Graves v Arpaio Expert Report on Medical Compliance at Maricopa County Jail Apr 2011 Parta
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Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 1 of 65 JorgeFranco, Franco,JI. Jr. (No. (No. 013834) 013834) 11 Jorge E-Mail: jf(Qjhc-law.com firstname.lastname@example.org E-Mail: HAVG CUNNINGHAM, L.L.P. JENNINGS, HAUG 22 JENNINGS, L.L.P. HAUG&& &CUNNINGHAM, 3 2800 North Central Avenue, Suite 1800 3 2800 North Arizona Central 85004-1049 Avenue, Suite 1800 Phoenix, 85004-1049 Phoenix, Arizona 4 Telephone: 602-234-7800 4 Telephone: FacsImile: 602-277-5595 FacSImile: 602-234-7800 Facsimile: 602-277-5595 55 66 FultonBrock, Brock,Don Attorneys for for Defendants DefendantsFulton DonStapley, Stapley, Attorneys AndrewKunasek, Kunasek, Max Max Wilson Wilsonand and Mary MaryRose Rose Wilcox Wilcox Andrew 77 88 99 UNITED STATES STATES DISCTRICT DISCTRICT COURT COURT 10 10 DISTRICT OF ARIZONA ARIZONA 11 11 12 12 13 13 Papoca, on their Isaac Popoca, Fred Graves, Isaac own behalf and and on onbehalf behalfof of aa class class of of all pretrial detainees in the Maricopa County Jails, County Jails, Plaintiffs, 14 14 15 15 vs. 16 16 Joseph Sheriff of Joseph Arpaio, Arpaio, Sheriff of :Maricopa Maricopa aL; County; et a1.; a1.; County; et 17 17 NOTICE OF OF FILING SIXTH FILING SIXTH REPORTS OF N. OF DR. DR. LAMBERT LAMBERT N. KING AND AND DR. DR. KATHRYN KATHRYN A. A. BURNS Defendants. 18 18 19 19 Case Case No. No. CV-77-0479-PHX-NVW CV-77-0479-PHX-NVW Pursuant this Court's January 28, 2009 (#1769),defendants defendants Pursuant to thistoCourt's OrderOrder dateddated January 28, 2009 (#1769), 20 Fulton Brock, Brock, Don Stapley, Andrew Wilson and Mary Rose Rose Wilcox, Wilcox, 20 Fulton Don Stapley, Andrew Kunasek, Kunasek, Max Max Wilson and Mary the sixth sixth reports reports of 21 through undersigned undersigned counsel, counsel, hereby lmdersigned 21 through hereby give give notice noticeofof filing fiing the datedMarch March31, 31, ~011 and Kathryn A. Burns, 22 LambertN. N.King, King,M.D., M.D., PhD., Ph.D.,F.A.C.P. F.A.C.P. dated 31,2011 22 Lambert 2011 Burns, 23 2011. The reports are attached hereto. hereto. M.D., M.P.H. dated April 2011. 23 MD., M.P.H. dated April 24 24 25 25 26 26 27 27 28 28 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 2 of 65 thisday 6th day of April, 2011. 11 DATEDDATED this 6th of ApriL, 2011. 22 33 JENNIN AUG AUG & & & CUNNINGHAM, CUNNINGHAM,L.L.P. L.L.P. 44 55 66 77 88 co, JI. Jr. Jorge Fra co, 2800 N. N. Central Central Avenue, Suite 1800 2800 Avenue, Suite 1800 Phoenix, AZ 85004-1049 Phoenix, AZ 85004-1049 for Defendants Defendants Fulton Fulton Brock, Brock, Don Attorneys for Attorneys Kunasek, Max Wilson and Stapley, Andrew Andrew Kunasek, Mary Mary Rose Rose Wilcox Wilcox 99 10 10 11 12 13 14 15 15 16 17 18 19 20 21 21 22 23 23 24 24 25 25 26 26 27 27 28 28 22 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 3 of 65 CERTIFICATEOF OFSERVICE SERVICE CERTIFICATE 11 22 NOTICEOF OF herebycertify certifythat thaton onApril April6,6,2011, 2011, II electronically electronically transmitted transmittedNOTICE IIhereby FILING SIXTH REPORTS OF DR. LAMBERT N. KING AND DR. KATHRYN A. FILING SIXTH REPORTS OF DR. LAMBERT N. KING AND DR. KATHRYN A. 33 BURNS totothe the theClerk's Clerk'sOffce Officeforfor theUnited UnitedStates StatesDistrict DistrictCourt, Court,District DistrictofofArizona, Arizona, BURNS 4 using the CM/ECF System for filing and transmittal of a Notice of Electronic Filing 4 using CM/ECF System for filng and transmittal of a Notice of Electronic Filng to the thethe following CM/ECF registrants: to following CM/ECF registrants: 55 Larry A. Hammond, Esq. Larry A. Hammond, Esq. Sharad H. Desai, Esq. 6 6 Sharad H. Desai, Esq. ChristinaC. C. Rubalcava Rubalcava Christina P.A. 7 Osborn Maledon, 7 Osborn Maledon, P.A. 2929 N. Central Avenue, Suite2100 2100 2929 Central Avenue, Suite Phoenix, AZ AZ85012-2793 85012-2793 88 Phoenix, email@example.com Ihammond(Qomlaw.com firstname.lastname@example.org 99 dhil(Qomlaw.com email@example.com 10 sdesai(Qomlaw.cQi 10 11 11 Winter,Esq. Esq.(admitted MargaretWinter, (admittedpro prohac hacvice) vice) Margaret Gabriel Eber, Esq. (admitted pro hac vice) 12 Gabriel Eber, Esq. hac vice) Eric Balaban, Balaban, Esq.(admitted (admittedpro prohac hac vice) vice) Eric Esq. (admitted pro 13 ACLU National Prison Project 13 ACLU National Prison Project 91515th Street, Street, N.W., 91515th N.W., 7th 7th Floor Floor 14 Washington, D.C. 20005 14 Washington, D.C. 20005 firstname.lastname@example.org mwinterC9npp-aclu.org email@example.com 15 geberC9npp-aclu.org firstname.lastname@example.org email@example.com 16 firstname.lastname@example.org 12 16 ebalabanC9npp-aclu.org 17 Daniel J. Pochoda, Esq. 17 Daniel ACLU ACLUJ. Pochoda, Esq. 18 P.O. Box 17148 Phoenix, AZ 85011 email@example.com 19 19 dpochoda(Qacluaz.org 18 P.O. Box AZ 17148 Phoenix, 85011 20 20 Michele Michele M. M. Iafrate, Iafrate, Esq. Esq. Courtney Cloman, 21 Cloman, Esq. Esq. 21 Courtney & Iafrate Associa tes Iafrate & & Associates Associates 22 649 N. 22 649 N. Second Second Avenue Avenue Phoenix, Phoenix,AZ AZ 85003-0001 85003-0001 23 michele.iafrate(\flJ:bar.org michele .iafrate@~zbar.org 23 firstname.lastname@example.org 24 24 25 25 26 26 27 27 28 28 33 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 4 of 65 th 2011, a copy of the attached document was I further certify on April 11 I further certify that that on April 7th7 2011, a copy of the attached document was 22 deliveredto: to: delivered 33 The Wake TheHonorable HonorableNeil Neil V. V. Wake 4 United States District Court Court, District of Arizona 4 United DistrictStreet, Court, District 401 W. W.States Washington Street, SPC 52 of Arizona 401 Washington SPC 52 5 Suite 524 55 Suite 524 AZ 85003-7640 Phoenix, Phoenix, AZ 85003-7640 66 7 8 sl K. Cecil kc/4982-2 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 4 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 5 of 65 Sixth Report Report on onMedical Medical Compliance Compliance with Second Second Sixth Amended Judgment Judgment Amended Graves v. v. Arpaio Arpaio Graves CV -- 77-0479-PHX-NVW 77-0479-PHX-NVW No. CV LambertN. N. King, King,MD, MD, PhD, PhD, FACP FACP Lambert 31,2011 March 31, 2011 Part A - Background On January 25,2011 and and Februar February28-March 28-March 1,2011, 1, 1,2011, 2011, II On Januar 25,2011 conducted site site visits visits of of Correctional Correctional Health HealthServices Services (CBS) (CBS) in conducted (MCJ) system. the Maricopa County Jail Jail (MCJ) system. This report is a summary myrecent recentobservations observations and and updated summar ofofmy recommendations concerning medical services in the Maricopa County is hereby hereby respectfully respectfully submitted to County Jail Jail system. system. ItIt is Honorable Honorable Judge Judge Neil Neil V. V. Wake Wakeof ofthe theUnited United States StatesDistrict District Court for for the the District of Arizona, Arizona,in in response response to to the requirements of of the Second Second Amended (SAJ) issued Amended Judgment Judgment (SAJ) by Judge Judge Wake Wake on on October October 22, 22, 2008. Since Since my my first first site site visit visit to to Maricopa Maricopa County County Jail Jail on March March 30 to 2009, 1I have have submitted submitted five five prior to April April1,1,2009, prior reports reports to to Judge Judge Wake. also prepared and submitted a report titled Wake. II also titled Expert's Expert's Report Report on Compliance Compliance with Medical Medical Provisions Provisions of of Second Second Amended For this AmendedJudgment Judgment on onAugust August20,2010. 20,2010. For this Sixth Sixth 1i Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 6 of 65 Report, II considered considered prior prior findings findings and andrecommendations recommendations and and Report, have updated updated and and revised revised many many of of them them in in the form of ofaa the form have Corrective Action Action Plan Plan(CAP). (CAP). This This CAP CAP is responsive responsive to to the the Corrective requirements of ofParagraphs Paragraphs 6, 6, 77 and 6,7 and88 ofofJudge JudgeWake's Wake's requirements requirements are Second Amended These requirements are the the Second Amended Judgment. Judgment. These following: Paragraph 6: 6:. "Defendants shall shallprovide provideaa receiving receiving screening screening 6: "Defendants of each detainee, prior prior to to the the placement placement of of any any pretrial pretrial of each pretrial pretrial detainee, be detainee in the general population. The screening screening wil will be population. The to identify segregation, and and sufficient to identify and and begin begin necessar necessarysegregation, of those with and injury; treatment of arid injury; with mental mental and and physical physical illness ilness and to provide to provide necessary necessar medication medication without without interruption; interruption; to recognize, recognize, segregate, segregate, and and treat those with communicable diseases; diseases;totoprovide providemedically medicallynecessary necessar special diets; diets; and to services to recognize recognizeand andprovide providenecessary necessar services to the the physically physically handicapped." Paragraph pretrial detainees detainees confined ails shall Paragraph7:7: "All pretrial confined in in the the jjails jails have have ready ready access access to to care care to to meet meet their their serious medical medical and and detainees needs. When mental When necessary, necessary, pretrial mental health needs. pretrial detainees confined confined in injail jail facilities facilitieswhich whichlack lacksuch such services services shall shall be be or location transferred jailor transferred to to another jail location where where such such services services or or health health facilities facilities can can be be provided provided or or shall otherwise be provided provided services." with with appropriate appropriate alternative on-site medical services." 22 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 7 of 65 Paragraph 8: 8: "Defendants "Defendants shall shall ensure ensure that thatpretrial pretrialdetainees' detainees' Paragraph prescription medications medications are are provided provided without without interruption interruption prescription where medically medically prescribed prescribed by by eorrectional correctional medical medical staff." staff." where In an 3,2009, an Order Order dated 3, 2009,Judge JudgeWake Wakeordered, ordered, In dated January Januar 3,2009, parties, that stipulationof ofthe the parties, "upon stipulation thatmedical medicalexpert expert Dr. Dr. "upon Lambert King and mental health expert Dr. Kathryn Kathryn Burns Burns are are Lambert to serve serve as independent evaluators evaluators of appointed to of the the appointed Defendants' compliance compliance with with the the medical mental health health Defendants' medical and and mental provisions of of the the Second Second Amended Judgment and to to be be Judgment and services." The The same compensated by Defendants for for their services." will evaluate evaluate the delivery delivery Order also also specified specified that that the "Experts will of medical medical and and mental health care at Maricopa County Jails, Services identify identify deficiencies, deficiencies, assist assist Correctional Health Services needed, to to ("CHS") ("CBS") ("CHS")in in developing developing aa corrective corrective action action plan, plan, ifif needed, achieve achieve compliance compliance with with the Second Amended Amended Judgment, Judgment, and submit reports reports on on compliance compliancetotothe thecourt courtat at 120-day l20-day intervals." intervals." During During the the past past two two years, years, Dr. Dr. Bums Burns and I have consistently fulfilled fulfilledthe theresponsibilities responsibilities of ofthe the Court's Court's appointed experts, as January 2009. as specified specifiedininJudge JudgeWake's Wake'sOrder Orderofof Januar 28, 28,2009. Litigation us. Litigationin inthe the case case of of Graves Graves vs. vs. Arpaio Arpaiohas has been been underway underway appointtnent for fordecades decades prior prior to to the the appointlnent appointment of the the Court's Experts in medical medicaland andmental mentalhealth healthcare. care. Prior to appointment of the the by Judge Wake, evidence evidence medical experts by Judge Wake, medical and and mental mental health experts 33 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 8 of 65 was presented presented concerning concerning systematic systematic deficiencies deficiencies in in standards standards was of medical medical care care in the Maricopa Maricopa County Jails. Concerning Concerningthe the of duration ofthis this litigation, litigation, Judge Judge Wake Wake said during during aa hearing hearing duration of in this thismatter matteron on Januar January21,2011, 21, 2011, 2011"We , "Wedon't don'thave havethat thatsame same in level of of stress stress here except this is an an old old case. case. The The judgment's level this is judgment's been around. I'm tryng tryingto to avoid avoid unnecessar unnecessarydifficulties difficulties for for been around. I'm anybodyconsistent consistent with with moving moving this this along anybody along diligently." dilgently." Judge Judge Wake further stated that thatPlaintiffs Plaintiffs and andDefendants Defendants"have "have done done Wake further stated good job to eontinue continue to to focus focus on on things things aa good job and and II expect expect that that to that are are useful and not create create unnecessary burdens for for either either that unnecessar burdens side." The CHS Maricopa County The CHS medical medical care care program program in in the the Maricopa County Jails Jails was evidently substandard and troubled troubled prior priorto to Judge Judge Wake's Wake's was Order This was wasno nosmall small problem, problem, since since Order of of January January 28,2009. 28,2009. This CHS CHS isis responsible responsible each each year year for for the the medical evaluation evaluation of more more than than 115,000 intake medical evaluations and aa daily inmate of over women, many inmate population population of over 7,200 7,200 men men and and women, many of of whom whom have have complex complex acute acute and and chronic chronic medical medical conditions. Moreover, CHS staffs six jjails ails and nine health care locations in in Moreover, CHS staffs six the two years, have acknowledged acknowledged the MCJ MCJ system. system. Over Over the the past past two years, II have aa number of improvements number of improvements CHS CHShas has made made in in scope scope and and quality quality of ofits its medical medicalcare careservices. services. These These improvements improvements have have been Over been documented documentedin inmy myprevious previousreports reportstotothe theCourt. Court. Over the CHS has the past past six six months, the executive leadership of CHS has been been fundamentally fundamentally changed, changed, whereby whereby the the Executive Executive Director, Director, 44 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 9 of 65 Medical Director and and Nursing Nursing Director Director positions positions have have been been Medical filled by byhealth healthcare careprofessionals professionals whose whose qualifications qualifications and and filled prior experience experience make them them well-suited well-suited to to take take those thosetimely timely prior and complex complex actions necessar necessaryto to achieve achieve full full compliance compliance with with and the requirements requirements of of the the SAJ. SAJ. Based Basedon onextensive extensive the conversations with with them, them, II believe believe these three three CHS CHS leaders are are conversations working diligently diligently and and in ingood good faith faith to to ensure ensure that that medical medical working Maricopa County County care of persons persons admitted and confined in the Maricopa Jails wil willmeet meetall allrequirements requirementsof ofthe theCourt's Court'sSecond Second Jails Amended Judgment. Although CHS CHS has has made made progress progress toward compliance, there is Although evidence, based mainly on on review review of medical records, evidence, based mainly of selected selected medical records, that further further major major actions actions are are necessary necessary to to fulfill fulfill the requirements of of Paragraphs 6, 77 and 8 of the Court's Court's Second Second Amended While perhaps perhaps seemingly seemingly paradoxical, Amended Judgment. Judgment. While the foregoing foregoing two in view view of the two observations observations are are not not surprising surprising in status status of medical medical care care in in Maricopa Maricopa County Jails Jails only a few years years ago agoand andthe thecomplexity complexityand and acuity acuity of of illness ilness among the large CHS serves. large population population that CHS In Sixth Report Report (Corrective (Corrective Action Plan), Plan), I have In Part E E of this Sixth have updated ('Remedies" updated and revised revised several several of of the the "Remedies" "Remedies"that that II recommended recommendedininmy myAugust August20,2010 20,2010Expert's Expert's Report Report on Medical MedicalCompliance Compliancewith with Medical MedicalProvisions Provisions of ofSecond Second Amended ThisCorrective Corrective Action Action Plan Plan represents represents Amended Judgment. Judgment. This 55 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 10 of 65 they mybest bestefforts effortsto toassist assistthe thenew newleadership leadershipofofCHS CHSas as they my work toward toward compliance compliance with with the the medical medical requirements ofthe the requirementsof work At the SAJ. At the same same time, time, aa corrective corrective action action plan, plan, ififitit is is to to be be SAJ. successful, successful~cannot cannot be be totally totally static For successful, static or or written written in instone. stone. For example, provision provision of of more more appropriate appropriate medications medications to to treat treat example, patientssuffering sufferingfrom from withdrawal withdrawal from from heroin heroin abuse abuseinvolves involves patients areintensively processes and and medications medications that thatare intensively regulated regulated by by processes agencies such as the Drug state and and federal federal agencies Drug Enforcement Enforcement state Thus, pathway to Administration. Thus, Thus~ the the pathway to an an appropriate appropriate Administration. actions, corrective action may involve sequential alternative actions, outcome of each with the outcome each next next step being dependent dependent on approvals. securing prior regulatory approvals. Fundamentally, neither neither the the ten ten remedies remedies I previously recommended or the Corrective Action recommended or the Corrective Action Plan Plan contained contained in in this this Sixth Wake's articulation articulation Sixth Report Report are are intended intended to to replace replace Judge Judge Wake's of and 88 of of the the Second Second Amended of Paragraphs Paragraphs 6,7, 6,7, and Amended Judgment Judgment as as the the definitive definitive measure of medical care compliance. expressed Plaintiffs' Counsel and and CHS CHS have have expressed Plaintiffs' and and Defendants' Defendants' Counsel of my agreement agreement with with many many aspects aspects of my prior prior recommendations, recommendations, most Corrective most of of which which are are adapted adaptedin in whole wholeor orin in part part in in the Corrective Action If differences differences Action Plan Plan proposed proposedininthis this Sixth Sixth Report. Report. If remain remain on on the the part part of of Plaintiffs Plaintiffs or or Defendants, Defendants, II am am readily readily available availabletotodiscuss discussand and address address them them jointly jointly with withboth both parties. parties. II will wil also also continue continue to toencourage encouragePlaintiffs Plaitiffsand and Defendants Defendantsrepresentatives representativesto tojoin join me me and and the the leaders leaders of CHS CHS 66 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 11 of 65 in meeting meetingregularly regularlytogether togetherto toreview review medical medical records, records, in policies and and procedures, procedures, and and ongoing ongoing plans plans and and efforts efforts to to policies improve medical medical services services consistent consistent with withSAJ SAJ requirements. requirements. improve Part B B -- List List of of Sources Sources and and Documents Reviewed DocumentsReviewed Part The content of of this this report report was was informed informed by by the the following following The sources and and methods: methods: sources 1. Continued Continued reviews reVIews of of CHS CRS CHS policies policies and and procedures procedures 1. pertaining to the objectives objectives of of the theSecond SecondAmended Amended pertaining to the Judgment (SAJ). (SAJ). Judgment Discussions with with executive executive and and clinical clinical leaders leaders of of CHS CRS 2. Discussions about their current current and and anticipated anticipated actions actions to assure assure about their access provision of proper proper medical medical care care as as accesstoto and and provision stipulated in in Paragraphs Paragraphs 6, 6,7 and 88 of of the the SAJ. SAJ. 7 and 3. 25, February February 28 and and March 3. On On January Januar 25, March 1,2011, 1,2011, I reviewed aIIlong aJIlong aa reviewed 38 38 medical medical records, records, all all of which were among list that CHS CRS CHS had provided for review by list of medical charts that Plaintiffs' CounseL Thirty of these these records records were among Plaintiffs' CounseL. Thirty of those Counsel had reviewed reviewed and those that that by Plaintiffs' Counsel and critiqued critiqued in in written written reviews reviews in in advance advance of of my myrecent recent site site visits. visits. 4. 4. II reviewed reviewed the the detailed detailed professional professional resumes resumes of the the CHS CHS Executive ExecutiveStaff Staffincluding including the the Department Department Director, Director, Thomas CCRP, ThomasTegeler, Tegeler, RN, RN, MPH, MPH,CCHP, CCHP,NEA-BC; NEA-BC; Medical Medical 77 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 12 of 65 Director, Jeffrey Jeffrey J. J. Alvarez, Alvarez, MD, MD, CCHP; CCHP; Director Director of of Director, Nursing,Katie KatieWingate, Wingate, RN, RN, MSN, MSN, CCHP; CCHP; Finance Finance Nursing, Manager, Lisa Lisa A. Gardner, BS; BS; HR HR Consultant, Consultant,Diane DianeM. M. Manager, Shook, MBA, MBA, SPHR; SPHR; and Don J. Wright, Wright, BS, BS, MBA, MBA, Shook, Clinical IT IT Director Director .. Clinical 5. Correctional Correctional Health Health Services Services Standard Standard Operating Operating 5. Proceduretitled titledINFIRMARY INFIRMARY ADMISSION/CARE ADMISSION/CARE Procedure DELIVERY /NURSING ACUITY AND DISCHARGE, DISCHARGE, as as DELIVERY revised on 01/03 01/03/11. revised jl 1. 6. CHS CHS Clinical ClinicalPolicy, Policy, titled titledGRIEVANCE GRIEVANCE MECHANISM MECHANISM FOR HEALTH HEALTH COMPLAINTS, COMPLAINTS,as asrevised revised10/12/10. 1O/12jlO. 7. Maricopa Maricopa County Services Special Special 7. County Correctional Correctional Health Health Services Needs Treatment Guidelines: Diabetes Needs Treatment Plan Guidelines: Diabetes Mellitus, Melltus, September September 29,2010. 29,2010. 8. of the monthly 8. Minutes and appended documents of meetings of the Maricopa County Correctional Health Services Quality Improvement Council from from August August for for 2010. 9. CHS Patient 9. Team Team Charter Charter and and minutes of the CHS Patient Health Care CQI Care Request Request cQr CQI Team Team from from August August through through November, November, 2010. 2010. 10. Team Charters and minutesofofthe the Health Health 10. Team Charters and minutes Assessment CQI 4 th Assessment cQr CQITeams Teamsfor forthe theLBJ, LBJ, Durango, Durango, and 4th Avenue Avenuefacilities. facilities.These Theseminutes minutes document document meetings meetings from from September September through through November, November, 2010. 2010. 88 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 13 of 65 "GrievanceDril DrillDown" dated Down" annual report, dated i11. 1. "Grievance annual report, December 31,2010. 31,2010. December Health Needs Request Reports,for forOctober, October, 12. CHSCHS Health Needs Request Reports, November and December, December, 2010 2010 November 13. CHS CHS Health AssessmentAudits Auditsfor for April, April, July, July, 13. Health Assessment August, September September October, October, and and November, November, 2010. 2010. August, 14. CHS/MCSO CHSjMCSO CHS/MCSO Statistical MonthlyReport Report for for July 14. Statistical Monthly 2010 -- December 2010.· 2010. 2010 December 2010. 15. ListList 4 thAvenue AvenueIntake IntakePre-Booking Pre-BookingRefusals Refusals for for 15. of of 4th Januaryand and Februar, February,2011. 2011. Januar 16. Maricopa County Correctional HealthServices, Services, 16. Maricopa County Correctional Health Continuous Quality Improvement Plan, 1, 20102010 Plan, July July 1, 2010 -30, 2011. 201l. 2011. June 30, 17. Maricopa County Correctional HealthServices, Services, 17. Maricopa County Correctional Health Continuous Quality Improvement Improvement Program, Program, FY FY 2010 Continuous Quality Annual Evaluation. 18. Maricopa County Correctional HealthServices, Services, 18. Maricopa County Correctional Health Continuous Quality Improvement Improvement Annual Annual Plan, Plan, July July 1, 2010 30, 201l. 20 II. 2010 -- June June 30,2011. 30,2011. 19. CHS, Patient SatisfactionSurvey SurveyResults, Results, for LBJ 19. CHS, Patient Satisfaction Outpatient, 4 th Avenue, Outpatient, 4th Avenue, Towers, Towers, Tents, Tents, MHU, MHU, Estrella, Estrella, Durango. Durango. These These anonymous anonymous surveys were were completed completed by by patients CHS Clinics patients seen in CHS Clinics on on aa particular particular day day in in late late January orearly early February February 2011. 2011. Januar or 20. CHS I-EHRPROGRAM PROGRAM TIMELINE,as as of of January 20. CHS I-EHR TIMELINE, Januar 2011. 2011. 99 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 14 of 65 21. National National Commission HealthCare, Care, on CorrectionalHealth 21. Commission on Correctional Technical Assistance Assistance Report Report of of the the Health Health Care Services CareServices Technical at Maricopa Maricopa County Sheriffs Sheriff's Offce, Office, December December 22,2010. 22,2010. at 22. PLAINTIFFS' PLAINTIFFS' STATEMENT 22. STATEMENT REGARDING REGARDING DISCOVERY DISPUTE, the Court Court on on March March 9, 99,~ DISCOVERY DISPUTE,filed fied with the 2010. 23. DEFENDANT DEFENDANTMARICOPA MARICOPACOUNTY COUNTY BOARD BOARD OF OF 23. SUPERVISOR'S STATEMENT RE: RE: DISCOVERY DISCOVERY 10, 20 II. DISPUTE, filed DISPUTE, fied with the Court on March 10,2011. 24. Judge Wake's ORDER of March 10,2011. 10,2011. 10~ 2011. 24. Judge Wake's ORDER of 25. RESPONSETO TODEFENDANTS' DEFENDANTS' STATEMENT 25. RESPONSE STATEMENT RE DISCOVERY DISCOVERY DISPUTE, DISPUTE,filed filedwith with the the Court on March 201I. 18, 2011. 18~ 18,2011. 26. 26. COUNTY BOARD BOARD OF DEFENDANTMARICOPA MARICOPACOUNTY DEFENDANT SUPERVISOR'S SUPERVISOR'SMOTION MOTIONTO TOVACATE VACATEJUNE JUNE 14, 14, 2011 EVIDENTIARY EVIDENTIARY HEARING, HEARING,filed fied with with the Court on march 21, 21, 2011. Part Part B B -- Observations Observations and and Findings Findings CHS 1.1.During CRS appointed Duringthe the past past six six months, months, CHS appointed aa new new Tegeler, RN, MPH, MPH, CCHP, CCHP, Executive (Thomas J. Tegeler, Executive Director Director (Thomas NEC-BC); NEC-BC);new newMedical MedicalDirector Director (Jeffrey (Jeffrey Alvarez, Alvarez, MD, MD, 10 10 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 15 of 65 CCHP); and and new new Director Directorof ofNursing Nursing(Katie (KatieWingate, Wingate,RN, RN, CCHP); MSN, CCHP). CCHP). All three three of them are are highly qualified in in their their MSN, respective professional professional disciplines and bring substantial substantial respective experience in correctional correctional health care, care, public public health, health, experience hospital and and ambulatory ambulatorycare. care. hospital 2. To To the the best best of of my my knowledge, knowledge, this the first first time time the the 2. this is is the Maricopa County County Board Board of of Supervisors Supervisors has has appointed appointed aa Maricopa CHS Executive Director who has extensive qualifications CHS qualifications and experience experience in services. Mr. Mr. Tegeler's Tegeler's prior work work in nursing services. included service service as as the Chief Chief Nurse Nurse Executive Executive of of the Davis Davis included Grant Medical Medical Center Center at at the the Travis Travis Air Air Force Force Base Base in Grant California. The The previous previous executive director had California. considerable administrative experience experience in considerable in Maricopa County government government but but lacked lacked the the great great advantage advantage possessed possessed by aa capable executive who who is is also also aa highly qualified qualified and and experienced experienced health health care professional. 3. Alvarez brings 3. As As the the new new CHS CHS Medical Medical Director, Director, Dr. Jeffrey Alvarez Board a primary care care specialty Board Certification Certification in in a specialty -- Family Medicine recognized by Medicine -- recognized by the the American American Board of Medical Specialties (ABMS). Neither Specialties (ABMS). Neither of of the the two two previous previous CHS Medical an ABMS-recognized ABMS-recognized Medical Directors Directors was was certified in an specialty. Prior to to being being appointed appointed as as the the CHS CHS Medical Medical specialty. Prior Director, Director, Dr. Dr. Alvarez Alvarezprovided provideddirect directpatient patient care care of excellent excellent quality quality to to patients patients in in the the CHS CHS Estrella EstrellaJail Jail Clinic. Clinic. Finally, Finally, itit is is important important to to note note that that Dr. Dr. Alvarez Alvarezisisbilingual. bilnguaL. This This is is aa 1111 Case 2:77-cv-00479-NVW Document 1966 Filed 04/06/11 Page 16 of 65 very useful useful asset assetin incommunicating communicatingwith with and andcaring caringfor for very Spanish-speaking MCJ MCJ patients. patients. Spanish-speaking 4. As As the the new new CHS CHS Director Director of of Nursing, Nursing, Katie Katie Wingate Wingate brings brings 4. many years years of of prior prior experience experience in nursing nursing care, care, care care of of many persons who have mental illness, care of of the the elderly, elderly, and and persons ilness, care correctional health healthcare. care. Before Beforejoining joiningCHS, CHS, she she was was the the correctional Nursing Program Program Manager Manager for for the the Arizona Arizona Department Department of of Nursing Corrections. Her Her span span of of responsibilities in this this position position Corrections. included supervision supervision of of 11 11 nursing nursing supervisors supervisors in ten ten included prison complexes complexes and supervision of of 34 34 prison and direct clinical clinical supervision psychiatric nurses. 5. With With the the appointment appointmentof ofThomas Thomas Tegeler Tegeler as as Executive Executive 5. Director and Katie Katie Wingate Wingate as as Director Director of Nursing, Nursing, it is apparent that CHS leadership team now possesses possesses greater greater apparent that CHS leadership team now authority and expertise expertise to to identify, identify, assess and improve improve any authority and assess and any nursing-related problems problems affecting compliance compliance with with the SAJ. For this this reason, reason, II do do not not believe believe that selection and SAJ. For that the the selection and employment employment of of aa correctional correctional health health care care nursing nursing specialist is is necessary necessary to to assist assist me mein in monitoring monitoring compliance compliance or or to advise advise CHS CHSon onimprovement improvement of of nursing nursing components of the the MCJ MCJ health health care care system. system. 6. 6. The The CHS CHSHealth HealthAssessment Assessment Audits Audits for for2010 2010 show show aa notable notable increase increase in in the the percentage percentage of of patients patients whose whose Health Health Assessment/Physical Assessment/Physical Examination Examinationand andtuberculin tuberculinskin skin test test (PPD) (PPD)was wascompleted completedwithin within14 14days days of oftheir their booking bookingdate. date. 12 12