was come confusion as to what to do with them once they were outside. Holding and triage areas were set up but there was a failure in communication that caused a delay in securing the inmates. The inmates were allowed to wander around while the officers conducting the ID headcount and ill the triage a·rea. . .. Officers ante'red the affected area :without ~irpacks afte·r the' imn.ates ha.d been ev.acuated but . before the area was cleared. . . Action Plan: 13 02/21/00 MC Confidential (June 08) 001173 Durango: Mass Casualty Drill, Shift 1,12/1105 MCSO . th - A hazardous gas tanker was· involved in a collision at the corner of 4 Ave. and Madison. Strong odors were smelled in Level2A Radio call requested a supervisor to report to House 2A, announced it was a drill and inmates were "acting weird". An "Incident Commander" was designated. Medical staff was held in an unaffected area until such time that detention staff donning airpacs were able to remove the downed inmates from the affected unit. Once turned over to medical staff the inmates were moved to designated triage areas in the hallway outside of Level 2 Medical and a secondary triage area in basement medical. As the inmates in need of medical attention· were being removed the rest of the inmates were being staged for a partial evacuation. The unaffected inmates were then . moved from 2-A-100 to 2-0-200 and secured in the recreation yard until such time it was safe to return to the assigned housing unit. CHS - Medical staff heard th.e call on the radio. The Nurse Manager gave instruction to the nursing staff and the Provider communicated with him. to the Sergeant. Additional staff arrived from the mini clinics and the Providers received additional instruction from the Doctor on scene. The nursing and medical staff were very clear on the health care chain of command. There was an initial problem. with p'atients blocking the exit to the housing unit. The injured were then transported to the mini din,ic, but nursing staff were prevented from entering the clinic to assess the patients. .Debriefing/Recommendations: D~t~ntiol) to deh;r!nine if the elevators can be iliated on overriqe to summon the .elevator . after a radio call·by medical: . , .. .......,... Detention to brief staff on the reduction of radio transmissions during an emergency to essential information only. Detention to advise medical staff of evacuation route and signs to be made to post in the main clinic and mini clinics. Detention to instruct their staff on location of stairs to the levels. Detention will instruct their staff to evacuate the "well" inmates first. Medical to order fluorescent vests; one for the medical staff member in charge and one for the detention officer in charge. Medical to instruct FTO's on use of the Stryker cots. There was some difficulty raising and lowering cots with patients on board. Need mechanism for documenting on each patient and keep information with the patient for the providers to continually review. Action Plan: 14 02/21/06 MC Confidential (June 08) 001174 APPENDIX 2 MC Confidential (June 08) 001175 ,....f;· CORRECTIONAL HEALTH SERVICES INFECTION CONTROL .COMMITTEE MEETING. Confidential pursuant."to ~RS 36-2401 et seq. ::s:: n n o ~ I-t) 1--'. P, (]) ~ IT 1--'- OJ f-' ~ Cj ~ ~ (]) o (X) o o f--' f-l -...J m --.. . '.. • 0' CorrectiOl'lSI H'ealth Ser"vices Infection Control' Conllliunicable Dl$ease Report Confidential pursuant to ARS 36-2401 et seq. Diseaffi 8: n n o ~ H1 1-" Q., (!) ~ rt 1-" OJ I-' Cj c ~ (!) April 1 0 0 0 i3 5 ~ 2 10 19 Tuberculosis Cases (New-Confirmed) Varicella Hepatitis A Hepatitis B Hepatitis C HIV/AIDS Syphilis, Early Syphilis, Late Chlamydia Gonontlea 11 '. ,61 Totals JlI1e • MaY' . .. 1 0 0 .. 2 : 16 '6 1 3 a " 4 3 23 13 Total for Qua rter 0 0 18 8 , .3 8 25 11 . '74' , .. 0 0 ' .... 68 21 47 19 9 21 67 35 203 o (X) o o I-' I--' --.l --.J • . .- -II .. '~ '. • ""un ' . I _, Ie .. .. · Correctional Health- Servfi;es . Infection Control CouIInunicable IJisease Report Confidential pursuant to':,-lli~ 36-2401 et seq. C·orifidentiaf pursuant to ARS 36· r2401 et seq. I I' Maricopa County Cor·r.ectional Hea.lth Services j.\''Reported Communicable Diseases All Clinics Per 1,000 Mandays i I ' Ul iii' "l;l 0.5 l: ro :E .::, 0 q ... ::s: 0> 0Ul 0> Ul <U <l> 0 2 .0 ro 0- L~-~~~=I 0.3 I 0 ::J rt E E. 1-" 0 () OJ I-' "0 ~ 0.25 0.2 I " 0.1)" -I ... 0.23 0.21 ~ 'c:l CD :;:. j 0 ::J 'I. I Ul H1 1-'- ",. 110/3/05 0.4 I .,.- n n .. .' ,.. I . . I <l> .t: 0 I a:: c- Y c O> ::J CD I:~; 0.0 I Apr 05 0 co :;: '. .":, '. "-:-: ~ .. May 05 . ';:~.}«'~.:; ~.;~" " I I.. <• ...; w ..... • • :. ". "~:.-'. ·:/:>~Yf:'·· . -': June 05 ". :' 1- > .: "t" 0 0 t-' I-' --.J co i I I ,_ 'J & din Wi _, • .. Correctiunal Health Services Infection Control Comulunicable Disease Exposures - Inmate Exposures Confidential pursuant to . .~S 36-2401 et seq.• April Inmate Exposures IJune !Total for Quarter 41 01 515 May .511 8: n n o ~ t-h f-'. 0.. CD ~ rt f-'. OJ I--' L.j c ~ CD a (Xl a a I--' I--' --J \.0 I' I .i it AM _Me '" E'" U _ Correctional Health Services Infection Control Communicable Disease E'xposures - Inmate Exposures Confidential pursuant to ARS 36-2401 et seq. l :, ',,:.' ~. ~_... I ",:,: Maricopa County Correctional Health Services "-:.:, , '., :r~~in~c~f ~e~~~~o~~~sn~:;s I '.~,. -I .'.. f' .: :; ":. ,,<:,<, . '-" ',:-, '11'0/3/05 .-j , .;::;:":" :::.. 2.0 I 1 , .-•.,. .. " ..~; ~ ... : -. ": ,.... .', - ': 1.80'; ,:, ' III ~ 'tl, C" ~ § 3:: () . , 1.5+----------"r;;:-------~----------------__J ...." ~ "/ () Co ::> = 8 1.0 o ~, t-i) 1-'P, ~ (j) 1I> ~' ::> ' ,. r o.lf·-j---------------------""----'--~-------------------------I rt c' 1-'- OJ I-' ~, '.~;~ ,;,. y . 0.00 __ .~·:".ltL.·~~~JL,i~1L~:·· " <i:~~'~:':<;,c~~:~r .~ ::0::dJtL.-. ' ~ ::> (j) o CO o a I-' f--l co o I I 'Ii 81J$' i 1 '-I I' _ Correctional Health Services Infection Control Communicable Disease Exposures ...,- Total CHSlRegistry Staff Confidential pursuant to ARS 36-2401 et seq. April.. ' Staff Expos lres IMay 4/ IJune ITotal for Quarter. 381 01 42 ::$ o o o ::s H) 1-". 0- ro ::s rt 1-". OJ f-' ~ Lj c ::s ro o co o o I--' ~ f-' I • .". '''. • .'1 . .-&5&$ *eM .;".' eO , Correctional HeaJth Services Infectio~ ,C,ontrol (Communicable Disease Exposures - TotaICHSlRegistry Staff Confidential pursuant toARS 36-2401 et seq. '.::' [ConfidentiarplJrsuant to ARS 12401 et sea. 36-1 ,r Maricopa County Correctional Health Services I~ Tota I # of Sta ff Expos ures CHStRegistry Staff All Clinics Per 1,000 Mandays .- " ., 05 1" , . '/10/3/ .., " . r. 0.5 fI) » o:l "0 c: o:l :E 0.4 C> 0 ....o...• ::s:: n (1) .,c. n e :3 ::::l c. x w 11= o 0.3 fI) 0 t-i) 1-" P, o:l (j) 0.2 ...en ::::l 0.,13 0 IT 1-" ~ '!j, ;:; ..., PJ 0 f-' I- 0.1 Cj e o.oi, ::::l (j) ,~' Apr 05 , o " . " ',. . ,,'. .- (Xl ~. '.-.';" o -.:. " ..:._....:::f:. ",:=:::;::;. . q .. : ,.!, '... "..'" .. ...' May 05' ,;,., " .. ".-,: :~'i;",1L' .' ,"-'~F , " '.~ .. June 05 . ..,.. ~: . _'::'~,~~ ·:":;?~~~~i·">~;~"~·£~';_'?:,<~:·~:~:;~~~,~:·~,.:- ',:. ~ :::'::'" :-'(, .; .::~~ o f---' f-' CO 1'0 _ •• ' I _.t~... 1-' < '.me tH , I 'WI '''iiej I Correctional Health Services Infection Control Communicable 'Disease Report Tuberculosis Cases Confidential pursuant to I Confidential pursuant 2401 et sea. A~S 36-2401 et seq. Maricopa County COfre~tional Health Services Total # 'of T6 Cases All Clinics Per ~ 0,000 Mandays to A RS36-1 J~::, 110/3/05 I I ~'J 0.4 I I 0.5 rn :., ~ <tl :aE oo 3: n n o q o .,... ~ :::l rn I-i) <ll 1--" ~ 0... (j I!! ~ CD :::l It 1--" OJ ~ i-' ~ t------------~------------J 0.3 0.2'r---------------~~--------------J , ,0,1 0.035 Lj . C :::l CD o.0 o I , Apr05 CO o "-r. o '. 0.034 0.033 '''' .;; , 1 ,\.,'" ; ,i ",:;' " ' . - " " , I ,.' '.,,:May05 ':" --, ""J, .,,:~/< ''''':c: " I < .' June 05 ":' :~':~;;;:~~~ . ' ':~'~ ~:/ '-~·~··;·>t~<,·:',<~ ,;, :,":,/~~~~·':":~:::.~:h; .,:~~.~, .~:,. -.." ~. r' C'" , I-' J--l CO W . . . . ., I ,,*SP .'MA@" I "IPIJ I Ii Correctional Health Services Infection ContrQI MRSACases Confidential pursuant to·A.RS 36-2401 et seq. Month January January February February March March March April April April April May May May May June 3: n n o ::J H1 f-'. 0.. (j) ::J rt f-'. OJ I--' Age ISex MRSASite Finger 441M Finger 241M 40lM 301M 591M 421M 181M 40lF 331M 241M 261F 261M 191F 47/M 311M 19/F Clinic IProbableLocation MRSA Acquired/Comments Madison Psych. !Jail . ICommunity-Skin graft at Good Sal"Tlprior to booking Durango IJail Towers Foot Towers IJaii Lt. index finger Towers IJaii Lt. axilla Estrella Support IJail Rt. Elbow Towers IJail Finger Estrella 'Community. Had ear tubes when booked. Ear ICommunity•. Had wound and sutures at bookin Rt. Leg wound Estrella Durango ICommunity. At booking, swollen thumb,"fish hook" Rt. Thumb Durango Psych ICommunity. CIO abd. pain when booked Urine Forearm Estrella 'Jail Bacteremia Estrella IPossibly Jail._ Septic ioint. IPossibly jail. Had lung problems when booked. Durango Nose Ear LBJ from Durango IJaii Ears Estrella IJail L.j C ::J (j) o <Xl 0 . ~ I-' <Xl ~ . . . . . . . . . . . . . . . . . . . . . . . . .q. . . . . .•.6'& .1111 • . . . . . . .e' _. • -I I' " Correctional Health Services Infection Control .l\{RSA Cases Confidential pursuant to .ARS 36-2401 et seq. .-------~~.....:....-'-'--~""----~'-'-.".,~< Confidential pursuant to ARS 36- . . Maricopa County Correctional Health Services ., : ";: 2401 et seq. Reported MRSA~ses MRSA by Month-All Clinics'Per 10,000 Mandays \., • /. i" ,':. 0.5 .,. ~.. f' ...~ -', . ;~ '110/3/05 ;." .. '.,' .: .. I, _. ..V. J ~'. ( I 0.4 rI> >- .t'<l ~ t: 8: t'<l n n o :1E 0 0 0 0.$ ....cf ::J "- I-h 1-'. ;0.'2 OJ 0... 0.14 ~ CD ::J ~ rt 1-'. PJ I-' 0.1 '~7 Ar o.~ O.O~ 0.13 ~ y C ::J CD o 0.0 " CO . . Jan 05 :~~.' : Feb 05'".' ' , . j .,": "~<:'~';-.' ••~ ~_ ':'loi" ~ • ~3 :,;' ;~. M~.05;>ii:·C/(.A~l.~:o~, *~ttYi ;" o o t-' f-l en (Jl . .' I nil ..-....,..._: ..... MfNf5 I I _, " "'ii" Ju.~I!,p~" '~~:'jJ:: , a Correctional Health Services Infection Control Wound Care Chart A'udit Report Confidential pursuant to:ARS 36-2401 et seq. ,);,~~~Fi~t ,;.~~.,;', :,.' (Totai rrediCal records revie1Wd (N)=25) "":; .'<?lnfideDtial.pUrsuant to ARS 36-2401 et seq tbiJ% 60.0% 50.0% 3: n n -= t o <I.l ~ ::J I-h 1-" 40.0% 30.0% 20.0% 10.0% O.O%]""m\K: 0. <D ::J Ie 02: Is the order spedftc? IT 1-'. OJ I-' Yes CJ ::J 21 8 No 4 17 C NA o o <D Percentage 84.0% o CO o o f--' I-' CO 0) I I . . . . n ' .',' ' . , ' _I II I U Correctional He'alth Services Infection Control Court Ordered ·RPR.s. ~ ,~, %Tests Completed Confidential pursuant toARS 36-2401 et seq. .'. ';';.?~.~~:: .~ . :: ··t . ..: ': CorrectionafHealth Service,s' Infection Control . ,:, "1 :' Tota' " 90~ ,( 76.0/0 ::s: n n o ::s I-h f-'. f-'. ~ 73.2% f . ... "",..""1 40ro '.:-1 No, data ,I a~aijabl~' f:'r~t~~ ~'o~th o~: J'an Uary,'20~~':data ( ...................... ":,. ~:$..t < available for JanuaryfFebruary, 2005 :E:'S /L, '. 7' " I =A 'PWIO '( :;;r>? 1------~~~------------~~r~-:-------------""'\~7F"I~~, aA tOL 50% I \ . I 7 '30% I nl"'" ~ I I 1_ lit{ I 49.0% I l ------------------------------ (1) :::s 74;5% ..•:' ·-':,~FXj§i.:<J: -:- 4: ~" -:.' :~8~':;'~~": 60% I Q., IT '. . 86.8% 1 ~(j!i;:' 0,:.', Fe bruary, 2004 • August, 200,5 "" Court Ordered RPRs - %Tests Completed ,'~':: '. £ .. 100% I'~ -,c· ~, OJ I-' 2b%~ l I ------~---------------,~.:...-.----------------II C-j 100/0 I---------------------':--------------------11 ~ :::s (1) o co o 1 0% "I~~~.". co -..J I x::- ,: ~~.,f.~:. ' ~(j " , ~f:.;;t:" ~ ,:'.;:;:j~i~;:.!:;~~:ft~·~ o t-' I-' 1 ... ~ - ·=,·tr--Zrtt u • • ,~~ '. 4~~1~1f' . ' 'C' ~~. ..:,., <:;:-q, ~~._ .. :~ ~. ;: •.•:"":~-; ~,.. ~~., ~~, ~~". ~ ":",,"~";~;', ..' :. .;•.::,j~~~~ . ~~. ,,.,,,~~.,;. 1 ~ ..... ~, ~~, ~. ·<:;:;?~;1~j~{t,:: ':~.~~?~:.- -:·'i:'J·~<' •. q,'\,.~ ", ''';:~<'':''.. ' q,\. ,. ~ &. it;{ .~.,:~..~:__~-l~~~~~~: ~~: 'A.-if;.~·~;11;"&~;·~1..~> ,~.-=~ ~ ..~~ i:.:'l'-' Ij... : . -.'. ., ,.-.~~f,' ,'; ~q,<$:'. ... , 'c/'~- .-"". ,. ~'<ir,~-c· ..~ .~'<i .. ' .... ~ ~ '.~" '...' .:. t,.~~,~::, ~ . ~.. "-' ~ .. "-~': .... ,. -- -,' Correctional Health Services Infection CO:ntroIEmployee ;Exposure Confidential pursuant to ARS 36-2401 et seq. CHS Staff DatEi ~.f IhQig~iU;r~·,:.tji:i~-A1~'[~~~;:1f?lt~·· Clinic~;';~~l~: .Devic.~ ty~}:.[~::·:::"~:::';·~~: ·~·:~~~Fr.~;-i;~~;;'!M:{!lUiru:t:'1~-~-Y~~S-::~,;#;]J6/11/2003 8/15/2003 9/13/2003 10/15/2003 1212212003 1/30/2004 71212004 8/412004 IMedical Assistant I I I I Lancet '·1 Pricked by an uncapped lancet. Scissors IAttempting to remove jammedstaple With scissors. Syringe Needle' -I Pricked when recapping needle Syringe Needle INeedle penetratedIn<:!ex firrgeLafter administering insulin to inmate. I Lancet. -I Inmate pulled hand back while nurse performed accu-check. I NtA IBlood spill on ftnqers of right hand. 125 Gauge NeedlelAccidental needlesticls to hand_whUeperfoming medical procedure. I Butterfly Needle /Inmate fainted, pulled hand back and was pricked by needle. IMadison OP ITowers Clinic I Medical Assistant I Madison Outpatient IRegistered Nurse I Madi~on Intake ILicensed PracticalNfvladison Intake IMedical Assistant IMadison OP IPhysician ITowers Clinic IMedical Assistant IMadison Intake IRegistered Nurse 3/13/2005 Physician Assistant IDuranqo OP Needle 6/1212005 Physician Assistant IEstrella Clinic Needle Needle stick afier suturinQ when disposing sharps 8: n n ·1 Putting needle in sharps container o ~ I-h 1-'- Registry Staff 0([) ::J rt 1-'- PJ I-' y 6/23/2003 4/20/2004 7/26/2005 IMedical Assistant IMedical Assistant IMedical Assistant IDuran~o Juvy IDurango OP I I ILBJ I Butterfly Needle IStuck by contaminated needle while drawinQ blood. Needle . IStuck by contaminated needle while disposlnQ. Butterfly Needle IPulled out needle from inmate and stuckleftthulTlb;did bleed C ::J ([) o CO o o I-' I-' CO CO 1__ WII MOO Jr. D ... • 2£ CORRECTIONALHEAlITH SERVICES INFECTION CONTROL··SUBCOIMMITTEE MEETING Confidential pursuant to ARS 36-2401 et seq. 3: o o o :::J H) ~. Q., ro :::J rt ~. OJ I-' -e L..j :::J ro o CO o o I-' I-' CO '-0 MSIsw::m::::ui'1 i _, 1M 'WI!!""'l Correctional Health Services Infection Control Communicable Disease Report Confidential pursuant to ARS 36-2401 et seq. .. .. ~ Disease Tuberculosis Cases (New--Confirmed) Varicella Hepatitis A Hepatitis B Hepatitis C HIV/AIDS Syphilis, Early Syp h ilis, Late Chlamydia Gonorrhea Totals Disease Tu bercu losis Cases (N ew--Confirm ed) Varicella Hepatitis A Hepatitis B Hepatitis C HIV/AIDS 8: () () o ::J H) /-'. P. CD ::J rt /-'- PJ I-' Ci July .. 0 0 .27 4 5 12 14 . 10 72 .. CO o 0 0 0 1 ' 14 6 3 8 27 14 . 73 Total for Quarter 0 0 : .. ' 1 0 0 0 a 1 21 5 3 7 40 12 90 0 13 1 61 13 Nov Oct Syphilis, Late Chlamydia Gonorrh a Totals CD o Sept 1 0 0 '. Syphilis, Early C ::J Aug 0 4 1 9 9 '28 40 16 83 . 94 Dec 2 0 0 3 11 Total for Quarter 1 1 0 1 11 6 4 0 5 11 28 11 73 5 20 12 59 38 245 3 1 0 5 36 16 8 24 75 37 205 o t-' I-' 1-0 o I' I ' l l ! 'i¥ ,_ ··.1·····1 'WI Correctional He'alth Services Infection Control Communicable Disease Report Confidential pursuant to:ARS 36-2401 et seq. .~.. -' -, ' Confidential purSJanttoARS36-2401 etreq. So""""" . .,Martcopa Countj C<>rrectJOnaI_ith R3ported Communicable l:Aseases All Qinics Per 1:,000 ,l\[P ". I .~ .: :. .. - ,';,.... ~.. of. 0- 10 0 0 q ... 0> T" a.; f/) 8: n n 0> Ui It! 0> .!!! 0 o .$ I--!) .0 It! ::i 9 ::i rt E E 3 ::i ([) o t-' .' ~.;; ~:" .. / ~b~u€!'Y 1,2006 ., . _. __ . , I . . '. :: .... • ~ / . ~19 .~ 1.66 .~. ( { ::11l) ",. .~ ~ ./' ~5·V ill" 5, 4 ~ '-'-.' . ," 6.68 6 § 1-" OJ i-' 7.5·~ 7.73 l.z::lm t .2 1-" _~~ 8 0.. ([) . - ~~'I~ Cl <! r"'.,if.'. f}.:.·. . . . . ··r :. :..' " ;"":. 0 U "C 2 c- 1 a 0> O> It 0 ~ . :,Apr d5 <Xl ;. o .":. ~~' 7f::j~:oo.·, ..~~::~ . . :~::~~1~~~~)~~~,i;'~;~·~~~~2:;'M' •::t{.r~ o t--' I-' \..0 I-' I "'. . .... .,. If! :._....... Mea I .~-- wi" • _ Correctional Health Services Infection Control" Communicable Diseas'e'·Expo-sures - Inmate Exposures Confidential pursuant to July /August" )Septerrber 01 " Inmate Exposures October 8: () () o ARS 36-2401 et seq. Inmate Exposures 01 01 INova1't>er IDecember 0/" "/Total for Quarter 0/ 0 ITotaf for Quarter 291/ 291 ::l I-i) 1-'. 0.. CD ::l rt 1-'. PJ I-' Cj C ::l CD o CD o o f--' I-' \.0 N • I m " - ....". ,__ ¥w I '_I eM _'" Correctional Health Services Infection CO,ntroI Communicable Disease Expos,ure,s - Inmate Expo'sures Confidential pursuant to ARS 3Q-2401 et seq. '-' I Confidential pursuant to ARS 36- 2401 etseq. " 60 0. 45 a 40 ~ 3: ::l 35 ~ 30 ~ o w ~ $ II:! f-'. E .5 25 ([) '0 =It -'-' 20 I-i) p.. ~ rt ~ 1-" I- OJ I-' ~ 15 5 ([) 0, o CO o o ' 'f" \ \ \ \ \ . :' 30.54 A / 'j \ \ 10 c;:J Pre pared by Quality Managem e nt ...F_e_b_r_u_a....;ry_7,_2_0_0_6 --l \ \ \ (/)' n n All Clinics Per 1,000 AD? :- '_" . 50, g ....q... I if' " '.:' 55.94 55 Cl <l: IMaricopa County Correctional Health Services I Total # of Inni ate Expos ures I, J", > ,Sf" ", / / / "t~'>;i' :;:,~~>.:;O<>.,' ,-.:~ , '" :;o..,.~,,~:,..> ",,:1<.• '1-<F<'" , ~;~; ~fi~~~?S~J;?"':·;~>::~~W~;~>;t:~~~~~t~~:;~:,:l\~~>!S >, 05 : ' f ' :•• f--' I-' \.0 W II I 0'**5 0"- sew' _." g _ Correctional Health Services Infection Control Communicable Disease Exposures - Total CHS/Registry Staff Confidential pursuant to 4-RS 36-2401 et-seq. SepteniJer 01 01 October INbverrber IDecerrber ITotal for Quarter 21 .. 11 51 1/ Staff Exposures 3: () () o ITotal for Quarter Staff Exposures 1 8 ::J rn 1-'- 0.. (J) ::J rt 1-'- OJ f-' ~ Cj ~ ::J (J) o OJ o o I-' f-l \.0 J::o, • 'm'.1 Iii!Illl3!lIIIi;* eewe ., d' _, -"- 'aM di Correctional Health Services Infection Control COllIIDunicable Disease Exposures - Total CHSlRegistry Staff Confidential purs~ant to ARS 36-2401 ,et seq. It~- Maricopa' County Correctional Health Services Confidential pursuant to ARS 36· 2401 et seq. sta'!f ' i Total # of Exposures CHS/Registry Staff All Clinics Per 1,OQO ADP .I .:~ " .. ·f·:: .... ;. :: 5 ;': . ." r~ ~. ~f 4[~~~--~7\~-----~--------~----------------~~~~ ~ I 0.;; o 4.08 ~ 1\ <t: .... :5: o o o ::s t--h i- 3 I f ' 19 ( a. 0.. ~ S 2 I ~. ::s (/) 1-" (]) It 1-'- OJ f-' I • I I \ '0 ;Il: p"iii 1 I '0 Cj 0.52 c ::s (]) 0.10 . o -I o m I-' f-l <..0 (Jl .r· ,.~ -~.. 0.00 i . • . ,. ~ .-P.-. ",.,. . , ~ • >g~:~5 ",""4~.·>:.· ...'~;~·l'.~:i,,,,j·;~~~·;·:ff±~~Yj:· :~·';;'=\~l4~ii· :t::~4~ ). ·Alir 05 o <::) ~ 0;00 0.20 I , M~y 05 ; ••, _.' :." ·J.un~,~~. ,- • Ju!y 05' . : .• ...- ... :- .. c,··~.r' '.~. ·::·~'Au.¥:;O~.. ';- " &. .:;, ..... ..ro;.:, • .lJE( • . ~e.p_~~;"'; :'.~·~.'·:-'}~i9.~.:~ ..' '1;" .••• '.~ ~,' N~~ 65. • ..:. I Correctional Health Services Infection Control Communicable Disease Report Tuberculosis Cases Confidential pursuant to ARS 36-2401 et seq. . ;. ',:""., 'M a ric opa County Correctio~<ll Health Se rvlces Confidential purs uant to ARS 36· 2401etseq. Ii Total # of TB' Cases AU Clinic$ Per Hi,OOO .. Prepared by Quality Management February 7,2006 AD? ',' ;" 3 ~ o 3 ~ o 1.979 o o 8: n n o ::J I-h f-'. 0.. <D ::; rt- f-'. OJ I-' ~ 2 ~ ID ~ ~ ID ~ 2 u ~ 1.095 l' ~ !o ~ ~ 1.073 1.045 1.021' A • •, I ~ I I ~ 1 y >=: ::; <D ..0 o CO o ." o '.'j~65 ,. f-' f-l \.D CY\ I I >"_ .~ Mlly 05 '-01:.-1. ~ .:...... .: ... .: .;,J.~.iie 0.5':;;"--. _ ,~.:..:~_~ ..• \ .. .:'-··.:l!Ultli.S· ':~-" ·.~:~~..--.:z--···:~--~.--=:;-' .;:~_.~j..~ ..: ~::.. ~1JJ;t~7!~.-~ ~:~l.~"':.;..t.,:....~; .. --. --..---~~:-1 .: ~.: '.fl:i1g:'Q~~" .., .:. ..•. ~ep·Q.5 ~7;·· ,~~};¥~ct'~_$~ :..~.:L ::;-;., ··Hd.V.05· .;- .Th"lC.<-'i'{;Dec 05 ~'. .:";·"··:~·.:L::~·~]':: . .·:>·: ; ~ .:.:~~~~ r/:~·;~· :~~~::~;7~~:;:;¥t~:·~·:~~i:.·~ .~i1}~·;t~11~:t<~~r :.~' ,,:~~ ~.~:.:r::::. nm c R1tttT1fbl*r" "'jrJt"W I : _I '''fI, .. Correctional.Health Services Infection Control Communicable Disease Report Chickenpox Confidential pursuant to ARS 36-2401 et seq. ',' .. .~g"11-~l~8~;:~~~~~~#,rfi~7;~~~~~~ ~,:~;llt1;9H~ :It.es:s:·~;2Z~'7LO,5.t~Iitl;2124/'O,5~;;?_:;: i~h;g~c::;~~ci~~';~t91;~~~f~$i~J~~~"~~~:,_. Total Exposed ~ Inmates Total Exposed ~ Staff (CHS & Registry) Total Exposed- Inmates.& Staff' 291 5 296 23 Released to other agencies Released to Self·PH Positive (Immune) Test results' Refused Testing Negative (Non-Immune) Test Results--Quarantined Known cases transmitted from index cases Known pregnant 1M exposed. 8: n n o ::l I-i) 1-'- 0.. (1) ::l 71 190 1 6 o o rt" 1-'OJ I-' Cj ~ ::l (1) o (Xl o o I-' I-l \.0 -...J _, I It • . t 'W-W. I r _1IiiiiIIIU Correctional ,Health Services Infection Control Communicable 'Disease Report Chickenpox Confidential pursuant to ARS 36-2401 et seq. W:I\itt~~~~;::.'Ho u:>"~:}iP a-!;2":~~--$-.: '..p.-; ' :.:F"lr--2:.~H'S:e-tE: : , :.. 'n :, ':"b':''':'~ .1.~:"7'::. Total Exposed - Inmates Total Exposed - Staff (CHS & Regi$try) Total Exposed - Inmates &Staff 77 4 81 3:: n Released to other agencies Released to Self-PH Positive (1m m une) Test r'esults Refused Testin g Equivocal Test Results--~uaranUl1ed Negative (Non-Immune) Test Results--Quarantined, Known cases transm itted from index case' Known pregnant 1M exposed . n o ::J I-t) f-'. P.- ro ::J rt- f-'. PJ f-' 1 2 69 2 3 o o o y C ::J ro o CO o o I-' ~ ~ CO I 'ME 'riii' MiB S I •• . 'w' ; MW Correctional Health Services Infection Control I\1RSA Cases Confidential pursuant to ARS. 36-2401 et seq. , 3: n n o ::s t-h f-'. 0.. (]) ::s rt f-'. PJ I-' y c ::s (]) o CO o July July August August August Sept. Sept. Sept. Sept. SeDt. Sept. October October October October October October October November November November December December December 361M 281M 471M 361M 271M 221M 181M 391M 211M 421F 261M 471M 451M 301M 361M 191M 251M 451F 281M 4aIF 231M 511M 42/F 201M Leg Wound ITowers Bil.legs, R arm IDurango legs at MMC 14th Ave IIA Ear ILBJ Lt. Buttock ITowers Facial cellulitis 'Towers Rt. Forearm 1LBJ Rt. Elbow ILBJ Lt. Knee ILBJ Groin, axilla IEstrella Nasal ILBJ R arm abscess 14th Ave. Outpt. Nasal culture 1LBJ Outpt. Nasal culture ITowers Blood cx MMC ILBJ Outpt. Nasal culture ITowers R Hand ITowers Leg wound IEstrella Nasal culture ILBJ Outpt. L Hand wound IEstrella Blood IInfirmary R leg wound 14th Ave. Outpt. Head/scalp IEstrella R infraorbital 14th Ave. Outpt. Community. Laceration Rt. ankl~ whenboQke(j (Jumped out window) Jail. Multiple absCesses Community. Abscesses both legs when b(){)ked, per pt., MRSA Community. C/O ear drainage x 1 yr. when booked Jail. 11M squeezed abscess on buttock Jail. Booked March '2004, to MMC Sept. 2005, facial cellulitis, MRSA Jail. Rt. Forearm abscess, not present when booked Community. Elbow'infected at time of booking. Jail. Booked July 2005, Adm. MMC Sept. 2005 with knee cellulitis Community. Multiple ,abscesses when booked, SIP skin graft Jail. Booked April 2005, Hx.mastoid cellulitis, but no prevo cultures Community =-AbsceSses; hx "skinpopPir'lg"_@ !ime of booking Jail - hx osteo R finger Jail; hx of head & abd wounds Community - adm.,To MMC 1 day after booking; hx of IVDA Jail - hx of spider bite; multiple abscesses; Nsg ruptured abd abscess w/pressure Jail Community ..hx of L leg fx w/pins @ time of bookin Community - On H&P multiple MRSA infections; suspect carrier Community-broke, drug pipe in h?nd~prior to booking Hospital acquired; tit PICC line' .' Community - multiple abscesses @ time of bookin Jail eom,munity - R infraorbital abscess sip removal of metal plate from previous MVA surgery o I-' I-' \.0 \.0 II I Flee em· I .'.' .' .. Correctional Health Services Infection Control l\tfRSA Cases Confidential pu:rsuant l I Confidential pursuant to ARS 36· 2401 et seq. to ARS 36-2401 et seq. . . ,#.c::";". r, ---------~~---..:..---~------,Ii··· Maricopa County Correctional Health servfces",: , ReportedMRSACases ;' MRSA by Month·AIlClinfcs Per 10,000 ADP . . ', I I .# Prepared by Quality February 7, 2006 ow. M anagem ent .... 1 "" 10 9 8 u.. tl « c;:I c;:I 8: q () ...... 6.87 7 5.92~ 6 c;:I () o ill Co :::J « I-h f-'. (J) ~ 0.. :E ([) 3 ~ 2 Cj 1 G ,,~~ q.''''~4.09 1\ / 4 ::::s It f-'. P.J 4.38 ~ 5 I 2.29 • \,,: 7 \ / u/ ~--\ "/ \ 2.0V. '\V 2.25/ '\ \2.97. 3.15 ....... - : ::::s ([) 0 o . j~ij 05 CO . o o f-' (\) o o _. M~r 05 '. .:·~;'~~r Feb 05 . .~.~ .....=:' I ,"'"''--' '~': .. .. ~ ,:' II 1 05 May 05 • :'t,...I.:- I.~ 05' . . . :. ~~lle'O§.:<~> JUI.Y~ 1-·:.-.~~~i'l· A~g.Q? <>;:.e~~~\p5 '" 4:. ~ QS ,'., ~~'" ':.;",:' :·~···:~~;:.;;~i·~.>'7,:· :·;~~_';~·~~\~~:~T?~iiE~· ~~~ ,:;,s._'· ':;.-", :>'.~ '~. :;:. '-~. . r. o ' ••••• ~ .'itt'. . w • Noy. O.r.;-' :!1~Oec ~ ,. " !;' 05 - Correctional Health Services Infection C;ontrol Court Ordered RPRs - .0/0 Tests' Completed ConfIdential pursuant to· ARS 36-2401 et seq. Correctionall-2alh Services ". . ". . '.. Infection Control lib data available for the mOrith of January, 2004-fIb data available February, 2004- ~cember, 200S ~ for JoouarylFebruary, 2005 Court Ordered RPRs - % Tests Completed :.; .......,---'::""'---;,:;~,;;"":. . , . . - - - - -_ _--,--.J '~----..J.,. .<> ',,~ ',.""l .: ... Total 10(j% 90% 80% 10% 3:: n n o 17.1.J'i oIJ32% ... ..... ... 60% 5(j% 40% 30% 20% ::J I-h f-'O Q, <D - 86.8% ... ..... ~ 802%r-. ' <J.:3 10 72.3% .. A vp.v~ . " " .Q770/ . ~;Gu/o ...... / 79.7% .... . '-;;;'>07..\ v. '\ 0 \J' ~ 77.6% '.:T,.. no/ ~-7 85.7,Yo ( ~... ~n 74.5"10 . 'v ~o~O/. !'9O% ::J 10% rt f-'O 0% OJ f-' ~~<:\ /iF- ~~ ~~ ,(:>0 'il,.,. ~~., :.0-0" :.o'?J' -:&~~"l <z} ,.•.. ~ .. , ~-, rP. .~~ # o.$; ."~" .', ~ \ _:.;,'i! ~~ ~ .~ , . '~ ~~ro<S' Ob9'.0.::4. '?I~" ':':o::~. '?IV" . .~."'''" - . ~ C-< .~., C ':., •...~: .,' ' ~ 'l " :'", n° <y' ."'. ~ •• ' '" ." .:, ~ ~, .. . . • . ,< '" .,. ••: ' ~ ; )~ ,." : •. ~ '.' '.. '" • ::J ~ ..-=------= . .~ ~ .' : 1~ ... ~ ~:- . .} ~'I- ~.JlI<' ,U;- ·k:" ".»~ .#~;~.'~' tf. ~"'IlJ": 0 r:J!. ~.~.,;: "~.. r,': • 0 • ~ ~ #,~0. ~ '-: . _:~ • •. f <D o <Xl o a I-' N o I-' I I "' ,~--" Rep I , ..... I_I "I ..., Correctional Health Services Infection .Control Employee Exposure Confidential pursuant to. ARS 36-2401 et seq. CHS Staff O<l.~e .bf l.tibJdeilfl F )~~:~. Title '{P" 6/11/2003 8/15/2003 9/13/2003 10/15/2003 12/22/2003 1/30/2004 71212004 8/4/2004 , .;' 1"~2~ifd(r;f. DDevi~~ltl·~ ~~'1 ~:~.~~~~~~~::~~?~~:~~:J.:~~. ::~·~;~·;·:i~~~~~:::~:·.~af1~ilf11fJE~t~:~:_·:i~;.~~·~·~~':J~~·~~r;'i~~:'·~ :. :::s: 3/13/2005 Physician Assistant IDurango OP Needle o 6/1212005 10/5/2005 Needle TB SyrinQe 10/27/2005 Physician Assistant IEstrella Clinic Medical Assistant IP-4 Licensed Practical Nurse Ip-4 11/612005 Registered Nurse n n ::J H1 f-'. Q, ::J Needle stick after.suturin!=l when disposinQ sharps Putting needle in sharps container Putting needle in sharps container TB SyrinQe Pricked in Rt FA with TB syringe/was depositinQ blood draw needle into sharps container. 22 gauge Eclipse needle needle stick· finQer while closing safety cap; contaminated needlelblood noted under glove CD rt f-'. p; .--. Lancet IPricked by an.uncapped lancet. IMedical Assistant I Madison OP Scissors IAttempting to remove jammed staple with scissors. IRegistered Nurse !Towers Clinic IMedical Assistant IMadison OutpatiE Syringe Needle !Pricked when··recapping needle Syringe Needle INeedle penetrated index finger after administering insulin to inmate. IRegistered Nurse I Madison Intake Lancet IInmate pulled hand back while nurse performed accu-eheck. ILicensed Practical NMadison Intake N1A IBlood spill on .fingers of riQht hand. IMedical Assistant IMadison OP 25 Gauge Needle IAccidental needl8?tick to hancj Vl'hile pejioming medical prOQedure. IPhysician ITowers Clinic Butterfly Needle IInmate fainted; pulled hand back and was pricked by needle. IMedical Assistant IMadison Intake in IDurango OP I--' Registry Staff Cj C ~~~~~~~~~~~~~:r-~:-"::~~~: ::J : CD o CD o 6123/2003 IMedical Assistant 4/20/2004-- ., Medical ASSIStant 7/26/2005 IMedical Assistant I Durango JUVy I I I I . Durango of:' I LBJ Butterfly Needle .lStuck by contaminated needle while drawing bIocJ<L NeMle IStuck by contaminated needle while disposing. Butterfly Needle IPuliedout ne8dtefrominmate and stuckleftthunlb; did bleed o I--' (\J a N iii I" ~_.. 'FAQ ¥H ' . b... .... APPENDIX 3 MC Confidential (June 08) 001203 Lindy Funkhouser - HCMX From: Cheryl McCall - SHERIFFX Sent: Tuesday, February 21, 2006 8:35 AM To: Lindy Funkhouser - HCMX Cc: Larry Hutcheson - SHERIFFX; Kundavaram Reddy - SHERIFFX; Nancy O'Neill- SHERIFFX SUbject: RE: Attorney-client communication regarding NCCHC survey response Good Momlng, It appears that MCSO Food Service is in COmplilll1Ce wit~ all standards, both in section J-F-02 Nutrition and . Medical Diets, and in section J-B-03 Kitchen Sanitation and Food Handlers. The only thing I see for J-F-02 that needs to be changed is the following: The statement that says the "food services manager i~ a dietician", which is notccirrect. A correct statement would be the following: The Assistant Food Service Manager has a: Registered Dietician on staff. The dietician is responsible for overseeing the nutritional component of meals served. For J-B-03, the description of food service could be changed to: . B. .MANAGING A SAFE AND HEALTHY ENVIR·ONi1JiNT· ~i1QJJ~1] Meals are prepared jn a massive modern kitchen complex at the Lower Buckeye complex. The kitchen has state-of-the-art equipment and is efficient and effective. Facility staff and inmate-workers are employed in the food services opcnltiol1s. Once prepared, food is placed on individual, seaJ"cd food trays that are· loaded into special insulated carts. The carts are loaded onto refrigerated trailers for transpOli to jail facilities. At the facilities, carts are loaded into docking stations which refrigerate the trays until an automatic cycle begins before meal time. During this cycle, trays are both heated and chilled, k.eeping food h01 on one side, and cold 011 the other. The survey team noted a very efficient food service in place. That is all that I saw that needed to be changed. See below for original text: F. HEALTH PROMOTION AND DISEASE PREVENTION 1. General Comments Medical diets are currently being prepared for patients with specific dietary needs. The food services manager is a dietitian and oversees the nutritional component of meals served. J-F-02 Nutrition and Medical Diets (1). I X ]compliance [ 1partial compliance [ )non-compliance. Corrective action [X ] is not required. [ ) is required for Compliance Indicator(s): B. MANAGING A SAFE AND HEALTHY ENVIRONMENT Kitchen Meals are prepared in a massive modern kitchen complex at LBJ. The kitchen has state-of-the-art equipment and is efficient and effective. Facility staff and inmate-workers are employed in the food services operations. Once prepared, food is prepared on individual food lrays that arc loadc:d inlo special insulated containers and then 0010 (0 giunl trucks which distribute 1h~ trays to the inl11at~ living areas. Th~ insulated containers for the trays keep hot· 2/21/2006 MC Confidential (June 08) 001204 ("oods hm on 01le: ~icie. slld cold thing-, cold on tile: Dtller. The survey team noted a very efficient food service in place. Meals are served twice a day; the interval between the evening meal and morning meal does not exceed 14 hours. The morning distribution is served between 7 am and 8 am. Inmates who are working also receive a "sack lunch" at this time. The evening meal is served between 5 pm and 6 pm. Diabetics, those who are pregnant and those whose health requires more frequent or additional meals or food are provided for. Surveyors noticed that there were no complaints regarding the food serVices from the inmates. The only other kitchen is at Durango. This kitchen is old, yet staff and inmates are attentive to daily cleaning and maintenance. There are plans to stop using the Durango kitchen.' J-B-03 Kitchen Sanitation and Food Handlers (I). [ X ]compliance ( ] partial compliance [ ]non-compliance. Corrective action [X ] is not required. [ ] is required for Compliance Indicator(s): Let me know if you need additional information. Cheryl McCall 2/21/2006 MC Confidential (June 08) 001205 APPENDIX 4 MC Confidential (June 08) 001206 Lindy Funkhouser - HCMX From: Frank Kelch - SHERIFFX Sent: Tuesday, February 21, 2006 11 :26 AM To: Lindy Funkhouser - HCMX Subject: Our response to the report Undy, :"'isted below you shall find our r.esponse to the two issues that were brought up by the inspectors during the NCCHC Inspection. j·C-04 Training for Correctional Officers. • Checking the statistics for the training for CPR and First Aid, the Sheriffs Office is well within the standards set forth by the standard. Listed below you shall discover the statistics for the number of staff assigned compared to the number who were not up 10 date on their CPR and First Aid training. In each case we were well ab0~e the 75 percentage allowed. ...· . ,;,:' Month Number of Officers Assigned Percentage of Number of-Staff not in compliance Staff in compliance :l~, November 1866 155 91.69 % December 1854 131 92.93 % January 1873 .131 93.01 % '1881 131 93.04% Febru"ary ,J-B-02 Environmental health and Safety Issues Upon receipt ofthe detailed inspection repOli, Our Institutional Services Division did a complete re-inspection and did find some of the same issues that were brought up within the inspection. Since that time we have doubled the cleaning schedule of the showers and have ordered some renovations to the showers in the Estrella Building which is near completion as of this writing. We are also seeking some additional funding to address the shower areas within the Towers Jail. The dusty conditions concerning the floors have been addressed and corrective action has been noted on various re-inspections. This should address those two issues Lindy. If you have any questions feel free to call me Frank 2/21/2006 MC Confidential (June 08) 001207 APPENDIX 5 MC Confidential (June 08) 001208 Maricopa County Correctional Health Services 234 N. Centrnl Ave, 5rh Fl. Phoenix., Arizona 85004 Phone: (602) 506-2906 Fax:. (602) 506-2577 Appendix 5 Cover Memorandum ,~ To: NeCHC From: Lindy Funkhouser Director, Correctional Health Services 0~~~ Attached to this cover memorandum are documents that evidence Correctional Health Services' (CHS) recruitment plan. Attachment "1" is the salary 'structure for CHS nurses. This salary structure became effective in Nove~ber 2005. Employees began to see these increases in their midDecember paychecks. Attachment "2" is a report of incoming certifications of eligible candidates for employment. This report is one of several that the CHS Director reviews with the CHS Human Relations staff every two weeks. This meeting also reviews the current list of open and funded positions in CBS. The Director reviews the status of every open position and, if necessary, develops an action plan for filling the position. The . . meeting: also revi.ews all. positions under administrative action in the event the' action: .., results in a vacancy. Attachment "3" lists the job fair opportunities that CHS plans to attend as a registered employer. CHS plans to coo~dinat~ with special Sheriff's Office recruitments to broaden its reach in the community. Attachment "4" is the CHS request to the County Office of Management and Budget for additional funding for recruitment and retention initiatives. The attachment lists the initiatives. Please note that the request is not effective unless and until it is reviewed by OMB and approved by the Maricopa County Board of Supervisors. MC Confidential (June 08) 001209 Placement in Range Salary Range Structure In accordance with Maricopa County Total Compensation Department's philosophy, Cqrrectional Health Services hires· individuals into the nursing market range at. the appropriate salary based on their total years ofjobreiated experience. For example, a RN with 5 years of experience would be compensated at $25.33 per hour, while a RN with 10 years of experience would be compensated at $31.72 per hour. Total Compensation recently c9mpressed the nursing salary ranges from 25 years to a total of 12 years. The following working titles are included within the nurse market range; Clinical Nurse Educator, Discharge Case Manager, Night Shift Supervisor, and Psych Registered Nurse. . Total Compensation also provided salary ranges for Licensed Practical Nurse, Nursing Supervisor and Nurse PractitionerlPhysician's Assistants using the saJI:le placement in range strategy. . These salary ranges were effective November 5, 2005 and will be reviewed on an annual basis by Total Compensation. Years of ..Experi·ence 0 1 2 3 4 5 6 7 8 9 10 11 12 .. LPN .Nurse . ($). . ($) 13.54 14.08 14.64 15.23 15.84 16-.4J 17.13 17.82 18.53 19.27 20.04 20.84 21:62 20.23 21.16 22.13 23.15 24.. 22 25.33 26.50 27.72 28.99 30.32 31.72 33.18 34.71 Nursing .. : .·SuperVisor 27.27 28.28 29.33 30.41 31.54 32.70 33.91 35.17 36.47 37.82 39.22 40.67 42.18 (n . Nurse -Practition~r($) -, ". 31.51 32.79 34.13 35.52 36.96 38.47 40.03 41.66 43.36 45.12 46.96 48.87 50.88 MC Confidential (June 08) 001210 Incoming Certifications of Eligible Candidates for Employment Position Title Health Unit Coordinator . Supervisor Wanda LaPoint Date Cert List(s) Issued 1/23/06 Correctional Health Tech. Lin Maschner 1/19/06 Mental Health Professional Dr. Joseph 1/24/06 Mental Health Professional (Temp) Dr. Joseph 1/24/06 Medic'al I~ventory and Stock Tech .. Margaret Green 2/6/06 Nurse Practitioner Dr. Joseph 1/26/06 -- LPN Ruth Philliben 1/30/2006,2/13/06 RN Ruth Philliben 1/30/2006,2/13/06 Nurse Recruiter Lin Maschner 2/13/06 Admin. Assistant Lin Maschner 2/21/06 -' MC Confidential (June 08) 001211 N rl Marrcopa County Correctf6nal Health Servic s FY 2005/2006 Job Fairs Dat~ .'. ·;T·~~~f~'(1~~'~!~. :!. .:11/2/2006 9113/2005 Tuesday N rl o o I Jobing.Com (747 N. 22nd Street /PhoeniX, P-Z'602 200-6818 85016 Nursing Spectrum/Nurs 12655 Villa Creek eWeek Drive, Suite 250 ASU Student l12/11/2C06 Nurses Saturday Assoclation I Dallas, TX 75234 j7001 E. Williams IMesa, Az Field Road 85212 1100 W. 2/25/2006 Maricopa County Sheriffs Washington, 19 Saturday Office, Floor Nursing 4/26/2006 Spectrum/Nurs 12655 Villa Creek Wednesday eWeek Drive, Suite 250 ~ '.~ ~.: I Pointe South Baseline Road & Mountain Pavilion 1-10 Cost o Q) ~ $1,524 g rl 111 N. 3rd St., http://events.nursingspe Phx 85004 Phx Civic Plaza 972 488-00911 ctrum.com http://WW'W.asu.ed/stude ASU Main Campus, Tempe, 1480-727-1550 480-727-1556'1 ntaff~irs/careerJEmpReg jASU Student INurslngCareerDaylnfo. Union P-Z htm I co . 1800-8688944 Ext 135 1~~g~2Ix, All 876-1 000 Dallas, TX 75234 ...: ....:. I . I WWN. iobing. com ~ .~ .Atldress . ';- ::. " ::.: ..:" .. Sheriffs Office Training Center http://events.nursingspe 1800-868ctrum.com I Phx Civic Plaza 8944 Ext 135 1'972488-0091 35th Ave & Lower Buckeye Road 111 N. 3rd St., Phx 85004 ro $1,995 'r! .j.J ~ (1) 'D $350 .r! lH $0 u u ~ o ;2:; $2,200 ((3 - Maricopa .County 'Correctional Health Services 234 N. Cent:r:ll Ave. Date: February 21,2006 Suite 5000 Phoenix, lIZ 85004 Phone: 602-506·5580 Pax: 602·506-25/7 To: Chris Bradley, Deputy Budget Director From: Lisa Gardner, CHS Finance Subject: Nursing Incentives :' Manag~\ ?f----- Vl"/ . . Per our previous discussions regarding CHS's desire to move forward with several initiatives related to recruitment of our clinical staff, we would like the opportunity to meet with 'you to talk in detail with respect to: a. b. c. d. Recruitment bonus for RN night and weekend shifts Retention bonus for select clinical market ranges Utilization of "Jobing.com" Uniform aUowance fo~. select c\.inical.market ranges : . . .. . I will· forward to you a draft cost proposal for the remainder of this fiscal year and next fiscal year, and also work with Neeraj to set up a meeting. Please let me know i(you have any questions, and we look forward to discussing these opportunities with you. ' MC Confidential (June 08) 001213 CHS Nursing Incentive Plan .Total Estimate for: Retention, Recruitment, and Uniform Allowance Plans For the Fiscal Years Ended FY06 and FY07 FY06 Recruitment Plan - RN only Uniform Allowance Jobing.com Retention ~Ian Total FY07 Total for 06 and 07 16,107 35.263 78,600' 38,542 152,943 35,263 -67,600 3,503 169.050 70,525 146,200 42,044 168,511 259,308 427.819 MC Confidential (June 08) 001214 CHS Nursing Incentive Plan Recruitment Plan - RN only $5,000 Per new recruit Assume Total Vacancies 30% turnover All RN Posistions 30 39 30 39 Assume 75% are eve/~ight 0.75 Eve/Night Vacancies Recommended Sign On Bonus Potential Total Cost 29 5,000 145,000 29 145,000 Pilas -In Scenario Approval by April 1, 2006 3:: n n Hire Phase in (25% success each month) May June JUly FY07 Aug o Cost By Month June Aug Sept May July 7 7,000 7,000 7 7,000 7,000 7 7,000 8 8,000 29 7,000 7,000 :::J 7,000 15,000 7,000 FY06 FY07 7,000 28,000 7,000 0 28,000 35,000 40,000 14,QOO 131,000 16,107 152,943 0 r-n 1-" 0.. CD :::J With Variable Benefit Rate at 15.05% fyOS and 16.75% fy07 rt 1-" OJ ~ Assumptions: Cj C :::J Vacancy numbers as of 12/28/2005 o 75% of the vacancies are evening and night shifts Will achieve 25% success each month after approval beginning in February 2006 Turnover rate of 30% in total was assumed CD CD o o ~ N ~ {Jl CHS Nursing Incentive Plan Uniform Allowance 3 Uniforms per year # of Positions CHT's. RNs, LPNs MIST's. Rad Tech, MR Techs HUCs Dental Offices 180 19 26 6 Totals 231 Est Positions Turnover R wi turn 30% 10% 10% 10% Est Cost Per Year 234 21 29 7 125 125 125 125 . 29 j 250 2,613 .' 3,575 825 290 500 .36,263 Includes Filled and Vacant positions ::$ () () o tl t-h f-"- 0- m tl It f-". OJ f-' ~ tl m o CO o o t--' I\.) f-' 01 Subtotal Assumptions: Turn over rate at 30% for RNs. LPNs, CHTs, 10% for all others Include 25% additional on top of $1 OO/uniform to cover employee taxable benefit Current Expense fy06 Total Cost fy07 Total Cost 1,000 29,250 2,613 3,575 (175) 29,250 2,613 3,575 (175) 1,000 35,263 35,263 Retention/Longevity Bonus Program* FY 2006 - YTD from date of hire 5 'r'ears of Continuous Service No of Emp Nurse Manager o Rr'l 7 $ LPN FY 2007 - Only current FY sleps 5 Years of Continuous Service No of Emp Amount $ 3,500.00 10 $ ~OOQOO $ 8,500.00 Nurse Manager $ Rlj $ 2 $ $ 1,000.00 2,000.00 3,000.00 15 Years of Continuous Service NLlfse Manager RN LPN Subtotals for NM, RN,LPN 3:: ::J Hl 1-" p.. (j) ::J rt HUC CHT OTH HUC PJ Cj C ::J CHT OTH (j) o Subtotals for HUC,CHT,Other $ $ 1,000.00 $ $ $ 3 $ $ Nur~e Manager RN . LPN 27 $ 22,000.00 Subtotals for NM, RN,LPN 500.00 500.00 1,000.00 . $ $ $ $ 4 $ 2,000.00 $ 500,00 500,00 FY 2007 5 Years of Continuous Service 4 $ 3 $ 1 $ $ 2,000.00 1,500.00 500.00 4,000.00 HUC CHT.· $ $ $ OTH 1,OO(),OO 10 Years of Continuous Service $ $ $ HUC $ CHT aTK .. $ $ $ 15 Years of Continuous Service HUC 500.00 500.00 $ LPN "$ 1-" f-' Nurse Manager RN . 1,500.00 4,500.00 4,500.00 10,500.00 1 $ 3 $ 10 Years of Continuous Service CHT OTH $ $ 15 'friars of Continuous ServiCe FY 2006 5 Years of Continuous Service n n o Nurse Manager RN' LPt-J 19 years of Continuous Service 10 Years of Continuous Service LPN Amount 15 Years of Continuous Service 4 $ o $ 6,000.00 1 $ 1,500.00 $ 7,500.00 13 $ 11,500.00 40 $ 33,500.00 HUC' $ CHT $ OTH $ $ Subtotals f r HUC,CHT,Oth r 2 $ 1,000,00 6 $ S,DOD,OD CD o o f-' N f-' --.l ·Does NOT include variable benefits that will be paid on Ihase dollars Nursing l'lCe'ltl·,'e.xls RetentioniLongevity Bonus Program* Cosls for Nurse Manager, RN & LPN for FY 06 $ 22,000,00 Cosls for Nurse Manager, RN & LPN for FY 07 $ $ 2,000.00 24,000,00 Costs for HUC, CHT, OTH for FY 06 $ 11,500.00 Costs for HUC, CHT, OTH for FY 07 $ $ 1,000.00 12,500,00 Tolal Costs for the next 2 fiscal years (FY 2005-2006 and FY 2006-2007) $ 36,500,00 3: n n o ::s H1 1--'- 0.. CD ::s rt 1--" OJ i-' C..j ~ ::s CD o CO o o f-l I'V i-' CO 'Does NOT include variable bene fils thai will be paid on these dollars Nursing Incentive. ~Is Usa Gardner - CHSX From: Lindy F.unkhouser - HCMX Sent: Tuesday, February 14,20064:36 PM To:· Janice stratton - CHSX; Peggy Garza - CHSX Cc: Rebecca Nicholson - CHSX; Lisa Gardner - CHSX; Margaret Green - CHSX Subject: RE: TV Prices MCSO also is very interested in working with us on our recruitment efforts. We might want to coordinate our messages, if possible. ---Original Message----From: Janice Stratton - CHSX Sent: Tuesday, February 14,20064:20 PM To: Peggy Garza CHSX; Lindy Funkhouser - HCMX Cc: Rebecca Nicholson - CHSX; Lisa Gardner - CHSX Subject: RE: TV Prices J My thought is that buying the 30 pack package is preferable because we want to get to the point fairly soon to recruit positions by location and so would have numerous postings with RNs, LPNs, HUCs, CHTs, etc. Right now we just posted RNs, LPNs, etc. Janice Stratton CHSHRM(J/uiger . PIrone:· 602506-5584 Fax: 602506-2160 -----Original Message----From: Peggy Garza - CHSX Sent: Tuesday, February 14, 20064:02 PM To: Lindy Funkhouser - HCMX Cc: Rebecca Nicholson - CHSX; Janice Stratton - CHSX; Lisa Gardner - CHSX Subject: RE: TV Prices Importance: High Lindy- I received the proposals from Jobing on cost of a 20 and 15 pack listing,-.Tb.e..20 pack cost is $1588.16; 15 pack cost is $1482.00. In comparing the cost for a 30 pacili$1577.33~versus the 20 pack ($15B8.33), there's a difference of $10.83. Does anyone have any comments? ·Thanks! -Peg -----Original Message----From: Lindy Funkhouser - HCMX Sent: Friday, February 10, 2006 10:45 AM. To: Peggy Garza - CHSX; Rebecca Nicholson - CHSX Cc: Lisa Gardner - CHSX; Janice Stratton - CHSX; Chris Bradley - OMBX; Neeraj Deshpande - OMBX Subject: RE: TV Prices Thanks, Peggy. -----Original Message----. From: Peggy Garza - CHSX Sent: Friday, February 10, 2006 10:44 AM To: Lindy Funkhouser - HCMX; Rebecca Nicholson - CHSX 2/21/2006 MC Confidential (June 08) 001219 Cc Lisa Gardner - CHSX; Janice Stratton - CHSX; Chris Bradley - OMBX; Neeraj Deshpande - OMBX Sobjece RE: TV Prices Importance: High Update: I made contact with Jobing on Wednesday, February 8 and inquired on the co~t of a 20 and 15 pack listing. I also asked Wit was possible tei prepare a proposal for months left of this fiscal year for the different packages. They , promised a response bye-mail by the end of the day today. - Peg ---Original Message--From: Lindy Funkhouser - HCMX Sent: Friday, February 10, 2006 10:30 AM To: Rebecca Nicholson - CHSX Cc: Lisa Gardner - CHSX; Janice Stratton. - CHSXi Chris Bradley - OMBX; Neeraj Deshpande - OMBXi Peggy Garza - CHSX Subject: RE: TV Prices Oops. I didn't catch that. Then the breakdown should be as follows. I will fill in the blanks when I hear from Peggy. ~ "Fees for at least 3 major job fairs Trinkets -frint Advertising (special displays, . .etc.) . ' . '. .., . '''Jobing.com . Display Materials and Graphics Laptops for remote access to PeopleSoft =- .. Jobinq.com listings and management TOTAL - - -r 5,000 0 1,000 . 15.000 . 45,000 5,000 I,\. ,,,,., g. I... tJf1L • 'I 6,000 [(1C U TBD " ; TBD -----Original Message----from: Rebecca Nicholson - CHSX Sent: Friday, February 10, 2006 itO:15 AM To: Lindy Funkhouser - HCMX Cc: Lisa Gardner - CHSX; Janice Stratton - CHSX Subject: RE: lV Prices Lindy, Don't forget to add in the additional amount for the Jobing.com listings and management. Peggy was to follow up on the pricing for 20 listings. I have not received that information from her; however, I believe the $45,000 was for the video only. Rebecca ----Original Message----From: Lindy Funkhouser - HCMX Sent: Friday, February 10, 20069:19 AM To: Lisa Gardner - CHSX Cc: Chris Bradley - OMBX; Neeraj Deshpande - OMBX; 2/2112006 MC Confidential (June 08) 001220 Janice Stratton - CHSX; Margaret Green - CHSX; Rebecca Nicholson - CHSX Subject: FW: TV Prices OMB has expressed an interest in setting up a budget for CHS recruitment. I think the sensible approach is to follow some· of the approaches that MeSO has found usefUl, including the Jobing.com feature. In the interest of putting something on the table, I have prepared the following draft annual budget. Items in red are one-time purchases. Fees for at least 3 major job fairs Trinkets Print Advertising (special displays, etc.) . Jobin~.com Dlsplav Materials and Graphics Laptops for remote access to PeopleSoft TOTAL 5,000 1,000 15.000 45,000 5,000 6,000 77,000 Let me "know what you think. -----Original Message----- . From: Rebecca Nicholson - CHSX . Sent: Tuesday, February 07, 2..0064;40 PM . To: Janice Strptton - CHSX; Peggy Garza - CHSX Cc: Lindy Funkhouser - HClvJX Subject: FVI/: TV Prices Here's the electronic version of the videofTV quote from Jobing.com -----Original Mes·sage----From: Matt Furrey [mailto:mattJurrey@jobing.com] Sent: Monday, February 06, 2006 1:35 PM To: Rebecca Nicholson - CHSX Subject: TV Prices Hi Rebecca, I wanted to get this information over to you on behalf of Kat. Included is the TV pricing that you and Kat had discussed. If you have any questions, please give Kat or I a call. Thanks!!! Have a great day and Go Jobing! Matt Furrey Industry Specialist matt.f.lJrrey@jQbil19.~om 602-200-6800 www.Jobing.com Tune into JobingTV - it's what's hot in Valley r cruiting! btlP-:lliobingty.,jQPj!l9~.~Qml..R.elault ..asp- 2/21/2006 MC Confidential (June 08) 001221 Great Local Jobs for Great Local People - Check out our Local PartnershipsI http;/lcQmmunity.jop.ing.comfdefault.asp.?PageJP..=1 0002831 No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.3751 Virus Database: 267.15.2/252· Release Date: 2/612006 2/21/2006 MC Confidential (June 08) 001222 APPENDIX 6 MC Confidential (June 08) 001223 Memornndum Margaret Green. RN, BSN, MBA Chief of Operations Correctional Health Services ,.., To: All Nurse ManagerstnHealth Care Administrators cc: Unda Maschner, DO ; Undy Funkhouser, Director From: Margaret Green~ Date: 2/21/2006 Re: Segregated Inmates I ' III follow-up to the NCCHC Survey Exit Conference; Maricopa County ~o[rectional . H~alth Services has been evaluating the proce~s of monitoring inmates in .. segregation. As per ti,iscussions in January thepblicy Segregated Inn~ates, J-E-:G9. ·hMheeil niodified to reflect tile change in documentation that ,¥as· determilled to:be . necessary. Meso will continue to provide each clinic with the list of inmates in segregation each week. When an inmate is initially placed 'in segregation a "Segregation ObsenJation" form is to be initiated and placed in the Segregation Log. Please review this policy (attached) with staff at your next staff meeting to insure full compliance. MC Confidential (June 08) 001224 CORRECTIONAL HEALTH SERVICES CLINICAL POLICIES NCCHe Standard: J-E-09 (Important) Policy.Title: SEGREGATED lNMATES Applicability: ALL cLiNIcs AND HEALTH CARE STAFF - Origination Date: 05/01104 Initiating Partyrream; Margaret Green, RN; ChiefofOperatiQns Last Revision Date: Approved: Next Review Date: g~ Gerar<lo~: 02/01/06 11/29/06 2i2:;Li2.&' F~hnnser, Page: 10f2 llndy Director, Correctional Health Services ". Date: I. PURPOSE: To ensure that inmates who are confined to their housing unit or cell maintain t.heir physical and mental health. II. POLICY: A. Imnates who are segregated and have limited contact with staff or other inmates will be monitored 3 days a week by medical or mental health staff as needed. . B. Inmates under with litt~e or no contact with other individuals are monitored daily by medical staff and at least once a week by mental health staff. C. MCSO will notify CHS when an inmate is placed in segregation. A licensed nurse will review the inmate's health record to detenrune whether existing medical, dental, Of mental health needs contraindicate the placement or require accommodation. Such review is documented in the health record. MC Confidential (June 08) 001225 PROCEDURES: ill. A. A roster of segregated inmates will be sent to the primer or delivered to each clinic per week. B. The inmates will be monitored on a frequency basis determined by level of segregation. 1. Inmates·who are segregated and have limited contact· with sU:iff or other inmates are monitored 3 days a week by medical or mental health staff. 2. Inmates under extreme isolation: (Note: Currently Maricopa County has no inmates in "extreme isolation". MeSO does not use this type of housing. Procedures will be developed in the event inmates are at some point placed in "extreme isolation".) C. Each inmate will be individually observed and asked ifhe/she has any health care requests. D. The health staffwill document on the "Segregation Obsen1ation" form for each inmate on the· roster indicating inmate mental and physical status of the inmate and any health complaints. The health staff will initial the date. Ai the end of each month (or when the inmate is· removed from segregation) the "Segregation Observation" form will be placed in the inmates chart. E. Documentation of emergent needs and intervention will be in the inmates chart. ..F:· Inrilat~s will be.en·couragelt to submit an Inm<;lte Medical Request F9rmJ6r')1on~einergent . health related prob·!ems.· '.' . G. Inmates detemlined to need health care will be referred to the appropriate clinical setting for triage, examination and treatment. All clinical encounters will be documented in the inmate's health record. m. EVALUATION REVIEW CRITERION: This policy is to be reviewed annually. IV. REFERENCES NeCHC Standard J-E-09. v. DEFINITIONS Segregated inmates are those isolated from the general population and who receive services and activities apart from the other inmates. VI. ATTACHMENTS None Policy Title: Segregated lmnates Page 2 of2 MC Confidential (June 08) 001226 Maricopa County Correctional Health Services Segregation Observation Name: Booking Nrnnber: Date ofBirth: Imnate labd or Addressograph Stamp Month: .. year: _ Wednesday Monday .' • 'J • ... ,' Week Housing Unit: _ Fridav o No Issues o No Issues o NoIssues Comments: .Comments: Comments: # 1 Initials Week Date DOlte Initials Date o No Issues o NoIssues o No Issues Comments: Comments: Comments: # 2 . Initials .. . Date o No Issue.~ Week Initials CODlIDents: Initials o No Issues Date Comments: . Initials . Date o No Issues Comments: # 3 Initials 1---- Week Date Initials Date Initials Date o NoIssues o No Issues o No Issues Comments: Comments: Comments: # 4 .. ImtJals Initials SIgnature Starn)) Date Initials Date .. InItials Initials Date SIgnature Starnl) CHS- Nurs- XXX 02-21-06 MC Confidential (June 08) 001227