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
jf@jhc-law.com
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

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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

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15
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19

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21
21
22

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24

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Case 2:77-cv-00479-NVW Document 1966

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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,
lhammond@omlaw.com
Ihammond(Qomlaw.com
dhill@omlaw.com
99 dhil(Qomlaw.com
sdesai@omlaw.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
mwinter@npp-aclu.org
mwinterC9npp-aclu.org
geber@npp-ac1u.org
15 geberC9npp-aclu.org
geber@npp-aclu.org
ebalaban@npp-ac1u.org
16 ebalaban@npp-aclu.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
dpochoda@acluaz.org
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
michele.iafrate@azbar.org
24
24
25
25

26
26
27
27

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28
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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

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23
24
25
26
27
28
4

Case 2:77-cv-00479-NVW Document 1966

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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

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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

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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

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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

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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