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u.s. Department of Justice
Civil Rights Division

OffiCi! oftltl! As.rlrtallt AttorJll!Y GtrllsraI

Wa.l'hll'lgrorr. D. C. 20530

NOV 73 '1IiJl
The Honorable Ron Sims
King County Ex~cutive
701 Fifth Ave. Suite 3210
Seattle, WA ,98104'
Re:

King County Correctional Facility,
Seattle, Washington

Dear Executive Sims:
I write' to report the findings of the Civil Rights
Division's investigation of conditions at the King County
Correctional Faqility (nKCCF").~ On October 3D, 2006, we
notified you, of our intent to conduct an investigatiQn of KCCP
pursuant to the Civil Rights of Institutionalized Persons Act
("~RIPAIf), 42 U. S. C. § 1997.
As we noted, CRIPA gives the
Department of ,Justice authority to seek a remedy for a pattern or
practice of conduct that violates the constitutional rights of
inmates in adult detention and correctional facilities.
On March 6-8, 2007 and August 1-2, 2007, we conducted onsite inspections at Kecp with expert consultants in cqrrections
and custodial sexual misconduct, medical care and contagious
disease prevention and treatment, and suicide prevention.
We
interviewed security staff, medical staff, administrative staff,
and inmates. Before, duringi and after our visits, we reviewed
an extensive number of documents, including policies and
procedures, incident reports, ,investigative reports, grievances
from inmates, staff personnel files, unit logs, orientation
materials, and staff training materials.
In keeping with our
pledge of transparency and to provide technical assistance where
appropriate, we conveyed ovr preliminary findings to King County
officials at the close of each of our on-site visits.

1
The King County Correctional Facility, also referred to
as the King County Jail, is located at 500 5th Avenue, Seattle,
Washington.

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During our August 2', 2007 exit meeting, and by letter on
August 8, 2007/ we notified King County officials of lifethreatening deficiencies in medical care for certain inmates at
KCCF.
In particular, we indicated that certain inmates were
.
being depriYed of urgent medical attention. On August 10, 2007,
the County responded by indicating that a number of corrective
measures were being implemented to address our concerns.

We comm@nd.the staff at RCCF for their helpful and
professional conduct throughout the course of the investigation.'
We received complete cooperation with our investigation and
appreciate the County's receptiveness to our consultants' on-site
recommendations. It is particularly noteworthy that King County
provided us with unfettered acc@ss to records and personnel, and
responded to all of our requests in a transparent and forthcoming
manner.
We have every reason to believe that the County is
committ@d to remedying all known deficiencies at KCeF,.
Consistent with the statutory requirements of CRIPA, we now
write to advise you of the 'findings of our investigation, the
facts supporting them, and' the minimum remedial 'steps that are
necessary.to address the deficiencies we have identified.
42 § U.S.C. 1997b. As desc~ibed. more fully below, we conclude
that certain conditions. at KCCF violate the constitutional rights
or inmates. In particular, we find that inmates confined at KCCF
are not adequately protected. from harm, including physical.harm
and custodial sexual misconduct.
In addition, we find that
inmates are not adequately protected from self harm.
Finally, we
find that inmates do not receive adequate m@dical care.

t.

BACKGROUND

KCCF serves King County, including inmates from the City of
Seattle. The facility houses both pre-trial inmates and inmates
serving sentences of up to one year.
The facility opened in 1986
and has a capacity of 1,700. The average daily population 'for
January 2007 was 1,368, with a high count of 1,443 and a low
count of 1,298. KCCF is currently undergoing rolling
renovations, with one floor closed at a time. Security functions
at KCCP. are administered by the King County Department of Ad~lt
and Juvenile Detention (~DAJD"). Health care services at KCCF
are provided by Jail Health Services (~JRsn), a division of
Public Health Seattle-King County, the County's public health
department.

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CRIPA gives the

LEGAL STANDARDS

Attor~ey

General authority to seek

~njunctive relief when a jurisdiction violates the constitutional

rights of inmates. See 42 u.s.c. § 1997; U.S. Canst. amend.
In defining the scope of jail inmates' Eighth and
Fourteenth Amendmen~ rights, the Supreme Court has held that
corrections officials must take reasonable, steps to guarantee
inmates' safety and 'provide ~humane conditions" of confinement.
Farmer v. Brennan, 511 U.S. 825, 832 (1994); Bell v. Wolfi~, 441
U.S. 5~O' (1979) (holding pre-trial detainees protected by
Fourteenth Amendment); Hydrick v. Hunter, - F.3d -/ 2007 WL
2445998 (9th Cir. 2007) (stating right to reasonably safe
conditions clearly established for prisoners and civilly
committed persons); Hoptowit v. Ray, 682 F.2d 1237, 1250 (~h
Cir. 1982)., Providing ~humane conditions" requires that a
corrections system must 'satisfy inmates' basic needs, such as
their need for safety, medical care, food, clothing, and shelter.
~
Additionally, jail officials have a duty to take reasonable
steps to protect inmates from physical abuse and the use of
'
excessive force. ~ Hydri~, 2007 WL 2445998, at *15; Hoptowit,
682 F.2d at 1250.

VIII, XIV.

The duty to protect inmates from physical abuse includes'
protecting inmates from custodial sexual 'abuse. Schwenk v~
Hartford, 204 F. 3d 1187, 1197-98 (9th Cir. 2000) (the Eighth
Amendment right of prisoners to be free from sexual abuse has
been unquestionably and clearly eS'tablished.). "'Rape, coerced
sodomy, unsolicited touching of women prisoners' vaginas, breasts
pnd buttocks by prison employees are simply not part of the
penalty ~hat criminal Offenders pay for their offensea against
society.'" Sohwenk, 204 F.3d, at 1197, quoting Women Prisoners
of the Diet. of Columbia DePt. of Correctio~, 877 F. Supp. 634,
665 (D.D.C. 1994).
The federal cQurts have also held that the right to "humane
conditions" includes a right to adequate medical care. Hoptowit
at 1255 (citing Estelle v. Gamble, 429 U.S. 97, 104 (1976)
(quoting Gregg v. Georgia, 428 U.S. 153, 182-83 (1976». Under
the Supreme Court's standard for relief, a jurisdiction fails to
meet constitutional requirements if local Officials exhibit
udeliberate indifference" to inmates' serious medical needs. The
standard for relief has three components;
(1) subjective
knowledge of the risk of serious harm; (2) disregard of that
risk; and (3) conduct that is more than mere negligence. Farm~,
511 U.S. at 834. The Supreme Cou~t has said that "prison
officials show deliberate indifference to serious medical needs
, if ,prisoners are unable to make their medical problems known to

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the medical staff." Estelle, 429 U.S. at 103-04. The Ninth
Circuit has stated that deliberate indiffe~ence may appear "when
prison officials deny, delay, or intentionally interfere with
medical treatment, or it may be shown by the way in which prison
physicians provide medical care. Jett v. Penner, 439 F.3d 1091,
1096 (9th Cir. 2006). Moreover, the Ninth Circuit has explained
that the "medical staff must be competent to deal with priso~ers'
problems." Gibson ¥; County of Washoe, 290 F.3d 1175, 1187 (9th
Cir. 2002), (quoting HoptQwit, 682 F.2d at 1252-55) (internal
quotation marks omitted). The prison must provide "adequate
facilities and staff to handle emergencies within the prison_If
Id.
Corrections officials may be constitutionally liable when
they "know or should know of a particular vulnerability [of an
inmate]," such as an inmate in severe emotional _distress, and
fail to protect the inmate· from that vulnerability. Redman v.
County of San Diego, 942 F.2d 1435, 1443 (9th Cir; 1991) (citing
Colburn Vo Upper Darby Township, 838 F.2d 663, 669 (9th Cir.
- 1988). The pri$on mu-st·provide "adequate facilities and staff to
handle. emergencies.within the prison. H Hoptowit, 682 F.2d at
1252-55.
Further, tbese requirements apply to mental health
care.
Id.- Delay in providing hospitalization to a prisoner in
need of immediate psychiatric.care constitutes deliberate
indifference. Gibson v. county of Washoe, Ne~, 290 F.3d 1175,
1190-91 (9th Cir. 2002), cert.· denied, 537 U.S. 1106. Finally,
prison officials have an obligation to act when there is a strong
likelihood that an inmate will engage in self-injurious behavior,
including suicide. ~ Funtanilla v. Rubles, 5 Fed. Appx. 590
(9th Cir. 2001).
.III.

FINDINGS

We find that KCCF fails to adequately protecD inmates from
harm and serious risk of harm by staff, fails to adequately
protect inmates from self-harm, and fails to provide inmates with
adequate medical care.
A.

INADEQUATE PROTECTION FROM HARH

Corrections officials must take reasonable steps to
guarantee inmates' safety and provide "humane conditions" of
confinement.
Providing "humane conditions" requires that a
corrections system must satisfy inmates' basic needs, such as
their need for safety. Additionally, jail officials have a duty
to take reasonable steps ·to protect inmates from physical abuse.

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- 5 To ensure reasonably safe conditions, officials must take
measures to prevent the use of unnecessary and inappropriate
force by staff. In addition, officials must provide adequate
systems to investigate staff misconduct, including alleged
physical and sexual abuse of inmates. For the reasons set forth
below, KeeF fails in both these regards.

1.

Unnecessary and Inappropriate Uses of Force

A determination of whether force is u~ed appropriately
requires an evaluation ot the 'need for the use of, force, the
relationship between that need and the amount of forced used, the
se~iousness of the threat reasonably believed to" exist, and
efforts made to temper the severity of a forceful response.
Hudson v. McMillian, 503 U.S. 1, 7 (1992). Generally accepted
corrections practices provide that appropriate uses of force in a
given circumstance should include a continuum of interventions,
and the amount of force used should not be disproportionate to
the threat posed by the inmate. Lesser forms of intervention,
such as issuing disciplinary infractions or passive escorts,
should be used or considered prior to more serious and forceful
interventions.
Inmates at KCCP'are routinely subject~d to unnecessary uses
of serious force.
Staff at KCCF are quick to resort to-serious
physical force or pepper spray, even when the inmate is passive
or poses no immediate security threat.
In addition, inmates are
pepper sprayed often, despite being confined in mechanical
res~raints, making the use of pepper spray unnecessary.
Als9,
staff use pepper spray on inmates even when several staff are
present and could gain control of the inmate using far less
severe methods. Further, there is little evidence that staff
employ a continuum of interventions when faced ~ith a resistant
inmate.
We also found the frequent and routine use of a technique
known as the "hair-hold technique."
specifically, the hair-hold
technique, involves grabbing and pulling the inmate's hair in
order to direct the inmate's movement, or otherwise obtain
compliance. According to our corrections consultant, the hairhold technique is a highly painful and degrading technique that
carries a high risk of injury when compared to equally effective
control techniques commonly taught in 'self-defense training
courses at correctional academies. It is an especially dangerous
tactic when utilized as a takedown technique on a handcuffed
inmate who is unable to break his/her fall to the ground.

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- 6 The following examples of unnecessary and inappropriate USes
of force are taken from KCCF's incident reports;

•

On January 23, 2007, a restrained female inmate in the
Intake Release Unit ("ITR") was "angry and uncooperative as
soon .as she arrived at the facility." Staff used hair-hold
and counter joint techniques "to restrain her against the
counter" although nothing in the use. of force report
provided justification for use of the hair-hold technique.
Thereafter, staff applied pepper spray on the inmate while
she was in a fetal position and posing
threat to the
staff. Accordingly,· the use·of force in this incident was
both excessive and unneoessary.

no

•

On January 10, 2007, a female inmate in·the ITR was being
"verbally abusive," threw her clothes on the floor, and tlien
picked them up and threw them at staff. Staff grabbed her
by the hair and "Spun" her to the floor, at which time th~
inmate sustained a head injury (bleeding ear). The hairhold technique was excessive and disproportionate to the
nature of the threat po~~d by the inmate.

•

On October 16, 2006, a female inmate in the ITR who was to
be housed on the psychiatric floor for suicidal statements
refused to "pick up her underwear and put them in a bag."
security staff applied a ·hair-hold on the inmate in order to
gain compliance. The hair-hold technique was an extreme and
unnecessary use of force given the nature of the inmate
misconduct.

•

On September 11, 2006, a female inmate showing signs of
mental diatress was being escorted to .the mental health unit
on the seventh floor.
She was placed in a wheelchair with
both waist and leg restraints. As she was wheeled from the
elevator to seven North, she "continued to yell, scream, and
tried to stand up out of the wheelchair.» Staff used hai~­
holds "to keep her in her wheelchair until [they] got to
seven North." The use of the hair-hold technique against an
inmate in arm and leg mechanical restraint·s is inexplicable.

•

On September 9, 2006, an inmate who is developmentally
disabled was observed having a seizure on the seventh floor.
When staff arrived, the inmate appeared "disoriented.» He
was moved to a cell for psychiatrio care. The inmate was in
an "agitated" state when he was subjected to pepper foam,
which had "little or no effect.# He was·then re-handcuffed·

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with a hobble cord. There is no explanation for why pepper
spray was justified against a,disabl@d inmate who was in
medical and mental distress.
Effective measures to prevent excessive and inappropriate
uses of force include adequate staff training, and adequate, use
of force polici@s and procedures. KeeF fails to provide adequate
use of force training for staff and relies upon inadequate and
outdated policies and procedures.
.
a.

Inadequate Staff Training

CQmprehensive annual staff training in appropriate use of
force techniques is an essential element of a jail's required
in-service training. However, training personnel at KCCF
conceded that there is currently no in-service training of staff
in use of defensive tactics. In addition, as described below,
the remainder
the use of force curriculum is.inadequate. This
lack of t~ainin9 contributes to the prevalence of inappropriate
uses of force at KCCF, and creates a significant danger of
inmates being unnecessarily subjected to se~ious bodily harm and
even death.
.

of

b.

Inadequate'Policies and Procedures

Adequate policies and procedures regarding proper use of
force are essential to ensuring that inmates ar~ not
unnecessarily injured by security staff. The policies should be
comprehensive and clear; and should reflect currently accepted
practices. Keep's policies and procedures are lacking on all
three counts.
As of the time of 'our March 2007 corrections tour, KCCF was
operating with outdated USe of force policies and procedures.
The basic policy is undated and contains numerous handwritten
interlineations. Moreover, it includes unauthorized control
tactics such as the choke hold and carotid sleeper hold, however,
both of these control holds have handwritten annotations
prohibiting their use. The policy is devoid of guidance on the
use of chemical agents such as pepper spray, which is routinely
use~ by security staff at the facility.
The policy contains no
guidance on the use of non-lethal weaponry on restrained inmates.
Further, the policy contains no guidance or reference to a
continuum of force o~interventions.
We were provided with a copy of a single-page chart entitled
"Use of Force Continuum" that simply lists response tactics
equated with resistance levels. The continuum contains responses

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that are either no longer authorized or may be unlawful.
In a
stark departure from generally accepted corrections practice l the
continuum authorizes ~lethal force" as a response to "active
aggr~vated aggressive u but fails to define "active aggravated
aggressive." This lack of definition causes a serious danger
that lethal force may be used without adequate justification.
Moreover., we reviewed a document that claSSified two incidents as
an "aggra~ated aggressive," where neither of the pre~ented
circumstances would have justified the use of lethal forc~.

2.

Inadequate Systems to Investigate Staff Misconduct
(Physical and Sexual Abuse)

The number and nature of allegations involving custodial
sexual misconduct at KCCF are generating an abnormally high
number of Internal Investigations Unit ("IIUU ) investigations. A
review of lID's report on "Internal Investigations 2006-Current"
indicates in excess of twenty-five investigations related to
allegations of staff misconduct of a sexual .nature. A number of
these investigations remain open, while others have been closed
with ftundetermined H or "non-sustained" findings and "no
discipline due to timeliness." However, sust~ined investigations
,or incidents resulting in suspensions, terminations, and criminal
charges since at least 2002 reflect a pattern of sex-related
staff misconduct 'by an alarming number of security staff. 3
To ensure reasonably safe conditions'for inmates,
facilities must develop and maintain adequate
systems to investigate staff misconduct, including alleged
physical and sexual abuse by staff. Essential elements of an
internal investigation system 'incl~des a comprehensive
investigation procedures manual, and adequately trained
investigators to implement the investigations process. ·KCCF is
lacking in both of these essential elements.
co~rectional

a.

Lack of Investigative Policies and

P~ocedures

Generally accepted correctional practices require clear and
comprehensive policies and procedures governing the investigation
of staff use of force and misconduct. Adequate policies and
procedures include, at a minimum, screening of all use of force

2
Three former KCCF staff have recently been convicted of
crimes relating to custodial sexual misconduct, including Harland
Richmond (second-degree sexual misconduct), Cedric McGrew
(second-degree custodial sexual misconduct and third-deg~ee
assault)j and Loui5 G. Laurencio (custodial sexual misconduct)",

,,
)
.:;
>
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incident reports, specific criteria for initiating.investigations_
based upon the incident report screening, specific criteria for
initiating investigations based upon allegations from any source,
timelines for the completion of internal investigations, and an
organized structure and format for recording and maintaining
information in the investigatory file.
As of the time of our March 2087 corrections tour, KCCF had
no policy for conducting investigations. The IIU is guided by a
regulation of the General Policy Manual, Section 3.01.000. This
regulation p~ovides only that the IIU ~establish methods and
procedures to investigate complainta. u However, there was no
formal investigato~y methods and procedures manual.
'--

b.

Lack of Training in Investigatory Techniques
and Procedure.s

Adequate internal investigation systems require
investigators to receive appropriate training in investigatory
processes, techniques, and procedures. While we found the rIU
staff to be committed and professional, we determined that the
IIU leadership and staff lacked any formalized t~aining
requirement or· process.
For example, the IIU commander has
substantial experience as a correctional administrator, . but lacks
any prior experience, expertise, or training in managing and
conducting internal cqrrectional investigations,
Similarly, the
lIU sergeants are not required to complete formal investigative.
training priqr to or during their assignment to the unit.

*

*

As a result of these failures, there are serious operational
deficiencies in KCCF's internal investigations.
Investigations
are inadequate,. poorly documented, and often disorganized. For
example:
•

Case Number OGOS-018 - Reported Sexual Assault
The IIU case file indicates that a female inmate purportedly
submitted a four-page grievance to staff alleging that she
was sexually assaulted on October 26, 2005. The inmate also
supplemented the grievance the following day.
IIU staff
could not locate either the grievance or the' supplement, and
closed the case as non-sustained. There is no evidence that
staff conducted appropriate follow-up or contacted the
inmate to discuss her complaint.

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•

Cas@ Number 0612-008 - Sexually Explicit Behavior
A KCCF captain was accused of engaging in sexually explicit
behavior while on the job in the presence of another captain
and a female sergeant. The captain has acknowledged that he
did indeed simulate a sexual gesture in the presence of the
two staff. This same captain, on three prior occasiona,
between January 2005 and October 2006, has been counseled
for inappropriate workplace behavior. He was promoted to
captain in June 2006 after having been assigned as an rIU
investigator from approximately 2003 through ~anuary 2006.
It is noteworthy that this commander/supervisor, who himael·f
was recently in charge of conducting investigations of staff
sexual misconduct, has been allowed to develop a chronic
record of workplace misconduct while being promoted to
positions of greater authority at KCCF.

•

Case Number 0610-015 - Excessive Use of Force
On September 23, 2006 a nurse in the ITR believed she had
witnessed excessive force when she observed' staff ~slamming
[anJ inmate's head on the counter, holding the inmate on the
floor with his knee/foot, and yelling at the inmate.
She
further alleged that the staff's supervisor took no action
to intervene in the incident. The nurse contacted the ITR
shift commander to report the incident. The commander
.advised her to report the matter to the ITR sergeant, who
was the very supervisor the nurse had claimed failed to
intervene in the incident_ The shift commander, in a memo
entitled "Preliminary Investigation," in effect exonerated
both the sergeant and staff based on his general discussion,
rife with his personal opinions, of the difficulty in
dealing with inmates during the intake process. The memo
did not in any fashion address the actual substantive
evidence related to the incident notwithstanding that the
staff acknowledged in his report, among 9ther things, that
during the use of force incident, he held the inmate by the
ear and told him he was going to "rip his ear off. d
The IIU
investigator entered a finding of "non-sustained,u
not~ithstanding the nurse's initial detailed observations of
the incident. The investigator did note that a letter of
corrective counseling "may be in·order" for the staff's
threatening remark. However, there was no record of the
staff having received any form of disciplinary action.
N

,

"

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•

Case Number 0612-005 - Unnecessary"US@ of Force
handcuffed behind his back, was under escort by
two staff when a verbal exchange occurred regarding escort
procedures. The inmate was returned to his cell and was
asked to get on his knees for the handcuffs-to be removed.
He refused and was taken to the floor. While the inmate was
handcuffed and on the floor, staff administered two
applications of pepper spray _because h@ was "refusing to
coope:r:ate."
According to a grievance filed by the inmate,
he was "slammed" to t~e ground while handcuffed, hitting his
head on the "metal side of [his] bed." He was then
subjected to pepper spray while another staff member held
him by the neck. The investigation conclud@d that the
allegation of unn@c@ssary force was "unfounded." Nothing in
the case file indicated ari assessment of why it was
necessary to utilize the chemical agent on a handcuffed
inmate who had been taken to the ground with no fewer than
four staff present.
In addition, there is no indication
that the involved staff were recommended for remedial or
corrective training in escort procedures and available
options.

An inmate,

In addition, some incidents that merit an investigation are
never investigated. Our review of a sample of incident reports
revealed that none "of the following incidents were inves~igated
by IIU or even questioned"by supervisors:
•

On "January 22, 2007, a handcuffed inmate was not cooperative
during an escort. The inmate was ~placed" against the wall
and then taken to the floor, at which time security staff
applied pepper spray. Staff then placed his head under the
bunk, ostensibly ~to facilitate a safer way to take the
handcuffs off." The inmate sustained a nose injury, a
swollen cheek, and an eye-laceration that required
hospitalization for sutures.
The number and nature of the
injuries sustained by a handcuffed inmate clearly merited
some level of investigative inquiry_
"

•

On January 1, 2007, an into~icated inmate was being moved
"from a holding cell in the ITR when he ~raised a sandai in
the direction of staff." He was restrained and ~pinnedn
against the cell wall. Pepper spray was utilized with
~little ef~ect." The inmate was then handcuffed by
utilizing "wrist locks and hair-holds," While on the floor
in handcuffs, another burst of pepper spray was
administered_ The inmate sustained multiple head
contusions, including an injUry to his eye.
In reviewing

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the matter, a supervisor commented that staff "were unaware
of how the injuries occurred because .they Uwere" focused on
getting him processed into clean clothing and did not notice
the facial contusions." Unexplained multiple head injuries
and the use of a chemical agent on a fully restrained inmate"
in the control and presence of a supervisor with no less
than five staff present, merits some level of investigative
inquiry.
•

An inmate alleged that,

on November 7, 2006 in the ITR,
security staff placed his boot on the head and neck of the
inmate. Nursing staff "noted some swelling to the left side
of the face and contusions to the bac~ of the head." The
incident report failed to explain the injuries.
This
incident came to the attention of a supervisor only when .
nursing staff notified a sergeant of the allegations and
injuries.
Indeed, contrary to generally accepted practice~,
the security staff did not promptly report the use of torce,
but instead provided
report two days after nursing staff
notified the supervisor.

a

B.

INADEQUATE PROTECTJ:ON FROM SELF HARM

Corrections officials have the obligation" to protect "
vulnerable inmates from harm, such as those who are at risk of
suicide.· Three ,inmates committed suicide in the "past three years
under circumstances that indicate that XCCF faile: to take
reasonable "measures to prevent and manage these risks. An
adequate "suicide prevention program requires that. all staff be
adequately trained and be aotive participants in executing a
comprehensive 'plan.
.
~

.L'ack of Training in Suicide Prevention Measures

Correctional' facilities must provide "adequate suicide
prevention training to staff to ensure the safety of all inmates.
Pre-service "and annual in-service training requirements should be
clearly set forth in the relevant policy and should include an
array of topics to ensure that staff are able to recognize the
verbal and behavioral signs that indicate a suicide risk, what,to
do when such a risk is suspected, and how to respond when there
is a suiCide attempt.
Successful suicide prevention is a
collaborative· process among all staff; however, training is
particularly critical for security staff because they are often
the only staff available 24 hours per day" and have regular
contact with inmates. ·Because KCCF policy fails to specify

I

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adequate suicide prevention training requirements, and the
facility fails to provide adequate hours of training, suicide
prevention training at KCCF falls far below generally accepted
correct~onal practices.
First, pre-service and in-service training requirements are
not clearly set forth in DAJD or JHS policies.- For example,
during our March 2007 suicide prevention tour, DAJD Policy
7.02.006 (Suicide Prevention an~ Psychiatric Procedures) required
only that ,"all staff that have regular contact with inmates ShAll
be trained in the identification'and management of suicidal
inmates
-offi'cers rec'eive on-lirietraining each year related
to suicide prevention. u JHS Policy (Suicide Prevention Program)
requires "training for staff members who work with inmates."
'
,These statements are too general to be useful. F~~ example, they,
do not state how many hours of pre-service and in-service
training staff are required to complete.
'w

•

•

Second, KCCF does not provide significant training hours,
and the training that is provided is cursory at best.
Specifically, training for new staff is limited to three hours
during a four-week training program provided at ,the Washington
State Trainin9 Academy, and only one hour completed during the
ll-day New Employee "Training Program prOVided by KeeF. As for
existing staff; training on suicide prevention is even more
limited, consisting of a one-hour computer course of 25
PowerPoint' slides and a ru~imentary true/false test of ten
queBtionB~ , The course refers ,to DAJD's suicide prevention
policy, but'merely advises 'employees to review it. Monthly
workshops offered by JHS have included topics concerning suicide;
howe~er the workshops are on~y Offered to security B~aff assigned
to the mental health housing units 'and participation is riot
required by policy.
-,

Four hours of suiCide prevention training for new staff and
one hour of annual training for existing gtaff are grossly
inadequate. Moreov@r, the one-hour computer course observed by
our consultant does not ensure that staff are adequately t~ained
on this criticffl topic. ~uicide prevention is a collaborative
proces's. ,If all staff are not adequately trained on how to
prevent and manage suicides, they will be unable to identify the
risks and respond appropriately.
2~

Lack of Adequate supervision of Suicidal Inmates

correctional facilities must prot@ct inmates from suicide by
providing adequate supervision. When an inmate attempts suicide,
his or,her life depends on the time it takes for staff to learn

0:S

1

~

"
"

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of the event and respond to it. The promptness o£ staff's
response to a suicide attempt is often driven by the level of
supervision.
KCCF, inmates who h~ve been identified as suicidal and'who
are placed on suicide precautions are purportedly observed every
fifteen 'minutes~ However, in addition to ,the ~5-minute'
obserVation'usually performed' by security staff, suicidal inmates
must alao be assessed daily by a mental health professional.
'Currently, KeeF'mental health 'staff only assess inmates once per
week, which falls ,far short of generally accepted correctional
.practice~L
Moreov-er, @ach assessment is only five' to ten mj.nutes
in length. This is not adequate time to evaluate the inmate's
status to properly determine whether he or she should remain on
suicid@ pr@cautions. Thus, mental health staff may overlook an
inmate whose status is in rapid decline. On the other hand, it
is also critical for mental health staff to identify those
,
inmates who are no longer in need of being ,on suicide precautions,
because the restrictive 'environment can quickly become antitherapeutic.
Five to ten minutes, once per week, is not adequate
to make this determination.
C.

:INADHQ'D'ATR MEDICAL CARE

Jail officials are responsible for providing adequate
medical ca~eto inmates. Moreover, a jail may ~ot deny or
int@nt~onally interfere with medical treatment.
A delay in
providing medical treatment may be so significant that it amounts
to a deni~l of tre~tment. Our investigation revealed' that "
medical care' provided at KCCF falls below the constitutionally
required standards of care. W@ found the following serious
defic,iencies":
(1) inadequate assessment of acute conditions;
(2) inadequate treatment of chronic conditions; (3) inadequate
emergency care; '(4) inadequate medication management; (5)
inadequate prevention and treatment of communicable diseases,
particularly skin'infections 'and MRSA; and (6) inadequate intake
screening.
1.

":Inadequate Assessment of Acute Conditions

Jail officials are required to adequately assess inmates so
that jail officials can provide appropriate and timely treatment.
Keep fails to provide adequate assessments, which has resulted
in serious delays in treatment for inmates who require urgent
medical attention. Delays, and outright denials, can cause'
urtnecessary pain, suffering, and morbidity in 'inmates, and ,can
contribute to the unnecessary transmission of illness.

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- 15 The most egregious example of KeeF's systematic failure to
adequately assess and treat inmates ~- and the grave harm that
can ~e5ult -- is a recent inmate death t which we found was likely
preventabl·e. The inmate had a history of alcohol withdrawal
seizures and active skin infection'on his legs and buttocks. The
day he was admitted to the jail, he was sent to the emergency
room at,Harbo~iew Medical Center. There, he was diagnosed with
multiple abscesses, profound anemia and either cellulitis (a
potentially serious bacterial infection) or deep yein thrombosis.
Although the hospital arguably should have admitted him, it did
not do'so.
Upon his return to'KCCF, the inmate was not 'seen by a
physic~an, even though he should have been.
Instead, he was
forced to wait more than 30 hours to receive his first dose of
the antibiotic that had been prescribed for his skin infection,
When the inmate requested care and was finally examined by a KeCF
physician, he had a tender abdomen with questionable bowel
sounds, highly abnormal and unstable vital signs, and a very low
oxygen saturation. Even after observing this, the KCCF physician
failed to send the inmate back to the hospital. Early in the
morning on his third day back at KCCF 1 the inmate developeq
severe abdominal pain, was sweating and doubled over, and had a
tender ~bdomen. Nonetheless, he was' forced to wait for seven
hours before he was examined by a physician, whO ultimately sent
him to the hospital.
The inmate died at the·hospital, apparently
of a peiforated'gastric ulcer. KeeF's inadequate diagnosis and
inordinate delays in providing treatment likely contributed to
this inmate's' death.
Under KCCF's current health care system, inmates who request
or present for· medical attention are prioritized by using .the
designations Pl through P4. These priority designations are
designed to represent a need for follow-up care within one day,
three days, dne week, and four weeks, respectively. Due· to
yerceived staffing and resource shortages, however, KeeF'a
current ~±ce--tifcoo.eny follow-up scheduling and treatment to
any inmate classified as P3 or P4.
Instead, inmates classified
as P3 or P4'are expected to re-request medical care if their 3
conditions·do not improve in one or three weeks, respectively.
As we explained in our August 8/ 2007 emergency letter regarding
an inmate whom we encountered during our August tour, we found
that miaclaasification of inmates as a P3 or P4 has had

Medical staff routinely do not record P3 or P4
designations because inmates classified as such are not being
seen. AccordinglYI an unknown and undocumented number of
additional inmates have informally been determined to fall under
this category.

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life-threatening consequences. Specifically, one day prior to
our tour, the inmate presented to a KeeF physician with shortness
of breath and a lump in his neck. The physician classified him
as P3 and sent him back to general population without orders for
referral or any follow-up. However, a physical exam by our
consultants revealed that the inmate required urgent evaluatio~
at an acute care hospital to rule out the risk of sudden death
from obstruction of his trachea. The physician's failure to
adequately a~sess the inmate falls far below generally accepted
standards of correctional health care and placed the inmate's
li.fe in· j.eopa:rdy.·
.
In reviewing the medical records of seven inmates who had
been classified as P3 or P4 we found that six had been
misclassified. The following inmates required prompt medical
attention and should have been designated as PI or P2 so .that
they. would receive follow-up care aocordingly:
j

•

An inmate with a skin infection had been treated·with three

failed courses of antibiotics and never received a wound
. ,culture.
•.

An·inmate· on ·medications for a pituitary tumor had no
evaluation medication, or lab teats.
j

•

An inmate' had bladder symptoms related either to a sexually

transmitted infection or acute prostate disease who should
have had·· an evaluation and treatment but did not receive
them ..
•

(elev~ted heart· rate)
for fou~ days. Notably, this inmate had seen nursing staff,
who did not provide for immediate access to a physician. By
the t·ime a physician finally examined the inmate, the
inmate's medical problems. had exacerbated significantly, and
he was complaining of serious urinary symptoms. Rather than
working him up to finding a diagnosis, the physician coded
the inmate for no further follow-up. These symptoms could
indicate a potentially life-threatening condition such as
alcohOl withdrawal or shock, and should not have been

An inmate had a sustained tachycardia

j

igriored~

4
By letter dated August 10, 2007; the County responded
to our emergency letter and stated that it was "taking imrnedia~e
steps" to. address the deficiencies.we identified.

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2.

Inadequate Treatment of Chronic Conditions

KeeF .fails to provide adequate treatment to inmates with
chronic conditions or diseases that require monitoring and
follow-up medical' care. This failure place~ inmates who are
already p~ysically and/or ·mentally ill at risk of even greater·
sUffering and harm.
Specifically, in examining a sampling of medical records of
inmates who have chronic conditions and/or are'on certain
medications, we found the following serious deficiencies:
•

,We reviewed the records of 20 inmates who were on lithium,
Dilantin, or valproic acid.
(The first is commonly used in
the treatment of bipolar disorder and the latter ·two are
anti-seizure medica~ions.) These three medications have
very narrow therapeutic indexes; if an inmate is given too
little, the medication will be ineffective, but if the
inmate is given too much, he or she will experience
substantial detrimental effects.
It is absolutely critical
that patients' blood levels are monitored to ensure that
there are appropriate levels of the medication.
Accordingly, laboratory,measurement of the levels of these
medications in a patient's blood is a nationally accepted
staridard of care. Only six of the twenty inmates Whose'
records we reviewed had their levels checked and documented
in the record.
Some ,of the records contained no·ordera for
such checks, and othe~s contained orders that nurses had
failed to pick up.

•

Similarly, we reviewed the reco~ds of the six inmates at the
facility who are on coumadin, a blood-thinner prescribed for
those at high risk·for a blood clot and for some heart
conditions. Like the medications discussed above, coumadin
has a· very narrow therapeutic index. Accordingly, frequent
measurement of the blood-clotting ability of inmates taking
it is critical. We found that one of the inmates on
coumadin was not being monitored appropriately/ p~tting him
at risk for a potentially life-threatening blood clot or a
hemorrhage.

•

We reviewed the records of nine inmates on antipsychotic
medications. Inmates on antipsychotic medications should
have documented screening for abnormal involuntary movements
and for metabolic syndrome, a forerunner to diabetes. Not
one of the files contained documentation indicating that the
inmates had been screened for either of these potentially
dangerous side effects.

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•

In reviewing the records of nine diabetic, inmates who had
been at KCCF for more than a month, we looked for seven
nationally accepted interventions. s There is substantial
evidence that selective interventions with diabetics will
prevent organ failure such as blindness, stroke, heart
disease, kidney disease, and peripheral vascular disease.
Review of the inmates' files revealed that KCCF does not
adequately monitor these inmates through chronic care visits
or consistently screen them for'the conditions that they are
at risk of developing. 6
.

•

We·reviewed the treatment of 14 inmates with moderate or
severe asthma, as determined by their medications. Chronic.
follow-up care and regular monitoring of peak expiratory
flow (a test that measures how well the airways are working)
are critical in the proper care of asthmatics. Only five
had been seen for Chronic care within the past three months
and only three had 'any measurement of their peak expiratory
flow.

.

3.

,

Inadequate Emergency Care

KCCFfails to'provide adequate emergency care to inmates,
putting them at risk of grave harm. We observed a life- .
threatening example of this during our first tour, when we
encountered a female inmate who was known by KCCF staff to be
depressed 'and suicidal.' While we were on her housing' unit, the
inmate 'swallowed multiple medications. Disturbingly, despite the
1.lll:folding emergency,. security staff. did not call 'for medical help
fQr a crucial eight minutes after the inmate had swallowed the
medicat10ns. A nurse did not arrive at the housing unit with the
crash cart for a total of 15 minutes after the incident. And, it
took
total of'25 minutes for EMS to arrive. Further
compounding this situatiori~ this suicidal inmate did not speak

a

5
These interventions are: measurement of sugar levels
upon intake, measurement of urinary microalbumin, dilated
examination of the retina, cholesterol measurement, measurement
of Alc hemoglobin, chronic care visit with physician, and aspirin
therapy.

6
For example, not .one of the inmates had had a
measurement of ·his or her urinary microalbumin or a dilated
examination 6£ the retina: Only one had had a cholesterol
measurement, only two had had their Alc hemoglobin measured, only
three had had a chronic care visit at all, and only four were on
aspirin.

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English.
The mental health staff who prescribed medication fo~
her had done so without the use of a translator,' even though one
was reportedly available by telephone.?
In observing this incident, we learned of some unwritten
"policies" that, according to security staff, must be followed
before a medical nurse may respond to an emergency cal~. Firat,
a psychiatric nurse must evaluate the inmate,. even if the inmate
is experiencing clearly life-threatening physical symptoms, like
crushing ,chest pain or hemorrhaging. Second, the page system
must be used, even if it would be much faster to summon the nurse
from an 'adjacent medical office or 'housing unit.
These
~policie8n favor process over provision of critical care of
inmates whose lives ,are at risk.
Moreover, although correctional facilities typically keep
logs of inmates they send, to hospital emergency rooms, KCCF lacks
such logs, making it difficult to ascertain the full extent of
the KCCF's,deficiencies in this area. We were able to ,review
care for 11 inmates who were sent to the emergencY,room, however,
and found that one of them was forced to wai~ two days to see
Kcep's in~house physician for an infection before finally
receivi~g treatment in the emergency room.' This inmate's trip to
the emergency room may have been prevented altogether if Keep had
provided the inmate with timely care.

4.·

Inadequate Medication Administration and Managament

We 'found numerous systematic problems with medication
administration and management. Kcep places inmates at risk of
grave harm through significant delays and lapses' in providing
critical medications to inmates and the practice of giving nurses
"standing ~ordersn to admi~ister antibiotics for skin infections.
First, 'orders for diagnostic tests and medications are
picked up by nursing staff on an inconsistent basis. The failure
to perform this important task regularly results in significant
delays and lapses in providing critical medications to inmates~
For example:

•

An HIV-positive inmate who had an abscess was forced to wait
26 days for his first dose of antibiotics and medications

for HIV.

7
Sinc~ our first tour, DAJD and JHS staff have made
increasing use of telephonic translation services.

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•

An inmate was admitted to the jail on linezolid, a

medication for drug-resistant staph skin infections. Once
at KeCp, he received only one of his six prescribed doses,
putting him at risk of a more serious infection and further
drug resistance.

•

An inmate ~ad a persistent skin infection because of a

•

An inmate who arrived at intake with infectious skin lesions

ten~day lag between the day he was prescribed an antibiotic
and the day he received his first dose.

did not get the necessary antibiotic treatment until his
fourth day·at KCCF/ by which time he had developed
cellulitis.
(Cellulitis is potentially serious bacterial
infection/ which left untreated, may 'turn into a lifethreatening condition.)
Moreover, KCCF nurses haYe standing o~ders to administer
antibiotics to inmates with skin infections. Standing orders for
prescription drugs are beyond the scope of nurses' licenses. The
only acceptable standing orders are for over-th~-counter
medications., vaccines, standard treatment for
sexually-transmitted infections, and emergency medications.
KCCF's standing orders for·antibiotics puts inmates at risk of
harm.
5.

Inadequate Prevention. and Treatment of Communicable
Diseases

Prevention and treatment o"f communicable diseases is
particularly critical in places where individuals live in
confined. quarters, such as jails. Skin 1nfections among inmates/
including methicillin-resistant staphylococcus aureus (1'MRSA H ) / a
potentially dangerous drug-resistant bacteria that can cause
serious systemic illness, 'permanent disfigurement, and death, is
rising across the United States. Transmission among inmates and
staff· can be·prevented through attention to laundry and personal
hygiene, as well as environmental cleaning. We found serious
deficiencies in these critical areas at KCCP. Moreover, we found
that KCCF fails to provide adequate treatment for inmates with
akin infections,· which places the infected inmate, other inmates,
and staff; all at risk of harm.

TO prevent the transmission of infection, jails must ensure
that inmates are able to maintain proper hygiene and that
inmates' living qua~ter8 are kept reasonably clean. Laundry is
also an important component.
Inmates should have access to clean
underwear and regular changes of un~£orm. KeCF, however, fails

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t·o launder inmates' underwear at all, thereby increasing the risk
of infection transmission. Inmates informed us that the only way
.to obtain clean underwear is to purchase it from the commissary
or to wash. it themselves in the cell area using their hand/shower
soap. Inmates further· informed us that even when they do wash
their own underwear, they are prohibited from hanging it to dry
in the cell area. B Moreover, the jail provides only one uniform
per week. These deficiencies greatly increase the risk of
intramural transmission of skin infections.
Surface disinfection is a also critical to the prevention·of
skin infections. We learned that, while moat of t~e cracked
mattresses we foUnd on our first tour had been replaced, and the
mattresses used in the jail are cleaned· with quaternary ammonium
disinfectant, this disinfectant is not being used prope~ly.
Quaternary ammonium disinfectant should have ten minutes of
contact time with a mattress surface before it is wiped dry.
Currently, the disinfectant is being wiped dry nearly immediately
,after it is sprayed, which likely makes it ineffective ~t killing
bacteria and viruaes.
.
Moreover, Keep fails to provide adequate treatment· to
inmates with skin infections, Not only does inadequate' treatment.
place the inmate at risk of harm, but it also increases the risk
of transmission to· other inmates and staff. 9 For example, prior
to our investigation, in January 2004, a 40-year-old inmate who
had been held at the Jail for about 20 days died from a
combinat~on of· flesh-eating disease and MRSA, which was linked to
chronic inject~bn drug abuse. The inmate's wound purportedly had
spread to 10 inches and was leaking fluid for.two days before he
received medical attention. 10 Staff have expressed concern over

B
We certainly appreciate that thiS restriction is likely
intended to epsure line of sight for security and to minimize
fire risk.

According to a' King· 5 News investigative report, staff
have reportedly contracted MRSA at KCCP and passed the infection·
on to family members. Additionally, seven staff have filed
workers.compensation claims involving MRSA, and haYe missed an
aggregate of 530 days of work due to the illness. Inyestigators:
Dangerous Infection Thriving at King County Jails, King 5 News,
November,?, 2005.
j

10

2005.

Contagion in the Jail, Seattle Weekly, December 7,

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- 22 -

.l
,.\

transmission of communicable diseases to the media stating that
the KeeF is understaffed, lacks an efficient medical
record-keeping system, and puts inmates at risk unnecessarily.~l
During our tour, we reviewed the charts of nihe inmates who
were seen in sick call in June 2007. Of those· nine inmates, four
had skin infections, and· all four experienced serious
deficiencies in treatment, as follows:
•

...

The most dangerous situation was that of an inmate who had
been seen for his skin infection on five separate occasions.
Each time, KeeF practitioners prescribed the same
medication, and each time, the medication was ineffective .
. The inmate had developed cellulitis and an abscess, neither
of which could improv~ until the abscess was drained.
Another inmate ~ith a skin infection was forced to wait
three days to get medication and five days to see a nurse
practitioner.

•

The third inmate "had to wait four days before receiving
prescription for·his skin inf@ction.

•

For the fourth inmate, m@dication was ordered, but the order"·
was never picked up by nursing staff. There was no
indication that· the inmate ever received the medication.

~

)

our investigation"also"reveal@d that KCCF performs very few
diagnostic' cultures of·skin infections. A culture, which· is· an
examination· of a sampling of cells taken from the affected 'area,
may be done to ··identify the microorganism causing the skin
infectidn and to determine the antibiotic or other treatment that
will effectively treat it. Keep reported that it performed only
13 to 21 diagnostic cultures per month for the six months prior
to our s@cond tour.
KCCF was unable to produce laboratory
~ecords for recent months, sO we were unable to quantify
baqterial cultures actually performed.
Moreover, while KceF tracks the incidence of skin infections
in its surveillance log, this log apparently does not present the
full state of skin infections at the jail. This is because the
log is likely incomplete due to problems with intake screening,
access (appointment backlogs and inadequate physician staffing),
inadequate methods of tracking data (absence of emergency room
utili~ation,logs), poo~ medical reco~ds (notably, lack of charted

11

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wound culture results), and inadequate laboratory testing (few
cultures).
Thus, it was not possible for us to determine
the full extent of the jail's problem with intramural
transmission of skin infections.

·wo~d

6.

Inadequate Intake Procedures

Adequate intake procedures are essential for ensuring that
inmates are properly screened by staff· who are trained to
tdentify and triage serious medical needs.
KCCP fails to
adequately train and supervise intake staff, and exhibits serious
lapses and delays in treatment during its intake process. These
failures prevent inmates from receiving adequate treatment for
acute or chronic medical needs, placing them at risk of serious
harm. For example:
•

•

We witnessed the processing of an inmate who had been
stopped by a state trooper. The trooper told ue the inmate
was staring into space and had been arrested for driving
under the influence. The inmate clearly had an altered
state of consciousness, either from drugs or psychosis.
Neither the· intake officer nor the intake nurse recognized
this altered state of consciousness. Only after our expert
·noted the inmate's condition to several staff members did
the inmate receive appropriate monito~ing and treatment.
An inma'te who had sustained a sexual assault and was

suicidal on intake was seen by psychiatry, but KCCF made·no
attempt to determine whether she had a sexually transmitted
infection·or to· conduct its own tests.

•

We encountered a 'seriously ill inmate on the women's housing
unit, whom the booking officer found had "no observed
medica~.problems," Her medical intake was ·not completed
because ·the nurse said the inmate was manic and could. not be
interviewed.· Despite the knowledge that the inmate was
me~tally ill, neither the nurse nor anyone else called-for
any, much less the·necessary immediate, psychiatric or
medical evaluation. By the time we observed the inmate on
the housing uriit, it was ,evident that she was seriously ill.
The inmate was shaking, vomiting, and showing signs of
serious malnourishment.

•

We witnessed an inmate who reported a history of bipolar
disorder.
She had been screaming and pounding her fists on
the door for two· hours in the intake area, yet she had not
had a medical screen and no one called for a mental health
evaluation.

,~

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A sixty-year-old inmate arrived at the jail uncooperative
and lethargic, with sutured head wounds, a stiff neck, and
unequal pupils (possibly a sign of acute brain ~amage). He
was not, seen by a physician for 24 hours.

•

Keep

•

KeeF also failed to evaluate and treat a woman with a
history of suiCide attempts and alcohol withdrawal ~eizures
'Who ha¢l an abscess and cellulitis upon admiSSion.

failed to provide evaluation or treatment at intake' to
a hypertensive alcoholiq who had abnormal vital signs
consistent with alcohol withdrawal syndrome.

'~
~

,~

.IV.

REMEDIAL MEASURES

In order to rectify the identified deficiencies and protect
the constitutional rights of inmates confined at KCCF, this
'
,facility should implement, at a minimum, the following remedial
meas'ures:

A.

Protection from HanD.
1.

B.

Develop and maintain comprehensive and contemporary
policies-and procedures regarding'permiss~ble use of
force.

2.

Ensure that staff receive adequate competency-based
,training'in use of force and'defensive tactics.

3.

Develop and maintain comprehensive-policies,
, procedures,', and practices for the investigation of
alleged staff misconduct.

4.

Ensure that incident reports and inmate grievances are
screened for allegations of staff misconduct and, if
the incident or allegation ~eets established criteria"
:r:eferred for 'investigation.

5.

Ensure that IIU management and staff receive
appropriate competency-based training in conductinginvestigations.
'

Suicide Prevention Measures
1.

Ensure that the number of hours of pre-service and
annual in-service suicide prevention training are
adequate.

,
0,
I

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c.

2.

'Provide a curriculum for pre-service and annual inservice competency-based suicide prevention training
that includes an array of topics so that staff are
adequately trained to identify and manage .suicide.

3.

Ensure that, prior to assuming their duties and on a
regular basis 'thereafter, all staff who work directly
with inmates have demonstrated competence in
identifying and managing suicide.

4.

Ensure that DAJD and JHS suicide prevention policies
include an operational description of the requirements
for both pre-service and annual in-service training.

5.

Ensure that any staff who are exempt from sUlcide
prevention training, i.e. "contract" JHS staff, have
limited inmate contact and'are prohibited from working
in the ITR area.

6.

Ensure that inmates on SUicide precautions receive
adequate mental status 'examinations by a mental health
clinician.

Medical Care
1.

Frovide adequate and timely, medical care for all
inmates~

2.

Provide adequate medical intake procedures.

3.

Ensure that medical staff cl~ssify inmates, properly and
examines and treats inmates 'in a timely manner,:

4.

Ensure that inmates with chronic diseases receive
adequate medical care, inclUding appropriate monitoring
and diagnostic testing.

5.

Develop and implement a system to review emergency room'
visit and hospitalization logs to effectively monitor
the care of ambulatory-sensitive conditions (e.g.,
preventable deaths, diabetic ketoacidosis) .

6.

Provide adequate competency-based training to security
staff, medical care staff, and intake staff regarding
responding to medical emergencies.

7.

Ensure that
sanitized.

ma~tresses

are frequently and effectively

~

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8.

Provide adequate and sanitary laundry services to
inmates.

9.

Develop and implement adequate clinical guidelines
regarding akin infections.

10.

Ensure that reliable data on the incidence of skin
infections are maintained, and analyze this data to
identify sources of intramural transmission.

11.

Ensure that inmates with skin infections receive timely
and app~opri~te wound CUltures, case identification,'
treatment, wound care, and monitoring.

12.

Ensure that inmates with persistent and, -recurrent skin
infections are referred to a physician.

13.

Ensure that inmates receive adequate and timely'
medication management,.

14.

Eliminate standing ord~ra for nurses to administer
antibiotics for skin infections.

*

*

'~

*

Please note that this findings letter is a public 'document.
It \tIill be posted on the Civil Rights Division's website,. While
we will provide a copy, of this letter to any individual or entity
upon request, as a matt'er of courtesy, we will not post this
letter on the Civil Rights DiVision'S website until ten calendar
days from the date of this letter.'
We hope to continue working with the county in an amicable
and cooperative fashion to resolve our outstanding concerns
regarding KCCF. Assuming there is a continuing spirit of
cooperation from the CQunty, we also would be willing to send our
consultants' evaluations under sepa~ate cover. These reports are
not public documents. ~lthough the consultants' evaluations and
work do not necessarily reflect the official conclusions of the
Department of Justice, their observations, analysis, and
recommendations provide further elaboration on the issues
discussed
this letter and offer practical technical assistance
in addressing them.

in

We are obligated to advise you that, in the entirely
unexpected event that we are unable to reach a resolution
regarding our concerns, the Attorney General may initiate a

, !

11/21/2007 14:00 FAX

2084842281

THE SEATTLE TIMES

141 027/027

- 27 lawsuit pursuant to CRIPA to correct deficiencies of ~he kind
identified in this letter 49 days after appropriate officials
have been notif,ied of them. 42 U, s. C. § 1997b (a) (1) .
We would prefer, however, to resolve this matter by working
cooperatively with you and are confident. that we will be able to
do so in this case. The lawyers assigned to this investigation
will be contacting the facility's attorney to·discuss thi~ matter
in further detail.
If you have any ,questions regarding this
letter, please call Shanetta Y. Cutlar, Chief of the Civil Rights
Division's Special Litigation Section" at (202) 514-0195.
Sincerely,

.... -..

Rena J. Comisac
Acting Assistant Attorney General
cc:

Dan Satterberg
Interim King· County Prosecutirtg Attorney
Reed Holtgeerts
Director
King County·Department of Adult

an~

Juvenile Detention

GOl:don Karlsson
Facility Commander
K~ng County Correctional Facility (Seattle Division Jail)
The Honorable Jeffrey C. Sullivan
United States Attorney
Western District of. washington
Kelly L. Harris
Assistant United States Attorney
Western District of Washington

~