California’s protection & advocacy system
Toll-Free (800) 776-5746

Report on Inspection of the Sacramento County Jail
(Conducted April 13-14, 2015)
October 2015, Pub. #7027.01
- Dated August 4, 2015
- Revised October 15, 2015
EXECUTIVE SUMMARY
Disability Rights California (DRC) is the state and federally
designated protection and advocacy agency charged with protecting the
rights of people with disabilities in California. DRC has the authority to
inspect and monitor conditions in any facility that holds people with
disabilities. Pursuant to this authority, DRC is conducting inspections of
conditions in six county correctional facilities in 2015. One of these
facilities is the Sacramento County Jail (“Jail”), which we inspected on
April 13 and 14, 2015. We appreciate that Sheriff Department staff were
helpful and cooperative during our inspection.
We observed many positive practices and programs. Booking was
efficient, with a private screening area and procedures to expedite intake
for prisoners with acute medical or mental health needs. Health and
mental health staff were engaged and followed up immediately on our
concerns about individual prisoners. The Main Jail has mental health
staff available 24 hours per day, 7 days per week due to the inpatient
unit. The Main Jail and the non-dorm areas in Rio Cosumnes
Correctional Center are of a podular design, with two tiers of cells
opening on to a central dayroom. Custody staff was aware of an
accessible route that avoided the stairs between the booking area in
which buses unload in the Main Jail, and had also monitored compliance
with lower bunk orders in Rio Cosumnes. The Sheriff’s Department has
a strong emphasis on education and re-entry that is apparent from its
website.

Page 2 of 33

However, we also found evidence of the following violations of the
rights of prisoners with disabilities:
(a) Undue and excessive isolation and solitary confinement;
(b) Inadequate mental health care; and
(c) Denial of rights under the Americans with Disabilities Act (ADA).
Pursuant to our authority under 42 U.S.C. §10805(a)(1) and
29 U.S.C. § 794(f)(3) and as a result of this initial inspection, we find
there is probable cause to conclude that prisoners with disabilities are
subjected to abuse and/or neglect in the Sacramento County Jail. We
are opening an investigation into the treatment of prisoners with
disabilities and will be requesting additional documents and information.
We are also interested in meeting with you to discuss these findings and
the next steps in our investigation.
Background
The Sacramento County Jail currently houses approximately 4300
prisoners in two facilities – the Main Jail and Rio Cosumnes Correctional
Center. When the Main Jail was completed in 1989, its 1250 cells were
intended to hold single prisoners with a rated capacity of 1625. Later,
these single cells were converted to double cells and the rated capacity
increased to 2400 prisoners.1 In 1989, a federal court set a population
cap of 2432 for the Main Jail.
Rio Cosumnes Correctional Center (“RCCC”) consists of some
newer podular buildings and older dormitories dating to the 1960s.
RCCC has a rated capacity of 1,625 prisoners but its actual census has

1

Sacramento County Office of Inspector General, Jail Operations Audit, September 2009, p. 2627, available at http://www.inspectorgeneral.saccounty.net/Documents/sac_020670.pdf.
“Return to Main Document”

Page 3 of 33

ranged from the current level of 1900 to as high as 2400 prisoners.
Sentenced prisoners are primarily housed at RCCC but can also be
housed in the Main Jail. Pre-trial detainees may also be housed in
RCCC to comply with the population cap in the Main Jail.
Following the implementation of AB 109 in 2011, prisoners may be
sentenced to California jails for years at a time. A recent report found
that by late 2014, the number of prisoners housed in county jails serving
sentences of more than five years has skyrocketed due to AB 109.2
Sacramento County is no exception. In late 2014, between 1700 and
1900 (about 40% of the total) prisoners in the Sacramento Jail were
there because they had been sentenced, with jail terms ranging from
several months to as long as eight years.3
FINDINGS RE: ABUSE AND/OR NEGLECT OF
PRISONERS WITH DISABILITIES

Based on our monitoring visits on April 13 and 14, 2015, review of
records and documents accessed, as well as review of other public
documents, we found the following evidence of abuse and neglect in
Sacramento County Jail.

Public Policy Institute of California, “California’s County Jails,” available from
http://www.ppic.org/main/publication_show.asp?i=1061. “Return to Main Document”
2

California Board of State and Community Corrections, Jail Profile Study,
http://www.bscc.ca.gov/downloads/2014_3rd_Qtr_JPS_Full_Report.pdf; Sacramento
County Grand Jury 2012-2013 Report, p. 44 (under AB 109, prisoners at RCCC began serving
sentences of 18 months to 8 years), available from http://www.sacgrandjury.org/reports/1213/2012-2013-Report.pdf. “Return to Main Document”
3

Page 4 of 33

1. Excessive use of Isolation and Solitary Confinement
Isolation and solitary confinement in correctional facilities are
generally considered to be situations in which prisoners are held in their
cells, alone or with a cellmate, for 22 to 24 hours per day.4 Prisoners
may be held in isolation because they are classified as maximum
security, are in administrative segregation or Protective Custody, or
subject to short-term discipline. In contrast, prisoners in general
population typically are locked in their cells only during sleeping hours,
and are in dayrooms, activities or recreation areas during waking hours.
Even a short stay in conditions of extreme isolation is likely to
worsen prisoners’ mental health symptoms, causing them “to lapse in
and out of a mindless state” or “semi-fatuous condition” at a heightened
risk for suicide. See Davis v. Ayala, 576 U.S. ___, No. 13-1428, 2015
WL 2473373, at *20 (U.S. June 18, 2015) (Kennedy, J., concurring).
Consequently, correctional facilities should place prisoners in isolation
only when security conditions permit no alternative.5 Prisoners with
mental health problems are especially harmed by prolonged isolation

For support for this accepted definition of isolation, see, e.g., U.S. Department of Justice,
Investigation of State Correctional Institution at Cresson, May 13, 2013, Attachment #7, p. 5,
available at http://www.justice.gov/crt/about/spl/documents/cresson_findings_5-31-13.pdf
(“terms ‘isolation’ or ‘solitary confinement’ mean the state of being confined to one’s cell for
approximately 22 hours per day or more, alone or with other prisoners, that limits contact with
others. … An isolation unit means a unit where either all or most of those housed in the unit are
subjected to isolation.”); Wilkinson v. Austin, 545 U.S. 209, 214, 224 (2005) (describing solitary
confinement as limiting human contact for 23 hours per day); Tillery v. Owens, 907 F.2d 418,
422 (3d Cir. 1990) (21 to 22 hours per day). “Return to Main Document”
4

Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge
for Medical Ethics,” J Am Acad Psychiatry Law 38:104–8, 2010, Attachment #2. “Return to Main
5

Document”

Page 5 of 33

(defined as a duration of more than three to four weeks).6 Many state
correctional systems, including those in California, Illinois,
Massachusetts, Ohio and Pennsylvania, have adopted policies to ensure
that prisoners with mental illness are excluded from isolation and solitary
confinement.7
We observed widespread overuse of isolation throughout the
Sacramento Jail. Conditions in isolation units in the Jail were
characterized by inadequate exercise, extreme social isolation and
inadequate mental health monitoring. Many prisoners and many
categories of prisoners were locked in small cells alone or with a cellmate for 22 to 24 hours per day. We observed this in the Main Jail in
pods on the 4th and 8th floor and in pods throughout RCCC. This isolation
occurs in areas that were designed to permit indirect supervision and

6

American Psychiatric Association, Position statement on segregation of prisoners with mental
illness (2012), Attachment #4, available from
http://www.psychiatry.org/File%20Library/Learn/Archives/Position-2012-PrisonersSegregation.pdf. Accord, Society for Correctional Physicians, “Restricted Housing of Mentally
Ill Inmates, Position Statement,” July 9, 2013, Attachment #5, avaiable from
http://societyofcorrectionalphysicians.org/resources/position-statements/restrictedhousing-of-mentally-ill-inmates (“prolonged segregation of inmates with serious mental
illness, with rare exceptions, violates basic tenets of mental health treatment.”) “Return to Main
Document”
Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Psychiatr Clin North
Am 29:761–72 (2006), Attachment #1. See also, U.S. Department of Justice, “Investigation of
the Pennsylvania Department of Corrections’ Use of Solitary Confinement on Prisoners with
Serious Mental Illness and/or Intellectual Disabilities,” February 24, 2014, Attachment #8,
http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-24-14.pdf. “Return to
Main Document”
7

Page 6 of 33

easy access to dayrooms for most of every day,8 but are instead
operated to restrict prisoners to small cells for extended periods.
The widespread use of isolation in the Sacramento Jail affects
prisoners with mental illness in at least two ways. First, the Jail makes
no attempt to screen and exclude prisoners with mental illness from
isolation conditions in administrative segregation, protective custody and
maximum security. Second, the housing areas specifically set aside for
prisoners with mental illness are operated as isolation units, in which
conditions are more solitary than in many maximum security and
supermax facilities.
ISOLATION IN MAXIMUM SECURITY AND ADMINISTRATIVE
SEGREGATION.
Prisoners are held in isolation if they are given a classification
status of maximum security using the Northpointe classification system
common to many jails, or if they are determined to be at risk of assault
by or upon other prisoners and classified as Administrative Segregation,
Protective Custody or Total Separation. Once assigned to isolation units
for these reasons, prisoners have no clear means to work their way into
less restrictive housing,9 and thus may remain in isolation for the
duration of their jail stay.

8

See Attachment #10, photographs of the Sacramento Main Jail Pods, 1989, available from
http://www.inspectorgeneral.saccounty.net/Documents/sac_023929.pdf;
http://www.inspectorgeneral.saccounty.net/Documents/sac_026412.pdf. “Return to Main
Document”
See Report from MGT of America, “ICE Detention Standards Compliance Review,” Dec. 12,
2009, pps 6, 9, 56, Attachment # 11 (no notice of classification status or how to appeal this).
“Return to Main Document”
9

Page 7 of 33

Prisoners with mental illness are not excluded from these isolation
conditions, although this is the recommended practice.10 In fact, during
our inspection, custody staff volunteered that 30% of the prisoners in
Maximum Security, Total Separation and Protective Custody pods in the
Main Jail also had mental illness and were taking psychotropic
medication.11 In interviews, several prisoners in a Total Separation pod
confirmed that they have a serious mental illness.
Custody staff reported the following schedules for out-of-cell time in
segregation housing areas:
- In Maximum Security and Protective Custody areas, the most
generous out-of-cell program described by custody was an hour
in the dayroom in the morning, 90 minutes in the afternoon.
Other than a scheduled three hours of outdoor recreation once
per week, prisoners spend the remaining 21.5 hours per day
locked down in their cells, sometimes with a cellmate;
- In Total Separation areas, custody stated that prisoners were
allowed out of their cells for 30 minutes daily. The remaining

See Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Attachment #1. A
recent agreement between the Department of Justice and a county jail in Georgia provides that
segregation “shall be presumed contraindicated” for inmates with serious mental illness. If an
inmate has a “serious mental illness” or other acute mental health contraindications to
segregation, that inmate “shall not remain in segregation absent extraordinary and exceptional
circumstances.” MOA Between the U.S. Department of Justice and Columbus, Georgia
Regarding the Muscogee County Jail, January 16, 2015, Attachment #9, available from
http://www.justice.gov/crt/about/spl/documents/muscogee_moa_1-16-15.pdf. “Return to
Main Document”
10

11

The Sacramento County Grand Jury recently described these classification categories and
reported that one third of the prisoners in the jail have mental illness. Grand Jury Report, 20132014, pps 48-49, available from http://www.sacgrandjury.org/reports/13-14/2013-2014Report-CF.pdf. “Return to Main Document”

Page 8 of 33

23.5 hours per day were spent locked down in their cells, other
than outdoor recreation for an hour per day, three times per
week.
Significantly, every prisoner in isolation units whom we interviewed
reported that he received far less than the out-of-cell time reported by
custody and only inconsistently received access to outdoor exercise
each week, if at all. Earlier reports on conditions in the Sacramento Jail
contained similar observations about the lack of out-of-cell time and
outdoor recreation.12
Conditions in all of the isolation units are very austere, with
extended, enforced idleness. Prisoners report that lights are left on
constantly for days at a time. Prisoners receive their meals through a slot
in their solid cell doors and eat alone in their cells. They are not
permitted to have televisions or radios in their cells. Generally, the
central day-rooms have a large television, but most prisoners cannot see
or hear these when locked in their cells. Sentenced prisoners in
isolation units may not leave their cells to participate in the vocational
and educational programs available to other sentenced inmates.
Some prisoners in the maximum security and administrative
segregation pods are housed alone, but others are held with a cell-mate.
Conditions for these prisoners are especially difficult because they are
confined in close quarters with a stranger (who may also have mental

12

See MGT of America report, Attachment # 11, p. 29 (jail population in Ad Seg and other
special management housing “does not routinely receive outdoor recreation”); Sacramento
County Grand Jury Report, 2010-2011, p. 5 (warning that prisoners are allowed out of their cells
for only three hours per week “due to limited staff. This presents a potential ‘boil-over’ situation.
Assaults among inmates are increasing.”), available from
http://www.sacgrandjury.org/reports/10-11/2010-2011%20Report.pdf. “Return to Main
Document”

Page 9 of 33

illness), while simultaneously deprived of access to programming,
meaningful forms of social interaction and distractions such a television
or radio. Since all the cells in the Main Jail were originally designed to
hold only a single prisoner, they are small for two people by any
measure.13
The Sacramento Jail’s practice of double-celling prisoners in
isolation may have contributed to the death of a prisoner in protective
custody in December 2014.14 The victim’s cell-mate had bipolar disorder
and has been charged with the murder, according to news reports. The
cell-mate had earlier complained to custody staff that the victim – a
registered sex offender who also had mental illness – was harassing him
and soiling his clothes and their cell and that if they did not move his cellmate, “he’s going to get beat up.”15 Custody staff took no action, and the
second prisoner was found dead the next day.
ISOLATION AND MENTAL HEALTH UNITS
The Jail has designated areas in the Main Jail and RCCC as
special housing for prisoners with mental illness who are stepping down
from suicide watch or the inpatient unit, or are deemed unable to
function in general population. Custody has elected to operate these
housing units as isolation housing, in which prisoners have even less
out-of-cell time than in maximum security units. According to custody,

13

See note 1, supra, and 2010-2011 Grand Jury Report, p. 17.
http://www.sacgrandjury.org/reports/10-11/2010-2011%20Report.pdf. “Return to Main
Document”
Sacramento Bee, “Two Inmates Killed in Separate Incidents at Sacramento County Jail,”
March 8, 2015, http://www/sacbee.com/news/local/crime/article13048712.html, accessed
April 17, 2015. “Return to Main Document”
14

15

Id. “Return to Main Document”

Page 10 of 33

this occurs because the mentally ill prisoners on the unit have different
security classifications, so deputies will not let an entire tier into the
dayroom together for showers and telephone. Because only a few
prisoners of the same classification level are let out at the same time,
out-of-cell time for prisoners with mental illness is reduced to 60 to 90
minutes per day. In interviews, prisoners stated that they customarily
had far less than this, with reports of no out-of-cell time (and thus, no
showers or telephone) for three days at a time, and of getting one hour
of dayroom time every other day at 8 pm or 9 pm, which is too late to call
legal representation.
In the Outpatient Psych Pod in the Main Jail and in the mental
health pods in RCCC, prisoners reported that they rarely get outdoor
recreation, and are provided recreation as seldom as once per month, or
even once every few months. The claims are credible in light of reported
custody practices. Custody staff in the mental health pod that we
observed in RCCC confirmed that they do not schedule regular
recreation times for prisoners on the unit. Custody stated that prisoners
could request outdoor recreation, but in interviews, prisoners denied any
knowledge of this procedure. Other custody staff stated that prisoners
declined outdoor recreation when it was offered. In interviews, prisoners
stated that when they were offered recreation in early morning or very
late at night, they would decline because it was too cold and dark.
In addition to the Outpatient Psych Pod, the Main Jail has an 18
bed inpatient mental health unit, in which the conditions of isolation were
especially disturbing. The unit is devoid of stimulation and without
essential mental health treatment. Cells are bare, with only a
combination sink/toilet and a steel bed with a thin mattress. The steel
bed has tie-off points that create an unreasonable risk of suicide. A steel
door facing the dayroom or hallway has a small window and a food-port.
These otherwise featureless rooms have no chairs or desks, and many
lack any natural light. There is no programming or television, and staff
report letting the prisoners out of their cells for dayroom only once or

Page 11 of 33

twice per week.16 The dayroom, which was dirty and stunk of feces
during the tour, is itself largely featureless with only a round bench in the
middle, and there are no recreational activities provided. Prisoners are
not released from their cells for clinical contacts. Instead, clinicians
speak through the food-port, preventing face-to-face contact and
confidentiality. This is not mental health treatment and does not provide
a therapeutic environment. Indeed, during the DRC tour, a prisoner—
celled in what staff said was a medical bed portion of the unit, where
conditions were indistinguishable from those of the mental health beds—
tried to commit suicide by submerging his head in a toilet. Prisoners
remained in bed in their cells throughout the tour, other than a shirtless
youth who was pressed against the cell window, crying and ignored by
staff; a sense of despair hung over the unit.
2. Inadequate Mental Health Care
Under the U.S. Constitution, there are “six basic, essentially
common sense, components of a minimally adequate prison mental
health care delivery system.” Coleman v. Brown, 938 F. Supp.2d 955,
970 (E.D. Cal. 2013). The components are: screening, staffing,
recordkeeping, medication, suicide prevention, and “a treatment program
that involves more than segregation and close supervision of mentally ill
inmates.” Id. at 970 n. 24; Balla v. Idaho State Board of Corrections, 595
F. Supp. 1558, 1577 (D. Idaho 1984); Ruiz v. Estelle, 503 F. Supp. 1265,
1339 (S.D.Tex.1980). The jail must address the negative effects of
housing in harsh segregated environments (Coleman, 938 F. Supp.2d at
979–80), and provide “treat[ment] in an individualized manner” for

16

Compare, Position Statement from Society for Correctional Physicians, Attachment #5
(“Inmates who are seriously mentally ill should be either excluded from prolonged segregation
status (i.e. beyond 4 weeks) or the conditions of their confinement should be modified in a
manner that allows for adequate out-of-cell structured therapeutic activities and adequate time in
an appropriately designed outdoor exercise area.”) “Return to Main Document”

Page 12 of 33

mental disorders. Id. at 984. Treatment must have the goal of
“stabilization and symptom management.” Madrid v. Gomez, 889 F.
Supp. 1146, 1222 (N.D. Cal. 1995).
The mental health treatment provided in the Sacramento Jail does
not meet these constitutional minimums, nor does it ameliorate the harsh
isolation conditions in which prisoners are confined. The prisoners we
interviewed described multiple suicide attempts, long delays in receiving
medication and that repeated requests to see a psychiatrist were often
ignored.
Mental health staff report that they do not offer group or individual
counseling and therapy, even in the Outpatient Psych Pod and areas set
aside in the RCCC for mental health housing. Outpatient mental health
care appears consists solely of medication management and what staff
described as “brief supportive contact” at cell-front or in dayrooms. The
absence of any structured out-of-cell therapeutic activities violates
minimum standards of care for prisoners with mental illness. For
example, the National Commission on Correctional Health Care provides
that “[r]egardless of facility size or type, basic on-site outpatient [mental
health] services include, at a minimum, … individual counseling, group
counseling and psychosocial/psychoeducational programs.” Standards
for Health Services in Jails (2014), Standard J-G-04, Attachment #3.17
Some of the other disturbing conditions we observed were:

See also APA Position Statement on Segregation of Prisoners with Mental Illness,”
Attachment #4 (“If an inmate with serious mental illness is placed in segregation, out of cell
structured therapeutic activities (i.e., mental health/psychiatric treatment) in appropriate
programming space and adequate unstructured out of cell time should be permitted.”); Muscogee
County Jail Agreement, Attachment #9, p. 12 – 13 (Prisoners with mental illness “shall be
offered a minimum of (i) at least 10 hours of out-of-cell structured time each week” including a
schedule of individual or group therapeutic treatment). “Return to Main Document”
17

Page 13 of 33

- Suicide gowns are used as “long-term” clothing for prisoners in
the Outpatient psych pod; and
- Custody staff appear to rely heavily on restraint chairs to
manage prisoner behavior.18
At both jail facilities, mental health staff were clear that they did not
make regular rounds of any segregation areas, including the outpatient
psych pods or other isolation units. In monitoring prisoners’ mental
health status, staff stated that they rely primarily on “kites” that prisoners
give to custody staff, who then forward the requests to medical or mental
health. Mental health staff also stated that they are on the mental health
units in both jails every day.
As we discuss below, relying primarily on requests transmitted via
custody officers violates confidentiality and may lead to drastic
underreporting of prisoner need. Instead, prisoners must be able to give
their health and mental health care requests directly to health care staff,
or place their requests in a locked box; custody should not be
responsible for/involved in collecting requests. In addition, the Jail has
no real-time means to tell whether kites that make it through to mental
health staff have been addressed in a timely manner. Mental health staff
stated that a report on overdue responses to kites could be run, but that
they do not do so on a regular basis.19

18

This finding is based on staff report and is consistent with an earlier report that restraint chairs
were used several times per week during some time periods. MGT of America Review,
Attachment #11, p. 5 (restraint chair used 26 times in a three month period). “Return to Main
Document”
19

This is consistent with findings by the Grand Jury about the absence of reliable data regarding
timely response to medical requests generally. Grand Jury 2005-2006 Report,
http://www.sacgrandjury.org/reports/05-06/GJReport2005-2006.pdf. The Grand Jury also

Page 14 of 33

The absence of regular mental health rounds for the Outpatient
Psych Pod and other isolation units violates accepted standards of
care.20 Even assuming that the Jail had a confidential and timely
procedure for requesting mental health assistance, an adequate mental
health care system cannot rely on requests alone and must include
regular rounds, especially of isolation and segregation units. The
National Commission on Correctional Health Care addresses the need
for regular rounds in segregation. For “inmates who are segregated and
have limited contact with staff or other inmates,” the Commission
recommends documented monitoring rounds three times per week.
Standard J-E-09 (2), Attachment #3. Accord, Metzner J.L., Dvoskin J.A.,
“An Overview of Correctional Psychiatry,” Attachment #1.
3. Denial of Rights under the Americans with Disabilities Act
Title II of the Americans with Disabilities Act (“ADA”) provides that
“no qualified individual with a disability shall, by reason of such disability,
be excluded from participation in or be denied the benefits of the
services, programs, or activities of a public entity, or be subjected to
discrimination by any such entity.” 42 U.S.C. § 12132. Jails and prisons
are subject to the prohibitions and protections in Title II. Pierce v. County
of Orange, 526 F.3d 1190, 1214 (9th Cir. 2008) (citing Pa. Dep’t of Corr.
v. Yeskey, 524 U.S. 206, 209-10 (1998). In correctional settings, the
ADA protects participation in jail programs, services and activities
including the ability to safely use personal hygiene services such as
toilets and showers, to engage in activities such as ambulation and
exercise, and participate in programs such as visitation, educational

raised concerns, which we share, about the ability of medical and mental health staff to
adequately triage requests for care. “Return to Main Document”
20

For example, the 2009 MGT Report found the Jail out of compliance with a federal
requirement that prisoners in Administrative Segregation have rounds from a medical
professional three times per week. Attachment #11 at page 65. “Return to Main Document”

Page 15 of 33

classes, religious services, and inmate worker programs on the same
basis as non-disabled prisoners.
In 2010, the Department of Justice issued a new regulation
specifically addressing the “nondiscrimination and program access
obligations” of a correctional facility. 28 C.F.R. § 35.152, effective March
15, 2011.21 This regulation provides in part that “[p]ublic entities shall
implement reasonable policies, including physical modifications to
additional cells in accordance with the 2010 Standards, so as to ensure
that each inmate with a disability is housed in a cell with the accessible
elements necessary to afford the inmate access to safe, appropriate
housing.” 42 C.F.R. § 35.152(b)(3). Justice Department commentary on
this regulation makes clear that it concerns the program access
obligations of a correctional facility, which do not depend on the date of
construction, as opposed to requirements for architectural accessibility,
which are tied to the date of construction or modification.22
Segregation of Inmates with Disabilities
In the Sacramento Jail, it is policy to place prisoners with physical
disabilities and mobility impairments in single cells in the medical area in
2 East 100, an area in which prisoners have no regular access to a day
room or outdoor recreation. Housing prisoners in the infirmary solely

21

U.S. Department of Justice, Notice re: Final Regulations implementing Title II of the ADA, 75
Fed. Reg. 56164, 56218-56223 (2010), Attachment #6, also available at
http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.htm#a2010guidance.
“Return to Main Document”
22

Id., 75 Fed. Reg. at 56218-56223, Attachment #6. “Return to Main Document”

Page 16 of 33

because they use assistive devices, as the jail appears to do, is not an
effective use of medical resources.
Housing prisoners with disabilities in the infirmary also violates 28
C.F.R. §135.152 (b)(2), which requires correctional facilities to “ensure
that inmates or detainees with disabilities are housed in the most
integrated setting appropriate to the needs of the individuals.” The
regulation expressly prohibits a jail from “plac[ing] inmates or detainees
with disabilities in designated medical areas unless they are actually
receiving medical care or treatment,” unless certain limited exceptions
are present. To resolve this problem, DOJ emphasized the importance
of dispersing accessible cells throughout a facility and correctional
system. 75 Fed. Reg. 56219 (2010).23
As noted above, the Jail also segregates prisoners with mental
illness in isolation units in which they have less access to outdoor
recreation, out-of-cell time and programming than non-disabled
prisoners. According to the Department of Justice, such a practice of
isolating prisoners on the basis of their mental illness constitutes
impermissible discrimination under the Americans with Disabilities Act
“where it unjustifiably denies those prisoners access to services and
programs provided to most other prisoners.”24
Toilet and Shower Areas

For example, veterans who use wheelchairs cannot participate in the special “Honor Dorm” in
RCCC, even if they meet other criteria for acceptance into this much lauded program, because it
has no ADA accessible cells. “Return to Main Document”
23

U.S. Department of Justice, “Investigation of the State Correctional Institution at Cresson and
Notice of Expanded Investigation,” May 31, 2013, Attachment #7, available from
http://www.justice.gov/crt/about/spl/documents/cresson_findings_5-31-13.pdf. “Return to
24

Main Document”

Page 17 of 33

The toilet and shower areas in the medical area of the Main Jail do
not meet architectural standards for wheelchair use, and lack properly
placed grab bars, shower heads, etc.25 In interviews, prisoners said they
were afraid of falling in the bathroom and shower, had requested
assistance from jail staff and been refused this help, and that some
prisoners had already fallen because of unsafe conditions in the shower
area. Segregating prisoners with disabilities in the medical area without
ensuring safe access to sanitary facilities violates 28 C.F.R §
35.152(b)(2).
ADA Coordinator
The ADA regulations require the Jail to have an ADA coordinator.
42 C.F.R. § 35.106. The coordinator’s role is “to ensure that individuals
dealing with large agencies [such as the Sheriff’s Department] are able
to easily find a responsible person who is familiar with the requirements
of the [ADA and the DOJ regulations] and can communicate those
requirements to other individuals in the agency who may be unaware of
their responsibilities.” Appendix A to Part 35, 28 C.F.R. at page 568. We
saw no evidence of an ADA coordinator in the Jail. When questioned,
staff were unaware of such a position and could not identify any
particular individual responsible for arranging accommodations. We
conclude that the Jail does not have an ADA coordinator and is not in
compliance with this requirement.

25

We are happy to provide you with copies of DOJ publications on accessibility standards for
correctional facilities, which can also be obtained online: ADA/Section 504 Design Guide:
Accessible Cells in Correctional Facilities, available from
http://www.ada.gov/accessiblecells.htm and the ADA standards for Accessible Design that
specify the requirements for an accessible shower, §§ 603.1 to 610.4; acceptable reach ranges for
fixtures, § 308, and accessible faucet and handle types, § 309.4.
http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#sec805.
“Return to Main Document”

Page 18 of 33

Notice of Rights and Complaint Procedure
The Jail also has an obligation to provide notice to prisoners of
their rights under the ADA (28 C.F.R. § 35.106), and must have an ADA
complaint procedure by which prisoners with disabilities may contest any
disability-based discrimination or violation of the ADA. 28 C.F.R. §
35.107(b). The complaint procedure must provide for “prompt and
equitable resolution of complaints alleging any action that would be
prohibited by [the ADA regulations.].” § 35.107(b) (emphasis added).
The Jail’s designated ADA coordinator is responsible for investigating
complaints submitted through this process. § 35.107(a).
Custody staff provided us with a copy of the Sacramento County
Main Jail Inmate Handbook, which is 66 pages and supposedly “contains
information about some of the services available to you, and what you
have to do to obtain or benefit from these services.” However, this
handbook did not mention rights under the ADA or how to submit an
ADA complaint. This omission violates the notice requirement in 28
C.F.R. § 35.106, as well as making the ADA complaint system effectively
unavailable. Not surprisingly, in interviews, prisoners were unfamiliar
with any procedure for requesting accommodations for their disabilities.
By report, the Jail does not have an ADA complaint system, and its
existing grievance system cannot substitute because it does not meet
the ADA requirements. In the Main Jail we saw no boxes in which to
place completed requests or grievances. There were request boxes in
RCCC but no grievance boxes. Custody stated that prisoners would give
them a “kite,” and they would “try to resolve the issue at the lowest
possible level” rather than communicating the request or complaint to a

Page 19 of 33

supervisor.26 This means that neither prisoners nor jail administration
have a record of how custody responds to their requests and grievances.
We did not have an opportunity to review the Jail’s substantive
policies regarding prisoners with disabilities. However, we have
concerns about what these will reveal because staff appeared to be
untrained in how to respond to disability issues in general. Asked about
accommodations for prisoners who are deaf or hard of hearing, staff said
that they had never seen a deaf person in the jail, and did not know how
to locate an American Sign Language (ASL) interpreter if needed, but
thought that a custody officer might know ASL. In addition, the Inmate
Handbook (pg. 21) states that hearing aids or hearing aid batteries are
not provided, and medical staff reported there is no contract with an
audiologist for these services.
Medical staff were unable to describe any procedure to obtain
disability accommodations for a prisoner, other than requests for a lower
bunk. In interviews, prisoners described how they were given jail-issued
wheelchairs without brakes and were refused staff assistance in bathing,
and with writing requests and kites.27 The Inmate Handbook (at pg. 21)
confirms the Jail’s policy of categorically denying items such as special
shoes and extra clothing and linen, without permitting any exception for

The Inmate Handbook for the Main Jail confirms this practice. Prisoners are to “file the
completed [grievance] form with the housing unit officer.” P. 12-13. The Sheriff’s Department
order regarding grievances states that “grievances shall not be discarded” even if resolved.
However, in light of prisoners’ reports that they frequently receive no response to their requests
and complaints, jail management has no effective means to assess compliance with this policy.
“Return to Main Document”
26

MGT of America Report, Attachment #11, p. 16 (no information about “how detainees may
obtain … special assistance if illiterate, disabled or non-English speaking during the grievance
process”) (emphasis added). “Return to Main Document”
27

Page 20 of 33

disability-related needs. We will continue to investigate this issue in the
future.
More generally, the ADA regulations require the Sheriff’s
Department to conduct a self-evaluation of its services, policies and
practices to determine whether they meet the requirements of the ADA.
28 C.F.R. § 35.105(a). Since the Jail has more than 50 employees, it
was also required to complete a Transition Plan by July 1993, detailing
the steps and timeline it will take to achieve compliance with the ADA.
Although the deadline to complete a self-evaluation and transition plan is
long past, this is a continuing obligation and public entities that missed
this deadline are not exempt from compliance. Reviewing policies and
procedures is one part of the self-evaluation required by §35.105(a).
4. Other Areas of Concern, Including Medical and Dental Care
a. Floor sleeping and Overcrowding
In the Main Jail in the medical unit and inpatient psych unit, we saw
prisoners who did not have a bunk or a boat and had only mattresses on
the floor. A county audit in 2009 also noted that although the census in
the Main Jail is 2400 prisoners, “the design and infrastructure for this
facility call for housing just over 1,200 inmates. The problem is that
staffing levels and facility infrastructure (kitchen, medical facilities, day
rooms, holding tanks, plumbing, etc.), for the most part, still reflect the
original design intent of around 1,200 inmates. This greatly compounds
the challenges associated with operating the Main Jail.”28 Also, the
Sacramento Grand Jury has reported on overcrowded conditions and

Office of Inspector General, 2009 Jail Operations Audit, note 1, supra, page 26. “Return to
Main Document”
28

Page 21 of 33

low staffing levels in RCCC, which it described as “jam-packed.”29 Unlike
the Main Jail, which is subject to a population cap of 2432 set by the
federal court, RCCC has no population cap.
b. Request and Complaint Process
The Jail does not have a confidential, reliable request and
complaint process. In addition to the ADA concerns described above,
we have questions about timely responses to medical and mental health
kites, and about confidential reporting of deputy misconduct.
c. Inmate Handbook
The Main Jail has an inmate handbook that explains inmate rights,
how to request medical and dental care, PREA, confidentiality,
discipline, visiting, canteen, etc. An earlier review also noted the
inadequacies in the handbook as regards appeals and prisoner rights.30
According to Custody staff, the handbook is provided to prisoners with
their clothing and bedroll at booking. However, no prisoners with whom
we spoke recalled having received this handbook, and RCCC did not
have a comparable handbook available for our review.
d. Dental Care
The Jail has a dental service in both facilities that provides
extractions and treats dental infection. The Jail does not offer dental
cleanings, periodontal care or dental floss; for sentenced prisoners with
months or years to serve, this practice violates standards of care. Jail
staff stated that the dentists will provide restorative dental care on a
“case by case” basis to prisoners sentenced to the Jail for a long period

29

2013-14 Grand Jury Report, p. 41, available from http://www.sacgrandjury.org/reports/1314/2013-2014-Report-CF.pdf. “Return to Main Document”
30

MGT of America Review, Attachment #11, pps 18, 24. “Return to Main Document”

Page 22 of 33

under AB 109. Such a policy is not transparent and fails to offer
prisoners information about their options and their right to appeal if
dental care is denied.
e. Medical Care for Chronic Conditions and Disabilities
In interviews, prisoners complained about poor care for diabetes
and other chronic conditions. The medical staff at RCCC conceded that
they “struggle” to provide care for chronic conditions and plan to develop
policies for long-term management of conditions such as asthma,
diabetes, hypertension, and hyperlipidemia. Prisoners also stated that
they were denied access to physical therapy, even when medically
necessary and/or prescribed by an outside physician. Since physical
therapy is part of a normal continuum of care, the Jail must either hire or
contract with a physical therapist to treat prisoners in the jail or take
prisoners to providers in the community when medically necessary.

SUMMARY OF INITIAL RECOMMENDATIONS31
1. Isolation
a. Increase out-of-cell time and ameliorate isolation conditions
in Administrative Segregation, Protective Custody, Total
Separation, Maximum Security and mental health housing.
b. Exclude prisoners with mental illness from any isolation
settings.
c. Develop a system to continuously monitor compliance with
standards for out-of-cell time and outdoor recreation.

The Sacramento County Sheriff’s Office provided DRC responses to these initial
recommendations prior to the public release of this report. Those response are included in the
Appendix, infra. “Return to Main Document”
31

Page 23 of 33

2. Mental health Treatment
a. Provide regular mental health rounds and offer structured
therapeutic activities and unstructured out of cell time in
mental health housing areas.
b. Reduce reliance on restraint chair, suicide gowns and
isolation as means to address disability-related behavior.
c. Schedule regular rounds to check on all prisoners in isolation
housing.
d. Develop a more effective therapeutic environment in the
inpatient psych unit.
e. Develop a confidential system for prisoners to submit
requests for mental health treatment directly to health care
staff, and implement a monitoring and tracking system to
ensure those requests received timely and appropriate
responses.
3. ADA
a. Add wheelchair accessible cells in different classification and
housing areas, including the honor dorms at RCCC.
b. Ensure that prisoners with physical, sensory and mental
health disabilities have access to the full range of jail
programs and activities, including all vocational and
education programs RCCC.
c. Appoint an ADA coordinator, establish an effective ADA
complaint system, conduct a self-evaluation and develop a
Transition plan to achieve ADA compliance.
d. Develop informational materials for prisoners with disabilities
about how to request accommodations.

Page 24 of 33

APPENDIX
Sacramento County Sheriff’s Department
Correctional Services
Response to Disability Rights California initial recommendations
1. Isolation
a.

Increase out-of-cell time and ameliorate isolation conditions in
Administrative Segregation, Protective Custody, Total Separation,
Maximum Security and mental health housing.
The Sacramento County Sheriff’s Department responds as
follows:
The maximum amount of recreation time a housing unit can offer
without negatively impacting the security, floor and daily operations
will be explored for all classification of inmates. The current
Operations Order will be amended to include any operational
changes. We are still awaiting a list of consultant experts to be
provided by DRC as discussed and open to implementing
reasonable suggestions.

b.

Exclude prisoners with mental illness from any isolation settings.
The Sacramento County Sheriff’s Department responds as
follows:
The above changes will include Out-Patient Psych inmates.

c.

Develop a system to continuously monitor compliance with
standards for out-of-cell time and outdoor recreation.
The Sacramento County Sheriff’s Department responds as
follows:

Page 25 of 33

Outdoor recreation and dayroom activities are noted in the control
room log book by control room officers. The log books are checked
twice a shift by a sergeant and once by a lieutenant. The
Operations Order pertaining to the monitoring of out of cell time
and outdoor recreation will be amended to add that a watch
commander or acting watch commander will be required to check
the log books to ensure compliance with inmate out of cell time or
outdoor recreation. We are currently looking at the feasibility of
electronically departing inmates on dayroom/outdoor recreation in
our current JIMS system. This would allow additional reports to be
generated to account for recreational time. The reports will further
assist in the monitoring of recreational activities. We are also
releasing an RFP this month for a new JIMS system that will
include reports for monitoring dayroom and outdoor recreation
activities along with the routine scheduling of these functions.
2. Mental health Treatment
a. Provide regular mental health rounds and offer structure
therapeutic activities and unstructured out of cell time in mental
health housing areas.

The Sacramento County Sheriff’s Department
responds as follows:
Jail Psychiatric staff is required to meet with all inmates to
diagnose any mental health issues. Based upon the inmate’s
diagnosis, medications administered for treatment and the medical
assessment of the inmate, will dictate the level of care each inmate
receives. We are currently working on increasing the amount of out
of cell time for those inmates in the outpatient mental health
housing areas. We are exploring the costs and requirements for
providing structured and unstructured therapeutic activities in
addition to the regular assessments and interventions provided in
our outpatient psychiatric areas.

Page 26 of 33

b. Reduce reliance on restraint chair, suicide gowns, and isolation as
means to address disability-related behavior.

The Sacramento County Sheriff’s Department
responds as follows:
The restraint chair, suicide gowns, and isolation are not used to
address disability-related behavior. The restraint chair is used to
restrain an individual that is uncontrollably violent and
demonstrating a desire to harm staff members, other inmates,
and/or themselves. A medical evaluation is immediately performed
upon placement in the restraint chair, and followed up in the first 15
minutes. A psychiatric evaluation is ordered, and completed within
eight hours of placement. Unless extended by the Watch
commander, no person will be placed in the restraint chair in
excess of one hour. Between January 1, 2015 and September 4,
2015, the restraint chair was only used 38 times.
The safety suit “suicide gown” program is currently being evaluated
and will most likely be modified and ONLY used for inmates that
state or report suicidal ideation and/or engages in deliberate selfharm. Every inmate placed in a safety suit is assessed by
psychiatric staff and regularly evaluated depending upon their
diagnosis and the assessment of their overall mental health.
Ongoing dialogue is occurring with Jail Psychiatric services on the
safety suit program.
The Operations Order pertaining to the use of safety suits will be
amended to include the changes as described.
Isolation is not used to address disability related behavior.
Placement into Administrative Segregation and Total Separation

Page 27 of 33

“isolation” is used to separate inmates from general population
when specific facts demonstrate they cannot be housed for the
safety of themselves or others. The inmate can also request
Administrative Segregation and or total separation at which time a
classification review will be initiated to determine the validity of their
request.
Schedule regular rounds to check on all prisoners in isolation
housing.

The Sacramento County Sheriff’s Department
responds as follows:
Medical staff is required to perform daily checks on all inmates who
have been placed in isolation. These checks are required to be
done twice daily by medical staff. During these checks an inmate
can request medical, mental health or dental services via a hand
delivered KITE to medical staff. All requests received are triaged by
priority of services needed. Any noted change, medical or
psychiatric, in an inmate while in isolation housing will be reported
to the correct medical discipline and triaged appropriately. The
inmate handbook will be updated to specify the necessary
procedures required by an inmate to ensure that their request for
medical, mental, or dental services is received and reviewed by
medical staff.
c. Develop a more effective therapeutic environment in the inpatient
psych unit.

The Sacramento County Sheriff’s Department
responds as follows:

Page 28 of 33

The inpatient psychiatric unit is an 18-bed unit used to treat acute
psychiatric issues. The average length of stay in the inpatient
psychiatric unit is six days. While in this unit, 24-hour care is
provided and inmate rounds are completed every thirty minutes in
addition to any extra checks order by the psychiatrist. A multidisciplinary treatment team makes daily rounds and assesses
inmates daily in the inpatient psychiatric unit. Treatment plans are
evaluated during all phases of treatment and conferences are held
within 72 hours of admission. The goal of the inpatient psychiatric
unit is to stabilize the patient’s mental health issues so they can be
discharged to the outpatient psychiatric area and eventually
released to general population.
d. Develop a confidential system for prisoners to submit requests for
mental health treatment to health care staff and implement a
monitoring and tracking system to ensure those request received
timely and appropriate response.

The Sacramento County Sheriff’s Department
responds as follows:
Inmates can request medical, mental health, and dental services
by completing a paper KITE. Instructions for requesting these
services and completing the KITE are provided during the medical
intake and in the inmate handbook. Additionally, complete
instructions for completing and submitting a KITE are spelled out
on the back of each KITE in Spanish and English. Inmates are
instructed to give completed KITEs to the nurse that delivers
medication to inmate housing locations, or other medical staff
members. Once the KITE is received, it is reviewed and urgent
mental health needs are immediately referred to our psychiatric
unit. All other KITES are entered into our electronic medical
records system and are triaged by an RN. All KITES are triaged
within 24 hours, but most are triaged within 12. Depending upon

Page 29 of 33

the medical request and the inmate's medical history an
appointment will be scheduled appropriately. Emergent requests
will be seen and assessed immediately in the medical housing
area. Urgent requests will be seen and assessed by an RN within
12 hours in the housing units. The timing for all other appointments
is based on medical need. All requests for medical, mental health,
and dental services, are logged and tracked within our electronic
medical records system.
The Department is currently evaluating new systems (kiosks) which
will allow inmates to request medical, mental health, and dental
services electronically. These systems will be able to electronically
transmit and track all requests for services. The electronic system
will also interface and upload directly to our electronic medical
records system confidentially.
The inmate handbook will be updated to specify and describe how
an inmate is to submit a confidential medical request to medical
staff.
3. ADA
a.

Add wheelchair accessible cells in different classification and
housing areas, including the honor dorms at RCCC.

The Sacramento County Sheriff’s Department
responds as follows:
The Sheriff’s Department is planning on consulting with an ADA
expert to devise solutions to address the issues associated with
the use of wheel chairs at the Main Jail.
b.

Ensure that prisoners with physical, sensory and mental health
disabilities have access to the full range of jail programs and
activities, including all vocational and education programs RCCC.

Page 30 of 33

The Sacramento County Sheriff’s Department
responds as follows:
We are currently developing a comprehensive transition plan to
ensure our facilities are ADA compliant. This will include an ADA
manager, ADA coordinator, and ADA policy. Once implemented,
the ADA Manager and Coordinator will facilitate the placement of
inmates with physical, sensory, and mental health disabilities and
ensure access to the full range of jail programs and activities,
including all appropriate vocational and education programs at
RCCC.
c.

Appoint an ADA coordinator, establish an effective ADA complaint
system, conduct a self-evaluation and develop a Transition plan to
achieve ADA compliance.

The Sacramento County Sheriff’s Department
responds as follows:
We are currently developing a comprehensive transition plan to
ensure our facilities are ADA compliant. This will consist of an ADA
manager, ADA coordinator, and ADA policy. The transition plan will
include an effective ADA complaint system. The final goal overall is
full ADA compliance in our correctional facilities.
d.

Develop informational materials for prisoners with disabilities about
how to request accommodations.

The Sacramento County Sheriff’s Department
responds as follows:
This will be part of the transition plan to full ADA compliance. The
inmate handbook will be updated to include information advising all
inmates of their ADA rights and how to submit a request for
accommodation. Future technology in the form of inmate kiosks will

Page 31 of 33

make it easier to inform inmates of the ability to request
accommodations and for facility personnel to process those
requests.

Page 32 of 33

ATTACHMENTS
1. Metzner J.L., Dvoskin J.A., “An Overview of Correctional
Psychiatry,” Psychiatr Clin North Am 29:761–72 (2006).
2. Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in
U.S. Prisons: A Challenge for Medical Ethics,” J Am Acad
Psychiatry Law 38:104–8, 2010.
3. National Commission on Correctional Health Care, Standards for
Health Services in Jails (2014), Standards J-E-09 and J-G-04.
4. American Psychiatric Association, Position statement on
segregation of prisoners with mental illness (2012),
http://www.psychiatry.org/File%20Library/Learn/Archives/Position2012-Prisoners-Segregation.pdf
5. Society for Correctional Physicians, “Restricted Housing of
Mentally Ill Inmates, Position Statement,” July 9, 2013, available
from http://societyofcorrectionalphysicians.org/resources/positionstatements/restricted-housing-of-mentally-ill-inmates.
6. U.S. Department of Justice, Notice re: Final Regulations
implementing Title II of the ADA, 75 Fed. Reg. 56164, 5621856223 (2010), also available from
http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.h
tm#a2010guidance.
7. U.S. Department of Justice, Investigation of State Correctional
Institution at Cresson, May 13, 2013 at 5, available at
http://www.justice.gov/crt/about/spl/documents/cresson_findings_531-13.pdf
8. U.S. Department of Justice, “Investigation of the Pennsylvania
Department of Corrections’ Use of Solitary Confinement on
Prisoners with Serious Mental Illness and/or Intellectual
Disabilities,” February 24, 2014,
http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-2414.pdf

Page 33 of 33

9. Memorandum of Agreement Between the United States
Department of Justice and the Consolidated Government of
Columbus, Georgia Regarding the Muscogee County Jail, January
16, 2015, available from
http://www.justice.gov/crt/about/spl/documents/muscogee_moa_116-15.pdf
10.
View of Pods in Sacramento Main Jail, from
http://www.inspectorgeneral.saccounty.net/Documents/sac_02392
9.pdf;
http://www.inspectorgeneral.saccounty.net/Documents/sac_02641
2.pdf
11.
MGT of America, ICE Detention Standards Compliance
Review, Dec. 12, 2009.
12.
Sacramento Bee, “Two Inmates Killed in Separate Incidents
at Sacramento County Jail,” March 8, 2015,
http://www/sacbee.com/news/local/crime/article13048712.html.

Disability Rights California is funded by a variety of sources, for a
complete list of funders, go to http://www.disabilityrightsca.org/
Documents/ListofGrantsAndContracts.html.