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MICHAEL W.BIEN — 096891

GAY CROSTHWAIT GRUNFELD — 121944

~~ MICHAEL FREEDMAN — 262850

SUMANA COOPPAN WOLF — 267967

3 ROSEN BIEN GALVAN & GRUNFELD LLP

315 Montgomery Street, Tenth Floor

D San Francisco, California 94104-1823

Telephone: (415)433-6830

Facsimile: (415)433-7104

Email:

mbien@rbgg.com

6

ggrunfeld@rbgg.com

mfreedman rbgg.com

7

scooppanwo f@rbgg.com

8 JAMES EGAR — 065702

Public Defender

9 DONALD E. LANDIS,JR. — 149006

Assistant Public Defender

10 OFFICE OF THE PUBLIC DEFENDER

COUNTY OF MONTEREY

11 111 West Alisal Street

Salinas, California 93901-2644

12 Telephone: (831)755-5806

Facsimile: (831)755-5873

13 Email:

EgarJS@co.monterey.ca.us

14 Attorneys for Plaintiffs

15

UNITED STATES DISTRICT COURT

16

NORTHERN DISTRICT OF CALIFORNIA

17
18 JESSE HERNANDEZ;ROBERT YANCEY;RICHARD MURPHY;
19 SARAB SARABI;and GLENDA HUNTER,on behalfofthemselves and all
20 others similarly situated,

~~ ~se No.
CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF:

21

Plaintiffs,

22

v.

23 COUNTY OF MONTEREY; MONTEREY COUNTY SHERIFF'S
24 OFFICE; CALIFORNIA FORENSIC MEDICAL GROUP,INCORPORATED,a
25 California corporation; and DOES 1 to 20, inclusive,
26 Defendants.
27

(1) Failure to Protect Prisoners From Violence: Violations of 8th and 14th Amendments of U.S. Constitution, and Article 1, Sections 7 and 17 of California Constitution
(2) Failure to Provide Adequate Medical Care: Violations of 8th and 14th Amendments of U.S. Constitution, and Article 1, Sections 7 and 17 of California Constitution

28

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(3) Failure to Provide Adequate Mental Health Care: Violations of 8th and 14th Amendments of U.S. Constitution, and Article 1, Sections 7 and 17 of California Constitution
(4) Failure to Provide Reasonable Accommodations to Prisoners with Disabilities: Violations of Americans with Disabilities Act, Rehabilitation Act, and California Government Code § 11135
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1

NATURE OF ACTION

2

1. The Monterey County Jail complex in Salinas, California(the "Jail")is

3 broken in every way. Severe overcrowding, outdated facilities, and chronic understaffing

4 have created dangerous conditions in the Jail, placing prisoners and staff at serious risk of

5 injury and death. Violent incidents between prisoners occur regularly, often resulting in

6 grave injuries that require medical treatment and even hospitalization. Prisoners in the

7 Jail, many of whom are pre-trial detainees or charged with violations ofparole or

8 probation,receive woefully inadequate medical care,including significant delays in

9'. evaluation and treatment, failure to provide necessary procedures, discontinuation of

10 needed medications, and poor post-operative follow up care. Mental health care at the Jail

11 is similarly deficient and lacking in sufficient use oftherapy and provision ofpsycho-

12 tropic medications. When such medications are prescribed,they are provided to prisoners

13 ~ in an inconsistent and ineffective manner. Defendants lack adequate policies to identify

14 and supervise prisoners who are at risk for suicide, relying instead on the disturbing

15 practice ofplacing such prisoners in isolation rooms called "rubber rooms." These "rubber

16 rooms" lack any furniture or features save for a grate in the floor which serves as a toilet.

17 In the last three years alone,there have been three completed and more than a dozen

18 attempted suicides at the Jail. Defendants also fail to provide reasonable accommoda-

19 tions to prisoners with disabilities, including the denial ofsign language interpreters to

20 prisoners with hearing impairments, failure to provide canes and walkers to prisoners with

21 mobility impairments, and placement in inaccessible and dangerous housing units and

22 bathrooms.

23

2. Defendants' failures to protect prisoners from violence, to provide minimally

24 adequate medical and mental health care, and to accommodate prisoners with disabilities

25 are particularly egregious given that Defendants have been aware ofthese problems and

26 their causes for years and yet failed to take the necessary actions to ameliorate the

27 unconstitutional conditions. In 2007,the County commissioned athird-party evaluation of

28 the Jail, which resulted in a report, dated June 19,2007,entitled "County of Monterey,

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1 Office ofthe Sheriff, Needs Assessment." The 2007 report concluded that "[t]he current

2 combination ofinsufficient beds, an inadequate detention facility and understaffing has

3 resulted in an almost untenable situation." In 2011,the County asked the third-party

4 consultant to update the 2007 report to reflect amendments to state law and changes within

5 the Sheriff's Office and the Jail population. This updated report, dated December 30,

6 2011,reached the exact same,word-for-word conclusion: "The current combination of

7 insufficient beds, an inadequate detention facility and understaffing has resulted in an

8 almost untenable situation." County of Monterey, Office ofthe Sheriff, Jail Needs

9 Assessment,December 30,2011 (hereinafter,"2011 Jail Needs Assessment" or

10 "Assessment"), at Ex. 2. The situation that was deemed "untenable" in December 2011

11 appears only to have worsened in the last year and half, despite Defendants' knowledge of

12 the risks this situation poses. Defendants' deliberate indifference to prisoners' safety,

13 medical and mental health, and disability needs is unconscionable,and must be stopped to

14 prevent additional unnecessary loss oflife, pain, and suffering.

15

3. This civil rights class action lawsuit seeks to remedy the profoundly

16 dangerous, wasteful, overcrowded, discriminatory, and unconstitutional conditions in the

17 Jail. The Plaintiffs—five prisoners detained in the Jail—bring this action against the

18 Defendants—the County of Monterey,the Monterey County Sheriff's Office, and the

19 California Forensic Medical Groupon behalfofthemselves and those similarly situated.

20

4. Plaintiffs seek declaratory and injunctive relief under the United States and

21 California Constitutions against Defendants' deliberate indifference to the exceedingly

22 high levels ofinmate violence in the Jail. The causes ofthe violence—understaffing,

23 overcrowded housing units, antiquated and poorly designed Jail facilities, and an

24 inadequate prisoner classification system—are well-known to and tolerated by Defendants.

25 Violent incidents between prisoners occur with alarming frequency and in nearly every

26 area ofthe Jail. According to Defendants' own incident reports from 2011 and January to

27 ~~ early-September 2012,there were more than 150 separate incidents ofviolence between

28 prisoners. In more than 100 ofthese incidents, at least one prisoner required some medical

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1 treatment. Violent incidents were reported in 26 out of29 housing units. Violence at the

2 Jail is not an anomaly; it is a way oflife. Forcing prisoners to live under ongoing threats

3 ofserious bodily injury is cruel and inhumane, especially when Defendants have the ability

4 to prevent and reduce such violence.

5

5. Plaintiffs seek declaratory and injunctive relief under the United States and

6 ~ California Constitutions against Defendants' deliberate indifference to their failure to

7 ~ provide prisoners with minimally adequate medical care. Monterey County outsources the

8 ~ provision of medical care to prisoners in the Jail to California Forensic Medical Group

9 (~ "CFMG"), a private corporation, which provides deficient medical care in nearly every

10 respect. Prisoners are not adequately screened for serious medical problems upon arrival

11 at the Jail, and Defendants lack an effective system for requesting care. When prisoners do

12 receive care, it is often after a delay ofweeks or even months. The medical care staff

13 employed by CFMG are insufficient in number to care for the more than 1,100 prisoners in

14, the severely overcrowded Jail. Both prisoners who arrive at the Jail with existing medical

15 care needs and those who develop conditions in the Jail fail to receive timely or

16 appropriate treatment, resulting in unnecessary and prolonged pain,suffering, and

17 worsening oftheir conditions. As a result ofDefendants' failure to provide minimally

18 adequate medical care, Defendants are deliberately indifferent to the substantial risk of

19 harm faced by all prisoners.

20

6. Plaintiffs also seek declaratory and injunctive relief under the United States

21 ~ and California Constitutions against Defendants' deliberate indifference to their failure to

22 provide prisoners with minimally adequate mental health care. Monterey County also

23 outsources the provision of mental health care to prisoners in the Jail to CFMG,which

24 provides deficient mental health care in nearly every respect. Prisoners are not adequately

25 screened for serious mental health problems upon arrival at the Jail. Defendants lack an

26 effective system for prisoners to request care. When prisoners do receive mental health

27 care, it is often after a delay of weeks or even months, and may not include therapy. Both

28 prisoners who arrive at the Jail with existing mental health concerns and those who

I

3

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1 develop conditions in the Jail rarely receive appropriate treatment. Defendants' approach

2 to prisoners with serious mental health problems(including suicidality)involves placing

3 such prisoners in unsanitary rubber rooms, which only exacerbates and prolongs their

4 already dire mental health crises. As a result ofDefendants' failure to provide minimally

5 adequate mental health care,Defendants are deliberately indifferent to the substantial risk

6 of harm faced by all prisoners.

~I

7. Under the Americans with Disabilities Act("ADA"), Section 504 ofthe

8 ~ Rehabilitation Act("Rehabilitation Act"), California Government Code Section 11135,

9 and the United States and California Constitutions,Plaintiffs seek declaratory and

10 injunctive relief against Monterey County, the Monterey County Sheriff's Office, and

11 CFMG as a remedy for Defendants' systemic and willful discrimination against and failure

12 to provide reasonable accommodations to prisoners in the Jail who have disabilities.

13

8. Defendants lack adequate policies and practices for accurately identifying

14 and tracking prisoners with disabilities and the accommodations those prisoners require.

15 Defendants have no adequate administrative grievance process available to prisoners to

16 request reasonable accommodations. Defendants do not provide effective communication

17 or basic and reasonable accommodations,such as sign language interpreting services and

18 hearing aids, to prisoners with hearing,speech and other communication impairments,

19 even for critical interactions with Jail staff, including for disciplinary hearings and medical

20 and mental health appointments. Many areas ofthe Jail are physically inaccessible to

21 prisoners with disabilities, both because Defendants refuse to permit prisoners to possess

22 needed assistive devices and fail to house prisoners with disabilities in accessible parts of

23 the Jail. Defendants' systemic failure to accommodate prisoners with disabilities results in

24 ~~ the widespread exclusion ofprisoners with disabilities from many ofthe programs,

25 services and activities offered by the Jail, including health care services, exercise, religious

26 services, sleeping, and educational and vocational programs. Moreover,Defendants' lack

27 of adequate policies and procedures makes prisoners with disabilities vulnerable to

28 exploitation and violence by other prisoners and increases their risk ofserious injury or

I

4

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1 death.

2

9. As a remedy for the statutory and constitutional violations described herein,

3 ~ Plaintiffs seek a declaration that Defendants are violating federal and state law and an

4 injunction compelling Defendants to provide prisoners with adequate protection from

5 violence and assault from other prisoners,to provide prisoners with adequate medical and

6 mental health care, and to provide reasonable accommodations to and cease discriminating

7 against prisoners with disabilities.

8,

JURISDICTION

9

10. This Court has jurisdiction over the claims brought under federal law

10 pursuant to 28 U.S.C. §§ 1331 and 1343. This Court has jurisdiction over the claims

11 brought under California law pursuant to 28 U.S.C.§ 1367. Plaintiffs seek declaratory and

12 injunctive relief under 28 U.S.C. §§ 1343,2201,and 2202,29 U.S.C. § 794a,42 U.S.C.

13 §§ 1983 and 12117(a), California Government Code § 11135,and Article 1, §§ 7 and 17 of

14 the California Constitution.

15

VENUE

16

11. Venue is properly in this Court, pursuant to Title 28 U.S.C. § 1391(b)(1), in

17 that Plaintiffs' claims for relief arose in this District and one or all ofthe Defendants reside

18 in this District.

19

PARTIES

20

12. PLAINTIFF JESSE HERNANDEZ was detained at Monterey County Jail on

21 April 28,2012. Prior to his incarceration,PlaintiffHERNANDEZ underwent a colostomy.

22 Despite his repeated requests over an eight-month period for colostomy reversal surgery,

23 Defendants provided untimely and inadequate medical care,including, but not limited to

24 repeated failures to remove the colostomy bag and failures to transfer Plaintiff

25 HERNANDEZ to a medical facility that would perform the surgery. Even after Plaintiff

26 HERNANDEZ finally received the colostomy reversal surgery in December 2012,

27 Defendants failed to provide adequate medical care, including, but not limited to proper

28 post-operative follow-up care. As a result ofDefendants' delayed and inadequate medical

5
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1 care, PlaintiffHERNANDEZ has suffered from unnecessary and avoidable pain and

2 symptoms,including, but not limited to intestinal swelling, bleeding, severe stomach pain,

3 fevers,cold sweats, and obstructed bowels. PlaintiffHERNANDEZ is a person with a

4 disability as defined in 42 U.S.C. § 12102,29 U.S.C. § 705(9)(B),and California

5 Government Code § 12926(1).

6

13. PLAINTIFF ROBERT.YANCEY was detained at Monterey County Jail on

7 ~ December 2,2012. He has a hearing impairment and has been completely deafsince birth.

8 ~ PlaintiffYANCEY also has a speech impairment that makes it impossible for him to be

9 understood when speaking. His primary method ofcommunication is American Sign

10' Language Plaintiff YANCEY ordinarily is somewhat able to communicate in a limited

11 manner using written notes; however,for much ofhis time in the Jail, his right hand was in

12 a cast, making it difficult and painful for him to write legibly. Despite multiple requests,

13 PlaintiffYANCEY did not receive reasonable accommodations from Defendants to allow

14 him to access the programs and services offered by the Jail. Defendants never provided

15 PlaintiffYANCEY with a sign language interpreter at any time during his time in the Jail.

16 Plaintiff YANCEY is a person with a disability as defined in 42 U.S.C. § 12102,29 U.S.C.

17 § 705(9)(B), and California Government Code § 12926(1).

18

14. PLAINTIFF RICHARD MURPHY was detained at Monterey County Jail on

19 ~ ~ January 18, 2013. Plaintiff MURPHY has a mobility impairment and requires a cane or

20 walker to ambulate without significant pain. Despite repeated requests,Plaintiff

21 MURPHY has not received reasonable accommodations from Defendants to allow him to

22 walk without pain, and to access the programs and services offered by the Jail. Plaintiff

23 MURPHY also has nerve damage in his back, and requires pain medication as well as

24 cortisone shots. Despite his repeated requests, Plaintiff MURPHY has not received timely

25 or adequate medical care,including but not limited to, necessary medications at the Jail.

26 Plaintiff MURPHY has been diagnosed with mental illness and has been prescribed and

27 requires various prescription psychiatric medications to treat his illness and alleviate his

28 symptoms. Despite repeated requests, Defendants have failed to provide timely and

I

~

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1 ~ appropriate mental health care, including, but not limited to, the failure to provide correct

2 dosages ofthe medications Plaintiff MURPHY requires and the failure to adequately

3 monitor the administration of medications. As a result,Plaintiff MURPHY is experiencing

4 ~ unnecessary and avoidable pain and symptoms,including, but not limited to, hearing

5 ~ voices, seeing shadows, depression and suicidality, and inability to sleep more than a few

6 ~ hours per night. Plaintiff MURPHY is a person with a disability as defined in 42 U.S.C.

7 ~ § 12102,29 U.S.C. § 705(9)(B), and California Government Code § 12926(j)and (1).

8

15. PLAINTIFF SARAB SARABI was detained at Monterey County Jail on

9, February 2,2013. PlaintiffSARABI has a mobility impairment as a result ofa serious

10 injury he sustained to his right leg when he was attacked by another inmate at the Jail.

11 PlaintiffSARABI did not receive timely or adequate medical care for his injury. Plaintiff

12 SARABI has sustained nerve damage,and must use crutches to walk. Despite Plaintiff

13 ~ SARABI's requests,Defendants have not provided PlaintiffSARABI with reasonable or

14 appropriate accommodations to allow him to walk without falling, or to access the

15 programs and services offered by the Jail. PlaintiffSARABI is a person with a disability

16 as defined in 42 U.S.C. § 12102,29 U.S.C. § 705(9)(B),and California Government Code

17 § 12926(1).

18

16. PLAINTIFF GLENDA HUNTER was detained at Monterey County Jail on

19 March 16, 2013. PlaintiffHUNTER has been diagnosed with numerous medical

20 conditions, including diabetes, fibromyalgia, high blood pressure, chronic back pain, bone

21 cancer, and seizures, and she has been prescribed and requires various medications to treat

22 her illnesses and alleviate her symptoms. Despite repeated requests, Defendants have

23 failed to provide timely and appropriate medical care, including, but not limited to, failing

24 to provide.PlaintiffHiTNTER with necessary prescription medications. Plaintiff WINTER

25 has also been diagnosed with mental illness, including manic depression, dementia, anxiety

26 and panic attacks. PlaintiffHUNTER requires mental health treatment to alleviate her

27 symptoms and to function. Defendants have failed to provide timely and appropriate

28 mental health care to Plaintiff HUNTER,including, but not limited to, appropriate

I

7

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1 medications(which PlaintiffHUNTER brought with her to the Jail but which were taken

2 from her by Defendants). As a result ofDefendants' inadequate medical and mental health

3 care,PlaintiffHUNTER is experiencing unnecessary and avoidable pain and symptoms,

4 including, but not limited to nightmares, anxiety, panic attacks, and aural hallucinations.

5 Plaintiff HUNTER is a person with a disability as defined in 42 U.S.C. § 12102,29 U.S.C.

6,~ § 705(9)(B), and California Government Code § 12926(j).

7'~

17. DEFENDANT COUNTY OF MONTEREY(the"COUNTY"or

8 ~"MONTEREY COUNTY")is a public entity, duly organized and existing under the laws

9 ofthe State of California. Under its authority, Defendant COUNTY operates and manages

10 ~ the Jail and is, and was at all relevant times mentioned herein, responsible for the actions

11 and/or inactions and the policies, procedures, practices, and customs ofthe MONTEREY

12 COUNTY SHERIFF'S OFFICE and its respective employees and/or agents. The Board of

13 Supervisors for the COUNTY authorized and approved the contract between

14 DEFENDANT MONTEREY COUNTY SHERIFF'S OFFICE and DEFENDANT

15 CALIFORNIA FORENSIC MEDICAL GROUP INCORPORATED("CFMG")for

16 CFMG to provide medical and mental health care to prisoners in the Jail. The COUNTY

17 by law retains the ultimate authority over and responsibility for the health care,treatment,

18 and safekeeping ofPlaintiffs and the class they seek to represent. The COUNTY employs

19 50 or more persons.

20

18. DEFENDANT MONTEREY COUNTY SHERIFF'S OFFICE(the

21 ~ "SHERIFF'S OFFICE")is a public entity, duly organized and existing under the laws of

22 the State ofCalifornia. Sheriff Scott Miller is the elected Sheriffofthe County of

23 Monterey. The SHERIFF'S OFFICE is responsible for the day-to-day operations ofthe

24 ~~ Jail facilities, including promulgating policies and procedures for the operation ofthe

25 facilities. The SHERIFF'S OFFICE has contracted with CFMG to provide all health care

26 ~~ services in the Jail, but by law retains the ultimate authority over and any responsibility for

27 the health care,treatment, and safekeeping ofPlaintiffs and the class they seek to

28 represent. The SHERIFF'S OFFICE employs 50 or more persons.

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1

19. DEFENDANT CFMG is a corporation organized under the laws ofthe State

2 ofCalifornia and operating under a contract with the SHERIFF'S OFFICE to provide

3 health care services to prisoners in the Jail, including medical and mental health care. The

4 current contract extends from April 1,2012 through June 30,2015. At all times when

5 CFMG and its employees provide medical and mental health care to prisoners in the Jail,

6 CFMG and its employees have acted and continue to act under color ofstate law. CFMG

7 employs 50 or more persons.

8

20. Plaintiffs are ignorant ofthe true names and capacities ofdefendants sued in

9 this complaint as DOES 1 through 20,inclusive, and therefore sue these defendants by

10 such fictitious names. Plaintiffs will amend this complaint to allege their true names and

11 capacities when ascertained. Plaintiffs are informed and believe and thereon allege that

12 each ofthe fictitiously named Defendants is responsible in some manner for the

13 occurrences, and the discrimination against Plaintiffs, alleged in this complaint.

14

21. At all times mentioned in this complaint, each Defendant was the agent of

15 the others, was acting within the course and scope ofthis agency, and all acts alleged to

16 have been committed by any one ofthem was committed on behalf ofevery other

17 Defendant.

18

CLASS ACTION ALLEGATIONS

19

Plaintiff Prisoner Class

20

22. Plaintiffs bring this action on their own behalf and, pursuant to Rule 23(a),

21 (b)(1), and (b)(2)ofthe Federal Rules ofCivil Procedure, on behalfofall others similarly

22 situated. Plaintiffs bring the claims articulated herein on behalf ofall adult men and

23 women who are now,or will be in the future, incarcerated in Monterey County Jail

24 ("Prisoner Class"). All prisoners are at risk ofsubstantial harm due to the following

25 policies and practices:

26

a. Denial of protection from injury and violence from other prisoners,

27

b. Denial of minimally adequate medical care,

28

c. Denial of minimally adequate mental health care,

II

(~

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1

d. Denial ofreasonable accommodations and equal access to programs

2 and services.

3

23. There are questions oflaw and fact common to the class, including:

4

a. Whether Defendants' failure to protect prisoners from violence from

5 other prisoners violates the Due Process Clause ofthe Fourteenth Amendment and the

6 Cruel and Unusual Punishment Clause ofthe ofthe Eighth Amendment to the United

7 States Constitution, and Article 1, Sections 7 and 17 ofthe California Constitution;

8

b. Whether Defendants' failure to provide minimally adequate medical

9 care to prisoners violates the Due Process Clause ofthe Fourteenth Amendment and the

10 Cruel and Unusual Punishment Clause ofthe Eighth Amendment to the United States

11 Constitution, and Article 1, Sections 7 and 17 ofthe California Constitution; and

12

c. Whether Defendants' failure to provide minimally adequate mental

13 health care to prisoners violates the Due Process Clause ofthe Fourteenth Amendment and

14 the Cruel and Unusual Punishment Clause ofthe Eighth Amendment to the United States

15 Constitution, and Article 1, Sections 7 and 17 ofthe California Constitution;

16

d. Whether Defendants' failure to ensure that prisoners are able to

17 communicate effectively with medical and mental health care staff violates the Due

18 ~ Process Clause ofthe Fourteenth Amendment and the Cruel and Unusual Punishment

19 Clause ofthe Eighth Amendment ofthe United States Constitution, and Article 1, Sections

20 7 and 17 ofthe California Constitution;

21

e. Whether Defendants' failure to ensure that prisoners are able to access

22 all programs and services at the Jail and communicate effectively during classification,

23 disciplinary hearings,and all programs and services, including chapel, law library,

24 education and visiting, violates the Americans with Disabilities Act, Section 504 ofthe

25 Rehabilitation Act, and Government Code Section 11135; and

26

£ Whether Defendants' failure to reasonably accommodate prisoners

27 with disabilities violates the Americans with Disabilities Act, Section 504 ofthe

28 Rehabilitation Act, and Government Code Section 11135.

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1

24. The proposed class as defined is sufficiently numerous thatjoinder of all

2 members ofthe class is impracticable and unfeasible. There are currently more than 1,150

3 prisoners in the Jail. All prisoners at the Jail are at risk ofinjury and violence from other

4 prisoners as a result ofDefendants' deliberate indifference toward violence in the Jail. All

5 prisoners are at risk ofdeveloping serious medical or mental health conditions or

6 disabilities while in the Jail, and while the exact number is unknown,Plaintiffs believe

7 there are hundreds ofprisoners at any given time who already have serious medical and/or

8 mental health conditions and/or disabilities.

9

25. The claims ofthe named Plaintiffs are typical ofthe claims ofthe members

10 ofthe proposed class. Plaintiffs and all other members ofthe class have sustained similar

11 injuries arising out ofand caused by Defendants' common course ofconduct in violation

12 ~ ofthe law as alleged herein.

13

26. Plaintiffs are members ofthe class and will fairly and adequately represent

14 and protect the interests ofthe putative class members because they have no disabling

15 ~ conflict(s) ofinterest that would be antagonistic to those ofthe other class members.

16 ~ Plaintiffs have retained counsel who are competent and experienced in complex class

17 action litigation.

18

27. Since the number of class members is more than 1,000, separate actions by

19 ~I ~ individuals would in all likelihood result in inconsistent and varying decisions, which in

20 turn would result in conflicting and incompatible standards ofconduct for the Defendants.

21

28. Defendants have acted and refused to act on grounds that apply generally to

22 ~~ the class, so that final injunctive reliefor corresponding declaratory relief is appropriate

23 respecting the class.

24

FACTUAL ALLEGATIONS

25 III
26

DEFENDANTS FAIL TO PROTECT PRISONERS FROM INJURY OR VIOLENCE FROM OTHER PRISONERS

27

29. Defendants have created a jail environment in which prisoners in all areas of

28 ~~ the Jail face a substantial risk ofbeing injured and intimidated by violence from other

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1 prisoners. Defendants have been aware ofthese risks since at least 2007,when the

2 SHERIFF'S OFFICE and the Monterey County Board of Supervisors contracted with TRG

3 Consulting to produce a needs assessment for the Jail. TRG Consulting completed its

4 report, entitled County ofMonterey, Office ofthe Sheriff, Needs Assessment(hereinafter,

5 "2007 Needs Assessment"), on June 19,2007. The Monterey County Board of

6 Supervisors explicitly accepted the report that same day by unanimous vote. In the report,

7 TRG acknowledged that"this needs assessment would not have been possible without the

8 assistance ofa number ofprofessionals from Monterey County," and specifically

9 recognized a number ofpeople"who helped make this planning effort a success." Among

10 the people listed are two current members Monterey County Board of Supervisors,former

11 Sheriff-Coroner-Marshall Mike Kanalakis,former UndersheriffNancy Cuffney, and

12' former Custody Bureau Chief, Bert Liebersbach.

13

30. Upon information and belief, in 2011, Sheriff Scott Miller requested that

14 TRG Consulting update the 2007 Needs Assessment. As a result, TRG Consulting

15 produced the 2011 Jail Needs Assessment, dated December 30,2011. Upon information

16 and belief, the 2011 Jail Needs Assessment was transmitted to Sheriff Miller and other

17 officials in Monterey County on or around December 30,2011. In the 2011 Jail Needs

18 Assessment,TRG Consulting recognized by name "the primary contributors who helped

19 make this planning effort a success." Assessment at 1. The list includes all five members

20 ofthe Monterey County Board of Supervisors, all ofwhom remain in their elected

21 positions as ofthe filing ofthis complaint. The list also includes Sheriff Miller and former

22 Custody Bureau Chief Jeffrey J. Budd.

23

31. Both the 2007 Needs Assessment and the 2011 Jail Needs Assessment

24 ~~ concluded that,"[t]he current combination ofinsufficient beds, an inadequate detention

25 facility and understaffing has resulted in an almost untenable situation." Assessment at

26 Ex.2. Both reports find that the conditions in the Jail and policies and practices ofthe

27 SHERIFF'S OFFICE create an unreasonable risk ofviolence between prisoners. The

28 situation that was untenable in December 2011 appears to have only worsened in the last

I I

~ 2

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1 ~ year and a half. Because Defendants are aware ofthe unreasonable risk ofviolence and

2 ~ have not acted to reduce the risk, Defendants are deliberately indifferent to the danger of

3 ~ assault faced by all prisoners.

4

A. Defendants' Deliberate Understaffing of the Jail Creates an

Environment in Which Violence Flourishes

5

6'

32. Defendants staff the Jail in a manner that makes it impossible for Defendants

7 ~ to keep prisoners safe from assault from other prisoners. For the past few years the Jail has

8 routinely housed more than 1,100 prisoners. Defendants generally staffthe Jail with as

9 few as 24 and no more than 26 officers. A significant number ofofficers are required to

10 staff other areas ofthe Jail, like the booking area, visitor processing areas, and kitchen.

11 Thus,usually no more than a handful ofofficers are responsible for directly supervising

12 most ofthe more than 1,10'0 prisoners in the jail. The current authorized staffing for the

13 Jail has been described as "woefully inadequate." Assessment at Ex. 7.

14

33. The minimum staffing plan utilized by the SHERIFF'S OFFICE does not

15 ~ provide for a sufficient number ofofficers to safely operate the Jail. As the 2011 Jail

16 Needs Assessment explained,"[i]t appears that the staffing provided by the County salary

17 ordinance is based on the rated capacity of[the Jail], not on how many inmates are actually

18 in custody." Assessment at Ex.6. Currently,the population in the Jail is 33% above the

19 facility's rated capacity.

20

34. Though the staffing plan being used by Defendants is not sufficient on its

21 ~~ face,Defendants have not even hired staffto fill all ofthe authorized positions. As the

22 2011 Jail Needs Assessment stated,"[v]acancies, extended periods ofleave, and normal

23 staff attrition have resulted in a significant amount ofvacant ... positions. The jail has an

24 increased reliance on overtime to meet minimum staffing." Assessment at Ex.7.

25

35. The 2011 Jail Needs Assessment noted that "[b]aseline staffing should be

26 ~~ above minimum staffing," but"[d]ue to vacancies and other factors,the Monterey County

27 Jail constantly is using overtime to staff up to their self-imposed minimum staffing. This

28 level is not adequate to provide basic safety and security for staff and inmates."

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1 Assessment at Ex.7(bolded emphasis added).

2

36. Typically, staffin the Jail work 12-hour shifts. Because ofthe insufficient

3 staffemployed by the Jail, Defendants often utilize a system ofmandatory overtime, where

4 staff are required to work an additional four hours before or after their 12-hour shifts to

5 cover a vacancy during another shift. This dangerous practice may result in staff being

6 e~austed, unfocused, and unable to properly handle the duties required ofthem.

7 Moreover,even when mandatory overtime is used,the extra 4 hours ofcoverage on either

8 end ofa 12-hour shift leaves a 4-hour gap uncovered in the middle ofthe shift. As the

9 2011 Jail Needs Assessment explained,"[u]nderstaffing has resulted in insufficient staff

10 coverage.... At times the middle ofa shift may be as many as three or four officers short.

11 This has been exacerbated by recent staffreductions. As a result there are not enough

12 officers present in the jail to respond to a major crisis or natural disaster.... There are

13 insufficient staffon some shifts to make the required safety checks." Assessment at Ex. 3.

14 Clearly,the staffing at the Jail is not adequate to keep prisoners safe.

15

37. The staff shortages are particularly acute in the housing units and for escort

16 officers. As described in the 2011 Jail Needs Assessment,"[a]review ofthe current

17 staffing pattern as practiced by the Monterey County Jail and the best practices staffing

18 plan included in the 2006 Staffing Analysis indicates that the critical needs are for the extra

19 staffing in the housing units and for facility-wide escort deputies. These positions will

20 ensure required safety checks are made,there is some level ofsupervision in the kitchen,

21 laundry and medical areas and adequate staffing is available to respond to emergencies and

22 unusual situations. Recent cuts in staffing have made this situation much worse ...."

23 Assessment at Ex. 7.

24

38. For example, when Plaintiff SARABI was attacked by another prisoner, the

25 other prisoner hit him 10-15 times with a fist in Plaintiff SARABI's head and legs,

26 knocking him unconscious. The two guards who were supposed to be monitoring the

27 dorm did not intervene or otherwise attempt to stop the attack. PlaintiffSARABI's only

28 recollection of guard involvement was when he awoke from his unconscious state as he

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1 was being dragged by a guard to a holding room, well after the attack had finished.

2

39. The severe understaffing creates a high risk of violence any time inmates are

3 escorted out oftheir housing units and in the presence ofinmates from incompatible

4 classifications. In an incident report, a deputy described visiting as a "time of disorder"

5 with the deputy expected to maintain order "with as many as 9-18 inmates filing into three

6 rooms," even though "differing and often conflicting classifications[are] present at the

7 same time." In the visiting area, lock-down inmates are moved as a group and are

8 unsecured. On April 1,2012,according to an incident report prepared by employees ofthe

9 SHERIFF'S OFFICE,three or four prisoners classified as Administrative Segregation-

10 Sophisticated Sureno forced their way into an unlocked room of Administrative

11 Segregation-Sensitive Needs prisoners. The Sophisticated Sureno prisoners were leaving

12 the visiting area as the Sensitive Needs prisoners were arriving. One deputy failed to lock

13 the visiting room door to secure the Sensitive Needs prisoners, because it would have

14 forced him to lose visual contact with another deputy who was responsible for escorting

15 the seven Administrative Segregation-Sophisticated Sureno prisoners out ofthe visiting

16 area. Three or four ofthe Sureno prisoners rushed past the deputies and into the unlocked

17 room. Then,one prisoner blocked the visiting room door while the others assaulted a

18 prisoner inside the room and outside ofthe deputies' sight. The deputies let the assault

19 continue until back-up arrived. In addition, according to another incident report prepared

20 by employees ofthe SHERIFF'S OFFICE,in February 2012,two Norteno gang members

21 assaulted an inmate while being escorted through the Rehabilitation Infirmary.

22

40. Upon information and belief, Defendants do not adequately train custody

23 ~ ~ staffin how to prevent and appropriately respond to prisoner violence. Such training is of

24 even greater import given the chronic understaffing at the Jail.

25

B. The Jail Is Severely Overcrowded,But Defendants Have Not Utilized

Available Solutions to Ameliorate the Problem

26

27

41. The Jail is severely overcrowded. The Jail has a rated capacity for 829

28 ~~ prisoners, but has in the recent past housed as many as 1,200 prisoners, nearly 150 percent

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1 of capacity. The Jail population has not dropped below 1,000 prisoners in many years.

2 ~ Some areas ofthe Jail are considerably more overcrowded than the Jail as a whole,

3 especially the women's section.

4

42. The Jail has been so overcrowded that for many years now, Monterey

5 County applies on a monthly basis to the Superior Court for the County of Monterey for an

6 order to release prisoners on an accelerated basis pursuant to California Penal Code section

7 4024.1. To support the application, the former ChiefDeputy Sherifffor the County swore

8 on multiple occasions that unless the Jail is able to release some inmates,the overcrowding

9 in the Jail would "compromise[]the inmate classification plan as well as the safety and

10 security ofthe detention facilities." In addition,in support ofthe application, Dr. Taylor

11 Fithian(Director ofDefendant CFMG)"advised that the excessive number ofinmates

12 housed in the Jail compromises the health ofthe inmates and the staff working at the

13 facility."

14

43. Defendants also admitted to the dangerously overcrowded conditions in

15 public statements regarding potential new jail construction. As recently as October 5,

16 2012,in a press release, Monterey County Sheriff Miller stated that "[o]vercrowding has

17 been a serious problem at the jail for many years, creating a dangerous situation for

18 inmates,jail staff and the community."

19

44. The severe overcrowding was also identified in the 2011 Jail Needs

20 Assessment. Specifically, the Assessment found that "[t]here are not enough beds to meet

21 ~~ the current adult detention needs, let alone the needs in the near future....The jail is so

22 overcrowded that no allowance can be made for peaking and classification or the routine or

23 emergency maintenance required in inmate housing areas. Severe overcrowding has

24 resulted in inmates being held in the intake area for up to forty-eight hours. This is not

25 permitted by the California Code ofRegulations. Severe overcrowding has forced the

26 Sheriffto use areas for housing that were not designed or intended for that use (e.g., the

27 rotunda area). This makes these areas much more difficult for officers to manage and

28 control. Overcrowding has forced the Sheriffto operate the jail as an indirect supervision

II

1 h

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1 ~ facility, while the jail was designed for direct supervision. This creates significant

2 ~ command,control and management problems." Assessment at Ex. 2.

3

45. The 2011 Jail Needs Assessment further noted that "[o]vercrowding creates a

4 number ofissues that affect staffand inmates, and put the County at risk. Overcrowding

5 ~ causes stress on both inmates and staff. Inmate vs. inmate assaults typically occur more

6 frequently, as do other disciplinary infractions." Assessment at Ex.9.

7

46. Despite the profound and persistent overcrowding, Defendants have not

8 availed themselves of numerous available opportunities to safely relieve the population

9 pressures in the Jail. For example, Defendants have failed to utilize any form ofpre-trial

10 risk assessment for all but a handful ofdetained defendants, have refused to expand

11 capacity for their existing work release program for sentenced individuals, and have failed

12 to investigate opportunities for collaboration between agencies and to expand their

13 capacity to supervise individuals on mandatory community supervision as part ofa split

14 sentence. Defendants have also failed to implement alternatives to incarceration found

15 safe and effective in otherjurisdictions, including but not limited to diversion and use of

16 home and GPS monitoring.

17

C. The Jail's Physical Structure is Inadequate, Makes It More Difficult for

Staff to Safely Monitor Prisoners, and Increases the Risk of Inmate

18

Violence

19

47. The Jail, which consists oftwo primary buildings—the Rehabilitation Center

20 ~ ~ and the Main Jail Building—constructed over the past 42 years, is a patchwork of

21 makeshift spaces,thrown together to keep up with Monterey's fast-growing Jail

22 population. Throughout the housing units and other spaces,there are numerous blind spots

23 ~~ where staffcannot safely monitor prisoners. As found in the 2011 Jail Needs Assessment,

24 "[t]he design ofthejail and the manner in which additions have been constructed results in

25 aphysical plant that is difficult to manage and control and unnecessarily expensive to

26 operate.... There is poor observation from most deputy stations. Officers cannot observe

27 ~~ inmates areas in Pods A through J. The wing walls in the dormitories are approximately

28 four feet high and provide a number ofareas where inmates cannot be observed. The

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l~ ~ manner in which additions have been constructed has resulted in a facility that lacks any

2 real central control or command post that would be used in the event ofa major

3 disturbance or disaster." Assessment at Ex. 2.

4

48. The 2011 Jail Needs Assessment further noted that "visual supervision is

5 problematic in the existing jail," and "[a]t best there is intermittent observation ofthe

6 inmates. In the Rehabilitation Facility, a Deputy Sheriff must walk into the inmate

7 housing area to see the entire living and shower area. It appears there is an attempt to

8 remedy the problem with the use ofcameras. Unfortunately,this is not working."

9 Assessment at Ex. 8. These physical limitations, especially when combined with the

10 severe understaffing and overcrowding in the Jail, compromise the safety and security of

11 staff, visitors, volunteers and inmates.

12

49. Upon information and belief, on or around April 29,2013,the Jail was under

13 lockdown due to several beatings in the K-Pod. These beatings took place behind a pillar

14 in the K-Pod that blocks the view of Jail staff(both from camera and window

15 perspectives). Upon information and belief, one prisoner was injured so badly in these

16 beatings that he was airlifted out ofthe Jail and taken to a hospital in San Jose where he

17 received treatment for a cracked skull.

18

50. According to incident reports prepared by employees ofthe SHERIFF'S

19 OFFICE,cell doors in many pods throughout the jail can be easily popped open by

20 prisoners, allowing prisoners to leave their cells without authorization at any time. This

21 includes cell doors in lockdown units that house active gang members. Numerous incident

22 reports recount assaults on prisoners who are on their authorized out-of-cell time or are in

23 a unit for kitchen work,times when all other prisoners should be locked in their cells. In

24 one example,an inmate on his out-of-cell hour in a lockdown unit told a nearby deputy

25 who was passing out medication with a nurse that particular inmates in his unit were

26 planning to"pop"their doors to fight him. Before the deputy could get back-up or enter

27 the unit himself,two cell doors were "popped," and two inmates chased the first inmate

28 into a cell on the top tier to assault him,just as he had predicted.

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1

51. As another example from an incident report prepared by an employee ofthe

2 SHERIFF'S OFFICE,a prisoner housed in G-Pod was recently assaulted by another

3 prisoner in the pod. G-Pod is a celled housing unit, meaning all prisoners are housed in

4 ~ cells with doors. Prior to the assault, the prisoner had informed the classification unit that

5 the assailant had been threatening him, had demonstrated to the prisoner that the assailant

6 could open his cell door at will, and had shown the prisoner a large jail-made shank that he

7 possessed. The prisoner requested that the assailant be moved to a different pod, but

8 ~ Defendants took no action to move the assailant to another housing unit. The following 9 day the prisoner was alone in the common area of G-Pod for his hour ofdaily recreation;

10 all ofthe other prisoners in G-Pod were in their cells with their doors closed and

11 purportedly locked. The prisoner then saw the assailant use the shank to attempt to open 12 the door to his cell. To protect himself,the prisoner ran to the assailant's door and used his

13 body to keep the door from opening; he was forced to remain in that position for the

14 ~ remainder ofhis hour outside ofhis cell. The assailant was,however, able to cut the

15 ,prisoner multiple times in his upper stomach area with the shank.

16

52. Poor jail design also exacerbates the dangers of understaffing. According to

17 another incident report prepared by an employee ofthe SHERIFF'S OFFICE,in

18 September 2011,one deputy opened a secure door to a Norteno unit to escort a single 19 prisoner to different part ofthejail while six prisoner workers and three other employees 20 were in the area. Three prisoners classified as Nortenos pushed past the deputy when he

21 ~~ opened the door and all four prisoners proceeded to assault a single inmate worker.

22 Another deputy from the control tower heard the fighting but could not see what was

23 happening. He opened the secured K-1 door to allow back-up to arrive, but in doing so,he

24 ~~ revealed another deputy who was escorting three prisoners classified as Nortenos to the

25 infirmary. All three attempted to join the fight when the door opened, because oftheir

26 gang allegiances. Two were able to enter the area where the fight was continuing and the

27 deputies had to repeatedly deploy their Tasers to get control ofthe situation until back-up

28 could arrive.

I

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1

53. Upon information and belief, Defendants fail to adequately train custody

2 ~ staffin how to prevent and appropriately respond to prisoner violence. Such training is of

3 ~ even greater import given the inadequate physical structure ofthe Jail.

4

D. Defendants Routinely Fail to Adequately Classify and Assign Prisoners

to Housing Locations Where Prisoners Will Be Safe From Violence and

5

Injury

6

54. Defendants fail to adequately classify and assign prisoners to housing

7 ~ locations in the Jail where they will be safe from injury and violence. Before prisoners are

8 assigned to certain housing locations in the Jail, they are "classified" based on a number of

9 factors including their criminal charges, gang affiliation, race, and history ofviolence.

10 These classification procedures are inappropriate and ineffective, however, and prisoners

11 who are incompatible for various reasons, including rival gang memberships and/or

12 histories ofassaultive behaviors, are housed together in the Jail. Moreover,the severe

13 overcrowding at the Jail makes proper and accurate classifications next to impossible. As

14 the 2011 Jail. Needs Assessment found,"[a]dequate separation and segregation resulting

15 from classification ofinmates cannot occur because ofthe severe overcrowding and lack

16 ofa sufficient number ofsingle and double cells. Thus, while the staff has the ability to

17 classify, they do not have the ability to physically segregate those inmates who should be

18 separated because oftheir classification. This creates an environment that is unsafe for

19 officers, inmates and visitors." Assessment at Ex.2.

20

55. The 2011 Jail Needs Assessment further noted that, "[i]t is obvious that the

21 ~~ system is dangerously out of balance in terms ofthe types of beds available and the

22 classification ofinmates held.... In Monterey County there is the possibility of

23 misclassifying inmates based on space rather than security level. Overcrowding reduces

24 the ability to classify. This is further compounded by the dormitory design. Normally,

25 10%-15% ofthe beds should be empty and available for classification spikes and

26 maintenance.... Proper separation and segregation ofinmates as envisioned in the Sheriff's

27 classification plan is very difficult because ofinsufficient staff, an inadequate physical

28 plant layout and ... severe overcrowding ...." Assessment at Ex.4-5.

I

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1

56. For example,PlaintiffSARABI was attacked by a fellow prisoner on or

2 around March 6,2013 in the B-Dorm ofthe Jail. After the attack, PlaintiffSARABI was

3 moved to C-Dorm so he would not be in the same housing areas as the prisoner who

4 attacked him. However,on or around April 11,2013,the Jail moved his attacker into

5 Plaintiff SARABI's C-Dorm,so the person who attacked him just 5 weeks prior would be

6 sleeping just 5 beds away from him. The Jail did not remove Plaintiff SARABI's attacker

7 until the attacker himself was assaulted by other prisoners in the dorm a few hours later.

8

57. Upon information and belief, Defendants fail to adequately train custody

9 staff in how to adequately classify and assign prisoners to housing locations in the Jail

10 where prisoners will be safe from injury and violence. Such training is ofeven greater

11 import given the chronic understaffing and overcrowding at the Jail.

12

E. Defendants Are Deliberately Indifferent to the Constitutionally

Unacceptable Risk of Violence Prisoners Face

13

14

58. Violent incidents between prisoners occur regularly, most of which involve

15 ~ injury to at least one participant that requires medical attention at the Jail or even at the

16 local hospital. In more than 100 ofthe reported incidents from 2011 and January through

17 early-September 2012, at least one prisoner involved in the altercation required some

18 medical treatment. In 13 ofthe incidents, the injuries suffered by at least one ofthe

19 participants were so severe that they had to be taken to an outside medical facility for

20 treatment.

21

59. Violent incidents between prisoners occur in nearly every area ofthe Jail.

22 ~ ~ Violent incidents were reported in 26 ofthe 29 housing units in the Jail from 2011 and

23 January through early-September 2012. There were multiple reports ofviolent incidents in

24 21 ofthe 29 housing units. In the A-Dorm ofthe Main Jail alone, there were 19 incidents,

25 while in the C-Wing ofthe Rehabilitation Center,there were 15 incidents. Violent

26 incidents also occurred in the booking area,the kitchen where prisoners work,the

27 infirmary, and the visiting area.

28

60. Violent incidents occur at _approximately equivalent per prisoner rates in the

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1~ portions ofthe Jail that house men and women. Twenty-one ofthe more than 150

2 incidents involved female prisoners, while another 137 incidents involved male prisoners.

3

61. Prisoners with disabilities are at increased risk of being the victims of

4 violence because oftheir perceived or actual inability to defend themselves. For example,

5 in many ofthe incidents described in incident reports, prisoners with mental health

6 problems were attacked by other prisoners because ofbehavior attributable to their mental

7 illness.

8

62. Defendants have known ofthese conditions and the violence they create for

9 some time,including through their own incident reports and 2007 and 2011 Jail Needs

10 Assessments.

11

63. According to Defendants' own incident reports from 2011 and January to

12 early September 2012,there were more than more than 150 separate incidents ofviolence

13 between prisoners. Some ofthe incident reports were incomplete and lack important

14' pieces ofinformation. Upon information and belief,there are many more incidents of

15 violence that were not captured in Defendants' incident reports.

16

64. In more than 65 ofthe incidents for which there was a full report, upon

17 information and belief,jail stafffailed to intervene to stop the incident before it was

18 completed. IfDefendants were not deliberately indifferent ofthe risk ofprisoner violence,

19 Defendants would be able to stop more violent incidents before they run their course,

20 preventing further injury to the victims. For example, when PlaintiffSARABI was

21 attacked on March 6,2013 by another prisoner, no guards intervened or otherwise

22 attempted to stop the attack.

23

65. In more than 35 ofthe incidents with full reports, Defendants were not able

24 to identify the assailant. Though Defendants have installed cameras in the Jail, upon

25 information and belief, only two cameras monitoring two units that house few prisoners

26 have recording capabilities. The understaffing ofthe Jail means that officers are rarely in a

27 position to identify the attackers visually. Moreover,because the conditions in the Jail are

28 so unsafe,the victims ofattacks frequently refuse to volunteer the name oftheir assailants

II

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1 for fear ofretaliatory attacks. IfDefendants were not deliberately indifferent in their

2 monitoring ofprisoner safety,they would sufficiently staffthe Jail and have other policies

3 in place that would(1)result in the staffidentification ofassailants in a far greater number

4 of attacks, and.(2)create an environment in which victims feel sufficiently safe such that

5 they identify their attackers.

6

66. Weapons are readily available inside the Jail, greatly increasing the danger to

7 ~ inmates and staff. In addition to the incident discussed above involving a shank,inmate

8 ~ assaults have also involved the use ofa"Tomahawk" made from a razor and a 13 to 19-

9 ~ inch long copper pipe.

10

67. Upon information and belief, Defendants fail to adequately train custody

11 staffin how to timely and appropriately intervene to stop violent incidents, and how to

12 ~ identify and confiscate weapons before they are used in an altercation.

13 II. 14

DEFENDANTS FAIL TO PROVIDE ADEQUATE MEDICAL CARE TO PRISONERS

15

68. Defendants are not meeting their constitutional obligation to provide

16 adequate medical care to prisoners in the Jail. Prisoners are entirely dependent on

17 Defendants for all medical care. The medical care provided by Defendants in the Jail is

18 woefully inadequate and subjects prisoners to a substantial risk ofserious injury or death.

19

A. Defendants Routinely and Systematically Fail to Maintain Sufficient

Numbers of Health Care Professionals

20

21

69. All health care in the Jail, including medical and mental health care, is

22 provided by Defendant CFMG and its employees. CFMG provides these services pursuant

23 to its contract with Monterey County. CFMG is afor-profit corporation.

24

70. Upon information and belief, Defendants maintain insufficient numbers of

25 ~~ health care professionals to provide minimally adequate care to the more than 1,000

26 prisoners in the Jail. There are not sufficient health care staffto timely respond to

27 prisoners' requests for medical evaluations and treatment, or to adequately screen, monitor,

28 and provide follow-up care to prisoners who are suffering from serious and chronic

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illnesses.

2

71. For example, when Plaintiff SARABI was attacked by another prisoner the

3 night of March 6,2013, he was seen by a nurse who placed an ACE bandage on his right

4 foot and ankle and gave him a wheelchair. Plaintiff SARABI complained for the next

5 several hours about the serious pain in his foot and a possible concussion, but his repeated

6 requests for help and medical care were ignored. When a nurse finally brought him back

7 to the infirmary at approximately 3:00 a.m.,she informed Plaintiff SARABI that there was

8 no qualified medical staffpresent at that hour to evaluate and help him,so he would have

9 to wait unti16:00 a.m. to receive his needed pain medications.

10

72. The insufficient number of custody staff makes it even more difficult for

11 Defendants to provide minimally adequate health care. Within the Jail, any time that a

12 prisoner must be transferred to or from a housing unit to another area ofthe Jail for health

13 care services, at least one custody officer must accompany and transport the prisoner.

14 Similarly, anytime that a prisoner requires transport to an outside medical facility for

15 treatment, at least one custody officer must accompany the prisoner and remain present for

16 the duration oftime that the prisoner is at the outside medical facility. To timely transport

17 all prisoners to and from all health care services would require Defendants to hire and staff

18 thejail with additional custody officers,something Defendants refuse to do.

19

B. Defendants Routinely and Systematically Fail to Properly Train and

Supervise the Conduct of Health Care Staff

20

21

73. Upon information and belief, the small number of health care staff that

22 Defendants do employ are not sufficiently trained to provide the care required ofthem.

23 Licensed Vocational Nurses("LVNs")and Licensed Psychiatric Technicians("LPTs")are

24 entry level health care providers who must only practice under the direct supervision of

25 physicians, psychologists, registered nurses, social workers, or other qualified

26 professionals, and are not qualified to do their own patient evaluations or assessments.

27 Yet, upon information and belief, Defendants improperly allow untrained entry-level

28 providers such as LVNs and LPTs to practice outside ofthe scope oftheir licensure and

I

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1 ~ perform medical gatekeeping functions,including independently assessing and responding

2 ~ to prisoners' health care requests and correctional officers' referrals for health care.

3

74. For example, Plaintiff SARABI suffered a serious leg injury when he was

4 attacked by another prisoner on March 6,2013. PlaintiffSARABI was initially seen and

5 ~ treated by nurses only for the first two weeks following the injury. The nurses wrapped his

6 ~ injured foot and ankle in an ACE bandage immediately after the attack,then approximately

7 ~ a week later placed a splint on his right foot and ankle. The splint was placed too low,

8 ~ resulting in discomfort and continued pain for Plaintiff SARABI. When PlaintiffSARABI

9 ~ finally saw a doctor for the first time(nearly two weeks after his date ofinjury), the doctor

10 ~ informed him that he likely had a peroneal nerve injury that required specific nerve

11,~ medication and would take at least a month if not longer to heal. When Plaintiff SARABI

12 asked why ittook medical staffso long to diagnose the nerve injury, the doctor replied that

13 it was a "staff problem" because the stafferroneously diagnosed PlaintiffSARABI's nerve

14 damage as a sprain.

15

75. Upon information and belief, Defendants fail to adequately train their

16 ~ medical staffin how to properly follow the Jail's medical policies and procedures.

17

76. Defendants also fail to maintain medical accreditations. Specifically, the

18 ~ Institute for Medical Quality("IMQ")offers voluntary accreditation to correctional and

19 detention facilities throughout California based upon meeting standards developed by the

20 IMQ. Monterey County Jail's IMQ accreditation expired on November 17,2011.

21

C. Defendants Lack Sufficient Facilities to Provide Adequate Medical Care

22

77. The physical spaces in the Jail used to deliver medical care are not sufficient

23 for the population ofprisoners. As the 2011 Jail Needs Assessment found,

24 "Medical/mental health treatment spaces are not adequate for the rated beds, let alone the

25 actual number ofinmates held." Assessment at Ex. 3. The Assessment further noted the

26 direct impact ofovercrowding on prisoners' overall health:"Overcrowding affects

27 inmates' mental and physical health by increasing the level ofuncertainty with which they

28 regularly cope." Assessment at Ex.9. The lack ofsufficient treatment space places

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1 prisoners at an unreasonable risk ofharm from inadequate medical care, compromises the 2 delivery of medical care, and fails to ensure confidentiality and safety during the delivery

3 ofsuch care.

4

D. Defendants' Inadequate Screening and Intake Process Fails to Identify

and Treat Medical Care Problems of Newly Arriving Prisoners

5

6

78. Defendants fail to adequately identify and treat the medical problems of

7 newly arriving prisoners during the screening and intake process. Defendants' policies and

8 practices for medical screening are inadequate. Upon information and belief, Defendants

9 fail to adequately train custody staffin how to timely and appropriately identify medical

10 problems during the screening and intake process. When a prisoner is newly booked into

11 the Jail, medical staff may not even play a role in screening the prisoner. Upon

12 information and belief, custody staff(who are not sufficiently trained to identify medical

13 needs)complete a brief one-page health screening form during a cursory interview with

14 the prisoner in anon-confidential space. Medical staff only evaluate prisoners at intake if

15 the custody staff note a problem on the screening form. Upon information and belief,

16 Defendants fail to take every prisoner's vital signs(including blood pressure and

17 temperature), and only take them for prisoners whom custody staffrefer to medical staff

18 for assessment. Upon information and belief, comprehensive intake evaluations by

19 medical staff, when they occur at all, frequently do not take place until days or weeks after

20 a prisoner is booked into the jail.

21

79. Because the screening process is inadequate to identify prisoners with

22 serious or chronic health care problems,prisoners are at a significant risk ofserious harm. _ __
23 For example,prior to being booked into the Jail, Plaintiff MURPHY had permanent nerve

24 damage that was caused by a bulge in his L4 and LS vertebrae. When he went through the

25 screening process,Plaintiff MURPHY was experiencing significant pain from the nerve

26 damage because he had not taken his pain medication and did not have a cane to assist him

27 in walking. The screening form for Plaintiff MURPHY does not indicate that he had any

28 potential or existing nerve damage or back problems.

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1

80. Another example is a prisoner whose colon had begun to rupture prior to his

2 being booked into the Jail. When he went through the screening process,this prisoner was

3 already experiencing symptoms from his condition,including a fever and significant

4 abdominal pain. The screening form for this prisoner does not indicate that he had any

SII potential health problems.
E. Defendants Fail to Provide Prisoners with a Reliable and Timely Way to Alert Health Care Staff of Their Medical Needs
7

8

81. Defendants fail to provide a reliable way for prisoners to alert health care

9 staffof their need for evaluation of medical problems. Defendants' policies and practices

10 for providing prisoners with a means for alerting health care staffof medical needs are

11 inadequate. Upon information and belief, Defendants fail to adequately train medical staff

12 in how to properly process and timely respond to prisoners' requests for medical

13 evaluation.

14

82. To request medical care, prisoners are supposed to submit a "sick call slip"

15 to medical staff when medical staffcome through a housing unit to distribute medications.

16 Once a sick call slip is received by medical staff, the prisoner is supposed to be seen by 17 medical staffon the next available sick call day. Though prisoners report little difficulty 18 submitting sick call slips to medical staff,they frequently receive no response to their

19 requests for medical care.

20

83. Other times, when prisoners do receive a response to a sick call slip, it is not

21 until many days after the sick call slip was submitted. These delays in response from

22 medical staffplace prisoners in danger. For example, one prisoner submitted a sick call

_

_

_

__-

23 slip to seek medical attention after falling in the yard. He was not seen by anyone from the

24 medical department for 6-7 days after he submitted the sick call slip.

25

84. Upon information and belief, the failure to timely respond to sick call slips is

26 caused, at least in part, by Defendants' failure to create an effective tracking and

27 scheduling system for health care appointments. Upon information and belief, another

28 contributing factor is that there are no standardized protocols dictating when prisoners

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1 should receive aface-to-face appointment with a nurse or other medical or mental health

2 care clinician. Consequently, health care providers arbitrarily determine whether the

3 content ofa sick call slip, often written by a prisoner who can barely read or write,

4. warrants an examination. Upon information and belief, Defendants do not adequately train

5 'I health care providers in how to review, process, and respond to sick call slips submitted by

6 ~ prisoners.

7

85. In emergency situations, prisoners sometimes request health care from

8 custody staff when medical staff are not immediately available. Rather than immediately

9 contact health care staffto determine whether emergency care is required, custody staff

10 often dismiss the prisoner's request and instruct prisoners to fill out a sick call slip. For

11 example,PlaintiffHERNANDEZ was experiencing significant pain, cold sweats, and a

12 fever after his colostomy reversal surgery. Although other prisoners in his pod began 13 yelling"Man down!" to alert the Jail staffthat PlaintiffHERNANDEZ was in serious

14 distress and incapable ofambulating,at least 30-60 minutes passed between when the

15 guard was first alerted to Plaintiff HERNANDEZ's"man down"status and when Plaintiff

16 HERNANDEZ actually began receiving any medical assistance.

17

86. When Plaintiff SARABI was complaining about intense pain in his right

18 ~ foot/ankle, and his concern about a broken ankle and a possible concussion one hour after 19 he was attacked by another prisoner, one ofthe guards outside his room said,"You're a

20 tough guy,suck it up, if you had broken your ankle you would be in more pain." Delays in

21 treating PlaintiffSARABI and other prisoners have created unnecessary suffering and

22 worsened health outcomes.

23

87. Upon information and belief, Defendants do not adequately train custody

24 staffin how to respond to prisoners' requests for emergency medical attention.

25

F. Defendants Routinely and Systematically Fail to Provide Adequate

Medical Care

26

27

88. Defendants fail to provide timely access to medical care. Defendants'

28 ~~ policies and practices for providing timely access to medical care are inadequate. Upon

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information and belief, Defendants fail to adequately train medical staffin how to provide

2 timely access to medical care. Ifprisoners are seen by medical care providers at all, they

3 often experience substantial delays in receiving those appointments. Prisoners commonly

4 wait several weeks,sometimes several months, before they are evaluated by clinicians for

5 medical symptoms. For example,PlaintiffHERNANDEZ was supposed to have his

6 colostomy reversed in June 2012. However,Jail medical staffrepeatedly refused to

7 perform the colostomy reversal surgery, at first claiming that it was improper for Jail

8 doctors to do so when an outside doctor had performed the original colostomy, and then

9 claiming that the procedure was"non-emergency"so could not be done at the Jail. The

10 Jail also refused to transfer PlaintiffHERNANDEZ to a facility where he could receive the

11 reversal surgery, and in August 2012 denied PlaintiffHERNANDEZ the day pass

12 necessary to go to Natividad Medical Center for the surgery. In total, Plaintiff

13 HERNANDEZ had to wait eight months to have his colostomy surgery after he arrived at

14 the Jail, during which time he suffered from intestinal swelling, bleeding, and pain.

15

89. Other prisoners have repeatedly been denied necessary medical treatments or

16 experienced significant delays in receiving what they needed,or had been prescribed prior

17 to arriving at the Jail, resulting in significant physical pain and discomfort, as well as

18 increased anxiety and panic. For example, another prisoner repeatedly requested

19 colostomy reversal surgery for three months, but was informed by the Jail that he could not

20 receive the surgery because it was an "elective," as opposed to emergency,procedure.

21 During these three months,this prisoner suffered from infections, bloody discharge,

22 fainting, and vomiting. Another prisoner was not timely provided with appropriate -- ___-
23 colostomy supplies, and when he appeared in court, he was leaking feces over his body.

24 The judge ordered him to be sent immediately to the hospital in an ambulance.

25

90. Another prisoner suffered a miscarriage immediately before being booked

26 into the Jail, and experienced heavy vaginal bleeding for at least 7 weeks afterward.

27 Despite repeated requests,this prisoner did not see a women's health specialist for 7

28 weeks. After 7 weeks ofbleeding and the filing of multiple grievances(most of which

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1 went unanswered),this prisoner was finally taken to Natividad Medical Center for an

2 evaluation by a women's health specialist. This prisoner did not receive timely and

3 appropriate care for her condition.

4

91. Upon information and belief, CFMG medical staffinform prisoners that they

5 will not receive medically necessary treatments, procedures, or medications while in the

6 Jail because their release from the Jail or transfer to state prison or another institution is

7 imminent. For example,when a prisoner's colostomy repeatedly became infected, he was

8 told that reversal surgery would not be provided while he was in the Jail because ofthe

9 expense, and that he would need to obtain the surgery once he was released.

10

92. In interactions with medical staff, Defendants fail to ensure that hearing and

11 speech impaired prisoners who use American Sign Language as their primary method of

12 communication are provided with sign language interpreters to ensure effective

13 communication. Without sign language,such prisoners are not able to explain to medical

14 care providers the symptoms they are experiencing, and medical staff are not able to

15 explain the benefits and risks oftreatments, medications, and procedures such.that

16 prisoners can provide their informed consent. The lack ofsign language interpretation

17 services results in Defendants making medical treatment decisions without all ofthe

18 necessary and pertinent information.they need, which increases the risk of misdiagnosis

19 and mistreatment for the prisoner.

20

93. For example, Plaintiff YANCEY was examined by a Physician's Assistant

21 ("PA") on December 4, 2012, two days after he was discharged from the hospital with a

22 fractured right arm and fractured left tibia. Defendants did not provide Plaintiff YANCEY

23 with a sign language interpreter for the examination. Though Plaintiff YANCEY pre-

24 sented with multiple, complex trauma issues, the PA's Progress Note admits that the

25 "[e]xam [was] limited due to decreased verbal communication ...." Because of Defend-

26 ants' failure to provide Plaintiff YANCEY with a sign language interpreter, he was unable

27 to explain the extent of his pain and other symptoms. As a result, he suffered from

28 needless and unnecessary pain. Defendants also failed to provide Plaintiff YANCEY with

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1 sign language interpreters at other medical appointments. The lack of a sign language

2 interpreter at other medical appointments similarly resulted in Plaintiff YANCEY's

3 inability to communicate his symptoms to medical staff and to understand medical staff.

4 Through their failure to provide sign language interpreters, Defendants are deliberately

5 indifferent to the medical needs ofprisoners who require assistance to communicate.

6

94. Upon information and belief, Defendants fail to provide foreign language

7 interpretation services to prisoners whose primary language is not English during medical

8 clinical evaluations. This is particularly true for prisoners who cannot speak either English

9 or Spanish. Without foreign language interpretation, such prisoners are not able to explain

10 to doctors the symptoms they are experiencing, and medical staffare not able to explain

11 the benefits and risks oftreatments, medications, and procedures such that prisoners can

12 provide their informed consent. The lack offoreign language interpretation services

13 results in Defendants making medical treatment decisions without all ofthe necessary and

14 pertinent information they need, which increases the risk of misdiagnosis and mistreatment

15 for the prisoner. Through their failure to provide foreign language interpreters, Defendants

16 are deliberately indifferent to the medical needs ofprisoners who require assistance to

17 communicate.

18

G. Defendants Fail to Continue Medically Necessary Treatments for

Prisoners Upon Their Arrival at the Jail

19

20

95. Defendants fail to continue medically necessary treatments for prisoners who

21 ~ ~ were in the process of undergoing care for chronic or serious conditions immediately prior

22 to being booked into the Jail. Defendants' policies and practices for continuing medically

23 necessary treatments for prisoners who arrive at the Jail are inadequate. Upon information

24 and belief, Defendants do not adequately train medical staffin how to evaluate and treat

25 prisoners who were undergoing care for chronic or serious conditions immediately prior to

26 being booked into the Jail.

27

96. Defendants routinely refuse to provide medications that prisoners have been

28 ~~ using to treat conditions outside ofthe Jail, even when the prisoners themselves, doctors,

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1 family members,or other entities bring their medications and/or valid prescriptions to the

2 ~ Jail.

3

97. For example, prior to his incarceration, Plaintiff MURPHY was taking

4 various pain medications at least four times a day as treatment for the nerve damage in his

5 back. However,despite his repeated requests, PlaintiffMi_IRPHY has not received the

6 necessary medications at the appropriate times, and he is in constant pain every day while

7 at the Jail.

8

98. Prior to her incarceration, Plaintiff HUNTER was taking various medications

9 to treat her diabetes,fibromyalgia, high blood pressure,chronic back pain, bone cancer,

10 seizures, bipolar disorder, manic depression, anxiety, and panic attacks. Plaintiff

11 HUNTER had many ofthese medications with her upon her arrival at the Jail, but they

12 were confiscated during the booking process. PlaintiffHUNTER was not provided with

13 all ofher necessary medications for two weeks,even though she brought them to the Jail.

14 Upon information and belief, PlaintiffHUNTER still has not been provided with all ofthe

15 medications that she requires.

16

99. Defendants place prisoners who arrive at the Jail and who are prescribed pain

17 ~ medications on what Defendants calla "detoxification treatment." This "detoxification

18 treatment" involves refusing,for up to 90 days,to provide prisoners with the pain and

19 other medications they were taking before they were booked into the Jail. This practice of

20 removing prisoners from prescribed medications is dangerous,inhumane,and does not

21 meet the standard ofcare. Prisoners placed on the "detoxification treatment" and removed

22 from pain medications suffer extreme pain, withdrawal symptoms,and degeneration of

23 conditions the medication was designed to treat. For example,one prisoner was taking

24 significant dosages ofpain medications for injuries stemming from gunshot wounds,

25 including a Fentanyl patch, Oxycontin,and Oxycodone. However, when he arrived at the

26 Jail, he was taken off all his pain medications and immediately subjected to the

27 detoxification treatment. As a result ofthe detoxification treatment,this prisoner suffered

28 through an extremely painful withdrawal.

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1

H. Defendants Fail to Maintain Adequate, Accurate,and Complete Medical

Care Records

2

3

100. Upon information and belief, Defendants fail to maintain adequate, accurate,

4 and complete medical care records. Defendants' policies and practices for maintaining

5 adequate medical care records are inadequate. Upon information and belief, Defendants

6 fail to adequately train medical staffin how to maintain adequate medical care records.

7 For example, physicians change prisoners' medications without documenting explanations.

8 As a result ofDefendants' failure to maintain adequate medical care records, prisoners

9 suffer from a substantial risk of misdiagnosis,dangerous mistakes, and unnecessary delays

10 in care. For example, certain Progress Notes from November 28,2012 and January 29,

11 2013,are missing from Plaintiff YANCEY's medical file, placing him at increased risk of

12 misdiagnosis and mistreatment.

13

101. Upon information and belief, Defendants fail to obtain medical files from

14 outside providers for significant periods oftime after the prisoner's arrival at the Jail(ifat

15 all). This lack ofinformation reduces the quality ofmedical care, as medical stafftreat

16 prisoners without reviewing pertinent medication background information and history,

17 which increases the risk of misdiagnosis and mistreatment.

18

I. Defendants Fail to Provide Adequate Medical Care and Follow Up

Treatment to Prisoners

19

20

102. Upon information and belief, Defendants fail to order diagnostic testing

21 when medically necessary. Defendants' policies and practices for ordering diagnostic

22 testing are inadequate. Upon information and belief, Defendants fail to adequately train

23 medical staffin when it is appropriate to order diagnostic testing. For example, when

24 PlaintiffSARABI sustained an injury to his right ankle/foot after he was attacked by

25 another prisoner, he did not timely receive tests to determine the extent ofthe muscle and

26 nerve damage. Other prisoners do not receive medically indicated diagnostic tests such as

27 a colonoscopy or an ultrasound in a timely manner.

28

103. Defendants also fail to refer prisoners to medical specialists or to an outside

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1 medical center when medically necessary. Defendants' policies and practices for referring

2 prisoner to specialist or outside providers are inadequate. Upon information and belief,

3 Defendants fail to adequately train medical staffin when it is appropriate to refer prisoners

4 to medical specialists or outside medical centers. For example,PlaintiffHERNANDEZ

5 required colostomy reversal surgery, but Defendants refused for eight months to perform

6 or provide the surgery.

7

104. Upon information and belief, another prisoner in the Jail recently suffered a

8 miscarriage due to the Jail's failure to timely take her to a hospital. While pregnant,this

9 prisoner began to experience uterine cramping and bleeding, but was informed by Jail

10 medical staffto go on bed rest. The Jail staff did not transport her to a hospital until at

11 least two days later, and by that time she had lost her baby. Between 2012-2013,at least

12' three women in the Jail suffered from miscarriages.

13

105. Defendants fail to adequately monitor prisoners discharged from the hospital

14 or Jail infirmary. Defendants' policies and practices for monitoring prisoners discharged

15 from the hospital or infirmary are inadequate. Upon information and belief, Defendants

16 fail to adequately train medical staffin how to appropriately and effectively monitor

17 prisoners discharged from the hospital or infirmary. For example,PlaintiffHERNANDEZ

18 received colostomy reversal surgery in December 2012,and had to return to the hospital

19 one day after surgery due to post-operative complications. Since his discharge from

20 Natividad Medical Center,PlaintiffHERNANDEZ has received inadequate care from Jail

21 medical staff. Specifically,PlaintiffHERNANDEZ's gauze at the surgery site was not

22 changed every 24 hours as is required, he did not receive the antibiotics that had been

23 prescribed for him,and when he experienced fever and severe pain, Jail stafffailed to

24 contact staffat the Natividad Medical Center(as they had been instructed to do). When

25 PlaintiffHERNANDEZ went"man down"due to the worst pain ofhis life, a fever, and

26 cold sweats,he did not receive medical assistance for 30-60 minutes, despite his recent

27 discharge from the hospital. PlaintiffHERNANDEZ was most recently discharged from

28 Natividad Medical Center on or around February 28,2013, and since then has only been

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1~ seen rarely by a doctor or even by nurses. PlaintiffHERNANDEZ was promised physical

2~ therapy for his stomach and periodic checkups for his various medical conditions, none of

3 which have occurred. PlaintiffHERNANDEZ continues to suffer from bowel obstructions

4 ~ and stomach pain.

5

106. Another prisoner suffered a ruptured colon and had to undergo colostomy

6 surgery in August 2012. After he was discharged from the Jail infirmary following the

7 surgery,the Jail failed to timely provide him with supplies to change his colostomy bag,

8 and when such supplies were provided,they were often improper(e.g.,the wrong size

9 colostomy bag). In November 2012, an infection developed around his suture from the

10 colostomy surgery and the prisoner suffered from bloody discharge from his colon, but Jail

11 staffrefused to perform the overdue colostomy reversal(which was originally scheduled

12 for October 2012). Despite his dire health complications after the colostomy surgery and

13 his need for the reversal,this prisoner was not seen by a doctor for over three weeks in

14 January 2013.

15

107. Upon information and belief, Defendants routinely release prisoners with

16 ~ serious medical conditions from the Jail without providing them with services to ensure

17 that their medical care is not disrupted. Defendants' policies and practices for the

18 provision ofcontinuing medical care services upon a prisoner's release are inadequate.

19 Upon information and belief, Defendants fail to adequately train custody and medical staff

20 in how to appropriately release prisoners with serious medical concerns so that such

21 prisoners can continue their medical care. Upon information and belief,for those prisoners

22 who are prescribed medications in the Jail, they are released without either a supply ofor a

23 prescription for them to fill those medications at a community pharmacy. Defendants do

24 not schedule follow-up appointments in the community,nor are prisoners provided with

25 sufficient referrals or information about where they may receive medical care services or

26 medications.

27

28

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1 III. 2 3

DEFENDANTS FAIL TO PROVIDE MINIMALLY ADEQUATE MENTAL HEALTH CARE TO PRISONERS
108. Defendants are not meeting their constitutional obligation to provide

4 adequate mental health care to prisoners in the Jail. Prisoners are entirely dependent on

5 Defendants for all mental health care. The mental health care provided by Defendants in 6 the Jail is woefully inadequate and subjects prisoners to a substantial risk of deteriorating

7 psychiatric conditions, extreme anguish and suffering, and in some cases, even death.

8 Defendants' mental health care system falls far short ofall ofthe minimum elements ofa

9 constitutional mental health system.

10

A. Defendants Fail to Identify and Track Prisoners in Need of Mental

Health Care

11

12

109. Defendants fail to adequately identify, track and treat the mental health

13' problems ofnewly arriving prisoners during the screening and intake process. Defendants'

14 policies and practices for mental health screening and tracking are inadequate. Upon

15 information and belief, Defendants fail to adequately train custody staffin how to timely

16 and appropriately identify mental health problems during the screening and intake process.

17 When a prisoner is newly booked into the Jail, mental health staffplay no role in the initial

18 j screening ofthe prisoner. Upon information and belief, custody staff(who are not

19 sufficiently trained to identify mental health concerns)complete a briefone-page general

20 health screening form through a cursory interview conducted with the prisoner in a non-

21 confidential area ofthe Jail. Mental health staff only evaluate prisoners at intake ifthe

22 custody staffrefer the prisoner to mental health care staff. Upon information and belief,

23 comprehensive intake evaluations by mental health staff, when they occur at all, frequently

24 do not take place until days or weeks after a prisoner is booked into the Jail.

25

110. Because the screening process is inadequate to identify prisoners with

26 serious mental health care problems, prisoners are at a significant risk ofserious harm. For 27 example,PlaintiffHUNTER arrived at the Jail on March 16,2013 with psychiatric 28 medications to treat her bipolar disorder, manic depression, anxiety, and panic attacks.

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1 Plaintiff HUNTER also brought with her a hard copy ofher medical history, which

2 documents the medications she requires. However,during the booking process,Plaintiff

3 HUNTER's psychiatric medications were confiscated, and she did not receive any ofher

4 needed psychiatric medications for at least 2 weeks, despite repeated requests and

5 grievances asking for the medications. As a result of not receiving her psychiatric

6 medications,PlaintiffHUNTER suffered from unnecessary and avoidable pain and

7 symptoms,including, but not limited to, nightmares, anxiety, panic attacks, and

8 hallucinations for this two week period.

9

111. Defendants fail to provide adequate treatment to prisoners who arrive at the

10 Jail and have been prescribed psychotropic medications. Defendants' policies and

11 practices for prisoners who have been taking prescribed psychotropic medications are

12 inadequate. Upon information and belief, Defendants fail to adequately train mental health

13 staffin how to evaluate and treat prisoners who arrive at the Jail and have been taking

14 prescribed psychotropic medications. Defendants sometimes place prisoners who arrive at

15 the Jail and who are prescribed psychotropic medications on what Defendants call a

16 "detoxification treatment." This "detoxification treatment" involves refusing,for up to 90

17 days,to provide prisoners with the psychotropic medications they were taking before they

18 were booked into the Jail. This practice ofremoving prisoners from prescribed

19 ~ medications is dangerous,inhumane, and does not meet the standard ofcare. Prisoners

20 placed on the "detoxification treatment" and removed from psychotropic medications

21 experience unnecessary pain and increases in psychiatric symptoms including paranoia,

22 hallucinations, and suicidality. Such individuals are at increased risk of attempting to

23 commit suicide.

24

112. Upon information and belief, Defendants do not maintain any central list,

25 ~~ electronic or otherwise, of prisoners with mental illness and the treatment they require.

26 Defendants do not maintain adequate information about prisoners' mental health needs in

27 the prisoners' custody and/or medical files. Moreover,upon information and belief, to the

28 extent that Defendants maintain information about a prisoner's mental health needs in any

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1 form, custody, medical, and clerical staffare not provided with access to the information in

2 a manner that would timely and effectively inform them ofa prisoner's mental health

3 concerns and treatment needs.

4

113. Upon information and belief, Defendants fail to adequately train mental

5 health staffin how to track and monitor prisoners with mental illness and the treatment

6 they require.

7

B. Defendants Lack Adequate Policies and Procedures to Identify, Treat,

Track and Supervise Prisoners at Risk for Suicide

8

9

114. Defendants fail to identify, treat, track and supervise prisoners who are at

10 I' risk for suicide. Defendants' policies and practices for screening, supervising, and treating

11 prisoners at risk for suicide are inadequate. These shortcomings in the Jail's suicide

12 prevention and treatment program have had tragic consequences. Over the past three

13 years,there have been three completed and more than a dozen attempted suicides. The

14 rate ofcompleted suicides at the Jail significantly exceeds the national average for local

15 jails.

16

115. The very design ofthe Jail itselfpresents a risk to suicidal prisoners. As

17~ noted in the 2011 Jail Needs Assessment,"The older design ofthe cells and dormitories

18 constructed prior to 1993 does not meet today's minimum standards for detention

19 facilities. Examples include: Suicide hazard elimination is not as stringent as it should be

20 to prevent self-harm and the attendant liability." Assessment at Ex. 3.

21

116. Upon information and belief, Defendants do not adequately train custody

22 staffto identify prisoners who are at risk ofsuicide and respond adequately to prisoners

23 who are e~ibiting suicidal tendencies. This is especially problematic because custody

24 staff, both during the intake process and for the duration ofa prisoner's time in the Jail,

25 have the primary responsibility for alerting mental health staff when a prisoner is suicidal.

26

117. Defendants routinely fail to identify and track prisoners who are at risk for

27 suicide. For example, a prisoner named Joshua Claypole.who recently arrived at the Jail

28 ~ was suicidal, and his attorney asked Jail staffto place this prisoner on suicide watch on the

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1 day ofhis arrest. Mr. Claypole was apparently initially placed on suicide watch, but was

2 soon taken off and cleared to go into the jail's general population. He was then housed in

3 a single cell, but upon information and belief did not receive any increased monitoring or

4 medication. Mr. Claypole attempted suicide by hanging in his cell, and was air-lifted to a

5 San Jose hospital where he was placed on life support. Five days later, he was taken off

6 life support and died. Another prisoner had attempted suicide at least twice before his

7 incarceration and spent6-8 months at Atascadero State Hospital before coming to the Jail.

8 Despite this prisoner's suicidal history,the Jail failed to identify him as at risk for suicide

9 and failed to take steps to safely house,track, and treat him to reduce the risk ofsuicide.

10 This prisoner attempted suicide by jumping offthe second floor ofthe housing pod,and

11 had to be airlifted to Santa Clara Hospital, where he was treated for trauma to his head and

12 broken ribs.

13

118. There are many examples of attempted suicides where deputies did not

14 identify warning signs or did not appropriately track the inmate to protect him once the

15 risk was apparent. For example,in May 2012, an inmate was placed in a safety cell

16 because he had been kicking his cell door, yelling and screaming. While serving the

17 afternoon meal, a deputy noticed the inmate was bleeding from-the head in his safety cell.

18 While removing the inmate from the safety cell, he was placed in a safety chair which was

19 inoperative. As deputies moved him to operative safety chair, the inmate was able to throw

20 himselfto the ground head first, and had to be transported to the ER.

21

119. Defendants routinely house suicidal prisoners in conditions that result in

22 further deterioration oftheir mental health. Defendants' policies and practices for housing

23 suicidal prisoners are inadequate. Rather than individually determine the most integrated

24 environment in which a suicidal prisoner can be safely housed,Defendants have a policy

25 and practice ofplacing prisoners with serious mental health concerns in the "rubber

26 rooms." The rubber rooms are single cells with no furnishings, toilets, or(in most cases)

27 windows for outside light. The only features ofthe cell are the door, which has a slot

28 ~ through which food can be delivered, and a grate in the floor that serves as the toilet for

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1 feces and urine. When housing a prisoner in a rubber room,Defendants routinely remove

2 all ofthe prisoner's clothing,leaving them naked in the room. In some instances,

3 Defendants permit a prisoner to have atear-proofsmock for clothing and nothing else.

4 There is no mattress or pad, let alone a bed,in any ofthe rubber rooms for prisoners to sit

5 or sleep on. Prisoners are thus forced to sit and sleep on the same cold, dirty floor in

6 which the grate for the toilet is located.

7

120. Upon information and belief, the rubber rooms are rarely cleaned when a

8 prisoner is being housed in one ofthe cells and are not cleaned sufficiently once a prisoner

9 is released from the cell. The walls and floor ofthe rubber rooms are soiled by feces

10 because ofthe inadequate toilet and non-existent sink. These conditions are traumatic for

11 all prisoners, but especially for those who are already experiencing mental health

12 symptoms. Suicidal prisoners may perceive the rubber rooms as a method ofpunishment

13 (as opposed to treatment), which may dissuade them from self-identifying as suicidal.

14

121. Defendants exacerbate the psychological trauma experienced by suicidal

15 prisoners who are housed in rubber rooms by failing to provide them with necessary

16 mental health care. These prisoners do not receive sufficient contact with mental health

17 providers(ifthey receive mental health care at all). As a result,their suicidality may

18. escalate and they are forced to stay in the rubber room even longer. For example,one

19 prisoner woke up screaming from a nightmare, and was sent to the rubber room. She was

20 given a filthy blanket, and forced to use a bathroom consisting ofa grate in the floor as she

21 was simultaneously vomiting green bile. During her time in the rubber room,the mental

22 health staff did not visit this prisoner or provide her with any mental health treatment,

23 aside from asking her ifshe was suicidal. Another prisoner was kept in the rubber room

24 for five full days, and described feeling as though the walls were closing in on him the

25 entire time. After he was released from the rubber room,this prisoner did not receive

26 adequate follow-up to evaluate his mental health state and risk ofsuicidality. While

27 Defendants may consider rubber rooms"safe" for suicidal prisoners,in fact the rubber

28 rooms lack any therapeutic value, and certainly do not replace the need for psychiatric

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1 j hospitalization and treatment.

2

122. Upon information and belief, Defendants fail to sufficiently observe

3 prisoners who have been identified as being at risk ofsuicide,including prisoners who

4 have been placed in rubber rooms. Specifically, Defendants lack any policy or procedure

5 for, and therefore fail to provide, uninterrupted,constant, one-on-one observation of

6 prisoners who are actively suicidal, either threatening to or engaging in the act ofsuicide.

7

123. Defendants have knowledge ofthe substantial risk ofharm caused by

8 inadequate suicide prevention and treatment policies and practices in the Jail, but have

9 failed to take steps to prevent, or even to diminish,the harmful effects ofthese unlawful

10 policies and practices. Defendants are thus deliberately indifferent to the risk ofharm to

11 prisoners created by their failure to operate a constitutionally adequate suicide prevention

12 and treatment program.

13

C. Defendants Lack Sufficient Facilities to Provide Adequate Mental

Health Care

14

15~

124. The outdated facility and overcrowding at the Jail only exacerbate the

16 inadequate mental health conditions and treatment at the Jail. As the 2011 Jail Needs

17 Assessment found,"Medical/mental health treatment spaces are not adequate for the rated

18 beds,let alone the actual number ofinmates held.... Overcrowding forces the entire

19 facility to operate as an indirect supervision facility. Mental health issues are considerably

20 more difficult to recognize, manage and treat in an indirect supervision facility."

21 Assessment at Ex. 3. The Assessment further noted the direct impact ofovercrowding on

22 prisoners' mental health conditions: "Overcrowding affects inmate' mental and physical

23 health by increasing the level of uncertainty with which they regularly cope." Assessment

24 at Ex.9. The lack ofsufficient treatment space places prisoners at an unreasonable risk of

25 harm from inadequate mental health care. Inadequate mental health offices and treatment

26 spaces compromise the delivery of mental health care, and fail to address the

27 confidentiality and safety concerns that arise in delivery ofsuch care. Defendants have not

28 sufficiently eliminated suicide hazards through the Jail.

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1

D. Defendants' Mental Health Treatment Program Involves Little More

than Segregation and Supervision

2

3

125. Defendants routinely discriminate against prisoners with serious mental

4 illness by isolating them from and denying them privileges granted to other prisoners.

5 Defendants' policies and practices for housing prisoners with serious mental illness are

6 inadequate. Upon information and belief, Defendants fail to adequately train mental health

7 staffin how to appropriate house prisoners with serious mental illness. Prisoners with

8 serious mental illness are generally housed by Defendants in celled housing units(in the A

9 and B Pods), as opposed to in dorm housing units. When housed in a cell, as opposed to

10 dorm, prisoners have far less freedom to move around and to interact with other prisoners.

11 Defendants refer to celled housing units as"lockdown" units. Prisoners housed in

12 lockdown units generally only are permitted outside oftheir cells for one hour per day.

13' During that one hour per day, prisoners are expected to shower,exercise, and use the

14 telephone. In contrast, prisoners in dorm housing units are free to access most areas ofthe

15 dorm unit, including the common area,showers,telephones, and yard, as they please

16 during most ofthe day. Prisoners with severe mental health concerns may also be housed

17 by Defendants in isolation cells. When housed in an isolation cell, prisoners have limited

18 freedom to move around and interact with other prisoners, and they have extremely limited

19 access to programs and services at the Jail. Accordingly, prisoners with serious mental

20 illnesses are denied access to programs and services because Defendants place prisoners

21 with serious mental illness in lockdown units or isolation cells.

22

126. Defendants routinely fail to provide medically necessary psychotropic

23 ~~ medications to prisoners with psychiatric illnesses. Defendants' policies and practices for

24 providing psychotropic medications to prisoners are inadequate. Upon information and

25 belief, Defendants fail to adequately train mental health staffin the proper administration

26 of psychotropic medications. Defendants fail to provide psychotropic medications even

27 when provided with valid. prescriptions from the California Department of Mental Health,

28 community providers, or family members. Especially during the first 90 days of

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1 incarceration, prisoners may be labeled by medical staffas drug seekers and malingerers,

2 ~ and use those labels to deny needed medications.

3

127. As a result ofDefendants' failure to provide medically necessary

4 psychotropic medications, prisoners with mental illness suffer from the following:

5 (1)withdrawal symptoms when the medications they were prescribed before admission to

6 the Jail are abruptly terminated;(2)recurrence ofdebilitating symptoms such as

7 hallucinations and suicidality; and(3)in some cases, decompensation to the point of being

8 found incompetent to stand trial and/or being sent to the State Hospital until they are stable

9 enough to return to the Jail.

10

128. Upon information and belief, Defendants fail to provide sign language

11 interpretation services to prisoners whose primary language is American Sign Language

12 during mental health clinical evaluations. Without sign language interpretation, such

13 prisoners are not able to explain to mental health staffthe symptoms they are experiencing,

14 and mental health staffare not able to explain the benefits and risks oftreatments and

15 medications such that prisoners can provide their informed consent. The lack ofsign

16 language interpretation services results in Defendants making mental health treatment

17 decisions without all ofthe necessary and pertinent information they need, which increases

18 the risk of misdiagnosis and mistreatment for the prisoner.

19

129. Upon information and belief, Defendants fail to provide foreign language

20 interpretation services to prisoners whose primary language is not English during mental 21 health clinical evaluations. This is particularly true for prisoners who cannot speak either

22 English or Spanish. Without foreign language interpretation, such prisoners are not able to

23 explain to mental health staffthe symptoms they are experiencing, and mental health staff 24 are not able to explain the benefits and risks oftreatments and medications such that

25 prisoners can provide their informed consent. The lack offoreign language interpretation

26 services results in Defendants making mental health treatment decisions without all ofthe

27 necessary and pertinent information they need, which increases the risk ofmisdiagnosis

28 and mistreatment for the prisoner.

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1

130. Defendants provide little to no individual or group treatment to prisoners

2 with mental health problems,even for prisoners with the most severe issues. For example,

3 PlaintiffHLJNTER's anxiety and panic attacks are exacerbated when she is in the

4 overcrowded Jail environment, but she been denied therapy sessions since her arrival at the

5 Jail. Another prisoner, who had attempted suicide twice prior to his arrival at the Jail and

6 once while at the Jail in December 2012, did not receive one-on-one therapy sessions, but

7 rather only medications(provided by nurses to the prisoner in his isolation cell). Plaintiff

8 MURPHY had been seeing an outside psychiatrist who provided him with therapy, but the

9 Jail failed to transport him to his April appointment with his outside psychiatrist. As a

10 result,Plaintiff MURPHY is not receiving adequate mental health care.

11

131. .Upon information and belief, Defendants' disciplinary process fails to take

12 into account behavior which results from inadequate mental health care. For example,as a

13 result ofDefendants' denial of medically necessary psychotropic medications and little or

14 no individual or group treatment, prisoners with serious mental conditions may be unable

15 to conform to Jail rules or be safely housed in cells with other prisoners. In response,

16 rather than provide them with the medications or treatment they need,Defendants

17 selectively house these prisoners in isolation in the "rubber rooms."

18

132. Upon information and belief, prisoners with serious mental health conditions

19 may be placed in rubber rooms as punishment for an inability to follow Jail rules. But

20 many ofthese prisoners would not have violated Jail rules had they been receiving

21 adequate mental health treatment.

22

133. When mental illness is inhibiting an inmate's ability to follow directions or

23 interact with others, many incident reports show no effort by staffto involve mental health

24 professionals who might be able to calm the inmate down and address the underlying

25 psychiatric issue without resorting to use of physical force. Instead, staff who do not have

26 adequate training regarding how to treat mental health issues, attempt to interact with the

27 prisoner on their own,and end up resorting to use ofphysical force and/or violence to

28 control the prisoners. Sometimes,the use offorce results in larger prisoner-on-prisoner

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1 fights in the unit.

2

134. Upon information and belief, Defendants fail to provide adequate training to

3 custody staffregarding how to respond to mentally ill prisoners whose non-conforming

4 behaviors are a product oftheir mental illness.

5

135. Upon information and belief, Defendants place prisoners in the rubber room

6 when they request mental health care from Defendants. For example, one prisoner was

7 suffering from mental health symptoms because he had not been provided with prescribed

8 medications for preexisting medical conditions. Rather than attempt to treat his psychiatric

9 distress, Defendants placed him naked in the rubber room without even a blanket for the

10 first few hours.

11

136. Upon information and belief, Defendants exacerbate the psychological

12 trauma experienced by prisoners with serious mental health conditions who are housed in

13 rubber rooms by failing to provide them with necessary mental health care. These

14 prisoners do not receive sufficient contact with mental health providers. As a result,their

15 nonconforming behaviors may escalate and they are forced to stay in the rubber room even

16 ~ longer.

17

E. Defendants Fail to Employ a Sufficient Number of Properly Trained

Mental Health Professionals

18

19

137. Upon information and belief, Defendants fail to maintain sufficient numbers

20 of mental health care professionals to provide minimally adequate care to the more than

21 1,100 prisoners in the Jail. Defendants' policies and practices for mental health care

22 staffing are inadequate.

23

138. The Jail's low staffing levels result in a mental health care staff being unable

24 to timely respond to prisoners' requests for psychiatric evaluations and treatment, or to

25 adequately screen,track, monitor, and provide follow-up care to prisoners who are

26 suffering from serious mental illnesses. For example, during an attorney interview, one

27 prisoner was incapable ofconversation, had feces in his hair, ranted obscene comments,

28 and frequently exposed his genitals. When alerted to this prisoner's deteriorated mental

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1 ~ health state by the attorney, Jail staffinformed the attorney that the prisoner would be seen

2 the next day because mental health staff had gone for the day.

3

139. Upon information and belief, Defendants fail to adequately train mental

4 health staffto timely respond to prisoners' requests for psychiatric evaluations and

5 ~ treatment, and to adequately screen, track, monitor, and provide follow-up care to

6 ~ prisoners who are suffering from serious mental illness.

7

F. Defendants Fail to Maintain Accurate, Complete and Confidential

Mental Health Treatment Records

8

9'

140. Upon information and belief, Defendants fail to maintain adequate, accurate,

10 and confidential mental health care records. For example,upon information and belief,

11 psychiatrists often change prisoners' medications without documenting explanations.

12 Upon information and belief, psychiatrists also fail to document their justification and

13 reasoning for changing the diagnoses and treatment plans for prisoners returning to the Jail

14 from psychiatric hospitals. As a result ofDefendants' failure to maintain adequate mental

15 health care records,prisoners suffer from a substantial risk of misdiagnosis, dangerous

16 mistakes, and unnecessary delays in care.

17

141. Upon information and belief, Defendants fail to obtain medical files from

18 outside providers for lengthy periods oftime after the prisoner's arrival at the Jail(if at

19 all). This lack ofinformation reduces the quality of mental health care. For example,

20 II Plaintiff MURPHY was arrested and booked into the Jail on January 18,2013. During an 21 intake triage assessment that same day, Jail staff was informed that Plaintiff MURPHY's

22 psychiatric medications were prescribed by a physician at the Monterey County Veteran's

23 Administration clinic. Plaintiff MURPHY was not seen by any mental health staff until

24 ~~ January 21,2013, when he had an appointment with a licensed psychiatric technician, who

25 did not prescribe him medications. Upon information and belief,the licensed psychiatric

26 technician made only one request for Plaintiff MURPHY'S medical records from the

27 Monterey County Veteran's Affairs office("VA")on January 21,2013, and made no

28 effort to follow up after that date. On January 28,2013,at least in part because he was not

I

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1 ~ provided with any psychiatric medications,Plaintiff MURPHY was placed in a "rubber

2 room" where he remained for at least 18 hours. As of at least April 19,2013,Defendants

3 still had not obtained Plaintiff MURPHY'S psychiatric records from the VA.

4

142. Upon information and belief, Defendants fail to adequately train mental

5 ~ health staffin how to maintain accurate mental health records, including the timely request

6 ~ ofprisoners' prior mental health records.

7

G. Defendants Administer Psychotropic Medications Without Appropriate

Supervision and Periodic Evaluation

8

9

143. Upon information and belief, Defendants fail to evaluate prisoners before

10 making treatment decisions, including whether to prescribe psychotropic medications.

11 Upon information and belief, Defendants fail to adequately train mental health staffin how

12 to appropriately evaluate prisoners before making mental health treatment decisions.

13

144. When Defendants do administer psychotropic medications to prisoners in the

14 Jail,they routinely fail to monitor or follow up with these prisoners after such medications

15 are prescribed. For example,Plaintiff MURPHY is taking a number ofpsychiatric

16 medications to address his aural and visual hallucinations. However,he is not receiving

17 the correct dosages ofthe medications, and continues to see shadows and hear voices. The

18 hallucinations are so frequent and intense that he can only sleep for a few hours at night.

19 Despite his repeated requests, mental health staff have not adjusted his dosages or

20 otherwise followed up with him to evaluate the efficacy ofthe medications.

21

145. Upon information and belief, Defendants routinely release prisoners with

22 ~ ~ serious mental health conditions from the Jail without providing them with any services to

23 ensure that their mental health care is not disrupted. Defendants' policies and practices for

24 the provision ofcontinuing mental health care services upon a prisoner's release are

25 inadequate. Upon information and belief, Defendants fail to adequately train custody and

26 ~ ~ mental health staff in how to appropriately release prisoners with serious mental health

27 concerns so that such prisoners can continue their mental health care. Upon information

28 and belief, for those prisoners who are prescribed psychiatric medications in the Jail, they

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1 are released without either a supply ofor a prescription for them to fill those medications

2 at a community pharmacy. Defendants do not schedule follow-up appointments in the

3 community, nor are prisoners provided with sufficient referrals or information about where

4 they may receive mental health care services or medications.

5 IV. DEFENDANTS DISCRIMINATE AGAINST,FAIL TO ACCOMMODATE,

AND VIOLATE THE CONSTITUTIONAL AND STATUTORY RIGHTS OF

6

PRISONERS WITH DISABILITIES

7

146. Defendants currently incarcerate in Monterey County Jail significant

8 numbers ofindividuals with disabilities, as that term is defined in the ADA,the

9 Rehabilitation Act,and California disability rights law. Defendants routinely fail to

10 provide these prisoners with basic reasonable accommodations to ensure equivalent access

11 to all ofthe programs and services offered by the Jail. Defendants' failure to

12 accommodate prisoners with disabilities not only denies them access to prison programs

13 and services, but also substantially increases the risk that they are injured in an emergency

14 and are the victim ofviolence or abuse from other prisoners. Moreover,Defendants'

15 refusal to accommodate prisoners with disabilities results in the provision ofinadequate

16 medical and mental health care and the trampling ofprisoners' due process rights in Jail

17 disciplinary proceedings.

18

A. Defendants Lack Adequate Policies and Practices to Identify and Track

Prisoners with Disabilities

19

20

147. Under the ADA,the Rehabilitation Act, and California disability rights law,

21 Defendants must create and maintain a system to identify and track individuals with

22 disabilities and the accommodations they require. Defendants, however,lack adequate

23 policies and practices for identifying individuals with disabilities and the reasonable

24 accommodations they require.

25

148. Defendants routinely fail to identify prisoners with disabilities. During

26 ~~ Defendants' intake process, custody officers collect various pieces ofinformation about 27 new prisoners. Defendants use the information to make a number ofdeterminations, 28 including how to classify a prisoner. A prisoner's classification determines with which

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1 other prisoners the new prisoner can share space and in what parts ofthe prison the new

2 prisoner can be housed.

3

149. Upon information and belief, the officers who are responsible for conducting

4 the intake process are not adequately trained by Defendants regarding how to identify and

5 track individuals with disabilities, and therefore frequently fail to identify prisoners with

6 disabilities or the accommodations they need to access Jail programs and services. Upon

7 information and belief,the forms and system that Defendants use to capture the

8 information gathered during the intake process lack adequate fields and space to document

9 if a prisoner has a disability and requires accommodations.

10

150. Defendants' failures to accurately identify new prisoners' disabilities and

11 needed accommodations during the intake process result in the denial ofaccommodations

12, mandated by the ADA,Rehabilitation Act, and California disability rights law, placing

13 prisoners at risk of discrimination,injury, and/or exploitation. For example, during

14 booking into the Jail in August 2012 and again in December 2012,staffcompleted

15 Monterey County Sheriff's Office Intake Health Screening forms for Plaintiff YANCEY.

16 Despite Plaintiff YANCEY's complete hearing impairment,staff did not indicate on the

17 forms that Plaintiff YANCEY had a hearing disability. Accordingly, staffthroughout the

18 Jail were unable to identify Plaintiff YANCEY as hearing impaired, resulting in a lack of

19 accommodations for his disability.

20

151. Plaintiff MURPHY was booked into the Jail in January 2013 with a

21 permanent back injury that requires him to use a walker or cane to ambulate without pain.

22 During the intake process,the Jail failed to identify him as having a mobility impairment

23 requiring an accommodation,and he was not provided with a walker or a cane. Without a

24 walker or cane,Plaintiff MURPHY avoids leaving his bed in order to reduce the pain that

25 accompanies any attempt to walk.

26

152. Another prisoner who was booked into the Jail in January 2012 with a

27 mobility impairment required a cane to help him safely ambulate and access his housing

28 unit and also required a lower bunk housing assignment to safely access a bed. During the

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1 intake process, the Jail failed to identify him as having a mobility impairment requiring 2 those accommodations; he was not provided with a cane and the only available bed in his 3 housing unit was on the upper bunk ofa triple bunk. Without a cane,the prisoner fell and 4 injured himself on a number ofoccasions. He has slept on the floor because it was too

5 difficult for him to access his bunk.

6

153. Upon information and belief, Defendants do not maintain any central list,

7 electronic or otherwise, ofprisoners with disabilities and the accommodations they require.

8 Defendants do not maintain adequate information about prisoners' disabilities and related

9 accommodations in the prisoners' custody and/or medical files. Upon information and

10 belief, to the extent that Defendants maintain information about a prisoner's disabilities in

11 any form, custody, medical, and clerical staff are not provided with access to the

12 information in a manner that would timely and effectively inform them ofa prisoner's

13 disabilities and required accommodations. Upon information and belief, Defendants do

14 not adequately train staffto maintain records or information about prisoners' disabilities

15 and related accommodations.

16

154. The lack of an adequate disability and accommodation tracking system

17 results in substantial injuries to prisoners with disabilities. Without an adequate tracking

18 system, medical and custody staff have no easily accessible means to determine whether a

19 prisoner has a disability, and what,if any, accommodations that prisoner requires.

20 Consequently,Defendants fail to provide prisoners with accommodations or withdraw

21 accommodations that have already been provided withoutjustification.

22

155. For example,PlaintiffYANCEY is deaf,cannot hear, and uses American

23 Sign Language as his primary form ofcommunication. Plaintiff YANCEY was not

24 provided with a sign language interpreter for his communications with Jail staff, including

25 at medical appointments,at a disciplinary hearing, and during the.booking and

26 classification process. 156. Plaintiff SARABI was provided with crutches after he sustained an injury to
28 his right leg when he was attacked by another prisoner on or around March 6,2013.

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1 However,on or around April 8,2013,PlaintiffSARABI was called in for an unsolicited

2 medical exam at which his crutches were prematurely taken away from him with no

3 explanation, despite the fact that his right leg was not healed. PlaintiffSARABI could not

4 use the restroom or shower without his crutches, and had to crawl around or hop on one

5 foot to get around the Jail until his attorney contacted the Jail to request that the crutches

6 be provided.

7

157. As another example, one prisoner whom the Jail identified as being a full-

8 time wheelchair user had his wheelchair taken away from him for at least 14 hours. As a

9 result ofbeing denied the needed assistive device, he was rendered immobile, was unable

10 to access the showers and restrooms, was forced to rely upon other prisoners for assistance,

11 and was therefore placed at increased risk ofbeing manipulated or attacked by other

12 prisoners.

13

B. Defendants Lack an Effective Grievance Procedure for Prisoners to

Request Reasonable Disability Accommodations

14

15

158. Defendants do not provide an effective or functional grievance system for

16 prisoners with disabilities as required by the ADA and Rehabilitation Act.

17

159. Defendants do not provide prisoners with adequate notice of how to request

18 ~~ reasonable accommodations for their disabilities. Upon information and belief, the only

19 formal notice prisoners receive regarding any Jail grievance procedure comes from the

20 "Monterey County Adult Detention Facility Inmate Information Booklet"(hereinafter

21 "Inmate Information Booklet"), which is provided to each prisoner when booked into the

22 Jail. Yet the Inmate Information Booklet does not discuss disabilities or the process for

23 requesting disability accommodations. As a result, prisoners are not informed ofany

24 specific process for complaining about disability discrimination or requesting disability

25 accommodations.

26

160. Defendants routinely deny prisoners access to grievance forms. Each

27 prisoner is provided with only one grievance form which is attached to the Inmate

28 Information Booklet provided during booking. Upon information and belief, grievance

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1 ~ forms are not freely available in the housing units.

2

161. Even when prisoners are able to submit grievances, Defendants frequently do

3 not provide any response. For example,PlaintiffYANCEY submitted a grievance on

4 ~ December 20,2012,requesting a number ofaccommodations relating to his serious

5 ~ hearing impairment,but he did not receive a response to the grievance. PlaintiffSARABI

6 ~ submitted a grievance on April 4,2013,requesting to see a doctor for the intense pain he

7 ~ was experiencing in his foot(the source ofhis mobility impairment), but he also did not

8 receive a response to the grievance. Plaintiff MURPHY submitted a grievance on Apri14,

9 2013,requesting a cane or walker as an accommodation for his mobility impairment; he

10 did not receive a response to the grievance either. Plaintiff HERNANDEZ has submitted

11 at least four grievances regarding inadequate medical care since February 28,2013,but did

12 not receive responses.

13

162. Even when prisoners are able to submit a grievance and Defendants provide

14 a response,Defendants' responses are not adequate or comprehensive, and may be

15 arbitrary and counterproductive. For example,a prisoner filed a grievance requesting a

16 walking cane to assist her in moving around the dorm,shower,and going to court. The

17 response stated only that"you did not have a `cane' when you came in to the facility. If

18 you are having problems go on sick call."

19

163. Upon information and belief, Defendants lack adequate policies and

20 procedures instructing health care or correctional officers how to respond if prisoners

21 request accommodations through means other than the grievance process.

22

164. Upon information and belief, Defendants do not adequately train staff in how

23 ~ ~ to provide, appropriately process,and timely respond to grievance forms.

24

C. Defendants Fail to Accommodate Prisoners with Hearing and Speech

Impairments

25

26

165. Prisoners with hearing, speech, and other communication impairments have

27 problems effectively communicating with Jail staff. Prisoners with disabilities that impair

28 communication require accommodations to ensure effective communication with prison

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1 staffand equal access to programs and services offered by the Jail. Defendants fail to

2 provide such accommodations. Upon information and belief, Defendants fail to

3 adequately train staffin how and when to provide such accommodations.

4

166. Defendants fail to provide prisoners with hearing and speech impairments

5 with sign language interpreters, hearing aids, or other auxiliary aids. Plaintiff YANCEY

6 has been booked into the Jail numerous times over the past three to five years. Plaintiff

7 YANCEY is completely deaf, and also has a speech impairment that makes it difficult or

8 impossible for him to communicate through spoken words. Plaintiff YANCEY uses

9 American Sign Language(ASL)as his primary form ofcommunication. Plaintiff

10 YANCEY was not provided with a sign language interpreter by the Jail during his

11 incarcerations in the Jail.

12

167. Defendants do not provide prisoners with hearing and speech impairments

13 with sign language interpreters, hearing aids, or other auxiliary aids during the booking

14 and intake process, which harms these prisoners by preventing them from communicating

15 specific concerns,including emergency medical issues, and understanding Jail policies and

16 practices.

17

168. For example, Defendants never provided Plaintiff YANCEY with a sign

18 language interpreter during the booking process. When he was booked into the Jail for his

19 most recent term,Plaintiff YANCEY's right arm was in a cast, making it impossible for

20 PlaintiffYANCEY to communicate through written notes. Accordingly, he essentially

21 lacked any means ofcommunicating with the custody officers conducting the intake

22 process.

23

169. Defendants fail to provide equal access to telephone services to prisoners

24 who require the use ofa Telecommunications Device for the Deaf/Teletype("TDD/TTY").

25 Non-TDD/TTY telephones are located in the housing units. Upon information and belief,

26 prisoners without disabilities have access to non-TDD/TTY telephones any time the

27 prisoner is permitted in the common area ofhis or her housing unit. Upon information and

28 belief, telephone calls are limited to 30 minutes in length, though there is no limit to the

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1~ number oftelephone calls a prisoner may make so long as he or she does not abuse or

2 ~ monopolize the telephone.

3

170. In contrast, there is one TDD/TTY for the entire Jail. Prisoners who require

4 the use ofthe TDD/TTY must ask an officer to transport them to the office where the

5 TDD/TTY is located. Officers frequently refused to transport Plaintiff YANCEY to the

6 TDD/TTY,claiming that they were too busy to do so. Even when allowed to use the

7 TDD/TTY,Plaintiff YANCEY was denied sufficient time to conduct a conversation,since

8 using a TDD/TTY takes longer than using a telephone.

9

171. Defendants' policies and practices for equal access to telephone services are

10 inadequate. Upon information and belief, Defendants fail to adequately train staffin how

11 to provide equal access to telephone services.

12

172. Defendants fail to provide prisoners with hearing or speech impairments with

13 sign language interpreters, hearing aids, or other auxiliary aids to permit participation in

14 other Jail programs and services, including religious services and educational and

15 vocational classes. For example,Plaintiff YANCEY was not provided with a sign

16 language interpreter when attending religious services on a weekly basis at the Jail. As a

17 result, he was not able to understand what was being said by the chaplain and other

18 participants, and could not participate in the services himself.

19

173. Defendants do not provide equal access to television to prisoners who are

20 hearing impaired. Upon information.and belief, most non-disciplinary housing units have

21 televisions installed for prisoners to watch, but PlaintiffYANCEY was not able to

22 understand what was being said on the television. Either Defendants have not installed

23 televisions with the capability to display closed captioning or they refuse to alter the

24 settings to the televisions to display closed captioning.

25

174. Defendants fail to provide sign language interpreters, hearing aids, and other

26 auxiliary aids at disciplinary hearings even though prisoners risk a loss ofcredits and

27 privileges ifthey are found guilty ofdisciplinary infractions. For example,Plaintiff

28 YANCEY was charged with a rule violation on December 16,2012. At the disciplinary

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1 hearing,Plaintiff YANCEY was found guilty ofthe violation and punished with two

2 weeks without visitation, canteen,or yard privileges. Plaintiff YANCEY was not provided

3 with a sign language interpreter at the disciplinary hearing, and therefore was not able to

4 defend himselfor explain his version ofthe events. Without an interpreter, Plaintiff

5 YANCEY also had difficulty understanding what the hearing officer and other Jail staff

6 were saying.

7

175. By failing to provide Plaintiff YANCEY and other hearing impaired

8 prisoners with sign language interpreters, hearing aids, or other auxiliary aids at

9 disciplinary hearings, Defendants deny such prisoners the same opportunity to participate

10 in the hearing regarding their guilt or innocence ofthe disciplinary charge and to present

11 their views to the hearing officer that prisoners without disabilities have.

12

D. Defendants Knowingly Subject Prisoners with Disabilities to Dangerous

Conditions in the Jail

13

14

176. Defendants fail to provide prisoners with hearing and speech impairments

l5 with sign language interpreters, hearing aids, or other auxiliary aids for interactions with

16 Jail medical and mental health care staff, despite the grave importance ofthe interactions.

17 Defendants fail to provide these accommodations despite knowledge that such prisoners

18 ~ cannot effectively communicate with staff without the accommodations and that the failure

19 to communicate effectively places such prisoners at an increased risk that medical or

20 mental health issues will not be not be diagnosed or will be misdiagnosed.

21

177. For example, during his most recent booking in the Jail, Plaintiff YANCEY

22 had at least six medical appointments. Plaintiff YANCEY was not provided with a sign

23 language interpreter at any ofhis appointments. Because there was no sign language

24 interpreter to help him communicate with the medical staff,PlaintiffYANCEY was not

25 able to explain that the pain medication he was being provided was insufficient to treat his

26 pain. Accordingly,Plaintiff YANCEY's pain symptoms were not adequately treated.

27

178. Defendants endanger prisoners with hearing impairments by failing to

28 ~ ~ institute any system for visually identifying prisoners with hearing impairments. Ifa fight

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1 breaks out in a housing unit, prison staff may order all prisoners to get down on the ground

2 ~ or to line up against a wall. For any number ofreasons, prison staff may also order a

3 specific prisoner to cease or engage in certain behavior. Upon information and belief, Jail

4 staff are authorized to initiate disciplinary proceedings and/or use force against prisoners

5 who fail to comply with orders. Upon information and belief, the use offorce for failure to

6 comply with an order can include the use ofTriers, non-lethal firearms(like "flash bang"

7 grenades)and lethal firearms.

8

179. Prisoners with communication impairments,like PlaintiffYANCEY,are not

9 capable of understanding and therefore are less likely to comply with alarms and oral

10 orders from jail staff. Without a visual identification system by which staff can identify

111 prisoners with communication impairments(e.g., vests),there is an increased risk that staff

12 will not recognize that a prisoner has a hearing impairment and will interpret such

13 prisoner's actions as a failure to comply with an order, rather than as a failure to hear

14 and/or understand the order. As a result, prisoners with hearing impairments are at 15 increased risk that staff will initiate disciplinary proceedings and/or use force for failure to

16 comply with an order that they have not heard.

17

180. Upon information and belief, Defendants lack any policy, practice, or system

18 for notifying prisoners with disabilities ofemergencies,including alarms, fires, and 19 earthquakes. Upon information and belief, Defendants fail to adequately train staff in how 20 to notify prisoners with disabilities ofemergencies. Upon information and belief,the Jail

21 does not have a visual or tactile alarm system installed to alert prisoners with disabilities.

22 Because Defendants lack a system for identifying prisoners with disabilities, including

23 those with hearing impairments, or notifying prisoners with disabilities ofan emergency,

24 these prisoners may not be aware ofan emergency, or may need assistance during the

25 emergency,and are therefore at increased risk ofinjury or death should one occur.

26

181: Upon information and belief, Defendants lack any policies or practices to

27 ensure that prisoners with difficulty walking,including prisoners in wheelchairs, are safely

28 evacuated from the Jail in the event ofan emergency. Upon information and belief,

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1 Defendants fail to adequately train staffin how to ensure that prisoners with mobility

2 impairments are safely evacuated from the Jail in an emergency. Upon.information and

3 belief,the emergency exits in the Jail, to the extent they exist, are not accessible to 4 prisoners in wheelchairs. As a result, prisoners with difficulty ambulating are at increased

5 risk ofinjury or death ifan emergency,like a fire or earthquake, were to occur.

6

182. Defendants endanger prisoners with mobility impairments by failing to

7 institute any system for staffto visually identify prisoners with mobility impairments.

8 Upon information and belief, Defendants fail to adequately train staffin how to visually 9 identify prisoners with mobility impairments. Upon information and belief, in response to 10 alarms or other incidents in the Jail, custody stafffrequently order prisoners to "prone out,"

11 i.e., lay down on the ground,face down. Upon information and belief,jail staffare 12 authorized to initiate disciplinary proceedings and/or use force against prisoners who fail

13 to prone out when ordered to do so. Upon information and belief, the use offorce for

14 failure to comply with an order to prone out can include the use ofTasers, non-lethal

15 firearms(like "flash bang" grenades)and lethal firearms.

16

183. Some prisoners with mobility impairments,like PlaintiffSARABI,are

17 incapable ofcomplying with an order to prone out because oftheir mobility impairments.

18 Without a visual identification system by which staffcan identify prisoners with such 19 mobility impairments(e.g., a vest or certain color ofclothing),there is an increased risk 20 that custody staff will not recognize that a prisoner has a mobility impairment and will 21 interpret such a prisoner's failure to prone out as a failure to comply with an order,rather

22 than an inability to comply with the order. As a result, prisoners with mobility 23 impairments are at increased risk that staff will initiate disciplinary proceedings and/or use 24 force for failure to comply with an order to prone out with which they cannot comply

25 because oftheir disability.

26

E. Defendants Routinely Fail to Provide Prisoners with Disabilities with

Needed Assistive Devices

27

28

184. Defendants lack policies and practices to ensure that prisoners with

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1 disabilities who require assistive devices, including, but not limited to, wheelchairs,

2 walkers, crutches, canes, braces,tapping canes, hearing aids, and pocket talkers, as

3 accommodations are provided with and are allowed to retain those devices. Upon

4 information and belief, Defendants fail to adequately train staffin how to timely and

5 appropriately provide assistive devices to prisoners with disabilities.

6

185. Because of Defendants' deficient disability screening procedure and

7 inadequate grievance process, prisoners who require assistive devices to access Jail

8 programs are frequently not identified. As a result,those prisoners do not receive needed

9 assistive devices and cannot access the programs and services offered by the Jail.

10

186. Upon information and belief, Defendants deny prisoners certain assistive

11 devices,claiming that such items are not permitted in the Jail. For example,Plaintiff

12 MURPHY,who uses a cane to ambulate and required a lower bunk housing assignment

13 while at the California Department ofCorrections and Rehabilitation, requested during the

14 booking process that he be provided with a cane or walker. He was informed by Jail staff

15 that canes and walkers were not allowed in the Jail.

16

187. Upon information and belief, Defendants have refused to provide some

17 ~~ prisoners with assistive devices as an accommodation for a disability, even after

18 Defendants have identified the person as a qualified individual with a disability and as

19 needing a particular assistive device. Upon information and belief, Defendants have

20 informed such prisoners that they are permitted to possess certain assistive devices, but

21 only if someone from outside ofthe Jail, like a family member,friend, or community

22 organization provides the assistive device. Unless the assistive device is provided by a

23 third party, such prisoners may be denied reasonable accommodations necessary for them

24 to access programs and services offered by the Jail.

25

188. Even when the Jail provides a prisoner with an assistive device, Defendants

26 unjustifiably remove these devices from prisoners, as alleged in paragraph 156,supra.

27 28

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1

F. Defendants Fail to Provide Prisoners with Disabilities with Safe and

Accessible Housing

2

3

189. Defendants fail to ensure that prisoners with disabilities are assigned to and

4 are actually housed in housing units and bed assignments.that are accessible and safe.

~yl Upon information and belief, Defendants fail to adequately train staffin how to house

0~ prisoners with disabilities in accessible and safe housing. 190. The Jail consists offive main housing areas—the Rehabilitation Center,the

Men's Section,K-Pod,the Dorm Section, and the Women's Section.

9

191. Each housing area is separated into a number ofsmaller housing units. The

10 housing units differ in their design, and importantly, in their accessibility to prisoners with

11 disabilities. Some ofthe housing units are dorm housing units, where many beds,

12 including triple bunks, are placed in an open area together that is shared by the prisoners.

13 Other housing units consist ofcelled housing, where the unit is divided into a number of

14 cells with doors in which one or two prisoners are housed. Cells that house two prisoners

15 typically have bunk beds in them.

16

192. Some ofthe housing units in the Jail are located up flights ofstairs, while

17 others are on the ground floor.

18

193. Defendants control housing unit assignments. In housing units with celled

19 housing, Defendants also assign prisoners to a particular cell.

20

194. Upon information and belief, Defendants make decisions regarding where to

21 house a particular prisoner without taking into account the prisoner's disability-related

22 limitations. Because ofDefendants' general failure to identify and track prisoners with

23 disabilities, Defendants decide where to house a prisoner without sufficient information

24 regarding the prisoner's limitations; this practice significantly increases the risk that a

2S prisoner will be assigned to a housing unit that is not accessible to him or her, because it 26 lacks adequate toilets or grab bars in the shower,or because it is up a flight ofstairs or

27 lacks space for a wheelchair, or other reasons.

28

195. One prisoner who was housed in the Jail for a significant period oftime was

I

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1~ a full-time wheelchair user. Defendants generally permitted this prisoner to retain his .

2 wheelchair in the Jail, meaning that Defendants were aware ofhis mobility impairment. 3 Nonetheless,Defendants housed this prisoner in the C-Dorm and D-Dorm within the Dorm

4 Section. The C-Dorm and D-Dorm are not wheelchair accessible, do not have toilets and

5 showers with grab bars, do not have shower chairs, and have lips between the housing

6 areas and the showers. This prisoner fell four times while housed in those dories when 7 attempting to access the toilets and showers,injuring himselfeach time he fell. He also 8 was frequently forced to rely on other prisoner's for assistance to access the toilets and

9 showers.

10

196. Another prisoner who was afull-time wheelchair user was permitted to

11 retain his wheelchair,indicating that Defendants were aware of his mobility impairment.

12 Nevertheless,Defendants housed this prisoner in the B-Dorm for 30-45 days. This

13 prisoner had difficulty accessing almost every feature ofB-Dorm,including the bathroom. 14 Specifically, this prisoner was forced to shower while sitting in his wheelchair due to the 15 lack ofa shower chair, and had to rely on other inmates to press the shower button for him 16 because he could not reach it. This prisoner also had to rely on other prisoners to lift him

17 onto the toilet.

18

197. Defendants house many ofthe prisoners with disabilities in the Rotunda

19 ~~ housing unit within the Men's Section. The recreation yards for the Men's Section 20 (including the Rotunda),the Women's Section, and K-Pod are located on the roof ofthe 21 Jail. In order to access the yards, prisoners must walk up one long flight ofstairs and then 22 down a smaller flight ofstairs. The stairways are the only means ofreaching the yard. 23 Because the yard is located on the roof, prisoners who are housed in the Men's Section, 24 Women's Section, or K-Pod and who have mobility or vision impairments that make 25 walking up or down stairs difficult, painful, impossible, or dangerous are denied access to

26 the recreation yard.

27

198. For example,because ofthe severe pain Plaintiff MURPHY experiences

28 when walking without a cane,Plaintiff MURPHY has rarely accessed the yard since he

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1 ;arrived at the Jail on January 18,2013. Ifthe yard for the Men's Section was not up a

2 flight ofstairs, and if he had a cane to ambulate,Plaintiff MURPHY would have gone to

3 the yard most times that it was offered to him.

4

199. Another prisoner who has a mobility impairment that makes walking up

5 stairs extremely difficult and painful was assigned to F-Pod. This prisoner declined to go

6 to yard every time that it was offered because the pain and difficulty ofclimbing the stairs

7 was too great. On at least one occasion, despite this prisoner's mobility impairments,

8 Defendants forced him to climb the stairs to the yard when Defendants were conducting 9 searches ofcells in F-Pod. The prisoner specifically requested that he be excused from the

10 need to go to the yard; Defendants denied his request. When he had to walk up to the yard,

11 it caused him great pain and placed him at serious risk offalling and further injuring

12 himself.

13

200. Upon information and belief, Defendants lack policies and practices for

14 ensuring the prisoners who require lower bunk bed assignments actually receive lower

15 bunk bed assignments. Upon information and belief, in many housing units, Defendants

16 have essentially no system for assigning particular prisoners to specific beds. Instead,

17 especially in dorm housing units, Defendants typically abdicate the assignment and

18 selection ofbeds in the housing unit to the prisoners themselves, who will be assigned to

19 the newly-vacated bed. In some dorm housing units, bed assignments and selection are 20 determined by who has been in the unit for the longest period oftime. In units that include 21 a significant number ofgang members, bed assignments may be determined by the leaders

22 ofthe gang within the unit.

23

201. Upon information and belief, Defendants have no means for ensuring that

24 prisoners who require lower bunk bed assignments are actually able to sleep in lower

25 bunks, and have no mechanism for guaranteeing that prisoners who should not be housed 26 in triple bunks avoid such bed placements. As a result, prisoners who require lower bunk
and non-triple bunk bed assignments as accommodations for their disabilities may be

forced to sleep on upper bunks and in triple bunks rather than experience the pain and

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1 danger ofsleeping in an inaccessible bed.

2

202. A prisoner booked into the jail in January 2012 with a mobility impairment

3 required a lower bunk housing assignment to safely access a bed. During the intake

4 process, the Jail failed to identify him as having a mobility impairment requiring that

5 accommodation. In the housing unit to which he was assigned,the only available bed was

6 on the upper bunk ofa triple bunk. No prisoner in the unit would agree to switch bed

7 assignments with him. Rather than sleep on the upper bunk,he slept on the floor because

8 it was too difficult and dangerous for him to access the available bed.

9

G. Defendants Fail to Provide Prisoners with Disabilities with Equal Access

to Programs and Services Offered by the Jail

10 203. Defendants house prisoners with serious mental illness in lockdown units,

11 isolation cells, and/or rubber rooms. Prisoners who are housed in "lockdown" units have

12 far less freedom to move around and to interact with other prisoners, and generally only

13 are permitted outside oftheir cells for one hour per day. During that one hour per day,

14 prisoners are expected to shower, exercise, and use the telephone. This leaves little to no

15 time for program participation. Prisoners who are housed in isolation cells lack freedom to

16 move around and interact with other prisoners, and have extremely limited (if any)access

17 to programs and services at the Jail'. Prisoners who are housed in rubber rooms do not

18 leave the room, do not interact with other prisoners, do not receive mental health

19 treatment, and do not access any programs or services for the duration oftheir time in the

20 rubber room. Accordingly, prisoners with serious mental health illnesses are denied equal

21 access to programs and services offered by the Jail through Defendants' discriminatory

22

housing practices.

23 204. Defendants' failure to provide prisoners with medically necessary treatment

24 (including mental health care and all medications) not only exposes prisoners to an

25 unreasonable risk of harm, but it also denies these prisoners equal access to programs and

26 services offered by the Jail. For example, prisoners who have not received adequate

27 medical care may be not be physically capable of accessing services offered by the Jail

28

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1 precisely because their medical needs have not been adequately addressed. Prisoners who

2 have not received adequate mental health care may not be psychologically capable of

3 participating in programs offered by the Jail because their mental health needs have not

4 been appropriately treated. By failing to provide prisoners with adequate medical and

5 mental health care, Defendants deny equal access to Jail programs and services.

6

205. Upon information and belief, Defendants fail to adequately train staff in how

7 to provide equal access to Jail services and programs.

8

H. By Failing to Provide Disability Accommodations,Defendants Place

Prisoners with Disabilities at Increased Risk of Exploitation and Harm

9

10

206. Prisoners with disabilities that are not accommodated are susceptible to

11 exploitation by other prisoners. For example,in exchange for help getting to the toilet,

12' shower,or meals, or communicating with prison staff, prisoners with disabilities may be

13 required to pay other prisoners, potentially leading to increased risk ofviolence or even

14 rape.

15

FIRST CAUSE OF ACTION

(Eighth Amendment to the United States Constitution,42 U.S.C.§ 1983)

16 By the Prisoner Class Against Defendants Monterey County,Monterey County

SheriffsOffice,and California Forensic Medical Group

17

18

207. Plaintiffs re-allege and incorporate by reference herein all allegations

19 previously made in paragraphs 1 through 206, above.

20

208. By their policies and practices described above, Defendants subject Plaintiffs

21 HERNANDEZ,YANCEY,MURPHY,SARABI,and HUNTER and the Prisoner Class

22 they represent to a substantial risk ofharm and injury from violence from other prisoners

23 and inadequate medical and mental health care. These policies and practices have and

24 continue to be implemented by Defendants and their agents or employees in their official

25 capacities, and are the proximate cause ofPlaintiffs' and the Plaintiffclass' ongoing

26 deprivation ofrights secured by the United States Constitution under the Eighth

27 Amendment.

28

209. Defendants have been and are aware ofall ofthe deprivations complained of

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1 herein, and have condoned or been deliberately indifferent to such conduct.

2

WHEREFORE,Plaintiffs and the Class they represent request relief as outlined

3 below.

4

SECOND CAUSE OF ACTION

(Fourteenth Amendment to the United States Constitution,42 U.S.C.§ 1983)

5 By the Prisoner Class Against Defendants Monterey County,Monterey County

SheriffsOffice,and California Forensic Medical Group

6

7

210. Plaintiffs re-allege and incorporate by reference herein all allegations

8 previously made in paragraphs 1 through 209,above.

9

211. By their policies and practices described above, Defendants subject Plaintiffs

10 HERNANDEZ,YANCEY,MURPHY,SARABI,and HUNTER and the Prisoner Class

11 they represent to a substantial risk of harm and injury from violence from other prisoners

12 and inadequate medical and mental health care. These policies and practices have and

13 continue to be implemented by Defendants and their agents or employees in their official

14 capacities, and are the proximate cause ofPlaintiffs' and the Plaintiffclass' ongoing

15 deprivation ofrights secured by the United States Constitution under the Fourteenth

16 Amendment.

17

212. Defendants have been and are aware ofall ofthe deprivations complained of

18 herein, and have condoned or been deliberately indifferent to such conduct.

19

WHEREFORE,Plaintiffs and the Class they represent request relief as outlined

20 below.

21

THIRD CAUSE OF ACTION

(Article 1, Section 7 of the California Constitution)

22 By the Prisoner Class Against Defendants Monterey County,Monterey County SheriffsOffice, and California Forensic Medical Group

23

24

213. Plaintiffs re-allege and incorporate by reference herein all allegations

25 previously made in paragraphs 1 through 212,above.

26

214. Defendants subject Plaintiffs HERNANDEZ,YANCEY,MURPHY,

27 SARABI,and HUNTER and the Prisoner Class they represent to a substantial risk ofharm

28 and injury from violence from other prisoners and inadequate medical and mental health

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1 care. These policies and practices have and continue to be implemented by Defendants

2 and their agents or employees in their official capacities, and are the proximate cause of

3 Plaintiffs' and the Plaintiff class' ongoing deprivation ofrights secured b3~ the California

4 Constitution, Article 1, Section 7.

5

215. Defendants have been and are aware of all ofthe deprivations complained of

6 herein, and have condoned or been deliberately indifferent to such conduct.

7

WHEREFORE,Plaintiffs and the Class they represent request relief as outlined

:I below.

9

FOURTH CAUSE OF ACTION

(Article 1, Section 17 of the California Constitution)

10 By Prisoner Class Against Defendants Monterey County,Monterey County Sheriffs

Office, and California Forensic Medical Group

11

12

216. Plaintiffs re-allege and incorporate by reference herein all allegations

13~ previously made in paragraphs 1 through 215, above.

14

217. Defendants subject Plaintiffs HERNANDEZ,YANCEY,MURPHY,

15 SARABI,and HUNTER and the Prisoner Class they represent to a substantial risk of harm

16 and injury from violence from other prisoners and inadequate medical and mental health

17 care. These policies and practices have and continue to be implemented by Defendants

18 and their agents or employees in their official capacities, and are the proximate cause of 19 Plaintiffs' and the Plaintiffclass' ongoing deprivation ofrights secured by the California

20 Constitution, Article 1, Section 17.

21

218. Defendants have been and are aware ofall ofthe deprivations complained of

22 ~ herein, and have condoned or been deliberately indifferent to such conduct.

23

WHEREFORE,Plaintiffs and the Class they represent request relief as outlined

24 below.

25

FIFTH CAUSE OF ACTION

(Americans with Disabilities Act,42 U.S.C.§ 12132)

26 By Prisoner Class Against Defendants Monterey County and Monterey County Sheriffs Office

27

28

219. Plaintiffs re-allege and incorporate by reference herein all allegations

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1 previously made in paragraphs 1 through 218, above.

2

220. The ADA prohibits public entities, including the COUNTY and the

3 SHERIFF'S OFFICE from denying "a qualified individual with a disability ... the benefits

4 ofthe services, programs, or activities of[the] public entity" because ofthe individual's

5 ~ disability. 42 U.S.C. § 12132.

6

221. The COUNTY and SHERIFF'S OFFICE are legally responsible for all

7 violations ofthe ADA committed by CFMG in the course of performing its duties under its

8 contractual arrangement with the SHERIFF'S OFFICE to provide medical and mental

9 health care services to prisoners in the Jail. See 28 C.F.R. § 35.130(b)(1).

10

222. The ADA defines "a qualified individual with a disability" as a person who

11 suffers from a "physical or mental impairment that substantially limits one or more major

12 life activities," including, but not limited to,"caring for oneself, performing manual tasks,

13 seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing,

14 learning, reading, concentrating,thinking, communicating,and working." 42 U.S.C.

15 § 12102(1)(A),(2)(A). All Plaintiffs are qualified individuals with disabilities as defined

16 in the ADA,as they have impairments that substantially limit one or more major life

17 activities.

18

223. The programs, services, and activities that Defendants provide to prisoners

19 include, but are not limited to, sleeping, eating,showering,toileting, communicating with

20 those outside the Jail by mail and telephone, exercising, entertainment,safety and security,

21 the Jail's administrative, disciplinary, and classification proceedings, medical, mental

22 health, and dental services, the library, educational, vocational, substance abuse, and anger

23 management classes, and discharge services. Defendants' programs, services and

24 activities are covered by the ADA.

25

224. Under the ADA,Defendants must provide prisoners with disabilities

26 reasonable accommodations and modifications so that they can avail themselves ofand

27 participate in all programs and activities offered by the Jail.

28

225. By failing to reasonably accommodate prisoners with disabilities as

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1 j described above,Defendants violate the ADA including by:

2

a. failing to "ensure that qualified inmates or detainees with disabilities

3 shall not, because a facility is inaccessible to or unusable by individuals with disabilities,

4 be excluded from participation in, or be denied the benefits of,the services, programs,or

~~ activities ofa public entity, or be subjected to discrimination by any public entity." 28

C.F.R. § 35.152(b)(1);

7

b. failing to "ensure that inmates or detainees with disabilities are

8 ~ housed in the most integrated setting appropriate to the needs ofthe individuals." 28

9 C.F.R. § 35.152(b)(2);

10

c. failing to "implement reasonable policies, including physical

11 modifications to additional cells in accordance with the 2010 accessibility] Standards, so

12 as to ensure that each inmate with a disability is housed in a cell with the accessible

13 elements necessary to afford the inmate access to safe, appropriate housing." 28 C.F.R.

14 § 35.152(b)(3);

15

d. failing or refusing to provide the Prisoner Class with reasonable

16 accommodations and other services related to their disabilities,see generally 28 C.F.R.

17

18

e. failing or refusing to provide equally effective communication,see

19 generally 28 C.F.R.§ 35.160(a);

20

f. denying Plaintiffs and the Prisoner Class they represent "the

21 opportunity to participate in or benefit from [an] aid, benefit, or service" provided by

22 Defendants,28 C.F.R. § 35.130(b)(1)(i);

23

g. failing to make "reasonable modifications in policies, practices, or

24 procedures when the modifications are necessary to avoid discrimination on the basis of

25 disability ...." 28 C.F.R.§ 35.130(b)(7);

26

h. failing to make available information to the Prisoner Class about their

27 rights under the ADA while detained in the Jail, 28 C.F.R. § 35.106;

28

i. failing to "adopt and publish grievance procedures providing for

f~7

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1 prompt and equitable resolution ofcomplaints alleging any action that would be prohibited

2 by ... [the ADA]." 28 C.F.R. § 35.107(b);

3

j. failing to "maintain in operable working condition those features of

4 facilities and equipment that are required to be readily accessible to and usable by persons

5 with disabilities by the[ADA]." 28 C.F.R. § 35.133(a); and

6

k. failing to "furnish appropriate auxiliary aids and services where

7 necessary to afford individuals with disabilities ... an equal opportunity to participate in,

8 and enjoy the benefits of, a service, program, or activity ofa public entity." 28 C.F.R.

9 § 35.160(b)(1).

10

226. As a result of Defendants' policy and practice of discriminating against and

11 failing to provide reasonable accommodations,Plaintiffs and the Prisoner Class they

12 represent do not have equal access to Jail activities, programs,and services for which they

13 are otherwise qualified.

14

WHEREFORE,Plaintiffs and the Prisoner Class they represent request relief as

15 outlined below.

16

SIXTH CAUSE OF ACTION

(Americans with Disabilities Act, 42 U.S.C. 12188)

17

By Prisoner Class Against Defendant CFMG

18

227. Plaintiffs re-allege and incorporate by reference herein all allegations

19 previously made in paragraphs 1 through 226,above.

20

228. CFMG is a public accommodation that owns, leases, leases to, or operates a

21 professional office ofa health care provider, hospital, or other service establishment within

22 the meaning of42 U.S.C. §§ 12181(7)(F), and Title III ofthe ADA's implementing

23 regulations,28 C.F.R. § 36.104.

24

229. Plaintiffs are all individuals with a disability and covered by Title III ofthe

25 ADA,42 U.S.C. § 12102(1), 12182(b); 28 C.F.R. § 36.104.

26

230. By its policies and practices described above, Defendant CFMG violates

27 Title III ofthe ADA,42 U.S.C. §§ 12181-12189, by discriminating against individuals

28 with disabilities on the basis of disability, in the full and equal enjoyment ofCFMG's

II

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1 goods,services, facilities, privileges, advantages, or accommodations. 42 U.S.C.

2 § 12182(a);28 C.F.R.,Part 36.

31

WHEREFORE,Plaintiffs and the Prisoner Class they represent request relief as

C~lI outlined below.

5

SEVENTH CAUSE OF ACTION

(Rehabilitation Act,29 U.S.C.§ 794)

6 By Prisoner Class Against Defendants Monterey County and Monterey County

Sheriffs Office

7

8

231. Plaintiffs re-allege and incorporate by reference herein all allegations

9 previously made in paragraphs 1 through 230,above.

10

232. By their policy and practice of discriminating against and failing to

11 reasonably accommodate prisoners with disabilities, Defendants violate Section 504 ofthe

12 Rehabilitation Act,29 U.S.C.§ 794.

13

233. Plaintiffs and the Prisoner Class they represent are qualified individuals with

14 ~ disabilities as defined in the Rehabilitation Act.

15

234. At all times relevant to this action, Defendants were recipients offederal

16 funding within the meaning ofthe Rehabilitation Act. As recipients offederal funds, they

17 are required to reasonably accommodate inmates with disabilities in their facilities,

18 program activities, and services, and to provide a grievance procedure.

19

235. As a result ofDefendants' discriminating against and failing to provide a

20 grievance procedure and reasonable accommodations,Plaintiffs and the Prisoner Class

21 they represent do not have equal access to Jail activities, programs,and services for which

~~a they are otherwise qualified.

23

WHEREFORE,Plaintiffs and the Prisoner Class they represent request relief as

24 outlined below.

25 ///

26 ///

27 ///

28 ///

II

fjC~

CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document1 Filed05/23/13 Page72 of 74

[716216-20]

1

EIGHTH CAUSE OF ACTION

(Cal. Gov't Code § 11135)

2 By Prisoner Class Against Defendants Monterey County,Monterey County Sheriffs

Office, and California Forensic Medical Group

3

4

236. Plaintiffs re-allege and incorporate by reference herein all allegations

5 previously made in paragraphs 1 through 235, above.

6

237. Defendants receive financial assistance from the State of California as part of

7 Realignment Legislation, Government Code §§ 30025,30026,and 30029,and through

8 other statutes and funding mechanisms. Plaintiffs and the Prisoner Class they represent are

9 all persons with disabilities within the meaning ofGovernment Code § 11135.

10

238. As described in this Complaint, Defendants deny all Plaintiffs full access to

11 the benefits ofthe Jail's programs and activities which receive financial assistance from

12 the State ofCalifornia and unlawfully subject Plaintiffs and the Prisoner Class they

13 represent to discrimination within the meaning ofGovernment Code § 11135(a)on the

14 basis oftheir disabilities.

15

239. From February 2012 through May 2013,through their counsel and through

16 grievances submitted to the Jail, Plaintiffs and the Prisoner Class they represent demanded

17 that Defendants stop their unlawful discriminatory conduct described above, but

18 Defendants refused and still refuse to refrain from that conduct.

19

240. Defendants' unlawful and discriminatory conduct, described above, unless

20 and until enjoined and restrained by order ofthis Court, will cause great and irreparable

21 injury to all Plaintiffs and the Prisoner Class they represent in that Plaintiffs and the

22 Prisoner Class are repeatedly subjected to discrimination, risk ofinjury, and denial offull

23 and equal access to the benefts, programs and services provided by the Jail.

24

241. Plaintiffs and the Prisoner Class they represent have no adequate remedy at

25 law for the injuries described above in that they are continually subjected to discrimination

26 on the basis oftheir disabilities and at increased risk for danger and injury and denied full

27 and equal access to programs,services and activities offered at the Jail.

28

WHEREFORE,Plaintiffs and the Prisoner Class they represent request relief as

CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document1 Filed05/23/13 Page73 of 74

p,sz~s-zoo

1 outlined below.

2

PRAYER FOR RELIEF

3

Plaintiffs and the class they represent have no adequate remedy at law to redress the

4 wrongs suffered as set forth in this complaint. Plaintiffs have suffered and will continue.to

5~ suffer irreparable injury as a result ofthe unlawful acts, omissions, policies, and practices

6 ofthe Defendants as alleged herein, unless Plaintiffs are granted the reliefthey request.

7 The need for relief is critical because the rights at issue are paramount under the

8 Constitution and laws ofthe United States and the State of California.

9

WHEREFORE,Plaintiffs HERNANDEZ,YANCEY,MURPHY,SARABI,and

10 HUNTER,on behalfofthemselves, the proposed Prisoner Class, and all others similarly

11 situated, pray forjudgment and the following specific relief against Defendants

12 MONTEREY COUNTY,MONTEREY COUNTY SHERIFF'S OFFICE,CALIFORNIA

13 FORENSIC MEDICAL GROUP,and DOES 1 through 20 as follows:

14

1. An order certifying that this action may be maintained as a class action

15 pursuant to Federal Rule ofCivil Procedure 23;

16

2. A finding that the conditions, acts, omissions, policies, and practices

17 described above are in violation ofthe rights ofPlaintiffs and the class they represent

18 under the ADA,Rehabilitation Act,the Eighth and Fourteenth Amendments to the United

19 States Constitution, Government Code § 11135, and Article 1, Sections 7 and 17 ofthe

20 California Constitution;

21

3. An order requiring Defendants,their agents, officials, employees, and all

22 persons acting in concert with them under color ofstate law or otherwise to protect

23 prisoners from substantial risk ofharm from other prisoners, to provide minimally

24 adequate health care to prisoners,to provide minimally adequate mental health care to

25 prisoners, and to cease discriminating against and failing to provide accommodations to

26 prisoners with disabilities and violating their due process rights;

27

4. An order enjoining Defendants,their agents, officials, employees, and all

28 persons acting in concert with them.under color ofstate law or otherwise,from continuing

I

71

CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document1 Filed05/23/13 Page74 of 74

[716216-19~

11 the tu~lawful acts, conditions,and practices described in this Complaint;

2

5. An award to Plaintiffs, pursuant to 29 U.S.C.§ 794a,42 U.S.C.§§ 1988,

3 12205,and California Code ofCivil Procedure § 1021.5,ofthe costs ofthis suit acid

4 reasonable attorneys'fees and litigation expenses;

5

6. An order retaining jurisdiction oft11is case until Defendants have fully

6 complied with the orders ofthis Court,and there is a reasonable assurance that Defendants

7 will continue to comply in the future absent continuing jurisdiction; and

8

7. An award to Plaintiffs ofsuch other and further reliefas the Court deemsjust

9 ~ and proper.

10

11 ~ DATED: May 23,2013

Respectfully submitted,

12

ROSEN BIEN GALVAN & GRUNFELD LLP

I3'

14

By:

~

c~

15

rost ait runfeld

16
~ DATED: May 23,2013 17

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY

18

19

By:

a es Egar

20

blic Defender

21

Attorneys for Plaintiffs

22

23

24

25

26

27

28

II

'72

CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

 </s> Case5:13-cv-02354-PSG Document25 Filed01/15/14 Page1 of 4

[1060758-1]

1 MICHAEL W. BIEN – 096891

GAY CROSTHWAIT GRUNFELD – 121944

2 MICHAEL FREEDMAN – 262850

SARAH P. ALEXANDER – 291080

3 ROSEN BIEN

GALVAN & GRUNFELD LLP

4 315 Montgomery Street, Tenth Floor

San Francisco, California 94104-1823

5 Telephone: (415) 433-6830

Facsimile: (415) 433-7104

6 Email: mbien@rbgg.com

ggr

unfeld@rbgg.com

7m

freedman@rbgg.com

spalexande

r@rbgg.com

8

JAMES EGAR – 065702

9 Public Defender

DONALD E. LANDIS, JR. – 149006

10 Assistant Public Defender

OFFICE OF THE PUBLIC DEFENDER

11 COUNTY OF MONTEREY

111 West Alisal Street

12 Salinas, California 93901-2644

Telephone: (831) 755-5806

13 Facsimile: (831) 755-5873

Email: EgarJS@co.monterey.ca.us

14 LandisD

E@co.monterey.ca.us

ALAN SCHLOSSER – 049957

LILLIAN C. CHEN – 280395

MICAELA DAVIS – 282195

AMERICAN CIVIL LIBERTIES UNION

FOUNDATION OF NORTHERN

CALIFORNIA

39 Drumm Street

San Francisco, California 94111-4805

Telephone: (415) 621-2493

Facsimile: (415) 255-8437

Email: aschlosser@aclunc.org

lchen@acl

unc.org

m

davis@aclunc.org

ERIC BALABAN* CARL TAKEI* ACLU NATIONAL PRISON PROJECT 915 15th Street N.W., 7th Floor Washington, D.C. 20005-2302 Telephone: (202) 393-4930 Facsimile: (202) 393-4931 Email: ebalaban@npp-aclu.org ctakei@npp-aclu.org *Admitted Pro Hac Vice

15 Attorneys for Plaintiffs

16

UNITED STATES DISTRICT COURT

17

NORTHERN DISTRICT OF CALIFORNIA

18 JESSE HERNANDEZ, CYNTHIA AGUILAR, HA COBB, GEORGE GREIM,
19 DENNIS GUYOT, GLENDA HUNTER, ALBERT KEY, WESLEY MILLER,
20 RICHARD MURPHY, JEFF NICHOLS, SARAB SARABI, and ROBERT YANCEY,
21 on behalf of themselves and all others similarly situated,
22 Plaintiffs,
23 v.
24 COUNTY OF MONTEREY; MONTEREY
25 COUNTY SHERIFF’S OFFICE; CALIFORNIA FORENSIC MEDICAL
26 GROUP, INCORPORATED, a California corporation; and DOES 1 to 20, inclusive,
27 Defendants.
28

Case No. CV 13 2354 PSG STIPULATION AND [PROPOSED] ORDER Judge: Hon. Paul S. Grewal

STIPULATION AND [PROPOSED] ORDER

Case5:13-cv-02354-PSG Document25 Filed01/15/14 Page2 of 4

[1060758-1]

1

WHEREAS, Plaintiffs JESSE HERNANDEZ, CYNTHIA AGUILAR, HA COBB,

2 GEORGE GREIM, DENNIS GUYOT, GLENDA HUNTER, ALBERT KEY, WESLEY

3 MILLER, RICHARD MURPHY, JEFF NICHOLS, SARAB SARABI, and ROBERT

4 YANCEY (“Plaintiffs”), on behalf of themselves and all others similarly situated, filed a

5 complaint in this Court on May 23, 2013 and filed a First Amended Complaint on

6 October 31, 2013 (the “Action”); and

7

WHEREAS, Defendants COUNTY OF MONTEREY and MONTEREY COUNTY

8 SHERIFF’S OFFICE, through their counsel, Deputy County Counsel Susan K. Blitch,

9 waived service of the First Amended Complaint on November 27, 2013, and Defendant

10 CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED (“CFMG”), through

11 its counsel, Peter Bertling (collectively “Defendants”), waived service of the First

12 Amended Complaint on November 25, 2013; and

13

WHEREAS, the parties previously entered into a Stipulation and Proposed Order

14 staying the Action until January 1, 2014, which the Court entered on July 29, 2013; and

15

WHEREAS, the parties seek to continue working towards a settlement of the

16 Action; and

17

WHEREAS, certain court deadlines apply to the Action, including that Defendants’

18 must respond to the First Amended Complaint no later than February 3, 2014;

19

NOW THEREFORE, IT IS HEREBY STIPULATED AND AGREED by and

20 between the parties to the Action, through their respective counsel, as follows:

21

1. All deadlines otherwise applicable to the Action shall be stayed until

22 February 17, 2014 (the “stay period”), to allow the parties time to: (1) to engage in

23 negotiations aimed at achieving mutually agreeable relief and (2) develop remedial plans

24 to improve conditions in Monterey County Jail; and

25

2. By February 17, 2014, Defendants shall provide to Plaintiffs a draft remedial

26 plan to improve the delivery of medical care at Monterey County Jail; and

27

3. During the stay period, Plaintiffs and Defendants will meet and confer

28 regarding the structure of an agreement to settle Plaintiffs’ claims against Defendants; and

1
STIPULATION AND [PROPOSED] ORDER

Case5:13-cv-02354-PSG Document25 Filed01/15/14 Page3 of 4

[1060758-1]

1

4. Defendants’ response to Plaintiffs’ First Amended Complaint is due no later

2 than March 5, 2014; and

3

5. Nothing in this Stipulation shall be construed as a waiver of any party’s

4 rights or an admission of liability by any Defendant.

5

IT IS SO STIPULATED.

6 DATED: January 14, 2014

ROSEN BIEN GALVAN & GRUNFELD LLP

7 By: 8

/s/ Gay Crosthwait Grunfeld Gay Crosthwait Grunfeld

9 DATED: January 14, 2014 10

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY

11 By: 12

/s/ James Egar James Egar, Public Defender

13 DATED: January 14, 2014 14

AMERICAN CIVIL LIBERTIES UNION FOUNDATION OF NORTHERN CALIFORNIA

15 By: 16 Alan

/s/ Alan Schlosser Schlosser

17 DATED: January 14, 2014 18 By: 19 Eric
20

ACLU NATIONAL PRISON PROJECT
/s/ Eric Balaban Balaban
Attorneys for Plaintiffs

21 DATED: January 14, 2014 22

OFFICE OF THE COUNTY COUNSEL COUNTY OF MONTEREY

23 By: 24 Susan 25 26 27

/s/ Susan K. Blitch K. Blitch
Senior Deputy County Counsel
Attorneys for Defendants COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF’S OFFICE

28

2
STIPULATION AND [PROPOSED] ORDER

Case5:13-cv-02354-PSG Document25 Filed01/15/14 Page4 of 4

[1060758-1]

1 DATED: January 14, 2014

BERTLING & CLAUSEN, L.L.P.

2 By: 3 4 5

/s/ Peter G. Bertling Peter G. Bertling
Attorneys for Defendant CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED

6

7

Pursuant to Northern District General Order 45(X)(B), I hereby attest that I have on

8 file approvals for any signatures indicated by a “conformed” signature (/s/) within this e-

9 filed document.

10

11 DATED: January 14, 2014

ROSEN BIEN GALVAN & GRUNFELD LLP

12 By: 13

/s/ Gay Crosthwait Grunfeld Gay Crosthwait Grunfeld

14

Attorneys for Plaintiffs

15

16

17

PROPOSED ORDER

18

The Court, having reviewed the above Stipulation of the parties, and good cause

19 appearing, hereby ORDERS that any currently pending deadlines, including Defendants’

20 deadline for responding to Plaintiffs’ First Amended Complaint, are hereby vacated and

21 this Action is stayed until February 17, 2014. On or before February 28, 2014, the parties

22 shall inform the Court of the status of the matter and request that the Court-ordered

23 deadlines be reset.

24

IT IS SO ORDERED.

25

26 DATED: _______________, 2014 27 28

Paul S. Grewal Magistrate Judge of the U.S. District Court

3
STIPULATION AND [PROPOSED] ORDER

 </s> Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page1 of 137

[1144098-2]

1 MICHAEL W. BIEN – 096891

GAY C. GRUNFELD – 121944

2 MICHAEL FREEDMAN – 262850

SARAH P. ALEXANDER – 291080

3 ROSEN BIEN

GALVAN & GRUNFELD LLP

4 315 Montgomery Street, Tenth Floor

San Francisco, California 94104-1823

5 Telephone: (415) 433-6830

Facsimile: (415) 433-7104

6 Email:

mbien@rbgg.com

ggrunfeld@rbgg.com

7

mfreedman@rbgg.com

spalexander@rbgg.com

8

JAMES EGAR – 065702

9 Public Defender

DONALD E. LANDIS, JR. – 149006

10 Assistant Public Defender

OFFICE OF THE PUBLIC DEFENDER

11 COUNTY OF MONTEREY

111 West Alisal Street

12 Salinas, California 93901-2644

Telephone: (831) 755-5806

13 Facsimile: (831) 755-5873

Email:

EgarJS@co.monterey.ca.us

14

LandisDE@co.monterey.ca.us

ALAN SCHLOSSER – 049957

MICAELA DAVIS – 282195

AMERICAN CIVIL LIBERTIES UNION

FOUNDATION OF NORTHERN

CALIFORNIA, INC.

39 Drumm Street

San Francisco, California 94111-4805

Telephone: (415) 621-2493

Facsimile: (415) 255-8437

Email:

aschlosser@aclunc.org

mdavis@aclunc.org

ERIC BALABAN*

CARL TAKEI*

ACLU NATIONAL PRISON PROJECT

915 15th Street N.W., 7th Floor

Washington, D.C. 20005-2302

Telephone: (202) 393-4930

Facsimile: (202) 393-4931

Email:

ebalaban@npp-aclu.org

ctakei@npp-aclu.org

*Admitted Pro Hac Vice

15 Attorneys for Plaintiffs

16

UNITED STATES DISTRICT COURT

17

NORTHERN DISTRICT OF CALIFORNIA

18 JESSE HERNANDEZ, CAIN AGUILAR, HA COBB, SUSAN DILLEY, CONNIE DOBBS,
19 SEAN ESQUIVEL, RAMONA GIST, MARTHA GOMEZ, GEORGE GREIM, DENNIS GUYOT,
20 JASON HOBBS, GLENDA HUNTER, ALBERT KEY, BRANDON MEFFORD, WESLEY
21 MILLER, RICHARD MURPHY, JEFF NICHOLS, ANGEL PEREZ, SARAB SARABI,
22 CLYDE WHITFIELD, and ROBERT YANCEY, on behalf of themselves and all others similarly
23 situated,

24

Plaintiffs,

v.

25 COUNTY OF MONTEREY; MONTEREY

26

COUNTY SHERIFF’S OFFICE; CALIFORNIA FORENSIC MEDICAL GROUP,

27

INCORPORATED, a California corporation; and DOES 1 to 20, inclusive,

28

Defendants.

Case No. CV 13 2354 PSG
SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF
Judge: Paul S. Grewal
(1) Failure to Protect Prisoners From Violence: Violations of 8th and 14th Amendments of U.S. Constitution, and Article I, Sections 7 and 17 of California Constitution
(2) Failure to Provide Adequate Medical Care to Prisoners: Violations of 8th and 14th Amendments of U.S. Constitution, and Article I, Sections 7 and 17 of California Constitution

SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page2 of 137

[1144098-2]

1

(3) Failure to Provide Adequate Mental

Health Care to Prisoners: Violations

2

of 8th and 14th Amendments of U.S.

Constitution, and Article I, Sections 7

3

and 17 of California Constitution

4

(4) Failure to Provide Reasonable Accommodations to Prisoners with

5

Disabilities: Violations of Americans with Disabilities Act, Rehabilitation

6

Act, and California Government Code § 11135

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page3 of 137

[1144098-2]

1

NATURE OF ACTION

2

1. The Monterey County Jail in Salinas, California, is broken in nearly every

3 way. Defendants County of Monterey (“Monterey County” or the “County”), Monterey

4 County Sheriff’s Office (“Sheriff’s Office”), and California Forensic Medical Group

5 (“CFMG” and collectively “Defendants”) knowingly provide inadequate security, medical

6 care, and mental health care to prisoners in the Monterey County Jail (the “Jail”), exposing

7 prisoners to substantial, unreasonable, and life-threatening risks of harm. Defendants also

8 routinely discriminate against and fail to accommodate prisoners with disabilities,

9 excluding them from programs, services, and activities offered in the Jail.

10

2. This civil rights class action lawsuit seeks to remedy the dangerous,

11 overcrowded, discriminatory, and unconstitutional conditions in the Jail. The twenty-one

12 individual Plaintiffs in the Jail bring this action against the Defendants on behalf of

13 themselves and those similarly situated.

14

3. Plaintiffs seek declaratory and injunctive relief under the United States and

15 California constitutions against Defendants for their deliberate indifference to the

16 exceedingly high levels of prisoner violence in the Jail. The causes of the violence—

17 understaffing, overcrowded housing units, lack of training and adequate policies and

18 procedures, antiquated and poorly designed Jail facilities, and an inadequate prisoner

19 classification system—are well-known to and tolerated by Defendants. Violent incidents

20 between prisoners occur with alarming frequency and in nearly every area of the Jail.

21 According to the Sheriff’s Office’s own incident reports from January 2011 through early-

22 September 2012, there were more than 150 separate incidents of violence between

23 prisoners. In more than 100 of these incidents, at least one prisoner required medical

24 treatment. Violent incidents were reported in 26 out of 29 housing units. Violence at the

25 Jail is not an anomaly; it is a way of life. Forcing prisoners to live under ongoing threats

26 of serious bodily injury is cruel and inhumane, especially when Defendants have the ability

27 to prevent and reduce such violence.

28

4. Plaintiffs seek declaratory and injunctive relief under the United States and

1
SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page4 of 137

[1144098-2]

1 California constitutions against Defendants for their deliberate indifference to their failure

2 to provide prisoners with minimally adequate medical care. Monterey County outsources

3 the provision of medical care to prisoners in the Jail to CFMG, a private corporation,

4 which provides deficient medical care in nearly every respect. Prisoners at the Jail, most

5 of whom are pretrial detainees or charged with violations of parole or probation, are not

6 adequately screened for serious medical problems upon arrival at the Jail, and Defendants

7 lack an effective system for prisoners to request medical or dental care. When prisoners do

8 receive care, it is often after a delay of weeks or even months. The medical care staff

9 employed by CFMG are insufficient in number to care for the more than 900 prisoners in

10 the severely overcrowded Jail. Both prisoners who arrive at the Jail with existing medical

11 care needs and those who develop conditions in the Jail fail to receive timely or

12 appropriate treatment, resulting in unnecessary and prolonged pain, suffering, worsening

13 of their conditions, and sometimes even death. As a result of Defendants’ failure to

14 provide minimally adequate medical care, Defendants are deliberately indifferent to the

15 substantial risk of harm faced by all prisoners.

16

5. Plaintiffs also seek declaratory and injunctive relief under the United States

17 and California constitutions against Defendants’ deliberate indifference to their failure to

18 provide prisoners with minimally adequate mental health care. Monterey County also

19 outsources the provision of mental health care to prisoners in the Jail to CFMG, which

20 provides deficient mental health care in nearly every respect. Prisoners are not adequately

21 screened for serious mental health problems upon arrival at the Jail. Defendants lack an

22 effective system for prisoners to request care. When prisoners do receive mental health

23 care, it is often after a delay of weeks or even months, and may not include appropriate and

24 necessary housing, medication, therapy, psychosocial intervention, and other mental health

25 treatment. Both prisoners who arrive at the Jail with existing mental health concerns and

26 those who develop conditions in the Jail fail to receive appropriate treatment. Defendants’

27 approach to prisoners with serious mental health problems (including suicidality) relies too

28 heavily on placing such prisoners in “rubber rooms”—filthy rooms with no features other

2
SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page5 of 137

[1144098-2]

1 than a slot in the door for food and a grate in the floor for a toilet—which only exacerbates

2 and prolongs their already dire mental health crises. In the last four years alone, there have

3 been three completed and more than a dozen attempted suicides at the Jail. As a result of

4 Defendants’ failure to provide minimally adequate mental health care, Defendants are

5 deliberately indifferent to the substantial risk of harm faced by all prisoners.

6

6. Defendants’ failure to protect prisoners from violence and failure to provide

7 minimally adequate medical and mental health care are particularly egregious given that

8 Defendants have been aware of these problems and their causes for years, yet have failed

9 to take the necessary actions to ameliorate the unconstitutional and illegal conditions. In

10 2007, the County commissioned a third-party evaluation of the Jail, which resulted in a

11 report, dated June 19, 2007, entitled “County of Monterey, Office of the Sheriff, Needs

12 Assessment” (hereinafter “2007 Needs Assessment” or “2007 Assessment”), which is

13 attached hereto as Exhibit A. The 2007 report concluded that “[t]he current combination

14 of insufficient beds, an inadequate detention facility and understaffing has resulted in an

15 almost untenable situation.” 2007 Assessment at Ex. 1-2. In 2011, the County asked the

16 third-party consultant to update the 2007 report to reflect amendments to state law and

17 changes within the Sheriff’s Office and the Jail population. This updated report, dated

18 December 30, 2011, reached the exact same, word-for-word conclusion: “The current

19 combination of insufficient beds, an inadequate detention facility and understaffing has

20 resulted in an almost untenable situation.” County of Monterey, Office of the Sheriff, Jail

21 Needs Assessment, December 30, 2011 (hereinafter “2011 Jail Needs Assessment” or

22 “2011 Assessment”), attached hereto as Exhibit B, at Ex. 2. Defendants’ deliberate

23 indifference to prisoners’ safety and medical and mental health is unconscionable, and

24 must be stopped to prevent additional unnecessary loss of life, pain, and suffering.

25

7. Under the Americans with Disabilities Act (“ADA”), Section 504 of the

26 Rehabilitation Act (“Rehabilitation Act”), and California Government Code § 11135,

27 Plaintiffs seek declaratory and injunctive relief against Defendants as a remedy for their

28 systemic and willful discrimination against, and failure to provide reasonable

3
SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

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[1144098-2]

1 accommodations in programs, services, and activities to, prisoners in the Jail who have

2 disabilities. Defendants lack adequate policies and practices for identifying and tracking

3 prisoners with disabilities and the accommodations those prisoners require. Defendants

4 have no adequate administrative grievance process available to prisoners to request

5 reasonable accommodations. Defendants do not provide effective communication or basic

6 and reasonable accommodations, such as sign language interpreting services and hearing

7 aids, to prisoners with hearing, speech, and other communication impairments, even for

8 critical interactions with Jail staff, including for intake and classification, disciplinary

9 hearings, and medical and mental health appointments. Many areas of the Jail are

10 physically inaccessible to prisoners with disabilities, both because Defendants refuse to

11 permit prisoners to possess needed assistive devices and fail to house prisoners with

12 disabilities in accessible parts of the Jail. Defendants’ systemic failure to accommodate

13 prisoners with disabilities results in the widespread exclusion of prisoners with disabilities

14 from many of the programs, services, and activities offered by Defendants, including

15 health care services, exercise, religious services, sleeping, and educational and vocational

16 programs. Moreover, Defendants’ lack of adequate policies and procedures makes

17 prisoners with disabilities vulnerable to exploitation and violence by other prisoners and

18 increases their risk of serious injury or death.

19

8. As a remedy for the statutory and constitutional violations described herein,

20 Plaintiffs seek a declaration that Defendants are violating federal and state law and an

21 injunction compelling Defendants to provide prisoners with adequate protection from

22 violence from other prisoners, to provide prisoners with adequate medical and mental

23 health care, and to provide reasonable accommodations to and cease discriminating against

24 prisoners with disabilities.

25

JURISDICTION

26

9. This Court has jurisdiction over the claims brought under federal law

27 pursuant to 28 U.S.C. §§ 1331 and 1343. This Court has jurisdiction over the claims

28 brought under California law pursuant to 28 U.S.C. § 1367. Plaintiffs seek declaratory and

4
SECOND AMENDED CIVIL CLASS ACTION COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case5:13-cv-02354-PSG Document41 Filed04/11/14 Page7 of 137

[1144098-2]

1 injunctive relief under 28 U.S.C. §§ 1343, 2201, and 2202, 29 U.S.C. § 794a, 42 U.S.C.

2 §§ 1983 and 12117(a), California Government Code § 11135, and Article I, Sections 7 and

3 17 of the California Constitution.

4

VENUE

5

10. Venue is properly in this Court, pursuant to 28 U.S.C. § 1391(b)(1), in that

6 Plaintiffs’ claims for relief arose in this District and one or all of the Defendants reside in

7 this District.

8

PARTIES

9

11. PLAINTIFF CAIN AGUILAR was most recently detained at Monterey

10 County Jail on July 6, 2013. During a prior term in the Jail, Plaintiff AGUILAR suffered a

11 fractured cheekbone, other facial injuries, slurred speech, and loss of vision after being

12 attacked by another inmate on February 10, 2013. The injury caused him severe pain, left

13 him unable to open his mouth, and has resulted in ongoing pain, headaches, and blurred

14 vision. Plaintiff AGUILAR did not receive adequate care from Defendants immediately

15 following the incident. He also received inadequate pain management for his pain both

16 before and after surgery to fix his fractured cheek bone. Defendants failed to provide

17 Plaintiff AGUILAR timely access to a proper soft diet, which resulted in him not being

18 able to eat for nearly two weeks after his surgery, and in significant weight loss, dizziness,

19 and a more difficult recovery. Plaintiff AGUILAR continues to experience blurred vision

20 in his right eye. An outside medical specialist recommended he see a specialist for his

21 vision problems, but despite numerous requests to medical staff through sick slips and

22 requests to custody staff through a grievance, he has yet to see such a specialist. Plaintiff

23 AGUILAR has also had problems getting timely responses to his sick call slips concerning

24 painful rashes and boils on his head and neck and has not received a response to his sick

25 slip request to see the Jail therapist concerning his ongoing depression and anxiety.

26 Plaintiff AGUILAR is a person with a disability as defined in 42 U.S.C. § 12102, 29

27 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

28

12. PLAINTIFF HA (TRAN) COBB was most recently detained at Monterey

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1 County Jail on April 4, 2013. Following her arrival at the Jail, Defendants provided

2 untimely and inadequate care for Plaintiff COBB’s severe kidney stones, including failing

3 to timely diagnose her condition, failing to provide appropriate pain management, failing

4 to provide appropriate and timely post-operative care after Plaintiff COBB had a surgical

5 drain inserted into her kidney, failing to timely schedule necessary surgery for the removal

6 of Plaintiff COBB’s kidney stones, and failing to provide appropriate and timely post-

7 operative care. As a result of Defendants’ inadequate medical care, Plaintiff COBB has

8 suffered severe and unnecessary pain and was placed at risk of permanent loss of kidney

9 function. Plaintiff COBB still has a number of kidney stones for which she will continue

10 to require treatment. Plaintiff COBB is a person with a disability as defined in 42 U.S.C.

11 § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(m).

12

13. PLAINTIFF SUSAN DILLEY was detained at Monterey County Jail on

13 June 28, 2013. She has been housed in the Women’s Section of the Jail since that date

14 with the exception of one week in August, when she was temporarily released for the Jail.

15 Plaintiff DILLEY has preliminarily been diagnosed with Multiple Sclerosis (“MS”). For

16 the entire time she has been in the Jail she has suffered from physical and neurological

17 problems, including numbness in her legs, problems maintaining her balance, substantial

18 nerve-related pain, cognitive issues, and memory loss. It is extremely difficult and causes

19 her severe pain any time she has to walk long distances or up more than one or two stairs.

20 During her time in the Jail, she has requested or been prescribed by outside medical

21 doctors numerous accommodations for her impairments, including a cane, an extra

22 mattress, a shower chair, and special shoes. She experienced substantial delays and other

23 problems obtaining each of these accommodations. For example, the shower chair

24 Defendants provided her is too large for both her and the chair to safely fit in the shower at

25 the same time. Even with the accommodations, Plaintiff DILLEY encounters numerous

26 obstacles in the Jail that prevent her from accessing Jail activities, programs, and services.

27 She has not been able to access a number of programs, including the exercise yard,

28 religious services, and educational programs, because they are only offered to her up a

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1 long flight of stairs that she can only climb with great difficulty and pain. Plaintiff

2 DILLEY is a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C.

3 § 705(9)(B), and California Government Code § 12926(j) and (m).

4

14. PLAINTIFF CONNIE DOBBS has been detained at the Jail since September

5 15, 2012. While in custody in November 2012, Plaintiff DOBBS sustained a fractured

6 nose, a permanent post-traumatic tremor in her right hand from mild traumatic brain

7 injury, and nerve damage, pain, and numbness in her left leg, knee, and ankle when she fell

8 at the courthouse while shackled at the ankles, waist, and wrists. Defendants failed to

9 provide Plaintiff DOBBS with timely and appropriate medical care, including, but not

10 limited to, failing to receive timely diagnostic tests, proper pain medication, or follow-up

11 tests after her serious injury. For example, Defendants did not diagnose the nasal fracture

12 for nearly two weeks. As result of her fall and other chronic, pre-existing injuries, Plaintiff

13 DOBBS has chronic pain, particularly in her left leg, hip, knee, and lower back.

14 Defendants did not provide her proper pain management for over four months after her

15 fall. Though she currently is prescribed Gabapentin and ibuprofen for her pain, she has

16 experienced interruptions in these medication when her prescriptions are set to expire; she

17 has been required to put in sick call slips and grievances to restart her medications. Even

18 with the medication, Plaintiff DOBBS has impaired mobility and cannot access all of the

19 programs and services of the Jail, such as religious services, because it is difficult for her

20 to climb the stairs to get there. Plaintiff DOBBS also suffers from Right Carpal Tunnel

21 syndrome which may have been exacerbated by her fall. Despite the recommendation by

22 her outside neurologist for a hard wrist splint over a year ago, and despite Jail medical staff

23 ordering her such wrist splint seven months ago, she has still yet to receive the splint.

24 Without the splint Plaintiff DOBBS continues to experience pain, numbness, and tingling

25 in her right wrist and hand which keeps her up at night. Plaintiff DOBBS is a person with

26 a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

27 Government Code § 12926(m).

28

15. PLAINTIFF SEAN ESQUIVEL was detained at Monterey County Jail on

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1 March 3, 2014. Plaintiff ESQUIVEL is a full-time wheelchair user. He has been a

2 prisoner in the Jail many times over the past 20 years, including three times in the past

3 year. During previous terms in the Jail, Defendants have failed to accommodate Plaintiff

4 ESQUIVEL’s disability by, among other things, denying Plaintiff ESQUIVEL access to

5 functioning wheelchairs and placing him in housing units where he could not access the

6 shower, toilet, or the exercise yard. Plaintiff ESQUIVEL also has a large tumor on his leg

7 that causes him considerable pain and requires consistent medical attention, including

8 repeated surgeries and follow up care. Defendants have repeatedly failed to provide

9 Plaintiff ESQUIVEL with appropriate medical care for his tumor, including failing to

10 follow post-operative orders in ways that placed him at risk for infection and other

11 complications and caused him pain. Plaintiff ESQUIVEL also has sleep apnea and

12 requires the use of a CPAP machine to sleep safely. Defendants have failed to provide him

13 with a CPAP machine in a timely manner during his last two stays at the Jail. Moreover,

14 Defendants only permit Plaintiff ESQUIVEL to use the CPAP machine in the infirmary,

15 meaning he cannot not sleep until custody staff are available to bring him from his housing

16 unit to the infirmary—sometimes as late as 1 am—and has to wake up to return to his

17 dorm when custody staff are available—sometimes as early as 4 am. Plaintiff ESQUIVEL

18 also suffers from a number of chronic medical conditions, including diabetes, asthma, and

19 hypertension. Defendants have failed to provide Plaintiff ESQUIVEL with the insulin,

20 inhalers, medication, and treatment he needs to manage these conditions in a safe and

21 consistent manner. Finally, Plaintiff ESQUIVEL has serious mental health conditions

22 including depression, attention deficit hyperactivity disorder (“ADHD”), and anxiety, for

23 which he is currently receiving no treatment at the Jail. Plaintiff ESQUIVEL is a person

24 with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

25 Government Code § 12926(j) and (m).

26

16. PLAINTIFF RAMONA GIST has been a prisoner in the Jail approximately

27 ten times over the past fifteen years, including three times over the past two years.

28 Plaintiff GIST was most recently detained at Monterey County Jail on December 20, 2013.

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1 Plaintiff GIST has a history of mental health conditions and suffers from schizophrenia,

2 bipolar disorder, anxiety, and insomnia. These conditions make it difficult for Plaintiff

3 GIST to effectively communicate with Jail staff, to understand the rules and processes of

4 the Jail, and to access Jail programs and services without accommodations. Defendants

5 have repeatedly failed to provide Plaintiff GIST with appropriate and timely mental health

6 care, including, but not limited to, denying her access to psychiatric medications

7 prescribed by her outside physician. For example, Defendants previously denied

8 prescribed psychiatric medications to Plaintiff GIST for up to 90 days upon her booking

9 into the Jail. When Defendants deny Plaintiff GIST her medications, her mental health

10 deteriorates and she suffers unnecessarily. Plaintiff GIST additionally has developmental

11 disabilities, including fetal alcohol syndrome and mild Down syndrome. Plaintiff GIST

12 encounters obstacles to participating in the Jail’s educational programs due to these

13 disabilities. Upon information and belief, she is unable participate in the Jail’s GED

14 program because she has difficulty understanding the classes. If there were special

15 education opportunities she would participate. Plaintiff GIST also has a number of

16 physical medical conditions, including scoliosis and congenital hip problems, from which

17 she experiences chronic pain. Despite numerous requests, Defendants have failed to

18 provide Plaintiff GIST with appropriate medical care for these conditions, including, but

19 not limited to, failing to provide the muscle relaxant she is prescribed by her outside

20 physician. Plaintiff GIST’s conditions affect her balance, causing her to fall often and

21 making it painful to walk for long periods or upstairs. Plaintiff GIST encounters numerous

22 obstacles in the Jail that prevent her from accessing Jail activities, programs, and services,

23 including the exercise yard, religious services, and Alcohol and Narcotics Anonymous

24 classes, because of her cognitive impairments, mental illness, and physical disabilities.

25 Plaintiff GIST is a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C.

26 § 705(9)(B), and California Government Code § 12926(j) and (m).

27

17. PLAINTIFF MARTHA GOMEZ has been detained at the Jail since

28 January 13, 2014. She has previously been detained in the Jail on a number of other

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1 occasions. Plaintiff GOMEZ experiences chronic pain due to injuries and degenerative

2 conditions including back pain, numbness and stiffness in her legs, pain in her right side

3 from pinched nerves, pain from arthritis in her knee and hands, and pain from when a

4 disease destroyed much of her muscle in her left shoulder. Plaintiff GOMEZ also suffers

5 from chronic hypertension, migraines and dementia. Plaintiff GOMEZ frequently falls and

6 injures herself, which happens often due to her pain and degenerative conditions. Plaintiff

7 GOMEZ uses a walker to ambulate. Defendants deprived Plaintiff GOMEZ of a walker

8 for two weeks, despite her repeated requests, which caused her serious problems

9 ambulating in the Jail and accessing Jail programs, services, and activities, including the

10 bathroom. Plaintiff GOMEZ has had and still is having problems receiving appropriate

11 and timely pain medication for her chronic conditions. Plaintiff GOMEZ also has mental

12 health problems which cause her anxiety, cause her to hear voices, and make it difficult for

13 her to sleep and cope with her various problems. Defendants have failed to provide

14 Plaintiff GOMEZ with timely and appropriate mental health care, including psychiatric

15 medications and other treatment. Plaintiff GOMEZ is a person with a disability as defined

16 in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j)

17 and (m).

18

18. PLAINTIFF GEORGE GREIM was detained most recently at Monterey

19 County Jail in September 2012. Plaintiff GREIM has a long history of severe mental

20 illness, and experiences severe anxiety, insomnia, and depression. Defendants are aware

21 of Plaintiff GREIM’s psychiatric conditions, but have repeatedly failed to provide him

22 with adequate care, treatment, or medication. In late-July 2013, Plaintiff GREIM was

23 transferred to the Alameda County Jail pursuant to a contract between Monterey County

24 and Alameda County, described in Paragraph 178, infra. Plaintiff GREIM was transferred

25 back to the Monterey County Jail on or about September 6, 2013. When Plaintiff GREIM

26 returned to the Jail from Alameda County Jail, Defendants discontinued the psychiatric

27 medication he had been provided in Alameda County. Due to Defendants’ failure to

28 timely and adequately determine and treat Plaintiff GREIM’s serious mental illness, he

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1 experienced significant mental health decompensation, with increasing anxiety, racing

2 thoughts, depression, and insomnia. As a result, Plaintiff GREIM had difficulty

3 communicating effectively with Jail staff, understanding the rules and processes of the Jail,

4 and accessing Jail programs and services without accommodations. Plaintiff GREIM was

5 also a victim of violence at the Jail in which custody staff did not intervene, due to

6 Defendants’ serious understaffing and lack of appropriate supervision of prisoners at the

7 Jail. Additionally, Plaintiff GREIM has an injured right knee, which has caused him

8 serious pain throughout his time in the Jail. Defendants have failed to provide adequate

9 care for his knee. Plaintiff GREIM is a person with a disability as defined in 42 U.S.C.

10 § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

11

19. PLAINTIFF DENNIS GUYOT was detained at Monterey County Jail on

12 March 3, 2013. On March 15, 2013, Plaintiff GUYOT was assaulted by a group of other

13 prisoners at the Jail, outside of the visual and audio supervision of any staff. Defendants

14 unreasonably failed to protect Plaintiff GUYOT and failed to timely intervene in the

15 attack. As a result of the assault, Plaintiff GUYOT experienced serious dental trauma for

16 which he had to undergo invasive oral surgery. Plaintiff GUYOT also suffered a

17 concussion, and continues to suffer from blurred vision, sensitivity to light, and serious

18 migraines. Defendants failed to provide adequate medical care for his post-concussion

19 medical needs, including, but not limited to, egregiously delaying in referring him for

20 necessary specialist evaluations. Plaintiff GUYOT is a person with a disability as defined

21 in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code

22 § 12926(m).

23

20. PLAINTIFF JESSE HERNANDEZ was detained at Monterey County Jail on

24 April 28, 2012. He remained in the Jail until September 27, 2013, when he was released

25 from the Jail to participate in a supervised home confinement program in lieu of serving

26 the remainder of his Jail term. From September 27, 2013 until February 19, 2014, he lived

27 in Salinas, California, and was supervised by the Monterey County Probation Department.

28 On February 19, 2014, he was arrested related to his home confinement and incarcerated in

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1 the Jail. He has been in the Jail since February 19, 2014. Prior to his initial incarceration,

2 Plaintiff HERNANDEZ underwent an ileostomy as treatment for serious gunshot wounds.

3 Defendants provided untimely and inadequate medical care, including, but not limited to,

4 repeated failures to reverse, and delays in reversing, the ileostomy. Even after Plaintiff

5 HERNANDEZ finally received the ileostomy reversal surgery in December 2012,

6 Defendants failed to provide adequate medical care, including, but not limited to, proper

7 post-operative follow-up care. As a result of Defendants’ delayed and inadequate medical

8 care, Plaintiff HERNANDEZ has suffered from unnecessary and avoidable pain and

9 symptoms, including, but not limited to, intestinal swelling, bleeding, severe stomach pain,

10 fevers, cold sweats, and an obstructed bowel. On two occasions in December 2012 and

11 January 2013, delays by Defendants to respond to emergencies related to Plaintiff

12 HERNANDEZ’s post-operative care caused Plaintiff HERNANDEZ serious pain, resulted

13 in hospitalizations of one week and seven weeks respectively, and placed Plaintiff

14 HERNANDEZ’s life at grave risk. When Plaintiff HERNANDEZ was arrested on

15 February 19, 2014, he was scheduled for abdominal surgery the following day.

16 Defendants refused to permit him to move forward with the scheduled surgery and have

17 not rescheduled him for the surgery. In the past and currently, Plaintiff HERNANDEZ has

18 been denied appropriate pain medications for his serious and painful abdomen and

19 shoulder injuries. Plaintiff Hernandez still suffers serious pain and requires medical

20 attention for his abdomen and shoulder injuries. Plaintiff HERNANDEZ is a person with a

21 disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

22 Government Code § 12926(m).

23

21. PLAINTIFF JASON HOBBS was detained at Monterey County Jail on

24 November 12, 2013. Plaintiff HOBBS suffers from a number of serious medical and

25 psychiatric conditions. He has been diagnosed with asthma, Hepatitis C, and degenerative

26 disc disease. Plaintiff HOBBS also suffers from depression and anxiety, which make it

27 difficult for him to communicate effectively with Jail staff. Around 2006, Plaintiff

28 HOBBS had major back surgery to fuse part of his spine at L4-S1. Plaintiff HOBBS’s

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1 back problems, which cause him constant pain, were severely aggravated when another

2 prisoner in the Jail attacked him, without provocation, on November 17, 2013. The

3 damage he sustained in the attack has caused him serious problems with walking and

4 balance, and significant pain. After the attack, Defendants failed to provide Plaintiff

5 HOBBS with adequate medical treatment, including, but not limited to, adequate pain

6 medication, rehabilitative services, and access to outside medical specialists. In addition,

7 Defendants did not timely provide him with a cane which he needed and requested to

8 ensure his balance when walking. Moreover, because of the lack of a safe and adequate

9 shower chair in his housing unit, on December 22, 2013, Plaintiff HOBBS fell while

10 showering and further aggravated his back condition. Finally, in July 2013 during a prior

11 term in the Jail, despite Plaintiff HOBBS’s requests, Defendants refused to provide him

12 with a lower bunk housing assignment; that same month, forced to sleep in the middle

13 bunk of a triple bunk, Plaintiff HOBBS fell and injured his back attempting to climb down

14 from his bed. Plaintiff HOBBS is a person with a disability as defined in 42 U.S.C.

15 § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

16

22. PLAINTIFF GLENDA HUNTER was detained at Monterey County Jail on

17 March 16, 2013. Plaintiff HUNTER has been released from custody at the present time;

18 however, she is on probation under the supervision of Monterey County Probation

19 Department until September 2014. As such, she may be incarcerated in the Jail at any time

20 without establishing a violation of any law and with little to no judicial process, subjecting

21 her to the violations of her constitutional and statutory rights described herein. Plaintiff

22 HUNTER has been diagnosed with numerous medical conditions, including diabetes,

23 fibromyalgia, high blood pressure, chronic back pain, bone cancer, and seizures, and she

24 has been prescribed and requires various medications to treat her illnesses and alleviate her

25 symptoms. Despite repeated requests, Defendants failed to provide timely and appropriate

26 medical care, including, but not limited to, failing to provide Plaintiff HUNTER with

27 necessary prescription medications and treatment. Plaintiff HUNTER has also been

28 diagnosed with mental illness, including manic depression, dementia, anxiety, and panic

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1 attacks, all of which make it difficult for Plaintiff HUNTER to communicate effectively

2 with Jail staff. Plaintiff HUNTER requires mental health treatment and other

3 accommodations to alleviate her symptoms and to function in the Jail. Defendants failed

4 to provide timely and appropriate mental health care to Plaintiff HUNTER, including, but

5 not limited to, appropriate medications (which Plaintiff HUNTER brought with her to the

6 Jail but which were taken from her by Defendants), and timely and adequate mental health

7 assessments, treatment, and interventions. As a result of Defendants’ inadequate medical

8 and mental health care, Plaintiff HUNTER experienced unnecessary and avoidable pain

9 and symptoms during her incarceration, including, but not limited to pain, nightmares,

10 anxiety, panic attacks, and auditory hallucinations. Plaintiff HUNTER is a person with a

11 disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

12 Government Code § 12926(j) and (m).

13

23. PLAINTIFF ALBERT KEY was detained at Monterey County Jail on

14 March 17, 2013. Plaintiff KEY is a Vietnam War veteran with a long history of post-

15 traumatic stress syndrome and bipolar disorder, and has received psychiatric care and

16 medications from various providers including doctors employed by Defendants and by the

17 California Department of Corrections and Rehabilitation (“CDCR”) for over a decade.

18 Nevertheless, on multiple occasions when he has arrived at Monterey County Jail,

19 Defendants have subjected him to their inhumane and medically unjustified

20 “detoxification” process, during which he is denied prescribed psychiatric medication for

21 90 days. During each incarceration, Plaintiff KEY has experienced extreme delays in

22 obtaining correct and appropriate psychiatric medications, and other necessary mental

23 health interventions and care, and as a result suffers auditory hallucinations, racing

24 thoughts, severe depression, nightmares, and periods of suicidal ideation. Plaintiff KEY

25 also has a recurrent tumor on his neck for which Defendants have failed to provide

26 appropriate medical care. As a result of Defendants’ inadequate medical and mental health

27 care, Plaintiff KEY has experienced unnecessary and avoidable pain and symptoms during

28 his incarceration. Plaintiff KEY is a person with a disability as defined in 42 U.S.C.

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1 § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

2

24. PLAINTIFF BRANDON MEFFORD was detained at Monterey County Jail

3 on December 3, 2013. Plaintiff MEFFORD has severe and chronic mental illness,

4 including borderline personality disorder, severe depression and anxiety, and ADHD, all of

5 which make it difficult for Plaintiff MEFFORD to communicate effectively with Jail staff,

6 understand Jail rules and processes, and access Jail programs and services. In prison,

7 CDCR officials considered Plaintiff MEFFORD eligible for inpatient and enhanced

8 outpatient levels of care. Plaintiff MEFFORD has previously attempted suicide on

9 multiple occasions and has a strong tendency to self-mutilate when anxious. While at the

10 Jail, Defendants have failed to provide Plaintiff MEFFORD with timely and appropriate

11 mental health care. Plaintiff MEFFORD has been placed in the Jail’s punitive and

12 unsanitary rubber rooms for periods as long as three days without receiving appropriate

13 care from mental health care staff and without being adequately observed by Jail custody

14 staff. Defendants have also housed Plaintiff MEFFORD by himself in an administrative

15 segregation unit; Plaintiff MEFFORD is only permitted outside of his cell for a maximum

16 of one hour per day. These isolating conditions negatively affect his mental health, cause

17 him significant anxiety, and occasionally lead him to engage in acts of self-harm. In

18 addition, he has been provided with inadequate and inconsistent psychotropic medications

19 to manage his conditions and has not been provided with adequate therapy. Plaintiff

20 MEFFORD also suffers from chronic medical conditions, including asthma and

21 hypertension. Defendants have failed to provide adequate treatment of his hypertension

22 and have, at various times, refused to provide him with an inhaler. Plaintiff MEFFORD

23 was also attacked by another prisoner while in the presence of custody staff, who failed to

24 intervene in a timely manner. Plaintiff MEFFORD is a person with a disability as defined

25 in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j)

26 (m).

27

25. PLAINTIFF WESLEY MILLER was detained at Monterey County Jail on

28 January 8, 2013. Plaintiff MILLER has severe Type 1 diabetes. As of October 31, 2013,

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1 Defendants had not provided Plaintiff MILLER with consistent and appropriate treatment

2 for his diabetes, resulting in multiple serious diabetic episodes, seizures, and periods of

3 unconsciousness. On February 11, 2013, an employee of Defendant CFMG improperly

4 administered insulin to Plaintiff MILLER, resulting in his emergency transport to

5 Natividad Medical Center in an unconscious state and his near death. Plaintiff MILLER is

6 losing his vision as a result of his diabetes, and Defendants, as of October 31, 2013, failed

7 to ensure appropriate and necessary care for his vision loss, including failing to ensure

8 timely visits to necessary specialists. As of October 31, 2013, Defendants also failed to

9 provide effective communication and otherwise to accommodate Plaintiff MILLER’s

10 vision impairment to ensure he could participate in programs, services, and activities at the

11 Jail. As a result of Defendants’ inadequate medical care and failures to accommodate

12 Plaintiff MILLER’s disability, he has suffered unnecessary and avoidable pain, diabetic

13 complications, and permanent loss of vision. Plaintiff MILLER is a person with a

14 disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

15 Government Code § 12926(m).

16

26. PLAINTIFF RICHARD MURPHY was detained at Monterey County Jail on

17 January 18, 2013. Plaintiff MURPHY has a mobility impairment and requires a cane or

18 walker to ambulate without significant pain. Despite repeated requests made by Plaintiff

19 MURPHY, Defendants failed to provide him with reasonable accommodations to allow

20 him to walk without pain, and to access the programs and services offered by Defendants.

21 Plaintiff MURPHY also has nerve damage in his back, and requires pain medication as

22 well as cortisone shots. Despite his repeated requests, Defendants failed to provide

23 Plaintiff MURPHY with timely or adequate medical care, including, but not limited to,

24 necessary medications at the Jail. Plaintiff MURPHY has been diagnosed with mental

25 illness and has been prescribed and requires various prescription psychiatric medications to

26 treat his illness and alleviate his symptoms. Despite repeated requests, Defendants failed

27 to provide timely and appropriate mental health care, including, but not limited to, the

28 failure to provide correct dosages of the medications Plaintiff MURPHY requires, the

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1 failure to adequately monitor the administration of medications, and the failure to provide

2 adequate psychotherapy and other treatments and interventions. As a result, Plaintiff

3 MURPHY experienced unnecessary and avoidable pain and symptoms, including, but not

4 limited to, hearing voices, seeing shadows, depression and suicidality, and inability to

5 sleep more than a few hours per night. Defendants placed Plaintiff MURPHY in a rubber

6 room on at least five occasions. Plaintiff MURPHY is a person with a disability as defined

7 in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j)

8 and (m).

9

27. PLAINTIFF JAMES JEFFREY NICHOLS was detained at Monterey

10 County Jail on June 20, 2013. Plaintiff NICHOLS has a permanent mobility impairment

11 arising from a motor vehicle accident many years ago. Although he normally uses a cane

12 to ambulate, when he arrived at the Jail he neither had nor was provided with any assistive

13 devices. On June 21, 2013, the staff at the Jail provided him with a wheelchair after he

14 presented to medical staff with complaints of falling on his head three times. After

15 entering the Jail, Plaintiff NICHOLS was assigned to a middle bunk which was difficult

16 and painful for him to access. Defendants then moved him to the Jail’s “Rotunda” area

17 where, although the bed assigned to him was accessible, he was not able to access the

18 recreational yard because of structural barriers. Because Defendants provided Plaintiff

19 NICHOLS with a wheelchair rather than his accustomed cane, he was less physically

20 active at the Jail than he is able and would like to be, suffered deterioration of his overall

21 physical condition, and was denied equal access to programs, services, and activities

22 offered by Defendants. Plaintiff NICHOLS also has brain injuries from the same car

23 accident that resulted in his mobility impairment. The brain injuries impair both his

24 cognitive function and his left arm, of which he only has partial use. Plaintiff NICHOLS is

25 a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and

26 California Government Code § 12926(j) and (m).

27

28. PLAINTIFF ANGEL PEREZ was detained at Monterey County Jail on

28 December 30, 2012. Plaintiff PEREZ has a potentially cancerous tumor on his right foot.

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1 During his time in the Jail, Defendants have failed to provide Plaintiff PEREZ with timely

2 and appropriate medical care, including, but not limited, failing to provide diagnostic

3 services and treatment for his tumor. Despite the fact that multiple doctors at Natividad

4 Medical Center have ordered that Plaintiff PEREZ see an expert in orthopedic oncology at

5 a tertiary facility to examine his tumor, Defendants have failed over the course of six

6 months to send Plaintiff to such an expert. Plaintiff PEREZ has been told that if he does

7 not receive treatment or evaluation from such an expert, he is at risk of having his foot

8 amputated. Despite Plaintiff PEREZ’s use of the sick slip and grievance process, he has

9 not been able to receive timely and adequate treatment for the severe pain he experiences

10 from the tumor, nor has he been able to receive adequate information about when he will

11 be treated for the tumor and what kind of treatment he should expect to receive. The tumor

12 on his foot also cause Plaintiff PEREZ tremendous pain and impairs his ability to walk.

13 Defendants have failed, at various times, to provide Plaintiff PEREZ with appropriate and

14 timely pain medications. Plaintiff PEREZ is a person with a disability as defined in 42

15 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code § 12926(m).

16

29. PLAINTIFF SARAB SARABI was detained at Monterey County Jail on

17 February 2, 2013. Plaintiff SARABI had a mobility impairment for many months as a

18 result of a serious injury he sustained to his right leg when he was attacked by another

19 prisoner at the Jail. Plaintiff SARABI did not receive timely or adequate medical care

20 from Defendants for his injury. Plaintiff SARABI was released from Monterey County

21 Jail to a three-year term of supervision by Monterey County Probation Department. As

22 such, he may be incarcerated in the Jail at any time without establishing a violation of any

23 law and with little to no judicial process, subjecting him to the violations of his

24 constitutional and statutory rights described herein. Plaintiff SARABI is a person with a

25 disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

26 Government Code § 12926(m).

27

30. PLAINTIFF CLYDE WHITFIELD was detained at Monterey County Jail on

28 November 30, 2013. Plaintiff WHITFIELD has severe narcolepsy with cataplexic attacks.

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1 Narcoleptics may fall asleep at any time, and, without treatment, may sleep for upwards of

2 20 hours a day. Cataplexy is a sudden loss of muscle control that may occur anywhere

3 without warning, causing Plaintiff WHITFIELD to collapse and risk serious injury. When

4 not in the Jail, Plaintiff WHITFIELD controls these conditions with a combination of

5 medications, Provigil and Xyrem, prescribed for him by a doctor. Defendants have failed

6 to provide Plaintiff WHITFIELD with appropriate and timely treatment for his narcolepsy.

7 Defendants have not provided Plaintiff WHITFIELD with Xyrem, which controls

8 cataplexy. As a result, Plaintiff WHITFIELD has experienced four cataplexic attacks since

9 being detained on November 30, 2013. Normally, Plaintiff WHITFIELD experiences one

10 such attack approximately every six months. Defendants also did not provide Plaintiff

11 WHITFIELD with Provigil for approximately two months after his arrest, despite knowing

12 he was prescribed the medication prior to incarceration. During that time, Plaintiff

13 WHITFIELD was unable to leave his bed most hours of the day and spent 20 hours a day

14 asleep. As a result, Plaintiff WHITFIELD experienced serious depression and anxiety and

15 was put at increased risk for violence and theft from other prisoners. Plaintiff

16 WHITFIELD also has sleep apnea. Plaintiff WHITFIELD is a person with a disability as

17 defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code

18 § 12926(j) and (m).

19

31. PLAINTIFF ROBERT YANCEY was detained at Monterey County Jail on

20 December 2, 2012. He has a hearing impairment and has been completely deaf since birth.

21 Plaintiff YANCEY also has a speech impairment that makes it impossible for him to be

22 understood when speaking. His primary method of communication is American Sign

23 Language. Plaintiff YANCEY ordinarily is able to communicate in a limited manner using

24 written notes; however, for much of his time in the Jail, his right hand was in a cast,

25 making it difficult and painful for him to write legibly. Despite multiple requests, Plaintiff

26 YANCEY did not receive reasonable accommodations from Defendants to allow him to

27 access the programs and services offered by Defendants. Defendants never provided

28 Plaintiff YANCEY with a sign language interpreter at any time during his time in the Jail.

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1 Plaintiff YANCEY is a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C.

2 § 705(9)(B), and California Government Code § 12926(j) and (m).

3

32. DEFENDANT COUNTY OF MONTEREY (the “COUNTY” or

4 “MONTEREY COUNTY”) is a public entity, duly organized and existing under the laws

5 of the State of California. Under its authority, Defendant COUNTY operates and manages

6 the Jail and is, and was at all relevant times mentioned herein, responsible for the actions

7 and/or inactions and the policies, procedures, practices, and customs of the MONTEREY

8 COUNTY SHERIFF’S OFFICE and its respective employees and/or agents. The Board of

9 Supervisors for the COUNTY authorized and approved the contract between Defendant

10 MONTEREY COUNTY SHERIFF’S OFFICE and Defendant CALIFORNIA FORENSIC

11 MEDICAL GROUP INCORPORATED for CFMG to provide medical and mental health

12 care to prisoners in the Jail. The COUNTY by law retains the ultimate authority over and

13 responsibility for the health care, treatment, and safekeeping of Plaintiffs and the class they

14 seek to represent. The COUNTY employs 50 or more persons.

15

33. DEFENDANT MONTEREY COUNTY SHERIFF’S OFFICE (the

16 “SHERIFF’S OFFICE”) is a public entity, duly organized and existing under the laws of

17 the State of California. Sheriff Scott Miller is the elected Sheriff of the County of

18 Monterey. The SHERIFF’S OFFICE is responsible for the day-to-day operations of the

19 Jail facilities, including promulgating policies and procedures for the operation of the

20 facilities. The SHERIFF’S OFFICE has contracted with CFMG to provide all health care

21 services in the Jail, but by law retains the ultimate authority over and any responsibility for

22 the health care, treatment, and safekeeping of prisoners in the Jail. The SHERIFF’S

23 OFFICE employs 50 or more persons.

24

34. DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP

25 INCORPORATED (“CFMG”) is a for-profit corporation organized under the laws of the

26 State of California. Pursuant to a contract with the SHERIFF’S OFFICE that was

27 approved by the Board of Supervisors for the COUNTY, CFMG provides all health care

28 services to prisoners in the Jail, including medical and mental health care. The current

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1 contract extends from April 1, 2012 through June 30, 2015. At all times when CFMG and

2 its employees provide medical and mental health care to prisoners in the Jail, CFMG and

3 its employees have acted and continue to act under color of state law. CFMG employs 50

4 or more persons.

5

35. Plaintiffs are ignorant of the true names and capacities of defendants sued in

6 this complaint as DOES 1 through 20, inclusive, and therefore sue these defendants by

7 such fictitious names. Plaintiffs will amend this complaint to allege their true names and

8 capacities when ascertained. Plaintiffs are informed and believe and thereon allege that

9 each of the fictitiously named Defendants is responsible in some manner for the

10 occurrences alleged in this complaint.

11

36. At all times mentioned in this complaint, each Defendant was the agent of

12 the others, was acting within the course and scope of this agency, and all acts alleged to

13 have been committed by any one of them was committed on behalf of every other

14 Defendant.

15

FACTUAL ALLEGATIONS

16 I. 17

DEFENDANTS FAIL TO PROTECT PRISONERS FROM INJURY OR VIOLENCE FROM OTHER PRISONERS

18

37. Defendants MONTEREY COUNTY, the MONTEREY COUNTY

19 SHERIFF’S OFFICE, and CFMG (“Defendants”) have created and maintain a jail

20 environment in which prisoners in all areas of the Jail face a substantial risk of being

21 harmed by violence from other prisoners. Defendants have been aware of these risks since

22 at least 2007, when the SHERIFF’S OFFICE and the Monterey County Board of

23 Supervisors contracted with TRG Consulting to produce a needs assessment for the Jail.

24 TRG Consulting completed its report, attached hereto as Exhibit A, and entitled “County

25 of Monterey, Office of the Sheriff, Needs Assessment” (hereinafter, “2007 Needs

26 Assessment” or “2007 Assessment”), on June 19, 2007. The Monterey County Board of

27 Supervisors explicitly accepted the report that same day by unanimous vote. In the report,

28 TRG acknowledged that “this needs assessment would not have been possible without the

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1 assistance of a number of professionals from Monterey County,” and specifically

2 recognized a number of people “who helped make this planning effort a success.” 2007

3 Assessment at 1. Among the people listed are two current members of the Monterey

4 County Board of Supervisors, as well as former Sheriff-Coroner-Marshall Mike Kanalakis,

5 former Undersheriff Nancy Cuffney, and former Custody Bureau Chief, Bert Liebersbach.

6 Id.

7

38. Upon information and belief, in 2011, Sheriff Scott Miller requested that

8 TRG Consulting update the 2007 Needs Assessment. As a result, TRG Consulting

9 produced a new report, attached hereto as Exhibit B, entitled “County of Monterey, Office

10 of the Sheriff, Jail Needs Assessment” (hereinafter “2011 Needs Assessment” or “2007

11 Assessment”), dated December 30, 2011. Upon information and belief, the 2011 Jail

12 Needs Assessment was transmitted to Sheriff Miller and other officials in Monterey

13 County on or around December 30, 2011. In the 2011 Jail Needs Assessment, TRG

14 Consulting recognized by name “the primary contributors who helped make this planning

15 effort a success.” 2011 Assessment at 1. The list includes all five members of the

16 Monterey County Board of Supervisors, all of whom remain in their elected positions as of

17 the filing of this first amended complaint. Id. The list also includes Sheriff Miller and

18 former Custody Bureau Chief Jeffrey J. Budd. Id.

19

39. Both the 2007 Needs Assessment and the 2011 Jail Needs Assessment

20 concluded that, “[t]he current combination of insufficient beds, an inadequate detention

21 facility and understaffing has resulted in an almost untenable situation.” 2007 Assessment

22 at Ex. 1-2; 2011 Assessment at Ex. 2. Both reports find that the conditions in the Jail and

23 policies and practices of the SHERIFF’S OFFICE create an unreasonable risk of violence

24 between prisoners. Because Defendants are aware of the unreasonable risk of violence and

25 have not acted to reduce the risk, they are deliberately indifferent to the danger of assault

26 faced by all prisoners.

27

28

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1

A. Defendants’ Understaffing of the Jail Creates an Environment in Which

Violence Flourishes

2

3

40. Defendants staff the Jail in a manner that creates an unreasonable risk of

4 prisoners being assaulted by other prisoners. For the past few years the Jail has routinely

5 housed more than 1,100 prisoners. Defendants generally staff the Jail with as few as 24

6 and no more than 26 officers. A significant number of officers are required to staff areas

7 of the Jail other than the housing units, like the booking area, visitor processing areas, and

8 kitchen. Thus, usually no more than a handful of officers are responsible for directly

9 supervising the prisoners in the jail. In 2011, outside consultants (TRG) notified

10 Defendants that the current authorized staffing for the Jail was “woefully inadequate.”

11 2011 Assessment at Ex. 7.

12

41. The minimum staffing plan utilized by the SHERIFF’S OFFICE does not

13 provide for a sufficient number of officers to safely operate the Jail. As the 2011 Jail

14 Needs Assessment explained, “[i]t appears that the staffing provided by the County salary

15 ordinance is based on the rated capacity of [the Jail], not on how many inmates are actually

16 in custody.” 2011 Assessment at Ex. 6. Currently, the population in the Jail is more than

17 15% above the facility’s rated capacity.

18

42. Though the staffing plan being used by Defendants is not sufficient on its

19 face, Defendants have not even hired staff to fill all of the authorized positions. As the

20 2011 Jail Needs Assessment stated, “[v]acancies, extended periods of leave, and normal

21 staff attrition have resulted in a significant amount of vacant … positions. The jail has an

22 increased reliance on overtime to meet minimum staffing.” 2011 Assessment at Ex. 7.

23 Upon information and belief, these staffing shortfalls identified at the end of 2011 continue

24 to exist today.

25

43. The 2011 Jail Needs Assessment noted that “[b]aseline staffing should be

26 above minimum staffing,” but “[d]ue to vacancies and other factors, the Monterey County

27 Jail constantly is using overtime to staff up to their self-imposed minimum staffing. This

28 level is not adequate to provide basic safety and security for staff and inmates.” 2011

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1 Assessment at Ex. 7 (bolded emphasis added, italics emphasis in original).

2

44. Typically, custody officers work 12-hour shifts. Because of the insufficient

3 staff employed by Defendants, Defendants often utilize a system of mandatory overtime,

4 whereby staff are required to work an additional four hours before or after their 12-hour

5 shifts to cover a vacancy preceding or following their shift. This dangerous practice may

6 result in staff being exhausted, unfocused, and unable to properly handle the duties

7 required of them. Moreover, even when mandatory overtime is used, the extra four hours

8 of coverage on either end of the preceding or following 12-hour shift leaves a four-hour

9 gap uncovered in the middle of the shift. As the 2011 Jail Needs Assessment explained,

10 “[u]nderstaffing has resulted in insufficient staff coverage.… At times the middle of a

11 shift may be as many as three or four officers short. This has been exacerbated by recent

12 staff reductions. As a result there are not enough officers present in the jail to respond to a

13 major crisis or natural disaster.… There are insufficient staff on some shifts to make the

14 required safety checks.” 2011 Assessment at Ex. 3-4. The staffing at the Jail is not

15 adequate to keep prisoners safe.

16

45. The staffing shortages are particularly acute in the housing units and for

17 escort officers. As described in the 2011 Jail Needs Assessment, “[a] review of the current

18 staffing pattern as practiced by the Monterey County Jail and the best practices staffing

19 plan included in the 2006 Staffing Analysis indicates that the critical needs are for the extra

20 staffing in the housing units and for facility-wide escort deputies. These positions will

21 ensure required safety checks are made, there is some level of supervision in the kitchen,

22 laundry and medical areas and adequate staffing is available to respond to emergencies and

23 unusual situations. Recent cuts in staffing have made this situation much worse ….” 2011

24 Assessment at Ex. 7. Upon information and belief, these staffing problems identified at

25 the end of 2011 continue to exist today.

26

46. Assaults experienced by prisoners where staff failed to intervene

27 demonstrate the risks posed by Defendants’ understaffing of the Jail. Plaintiff GUYOT

28 was assaulted by a group of other prisoners 12 days after his arrival at the Jail, while

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1 housed in C-Dorm. No deputies intervened in the assault and no deputies either saw or

2 heard the incident while it was occurring. Plaintiff GUYOT’s severe injuries only came to

3 the attention of custody staff when he “came up to the front of C-wing with all of his

4 belon[g]ings” at some time after the assault concluded. Similarly, Plaintiff GREIM was

5 attacked by other prisoners in A-Dorm, and received a black eye and other facial injuries

6 as a result of the attack. Custody staff were apparently unaware of the attack until Plaintiff

7 GREIM appeared at the door of A-Dorm and asked to be moved to another housing unit.

8

47. Plaintiff AGUILAR was brutally attacked by another inmate when deputies

9 cleared the approximately 65 inmates from D-Dorm to conduct a search. All of the

10 inmates were placed into the small isolation day room during the search where they were

11 crowded together shoulder-to-shoulder. There were no guards present in the day room at

12 the time and the only observation was from the guard tower. The inmates had been

13 crowded into the day room for approximately half an hour at which point a large fight

14 broke out during which Plaintiff AGUILAR was attacked. Plaintiff AGUILAR suffered a

15 fractured cheekbone, other facial injuries, slurred speech and loss of vision due the attack.

16 He had to undergo surgery to fix the fractured cheekbone and to this day experiences pain,

17 headaches, and blurred vision as a result of the injury.

18

48. When Plaintiff SARABI was attacked by another prisoner, the other prisoner

19 hit Plaintiff SARABI 10-15 times on his head and legs, knocking him unconscious. The

20 two guards who were supposed to be monitoring the dorm did not intervene or otherwise

21 attempt to stop the attack. Plaintiff SARABI’s only recollection of guard involvement was

22 when he awoke from his unconscious state as he was being dragged by a guard to a

23 holding room, well after the attack had finished.

24

49. The severe understaffing creates a high risk of violence any time prisoners

25 are escorted out of their housing units and in the presence of prisoners from incompatible

26 classifications. For example, according to an incident report dated April 1, 2012, and

27 prepared by employees of the SHERIFF’S OFFICE, visiting is a particular “time of

28 disorder” with a single deputy expected to maintain order “with as many as 9-18 inmates

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1 filing into three rooms,” even though “differing and often conflicting classifications [are]

2 present at the same time.” According to the same incident report, in the visiting area, lock-

3 down inmates are moved as a group and are unsecured. The April 1, 2012 incident report

4 also describes a serious incident in which three or four prisoners classified as

5 Administrative Segregation-Sophisticated Sureño forced their way into an unlocked room

6 in which Administrative Segregation-Sensitive Needs prisoners were located. The

7 Sophisticated Sureño prisoners were leaving the visiting area as the Sensitive Needs

8 prisoners were arriving. One deputy failed to lock the visiting room door to secure the

9 Sensitive Needs prisoners, because it would have forced him to lose visual contact with

10 another deputy who was responsible for escorting the seven Administrative Segregation-

11 Sophisticated Sureño prisoners out of the visiting area. Three or four of the Sureño

12 prisoners rushed past the deputies and into the unlocked room. Then, one prisoner blocked

13 the visiting room door while the others assaulted a prisoner inside the room and outside of

14 the deputies’ sight. The deputies let the assault continue until back-up arrived. In

15 addition, according to another incident report prepared by employees of the SHERIFF’S

16 OFFICE, in February 2012, two Norteño gang members assaulted a prisoner while being

17 escorted through the Rehabilitation Infirmary.

18

50. Defendants have frequently acknowledged the understaffing of the Jail. For

19 example, in a June 2, 2013 article in The Salinas California, Sheriff Miller was quoted as

20 saying that with a population of about 1,100 prisoners, “[w]e are getting to the level we’re

21 becoming uncomfortable with the ratio of inmates.”

22

B. The Jail Is Severely Overcrowded, Which Increases the Risk of

Prisoner-on-Prisoner Violence, but Defendants Have Not Utilized

23

Available Solutions to Ameliorate the Problem

24

51. The Jail is severely overcrowded. The Jail has a rated capacity for 825

25 prisoners, but has in the recent past housed as many as 1,200 prisoners, nearly 150 percent

26 of capacity. From January 1 to March 11, 2014, the Jail’s population was above 900 all

27 but one day and was as high as 975 prisoners. Some areas of the Jail are considerably

28 more overcrowded than the Jail as a whole, especially the women’s section.

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1

52. The Jail has been so overcrowded that, for many years now, Defendant

2 SHERIFF’S OFFICE applies on a monthly basis to the Superior Court for the County of

3 Monterey for an order to release prisoners on an accelerated basis pursuant to California

4 Penal Code § 4024.1. To support the application, the former Chief Deputy Sheriff for the

5 County and, upon information and belief, the current Chief Deputy Sheriff, swore on

6 multiple occasions that unless the SHERIFF’S OFFICE is able to release some prisoners,

7 the overcrowding in the Jail would “compromise[] the inmate classification plan as well as

8 the safety and security of the detention facilities.” Defendants’ failure to implement an

9 effective classification system, which is exacerbated by overcrowding, places prisoners at

10 a serious risk of harm, as described more fully in Section I.D, below. In addition, in

11 support of the application, Dr. Taylor Fithian (Director of Defendant CFMG) “advised that

12 the excessive number of inmates housed in the Jail compromises the health of the inmates

13 and the staff working at the facility.”

14

53. The severe overcrowding was also identified as a problem in the 2011 Jail

15 Needs Assessment. Specifically, the Assessment found that

16

[t]here are not enough beds to meet the current adult detention needs, let

alone the needs in the near future.… The jail is so overcrowded that no

17

allowance can be made for peaking and classification or the routine or

emergency maintenance required in inmate housing areas. Severe

18

overcrowding has resulted in inmates being held in the intake area for up to

forty-eight hours. This is not permitted by the California Code of

19

Regulations. Severe overcrowding has forced the Sheriff to use areas for

housing that were not designed or intended for that use (e.g., the rotunda

20

area). This makes these areas much more difficult for officers to manage and

control. Overcrowding has forced the Sheriff to operate the jail as an

21

indirect supervision facility, while the jail was designed for direct

supervision. This creates significant command, control and management

22

problems.

23 2011 Assessment at Ex. 2.

24

54. The 2011 Jail Needs Assessment further noted that “[o]vercrowding creates a

25 number of issues that affect staff and inmates, and put the County at risk. Overcrowding

26 causes stress on both inmates and staff. Inmate vs. inmate assaults typically occur more

27 frequently, as do other disciplinary infractions.” 2011 Assessment at Ex. 9 (emphasis

28 added).

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1

55. Defendants have also admitted to the dangerously overcrowded conditions in

2 public statements regarding potential new jail construction. In an October 5, 2012 press

3 release, Sheriff Miller stated that “[o]vercrowding has been a serious problem at the jail for

4 many years, creating a dangerous situation for inmates, jail staff and the community.”

5 Sheriff Miller recently commented on the “overcrowded nature of the current facility.”

6 See Sunita Vijayan, Jail Funds Welcome, More Money Sought, The Salinas Californian,

7 Dec. 10, 2012. More recently, on May 28, 2013, he was quoted in the Monterey Herald as

8 saying that “we realized the jail was overcrowded, that overcrowding can create

9 problems.” In addition, a document on the SHERIFF’S OFFICE’s website entitled “Jail

10 Housing Addition Fact Sheet” states that “[t]he Monterey County Jail has been

11 significantly overcrowded for many years. The jail has a design bed capacity of 825 but

12 currently houses a total of 1150 detainees. Such overcrowding puts officers, staff, inmates

13 and the public at risk.” The Fact Sheet also states that the Jail has “[i]nsufficient beds for

14 existing inmate population.”

15

56. Despite the profound and persistent overcrowding, Defendants have not

16 availed themselves of numerous available opportunities to safely relieve the population

17 pressures in the Jail. For example, Defendants have failed to undertake adequate measures

18 to address their high pretrial population, including by failing to ensure that the maximum

19 number of people possible are evaluated with the County’s risk assessment tool. Such

20 evaluation could result in lower risk persons being released from potentially unnecessary

21 detention prior to their case disposition. Defendants have also failed to ensure that county

22 departments are adequately staffed and that there is appropriate inter-agency coordination

23 to ensure the pretrial services program is assessing and serving the greatest number of

24 people possible. Increased capacity and coordination could also result in an increase of

25 appropriate pretrial persons being safely managed in the community rather than housed in

26 Jail prior to case disposition. Defendants have also failed to undertake adequate measures

27 to expand capacity for their existing work release program for sentenced individuals, and

28 have failed to investigate opportunities for collaboration between agencies and to expand

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1 their capacity to supervise individuals on mandatory supervision as part of a split sentence.

2 Defendants have also failed to adequately implement alternatives to incarceration found

3 safe and effective in other jurisdictions, including, but not limited to, diversion and use of

4 home and GPS monitoring.

5

57. According to the Monterey County Community Corrections Partnership

6 AB109 Statistical Report for Fiscal Year 2013/2014, Second Quarter: October 2013-

7 December 2013, since the inception of the County’s pretrial release program in October

8 2012, there have been more than 17,000 prisoners booked into the Jail. The County has

9 only interviewed and assessed 491 prisoners for eligibility for pretrial release and has

10 actually released only 209 individuals. At the same time, the population of pretrial

11 defendants in the Jail rose to approximately 77 percent during the last quarter of 2013, up

12 from 71 percent during the last quarter of 2012.

13

58. The County has also failed to utilize split sentences to reduce the Jail

14 population. During the last quarter of 2013, an average of only nine individuals per month

15 were given split sentences. As of December 2013, there had been a total of 85 individuals

16 who had received a split sentence out of the total of 665 individuals sentenced under

17 California Penal Code § 1170(h) in the County since October 2011. As of the end of

18 September 2013 the rate of split sentencing in Monterey County—at that time 11

19 percent—was the tenth lowest rate of split sentencing in the state and far below the

20 statewide average of 28 percent, according to data collected by the Chief Probation

21 Officers of California.

22

C. The Jail’s Physical Structure Is Inadequate, Which Makes It More

Difficult for Staff to Safely Monitor Prisoners and Increases the Risk of

23

Prisoner Violence

24

59. The Jail, which consists of two primary buildings—the Rehabilitation Center

25 and the Main Jail Building—constructed over the past 42 years, is a patchwork of

26 makeshift spaces, thrown together to keep up with Monterey’s fast-growing Jail

27 population. Throughout the housing units and other spaces, there are numerous blind spots

28 where staff cannot safely monitor prisoners. As found in the 2011 Jail Needs Assessment,

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1 “[t]he design of the jail and the manner in which additions have been constructed results in

2 a physical plant that is difficult to manage and control and unnecessarily expensive to

3 operate.… There is poor observation from most deputy stations. Officers cannot observe

4 inmates areas in Pods A through J. The wing walls in the dormitories are approximately

5 four feet high and provide a number of areas where inmates cannot be observed. The

6 manner in which additions have been constructed has resulted in a facility that lacks any

7 real central control or command post that would be used in the event of a major

8 disturbance or disaster.” 2011 Assessment at Ex. 2.

9

60. The 2011 Jail Needs Assessment further noted that “visual supervision is

10 problematic in the existing jail,” and “[a]t best there is intermittent observation of the

11 inmates. In the Rehabilitation Facility, a Deputy Sheriff must walk into the inmate

12 housing area to see the entire living and shower area. It appears there is an attempt to

13 remedy the problem with the use of cameras. Unfortunately, this is not working.” 2011

14 Assessment at Ex. 8. Upon information and belief, despite being made aware of these

15 problems in 2011, Defendants have not remedied the problems. These physical

16 limitations, especially when combined with the severe understaffing and overcrowding in

17 the Jail, create an unreasonable threat of harm to the safety and security of staff, visitors,

18 volunteers, and prisoners.

19

61. Upon information and belief, on or around April 29, 2013, the Jail was under

20 lockdown due to several attacks in the K-Pod. These beatings took place behind a pillar in

21 the K-Pod that blocks the view of Jail staff (both from camera and window perspectives).

22 Upon information and belief, one prisoner was injured so badly in these beatings that he

23 was airlifted out of the Jail and taken to a hospital in San Jose where he received treatment

24 for a fractured skull.

25

62. According to incident reports prepared by employees of the SHERIFF’S

26 OFFICE, cell doors in many pods throughout the Jail can be easily popped open by

27 prisoners, allowing prisoners to leave their cells without authorization at any time. This

28 includes cell doors in lockdown units that house active gang members. Numerous incident

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1 reports recount assaults on prisoners who are on their authorized out-of-cell time or are in

2 a unit for kitchen work, times when all other prisoners should be locked in their cells. In

3 one example, a prisoner on his out-of-cell hour in a lockdown unit told a nearby deputy

4 who was passing out medication with a nurse that particular prisoners in his unit were

5 planning to “pop” their doors to fight him. Before the deputy could get back-up or enter

6 the unit himself, two cell doors were “popped,” and two prisoners chased the first prisoner

7 into a cell on the top tier to assault him, just as he had predicted.

8

63. As another example from an incident report dated April 1, 2013, and

9 prepared by an employee of the SHERIFF’S OFFICE, a prisoner housed in G-Pod was

10 assaulted by another prisoner in the pod. G-Pod is a celled housing unit, meaning all

11 prisoners are housed in cells with doors. Prior to the assault, the prisoner had informed the

12 classification unit that the assailant had been threatening him, had demonstrated to the

13 prisoner that the assailant could open his cell door at will, and had shown the prisoner a

14 large jail-made shank that he possessed. The prisoner requested that the assailant be

15 moved to a different pod, but Jail staff took no action to move the assailant to another

16 housing unit. The following day the prisoner was alone in the common area of G-Pod for

17 his hour of daily recreation; all of the other prisoners in G-Pod were in their cells with their

18 doors closed and purportedly locked. The prisoner then saw the assailant use the shank to

19 attempt to open his cell door. To protect himself, the prisoner ran to the assailant’s door

20 and used his body to keep the door from opening; he was forced to remain in that position

21 for the remainder of his hour outside of his cell. The assailant was, however, able to cut

22 the prisoner multiple times in his upper stomach area by wielding the shank through the

23 food tray slot, which was also not secured and which the assailant was able to open.

24

64. On December 15, 2013, Plaintiff MEFFORD and other prisoners housed in

25 G-Pod, an administrative segregation lockdown unit, were able to “pop” their tray slots—

26 that is, open them from the inside. The tray slots are metal are cut-outs in the cell door that

27 can be shut with a metal flap and locked closed from the outside. That prisoners are able

28 to open their own tray slots runs contrary to the entire design of the lockdown unit, which

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1 is supposed to prevent prisoners from any access to the outside from inside their cells.

2

65. Poor jail design also exacerbates the dangers of understaffing. According to

3 another incident report prepared by an employee of the SHERIFF’S OFFICE, in

4 September 2011, one deputy opened a secure door to a Norteño unit to escort a single

5 prisoner to different part of the jail while six prisoner workers and three other employees

6 were in the area. Three prisoners classified as Norteños pushed past the deputy when he

7 opened the door and all four prisoners proceeded to assault a single prisoner worker.

8 Another deputy from the control tower heard the fighting but could not see what was

9 happening. He opened a secure door to allow back-up to arrive, but in doing so, he

10 revealed another deputy who was escorting three prisoners classified as Norteños to the

11 infirmary. All three attempted to join the fight when the door opened, because of their

12 gang allegiances. Two were able to enter the area where the fight was continuing and the

13 deputies had to repeatedly deploy their Tasers to get control of the situation until back-up

14 could arrive.

15

66. Defendants have repeatedly acknowledged the dangers posed by the Jail’s

16 structure. In an October 24, 2013 article in the Monterey County Weekly entitled

17 “Monterey County Closer to Jail Expansion, Amid Criticism,” Sheriff Miller stated that

18 “right now we lack adequate housing by any standards.” (Emphasis added.) In an

19 April 4, 2013 article in the Monterey Herald, Sheriff Miller called the Jail “antiquated” and

20 referred to the Jail as the “Winchester Mystery House of jails.” The “Jail Housing

21 Addition Fact Sheet” posted on the SHERIFF’S OFFICE’s website states that the “[t]he

22 labyrinth-like manner of jail additions has created security and evacuation issues.” A 2006

23 article on the Monterey County Jail in the Monterey County Weekly was titled “Hell Hole:

24 The Monterey County Jail is an overcrowded pit of violence and despair. There is no plan

25 to fix it.” The article discussed how “[t]he jail was designed with little practical

26 knowledge and almost no foresight. It’s made up of 27 separate housing units, each tacked

27 to the next in partially-funded bursts of administrative desperation....” The then-Chief

28 Deputy of the Jail, Burt Liebersbach, was quoted extensively throughout the article and

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1 provided the author access to the Jail. After describing the deficiencies in the Jail’s design

2 and an increase in prisoner-on-prisoner violence, Chief Deputy Liebersbach was quoted as

3 saying that “[i]f things continue this way, the possibility for a riot exists.”

4

D. Defendants Routinely Fail to Adequately Classify and Assign Prisoners

to Housing Locations Where Prisoners Will Be Safe from Violence and

5

Injury

6

67. Defendants fail to adequately classify and assign prisoners to housing

7 locations in the Jail where they will be safe from injury and violence. Before prisoners are

8 assigned to certain housing locations in the Jail, they are “classified” based on a number of

9 factors including their criminal charges, gang affiliation, race, and history of violence.

10 These classification procedures are inappropriate and ineffective, however, and prisoners

11 who are incompatible for various reasons, including rival gang memberships and/or

12 histories of assaultive behaviors, are housed together in the Jail. Moreover, the severe

13 overcrowding at the Jail makes proper and accurate classifications next to impossible. As

14 the 2011 Jail Needs Assessment found, “[a]dequate separation and segregation resulting

15 from classification of inmates cannot occur because of the severe overcrowding and lack

16 of a sufficient number of single and double cells. Thus, while the staff has the ability to

17 classify, they do not have the ability to physically segregate those inmates who should be

18 separated because of their classification. This creates an environment that is unsafe for

19 officers, inmates and visitors.” 2011 Assessment at Ex. 2.

20

68. The 2011 Jail Needs Assessment further noted that, “[i]t is obvious that the

21 system is dangerously out of balance in terms of the types of beds available and the

22 classification of inmates held.… In Monterey County there is the possibility of

23 misclassifying inmates based on space rather than security level. Overcrowding reduces

24 the ability to classify. This is further compounded by the dormitory design. Normally,

25 10%-15% of the beds should be empty and available for classification spikes and

26 maintenance.… Proper separation and segregation of inmates as envisioned in the

27 Sheriff’s classification plan is very difficult because of insufficient staff, an inadequate

28 physical plant layout and … severe overcrowding ….” 2011 Assessment at Ex. 4-5.

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1

69. For example, Plaintiff SARABI was attacked by a fellow prisoner on or

2 around March 6, 2013, in the B-Dorm of the Jail. After the attack, Plaintiff SARABI was

3 moved to C-Dorm, so he would not be in the same housing areas as the prisoner who

4 attacked him. However, on or around April 11, 2013, the Jail moved his attacker into

5 Plaintiff SARABI’s C-Dorm, so the person who attacked him just five weeks prior would

6 be sleeping just five beds away from him. The Jail did not remove Plaintiff SARABI’s

7 attacker until the attacker himself was assaulted by other prisoners in the dorm a few hours

8 later.

9

70. Upon information and belief, on August 22, 2013, a gang-related stabbing

10 occurred in one of the housing units at the Jail. Upon information and belief, a prisoner

11 was airlifted to San Jose for treatment as a result of the stabbing.

12

71. In an October 10, 2013 article in the Salinas Californian, Sheriff Miller was

13 quoted as saying that an entire portion of the Jail, the Rehabilitation Facility, was not

14 useful for housing prisoners because it was designed for prisoners with lower risk than the

15 prisoners actually detained in the Jail: “[T]he Rehabilitation Facility” he said, “has about

16 outlived its usefulness.... Everyone low risk who comes in is generally released early so

17 the people we have locked up are more hardcore. It makes them more difficult to deal

18 with.” The “Jail Housing Addition Fact Sheet” posted on the SHERIFF’S OFFICE’s

19 website states that in the Jail, Defendants have “[i]neffective separation of potentially

20 dangerous inmates, such as rival gang members.”

21

E. Defendants Fail to Adequately Train Staff How to Prevent and Respond

to Violence Between Prisoners in the Jail

22

23

72. Upon information and belief, Defendants do not adequately train custody

24 staff in how to prevent and appropriately respond to prisoner violence. The lack of

25 training is evident from the incidents and security lapses described above, which endanger

26 prisoner safety. As a result of a lack of adequate training, staff do not timely respond to

27 violent incidents at the jail, do not recognize apparent dangers that can result in prisoner-

28 on-prisoner assaults, do not timely carry out their responsibilities to adequately monitor

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1 prisoner activity in the housing units and elsewhere where prisoner assaults occur, do not

2 adequately classify and assign prisoners to housing locations in the Jail where prisoners

3 will be safe from injury and violence, allow security lapses that endanger prisoners, and

4 fail to appropriately intervene when prisoner assaults and security breaches occur. Such

5 training is of even greater import given the chronic understaffing and overcrowding at, and

6 structural inadequacy of, the Jail.

7

F. Defendants Are Deliberately Indifferent to the Constitutionally

Unacceptable Risk of Violence Faced by Prisoners

8

9

73. Violent incidents between prisoners occur regularly. According the

10 SHERIFF’S OFFICE’s own incident reports from 2011 and from January to early-

11 September 2012, there were more than 150 separate incidents of violence between

12 prisoners. Some of the incident reports were incomplete and lack important pieces of

13 information. Upon information and belief, there are many more incidents of violence that

14 were not captured in incident reports.

15

74. Most instances of prisoner-on-prisoner violence involve injury to at least

16 one participant that requires medical attention at the Jail or even at the local hospital. In

17 more than 100 of the reported incidents from 2011 and from January through early-

18 September 2012, at least one prisoner involved in the altercation required some medical

19 treatment. In 13 of the incidents, the injuries suffered by at least one of the participants

20 were so severe that they had to be taken to an outside medical facility for treatment.

21 Plaintiff HOBBS, who had existing serious back problems prior to his incarceration,

22 required medical attention for his back after he was attacked by another prisoner. To this

23 day, Plaintiff HOBBS experiences serious back pain and problems with mobility as a result

24 of the attack.

25

75. Violent incidents between prisoners occur in nearly every area of the Jail.

26 Violent incidents were reported in 26 of the 29 housing units in the Jail from 2011 and

27 from January through early-September 2012. There were multiple reports of violent

28 incidents in 21 of the 29 housing units. In the A-Dorm of the Main Jail alone, there were

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1 19 incidents, while in the C-Wing of the Rehabilitation Center, there were 15 incidents.

2 Violent incidents also occurred in the booking area, the kitchen where prisoners work, the

3 infirmary, and the visiting area.

4

76. Violent incidents occur at approximately equivalent per prisoner rates in the

5 portions of the Jail that house men and women. 21 of the more than 150 incidents

6 involved female prisoners, while another 137 incidents involved male prisoners.

7

77. Prisoners with disabilities are at increased risk of being the victims of

8 violence because of their perceived or actual inability to defend themselves. For example,

9 in many of the incidents described in incident reports, prisoners with mental health

10 problems were attacked by or attacked other prisoners because of behavior attributable to

11 their mental illness.

12

78. In more than 35 of the incidents with full reports, custody staff at the Jail

13 were not able to identify the assailant. Though the SHERIFF’S OFFICE has installed

14 cameras in the Jail, upon information and belief, only two cameras monitoring two units

15 that house few prisoners have recording capabilities. The understaffing of the Jail means

16 that officers are rarely in a position to identify the attackers visually. Moreover, because

17 the conditions in the Jail are so unsafe, the victims of attacks frequently refuse to volunteer

18 the name of their assailants for fear of retaliatory attacks. As a result of Defendants’

19 deliberate indifference to prisoner safety, they have failed to sufficiently staff the Jail and

20 to put in place other policies and practices that would (1) result in the staff identification of

21 assailants in a far greater number of attacks, and (2) create an environment in which

22 victims feel sufficiently safe such that they identify their attackers.

23

79. Weapons are readily available inside the Jail, greatly increasing the danger to

24 prisoners and staff. In addition to the incident discussed above involving a shank, prisoner

25 assaults have also involved the use of a “Tomahawk” made from a razor and a 13 to 19-

26 inch long copper pipe.

27

80. Upon information and belief, Defendants fail to adequately train custody

28 staff in how to timely and appropriately intervene to stop violent incidents, and how to

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1 identify and confiscate weapons before they are used in an altercation.

2

81. Upon information and belief, Defendants lack any policy or practice for

3 regularly reviewing incident reports in order to identify systemic problems regarding the

4 manner in which Defendants keep prisoners safe from violence from other prisoners.

5

82. Defendants have known of these conditions and the violence they create for

6 years, including through their own incident reports and the 2007 and 2011 Jail Needs

7 Assessments.

8 II. 9

DEFENDANTS FAIL TO PROVIDE ADEQUATE MEDICAL CARE TO PRISONERS

10

83. Defendants MONTEREY COUNTY, MONTEREY COUNTY SHERIFF’S

11 OFFICE, and CFMG have a policy and practice of failing to provide adequate medical

12 care to prisoners in the Jail, and are deliberately indifferent to the fact that their failure to

13 do so subjects prisoners to a substantial risk of unnecessary suffering, serious injury,

14 clinical deterioration, or death.

15

84. CFMG is a for-profit corporation. CFMG provides medical, mental health,

16 and dental services to prisoners in the Jail pursuant to its contract with Defendants

17 MONTEREY COUNTY and the SHERIFF’S OFFICE. The term of the agreement is from

18 April 1, 2012, through June 30, 2015. The COUNTY and the SHERIFF’S OFFICE

19 compensate CFMG for providing health care to prisoners with a flat fee payment made

20 annually for the term of the contract. In the first year of the contract, CFMG was paid

21 $4,826,195. In the second and third years of the contract, the amount paid to CFMG is

22 supposed to be increased according to the Medical Consumer Price Index for San

23 Francisco/Oakland. In addition, CFMG receives an additional $4.02 each day for each

24 prisoner housed in the Jail in excess of a population of 1,065. The COUNTY has the right

25 to terminate the agreement if CFMG violates any of the material terms of the agreement.

26 The material terms of the agreement include that CFMG “shall perform all work in a safe

27 and skillful manner and in compliance with all applicable laws and regulations.”

28

85. Defendants fully control all medical, mental health, and dental care available

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1 to prisoners in the Jail. Defendants prohibit prisoners from obtaining any medications,

2 including over-the-counter medications like ibuprofen and Tylenol and prescription

3 medication for which prisoners possess valid prescriptions, without approval from

4 Defendants. Prisoners at the Jail cannot be seen by any medical professionals, inside or

5 outside of the Jail, without approval from Defendants. Prisoners cannot receive laboratory

6 or other diagnostic testing without approval from Defendants. Put simply, Defendants

7 control every aspect of provision of medical care to prisoners in the Jail.

8

A. Defendants Routinely and Systematically Fail to Maintain Sufficient

Numbers of Health Care Professionals

9

10

86. Defendants maintain insufficient numbers of health care professionals to

11 provide minimally adequate care to the more than 900 prisoners in the Jail. There are not

12 sufficient health care staff to timely respond to prisoners’ requests for medical evaluations

13 and treatment, to adequately screen, monitor, and provide follow-up care to prisoners who

14 are suffering from serious and chronic illnesses, or to treat prisoners on an emergency

15 basis.

16

87. For example, when Plaintiff SARABI was attacked by another prisoner the

17 night of March 6, 2013, he was seen by a nurse who placed an ACE bandage on his right

18 foot and ankle and gave him a wheelchair. Plaintiff SARABI complained for the next

19 several hours about the serious pain in his foot and a possible concussion, but his repeated

20 requests for help and medical care were ignored. When a nurse finally brought him back

21 to the infirmary at approximately 3:00 a.m., she informed Plaintiff SARABI that there was

22 no qualified medical staff present at that hour to evaluate and help him, so he would have

23 to wait until 6:00 a.m. to receive his needed pain medications. Plaintiff SARABI was not

24 transported to a local hospital for treatment.

25

88. The insufficient number of custody staff, discussed in Section I.A, supra,

26 makes it even more difficult for Defendants to provide minimally adequate health care.

27 Within the Jail, any time that a prisoner must be transferred to or from a housing unit to

28 another area of the Jail for health care services, at least one custody officer must

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1 accompany and transport the prisoner. Similarly, anytime that a prisoner requires transport

2 to an outside medical facility for treatment, at least one custody officer must accompany

3 the prisoner and remain present for the duration of time that the prisoner is at the outside

4 medical facility. To timely transport all prisoners to and from all health care services

5 would require Defendants to hire and staff the jail with additional custody officers.

6 Defendants have been aware of the insufficiency of the number of custody staff for some

7 time, including as a result of the 2007 and 2011 Jail Needs Assessments. Defendants,

8 however, refuse to adequately staff the Jail.

9

89. Prisoners are routinely unable to see medical or dental staff because of a lack

10 of available custody staff for escorting prisoners to and from medical appointments. For

11 example, a doctor requested to see Plaintiff HOBBS on or around December 19, 2013, but

12 the appointment could not take place because custody staff were unavailable to escort

13 Plaintiff HOBBS from his housing unit to the appointment. Many other plaintiffs

14 experienced similar problems where appointments with medical staff or ordered treatment

15 (such as the taking of vital sign or the changing of dressings) did not take place as ordered

16 because of a lack of custody staff to escort the plaintiffs to the infirmary.

17

B. Defendants Routinely and Systematically Fail to Supervise the Conduct

of Health Care and Custody Staff

18

19

90. Upon information and belief, the small number of health care staff that

20 Defendants do employ are not sufficiently trained or supervised to provide the care they

21 provide. At the Jail, much of the health care is provided by the one Physician’s Assistant

22 (“PA”) employed by CFMG. The PA, who has prescribing authority but must be

23 supervised by a physician, is not adequately supervised by the physicians at the Jail. As a

24 result, the PA has, at least in part because of lack of supervision, provided inappropriate

25 and untimely care to prisoners and caused many lapses in care.

26

91. In addition, Licensed Vocational Nurses (“LVNs”) and Licensed Psychiatric

27 Technicians (“LPTs”) are entry-level health care providers who must only practice under

28 the direct supervision of physicians, psychologists, registered nurses, social workers, or

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1 other qualified professionals, and are not qualified to do their own patient evaluations or

2 assessments. Yet, upon information and belief, Defendants improperly allow untrained

3 entry-level providers such as LVNs and LPTs to practice outside of the scope of their

4 licensure and perform medical gatekeeping functions, including independently assessing

5 and responding to prisoners’ medical and dental care requests and correctional officers’

6 referrals for health care.

7

92. For example, Plaintiff SARABI suffered a serious leg injury when he was

8 attacked by another prisoner on March 6, 2013. Plaintiff SARABI was initially seen and

9 treated by nurses only for the first two weeks following the injury. The nurses wrapped his

10 injured foot and ankle in an ACE bandage immediately after the attack, then approximately

11 a week later placed a splint on his right foot and ankle. The splint was placed too low,

12 resulting in discomfort and continued pain for Plaintiff SARABI. When Plaintiff SARABI

13 finally saw a doctor for the first time (nearly two weeks after his date of injury), the doctor

14 informed him that he likely had a peroneal nerve injury that required specific nerve

15 medication and would take at least a month if not longer to heal. When Plaintiff SARABI

16 asked why it took medical staff so long to diagnose the nerve injury, the doctor replied that

17 it was a “staff problem” because the staff erroneously diagnosed Plaintiff SARABI’s nerve

18 damage as a sprain.

19

93. Plaintiff MILLER received an improper insulin injection from a CFMG

20 nurse-employee on February 11, 2013. As a result, he suffered a severe diabetic episode

21 and was transported to Natividad Medical Center by ambulance in an unconscious state.

22 The pain, distress, and permanent physical impairment that Plaintiff MILLER has suffered,

23 and continues to suffer, as a result of this episode are directly attributable to Defendants’

24 failure to adequately train and properly supervise health care staff.

25

94. Physicians at the Jail ordered that lower-level medical staff change dressings

26 on wounds for Plaintiffs HERNANDEZ and COBB at regular intervals. Lower-level staff,

27 on numerous occasions, failed to change the dressings as ordered. During periods of time

28 when lower-level medical staff failed to change Plaintiff HERNANDEZ’s dressing as

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1 ordered, he experienced unnecessary pain and developed numerous abscesses in his

2 abdomen that required multiple hospitalizations, including a seven-week hospitalization in

3 January and February 2013.

4

95. Defendants also fail to maintain medical accreditations. Specifically, the

5 Institute for Medical Quality (“IMQ”) offers voluntary accreditation to correctional and

6 detention facilities throughout California based upon meeting standards developed by the

7 IMQ. According to a certificate prominently placed on the wall of the lobby for the

8 visiting area of the Jail, Monterey County Jail’s IMQ accreditation expired on

9 November 17, 2011. On information and belief, Defendant CFMG contacted IMQ in or

10 around May 2013 to request a reaccreditation survey. To date, Defendants have not

11 received an updated accreditation from IMQ.

12

C. Defendants Lack Sufficient Facilities to Provide Adequate Medical Care

13

96. The physical spaces in the Jail used to deliver medical care are not sufficient

14 for the population of prisoners. As the 2011 Jail Needs Assessment found,

15 “Medical/mental health treatment spaces are not adequate for the rated beds, let alone the

16 actual number of inmates held.” 2011 Assessment at Ex. 3. The Assessment further noted

17 the direct impact of overcrowding on prisoners’ overall health: “Overcrowding affects

18 inmates’ mental and physical health by increasing the level of uncertainty with which they

19 regularly cope.” 2011 Assessment at Ex. 9. The lack of sufficient treatment space places

20 prisoners at an unreasonable risk of harm from inadequate medical care, compromises the

21 delivery of medical care, and fails to ensure confidentiality and safety during the delivery

22 of such care.

23

97. Upon information and belief, medical screening procedures and

24 appointments are routinely conducted in non-confidential treatment space and hallways.

25 For example, Plaintiff COBB was seen by a member of CFMG’s medical staff in a non-

26 confidential hallway setting for a treatment discussion that included, among other things, a

27 discussion of the staff member’s view that Plaintiff COBB’s poor personal hygiene was a

28 contributing factor to her recurrent alleged urinary tract infections. Plaintiff COBB in fact

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1 had severe kidney stones that the Jail medical staff had failed to diagnose.

2

D. Defendants’ Inadequate Screening and Intake Process Fails to Identify

and Treat Medical Care Problems of Newly Arriving Prisoners

3

4

98. Defendants fail to adequately identify and treat the medical problems of

5 newly arriving prisoners during the screening and intake process. Defendants’ policies and

6 practices for medical screening are inadequate. Defendants fail to adequately train custody

7 and medical staff in how to timely and appropriately identify medical problems during the

8 screening and intake process. When a prisoner is newly booked into the Jail, medical staff

9 may not even play a role in screening the prisoner. Custody staff (who are not sufficiently

10 trained to identify medical needs) complete a brief one-page health screening form during

11 a cursory interview with the prisoner in a non-confidential space. Medical staff only

12 evaluate prisoners at intake if the custody staff note a problem on the screening form. The

13 screening form used by custody fails to capture critical and basic information necessary to

14 identify prisoners in need of medical attention. Upon information and belief, Defendants

15 fail to take every prisoner’s vital signs (including blood pressure and temperature), and

16 only take them for prisoners whom custody staff refer to medical staff for assessment.

17 Upon information and belief, comprehensive intake evaluations by medical staff, when

18 they occur at all, frequently do not take place until days or weeks after a prisoner is booked

19 into the jail.

20

99. Because the screening process is inadequate to identify prisoners with

21 serious or chronic health care problems, prisoners are at a significant risk of serious harm.

22 For example, prior to being booked into the Jail, Plaintiff MURPHY had permanent nerve

23 damage that was caused by a bulge in his L4 and L5 vertebrae. When he went through the

24 screening process, Plaintiff MURPHY was experiencing significant pain from the nerve

25 damage because he had not taken his pain medication and did not have a cane to assist him

26 in walking. The screening form for Plaintiff MURPHY does not indicate that he had any

27 potential or existing nerve damage or back problems. Similarly, although Plaintiff COBB

28 reported during her intake screening that she had recently been seen by an outside medical

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1 provider and referred to a urologist for cloudy and discolored urine, her intake screening

2 form does not indicate any urology concerns.

3

100. During the intake process Defendants also under-identify prisoners with

4 chronic illness, including hypertension, asthma, and diabetes.

5

E. Defendants Fail to Provide Prisoners with a Reliable and Timely Way to

Alert Health Care Staff of Their Medical Needs

6

7

101. Defendants fail to provide a reliable way for prisoners to alert health care

8 staff of their need for evaluation of medical or dental problems, and are deliberately

9 indifferent to the harm and risk of harm to prisoners that their failure creates. Defendants’

10 policies and practices for providing prisoners with a means for alerting health care staff of

11 medical or dental needs are inadequate. Upon information and belief, Defendants fail to

12 adequately train custody and medical staff in how to properly process and timely respond

13 to prisoners’ requests for medical or dental evaluation.

14

102. To request medical care, prisoners are supposed to submit a “sick call slip”

15 to medical staff when medical staff comes through a housing unit to distribute medications.

16 Prisoners may also submit sick call slips in boxes in some housing units that are designed

17 for submission of grievances. These boxes are not sufficiently confidential, as custody

18 staff are the only staff who have keys to the boxes, and thus have access to prisoners’

19 confidential sick call slips. Once a sick call slip is received by medical staff, the prisoner

20 is supposed to be seen by medical staff on the next available sick call day.

21

103. Though prisoners report little difficulty submitting sick call slips to medical

22 staff, they frequently receive no response to their requests for medical care. Other times,

23 when prisoners do receive a response to a sick call slip, it is not until many days after the

24 sick call slip was submitted.

25

104. The failure to timely respond to sick call slips is caused, at least in part, by

26 Defendants’ failure to create an effective tracking and scheduling system for health care

27 appointments.

28

105. Upon information and belief, Defendants do not adequately train health care

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1 staff in how to review, process, and respond to sick call slips submitted by prisoners.

2

106. Though Defendants have a policy that all prisoners are supposed to be seen

3 by medical staff on the next available sick call day after submitting a sick call slip, in

4 practice, Defendants use Licensed Vocational Nurses (LVNs) to screen the sick call slips

5 and determine whether the prisoner should actually be seen by medical or mental health

6 care staff. No standardized protocols exist to guide LVNs’ exercise of discretion in

7 determining when prisoners should receive a face-to-face appointment with a nurse or

8 other medical or mental health care clinician. Consequently, LVNs arbitrarily determine

9 whether the content of a sick call slip, often written by a prisoner who can barely read or

10 write, warrants an appointment with a nurse or physician.

11

107. These failures to respond and delays in response from medical staff place

12 prisoners in danger. For example, during Plaintiff HERNANDEZ’s term of incarceration

13 from April 28, 2012 to September 27, 2013, he required significant medical attention for

14 his ileostomy and, after the ileostomy was removed, for his post-surgical care. On many

15 occasions, Plaintiff HERNANDEZ submitted sick call slips complaining of abdominal

16 pain or other related symptoms. He frequently experienced significant delays before he

17 was seen by medical staff. As one example, he submitted a sick call slip on October 2,

18 2012, complaining of not receiving certain medications for his stomach and was

19 experiencing strong cramping pains; he was not fully evaluated by appropriate medical

20 staff until October 26, 2012—24 days later. As another example, Plaintiff HERNANDEZ

21 submitted sick call slips related to pain in his abdomen on November 18, 25, and

22 December 2, 2012. He was not evaluated by an appropriate provider prior to being

23 transferred to the hospital on or around December 11, 2013 for his ileostomy reversal

24 surgery, a period of 23 days.

25

108. Prisoners can file grievances through the Jail’s grievance procedure if they

26 do not receive the care they need after filing a sick call slip. However, Defendants

27 routinely fail to respond or to provide an adequate response to submitted grievances. For

28 example, Plaintiff DOBBS attempted to use the grievance process to request Gabapentin

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1 and ibuprofen that Defendants had prescribed for her after Defendants failed to provide

2 them to her. Defendants did not provide appropriate or timely responses to the grievances,

3 and failed to provide the prescribed medications for more than 20 days.

4

109. As another example, Plaintiff WHITFIELD had to submit five sick call slips

5 and two grievances before he was able to obtain the emergency dental care he needed to

6 extract an infected wisdom tooth. Plaintiff WHITFIELD was not given an appointment

7 with a dentist until after he had first seen two different nurses to complain of his serious

8 pain. At the same time, it took weeks for Plaintiff WHITFIELD to get the ibuprofen he

9 requested. Even after he did obtain an order for the pain medication, it was given to him

10 intermittently and inconsistently. Plaintiff WHITFIELD’s dental pain ceased as soon as

11 the dentist extracted his tooth—over a month after Plaintiff WHITFIELD first alerted the

12 Jail to his emergency dental need.

13

110. Upon information and belief, Defendants have failed to implement

14 appropriate triage procedures to ensure that non-emergency medical needs are attended to

15 before they develop into emergencies. For example, Methicillin-resistant Staphylococcus

16 aureus (“MRSA”, commonly known as “staph”) infections are frequently reported at the

17 Jail. Many prisoners report filing multiple sick call slips for emerging and beginning

18 staph-related wounds, but are not seen until their wounds develop into serious and

19 emergency conditions requiring intense treatment. For example, one prisoner was not seen

20 for a staph-infection-caused wound until it developed into cellulitis and a necrotizing soft

21 tissue infection, requiring intensive and invasive treatment. Another prisoner had a staph-

22 infection-caused abscess that required the insertion of a surgical drain into the wound,

23 which Defendants then failed to properly monitor and cleanse following the procedure.

24

111. Even when the sick call process operates as set forth in Defendants’ written

25 policies, the sick call process places prisoners at an unreasonable risk of harm. For

26 example, on July 28, 2012, a prisoner was booked into the Jail whose colon had begun to

27 rupture shortly before or after his arrest. Once the prisoner was placed in a housing unit in

28 the Jail, his symptoms from his condition began to worsen. During the night he was

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1 booked into the Jail, he filed a sick call slip stating that he had been experiencing severe

2 abdominal pains for the previous eight hours. The sick call slip was not reviewed by any

3 staff at the Jail until 5 p.m. on July 29, 2012. Moreover, the prisoner was not seen by

4 medical staff until 12 p.m. on July 30, 2012, at which time his temperature was 102

5 degrees. The prisoner was rushed to the Emergency Department at Natividad Medical

6 Center, where he was diagnosed with a perforated bowel and had an emergency colostomy

7 procedure that same day. According to the medical records maintained by CFMG, at least

8 36 hours passed between when the prisoner requested and received medical attention from

9 staff at the Jail. The delay in response caused the prisoner considerable and unnecessary

10 pain, and placed him at a significant risk of death.

11

112. Upon information and belief, custody staff do not adequately respond to

12 requests from prisoners for medical care. When Plaintiff SARABI complained about

13 intense pain in his right foot/ankle, and voiced concern about a broken ankle and a possible

14 concussion one hour after he was attacked by another prisoner, one of the guards outside

15 his room said, “You’re a tough guy, suck it up, if you had broken your ankle you would be

16 in more pain.” Delays in treating Plaintiff SARABI and other prisoners have created

17 unnecessary suffering and worsened health outcomes. Upon information and belief,

18 Defendants do not adequately train custody staff in how to respond to prisoners’ requests

19 for emergency medical attention.

20

F. Defendants Routinely and Systematically Fail to Provide Adequate

Medical Care

21

22

113. Defendants fail to provide timely access to medical and dental care.

23 Defendants’ policies and practices for providing timely access to medical and dental care

24 are inadequate. Upon information and belief, Defendants fail to adequately train custody

25 and medical staff in how to provide timely access to medical and dental care. If prisoners

26 are seen by health care providers at all, they often experience substantial delays in

27 receiving those appointments. Prisoners also experience long delays before they are seen

28 and treated by outside specialists, before they receive surgery at outside facilities, or before

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1 they receive dental care. The Jail has also failed to institute adequate policies and practices

2 to treat prisoners with chronic conditions. Prisoners commonly wait several weeks,

3 sometimes several months, before they are evaluated by clinicians for medical symptoms.

4 As a result of these deficiencies, prisoners with serious and life-threatening conditions

5 unnecessarily suffer and are put at risk of harm.

6

114. For example, in October, November, and December 2013, Plaintiff PEREZ

7 was seen by three specialists at outside medical facilities regarding the tumor on his foot.

8 Each of these specialists instructed that Plaintiff PEREZ needed to be seen by an expert in

9 orthopedic oncology at a tertiary facility such as Stanford or UCSF for evaluation and

10 treatment of the possibly cancerous tumor. Upon information and belief, to date, more

11 than six months after the original referral, Plaintiff PEREZ still has not been seen by an

12 orthopedic oncologist. Plaintiff PEREZ was informed by at least one of the three doctors

13 whom he saw that if he did not receive proper attention for his tumor, he was at risk of

14 having his foot amputated.

15

115. Plaintiff HERNANDEZ was supposed to have his colostomy reversed in

16 June 2012. However, CFMG medical staff repeatedly refused to perform the colostomy

17 reversal surgery, at first claiming that it was improper for Jail doctors to do so when an

18 outside doctor had performed the original colostomy, and then claiming that the procedure

19 was “non-emergency” so could not be done at the Jail. The Jail also refused to transfer

20 Plaintiff HERNANDEZ to a facility where he could receive the reversal surgery, and in

21 August 2012 denied Plaintiff HERNANDEZ the day pass necessary to go to Santa Clara

22 County for the surgery. In total, Plaintiff HERNANDEZ had to wait eight months to have

23 his colostomy surgery after he arrived at the Jail, during which time he suffered from

24 intestinal swelling, bleeding, and pain.

25

116. Plaintiff COBB disclosed during her intake screening on April 4, 2013, that

26 she had seen an outside provider and been referred to a urologist for complaints of cloudy

27 and discolored urine. Over the next eight weeks, Defendants repeatedly failed to diagnose

28 Plaintiff COBB’s severe kidney stones, at times treating her for a urinary tract infection

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1 and at times offering no treatment at all. On June 1, 2013 she was taken to Natividad

2 Medical Center in an ambulance due to a high fever and severe pain. At Natividad, she

3 was finally diagnosed as having large kidney stones. Doctors at Natividad instructed that

4 she be seen by a urologist immediately. She was not seen by a urologist until June 19,

5 2013, at which time the urologist was concerned about whether Plaintiff COBB had lost so

6 much kidney function that her kidney would have to be removed. On June 25, 2013,

7 Plaintiff COBB had a surgical drain inserted into her kidney, and shortly thereafter it was

8 determined that her affected kidney only had approximately 31% remaining function. She

9 did not receive any surgery to remove any kidney stones until September 13, 2013. She

10 has suffered severe and unnecessary pain and risk of permanent loss of kidney function

11 due to Defendants’ failure to timely diagnose and appropriately treat her medical

12 condition.

13

117. Other prisoners have repeatedly been denied necessary medical treatments or

14 experienced significant delays in receiving what they needed or had been prescribed prior

15 to arriving at the Jail, resulting in significant physical pain and discomfort, as well as

16 increased anxiety and panic. For example, one prisoner repeatedly requested colostomy

17 reversal surgery for three months, but was informed by Defendants that he could not

18 receive the surgery because it was an “elective,” as opposed to emergency, procedure.

19 During these three months, this prisoner suffered from infections, bloody discharge,

20 fainting, and vomiting. Another prisoner was not timely provided with appropriate

21 colostomy supplies, and when he appeared in court, he was leaking feces over his body.

22 The judge ordered him to be sent immediately to the hospital in an ambulance.

23

118. Plaintiff HOBBS suffers from asthma and has been prescribed an Albuterol

24 inhaler during his current and past terms in the Jail. In late-February 2014, his Albuterol

25 inhaler ran out. Despite numerous sick call slips and other requests to medical staff, was

26 not refilled for more than a month. Without his inhaler, he suffered asthma attacks on a

27 near-nightly basis. Defendants also failed to provide Plaintiffs ESQUIVEL and

28 MEFFORD with the inhalers they require to treat their asthma. Plaintiff ESQUIVEL

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1 requires two inhalers—Albuterol and Flovent. During a previous stay in the Jail from

2 January to February 2014, he was allowed to bring in his own inhalers, which were almost

3 empty. When they ran out after a couple of weeks, he was not given replacements, despite

4 orally requesting new inhalers from the staff. During his current stay in the Jail, Plaintiff

5 ESQUIVEL is only receiving Flovent, not Albuterol. As a result, he is wheezing at night

6 and experiencing increased fatigue. Plaintiff MEFFORD was provided with an inhaler

7 during his initial days in the Jail in early December 2013. However, the Jail staff failed to

8 mark the inhaler as his property. Custody staff thus confiscated it during a search as

9 suspected contraband. Plaintiff MEFFORD requested a replacement inhaler from a nurse

10 in January 2014. However, the nurse failed to find the doctor’s order from December 2013

11 prescribing an inhaler for Plaintiff MEFFORD in his medical records. Thus, the nurse

12 denied Plaintiff MEFFORD a new inhaler. Plaintiff MEFFORD had to again request to

13 see the medical staff before a different staff member was able to find the order for an

14 inhaler in his file and gave it to him. Without his inhaler, Plaintiff MEFFORD suffered

15 increased chest pain and tightness and struggled to breathe normally.

16

119. Upon information and belief, CFMG medical staff inform prisoners that they

17 will not receive medically necessary treatments, procedures, or medications while in the

18 Jail because their release from the Jail or transfer to state prison or another institution is

19 allegedly imminent. For example, notes in Plaintiff PEREZ’s medical file made by a

20 doctor employed by CFMG indicate that Defendants may have been attempting to delay

21 his referral to an orthopedic oncologist at UCSF or Stanford in an attempt to avoid the

22 expense involved in transporting Plaintiff PEREZ to the specialist. In addition, in response

23 to Plaintiff PEREZ’s inquiries to nurses at the Jail for information regarding when he

24 might see an appropriate specialist, Plaintiff PEREZ has been asked by the nurses when he

25 will getting out of custody.

26

120. Defendants have demonstrated that they are incapable of properly managing

27 and treating severe chronic conditions suffered by many prisoners. For example, Plaintiff

28 MILLER has severe type 1 diabetes. Staff of Defendants MONTEREY COUNTY and the

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1 SHERIFF’S OFFICE wrote on an Intake Health Screening form dated January 8, 2013,

2 that Plaintiff MILLER had diabetes; staff of Defendant CFMG noted on an Intake Triage

3 Assessment form completed on that same date that Plaintiff MILLER took two different

4 types of insulin. In nine months of incarceration Defendants have been unable to develop

5 and implement a treatment plan to appropriately manage Plaintiff MILLER’s diabetes. He

6 suffers serious diabetic episodes resulting in periods of unconsciousness, and is

7 experiencing diabetes-related vision loss and other serious and permanent side effects of

8 his uncontrolled diabetes.

9

121. Plaintiff ESQUIVEL also has diabetes. In January 2014, Plaintiff

10 ESQUIVEL entered the jail with a high blood sugar level over 280 mg/dl. After his intake

11 forms noted his diabetic condition, it was ordered that he receive daily insulin. After

12 initially providing one dose of insulin, the Jail failed to provide him with any insulin for 48

13 hours, after which time Plaintiff ESQUIVEL’s blood sugar spiked above 330 mg/dl.

14

122. Another prisoner suffered a miscarriage immediately before being booked

15 into the Jail, and experienced heavy vaginal bleeding for at least seven weeks afterward.

16 Despite repeated requests, this prisoner did not see a women’s health specialist for seven

17 weeks. After seven weeks of bleeding and the filing of multiple grievances (most of which

18 went unanswered), this prisoner was finally taken to Natividad Medical Center for an

19 evaluation by a women’s health specialist. This prisoner did not receive timely and

20 appropriate care for her condition.

21

123. In interactions with medical staff, Defendants fail to ensure that hearing and

22 speech impaired prisoners who use American Sign Language as their primary method of

23 communication are provided with sign language interpreters to ensure effective

24 communication. Without sign language, such prisoners are not able to explain to medical

25 care providers the symptoms they are experiencing, and medical staff are not able to

26 explain the benefits and risks of treatments, medications, and procedures such that

27 prisoners can provide their informed consent. The lack of sign language interpretation

28 services results in Defendants making medical treatment decisions without all of the

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1 necessary and pertinent information they need, which increases the risk of misdiagnosis

2 and mistreatment for the prisoner.

3

124. For example, Plaintiff YANCEY was examined by a Physician’s Assistant

4 (“PA”) at the Jail on December 4, 2012, two days after he was discharged from the

5 hospital with a fractured right arm and fractured left tibia. Defendants did not provide

6 Plaintiff YANCEY with a sign language interpreter for the examination. Though Plaintiff

7 YANCEY presented with multiple, complex trauma issues, the PA’s Progress Note admits

8 that the “[e]xam [was] limited due to decreased verbal communication ....” Because of

9 Defendants’ failure to provide Plaintiff YANCEY with a sign language interpreter, he was

10 unable to explain the extent of his pain and other symptoms. As a result, he suffered from

11 needless and unnecessary pain. Defendants also failed to provide sign language

12 interpreters at other medical appointments for Plaintiff YANCEY. The lack of a sign

13 language interpreter at other medical appointments similarly resulted in Plaintiff

14 YANCEY’s inability to communicate his symptoms to medical staff and to understand

15 medical staff. Through their failure to provide sign language interpreters for medical

16 appointments, Defendants are deliberately indifferent to the medical needs of prisoners

17 who require assistance to communicate.

18

125. Upon information and belief, Defendants fail to ensure effective

19 communication of critical medical information to prisoners with vision loss, such as

20 Plaintiff MILLER. Defendants do not have a policy or protocol of implementing, tracking,

21 or recording effective communication. Defendants provide written materials to vision-

22 impaired prisoners without documenting that such materials were read aloud or otherwise

23 communicated to the prisoners, and fail to ensure that vision-impaired prisoners are

24 adequately informed of, among other things, the medications that are being administered.

25 As a result of Defendants’ failure to ensure effective communication in the provision of

26 medical care, vision-impaired prisoners are subject to risk of serious medical harms, as

27 was the case when Plaintiff MILLER was provided with an improper insulin injection and

28 lapsed into unconsciousness.

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1

126. Upon information and belief, Defendants fail to provide foreign language

2 interpretation services to prisoners whose primary language is not English during medical

3 clinical evaluations. This is particularly true for prisoners who cannot speak either English

4 or Spanish. Without foreign language interpretation, such prisoners are not able to explain

5 to doctors the symptoms they are experiencing, and medical staff are not able to explain

6 the benefits and risks of treatments, medications, and procedures such that prisoners can

7 provide their informed consent. The lack of foreign language interpretation services

8 results in Defendants making medical treatment decisions without all of the necessary and

9 pertinent information they need, which increases the risk of misdiagnosis and mistreatment

10 for the prisoner. Through their failure to provide foreign language interpreters for medical

11 appointments, Defendants are deliberately indifferent to the medical needs of prisoners

12 who require assistance to communicate.

13

G. Defendants Fail to Continue Medically Necessary Treatments for

Prisoners Upon Their Arrival at the Jail

14

15

127. Defendants fail to continue medically necessary treatments for prisoners who

16 were in the process of undergoing care for chronic, serious, or other conditions

17 immediately prior to being booked into the Jail, putting those prisoners at risk of harm.

18 Defendants’ policies and practices for continuing medically necessary treatments for

19 prisoners who arrive at the Jail are inadequate. Upon information and belief, Defendants

20 do not adequately train medical staff in how to evaluate and treat prisoners who were

21 undergoing care for chronic or serious conditions immediately prior to being booked into

22 the Jail.

23

128. Defendants routinely refuse to provide medications that prisoners have been

24 using to treat conditions outside of the Jail, even when the prisoners themselves, doctors,

25 family members, or other entities bring their medications and/or valid prescriptions to the

26 Jail.

27

129. For example, one prisoner re-entered the Jail on June 15, 2013 following a

28 period on which she had been released by the SHERIFF’S OFFICE to home confinement

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1 in order for her to have necessary back surgery. On information and belief, this prisoner,

2 who is an insulin-dependent diabetic, brought her insulin with her to the Jail on June 15,

3 2013. In the Diabetes section on this prisoner’s Intake Triage Assessment form dated June

4 15, 2013, the Registered Nurse who completed the form wrote that the prisoner took seven

5 units of Lantus twice a day. Although Defendants were aware of her diabetic condition

6 and need for insulin, the “Diabetic Chart” in this prisoner’s medical file indicates that she

7 did not receive any insulin from June 15, 2013 through at least June 27, 2013. On

8 information and belief, this prisoner did not begin to regularly receive insulin until on or

9 after July 24, 2013.

10

130. Plaintiff GIST was prescribed the muscle relaxant Flexeril by her physician

11 prior to entering the Jail in order to help manage the chronic back pain she experiences due

12 to her scoliosis and congenital hip dislocation. The Jail is aware of her condition and has

13 confirmed her prescription. Despite numerous requests, Plaintiff GIST has not received

14 this pain medication while in the Jail, which has exacerbated the pain and swelling in her

15 back. Due to her back pain Plaintiff GIST has difficulty walking, sitting, standing, and

16 lying down in one position for a long time and has difficulty walking up stairs. Plaintiff

17 GIST’s condition also makes it difficult for her to balance and causes her to fall often. She

18 has difficulty accessing programs and services, which are up a long flight of stairs, due to

19 the pain.

20

131. Plaintiff WHITFIELD suffers from narcolepsy and cataplexy, two conditions

21 that can be adequately controlled through the provision of two medications: Provigil and

22 Xyrem. Plaintiff WHITFIELD was prescribed such medications by his outside specialist

23 physician. Plaintiff WHITFIELD requested both drugs upon entering the Jail in November

24 2013. Plaintiff WHITFIELD saw a physician at the Jail on December 5, 2013, who then

25 called Plaintiff WHITFIELD’s outside specialist on December 6, 2013, to verify Plaintiff

26 WHITFIELD’s condition and medication regime. Immediately after this telephone call,

27 the Jail physician ordered Provigil for Plaintiff WHITFIELD. However, Defendants did

28 not provide Plaintiff WHITFIELD with Provigil for nearly two months, during which time

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1 he was at risk for falling asleep at any time, without warning. He spent upwards of 20

2 hours a day in bed in an attempt to minimize his risk of falling and hurting himself.

3 Plaintiff WHITFIELD eventually was forced to submit two grievances before Defendants

4 finally provided him with Provigil on or around February 1, 2014. Defendants still refuse

5 to provide him with Xyrem, which controls cataplexy. As a result, Plaintiff WHITFIELD

6 has had four cataplexic episodes in the Jail since November 30, 2013—which is a far more

7 frequent rate of attacks than he normally experiences.

8

132. Defendants place many prisoners who arrive at the Jail and who are

9 prescribed pain and other medications on what Defendants call a “detoxification

10 treatment.” The detoxification treatment involves taking prisoners off of their prescribed

11 medications “cold turkey” without any tapering, and refusing, for up to 90 days, to provide

12 prisoners with the pain and other medications they were taking pursuant to prescription

13 before they were booked into the Jail. This practice of removing prisoners from prescribed

14 medications is dangerous, inhumane, and does not meet the standard of care. Prisoners

15 placed on the detoxification treatment and removed from prescribed pain medications

16 suffer extreme pain, withdrawal symptoms, and degeneration of conditions the medication

17 was designed to treat.

18

133. For example, one prisoner was placed on a detoxification treatment when she

19 re-entered the Jail on June 15, 2013, following significant spinal surgery on June 3, 2013.

20 As treatment for the pain associated with the surgery, her treating physician outside of the

21 Jail had prescribed for her various pain medications, including hydrocodone and diazepam.

22 On June 15, 2013, Defendants refused to provide this prisoner any of her prescribed pain

23 medications and gave her only ibuprofen and anti-anxiety medications until she was seen

24 by a physician at the Jail almost two weeks later. Staff of Defendant CFMG placed this

25 prisoner on detoxification treatment solely because she was taking prescribed pain

26 medications and not because she was taking other substances, such as alcohol or illegal or

27 non-prescribed drugs. As a result, the prisoner experienced extreme pain and physical and

28 emotional distress, as well as significant mobility impairment as a result of her pain and

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1 back injuries.

2

134. Another prisoner was taking significant dosages of prescription pain

3 medications for injuries stemming from gunshot wounds, including a Fentanyl patch,

4 Oxycontin, and Oxycodone. However, when he arrived at the Jail in August 2012,

5 Defendants refused to provide him with any of his prescribed pain medications and

6 subjected him to the detoxification treatment. As a result of the detoxification treatment,

7 this prisoner suffered through an extremely painful withdrawal. Yet another prisoner was

8 subjected to the formulaic detoxification treatment in March 2013, even though her intake

9 form clearly indicates that she was receiving methadone under the supervision of a

10 physician at Natividad Medical Center for treatment of her heroin dependency.

11

135. Prior to her incarceration, Plaintiff HUNTER was taking various prescription

12 medications to treat her diabetes, fibromyalgia, high blood pressure, chronic back pain,

13 bone cancer, seizures, bipolar disorder, manic depression, anxiety, and panic attacks.

14 Plaintiff HUNTER had many of these medications with her upon her arrival at the Jail, but

15 they were confiscated during the booking process. Defendants refused to provide her with

16 all of her necessary medications for two weeks.

17

136. Prior to his incarceration, Plaintiff MURPHY was taking various prescribed

18 pain medications at least four times a day as treatment for the nerve damage in his back.

19 However, despite his repeated requests, Plaintiff MURPHY has not received the necessary

20 medications at the appropriate times, and he is in constant pain.

21

H. Defendants Fail to Provide Adequate Care in Emergency Situations

22

137. Defendants fail to provide adequate medical care when confronted with

23 prisoners who require emergency medical attention. Defendants’ policies and practices for

24 providing emergency treatment to prisoners are inadequate. Upon information and belief,

25 Defendants do not adequately train custody or medical staff regarding how to respond to

26 emergency medical situations and requests for emergency medical treatment from

27 prisoners.

28

138. Plaintiff HERNANDEZ experienced two serious emergencies while in the

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1 Jail in the month following his ileostomy reversal surgery in December 13, 2012. In both

2 instances, Defendants’ emergency response placed Plaintiff HERNANDEZ’s life in

3 jeopardy. The discharge instructions from his surgery indicated that he should either call

4 the hospital or be taken to the emergency department if he had pain uncontrolled by pain

5 medication, bleeding, inability to urinate, a fever, vomiting, or if his wounds became red or

6 drained fluid. On December 22, 2012, his first day back in the Jail, he saw a nurse in the

7 early afternoon and complained of extreme pain in his abdomen near the site of his

8 surgery. Instead of immediately returning him to the hospital, the nurse called a PA, who

9 ordered Tylenol, Milk of Magnesium, and Colace, and instructed that she should be called

10 if his condition worsened. By 2:15 P.M., his condition had worsened. The nurse paged

11 the PA, but did not send Plaintiff HERNANDEZ to the emergency department. When the

12 PA did not respond, the nurse paged her again at 3:15 P.M.; still, the nurse did not send

13 Plaintiff HERNANDEZ to the emergency department, even though his symptoms persisted

14 and had possibly worsened. Finally, at 3:50 P.M., one of the Jail doctors called and

15 ordered that he should be sent to the hospital. Ultimately, Plaintiff HERNANDEZ was

16 transported to Natividad, where he remained for eight days to treat a bowel obstruction.

17 The December 30, 2012 discharge note from the hospital stated that he should be returned

18 to the emergency room if he had a fever, increased pain, vomiting, inability to have a

19 bowel movement, or for any other problem.

20

139. On January 7, 2013, Plaintiff HERNANDEZ complained early in the

21 morning to a nurse that he had a fever, that he woke up in a sweat, that he had diarrhea,

22 that he was experiencing nausea, and that he had vomited one time. Rather than sending

23 Plaintiff HERNANDEZ to the emergency department, the nurse ordered that he be

24 provided Imodium and Phenergan and be evaluated by the PA later that day. Plaintiff

25 HERNANDEZ was never seen by the PA that day. When he saw a nurse at 6:00 P.M. to

26 change his dressing, he told her that he felt like he had a fever. She measured his

27 temperature, which was 101.0 degrees. The nurse did not contact a doctor or the PA or

28 send Plaintiff HERNANDEZ to the emergency department. Instead, she entered an order

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1 to provide him with Tylenol, have his temperature checked regularly for a day, and set him

2 up to be seen by the PA the next day.

3

140. That night, at about 1 A.M., Plaintiff HERNANDEZ started experiencing

4 unbearable pain in his abdomen, which he describes as the worst pain of his life. At the

5 time, he was single-celled in J-Pod. He collapsed on his bunk and could not move. He

6 pleaded with another prisoner to get the attention of staff, but there was no custody staff

7 around for the prisoner to notify for about 15 minutes. Staff finally made their rounds of

8 the pods and the prisoner spoke with the staff. Without entering the pod or looking at

9 Plaintiff HERNANDEZ, the officer stated that medical staff wouldn’t be able to come for

10 30 minutes. The other prisoner said “But he’s already been down for 15 minutes.” The

11 officer said, “I’ll see what I can do.” About a half hour passed and the same officer passed

12 by J-Pod to conduct a regular check. The same prisoner banged on his door to get the

13 guard’s attention. The prisoner said that Plaintiff HERNANDEZ still hadn’t been seen by

14 medical staff. The guard then entered the pod for the first time and observed Plaintiff

15 HERNANDEZ. He said “I’ll be right back, let me get a hold of my Sergeant.” He then

16 left the pod. Another 10-15 minutes passed and still no medical staff came to see Plaintiff

17 HERNANDEZ. Other prisoners started banging on their doors and yelling “Man down!”

18 to try to get staff attention. Finally, medical staff finally arrived at around 2:50 A.M. on

19 January 8, 2013. Plaintiff HERNANDEZ was transported to Natividad at 3:00 A.M., and

20 remained in the hospital for treatment of multiple abscesses until February 27, 2013.

21

141. Plaintiff DOBBS sustained a fractured nose, a permanent post-traumatic

22 tremor in her right hand from mild traumatic brain injury, and nerve damage, pain, and

23 numbness in her left leg, knee, and ankle when she fell at the courthouse while shackled at

24 the ankles, waist, and wrist. In addition to the permanent damage, she also suffered two

25 black eyes and bruises on her elbows, knees, and ankles. Plaintiff DOBBS did not receive

26 timely medical attention, proper pain medication, or proper follow-up tests after the

27 incident despite the serious nature of the fall. For example, although she was given an ice

28 pack and one dose of pain medication immediately after the incident, she did not see a

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1 nurse until later that night despite being in severe pain. When Plaintiff DOBBS did see the

2 nurse, the nurse simply gave her an ibuprofen prescription and recommended she go to

3 sick call three days later with the PA. In fact, Plaintiff DOBBS had fractured her nose.

4 The injury was not diagnosed for more than a week. She also experienced the onset of a

5 tremor in her right hand, but was not taken to see a specialist for more than a month. This

6 specialist concluded she had a post-traumatic tremor from a mild traumatic brain injury

7 sustained from her fall. Medical staff should have, but did not, recognize the seriousness

8 of her injuries when they occurred and provided more timely and appropriate treatment.

9

142. In emergency situations, prisoners sometimes request health care from

10 custody staff when medical staff are not available. Rather than immediately contact health

11 care staff to determine whether emergency care is required, custody staff often dismiss the

12 prisoner’s request and instruct prisoners to fill out a sick call slip. Plaintiff

13 HERNANDEZ’s experience, discussed above, in which it took approximately 60 minutes

14 for custody staff to summon emergency medical care, is one example of this problem.

15

143. Upon information and belief, another prisoner in the Jail suffered a

16 miscarriage due to the Jail’s failure to timely respond to her emergency medical situation.

17 While pregnant, this prisoner began to experience uterine cramping and bleeding, but was

18 informed by medical staff to go on bed rest. The Jail staff did not transport her to a

19 hospital until at least two days later, and by that time she had lost her baby. Between

20 2012-2013, at least two women in the Jail suffered from miscarriages.

21

144. Often there is neither custody nor medical staff around. Prisoners are thus

22 forced to provide needed care to each other. For example, Plaintiff ESQUIVEL started

23 bleeding profusely from his leg wound in October 2013. As there were no custody staff

24 nor medical staff in the area, other prisoners had to actively seek a guard’s attention before

25 any custody staff recognized the existence of an emergency. This delayed care for

26 Plaintiff ESQUIVEL’s leg considerably. As another example, Plaintiff WHITFIELD has

27 collapsed in a cataplexic episode four times thus far during his incarceration. Twice, no

28 one woke him up and he woke up on the floor by himself. The third time, other prisoners

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1 saw him collapse and banged on their doors to alert the guards. The fourth time, he was

2 awoken on the floor by medical staff coming by to bring him his medication. These staff

3 members did nothing to respond to him being on the floor but merely asked if he was

4 ready to take his medication.

5

I. Defendants Fail to Provide Adequate Diagnostic Care to Prisoners,

Including Failing to Appropriately Refer Prisoners to Outside

6

Specialists When Necessary

7

145. Upon information and belief, Defendants fail to order diagnostic testing

8 when medically necessary, creating an unreasonable risk of harm to prisoners.

9 Defendants’ policies and practices for ordering diagnostic testing are inadequate. Upon

10 information and belief, Defendants fail to adequately train medical staff in when it is

11 appropriate to order diagnostic testing.

12

146. When Plaintiff COBB reported unusually cloudy and discolored urine and

13 increasing pain over a period of nearly six weeks, CFMG personnel evidently performed

14 no diagnostic tests other than taking urine samples, which yielded inconsistent results and

15 failed to lead to a diagnosis of Plaintiff COBB’s large kidney stones. No ultrasound was

16 performed until Plaintiff COBB was taken by ambulance to Natividad Medical Center on

17 June 1, 2013.

18

147. In September 2013, an outside neurologist treating Plaintiff DILLEY for her

19 likely diagnosis of MS ordered that Plaintiff DILLEY receive a full neuropsychiatric

20 assessment to evaluate her cognitive function. To date, Defendants have not provided

21 Plaintiff DILLEY with a full neuropsychiatric assessment.

22

148. When Plaintiff KEY reported to a PA at the Jail that he had previously been

23 treated for a salivary gland tumor and was experiencing a recurrence of that tumor, no

24 appropriate diagnostic tests were performed. Rather, the PA told him, on the basis of no

25 testing, that it was a fatty tumor and did not require further treatment. Plaintiff KEY was

26 only seen by a doctor for proper evaluation of his complaint after he filed a grievance.

27

149. When Plaintiff SARABI sustained an injury to his right ankle/foot after he

28 was attacked by another prisoner, he did not timely receive tests to determine the extent of

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1 the muscle and nerve damage. Other prisoners do not receive medically indicated

2 diagnostic tests such as colonoscopies or ultrasounds in a timely manner.

3

150. Defendants also fail to refer prisoners to medical specialists or to an outside

4 medical center when medically necessary. Defendants’ policies and practices for referring

5 prisoners to specialists or outside providers are inadequate. Upon information and belief,

6 Defendants fail to adequately train medical staff regarding when it is appropriate to refer

7 prisoners to medical specialists or outside medical centers.

8

151. For example, Plaintiff GUYOT suffered a concussion when he was attacked

9 by a group of other prisoners on March 15, 2013. On March 31, 2013, he filed the first of

10 approximately 26 sick call slips in which he has complained of blurred vision, severe

11 migraines, dizziness, and/or sensitivity to light. He was not sent for a CT scan until

12 May 16, 2013 (by which time he had filed approximately seven sick call slips with similar

13 complaints of post-concussion trauma), and was not seen by a neurologist until June 7,

14 2013. Since June 7, 2013, he has filed approximately 17 sick call slips continuing to report

15 serious vision and neurologic issues, but on information and belief, he has not been seen

16 by any other specialists.

17

152. Plaintiff COBB suffered a delay of more than two weeks between her

18 diagnosis, at Natividad Medical Center, of severe kidney stones and her first follow up

19 visit with an outside medical provider. This delay was in part due to the Defendant’s

20 failure to promptly ensure that the first provider to whom Plaintiff COBB was referred

21 would accept prisoner patients, which resulted in the belated cancellation of an

22 appointment and a delayed effort to find a willing provider. After Plaintiff COBB had a

23 surgical drain inserted into her kidney, she then went more than six weeks without again

24 seeing a specialist or having surgery to remove her kidney stones.

25

153. As is discussed above in Paragraph 114, in October 2013, outside medical

26 specialists first instructed that Plaintiff PEREZ be seen by an expert in orthopedic

27 oncology at a tertiary facility to evaluate a possibly-cancerous tumor on his foot. Upon

28 information and belief, he still has not been seen by an orthopedic oncologist.

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1

154. Plaintiff MILLER began to complain of extremely painful involuntary hand

2 contractions in mid-April 2013. Defendants did not arrange for a necessary hand operation

3 to occur until July 27, 2013, leaving Plaintiff MILLER in excruciating pain and with

4 limited use of his hand for more than two months. Plaintiff MILLER also began to

5 complain of blurred vision by February 27, 2013. Although vision loss is a common and

6 well-known complication of diabetes, Plaintiff MILLER did not see an ophthalmologist

7 until April 17, 2013, did not have a follow-up appointment until May 11, 2013, and did not

8 have a final ophthalmology appointment until July 24, 2013. Despite the long delays

9 between specialist visits, Jail medical staff deferred eye examinations during Plaintiff

10 MILLER’s check-ups on the grounds that he was under an ophthalmologist’s care.

11

155. Upon information and belief, another prisoner in the Jail suffered a

12 miscarriage due to the Jail’s failure to timely take her to a hospital after this prisoner

13 reports uterine cramping and bleeding. Defendants did not order any diagnostic testing or

14 take her to see a specialist. Two days later she was transferred to the hospital, and by that

15 time she had lost her baby.

16

J. Defendants Fail to Provide Adequate Post-Operative and Other

Medically Necessary Follow-Up Care to Prisoners

17

18

156. Defendants fail to adequately treat prisoners discharged from the hospital or

19 Jail infirmary. Defendants’ policies and practices for treating prisoners discharged from

20 the hospital or infirmary are inadequate. Upon information and belief, Defendants fail to

21 adequately train employees regarding how to appropriately and effectively treat prisoners

22 discharged from the hospital or infirmary.

23

157. For example, Plaintiff HERNANDEZ received colostomy reversal surgery in

24 December 2012, and had to return to the hospital one day after surgery due to post-

25 operative complications. Since his discharge from Natividad Medical Center, Plaintiff

26 HERNANDEZ has received inadequate care from CFMG medical staff. Specifically,

27 Plaintiff HERNANDEZ’s gauze at the surgery site was not changed every 24 hours as is

28 ordered, he did not receive his prescribed narcotics, and, when he experienced fever and

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1 severe pain, Jail staff failed to contact staff at the Natividad Medical Center (as they had

2 been instructed to do in the discharge summary).

3

158. Another prisoner suffered a ruptured colon and had to undergo colostomy

4 surgery in August 2012. After he was discharged from the Jail infirmary following the

5 surgery, Defendants failed to timely provide him with supplies to change his colostomy

6 bag, and when such supplies were provided, they were often improper (e.g., the wrong size

7 colostomy bag). In November 2012, because of the improper post-operative treatment and

8 maintenance of the colostomy and Defendants’ refusal to authorize a colostomy reversal

9 procedure, an infection developed around his stoma from the colostomy surgery and the

10 prisoner suffered from bloody discharge from his colon.

11

159. Plaintiff DOBBS suffers from Right Carpal Tunnel syndrome which may

12 have been exacerbated by her fall at the courthouse in November 2012. Although her

13 outside neurologist recommended a hard wrist splint over a year ago, and Jail medical staff

14 orders her such a wrist splint seven months ago, she has still yet to receive the splint.

15 Without the splint Plaintiff DOBBS continues to experience pain, numbness, and tingling

16 in her right wrist and hand which keeps her up at night. In lieu of the wrist splint, Plaintiff

17 DOBBS has been given an ACE bandage wrap, which is not effective. Plaintiff DOBBS

18 has also had the ACE wrap taken twice in raids on her pod after which time it has taken

19 her two weeks to a month to get the bandage back.

20

160. Plaintiff COBB was diagnosed with large kidney stones at Natividad

21 Medical Center on June 1, 2013, and had a surgical drain inserted into her kidney on

22 June 26, 2013. In the four weeks between her diagnosis and the insertion of the drain,

23 Defendants failed to consistently provide her with the pain medications that she had been

24 prescribed at Natividad. When she returned to the Jail after her June 26, 2013 surgery, she

25 experienced several weeks of increasing pain, nightly fevers, and distress due to

26 Defendants’ failure to consistently provide her with prescribed post-operative pain

27 medications.

28

161. Another prisoner had major spinal surgery shortly before she re-entered the

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1 Jail on June 15, 2013. CFMG medical personnel made no arrangements to ensure

2 continuity of post-operative care either within the Jail or by this prisoner’s outside treating

3 physicians. Although a CFMG physician noted on June 28, 2013, that post-operation

4 appointments with her treating physician would be approved, the prisoner was required to

5 submit multiple requests for temporary release in order to attend scheduled appointments

6 with her treating physicians, none of which were approved by Jail staff until July 26, 2013,

7 nearly six weeks after she returned to the Jail.

8

162. Plaintiff MILLER had surgery on his hand for diabetes-related complications

9 on June 27, 2013. Following the surgery, Defendants failed to consistently provide

10 Plaintiff MILLER with timely and appropriate pain medications. As a result, he has

11 suffered severe and unnecessary pain and has had limited use of his hand.

12

163. Plaintiff AGUILAR had to receive surgery while in custody to fix the

13 fractured cheekbone he suffered after he was attacked by another inmate. He was returned

14 to the Jail the same morning as his surgery. Once back in the Jail, he did not receive

15 adequate follow-up care. Despite orders from both the outside doctor and Jail medical

16 staff that Plaintiff AGUILAR was to be on a soft diet, he did not receive the proper diet.

17 Despite filing numerous sick call slips and two grievances about the diet, Plaintiff

18 AGUILAR went nearly two weeks without medically appropriate food to eat. During this

19 time Plaintiff AGUILAR lost significant weight, constantly felt dizzy, could not

20 concentrate, and often lacked the energy to do anything other than lay on his bed.

21

164. In addition, Plaintiff AGUILAR experienced problems receiving prescribed

22 pain medication after his surgery. Despite orders from Jail medical staff that he was to

23 receive Norco for 10 days, the medication stopped after the first five days, requiring him to

24 fill out a sick call slip and a grievance in order to be seen by a doctor and get back on the

25 medication. During the time Plaintiff AGUILAR was without Norco, his pain spiked to

26 nine out of 10 and it was back to nearly the same amount of pain as right after the injury

27 had occurred. He had stitches on both the inside of his and the outside of his face, which

28 gave him sharp stabs of pain in addition to the throbbing pain where the fracture had

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1 occurred.

2

165. Upon information and belief, Defendants routinely release prisoners with

3 serious medical conditions from the Jail without providing them with services to ensure

4 that their medical care is not disrupted. Defendants’ policies and practices for the

5 provision of continuing medical care services upon a prisoner’s release are inadequate.

6 Upon information and belief, Defendants fail to adequately train custody and medical staff

7 regarding how to appropriately release prisoners with serious medical concerns so that

8 such prisoners can continue their medical care. Upon information and belief, for those

9 prisoners who are prescribed medications in the Jail, they are released without either a

10 supply of or a prescription for them to fill those medications at a community pharmacy.

11 Defendants do not schedule follow-up appointments in the community, nor are prisoners

12 provided with sufficient referrals or information about where they may receive medical

13 care services or medications.

14

K. Defendants Fail to Maintain Adequate, Accurate, and Complete Medical

Care Records

15

16

166. Upon information and belief, Defendants fail to maintain adequate, accurate,

17 and complete medical care records. Defendants’ policies and practices for maintaining

18 adequate accurate and complete medical care records are inadequate. Upon information

19 and belief, Defendants fail to adequately train medical staff in how to maintain adequate

20 medical care records.

21

167. For example, physicians change prisoners’ medications without documenting

22 a rationale.

23

168. Many of the medical files for Plaintiffs are incomplete. For example, some

24 are missing progress notes that were dictated but never placed in the medical file.

25

169. As a result of Defendants’ failure to maintain adequate medical care records,

26 prisoners suffer from a substantial risk of misdiagnosis, dangerous mistakes, and

27 unnecessary delays in care.

28

170. For example, Plaintiff MEFFORD was denied his prescribed inhaler for a

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1 few days because a nurse did not find the order prescribing it in his records. Another nurse

2 was able to find the order a few days later.

3

171. Defendants do not appear to have any policy, procedure, or practice for

4 tracking, recording, or storing sick call slips in prisoners’ medical files. Rather, the sick

5 call slips appear to be stored in a loose and disorganized stack of slips of paper.

6

172. On information and belief, prisoners’ medical files do not contain any log of

7 sick call slips submitted, what complaints were raised in the sick call slips, and whether or

8 when the prisoner was seen with regard to the complaint raised. As a result, prisoners’

9 medical records do not contain a complete record of the condition of the prisoner or the

10 care he or she has been provided, which compromises the adequacy of care that prisoners

11 receives.

12

173. Upon information and belief, Defendants fail to obtain medical files from

13 outside providers for significant periods of time after the prisoner’s arrival at the Jail (if at

14 all). When prisoners who arrive at the Jail inform CFMG employees that they suffer from

15 a condition or take certain prescription medications, medical providers often indicate in

16 progress notes that they will not provide the prisoner with the requested care until they can

17 confirm the condition or prescription medication through outside medical or pharmacy

18 records. Defendants routinely fail to request and obtain outside records in a timely manner

19 or at all. Nonetheless, Defendants use their lack of possession of outside medical records

20 as a justification for denying prisoners the care they were receiving outside of the Jail and

21 are requesting inside the Jail. Defendants’ repeated failures to timely obtain medical

22 records from outside providers or pharmacies reduce the quality of medical care, as

23 medical staff treat prisoners without reviewing pertinent medication background

24 information and history, and significantly increase the risk of misdiagnosis, mistreatment,

25 and harm.

26

174. Plaintiff HERNANDEZ’s medical file does not include any progress notes or

27 discharge summaries for either his December 13, 2012 surgery to reverse his ileostomy or

28 for his seven-week hospitalization for abscesses in his abdomen.

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1

175. Plaintiff AGUILAR was prescribed Vicodin by an outside doctor to help

2 manage his pain prior to surgery for his fractured cheek bone. He was placed back in

3 custody prior to the surgery. Although he informed medical staff of his pain medication,

4 medical staff said they would not give it to him because they had to verify his prescription.

5 Defendants never provided him with the medication.

6

176. Plaintiff AGUILAR’s file is missing complete outside medical records from

7 the doctor’s office who performed surgery to repair the fracture in his cheek. The Jail

8 medical file does not contain progress notes of Plaintiff AGUILAR’s February 13 and 15,

9 2013 appointments in which he was initially examined, given post-operative instructions,

10 and scheduled for surgery.

11

177. Defendants also fail to provide complete and accurate medical records

12 regarding treatment within the Jail to outside providers to whom prisoners are sent for

13 specialty care. For example, one prisoner was sent to an orthopedic specialist for follow-

14 up care for his severe dog bite. That specialist noted: “It is unclear at this point if he is on

15 any medications. I do not have any records from the jail.” Defendants’ failure to ensure

16 that outside providers have access to jail medical records subjects prisoners to

17 unreasonable risks of harm, including, but not limited to, risks of fatal drug interactions.

18

178. MONTEREY COUNTY has contracted with the County of Alameda to

19 house certain Monterey County Jail prisoners in Alameda County’s Santa Rita Jail

20 Facility. According to the terms of the contract between the counties, prisoners remain in

21 the legal custody of MONTEREY COUNTY and may be returned to Monterey County Jail

22 at any time. In addition, the agreement may be cancelled upon 30 days’ notice of either

23 party, which would result in the return of all prisoners to the Monterey County Jail. Under

24 the contract between the counties, MONTEREY COUNTY retains the right to pre-approve

25 outside medical care for prisoners it sends to Alameda County, and has contractual

26 obligations to provide the medical records of Monterey County Jail prisoners to Alameda

27 County. Dozens of Monterey County Jail prisoners have been sent to Alameda County

28 pursuant to the contract between the counties, including Plaintiff GREIM. As described

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1 above, however, they are subject to return to the Jail and its unconstitutional conditions at

2 any time.

3

179. Upon information and belief, Defendants have not ensured that the medical

4 and medication records of prisoners who are sent to Alameda County accompany those

5 prisoners to Alameda County or follow in a timely manner. As a result, Monterey County

6 prisoners, including Plaintiff GREIM, have experienced interruptions in care and delays in

7 receiving necessary medications when transferred to the physical custody of Alameda

8 County.

9

L. Defendants Fail to Adequately Train Staff to Provide Appropriate and

Timely Medical Care

10

11

180. Upon information and belief, Defendants fail to adequately train custody and

12 medical staff in how to provide appropriate and timely medical care. The lack of training

13 is evident from the numerous incidents in which prisoners’ health and lives were placed at

14 risk as a result of the deficient medical care provided in the Jail. As a result of a lack of

15 adequate training, custody and health care staff do not, among other failings: timely and

16 appropriately identify medical and dental problems during the screening and intake

17 process, properly process and timely respond to prisoners’ requests for medical evaluation,

18 evaluate and treat prisoners who were undergoing care for chronic or serious conditions

19 prior to being booked into the Jail, appropriately respond to emergency medical situations

20 and requests for emergency medical treatment from prisoners, timely order appropriate

21 diagnostic testing, timely refer prisoners to appropriate medical specialists or outside

22 medical centers, appropriately and effectively treat prisoners discharged from the hospital

23 or infirmary, appropriately release prisoners with serious medical concerns so that such

24 prisoners can continue their medical care, and maintain adequate medical care records.

25 III. DEFENDANTS FAIL TO PROVIDE MINIMALLY ADEQUATE MENTAL HEALTH CARE TO PRISONERS
26

27

181. Defendants MONTEREY COUNTY, MONTEREY COUNTY SHERIFF’S

28 OFFICE, and CFMG are not meeting their constitutional obligation to provide adequate

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1 mental health care to prisoners in the Jail. The mental health care provided by Defendants

2 to prisoners in the Jail is woefully inadequate and falls far short of all of the minimum

3 elements of a constitutional mental health system. Defendants are deliberately indifferent

4 to the fact that their failure to provide adequate mental health care subjects prisoners to a

5 substantial risk of deteriorating psychiatric conditions, extreme and unnecessary anguish

6 and suffering, and, in some cases, even death.

7

182. All mental health care in the Jail, like medical care, is provided by Defendant

8 CFMG and its employees. CFMG provides these services pursuant to its contract with

9 Defendants MONTEREY COUNTY and the SHERIFF’S OFFICE. CFMG is a for-profit

10 corporation.

11

183. Prisoners are entirely dependent on Defendants for all mental health care.

12 Defendants provide and control all mental health care services. Accordingly, prisoners

13 cannot receive any mental health care services—including psychotropic medication, group

14 and individual therapy, and suicide intervention—unless Defendants provide them.

15 Defendants control prisoners’ access to mental health care professionals, inside or outside

16 of the Jail, as well as their access to laboratory or other diagnostic testing.

17

A. Defendants Fail to Identify and Track Prisoners in Need of Mental

Health Care

18

19

184. Defendants fail to adequately identify, track, and treat the mental health

20 problems of newly arriving prisoners during the screening and intake process. Defendants’

21 policies and practices for mental health screening and tracking are inadequate. Upon

22 information and belief, Defendants fail to adequately train custody staff regarding how to

23 timely and appropriately identify prisoners with mental health problems during the

24 screening and intake process. The first step of the intake process involves custody staff

25 completing a brief one-page general health screening form, called an Intake Health

26 Screening form, through a cursory interview conducted with the prisoner in a non-

27 confidential area of the Jail. The form itself fails to capture basic and essential data

28 necessary to identify prisoners in need of mental health care, including those at risk of self-

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1 harm. When a prisoner is newly booked into the Jail, mental health staff play no role in

2 the initial screening of the prisoner. As a result, prisoners in need of mental health care at

3 admission are either denied that care, or their care is delayed, causing them unnecessary

4 suffering.

5

185. After the custody staff complete the Intake Health Screening form, newly

6 booked prisoners are typically interviewed by a member of the medical staff employed by

7 CFMG. The medical staff member, typically a Licensed Vocational Nurse (“LVN”) or

8 other medical staff not trained in mental health and without ability to order treatments or

9 prescribe medications, complete a two-sided Intake Triage Assessment form. Mental

10 health staff play no role in this process. Mental health staff only evaluate prisoners at

11 intake if the medical care staff who complete the Intake Triage Assessment form refer the

12 prisoner to mental health care staff. Upon information and belief, intake evaluations by

13 mental health staff, when they occur at all, frequently do not take place until days or weeks

14 after a prisoner is booked into the Jail.

15

186. Defendants also fail to provide adequate treatment to prisoners who arrive at

16 the Jail and have been prescribed psychotropic medications. Defendants’ policies and

17 practices for prisoners who have been taking prescribed psychotropic medications are

18 inadequate. Upon information and belief, Defendants fail to adequately train mental health

19 staff regarding how to evaluate and treat prisoners who arrive at the Jail and have been

20 taking prescribed psychotropic medications. Defendants sometimes place prisoners who

21 arrive at the Jail and who are prescribed psychotropic medications on what Defendants call

22 a detoxification treatment. The detoxification treatment involves refusing, for up to 90

23 days, to provide prisoners with the psychotropic medications they were taking before they

24 were booked into the Jail. This practice of removing prisoners from prescribed

25 medications is dangerous, inhumane, and does not meet the standard of care. Prisoners

26 placed on the detoxification treatment and removed from psychotropic medications

27 experience unnecessary pain and increases in psychiatric symptoms including paranoia,

28 hallucinations, and suicidality. Such individuals are at increased risk of attempting to

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1 commit suicide. They are also at heightened risk of failing to respond to medications once

2 they are restarted.

3

187. Defendants fail to identify and initiate adequate mental health treatment via

4 the Jail’s intake process. As a result, prisoners arriving at the Jail with mental health needs

5 are at a significant risk of serious harm. For example, Plaintiff MURPHY was booked into

6 the Jail on January 18, 2013. Both his Intake Health Screening Form (completed by

7 custody staff) and his Intake Triage Assessment form (completed by medical staff of

8 CFMG) indicated that he self-reported mental health problems. Moreover, medical

9 records in CFMG’s possession from a prior term that Plaintiff MURPHY had spent in the

10 Jail indicated the Plaintiff MURPHY suffered from mental illness and had received

11 psychiatric medications. Despite this information, no mental health care staff met with

12 Plaintiff MURPHY until January 21, 2013, at which point he had an appointment with a

13 Licensed Psychiatric Technician who lacked authority to prescribe treatment or

14 medication. On January 21 and 22, Plaintiff MURPHY submitted sick call slips stating,

15 among other things, “need psych meds – seeing and hearing things” and “need psych meds

16 or psych hospital, Attn: head psych please.” On January 24, 2013, he submitted another

17 sick call slip, this one addressed to Dr. Fithian, stating “I take varies physch medication ...

18 for hearing voices and seeing demons coming out of the walls driving me crazy, can’t

19 sleep or eat right at all. Ive been trying to see a physch doctor, PLEASE help if possible.”

20 (Typographical errors and misspellings in original).

21

188. On another day on or around January 24, 2013, Plaintiff MURPHY

22 submitted another sick call slip stating that the staff were “placing my life in serious

23 danger and possible death after many attempts to receive my medications during and after

24 intake. I’m a disabled vet who served my country with honorable discharge and should not

25 be treated like trash over a officers attitude.” Despite these pleas for help, Plaintiff

26 MURPHY was not seen by mental health care staff with authority to prescribe treatment

27 until January 29, 2013. Plaintiff MURPHY was only seen by a psychiatrist on that day

28 because on January 28, 2013 he informed staff that he was hearing demonic voices that

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1 were telling him to kill himself. Consequently, Defendants placed Plaintiff MURPHY in a

2 rubber room, from which he was not released until January 30, 2013. Between the time

3 that Plaintiff MURPHY was booked in the Jail and January 29, 2013, when a psychiatrist

4 finally saw him and prescribed psychiatric medication, Plaintiff MURPHY was exposed to

5 an extraordinary risk of harm and suffered extreme, unnecessary pain and mental anguish.

6

189. Plaintiff HUNTER arrived at the Jail on March 16, 2013, with psychiatric

7 medications to treat her bipolar disorder, manic depression, anxiety, and panic attacks.

8 Plaintiff HUNTER also brought with her a hard copy of her medical history, which

9 documents the medications she requires. However, during the booking process, Plaintiff

10 HUNTER’s psychiatric medications were confiscated, and she did not receive any of her

11 needed psychiatric medications for at least three weeks, despite repeated requests and

12 grievances asking for the medications. She did not see any mental health care staff until

13 March 19, 2013, and did not see any staff with the authority to prescribe psychiatric

14 medications until March 21, 2013. As a result of not receiving appropriate attention from

15 mental health care staff, Plaintiff HUNTER ultimately did not begin to receive her

16 prescribed medications until three weeks after being booked into the Jail; during that

17 period, she suffered from unnecessary and avoidable pain and symptoms, including, but

18 not limited to, nightmares, anxiety, panic attacks, and hallucinations for this three-week

19 period.

20

190. Plaintiff GREIM was booked into the Jail on September 13, 2012. He

21 reported to custody staff that he had psychiatric problems, was bipolar, and took Remeron;

22 the custody officer recorded this information on Plaintiff GREIM’s Intake Health

23 Screening form. The following day, September 14, 2012, Plaintiff GREIM reported to

24 medical staff that he was bipolar and had been prescribed Remeron. Plaintiff GREIM was

25 not seen by any mental health care staff until September 17, 2012, even though during a

26 previous term in the Jail in August 2012 he had been placed in a rubber room because he

27 expressed suicidal thoughts to Jail staff. Even after seeing this staff member, he was not

28 provided with any medication for his serious mental health conditions. As a result of the

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1 lack of attention from mental health care staff during his booking into the Jail, Plaintiff

2 GREIM was placed at an unreasonable risk of deterioration in his mental health.

3

191. Plaintiff GIST has been subjected to the detoxification treatment at least

4 twice. Plaintiff GIST was booked into the Jail on March 15, 2012. She informed medical

5 and custody staff that she was taking a number of psychotropic medications, including

6 Risperidone, Fluoxetine, Benztropine, and Trazodone. Four days later, on March 19,

7 2012, her relatives brought those psychotropic medications to the Jail for her. That same

8 day, the Jail obtained pharmacy records that confirmed that she was prescribed the same

9 medications. On March 20, 2012, a psychologist at the Jail consulted with Dr. Fithian

10 about whether Plaintiff GIST should be provided with her prescription medication.

11 Dr. Fithian instructed that “due to history of alcoholism, … we should hold off medicating

12 her for now to allow her to detox from alcohol while in custody.” On March 27, Plaintiff

13 GIST was again seen by the psychologist. In a progress note, the psychologist wrote that

14 “[p]rior to seeing inmate, writer conferred with Dr. Fithian. It was agreed that she is to

15 remain medication free and clean and sober for 90 days.” Similarly, when Plaintiff GIST

16 was booked in the Jail in November 2012, despite Defendants’ knowledge of her mental

17 health conditions and medications, medical staff again denied her the prescribed

18 medications for 90 days. Upon information and belief, there was no clinical justification

19 for denying Plaintiff GIST psychotropic medications for 90 days because of a history of

20 alcohol abuse. Without her medications, Plaintiff GIST began experiencing auditory

21 hallucinations, talking to herself, feeling increased depression, and having trouble

22 organizing her thoughts, expressing herself, and focusing.

23

192. Plaintiff KEY has been subjected to the detoxification treatment on multiple

24 occasions, even though Defendants themselves have an extensive medical record

25 documenting his history of receiving psychotropic medications. Defendants appear unable

26 to review even their own files to determine whether psychiatric medications are indicated,

27 as one progress note for a psychiatric consult states in the same note that “Mr. Key … has

28 been seen in the past by Dr. Fithian [director of Defendant CFMG] and placed on

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1 trazodone” and also states that Plaintiff KEY “has no history of any psychiatric

2 medications.”

3

193. By custom and policy, there is poor coordination of care for prisoners with

4 mental health needs. Upon information and belief, neither medical nor corrections staff

5 appropriately refer to mental health staff prisoners who exhibit symptoms of mental illness

6 during encounters with medical and corrections staff. As a result, prisoners who exhibit

7 symptoms of mental illness are not timely treated. Upon information and belief, by custom

8 and policy, neither medical nor corrections staff is adequately trained to recognize signs

9 and symptoms of mental illness, and to refer to mental health staff prisoners exhibiting

10 such signs and symptoms. Upon information and belief, medical and mental health care

11 staff do not adequately coordinate their care of prisoners with co-existing medical and

12 mental health conditions.

13

194. Upon information and belief, Defendants do not maintain any central list,

14 electronic or otherwise, of prisoners with mental illness and the treatment they require.

15 Defendants do not maintain adequate information about prisoners’ mental health needs in

16 the prisoners’ custody and/or medical files. Moreover, upon information and belief, to the

17 extent that Defendants maintain information about a prisoner’s mental health needs in any

18 form, custody, medical, and clerical staff are not provided with access to the information in

19 a manner that would timely and effectively inform them of a prisoner’s mental health

20 concerns and treatment needs.

21

195. For example, one prisoner was noted to have “pressured speech” and a

22 “paranoid” presentation when he was booked into the Jail on July 17, 2013. During his

23 incarceration, this prisoner filed several grievances that demonstrated paranoid and

24 possibly delusional thinking, which received only cursory responses from custody staff.

25 This prisoner also had to be removed from at least one medical appointment due to

26 aggressive and abusive behavior. Nevertheless, a psychiatric consult note in the prisoner’s

27 filed dated August 9, 2013, states that he was on no psychiatric medications and that his

28 “mental status is perfectly clear.” This note does not appear to take into account any

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1 information about this prisoner’s mental state that is present elsewhere in his medical and

2 custody records.

3

196. One prisoner waited nearly three months after entering the Jail for an

4 appointment with the Jail’s psychiatrist even though she had a significant history of mental

5 health crises, including episodes of self-harm and suicidal ideation, during prior

6 incarcerations at the Jail. Although this prisoner had asked for medication at her first

7 screening appointment on the day after her arrival, Dr. Fithian denied her medication when

8 he saw her three months after her arrival because she was pregnant and without evident

9 regard for the severity of this prisoner’s mental health symptoms. Upon information and

10 belief, no effort was made to consult with this prisoner’s obstetrician to determine whether

11 any appropriate psychotropic medications could be prescribed.

12

197. Plaintiff WHITFIELD, who was forced to spend almost all of his time in bed

13 for the first two months of his incarceration after the Jail failed to provide him with

14 Provigil to treat his narcolepsy, requested treatment for depression and anxiety via sick call

15 slips submitted on January 26 and 27, 2014. Plaintiff WHITFIELD has previously been

16 treated—both inside and outside the Jail—for depression and has attempted suicide in the

17 past. Spending upwards of 20 hours a day in bed had a deleterious effect on Plaintiff

18 WHITFIELD’s mental health, but upon information and belief, medical and mental health

19 care staff failed to coordinate their care of Plaintiff WHITFIELD to ensure that his co-

20 existing medical and mental health conditions were adequately treated. A psychiatrist

21 came to see him, but only to inform him that the Jail would do nothing to treat his

22 depression or anxiety.

23

198. Upon information and belief, Defendants fail to adequately train mental

24 health staff in how to track and monitor prisoners with mental illness and the treatment

25 they require.

26

B. Defendants Fail to Ensure That Prisoners Raising Mental Health

Complaints Are Timely Seen and Adequately Treated

27

28

199. As discussed in Section II.E, the sick call process does not provide prisoners

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1 with a timely and effective means for requesting medical care. Prisoners must use the

2 same inadequate sick call process to request mental health care services, and are thus

3 placed at risk of harm. Upon information and belief, Defendants fail to ensure that

4 requests for mental health care reach mental health care staff in a timely manner, if at all.

5 Upon information and belief, there is no policy in place to ensure that requests for mental

6 health care are forwarded to mental health care staff. As a result, prisoners with serious

7 mental health complaints are not timely seen or adequately treated.

8

C. Defendants Fail to Timely Identify, Adequately Treat, or Effectively

Track and Supervise Prisoners at Risk for Suicide

9

10

200. Defendants fail to identify, treat, track, and supervise prisoners who are at

11 risk for suicide. Defendants’ policies and practices for screening, supervising, and treating

12 prisoners at risk for suicide are inadequate. These shortcomings in the suicide prevention

13 and treatment program have had tragic consequences. Over the past four years, there have

14 been three completed and more than a dozen attempted suicides. The rate of completed

15 suicides at the Jail is nearly twice the national average for jail facilities.

16

201. The very design of the Jail itself presents a risk to suicidal prisoners. As

17 noted in the 2011 Jail Needs Assessment, “The older design of the cells and dormitories

18 constructed prior to 1993 does not meet today’s minimum standards for detention

19 facilities. Examples include: Suicide hazard elimination is not as stringent as it should be

20 to prevent self-harm and the attendant liability.” 2011 Assessment at Ex. 3.

21

202. Upon information and belief, Defendants do not adequately train custody

22 staff to identify prisoners who are at risk of suicide and respond adequately to prisoners

23 who are exhibiting suicidal tendencies. This is especially problematic because custody

24 staff, both during the intake process and for the duration of a prisoner’s time in the Jail,

25 have the primary responsibility for alerting mental health staff when a prisoner is suicidal.

26

203. Defendants routinely fail to identify and track prisoners who are at risk for

27 suicide. For example, a prisoner named Joshua Claypole was suicidal when he arrived at

28 the Jail on May 1, 2013, and his attorney asked Jail staff to place Mr. Claypole on suicide

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1 watch on the day of his arrest. Mr. Claypole was initially placed on suicide watch, but was

2 soon taken off and cleared to go into the Jail’s general population. He was then housed in

3 a single cell, and, upon information and belief, did not receive any increased monitoring or

4 effective treatment. On May 4, 2013, Mr. Claypole attempted suicide by hanging in his

5 cell, and was air-lifted to a San Jose hospital where he was placed on life support. Five

6 days later, he was taken off life support and died.

7

204. A prisoner named Daniel Lariviere committed suicide on July 8, 2011. Upon

8 his arrest, he was initially placed in a rubber room, but after a few hours he was released to

9 a booking cell without having been evaluated by any mental health care staff.

10 Mr. Lariviere informed custody and medical staff during the intake process that he had

11 serious mental health issues, was having auditory hallucinations, and had been released

12 from a psychiatric hospital just four days earlier. Despite these numerous indicia of

13 suicide risk, Defendants decided to house Mr. Lariviere in an administrative segregation

14 unit. The conditions in this segregation unit place prisoners at increased risk of suicide.

15 Defendants also did not schedule Mr. Lariviere to see any mental health care staff at the

16 Jail until three days after his booking. On the morning of the day he was supposed to be

17 seen by mental health care staff, Mr. Lariviere committed suicide by hanging in his cell.

18

205. Another prisoner had attempted suicide at least twice before his incarceration

19 and spent 6-8 months at Atascadero State Hospital, a state inpatient psychiatric hospital,

20 before coming to the Jail. Despite this prisoner’s attempted suicide and mental health

21 history, about which Defendants were well aware, the Jail failed to identify him as at risk

22 for suicide and failed to take steps to safely house, track, and treat him to reduce the risk of

23 suicide. This prisoner attempted suicide by jumping off the second floor of the housing

24 pod, and had to be airlifted to Santa Clara Hospital, where he was treated for trauma to his

25 head and broken ribs.

26

206. Defendants routinely house suicidal and seriously mentally ill prisoners in

27 conditions that result in further deterioration of their mental health, that violate notions of

28 minimally adequate mental health care and basic human dignity, and that are incompatible

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1 with civilized standards of humanity and decency. Defendants’ policies and practices for

2 housing suicidal prisoners are inadequate. Rather than individually determining the most

3 integrated environment in which a suicidal prisoner can be safely housed, Defendants have

4 a policy and practice of placing prisoners with serious mental health concerns in the

5 “rubber rooms.” The rubber rooms are single cells with no furnishings, toilets, or (in most

6 cases) windows for outside light. The only features of the cell are the door, which has a

7 slot through which food can be delivered, and a grate in the floor that serves as the toilet

8 for feces and urine. When housing a prisoner in a rubber room, Defendants routinely

9 remove all of the prisoner’s clothing, leaving the prisoner naked in the room. In some

10 instances, Defendants permit a prisoner to have a tear-proof smock for clothing and

11 nothing else. There is no mattress or pad, let alone a bed, in any of the rubber rooms for

12 prisoners to sit or sleep on. Prisoners are thus forced to sit, sleep, and eat on the same

13 cold, dirty floor in which the grate for the toilet is located. Upon information and belief,

14 when prisoners act out in rubber rooms, Jail staff place them in restraints, including in

15 restraint chairs. However, upon information and belief, Defendants fail to properly use

16 restraints on mentally ill prisoners or adequately monitor restrained prisoners. Defendants’

17 improper use of restraints and seclusion places seriously mentally ill prisoners at an

18 unreasonable risk of harm.

19

207. For example, in May 2012, a prisoner was placed in a rubber room because

20 he had been kicking his cell door, yelling and screaming. While serving the afternoon

21 meal, a deputy noticed the prisoner was bleeding from the head in his safety cell. While

22 removing the prisoner from the safety cell, the prisoner was placed in a safety chair which

23 was inoperative. As deputies moved him to an operative safety chair, the prisoner was

24 able to throw himself to the ground head first, and had to be transported to the emergency

25 room.

26

208. The rubber rooms are rarely cleaned when a prisoner is being housed in one

27 of the cells and are not cleaned sufficiently once a prisoner is released from the cell. The

28 walls and floor of the rubber rooms are soiled by feces because of the inadequate toilet and

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1 non-existent sink. These conditions are traumatic for all prisoners, but especially for those

2 who are already experiencing mental health symptoms. Voluminous psychiatric literature

3 spanning nearly two hundred years has documented the adverse mental health effects of

4 isolation, particularly on the mentally ill, and Monterey County Jail prisoners are no

5 exception. Moreover, suicidal prisoners may perceive the rubber rooms as a method of

6 punishment (as opposed to treatment), which may dissuade them from self-identifying as

7 suicidal.

8

209. Plaintiff MEFFORD has been placed on suicide watch and put in a rubber

9 room at least five separate times since entering the Jail after engaging in self-harming

10 behavior. Plaintiff MEFFORD was able to continue engaging in self-harming behavior

11 inside the rubber room, by banging his head repeatedly against the door until he was

12 bleeding. Custody staff’s only response to these episodes of self-mutilation has been to

13 place Plaintiff MEFFORD in a restraint chair. Plaintiff MEFFORD was able to free

14 himself from the restraint chair at least once, and began again hurting himself. Each time,

15 he has been placed in a rubber room for varying lengths of time. Custody staff has

16 routinely failed to conduct safety checks twice every thirty minutes as required by the

17 Jail’s own policies. The Jail has also failed to provide him with adequate food and water

18 during these periods of time.

19

210. Plaintiff MEFFORD has informed the Jail medical and custody staff

20 repeatedly that sensory deprivation and particularly a lack of light make his anxiety and

21 other psychiatric conditions much worse. He has also stated a reluctance to express his

22 true level of suicidality to staff because of fear of being placed in a rubber room. Despite

23 this, custody staff continues to place him in rubber rooms.

24

211. Defendants placed Plaintiff MURPHY in a rubber room at least five times

25 between January 2013 and October 31, 2013. When Plaintiff MURPHY was placed in a

26 rubber room, the conditions were horrific, with feces on the walls and floor of the room.

27 Defendants stripped Plaintiff MURPHY naked, provided him only with a safety smock,

28 and forced him to eat and sleep on the same floor where the toilet grate is located. In

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1 January 2013, during the more than 38 hours for which he was in the rubber room,

2 Defendants’ own documents show that they did not provide Plaintiff MURPHY a single

3 meal and only offered him water on three occasions.

4

212. Defendants exacerbate the psychological trauma experienced by seriously

5 mentally ill prisoners who are housed in rubber rooms by failing to provide them with

6 necessary mental health care. These prisoners do not receive sufficient contact with

7 mental health providers (if they receive mental health care at all). And, the harsh

8 conditions of their confinement render less effective the minimal treatment they do

9 receive. As a result, there is an unreasonable risk that their symptoms, including

10 suicidality, will escalate and Defendants may force them to stay in the rubber rooms even

11 longer.

12

213. For example, in January 2012, one prisoner woke up screaming from a

13 nightmare, and was sent to the rubber room. She was given a filthy blanket, and forced to

14 use a bathroom consisting of a grate in the floor as she was simultaneously vomiting green

15 bile. During her time in the rubber room, the mental health staff did not visit this prisoner

16 or provide her with any mental health treatment, aside from asking her if she was suicidal.

17 Upon information and belief, during the time she was in the rubber room, all of the

18 prisoner’s interactions with mental health care staff took place at the cell front door; none

19 of the interactions were face to face without barriers. While Defendants may consider

20 rubber rooms “safe” for suicidal and seriously mentally ill prisoners, in fact the rubber

21 rooms lack any therapeutic value, and certainly do not replace the need for psychiatric

22 hospitalization and treatment.

23

214. Defendants fail to sufficiently observe prisoners who have been identified as

24 being at risk of suicide, including prisoners who have been placed in rubber rooms.

25 Specifically, Defendants lack any policy or procedure for, and therefore fail to provide,

26 constant observation of prisoners who are actively suicidal, either threatening to or

27 engaging in the act of suicide.

28

215. Defendants fail to ensure by policy and practice that mental health care staff

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1 are consulted prior to placing a prisoner in a rubber room and before a prisoner is released

2 from a rubber room. Upon information and belief, by not adequately involving mental

3 health care staff in the decision to put prisoners in a rubber room, Defendants overuse the

4 rubber rooms and place prisoners who do not require exposure to the punitive conditions of

5 the rubber rooms to those conditions. Upon information and belief, by not adequately

6 involving mental health care staff in the decision to release prisoners from rubber rooms,

7 Defendants increase the risk that a prisoner who still requires enhanced monitoring will be

8 placed back into housing conditions where they are not monitored as closely and are more

9 able to engage in self-harm.

10

216. Defendants fail to adequately follow up with, monitor, and treat prisoners

11 who have been released from the rubber room. For example, Plaintiff MURPHY was

12 placed in a rubber room on February 11, 2013, at approximately 4 p.m. and was released at

13 5 a.m. the following day. No health care staff conducted any evaluation of Plaintiff

14 MURPHY’s physical or mental status until February 18, 2013. In fact, the psychiatric

15 progress note for his February 18, 2013 appointment with Dr. Fithian does not even

16 acknowledge that Plaintiff MURPHY had been placed in a rubber room. Another prisoner

17 was kept in the rubber room for five full days, and described feeling as though the walls

18 were closing in on him the entire time. After he was released from the rubber room, this

19 prisoner did not receive adequate follow-up to evaluate his mental health state and risk of

20 suicidality.

21

217. Defendants have knowledge of the substantial risk of harm caused by

22 inadequate suicide prevention and treatment policies and practices in the Jail, but have

23 failed to take steps to prevent, or even to diminish, the harmful effects of these unlawful

24 policies and practices. Defendants are thus deliberately indifferent to the risk of harm to

25 prisoners created by their failure to operate a constitutionally adequate suicide prevention

26 and treatment program.

27

28

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1

D. Defendants Lack Sufficient Facilities to Provide Adequate Mental

Health Care

2

3

218. The outdated facility and overcrowding at the Jail only exacerbate the

4 inadequate mental health conditions and treatment at the Jail. As the 2011 Jail Needs

5 Assessment found, “Medical/mental health treatment spaces are not adequate for the rated

6 beds, let alone the actual number of inmates held…. Overcrowding forces the entire

7 facility to operate as an indirect supervision facility. Mental health issues are considerably

8 more difficult to recognize, manage and treat in an indirect supervision facility.” 2011

9 Assessment at Ex. 3. The Assessment further noted the direct impact of overcrowding on

10 prisoners’ mental health conditions: “Overcrowding affects inmates’ mental and physical

11 health by increasing the level of uncertainty with which they regularly cope.” 2011

12 Assessment at Ex. 9. The lack of sufficient treatment space places prisoners at an

13 unreasonable risk of harm from inadequate mental health care. Inadequate mental health

14 offices and treatment spaces compromise the delivery of mental health care, and fail to

15 address the confidentiality and safety concerns that arise in delivery of such care.

16 Defendants have not sufficiently eliminated suicide hazards through the Jail.

17

219. Plaintiff MEFFORD, who has serious mental health conditions that require

18 significant and sustained psychiatric care, was seen by a psychiatrist at his cell in G-Pod.

19 Plaintiff MEFFORD was forced to share private and personal information about himself

20 and his condition publically through the tray slot in his cell door, while the psychiatrist

21 stayed in the public hallway, allowing any prisoner or custody staff member who might

22 have been close by to overhear their conversation.

23

220. Plaintiff AGUILAR suffers from depression and anxiety and has trouble

24 sleeping. In the Jail, he saw a psychiatrist who referred him to a therapist. The therapist

25 came to speak with Plaintiff AGUILAR, but in the presence of a custody officer and not in

26 a confidential treatment space. The therapist told Plaintiff AGUILAR to put in a sick call

27 slip to see her another time so they could talk alone. He put in a sick call slip to do so, but

28 was not seen in response to the sick call slip.

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1

E. Defendants’ Mental Health Treatment Program Involves Little More

than Segregation and Supervision

2

3

221. Defendants provide little to no individual or group treatment to prisoners

4 with mental health problems, even for prisoners who are acutely or chronically mentally

5 ill. Therapy in an individual or group setting is almost never offered or provided to

6 prisoners, regardless of whether prisoners were receiving therapy as a part of their

7 treatment for mental illness outside of the Jail.

8

222. For acutely and chronically mentally ill prisoners, the standard of care

9 includes, and they should be provided with, psychosocial rehabilitation services, which

10 include structured out-of-cell programming that addresses their symptoms of mental

11 illness, reduces their isolation, and promotes compliance with treatment and medications.

12 Without this care, seriously mentally ill prisoners are at an unreasonable risk of

13 decompensating and of not responding fully to the treatment they do receive. This

14 deterioration can take many damaging forms, including increased symptoms and non-

15 adherence to treatment. Defendants fail to provide adequate psychosocial rehabilitation

16 services to seriously mentally ill prisoners in need of this care.

17

223. Defendants house prisoners with some of the most serious mental health

18 problems in A and B Pods for men and in R and S pods for women. A, B, R, and S Pods

19 are administrative segregation units. Defendants offer group therapy to prisoners in these

20 pods once every other week for one hour. That amount of structured out of cell time falls

21 far below the standard of care, and thus places prisoners at substantial risk of serious harm.

22

224. Upon information and belief, Defendants fail to train staff regarding when

23 and how to provide therapy to prisoners with mental illness as a component of mental

24 health care.

25

225. Plaintiff MURPHY had been seeing an outside psychiatrist who provided

26 him with therapy, but the Jail failed to transport him to his April 2013 appointment with

27 his outside psychiatrist. On information and belief, he repeatedly missed appointments

28 with his outside psychiatrist due to errors on the part of Jail staff. Defendants informed

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1 Plaintiff MURPHY that the provider will no longer see him, but appear to have made no

2 attempt to provide Plaintiff MURPHY with therapy or to arrange that a different outside

3 psychiatrist provide Plaintiff MURPHY with therapy. As a result of the total lack of

4 therapy, at least as of October 31, 2013, Plaintiff MURPHY was not receiving adequate

5 mental health care.

6

226. Plaintiff HUNTER suffered from anxiety and panic attacks that were

7 exacerbated when she was in the overcrowded Jail environment, but she was denied

8 therapy sessions during her time at the Jail. Another prisoner, who had attempted suicide

9 twice prior to his arrival at the Jail and once while at the Jail in December 2012, did not

10 receive one-on-one therapy sessions, but rather only medications (provided by nurses to

11 the prisoner in his isolation cell).

12

F. Defendants Do Not Adequately Prescribe, Monitor, and Evaluate the

Provision of Psychotropic Medications

13

14

227. Defendants routinely fail to provide medically necessary psychotropic

15 medications to prisoners with psychiatric illnesses. Defendants’ policies and practices for

16 providing psychotropic medications to prisoners are inadequate. Upon information and

17 belief, Defendants fail to adequately train mental health staff in the proper administration

18 of psychotropic medications. Defendants fail to provide psychotropic medications even

19 when provided with valid prescriptions from the California Department of Mental Health,

20 community providers, or family members. Especially during the first 90 days of

21 incarceration, prisoners are at risk of being labeled by medical staff as drug seekers and

22 malingerers, and those labels are then used to deny needed medications.

23

228. Upon information and belief, Defendants fail to evaluate prisoners before

24 making treatment decisions, including whether to prescribe psychotropic medications.

25 Upon information and belief, Defendants fail to adequately train mental health staff

26 regarding how to appropriately evaluate prisoners before making mental health treatment

27 decisions.

28

229. As is discussed in Paragraph 187, supra, Plaintiff GIST has been denied

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1 access to her prescribed antipsychotics, antidepressants, and sleep aids for up to 90 days

2 when booked into the Jail. During these prolonged periods without her medication,

3 Plaintiff GIST’s mental health deteriorates. She hears voices, talks constantly to herself,

4 has trouble organizing her thoughts and expressing herself, gets easily distracted and

5 experiences depression. The back and forth of being on her medications on the outside and

6 then abruptly off them for a long period in custody is further damaging to her long-term

7 mental health and well-being.

8

230. Plaintiff KEY has experienced many different incarcerations at the Jail. He

9 has repeatedly been subjected to Defendants’ detoxification treatment during which he is

10 denied all medications for 90 days. One psychiatric progress note in Plaintiff KEY’s file

11 offers this rationale for denying Plaintiff KEY psychiatric medications upon which he has

12 depended for many years: “I was not going to put him on medication until he had been

13 clean and sober for a while.” After that initial 3-month period of denial, which each time

14 causes Plaintiff KEY to suffer auditory hallucinations, severe depression, and other serious

15 mental health problems, Defendants have repeatedly failed to provide Plaintiff KEY with

16 appropriate psychiatric medications—even with the same psychiatric medications that they

17 have previously provided him.

18

231. One pregnant prisoner was denied psychotropic medication because of her

19 pregnancy, with the notation made that she could discuss the issue with her obstetrician at

20 an appointment scheduled for a month after Defendants denied her medication.

21

232. As a result of Defendants’ failure to provide medically necessary

22 psychotropic medications, prisoners with mental illness suffer from the following:

23 (1) withdrawal symptoms when the medications they were prescribed before admission to

24 the Jail are abruptly terminated; (2) recurrence of debilitating symptoms such as

25 hallucinations and suicidality; and (3) in some cases, decompensation to the point of being

26 found incompetent to stand trial and/or being sent to the state hospital until they are stable

27 enough to return to the Jail. In addition, pursuant to what is known as the “kindling

28 phenomenon,” interruptions in prisoners’ psychotropic medications can cause a prisoners’

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1 underlying mental illness to worsen. This not only worsens the underlying condition, but

2 makes it more difficult to treat the underlying condition.

3

233. Upon information and belief, Defendants lack adequate policies and

4 practices for monitoring and treating the side effects or efficacy of psychotropic

5 medications and their effect upon prisoners with mental health issues. Upon information

6 and belief, Defendants also fail to order diagnostic tests necessary to measure the efficacy

7 of medications, as well as potential side and adverse effects, and fail to prescribe

8 medications to address potential side and adverse effects of psychotropic medications.

9 These adverse effects include extrapyramidal symptoms (EPS), which are involuntary and

10 often painful movements of the limbs and muscles, including tardive dyskinesia, a

11 potentially permanent disabling condition. Upon information and belief, Defendants fail to

12 track, monitor, and treat prisoners prescribed psychotropic medications for dangerous and

13 potentially fatal drug interactions.

14

234. For example, Plaintiff MURPHY is taking a number of psychiatric

15 medications to address his auditory and visual hallucinations. However, during his time in

16 the Jail, he has not received the correct dosages of the medications, and has continued to

17 see shadows and hear voices. The hallucinations have been so frequent and intense that he

18 was unable to sleep more than a few hours at night. Despite his repeated requests, mental

19 health staff did not adjust his dosages or otherwise follow up with him to evaluate the

20 efficacy of the medications.

21

235. Defendants have, without adequate justification, refused to provide Plaintiff

22 GIST with the same psychotropic medication regimen she was taking pursuant to

23 prescription immediately prior to her arrest. Plaintiff GIST’s medication regimen

24 consisted of four drugs. During her current term in the Jail, Defendants have only

25 provided her with two of the four drugs at any given time. As a result, she has experienced

26 auditory hallucinations, significant trouble sleeping, and mood instability.

27

236. Plaintiff MEFFORD has received a variety of medication during his

28 incarceration without effective follow up or measurement of its efficacy. Instead, mental

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1 health care staff have changed his prescriptions without seeing him and/or without

2 providing adequate clinical explanations for the change. Plaintiff MEFFORD has suffered,

3 and continues to suffer, from serious psychiatric conditions that remain undertreated and

4 under-evaluated.

5

237. Plaintiff MEFFORD has also at least twice complained about serious side

6 effects from his psychotropic medication. On February 24, 2014, Plaintiff MEFFORD

7 complained to a psychiatrist at the Jail that valporic acid—a drug prescribed for Plaintiff

8 MEFFORD in lieu of Depakote, which Plaintiff MEFFORD received in prison—was

9 upsetting his stomach sufficiently that he wished to try an alternative treatment. The

10 psychiatrist began providing Plaintiff MEFFORD with Tegretol. Tegretol caused Plaintiff

11 MEFFORD to experience blurred vision, confusion, headaches, as well as an upset

12 stomach. In response to Plaintiff MEFFORD’s report of these side effects, the psychiatrist

13 merely switched his medication back to valporic acid, instead of the better tolerated

14 Depakote.

15

238. Defendants also lack adequate policies and practices for ensuring the

16 continuity of administration of psychotropic medications for prisoners transferred to

17 Alameda County pursuant to the contract between MONTEREY COUNTY and Alameda

18 County, discussed in Paragraph 178, supra. After late-July 2013 when Plaintiff GREIM

19 was transferred to the physical custody of Alameda County, doctors there prescribed two

20 psychiatric medications to Plaintiff GREIM, which he received and took until he was

21 returned to Monterey County Jail on or around September 6, 2013. Plaintiff GREIM

22 received these two medications for the first three nights after he was returned to Monterey

23 County Jail. On or around September 9, 2013, he was seen by a female staff member of

24 Defendant CFMG who discontinued both of the medications. The staff member informed

25 Plaintiff GREIM that he would not receive any psychiatric medications because he had not

26 received medication when he was at Monterey County Jail before being transferred to

27 Alameda County. Plaintiff GREIM experienced increased depression, anxiety, anger, and

28 racing thoughts as a result of being removed from the medications he had been taking in

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1 Alameda County.

2

239. Upon information and belief, Defendants routinely release prisoners with

3 serious mental health conditions from the Jail without providing them with any services to

4 ensure that their mental health care is not disrupted. Defendants’ policies and practices for

5 the provision of continuing mental health care services upon a prisoner’s release are

6 inadequate. Upon information and belief, Defendants fail to adequately train custody and

7 mental health staff in how to appropriately release prisoners with serious mental health

8 concerns so that such prisoners can continue their mental health care. Upon information

9 and belief, for those prisoners who are prescribed psychiatric medications in the Jail, they

10 are released without either a supply of, or a prescription for them to fill, those medications

11 at a community pharmacy. Defendants do not schedule follow-up appointments in the

12 community, nor are prisoners provided with sufficient referrals or information about where

13 they may receive mental health care services or medications.

14

240. Upon information and belief, Defendants lack any comprehensive system for

15 monitoring the prescription, distribution, efficacy, and side effects of psychotropic

16 medication and for ensuring continuity of care for prisoners with mental illness before,

17 during, and after their incarceration at the Jail.

18

G. Defendants Fail to Transfer Prisoners to Facilities That Provide Higher

Levels of Mental Health Care When Necessary

19

20

241. Upon information and belief, Defendants routinely fail, when necessary, to

21 transfer prisoners who require inpatient care to outside facilities that provide such care.

22 Defendants’ policies and practices transferring prisoners to outside facilities that provide

23 inpatient care are inadequate. Upon information and belief, Defendants fail to adequately

24 train custody and mental health staff regarding how to, when necessary, transfer prisoners

25 to facilities that provide inpatient mental health care.

26

242. Prisoners in the Jail may require care at an inpatient facility in a variety of

27 circumstances, including, but not limited to, when they are in acute mental health crisis or

28 if they have been found mentally incompetent to stand trial. Upon information and belief,

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1 Monterey County Jail is not a facility licensed to provide inpatient mental health care

2 treatment to any individuals, and the Jail does not provide an inpatient level of care.

3

243. Upon information and belief, Defendants lack adequate policies and

4 procedures regarding when to transfer prisoners who require inpatient care to outside

5 medical facilities that provide higher levels of care.

6

244. Upon information and belief, when Defendants identify or are ordered by the

7 Superior Court to transfer prisoners to outside facilities that provide inpatient level of care,

8 there are frequently delays in transferring these prisoners from Monterey County Jail. The

9 delays result in prisoners being denied needed inpatient care, which could result in further

10 deterioration in their mental health, and creates a risk to the long-term prognosis of these

11 patients: the longer the inpatient care is denied to the patients in need of that level of care,

12 the less likely they are to respond to appropriate treatment once it is initiated.

13

245. For example, in April 2013, Dr. Fithian recommended that a pretrial detainee

14 in the Jail be found incompetent to stand trial because of her mental health status. The

15 Superior Court judge ordered her to be placed in a competency program in the state

16 hospital to receive inpatient care. Until at least October 11, 2013, the prisoner had not

17 been transferred to the state hospital and remained at the Jail.

18

H. Defendants Place Prisoners with Mental Illness at Risk by Housing

Them in Restrictive Administrative Segregation Units Without

19

Adequate Supervision

20

246. Defendants house prisoners with mental illness in administrative segregation

21 units in the Jail in ways that place such prisoners at substantial risk of serious harm. In the

22 Jail, A through D Pods, G through J Pod, and R and S Pods are administrative segregation

23 units. All of the beds in these units are located in locked cells. Collectively,

24 approximately 200 prisoners are housed in administrative segregation units at any given

25 time.

26

247. The conditions in the administrative segregation units are extremely punitive,

27 isolating, and restrictive. Upon information and belief, Defendants permit prisoners in

28 administrative segregation to have only one hour of out-of-cell time per day. During that

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1 hour, prisoners are expected to shower, exercise, and use the telephone. Prisoners are

2 generally released from their cells individually, meaning they are outside of their cells by

3 themselves. As a result, there are very few opportunities for human interaction.

4

248. These conditions significantly increase the risk that prisoners with mental

5 illness will have their condition decompensate when placed in administrative segregation.

6 A significantly disproportionate percentage of suicides occur in administrative segregation

7 units. Because of the risks posed by administrative segregation to prisoners with mental

8 illness, a consensus has been reached in mental health correctional communities that

9 prisoners with mental illness should only be placed in administrative segregation if

10 absolutely necessary. In addition, if prisoners with mental illness are placed in

11 administrative segregation, there must be limits on the amount of time they remain in such

12 units, they must be monitored closely, and they must be provided with significant

13 structured and unstructured out-of-cell time.

14

249. Upon information and belief, Defendants do not have adequate safeguards in

15 place to ensure that prisoners with mental illness are only placed in administrative

16 segregation when absolutely necessary. In fact, upon information and belief, Defendants

17 have a policy and practice of placing prisoners with the most serious mental illness in A

18 and B Pods for men and R and S Pods for women. As a result, rather than only placing

19 prisoners with mental illness in administrative segregation when absolutely necessary,

20 Defendants have a policy and practice of placing mentally ill prisoners there because of

21 their mental illness. Upon information and belief, Defendants also lack policies and

22 practices to reevaluate whether prisoners with mental illness placed in administrative

23 segregation should remain in administrative segregation. The amount of unstructured out-

24 of-cell time that Defendants provide to prisoners in administrative segregation—a

25 maximum of seven hours per week—falls far below the standard of care. The amount of

26 structured out-of-cell time provided to prisoners in administrative segregation—at most

27 one hour every other week—falls even farther below the standard of care.

28

250. Upon information and belief, Defendants have a policy of conducting safety

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1 checks once every hour in administrative segregation units. Upon information and belief,

2 Defendants do not conduct safety checks at intermittent and unpredictable times.

3 Defendants’ policy for conducting safety checks is inadequate to ensure the safety of

4 prisoners with serious mental illness in administrative segregation. Upon information and

5 belief, Defendants sometimes even fail to conduct safety checks in administrative

6 segregation units once per hour according to their inadequate policy. As a result,

7 Defendants’ policy and practice for conducting safety checks of prisoners in administrative

8 segregation place prisoners at a substantial risk of serious harm.

9

251. Plaintiff MEFFORD has been housed in administrative segregation or in a

10 safety cell since arriving at the Jail. He has repeatedly informed custody and medical staff,

11 both orally and through a formal grievance, that the sensory deprivation caused by this

12 housing assignment is making his psychiatric conditions much worse and causing him

13 considerable anxiety. The Jail has not responded to his repeated requests for

14 accommodation or alternative housing.

15

252. Defendants placed Plaintiff MURPHY in an isolation cell at least one time

16 for a period of 10 days in April 2013. Upon information and belief, Plaintiff MURPHY’s

17 mental health decompensated during his time in isolation, at least in part because of his

18 inability to talk with anyone else.

19

253. Jessie Crow and Daniel Lariviere committed suicide by hanging in

20 administrative segregation in 2010 and 2011 respectively. Defendants’ inadequate policies

21 and procedures for monitoring prisoners with mental illness in administrative segregation

22 units placed both Mr. Crow and Mr. Lariviere at risk prior to their suicides and may have

23 contributed to their suicides. For example, if Defendants had conducted safety checks

24 every half hour at intermittent and unpredictable times, they may have been able to prevent

25 Mr. Crow or Mr. Lariviere from committing suicide.

26

I. Defendants Discriminate Against and Unfairly Punish Prisoners with

Mental Illness

27

28

254. Defendants discriminate against prisoners with serious mental illness by

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1 isolating them from and denying them privileges granted to other prisoners. Defendants’

2 policies and practices for housing prisoners with serious mental illness are inadequate.

3 Upon information and belief, Defendants fail to adequately train mental health staff in how

4 to appropriately house prisoners with serious mental illness. Prisoners with serious mental

5 illness are frequently housed by Defendants in administrative segregation units, as opposed

6 to in dorm housing units. When housed in a cell, as opposed to dorm, prisoners have far

7 less freedom to move around and to interact with other prisoners. See Section III.H. In

8 contrast, prisoners in dorm housing units are free to access most areas of the dorm unit,

9 including the common area, showers, telephones, and exercise yard during most of the day.

10 Prisoners with severe mental health concerns may also be housed by Defendants in

11 isolation cells. When housed in an isolation cell, prisoners have even less freedom to

12 move around and interact with other prisoners, and they have extremely limited access to

13 programs and services at the Jail. Accordingly, prisoners with serious mental illnesses are

14 denied access to programs and services because Defendants place prisoners with serious

15 mental illness in lockdown units or isolation cells.

16

255. Upon information and belief, prisoners with serious mental health conditions

17 may be placed in rubber rooms as punishment for an inability to follow Jail rules. Many of

18 these prisoners may not have violated Jail rules had they been receiving adequate mental

19 health treatment.

20

256. Upon information and belief, Defendants place prisoners in a rubber room

21 when they request mental health care from Defendants. For example, in late-Spring or

22 early-Summer 2012, one prisoner was suffering from mental health symptoms because he

23 had not been provided with prescribed medications for preexisting medical conditions.

24 Rather than attempt to treat his psychiatric distress, Defendants placed him naked in the

25 rubber room without even a blanket for the first few hours. A female prisoner who entered

26 the Jail in a manic state was placed in a rubber room for a period of days without clothing,

27 and was forced to tear her blanket to minimally cover herself.

28

257. Upon information and belief, Defendants exacerbate the psychological

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1 trauma experienced by prisoners with serious mental health conditions who are housed in

2 rubber rooms by failing to provide them with necessary mental health care. These

3 prisoners do not receive sufficient contact with mental health providers. As a result, their

4 nonconforming behaviors may escalate and they are forced to stay in the rubber room even

5 longer.

6

258. Upon information and belief, Defendants’ disciplinary process fails to take

7 into account behavior which results from inadequate mental health care. Upon information

8 and belief, as a result of Defendants’ failure to provide adequate mental health care,

9 prisoners with serious mental conditions may be unable to conform to Jail rules or be

10 safely housed in cells with other prisoners. In response, rather than provide them with the

11 medications or treatment they need, Defendants selectively house these prisoners in

12 isolation in the rubber rooms.

13

259. When mental illness is inhibiting a prisoner’s ability to follow directions or

14 interact with others, many incident reports show no effort by staff to involve mental health

15 professionals who might be able to calm the prisoner down and address the underlying

16 psychiatric issue without resorting to use of physical force. Upon information and belief,

17 staff who do not have adequate training regarding how to treat mental health issues attempt

18 to interact with the prisoner on their own, and end up resorting to use of physical force,

19 improper use of restraints, and/or violence to control the prisoners. Sometimes, the use of

20 force results in larger prisoner-on-prisoner fights in the unit.

21

260. Upon information and belief, Defendants fail to provide adequate training to

22 custody staff regarding how to respond to mentally ill prisoners whose non-conforming

23 behaviors are a product of their mental illness.

24

261. For example, Plaintiff MEFFORD received a Disciplinary Action Report on

25 December 15, 2013, for yelling at a guard. As punishment, Plaintiff MEFFORD lost four

26 weeks of commissary, yard, and visiting privileges. Plaintiff MEFFORD was then brought

27 to a safety cell where he remained overnight on suicide watch. After being released from

28 the safety cell, Plaintiff MEFFORD appealed this Disciplinary Action Report on the

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1 grounds that four weeks of punishment was too severe because his conduct had been

2 caused by his mental illness. Plaintiff MEFFORD noted that these punishments would

3 “lead to me being very depressed and or suicidal and self harmful.” Defendants denied

4 Plaintiff MEFFORD’s appeal on January 2, 2014, because “in this facility we take serious

5 [sic]” “threats against an officer…regardless of an inmate’s medical condition.”

6

262. Defendants fail to provide sign language interpretation services to prisoners

7 whose primary language is American Sign Language during mental health clinical

8 evaluations. Without sign language interpretation, such prisoners are not able to explain to

9 mental health staff the symptoms they are experiencing, and mental health staff are not

10 able to explain the benefits and risks of treatments and medications such that prisoners can

11 provide their informed consent. The lack of sign language interpretation services results in

12 Defendants making mental health treatment decisions without all of the necessary and

13 pertinent information they need, which increases the risk of misdiagnosis and mistreatment

14 for the prisoner.

15

263. Upon information and belief, Defendants fail to provide foreign language

16 interpretation services to prisoners whose primary language is not English during mental

17 health clinical evaluations. This is particularly true for prisoners who cannot speak either

18 English or Spanish. Without foreign language interpretation, such prisoners are not able to

19 explain to mental health staff the symptoms they are experiencing, and mental health staff

20 are not able to explain the benefits and risks of treatments and medications such that

21 prisoners can provide their informed consent. The lack of foreign language interpretation

22 services results in Defendants making mental health treatment decisions without all of the

23 necessary and pertinent information they need, which increases the risk of misdiagnosis

24 and mistreatment for the prisoner.

25

J. Defendants Fail to Employ a Sufficient Number of Properly Trained

Mental Health Professionals

26

27

264. Defendants fail to maintain sufficient numbers of mental health care

28 professionals to provide minimally adequate care to the more than 900 prisoners in the Jail.

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1

265. The Jail’s low staffing levels result in mental health care staff being unable

2 to timely respond to prisoners’ requests for psychiatric evaluations and treatment, to

3 adequately screen, track, monitor, and provide follow-up care to prisoners who are

4 suffering from serious mental illnesses, and to provide adequate group and individual

5 therapy. Upon information and belief, there are no mental health care staff on site at the

6 Jail on the weekends or holidays. Prisoners who experience serious mental health

7 problems over a weekend or holiday, including prisoners newly booked into the Jail, are

8 not seen by mental health care staff until the next business day. Over certain holiday

9 weekends, prisoners in need of acute mental health care treatment may not be seen for

10 more than 72 hours. Upon information and belief, Defendants often place such prisoners

11 in rubber rooms until mental health care staff are available to see them.

12

266. For example, Plaintiff MEFFORD experienced an acute psychiatric incident

13 in January 2014 on a Friday afternoon when he began engaging in acts of self-harm.

14 Plaintiff MEFFORD was housed in rubber rooms (sometimes while being placed in a

15 restraint chair) and booking cells until Monday, when he was seen by mental health care

16 staff. The psychiatrist at the Jail explicitly ordered that Plaintiff MEFFORD be kept in a

17 rubber room or booking cell over the weekend until the doctor could evaluate Plaintiff

18 MEFFORD on Monday. Because of his placement in rubber rooms and booking cells over

19 the weekend without any evaluation by mental health care staff, Plaintiff MEFFORD’s

20 mental health deteriorated and he engaged in additional acts of self-harm.

21

267. As another example, during an attorney interview, one prisoner was

22 incapable of conversation, had feces in his hair, ranted obscene comments, and frequently

23 exposed his genitals. When alerted to this prisoner’s deteriorated mental health state by

24 the attorney, Jail staff informed the attorney that the prisoner would be seen the next day

25 because mental health staff had gone for the day.

26

268. Upon information and belief, Defendants fail to adequately train mental

27 health staff to timely respond to prisoners’ requests for psychiatric evaluations and

28 treatment, and to adequately screen, track, monitor, and provide follow-up care to

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1 prisoners who are suffering from serious mental illness.

2

K. Defendants Fail to Maintain Accurate, Complete, and Confidential

Mental Health Treatment Records

3

4

269. Upon information and belief, Defendants fail to maintain adequate, accurate,

5 and confidential mental health care records. For example, upon information and belief,

6 psychiatrists often change prisoners’ medications without documenting a clinical rationale.

7 Upon information and belief, psychiatrists also fail to document their justification and

8 reasoning for changing the diagnoses and treatment plans for prisoners returning to the Jail

9 from psychiatric hospitals. As a result of Defendants’ failure to maintain adequate mental

10 health care records, prisoners suffer from a substantial risk of misdiagnosis, dangerous

11 mistakes, and unnecessary delays in care.

12

270. Plaintiff MEFFORD’s psychiatric medications have been changed multiple

13 times since he arrived at the Jail in the beginning of December 2013. Some of these shifts

14 are documented by progress notes with a few words justifying the shift, but many are not.

15 Plaintiff MEFFORD is a former CDCR prisoner. While in a CDCR prison, Plaintiff

16 MEFFORD consistently received a set of psychiatric medications to treat his mental

17 illness. Soon after Plaintiff MEFFORD arrived at the Jail, a psychiatrist at the Jail

18 changed his medication regime by substituting one medication for a cheaper version and

19 adding an additional medication. On information and belief, the psychiatrist failed to

20 document any clinical explanation for this medication shift. Plaintiff MEFFORD has

21 suffered a number of psychotic episodes since entering the Jail and has struggled with

22 continuing anxiety, depression, and episodes of self-harm.

23

271. Upon information and belief, Defendants fail to obtain medical files from

24 outside providers for lengthy periods of time after the prisoner’s arrival at the Jail (if at

25 all). This lack of information results in inadequate and delayed mental health care which

26 places prisoners at an unreasonable risk of harm. For example, Plaintiff MURPHY was

27 arrested and booked into the Jail on January 18, 2013. During an intake triage assessment

28 that same day, Jail staff was informed that Plaintiff MURPHY’s psychiatric medications

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1 were prescribed by a physician at the Monterey County Veteran’s Administration clinic.

2 Plaintiff MURPHY was not seen by any mental health staff until January 21, 2013, when

3 he had an appointment with a Licensed Psychiatric Technician, who could not and did not

4 prescribe him medications. Upon information and belief, the Licensed Psychiatric

5 Technician made only one request for Plaintiff MURPHY’s medical records from the

6 Monterey County Veteran’s Affairs office (“VA”) on January 21, 2013, and made no

7 effort to follow up after that date. On January 28, 2013, at least in part because he was not

8 provided with any psychiatric medications, Plaintiff MURPHY was placed in a rubber

9 room where he remained until January 30, 2013. As of at least April 19, 2013, Defendants

10 had not obtained Plaintiff MURPHY’s psychiatric records from the VA.

11

272. Plaintiff GREIM arrived at the Jail in September 2012. He reported during

12 an intake screening that he had received mental health care and psychiatric medications

13 while incarcerated in a CDCR prison as recently as the spring of 2012. Defendants did not

14 request his records until March 2013. These records confirmed that Plaintiff GREIM

15 suffers from a mood disorder and was prescribed Remeron while in prison and on parole in

16 2012 immediately prior to his booking in Monterey County Jail. Plaintiff GREIM had

17 received care at the enhanced outpatient level while in prison. Even after receiving these

18 records, Defendants failed to provide Plaintiff GREIM with any treatment for his serious

19 mental illness. And when Plaintiff GREIM again requested psychiatric medication in July

20 2013, Defendants noted in his file that they “would get” his prison records—records they

21 had received months before. Plaintiff GREIM did not begin to regularly receive any

22 psychiatric medications while in Monterey County Jail until on or around October 3, 2013.

23

273. Upon information and belief, Defendants fail to adequately train mental

24 health staff regarding how to maintain accurate mental health records, including the timely

25 request of prisoners’ prior mental health records.

26

274. Upon information and belief, Defendants have not ensured that the

27 psychiatric care records of prisoners who are sent to Alameda County pursuant to the

28 contract described in Paragraph 178, supra, either accompany those prisoners to Alameda

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1 County or follow in a timely manner. As a result, Monterey County prisoners including

2 Plaintiff GREIM, have experienced interruptions in care and delays in receiving necessary

3 medications when transferred to the physical custody of Alameda County. As a result,

4 Plaintiff GREIM experienced severe anxiety and mental health distress upon his arrival at

5 Alameda County Jail, and staff there lacked the necessary information to provide him with

6 appropriate care.

7

275. Upon information and belief, Defendants also fail to prepare adequate

8 discharge summaries and to take steps to ensure continuity of care for prisoners with

9 mental health impairments who are released from the Jail or transferred to other

10 institutions. These failures result in unnecessary decompensation and inability to receive

11 appropriate medications for prisoners with mental health issues housed at the Jail.

12

L. Defendants Fail to Adequately Train Staff to Provide Appropriate and

Timely Mental Health Care

13

14

276. Upon information and belief, Defendants fail to adequately train custody and

15 health care staff in how to provide appropriate and timely mental health care. The lack of

16 training is evident from the numerous incidents in which prisoners’ health and lives were

17 placed at risk as a result of the deficient mental health care provided in the Jail. As a result

18 of a lack of adequate training, custody and health care staff do not, among other failings:

19 timely and appropriately identify mental health problems during the screening and intake

20 process, properly evaluate and treat prisoners who arrive at the Jail and have been taking

21 prescribed psychotropic medications, recognize signs and symptoms of mental illness and

22 refer prisoners exhibiting such signs and symptoms to mental health care staff, track and

23 monitor prisoners with mental illness and the treatment they require, identify prisoners

24 who are at risk of suicide and respond adequately to prisoners who are exhibiting suicidal

25 tendencies, provide therapy to prisoners with mental illness as a component of mental

26 health care, properly administer psychotropic medications, appropriately evaluate prisoners

27 before making mental health treatment decisions, appropriately release prisoners with

28 serious mental health concerns so that such prisoners can continue their mental health care,

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1 appropriately house prisoners with serious mental illness, ensure that prisoners with mental

2 illness are only housed in administrative segregation when absolutely necessary and are

3 adequately monitored and treated when placed in such punitive and isolating units,

4 appropriately respond to mentally ill prisoners whose non-conforming behaviors are a

5 product of their mental illness, respond to prisoners’ requests for psychiatric evaluations

6 and treatment, provide follow-up care to prisoners who are suffering from serious mental

7 illness, and maintain accurate mental health records, including the timely request of

8 prisoners’ prior mental health records.

9 IV. DEFENDANTS DISCRIMINATE AGAINST, FAIL TO ACCOMMODATE, AND VIOLATE THE RIGHTS OF PRISONERS WITH DISABILITIES
10

11

277. Defendants MONTEREY COUNTY and MONTEREY COUNTY

12 SHERIFF’S OFFICE currently incarcerate in Monterey County Jail significant numbers of

13 individuals with disabilities, as that term is defined in the ADA, the Rehabilitation Act,

14 and California disability rights law. Together with Defendant CFMG, these Defendants

15 fail to provide prisoners with disabilities with basic reasonable accommodations to ensure

16 equivalent access to all of the programs, activities, and services offered at the Jail.

17 Defendants’ failure to accommodate prisoners with disabilities not only denies them access

18 to prison programs and services, but also substantially increases the risk that they are

19 injured in an emergency or are the victim of violence or abuse from other prisoners.

20 Moreover, Defendants’ refusal to accommodate prisoners with disabilities results in the

21 provision of inadequate medical and mental health care and the trampling of prisoners’ due

22 process rights in Jail disciplinary proceedings.

23

A. Defendants Lack Adequate Policies and Practices to Identify and Track

Prisoners with Disabilities and Provide Them with Needed

24

Accommodations

25

278. Under the ADA, the Rehabilitation Act, and California disability rights law,

26 Defendants must create and maintain a system to identify and track individuals with

27 disabilities and the accommodations they require. Defendants, however, lack adequate

28 policies and practices for identifying individuals with disabilities and the reasonable

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1 accommodations they require.

2

279. Defendants fail to identify prisoners with disabilities. During the intake

3 process, custody officers collect various pieces of information about new prisoners.

4 Custody staff use the information to make a number of determinations, including how to

5 classify a prisoner. A prisoner’s classification determines with which other prisoners the

6 new prisoner can share space and in what parts of the prison the new prisoner can be

7 housed.

8

280. Upon information and belief, the custody officers who are responsible for

9 conducting the intake process are not adequately trained by Defendants regarding how to

10 identify and track individuals with disabilities, and therefore frequently fail to identify

11 prisoners with disabilities or the accommodations they need to access Jail programs and

12 services. Upon information and belief, the forms and system that the custody staff use to

13 capture the information gathered during the intake process lack adequate fields and space

14 to document if a prisoner has a disability and requires accommodations.

15

281. Defendants’ failures to accurately identify new prisoners’ disabilities and

16 needed accommodations during the intake process result in the denial of accommodations

17 mandated by the ADA, Rehabilitation Act, and California disability rights law, placing

18 prisoners at risk of discrimination, injury, and/or exploitation. For example, during

19 booking into the Jail in August 2012 and again in December 2012, custody staff completed

20 Monterey County Sheriff’s Office Intake Health Screening forms for Plaintiff YANCEY.

21 Despite Plaintiff YANCEY’s complete hearing impairment, staff did not indicate on the

22 forms that he had a hearing disability. Accordingly, staff throughout the Jail were unable

23 to identify Plaintiff YANCEY as hearing impaired, resulting in a lack of accommodations

24 for his disability.

25

282. Plaintiff ESQUIVEL is a full-time wheelchair user. He is unable to get

26 around at all without a wheelchair. Despite this, when Plaintiff ESQUIVEL entered the

27 Jail in October 2013, on neither his Intake Health Screening form nor his Intake Triage

28 Assessment did any custody or medical staff member note that he requires a wheelchair.

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1

283. Plaintiff MURPHY was booked into the Jail in January 2013 with a

2 permanent back injury that requires him to use a walker or cane to ambulate without pain.

3 During the intake process, the Jail failed to identify him as having a mobility impairment

4 requiring an accommodation, and he was not provided with a walker or a cane. Plaintiff

5 MURPHY was eventually provided with a cane after many months’ delay, during which

6 he frequently was unable to leave his bed due to his inability to walk unassisted.

7

284. Plaintiff NICHOLS was detained at the Jail on June 20, 2013. Plaintiff

8 NICHOLS has a permanent mobility impairment arising from a motor vehicle accident

9 many years ago. Although he normally uses a cane to ambulate and visibly has trouble

10 walking, when he arrived at the Jail he neither had nor was provided with any assistive

11 devices. Because he did not receive any assistive device, Plaintiff NICHOLS presented to

12 medical staff with complaints of falling on his head three times, after which he received a

13 wheelchair.

14

285. Another prisoner who was booked into the Jail in January 2012 with a

15 mobility impairment required a cane to help him safely ambulate and access his housing

16 unit and also required a lower bunk housing assignment to safely access a bed. During the

17 intake process, the Jail failed to identify him as having a mobility impairment requiring

18 those accommodations; he was not provided with a cane and the only available bed in his

19 housing unit was on the upper bunk of a triple bunk. Without a cane, the prisoner fell and

20 injured himself on a number of occasions. He slept on the floor because it was too difficult

21 for him to access his bunk.

22

286. Defendants do not maintain any central list, electronic or otherwise, of

23 prisoners with disabilities and the accommodations they require. Defendants do not

24 maintain adequate information about prisoners’ disabilities and related accommodations in

25 the prisoners’ custody and/or medical files. Upon information and belief, to the extent that

26 Defendants maintain information about a prisoner’s disabilities in any form, custody,

27 medical, and clerical staff are not provided with access to the information in a manner that

28 would timely and effectively inform them of a prisoner’s disabilities and required

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1 accommodations. Upon information and belief, Defendants do not adequately train staff to

2 maintain records or information about prisoners’ disabilities and related accommodations.

3

287. The lack of an adequate disability and accommodation tracking system

4 results in substantial injuries to prisoners with disabilities, and results in their being denied

5 the benefits of programs, services, and activities at the Jail. Without an adequate tracking

6 system, medical and custody staff have no easily accessible means to determine whether a

7 prisoner has a disability, and what, if any, accommodations that prisoner requires.

8 Consequently, Defendants fail to provide prisoners with accommodations or withdraw

9 accommodations that have already been provided without justification.

10

288. For example, Plaintiff YANCEY is deaf, cannot hear, and uses American

11 Sign Language as his primary form of communication. Plaintiff YANCEY was not

12 provided with a sign language interpreter for his communications with Jail staff, including

13 at medical appointments, at a disciplinary hearing, and during the booking and

14 classification process.

15

289. Plaintiff SARABI was provided with crutches after he sustained an injury to

16 his right leg when he was attacked by another prisoner on or around March 6, 2013.

17 However, on or around April 8, 2013, Plaintiff SARABI was called in for an unsolicited

18 medical exam at which his crutches were taken away from him with no explanation,

19 despite the fact that he still required the crutches in order to ambulate. Plaintiff SARABI

20 could not use the restroom or shower without his crutches, and had to crawl around or hop

21 on one foot to get around the Jail until his attorney contacted the Jail to request that the

22 crutches be provided.

23

290. Plaintiff MILLER suffers from vision loss as a complication of his severe

24 Type 1 diabetes. He began complaining of blurred vision shortly after his arrival at the

25 Jail; his vision limitations were confirmed by an ophthalmologist to which he was sent by

26 Defendants. His custody file, however, contains no documentation of his vision limitation.

27 Nor does the Jail provide any kind of vest or other visible means by which custody staff

28 may identify Plaintiff MILLER as vision-impaired in event of an emergency.

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1

291. Plaintiff ESQUIVEL had his wheelchair taken away from him for at least 14

2 hours in August 2012. As a result of being denied the needed assistive device, he was

3 rendered immobile, was unable to access the showers and restrooms, was forced to rely

4 upon other prisoners for assistance, and was therefore placed at increased risk of being

5 manipulated or attacked by other prisoners.

6

B. Defendants Lack an Effective Grievance Procedure for Prisoners to

Request Reasonable Disability Accommodations

7

8

292. Defendants do not provide an effective or functional grievance system for

9 prisoners with disabilities as required by the ADA and Rehabilitation Act.

10

293. Defendants do not provide prisoners with adequate notice of how to request

11 reasonable accommodations for their disabilities. Upon information and belief, the only

12 formal notice prisoners receive regarding any Jail grievance procedure comes from the

13 “Monterey County Adult Detention Facility Inmate Information Booklet” (hereinafter

14 “Inmate Information Booklet”), which is provided to each prisoner when booked into the

15 Jail. Yet the Inmate Information Booklet does not discuss disabilities or the process for

16 requesting disability accommodations. As a result, prisoners are not informed of any

17 specific process for complaining about disability discrimination or requesting disability

18 accommodations.

19

294. Defendants routinely deny prisoners access to grievance forms. Each

20 prisoner is provided with only one grievance form which is attached to the Inmate

21 Information Booklet provided during booking. Upon information and belief, grievance

22 forms are not freely available in the housing units.

23

295. Even when prisoners are able to submit grievances, Defendants frequently do

24 not provide any response. One prisoner submitted multiple grievances following her re-

25 entry to the Jail on June 15, 2013, but received no responses. A housing deputy told her

26 that one of her grievances had been “lost” and would not be returned to her. This prisoner

27 then filed a grievance with regards to this purportedly lost grievance, which also did not

28 receive a response. Plaintiff HERNANDEZ submitted at least four grievances to which he

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1 never received responses. Plaintiff MURPHY submitted a grievance on April 4, 2013,

2 requesting a cane or walker as an accommodation for his mobility impairment; he did not

3 receive a response to the grievance either. Plaintiff SARABI submitted a grievance on

4 April 4, 2013, requesting to see a doctor for the intense pain he was experiencing in his

5 foot (the source of his mobility impairment), but he also did not receive a response to the

6 grievance. Plaintiff WHITFIELD submitted multiple grievances to which he received no

7 response or was told that the issue was resolved, even when it was not. These include at

8 least two grievances informing the Jail that he was still not receiving his needed and

9 prescribed Provigil. On both of these grievances, Jail staff members wrote that the issue

10 was resolved, but he had not yet received his medication. Plaintiff YANCEY submitted a

11 grievance on December 20, 2012, requesting a number of accommodations relating to his

12 serious hearing impairment, but he did not receive a response to the grievance.

13

296. Even when prisoners are able to submit a grievance and Defendants provide

14 a response, the responses are not adequate or comprehensive, and may be arbitrary and

15 counterproductive. One prisoner filed three successive grievances concerning the Jail’s

16 failure to provide her with necessary medications, none of which provided a satisfactory

17 response or resulted in her receiving medication. The Jail’s response to the first grievance

18 was that she should have received her medication; to the second, that her issue had been

19 addressed (it had not); and the third, that she should file a sick call slip for a refill of a

20 medication the Jail had never given her. As another example, a prisoner filed a grievance

21 requesting a walking cane to assist him in moving around the dorm, shower, and going to

22 court. The response stated only that “you did not have a ‘cane’ when you came in to the

23 facility. If you are having problems go on sick call.”

24

297. Defendants lack adequate policies and procedures instructing health care or

25 correctional officers how to respond if prisoners request accommodations through means

26 other than the grievance process.

27

298. Defendants do not adequately train staff in how to provide, appropriately

28 process, and timely respond to grievance forms.

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1

299. Defendants do not make available to prisoners in the Jail information

2 regarding their rights and the protections against discrimination under the American with

3 Disabilities Act.

4

C. Defendants Fail to Accommodate Prisoners with Disabilities That Affect

Communication

5

6

300. Prisoners with hearing, speech, developmental disabilities, mental illness,

7 and other communication impairments have problems effectively communicating with Jail

8 staff. Prisoners with disabilities that impair communication require accommodations to

9 ensure effective communication with prison staff and equal access to programs and

10 services offered by Defendants. Defendants fail to provide such accommodations. As a

11 result, prisoners with communication disabilities are denied the benefits of programs,

12 services, and activities at the Jail. Upon information and belief, Defendants fail to

13 adequately train staff in how and when to provide such accommodations.

14

301. Defendants fail to provide prisoners with hearing and speech impairments

15 with sign language interpreters, hearing aids, or other auxiliary aids. Plaintiff YANCEY

16 has been booked into the Jail numerous times over the past three to five years. Plaintiff

17 YANCEY is completely deaf, and also has a speech impairment that makes it difficult or

18 impossible for him to communicate through spoken words. He uses American Sign

19 Language (ASL) as his primary form of communication, but was not provided with a sign

20 language interpreter by Defendants during his incarcerations in the Jail.

21

302. Defendants do not provide prisoners with hearing, speech, and other

22 communication impairments with sign language interpreters, hearing aids, staff assistants,

23 or other auxiliary aids during the booking and intake process, which harms these prisoners

24 by preventing them from communicating specific concerns, including emergency medical

25 issues, and understanding Jail policies and practices.

26

303. For example, Defendants never provided Plaintiff YANCEY with a sign

27 language interpreter during the booking process. When he was booked into the Jail for his

28 most recent term, Plaintiff YANCEY’s right arm was in a cast, making it impossible for

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1 him to communicate through written notes. Accordingly, he essentially lacked any means

2 of communicating with the custody officers conducting the intake process.

3

304. Defendants fail to provide equal access to telephone services to prisoners

4 who require the use of a Telecommunications Device for the Deaf/Teletype (“TDD/TTY”).

5 Non-TDD/TTY telephones are located in the housing units. Upon information and belief,

6 prisoners without disabilities have access to non-TDD/TTY telephones any time the

7 prisoner is permitted in the common area of his or her housing unit. Upon information and

8 belief, telephone calls are limited to 30 minutes in length, though there is no limit to the

9 number of telephone calls a prisoner may make so long as he or she does not abuse or

10 monopolize the telephone.

11

305. In contrast, there is one TDD/TTY for the entire Jail. Prisoners who require

12 the use of the TDD/TTY must ask a custody officer to transport them to the office where

13 the TDD/TTY is located. Officers frequently refused to transport Plaintiff YANCEY to

14 the TDD/TTY, claiming that they were too busy to do so. Even when allowed to use the

15 TDD/TTY, Plaintiff YANCEY was denied sufficient time to conduct a conversation, since

16 using a TDD/TTY takes longer than using a telephone.

17

306. Defendants’ policies and practices for equal access to telephone services are

18 inadequate. Upon information and belief, Defendants fail to adequately train staff in how

19 to provide equal access to telephone services.

20

307. Defendants fail to provide prisoners with hearing, speech, or other

21 communication impairments with sign language interpreters, hearing aids, staff assistants,

22 or other auxiliary aids to permit participation in other Jail programs and services, including

23 religious services and educational and vocational classes. For example, Plaintiff

24 YANCEY was not provided with a sign language interpreter when attending religious

25 services at the Jail. As a result, he was not able to understand what was being said by the

26 chaplain and other participants, and could not participate in the services himself.

27

308. Defendants do not provide equal access to television to prisoners who are

28 hearing impaired. Upon information and belief, most non-disciplinary housing units have

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1 televisions installed for prisoners to watch, but Defendants have either not installed

2 televisions with the capability to display closed captioning or they fail to alter the settings

3 to the televisions to display closed captioning.

4

309. Defendants fail to provide sign language interpreters, hearing aids, staff

5 assistants, and other auxiliary aids at disciplinary hearings even though prisoners risk a

6 loss of credits and privileges if they are found guilty of disciplinary infractions. For

7 example, Plaintiff YANCEY was charged with a rule violation on December 16, 2012. At

8 the disciplinary hearing, he was found guilty of the violation and punished with two weeks

9 without visitation, canteen, or yard privileges. Plaintiff YANCEY was not provided with a

10 sign language interpreter at the disciplinary hearing, and therefore was not able to defend

11 himself or explain his version of the events. Without an interpreter, Plaintiff YANCEY

12 also had difficulty understanding what the hearing officer and other Jail staff were saying.

13

310. By failing to provide Plaintiff YANCEY and other hearing impaired

14 prisoners with sign language interpreters, hearing aids, or other auxiliary aids at

15 disciplinary hearings, Defendants deny such prisoners the same opportunity to participate

16 in the hearing regarding their guilt or innocence of the disciplinary charge and to present

17 their views to the hearing officer that prisoners without disabilities have.

18

311. Similarly, as is discussed in Paragraph 261, supra, Plaintiff MEFFORD

19 received a Disciplinary Action Report on December 15, 2013, for yelling at a guard.

20 Despite knowing of his serious mental illness, Defendants did not provide and did not even

21 consider whether they should provide Plaintiff MEFFORD with a staff assistant to help

22 him understand the disciplinary proceedings. As punishment, Plaintiff MEFFORD lost

23 four weeks of commissary, yard, and visiting privileges. Plaintiff MEFFORD appealed

24 this Disciplinary Action Report on the grounds that four weeks of punishment was too

25 severe because his conduct had been caused by his mental illness. Plaintiff MEFFORD

26 noted that these punishments would “lead to me being very depressed and or suicidal and

27 self harmful.” Defendants denied Plaintiff MEFFORD’s appeal on January 2, 2014,

28 because “in this facility we take serious [sic]” “threats against an officer…regardless of an

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1 inmate’s medical condition.” Defendants failed to ensure that they effectively

2 communicated their response to Plaintiff MEFFORD’s grievance.

3

312. Upon information and belief, Defendants fail to communicate effectively

4 with prisoners with disabilities that affect cognitive functions, including prisoners with

5 learning disabilities, developmental disabilities, mental illness, and brain injuries. Plaintiff

6 NICHOLS has a brain injury that affects his cognitive function. Defendants noted his

7 brain injury multiple times in his medical file. Nonetheless, neither his custody nor his

8 medical files have any indication that any staff at the Jail ever used any method of

9 effective communication to ensure that Plaintiff NICHOLS understood any of his

10 interactions with staff, including during medical appointments and the booking process.

11

D. Defendants Routinely Fail to Provide Prisoners with Disabilities with

Needed Assistive Devices

12

13

313. Defendants lack policies and practices to ensure that prisoners with

14 disabilities who require assistive devices, including, but not limited to, wheelchairs,

15 walkers, crutches, canes, braces, tapping canes, hearing aids, and pocket talkers, as

16 accommodations are provided with and are allowed to retain those devices. Upon

17 information and belief, Defendants fail to adequately train staff in how to timely and

18 appropriately provide assistive devices to prisoners with disabilities.

19

314. Because of Defendants’ deficient disability screening procedure and

20 inadequate grievance process, prisoners who require assistive devices to access Jail

21 programs are frequently not identified. As a result, those prisoners do not receive needed

22 assistive devices and cannot access the programs and services offered at the Jail.

23

315. Upon information and belief, Defendants deny prisoners certain assistive

24 devices, claiming that such items are not permitted in the Jail. For example, Plaintiff

25 MURPHY, who uses a cane to ambulate and required a lower bunk housing assignment

26 while at CDCR facilities, requested during the booking process that he be provided with a

27 cane or walker. He was informed by Jail staff that canes and walkers were not allowed in

28 the Jail. Despite this initial assertion, Plaintiff MURPHY has now been provided with a

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1 cane. Other prisoners’ files indicate that canes are sometimes allowed if approved by

2 custody staff, rather than if deemed medically necessary as accommodations for

3 documented disabilities.

4

316. Upon information and belief, Defendants have refused to provide some

5 prisoners with assistive devices as an accommodation for a disability, even after

6 Defendants have identified the person as a qualified individual with a disability and as

7 needing a particular assistive device. Upon information and belief, Defendants have

8 informed such prisoners that they are permitted to possess certain assistive devices, but

9 only if someone from outside of the Jail, like a family member, friend, or community

10 organization provides the assistive device. Unless the assistive device is provided by a

11 third party, such prisoners may be denied reasonable accommodations necessary for them

12 to access programs and services offered by Defendants.

13

317. Even when the Jail provides a prisoner with an assistive device, Defendants

14 unjustifiably remove these devices from prisoners, as alleged in Paragraphs 289-291,

15 supra.

16

318. Defendants fail to consider prisoners’ specific needs and abilities in

17 assigning assistive devices, to the detriment of those prisoners’ overall health and safety.

18 For example, Plaintiff NICHOLS normally uses a cane to ambulate, but was provided with

19 a wheelchair by Defendants because he did not have a cane with him at time of arrest.

20 Because Defendants have provided Plaintiff NICHOLS with a wheelchair rather than his

21 accustomed cane, he is less physically active at the Jail than he is able to be and would like

22 to be, and has suffered deterioration of his overall physical condition. He is also denied

23 equal access to Jail programs, services, and activities as a result of his confinement to a

24 wheelchair.

25

319. Defendants also fail to provide properly operational assistive devices to

26 prisoners. Plaintiff ESQUIVEL received a wheelchair in October 2013 with a broken right

27 wheel and a missing foot bed. Plaintiff ESQUIVEL was thus only able to get around by

28 performing a “wheelie” to lift up the broken wheel and move himself forward. Even after

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1 he complained about this wheelchair to medical staff, he was not provided with an

2 operational wheelchair. It was only after he complained to the CFMG Program Manager

3 that he was provided with a functioning wheelchair.

4

E. Defendants Fail to Provide Prisoners with Disabilities with Equal Access

to Programs and Services, Including Safe and Accessible Housing

5

6

320. Defendants fail to ensure that prisoners with disabilities have equal access to

7 all programs and services offered at the Jail.

8

321. Defendants fail to ensure that prisoners with disabilities are assigned to and

9 are actually housed in housing units and bed assignments that are accessible and safe.

10 Upon information and belief, Defendants fail to adequately train staff in how to house

11 prisoners with disabilities in accessible and safe housing.

12

322. The Jail consists of five main housing areas—the Rehabilitation Center, the

13 Men’s Section, K-Pod, the Dorm Section, and the Women’s Section—located in two

14 buildings.

15

323. Each housing area is separated into a number of smaller housing units. The

16 housing units differ in their design, and importantly, in their accessibility to prisoners with

17 disabilities. Some of the housing units are dorm housing units, where many beds,

18 including triple bunks, are placed in an open area that is shared by the prisoners. Other

19 housing units consist of celled housing, where the unit is divided into a number of cells

20 with doors in which one or two prisoners are housed. Cells that house two prisoners

21 typically have bunk beds in them.

22

324. Some of the housing units in the Jail are located up flights of stairs, while

23 others are on the ground floor.

24

325. Defendants control housing unit assignments. In housing units with celled

25 housing, Defendants also assign prisoners to a particular cell.

26

326. Upon information and belief, Defendants make decisions regarding where to

27 house a particular prisoner without taking into account the prisoner’s disability-related

28 limitations. Because of Defendants’ general failure to identify and track prisoners with

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1 disabilities, Defendants decide where to house a prisoner without sufficient information

2 regarding the prisoner’s limitations; this practice significantly increases the risk that a

3 prisoner will be assigned to a housing unit that is not accessible to him or her, because, for

4 example, it lacks adequate toilets or grab bars in the shower, is up a flight of stairs, lacks

5 space for a wheelchair.

6

327. One prisoner who was housed in the Jail for a significant period of time was

7 a full-time wheelchair user. Defendants generally permitted this prisoner to retain his

8 wheelchair in the Jail, meaning that Defendants were aware of his mobility impairment.

9 Nonetheless, Defendants housed this prisoner in the C-Dorm and D-Dorm within the Dorm

10 Section. The C-Dorm and D-Dorm were not then wheelchair accessible in that they did

11 not have toilets and showers with grab bars, did not have shower chairs, and had structural

12 lips between the housing areas and the showers. Upon information and belief, C-Dorm

13 and D-Dorm still do not have shower grab bars and lack adequate shower chairs. This

14 prisoner fell four times while housed in those dorms when attempting to access the toilets

15 and showers, injuring himself each time he fell. He also was frequently forced to rely on

16 other prisoners for assistance to access the toilets and showers.

17

328. Plaintiff ESQUIVEL has previously been housed in both C-Dorm and D-

18 Dorm. While there, he was unable to use the shower or toilet without assistance from

19 other prisoners or serious concern for his own safety.

20

329. Another prisoner who was a full-time wheelchair user was permitted to

21 retain his wheelchair, indicating that Defendants were aware of his mobility impairment.

22 Nevertheless, Defendants housed this prisoner in the B-Dorm for 30-45 days. This

23 prisoner had difficulty accessing almost every feature of B-Dorm, including the bathroom.

24 Specifically, this prisoner was forced to shower while sitting in his wheelchair due to the

25 lack of a shower chair, and had to rely on other prisoners to press the shower button for

26 him because he could not reach it. This prisoner also had to rely on other prisoners to lift

27 him onto the toilet.

28

330. One prisoner was known to have a mobility impairment and provided with

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1 crutches to use within the Jail. Nevertheless, he was housed in J-Pod, which has a shower

2 without any minimal accessibility features such as a grab bar or shower chair. As a result,

3 he suffered several serious falls while attempting to use a shower that was not accessible to

4 him, but was the only shower available to him.

5

331. Upon information and belief, Defendants lack policies and practices for

6 ensuring the prisoners who require lower bunk bed assignments actually receive lower

7 bunk bed assignments. Upon information and belief, in many housing units, Defendants

8 have essentially no system for assigning particular prisoners to specific beds. Instead,

9 especially in dorm housing units, Defendants typically abdicate the assignment and

10 selection of beds in the housing unit to the prisoners themselves, who will be assigned to

11 the newly-vacated bed. In some dorm housing units, bed assignments and selection are

12 determined by who has been in the unit for the longest period of time. In units that include

13 a significant number of gang members, bed assignments may be determined by the leaders

14 of the gang within the unit.

15

332. Plaintiff WHITFIELD, who is at serious risk for falling off of his bunk due

16 to his narcolepsy and cataplexy, was inappropriately housed on an upper-level bunk of a

17 triple bunk in C-Wing upon first entering the Jail in November 2013. Jail staff did not

18 assign him to a lower bunk and thus he was forced to accept the empty bed offered to him

19 by the other prisoners. It took repeated requests to medical and custody staff for him to be

20 moved to the Rotunda, where he was finally provided with a single bed.

21

333. Upon information and belief, Defendants have no means for ensuring that

22 prisoners who require lower bunk bed assignments are actually able to sleep in lower

23 bunks, and have no mechanism for guaranteeing that prisoners who should not be housed

24 in triple bunks avoid such bed placements. As a result, prisoners who require lower bunk

25 and non-triple bunk bed assignments as accommodations for their disabilities may be

26 forced to sleep on upper bunks and in triple bunks rather than experience the pain and

27 danger of sleeping in an inaccessible bed. For example, Plaintiff NICHOLS was housed

28 for many weeks in a dorm where he was required to sleep in a middle bunk, although that

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1 bunk was difficult and painful for him to access.

2

334. A prisoner booked into the jail in January 2012 with a mobility impairment

3 required a lower bunk housing assignment to safely access a bed. During the intake

4 process, Defendants failed to identify him as having a mobility impairment requiring that

5 accommodation. In the housing unit to which he was assigned, the only available bed was

6 on the upper bunk of a triple bunk. No prisoner in the unit would agree to switch bed

7 assignments with him. Rather than sleep on the upper bunk, he slept on the floor because

8 it was too difficult and dangerous for him to access the available bed.

9

335. On information and belief, Defendants’ general practice is to house prisoners

10 with disabilities, mobility impairments, and/or significant medical needs in the Rotunda of

11 the Jail, a space designed for use as a programmatic area and not as a housing unit. One

12 prisoner who uses a wheelchair and was housed in the Rotunda in July 2013 fell and was

13 injured while attempting to use the Rotunda shower, which is not properly equipped for

14 use by prisoners with disabilities.

15

336. The recreation yards for the Men’s Section (including the Rotunda), the

16 Women’s Section, and K-Pod are located on the roof of the Jail. In order to access the

17 yards, prisoners must walk up one long flight of stairs and then down a smaller flight of

18 stairs. The stairways are the only means of reaching the yard. Because the yard is located

19 on the roof, prisoners who are housed in the Men’s Section, Women’s Section, or K-Pod

20 and who have mobility or vision impairments that make walking up or down stairs

21 difficult, painful, impossible, or dangerous are denied access to the recreation yard.

22

337. One such prisoner, due to her use of a walker, was thus denied access to the

23 rooftop recreation yard used by female prisoners. Mobility-impaired prisoners housed in

24 the Rotunda, such as Plaintiff NICHOLS, are also unable to access the recreational yard.

25 Because of his mobility impairment, Plaintiff MURPHY has rarely accessed the yard since

26 he arrived at the Jail on January 18, 2013. If the yard for their housing units was not up a

27 flight of stairs, all three prisoners would have gone to the yard most times that it was

28 offered to them.

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1

338. Plaintiff DILLEY can only climb the stairs to access the exercise yard if she

2 is willing to endure great pain in her legs. As a result, she has not been able to access the

3 exercise yard for the entire duration of her time in the Jail. While incarcerated, Plaintiff

4 DILLEY has not been outside except when she has been escorted to medical appointments

5 at outside medical specialists and to go to court. She had not been outside at all between

6 mid-December 2013 and late-March 2014.

7

339. Plaintiff GIST would like to attend the religious services and substance

8 abuse treatment classes, Narcotics Anonymous and Alcoholics Anonymous, but in order to

9 access the programs and services she must climb the same long staircase that provides the

10 Women’s Section with access to the exercise yard. There is no alternative means of

11 accessing these programs and services. Plaintiff GIST does not attend these programs due

12 to the pain caused by climbing the stairs. Plaintiff GIST could likely access the class if

13 Defendants offered the class in an area of the Jail that could be reached without having to

14 climb stairs.

15

340. As a permanent wheelchair user, Plaintiff ESQUIVEL was not able to access

16 the exercise yard while he was housed in the Rotunda

17

341. Another prisoner who has a mobility impairment that makes walking up

18 stairs extremely difficult and painful was assigned to F-Pod. This prisoner declined to go

19 to yard every time that it was offered because the pain and difficulty of climbing the stairs

20 was too great. On at least one occasion, despite this prisoner’s mobility impairments,

21 Defendants forced him to climb the stairs to the yard when Defendants were conducting

22 searches of cells in F-Pod. The prisoner specifically requested that he be excused from the

23 need to go to the yard; Defendants denied his request. When he had to walk up to the yard,

24 it caused him great pain and placed him at serious risk of falling and further injuring

25 himself.

26

342. Defendants offer an educational program to some prisoners called Choices

27 and Pride. Prisoners who complete the more than 20 sessions of Choices and Pride,

28 conducted over a period of weeks, receive a five-day reduction of their sentence. Choices

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1 and Pride is only offered to women in the Jail in a room that is located up the same long

2 staircase that provides the Women’s Section with access to the exercise yard. There is no

3 alternative means of accessing the classroom. Plaintiff DILLEY desires to complete the

4 class to receive a reduction in her sentence. She was able to access the classroom for the

5 first session of the class, but did so by suffering through the extraordinary pain caused by

6 climbing up and down the stairs. By forcing Plaintiff DILLEY to climb the stairs to access

7 the class, and suffer significant, unnecessary pain, Defendants discriminate against

8 Plaintiff DILLEY. Plaintiff DILLEY could access the class without any unnecessary pain

9 if Defendants offered the class in an area of the Jail that could be reached without having

10 to climb stairs.

11

343. Plaintiff GIST would like to participate in the Jail’s educational programs

12 but cannot because of her developmental and physical disabilities, which prevent her both

13 from accessing the classroom space (which is located up a long flight of stairs that she

14 cannot access without difficulty and pain) and understanding the classes. If there were

15 special education opportunities offered in a more accessible area, she would participate.

16

344. Defendants use segregated isolation units to house prisoners with disabilities

17 whom they are unable to properly accommodate. One prisoner, who is mobility impaired

18 due to permanent spinal injuries and uses a walker, was housed in the general population

19 for approximately one month after she returned to the Jail following surgery. On July 12,

20 2013, she had a dispute with a deputy because that deputy would not allow her to leave her

21 cell to pick up her dinner tray, “as she uses a walker and [it] would be hard for her to walk

22 up and down the stairs with trays and her walker.” She received a Disciplinary Action

23 Report as a result of this conflict. Rather than accommodating this prisoner to ensure that

24 she could remain in the least restrictive possible housing environment and have equal

25 access to dining services, Defendants moved her to the “holding” area of the women’s

26 facility, a segregated and isolated single-cell unit. Defendants moved this prisoner to the

27 holding area at least in part because of her disability. On a July 13, 2013

28 Lockdown/Inmate Movement form Defendants wrote that they “moved [this prisoner] to

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1 holding so this incident [not being able to safely navigate the stairs with a tray] does not

2 occur again.” In the holding area, this prisoner slept on a mattress on the floor and had

3 limited access to toilet facilities and running water. On information and belief, this

4 prisoner was housed in the holding area for approximately six weeks.

5

345. Defendants routinely discriminate against prisoners with serious mental

6 illness by isolating them from and denying them privileges granted to other prisoners, as

7 described in Paragraphs 254-256, supra. When housed in lockdown units, isolation cells,

8 or rubber rooms, prisoners with serious mental illnesses are denied access to programs and

9 services.

10

346. Plaintiff MEFFORD has only been housed in lockdown, isolation, and safety

11 cells while at the Jail. In addition, he has repeatedly lost yard privileges due to disciplinary

12 actions where the custody staff failed to consider the effect of his mental illness. As such,

13 he has been essentially denied access to the even limited recreational and therapeutic

14 opportunities offered to prisoners housed in these cells.

15

347. Defendants have placed Plaintiff MURPHY in an isolation cell at least one

16 time for a period of 10 days in April 2013. Upon information and belief, Plaintiff

17 MURPHY’s was denied access to programs, services, and activities at the Jail during his

18 time in isolation.

19

F. Defendants Subject Prisoners with Disabilities to Dangerous Conditions

in the Jail

20

21

348. Defendants fail to accommodate prisoners with disabilities that affect

22 communication for interactions with medical and mental health care staff, despite the

23 grave importance of the interactions. Specifically, Defendants fail to provide sign

24 language interpreters, hearing aids, staff assistants, and other auxiliary aids, or use other

25 methods of effective communication, for prisoners with disabilities that affect

26 communication. Defendants fail to provide these accommodations despite knowledge that

27 such prisoners cannot effectively communicate with staff without the accommodations and

28 that the failure to communicate effectively places such prisoners at an increased risk that

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1 medical or mental health issues will not be not be diagnosed or will be misdiagnosed.

2

349. For example, during his most recent booking in the Jail, Plaintiff YANCEY

3 had at least six medical appointments. He was not provided with a sign language

4 interpreter at any of his appointments. Because there was no sign language interpreter to

5 help him communicate with the medical staff, Plaintiff YANCEY was not able to explain

6 that the pain medication he was being provided was insufficient to treat his pain.

7 Accordingly, his pain symptoms were not adequately treated.

8

350. Plaintiff NICHOLS had at least eight interactions with medical staff during

9 his time in the Jail. None of the notes from those interactions indicate that medical staff

10 used any method of effective communication to ensure that Plaintiff NICHOLS understood

11 the information conveyed to him.

12

351. Defendants endanger prisoners with hearing impairments by failing to

13 institute any system for visually identifying prisoners with hearing impairments (e.g.,

14 vests). If a fight breaks out in a housing unit, Jail staff may order all prisoners to get down

15 on the ground or to line up against a wall. For any number of reasons, Jail staff may also

16 order a specific prisoner to cease or engage in certain behavior. Upon information and

17 belief, Jail staff are authorized to initiate disciplinary proceedings and/or use force against

18 prisoners who fail to comply with orders. Upon information and belief, the use of force for

19 failure to comply with an order can include the use of Tasers, non-lethal firearms (like

20 “flash bang” grenades) and lethal firearms.

21

352. Prisoners with communication impairments like Plaintiff YANCEY, Plaintiff

22 NICHOLS, or Plaintiff MEFFORD are not capable of understanding and therefore are less

23 likely to comply with alarms and oral orders from jail staff. Without a visual identification

24 system by which staff can identify prisoners with communication impairments (e.g., vests),

25 there is an increased risk that staff will not recognize that a prisoner has an impairment and

26 will interpret such prisoner’s actions as a failure to comply with an order, rather than as a

27 failure to hear and/or understand the order. As a result, prisoners with hearing and other

28 communication impairments are at increased risk that staff will initiate disciplinary

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1 proceedings and/or use force for failure to comply with an order that they have not heard

2 or understood.

3

353. Defendants lack any policy, practice, or system for notifying prisoners with

4 disabilities of emergencies, including alarms, fires, and earthquakes. Upon information

5 and belief, Defendants fail to adequately train staff in how to notify prisoners with

6 disabilities of emergencies. Upon information and belief, the Jail does not have a visual or

7 tactile alarm system installed to alert prisoners with disabilities. Because Defendants lack

8 a system for identifying prisoners with disabilities, including those with hearing and

9 communication impairments, or notifying prisoners with disabilities of an emergency,

10 these prisoners may not be aware of an emergency, or may need assistance during the

11 emergency, and are therefore at increased risk of injury or death should one occur.

12

354. Defendants lack any policies or practices to ensure that prisoners with

13 difficulty walking, including prisoners in wheelchairs, are safely evacuated from the Jail in

14 the event of an emergency. Upon information and belief, Defendants fail to adequately

15 train staff in how to ensure that prisoners with mobility impairments are safely evacuated

16 from the Jail in an emergency. Upon information and belief, the emergency exits in the

17 Jail, to the extent they exist, are not accessible to prisoners in wheelchairs. As a result,

18 prisoners with difficulty ambulating are at increased risk of injury or death if an

19 emergency, like a fire or earthquake, were to occur.

20

355. Defendants endanger prisoners with mobility impairments by failing to

21 institute any system for staff to visually identify prisoners with mobility impairments.

22 Upon information and belief, Defendants fail to adequately train staff in how to visually

23 identify prisoners with mobility impairments. Upon information and belief, in response to

24 alarms or other incidents in the Jail, custody staff frequently order prisoners to “prone out,”

25 i.e., lay down on the ground, face down. Upon information and belief, Jail staff are

26 authorized to initiate disciplinary proceedings and/or use force against prisoners who fail

27 to prone out when ordered to do so. Upon information and belief, the use of force for

28 failure to comply with an order to prone out can include the use of Tasers, non-lethal

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1 firearms (like “flash bang” grenades) and lethal firearms.

2

356. Some prisoners with mobility impairments are incapable of complying with

3 an order to prone out because of their mobility impairments. Without a visual

4 identification system by which staff can identify prisoners with such mobility impairments

5 (e.g., a vest or certain color of clothing), there is an increased risk that custody staff will

6 not recognize that a prisoner has a mobility impairment and will interpret such a prisoner’s

7 failure to prone out as a failure to comply with an order, rather than an inability to comply

8 with the order. As a result, prisoners with mobility impairments are at increased risk that

9 staff will initiate disciplinary proceedings and/or use force for failure to comply with an

10 order to prone out with which they cannot comply because of their disability.

11

357. Prisoners with disabilities that are not accommodated are susceptible to

12 exploitation by other prisoners. For example, in exchange for help getting to the toilet,

13 shower, or meals, or communicating with prison staff, prisoners with disabilities may be

14 required to pay other prisoners, potentially leading to increased risk of violence or even

15 rape.

16

G. Defendants Fail to Adequately Train Staff to Accommodate Prisoners

with Disabilities

17

18

358. Upon information and belief, Defendants fail to adequately train custody and

19 health care staff in how to provide appropriate and timely accommodations to prisoners

20 with disabilities. The lack of training is evident from the numerous failures to

21 accommodate prisoners with disabilities, and exclusion of prisoners with disabilities from

22 equal access to programs, services, and activities offered by Defendants, and placement of

23 prisoners with disabilities at risk of injury and exploitation. As a result of a lack of

24 adequate training, custody and health care staff do not, among other failings: identify and

25 track individuals with disabilities and the accommodations they require, maintain records

26 or information about prisoners’ disabilities and related accommodations, appropriately

27 process and timely respond to grievance forms, provide accommodations necessary for

28 effective communication, including sign language interpreters, hearing aids, staff

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1 assistants, and other auxiliary aids, provide equal access to telephone services for prisoners

2 with communication disabilities, notify prisoners with disabilities of emergencies, ensure

3 that prisoners with mobility impairments are safely evacuated from the Jail in an

4 emergency, and provide equal access to Jail services and programs.

5

CLASS ACTION ALLEGATIONS

6

Prisoner Class

7

359. All Plaintiffs bring this action on their own behalf and, pursuant to Rule

8 23(a), (b)(1), and (b)(2) of the Federal Rules of Civil Procedure, on behalf of a class of all

9 adult men and women who are now, or will be in the future, incarcerated in Monterey

10 County Jail (“Prisoner Class”). All prisoners incarcerated in the Jail are at substantial risk

11 of serious harm due to the policies and practices of Defendants MONTEREY COUNTY,

12 MONTEREY COUNTY SHERIFF’S OFFICE, and CFMG (“Defendants”), including:

13

a. Denial of protection from injury and violence from other prisoners,

14

b. Denial of minimally adequate medical care, and

15

c. Denial of minimally adequate mental health care.

16

Numerosity: Fed. R. Civ. P. 23(a)(1)

17

360. The proposed class as defined is sufficiently numerous that joinder of all

18 members of the class is impracticable and unfeasible. Currently, there are more than 900

19 prisoners in the Jail, as well as thousands of individuals either in CDCR custody or in the

20 community on probation, mandatory supervision, home confinement, and Post-Release

21 Community Supervision (“PRCS”), all of whom are subject to being returned to the Jail at

22 any time on an alleged violation or revocation of their supervision or to participate in civil

23 or criminal court proceedings. Due to Defendants’ policies and practices, all prisoners in

24 Monterey County Jail are at risk of being harmed by violence from other prisoners. Due to

25 Defendants’ policies and practices, all prisoners at Monterey County Jail receive or are at

26 substantial risk of receiving inadequate medical, dental, and mental health care.

27

361. The plaintiff class members are identifiable using records maintained in the

28 ordinary course of business by Defendants.

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1

Commonality: Fed. R. Civ. P. 23(a)(2)

2

362. There are questions of law and fact common to the Prisoner Class, including,

3 but not limited to:

4

a. Whether Defendants’ failure to protect prisoners from violence from

5 other prisoners violates the Due Process Clause of the Fourteenth Amendment and the

6 Cruel and Unusual Punishment Clause of the of the Eighth Amendment to the United

7 States Constitution, and Article I, Sections 7 and 17 of the California Constitution;

8

b. Whether Defendants’ failure to provide minimally adequate medical

9 care to prisoners violates the Due Process Clause of the Fourteenth Amendment and the

10 Cruel and Unusual Punishment Clause of the Eighth Amendment to the United States

11 Constitution, and Article I, Sections 7 and 17 of the California Constitution; and

12

c. Whether Defendants’ failure to provide minimally adequate mental

13 health care to prisoners violates the Due Process Clause of the Fourteenth Amendment and

14 the Cruel and Unusual Punishment Clause of the Eighth Amendment to the United States

15 Constitution, and Article I, Sections 7 and 17 of the California Constitution.

16

363. Defendants are expected to raise common defenses to these claims, including

17 denying that their actions violate the law.

18

Typicality: Fed. R. Civ. P. 23(a)(3)

19

364. The claims of the named Plaintiffs are typical of the claims of the members

20 of the proposed class. Plaintiffs and all other members of the class have sustained similar

21 injuries arising out of and caused by Defendants’ common course of conduct and policies

22 in violation of the law as alleged herein.

23

Adequacy: Fed. R. Civ. P. 23(a)(4)

24

365. Plaintiffs are members of the class and will fairly and adequately represent

25 and protect the interests of the putative class members because they have no disabling

26 conflict(s) of interest that would be antagonistic to those of the other class members.

27 Plaintiffs, as well as plaintiff class members, seek to enjoin the unlawful acts and

28 omissions of Defendants. Plaintiffs have retained counsel who are competent and

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1 experienced in complex class action litigation and prisoner’s rights litigation.

2

Fed. R. Civ. P. 23(b)(1)(A) and (B)

3

366. Since the number of class members is more than 900, separate actions by

4 individuals could result in inconsistent and varying decisions, which in turn would result in

5 conflicting and incompatible standards of conduct for Defendants.

6

Fed. R. Civ. P. 23(b)(2)

7

367. This action is also maintainable as a class action pursuant to Federal Rule of

8 Civil Procedure 23(b)(2) because Defendants have acted and refused to act on grounds that

9 apply generally to the class, so that final injunctive relief or corresponding declaratory

10 relief is appropriate respecting the class and will apply to all members of the class.

11

Prisoners with Disabilities Subclass

12

368. All Plaintiffs bring this action on their own behalf and, pursuant to Rule

13 23(a), (b)(1), and (b)(2) of the Federal Rules of Civil Procedure, on behalf of a subclass of

14 all qualified individuals with a disability, as that term is defined in 42 U.S.C. § 12102, 29

15 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m), and who are

16 now, or will be in the future, incarcerated in Monterey County Jail (“Prisoners with

17 Disabilities Subclass”). All prisoners with disabilities who are incarcerated in the Jail are

18 at risk of being discriminated against or denied access to programs, services and activities

19 offered at the Jail as a result of the policies and practices of Defendants MONTEREY

20 COUNTY, MONTEREY COUNTY SHERIFF’S OFFICE, and CFMG (“Defendants”).

21

Numerosity: Fed. R. Civ. P. 23(a)(1)

22

369. The proposed subclass as defined is sufficiently numerous that joinder of all

23 members of the subclass is impracticable and unfeasible. The exact number of members of

24 the Prisoners with Disabilities Subclass is unknown. According to data regarding the

25 incidence of disabilities among the general population, at least 30% of the prisoners in the

26 Jail are qualified individuals with disabilities as that term is defined in 42 U.S.C. § 12102,

27 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

28

370. The Prisoners with Disabilities Subclass members are identifiable using

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1 records maintained in the ordinary course of business by Defendants.

2

Commonality: Fed. R. Civ. P. 23(a)(2)

3

371. There are questions of law and fact common to the Prisoners with

4 Disabilities Subclass, including, but not limited to: Whether Defendants’ failure to

5 reasonably accommodate prisoners with disabilities violates the Americans with

6 Disabilities Act, Section 504 of the Rehabilitation Act, and California Government Code

7 § 11135.

8

372. Defendants are expected to raise common defenses to these claims, including

9 denying that their actions violate the law.

10

Typicality: Fed. R. Civ. P. 23(a)(3)

11

373. The claims of the named Plaintiffs are typical of the claims of the members

12 of the proposed subclass. Plaintiffs and all other members of the subclass have sustained

13 similar injuries arising out of and caused by Defendants’ common course of conduct and

14 policies in violation of the law as alleged herein.

15

Adequacy: Fed. R. Civ. P. 23(a)(4)

16

374. Plaintiffs are members of the subclass and will fairly and adequately

17 represent and protect the interests of the putative subclass members because they have no

18 disabling conflict(s) of interest that would be antagonistic to those of the other subclass

19 members. Plaintiffs, as well as Prisoners with Disabilities Subclass members, seek to

20 enjoin the unlawful acts and omissions of Defendants. Plaintiffs have retained counsel

21 who are competent and experienced in complex class action litigation and prisoner’s rights

22 litigation.

23

Fed. R. Civ. P. 23(b)(1)(A) and (B)

24

375. Since the subclass consists of more than 30% of the prisoner population in

25 the Jail, separate actions by individuals could result in inconsistent and varying decisions,

26 which in turn would result in conflicting and incompatible standards of conduct for

27 Defendants.

28

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1

Fed. R. Civ. P. 23(b)(2)

2

376. This action is also maintainable as a class action pursuant to Fed. R. Civ. P.

3 23(b)(2) because Defendants have acted and refused to act on grounds that apply generally

4 to the subclass, so that final injunctive relief or corresponding declaratory relief is

5 appropriate respecting the subclass and will apply to all members of the class and subclass.

6

FIRST CAUSE OF ACTION

7

(Eighth Amendment to the United States Constitution, 42 U.S.C. § 1983)

8

By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

9

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

10 and the Prisoner Class Against Defendants MONTEREY COUNTY, MONTEREY

COUNTY SHERIFF’S OFFICE, and CALIFORNIA FORENSIC MEDICAL

11

GROUP

12

377. Plaintiffs re-allege and incorporate by reference herein all allegations

13 previously made in paragraphs 1 through 376 above.

14

378. By their policies and practices described above, Defendants MONTEREY

15 COUNTY, MONTEREY COUNTY SHERIFF’S OFFICE, and CFMG (“Defendants”)

16 subject Plaintiffs AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL, GIST, GOMEZ,

17 GREIM, GUYOT, HERNANDEZ, HOBBS, HUNTER, KEY, MEFFORD, MILLER,

18 MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY, and the Prisoner

19 Class they represent, to a substantial risk of harm and injury from violence from other

20 prisoners and inadequate medical and mental health care. These policies and practices

21 have been, and continue to be, implemented by Defendants and their agents or employees

22 in their official capacities, and are the proximate cause of Plaintiffs’ and the Prisoner

23 Class’s ongoing deprivation of rights secured by the United States Constitution under the

24 Eighth Amendment.

25

379. Defendants have been and are aware of all of the deprivations complained of

26 herein, and have condoned or been deliberately indifferent to such conduct.

27

WHEREFORE, Plaintiffs and the Prisoner Class they represent request relief as

28 outlined below.

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1

SECOND CAUSE OF ACTION

2

(Fourteenth Amendment to the United States Constitution, 42 U.S.C. § 1983)

3

By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

4

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

5 and the Prisoner Class Against Defendants MONTEREY COUNTY, MONTEREY

COUNTY SHERIFF’S OFFICE, and CALIFORNIA FORENSIC MEDICAL

6

GROUP

7

380. Plaintiffs re-allege and incorporate by reference herein all allegations

8 previously made in paragraphs 1 through 379, above.

9

381. By their policies and practices described above, Defendants subject Plaintiffs

10 AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL, GIST, GOMEZ, GREIM, GUYOT,

11 HERNANDEZ, HOBBS, HUNTER, KEY, MEFFORD, MILLER, MURPHY, NICHOLS,

12 PEREZ, SARABI, WHITFIELD, and YANCEY, and the Prisoner Class they represent, to

13 a substantial risk of harm and injury from violence from other prisoners and inadequate

14 medical and mental health care. These policies and practices have been, and continue to

15 be, implemented by Defendants and their agents or employees in their official capacities,

16 and are the proximate cause of Plaintiffs’ and the Prisoner Class’s ongoing deprivation of

17 rights secured by the United States Constitution under the Fourteenth Amendment.

18

382. Defendants have been and are aware of all of the deprivations complained of

19 herein, and have condoned or been deliberately indifferent to such conduct.

20

WHEREFORE, Plaintiffs and the Prisoner Class they represent request relief as

21 outlined below.

22

THIRD CAUSE OF ACTION

23

(Article I, Section 7 of the California Constitution)

24

By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

25

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

26 and the Prisoner Class Against Defendants MONTEREY COUNTY, MONTEREY

COUNTY SHERIFF’S OFFICE, and CALIFORNIA FORENSIC MEDICAL

27

GROUP

28

383. Plaintiffs re-allege and incorporate by reference herein all allegations

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1 previously made in paragraphs 1 through 382, above.

2

384. By their policies and practices described above, Defendants subject

3 AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL, GIST, GOMEZ, GREIM, GUYOT,

4 HERNANDEZ, HOBBS, HUNTER, KEY, MEFFORD, MILLER, MURPHY, NICHOLS,

5 PEREZ, SARABI, WHITFIELD, and YANCEY, and the Prisoner Class they represent, to

6 a substantial risk of harm and injury from violence from other prisoners and inadequate

7 medical and mental health care. These policies and practices have been, and continue to

8 be, implemented by Defendants and their agents or employees in their official capacities,

9 and are the proximate cause of Plaintiffs’ and the Prisoner Class’s ongoing deprivation of

10 rights secured by the California Constitution, Article I, Section 7.

11

385. Defendants have been and are aware of all of the deprivations complained of

12 herein, and have condoned or been deliberately indifferent to such conduct.

13

WHEREFORE, Plaintiffs and the Prisoner Class they represent request relief as

14 outlined below.

15

FOURTH CAUSE OF ACTION

16

(Article I, Section 17 of the California Constitution)

17

By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

18

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

19 and the Prisoner Class Against Defendants MONTEREY COUNTY, MONTEREY

COUNTY SHERIFF’S OFFICE, and CALIFORNIA FORENSIC MEDICAL

20

GROUP

21

386. Plaintiffs re-allege and incorporate by reference herein all allegations

22 previously made in paragraphs 1 through 385, above.

23

387. By their policies and practices described above, Defendants subject Plaintiffs

24 AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL, GIST, GOMEZ, GREIM, GUYOT,

25 HERNANDEZ, HOBBS, HUNTER, KEY, MEFFORD, MILLER, MURPHY, NICHOLS,

26 PEREZ, SARABI, WHITFIELD, and YANCEY, and the Prisoner Class they represent, to

27 a substantial risk of harm and injury from violence from other prisoners and inadequate

28 medical and mental health care. These policies and practices have been, and continue to

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1 be, implemented by Defendants and their agents or employees in their official capacities,

2 and are the proximate cause of Plaintiffs’ and the Prisoner Class’s ongoing deprivation of

3 rights secured by the California Constitution, Article I, Section 17.

4

388. Defendants have been and are aware of all of the deprivations complained of

5 herein, and have condoned or been deliberately indifferent to such conduct.

6

WHEREFORE, Plaintiffs and the Prisoner Class they represent request relief as

7 outlined below.

8

FIFTH CAUSE OF ACTION

9

(Americans with Disabilities Act, 42 U.S.C. § 12132)

10 By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

11 MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

and the Prisoners with Disabilities Subclass Against Defendants MONTEREY

12

COUNTY and MONTEREY COUNTY SHERIFF’S OFFICE

13

389. Plaintiffs re-allege and incorporate by reference herein all allegations

14 previously made in paragraphs 1 through 388, above.

15

390. The ADA prohibits public entities, including the COUNTY and the

16 SHERIFF’S OFFICE from denying “a qualified individual with a disability … the benefits

17 of the services, programs, or activities of [the] public entity” because of the individual’s

18 disability. 42 U.S.C. § 12132.

19

391. Defendants MONTEREY COUNTY and SHERIFF’S OFFICE are legally

20 responsible for all violations of the ADA committed by CFMG in the course of performing

21 its duties under its contractual arrangement with the SHERIFF’S OFFICE to provide

22 medical and mental health care services to prisoners in the Jail. See 28 C.F.R.

23 § 35.130(b)(1).

24

392. The ADA defines “a qualified individual with a disability” as a person who

25 suffers from a “physical or mental impairment that substantially limits one or more major

26 life activities,” including, but not limited to, “caring for oneself, performing manual tasks,

27 seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing,

28 learning, reading, concentrating, thinking, communicating, and working.” 42 U.S.C.

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1 § 12102(1)(A), (2)(A). All Plaintiffs are qualified individuals with disabilities as defined

2 in the ADA, as they have impairments that substantially limit one or more major life

3 activities.

4

393. The programs, services, and activities that Defendants MONTEREY

5 COUNTY and SHERIFF’S OFFICE provide to prisoners include, but are not limited to,

6 sleeping, eating, showering, toileting, communicating with those outside the Jail by mail

7 and telephone, exercising, entertainment, safety and security, the Jail’s administrative,

8 disciplinary, and classification proceedings, medical, mental health, and dental services,

9 the library, educational, vocational, substance abuse, and anger management classes, and

10 discharge services. Defendants MONTEREY COUNTY’s and SHERIFF’S OFFICE’s

11 programs, services, and activities are covered by the ADA.

12

394. Under the ADA, Defendants MONTEREY COUNTY and SHERIFF’S

13 OFFICE must provide prisoners with disabilities reasonable accommodations and

14 modifications so that they can avail themselves of and participate in all programs and

15 activities offered by Defendants.

16

395. Defendants MONTEREY COUNTY and SHERIFF’S OFFICE fail to

17 accommodate the Plaintiffs and the Prisoners with Disabilities Subclass they represent as

18 described above, including by:

19

a.

failing to “ensure that qualified inmates or detainees with disabilities

20 shall not, because a facility is inaccessible to or unusable by individuals with disabilities,

21 be excluded from participation in, or be denied the benefits of, the services, programs, or

22 activities of a public entity, or be subjected to discrimination by any public entity,” 28

23 C.F.R. § 35.152(b)(1);

24

b.

failing to “ensure that inmates or detainees with disabilities are

25 housed in the most integrated setting appropriate to the needs of the individuals,” 28

26 C.F.R. § 35.152(b)(2);

27

c.

failing to “implement reasonable policies, including physical

28 modifications to additional cells in accordance with the 2010 [accessibility] Standards, so

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1 as to ensure that each inmate with a disability is housed in a cell with the accessible

2 elements necessary to afford the inmate access to safe, appropriate housing,” 28 C.F.R.

3 § 35.152(b)(3);

4

d.

failing or refusing to provide Plaintiffs and the Prisoners with

5 Disabilities Subclass they represent with reasonable accommodations and other services

6 related to their disabilities, see generally 28 C.F.R. § 35.130(a);

7

e.

failing or refusing to provide equally effective communication, see

8 generally 28 C.F.R. § 35.160(a);

9

f.

denying Plaintiffs and the Prisoners with Disabilities Subclass they

10 represent “the opportunity to participate in or benefit from [an] aid, benefit, or service”

11 provided by Defendants, 28 C.F.R. § 35.130(b)(1)(i);

12

g.

failing to make “reasonable modifications in policies, practices, or

13 procedures when the modifications are necessary to avoid discrimination on the basis of

14 disability,” 28 C.F.R. § 35.130(b)(7);

15

h.

failing to make available information to the Prisoners with Disabilities

16 Subclass about their rights under the ADA while detained in the Jail, see 28 C.F.R.

17 § 35.106;

18

i.

failing to “adopt and publish grievance procedures providing for

19 prompt and equitable resolution of complaints alleging any action that would be prohibited

20 by … [the ADA],” 28 C.F.R. § 35.107(b);

21

j.

failing to “maintain in operable working condition those features of

22 facilities and equipment that are required to be readily accessible to and usable by persons

23 with disabilities by the [ADA],” 28 C.F.R. § 35.133(a); and

24

k.

failing to “furnish appropriate auxiliary aids and services where

25 necessary to afford individuals with disabilities … an equal opportunity to participate in,

26 and enjoy the benefits of, a service, program, or activity of a public entity,” 28 C.F.R.

27 § 35.160(b)(1).

28

396. As a result of Defendants MONTEREY COUNTY and SHERIFF’S

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1 OFFICE’s policy and practice of discriminating against and failing to provide reasonable

2 accommodations to prisoners with disabilities, Plaintiffs and the Prisoners with Disabilities

3 Subclass they represent do not have equal access to Jail activities, programs, and services

4 for which they are otherwise qualified.

5

WHEREFORE, Plaintiffs and the Prisoners with Disabilities Subclass they

6 represent request relief as outlined below.

7

SIXTH CAUSE OF ACTION

8

(Americans with Disabilities Act, 42 U.S.C. § 12188)

9 By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

10 MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

and the Prisoners with Disabilities Subclass Against Defendant CALIFORNIA

11

FORENSIC MEDICAL GROUP

12

397. Plaintiffs re-allege and incorporate by reference herein all allegations

13 previously made in paragraphs 1 through 396, above.

14

398. Defendant CFMG is a public accommodation that owns, leases, leases to, or

15 operates a professional office of a health care provider, hospital, or other service

16 establishment within the meaning of 42 U.S.C. § 12181(7)(F), and Title III of the ADA’s

17 implementing regulations, 28 C.F.R. § 36.104.

18

399. Plaintiffs are all individuals with a disability and covered by Title III of the

19 ADA, 42 U.S.C. §§ 12102(1), 12182(b); 28 C.F.R. § 36.104.

20

400. By its policies and practices described above, Defendant CFMG violates

21 Title III of the ADA, 42 U.S.C. §§ 12181-12189, by discriminating against individuals

22 with disabilities on the basis of disability, in the full and equal enjoyment of Defendant

23 CFMG’s goods, services, facilities, privileges, advantages, or accommodations. 42 U.S.C.

24 § 12182(a); 28 C.F.R., Part 36.

25

WHEREFORE, Plaintiffs and the Prisoners with Disabilities Subclass they

26 represent request relief as outlined below.

27

28

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1

SEVENTH CAUSE OF ACTION

2

(Rehabilitation Act, 29 U.S.C. § 794)

3 By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,

4 MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY

and the Prisoners with Disabilities Subclass Against Defendants MONTEREY

5

COUNTY and MONTEREY COUNTY SHERIFF’S OFFICE

6

401. Plaintiffs re-allege and incorporate by reference herein all allegations

7 previously made in paragraphs 1 through 400, above.

8

402. At all times relevant to this action, Defendants MONTEREY COUNTY and

9 SHERIFF’S OFFICE were recipients of federal funding within the meaning of the

10 Rehabilitation Act. As recipients of federal funds, they are required to reasonably

11 accommodate prisoners with disabilities in their facilities, program activities, and services,

12 and to provide a grievance procedure.

13

403. Plaintiffs and the Prisoners with Disabilities Subclass they represent are

14 qualified individuals with disabilities as defined in the Rehabilitation Act.

15

404. By their policy and practice of discriminating against and failing to

16 reasonably accommodate prisoners with disabilities, Defendants MONTEREY COUNTY

17 and SHERIFF’S OFFICE violate Section 504 of the Rehabilitation Act, 29 U.S.C. § 794.

18

405. As a result of Defendants MONTEREY COUNTY and SHERIFF’S

19 OFFICE’s discriminating against and failing to provide a grievance procedure and

20 reasonable accommodations, Plaintiffs and the Prisoners with Disabilities Subclass they

21 represent do not have equal access to Jail activities, programs, and services for which they

22 are otherwise qualified.

23

WHEREFORE, Plaintiffs and the Prisoners with Disabilities Subclass they

24 represent request relief as outlined below.

25

26

27

28

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1

EIGHTH CAUSE OF ACTION

2

(Cal. Gov’t Code § 11135)

3 By Plaintiffs HERNANDEZ, AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL, GIST, GOMEZ, GREIM, GUYOT, HOBBS, HUNTER, KEY, MEFFORD,
4 MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and YANCEY and the Prisoners with Disabilities Subclass Against Defendants MONTEREY
5 COUNTY, MONTEREY COUNTY SHERIFF’S OFFICE, and CALIFORNIA FORENSIC MEDICAL GROUP
6

7

406. Plaintiffs re-allege and incorporate by reference herein all allegations

8 previously made in paragraphs 1 through 405, above.

9

407. Defendants receive financial assistance from the State of California as part of

10 Realignment Legislation, California Government Code §§ 30025, 30026, and 30029, and

11 through other statutes and funding mechanisms. Plaintiffs and the Prisoner with

12 Disabilities Subclass they represent are all persons with disabilities within the meaning of

13 California Government Code § 11135.

14

408. As described in this Complaint, Defendants deny Plaintiffs full access to the

15 benefits of the Jail’s programs and activities which receive financial assistance from the

16 State of California and unlawfully subject Plaintiffs and the Prisoners with Disabilities

17 Subclass they represent to discrimination within the meaning of California Government

18 Code § 11135(a) on the basis of their disabilities.

19

409. From February 2012 through October 2013, through their counsel and

20 through grievances submitted to the Jail, Plaintiffs and the Prisoners with Disabilities

21 Subclass they represent demanded that Defendants stop their unlawful discriminatory

22 conduct described above, but Defendants refused and still refuse to refrain from that

23 conduct.

24

WHEREFORE, Plaintiffs and the Prisoners with Disabilities Subclass they

25 represent request relief as outlined below.

26

PRAYER FOR RELIEF

27

Plaintiffs and the class and subclass they represent have no adequate remedy at law

28 to redress the wrongs suffered as set forth in this Second Amended Complaint. Plaintiffs

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1 have suffered and will continue to suffer irreparable injury as a result of the unlawful acts,

2 omissions, policies, and practices of the Defendants as alleged herein, unless Plaintiffs are

3 granted the relief they request. Plaintiffs and Defendants have an actual controversy and

4 opposing legal positions as to Defendants’ violations of the constitutions and laws of the

5 United States and the State of California. The need for relief is critical because the rights

6 at issue are paramount under the constitutions and laws of the United States and the State

7 of California.

8

WHEREFORE, Plaintiffs AGUILAR, COBB, DILLEY, DOBBS, ESQUIVEL,

9 GIST, GOMEZ, GREIM, GUYOT, HERNANDEZ, HOBBS, HUNTER, KEY,

10 MEFFORD, MILLER, MURPHY, NICHOLS, PEREZ, SARABI, WHITFIELD, and

11 YANCEY, on behalf of themselves, the proposed class and subclass, and all others

12 similarly situated, pray for judgment and the following specific relief against Defendants

13 MONTEREY COUNTY, MONTEREY COUNTY SHERIFF’S OFFICE, CALIFORNIA

14 FORENSIC MEDICAL GROUP, and DOES 1 through 20 as follows:

15

410. An order certifying that this action may be maintained as a class action

16 pursuant to Federal Rule of Civil Procedure 23(a) and 23(b)(1) and (2);

17

411. A declaratory judgment that the conditions, acts, omissions, policies, and

18 practices described above are in violation of the rights of Plaintiffs and the class and

19 subclass they represent under the Eighth and Fourteenth Amendments to the United States

20 Constitution, the ADA, the Rehabilitation Act, Article I, Sections 7 and 17 of the

21 California Constitution, and California Government Code § 11135;

22

412. An order requiring Defendants, their agents, officials, employees, and all

23 persons acting in concert with them under color of state law or otherwise to protect

24 prisoners from substantial risk of harm from other prisoners, to provide minimally

25 adequate medical care to prisoners, to provide minimally adequate mental health care to

26 prisoners, and to cease discriminating against and failing to provide accommodations to

27 prisoners with disabilities;

28

413. An order enjoining Defendants, their agents, officials, employees, and all

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1 persons acting in concert with them under color of state law or otherwise, from continuing

2 the unlawful acts, conditions, and practices described in this Complaint;

3

414. An order requiring Defendants and their agents, employees, officials, and all

4 persons acting in concert with them under color of state law or otherwise to develop and

5 implement, as soon as practical, a plan to eliminate the substantial risk of harm,

6 discrimination, and statutory violations that Plaintiffs and members of the class and

7 subclass they represent suffer due to the unlawful acts, omissions, conditions and practices

8 described in this Complaint. Defendants’ plan shall include at a minimum the following:

9

a.

Population: Implement appropriate population management so that

10 the number of prisoners is kept at a level that can be safely managed.

11

b.

Staffing: Ensure adequate numbers of correctional staff to ensure the

12 safety and security of the prisoner population.

13

c.

Physical Plant: Remedy all physical plant problems that endanger the

14 safety and security of the prisoner population.

15

d.

Protection from Harm: Take all steps to ensure that prisoners are safe

16 from harm from fellow prisoners.

17

e.

Training: Ensure that corrections staff are adequately trained to carry

18 out their duties to ensure the safety and security of the prisoner population.

19

f.

Classification and Housing: Appropriately classify and house

20 prisoners to ensure their safety and security.

21

g.

Medical Care: Ensure timely access to medical care to treat the

22 serious medical needs of the prisoner population.

23

h.

Access to Care: Ensure timely access to appropriately trained

24 providers and staff to adequately treat prisoners’ serious medical needs.

25

i.

Medical Staffing: Ensure adequate numbers of staff by discipline to

26 ensure the timely and appropriate treatment of the prisoner populations’ serious medical

27 needs.

28

j.

Emergency Care: Ensure timely access to appropriate emergency care

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1 of prisoner’s emergent medical needs.

2

k.

Chronic Care: Ensure appropriate and timely monitoring and care of

3 prisoners’ chronic conditions.

4

l.

Medical Records: Ensure appropriate and complete medical records

5 are maintained as necessary to ensure adequate treatment of prisoners’ serious medical

6 needs.

7

m.

Specialist and Outside Treatment: Ensure appropriate and timely

8 access to specialists and outside treatment and hospitalization for prisoners who cannot be

9 adequately treated at the Jail.

10

n.

Mental Health Care: Ensure timely access to necessary treatment by

11 qualified staff for serious mental illness, including appropriate medication practices,

12 appropriate therapies, access to hospitalization and inpatient care, appropriate suicide

13 prevention practices and policies, appropriate use of seclusion and restraints, appropriate

14 disciplinary policies and practices regarding the mentally ill, and appropriate training of

15 corrections and mental health staff to recognize and treat prisoners’ mental illness.

16

o.

Quality Assurance: Ensure a system that regularly assesses the

17 performance of health care and custodial staff regarding the provision of health services at

18 the Jail against a set of established and appropriate criteria, so that errors and deficiencies

19 in the Jail’s health care system are identified and corrected timely.

20

p.

Accommodation for Prisoners with Disabilities: Ensure that the

21 members of the Prisoners with Disabilities Subclass are not denied the benefits of, or

22 participation in, programs, services, and activities at the Jail; that prisoners with disabilities

23 are timely identified and tracked; have their disabilities accommodated; are provided with

24 an effective grievance procedure; are provided with all needed assistive devices and other

25 accommodations; and receive effective communication in all medical, mental health, and

26 due process settings and encounters.

27

415. An award to Plaintiffs, pursuant to 29 U.S.C. § 794a, 42 U.S.C. §§ 1988,

28 12205, and California Code of Civil Procedure § 1021.5, of the costs of this suit and

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1 reasonable attorneys’ fees and litigation expenses;

2

416. An order retaining jurisdiction of this case until Defendants have fully

3 complied with the orders of this Court, and there is a reasonable assurance that Defendants

4 will continue to comply in the future absent continuing jurisdiction; and

5

417. An award to Plaintiffs of such other and further relief as the Court deems just

6 and proper.

7

Respectfully submitted,

8 DATED: April 11, 2014 9 10 11

ROSEN BIEN GALVAN & GRUNFELD LLP
By: /s/ Gay Crosthwait Grunfeld Gay Crosthwait Grunfeld

12 DATED: April 11, 2014 13 14 15

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY
By: /s/ James Egar James Egar Public Defender

16 DATED: April 11, 2014
17

AMERICAN CIVIL LIBERTIES UNION OF NORTHERN CALIFORNIA

18

By: /s/ Alan Schlosser

19

Alan Schlosser

20 DATED: April 11, 2014

ACLU NATIONAL PRISON PROJECT

21

By: /s/ Eric Balaban

22

Eric Balaban

23

24

25

26

27

28

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1 CHARLES J. McKEE, SBN 152458 County Counsel
2 SUSAN K. BLITCH, SBN 187761 Senior Deputy County Counsel
3 IRVEN L. GRANT, SBN 068950 Deputy County Counsel
4 MICHAEL R. PHILIPPI, SBN 120967 Deputy County Counsel
5 County of Monterey 168 West Alisal Street, Third Floor
6 Salinas, California 93901-2653 Telephone: (831) 755-5045
7 Facsimile: (831) 755-5283

8 Attorneys for Defendants COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF’S OFFICE
9

10

11

UNITED STATES DISTRICT COURT

12

NORTHERN DISTRICT OF CALIFORNIA

13

San Jose Division

14

15 JESSE HERNANDEZ, CAIN AGUILAR, HA

COBB, SUSAN DILLEY, CONNIE DOBBS,

16 SEAN ESQUIVEL, RAMONA GIST, MARTHA

GOMEZ, GEORGE GREIM, DENNIS GUYOT,

17 JASON HOBBS, GLENDA HUNTER, ALBERT

KEY, BRANDON MEFFORD, WESLEY 18 MILLER, RICHARD MURPHY, JEFF

NICHOLS, ANGEL PEREZ, SARAB SARABI, 19 CLYDE WHITFIELD, and ROBERT YANCEY,

20

on behalf of themselves and all others similarly situated,

21 Pl

22

v.

aintiffs,

23

COUNTY OF MONTEREY; MONTEREY COUNTY SHERIFF’S OFFICE; CALIFORNIA

24

FORENSIC MEDICAL GROUP, INCORPORATED, a California corporation; and

25 DOES 1 to 20, inclusive,

26 D 27

efendants.

Case No. CV 13 2354 PSG

NOTICE OF MOTION AND MOTION OF DEFENDANTS COUNTY OF MONTEREY AND MONTEREY COUNTY SHERIFF’S OFFICE TO DISMISS PLAINTIFFS, ROBERT YANCEY, RICHARD MURPHY, DENNIS GUYOT, GLENDA HUNTER, MARTHA GOMEZ, WESLEY MILLER, JEFFREY NICHOLS, SARAB SARABI, and ALBERT KEY, PURSUANT TO FRCP RULE 12(b)(6); MEMORANDUM OF POINTS AND AUTHORITIES IN SUPPORT OF MOTION

[Filed concurrently with Request for Judicial Notice]

Date: Time: Courtroom: 5, Judge:

June 3, 2014 10:00 a.m.
4th Floor Hon. Paul S. Grewal

28

Hernandez, et al. v. County of Monterey, et al. Case
County Motion to Dismiss Pursuant to FRCP Rule 12(b)(6)

No. CV 13-2354 PSG

Case5:13-cv-02354-PSG Document44 Filed04/25/14 Page2 of 12

1

TABLE OF CONTENTS

2

Page

3 Table of Authorities ................................................................................................................... i

4 NOTICE OF MOTION..............................................................................................................1

5 MEMORANDUM OF POINTS AND AUTHORITIES ...........................................................1

6 I. INTRODUCTION AND STATEMENT OF FACTS ...................................................1

7 II. LEGAL ARGUMENT...................................................................................................2

8 A.

RULE 12(b)(6)...................................................................................................2

9

B. PLAINTIFFS LACK STANDING OR IN THE ALTERNATIVE

THEIR

CLAIMS ARE MOOT ..........................................................................3

10

III. CONCLUSI ON..............................................................................................................8

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28
i
Hernandez, et al. v. County of Monterey, et al. Case
County Motion to Dismiss Pursuant to FRCP Rule 12(b)(6)

No. CV 13-2354 PSG

Case5:13-cv-02354-PSG Document44 Filed04/25/14 Page3 of 12

1

TABLE OF AUTHORITIES

2

Page

3

Cases

4 ACLU v. Lomax, 471 F.3d 1010 (9th Cir. 2006)............................................................................4

5 Abdul-Akbar v. Watson, 4 F.3d 195 (3d Cir. 1993) ......................................................................7 6 Albino v. Baca, 2014 U.S. App. LEXIS 6153 (9th Cir. Cal. Apr. 3, 2014)...................................2 7 Anderson v. Clow, 89 F.3d 1399 (9th Cir. 1996)..........................................................................3

8 Ashcroft v. Iqbal, 556 U.S. 662, 129 S. Ct. 1937, 173 L. Ed. 2d 868 (2009) ...............................2

9 Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 167

L. Ed. 2d 929 (2007) .....................................................................................................2, 3

10

Bowers v. City of Philadelphia, 2006 U.S. Dist. LEXIS 64651 (E.D. Pa.

11

Sept. 8, 2006) ....................................................................................................................5

12 Carty v. Nelson, 426 F.3d 1064 (9th Cir. 2005) ............................................................................4

13 Citizens for Health v. Leavitt, 428 F.3d 167 (3d Cir. 2005) ..................................................... 5-6

14 Clarke v. Lane, 267 F.R.D. 180 (E.D. Pa. 2010) ..........................................................4, 5, 6, 7, 8 15 Epstein v. Washington Energy Co. (9th Cir. 1996) 83 F.3d 1136 .................................................3

16 Ferreira v. Dubois, 963 F. Supp. 1244 (D. Mass. 1996) ..........................................................3, 4

17 Friends of the Earth, Inc. v. Laidlaw Envtl. Servs. (TOC), Inc., 528 U.S.

167

(2000) .........................................................................................................................5

18 Holland v. Purdy, 457 F.2d 802 (5th Cir. 1972)............................................................................6

19 Johnson v. Rancho Santiago Cmty. College Dist., 623 F.3d 1011 (9th Cir.

20 2010)

.................................................................................................................................4

21 L.A. v. Lyons, 461 U.S. 95 (1983).........................................................................................4, 6, 7

22 Lusardi v. Xerox Corp., 975 F.2d 964 (3d Cir. 1992)...................................................................8

23 Murphy v. Hunt, 455 U.S. 478 (1982) ..........................................................................................7

24 Neitzke v. Williams, 490 U.S. 319 (1989) .....................................................................................3

25 O’Shea v. Littleton, 414 U.S. 488 (1974) .............................................................................4, 6, 7

26 Preiser v. Newkirk, 422 U.S. 395 (1975)......................................................................................5

27 Roe v. Operation Rescue, 919 F.3d 857 (3d Cir. 1990)................................................................7

28 Rosetti v. Shalala, 12 F.3d 15 1216 (3d Cir. 1993) ..................................................................4, 6

ii
Hernandez, et al. v. County of Monterey, et al. Case
County Motion to Dismiss Pursuant to FRCP Rule 12(b)(6)

No. CV 13-2354 PSG

Case5:13-cv-02354-PSG Document44 Filed04/25/14 Page4 of 12

1 SmileCare Dental Group v. Delta Dental Plan of Cal., Inc., 88 F.3d 780 (9th Cir. 1996), cert. denied, 519 U.S. 1028 (1996) ..........................................................3

2

Sosna v. Iowa, 419 U.S. 393 (1975) .....................................................................................5, 6, 7

3

United States Parole Commission v. Geraghty, 445 U.S. 388, 100 S.Ct. 1202

4

63 L. Ed. 2d 479 (1980) ............................................................................................4, 5, 7

5 Valley Forge Christian Coll. v. Americans United for Separation of Church and State, 454 U.S. 464 (1982)............................................................................3
6 Weaver v. Wilcox, 650 F.2d 22 (3d Cir. 1981) .........................................................................5, 6
7 Wiggens v. Rushen, 760 F.2d 1009 (9th Cir. 1985) .......................................................................3
8

9

10

Statutes

11 Federal Rules of Civil Procedure

Rule

12(b)(6).............................................................................................................1, 2, 3

12

42 U.S.C.

13 Section

1983......................................................................................................................3

14 United States Constitution

Article

III ..................................................................................................................3, 5, 8

15

Article III, § 2 ...................................................................................................................5

16

17

Treatises

18 2-12 Moore’s Federal Practice – Civil § 12.34......................................................................... 2-3

19

20

21

22

23

24

25

26

27

28
iii
Hernandez, et al. v. County of Monterey, et al. Case
County Motion to Dismiss Pursuant to FRCP Rule 12(b)(6)

No. CV 13-2354 PSG

Case5:13-cv-02354-PSG Document44 Filed04/25/14 Page5 of 12

1

TO ALL PARTIES AND THEIR ATTORNEYS OF RECORD:

2

PLEASE TAKE NOTICE that on June 3, 2014 at 10:00 a.m., or as soon thereafter as this

3 matter may be heard, in Courtroom 5, 4th Floor of the above-entitled Court, Defendants,

4 COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF’S OFFICE1, will and

5 hereby do move this Court, pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, for

6 an order dismissing all claims of Plaintiffs, Robert Yancey, Richard Murphy, Dennis Guyot,

7 Glenda Hunter, Martha Gomez, Wesley Miller, Jeffrey Nichols, Sarab Sarabi, and Albert Key.

8 These named Plaintiffs are no longer incarcerated in the Monterey County jail. As such, they

9 lack the standing to assert causes of action for injunctive and declaratory relief related to

10 conditions at the jail; or, in the alternative, their claims are now moot.

11

This motion is based upon this Notice; the Memorandum of Points and Authorities

12 attached hereto; the concurrently filed Declaration of Cmdr. James H. Bass; the concurrently

13 filed Request for Judicial Notice; the papers and records filed herein; and such other evidence

14 and argument the Court may entertain at the hearing of this matter.

15

16

MEMORANDUM OF POINTS AND AUTHORITIES

17

I. INTRODUCTION AND STATEMENT OF FACTS

18

Although Plaintiffs’ Second Amended Complaint is a lengthy homily of allegations

19 concerning the Monterey County jail, the claims can be distilled into four main assertions: 1)

20 Defendants are deliberately indifferent in the provision of certain Plaintiffs’ medical care; 2)

21 Defendants are deliberately indifferent in the provision of certain Plaintiffs’ mental health care;

22 3) Defendants are deliberately indifferent in the provision of certain Plaintiffs’ security and

23 safety needs; and 4) Defendants are deliberately indifferent in caring for certain Plaintiffs who

24 allegedly need accommodations pursuant to the ADA.

25

Plaintiffs’ initial complaint was filed on May 23, 2013. Plaintiffs did not file their

26 Second Amended Complaint until April 11, 2014. Plaintiffs’ counsel has indicated they will be

27 28 1 Monterey County Office of the Sheriff is not a separate legal entity from the County of Monterey.

1
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1 filing a motion for class certification shortly. However, at the filing of this motion to dismiss,

2 they have not yet filed a motion for class certification. Defendants anticipate that they will

3 oppose such a motion on a number of grounds, including the fact that the individual Plaintiffs are

4 unquestionably unique in the various claims they are making. For instance, the care and

5 treatment of an inmate with a colostomy bag or a rare foot tumor is in no way representative of

6 the normal population of the Monterey County jail.

7

Defendants also specifically raise and preserve the affirmative defense that all Plaintiffs’

8 have failed to exhaust administrative procedures under the Prison Litigation Reform Act.

9 To the extent Defendants are required to raise the defense of failure to exhaust administrative

10 procedures at their initial responsive pleadings, they do so now for each and every Plaintiff. (See

11 Albino v. Baca, 2014 U.S. App. LEXIS 6153 (9th Cir. Cal. Apr. 3, 2014). Defendants also

12 reserve their right to assert the defense of statute of limitations.

13

Plaintiffs, Robert Yancey, Richard Murphy, Dennis Guyot, Glenda Hunter, Martha

14 Gomez, Wesley Miller, Jeffrey Nichols, Sarab Sarabi, and Albert Key are not incarcerated in the

15 Monterey County jail. (Defendants’ Request for Judicial Notice). Plaintiffs’ Second Amended

16 Complaint does not plead that these Plaintiffs are currently incarcerated. As such, Plaintiffs fail

17 to have the standing required to assert claims for declaratory and injunctive relief; or, assuming

18 that Plaintiffs originally had standing, their claims for declaratory and injunctive relief are now 19 moot.2

20

II. LEGAL ARGUMENT

21

A. RULE 12(b)(6)

22

To survive a motion to dismiss, a complaint must contain sufficient factual matter,

23 accepted as true, to state a claim that is plausible on its face. Ashcroft v. Iqbal, 556 U.S. 662,

24 678, 129 S.Ct. 1937, 173 L. Ed. 2d 868 (2009) (citing Bell Atlantic Corp. v. Twombly, 550 U.S.

25 544, 555, 127 S.Ct. 1955, 167 L. Ed. 2d 929 (2007)) (quotation marks omitted). “Conclusory

26 allegations or legal conclusions masquerading as factual conclusions will not suffice to prevent a

27 28 2 Robert Yancey was released before the filing of the original complaint.
2
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1 motion to dismiss.” 2-12 Moore’s Federal Practice – Civil § 12.34 (citing in part Anderson v.

2 Clow, 89 F.3d 1399, 1403 (9th Cir. 1996) (conclusory allegations of law and unwarranted

3 inferences are insufficient to defeat motion to dismiss for failure to state claim)); Epstein v.

4 Washington Energy Co. (9th Cir. 1996) 83 F.3d 1136, 1140. “While facts must be accepted as

5 alleged, this does not automatically extend to bald assertions, subjective characterizations, or

6 legal conclusions.” 2-12 Moore’s Federal Practice – Civil § 12.34 (citations omitted.) . See,

7 Bell Atlantic Corp. v. Twombly, 550 U.S. at 555 (Courts “are not bound to accept as true a legal

8 conclusion couched as a factual allegation.”).

9

The purpose of Federal Rules of Civil Procedure Rule 12(b)(6) is to permit trial courts to

10 terminate lawsuits that are fatally flawed in their legal premises and destined to fail, and thus to

11 spare litigants the burdens of unnecessary pretrial and trial activity. Neitzke v. Williams, 490

12 U.S. 319, 326-27 (1989). A claim may be dismissed either because it asserts a legal theory that

13 is not cognizable as a matter of law or because it fails to allege sufficient facts to support a

14 cognizable legal claim. SmileCare Dental Group v. Delta Dental Plan of Cal., Inc., 88 F.3d 780,

15 783 (9th Cir. 1996), cert. denied, 519 U.S. 1028 (1996) (citations omitted).

16

B. PLAINTIFFS LACK STANDING OR IN THE ALTERNATIVE THEIR

CLAIMS ARE MOOT

17

18

In general, Plaintiffs who are no longer incarcerated cannot seek injunctive relief for the

19 conditions of their incarceration, but, instead, may proceed with a claim for damages. See

20 Wiggins v. Rushen, 760 F.2d 1009 (9th Cir.1985). To demonstrate standing, when a claimant

21 seeks equitable relief, Article III of the U.S. Constitution requires: 1) the plaintiff has suffered

22 some actual or threatened injury as a result of the putatively illegal conduct of the defendant; 2)

23 the injury can be traced to the challenged action of the defendant; and 3) the injury is “likely to

24 be redressed by a favorable decision.” Valley Forge Christian Coll. v. Americans United for

25 Separation of Church and State, 454 U.S. 464, 472 (1982).

26

The general rule for 42 U.S.C. § 1983 claims for deprivation of rights in a detention

27 setting is that the plaintiff must be incarcerated at the time of filing and throughout the pendency

28 of the matter. See generally, Ferreira v. Dubois, 963 F. Supp. 1244 (D. Mass. 1996). The

3
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1 reasoning for this flows from the principle established in L.A. v. Lyons, 461 U.S. 95 (1983)

2 which holds that threat of future harm that is so attenuated is insufficient to maintain standing to

3 maintain a law suit and renders the matter moot. L.A. v. Lyons, 461 U.S. 95 (1983) (neither the

4 existence of past injury nor conjecture over the prospect of some future injury creates the case or

5 controversy required for jurisdiction). It has to be assumed that the released inmate “will

6 conduct [his or her] activities within the law and so avoid prosecution and conviction” and

7 subsequent incarceration. L.A. v. Lyons, 461 U.S. at 103, citing O'Shea v. Littleton, 414 U.S.

8 488, 495-97 (1974). It is also highly unlikely and, in fact, conjectural that, once reincarcerated, a

9 plaintiff will be subjected to the same deprivations faced in his individualized claim.

10

“The cases articulating the case or controversy requirement conceive of mootness as ‘the

11 doctrine of standing set in a time frame: The requisite personal interest that must exist at the

12 commencement of the litigation (standing) must continue through its existence (mootness).’”

13 Ferreira v. Dubois, 963 F. Supp. 1244, 1261-1262 (D. Mass. 1996), quoting Rosetti v. Shalala,

14 12 F.3d 1216, at 1224 n. 19 (3d Cir. 1993); and citing United States Parole Commission v.

15 Geraghty, 445 U.S. 388, 397, 100 S.Ct. 1202, 63 L. Ed. 2d 479 (1980) (dicta noting same).

16

Mootness examines whether a party has lost standing due to a change in facts over the

17 course of the suit. Clarke v. Lane, 267 F.R.D. 180, 189 (E.D. Pa. 2010) (citations omitted). "In

18 general, a case is moot if there is no longer any 'present controversy as to which effective relief

19 can be granted.'" Johnson v. Rancho Santiago Cmty. College Dist., 623 F.3d 1011, 1018 (9th Cir.

20 2010). Even if a plaintiff has standing with respect to a claim for relief at the time the complaint

21 is filed, mootness considerations "require courts to look to changing circumstances that arise

22 after the complaint is filed," and "[i]f a live controversy no longer exists, the claim is moot."

23 ACLU v. Lomax, 471 F.3d 1010, 1016 (9th Cir. 2006) (internal citations omitted). "The case-or-

24 controversy requirement demands that, through all stages of federal judicial proceedings, the

25 parties continue to have a personal stake in the outcome of the lawsuit." Carty v. Nelson, 426

26 F.3d 1064, 1071 (9th Cir. 2005).

27

"An action becomes moot when '(1) there is no reasonable expectation that the alleged

28 events will recur . . . and (2) interim relief or events have completely eradicated the effects of the

4
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1 violation.'"). Further, federal courts' jurisdiction is limited for mootness "when the issues

2 presented are no longer 'live' or the parties lack a legally cognizable interest in the outcome" (the

3 personal stake requirement). Clarke v. Lane, 267 F.R.D. 180, 189 (E.D. Pa. 2010), quoting

4 Bowers v. City of Philadelphia, 2006 U.S. Dist. LEXIS 64651 (E.D. Pa. Sept. 8, 2006) (citing

5 United States Parole Comm'n v. Geraghty, 445 U.S. 388, 396, 100 S. Ct. 1202, 63 L. Ed. 2d 479

6 (1980) (internal citation omitted)). Both standing and mootness must be satisfied in order to

7 satisfy the “case and controversy” requirement under Article III. See, Sosna v. Iowa, 419 U.S.

8 393, 402 (1975). “The Constitution limits federal court jurisdiction to review of ‘actual cases or

9 controversies’ in which the plaintiff has a ‘personal stake’ in the litigation.” See U.S. Const. Art.

10 III, § 2; United States Parole Comm'n v. Geraghty, 445 U.S. 388, 396-97 (U.S. 1980).

11

As to former, current, or future prisoners, to have a continuing case or controversy that is

12 live at all stages of the proceedings a former prisoner must be subject to the alleged violations he

13 intends to challenge; otherwise a prisoner lacks standing to seek injunctive relief. Preiser v.

14 Newkirk, 422 U.S. 395, 401 (1975) (a federal court has neither the power to render advisory

15 opinions nor to decide questions that cannot affect the rights of litigants in the case before them);

16 Weaver v. Wilcox, 650 F.2d 22, 27 (3d Cir. 1981). Here, Plaintiffs Robert Yancey, Richard

17 Murphy, Dennis Guyot, Glenda Hunter, Martha Gomez, Wesley Miller, Jeffrey Nichols, Sarab

18 Sarabi, and Albert Key have been released from the County of Monterey jail. As such, they do

19 not have standing to seek injunctive relief as they are no longer subject to the alleged conditions

20 they are attempting to challenge. Weaver, 650 F.2d at 27. Their claims are moot.

21

Plaintiffs also cannot satisfy the last element of standing as to redressability. “[T]he

22 redressability factor focuses on the connection between the plaintiff’s injury and the judicial

23 relief sought.” Clarke v. Lane, 267 F.R.D. 180 (E.D. Pa. 2010) (citing Friends of the Earth, Inc.

24 v. Laidlaw Envtl. Servs. (TOC), Inc., 528 U.S. 167 (2000) (petitioners' citizen suit for civil

25 penalties under Clean Water Act was moot when respondent came into compliance). Plaintiffs

26 cannot demonstrate that equitable relief will redress their injuries to establish standing as they are

27 no longer incarcerated at the Monterey County jail and subject to the conditions they wish to

28 abate. See Citizens for Health v. Leavitt, 428 F.3d 167, 176 n. 9 (3d Cir. 2005) (“An injury is

5
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1 redressable for justiciability purposes where the plaintiff can show that it is likely, as opposed to

2 merely speculative, that the injury will be redressed by a favorable decision.”). It has to be

3 assumed that the released inmate “will conduct [his] activities within the law and so avoid

4 prosecution and conviction” and subsequent incarceration. L.A. v. Lyons, 461 U.S. at 103, citing

5 O'Shea v. Littleton, 414 U.S. 488, 495-97 (1974).

6

It should be noted that even if Plaintiffs’ claims are dismissed for lack of standing or

7 based on mootness, they may still pursue a claim for damages. Weaver v. Wilcox, 650 F.2d 22,

8 27 (3d Cir. Pa. 1981); see also Holland v. Purdy, 457 F.2d 802, 803 (5th Cir. 1972) (per curiam)

9 (plaintiff's case considered to be "moot" because he was no longer subject to the complained of

10 condition at the time he instituted his litigation). Plaintiffs, Robert Yancey, Richard Murphy,

11 Dennis Guyot, Glenda Hunter, Martha Gomez, Wesley Miller, Jeffrey Nichols, Sarab Sarabi, and

12 Albert Key are not currently incarcerated at the Monterey County jail. Accordingly, there is no

13 evidence that Plaintiffs will be incarcerated at the time Plaintiffs file a motion for class

14 certification. Plaintiffs’ claims are moot and they lack standing to proceed.

15

Admittedly, there are some exceptions to the mootness doctrine. However, none of them

16 are applicable to the instant Plaintiffs. Defendants anticipate Plaintiffs will argue that Plaintiffs’

17 claims are “capable of repetition, yet evading review”; that Plaintiffs meet the Sosna exception;

18 or that Plaintiffs meet the transitory claim exception. See generally, Clarke v. Lane, 267 F.R.D.

19 180, 191 (E.D. Pa. 2010).

20 In

Sosna v. Iowa, 419 U.S. 393 (1975), the named plaintiff’s, who had been designated

21 lead plaintiff, claim became moot while the case was on appeal. The Sosna court held that it

22 retained jurisdiction because the controversy the suit involved remained very much alive for the

23 class of persons [the named plaintiff] had been certified to represent, even though the named

24 plaintiff’s claims had expired. Sosna, 419 U.S. at 401. Accordingly, “the mooting of a named

25 plaintiff’s claim does not eliminate federal jurisdiction over a class action provided a class has

26 already been certified.” Rosetti v. Shalala, 12 F.3d 1216, 1225 (3d Cir. 1993) (when claims of

27 the named plaintiffs become moot before class certification, dismissal of the action is required).

28 In this case, unlike in Sosna, a class has not been certified and therefore, Sosna is inapplicable.

6
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1

Defendants anticipate that Plaintiffs will argue that due to the “inherently transitory”

2 nature of Plaintiffs as inmates, the alleged constitutional violations are “capable of repetition, yet

3 evading review.” To qualify for the “capable of repetition, yet evading review”, Plaintiffs must

4 demonstrate two elements: “(1) the challenged action was in its duration too short to be fully

5 litigated prior to its cessation or expiration, and (2) there was a reasonable expectation that the

6 same complaining party would be subjected to the same action again.” Murphy v. Hunt, 455

7 U.S. 478, 482 (1982) (internal citations omitted). “The capable-of-repetition doctrine applies

8 only in exceptional situations, and generally only where the named plaintiff can make a

9 reasonable showing that he will again be subjected to the alleged illegality.” L.A. v. Lyons, 461

10 U.S. 95, 109 (1983).

11

Plaintiffs fail to satisfy the second prong of the test that requires the Plaintiffs to be

12 subjected to the same action again. Murphy, 455 U.S. at 482. The “likelihood” of Plaintiffs

13 returning to the Monterey County jail because of future criminal conduct is too speculative and

14 not the “likelihood of future injury” that is required. Clarke v. Lane, 267 F.R.D. 180, 192 (E.D.

15 Pa. 2010). Plaintiffs have not shown they are capable of suffering from the illegality again and

16 as such have not satisfied their burden. See Roe v. Operation Rescue, 919 F.3d 857, 864 (3d Cir.

17 1990) (holding that where “injunctive relief is sought, a plaintiff must demonstrate that he is

18 likely to suffer future injury from the defendant’s threatened conduct); see also Abdul-Akbar v.

19 Watson, 4 F.3d 195, 207 (3d Cir. 1993) (“conjecture as to the likelihood of repetition has no

20 place in the application of this exception and narrow grant of judicial power . . . speculative

21 hypothesis” regarding whether plaintiff is likely to be incarcerated again is not appropriate in this

22 analysis.”). It has to be assumed that the released inmate “will conduct [his] activities within the

23 law and so avoid prosecution and conviction” and subsequent incarceration. L.A. v. Lyons, 461

24 U.S. at 103 (citing O’Shea v. Littleton, 414 U.S. 488 (1974)).

25

Defendants also anticipate that Plaintiffs will argue that the circumstances in the instant

26 case warrant the transitory claim exception as an exception to the mootness doctrine. See

27 Garaghty, 445 U.S. at 404. However, the law is very clear that Garaghty does not apply where it

28 is undisputed that Plaintiffs’ claims are mooted prior to the filing or granting of class

7
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1 certification. Clarke v. Lane, 267 F.R.D. at 192-193. When claims of the named plaintiffs

2 become moot before class certification, dismissal of the action is required. Lusardi v. Xerox

3 Corp., 975 F.2d 964, 974-75 (3d Cir. 1992) (“In such a situation, there is no plaintiff (either

4 named or unnamed) who can assert a justiciable claim against any defendant and consequently

5 there is no longer a ‘case or controversy’ within the meaning of Article III of the Constitution.”).

6

III. CONCLUSION

7

For the foregoing reasons, Defendants respectfully request Plaintiffs, Robert Yancey,

8 Richard Murphy, Dennis Guyot, Glenda Hunter, Martha Gomez, Wesley Miller, Jeffrey Nichols,

9 Sarab Sarabi, and Albert Key, be dismissed.

10

11 Dated: April 25, 2014

12

CHARLES J. McKEE

County Counsel

13

14

15

By /s/ Susan B. Blitch

SUSAN K. BLITCH, Sr. Deputy County Counsel

16

Attorneys for Defendants COUNTY OF

MONTEREY and MONTEREY COUNTY

17

SHERIFF’S OFFICE

18

19

20

21

22

23

24

25

26

27

28
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1 Peter G. Bertling # 131602 Jemma Parker Saunders, #227962
2 BERTLING & CLAUSEN L.L.P. 15 West Carrillo Street, Suite 100
3 Santa Barbara, California 93101 Telephone: (805) 892-2100
4 Facsimile: (805) 963-6044

5 Attorneys for Defendant CALIFORNIA FORENSIC MEDICAL GROUP, INC.
6

7

8

UNITED STATES DISTRICT COURT

9

FOR THE NORTHERN DISTRICT OF CALIFORNIA

10

11 JESSE HERNANDEZ, CAIN AGUILAR, ) Case No. CV 5:13 2354 PSG

12

HA COBB, SUSAN DILLEY, CONNIE DOBBS, SEAN ESQUIVEL, RAMONA

) ) DEFENDANT CALIFORNIA

13

GIST, MARTHA GOMEZ, GEORGE

) FORENSIC MEDICAL GROUP,

GREIM, DENNIS GUYOT, JASON HOBBS,) INC.’S MEMORANDUM OF

14

GLENDA HUNTER, ALBERT KEY, BRANDON MEFFORD, WESLEY

) POINTS AND AUTHORITIES IN ) SUPPORT OF MOTION TO

15

MILLER, RICHARD MURPHY, JEFF NICHOLS, ANGEL PEREZ, SARAB

) DISMISS PLAINTIFFS’ SECOND ) AMENDED COMPLAINT

16

SARABI, CLYDE WHITFIELD, and

) PURSUANT TO FEDERAL RULE

ROBERT YANCEY, on behalf of themselves ) OF CIVIL PROCEDURE

17 and all others similarly situated,

) RULE 12(b)(6) )

18

Plaintiffs,

) ) Hearing Date: June 10, 2014

19 v.

) Hearing Time: 10:00 a.m. ) Hearing Dept.: 5

20

COUNTY OF MONTEREY; MONTEREY COUNTY SHERIFF’S OFFICE;

) )

21

CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED, a California

) )

22 corporation; and DOES 1 to 20,

) Action Filed: May 23, 2013 ) Trial Date: None yet

23

Defendants.

) Judge: )

Hon. Paul Singh Grewal

24

25

I. INTRODUCTION

26

Plaintiffs’ Second Am ended Com plaint cont ains eight separate causes of action

27 concerning the care and treatm ent of various inm ates in the Monterey County Jail.

28 Essentially, plaintiffs’ allegedefendants were and are deliberately indifferent to plaintiffs’

1

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page2 of 7

1 mental and physical healthcare, physical secu rity and safety. In addition, the Second

2 Amended Complaint asserts CFMG, the entitywhich has “contract[ed]with the [Monterey

3 County] Sheriff’s Office that . . . provides all health care services to prisoners in the Jail,

4 including medical and m ental health care” has violated Title III of the Am ericans with

5 Disabilities Act in the context of their Six th Cause of Action. See Plaintiffs’ Second

6 Amended Complaint at ¶34.

7

Defendant CFMG now moves in joinder with defendants County of Monterey and

8 Monterey County Sheriff’s Office to dism iss plaintiffs Robert Yancy, Richard Murphy,

9 Dennis Guyot, Glenda Hunter, Martha Gom ez, Wesley Miller, Jeffrey Nichols, Sarab

10 Sarabi and Albert Keys’ claims in their entireyt because said plaintiffs either lack standing

11 to bring this injunctive and declaratory action,or in the alternative their claims are mooted

12 by virtue of their release from the Monterey County Jail. Defendant CFMG now further

13 moves to dismiss plaintiffs’ Sixth Cause of Action against it on the basis that plaintiffs

14 have failed to state a claim pursuant to Rule12(b)(6) insofar as CFMG does not own, lease

15 or operate a place of “public accommodation” pursuant to 42 U.S.C. §12181(7)(F).

16

II. ENABLING AUTHORITY

17

Federal Rule of Civil Proceduer Rule 12 permits a party toassert defenses by motion,

18 including the defense of plaintiff’s failure tostate a claimupon which relief can be granted.

19 Federal Rule of Civil Procedure Rule 12(b)(6 ). Rule 12(b)(6) affords a defendant an

20 opportunity to test whether, as m atter of la w, plaintiff is entitled to legal relief even if

21 everything alleged in complaint is true. Mueller v. Gallina, (2004) 311 F.Supp. 2d 606. A

22 Complaint cannot survive a Rule 12(b)(6) motion to dismiss merely by setting forth all of

23 elements of causes of action pled, since Rule12(b)(6) was also designed to screen out cases

24 where a complaint stated a claim based on a wrong for which there was clearly no remedy

25 and for which no relief coul d possibly be granted. Port Auth. v. Arcadian Corp. , (1999,

26 CA3 N.J.) 189 F.3d 305. Dismissal of a Complaint is appropriate when the Complainant

27 fails to allege a cognizablelegal theory or sufficient facts to support such theoryB. alistreri

28 v. Pacifica Police Dept., (9th Cir. 1988) 901 F.2d 696, 699.

2

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page3 of 7

1

Additionally, Courts are not “bound to acceptas true a legal conclusion couched as

2 a factual allegation.” Bell Atlantic Corp. v. Two mbly, (2007) 550 U.S. 544, 550. Rule

3 12(b)(6) allows a defendant to test whether,as matter of law, a plaintiff is entitled to legal

4 relief even if everything alleged in complaint is true.Doe v. Detroit Bd. of Educ(.2004) 310

5 F.Supp.2d 871. A motion to dismiss pursuant to Rule 12(b)(6) is properly granted where,

6 as here, it is clear that no relief c ould be granted under any set of facts . M cCray v.

7 Veneman (2002) 298 F.Supp.2d 13. Further, and specific to plaintiffs’ claims herein, Rule

8 12(b)(6) motions are appropriate to examine the legality of a plaintiff’s claims under Title

9 III of the Americans with Disabilities Act. See, e.g. Norkunas v. Park Rd. Shopping Ctr.,

10 Inc. (2011) 777 F.Supp.2d 998.

11

Plaintiffs’ Second Am ended Com plaint fails to state a cognizab le claim against

12 CFMG pursuant to Title III of the Americans with Disabilities Act. Additionally, since

13 certain plaintiffs lack standing to sue, and/or their claims are moot, granting defendant’s

14 Rule 12(b)(6) Motion to Dismiss is proper.

15

III. ARGUMENT

16

A. CFMG Joi ns and Incorporates Defendants County of Monterey and

17

Monterey County Sheriff’s Office’s Motoi n to Dismiss Certain Plaintiffs’

18

Claims on the Bases of Lack of Standing and/or Mootness.

19

Defendant CFMG moves firstly in joinder to defendants County of Monterey and

20 Monterey County Sheriff’s Office’s Motion toDismiss filed on April 25, 2014 and set for

21 hearing on June 3, 2014. Defendnat CFMG specifically moves herein that plaintiffs Robert

22 Yancy, Richard Murphy, Dennis Guyot, Glenda Hunter, Martha Gomez, Wesley Miller,

23 Jeffrey Nichols, Sarab Sarabi and Albert Key, by virtue of their release fromthe Monterey

24 County Jail, lack standing to assert causes of action for injunctive and declaratory relief

25 related to conditions in the Monterey County Jailo, r in the alternative, their claims are now

26 moot.

27

Defendant CFMG specifically incorporates herein by reference defendants County

28 of Monterey and Monterey County Sher iff’s Office’s m emorandum of points and

3

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page4 of 7

1 authorities in support of their Motion to Dism iss in addition to all requests for judicial

2 notice, declarations and exhibits thereto filed in support of the motion.

3

Defendant CFMG req uests the entirety of the claims of plaintiffs Robert Yancy,

4 Richard Murphy, Dennis Guyot, Glenda Hunter, Martha Gomez, Wesley Miller, Jeffrey

5 Nichols, Sarab Sarabi and Albert Key be dismissed.

6

B. Plaintiffs’ Sixth Cause of Action for ADA Violations Pursuant to Title III

7

Should Be Dismissed Because Title III Does Not Apply to CFMG at the

8

Monterey County Jail.

9

Title III of the Americans with Disabilities Act provides in part that “no individual

10 shall be discriminated against on the basis of disability in the full and equal enjoyment of

11 the goods, services, facilities, privileges, advantages, or accommodations of any place of

12 public accommodation by any person who owns, leases (or leases to), or operates a place

13 of public accommodation.” ADA § 302(a), 42 U.S.C. § 12182(a). Essentially, Title III of

14 the ADA requires a plaintiff plead and prove the following elements: 1) a plaintiff was

15 disabled within the meaning of the Act; 2) the plaintiff was discriminated against on the

16 basis of that disability; and 3)the defendant owns, leases orleases to or operates a place of

17 public accommodation. For the purposes of this motion alone, CFMG assumes plaintiffs

18 have sufficiently plead the first and second eelments in their Second Amended Complaint.

19 CFMG moves to dismiss plaintiffs’ Sixth Causeof Action on the bassi that it does not own,

20 lease or operate a “place of public accom modation.” As a m atter of law, Title II I i s

21 therefore inapplicable to CFMG, and defe ndant’s m otion to dism iss pursuant to Rule

22 12(b)(6) should be granted.

23

Title III’s general anti-discrimination provision refers todiscrimination on the basis

24 of disability by the owner, lessor, l essee or operator of any “place of public

25 accommodation.” 4 2 U.S.C. §12182(a). A pl ace of public accom modation has been

26 intentionally defined by 42 U.S.C. §12181(7) at subparts (7)(A) through (7)(L). Specific

27 to this action, section 12181(7)(F) provides: “t[]he following private entities are considered

28 public accommodations for purposes of this subchapter, if the operations of such entities

4

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page5 of 7

1 affect commerce—. . . (F). . .a professional o ffice of a health care provider, hospital, or

2 other service establishment.”

3

In the context of t his Second Amended Complaint at the Sixth Cause of A ction

4 against CFMG, plaintiffs assert, without ba sis, that CFMG itself is a “place of public

5 accommodation” in that it “owns, leases, leases to, or operates a professional office of a

6 health care provider, hospital, or other servcie establishment.” Plaintiffs’ Second Amended

7 Complaint at ¶398. This language is lifted precisely from 42 U.S.C §12181(7)(F) and it is

8 on this basis alone that plaintiffs claimCFMG is subject to suit under Title III of the ADA.

9

CFMG is not an owner, lessor/lessee oroperator of a place of public accommodation.

10 As a matter of law, Title III is therefore inapplicable to CFMG and plaintiffs’ Sixth Cause

11 of Action should be dismissed.

12

The purpose of Title III of the ADA was toapply to equal access for the disabled to

13 physical services of a defined place of public accom modation. See Pappas v. Bethesda

14 Hosp. Ass'n, (1994) 861 F.Supp.616, 620. The only physical place described in plaintiffs’

15 Second Amended Complaint is the Monterey County Jail. A jail is undisputedly not a

16 place of public accommodation. It not neither enumerated within the statutory definition

17 of 42 U.S.C. §12181, and is not a place “open to the public.” See e.g. Disabled Rights

18 Action Comm. v. Las Vegas Events, Inc. , (2003) 375 F.3d 861, 873; Debord v Board of

19 Educ. (1997) 126 F.3d 1102, cert. denied (1998)523 U.S. 1073. TitleIII does not apply to

20 jails, or to any part thereof. See, e.g. Baaske v. City of Rolling Meadows (2002) 191

21 F.Supp.2d 1009 (Title III of ADA does not apply to public entities.)

22

By way of converse illustration, interpreting case law as well as the plain language

23 of the statute have clearly defined a physician’s office, a dentist’s office, a medical clinic

24 and a hospital, in addition to hotels, inns, bars, arenas, etc. as p

laces of public

25 accommodation to satisfy Title III of the ADA. See, e.g. Mayberry v. Von Valtier (1994)

26 843 F.Supp.1160 [physician’s office] ; D.B. v Bloom (1995) 896 F. Supp.166 [ dentist

27 office]; Sharrow v Bailey (1995) 910 F.Supp.187 [medical clinic]. CFMG, as defined by

28 plaintiffs in their Second Am ended Com plaint, is none of these types of “public

5

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page6 of 7

1 accommodations.” Public accom modations are precisely that: open and usable by the

2 public. The Monterey County Jail could be no further from this legal definition.

3

Further, in addition to CFMG and/or Monterey County Jail not being a place of

4 public accommodation in accord with Title III, it is undisputed that CFMG is neither an

5 owner, lessor/lessee or operator of the alle ged “place of public accommodation,” i.e. the

6 jail, or any part thereof. CFMG therefore negates an additionalsecond prong of Title III’s

7 public accommodation regulation. Since CFMG is neither the owner, lessor/lessee or

8 operator of the Monterey County Jail, even ifthe jail could somehow be deemed a place of

9 public accommodation, as a matter of law, CFMG is not the responsible entity for the jail

10 under Title III.

11

In their Second Amended Complaint, plaintiffs claim CFMG is the “entity [which]

12 has “contract[ed] with the [Monterey County] Sheriff’s Office that . . . provides all health

13 care services to prisoners in the Jail, includingmedical and mental health care.” Plaintiffs’

14 Second Amended Complaint at ¶34. While CFMG is alleg ed to be the sole provider of

15 such m edical se rvices t o pl aintiffs, t here a re no fa cts a lleged i n t he Second A mended

16 Complaint that CFMG “owns” the Monterey County Jail or anypart thereof. There are no

17 facts alleged in the Second Amended Complaint which describeCFMG as a lessor or lessee

18 of the Monterey County Jail, and indeed no description or provision of a valid lease

19 subjecting CFMG to liability under Title III has been provided by plaintiffs. Sim ilarly,

20 there are no facts alleged within the SecondAmended Complaint to support CFMG as the

21 “operator” of the Monterey County Jail. Indeed, by plaintiffs’ own allegations, CFMG is

22 an independent contractor w ith the County of Monterey. Plaintiffs’ Second Am ended

23 Complaint at ¶34. The Northern District Court ha s pre viously held an independent

24 contractor could not be liable under the ADA without some nexus establishing he was an

25 “operator.” Aikins v. St. Helena Hosp. (1994) 843 F.Supp 1329. Rather than set forth such

26 a nexus, plaintiffs have prima facie refuted it, stating that the Monterey County Sheriff’s

27 office is responsible for the day-to-day operations of the Jail facilities, including

28 promulgating policies and procedures for theoperation of the facilities and that “by law it

6

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

Case5:13-cv-02354-PSG Document59 Filed05/02/14 Page7 of 7

1 retains the ultimate authority over and any responsibility for the health care, treatment, and

2 safekeeping of prisoners in the Jail.” Plaitniffs’ Second Amended Complaint at ¶33. Since

3 there is no rational basis to conclude CFMG is the operator of Monterey County Jail, and

4 since plaintiffs own claim s circum vent su ch a finding, plaintiffs’ Title III claim is

5 inapplicable to defendant and defendant’s motion to dismiss should be granted.

6

In sum, for plaintiffs’ Title III claimto survive defendant’s instant motion, this Court

7 must find both that the Monterey County Jail isindeed a place of public accommodation,

8 and CFMG is the owner, lessor/lessee or opertaor of that public place specifically under 42

9 U.S.C.§12181(7)(F). Neither of these propositionsare supportable, and neither have been

10 properly alleged in plaintiffs’ Second Amended Complaint. Undisputedly, plaintiffs seek

11 a remedy for alleged violations of the ADA. However, that remedy does not li e with

12 TitleIII, and does not lie with California Forensic Medical Group. Defendants’ Motion to

13 Dismiss based on plaintiffs’ failure to state a claim in their Sixth Cause of Action should

14 be granted.

15

IV. CONCLUSION.

16

For the foregoing reasons, defendant Caliofrnia Forensic Medical Group respectfully

17 requests plaintiffs Robert Yancy, RichardMurphy, Dennis Guyot, Glenda Hunter, Martha

18 Gomez, Wesley Miller, Jeffrey Nichols, Sarab Sarabi and Albert Key be dismissed from

19 this action in their entirety , and further respectfully requests plaintiffs’ Sixth Cause of

20 Action against CFMG for violations of Title III of the ADA be dismissed.

21

Respectfully submitted,

22 DATED: May 2, 2014. 23

BERTLING & CLAUSEN, L.L.P.

24

By: /s/ Jemma Parker Saunders

25

Peter G. Bertling Jemma Parker Saunders

26

Attorneys for Defendant CALIFORNIA FORENSIC

27

MEDICAL GROUP, INC.

28

7

5:13cv2354 PSG

DEFENDANT CALIFORNIA FORENSIC MEDICAL GROUP, INC.’S MEMORANDUM OF

POINTS AND AUTHORITIES IN SUPPORT OF MOTION TO DISMISS PLAINTIFFS’

SECOND AMENDED COMPLAINT PURSUANT TO FEDERAL RULE OF CIVIL

PROCEDURE RULE 12(b)(6)

 </s> 1

2

3

4

5

6

7

8

United States District Court For the Northern District of California

9

UNITED STATES DISTRICT COURT

10

NORTHERN DISTRICT OF CALIFORNIA

11

SAN JOSE DIVISION

12 JESSE HERNANDEZ et al.,

13 v.
14

Plaintiffs,

COUNTY OF MONTEREY, et al., 15

Defendants. 16

) Case No. 5:13-cv-02354-PSG ) ) ORDER DENYING DEFENDANTS’ ) MOTIONS TO DISMISS ) ) (Re: Docket Nos. 44, 58, 75) ) ) )

17

The present motions in this civil rights suit raise two related issues: exactly who may

18 challenge the conditions of a county jail and who exactly may be challenged? While standing and
19 mootness disputes in cases such as this are hardly new, the question of whether a private provider
20 of jail medical facilities are services can face scrutiny under Title III of the Americans with
21
22 Disabilities Act does appear to be novel.1

23

24 1 “Defendants also specifically raise and preserve the affirmative defense that all Plaintiffs’ have

failed to exhaust administrative procedures under the Prison Litigation Reform Act. To the extent 25 Defendants are required to raise the defense of failure to exhaust administrative procedures at their

26

initial responsive pleadings, they do so now for each and every Plaintiff. . . . Defendants also reserve their right to assert the defense of statute of limitations.” Docket No. 44 at 2. Defendants

27 made no further arguments on these points, however, so the court has not considered the Prison

Litigation Reform Act or the statute of limitations here.

28

1

Case No. 5:13-cv-02354-PSG

ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1

The first motion before the court is a motion to dismiss filed by Defendants County of

2 Monterey and Monterey County Sheriff’s Office.2 The second motion to dismiss was filed by

3 Defendant California Forensic Medical Group, Incorporated.3 Plaintiffs oppose,4 and the parties

4 appeared for a hearing.5 Having considered the arguments, the court denies both motions.

5

I. BACKGROUND

6

A. Factual

Background6

7 Plaintiffs are inmates or recently released inmates from the Monterey County jail.7 Each
8

9 plaintiff has been jailed multiple times.8 The jail frequently houses more than 1,100 inmates per

10 day,9 and inmates stay in the jail on average for 30-40 days.10 The vast majority of the jail’s

United States District Court For the Northern District of California

11 population constitutes pretrial detainees with unpredictable, but brief, lengths of stay. The

12 complaint alleges a litany of substandard conditions at the jail, including: violence due to
13 understaffing, overcrowding, inadequate training, policies, procedures, facilities, and prisoner 14
classification; inadequate medical and mental health care screening, attention, distribution, and 15

16

17

18 2 See Docket No. 44 (amended by Docket No. 75).

19 3 See Docket No. 58. CFMG joins and incorporates all arguments in the County and County Sheriff’s motion to dismiss in its own. See id. at 3.

20

4 See Docket Nos. 77 and 83.

21 5 See Docket No. 100.

22 6 For the purposes of Defendants’ motions, unless otherwise noted, the court draws the following
23 facts from Plaintiffs’ second amended complaint, accepted as true. See Docket No. 41.

24 7 See Docket No. 77 at 1-2.

25 8 See id. at 1.
26 9 See Docket No. 41 at ¶ 40.
27 10 See Docket No. 77 at 1.
28 2
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 resources; and lack of policies and practices for identifying, tracking, responding, communicating, 2 and providing accessibility for accommodations for prisoners with disabilities.11

3

The County provides inmates access to health care and services under a contract with

4 CFMG, a private company that administers all jail health care facilities and services.12 The
5 contract took effect on April 1, 2012.13 The contract provides that CFMG “shall be responsible for 6 the medical care, dental care, and mental health care of an inmate commencing with [] booking.”14 7
CFMG is further responsible for “administering medications to inmates,” providing required 8 9 “medical supplies, and medical record supplies,” and for “the cost of all pharmaceuticals 10 administered.”15 Under the contract, CFMG “shall determine the method, details and means of

United States District Court For the Northern District of California

11 performing services,” and CFMG’s Medical Director is “responsible to assure the quality of health

12 care provided.”16 CFMG employs over fifty staff members.17
13 B. Procedural Background 14
Five plaintiffs filed an initial complaint.18 In eight causes of action seeking declaratory and 15
injunctive relief on behalf of a putative class, the complaint alleges the conditions in the jail violate 16
17 the Eights and Fourteenth Amendments of the United States Constitution, Article I, Sections 7 and

18 17 of the California Constitution, the Americans with Disabilities Act, the Rehabilitation Act, and

19 20 11 See Docket No. 41 at ¶¶ 2-5, 7. 21 12 See id. at ¶ 84.

22 13 See Docket No. 41 at ¶ 41.

23 14 See Docket No. 83 at 2 (App’x A at 18).

24 15 Id. at 21-23.

25

16 Id.

26 17 See Docket No. 34 at ¶ 84.

27

18 See Docket No. 1.

28 3
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

Cal. Gov’t Code Section 11135.19 In a first amended complaint, eight named plaintiffs were 1 2 added.20 In a second amended complaint, nine new plaintiffs were added and one plaintiff was
3 dismissed, resulting in the current total of 21 named plaintiffs.21

4

The County and Sheriff’s Office filed an initial motion to dismiss challenging the standing

5 of one plaintiff not in custody when his claim was filed and the mootness of the claims of nine 6 others who were no longer in custody.22 In the meantime, Plaintiffs filed a motion for class 7
certification.23 Plaintiffs seek certification of a prisoner class, consisting of all current and future 8 9 prisoners in the jail, and a prisoners with disabilities subclass, consisting of all current and future 10 prisoners who have a qualifying disability.24

United States District Court For the Northern District of California

11

CFMG also filed a motion to dismiss of its own, joining the County and Sheriff’s Office’s

12 motion based on standing as well as challenging Plaintiffs’ sixth cause of action against CFMG
13 under Title III of the ADA.25 Defendants then amended their motion to dismiss by dropping one 14
plaintiff based on his re-incarceration and adding two others because they had been released from 15

16

17

18

19

20 19 See Docket Nos. 1, 16, and 41.
21

22

20 See Docket No. 16.

23 21 See Docket No. 41 at ¶¶ 11-31.

24 22 See Docket No. 44.

25 23 See Docket Nos. 48-56.

26 24 See Docket No. 56 at 20-21.

27

25 See Docket No. 59.

28 4
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

custody.26 In their reply brief, Defendants further dropped from their motion yet another plaintiff 1 2 because he, too, returned to custody.27

3

II. LEGAL STANDARDS

4 A. 12(b)(6) Motion to Dismiss

5

A complaint must contain “a short plain statement of the claim showing that the pleader is

6 entitled to relief.”28 If a plaintiff fails to proffer “enough facts to state a claim to relief that is 7
plausible on its face,” the complaint may be dismissed for failure to state a claim upon which relief 8 9 may be granted.29 A claim is facially plausible “when the pleaded factual content allows the court

10 to draw the reasonable inference that the defendant is liable for the misconduct alleged.”30 But

11 courts “are not bound to accept as true a legal conclusion couched as a factual allegation.”31 Under

United States District Court For the Northern District of California

12 Fed. R. Civ. P. 12(b)(6), “dismissal can be based on the lack of a cognizable legal theory or the
13 absence of sufficient facts alleged under a cognizable legal theory.”32 A court may dismiss a claim 14

15 26 See Docket No. 75.

16 27 See Docket No. 90 at 1, n.1. Plaintiffs filed a sur-reply indicating that still another of those

17 challenged is currently incarcerated in the jail and that another continues to reside in Monterey County. See Docket No. 98 at 3-4. Plaintiffs have since introduced further evidence that another

18 plaintiff has been re-incarcerated, see Docket Nos. 114, 116, one of the released plaintiffs has been

re-incarcerated, and that yet another was re-incarcerated and then released again. See Docket No. 19 125-1. Defendants object to the evidence Plaintiffs present on this issue and its exhibits on the

20

grounds that the documents are not authenticated, the testimony in the supporting declaration is improper expert testimony, and the declarant lacks personal knowledge. Docket No. 90 at 7.

21 These objections are improper and therefore overruled because they do not specifically identify which statements or exhibits are objectionable on which grounds. See Fed. R. Evid. 103(a)(1)(B)

22 (requiring that a party “state[] the specific ground” of an objection).

23 28 Fed. R. Civ. P. 8(a)(2).

24 29 Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007).

25 30 Ashcroft v. Iqbal, 556 U.S. 662, 663 (2009).

26

31 Twombly, 550 U.S. at 555.

27 32 Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990).
28 5
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 “only if it is clear that no relief could be granted under any set of facts that could be proved 2 consistent with the allegations.”33

3 B. Standing

4

To demonstrate standing to seek equitable relief, Article III of the U.S. Constitution

5 requires that (1) a plaintiff has suffered an actual or threatened injury as a result of the defendant’s
6 alleged illegal conduct; (2) the injury is “fairly traceable” to the defendant’s action; and (3) the
7 injury is likely to be redressed by a favorable decision.34 A plaintiff must establish standing as of
8 9 the filing of the complaint.35 Where multiple plaintiffs present the same class claims in multiple

10 complaints, each plaintiff must establish standing as of the date of the filing in which the plaintiff

11 first appears.36 Where a plaintiff seeks prospective injunctive relief, he also must demonstrate “that

United States District Court For the Northern District of California

12 he is realistically threatened by a repetition of [the violation].”37 “Where a named plaintiff is a
13 member of a plaintiff class, and ‘members of the class have repeatedly suffered personal injuries in 14
the past that can fairly be traced to the [defendants’] standard . . . practices,’ the defendant’s 15
treatment of the class as a whole must be considered to determine whether the individual plaintiff 16 17 ‘ha[s] been and will continue to be aggrieved by the defendants’ [illegal] pattern of conduct.”38 Put

18 another way, “[w]hen a named plaintiff asserts injuries that have been inflicted upon a class of

19 33 Swierkiewicz v. Sorema N.A., 534 U.S. 506, 514 (2002).

20 34 U.S. Const. Art. III, § 2; Valley Forge Christian Coll. v. Americans United for Separation of

21 Church and State, 454 U.S. 464, 472 (1982); see also Bates v. United Parcel Serv., Inc., 511 F.3d 977, 985 (9th Cir. 2007) (holding under the first prong that the plaintiff must have suffered an

22 injury in fact, i.e. one that is sufficiently “concrete and particularized” and “actual or imminent, not

conjectural or hypothetical”); Lujan v. Defenders Wildlife, 504 U.S. 555, 560-61 (1992)).

23

24

35 See County of Riverside v. McLaughlin, 500 U.S. 44, 51-52 (1991); Monaco v. Stone, 187 F.R.D. 50, 66 (E.D.N.Y. 1999).

25 36 See Monaco, 187 F.R.D. at 66.

26 37 Armstrong v. Davis, 275 F.3d 849, 860-61 (9th Cir. 2001) (citation omitted).
27 38 Id. at 864 (quoting LaDuke v. Nelson, 762 F.2d, 1318, 1326 (9th Cir. 1985)).
28 6
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 plaintiffs, we may consider those injuries in the context of the harm asserted by the class as a 2 whole, to determine whether a credible threat that the named plaintiff’s injury will recur has been 3 established.”39

4

An exception to the general rules regarding standing pertains to past inmates under

5 supervision.40 When a past inmate remains supervised by law enforcement and subject to unlawful
6 conditions without engaging in illegal activity, that plaintiff maintains standing with regard to the
7 unlawful policies or conditions he or she may confront.41 The question is whether plaintiffs have
8 9 “demonstrate[d] a concrete injury and a realistic likelihood that the injury will be repeated.”42 In

10 Armstrong v. Davis, the Ninth Circuit held California parolees with disabilities could challenge

United States District Court For the Northern District of California

11 policies and practices in state parole revocation proceedings that violated the ADA and the

12 Rehabilitation Act.43 The parolees could not be subjected to the discriminatory parole revocation
13 proceedings unless they were arrested and charged with violating the terms and conditions of their
14 parole. Because they could be arrested without a warrant and for violating parole terms that
15 prohibited otherwise legal conduct,44 parolees did not need to “engage in unlawful conduct to
16 17 become subject to the unlawful practices they s[ought] to enjoin.”45

18

39 Id. at 861. 19

20

40 Id. at 866.

21 41 See id. at 860-6.

22 42 Taylor v. Westly, 488 F.3d 1197, 1199 (9th Cir. 2007) (citing Armstrong v. Davis, 275 F.3d at 860-61).

23 43 Armstrong v. Davis, 275 F.3d at 860-67.
24 44 See id. at 866.
25

26

45 Armstrong v. Davis, 275 F.3d at 866 (“[T]here was ‘no string of contingencies necessary to produce an injury’”) (quoting Hodgers-Durgin v. de la Vina, 199 F.3d 1037, 1041-42 (9th Cir.

27 1999)). Arrest for violating the terms and conditions of parole “led inexorably to the injury” of being subjected to the unlawful parole revocation procedures. Id. at 866 n.25.

28 7

Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 C. Mootness

2

Mootness is “the doctrine of standing set in a time frame: The requisite personal interest

3 that must exist at the commencement of litigation (standing) must continue throughout its existence

4 (mootness).”46 In general, a case is moot if there is no longer any personal stake in the outcome47

5 or “‘present controversy as to which effective relief can be granted,’”48 even if the plaintiff had

6

standing at the time the complaint was filed.49 In L.A. v. Lyons,50 the Supreme Court held that

7

where the plaintiff could only be “expos[ed] to the challenged course of conduct” by breaking the 8

9 law, his claim was moot because the threat of future harm was too attenuated.

10

An exception to the mootness doctrine applies in class actions “where it is ‘certain that

United States District Court For the Northern District of California

11 other persons similarly situated’ will continue to be subject to the challenged conduct and the

12 claims raised are ‘so inherently transitory that the trial court will not have even enough time to rule
13 on a motion for class certification before the proposed representative’s individual interest 14
expires.’”51 In determining whether prisoners’ claims are inherently transitory, the court must 15

16 17 46 U.S. Parole Comm’n v. Geraghty, 445 U.S. 388, 397 (1980). 18 47 Carty v. Nelson, 426 F.3d 1064, 1071 (9th Cir. 2005); Geraghty, 445 U.S. at 396-97. 19 48 Johnson v. Rancho Santiago Cmty. College Dist., 623 F.3d 1011, 1018 (9th Cir. 2010).

20 49 ACLU v. Lomax, 471 F.3d 1010, 1016 (9th Cir. 2006) (internal citations omitted) (requiring “courts to look to changing circumstances that arise after the complaint is filed," and "[i]f a live
21 controversy no longer exists, the claim is moot").

22 50 L.A. v. Lyons, 461 U.S. 95, 103 (1983) (holding that neither the existence of past injury nor

23 conjecture over the prospect of some future injury creates the case or controversy required for jurisdiction. The assumption is that a plaintiff “will conduct [his or her] activities within the law

24 and so avoid prosecution and conviction” and subsequent incarceration (citing O’Shae v. Littleton,

414 U.S. 488, 495-97 (1974)). 25

26

51 Genesis Healthcare Corp. v. Symczyk, 133 S. Ct. 1523, 1530 (2013) (quoting County of Riverside, 500 U.S. at, 51-52 (internal quotation marks omitted)). In County of Riverside, class

27 certified comprised “all present and future prisoners in the Riverside County Jail including those pretrial detainees arrested without warrants and held in the Riverside County Jail from August 1,

28 1987 to the present, and all such future detainees who have been or may be denied prompt probable

8

Case No. 5:13-cv-02354-PSG

ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 focus on “the average length of detention in the county jail” and “must look at the claims of the 2 class as a whole” rather than Plaintiffs’ “individual claims for relief.”52

3

If the inherently transitory exception applies, the mootness determination merges with the

4 standing analysis as of the filing of the complaint.53 Inherently transitory claims “relate to [class
5 representatives’] standing at the outset of the case in order to preserve the merits of the case for 6 judicial resolution.”54 If class claims fall within the transitory exception, a plaintiff need not file a 7
motion for class certification before the mooting of the plaintiff’s claim for injunctive relief,55 8 9 unlike cases in which the transitory exception does not apply.56
10 D. Title III of the ADA

United States District Court For the Northern District of California

11

The ADA’s purpose includes a national mandate to eliminate discrimination against

12 individuals with disabilities and to help them to “‘integrate into the economic and social
13 mainstream of American life.’”57 The ADA’s language is broad, emphasizes access to health care, 14

15 cause, bail or arraignment hearings.” Id. See also Wade v. Kirkland, 118 F.3d 667, 670 (9th Cir. 1997).
16

17

52 Wade, 118 F.3d at 670.

18 53 Symczyk, 133 S. Ct. at 1531.

19 54 Wade, 118 F.3d at 670 (internal quotation marks omitted).

20 55 See County of Riverside, 500 U.S. at 51-52; Haro v. Sebelius, 747 F.3d 1099, 1110 (9th Cir.

2014) (holding that even though the plaintiff’s individual claims were mooted prior to the filing of 21 the motion for class certification, the claims of the class were inherently transitory, meaning that

22

the class’s “claim for injunctive relief is not moot, and that Article III’s justiciability requirements are satisfied.”); Gomez v. Campbell-Ewald Co., 805 F. Supp. 2d 923, 928-30 (C.D. Cal. 2011).

23

56 See Sosna, 419 U.S. at 393, 402-403 (holding that unless a case has been certified by the trial

24 court as a class action prior to the time that the case has been mooted with respect to the named

plaintiff, then dismissal is required by the "case or controversy" provisions of Article III of the 25 Federal Constitution); Arizonans for Official English v. Arizona, 520 U.S. 43, 68, n. 22 (1997)

26

("Mootness has been described as the doctrine of standing set in a time frame: The requisite personal interest that must exist at the commencement of the litigation (standing) must continue

27 throughout its existence (mootness).") (internal quotation marks omitted).

28 57 Docket No. 89 at 3; Martin v. PGA Tour, Inc. 532 U.S. 661, 675, 680 (2000) (stressing 9
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 and extends to upholding rights and combatting disability discrimination in institutionalized 2 settings including prisons.58

3

Title III of the ADA provides in part that “no individual shall be discriminated against on

4 the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges,
5 advantages, or accommodations of any place of public accommodation by any person who owns, 6 leases (or leases to), or operates a place of public accommodation.”59 To survive a motion to 7
dismiss, 60 Title III requires a plaintiff to plead the following elements: (1) the plaintiff was 8 9 disabled within the meaning of the Act; (2) the plaintiff was discriminated against on the basis of
10 that disability; and (3) the defendant owns, leases or leases to or operates a place of public
11 accommodation.61 Under Title III, “professional offices of a health care provider, hospital, or other

United States District Court For the Northern District of California

12 service establishment” are considered public accommodations.62

13

To be liable under Title III of the ADA, an entity need not “own” the location, but may

14 merely “operate” a place of public accommodation in that space.63 The Ninth Circuit has held that
15

16 Congress’ “expansive purpose” that the ADA be “a ‘clear and comprehensive national mandate’ to eliminate discrimination against disabled individuals, and to integrate them ‘into the economic and
17 social mainstream of American life’”) (quoting H.R. REP. 101-485, pt. 2, 50).
18 58 Pennsylvania Dep’t of Corrections v. Yeskey, 524 U.S. 206, 212 (1998); Armstrong v. Schwarzenegger, 622 F.3d 1058, 1068 (9th Cir. 2010); Armstrong v. Brown, 732 F.3d 955 (9th Cir.
19 2013); Armstrong v. Wilson, 124 F.3d 1019, 1023, 1025 (9th Cir. 1997) (citation omitted) (“Nothing in the legislative history of the . . . ADA reflects an intent by Congress to exclude
20 prisons or prisoners from the reach of the statutes.”).

21 59 ADA § 302(a), 42 U.S.C. § 12182(a).

22 60 See, e.g. Norkunas v. Park Rd. Shopping Ctr., Inc. 777 F. Supp. 2d 998, 999 (W.D.N.C. 2011) 23 aff’d, 474 F. App’x 369 (4th Cir. 2012) (granting motion to dismiss based on ADA Title III claim).

24 61 See Docket No. 58 at 4; ADA § 302(a), 42 U.S.C. § 12182(a).

25

62 Section 12181(7)(F) provides: “[t]he following private entities are considered public accommodations for purposes of this subchapter, if the operations of such entities affect

26

commerce—. . . (F). . .a professional office of a health care provider, hospital, or other service establishment.”

27 63 42 U.S.C. § 12182(a); Lentini v. California Center for the Arts, Escondido, 370 F.3d 837, 849
28 (9th Cir. 2004). 10
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 “to operate” is “to put or keep in operation, to control or direct the functioning of, or to conduct the 2 affairs of; manage.”64 This is a broad definition,65 but this district has previously held an

3 independent contractor must have some nexus establishing he was an “operator” to be subject to

4 Title III of the ADA.66

5

Courts have held that Title II of the ADA,67 as well as California’s Unruh Civil Rights

6

Act68 and the California Disabled Persons Act,69 apply to jails, but there is limited jurisprudence on

7 the applicability of Title III of the ADA to private health facilities in jails.70 In Wilkins-Jones,
8

9 however, Judge Chen recognized that a health care provider in the jail was a separate entity from

10

United States District Court For the Northern District of California

11 64 Lentini, 370 F.3d at 849 (holding an employee who served as Director of Center Sales and Event

12 Services at the California Center for the Arts was an “operator” within the meaning of Title III, and

thus accountable for the discriminatory treatment of a theater patron with a disability, because he

13 “was in a position of authority, having the ability to instruct the Center staff on who could or could

14

not be admitted to the theater”); Disabled Rights Action Comm. v. Las Vegas Events, Inc., 375 F.3d 861, 878, n.14 (9th Cir. 2004).

15 65 See e.g. Lentini, 370 F.3d at 849.

16 66 Aikins v. St. Helena Hosp. 843 F. Supp 1329, 1335 (N.D. Cal. 1994).

17 67 See, e.g., Yeskey, 524 U.S. at 212; Armstrong v. Schwarzenegger, 622 F.3d at 1068; Armstrong v.

18

Brown, 732 F.3d at 955; Armstrong v. Wilson, 124 F.3d at 1023, 1025; Wilkins-Jones v. County of Alameda, 859 F. Supp. 2d 1039, 1054 (N.D. Cal. 2012) (finding “it is reasonable to consider a jail

19

a public place in the context of inmates’ rights to be free from discrimination on the basis of their disabilities. While the general public is not permitted inside a jail at any given time, the

20

government has the power to compel members of the public to a jail under certain circumstances. … [A] jail is more like schools and hospitals contemplated under the ADA, which also restrict

21

public access in certain times and circumstances but are nonetheless designed and intended to provide services, goods, privileges, and advantages to members of the public” (internal quotation

22 marks and citations omitted)).

23

68 See Cal. Civ. Code § 51; Wilkins-Jones, 859 F. Supp. 2d at 1043; Isbister v. Boys’ Club of Santa Cruz, 40 Cal. 3d 72, 83 (1985) (explaining The Unruh Act’s coverage in terms of “business

24 establishments” includes “places of public accommodation”).

25

69 Civ. Code § 54.1 (protecting the rights of persons with disabilities to full and equal access to a broad list of facilities and accommodations, including “medical facilities, including hospitals,

26

clinics, and physicians’ offices” and “places of public accommodation … to which the general public is invited.” Cal. Civ. Code § 54.1(a)(1)); Wilkins-Jones, 859 F. Supp. 2d at 1043.

27

70 See Docket No. 89 at 5.

28 11

Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

the jail and a “business establishment” operating “for profit” within the facility.71 While Title II 1 2 and Title III are “parallel provisions” with Title II covering only public entitles and Title III 3 covering only private entities,72 “[t]here are many situations . . . in which public entities stand in

4 very close relation to private entities that are covered by title III.”73 The result is that “certain

5 activities may be affected, at least indirectly, by both titles. . . .Where public and private entities act

6 jointly, the public entity must ensure that the relevant requirements of title II are met; and the
7 private entity must ensure compliance with title III.”74
8

9

III. DISCUSSION

10 A. Plaintiffs Have Standing to Pursue Their Claims

United States District Court For the Northern District of California

11

Defendants argue that those Plaintiffs who are no longer incarcerated do not have standing

12 for mootness and for lack of redressability because they are no longer subject to the conditions they
13 challenge. Citing Lyons, Defendants contend it must be assumed a released inmate “will conduct 14
[his] activities within the law and so avoid prosecution and conviction” and incarceration, denying 15
these Plaintiffs’ standing75 because their injury is too abstract and speculative.76 Defendants assert 16
17 those Plaintiffs still in the jail and not a part of their motion to dismiss rebut Plaintiffs’ argument
18 that their class is transitory,77 and because the class is not transitory, Plaintiffs cannot rely on

19

20 71 Wilkins-Jones, 859 F. Supp. 2d at 1049.

21 72 Americans with Disabilities Act Title III Technical Assistance Manual Covering Public

22

Accommodations and Commercial Facilities, § III–1.7000, available at http://www.ada.gov/taman3.html; Wilkins-Jones, 859 F. Supp. 2d at 1047.

23

73 Id.

24

74 Id.

25 75 See id.; Lyons, 461 U.S. at 103 (citing O’Shae, 414 U.S. at 495-97).

26 76 See Docket No. 90 at 2; O'Shae, 414 U.S. at 493-495.
27 77 See Docket No. 90 at 2.
28 12
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

Armstrong v. Davis and similar cases because class certification has not been granted.78 “The 1 2 general rule remains for 42 U.S.C. § 1983 claims for deprivation of rights in a detention setting is

3 that the plaintiff must be incarcerated at the time of filing and throughout the pendency of the

4 matter. The reasoning for this flows from the principle established in Lyons.”79

5

Plaintiffs emphasize that because this is a class action for injunctive relief, the claims of the

6 putative class and subclass members must be considered when evaluating standing and mootness,
7 not just those of the named plaintiffs who seek to represent the class.80 Plaintiffs argue they qualify
8

9 for the transitory exception, under which a named plaintiff need only have standing at the time they

10 enter the dispute,81 considering that the population of the jail is “transitory, fluid, and constantly

United States District Court For the Northern District of California

11 changing and evolving. Individual prisoners frequently come and go for stays of days, weeks, and

12 months. The vast majority of the jail’s population are pretrial detainees with completely
13 unpredictable, but generally brief, lengths of stay. The average term in the jail ranges from 30-40 14
days, far too short for a prisoner to raise claims about the conditions in the jail and for the court to 15

16

17

18

19 78 See id. at 4 (citing Von Colln v. County of Ventura, 189 F.R.D. 583, 590 (C.D. Cal. 1999)

20 (analyzing standing in conjunction with a motion for class certification); Parsons v. Ryan, Case

No. 13-cv-16396, 2014 U.S. App. LEXIS 10466 (9th Cir. Ariz. June 5, 2014) (appealing an order

21 certifying a class and a subclass of inmates in Arizona's prison system)); cf. Wade v. Kirkland, 118

F.3d 667, 669 (9th Cir. 1997) (deciding not whether the plaintiff’s claim was moot but rather

22 remanded the action to the trial court to determine whether the plaintiff could continue as a class

representative or whether other putative class members should be allowed to intervene); R.G. v.

23 Koller, 415 F. Supp. 2d 1129, 1137 (D. Haw. 2006) (holding “the plaintiffs in this case need not

engage in illegal conduct to be returned to [the juvenile facility]”).

24

25

79 See Docket No. 90 at 8; Lyons, 461 U.S. at 95 (neither the existence of past injury nor conjecture over the prospect of some future injury creates the case or controversy required for jurisdiction).

26

80 See Docket No. 77 at 14.

27 81 County of Riverside, 500 U.S. at 51-52.

28 13

Case No. 5:13-cv-02354-PSG

ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

issue a decision on class certification.82 Plaintiffs further highlight those Plaintiffs who have 1 2 returned to jail since Defendants filed their motions.83

3

Plaintiffs also argue that even if the transitory exception does not apply, the claims of

4 Plaintiffs who have now been released but are under supervision are not moot.84 Plaintiffs’

5 argument regarding supervision is especially pertinent to Plaintiff Yancey, who had been

6 transferred to a different institution by the time Plaintiffs’ first complaint was filed,85 and Plaintiff

7

Miller, who was supervised on probation and not in the jail on the date he became a named plaintiff 8

9

in this suit.86

10

On balance, the court is persuaded that the short average length of stay of prisoners in the

United States District Court For the Northern District of California

11 putative class and the plodding speed of legal action qualify Plaintiffs for the inherently transitory

12 exception.87

13

First, Defendants may be right that county jails in the State of California have forever

14 changed as a result of realignment under Assembly Bill 109, more formally known as “The 2011
15

Realignment Legislation Addressing Public Safety.” The bill shifted responsibility for 16

17 incarceration and parole supervision of prisoners convicted of certain types of crimes from the state

18 prison system to the counties.88 But the vast majority of inmates in the jail continue to be pretrial

19

20

21 82 See Docket No. 77 at 1.

22 83 See Docket Nos. 75; Docket No. 77 at 21; Docket Nos. 98 and 114.

23 84 See Docket No. 77 at 8, 21; Armstrong v. Davis, 275 F.3d at 866.
24 85 See Docket No. 77 at 19; Docket No. 114.
25 86 See Docket No. 77 at 8.
26 87 See Wade, 118 F.3d at 670; Symczyk, 133 S. Ct. at 1530; County of Riverside, 500 U.S. at 51-52. 27
88 See Coleman v. Brown, 922 F. Supp. 2d 1004, 1014-15 (E.D. Cal. 2013). 28
14 Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

detainees.89 For such inmates, “the length of detention cannot be ascertained at the outset and may 1 2 be ended before class certification by various circumstances.”90 Nor do those Plaintiffs not subject

3 to Defendants’ motion suggest otherwise. Even those who can expect to remain in the jail for two

4 years or more will likely move on before the resolution of this litigation, which in its second year

5 has yet to reach even the class certification stage.
6 Second, the average length of incarceration for this largely pretrial detainee population is
7 uncertain and short—only approximately 34 days.91 This is too short a period for the court to
8 9 resolve a motion for class certification.

10

Third, because all inmates in the jail are alleged to be at risk simply by virtue of being

United States District Court For the Northern District of California

11 detained, it is “certain that other persons similarly situated will continue to be subject to the

12 challenged conduct.”92 Under these circumstances, the mooting of Plaintiffs’ individual claims,
13 even if before the filing of a motion for class certification, does not impact their standing as long as 14
each plaintiff had standing when they entered the case.93 15

16

17 89 See Docket No. 49-13, Ex. BB (daily jail population statistics showing that for the period

18 between January 1, 2014 and March 10, 2014, unsentenced prisoners made up a minimum of 67

percent and a maximum of 79 percent of the jail population). 19
90 Lyon v. U.S. Immigration & Customs Enforcement, Case No. 3:13-cv-5878-EMC, 2014 WL 20 1493846, at *9 (N.D. Cal. Apr. 16, 2014); see Olson v. Brown, 594 F.3d 577, 582 (7th Cir. 2010)

21 (“[T]he length of incarceration in a county jail generally cannot be determined at the outset and is subject to a number of unpredictable factors”).

22

91 See Docket No. 49-13, Ex. AA, Ex. J at 16.

23 92 Symczyk, 133 S. Ct. at 1531 (internal quotation marks omitted).
24 93 See County of Riverside, 500 U.S. at 51-52; cf. Amador v. Andrews, 655 F.3d 89, 100-01 (2d Cir.
25 2011); Olson v. Brown, 594 F.3d 577, 580-84 (7th Cir. 2010); Butler v. Suffolk County, 289 F.R.D.

26

80, 91-92 (E.D.N.Y. 2013); Chief Goes Out v. Missoula County, Case No. CV-12-155-M-DWM, 2013 WL 139938, at *6-7 (D. Mont. Jan. 10, 2013); see also Or. Advocacy Ctr. v. Mink, 322 F.3d

27 1101, 1116-18 (9th Cir. 2003); Preap v. Johnson, Case No. 4:13-cv-5754-YGR, 2014 WL 1995064, at *2, n.2 (N.D. Cal. May 15, 2014); Lyon, 2014 WL 1493846, at *8.
28 15

Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1

Those Plaintiffs not incarcerated at the jail at the time the complaint was filed stand apart

2 from the other Plaintiffs.94 For example, Plaintiff Yancey is presently housed in the state detention

3 facility in Corcoran. Under Armstrong v. Davis, however, he too had standing when he became a

4 named plaintiff in this suit because he was still subject to the disputed conditions of the jail.95
5 Even if his release is not scheduled for a number of years, upon the completion of his prison 6
sentence, Plaintiff Yancey will necessarily be supervised on parole in Monterey County by the 7
California Department of Corrections and Rehabilitation’s Division of Adult Parole Operations.96 8 9 Plaintiffs also have sufficiently alleged that in the meantime, Plaintiff Yancey would be held in the
10 jail for further proceedings before the Monterey Superior Court during the period of his sentence.

United States District Court For the Northern District of California

11 As another example, Plaintiff Miller too was already under supervision and subject to the

12 conditions of the jail when he entered the suit.97 Both therefore have “a personal stake in the

13 outcome of the controversy” and the parties to the controversy are plainly adverse to each other.98
14 In sum, all Plaintiffs may proceed.
15 B. CFMG’s Motion to Dismiss Claim Six Regarding Title III of the ADA
16

17

CFMG asserts Plaintiffs’ sixth cause of action fails to state a claim because CFMG does not

18 own, lease, or operate a place of “public accommodation” pursuant to 42 U.S.C. § 12181(7)(F).99

19

20 21 94 See Docket No. 77 at 8.

22 95 See id. at 19; Docket No. 114.

23 96 See Cal. Penal Code §§ 3000.08(a) & (b), Cal. Penal Code § 3003(a) (requiring individuals released from prison to be supervised in the country of their “last legal residence . . . prior to his or
24 her incarceration,” which for Plaintiff Yancey is Monterey County).

25 97 See Docket No. 77 at 8; Docket No. 114.

26 98 See Armstrong v. Davis, 275 F.3d at 866.

27

99 See Docket No. 83.

28 16

Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

Rather, CFMG argues it is an independent contractor with the County of Monterey.100 It does not 1 2 operate the physical space of the jail, neither the jail nor its medical services are open to the 3 public,101 and many of Plaintiffs’ allegations against CFMG did not occur in CFMG’s jail clinical

4 rooms.102 CFMG argues Plaintiffs’ claim against them is superfluous, because Plaintiffs already
5 have a remedy against the jail under Title II.103 6
Plaintiffs respond that CFMG is an operator of a place of public accommodation in that it 7
“operates a professional office of a health care provider, hospital, or other service establishment” 8 9 within the jail—Plaintiffs do not allege CFMG operates other functions of the jail.104 The “services
10 establishment” category of public accommodations explicitly includes a “professional office of a
11 health care provider” and a “hospital” as places of public accommodation under Title III.105

United States District Court For the Northern District of California

12 Plaintiffs further argue CFMG is not insulated from Title III liability just because its health care
13 facilities in the jail are not open to the general public.106 Instead, the health care facilities that
14 CFMG operates in the jail are covered service establishments and public accommodations within
15 the meaning of Title III.107 Under its contract with the jail, CFMG is the “sole provider” of health
16

17

18

100 See Docket No. 58 at 6.

19

101 See id. at 5-6 (“It is neither enumerated within the statutory definition of 42 U.S.C. § 12181, and is not a place ‘open to the public’”); See, e.g., Disabled Rights Action Comm. v. Las Vegas Events,

20

Inc., 375 F.3d 861, 873 (9th Cir. 2004); cf. Debord v Board of Educ., 126 F.3d 1102 1106 (8th Cir. 1997) (regarding a school); cf. Baaske v. City of Rolling Meadows, 191 F. Supp. 2d 1009, 1013

21 (N.D. Ill. 2002) (regarding a city).

22 102 See Docket No. 89 at 6-7.

23 103 See id. at 4; Docket No. 59 at 5.

24 104 See Docket No. 41 at ¶ 398.

25 105 See 42 U.S.C. § 12181(7)(F).

26 106 See Docket No. 83 at 1.

27

107 See id. at 2.

28 17

Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 services in the jail and so must be responsible for the substantive Title III violations CFMG does 2 not contest.108 CFMG therefore has a nexus establishing itself as an operator of the medical
3 facilities in the jail.109

4

On balance, the court is persuaded that Plaintiffs have sufficiently alleged that CFMG

5 operates of a place of public accommodation for purposes of Title III.

6

First, in Martin, the Supreme Court stressed Congress’ “expansive purpose”110 that the

7

ADA be “a ‘clear and comprehensive national mandate’ to eliminate discrimination against 8

9 disabled individuals, and to integrate them ‘into the economic and social mainstream of American

10 life.’”111 The legislative intent was that the statute reach all “critical areas” of society where

United States District Court For the Northern District of California

11 persons with disabilities face discrimination, two of which are involved in the instant case:

12 “‘discrimination against individuals with disabilities persists in such critical areas as employment .
13 . . transportation, communication, recreation, institutionalization, health services, voting, and 14
access to public services.’”112 15
Second, only recently, this district held that a private provider of county jail health care 16 17 could face claims for disability discrimination.113 While neither of the two California statutes at

18

19

20

21 108 See id. at 1.
22 109 See id. at 6.
23

24

110 See Martin, 532 U.S. 661 at 680.

25 111 Id. at 675 (quoting H.R. REP. 101-485, pt. 2, 50).

26 112 Id. (quoting 42 U.S.C. § 12101(a)(3)).

27 113 Wilkins-Jones, 859 F. Supp. 2d at 1054 (regarding the Unruh Act and the California Disabled Person Act).
28 18
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 issue in Wilkins-Jones were Title III of the ADA, all three statutes require sufficient allegations to 2 tie the alleged discrimination to the operation of a physical place.114

3

Third, the complaint cites “the jail” as the specific place where the discriminatory acts are

4 alleged to have taken place.115 To be sure, the “place” of jails is typically considered to be the
5 territory of Title II of the ADA, not Title III.116 But courts have consistently found Title III applies 6
to “places of public accommodation” within places that normally do not fit into Title III either 7
because they are owned by a public entity or are operated for other purposes by a public entity.117 8

United States District Court For the Northern District of California

9

10

114 Weyer v. Twentieth Century Fox Film Corp., 198 F.3d 1104, 1114 (9th Cir. 2000) (holding that for Title III to apply to a private entity operating a “place of public accommodation,” a court must

11 evaluate whether “some connection” exists between “an actual physical place” and the private entity employing allegedly discriminatory practices); Wilkins-Jones, 859 F. Supp. 2d at 1049
12 (“PHS/Corizon is thus qualitatively different from a correctional facility itself; while the County's

operation of a jail may not be a business, PHS/Corizon is a business establishment operating for 13 profit within a correctional facility”) (citing Burks v. Poppy Const. Co., 57 Cal.2d 463, 468–69

14

(1962) (“The word ‘establishment,’ as broadly defined, includes not only a fixed location, such as the place where one is permanently fixed for residence or business, but also a permanent

15 commercial force or organization or a permanent settled position (as in life or business)” (internal citations and quotation marks omitted)); id. at 1054-55 (holding that while the CDPA applies to
16 jails and the accommodations and services provided therein, it is concerned solely with physical

access to public spaces, so plaintiffs could not maintain a claim based on the denial of service); 17 Lopez v. County of Tulare, Case No. CV-F-11-1547–LJO–BAM, 2012 WL 33244, at *10 (E.D.

18 Cal. Jan. 6, 2012) (“The CDPA only guarantees physical access to a facility”); Anderson v. County of Siskiyou, Case No. 4:10-cv-01428-SBA, 2010 WL 3619821, at *6 (N.D. Cal. Sept. 13, 2010)

19 (dismissing claim where it is “predicated upon the alleged denial of services, not the denial of access to a public facility”).
20
115 See, e.g., Docket No. 41 at 2-3, 8, 129. 21

22

116 See Yeskey, 524 U.S. at 212.

23 117 See, e.g., Disabled Rights Action Comm., 375 F.3d at 878 (regarding private association operating a rodeo within a state-owned arena, holding a Title III-covered facility was still covered

24 even if its activities were carried out at or within a publicly-owned facility which is not covered by Title III); Fiedler v. Am. Multi–Cinema, Inc., 871 F.Supp. 35, 37-38 (D.D.C. 1994) (concluding
25 that Title III was applicable to AMC although the federal government owned the property, relying

26

primarily upon the language of Title III, the DOJ regulations, and the DOJ Title III Technical Assistance Manual); Bowers v. Nat'l Collegiate Athletic Ass'n, 9 F. Supp. 2d 460, 485–89 (D.N.J.

27 1998) (holding that private college athletic association could be held liable under Title III for its operation of places of public accommodation owned by its member colleges and universities);

28 Tatum v. Nat'l Collegiate Athletic Ass'n, 992 F.Supp. 1114, 1119–21 (E.D. Mo. 1998) (finding that 19
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

1 In finding a county jail to be a “public place” or “place of public accommodation” under the Unruh 2 Act and the California Disabled Person Act pertaining to the operations of a private healthcare

3 provider in the jail, Judge Chen in Wilkins-Jones articulated:

4

[I]t is reasonable to consider a jail a public place in the context of inmates’ rights to be free

5

from discrimination on the basis of their disabilities. While the general public is not permitted inside a jail at any given time, the government has the power to compel members

6

of the public to a jail under certain circumstances. … [A] jail is more like schools and

hospitals contemplated under the ADA, which also restrict public access in certain times

7

and circumstances but are nonetheless designed and intended to provide services, goods,

privileges, and advantages to members of the public.118

8

9 This same reasoning makes just as much sense when considering whether to understand whether

10 “place of public accommodation” under Title III also covers private operations within jails.

United States District Court For the Northern District of California

11 Although inartful in identifying CFMG as the accommodation itself, Plaintiffs have sufficiently

12 alleged that CFMG “operates” a professional office in the actual physical “place” of the jail to

13 provide the “public accommodation” of all required medical care.119 CFMG’s motion to dismiss

14 must be denied.
15
16

IV. CONCLUSION

17

All of Defendants’ motions to dismiss are DENIED. All named plaintiffs remain in the

18 case, and Plaintiffs’ sixth cause of action stands.

19

20 plaintiff had a “reasonable likelihood” of demonstrating that private college athletic association “operates” the athletic facilities owned by its member colleges and universities); Ganden v. Nat'l
21 Collegiate Athletic Ass'n, Case No. 96-C-6953, 1996 WL 680000, at *11 (N.D. Ill. Nov. 21, 1996) 22 (holding that regardless of whether a public university owns or operates the athletic facility, private
college athletic association may also “operate” the facility for Title III purposes); Butler v. Nat'l 23 Collegiate Athletic Ass'n, Case No. C96–1656D, 1996 WL 1058233, at *4–5 (W.D. Wash. Nov. 8,
1996) (noting that Title III does not provide that public facilities operated by private entities cannot 24 constitute public accommodations, and holding that the NCAA may be covered by Title III if it 25 operates the athletic facilities owned by the state university).
26 118 Wilkins-Jones, 859 F. Supp. 2d at 1049, 1054-55; see also Yeskey, 524 U.S. at 212.
27 119 See, e.g., Docket No. 41 at 2-3, 8, 129; see Docket No. 83 at 15.

28 20
Case No. 5:13-cv-02354-PSG ORDER DENYING DEFENDANTS’ MOTIONS TO DISMISS

 </s> 1

2

3

4

5

6

7

8

9

United States District Court For the Northern District of California

10 UNITED STATES DISTRICT COURT
11 NORTHERN DISTRICT OF CALIFORNIA
12

13

SAN JOSE DIVISION

14 JESSE HERNANDEZ et al.,

15

Plaintiffs,

v. 16

COUNTY OF MONTEREY, et al., 17

18

Defendants.

19

) Case No.: 5:13-cv-2354-PSG ) ) ORDER GRANTING MOTION TO ) CERTIFY CLASS AND DENYING ) MOTION TO STRIKE ) ) (Re: Docket Nos. 48, 181) ) )

20

On any given day, approximately 1000 adult men and women find themselves in the

21 Monterey County Jail.1 This is a case about their custody and care at the hands of Defendants

22 County of Monterey, Monterey County Sheriff’s Office and California Forensic Medical Group,

23 Inc.

24

Plaintiffs are current or former inmates who allege that a variety of jail policies and

25 practices regarding inmate safety, medical care, mental health care and disabilities expose them to
26

27 1 Unless otherwise cited, all facts come from Plaintiffs’ second amended complaint at Docket No. 41.
28
1 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 a substantial risk of serious harm to which Defendants are deliberately indifferent. The inmates 2 seek declaratory and injunctive relief from the alleged constitutional violations.

3

After reviewing the substantial record compiled by the parties, which includes four neutral

4 expert reports, two outside expert reports commissioned at the County’s request, declarations from
5 two experts retained by Plaintiffs and various inmates, the court finds that Plaintiffs meet the
6 standard for class certification set forth in Federal Rule of Civil Procedure 23 and as construed by
7 the Ninth Circuit. It therefore certifies a class of inmates challenging jail safety and health care
8 9 policies and practices, and a subclass of inmates challenging jail disability policies and practices.2

United States District Court For the Northern District of California

10 2 The court may take judicial notice of a “fact that is not subject to reasonable dispute because it is

11 generally known” or “can be accurately and readily determined from sources whose accuracy

cannot reasonably be questioned.” Fed. R. Evid. 201(b). If the fact is not in dispute and may be 12 verified by resort to the public record, see id., the court takes judicial notice as requested.

13

Plaintiffs first request that the court take judicial notice of 55 applications made by the Sheriff’s Office to the Monterey Superior Court in an attempt to relieve overcrowding, and

14 subsequent orders. See Docket No. 49-11, Ex. Z; Docket No. 54 at 1. The court takes judicial notice of these applications and orders because they were filed in state court. Second, Plaintiffs ask

15 the court to take judicial notice of County charts documenting the jail’s average daily population.

See Docket No. 49-13, Ex. AA and BB; Docket No. 54 at 2. As the daily inmate population is 16 verifiable and not in dispute, the court takes judicial notice. Third, Plaintiffs seek judicial notice of

17

minutes of the Monterey County Board of Supervisors in which the Board approved legislation to “accept the Jail Facility Needs Assessment Report.” See Docket No. 49-16, Ex. FF; Docket No. 54

18 at 3. The court takes judicial notice of this legislative enactment. Fourth, Plaintiffs request judicial notice of the Monterey County Correction Facility Information Manual and certain sections of the

19 Custody Operations Bureau’s Policies and Procedures. See Docket Nos. 49-1, Ex. E; Docket No.

49-2; Ex. F; Docket No. 54 at 3-4. The court takes judicial notice of these agency manuals, rules 20 and policies not subject to a reasonable dispute. Fifth, Plaintiffs ask for judicial notice of the

21

United States Census Bureau Report on Americans with Disabilities. See Docket No. 49-17; Ex. II; Docket No. 54 at 4. The accuracy of these facts are verifiable and certain, and so the court again

22 takes judicial notice. The County first seeks judicial notice of Monterey County Board Orders: approving

23 Amendment #1 to Agreement A-1083, see Docket No. 140-1, Ex. A; Docket No. 133-1 at 2;

designating the Monterey County Sheriff’s Office as the authorized representative on Medi-Cal 24 applications, see id., Ex. B; Docket No. 133-1 at 2; authorizing $4,032,778 in County funds to be

25

used for the County of Monterey Jail Housing Addition, see id., Ex. C; Docket No. 133-1 at 2; authorizing an additional $4,867,222 in County funds to be used for the Jail Housing Addition

26 Project, see id., Ex. D; Docket No. 133-1 at 2; and authorizing Sheriff Scott Miller to submit an

application for a local adult detention facility construction grant and expenditure of $200,000. See

27 id., Ex. E; Docket No. 133-1 at 2. The court takes judicial notice that these board orders occurred.

Second, the County seeks judicial notice of affidavits and minute orders of conflict as to Glenda 28 Hunter, Angel Perez, Ha Ngoc Tran, Dennis Guyot, Albert Key and Brandon Mefford. See id., Ex.

2

Case No.: 5:13-cv-2354-PSG

ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

I.

2

The United States and California Constitutions require California’s counties to provide for

3 the safety and well-being of inmates housed in county jails.3 To meet these obligations, as well as

4 those imposed by federal and state statutes,4 Monterey County has promulgated extensive policies
5 governing health care and conditions of confinement. These policies apply to all of the inmates in 6
its custody and all of its staff throughout its main jail in Salinas. 7
Since 1984, Monterey County has contracted with CFMG, a private health care provider, to 8 9 provide medical, dental and mental-health care services to inmates. Under the terms of its contract,
10 CFMG agreed to follow all County policies and to work with the County to implement additional

United States District Court For the Northern District of California

11 policies governing such matters as health care staffing, access to prescriptions, emergency care,

12 and mental health services. Monterey County regularly monitors CFMG’s compliance with these
13 policies. 14
Twenty-one current or former inmates brought this suit. Plaintiffs allege a variety of jail 15
policies and practices “fail to keep [inmates] safe from violence, to deliver adequate medical and 16 17 mental health care or to provide required assistance to [inmates] with disabilities.”5 Plaintiffs

18 support these general allegations with detailed references to dozens of specific jail policies and

19 practices, including inadequate staffing, training, space, inmate classification, intake health

20 H-N; Docket No. 133-1 at 3. The court takes judicial notice of the Public Defenders’ declarations

21 of conflict. CFMG requests the court take judicial notice of a judicial order at Exhibit G to the Bertling

22 Declaration. See Docket Nos. 243, 184-2, Ex. G. The court does not do so because Exhibit G to

the Bertling Declaration is actually a deposition. 23

24

3 See U.S. CONST. amend. VIII; U.S. CONST. amend. XIV; CA Const. art. I, § 7; CA Const. art. I, § 17.

25 4 See, e.g. Americans with Disabilities Act of 1990, 42 U.S.C. § 12101 et seq.; Rehabilitation Act 26 of 1973, 29 U.S.C. § 701; Cal. Gov’t Code § 11135.

27 5 Docket No. 56 at 1. While Plaintiffs refer to jail residents as “prisoners,” the court will adhere to the alternative reference of “inmates.”
28
3 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 screening, care scheduling, medication, infection control, emergency response and suicidal inmate 2 segregation.

3

Plaintiffs also claim that inmates are routinely denied reasonable accommodation for their

4 disabilities. They allege, for example, that inmates who cannot climb stairs spend months without
5 going outside because the exercise yard can only be accessed up a flight of stairs. Inmates who use 6
sign language to communicate are not provided interpreters for the intake process, doctor’s 7
appointments and disciplinary hearings. Defendants are further alleged not to maintain any central 8 9 list, electronic or otherwise, of inmates with disabilities and the accommodations they require. The
10 result, say Plaintiffs, is that “because Defendants completely lack policies and practices for

United States District Court For the Northern District of California

11 evacuating and communicating with [inmates] with disabilities in case of emergencies, including

12 natural disasters and security incidents, [inmates] with disabilities are at increased risk of injury in
13 such circumstances.”6 14
With respect to all these claims, Plaintiffs allege that Defendants are aware of these 15
constitutionally defective conditions and tolerate the resulting risk to which inmates are exposed. 16
17 For example, Plaintiffs allege that in 2007, the County commissioned a third-party evaluation of

18 the jail, which resulted in a June 19, 2007 report called “County of Monterey, Office of the Sheriff,

19 Needs Assessment.” The 2007 report concluded that “[t]he current combination of insufficient

20 beds, an inadequate detention facility and understaffing has resulted in an almost untenable
21 situation. In 2011, the County asked the third-party consultant to update the 2007 report to reflect
22 amendments to state law and changes within the Sheriff’s Office and the jail population. This
23
24 updated report, dated December 30, 2011, reached the exact same, word-for-word conclusion:

25

26

27 6 Id. at 19.
28
4 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 “The current combination of insufficient beds, an inadequate detention facility and understaffing 2 has resulted in an almost untenable situation.”7

3

Plaintiffs seek a declaration that Defendants are violating federal and state law and an

4 injunction compelling Defendants to provide inmates with adequate protection from violence from

5 other inmates, to provide inmates with adequate medical and mental health care, and to provide

6 reasonable accommodations to and cease discriminating against inmates with disabilities.8

7

II. 8

9

Shortly after filing their second amended complaint,9 Plaintiffs moved for class

10 certification. In addition to the detailed allegations of their complaint, Plaintiffs cite thousands of

United States District Court For the Northern District of California

11 pages of documents that they secured by investigation and from public records requests, expert

12 reports by four neutral specialists in prison medical care and conditions of confinement retained by
13 mutual agreement of the parties, two reports on conditions at the jail commissioned by the County 14
in 2007 and 2011, two declarations from experts they retained and their own declarations. The 15
investigation and records requests produced (1) more than one hundred interviews of former and 16
17 current inmates in the jail; (2) tens of thousands of pages of medical and custody records for

18 current and former inmates in the jail; (3) documents produced by the County in response to three

19 requests for information pursuant to the California Public Records Act and (4) hundreds of

20 Sheriff’s Office reports of incidents that occurred in the jail.
21 In their responses, Defendants submit declarations from attorneys, jail staff and medical
22 experts, news articles, depositions, declarations, grievance and medical records of Plaintiffs, board
23 24 orders for improvements and a letter from Monterey County Public Defender James Egar praising 25 7 See Docket No. 41 at 3:9-22.
26 8 See id. at 132-35.

27 9 On September 29, 2014, the court denied Defendants’ motions to dismiss the second amended complaint. See Docket No. 128.
28
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1

CFMG’s work.10 They claim conditions have improved, despite difficulties due to inmate

2 realignment resulting from the enactment of Assembly Bill 109.11

3

A.

4

The 135-page second amended complaint in this case sets out detailed factual allegations

5 concerning the existence of jail policies and practices impacting the safety, health and disability

6 accommodations of all inmates. According to Plaintiffs, these policies and practices expose all jail
7 inmates to a substantial risk of harm.
8

9

Regarding their safety claims, Plaintiffs allege the following policies and practices: (1)

10 insufficient custody staffing; (2) inadequate inmate classification system; (3) dangerous and

United States District Court For the Northern District of California

11 inadequate jail facilities that are difficult to safely monitor; (4) housing more inmates in the jail

12 than the jail’s rated capacity and (5) inadequate training of custody staff.

13

Regarding their medical care claims, Plaintiffs allege the following policies and practices:

14 (1) failure to provide timely access to health care; (2) insufficient custody staffing to ensure
15

inmates receive necessary health care; (3) insufficient health care staff to ensure the timely and 16

17 appropriate treatment of inmates’ serious medical needs; (4) failure to adequately supervise health

18 care staff; (5) failure to provide adequate, clean and confidential clinical spaces;(6) inadequate or

19 non-existent written policies for intake health screening, health care requests, emergency response,

20 continuity of medications, care for inmates with chronic illness, housing of inmates in segregation,
21 care for developmentally disabled inmates, care for patients on dialysis, care for elderly patients,
22 care for patients with dementia, care for patients requiring wheelchairs, care for inmates who have
23 24 physical disabilities, housing for pregnant women, persons with communicable diseases, the
25 mentally ill and the terminally ill; (7) failure to adequately identify inmates in need of health care,

26 10 See Docket Nos. 133-179; 299, 369, 368.
27 11 See, e.g., Docket No. 169 at 17, 19, 29; Docket No. 369 at 2-3.
28
6 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

United States District Court For the Northern District of California

1 including inmates with chronic illness, during the intake process and thereafter; (8) use of 2 inadequately trained custody staff to conduct intake health screening; (9) failure to provide
3 adequate treatment to inmates with chronic diseases; (10) failure to provide adequate treatment to
4 inmates with infectious diseases; (11) failure to provide timely and appropriately treatment by
5 outside medical providers and specialists when necessary; (12) failure to provide timely and 6
adequate treatment for inmates experiencing withdrawal; (13) failure to provide necessary 7
medication and medical devices; (14) failure to timely and adequately respond to requests for 8 9 health care; (15) failure to provide a confidential means for inmates to request health care; (16)
10 failure to timely and adequately respond to health care emergencies; (17) failure to provide
11 appropriate and timely post-operative and post-hospital discharge care; (18) failure to maintain
12 adequate health care records; (17) failure to operate an adequate quality improvement program; 13 (18) failure to adequately train medical and custody staff regarding the provision of health care to 14
inmates and (19) failure to provide timely and appropriate dental care. 15
Regarding their mental health claims, Plaintiffs allege the following policies and practices: 16 17 (1) failure to provide mentally ill inmates medically necessary mental health treatment such as
18 psychotropic medication, therapy and inpatient treatment; (2) failure to provide inmates access to
19 timely and appropriate inpatient mental health care; (3) inadequate suicide prevention policies and
20 practices; (4) failure to provide suicidal and self-harming inmates adequate mental health care; (5) 21
housing inmates with mental illness in administrative segregation because they have mental 22
illnesses; (6) failure to provide a clean, safe and therapeutic location for the housing of inmates at 23 24 risk for suicide; (7) inappropriate use of safety cells, restraints and restraint chairs; (8) failure to 25 adequately monitor inmates at risk of suicide and (9) failure to eliminate suicide hazards in
26 administrative segregation.
27
28 7
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1

Regarding their disability accommodation claims, Plaintiffs allege the following policies

2 and practices: (1) failure to identify and track inmates with disabilities; (2) failure to identify and

3 track the accommodations that inmates with disabilities require; (3) failure to ensure that inmates

4 with disabilities receive and retain needed assistive devices and auxiliary aids; (4) failure to ensure

5 that inmates with disabilities that require accommodations in housing receive and retain 6
appropriate housing assignments; (5) housing inmates with disabilities in administrative 7
segregation, where inmates have less access to programs, services, activities and privileges; (6) 8 9 failure to provide sufficient housing for inmates in wheelchairs; (7) failure to ensure that each
10 program, service or activity offered to inmates in the jail, when viewed in its entirety, is readily

United States District Court For the Northern District of California

11 accessible to and usable by individuals with disabilities; (8) failure to ensure that each part of the

12 facilities at the jail altered after January 26, 1992, in a manner that affects or could affect the
13 usability of all or part of the jail, complies with relevant accessibility standards, including the 14
Uniform Federal Accessibility Standards, the Americans with Disabilities Act Accessibility 15
Guidelines and the 2010 Americans with Disability Act Standard for Accessible Design; (9) failure 16
17 to provide effective communication to inmates with disabilities that affect communication; (10)

18 failure to adequately take disabilities into account in the disciplinary process; (11) failure to

19 provide sign language interpreters to inmates who use sign language as their primary method of

20 communication; (12) failure to ensure the safe evacuation of inmates with disabilities in an

21 emergency and (13) failure to operate an effective and prompt grievance system for inmates to

22
request accommodations for their disabilities. 23

24

For each of these alleged policies and practices, the second amended complaint sets out

25 multiple paragraphs or pages of particularized factual allegations. For example, regarding

26 Defendants’ alleged safety policies and practices, Plaintiffs allege roughly 150 separate instances

27 of violence were reported from (presumably January) 2011 to September 2012, occurring in nearly

28
8 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 every area of the jail, and most requiring medical attention at the jail or the local hospital. 2 Weapons such as shanks and Tomahawks are “readily available” in the jail.12 Surveillance is

3 inadequate, as many assailants remain unidentified, most cameras do not have recording

4 capabilities, and the jail’s understaffing means officers are rarely positioned to visually identify the

5 attackers. Reporting is inadequate for fear of retaliation given the lax conditions. Undertraining of
6 staff means inadequate intervention and confiscation of weapons. Plaintiffs say that despite
7 incident reports and the 2007 and 2011 Jail Needs Assessments, Defendants lack policies and
8 9 practices for regularly reviewing incident reports to identify systemic problems.13

10

As another example, regarding the alleged medical care policies and practices, Plaintiffs

United States District Court For the Northern District of California

11 claim that “[t]hough Defendants have a policy that all [inmates] are supposed to be seen by medical

12 staff on the next available sick call day after submitting a sick call slip, in practice, Defendants use
13 Licensed Vocational Nurses (LVNs) to screen the sick call slips and determine whether the 14
[inmate] should actually be seen by medical or mental health care staff. No standardized protocols 15
exist to guide LVNs’ exercise of discretion in determining when [inmates] should receive a face-to16 17 face appointment with a nurse or other medical or mental health care clinician.”14 Plaintiffs further
18 allege that “[c]onsequently, LVNs arbitrarily determine whether the content of a sick call slip,

19 often written by [an inmate] who can barely read or write, warrants an appointment with a nurse or

20 physician.” Plaintiffs also detail the harm that members of the proposed class suffer as a result of

21

these policies.15

22

23 12 See Docket No. 41 at 36.

24 13 See id. at 35-37.

25

14 Id. at 44.

26 15 Plaintiffs allege that during “Plaintiff Hernandez’s term of incarceration from April 28, 2012 to
27 September 27, 2013, he required significant medical attention for his ileostomy and, after the
ileostomy was removed, for his post-surgical care. On many occasions, Plaintiff Hernandez 28 submitted sick call slips complaining of abdominal pain or other related symptoms. He frequently
9
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

As still another example of Plaintiffs’ medical care claims, Plaintiffs allege that

2 “Defendants have failed to implement appropriate triage procedures to ensure that non-emergency

3 medical needs are attended to before they develop into emergencies.” According to the complaint,

4 Methicillin-resistant Staphylococcus aureus (commonly known as “staph”) infections are
5 frequently reported at the jail. Many inmates report filing multiple sick call slips for emerging and 6
beginning staph-related wounds, but are not seen until their wounds develop into serious and 7
emergency conditions requiring intense treatment.16 The complaint explains that “one [inmate] 8 9 was not seen for a staph-infection-caused wound until it developed into cellulitis and a necrotizing
10 soft tissue infection, requiring intensive and invasive treatment. Another [inmate] had a staph

United States District Court For the Northern District of California

11 infection-caused abscess that required the insertion of a surgical drain into the wound, which

12 Defendants then failed to properly monitor and cleanse following the procedure.”17

13

Yet another example of Plaintiffs’ medical care claims concern Defendants’ alleged

14 policies and practices for medical screening. Plaintiffs allege “Defendants fail to adequately train
15

custody and medical staff in how to timely and appropriately identify medical problems during the 16

17 screening and intake process. When [an inmate] is newly booked into the jail, medical staff may

18

19

experienced significant delays before he was seen by medical staff. As one example, he submitted 20 a sick call slip on October 2, 2012, complaining of not receiving certain medications for his

21

stomach and was experiencing strong cramping pains; he was not fully evaluated by appropriate medical staff until October 26, 2012—24 days later.” Id. at 44:12-24. As another example,

22 Plaintiff Hernandez submitted sick call slips related to pain in his abdomen on November 18, 25, and December 2, 2012. He was not evaluated by an appropriate provider prior to being transferred

23 to the hospital on or around December 11, 2013 for his ileostomy reversal surgery, a period of 23

days.” Plaintiffs similarly allege that “[w]hen Plaintiff Sarabi complained about intense pain in his 24 right foot/ankle, and voiced concern about a broken ankle and a possible concussion one hour after

25

he was attacked by another inmate, one of the guards outside his room said, “You’re a tough guy, suck it up, if you had broken your ankle you would be in more pain.” Id. at 46:12-17.

26 16 See id. at 45.
27 17 See id.
28

10
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1

not even play a role in screening the [inmate].”18 Plaintiffs further allege that “[c]ustody staff (who

2 are not sufficiently trained to identify medical needs) complete a brief one-page health screening

3 form during a cursory interview with the [inmate] in a non-confidential space. Medical staff only

4 evaluate [inmates] at intake if the custody staff note a problem on the screening form. The

5 screening form used by custody fails to capture critical and basic information necessary to identify

6

[inmates] in need of medical attention.”19

7

Regarding Defendants’ alleged mental health policies and practices, in addition to intake 8

9 and tracking problems, Plaintiffs allege that “Defendants sometimes place [inmates] who arrive at

10 the jail and who are prescribed psychotropic medications on what Defendants call a detoxification

United States District Court For the Northern District of California

11 treatment. The detoxification treatment involves refusing, for up to 90 days, to provide [inmates]

12 with the psychotropic medications they were taking before they were booked into the Jail. . . .
13 [Inmates] placed on the detoxification treatment and removed from psychotropic medications 14
experience unnecessary pain and increases in psychiatric symptoms including paranoia, 15
hallucinations, and suicidality. . . . They are also at heightened risk of failing to respond to 16 17 medications once they are restarted.”20 As one example, Plaintiff Murphy’s January 18, 2013

18 Intake Health Screening Form (completed by custody staff) and his Intake Triage Assessment form

19 (completed by medical staff of CFMG) indicated self-reported mental health problems. Further,

20 medical records in CFMG’s possession from a prior term Murphy had spent in the jail indicated he
21 suffered from mental illness and had received psychiatric medications. Only four days after intake
22 did Murphy have an appointment with a Licensed Psychiatric Technician who lacked authority to
23
24 prescribe treatment or medication. Murphy submitted several sick slips from that day on, stating:

25 18 See Docket No. 41 at 42.
26 19 Id. at 42:6-14.
27 20 Docket No. 41 at 69-70.
28
11 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 “need psych meds – seeing and hearing things”; “need psych meds or psych hospital, Attn: head 2 psych please”; “I take varies physch medication . . . for hearing voices and seeing demons coming

3 out of the walls driving me crazy, can’t sleep or eat right at all. Ive been trying to see a physch

4 doctor, PLEASE help if possible”; “placing my life in serious danger and possible death after many
5 attempts to receive my medications during and after intake. I’m a disabled vet who served my 6
country with honorable discharge and should not be treated like trash over a officers attitude.” On 7
January 28, 2013 he informed staff that he was hearing demonic voices that were telling him to kill 8 9 himself. Consequently, Defendants placed Murphy in a rubber room, from which he was not
10 released until three days later. Murphy was not seen by mental health care staff with authority to

United States District Court For the Northern District of California

11 prescribe treatment until January 29, 2013.

12

As another example, Plaintiffs allege that Defendants house inmates with mental illness in

13 administrative segregation units in such a way that inmates suffer substantial risk of serious harm.21
14 Plaintiffs describe how “Jessie Crow and Daniel Lariviere committed suicide by hanging in
15 administrative segregation in 2010 and 2011 respectively. . . . [I]f Defendants had conducted safety
16

17 checks every half hour at intermittent and unpredictable times, they may have been able to prevent

18 Mr. Crow or Mr. Lariviere from committing suicide.”22

19

Plaintiffs allege inmates with mental illnesses are punished and discriminated against. For

20 example, after engaging in self-harming behavior, Plaintiff Mefford has been placed on suicide
21 watch and put in an “unsanitary” rubber room at least five separate times for varying lengths of
22 time since entering the jail. Mefford “was able to continue engaging in self-harming behavior
23 inside the rubber room, by banging his head repeatedly against the door until he was bleeding.”23
24

25

21 See id. at 88.

26 22 See id. at 90.
27 23 See id. at 78.
28

12
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1 Custody staff responded by placing Mefford in a restraint chair. Mefford freed himself from the 2 restraint chair at least once, and began again hurting himself. “Custody staff has routinely failed to

3 conduct safety checks twice every thirty minutes as required by the Jail’s own policies. The Jail has

4 also failed to provide him with adequate food and water during these periods of time. Plaintiff
5 MEFFORD has informed the Jail medical and custody staff repeatedly that sensory deprivation and 6
particularly a lack of light make his anxiety and other psychiatric conditions much worse. He has 7
also stated a reluctance to express his true level of suicidality to staff because of fear of being 8 9 placed in a rubber room. Despite this, custody staff continues to place him in rubber rooms.”24
10 These experiences show inadequate training, identification, tracking, treatment, suicide-watch,

United States District Court For the Northern District of California

11 facilities, housing, prescription, monitoring, evaluation, records, as well as apparent discrimination

12 and punishment of inmates with mental illnesses.25

13

Regarding Defendants’ alleged disabilities accommodation policies and practices, Plaintiffs

14 claim Defendants’ failures to accurately identify new inmates’ disabilities and needed
15

accommodations during the intake process result in the denial of accommodations mandated by the 16

17 ADA, Rehabilitation Act, and California disability rights law, placing inmates at risk of

18 discrimination, injury, and exploitation. For example, during booking into the jail in August 2012

19 and again in December 2012, custody staff completed Monterey County Sheriff’s Office Intake

20 Health Screening forms for Plaintiff Yancey. Despite Yancey’s complete hearing impairment, staff
21 did not indicate on the forms that he had a hearing disability. Accordingly, staff throughout the jail
22 were unable to identify Yancey as hearing impaired, and he received no accommodations for his
23 disability.26 Yancey was not provided with a sign language interpreter for his communications
24

25

24 See id.

26 25 See id. at 67-88.
27 26 See Docket No. 41 at 99.
28

13
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1 with jail staff, including at medical appointments, at a disciplinary hearing, during the booking and 2 classification process27 or for church services.28 Yancey submitted a grievance, requesting
3 accommodations relating to his hearing impairment, but he received no response.29

4

Another inmate who was booked into the jail in January 2012 with a mobility impairment

5 required a cane to help him safely ambulate and access his housing unit and required safe access to
6 a bed. During the intake process, the jail failed to identify him as having a mobility impairment
7 requiring those accommodations; he was not provided with a cane and he was placed in the only
8
9 available bed in his housing unit on the upper bunk of a triple bunk. Without a cane, the inmate

10 fell and injured himself on a number of occasions. He slept on the floor because it was too difficult

11 to access his bunk.30

United States District Court For the Northern District of California

12

The sum total of all this is that Plaintiffs allege a variety of jail policies and practices

13 applying to all inmates and staff dealing with safety, health care and disabilities, and that these

14 policies and practices expose all members of the proposed class and subclass to a substantial risk of
15
harm. 16

17

B.

18

Plaintiffs also support their motion for class certification with documents obtained by

19 investigation and various requests pursuant to California’s Public Records Act. For example, they

20 submit Sheriff’s Office’s incident reports of the 2011 and 2012 incidents of violence between 21 inmates alleged in the complaint.31 Over 100 of these incidents led to at least one inmate requiring 22
23 27 See id. at 101.

24 28 See Docket No. 52 at ¶¶ 4, 6-8, 11-13, 23.
25 29 See Docket No. 41 at 103.
26 30 See id. at 100.
27 31 See Docket No. 49 at ¶¶ 45-47.
28
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1

medical treatment.32 Widespread violent incidents were reported in 26 out of 29 housing units.33

2 Highlighting the impact of jail overcrowding on inmate safety, Plaintiffs also submit Defendants’

3 regular applications to the Superior Court for the County of Monterey for orders to release inmates

4 on an accelerated basis pursuant to California Penal Code § 4024.1.34 To support these
5 applications, jail administrators repeatedly swore that unless the court authorized inmate releases, 6
the overcrowding in the jail would make it impossible for staff to “adequately supervise inmates 7
and to properly house them in accordance with the approved classification plan.”35 In these 8 9 applications, CFMG Director Dr. Taylor Fithian also repeatedly “advised that the excessive
10 number of inmates housed in the jail compromises the health of the inmates and the staff working
11 at the facility.”36 Jail administrators, including the Sheriff, also have addressed the impact of

United States District Court For the Northern District of California

12 overcrowding in other public forums.37

13

C.

14 Plaintiffs submit a total of eight reports from different experts on the policies and practices
15

in dispute. Four of these experts are independent of the parties, and were jointly retained by the 16

17 parties in 2013. At the parties’ request, the court ordered “a process of mutually agreeing to

18 experts who will review and analyze the conditions at the Monterey County Jail and issue

19 reports”38 in four areas: medical care, mental health care, corrections and security and disability

20

21

32 See id. ¶ 47.

22 33 See id.

23 34 Docket Nos. 49-9, 49-10, 49-11, 49-12.

24

35 Id.

25

36 Id.

26 37 See Docket No. 49-3 at ¶¶ 25-33; Docket Nos. 49-7, 49-8.
27 38 See Docket No. 348 at 2-3; Docket No. 9 at 1; Docket No. 348-1 at ¶ 2; Docket No. 349 at ¶¶ 2-
28 3. 15
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1

accommodations and access.39 The parties agreed that the resulting reports and recommendations

2 would provide the framework for negotiating a remedial plan and consent decree. If settlement

3 negotiations were unsuccessful, the parties agreed that the reports would be admissible evidence in

4 the litigation.40 The parties exchanged nominations and conferred to identify mutually acceptable

5 neutral experts.41 Two other reports were prepared in 2007 and 2011 by TRG Consulting, a private

6

consulting firm, at the County’s request.42

7

The parties jointly retained Michael Hackett as a neutral expert to evaluate “whether 8

9 Defendants adequately protect [inmates] from injury and violence in the Jail.”43 Hackett reported

10 that staffing and housing is inadequate, the jail population is overcrowded and the old physical

United States District Court For the Northern District of California

11 plant is not adequate for safety monitoring, therefore inciting violence. He concluded that

12 Defendants operate the jail in a dangerous manner, placing all inmates at serious risk of harm.

13

The parties jointly retained Dr. Michael Puisis, D.O. as a neutral expert to evaluate

14 “whether Defendants’ system for providing medical care at the jail is adequate.”44 Puisis wrote
15
that the jail’s medical staffing is 40-70% less than it should be at all levels, leading to inadequate 16

17 intake, evaluation, care, management and surveillance. Puisis also found the spaces of care

18 delivery were unhygienic, inadequate and small, discouraging proper examinations. Almost every

19 important policy governing medical care suffered from serious infirmities: intake, requests,

20 emergency services, continuing medications, scheduling care, segregation and special needs. 21 22 39 See Docket No. 349 at ¶ 2.
23 40 See id.

24 41 See Docket No. 348-1 at ¶¶ 3-4.
25 42 See Docket No. 41 at ¶¶ 39-41; Docket Nos. 41-1, 41-2, 41-3, 41-4.
26 43 See Docket No. 56 at 3.
27 44 See Docket No. 49 at ¶ 8; Docket No. 49-1 Ex. B.
28
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1 Puisis concluded Defendants’ system-wide policies and practices for providing medical care 2 harmed inmates or placed them at great risk of serious harm due to inadequate diagnosis, treatment 3 infection control, drug and alcohol withdrawal policies, and medical records.45

4

The parties jointly retained Dr. Richard Hayward, Ph.D. as a neutral expert to evaluate

5 “whether Defendants’ system for providing mental health care in the jail is adequate.”46 Hayward

6 produced a draft report finding that Defendants’ system-wide policies and practices for providing
7 mental health care place inmates at risk of serious harm.47
8

9

The parties jointly retained SZS Consulting as a neutral expert to evaluate Defendants’

10 compliance with the ADA and other disability rights laws.48 SZS Consulting’s detailed report

United States District Court For the Northern District of California

11 found that Defendants operate the jail in violation of the rights and needs of inmates with

12 disabilities.49 SZS identified 119 architectural elements that did not comply with the relevant
13 guidelines.50 Some of these barriers violated the requirements of federal and state law in multiple 14
ways.51 The problems SZS identified include the following: the jail has far fewer housing areas 15

16

17 45 CFMG’s motion to strike the report of Puisis is DENIED. Puisis is a neutral expert. Contrary to

18

CFMG’s assertions, Puisis did not violate HIPAA or the federal privaicy rights of any person. In providing the names of the patients whose charts he reviewed to Plaintiffs’ counsel, Puisis acted

19

under the protective order entered in this case. Finally, Puisis is a well-qualified expert in correctional medical services. Puisis used methodology and reasoning in support of his opinions

20

that are scientifically valid, and his credentials and experience qualify him as an expert in this action. See Daubert v. Merril Dow Farms, Inc., 509 U.S. 59, 597 (1993); Ralston v. Mortgage

21 Investors Grop., Inc., Case No. 08-cv-536-JF, 2011 WL 6002640, at *3 (N.D. Cal. Nov. 30, 2011).

22 46 Docket No. 49 at ¶ 9; Docket No. 49-1 Ex. C.

23 47 Docket No. 49-7 Ex. M.

24 48 Docket No. 49 at ¶ 10; Docket No. 49-1 Ex. D.
25 49 See Docket Nos. 49-4, 49-5, 49-6 Ex. K.
26 50 See id. at 98-691.
27 51 See id.
28
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1

and cells available to inmates in wheelchairs than required by the relevant state and federal laws.52

2 None of the areas in which inmates are housed, either temporarily (e.g., holding cells, isolation

3 cells, and safety cells) or more permanently (housing units), are fully accessible to inmates in

4 wheelchairs.53 Many areas of the jail in which Defendants offer programs, including housing,
5 health care and exercise, are partially or completely inaccessible to inmates with mobility 6
impairments, including those in wheelchairs. Not one medical exam room has adequate clearances 7
for inmates in wheelchairs.54 Moreover, the exercise facilities for all inmates housed in Pods AJ, 8 9 K-Pod, the Women’s Section, the Rotunda, and the Infirmary, were at least for some inmates
10 located on the roof of the jail, up a long flight of stairs; “[t]he result is that no accessible exercise

United States District Court For the Northern District of California

11 areas are provided in the facility for female inmates and male inmates have access to exercise areas

12 only if they are housed in dorms A, B, C, or D.”55

13

TRG Consulting drafted the 2007 and 2011 reports at the County’s request.56 The 2007 and

14 2011 Jail Needs Assessments both concluded that, “[t]he current combination of insufficient beds,
15

an inadequate detention facility and understaffing has resulted in an almost untenable situation [at 16

17

the jail].”57

18

Plaintiffs also retained expert Dr. Pablo Stewart, M.D., a psychiatrist with decades of

19 experience evaluating correctional mental health care systems.58 Stewart based his conclusions on

20

21

52 See id. at 7-10.

22 53 See id. at 8, 9; see Docket No. 50 at ¶¶ 18-19; Docket No. 49-1, Ex. D at 49-56.

23 54 See Docket No. 49-4 at 9.

24 55 Id. at 9.
25 56 See Docket No. 41-1 at ¶¶ 39-40, Ex. A; Docket No. 41-4 Ex. B; Docket No. 49 at ¶ 41.
26 57 Docket No. 41-1, Ex. A, at EX. 1-2; Docket No. 41-4 Ex. B, at EX.2.
27 58 See Docket No. 355 at 11.
28
18 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 reviews of the reports of the joint experts, the relevant policies and procedures and other materials. 2 Stewart concluded that in nearly every respect, Defendants’ policies and practices for delivering

3 mental health care to inmates in the jail places all inmates, especially those with serious mental

4 illness, at a substantial risk of serious harm.59 Dr. Robert Cohen, M.D., a second medical expert

5 with experience as a director of medical services at Riker’s Island,60 found a variety of policies and

6 practices placed inmates at an unreasonable risk of harm, such as to do with tuberculosis,
7 medication continuity, withdrawal and staffing.
8

9

D.

10

Beyond the allegations in the second amended complaint, the investigation and public

United States District Court For the Northern District of California

11 records documents, and the expert reports, Plaintiffs also submitted declarations describing their

12 own experiences with jail policies and practices governing safety, medical care, mental health care
13 and disabilities. Plaintiffs did not submit these declarations in support of individual constitutional 14
and statutory claims, which they do not bring, but instead offer these declarations as evidence of 15
the defendants’ unlawful policies and practices, and as examples of the serious harm to which all 16 17 inmates in jail custody are allegedly exposed. For example, Plaintiff Dilley, who suffers from
18 multiple sclerosis, describes how she cannot walk up the stairs to access the exercise yard without

19 experiencing excruciating pain.61 Since she was booked into the jail in June 2013, she has only

20 been outside to go to court or medical appointments at outside facilities—she has not been outside
21 at all since mid-December 2013.62 Plaintiff Miller has vision loss, and Defendants fail to ensure
22 that vision-impaired inmates are adequately informed of, among other things, administered
23

24 59 See Docket No. 52 at ¶¶ 6-7, 69, 72, 76.
25 60 See Docket No. 355 at 11.
26 61 Docket No. 52-7 at ¶ 4.
27 62 Id. ¶ 12-13.
28
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1 medications. This was the case when Defendants provided Miller with an improper insulin 2 injection and he lapsed into unconsciousness.63 Each of the other named Plaintiffs submitted a

3 sworn declaration attesting to his or her experiences with jail safety, medical, mental health or

4 disabilities policies.64

5

III.

6 This court has jurisdiction under 28 U.S.C. §§ 1331 and 1367. The parties further

7

consented to the jurisdiction of the undersigned magistrate judge under 28 U.S.C. § 636(c) and 8

9

Fed. R. Civ. P. 72(a).65

10

Defendants again object to the Plaintiffs’ standing.66 The court declines to deviate from its

11 previous order denying Defendants’ motions to dismiss for lack of standing.67 As the court

United States District Court For the Northern District of California

12 previously explained, simply because an inmate does not use medical care, receives adequate care

13 once, or does not or get attacked does not mean they are not at an unreasonable risk when policies

14 and practices are deficient.68 A transitional group of individuals suffer “injury in fact” if exposed
15 to unreasonable risk.69 In any event, the claims at issue are current for at least one named
16

17

Plaintiff.70

18

63 See Docket No. 41 at 52.

19 64 See, e.g., Docket No. 52-3 at ¶ 23; Docket No. 52-11 at ¶ 27; Docket No. 52-13 at ¶¶ 3-15;
20 Docket No. 52-15 at ¶¶ 7-10; Docket No. 52-17 at ¶¶ 4-12, 14-17; Docket No. 52-21 at ¶ 23;

21 Docket No. 52-23 at ¶¶ 7-15, 17-20, 22-25, 28-37; Docket No. 52-27 at ¶ 28.

22 65 See Docket Nos. 8, 34.

23 66 See Docket No. 133 at 17; Docket No. 169 at 13-14.

24 67 See Docket No. 128 at 14.
25 68 See Docket No. 133 at 18.
26 69 Lujan v. Defenders of Wildlife, 504 U.S. 555, 560 (1992); Amchem Prods. v. Windsor, 521 U.S.
27 591, 613 (1997) (“Rule 23’s requirements must be interpreted in keeping with Article III constraints”); Mazda v. Am. Honda Motor Co., 666 F.3d 581, 594 (9th Cir. 2012) (“no class may
28 be certified that contains members lacking Article III standing”). 20
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1

IV.

2

Plaintiffs request that the court certify an inmate class of “all [inmates] who are now or will

3 be in the future in the Jail” and an inmates with disabilities subclass of “all individuals who are

4 now or will be in the future in the Jail and who have a disability, as defined by federal and
5 California law.”71 Plaintiffs also request that the court appoint Michael Bien and Gay Crosthwait 6
Grunfeld of Rosen Bien Glavan & Grunfeld, LLP, James Egar of the Office of the Public 7
Defender, County of Monterey, Alan Schlosser of the American Civil Liberties Union Foundation 8 9 of Northern California, and Eric Balaban of the ACLU National Prison Project to represent the 10 certified class and subclass pursuant to Rule 23(g).72

United States District Court For the Northern District of California

11

“An order that certifies a class action must define the class and the class claims, issues, or

12 defenses.”73 Clearly delineating the contours of the class provides the parties with clarity and
13 assists class members in understanding their rights and making informed opt-out decisions.74 If 14

15 70 See Bates v. United Parcel Serv., Inc., 511 F.3d 974, 985 (9th Cir. 2007) (en banc) (holding that
16 “[i]n a class action, standing is satisfied if at least one named plaintiff meets the requirements.”);

17

see also Warth v. Seldin, 422 U.S. 490, 502 (1975) (finding named plaintiffs need not show “that injury has been suffered by other, unidentified members of the class to which they belong and

18 which they purport to represent”); Lewis v. Casey, 518 U.S. 343, 395 (1996) (Souter, J., concurring); Stearns v. Ticketmaster Corp., 655 F.3d 1013, 1021 (9th Cir. 2011); Arnott v. U.S.

19 Citizenship and Immigration Servs., 290 F.R.D. 579, 584 (C.D. Cal. 2012) (explaining why Mazza

v. Am. Honda Motor Co., 666 F.3d 581 (9th Cir. 2012), a case about damages, is not binding). 20

21

71 See Docket No. 56 at 2. Claim arise under the Eighth and Fourteenth Amendments to the U.S. Constitution and Article I, Sections 7 and 17 of the California Constitution; the Americans with

22 Disabilities Act, Section 504 of the Rehabilitation Act, and California Government Code § 11135.

23 72 See Docket No. 48 at 2; 355-1 at 7.

24 73 Fed. R. Civ. P. 23(c)(1)(B); Wachtel v. Guardian Life Ins. Co., 453 F.3d 179, 187 (3d Cir. 2006)

25

(“[T]he text of the order or an incorporated opinion must include (1) a readily discernible, clear, and precise statement of the parameters defining the class or classes to be certified, and (2) a

26 readily discernible, clear, and complete list of the claims, issues or defenses to be treated on a class

basis”).

27

74 Wachtel, 453 F.3d at 187. 28

21
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1 class members are impossible to identify without extensive and individualized fact-finding or 2 “mini-trials,” then a class action is inappropriate.75

3

“The class action is ‘an exception to the usual rule that litigation is conducted by and on

4 behalf of the individual named parties only.’”76 To satisfy class certification requirements, such
5 claims must be capable of satisfaction in “one stroke.”77 To satisfy the four threshold requirements 6
of Fed. R. Civ. P. 23(a), (1) the class must be “so numerous that joinder of all members is 7
impracticable” (numerosity); (2) there must be “questions of law or fact common to the class” 8 9 (commonality); (3) “the claims or defenses of the representative parties” must be “typical of the
10 claims or defenses of the class” (typicality); and (4) the named plaintiffs must “fairly and
11 adequately protect the interests of the class” (adequacy).78 Plaintiffs seeking class certification

United States District Court For the Northern District of California

12 must also satisfy the requirements of Rule 23(b), subdivisions 1, 2 or 3, which define three
13 different types of classes.79 14
In evaluating whether a party has met the requirements of Rule 23, “Rule 23 does not set 15
forth a mere pleading standard.”80 A party seeking class certification must “affirmatively 16
17 demonstrate his compliance with the Rule—that is, he must be prepared to prove that there are in

18

19 75 See Bradford v. Union Pac. R.R. Co., Case No. 05-cv-4075, 2007 LEXIS 72951, at *25 (9th Cir. 2007).
20

21

76 Wal-Mart Stores v. Dukes, 131 S. Ct. 2541, 2550 (2011) (quoting Califano v. Yamasaki, 442 U.S. 682, 700-01 (1979)).

22 77 Id. at 2551.
23 78 In re Cmty. Bank of N. Va., 622 F.3d 275, 291 (3d Cir. 2010) (quoting Fed. R. Civ. P. 23); Levya
24 v. Medline Indus., Inc., 716 F.3d 510, 512 (9th Cir. 2013); Zinser v. Accufix Research Inst., Inc.,
25 253 F.3d 1180 (9th Cir. 2001).

26 79 See Fed. R. Civ. P. 23(a)-(b); Hanlon v. Chrysler Corp., 150 F.3d 1011, 1022 (9th Cir. 1998); Leyva, 716 F.3d at 512.
27
80 Wal–Mart, 131 S. Ct. at 2551. 28

22
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1

fact sufficiently numerous parties, common questions of law or fact, etc.”81 Similarly a party must

2 affirmatively prove that he or she complies with one of the three subsections of Rule 23(b). This is

3 a “rigorous analysis”82 that must “‘entail some overlap with the merits of the plaintiff’s underlying

4 claim.’”83 Rule 23(b) is “unquestionably satisfied when members of a putative class seek uniform

5 injunctive or declaratory relief from policies or practices that are generally applicable to the class

6

as a whole.”84

7

Rule 23(b)(1) allows a class action if “prosecuting separate actions by or against individual 8

9 class members would create a risk of (A) inconsistent or varying adjudications with respect to

10 individual class members that would establish incompatible standards of conduct for the party

United States District Court For the Northern District of California

11 opposing the class; or (B) adjudications with respect to individual class members that, as a practical

12 matter, would be dispositive of the interests of the other members not parties to the individual 13

14

15

16

17

18

81 Id.

19 82 E.g. Wang v. Chinese Daily News, Inc., 737 F.3d 538, 542-543 (9th Cir. 2013); Wal-Mart Stores, Inc., 131 S. Ct. at 2551; Mazza, 666 F.3d at 588 (“Before certifying a class, the trial court must
20 conduct a ‘rigorous analysis’ to determine whether the party seeking certification has met the 21 prerequisites of Rule 23”).

22 83 See In re Google Inc. Gmail Litig.,Case No. 5:13-md-02430-LHK, 2014 U.S. Dist. LEXIS 36957 (N.D. Cal. March 18, 2014) (citing Amgen Inc. v. Conn. Ret. Plans and Trust Funds, 133 S. Ct.

23 1184, 1194 (2013)); Wal-Mart Stores, Inc., 131 S. Ct. at 2551 (“Rule 23 does not set forth a mere

pleading standard. A party seeking class certification must affirmatively demonstrate his 24 compliance with the Rule—that is, he must be prepared to prove that there are in fact sufficiently

25

numerous parties, common questions of law or fact, etc. We recognized in Falcon that “sometimes it may be necessary for the court to probe behind the pleadings before coming to rest on the

26 certification question”); General Telephone Co. of Southwest v. Falcon, 457 U.S. 147, 160 (1982)

(“[A]ctual, not presumed, conformance with Rule 23(a) remains . . . indispensable.”).

27

84 Parsons v. Ryan, 754 F.3d 657, 688 (9th Cir. 2013) (quoting Fed. R. Civ. P. 23(b)(2)). 28

23
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1

adjudications or would substantially impair or impede their ability to protect their interests.”85

2 Prison condition cases have been certified under both 23(b)(1)(A)86 and (B).87

3

Rule 23(b)(2) allows a class action if “the party opposing the class has acted or refused to

4 act on grounds that apply generally to the class, so that final injunctive relief or corresponding
5 declaratory relief is appropriate respecting the class as a whole.”88 Rule 23(b)(2) is “‘almost 6 automatically satisfied in actions primarily seeking injunctive relief.’”89 “The key to the (b)(2) 7
class is ‘the indivisible nature of the injunctive or declaratory remedy warranted—the notion that 8 9 the conduct is such that it can be enjoined or declared unlawful only as to all of the class members 10 or as to none of them.’”90 Rule 23(b)(2) requires a single injunction or declaratory judgment to

United States District Court For the Northern District of California

11 provide relief to each member of the class. It does not authorize class certification when each

12 individual class member would be entitled to a different injunction or declaratory judgment against 13 the defendant.91 Rule 23(b) is “unquestionably satisfied when members of a putative class seek 14 15 85 Fed. R. Civ. P. 23(b)(1).

16 86 See Ashker v. Governor of State of Cal., Case No. 4:09-cv-5796-CW, 2014 WL 2465191 at *7

17

(N.D. Cal. June 2, 2014) (prison conditions case certified under Rule 23(b)(1)(A) for class actions that create a risk of inconsistent adjudications).

18

87 See Docket No. 358-4, Ex. VV at 107-10; Gray v. County of Riverside, Case No. 13-cv-0444-

19 VAP, Docket No. 131 at 107-10 (C.D. Cal., Sept. 2, 2014) (Order Granting Plaintiffs’ Motion for

Class Certification, Denying Defendant’s Motion to Dismiss, certifying jail conditions class action 20 under both Rule 23(b)(1)(A) and (B)).

21 88 Fed. R. Civ. P. 23(b)(2).

22 89 Gray v. Golden Gate Nat’l Recreational Area, 279 F.R.D. 501, 520 (N.D. Cal. 2011) (quoting

23 Baby Neal for and by Kanter v. Casey, 43 F.3d 48, 58 (3rd Cir. 1994)); see also Rodriguez v.

Hayes, 591 F.3d 1105, 1125 (9th Cir. 2010); Californians for Disability Rights, Inc. v. Cal. Dep’t 24 of Transp., 249 F.R.D. 334, 345 (N.D. Cal. 2008) (“Cases challenging an entity’s policies and

25

practices regarding access for the disabled represent the mine run of disability rights class actions certified under Rule 23(b)(2).”).

26 90 Wal-Mart, 131 S. Ct. at 2557 (citation omitted).
27 91 Id.
28

24
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1 uniform injunctive or declaratory relief from policies or practices that are generally applicable to 2 the class as a whole. . . . [A]s the text of the rule makes clear, . . . [the rule] asks only whether ‘the 3 party opposing the class has acted or refused to act on grounds that apply generally to the class.’”92

4

In Parsons v. Ryan,93 the Ninth Circuit held inmates challenging the constitutionality of

5 health care in the Arizona correctional system satisfied the requirements of Rule 23.94 Such
6 “systemic, future oriented Eighth Amendment claim[s]” 95 claims were the “kind . . . firmly 7
established in our constitutional law,” in which inmates allege that “policies and practices of 8 9 [system-]wide application expose all inmates in . . . custody to a substantial risk of serious harm.”96

10 The plaintiffs in Parsons relied “on system-wide deficiencies in the provision of [safety and]

United States District Court For the Northern District of California

11 medical and mental health care that, taken as a whole, subject . . . [inmates] . . . to ‘substantial risk

12 of serious harm.’”97 Disability discrimination claims under the Americans with Disabilities Act,

13 Rehabilitation Act, and California Government Code section 11135 are of the same type: requiring
14 injunctive relief from system-wide policies and practices, which institutionalize a failure to provide
15 necessary accommodations to inmates with all types of disabilities.98
16

17

Because Plaintiffs seek certification under Rule 23(b)(1) and (2), they need not show “that

18 the issues common to the class satisfy a Rule 23(b)(3)-like predominance test.”99

19 92 Parsons, 754 F.3d at 688 (quoting Fed. R. Civ. P. 23(b)(2)).
20

21

93 See id. at 657.

22 94 Id. at 676 (emphasis added).

23 95 Id. at 677 (citing Brown v. Plata, 131 S. Ct. 1910, 1925 n.3 (2011)).

24 96 Id. at 676 (emphasis added).
25 97 Plata, 131 S. Ct. at 1925 n.3. 26
98 See Armstrong v. Davis, 275 F.3d 849, 868-69 (9th Cir. 2001); Pierce v. County of Orange, 526 27 F.3d 1190, 1218-23 (9th Cir. 2008).

28 99 See Parsons, 754 F.3d at 688. 25
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1

A.

2

As a preliminary matter, under the ascertainability doctrine, the class must be sufficiently

3 definite so that it is feasible for the court to determine membership by reference to objective

4 criteria.100 Thus, a class is generally not ascertainable if membership in the class is based on
5 subjective criteria, such as states of mind, or if the court would have to “make a determination
6 about the merits of each claim in deciding whether a particular individual is a class member.”101 7
The requirement helps to eliminate “serious administrative burdens that are incongruous with the 8 9 efficiencies expected in a class action” by compelling easy identification of class members.102 It
10 also protects defendants by ensuring the identification of those bound by the final judgment.103 But

United States District Court For the Northern District of California

11 as a general matter, less precision is required of class definitions under Rule 23(b)(2) than

12 under Rule 23(b)(3), where mandatory notice is required by due process.104 13

14 100 See Williams v. Oberon Media, Inc., 468 Fed. Appx. 768, 771 (9th Cir. 2012) (class motion was 15 properly denied because the proposed members are not “precise, objective or presently
ascertainable”); Khalif L. v. City of Union City, Case No. 4:09-cv-2723-PJH, 2012 U.S. Dist. 16 LEXIS 64567, *15 (N.D. Cal. May 8, 2012) (finding a class of students “subjected to violence or 17 threats of violence, by ‘Latino gangs’” cannot be ascertained).

18 101 Velazquez v. HSBC Finance Corp., Case No. 3:08-4592, 2009 WL 112919, at *4 (N.D. Cal. Jan. 16, 2009) (defining a “fail-safe class” as (by the merits of [the plaintiffs] legal claims, and [is]
19 therefore unascertainable prior to a finding of liability in the plaintiffs’ favor.”); Kamar v. Radio Shack Corp., 375 F. App’x 734, 735 (9th Cir. 2010).
20
21 102 Sanneman v. Chrysler Corp., 191 F.R.D. 441, 446 (E.D. Pa. 2000).

22 103 See Xavier v. Philip Morris USA, Inc., 787 F. Supp. 2d 1075, 1089 (N.D. Cal. 2011) (“Ascertainability is needed for properly enforcing the preclusive effect of final judgment. The
23 class definition must be clear in its applicability so that it will be clear later on whose rights are

merged into the judgment, that is, who gets the benefit of any relief and who gets the burden of any 24 loss. If the definition is not clear in its applicability, then satellite litigation will be invited over

25

who was in the class in the first place”); 1 William B. Rubenstein et al., Newberg on Class Actions, § 3:1 (5th ed.).

26 104 See Phillips Petroleum Co. v. Shutts, 472 U.S. 797, 812, 105 S. Ct. 2965, 86 L.Ed.2d 628
27 (holding that notice of right to opt-out of suit for money damages is required by the Due Process

Clause); Yaffe v. Powers, 454 F.2d 1362, 1366 (1st Cir.1972) (stating that in contrast to 28 certification of a subdivision (b)(3) class, “notice to the members of a(b)(2) class is not required
26
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1

Defendants dispute the breadth of Plaintiffs’ class and subclass definitions.105 They

2 contend the class and subclass are not ascertainable because the definitions are vague, require mini-

3 trials and do not precisely identify future members.106 But classes like the class and subclass here

4 have been routinely certified.107 Class and subclass membership can “be ascertained by reference

5 to objective criteria,” and the class definitions “avoid subjective standards (e.g. a plaintiff’s state of
6 mind) or terms that depend on resolution of the merits (e.g., persons who were discriminated
7 against).”108 The proposed class and subclass are sufficiently narrow: class members are those in
8 9 the jail, and subclass members are those with disabilities, as defined by federal and state law.109

10

B.

United States District Court For the Northern District of California

11

Rule 23(a)(1) requires that a class be “so numerous that joinder of all members is

12 impracticable.” The Rule ensures judicial economy110 and creates greater access to judicial relief, 13

14 and the actual membership of the class need not therefore be precisely delimited.”). Manageability
15 is not as important a concern for injunctive classes as for damages classes. See Elliott v. Weinberger, 564 F.2d 1219, 1229 (9th Cir.1977) (“by its terms, Rule 23 makes manageability an
16 issue important only in determining the propriety of certifying an action as a(b)(3), not a(b)(2), 17 class action.”), aff’d in pertinent part sub nom. Califano, 442 U.S. at 701.
18 105 See Docket No. 133 at 9.
19 106 See id. at 34; Docket No. 169 at 17.

20 107 See, e.g., Parsons, 754 F.3d at 672 (class of “[a]ll [inmates] who are now, or will in the future

21

be, subjected to the medical, mental health, and dental care policies and practices” in Arizona prisons); Armstrong v. Davis, 275 F.3d at 856-57 (certifying class of “all present and future

22 California state [inmates] and parolees with mobility, sight, hearing, learning, developmental and kidney disabilities that substantially limit one or more of their major life activities”) (quotation

23 marks omitted); Rodriguez, 591 F.3d at 1118 (“the inclusion of future class members in a class is

not itself unusual or objectionable”). 24

25

108 Lyon v. U.S. Immigration & Customs Enforcement, Case No. 3:13-5878, 2014 WL 1493846, at *5 (N.D. Cal. Apr. 16, 2014) (citations and internal quotation marks omitted).

26 109 See Docket No. 355 at 5.
27 110 See 1 Rubenstein, supra, §§ 1:12; 3:11.
28

27
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1

particularly for those persons with claims that would be uneconomical to litigate individually,111

2 including for injunctive relief. A class or subclass with more than 40 members “raises a

3 presumption of impracticability based on numbers alone.”112 This is especially true where, as here,

4 the class and subclass include future, unknowable class members.113

5

CFMG concedes and stipulates that Plaintiffs meet the numerosity element, and joinder of

6 all class members would be impracticable.114 The County similarly does not argue against 7
numerosity.115 Because the class and subclass are each over 40 members, and Defendants provide 8

9 no real opposition on this point, the court finds Plaintiffs meet the numerosity requirement.

10

C.

11

As to commonality, there must be “questions of law and fact common to the class,”116 and

United States District Court For the Northern District of California

12 class members must “‘have suffered the same injury,’” and not merely violations of “the same
13 provision of law.”117 “[T]he class members’ claims ‘depend upon a common contention’ such that
14 ‘determination of its truth or falsity will resolve an issue that is central to the validity of each claim
15 in one stroke.’”118 “Put another way, the key inquiry is not whether the plaintiffs have raised
16

17 111 See Phillips Petroleum Co., 472 U.S. at 809; 7A Charles Alan Wright, et al., Federal Practice 18 and Procedure § 1762 (3d ed. 2005).

19 112 1 William Rubenstein, Newberg on Class Actions § 3:12, at 198 (5th ed. 2011); see also Rannis v. Recchia, 380 F. App’x 646, 651 (9th Cir. 2010); Gen. Tel. Co. of the N.W. v. EEOC, 446 U.S.
20 318, 330 (1980).

21 113 See Nat’l Ass’n of Radiation Survivors v. Walters, 111 F.R.D. 595, 599 (N.D. Cal. 1986).

22 114 See Docket No. 169 at 15.
23 115 See Docket No. 133 at 19-21; Docket No. 355 at 6.
24

25

116 Fed. R. Civ. P. 23(a)(2).

26 117 Wal-Mart Stores, Inc., 131 S. Ct. at 2551.

27 118 Parsons, 754 F.3d at 675; Mazza, 666 F.3d at 588 (quoting Wal–Mart, 131 S. Ct. at 2551) (internal alteration omitted).
28
28 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 common questions, ‘even in droves,’ but rather whether class treatment will ‘generate common 2 answers apt to drive the resolution of the litigation.’”119

3

Dissimilarities between class members must be considered in determining whether a

4 common question will generate a common answer because dissimilarities within the proposed class

5 can “impede the generation of common answers.”120 Thus commonality may be determined based

6

on substantive law121 and an understanding of the nature and merit of the underlying claims.122

7

Plaintiffs need not show, however, that “every question in the case, or even a preponderance of 8

9 questions, is capable of class-wide resolution. So long as there is ‘even a single common

10 question,’ a would be class can satisfy the commonality requirement of Rule 23(a)(2).”123 Thus,

United States District Court For the Northern District of California

11 “[w]here the circumstances of each particular class member vary but retain a common core of

12 factual or legal issues with the rest of the class, commonality exists.”124

13

In civil rights cases, “commonality is satisfied where the lawsuit challenges a system-wide

14 practice or policy that affects all of the putative class members.”125 Where such a policy exists,
15

“individual factual differences among the individual litigants or groups of litigants will not 16

17

18 119 Abdullah v. U.S. Sec. Ass., Inc., 731 F.3d 952, 957 (9th Cir. 2013) (quoting Wal-Mart, 131 S. Ct. at 2551 (emphasis in original)).

19 120 Id. at 2551, 2556.
20

21

121 Stearns, 655 F.3d at 1012.

22 122 Amgen, 133 S. Ct. at 1194-95; Ellis v. Costco Wholesale Corp., 657 F.3d 970, 981 (9th Cir. 2011).
23 123 Wang, 737 F.3d at 544 (quoting Wal–Mart, 131 S. Ct. at 2556); see also Mazza, 666 F.3d at 589
24 (9th Cir. 2012) (noting that “commonality only requires a single significant question of law or
25 fact”).

26 124 Evon v. Law Offices of Sidney Mickell, 688 F.3d 1015, 1029 (9th Cir.2012) (quotation marks and citation omitted).
27
125 Armstrong v. Davis, 275 F.3d at 868. 28

29
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1

preclude a finding of commonality.”126 The Supreme Court’s Wal-Mart decision reaffirmed that

2 where a system-wide policy or practice is the cause of class members’ injuries, plaintiffs satisfy the

3 commonality requirement.127

4

Post-Wal-Mart, courts continue to find the commonality requirement satisfied in cases

5 challenging correctional facility conditions similar to those at issue here.128 Recently, in
6 Parsons,129 the defendants’ argument against commonality was that “a systemic constitutional 7
violation [of the sort alleged here] is a collection of individual constitutional violations, each of 8 9 which hinges on the particular facts and circumstances of each case.”130 But the Ninth Circuit

10 affirmed class certification, holding that “[t]he putative class and subclass members . . . all set forth

United States District Court For the Northern District of California

11 numerous common contentions whose truth or falsity can be determined in one stroke: whether the

12 specified [system-]wide policies and practices to which they are all subjected . . . expose them to a 13

14

15

126 Id.

16 127 See Wal-Mart, 131 S. Ct. at 2553; Stockwell v. City & County of San Francisco, 749 F.3d 1107, 17 1111-13 (9th Cir. 2014).

18 128 See Parsons v. Ryan, 289 F.R.D. 513, 516-23 (D. Ariz. 2013) (commonality in case challenging medical and mental healthcare provided to 33,000 inmates in Arizona); Jones v. Gusman, 296

19 F.R.D. 416, 465-66 (E.D. La. 2013) (commonality for claims by pre- and post-trial detainees

regarding failures to protect inmates from violence and inadequacies in medical and mental health 20 care at jails in New Orleans Parish); Butler v. Suffolk County, 289 F.R.D. 80, 97-98 (E.D.N.Y.

21

2013) (commonality for claims that unsanitary conditions in jail constituted cruel and unusual punishment); Henderson v. Thomas, 289 F.R.D. 506, 511 (M.D. Ala. 2012) (commonality for ADA

22 claims challenging Alabama prison policy of segregating HIV positive inmates from general prison population); Olson v. Brown, 284 F.R.D. 398, 410-12 (N.D. Ind. 2012) (commonality for class

23 claims regarding, among other things, constitutionality of jail mail policy); Hughes v. Judd, Case

No. 8:12-cv-568-MAP, 2013 WL 1821077, at *23-24 (M.D. Fla. Mar. 27, 2013) (commonality for 24 claims regarding constitutionality of jail’s policies for protecting juvenile inmates from violence)

25

(report and recommendation adopted as modified, 8:12-cv-568-SDM, 2013 WL 1810806 at *2 (M.D. Fla. Apr. 30, 2013)).

26 129 See Parsons, 754 F.3d at 662, 683.
27 130 Id. at 675 (alteration in original) (internal quotation marks omitted).
28

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1

substantial risk of harm.”131 Because of the nature of the plaintiffs’ system-wide challenge, “either

2 each of the policies and practices is unlawful as to every inmate or it is not.”132 Any determination

3 of the merits would “not require [the court] to determine the effect of those policies and practices

4 upon any individual class member (or class members) or to undertake any other kind of
5 individualized determination.”133 6
“Commonality cannot be determined without a precise understanding of the nature of the 7
underlying claims.”134 “To assess whether the putative class members share a common question, 8 9 the answer to which ‘will resolve an issue that is central to the validity of each one of the [class 10 members’s] claims,’ we must identify the elements of the class members’[] case-in-chief.”135

United States District Court For the Northern District of California

11

12 131 Id. at 678 (citing Wal-Mart, 131 S. Ct. at 2551) (“What all members of the putative class and

13

subclass have in common is their alleged exposure, as a result of specified statewide ADC policies and practices that govern the overall conditions of health care services and confinement, to a

14 substantial risk of serious future harm to which the defendants are allegedly deliberately indifferent. . . .[A]lthough a presently existing risk may ultimately result in different future harm

15 for different inmates—ranging from no harm at all to death—every inmate suffers exactly the same

constitutional injury when he is exposed to a single statewide . . . policy or practice that creates a 16 substantial risk of serious harm”); id. at 678-79 (holding that since “every inmate . . . is necessarily

17

subject to the same medical, mental health, and dental care policies and practices” and because “any one of them could easily fall ill, be injured, need to fill a prescription, require emergency or

18 specialist care, crack a tooth, or require mental health treatment . . . [,] every single ADC inmate faces a substantial risk of serious harm if ADC policies and practices provide constitutionally

19 deficient care for treatment”); Plata, 131 S. Ct. at 1940 (“[Inmates] who are not sick or mentally ill

do not yet have a claim that they have been subjected to care that violates the Eighth Amendment, 20 but in no sense are they remote bystanders in California’s medical care system. They are that

21 system’s next potential victims”).

22 132 Parsons, 754 F.3d at 678.

23 133 Id. at 679.

24 134 Id. at 676; see Amgen Inc., 133 S. Ct. at 1194–95 (“Merits questions may be considered to the

25

extent—but only to the extent—that they are relevant to determining whether the Rule 23 prerequisites for class certification are satisfied.” (citation omitted)); Ellis, 657 F.3d at 981 (“[T]he

26 merits of the class members’ substantive claims are often highly relevant when determining

whether to certify a class.”).

27

135 Stockwell, 749 F.3d at 1114, (quoting Wal–Mart, 131 S. Ct. at 2551). 28

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1

Here, a central question of injury is whether Defendants’ policies and practices reflect

2 deliberate indifference as to Plaintiffs’ medical care, mental health care, and safety needs.136 The

3 court’s broad yes-or-no answer to that question is “apt to drive the resolution of the litigation”

4 because it determines whether Plaintiffs’ constitutional rights have been violated and whether an
5 injunction directing Defendants to remedy the constitutional violations is appropriate.137 The 6
deliberate indifference standard focuses on the risk of future illness or injury to which defendants 7
expose inmates.138 “This kind of claim is firmly established in our constitutional law.”139 8

9

United States District Court For the Northern District of California

10

11 136 See Wilson v. Seiter, 501 U.S. 294 298 (1991) (constitutional violation occurs where deprivation

was “sufficiently serious” and the official has acted with “deliberate indifference” to inmate health 12 or safety); Farmer v. Brennan, 511 U.S. 825, 828, 833 (1994) (deliberate indifference to inmates’

13

safety from “violence at the hands of other [inmates]” (internal quotation marks omitted)); Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (deliberate indifference to inmates’ serious medical

14 needs); Doty v. County of Lassen, 37 F.3d 540, 546 (9th Cir. 1994) (deliberate indifference to inmates’ serious mental health care needs); Coleman v. Brown, 938 F. Supp. 2d 955, 970 n.24

15 (E.D. Cal. 2013) (elements of a constitutional correctional mental health system).

16 137 Wal-Mart, 131 S. Ct. at 2551.

17 138 See Helling v. McKinney, 509 U.S. 25, 33 (1993) (holding that prison officials may not “ignore

18 a condition of confinement that is sure or very likely to cause serious illness and needless suffering the next week or month or year”); Estelle v. Gamble, 429 U.S. 97, 104-05 (1976); McGuckin v.

19 Smith, 974 F.2d 1050, 1059 (9th Cir. 1992), overruled on other grounds by WMX Technologies v.

Miller, 104 F.3d 1133 (9th Cir. 1997). A plaintiff establishes deliberate indifference by showing

20 that a public entity “(1) had a policy that posed a substantial risk of serious harm . . . ; and (2)

21

kn[ew] that its policy posed this risk.”138 In class actions challenging a jail facility’s healthcare systems or safety practices, liability may also be premised on a showing of “systematic or gross

22 deficiencies in staffing, facilities, equipment or procedures.” Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir. 1980); see also Plata, 131 S. Ct. at 1925 n.3; (upholding, in case against California

23 prison system, sweeping injunctive relief to remedy “system-wide deficiencies in the provision of

medical and mental health care that, taken as a whole, subject sick and mentally ill [inmates] in 24 California to [a] substantial risk of serious harm” (internal quotation marks omitted)); Madrid v.

25

Gomez, 889 F. Supp. 1146, 1256 (N.D. Cal. 1995) (“In class actions challenging the entire system of mental or medical health care, courts have traditionally held that deliberate indifference can be

26 shown by proving either a pattern of negligent acts or serious systemic deficiencies in the prison’s

health care program.”).

27

139 Parsons, 754 F.3d at 676. 28

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1

Defendants argue that what is reasonable treatment to one inmate may not be appropriate or

2 reasonable treatment to another140—and whether Defendants have acted with deliberate

3 indifference—will require distinct legal questions, burdens of proof and “mini-trials” for each

4 Plaintiff.141 System-wide allegations require proof of either an official policy or admissible and

5 convincing proof rather than just allegations that a constitutional violation persists system-

6

wide142—something Plaintiffs cannot show, according to Defendants.143

7

But Plaintiffs have produced adequate evidence of specific system-wide policies and 8

9 practices exposing inmates to a substantial risk of serious harm, violating their constitutional or

10 statutory rights; and they have clearly defined the class claims.144 “That the Eighth Amendment

11 protects against future harm to inmates is not a novel proposition.”145 Noting that it “would be odd

United States District Court For the Northern District of California

12 to deny an injunction to inmates who plainly proved an unsafe, life-threatening condition in their
13 prison on the ground that nothing yet had happened to them,” Helling rejected a proposition like 14
the Defendants’ here that “only deliberate indifference to current serious health problems of 15

16

17 18 140 See Docket No. 21-22. 19 141 See Docket No. 133 at 17.

20 142 See Armstrong v. Davis, 275 F.3d at 870; Armstrong v. Schwarzenegger, 622 F.3d 1058, 1073-

21

74 (9th Cir. 2010); Lewis, 518 U.S. at 359-60 (stressing, regarding inmate access to a law library, that a system wide injunction can only be issued upon proof of system wide, not isolated,

22 problems); Dayton Bd. of Ed. v. Brinkman, 433 U.S. 406, 417 (1977) (“Instead of tailoring a remedy commensurate with the three specific violations, the Court of Appeals imposed a system

23 wide remedy going beyond their scope”); id., at 420 (“Only if there has been a system wide impact

may there be a system wide remedy”); Califano, 442 U.S. at 702 (“The scope of injunctive relief is 24 dictated by the extent of the violation established.”).

25 143 See Docket No. 133 at 30; Docket No. 169 at 9-10, 16-17.
26 144 Fed. R. Civ. P. 23(c)(1)(B); Parsons, 754 F.3d at 683; Docket No. 355 at 8-21.
27 145 Helling, 509 U.S. at 33.
28

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1

inmates is actionable under the Eighth Amendment.”146 In Farmer v. Brennan, the Court

2 elaborated on Helling’s recognition that a “remedy for unsafe conditions need not await a tragic

3 event”147 by holding that “[a] prison official's ‘deliberate indifference’ to a substantial risk of

4 serious harm to an inmate violates the Eighth Amendment.”148 Prison officials are definitively

5 constitutionally prohibited from being deliberately indifferent to policies and practices that expose

6

inmates to a substantial risk of serious harm.149

7

In Brown v. Plata, the Supreme Court distinguished the kind of systemic, future-oriented 8

9 constitutional and statutory claims at issue here from claims in which a past instance of

10 mistreatment is alleged to have violated the Constitution:

United States District Court For the Northern District of California

11

Because plaintiffs do not base their case on deficiencies in care provided on any one

occasion, this Court has no occasion to consider whether these instances of delay—or any

12

other particular deficiency in medical care complained of by the plaintiffs—would violate

13

the Constitution under Estelle v. Gamble, 429 U.S. 97, 104–105 . . . (1976), if considered in isolation. Plaintiffs rely on system-wide deficiencies in the provision of medical and mental

14

health care that, taken as a whole, subject sick and mentally ill [inmates] in California to

“substantial risk of serious harm” and cause the delivery of care in the prisons to fall below

15

the evolving standards of decency that mark the progress of a maturing society.150

16

17 146 Id. at 33, 34, 113 S. Ct. 2475; see also id. at 33, 113 S. Ct. 2475 (“We have great difficulty 18 agreeing that prison authorities may not be deliberately indifferent to an inmate’s current health
problems but may ignore a condition of confinement that is sure or very likely to cause serious 19 illness and needless suffering the next week or month or year.”).

20

147 Id.

21 148 511 U.S. 825, 828, 114 S. Ct. 1970, 128 L.Ed.2d 811 (1994).

22 149 See, e.g., Graves v. Arpaio, 623 F.3d 1043, 1049 (9th Cir.2010) (substantial risk of harm from

23 exposure of pretrial detainees on psychotropic medication to extreme heat); Wallis v. Baldwin, 70

F.3d 1074, 1076 (9th Cir.1995) (substantial risk of harm from sustained exposure to asbestos). See 24 Thomas v. Ponder, 611 F.3d 1144, 1151 n. 5 (9th Cir.2010) (“In its order, the district court

25

erroneously considers whether the prison officials were aware that Thomas was ‘suffering serious harm from the deprivation’ of exercise. The correct issue for consideration is, however, whether

26 the prison officials were subjectively aware of a ‘serious risk of substantial harm.’” (citing Farmer, 511 U.S. at 837, 114 S. Ct. 1970; Helling, 509 U.S. at 32)).

27

150 Farmer, 511 U.S. at 834; Plata, 131 S. Ct. at 925 n.3. 28

34
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1

Thus, “[i]ndividual claims for injunctive relief related to medical treatment are discrete

2 from the claims for systemic reform addressed in Plata”151 and here. The constitutional and

3 statutory claims in this case are of the same basic kind as the claims in Helling, Farmer, Plata,

4 Graves, Wallis, and Parsons. In those cases, courts have asked only whether the plaintiffs were
5 exposed to a substantial risk of harm to which prison officials were deliberately indifferent—and 6 have recognized that many inmates can simultaneously be endangered by a single policy.152 7
Here, all members of the putative class and subclass have in common their alleged exposure 8 9 to a substantial risk of serious future harm to which Defendants are allegedly deliberately
10 indifferent, as a result of policies and practices that govern the overall conditions of health care
11 services and confinement.153 While results of exposure may vary, ranging from no harm to death,

United States District Court For the Northern District of California

12 each inmate suffers the same constitutional or statutory injury when exposed to a policy or practice
13 that creates a substantial risk of serious harm.154 For example, inadequate health care in a prison 14
system endangers every inmate: “[e]ven [inmates] with no present physical or mental illness may 15
become afflicted, and all [inmates] in California are at risk so long as the State continues to provide 16 17 inadequate care. . . . [Inmates] who are not sick or mentally ill . . . [are] in no sense [ ] remote
18 bystanders in California's medical care system. They are that system's next potential victims.”155

19

20 151 Pride v. Correa, 719 F.3d 1130, 1137 (9th Cir.2013).

21 152 See Helling, 509 U.S. at 33 (unsafe drinking water); Graves, 623 F.3d at 1049 (heat exposure);
22 Wallis, 70 F.3d at 1076 (asbestos); Hoptowit v. Spellman, 753 F.2d 779, 783–84 (9th Cir.1985) (substandard fire prevention).
23 153 See Parsons, 754 F.3d at 678.
24

25

154 See, e.g., Farmer, 511 U.S. at 834, 114 S. Ct. 1970; Helling, 509 U.S. at 33; cf. Plata, 131 S. Ct. at 1923 (“For years the medical and mental health care provided by California’s prisons has fallen

26 short of minimum constitutional requirements and has failed to meet [inmates’] basic health needs.

Needless suffering and death have been the well-documented result.”).

27

155 131 S. Ct. at 1940. 28

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1

The court need only determine if it can answer the question “whether [Defendants’] staffing

2 policies pose a risk of serious harm to . . . the entire class ‘in one stroke.’”156 The identified 37

3 policies and practices to which all members are exposed hold together the putative class and

4 subclass.157

5

Defendants’ proffered changes in intake health screening and the future hiring of more

6 medical staff, even if successful, cannot defeat commonality.158 “Either [Defendants] employ[] 7
enough nurses and doctors [and custody staff] to provide adequate care to all . . . inmates or [they] 8

9 do[] not; there is no need for an inmate-by-inmate inquiry to determine whether all inmates in [the

10 Jail] are exposed to a substantial risk of serious harm by [Defendants’] staffing policies.”159

United States District Court For the Northern District of California

11 CFMG and the County admit to mistakes in care and treatment, and their knowledge of the risks to

12 which their acknowledged system-wide policies and practices expose Plaintiffs can be evaluated on
13 a class-wide basis.160 The County also admits to system-wide, insufficient accommodations for 14
persons with disabilities,161 and whether Defendants had knowledge of any insufficiencies can also 15
be evaluated in “one-stroke” for the entire sub-class. No individualized inquiry into the 16 17 experiences of any particular inmate or Plaintiff is necessary. The claims of the inmates with
18 disabilities sub-class also satisfy the commonality requirement: either the Plaintiffs are housed in a

19

20

21 156 Parsons, 754 F.3d at 679 (citing Wal-Mart, 131 S. Ct. at 2551).
22 157 See id. at 678.
23 158 See id. at 680; Friends of the Earth, Inc. v. Laidlaw Envtl. Servs. (TOC), Inc., 528 U.S. 167, 189
24 (2000); Bell v. City of Boise, 709 F.3d 890, 901 (9th Cir. 2013).
25 159 Parsons, 754 F.3d at 680; see Docket No. 356 at ¶ 53.
26 160 See Docket No. 355 at 16-17.
27 161 See Docket No. 371.
28
36 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

facility that comports with the ADA or they are not.162 As exemplified by Plata, claims of this

2 kind, involving detailed factual and legal allegations of specified systemic deficiencies in prison

3 conditions giving rise to a substantial risk of serious harm, have long been brought in the form of

4 class actions lawsuits.163 “In fact, without such a means of challenging unconstitutional prison

5 conditions, it is unlikely that a state's maintenance of prison conditions that violate the Eighth

6

Amendment could ever be corrected by legal action.”164

7

8

United States District Court For the Northern District of California

9 162 A public entity must take steps, including altering existing or constructing new facilities, to 10 accommodate inmates with disabilities unless to do so would fundamentally alter a program or
create an undue financial or administrative burden. See 28 C.F.R. §§ 35.150, 35.152. Whether a 11 facility was constructed prior to 1992 only determines whether the structure itself must comply
fully with the ADA’s architectural guidelines. See 28 C.F.R. § 35.151(a) & (b). That the jail was 12 constructed prior to 1992 does not vitiate Defendants’ obligation to accommodate inmates with 13 disabilities or alter the reasonableness of an accommodation in any way.
14 163 See also, e.g., Armstrong v. Davis, 275 F.3d at 849.

15 164 Parsons, 754 F.3d at 680; see, e.g., Chief Goes Out v. Missoula Cnty., Case No. 12-cv-155-

DWM, 2013 WL 139938, at *5 (D. Mont. Jan. 10, 2013) (“[C]ourts have long recognized that, in 16 prison condition cases like this one, the injury is the [deprivation] itself, not just the negative

17

effects resulting from the [deprivation]. . . . [O]ther courts have certified classes of inmates claiming unconstitutional deprivation of outdoor exercise, and scores of courts have certified

18 classes of [inmates] claiming other unconstitutional prison conditions.”); Butler, 289 F.R.D. at 98 (“Whether the County was aware of and deliberately indifferent to the conditions at the [prison] is

19 a common question subject to class-wide resolution.”); Hughes, 2013 WL 1821077, at *23

(“Plaintiffs’ claims related to these [prison] conditions are capable of class-wide resolution: 20 Plaintiffs seek permanent injunctive and declaratory relief that would enjoin allegedly

21

unconstitutional behavior as applied to the entire class. Importantly, the questions of law are applicable in the same manner to each potential class member . . . . Each class member, if

22 proceeding separately against Defendants, would need to meet the same test under the Eighth and Fourteenth Amendments to prevail.”); Rosas v. Baca, Case No. 12-cv-428-DDP, 2012 WL

23 2061694, at *3 (C.D. Cal. June 7, 2012) (“In a civil rights suit such as this one ... commonality is

satisfied where the lawsuit challenges a system-wide practice or policy that affects all of the 24 putative class members. Under such circumstances, individual factual differences among class

25

members pose no obstacle to commonality.”); Indiana Prot. & Advocacy Servs. Comm’n v. Comm’r, Indiana Dep’t of Correction, Case No. 08-cv-1317-TWP, 2012 WL 6738517, at *18

26 (S.D. Ind. Dec. 31, 2012) (“The mentally ill [inmates] here, have demonstrated through a wealth of

evidence, that the class is united by the common question of whether the lack of treatment and

27 isolated living conditions in IDOC facilities violate the Eighth Amendment.”); see also Armstrong

v. Davis, 275 F.3d at 868. 28

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1

Here, as in Parsons, Plaintiffs have met or exceeded Wal-Mart’s requirement of proof that

2 there are “in fact . . . common questions of law or fact.”165 The materials that they submitted

3 include six thorough and neutral or County-appointed expert reports, two Plaintiff-retained expert

4 declarations, the detailed allegations in the 135-page complaint, hundreds of internal documents,
5 and declarations by the named Plaintiffs—constituting more than sufficient evidence at this stage 6
in the litigation of the existence of policies and practices that allegedly expose all members of the 7
putative class and subclass to a substantial risk of serious harm. These policies and practices are 8 9 defined with sufficient precision and specificity; they involve particular and readily identifiable
10 conduct on the part of the defendants, such as failing to hire enough medical staff, failing to fill

United States District Court For the Northern District of California

11 prescriptions, denying inmates access to medical specialists, depriving suicidal and mentally ill

12 inmates access to basic mental health care, and failure to accommodate disabilities that affect
13 communication and mobility.166 The evidence submitted by the plaintiffs adequately demonstrates 14
the existence of the challenged statewide policies and practices. 15
“A clear line of precedent, stretching back long before Wal–Mart and unquestionably 16 17 continuing past it, firmly establishes that when inmates provide sufficient evidence of systemic and
18 centralized policies or practices in a prison system that allegedly expose all inmates in that system

19 to a substantial risk of serious future harm, Rule 23(a)(2) is satisfied.”167 Here, Plaintiffs’

20

21

165 131 S. Ct. at 2551; see also Comcast Corp. v. Behrend, 133 S. Ct. 1426, 1432 (2013) (noting that “it may be necessary for the court to probe behind the pleadings before coming to rest on the

22 certification question” (quotation marks and citations omitted)); DL v. District of Columbia, 713 F.3d 120, 126 (D.C. Cir. 2013) (concluding that commonality had not been shown where the

23 plaintiffs in a putative IDEA class action had not identified a “single or uniform policy or practice

that bridges all their claims”); M.D. v. Perry, 675 F.3d 832, 844 (5th Cir. 2012) (cautioning that 24 “mere allegations of systemic violations of the law . . . will not automatically satisfy Rule 23(a)’s

25 commonality requirement” (quotation marks and citations omitted)).

26 166 Compare M.D., 675 F.3d at 844 (noting that commonality is not shown when plaintiffs allege an amorphous claim of undefined and unspecified systemic misconduct).
27
167 Parsons, 754 F.3d at 684. 28

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1 constitutional and statutory claims satisfy all of those criteria. The factual and legal questions that 2 they present can be answered “yes” or “no” in one stroke as to the entire class, dissimilarities

3 among class members do not impede the generation of common answers to those questions, and the

4 capacity of class-wide proceedings to drive the resolution of this litigation is not in doubt.168 The

5 claims, defenses, relevant facts, and substantive law are all common across the class and

6

subclass.169

7

D. 8

9

The question of typicality170 “refers to the nature of the claim or defense of the class

10 representative, and not to the specific facts from which it arose or the relief sought.”171 “[T]he

United States District Court For the Northern District of California

11 typicality inquiry involves comparing the injury asserted in the claims raised by the named

12 plaintiffs with those of the rest of the class.”172 “Under the rule’s permissive standards,
13 representative claims are ‘typical’ if they are reasonably co-extensive with those of absent class 14
members; they need not be substantially identical.”173 The test of typicality is “whether other 15
members have the same or similar injury, whether the action is based on conduct which is not 16
17 unique to the named plaintiffs and whether other class members have been injured by the same

18

19 168 See Wal–Mart, 131 S. Ct. at 2551–52.
20

21

169 See, e.g., Parsons, 754 F.3d at 684-86.

22 170 See Fed. R. Civ. P. 23(a)(3).

23 171 Parsons, 754 F.3d at 686 (internal quotation marks omitted).

24 172 Armstrong v. Davis, 275 F.3d at 869.

25

173 See Fed. R. Civ. P. 23(a)(3); Parsons, 754 F.3d at 686 (“Rule 23(a)(3) requires only that their claims be ‘typical’ of the class, not that they be identically positioned to each other or to every

26 class member.”); Armstrong v. Davis, 275 F.3d at 869; Hanlon, 150 F.3d at 1020; Hanon v.

Dataproducts Corp., 976 F.2d 497, 508 (9th Cir. 1992) (typicality analysis “refers to the nature of

27 the claim or defense of the class representative, and not to the specific facts from which it arose or

the relief sought” (internal quotation marks omitted)). 28

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1

course of conduct.”174 “Typicality refers to the nature of the claim or defense of the class

2 representative, and not to the specific facts from which it arose or the relief sought.”175

3

While typicality and commonality occasionally merge,176 typicality derives its independent

4 legal significance from its ability to “screen out class actions in which the legal or factual position
5 of the representatives is markedly different from that of other members of the class even though 6 common issues of law or fact are present.”177 But it is not necessary “that the named plaintiffs’ 7
injuries be identical to those of other class members, only that the unnamed class members have 8 9 injuries similar to those of the named plaintiffs and that the injuries result from the same, injurious 10 course of conduct.”178

United States District Court For the Northern District of California

11

To the County, the typical grievances and complaints named Plaintiffs make in this case are

12 adequacy or timely care, which Defendants believe are individual, unique issues, requiring
13 individual, unique responses and assessments of specific inquiries on an individual level.179 The 14
determination of deliberate indifference, the County asserts, would require individual analysis, 15
undermining any judicial economy found in certifying a class.180 Using the same defenses as for 16
17 commonality, CFMG attempts to discount any problems any named Plaintiff has had with any
18 aspect of CFMG’s medical and mental care, but the medical records show otherwise.181

19 174 Hanon, 976 F.2d at 508.
20

21

175 Id.

22 176 See Wal-Mart, 131 S. Ct. at 2551 n. 5; Armstrong v. Davis, 275 F.3d at 868–69.

23 177 7A Wright, § 1764 (emphasis added).

24 178 Armstrong v. Davis, 275 F.3d at 869.

25

179 See Docket No. 133 at 24.

26 180 See id.
27 181 See Docket No. 355 at 25; Docket Nos. 52-3 to 52-30.
28

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1

Here, the transitory putative class and subclass members are all inmates in the jail. Each

2 named Plaintiff declares exposure, like all other members of the putative class and subclass, to a

3 substantial risk of serious harm due to the challenged policies and practices. The named Plaintiffs

4 allege “the same or [a] similar injury” as the rest of the putative class; they allege that this injury is
5 a result of a course of conduct that is not unique to any of them; and they allege that this injury 6 follows from the “same, injurious course of conduct” at the center of the class claims.182 Relief for 7
one individual would provide relief to everyone.183 “[G]iven that every inmate in [the Jail] is 8 9 highly likely to require medical, mental health, and dental care, each of the named plaintiffs is
10 similarly positioned to all other [Jail] inmates with respect to a substantial risk of serious harm
11 resulting from exposure to defendants’ policies and practices.”184 This applies as well for the

United States District Court For the Northern District of California

12 subclass. “It does not matter that the named plaintiffs may have in the past suffered varying

13 injuries or that they may currently have different health care needs; Rule 23(a)(3) requires only that
14 their claims be ‘typical’ of the class, not that they be identically positioned to each other or to every
15 class member.”185
16

17

E.

18

As to adequacy of representation,186 class representatives are adequate if they do not have

19 “any conflicts of interest with other class members” and if they will “prosecute the action

20

21
22 182 See Fed. R. Civ. P. 23(a)(3); Armstrong v. Davis, 275 F.3d at 869.
23 183 See Parsons, 754 F.3d at 689 n.35 (rejecting Shook v. Bd. of County Comm’rs, 543 F.3d 597 (10th Cir. 2008)).
24 25 184 Id.; see also Plata, 131 S. Ct. at 1940; Armstrong, 275 F.3d at 869.
26 185 Parsons, 754 F.3d at 686; see Ellis, 657 F.3d at 985 n.9 (“Differing factual scenarios resulting in a claim of the same nature as other class members does not defeat typicality.”).
27 186 See Fed. R. Civ. P. 23(a)(4).
28
41 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

vigorously on behalf of the class.”187 Class representatives have less risk of conflict with unnamed

2 class members when they seek only declaratory and injunctive relief. With regard to claims, the

3 honesty and credibility of a class representative is a relevant consideration into adequacy, because

4 an untrustworthy plaintiff could reduce the likelihood of prevailing on the class action188 and may

5 be considered to have interests antagonistic to the class.189 But a plaintiff is inadequate only “when

6 attacks on the [plaintiff’s] credibility . . . are so sharp as to jeopardize the interests of absent class

7

members” and “where the representative’s credibility is questioned on issues directly relevant to 8

9

the litigation.”190

10

The County argues that the named Plaintiffs are inadequate because, among other things,

United States District Court For the Northern District of California

11 they request conflicting relief. For example, some Plaintiffs wish to see mentally ill inmates

12 segregated from the rest of the inmates, and others admonish Defendants for failure to “ensure that
13 inmates or detainees with disabilities are housed in the most integrated setting appropriate to the 14
needs of the individuals.”191 Citing certain deposition testimony and counsel’s role in preparing 15
defendants, CFMG contends the named Plaintiffs are not adequate representatives because they are 16 17 not credible and because they can establish neither the requisite case or controversy nor personal
18 injury from being subjected to the alleged risks.192 As to this latter point, CFMG disputes that any

19 named Plaintiffs were exposed to the inadequate conditions they challenge relating to in screening,

20 187 Hanlon, 150 F.3d at 1020.
21 188 See Harris v. Vector Marketing Corp., 753 F. Supp. 2d 996, 1015 (N.D. Cal. 2010)); Feske v. 22 MHC Thousand Trails L.P., Case No. 5:11-cv-4124-PSG, 2013 U.S. Dist. LEXIS 37232, at *36-
41(N.D. Cal. 2013). 23
189 Harris, 753 F. Supp. 2d at 1015. 24 25 190 Id. (internal quotation marks and citations omitted); see also Feske, 2013 WL 1120816, at *13.
26 191 See Docket No. 133 at 27.

27 192 See Docket No. 169 at 18, Lewis, 518 U.S. at 357; Berger v. Home Depot USA, Inc. 741 F.3d 1061, 1067 (9th Cir. 2014).
28
42 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 staffing, facilities, requests for care, care, treatment quality management, training, suicide 2 prevention and use of safety cells.193 CFMG also questions whether certain Plaintiffs suffering
3 from mental illness can adequately represent a class.194

4

Any minor disagreements between various class representatives’ individual beliefs

5 regarding appropriate remedies do not render the class representatives inadequate. Rather than
6 personal relief, Plaintiffs ask for relief from Defendants’ problematic system-wide policies and
7 practices. For example, while opinions may differ about housing inmates with mental illness in
8 9 general population or in special housing units, all plaintiffs agree inmates with mental illnesses
10 should not be housed in administrative segregation, and this is part of the relief they request.195

United States District Court For the Northern District of California

11 And “[i]nconsistent deposition testimony in and of itself will not serve as a ground for denial of

12 class certification.”196 While lack of credibility is an issue for Plaintiffs to consider in constructing

13 their case, the court does not consider the named Plaintiffs inadequate. Nor are alleged cognitive

14 impairments a valid reason to deem Plaintiffs inadequate.197
15
F. 16

17

Counsel may be appointed under Fed. R. Civ. P. 23(g)(1) and (4) if they are adequate; that

18 is, if counsel does not have “any conflicts of interest with other class members” and if they will

19 193 See Docket No. 169 at 18-19.
20 194 See id. at 21-22, 24-25, 26-29. 21 195 See Docket No. 355 at 29-30. 22
196 Savino v. Computer Credit, Inc., 173 F.R.D. 346, 357 (E.D.N.Y. 1997) aff’d, 164 F.3d 81 (2d 23 Cir. 1998).

24 197 See Ingles v. City of New York, Case No. 01-cv-8279-DC, 2003 WL 402565, at *1, *7

25

(S.D.N.Y. Feb. 20, 2003) (ruling that class representative who was currently on psychiatric medication and had a “psychiatric condition” was an adequate class representative); Hill v. Priority

26 Fin. Servs., Inc., Case No. 98-cv-1319-SEB, 2000 WL 1876582, at *1 (S.D. Ind. Dec. 22, 2000)

(noting that even if the class representative were “currently undergoing treatment for mental

27 illness,” that would not disqualify him if it did not “affect his understanding of the case, his

processing of information, or his ability to perform his duties as class representative”). 28

43
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

“prosecute the action vigorously on behalf of the class.”198 Here, appointment is sought by the

2 following counsel: Rosen Bien Galvan & Grunfeld LLP, Monterey County Public Defender James

3 Egar and the American Civil Liberties Union.

4

Under Fed. R. Civ. P. 23(g)(1) and (4), class counsel with experience with class action

5 lawsuits, class action lawsuits regarding conditions in correctional facilities, criminal justice issues

6

and commitment of resources are likely to adequately represent the class.199

7

The County posits that the Rosen Bien firm may be financially interested in keeping 8

9 inmates in jail, while the Office of the Public Defender’s incentives may aim to keep inmates out of

10 jail.200 The County further argues the Office of the Public Defender has declared conflict in

11 representing six of the named Plaintiffs.201 The County also claims that because Egar filed a

United States District Court For the Northern District of California

12 declaration in support of Plaintiffs’ motion for class certification in which he testified to his
13 personal knowledge of the conditions at the jail, he is a witness in this lawsuit, disqualifying him
14 from representation in this lawsuit.202 CFMG focuses on a letter Egar once wrote lauding Fithian’s
15 work.203
16

17 198 Hanlon, 150 F.3d at 1020.

18

199 See Fed. R. Civ. P. 23(g)(1)(A)(i), (ii), (iii), and (iv); Fed. R. Civ. P. 23(g)(4).

19 200 See Docket No. 133 at 27.
20

21

201 See id. at 4.

22 202 Reich v. Club Universe, 125 Cal. App. 3d 965, 970-972 (1981) (“The reasons for the rule prohibiting such a dual role by an attorney-potential witness are (1) an attorney who attempts to be

23 both advocate and witness impairs his credibility as a witness and diminishes his effectiveness as

an advocate, and (2) such conduct may diminish the public’s respect and confidence toward the 24 profession”); see also Sicinski v. Reliance Funding Corp., 82 F.R.D. 730, 734 (S.D.N.Y. 1979)

25

(“As stated in Ethical Consideration 5-9 of the Code of Professional Responsibility, ‘(t)he roles of an advocate and of a witness are inconsistent; the function of an advocate is to advance or argue the

26 cause of another, while that of a witness is to state facts objectively;’); Arthur v. Zearley, 320 Ark.

273, 279-82 (1995) (finding attorney for plaintiffs in prospective class action who testified at class

27 certification hearing improperly testified and acted as advocate in same proceeding).

28 203 See Docket No. 169 at 1-2. 44
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

Defendants’ arguments as to plaintiffs’ counsel’s conflicting incentives are unpersuasive,

2 especially where the class is transitory204 and where Rosen Bien advocates for reducing jail and

3 prison overcrowding.205 Pursuant to Cal. Gov. Code § 27706(g), conflicts in criminal cases do not

4 carry over into civil cases,206 and Egar’s representation does not implicate California ethics
5 rules.207 An attorney may be both counsel and witness in a single action, although Plaintiffs have 6 stated they do not intend to call Egar to testify.208 The letter Egar once sent to Fithian also does not 7
undermine his ability to represent the plaintiffs adequately. Rosen Bien Galvan & Grunfeld LLP, 8 9 Egar and the ACLU all have the necessary experience and resources to litigate cases such as this
10 one.

United States District Court For the Northern District of California

11

G.

12

Rule 23(b)(2) requires that “the party opposing the class has acted or refused to act on

13 grounds that apply generally to the class, so that final injunctive relief or corresponding declaratory
14 relief is appropriate respecting the class as a whole.” Wal-Mart summarized Rule 23(b)(2)’s
15 requirements as follows:
16

17

the key to the (b)(2) class is “the indivisible nature of the injunctive or declaratory remedy warranted—the notion that the conduct is such that it can be enjoined or declared unlawful

18

only as to all of the class members or as to none of them.” In other words, Rule 23(b)(2)

19 204 See Docket No. 128 at 13-16.
20 21 205 See Docket No. 355 at 32; Docket No. 358 at ¶ 2; Docket No 358-1, Ex. A.

22 206 See also State v. Lucas, 123 Ariz. 39, 41 (1979) (no conflict between prosecutor prosecuting man while simultaneously defending the county against the man’s civil lawsuit).
23 207 Cal. R. Prof. Conduct 3-100(C).
24

25

208 See Colyer v. Smith, 50 F. Supp. 2d 966, 974 (C.D. Cal. 1999) (finding that attorneys are not necessarily disqualified even if they are compelled to be fact witnesses at trial); cf. Cal. R. Prof.

26 Conduct 5-210 (allowing attorneys to act as witnesses in jury trials under certain circumstances); Yaman v. Galipo, Case No. 12-cv-7908-GW, 2014 WL 2566129, at *3 (C.D. Cal. June 3, 2014);
27 McLellan v. McLellan, 23 Cal. App. 3d 343, 360 (Cal. Ct. App. 1972) (allowing attorney

declaration). 28

45
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

applies only when a single injunction or declaratory judgment would provide relief to each member of the class. It does not authorize class certification when each individual class

2

member would be entitled to a different injunction or declaratory judgment against the defendant.209

3

These requirements unquestionably are satisfied when putative class members seek uniform 4

5 injunctive or declaratory relief from policies or practices generally applicable to the class as a

6 whole.210 Such an inquiry “does not require an examination of the viability or bases of the class

7 members’ claims for relief, does not require that the issues common to the class satisfy a Rule

United States District Court For the Northern District of California

8 23(b)(3)-like predominance test, and does not require a finding that all members of the class have

9 suffered identical injuries.”211 Rather, as the rule’s text makes clear, this inquiry asks only whether

10 “the party opposing the class has acted or refused to act on grounds that apply generally to the

11 class.”212
12

13

The primary role of this provision is the certification of civil rights class actions.213

14 Following Rule 23(b)(2)’s text and purpose, courts have repeatedly invoked it to certify classes of

15 209 131 S. Ct at 2557 (citation omitted).
16

17

210 See Rodriguez, 591 F.3d at 1125.

18 211 Parsons, 754 F.3d at 688 (citing Rodriguez, 591 F.3d at 1125; Walters v. Reno, 145 F.3d 1032, 1047 (9th Cir. 1998)).

19 212 Fed. R. Civ. P. 23(b)(2).
20

21

213 See Amchem Products, Inc., 521 U.S. at 614 (“Rule 23(b)(2) permits class actions for declaratory or injunctive relief where ‘the party opposing the class has acted or refused to act on

22 grounds generally applicable to the class.’ Civil rights cases against parties charged with unlawful, class-based discrimination are prime examples.” (citations omitted)); Walters, 145 F.3d at 1047

23 (“Rule 23(b)(2) was adopted in order to permit the prosecution of civil rights actions.”); Baby Neal

for & by Kanter, 43 F.3d at 63 (“The writers of Rule 23 intended that subsection (b)(2) foster 24 institutional reform by facilitating suits that challenge widespread rights violations of people who

25

are individually unable to vindicate their own rights.” (citations omitted)); Wright & Miller, 7AA Fed. Prac. & Proc. Civ. § 1776 (3d ed.) (“[S]ubdivision (b)(2) was added to Rule 23 in 1966 in part

26 to make it clear that civil-rights suits for injunctive or declaratory relief can be brought as class actions ... [T]he class suit is a uniquely appropriate procedure in civil-rights cases, which generally

27 involve an allegation of discrimination against a group as well as the violation of rights of

particular individuals. By their very nature, civil-rights class actions almost invariably involve a 28 plaintiff class, although they may also be brought against a defendant class.”

46

Case No.: 5:13-cv-2354-PSG

ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 inmates seeking declaratory and injunctive relief for alleged widespread constitutional and 2 statutory violations in prison systems.214

3

As in Parsons, here Plaintiffs “seek uniform injunctive or declaratory relief from policies or

4 practices that are generally applicable to the class as a whole.”215 In their prayer for relief,
5 Plaintiffs request that Defendants be ordered “to protect [inmates] from substantial risk of harm 6
from other [inmates], to provide minimally adequate medical [and mental] care to [inmates], and to 7
cease discriminating against and failing to provide accommodations to [inmates] with disabilities; . 8 9 . . from continuing the unlawful acts, conditions, and practices described in this Complaint; . . . to
10 develop and implement, as soon as practical, a plan to eliminate the substantial risk of harm,

United States District Court For the Northern District of California

11 discrimination, and statutory violations that Plaintiffs and members of the class and subclass they

12 represent suffer due to the unlawful acts, omissions, conditions and practices described in this
13 Complaint [detailing needs for population, staffing, physical plant, protection from harm, training, 14
classification and housing, medical care, access to care, medical staffing, emergency care, chronic 15
care, medical records, specialist and outside treatment, mental health care, quality assurance, and 16
17 accommodation for inmates with disabilities]; . . . the costs of this suit and reasonable attorneys’

18 fees and litigation expenses; . . . retaining jurisdiction . . . until Defendants have fully complied

19 with the orders of this Court, and there is reasonable assurance that Defendants will continue to

20 comply in the future absent continuing jurisdiction; and [a]n award to Plaintiffs of such other and 21

22 214 Id. at § 1776.1 “[I]t should be noted that a common use of Rule 23(b)(2) is in [inmate] actions

23 brought to challenge various practices or rules in the prisons on the ground that they violate the

constitution. For example, Rule 23(b)(2) class actions have been utilized to challenge prison 24 policies or procedures alleged to . . . violate the [inmates’] Eighth Amendment rights to be free

25

from cruel and unusual punishment.” see also, e.g., Butler, 289 F.R.D. at 101 (certifying Rule 23(b)(2) class of inmates alleging systemic Eighth Amendment violations); Hughes, 2013 WL

26 1821077, at *20 (same); Rosas, 2012 WL 2061694, at *5 (same); Indiana Prot. & Advocacy Servs. Comm’n, 2012 WL 6738517 at *18 (same).

27

215 Parsons, 754 F.3d at 688 (quoting Fed. R. Civ. P. 23(b)(2)). 28

47
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

further relief as the Court deems just and proper.”216 Plaintiffs’ expert reports also include

2 descriptions of the kinds of court-ordered changes in the jail’s policy and practices that could

3 alleviate the alleged systemic constitutional and statutory violations, as well as affirmations by all

4 experts that court-ordered injunctive relief could effectively alleviate the deficiencies in the jail’s
5 policies and practices identified in their reports. 6
The County argues Plaintiffs’ requests are too vague regarding constitutional adequacy and 7
deficiency.217 But the civil rights claims of the inmate class and the inmates with disabilities 8 9 subclass “are precisely the sorts of claims that Rule 23(b)(2) was designed to facilitate.”218
10 Defendants “ha[ve] acted or refused to act on grounds that apply generally to the class, so that final

United States District Court For the Northern District of California

11 injunctive relief or corresponding declaratory relief is appropriate respecting the class as a

12 whole.”219 Plaintiffs satisfy Rule 23(b)(2) because “class members seek uniform relief from a
13 practice applicable to all of them.”220 “Contrary to the [D]efendants’ assertion that each inmate's 14
alleged injury is amenable only to individualized remedy, every inmate in the proposed class is 15
allegedly suffering the same (or at least a similar) injury and that injury can be alleviated for every 16 17 class member by uniform changes in [jail] policy and practice.”221 Plaintiffs request no damages or
18 relief for any specific Plaintiff.222 Instead, Plaintiffs seek injunctive and declaratory relief from a

19

20

21

216 See Docket No. 41 at 132-35.

22 217 See Docket No. 133 at 33-34.

23 218 Walters, 145 F.3d at 1047.

24 219 Fed. R. Civ. P. 23(b)(2).
25 220 Rodriguez, 591 F.3d at 1125; Parsons, 754 F.3d at 688.
26 221 Parsons, 754 F.3d at 689.
27 222 Docket No. 41 at ¶¶ 410-17.
28
48 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1

specific set of Defendants’ policies and practices,223 and while each may not affect every member

2 of the proposed class and subclass in exactly the same way, they constitute shared grounds for all

3 inmates in the proposed classes.224 “For example, every inmate in [jail] custody is allegedly placed

4 at risk of harm by [the jail’s] policy and practice of failing to employ enough doctors—an injury
5 that can be remedied on a class-wide basis by an injunction that requires [the jail] to hire more 6
doctors, with the exact number of necessary additional hires to be determined by the district court 7
if, after a trial, it ultimately concludes that the defendants engaged in unlawful conduct.”225 8 9 Because Defendants allegedly established systemic policies and practices that place every inmate
10 in the jail in peril, and by allegedly doing so with deliberate indifference to the resulting risk of

United States District Court For the Northern District of California

11 serious harm to them, Defendants have acted on grounds that apply generally to the proposed class

12 and subclass, such that Plaintiffs’ prayer for relief would provide an appropriate remedy for

13 both.226 Accordingly, Plaintiffs satisfy Rule 23(b)(2).
14 V.
15 The court GRANTS Plaintiffs’ motion for class certification under Rule 23(b)(2), and
16
17 appoints named Plaintiffs as class representatives. The court also designates as class counsel under

18 Rule 23(g) Michael Bien and Gay Crosthwait Grunfeld of Rosen Bien Galvan & Grunfeld LLP,

19 223 See Docket No. 355 at 33; Docket No. 41 at ¶¶ 410-17; Docket No. 108-2 at 2-5; see Parsons, 754 F.3d at 687.
20 21 224 See Rodriguez, 591 F.3d at 1125–26; Walters, 145 F.3d at 1047.
22 225 Parsons, 754 F.3d at 689.

23 226 See Fed. R. Civ. P. 23(b)(2). Plaintiffs also claim the class and subclass can also be certified

under Rule 23(b)(1)(A) and (B). See Docket No. 355 at 35; Ashker, 2014 WL 2465191 at *7 24 (prison conditions case certified under Rule 23(b)(1)(A) for class actions that create a risk of

25

inconsistent adjudications); Docket No. 358-4, Ex. VV at 107-10; Gray v. County of Riverside, Case No. 13-cv-0444-VAP, Docket No. 131 at 107-10 (C.D. Cal., Sept. 2, 2014) (Order Granting

26 Plaintiffs’ Motion for Class Certification, Denying Defendant’s Motion to Dismiss, certifying jail

conditions class action under both Rule 23(b)(1)(A) and (B)). Because the court has found for

27 certification appropriate under Rule 23(b)(2), the court does not address whether Plaintiffs also

satisfy Rule 23(b)(1). 28

49
Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

1 Monterey County Public Defender James Egar, Alan Schlosser of the American Civil Liberties 2 Union of Northern California and Eric Balaban of the American Civil Liberties Union-National

3 Prison Project. The class and subclass are defined as follows: “all adult men and women who are

4 now, or will be in the future, incarcerated in Monterey County Jail” and “all qualified individuals

5 with a disability, as that term is defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and 6
California Government Code § 12926(j) and (m), and who are now, or will be in the future, 7
incarcerated in Monterey County Jail.” 8 9 SO ORDERED.
10 Dated: January 29, 2015

United States District Court For the Northern District of California

11

_________________________________

PAUL S. GREWAL

12

United States Magistrate Judge

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28
50 Case No.: 5:13-cv-2354-PSG ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE

 </s> Case5:13-cv-02354-PSG Document460 Filed04/14/15 Page1 of 44

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Pursuant to Title n of the ADA, a "qualified individual with a disability" cannot, "by

2 reason of such disability, be excluded from participation in or be denied the benefits of the 3 services, programs, or activities of a public entity, or be subjected to discrimination by any such

4 entity.,,12 The Department of Justice has promulgated regulations to enforce this general

5 mandatcY "To prevail under Title II [of the ADA], [a] plaintiifmust show that: (I) he is a

6 qualified individual with a disability; (2) he was either excluded from participation in or denied the

7

benefits of a public entity's services, programs, or activities, or was otherwise discriminated

8

against by tbe public entity; and (3) this exclusion, denial; or discrimination was by reason of his

!, .

9

10 disability.,,14 Violations of Title II are largely defined by its implementing regulations, which

'E• 11

"flesh out public entities' statutory obligations with more specificity," and are controlling authority

1002

Uo=:U..·:;

12

"'unless they are arbitrary, capricious, or manifestly contrary to the statute.,,,13 A public entity

~~

·yc

O
U

13

must "make reasonable modifications in policies, practices, or procedures when the modifications

.~!l.Q-
Q.~

14

.0

arc necessary to avoid discrimination on the basis of disability, unless the public entity can

3~ 15

"'~
":~':0z

16

..."";0-;5 0 •

17 18

demonstrate that making the modifications would fundamentally alter the nature of the service, program, or actl.Vl.ty.,,16

I

19

20 21 12 42 U.S.C. § 12132.
22 13 See, e.g., 28 C.F.R. § 35.150(a) (requiring that public services, programs, and activities be "readily accessible to and usable by individuals with disabilities."); see also id § 35.149
23 (mandating that public facilitie~ be accessible to people with disabilities).

24 14 Cohen v. City o/Culver City, 754 F.3d 690, 695 (9th Cir. 2014); see also 42 U.S.C. § 12132.

25

13 Cohen, 754 F.3d at 695 (quoting Armstrong v. Sclrwarzenegger, 622 F.3d 1058,1065 (9th Cif.

26 2010).

27 16 28 C.F.R. § 35.130(b)(7); see also Pierce v. County a/Orange, 526 F.3d 1190, 1215 (9th Cir.

2008).

28
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• The jail 's TB policy does not require the isolation of inmates with positive TB

1

screens.88 Under the guidelines, individuals who screen positively for TB

2

symptoms should be placed in isolation until TB is ruled out or, ifdiagnosed, until it can be treated.89

3

• Skin tests arc administered 14 days after admission, double the seven-day timeline

4

recommended by the CDC.9O Rather than conducting skin tests on all inmates,

however, the jail only perfolTIlcd skin testing on apRfoximately a quarter of

5

incoming inmates for the first nine months of2013.91 CDC Guidelines recommend

6

tuberculin skin teste; of all inmates within seven days of admission.92 Given the high rate ofTB in Monterey County and California, Mel's intake screening "should be

7

very aggressive.,,9) Puisis agrees that the best practice would be to administer TB skin tests on intake. with the results read by a nurse within 72 hours.94

8

• The jail does not require those with positive skin tests to receive chest x-rays within

9

72 hours, and those with positive x-rays are not required to be medically isolated, as

10

the CDC Guidelines require.9~ Chest x-rays are thus sometimes performed one or two weeks after a positive skin test reading, or sometimes not performed at all.96

's~ II

t:<S
=o:.~ =: 12

UU

-~ '£": t0)

13

• There is no evidence of infection control surveillance for TB within the jail,

f' -

including tracking TB prevalence, rates, positivity numbers or employee skin tests.91 Medical staff is thus unaware of whether there might be a TB problem within the facility-cnhancing the risk that TB can spread from inmates to MCJ employees to

I
I

1;; '':
S.1!l

14

persons in the community.98

~O

$,s8o 15

"''''=0 :"~ :,:to Z:
;:>-5
-0
'"

16 17 18

sg See Docket No. 49-3 Ex. J at 18. S9See Docket No. 109-1 Ex. A at 2,5; Docket No. 49-3 Ex. J at 18. 90 Id. at J2. 91Id. at 18.

I I ,

19 92 See Docket No. 109-1 Ex. A at 8.

20 93 Docket No. 108-8 at, 13.

21 94 Docket No. 109-1 Ex. E at 167:1-168:2.

22 95 See, C.g ., Docket No. 49-3 Ex. J at 12; see also Docket NO.1 09-1 Ex. Eat 167:17-21 , 168:16-22; 23 Docket No. 109-1 Ex. A at 6.

24 96 See Docket No. 49-3 Ex. J at 71 ; Docket No.1 09-1 Ex. E at 168: 17-22.

25 91 See Docket No. 49-3 Ex. J at 23-24; Docket No. 109-1 Ex. E at 238:8-17. 26 9g Docket No. 49-3 Ex. J at 24; Docket No. 108-8 at, 14 ("A primary responsibility of a

I

correctional medical program is to ensure the continued safety and health of inmates and staff.

27 which is impossible without any effective method of tracking communicable diseases and the

efforts of staff to treat and control thcm.''). Puisis' review of inmate medical records found 28 repeated examples of potentially dangerous and substandard monitoring and treatment for

18

Case No.: 5:13-cv-2354-PSG

ORDER GRANTING MOTION FOR PRELIMINARY INJUNCTION

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Suicide and Self-Harm Prevention . Approximately half of all suicides committed in

2 correctional facilities take place in administrative segregation units,l06 While housed in

3 segregation, the mentally ill are especially vulnerable, and their mental health symptoms-

4 including depression, psychosis, and self-harm-are especially likely to grow more severe. 107

5

Once again, Plaintiffs provide significant evidence that Defendants' policies and practices

6 constitute de liberate indifference to Plaintiffs' serious medical needs, particillarly for the mentally

7
ill. Since 2010, four inmates have committed suicide in the jail, and from 2010 to 2013, the jail 8

9

had a suicide rate that is nearly twice the national aventge for jail populations in 2011. lOB All four

10 of those suicides occurred in the jail's administrative segregation units. 109 As II matter of policy

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and practice, Defendants house the inmates with the most serious meotal illness and who are most clinically unstable in segregation units because of their mental iIIness. IIO And Defendants fail to
106 See Docket No. 51 at 169.

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107 See id atfj1.f 63·67; see also Docket No. 108·7 at 11 .
108 See Docket No. 51 at 172; Docket No. 444-1 at 1 3· 12; Docker No. 444·3 at 1 3, 5.

~.s 17 109 Docket No. 51 at '11'/93-96; Docket No. 444-1 at " 3- 12; Docket No. 444-3 at 3_5.

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these risky Jockdown cells. See, e.g., Docket No. 52·16 at ~'I! 7, II ; Ex. 0 at 34:23-35 :4; Docket No. 108-7 at '~ 4·6.

21

Case No.: 5: 13-cv-23S4-PSG

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CFMG's own policies provide that a nurse does not conduct an assessment until after custody staff
has placed the inmate in the sobering cell and notified medical staff. I57
CFMG defends its reliance on nurses for alcohol and drug withdrawal treatment by stating
that its Standardized Nursing Procedures comply with California practice regulations and describing why eFMG selected a nonstandard protocol for identifYing and treating withdrawal. 158
But this nonstandard protocol is not referenced in any recent academic literature, does not appear to
have been validated for the uses to which il is being put and inappropriately conflates treatment approaches for alcohol, opiate and benzodiazepine withdrawal. 1S9 Nor does the protocol address
the lack of training tbcse nurses have received to make on-the-spot complex determinations of drug interactions and contraindications on RNS.I60 In any event, the evidence presented suggests that
nurses often depart from the protoCOJ.161 The result is what Cohen describes as a "dangerous and
substandard" withdrawal program. 162
1 ~8 See Docket No. 335 at 13, 15-16,20,27-29, 33. 159 Docket No . 360 at ' 1' 162-65,82. 160!d. ,,68_70. 161 Docket No. 49-3 Ex. J at 3, 20, 54..;56; Docket No. 108·8 at ,21. 162 Docket No. 360 at'l 79. One particular graphic example is the treatment received by Plaintiff Gomez when she was in extreme distress. See id. at ~~ 85-88. Gomez was admitted on January 13, but was not examined by a physician' further her treatment for alcohol and heroin withdrawal consisted of only onc day in a sobering cell. See id at,. 85. On January 15. when Gomez's blood pressure rose to 172/100, she was prescribed medication without any examination. The following day, no one conducted any clinical observation. See id. at~ 86. On January 17, a nurse made these observations: "Pt. seen by RN in room after reports from deputies that pt's room took 2 hrs to clean from vomit and diarrhea all over the place. RN found pi on bed frail audible congestion. Green mucous from nose. Vomit and diarrhea in toilet. Soiled diaper soaked through to clothes and linen." Without examining Gomez, the PA ordered IV fluid s and an anti-emetlc. The RN tried twice to start the IV line, but was unsuccessful and offered Gomez (who was vomiting) a pitcher of
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• Defendants shall implement a system to document that Defendants have provided qualified sign language interpreters to inmates who need them and that the inmates have understood the information conveyed by the qualified sign language interpreter.
Plaintiffs shall file any objections to Defendants' proposed plan within 10 days. The court will then make any necessary plan revisions and enter an order. Plaintiffs arc entitled Lo conduct reasonable monitoring of Defendants' compliance with this order, including the right to inspect the jail, interview staff and inmates, review relevant records and observe practices related to Defendants' compliance with the provisions of this order. As noted above, the bond requirement is waived. SO ORDERED. Dated: April 14, 2015
44 Case No.: 5: 13-cv-2354-PSG ORDER GRANTING MOTION FOR PRELIMINARY INJUNCTION

 </s> [2695914-1]

EXECUTION COPY
1

2

3

4

5 6

7

8 UNITED STATES DISTRJCT COURT
9
NORTHERN DISTRJCT OF CALIFORNIA 10

11

12
JESSE HERNANDEZ et al., on behalf of 13 themselves and all others similarly situated,

14

Plaintiffs,

15

v.

16 COUNTY OF MONTEREY; MONTEREY COUNTY SHERlFF' S OFFICE;
17 CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED, a California
18 corporation; and DOES 1 to 20, inclusive,

19

Defendants.

20

21

22

Case No. CV 13 2354 PSG SETTLEMENT AGREEMENT Judge: Hon. PaulS. Grewal Trial Date: September 8, 20 15

23

24 25
26

27
28

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1 I. INTRODUCTION

2

1. Plaintiffs are prisoners in the custody of the Monterey County Sheriffs

3 Office ("MCSO").

4

2. Defendants are the County of Monterey, Monterey County Sheriffs Office

5 and, California Forensic Medical Group, Incorporated ("CFMG").

6

3. The Court has certified this case as a class action. The class is defined as

7 "all adult men and women who are now, or will be in the future, incarcerated in the

8 Montere)'__County JaiL" The Court has also certified a sub-class of "all qualified

9 individuals with a disability, as that term is defined in 42 U.S.C. § 12102, 29 U.S.C. §

10 705(9)(B), and California Government Code§ 129260) and (m), and who are now, or will

11 be in the future, incarcerated in the Monterey County Jail."

12

4. The Court on April14, 2015, entered a Preliminary Injunction.

13

5. The purpose of this Settlement Agreement is to settle the above-captioned

14 case. The parties believe this agreement is fair, reasonable, and adequate to protect the

15 interests of all parties.

16

6. Defendants deny every allegation in each of the Complaints filed in this case.

17 This Settlement Agreement does not constitute, and shall not be construed, as an admission

18 of or evidence of any act of deliberate indifference to any inmate's constitutional rights,

19 violation of 42 U.S.C. § 1983, violation ofthe ADA, violation ofthe U.S. Constitution, or

20 any other wrongdoing or liability by any party. The Defendants expressly deny any

21 liability. Defendants deny that any of their policies, procedures and/or practices subject

22 inmates to a risk of harm or result in any deliberate indifference to inmates' safety,

23 medical, mental health, dental, or accessibility needs in violation of their state or federal

24 constitutional rights, state or federal law, or the ADA and Rehabilitation Act. The parties

25 agree that nothing in this Settlement Agreement shall be used against any Defendant in any

26 other litigation that has been or may be filed against any Defendant.

27

7. The Defendants state that prior to and since the initiation of this litigation,

28 the County of Monterey and Monterey County Sheriffs Office ("Monterey Defendants")

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1 and California Forensic Medical Group ("CFMG") had commenced significant initiatives

2 to enhance the delivery of mental health services and medical care, improve the safety of

3 the MCJ and improve jail and program accessibility, and the process has been ongoing

4 throughout the course of the litigation.

5

8. The parties will jointly file this Settlement Agreement with the Court, and

6 ask that the Court issue an order directing notice to the class, setting an objection period,

7 and a fairness hearing ("Preliminary Approval"), and that the Court approve it as final after

8 the fairness hearing ("Final Approval"). Final Approval is a condition precedent to the

9 Agreement's effectiveness, except as to the specific steps that the parties herein agree to

10 perform after Preliminary Approval.

11 II. PRELIMINARY AND FINAL APPROVAL OF CLASS ACTION SETTLEMENT
12 9. By May 29,2015, the parties shall jointly submit this Settlement Agreement
13 to the Court for Preliminary Approval and with a proposed order for Preliminary Approval
14 providing a schedule for notice, proposed notices of Preliminary Approval, objection
15 period, and fairness hearing, and proposed notice of the final remedy for posting upon
16 Final Approval under Rule 23(e) of the Federal Rules of Civil Procedure. Concurrent with
17 this filing the parties shall file a request to modify the dates mandated by the preliminary
18 injunction.
19 III. DEFINITIONS
20 10. "Substantial compliance" shall mean adherence to the requirements of the
21 Settlement Agreement and the Implementation Plans in all material respects, recognizing
22 that 100% compliance is not required. Non-systemic deviations from the requirements of
23 the Settlement Agreement and the Implementation Plans shall not prevent a finding of
24 substantial compliance, provided that the Defendants demonstrate that they have
25 (a) implemented a system for tracking compliance, where appropriate and practical, and
26 for taking corrective measures in response to instances of non-compliance, and (b) that
27 Defendants have instituted policies, procedures, practices, and resources that are capable of
28

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1 durable and sustained compliance. Substantial compliance shall be assessed by the 2 subject-area monitors and shall govern all requirements for the Settlement Agreement and

3 Implementation Plans.

4

11. "Administrative Segregation" shall be defined as a classification or program

5 in which prisoners are removed from the general population and confined in a designated

6 unit to separate them from other prisoners.

7

12. "MC": County of Monterey.

8

1]._~M~SQ": _M9n!~reyGol!l1tY§l1eriffs Office.

9

14. "CFMG": California Forensic Medical Group.

10

15. "Day(s)": Calendar days unless otherwise specified.

11

16. "Facility" or "Jail": Monterey County Jail.

12

17. "Disability" and "Disabilities" shall be defined in the same manner as to

13 include all persons considered to have a disability under the Americans with Disabilities

14 Act, and/or the Rehabilitation Act.

15

18. "Mediator" shall refer to the Honorable Nathanael Cousins. The parties

16 consent to the jurisdiction of the Honorable Nathanael Cousins to serve in this capacity.

17

19. "Prisoner(s)" shall be construed broadly to refer to one or more individuals

18 detained at, or otherwise housed, held, in the custody of, or confined at the Jail, or under

19 the custody ofMCSO at another location, such as a hospital or other treatment facility. The

20 term "prisoner" shall not include those individuals who are on parole or probation and not

21 physically in the custody of the MCSO. The term "prisoner" shall not include those

22 individuals who are detained during the process of investigation or arrest prior to booking

23 into jail. It shall also not include individuals participating in various pretrial release

24 programs.

25

20. To "implement" a policy means that the policy has been drafted and

26 distributed to all staff responsible for following or applying the policy; and, if appropriate,

27 all relevant staff have been trained on the policy; compliance with the policy is monitored

28

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1 and tracked, if practical, to assure the policy is consistently applied; and there are

2 corrective action measures to address lapses in application of the policy.

3

21. "Qualified Medical Professional" means a currently licensed physician,

4 physician assistant, nurse practitioner, or registered nurse qualified to deliver those health

5 care services he or she has undertaken to provide.

6

22. "Qualified Mental Health Professional" refers to an individual with training

7 in psychology, social work, psychiatric nursing, or marriage and family therapy, who is 8 currently licensed by the State of California to deliver those mental health services he or

9 she has undertaken to provide.

10

23. A Psychiatrist is a licensed Medical Doctor who has completed an approved

11 residency in psychiatry and is either certified by the American Board of Psychiatry and

12 Neurology or is eligible to take the exam for board certification.

13

24. "Staff members" or "staffing" includes all employees ofMC or CFMG,

14 including correctional officers, who have contact with prisoners.

15

25. "Medical Clearance" is a clinical assessment of physical and mental status

16 before an individual is admitted into the facility. The medical clearance may come from 17 on-site health staff or may require sending the individual to the hospital emergency room.

18 The medical clearance is to be documented in writing.

19

26. "Face-to-face interview" refers to an encounter between a clinician and

20 patient. The encounter is typically in-person, but this term does not preclude the use of

21 telemedicine and/or tete-psychiatry services.

22

27. "Initial Health Screening" is a face-to-face interview conducted by nursing

23 staff with the arriving individual that identifies immediate medical, mental health and/or

24 dental needs and provides for medication continuity.

25

28. "Initial Health Assessment" is a medical, mental health, dental and

26 communicable diseases screening which includes a history and physical examination by

27 appropriate clinical staff.

28

4
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1

29. "Mental Health Screening" is a face-to- face interview conducted by

2 Qualified Mental Health Professional using a standardized Mental Health Screening

3 questionnaire.

4

30. "Psychological Evaluation" is a confidential face-to-face interview and file

5 review conducted by a QUALIFIED MENTAL HEALTH PROFESSIONAL or

6 PSYCHIATRIST, primarily for purposes of determining diagnosis, level of functioning,

7 and recommended level of care and course of treatment.

8 IV. SIIBSIANIIVE_pR_OYISJ_O_NS_____ _ _

9

31. The parties shall develop Implementation Plans in the following subject

10 areas for improvement of care, services, programs, and activities at the Jail. The plans are

11 intended to ensure that the class is not exposed to substantial risks of serious harm, and

12 that the subclass is not subject to discrimination on account of disability. These

13 Implementation Plans will be adopted as part of the Settlement Agreement. The recitation

14 of subject matters to be addressed by the Implementation Plans is for purposes of

15 describing the scope of the Settlement Agreement and does not constitute an admission by

16 Defendants that existing policies and procedures are inadequate.

17

a. Intake Screening. Defendants will develop and implement an Intake

18 Screening Implementation Plan that specifies standards and timelines to ensure that

19 arriving prisoners are promptly screened for urgent medical, mental health and dental

20 needs, with prompt follow-up and disability accommodations. The standards and timelines

21 shall include Medical Clearance on arrival at the jail to determine whether the prisoner

22 must be excluded on medical or mental health grounds, Intake Health Screening on arrival

23 at the jail, and Initial Health Assessment within time frames determined by the conditions

24 and acuity found in the Intake Health Screening. The Implementation Plan shall include a

25 mental health assessment tool to be used with all prisoners at intake to determine which

26 prisoners need Psychological or Psychiatric Evaluation and on what time frame. The

27 Implementation Plan shall also include standards and timelines for Dental Evaluation. The

28 Intake Screening Implementation Plan shall provide for appropriate infectious disease

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1 screening and follow-up, including but not limited to screening for tuberculosis and

2 methicillin resistant staphylococcus aureus (MRSA). The Intake Screening

3 Implementation Plan shall also provide for standards and timelines for medication

4 continuity either through outside verification or on-site physician medication order, Initial

5 Health Assessment for all incoming prisoners with chronic illnesses, Psychological

6 Evaluation for persons with signs of development disability, Psychological Evaluation for

7 persons with signs and/or histories of mental illness that meet certain thresholds, clinical 8 evaluation of persons in need of detoxification with clinical determinations for any use of

9 sobering, safety or isolation cells, use of a suicide risk assessment tool, with Psychological

10 Evaluation for those with positive findings on the suicide assessment.

11

b. Infection Control

12

1. Defendants' tuberculosis identification, control and treatment

13 program shall comply with the standards laid out in Prevention and Control of 14 Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC (June

15 2006).

16

11. All inmates newly booked into the jail shall receive a timely

17 tuberculosis symptom screening administered by adequately trained health care staff (nurse

18 or higher level staff).

19

111. Defendants shall have a reliable system to track whether all

20 newly booked inmates have received tuberculosis screening and appropriate follow-up

21 testing and treatment.

22

c. Detoxification

23

1. Medical staff shall timely conduct the initial evaluation to

24 determine if an inmate is intoxicated and/or suffering from withdrawal or at high risk for

25 withdrawal.

26

11. The Health Care and Mental Health Implementation Plans shall

27 provide for necessary coordination between medical staff and custody regarding placement 28 ofprisoners in a sobering cell, addressing the prisoner's medical and mental health needs,

6
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1 custody's overall responsibility for safety and security of prisoners, prompt reviews by 2 medical of all placements, and a process of resolving disagreements between medical and

3 custody.

4

111. Medical providers shall be timely involved in assessing and

5 treating inmates potentially undergoing withdrawal, and non-provider medical staff shall

6 timely refer to providers those inmates undergoing withdrawals when clinically indicated.

7

d. Safety Cells. The Health Care and Mental Health Implementation

8 Plans shall provide for necessary_coor<i_ina_tiQ_l! be_tw~en Il].§dicajstaff and custody

9 regarding placement of prisoners in a safety cell, addressing the prisoner's medical and

10 mental health needs, custody's overall responsibility for safety and security of prisoners,

11 prompt reviews by medical of all placements, and a process of resolving disagreements

12 between medical and custody.

13

e. Medication Continuity

14

1. All inmates newly booked into the jail, who at the time of

15 booking are prescribed medications in the community, shall be timely continued on those

16 medications, or prescribed comparable appropriate medication, unless a medical provider

17 makes an appropriate clinical determination that medications are not necessary for

18 treatment.

19

11. Inmates who, at the time of booking, report to Defendants that

20 they are taking community-prescribed medications, but whose medications cannot be

21 verified by Defendants, shall be timely assessed by a medical provider and timely

22 prescribed medications necessary to treat their health needs.

23

f. Custody Staffing

24

1. Defendants will develop and implement a Custody Staffing

25 Implementation Plan to address inmate and staff safety and to address medical, mental

26 health, disability-related, and other required programs and services.

27

n. The Staffing Implementation Plan will include necessary posts

28 and functions to increase prisoners' access to out-of-cell activity, yard, education and other

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1 in-house jail programs, including using programs necessary for milestone credit earning

2 under Cal. Penal Code§ 4019 or any other applicable law.

3

111. The Staffing Implementation Plan will identify all needed posts

4 and positions for custody staff members based on current and projected Jail population,

5 and the number and qualification of correctional staffto cover each post and position, with

6 shift relief.

7

lV. The Staffing Implementation Plan will ensure adequate

8 coverage to supervise each housing and specialized housing area, to escort prisoners for

9 court, for visits and legal visits, medical and mental health appointments, yard and other

10 operations of the Jail, and to respond to medical, mental health, security, and natural

11 disaster emergencies.

12

g. Clinical Staffing. Defendants will develop and implement a Clinical

13 Staffing Implementation Plan to establish and maintain Qualified Medical Professional and

14 Qualified Mental Health Professional staffing at the Jail to ensure adequate staffing to

15 provide all necessary medical and mental health care, including intake, sick call, chronic

16 and emergency care, psychiatric therapy, medication management, records management,

17 and suicide prevention. The plan will identify all needed positions based on current and

18 projected Jail population, and the number and qualifications of medical and mental health

19 care staff to cover each position, with shift relief.

20

h. Medical Care

21

1. Defendants shall develop and implement a Health Care

22 Implementation Plan to expand the provision of care for inmates with serious medical

23 and/or mental health needs and to ensure they receive timely treatment appropriate to the

24 acuity of their conditions.

25

11. Defendants shall ensure timely access to necessary treatment

26 by Qualified Medical Professionals for prisoners with medical issues, including

27 appropriate medication practices, appropriate treatment, adequate clinical and

28 administrative treatment space, access to specialists and hospitalization, appropriate

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1 emergency response, appropriate means for requesting medical attention in all levels of

2 custody including segregation, appropriate chronic care, appropriate follow up medical

3 attention for prisoners discharged from the hospital, and appropriate supervision of all

4 medical staff.

5

Ill. Defendants shall ensure that appropriate and complete medical

6 records are maintained to ensure adequate treatment of prisoners' serious medical and

7 mental health needs. Medical records shall include all records, results, and orders received

8 from off-site consultations and tre'!tm~_1!_t~9nc!_~te4_while_the prisoner is in the Jail

9 custody.

10

1. Mental Health Care

11

1. Defendants shall develop and implement a Mental Health Care

12 Implementation Plan to more thoroughly ensure timely access to necessary treatment by

13 Qualified Mental Health Professionals for prisoners with mental illness, including

14 appropriate screening, detoxification and medication practices, appropriate therapies,

15 adequate clinical and administrative treatment space, access to hospitalization and

16 inpatient care, appropriate suicide prevention practices and policies, appropriate use of

17 seclusion, and appropriate disciplinary policies and practices regarding the mentally ill,

18 and appropriate training of corrections and mental health staff to recognize and treat

19 prisoners' mental illness.

20

n. Defendants shall develop policies and procedures for the safe

21 and appropriate use of restraint chairs and similar means of physical restraint, including

22 but not limited to prompt clinical consultations, and observations.

23

111. The Mental Health Implementation Plan shall require

24 classification to assess a totality of factors when assigning prisoners to administrative

25 segregation units. It is the understood that the goal of Defendants is to limit the use of

26 administrative segregation for prisoners with serious mental illness. The Mental Health

27 Implementation Plan shall require placement screening of all prisoners for mental illness

28 and suicidality before or promptly after they are housed in administrative segregation, and

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1 require procedures to mitigate the impact of administrative segregation on persons with

2 mental illness, including but not limited to structured therapeutic activity outside the

3 segregation cell and where feasible assignment of cell mates.

4

IV. The Mental Health Implementation Plan shall address suicide

5 watch and suicide precaution procedures to ensure that prisoners in crisis are not placed in

6 punitive and/or unsanitary conditions.

7

v. Defendants shall remove hanging points and other hazards in

8 jail administrative segregation cells that pose an unreasonable risk of being used by

9 inmates to harm themselves or attempt suicide. While it is recognized that it is impossible

10 to suicide proof a jail, Defendants will in good faith work with a consultant to develop and

11 implement a plan to reduce hanging points and other suicide hazards in the jail

12 administrative segregation cells.

13

VI. The Implementation Plans shall address standards for health

14 and safety checks of all inmates housed in segregation cells at irregular intervals with the

15 specific frequency of checks to be addressed in the Plans to address the needs of particular

16 classifications of inmates.

17

vu. Nursing staff shall conduct daily mental health rounds in

18 segregation.

19

J. Dental Care: Defendants shall develop and implement a Dental Care

20 Implementation Plan to ensure timely access to necessary treatment for dental and oral

21 health conditions, including but not limited to Intake Screening, access to care other than

22 extractions, a safe and sanitary on or off-site facility for necessary dental care, periodic

23 dental care for long-term prisoners, and access to dental hygiene supplies.

24

k. Safety

25

1. Defendants shall develop and implement a Violence Reduction

26 Implementation Plan to provide prisoners with a safe and secure environment and intended

27 to ensure reasonable safety from harm. Defendants shall take all reasonable measures to

28 improve inmate and custodial staff safety. The Implementation Plan shall ensure that

10
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1 during the course of incarceration, prisoners are not subjected to unnecessary or excessive

2 force by Staff and are reasonably protected from violence by other prisoners.

3

11. Defendants' plan shall include physical and structural issues to

4 improve safety and security, which may include camera installation. Defendants' plan

5 shall, to the extent possible, prioritize the use of evidence-based policies, including but not

6 limited to increasing Work Alternative Program limits, Involuntary Home Detention, Pre-

7 trial Release though Probation, a revised Own Recognizance (OR) eligibility policy,

8 ChoicesLLiberty_p_ride (QI"~quival~nlpJ:'QgJ."~!TI~l~i!!l~at!<ma! early _l'e)_t;:ase kickouts, Penal

9 Code 4018.1 and 4014.1 kickouts. The parties recognize that pre-trial release, diversion,

10 split sentencing, the use of home and GPS monitoring are also available and beneficial,

11 and should be tracked, but are dependent on the discretion of the Monterey County

12 Superior Court and District Attorney.

13

1. Prisoners with Disabilities

14

1. Defendants shall develop and implement an ADA

15 Implementation Plan to improve accessibility to inmate programs and services. The

16 Implementation Plan will ensure that prisoners with disabilities are not discriminated

17 against and are not denied the benefits of, or participation in, programs, services, and

18 activities at the Jail.

19

11. Defendants shall design and implement a system for

20 identifying and tracking all inmates who are qualified individuals with disabilities, as that

21 term is defined by the ADA and its implementing regulations, including but not limited to

22 inmates with mobility impairments or who are deaf, hard of hearing or unable to speak.

23 Defendants shall also design and implement a system for identifying and tracking the

24 reasonable accommodations necessary for qualified inmates with disabilities to participate

25 in programs, services and activities offered by Defendants at the Jail.

26

111. Prisoners' requests for a particular type of accommodation

27 shall be given primary consideration and shall be granted unless the request is

28

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1 unreasonable for specific articulated reasons allowable under Title II of the ADA or pose a

2 significant safety or security threat.

3

IV. Defendants shall furnish qualified sign language interpreters to

4 any inmates for whom sign language is their only or primary method of communication, in

5 all circumstances where a qualified sign language interpreter is necessary to ensure an

6 inmate has an equal opportunity to participate in, and enjoy the benefits of, programs,

7 services and activities offered by Defendants. The interactions for which Defendants must

8 furnish qualified sign language interpreters include but are not limited to the intake

9 process, at classification hearings, disciplinary hearings, all medical, mental health and

10 dental treatment, religious services, educational classes such as Choices and Pride classes

11 or the equivalent, Narcotics and Alcoholics Anonymous meetings or the equivalent, and

12 any other interactions with staff that implicate an inmates' due process rights. Defendants

13 may employ alternatives to a live sign language interpreter such as video remote

14 interpreting providing that Defendants demonstrate to the ADA monitor the efficacy of the

15 alternatives employed. Defendants need not maintain a full-time staff sign language

16 interpreter, but may use on-call services.

17

v. Defendants shall implement a system to document that

18 Defendants have provided qualified sign language interpreters or reasonable alternatives to

19 inmates who need them and that the inmates have understood the information conveyed by

20 the qualified sign language interpreter or alternative form of communication as outlined in

21 Paragraph iv above.

22

Vl. The County Defendants shall offer inmates with ambulatory

23 disabilities all programs, services and activities offered to other inmates, including but not

24 limited to outdoor exercise, religious services, education programs such as Choices and

25 Pride classes or the equivalent, and Narcotics and Alcoholics Anonymous meetings or the

26 equivalent, in locations that do not require them to climb stairs in order to access the

27 programs, services and activities, as long as those programs, services and activities are

28 offered to the general population.

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1

32. The Implementation Plans outlined in this Settlement Agreement shall not

2 extend to subject areas beyond what is addressed in Section IV of this Agreement.

3

33. The parties agree to begin work on development of the Implementation Plans

4 immediately, without awaiting Final Approval of the class action settlement. If the parties

5 agree on all aspects of the Implementation Plans, the settlement agreement will be

6 amended to incorporate the plans.

7

a. No later than July 30, 2015, Defendants shall submit to Plaintiffs the

8 plans identifie_d_in the_Or_der Granting Motion for Preliminary Injun<;tion (Docket No. 460,

9 at 42-43.) No later than 10 days thereafter, Plaintiffs shall respond with specific comments

10 or objections if any. The parties shall meet and confer to resolve all disputed items within

11 30 days thereafter. Any unresolved items shall be submitted to the agreed upon mediator.

12 If the parties are still unable to agree to the content of the plans, the parties shall seek

13 redress with the Court.

14

b. No later than October 15, 2015, the parties shall have completed

15 meeting and conferring concerning the Implementation Plans. At that time, if there are any

16 unresolved issues, the parties agree to submit the unresolved issues to the agreed upon

17 mediator. If the parties are still unable to agree to the content of the Implementation Plans,

18 the parties shall seek redress with the Court. The parties shall jointly file all

19 Implementation Plans with the Court, requesting that the Court approve the plans as an

20 amendment to the Settlement Agreement.

21

34. All provisions of the Implementation Plans will be enforceable by the Court,

22 as part of the Settlement Agreement.
23 v. MONITORING

24

35. The parties agree that expert monitors will be retained to monitor

25 Defendants' compliance with this Settlement Agreement and the Implementation Plans in

26 the following subject areas:

27

a. ADA Compliance.

28

b. Mental health care.

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1

c. Medical care.

2

d. General conditions of confinement and jail security.

3

e. Dental care.

4

36. The parties shall meet and confer on the process for selecting monitors. If no

5 monitors are selected by Oct. 1, 2015, the parties shall submit lists of names to the

6 mediator for selection.

7

37. If any of the monitors become unavailable to monitor their respective areas,

8 the parties will meet and confer, and assign a new expert to monitor compliance with this

9 Settlement Agreement and the Implementation Plans for their respective areas of expertise.

10 The parties may agree at any time to remove and replace a monitor.

11

38. Defendants shall pay the fees and costs incurred by the designated monitors

12 and their staff. Invoices will be provided to all parties for their review before payment.

13 There will be a yearly budget negotiated with each designated monitor. If any monitor

14 exceeds the budget for fees or costs without prior approval, he or she may be removed and

15 replaced through the process described in Paragraph 36 above. If the parties do not agree

16 on removal, either party may refer the matter to the mediator, and if necessary to the Court

17 to determine whether the monitor should be retained or removed.

18

39. The designated monitors shall have access to all jail facilities upon

19 reasonable notice, to assess substantial compliance with this Settlement Agreement, and

20 the incorporated Implementation Plans. All site visits shall take place on consecutive days.

21 There shall be no more than two (2) site visits in each year, per monitor, that the

22 Settlement Agreement is in effect. These visits may take up to two (2) days each.

23

40. The designated monitors shall have access to meet and interview personnel

24 whose duties pertain to the provision of services and/or who work with inmates in the area

25 of the expert's expertise.

26

a. The designated monitors shall have a reasonable opportunity to

27 conduct confidential interviews of inmates to assess whether Defendants are in compliance

28 with the terms of the Settlement Agreement and Implementation Plans.

14
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1

b. The designated monitors may request to review County or CFMG

2 documents, except those documents protected by attorney-client or work product

3 privileges, or by state or federal law, to monitor Defendants' compliance with the terms of

4 this Settlement Agreement and all Implementation Plans. If these documents are requested

5 in conjunction with a site visit, Defendants will provide these documents to the extent

6 feasible within ten (1 0) days prior to the visit.

7

c. During the site visits, the designated medical, mental health and

8 dental me>_11ito]_'S shall ha~~_re('I,SQnable _'!_ccess tq current inmate health records, induding

9 mental health records, consistent with Defendants' obligations under Federal and State

10 law, as those obligations have been modified by Court order.

11

d. Monitors shall be provided with and agree to be bound by any

12 protective or Court orders entered in this case to protect the confidentiality of prisoner

13 records and security sensitive information.

14

e. The designated monitor will prepare a draft written report on the

15 Defendants' efforts to meet the terms of this Settlement Agreement and all Implementation

16 Plans at least twice a year and within 30 days of the later of the monitor's site inspection

17 and the monitor's receipt of all requested documents and information, and in no case later

18 than 45 days after the inspection. Each report shall contain a determination of whether

19 Defendants are "substantially complying" with the applicable Implementation Plan. The

20 draft report will be delivered to all parties to this Agreement. If the designated monitor

21 concludes that Defendants have not substantially complied with the terms of any provision

22 or provisions of the Settlement Agreement and Implementation plans, the designated

23 monitor shall make recommendations as to actions they believe to be necessary to

24 substantially comply with the terms of the provision or provisions. The parties will have

25 30 days to provide written comments, objections or to cure issues and 7 days to reply. The

26 monitor may re-inspect before issuing a final report. Final reports shall be due 20 days

27 after the later of the monitor's receipt of any comments, objections or replies, or any re-

28 inspection.

15
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1

41. Plaintiffs are entitled to conduct reasonable monitoring of Defendants'

2 compliance with this Agreement, including the right to inspect the jail, interview staff and

3 inmates, review relevant records and observe practices related to Defendants' compliance

4 with the provisions of this Agreement. Plaintiffs' routine monitoring will not exceed four

5 (4) inspections of not more than one day per inspection of Jail operations per year, limited

6 to no more than one attorney and one expert per inspection. Defense counsel reserves the

7 right to be present for any inspections and/or staff interviews. The parties shall develop a

8 monthly report for the purposes of monitoring and tracking performance under the

9 Implementation Plans. Plaintiffs shall use the Office of the Public Defender for

10 monitoring as appropriate. The parties shall meet and confer regarding any disputes

11 regarding the scope and extent of inspections or access to information, and if necessary,

12 shall seek the involvement of the mediator.

13

42. Defendants will notify Plaintiffs at least 30 days in advance of any scheduled

14 training sessions related to substantial compliance with this Settlement Agreement and/or

15 the Implementation Plans, and shall provide Plaintiffs with all training materials at least 10

16 days in advance of the training.

17

43. The parties shall agree on a mechanism for promptly addressing concerns

18 raised by Plaintiffs' counsel regarding individual class members and emergencies. Before

19 contacting Defendants, Plaintiffs' counsel will make every effort to verify that the

20 concerns of individual class members are accurate, substantive and not frivolous, such as

21 having the Office of the Public Defender meet with the individual class members. The

22 parties agree that Defendants may appeal to the Court for modification of this paragraph

23 should a significant number of concerns raised by Plaintiffs' counsel be found to be

24 inaccurate, lacking substantive, or frivolous.

25

26 VI. RESERVATION OF JURISDICTION AND ENFORCEMENT

27

44. The parties consent to the reservation and exercise ofjurisdiction by the

28 District Court over all disputes between and among the parties arising out of this

16
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1 Settlement Agreement. The parties agree this Settlement Agreement shall not be construed

2 as a consent decree.

3

45. For the purposes ofjurisdiction and enforcement of this Settlement

4 Agreement only, the parties jointly request the Court find that this Settlement Agreement

5 satisfies the requirements of 18 U.S.C. § 3626(a)(1)(A) in that it is narrowly drawn,

6 extends no further than necessary to correct the violation of the Federal right, and is the

7 least intrusive means necessary to correct the violation of the Federal right of the Plaintiffs.

8 In the even_t th~ Court fin!l~tbat:l)~encia11!S have not substantially complied with the

9 Agreement, it shall in the first instance require Defendants to submit a plan for approval by

10 the Court to remedy the deficiencies identified by the Court. In the event the Court

11 subsequently determines that the Defendants' plan did not remedy the deficiencies, the

12 Court shall retain the power to enforce this Agreement through all remedies provided by

13 law, excluding the imposition of a consent decree.

14

46. The Court shall retain jurisdiction to enforce the terms of this Settlement

15 Agreement and, once they are approved, the Implementation Plans for a period of five

16 years, unless Plaintiffs' counsel can demonstrate to the Court through noticed motion that

17 jurisdiction should be retained for a longer period. The Court shall have the power to

18 enforce the terms of this Settlement Agreement through specific performance and all other

19 remedies permitted by law or equity, excluding the imposition of a Consent Decree.

20

47. The Court shall be the sole forum for the enforcement of this Settlement

21 Agreement. Any order to achieve substantial compliance with the provisions of this

22 Settlement Agreement shall be subject to the applicable provisions of the Prison Litigation

23 Reform Act, 18 U.S.C. Section 3626.

24

48. If Plaintiffs' counsel believes that Defendants are not substantially

25 complying with any of the acts required by this Settlement Agreement or the

26 Implementation Plans, they shall notify Defendants in writing of the facts supporting their

27 belief. Defendants shall investigate the allegations and respond in writing within 30 days.

28 If Plaintiffs' counsel are not satisfied with Defendants' response, the parties shall conduct

17
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1 negotiations to resolve the issue(s). If the parties are unable to resolve the issue(s)

2 satisfactorily, the parties agree to present the issue(s) to the agreed upon mediator. If the

3 parties are still unable to resolve the issue(s), either party may move the Court for any

4 relief permitted by law or equity. In cases of particular urgency that are central to the

5 purpose of the Settlement Agreement, a party may opt to bring disputes directly to the

6 District Court, or both parties may consent to bypass the use of the mediator if the parties

7 agree the issue should be briefed to the Court with prior notice to the mediator.

8

49. This Settlement Agreement may be enforced only by the parties hereto.

9 Nothing contained in this Settlement Agreement is intended or shall be construed to

10 evidence of an intention to confer any rights or remedies upon any person other than the

11 parties hereto.

12 VII. TERMINATION

13

50. The parties or any party may agree or request a finding that Defendants are

14 in substantial compliance with a particular Implementation Plan or any material part

15 thereof and have maintained substantial compliance for a period of twelve months. [See

16 definitions and monitoring sections.] Such a finding will result in a reduction or

17 suspension of monitoring of that issue. If Plaintiffs present evidence that Defendants are

18 no longer in substantial compliance with requirements previously found in substantial

19 compliance, the Court may order additional relief including but not limited to reinstating

20 full monitoring.

21

51. If at any time, the Court finds that Defendants are in substantial compliance

22 with all requirements of this Settlement Agreement and all Implementation Plans,

23 Defendants may move the Court for an order terminating the Settlement Agreement.

24

52. The parties intend to work in good faith to achieve substantial compliance

25 with all requirements of this Settlement Agreement and all Implementation Plans within

26 five (5) years from Court approval of the Settlement Agreement and Implementation Plans.

27 If Plaintiffs believe that the Defendants are not in substantial compliance at the end of five

28 (5) years from Court approval of the Implementation Plans, Plaintiffs may move for an

18
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1 order extending jurisdiction over the Settlement Agreement. In order to extend

2 jurisdiction, the Plaintiffs must establish and the Court must determine that Defendants are

3 not in substantial compliance. Unless jurisdiction is extended by the Court, the Settlement

4 Agreement shall terminate five (5) years from Court approval of the Settlement Agreement

5 and Implementation Plans. Nothing in this paragraph shall limit the parties' rights to

6 challenge or appeal any finding as to whether Defendants are not in substantial compliance

7 with the Settlement Agreement and all Implementation Plans, or consequent order entered

8 by the Court_.______________ _

9 VIII. AMENDMENTS

10

53. By mutual agreement, the parties may change the terms of this Settlement

11 Agreement, including, but not limited to, the timetables for taking specific actions,

12 provided that such mutual agreement is memorialized in writing, signed by the parties and

13 approved by the Court.

14

54. Defendants shall not make any changes to any policy provision

15 implementing the provisions of this Settlement Agreement and Implementation Plans

16 without providing Plaintiffs a written draft of such policy or policies, for their review and

17 comment.

18

55. Without prior agreement of the parties, Defendants may not amend any

19 policy provision to conflict with the terms of this Settlement Agreement while the

20 Settlement Agreement remains in effect.

21

56. Defendants shall not approve any changes to a policy maintained by its

22 health care provider that conflicts with the terms of this Settlement Agreement and

23 Implementation Plans.

24 IX. FUNDING

25

57. The parties acknowledge that implementation of this Settlement Agreement

26 and the Implementation Plans are subject to the availability and receipt of appropriated

27 funds.

28

19
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1

58. The parties further acknowledge that the lack of funding does not preclude

2 the Court from entering any order to achieve compliance with this Settlement Agreement

3 that comports with the applicable provisions of the Prison Litigation Reform Act, 18

4 U.S.C. Section 3626 and with other applicable law, provided that Defendants reserve the

5 right to assert that the lack of funding should be taken into account in any remedial order.

6

59. Defendants agree to make all possible good faith efforts to seek all necessary

7 funding to implement this Settlement Agreement and all Implementation Plans. In the

8 event that the parties are unable to agree as to whether there is sufficient funding to

9 implement fully this Settlement Agreement and Implementation Plans, the parties shall

10 meet and confer, and if necessary, consult the Court. In the event that the parties continue

11 to be unable to agree, either Defendants or Plaintiffs may seek the assistance of the Court

12 and if necessary consult the mediator.

13 X. ATTORNEY'S FEES AND EXPENSES

14

60. Attorney's fees and expenses shall be addressed as follows.

15

61. Plaintiffs shall provide the Court and Defendants with a fees application

16 including the supporting materials provided by Civil L.R. 54-5.

17

62. Fees and expenses through Final Approval of Settlement Agreement,

18 including approval of all Implementation Plans: Plaintiffs agree not to seek fees and

19 expenses from the Court in an amount above $4.8 million, for fees and expenses incurred

20 through Final Approval of the Settlement Agreement, including approval of all

21 Implementation Plans. Defendants agree not to object to plaintiffs' petition for fees and

22 expenses up that amount. The parties acknowledge that Court approval of the fees and

23 expenses is required.

24

63. Fees and expenses after Final Approval of Settlement Agreement:

25 Plaintiffs may petition the Court for an award of no more than $250,000 per year in fees

26 and expenses arising from monitoring work, inspections, negotiations, meet and confer

27 processes, mediation, review of documents, and correspondence with class members, until

28 termination of Court enforcement. The parties contemplate that Plaintiffs will use the

20
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1 services of the Public Defender as part of this post-settlement monitoring and enforcement.

2 In any petition to the Court for fees and expenses, the Court should consider the efficiency

3 of the services rendered, including how Plaintiffs' counsel allocated services among the

4 different private counsel and the Public Defender. The $250,000 annual cap does not

5 apply to (1) Plaintiffs' motions to enforce the Settlement Agreement and Implementation

6 Plans; and (2) Plaintiffs' opposition to any motions filed by defendant(s) arising out of the

7 Settlement Agreement and Implementation Plans. The standard for Plaintiffs' eligibility

8 for fees and expense~arisi11g frol!l ~!aintifft__motions to the Court shall be that no fees and

9 expenses shall be awarded unless the Court finds (1) that the motion or opposition was

10 necessary to enforce substantial rights of the class under the Eighth Amendment and

11 Fourteenth Amendments to the United States Constitution, Article I, Sections 7 and 17 of

12 California Constitution, the Americans with Disabilities Act, Rehabilitation Act, or

13 California Government Code§ 11135; and, (2) that Plaintiffs attempted to resolve the

14 matter and/or narrow the issues as much as possible by meeting and conferring with

15 Defendants, taking full opportunity of recourse to the mediator before presenting the issues

16 to the Court. Defendants shall be eligible for an award of fees and costs from plaintiffs'

17 private counsel, and Plaintiffs shall receive none, in the event that the Court finds that

18 Plaintiffs' motion was frivolous, unreasonable or groundless, or that Plaintiffs continued to

19 litigate it after it clearly became so. Furthermore, Plaintiffs agree that they may not seek

20 more than $150,000 each year in fees and expenses on motions to enforce the Settlement

21 Agreement.

22

64. If the Court determines that any enforcement motion is filed or opposed in

23 bad faith, it may award sanctions in the form of attorneys' fees and expenses, among other

24 remedies. The caps in Paragraph 63 do not apply to enforcement motions opposed in bad

25 faith by Defendants.

26

65. The parties commit to work together in good faith to resolve any future

27 disputes over fees and expenses. They agree to confer, and mediate, before presenting a

28 fee dispute motion to the Court.

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1

2 XI. MISCELLANEOUS PROVISIONS

3

66. Plaintiffs agree that if the Court does not grant Final Approval of this

4 Settlement Agreement, then Defendants reserve their right to appeal the preliminary

5 injunction entered in this case.

6

67. The parties agree to issue a joint press release announcing the settlement.

7

68. This Agreement constitutes the entire agreement among the parties as to all

8 claims raised by Plaintiffs in this action, and supersedes all prior agreements,

9 representations, statements, promises, and understandings, whether oral or written, express 10 or implied, with respect to this Agreement. Each Party represents, warranties and 11 covenants that it has the full legal authority necessary to enter into this Agreement and to

12 perform the duties and obligations arising under this Agreement. The County Defendant

13 shall be the last signatory to this agreement. This agreement may be signed in counterparts

14 and a copy shall be as good as an original and may be introduced as evidence.

15

69. This is an integrated agreement and may not be altered or modified, except

16 by a writing signed by all representatives of all parties at the time of modification.

17

70. This Agreement shall be binding on all successors, assignees, employees,

18 agents, and all others working for or on behalf of Defendants and Plaintiffs.

19

20 DATED:

ROSEN BIEN GALVAN & GRUNFELD LLP

21

By:

22

Michael W. Bien

23 24 DATED: 25 26 27

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY
By: James Egar, Public Defender Donald Landis, Assistant Public Defender

28

22
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1 DATED: 2 3 4

AMERICAN CIVIL LIBERTIES UNION FOUNDATION OF NORTHERN CALIFORNIA
By: Alan Schlosser

5 DATED:

ACLU NATIONAL PRISON PROJECT

6

By:

7

Eric Balaban

)/?/;s- ::UNzz 8

Attorneys for Plaintiffs

- - - - -------------------

9 DATED:

10

11

7Simon Salinas

12

Chair of the Board of Supervisors

13 DATED: 14 15

CALIFORNIA FORENSIC MEDICAL GROUP By:

16

17 Approved as to Form:
j;;;- 5'/7 18
19 DATED: 20 21 22 23 24

OFFICE OF THE COUNTY COUNSEL COUNTY OF MONTEREY
By: cli_cd~b;l~ Charles J. McK.ee County Counsel
Attorneys for Defendants COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF'S OFFICE

25

26

27

28

23
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1 DATED: 2 3 4 5 6 7 8 9 10
11
12
13
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

BERTLING & CLAUSEN, L.L.P.
By: Peter G. Bertling
Attorneys for Defendant CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED

24
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[2695914-1]

1

2 XI. MISCELLANEOUS PROVISIONS

3

66. Plaintiffs agree that if the Court does not grant Final Approval of this

4 Settlement Agreement, then Defendants reserve their right to appeal the preliminary

5 injunction entered in this case.

6

67. The parties agree to issue a joint press release announcing the settlement.

7

68. This Agreement constitutes the entire agreement among the parties as to all

8 claims raised by Plaintiffs in this action, and supersedes all prior agreements,

9 representations, statements, promises, and understandings, whether oral or written, express

10 or implied, with respect to this Agreement. Each Party represents, warranties and

11 covenants that it has the full legal authority necessary to enter into this Agreement and to

12 perform the duties and obligations arising under this Agreement. The County Defendant

13 shall be the last signatory to this agreement. This agreement may be signed in counterparts

14 and a copy shall be as good as an original and may be introduced as evidence.

15

69. This is an integrated agreement and may not be altered or modified, except

16 by a writing signed by all representatives of all parties at the time of modification.

17

70. This Agreement shall be binding on all successors, assignees, employees,

18 agents, and all others working for or on behalf of Defendants and Plaintiffs.

19
~~ D;r~:'J 1 )o (<)"'
22

By: ;! ~ ROSEN ~~UNFELD1LLP
Michael W. Bien

23 24 DATED: 25 26 27

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY
By: James Egar, Public Defender Donald Landis, Assistant Public Defender

28

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[2695914-1J

1

2 XI. MISCELLANEOUS PROVISIONS

3

66. Plaintiffs agree that if the Court does not grat1t Final Approval of this

4 Settlement Agreement, then Defendants reserve their right to appeal the preliminary

5 injunction entered in this case.

6

67. The parties agree to issue a joint press release announcing the settlement.

7

68. This Agreement constitutes the entire agreement among the parties as to all

8 claims raised by Plaintiffs in this action, and supersedes all prior agreements,

9 representations, statements, promises, and understandings, whether oral or written, express

10 or implied, with respect to this Agreement. Each Party represents, warranties and

11 covenants that it has the full legal authority necessary to ent er into this Agreement and to

12 perform the duties and obligations arising under this Agreement. The County Defendant

13 shall be the last signatory to this agreement. This agreement may be signed in counterparts

14 and a copy shall be as good as an original and may be introduced as evidence.

15

69. This is an integrated agreement and may not be altered or modified, except

16 by a writing signed by all representatives of all parties at the time of modification.

17

70. This Agreement shall be binding on all successors, assignees, employees,

18 agents, and all others working for or on behalf of Defendants and Plaintiffs.

19

20 DATED:

ROSEN BIEN GALVAN & GRUNFELD LLP

21

By:

22

Michael W. Bien

23
17r 24 DATED: .5"' j\)"'
25 26

OFFICE OF THE PUBLIC DEFENDER COUNTY OF MONTEREY
By:

27

28

22
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PAGE. 1/ 1

(2696914-1)

DATED:
2
3 4
5 DATED: 6
7 8
9 DATED:
10 11
12
13 DATED:
14
15 16 17 Approved as to Fonn: 18
DATED: 19 20
21 22 23 24 25 26
27 28

AMERICAN CIVIL LIBERTIES UNION FOUNDATION OF NORTHERN CALIFORNIA By:
Alan Schlosser
ACLU NATIONAL PRISON PROJECT By:
Eric Balaban Attorneys for Plaintiffs
COUNTY OF MONTEREY By:
Simon Salinas Chair of the Board of Supervisors
OFFICE OF THE COUNTY COUNSEL
COUNTY OF MONTEREY By:
Charles J. McKee County Counsel Attorneys for Defendants COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF,S OFFICE

23
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1 DATED: ~· l \·d-O \s-
2 3 4 5 6 7 8 9 10 11 12
13
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

BERTLING & CLAUSEN, L.L.P.
By:\)_,__~~. ~+-L·;s=~
Peter G. Bertling
Attorneys for Defendant CALIFORNIA FORENSIC MEDICAL GROUP, INCORPORATED

Settlement Agreement-Execution Copy

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 </s> CCaassee55:1:133-c-cvv-0-022335544-P-PSSGG DDooccuummeennt4t48835-4 FFileiledd0055/1/154/1/155 PPaaggee11oof f55

[2705980-1]

1 MICHAEL W. BIEN – 096891

ERNEST GALVAN – 196065

2 GAY C. GRUNFELD – 121944

VAN SWEARINGEN – 259809

3 MICHAEL FREEDMAN – 262850

KRISTA STONE-MANISTA – 269083

4 SARAH P. ALEXANDER – 291080

ROSEN BIEN

5 GALVAN & GRUNFELD LLP

315 Montgomery Street, Tenth Floor

6 San Francisco, California 94104-1823

Telephone: (415) 433-6830

7 Facsimile: (415) 433-7104

Email:

mbien@rbgg.com

8

egalvan@rbgg.com

ggrunfeld@rbgg.com

9

vswearingen@rbgg.com

mfreedman@rbgg.com

10

kstone-manista@rbgg.com

spalexander@rbgg.com

11

JAMES EGAR – 065702

12 Public Defender

DONALD E. LANDIS, JR. – 149006

13 Assistant Public Defender

OFFICE OF THE PUBLIC DEFENDER

14 COUNTY OF MONTEREY

111 West Alisal Street

15 Salinas, California 93901-2644

Telephone: (831) 755-5806

16 Facsimile: (831) 755-5873

Email:

EgarJS@co.monterey.ca.us

17

LandisDE@co.monterey.ca.us

ALAN SCHLOSSER – 049957

MICAELA DAVIS – 282195

AMERICAN CIVIL LIBERTIES UNION

FOUNDATION OF NORTHERN

CALIFORNIA, INC.

39 Drumm Street

San Francisco, California 94111-4805

Telephone: (415) 621-2493

Facsimile: (415) 255-8437

Email:

aschlosser@aclunc.org

mdavis@aclunc.org

ERIC BALABAN (admitted pro hac vice)

CARL TAKEI – 256229

NATIONAL PRISON PROJECT of the

AMERICAN CIVIL LIBERTIES UNION

915 15th Street N.W., 7th Floor

Washington, D.C. 20005-2302

Telephone: (202) 393-4930

Facsimile: (202) 393-4931

Email:

ebalaban@npp-aclu.org

ctakei@npp-aclu.org

18 Attorneys for Plaintiffs

19

UNITED STATES DISTRICT COURT

20

NORTHERN DISTRICT OF CALIFORNIA

21 JESSE HERNANDEZ et al., on behalf of themselves and all others similarly situated,
22 Plaintiffs,
23 v.
24 COUNTY OF MONTEREY; MONTEREY
25 COUNTY SHERIFF’S OFFICE; CALIFORNIA FORENSIC MEDICAL
26 GROUP, INCORPORATED, a California corporation; and DOES 1 to 20, inclusive,
27 Defendants.
28

Case No. CV 13 2354 PSG
[PROPOSED] ORDER GRANTING STIPULATED MOTION FOR PRELIMINARY APPROVAL OF CLASS ACTION SETTLEMENT AND EXTENSION OF TIME FOR PRELIMINARY INJUNCTION COMPLIANCE
Judge: Hon. Paul S. Grewal
[No Hearing Requested]

[PROPOSED] ORDER

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[2705980-1]

1

1. The Court finds that the proposed settlement falls within the range of

2 possible approval and is sufficiently fair to warrant the dissemination of notice to the class

3 members apprising them of the settlement.

4

2. The proposed settlement is the product of arm’s-length, serious, informed

5 and non-collusive negotiations between experienced and knowledgeable counsel who have

6 actively prosecuted and defended this litigation.

7

3. The Settlement Agreement is granted preliminary approval and incorporated

8 herein by this reference, and has the full force and effect of an order of the Court.

9

4. A hearing is appropriate to consider whether this Court should grant final

10 approval to this settlement, and to allow adequate time for members of the class, or their

11 counsel, to support or oppose this settlement.

12

GOOD CAUSE APPEARING THEREFORE, IT IS HEREBY ORDERED:

13

5. This action is determined to be properly maintained as a class action

14 pursuant to Rule 23(b)(2), Federal Rules of Civil Procedure. The Court has already

15 certified a class defined as “all adult men and women who are now, or will be in the future,

16 incarcerated in the Monterey County Jail.” The Court also certified a sub-class of “all

17 qualified individuals with a disability, as that term is defined in 42 U.S.C. § 12102, 29

18 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m), and who are

19 now, or will be in the future, incarcerated in the Monterey County Jail.”

20

6. Within 7 days after this Order granting Preliminary Approval, the written

21 notice of settlement (the “Notice”) shall be disseminated to the Class, substantially in the

22 form attached as Exhibit B to the Declaration of Ernest Galvan accompanying the

23 Stipulated Motion by the following means: (1) For the benefit of all class and sub-class

24 members, written Notices shall be posted throughout the Monterey County Jail, in the

25 same locations within the Jail that the Parties agreed class certification notices were to be

26 placed. (2) Copies of the Settlement Agreement shall be available in the Jail library and

27 made available to Jail inmates upon request. (3) Inmates under the custody of the

28 Monterey County Sheriff’s Office who reside at other locations (such as Natividad

1
[PROPOSED] ORDER

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1 Medical Center or the jail in Alameda County) shall be sent the Notice by first class mail

2 to their last known address, or shall be provided with the notice in person by custodial

3 staff. (4) The Notice and the Settlement Agreement shall be posted on the website of the

4 Monterey County Sheriff’s Office and made available for public review and downloading.

5 The notice informs class members that there is no right to opt-out of the class. The Court

6 certified a Rule 23(b)(2) class in which the class seeks “‘uniform relief from a practice

7 applicable to all of them,’” rather than “damages or relief for any specific Plaintiff.” (Dkt.

8 No. 431 at 48.) Opt-out rights are “contradictory to the very nature of . . . (b)(2) class

9 actions.” Newberg on Class Actions § 9:51 (5th ed.). The Notice constitutes valid, due,

10 and sufficient notice to the class, constitutes the best notice practicable under the

11 circumstances, and complies fully with the requirements of Rule 23 of the Federal Rules of

12 Civil Procedure. The proposed forms of Notice apprise class members in a fair and neutral

13 way of the existence of the settlement with the Defendants and their rights with respect to

14 the settlement.

15

7. The expense of giving notice to the class members shall be paid by the

16 Defendants. Dissemination of the Notice as provided above is hereby authorized and

17 approved, and satisfies the notice requirement of Rule 23(e), Federal Rules of Civil

18 Procedure, the Constitution of the United States, due process and any other applicable

19 rule(s) of this Court. No later than June 1, 2015, Defendants must file and serve on

20 Plaintiffs’ counsel an affidavit affirming that they published notice as required in the

21 Court’s order.

22

8. Any member of the class may write to the Court about whether the

23 settlement is fair. The Court will consider written communications when deciding whether

24 to approve the settlement. Comments must include at the top of the first page the case

25 name, Hernandez v. County of Monterey and case number (5:13-cv-02354-PSG).

26 Comments must be postmarked no later than July 11, 2015, and sent to the following

27 address:

28

Clerk of the Court

2
[PROPOSED] ORDER

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1

United States District Court

Northern District of California

2

280 South 1st Street

San Jose, CA 95113

3

9. A final approval hearing pursuant to Rule 23(e), Federal Rules of Civil

4

Procedure, will be in the Courtroom of undersigned on August 4, 2015 at 10:00 a.m. in the

5

United States District Court for the Northern District of California, to determine whether

6

the proposed settlement is fair, reasonable and adequate, and whether it should be finally

7

approved by the Court. The hearing may be continued from time to time without further

8

notice.

9

10. Party briefs in support of final approval shall be filed on or before July 28,

10

2015.

11

11. Plaintiffs’ motion for reasonable attorneys’ fees and expenses shall be filed

12

and served no later than October 2, 2015. Defendants’ response to the fees motion shall be

13

filed and served no later than October 16, 2015. Plaintiffs’ reply shall be filed and served

14

no later than October 23, 2015. A hearing on the motion for attorneys’ fees and expenses

15

shall be held on November 6, 2015.

16

12. The deadlines set by the Order Granting Motion for Preliminary Injunction

17

(Docket No. 460, at 42-44) are amended as follows:

18

a. No later than July 30, 2015, Defendants must provide to Plaintiffs’

19

counsel the plans to address the elements set forth at pages 42-44 of the Order. The plans

20

shall not be filed with the Court.

21

b. No later than 10 days thereafter Plaintiffs shall respond with specific

22

comments or objections if any.

23

/ / /

24

/ / /

25

/ / /

26

/ / /

27

/ / /

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3
[PROPOSED] ORDER

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1

c. The Parties shall meet and confer to resolve all disputed items within

2 30 days thereafter. Any unresolved items shall be submitted to the agreed upon mediator,

3 Hon. Nathanael Cousins. If the Parties are still unable to agree to the content of the plans,

4 the Parties shall submit disputed issues to the Court.

5

IT IS SO ORDERED.

6 DATED: May _1_5_, 2015

7

8

Paul S. Grewal

9

Magistrate Judge of the U.S. District Court

10

11

12

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14

15

16

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18

19

20

21

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23

24

25

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4
[PROPOSED] ORDER

 </s> Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 1 of 140

1 Peter G. Bertling # 131602 Jemma Parker Saunders, #227962
2 Paul D. Singer, #254957 BERTLING & CLAUSEN L.L.P.
3 15 West Carrillo Street, Suite 100 Santa Barbara, California 93101
4 Telephone: (805) 892-2100 Facsimile: (805) 963-6044
5 pgb@bertling-clausen.com jps@bertling-clausen.com
6 Attorneys for Defendant
7 CALIFORNIA FORENSIC MEDICAL GROUP, INC.

8

9

10

UNITED STATES DISTRICT COURT

11

FOR THE NORTHERN DISTRICT OF CALIFORNIA

12

13

JESSE HERNANDEZ, CAIN AGUILAR, HA COBB, SUSAN DILLEY, CONNIE

) Case No. CV 5:13 2354 PSG )

14

DOBBS, SEAN ESQUIVEL, RAMONA GIST, MARTHA GOMEZ, GEORGE

) DEFENDANT CFMG’S MOTION ) FOR APPROVAL OF

15

GREIM, DENNIS GUYOT, JASON HOBBS,) IMPLEMENTATION PLAN

GLENDA HUNTER, ALBERT KEY,

)

16

BRANDON MEFFORD, WESLEY MILLER, RICHARD MURPHY, JEFF

) )

17

NICHOLS, ANGEL PEREZ, SARAB SARABI, CLYDE WHITFIELD, and

) )

18

ROBERT YANCEY, on behalf of themselves )

and all others similarly situated,

)

19

)

Plaintiffs,

)

20 v.

) ) Action Filed: May 23, 2013

21

COUNTY OF MONTEREY; MONTEREY

) Judge: ) Ctrm:

Hon. Paul Singh Grewal 5 - Fourth Floor

22

COUNTY SHERIFF’S OFFICE; CALIFORNIA FORENSIC MEDICAL

) )

23

GROUP, INCORPORATED, a California corporation; and DOES 1 to 20,

) )

24

)

Defendants.

)

25

)

26

DEFENDANT CFMG’S MOTION FOR APPROVAL

27

OF IMPLEMENTATION PLAN

28

i

5:13cv2354 PSG

DEFENDANT CFMG'S MOTION FOR APPROVAL OF IMPLEMENTATION PLAN

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 2 of 140

1

I. INTRODUCTION

2

During the course of this litigation CFMG has worked with Plaintiffs’ counsel to

3 develop a comprehensive Implementation Plan designed to ensure that inmates at the

4 Monterey County Jail (MCJ) receive medical, mental health and dental services that meet

5 or exceed community and constitutional standards. In reality, Plaintiffs’ counsel and

6 CFMG share a common goal. They each want to see a medical, mental health and dental

7 care delivery system at MCJ which provides constitutionally adequate treatment for all

8 inmates. Unfortunately, the Parties are not in complete agreement on how to reach that

9 goal.

10

CFMG’s Implementation Plan has been revised on numerous occasions in response

11 to various recommendations and objections which have been raised by Plaintiffs’ counsel.

12 Attached hereto as Exhibit A is a copy of the Implementation Plan most recently proposed

13 by CFMG. CFMG requests that the Court approve this Implementation Plan in its entirety

14 and allow them 45 days to train their staff regarding the provisions of the Plan before

15 requiring its implementation.

16

In a Joint Letter Re: Implementation Plan Status filed with this Court on March 18,

17 2016, (Dkt. 527) the parties set forth two lists: (1) Issue on which the parties continued to

18 negotiate and which may need to be briefed and (2) Disputed issues which were fairly

19 certain to require briefing. CFMG and Plaintiffs’ counsel have been able to resolve many

20 of the issues on which they continued to negotiate since March 18, 2016. However,

21 CFMG and Plaintiffs’ counsel have not been able to resolve any of the disputed issues.

22

Plaintiffs’ counsel continues to raise a number of specific objections to CFMG’s

23 Implementation Plan. CFMG contends these objections are unfounded and include

24 requirements that were never contemplated nor negotiated as part of the Settlement

25 Agreement approved by the Honorable Paul Grewal on August 18, 2015. In addition,

26 many of Plaintiffs’ objections require CFMG to exceed community standards or guidelines

27 published by the Institute of Medical Quality (IMQ) or National Commission on

28 ///

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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 3 of 140

1 Correctional Health Care (NCCHC). This is not what CFMG bargained for when entering

2 into the Settlement Agreement.

3

II. PLAINTIFFS’ SPECIFIC OBJECTIONS TO

4

CFMG’S IMPLEMENTATION PLAN

5

A. Restraint Chairs and Other Physical Means of Restraint

6

Plaintiffs contend that placement in a restraint chair “should be considered an

7 emergency–with evaluation by a Qualified Mental Health Provider (QMHP) as soon as

8 possible and no later than one hour after placement, and hourly thereafter.” (DKT 515 at

9 page 11, lines 20-22.) After consultation with Plaintiffs’ counsel regarding this issue

10 CFMG amended their Implementation Plan to include the following language:

11

Physical restraint devices shall only be utilized on inmates who

display bizarre behavior which results in the destruction of

12

property or reveals an intent to cause physical harm to others.

Physical restraints should only be used when it appears less

13

restrictive alternatives would be ineffective in controlling the

disordered behavior.

14

Any inmate placed in a restraint chair will be seen and

15

evaluated by a medical provider no later than one hour from

the time of placement. The medical evaluation may be

16

performed by trained nursing staff, physician assistant, nurse

practitioner or physician. If the medical provider believes the

17

inmate is experiencing a mental health crises the medical

provider will promptly contact a qualified mental health

18

provider who will see and evaluate the inmate within one hour

of being contacted by the medical provider. (CFMG

19

Implementation Plan at page 40.)

20

B. Pharmacy.

21

Plaintiffs contend CFMG seeks “to maintain the status quo in which Licensed

22 Vocational Nurses dispense medications from stock bottles into individual doses – despite
23 the fact that California law and a minimal respect for patient safety reserves dispensing for licensed pharmacists.”
24 Plaintiffs mistakenly believe that CFMG uses Licensed Vocational Nurses (LVNs)
25 to dispense medication. The parties do not dispute that LVNs are authorized to administer
26 and deliver medications to inmates because this is clearly within the scope of an LVN’s

27 practice.

28 ///

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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 4 of 140

1

California Code of Regulation, Title 15, §1006 provides definitions for the terms

2 “administering,” “dispensing,” and “delivering” medications. These regulations state:

3

4

“Administering Medication,” as it relates to managing legally obtained drugs, means the act by which a single dose of

5

medication is given to a patient. The single dose of medication may be taken either from stock (undispensed), or dispensed

6

supplies.” (Italics added.)

7

“Dispensing,” as it relates to managing legally obtained drugs, means the interpretation of the prescription order, the

8

preparation, repackaging, and labeling of the drug based upon a prescription from the physician, dentist or other prescriber

9

authorized by law.

10

“Delivering Medication,” as it relates to managing legally obtained drugs, means the act of writing one or more doses of a

11

prescribed and dispensed medication to a patient. (CCR, Title 15, §1006.)

12

Delivery of medication may be done by either licensed or

13

nonlicensed personnel, e.g., custody staff, acting on the order of a prescriber. (CCR Title 15, § 1216(b)(7)).

14 As more fully set forth in the Declaration of Kathy Wild, R.N., attached hereto as
15 Exhibit B, the LVN’s at the MCJ do not dispense medications. Instead, Diamond
16 Pharmacy dispenses the medications used at the MCJ and they are then administered by
17 the LVNs.
18 Diamond Pharmacy dispenses many of their medications to the MCJ in bulk or stock
19 supply. The LVNs at CFMG are trained to take a single dose of medication from the
20 properly labeled stock supply and them administer the medication to the inmate. This
21 method of administering medications is within the scope of an LVN’s practice and does
22 not violate Title 15, state, or federal laws. This method is also consistent with the Institute
23 of Medical Quality (IMQ) and National Commission on Correctional Health Care
24 Standards (NCCHC).
25 C. Plans for Treatment in Addition to Medication.
26 Plaintiffs claim the MCJ “has no regular program of mental health treatment other
27 than medication.” This is inaccurate. CFMG provides on-site mental health services by
28 qualified mental health providers seven days a week. An on-call qualified mental health

3

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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 5 of 140

1 provider is available 24/7.

2

The on-site mental health team at MCJ is comprised of a psychiatrist, psychologist,

3 marriage family therapist, licensed clinical social worker and psychiatric Registered Nurse.

4 (CFMG Plan at page 32.) Mental health services provided on site include crisis

5 intervention, socialization programs, group therapy, medication management, psychiatric

6 evaluations and individual therapy. (CFMG Plan at page 32.) CFMG and custody staff

7 also conduct monthly meetings to discuss the treatment and care of inmates with serious

8 mental health conditions.

9

The mental health services as set forth in the CFMG Plan comply with the

10 provisions of the Settlement Agreement approved by this Court on August 18, 2015. There

11 is no need to expand CFMG’s Proposed Implementation Plan beyond what was intended

12 and contemplated by the Settlement Agreement which was agreed upon by the parties after

13 substantial negotiations and input from the Honorable Nathanael Cousins.

14

D. Telepsychiatry.

15

Plaintiffs are attempting to limit CFMG’s use of telepsychiatry. They recognize it

16 may be appropriate for followup but not for patients beginning mental health treatment or

17 in a mental health crisis. Plaintiffs believe CFMG’s telepsychiatry program should be

18 revised to provide that telepsychiatry referrals be made by a psychiatrist or psychiatric

19 nurse after an inmate has first received face-to-face care to start treatment and limit the use

20 of telepsychiatry during a mental health crisis.

21

Plaintiffs are attempting to impose conditions which were never contemplated by

22 CFMG during settlement negotiations. Instead, CFMG argued that the definition of

23 “face-to-face interview” did not preclude the use of telemedicine and/or telepsychiatry

24 services. (Settlement Agreement at page 4, lines 19-21). CFMG does not believe the use

25 of telepsychiatry should be limited to followup psychiatric encounters. It is appropriate to

26 use the services whenever an inmate is in need of psychiatric services, unless specifically

27 precluded in CFMG’s Plan.

28

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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 6 of 140

1

E. Safety Cells.

2

The use of safety cells in the correctional setting has been approved by the Ninth

3 Circuit in the case of Henderson v. County of Kern, 45 F.3d 1310 (9th Cir. 1995). Their

4 use has been regulated per CCR Title 15, §1055, as follows:

5

An inmate shall be placed in a safety cell only with the approval

of the facility manager, the facility watch commander, or the

6

designated physician; continued retention shall be reviewed a

minimum of every eight hours. A medical assessment shall be

7

completed within a maximum of 12 hours of placement in the

safety cell or at the next daily sick call, whichever is earliest.

8

The inmate shall be medically cleared for continued retention

every 24 hours thereafter. A mental health opinion on placement

9

and retention shall be secured within 24 hours of placement.

Direct visual observation shall be conducted at least twice every

10

thirty minutes. Such observation shall be documented. (Italics

added).

11

CFMG and the County have agreed to limit the use of safety cells and no inmate will

12

remain in a safety cell for greater than 24 continuous hours. In addition, CFMG has agreed

13

to perform a Suicide Risk Assessment, including use of the Suicide Risk Assessment Tool

14

recommended by Dr. Hayward, “after placement in or release from a safety cell. Plaintiffs

15

believe the Suicide Risk Assessment should be performed by a qualified mental health

16

provider within 15 minutes of placement. This is an unrealistic requirement which is not

17

supported by any national or state standards. Title 15 requires that the mental health

18

evaluation should be performed within 24 hours. However, CFMG’s Implementation Plan

19

requires that the evaluation occur within four hours of an inmate’s placement in the safety

20

cell. (CFMG’s Amended Plan at p. 33).

21

F. Dental

22

CFMG has submitted a Dental Service Plan with staffing provisions which are

23

greater than existed when Plaintiffs’ dental expert toured MCJ. The adequacy of these

24

staffing levels will be determined by the neutral monitors and adjusted as needed.

25

CFMG’s Dental Service Plan reflects a two-tiered system of services which are

26

provided to inmates who are (1) incarcerated less than one year and services to inmates

27

who are (2) incarcerated more than one year. (CFMG’s Implementation Plan at pages 98

28

to 112).

5

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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 7 of 140

1

CFMG’s Dental Service Plan includes the Settlement Agreement requirement that

2 dental services are provided in a “safe and sanitary” facility. (CFMG’s Implementation

3 Plan at page 96). In addition, the Plan requires that Dental Intake Screening will be

4 performed by a qualified health care professional who has been trained by the dentist.

5 (CFMG’s Implementation Plan at page 98).

6

XI. CONCLUSION

7

The Implementation Plan submitted by CFMG complies with or exceeds the

8 requirements of the Final Settlement Agreement approved on August 18, 2015. CFMG

9 requests that this Court approve its Amended Implementation Plan and allow for a 45-day

10 training period before actual implementation is required.

11 DATED: April 1, 2016

BERTLING & CLAUSEN, L.L.P.

12

13

By: /s/Peter G. Bertling

Peter G. Bertling

14

Jemma Parker Saunders

Attorneys for Defendant

15

CALIFORNIA FORENSIC

MEDICAL GROUP, INC.

16

17 I hereby attest that I have on file all holograph signatures for any signatures indicated by a “conformed” signature within this e-filed document.
18

19

20

21

22

23

24

25

26

27

28

6

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DEFENDANT CFMG'S MOTION FOR APPROVAL OF IMPLEMENTATION PLAN

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 8 of 140

1

2

Exhibit A

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

7

5:13cv2354 PSG

DEFENDANT CFMG'S MOTION FOR APPROVAL OF IMPLEMENTATION PLAN

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 9 of 140
Jesse Hernandez v. County of Monterey United States District Court Northern
District of California Case No. CV 5:13 2354 PSG
CFMG’S IMPLEMENTATION PLAN
The CFMG Implementation Plan addresses all of the issues identified in the Settlement Agreement approved by the Honorable Paul Grewal on August 18, 2015.
All CFMG health services staff will participate in classroom orientation and training regarding compliance with all aspects of the CFMG Implementation Plan. Orientation and training will be conducted by a qualified health services instructor. Counseling, training or appropriate discipline may ensue from failure to comply with the Implementation Plan.
The CFMG Implementation Plan is designed to be used in concert with the County of Monterey's Implementation Plan. If there are any inconsistencies between the plans, they shall be resolved through a meet and confer process which shall include a representative from CFMG, the Monterey County Office of the Sheriff and the Monterey County Office of the Public Defender.
Post-implementation monitoring will include focused process and outcome audits to measure compliance with the elements of the CFMG Implementation Plan. Corrective action plans will be developed and instituted for identified deficiencies, including re-audits within a stipulated time frame. All monitoring and audit findings will be reported to the Quality Management Committee at its quarterly meetings.

CFMG’s Implementation Plan

Exhibit A 8

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 10 of 140

TABLE OF CONTENTS

Page

I. INTAKE HEALTH SCREENING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 II. CONTINUATION OF MEDICATIONS BEGUN PRIOR TO INCARCERATION. . . . . 7 III. INMATE ACCESS TO HEALTH CARE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 IV. INMATE ACCESS TO MENTAL HEALTH SERVICES. . . . . . . . . . . . . . . . . . . . . . . 31 V. TREATMENT OF ALCOHOL WITHDRAWAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 VI. TREATMENT OF DRUG WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 VII. SUICIDE PREVENTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 VIII. TUBERCULOSIS IDENTIFICATION, CONTROL AND TREATMENT PROGRAM. . 68 IX. PHARMACEUTICAL ADMINISTRATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 X. INVOLUNTARY ADMINISTRATION OF PSYCHOTROPIC MEDICATIONS. . . . . . 86 XI. CFMG DENTAL SERVICES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 XII. HEALTH RECORDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 XIII. CFMG STAFFING PLAN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
EXHIBIT INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

CFMG’s Implementation Plan

Exhibit A 9

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 11 of 140
I. INAKE HEALTH SCREENING
All arrestees detained in the Monterey County Jail (MCJ) will be screened by a Registered Nurse (RN) at the time of intake using the MCJ Medical Intake Questionnaire, a copy of which is attached hereto as Exhibit A. The screening will be conducted in a manner to ensure the inmate’s privacy. Translators and interpreters will be used whenever necessary to ensure effective communication.
A. The following three levels of medical conditions will be identified initially upon arrival of the arrestee.
1. Those obvious and acute conditions which would preclude acceptance into custody prior to "outside" medical evaluation and clearance.
a. Arrestees who are unconscious or who cannot walk under their own power.
b. Arrestees who are having or have recently had convulsions. c. Arrestees with any significant external bleeding. d. Arrestees with any obvious fractures. e. Arrestees with signs of head injuries. f. Arrestees with any signs of serious injury or illness. g. Arrestees displaying signs of acute alcohol or drug withdrawal. h. Pregnant women in labor or with other serious problems. i. Arrestees who display symptoms of possible internal bleeding or
with abdominal bleeding. j. Arrestees with complaints of severe pain or trauma. k. Arrestees who by reason of mental health disorder are a danger
to others or themselves, or gravely disabled except for arrestees who have been released from a County-designated LPS involuntary detention facility with the previous 12 hours.
1 CFMG’s Implementation Plan
Exhibit A 10

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 12 of 140
2. Those conditions which are identified during the completion of the MCJ Medical Intake Questionnaire by the Booking RN may or may not be deemed to require "outside" medical evaluation and treatment.
a. If the Booking RN determines that the arrestee requires medical evaluation and clearance prior to incarceration, the arrestee will be transported to Natividad Medical Center for medical clearance prior to booking.
b. All acutely positive findings identified on the MCJ Medical Intake Questionnaire will be assessed by the Booking RN using the CFMG
3. Those conditions which are identified during the completion of the Intake Triage Assessment will be evaluated by the Booking RN and treated in accordance with CFMG Standardized Procedures or referred to the medical provider as indicated.
B. The arresting officer shall report any signs of trauma or acute illness to the reception officer prior to transfer of custody. The information obtained by the arresting officer will be communicated to the Booking RN. If the arrestee is taken to an emergency treatment center for medical evaluation and clearance prior to booking, documented evidence of such evaluation, treatment and clearance must be returned to the jail so as to become part of that inmate's medical record. The Booking RN in booking will review the treatment records to determine the course of treatment and/or contact the medical provider as indicated.
2 CFMG’s Implementation Plan
Exhibit A 11

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 13 of 140
C. Receiving Health Screening by Booking RN during the Intake Screening Process.
The MCJ Medical Intake Questionnaire will be completed on all inmates at the time of intake into the facility by the Booking RN. The receiving screening shall include vital signs and, inquiry into:
1. Current illness and health problems, including medical, mental health, dental and communicable diseases (including sexually transmitted diseases and tuberculosis and other aerosol transmissible diseases).
2. Medications and special health requirements.
3. Substance use, including type, methods, amount, frequency, date or time of last use, and history of withdrawal problems.
4. History or appearance of suspected mental illness, including suicidal ideation or behavior.
5. Appearance or history of developmental disability.
6. Appearance or history of recent sexual abuse or abusiveness.
7. For females, a history of gynecological problems, possibility of current pregnancy, recent delivery and present use of birth control.
Observation of:
1. Behavior, to include state of consciousness, mental status, appearance, conduct, tremors and sweating;
2. Body deformities and ease of movement;
3 CFMG’s Implementation Plan
Exhibit A 12

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 14 of 140
3. Condition of skin, including bruises, trauma markings, lesions, jaundice, rashes and infestations, needle marks or other indication of drug abuse; and,
4. Slowness in speech or lack of comprehension of questions suggestive of developmental disabilities.
Disposition:
1. Positive receiving screening findings will be referred to the provider for further evaluation as deemed necessary by the Booking RN.
2. Inmates with chronic medical conditions will be referred to and seen by a medical provider within five to seven days of arrival.
3. Immediate referral to the local emergency room for clearance, if warranted.
4. Persons with possible communicable disease will be isolated from others pending evaluation by health services staff.
5. Refer to classification for housing.
D. Developmental Disabilities Screening by the Booking RN during the Intake Screening Process.
All inmates at time of booking are screened using the Guide to Developmental Disabilities, a copy of which is attached as Exhibit C. If an inmate is believed to have a developmental disability, the San Andreas Regional Center will be contacted within 24 hours.
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1. The Booking RN performing the intake screening will determine if new detainees have known or suspected developmental disabilities.
2. The Booking RN shall complete an initial assessment to determine the level of disability and need for special housing and/or care, and contact the psychiatric provider on-call.
3. The Booking RN shall consult with shift supervisor regarding appropriate housing such as protective custody.
4. The CFMG Program Manager or designee will notify the San Andreas Regional Center within 24 hours of the presence of inmates believed to have developmental disabilities.
5. If the San Andreas Regional Center cannot be reached by phone at (831) 759-7500, a letter will be sent notifying them of the developmentally disabled inmate.
6. The San Andreas Regional Center is mandated by law to assure provision of services to individuals in whom developmental disability criteria are met. Criteria include: I.Q. of 70 or lower with epilepsy, autism, or significant neurological impairment which occurred before age 18 and resulted in a significant handicap.
The medical staff is encouraged to develop an ongoing relationship with the San Andreas Regional Center.
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E. Mental Health Screening by Booking RN during the Intake Screening Process.
1. All new inmates shall be observed and queried for signs/presence and history of mental illness, including suicidal behavior/ideations, and use of medication for psychiatric treatment as part of the intake health screening completed by the Booking RN. Verification of medications and request of treatment records will be initiated for inmates indicating current or recent treatment including medications, hospitalization, emergency department visits and/or outpatient services. Any inmate exhibiting or testifying to presence or history of mental illness is referred to mental health services staff for further evaluation. A physician's opinion is secured within 24 hours or the next scheduled sick call.
2. The Booking RN will complete a Nursing Psychiatric and Suicidal Assessment Form on all inmates with a positive mental health history. A copy of the Nursing Psychiatric and Suicidal Assessment form is attached as Exhibit D.
3. The on-site mental health team is comprised of the psychiatrist, psychologist, Marriage and Family Therapist and Psychiatric Registered Nurse. A licensed psychiatrist and psychologist are available on-site and on-call to health services staff at the jail for consultation, referral and treatment.
4. Inmates in safety cells whose condition deteriorates, or for whom the nurse is unable to complete a hands-on assessment including vital signs after six hours of placement shall be transferred to Natividad Medical Center for further assessment.
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II. CONTINUATION OF MEDICATIONS BEGUN PRIOR TO INCARCERATION
Continuation and bridging of all medications begun prior to incarceration is essential to the health and well-being of inmates. It is the policy of CFMG to ensure that inmates will not miss any medications whether verified or unverified, formulary or non-formulary.
A. The following information shall be obtained from the inmate or his/her attending physician:
1. Drug name, dosage and frequency ordered. Time the previous dose was ingested (prior to incarceration).
2. Name of physician who prescribed the medication and the last time the inmate was seen by the physician.
3. The frequency with which the medication was taken.
B. Confirmation of the information should be attempted by calling the pharmacy to confirm legitimacy of the prescription and/or:
1. Seeing the prescription or bottle of medication and verifying that the contents have not been tampered with and are as labeled.
2. Communication with the prescribing physician or his office.
C. Ordering Verified Medications for Continuation and Bridging.
1. If the RN verifies the medication with the prescribing physician or pharmacy, the RN will provide the medication after contacting the on-call provider for an order. During this consultation the on-call provider, based on clinical judgment, will schedule a date for a provider to see the patient
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face-to-face within 7 days. The date of the appointment will be reflected in the written record of the order.
D. Ordering Unverified Medications or Medications that Have the Potential for Abuse.
1. If possible, find out what chronic conditions the inmate is being treated for or has been treated for in the past.
2. If inmate was on medications, inquire whether s/he remembers names or dosages.
3. Obtain random blood sugar on inmate if s/he states history of diabetes.
4. If female inmate states she is on opiates, request urine sample for pregnancy test. If inmate is pregnant, contact on-call provider for orders or send to ED for evaluation and possible emergency three-day methadone or buprenorphine prescription. FOR THE SAFETY OF THE FETUS, pregnant inmates should not be allowed to withdrawal for opioids and may need to be sent to the ED or methadone clinic or buprenorphine provider daily to avoid withdrawal.
5. By the end of the nursing shift, the RN will contact the on-call provider for orders to address critical unverified medications or medications with abuse potential and obtain orders to either continue, discontinue, or substitute with a clinically equivalent formulary alternative. During this consultation the on-call provider will set the time for a provider to see the patient within 5-7 days. The date of the appointment will be reflected in the written record of the order.
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6. Submit all medication orders to emergency backup pharmacy to ensure inmate-patient will not miss any doses within 12 hours of booking.
E. Ordering Psychotropic Medications
1. The Booking RN will assess all arrestees who state they are taking psychotropic medications upon arrival at the facility.
2. The Booking RN will obtain a signed release for records and attempt to verify current prescriptions. By the end of the nursing shift, the RN will consult with the on-call psychiatrist regarding any verified or unverified medications. The on-call psychiatrist will give an order to either continue, discontinue or substitute the medication with a clinically equivalent formulary alternate. During this consultation, the on-call psychiatrist will set the time to see the inmate within 5-7 days. The date of the appointment will be reflected on the written record of the order.
3. No psychotropic medications shall be unilaterally discontinued without consultation with the facility physician or psychiatrist.
4. Psychotropic medication shall not be ordered for longer than 90 days, new psychiatric medications will not exceed 30 days, until condition is documented stable by the ordering physician. The prescribing provider will renew medications only after a clinical evaluation of the individual is performed.
5. Absent an emergency, inmates will not be administered involuntary psychotropic medications at the Monterey County Jail.
6. Psychotropic medication will not be administered for disciplinary purposes.
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7. Absent an emergency or a court order for treatment, an inmate shall give his or her informed consent and refusal.
8. The on-call psychiatrist will be contacted whenever an inmate refuses his or her medications on three consecutive occasions.
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III. INMATE ACCESS TO HEALTH CARE
A. Health Care Philosophy
Inmates shall have access to emergent and medically necessary non-emergent health care services as deemed appropriate by qualified health services professionals to maintain health and safety of the inmate during his/her period of incarceration. Elective procedures shall not be performed unless, in the opinion of qualified medical/dental professionals, the postponement of such procedures would adversely affect the immediate health and safety of the inmate or future course of treatment and/or prognosis of the individual. Medically necessary services which are not provided on-site shall be made available by referral to County or private medical/health services providers. Health services shall be provided by licensed health care professionals in accordance with community standards and professional ethical codes for confidential and appropriate practices.
1. CFMG personnel provide health care services for inmates and act as their advocates in health care matters. Health services shall be rendered with consideration for the patient's dignity and feelings and in a manner which encourages the patient's subsequent utilization of appropriate health services.
a. Medical procedures and interviews shall be performed in a private clinical setting in accordance with facility security procedures.
b. Chaperons shall be present when indicated.
c. Verbal consent shall be obtained and implicit for all direct patient contact. Written informed consent shall be obtained for all invasive
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and other procedures in accordance with established CFMG procedure and community standards of practice.
d. Inmates have a right to refuse treatment. Inmates refusing treatment will be counseled regarding any untoward effects of such refusal. Refusals shall be documented in the medical record progress note and refusal of medical treatment form completed, signed by the inmate and filed in the medical record. If the inmate refuses to sign the form, such refusal shall be noted on the form and witnessed by two staff members.
e. Refusal of essential medications and treatment (i.e., the absence of which would jeopardize the health and safety of the inmate) shall be reported to the responsible medical provider after three sequential refusals.
2. Inmates shall have access to their private physician and/or dentist at their own expense.
3. The patient/provider confidentiality practices of the community shall prevail in all inmate-patient/jail provider encounters except where state statute supersedes.
a. Patient information necessary for the protection of the health and safety of facility staff and inmates shall be communicated to the facility manager or his/her designee by the responsible physician or other designated health services staff.
b. Access to medical and psychiatric records shall be under the control of the Health Authority. Confidentiality of health records shall be maintained at all times.
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4. Inmates requiring medical or mental health services beyond the scope of services provided by CFMG shall be transferred to a community provider in accordance with CFMG Policy and Procedures.
5. Inmates retain all the recognized rights of an ordinary citizen relative to informed consent and self-determination of health care. This shall include the ability to appoint a Durable Power of Attorney for Health Care, and to create a Natural Death Act Declaration addressing end-of-life care.
a. Health services and custody staff will work cooperatively to provide access to the means necessary for the creation and recognition of properly executed advance directives. County counsel shall be consulted in the creation of advanced directives.
b. A documented end-of-life care plan will be developed when warranted by the inmate-patient's condition. The plan will include, but not be limited to, the inmate-patient's input and consent, properly executed DNR, advanced directives and durable power-of-attorney, pain management, and provision for psychological/spiritual support.
B. Protocols and Standardized Procedures.
RNs function under standardized procedures developed in accordance with California Board of Registered Nursing requirements. All treatment is pursuant to protocol, standard procedures and/or direct MD orders by personnel licensed to carry out such functions in the State of California. Physician Assistants and Nurse Practitioners shall function under agreements specific to their scope of
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practice with the supervision of the responsible physician in accordance with the Medical Board of California regulatory guidelines.
1. Standardized procedures and PA protocols are developed by PA/nursing staff, CFMG Administration, Program Manager, Director of Nursing, and the responsible physician. All orders are subject to the approval of the responsible physician.
2. When utilized, a minimum of ten percent (10%) of all protocol/standardized procedures initiated care/treatment provided by a physician assistant, nurse practitioner and registered nurse charts shall be reviewed and countersigned by the responsible physician.
3. All RN protocols/standardized procedures and PA and NP practice agreements are reviewed by the Program Manager, responsible physician and administrative staff at least annually and revised as necessary.
C. Access to Treatment.
Information regarding access to health care services shall be communicated verbally and in writing to inmates upon their arrival at the facility. Upon confirmation of pregnancy, females shall be informed of their rights to services while in custody and use of restraints prohibition. Provision shall be made to communicate this information to non-English speaking inmates.
1. Verbal explanations of the sick call procedure shall be communicated to all detainees at the time of booking by the Booking RN. Verification of the nurse's verbal explanation is documented on health screening form. Direct referral to health services staff shall be made in any case of an immediate health need upon booking or as soon as possible after the individual enters the facility.
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2. Signs posted in English and Spanish describing sick call availability and procedure shall be posted in booking and in the common areas of the living units.
3. Information regarding access to medical and mental health services is provided in English and Spanish versions of the Inmate Rules booklets given to all inmates.
D. Daily Management of Health or Mental Health Care Requests.
Health and mental health complaints of inmates shall be collected, processed and documented on a daily basis. Health services staff shall triage and treat health complaints as appropriate. Medical complaints will be triaged to the medical provider as appropriate. Mental health care complaints will be triaged to a qualified medical health care provider as appropriate.
1. Medical and/or mental health sick call slips are triaged daily. Urgent sick call requests are seen by the on duty medical provider, Monday through Friday. On weekends and holidays, urgent complaints/requests are communicated to the on-call medical provider by the nurse on duty. The on-call provider will treat or refer the patient as deemed medically appropriate.
2. Emergency requests are seen immediately by on-duty, on-call staff and/or transported to Natividad Medical Center.
3. All medical or mental health care sick call request slips are reviewed by licensed health services staff on a daily basis. Sick call slips will have the following notations:
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a. date and time reviewed b. signature of medical staff c. disposition
4. Sick call slips are filed in the inmate's medical record and the sick call roster shall be kept on file in the medical record room.
5. Health care providers shall record sick call visits in the inmate's personal medical record.
E. Sick Call
1. Sick call is conducted five days per week in a designated clinical environment ensuring privacy for all inmates.
2. Inmates wishing to be seen on sick call will fill out a slip, listing name, location, date of birth, and complaint.
3. Slips are collected and triaged daily by health services staff. Sick call slips received prior to 2300 hours will be scheduled for the next sick call. If an inmate's custody status precludes attendance at clinic, such as going to court or visits, the inmate must reschedule his/her self for the next scheduled sick call. Exceptions will be assessed by physician or other medical providers.
4. Inmates housed in holding and isolation are visited by an MD or RN every Monday, Wednesday and Friday.
5. Inmates requesting sick call services may be charged a $3.00 co-pay as defined in Penal Code Section 4011.2. Inmates shall not be refused services because of inability to pay.
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F. Individualized Treatment Plans
A written individualized treatment plan shall be developed by qualified health services staff for inmates requiring close medical and/or mental health supervision, including chronic and convalescent care, and includes directions to health services and other staff regarding their roles in the care and supervision of these inmates.
1. Inmates with medical and/or psychiatric conditions identified during intake screening or returning to the jail from off-site hospitalization shall be assessed by the Booking RN who will begin initial treatment planning by initiating the continuation of essential care and treatment at the time of intake; consultation with the on-call provider as necessary; and, scheduling referrals for follow up evaluation by the responsible physician mid-level provider or RN who will be responsible for further developing and documenting an individualized plan of treatment.
2. Treatment plans shall include specific medical and/or psychiatric problem, nursing interventions, housing, dietary, medication, observation and monitoring, and follow-up referral and/or evaluation as appropriate.
3. The Facility Manager or his designee shall be informed of aspects of the treatment plan which include custody staff, e.g., housing, observation, transportation, etc.
4. A treatment plan is a series of written statements which specify the particular course of treatment. A thorough plan will be included in the plan portion of S.O.A.P. progress note and problem lists will reflect current problems or conditions being followed. Monitoring the efficacy of treatment while in custody, and discharge planning are essential components of the treatment plan.
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G. Chronic Care
CFMG will provide a system for managing patients with chronic health conditions through screening, identifying and monitoring these patients while incarcerated in the Monterey County Jail.
Chronic illness is any health problem/condition lasting at least six months which has the potential to, or actually does, impact an individual's functioning and long term prognosis. Such conditions may include, but are not limited to, cardiovascular disease, diabetes mellitus, gynecological disorders or diseases, chronic infectious diseases, chronic pulmonary diseases, seizure disorders and psychiatric disorders.
Chronic Care Clinic: Routinely scheduled encounters between an FNP, PA or MD and a patient with an identified chronic medical or mental condition for the purpose of treatment planning, monitoring the patient's condition and therapeutic regimen while in custody. Such encounters shall be scheduled at least every ninety days, but may occur more frequently at the discretion of the medical provider. Routinely scheduled Chronic Care Clinic monitoring shall apply to the following conditions: diabetes; cardiac disorders, hypertension, seizure disorders, communicable diseases, respiratory disorders, and psychiatric disorders. Other conditions may be included as appropriate at the discretion of the medical provider.
Inmates with chronic care conditions will be managed pursuant to chronic care protocols and standardized procedures that are consistent with national practice guidelines. National Practice Guidelines constitute recommendations regarding patient care and are not intended to preclude clinical judgment. Any national practice guidelines must be applied in the context of clinical care and with adjustments for individual preferences, comorbidities, and other patient factors.
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1. Screening/Identification
a. Intake Health Screening
(1) Individuals giving a history of a chronic medical or psychiatric condition and/or are taking essential medication for the management of a chronic medical or mental condition will be identified at the time of jail intake screening by the Booking RN.
(2) The RN will:
(a) Complete an assessment, document and verify all current medications.
(3) Continue verified, current medication prescriptions that are on CFMG formulary in accordance with CFMG Medication Continuation Policy and Procedure.
(a) The nurse will contact the on-call medical provider by the end of the nursing shift to obtain an order for all medications, whether verified or unverified, formulary or non-formulary.
(b) Schedule the patient to be seen on medical provider line, within five to seven days if the inmate's condition is stable. Refer individuals for whom medications cannot be verified or whose condition is unstable to the medical provider on duty or contact the on-call medical provider for orders.
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(c) Attempt to obtain an authorization from the inmate for a release of his/her medical records from outside providers and use the authorization to try and obtain the outside medical records.
(4) The medical provider will complete a baseline physical examination and history, order a therapeutic regimen and schedule the patient to be seen at least every ninety days for chronic care management.
(5) Any patient whose chronic condition cannot be managed at MCJ will be transferred offsite for appropriate treatment and care.
2. The medical/mental health condition and other pertinent problems will be entered on the Patient Problem List in the health record.
a. 14-Day Health Inventory & Communicable Disease Screening
(1) Chronic problems identified during the 14-day health inventory and communicable disease screening that have not previously been identified will be referred to the next medical or psychiatric provider line for evaluation and follow up.
(2) The medical or psychiatric provider will complete a baseline history and physical or psychiatric examination; order a therapeutic regimen, as appropriate; and, schedule the patient to be seen for chronic care clinic at least every ninety
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Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 31 of 140
days for the length of the jail stay. Patients on psychiatric medications will be seen by the psychiatrist every thirty days until determined stable and then at least every 60 to 90 days. (3) The medical / mental condition will be entered on the Patient Problem List in the health record and in the IMS computer system.
b. Sick Call. (1) Chronic medical/mental health conditions identified during the routine sick call process shall be evaluated; baseline history and physical examination completed; a therapeutic regimen ordered as appropriate and, scheduled to be seen at least every ninety days for the length of jail stay. Patient’s on psychiatric medications will be seen by the psychiatrist every thirty days until determined stable and then at least every sixty/ninety days. More frequent evaluations by a psychiatrist will be scheduled if necessitated by the patient’s condition.
3. Monitoring.
a. Patients with identified chronic medical/mental health conditions shall be scheduled for Chronic Care Clinic and seen by the physician or the psychiatrist at least every ninety days if condition is stable or more frequently if condition is unstable while in custody.
b. The medical/psychiatric provider conducting the chronic care clinic will assess at minimum:
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(1) History:
(a) Current medications (b) Complaints/problems (c) Compliance with therapeutic regimen
(2) Examination:
(a) Vital signs and weight recorded each visit (medical conditions; patients on psychotropic medications with metabolic side effects).
(b) Systems examination in accordance with the nature of the chronic condition.
(3) Assessment:
(a) Diagnosis, degree of control, compliance with treatment plan and clinical status in comparison to prior visit.
(4) Plan:
(a) Periodic laboratory and diagnostic tests as indicated by medical and professional practice standards.
(b) Strategies to improve outcomes if the degree of control is fair or poor or the clinical status has worsened.
(c) The plan also includes:
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i) Medications.
ii) Vital signs and other condition specific key indicator monitoring (e.g., blood glucose monitoring in diabetes; peak flow monitoring in chronic pulmonary conditions, serum drug levels, etc.), as clinically indicated.
iii) Health care education (e.g., nutrition, exercise and lifestyle changes; medication management).
iv) Referral to MD or specialist, as clinically indicated.
v) Interval to next visit.
vi) Discharge planning in preparation for release or transfer from the facility.
4. Documentation:
a. Chronic care clinic interactions will be documented in the health record in a SOAP format progress note or on approved, standardized, condition specific Chronic Care Clinic forms.
b. Chronic medical/mental conditions and other pertinent problems will be recorded on the Patient Problem List.
5. Health Inventory & Communicable Disease Screening.
A complete gender specific health history inventory and communicable disease screening shall be completed on all inmates within 14 days of arrival at the facility by a Registered Nurse who has completed appropriate training that is approved or provided by the responsible
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physician. A copy of the Health Inventory & Communicable Disease Screening Form is attached as Exhibit E. Communicable disease screening shall include at a minimum, screening for diseases in accordance with the findings of the health inventory and prevalence data for the local community. The extent of communicable disease screening shall be determined by the responsible physician in collaboration with local public health officials. Individuals returning to custody within 3 months of the prior incarceration shall have vital signs and communicable disease screening repeated; the remaining history will not be repeated unless the individual indicates a change in historical information since the prior documented history.
6. Inmates will complete a gender specific self-health history form which has been approved by the health authority. The health history form will include, at a minimum:
• prior illnesses • operations • injuries • medications • allergies • systems review • relevant family history, e.g., heart disease, cancer, substance abuse,
etc. • substance abuse • risk factors for sexually transmitted disease • history of sexual abuse and/or abusiveness
7. The completed history form and the intake health screening will be reviewed with the inmate by a qualified health professional, i.e., licensed vocational nurse, registered nurse, mid-level provider, or
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physician. The date and outcome of the review and signature of the reviewer shall be documented on the approved form.
8. Temperature, pulse, respirations, blood pressure, height and weight will be recorded on the approved form.
9. The STD Supplemental form will be completed. Positive responses will be referred to the medical provider.
10. Positive findings shall be recorded onto a problem list. A follow-up plan of action shall be developed and documented in the health record by a qualified health professional (i.e., physician, mid-level provider or registered nurse in accordance with approved standardized procedures).
11. All positive health inventory findings and plans of action shall be reviewed by the responsible physician.
12. Positive findings and conditions requiring further evaluation and/or treatment shall be referred to the appropriate provider, i.e., medical, mental health and dental, next scheduled sick call. Urgent conditions will be referred immediately to on-site or on-call provider resources.
13. Individuals returning to custody within 3 months of prior incarceration: vital signs and communicable disease screening will be repeated at each jail admission; inmate will be queried regarding any changes in health status since last documented health inventory. All assessment data will be documented, dated, timed, and signed by the health services staff completing the assessment.
14. Inmates refusing the Health Inventory & Communicable Disease Screening will be counseled by medical staff as to the confidentiality and medical importance. If an inmate still refuses, a refusal form will be
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signed by the inmate and medical staff. Document in the inmate's medical chart that he/she was counseled and contact a provider for orders.
H. Mental Health Screening and Evaluation.
1. Within 14 days of admission to the Monterey County Jail all inmates will have an initial mental health screening performed by a qualified mental health professional on the mental health staff.
2. The initial mental health screening will consist of a structured interview including inquiries into the following:
a. A history of psychiatric hospitalizations and outpatient treatments, substance use hospitalization, detoxification and outpatient treatment, suicidal behavior, violent behavior; victimization, special education placement; cerebral trauma or seizures and sex offenses.
b. The current status of psychotropic medications, suicidal ideations, drug or alcohol use and orientation to person, place and time.
c. Emotional response to incarceration.
d. A screening of intellectual function (i.e., mental retardation, developmental disability and learning disabilities).
3. Inmates who score positive for mental health problems will be referred to a qualified mental health provider for further evaluation.
4. Inmates who require acute mental health services beyond those available on site are transferred to an appropriate facility.
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I. Health Care Maintenance.
A complete physical examination for the purpose of health maintenance will be completed by health services staff within six months of the date of incarceration. The components of the physical examination shall be determined by the responsible physician and will include a review of body systems; breast exam for all females; a rectal exam and PSA for males 50 years of age or older.
1. A computer generated list of inmates requiring a physical examination (those who have been in custody 170 days) will be utilized to schedule physical exams Monday through Friday (holidays excluded).
2. The exam will be completed by the responsible physician, physician assistant or nurse practitioner.
3. The physical examination shall include:
a. Review of the health inventory and communicable disease screening;
b. Vital signs, height and weight;
c. A full body system review and assessment consistent with community standards and guidelines.
d. A documented assessment of the individual's health status based on the physical findings;
e. A plan for follow up, treatment and referral as indicated; and,
f. Review and countersignature by the responsible physician.
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4. All examination findings will be recorded on an approved CFMG physical examination form and filed in the inmate's medical record.
J. Continuity of Care
Patients will receive continuity of care from admission to discharge while in this facility, including referral to community care when indicated.
1. If possible, health providers will obtain information regarding previous care when undertaking the care of a new patient.
2. When the care of the patient is transferred, appropriate health information is shared with the new providers in accord with consent requirements.
3. A Transfer of Medical Information form will be completed and accompany inmates being transferred to another detention/corrections system who have been receiving medical and/or mental health treatment while detained within the Monterey County Jail system.
4. A prescription for a 30-day supply of medications taken while in jail may be given to inmates upon discharge by order of the responsible physician.
5. Referral to public health and/or community clinics for follow-up care and treatment will be made as appropriate to need and availability for inmates who are released prior to resolution of a continuing medical/mental health condition.
6. Inmates released to the community will be provided with written instructions for the continuity of essential care, including, but
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not limited to, name and contact information of community providers for follow up appointments, prescriptions and/or adequate supply of medication for psychiatric patients.
K. Outside Appointments.
Inmates will have access to outside health care providers in one of two ways:
1. The medical staff (M.D. N.P. or P.A.) determines that a medical consultation is indicated for which the cost for service will be the responsibility of CFMG.
2. When an inmate requests to see a private health care provider which is not determined necessary by the in-house medical staff. In this case, the inmate will assume responsibility for all costs incurred. All requests to see off-site providers must be approved by the physician and by custodial staff for security reasons.
a. The Program Manager or his/her designee will:
(1) Establish contact with outside provider to schedule appointments
(2) Arrange transportation services (3) Complete medical referral forms only for inmates that they
determine need outside medical consultation
b. The Inmate:
(1) If inmate assumes responsibility for cost, must contact outside provider to arrange payment for services. Once arrangements are made, the medical records coordinator will schedule
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appointments and transportation services. CFMG medical referral forms are not completed for this type of appointment.
L. CFMG Medical Referral Form. The CFMG Referral Form is utilized at all times when the medical staff refers an inmate off-site for medical information to the outside provider as well as authorize payment. A copy of the CFMG Referral Form is attached as Exhibit F.
1. The M.D. N.P. or P.A. may refer an inmate to an outside provider for medical care which cannot be provided on-site. When this occurs, the medical staff will complete the medical referral form, and give it to the medical record clerk, who will then arrange the appointment.
2. In an emergency, when an ambulance is called, medical staff will complete two medical referral forms, one for the hospital and one for the ambulance company.
3. Medical staff should not complete the medical referral form for:
a. Inmates who are refused at time of booking (CFMG is not financially responsible for these inmates).
b. Inmates going off-site to see their private physicians at their expense.
4. All sections of the referral form should be completed except the section, "Recommendations to the Referring Agency." The Medical Insurance Section should be completed and all pertinent information noted.
5. A copy is retained in the inmate's medical chart. Two copies are given to transportation to pass on to the outside provider. One of those copies is then returned with recommendations for follow-up.
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IV. INMATE ACCESS TO MENTAL HEALTH SERVICES
Outpatient mental health services to include screening, evaluation, diagnosis, treatment and referral services shall be available to all inmates in the Monterey County Jail. All mental health outpatient services will be provided by qualified mental health providers. Inmates requiring services beyond the on-site capability at the Monterey County Jail shall be referred to appropriate off-site providers.
A. All new inmates shall be observed and queried for signs/presence and history of mental illness, including suicidal behavior/ideations, and use of medication for psychiatric treatment as part of the intake health screening completed by the Booking Registered Nurse. Verification of medications and request of treatment records will be initiated for inmates indicating current or recent treatment including medications, hospitalization, emergency department visits and/or outpatient services. Any inmate exhibiting or testifying to presence or history of mental illness is referred to mental health services staff for further evaluation.
B. Mental Health Screening and Evaluation.
1. Within 14 days of admission to the Monterey County Jail all inmates will have an initial mental health screening performed by a qualified mental health professional on the mental health staff.
2. The initial mental health screening will consist of a structured interview including inquiries into the following:
a. A history of psychiatric hospitalizations and outpatient treatments, substance use hospitalization, detoxification and outpatient treatment, suicidal behavior, violent behavior; victimization, special education placement; cerebral trauma or seizures and sex offenses.
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b. The current status of psychotropic medications, suicidal ideations, drug or alcohol use and orientation to person, place and time.
c. Emotional response to incarceration.
d. A screening of intellectual function (i.e., mental retardation, developmental disability and learning disabilities).
3. Inmates who score positive for mental health problems will be referred to a qualified mental health provider for further evaluation.
4. Inmates who require acute mental health services beyond those available on site are transferred to an appropriate facility.
C. The on-site mental health team is comprised of the psychiatrist, psychologist, Marriage and Family Therapist, Licensed Clinical Social Worker and Psychiatric Registered Nurse. A licensed psychiatrist and psychologist are available on-site and on-call to health services staff at the jail for consultation, referral and treatment.
D. Mental Health services provided on-site will include crisis evaluation, socialization programs, group therapy, medication management, psychiatric evaluations and individual therapy.
E. Inmates requiring special in-jail housing and/or observation for psychiatric reasons will be housed in single cells and/or the Outpatient Housing Unit pursuant to consultation with the Facility Manager or Watch Commander and the responsible on-duty medical/mental health staff.
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F. Individual treatment plans shall be developed by the responsible mental health provider and the Program Manager or designee to meet the outpatient treatment needs of the inmate during his/her period of incarceration including the opportunity for social interaction and participation in community activities. If the inmate is unable to participate, the reason will be documented by the responsible mental health professional.
G. Crisis intervention and management of acute psychiatric episodes shall be handled initially by on-duty medical and/or mental health team staff with referral to the psychologist and/or psychiatrist on a 24 hour per day basis.
H. A suicide risk assessment, including use of the Suicide Risk Assessment Tool, a copy of which is attached as Exhibit G, will be performed by a qualified mental health provider when the booking R.N. identifies suicidality during the Initial Health Screening; within four hours after placement in a safety cell; before release from a safety cell; o r after placement in Administrative Segregation. Any qualified mental health provider who performs a suicide risk assessment will be trained in the use and interpretation of the Suicide Risk Assessment Tool.
I. Inmates with a serious mental illness who are housed in Administrative Segregation will be scheduled for a weekly appointment with a qualified mental health provider. Nursing staff shall conduct mental health rounds in Administrative Segregation daily, separate and apart from medication distribution.
J. Inmates requiring psychiatric care beyond the on-site capability will be transferred to an appropriate off-site facility as deemed necessary by responsible jail psychiatric staff. The shift supervisor or his/her designee will be contacted to process the documents required for transfer.
K. A prescription for a 30-day supply of medications taken while in jail may be given to inmates upon discharge by order of the responsible physician.
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L. Referral to public health and/or community clinics for follow-up care and treatment will be made as appropriate to need and availability to inmates who are released prior to resolution of a continuing mental health condition.
M. Inmates released to the community will be provided with written instructions for the continuity of essential care, including, but not limited to, name and contact information for community providers for follow-up appointments, prescriptions, and/or adequate supply of medication for psychiatric patients.
N. Tele-Psychiatry Program
1. All inmates within the Monterey County Jail have access to the tele-psychiatry program.
2. Referrals to the tele-psych program can be made by the following:
a. MD b. Registered Nurse c. Program Manager d. Mental Health Provider (LCSW, MFT, Psych RN)
3. Tele-Psych Clinic Procedure
a. Inmates being referred to the clinic will be placed on the sick call list.
b. The mental health worker will set up the clinic for the scheduled day. The tele-psych referral form will be completed and sent to the psychiatrist for each individual patient being seen.
c. All the information on each patient will be faxed to the psychiatrist at least 1 hour before the start of the clinic. All pertinent
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information, i.e., pertinent history, lab results, progress notes from mental health provider, medication compliance, etc., will be included.

d. Once the clinic begins the mental health worker will facilitate the process:

(1) Provide privacy for the patient by closing the room door, whenever possible. There may be times when the door cannot be closed for security/safety reasons. If this occurs, the mental health worker will make sure there are no inmates and/or non-essential staff seated outside the room or within hearing distance of the room. The medical assistant will work with the facility staff to do everything possible to ensure privacy for the patients. If at any time the patient requests to speak to the doctor privately, the medical assistant will advise the appropriate detention staff and leave room.

(2) Assist the psychiatrist with information needed from the medical record and will write the doctor's orders in the chart. The psychiatrist's orders will then be faxed to the doctor at the corporate office for signature, and will be returned to the county to be put into the patient record.
(3) Assist the inmate by explaining the process and providing support during the procedure.

(4) Medication

(a) Informed consent for medication

i)
CFMG’s Implementation Plan

The psychiatrist will verbally provide the inmate with
the rationale for the use of the specific medication,
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the benefits, and potential side effects; the potential risks of refusing to take the medication; and document this information and the patient's level of understanding in the medical record.
ii) The medical assistant will complete the consent form, obtain the patient's signature and fax the consent form to the psychiatrist for signature. The completed, signed form will be faxed back to the county and filed in the inmate's medical record.
(b) Medication monitoring
i) Patients on psychiatric medications will be seen by a psychiatrist every thirty days until determined stable and then every 60 to 90 days. More frequent evaluations by a psychiatrist will be scheduled as necessitated by the patient's condition.
(5) Onsite monitoring / follow up of patient status
(a) The onsite mental health provider will routinely monitor patient status and report significant changes to the psychiatrist between scheduled tele-psychiatry clinics.
(b) Urgent or emergent patient conditions will be referred to local community providers through consultation with the onsite medical director.
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(6) Documentation
(a) The tele-psychiatrist will document all patient progress notes and transmit them electronically to the facility for inclusion in the patient's medical record within 24 hours of the clinic visit.
O. Medical and mental health staff shall be consulted before any planned use of force on an inmate.
P. Mental illness will be considered in administering any disciplinary measures against an inmate. Custody staff shall contact the appropriate qualified mental health care staff when evaluating the level of discipline for an inmate with mental illness.
Q. Physical restraint devices shall only be utilized on inmates who display bizarre behavior which results in the destruction of property or reveals an intent to cause physical harm to others. Physical restraints should only be used when it appears less restrictive alternatives would be ineffective in controlling the disordered behavior.
Any inmate placed in a restraint chair will be seen and evaluated by a medical provider no later than one hour from the time of placement. The medical evaluation may be performed by trained nursing staff, physician assistant, nurse practitioner or physician. If the medical provider believes the inmate is experiencing a mental health crises the medical provider will promptly contact a qualified mental health provider who will see and evaluate the inmate within one hour of being contacted by the medical provider.
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V. TREATMENT OF ALCOHOL WITHDRAWAL
A. Policy
Individuals booked into the Monterey County Jail who are intoxicated, a threat to their own safety or the safety of others are placed in the protective environment of the sobering cell will be under close observation by custody and health services staff. Detoxification from alcohol, when performed in this facility, will be done under medical supervision in accordance with direct orders from the responsible medical provider using approved protocols/standardized procedures.
B. Circumstances under which the RN may perform the function:
1. Setting - CFMG Monterey County Correctional Facilities.
2. Supervision - Direct supervision required prior to starting any prescription medication.
3. Patient conditions - Registered nurses may routinely assess and care for patients' in a state of alcohol intoxication and/or withdrawal following procedures approved by the responsible physician.
4. Access to the on-site or on-call medical provider for consultation. Medical Provider consultation is required prior to initiation of prescription medication.
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C. Protocol
1. Definition:
a. Intoxication - behavior and physical abnormalities that are manifested when the amount of substance exceeds the person's tolerance.
b. Withdrawal - signs and symptoms that appear when a substance known to cause physiological dependency is stopped.
c. CIWA(Ar) (Clinical Institute Withdrawal Assessment, revised) is a common measure used in to assess and treat Alcohol Withdrawal Syndrome.
d. Alcohol abuse - use of alcoholic beverages to excess, either on individual occasions ("binge drinking") or as a regular practice.
e. Alcohol dependence also known as alcoholism is a chronic, progressive, and potentially fatal disease. The characteristics include:
(1) Drinking excessive amounts frequently.
(2) Inability to curb drinking despite medical, psychological, legal or social complications.
(3) Increased tolerance to alcohol.
(4) Occurrence of withdrawal symptoms when the person stops drinking.
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f. Tolerance - a state in which increased amount of psychoactive substance is needed to produce a desired effect.
g. Alcohol Withdrawal Syndrome (AWS) -a defined clinical syndrome of autonomic hyper-excitability that develops on cessation of prolonged alcohol consumption because neuroreceptors previously inhibited and up-regulated by alcohol are no longer inhibited resulting in the clinical manifestations of AWS.
(1) Eighty-five percent of people have only very minor symptoms or none at all.
(2) Fifteen percent develop major symptoms.
(3) One percent of those will develop significant morbidity and/or death.
(a) Alcohol withdrawal follows a bimodal pattern of clinical evolution with minor symptoms generally occurring in the first 48 hours and major symptoms occurring thereafter.
(b) Minor symptoms:
i) Anxiety and agitation ii) Tremors iii) Nausea and vomiting iv) Headache v) Insomnia vi) Tachycardia vii) Elevated blood pressure viii) Flushed face ix) Diaphoresis
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(c) Major Symptoms

i) Seizures ii) Delirium iii) Arrhythmias

(d) Treatment Goals

i) Reduce the generalized hyper-excitability and make patients more comfortable
ii) Prevent the development of major symptoms iii) Reduce the overall morbidity and mortality

(e) Treatment

D. Data Base

i) Benzodiazepines ii) Beta blockers iii) Clonidine (Catapres) iv) Adjunct medication such as Gabapentin, Tegretol,
atypical antipsychotics v) Nutrition, fluids, multi-vitamins, thiamine vi) Treat underlying medical problems

1. Subjective:

a. Obtain consumption history: amount, kind, frequency, and date/time of last consumption.

b. Obtain withdrawal history: seizures*, delirium arrhythmias*, other complications.
_____________ *High risk factors.
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tremens*,
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c. Obtain past medical history: (1) Particularly heart disease* and/or pulmonary disease* (2) Recent trauma, particularly head trauma* (3) Determine if other drugs or prescriptions taken, date/time last taken. (4) Females: determine if pregnant. (5) Allergy history
2. Objective:
a. Initial assessment includes vital signs and somatic symptoms: Pulse, blood pressure, respiration, diaphoresis, tremor, nausea and vomiting; and, headache. Look for signs of head trauma, i.e., abrasions, lacerations, bruising, raccoon eyes, blood from ears and/or nose;
(1) Initial assessment also includes behavioral symptoms: Agitation, contact, hallucinations, and anxiety
(2) Patient appears under the influence of alcohol such as smells of alcohol, has withdrawal symptoms*, or has a measurable blood alcohol content in the presence of active signs/symptoms of withdrawal*
(3) Tachycardia greater than 120*
(4) Alcohol Withdrawal Scale (AWS) score of eight or greater on initial evaluation*
(5) Access previous jail medical records for history of in custody AWS protocol treatment*.
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E. Assessment
1. Altered nutrition: less than body requirements related to poor dietary habits.
2. Altered thought processes related to potential delirium tremors.
3. Anxiety related to withdrawal.
4. High risk for fluid volume deficit related to (specify: excessive diaphoresis, agitation, decreased fluid intake)
5. High risk for violence related to substance withdrawal.
6. Sensory/Perceptual Alterations; visual, auditory, kinesthetic, tactile, olfactory related to neurochemical imbalance in brain.
F. Plan
1. Level 0 - Alcohol Withdrawal Scale (CIWA-Ar ) 8 or less & NO Identified Risk Factors.
a. A CIWA-Ar monitoring every 4 hours x 72 hours; if scores less than 8 for 72 hours, discontinue monitoring.
b. House per custody classification
(1) Encourage fluids
2. Level I - Alcohol Withdrawal Scale (CIWA revised) 8 or less with one or more identified risk factors (i.e., measurable blood alcohol level in the presence of active signs/symptoms of withdrawal; tachycardia above 120; history of withdrawal seizures, DT's, arrhythmias, or other complications; past medical history of heart disease, pulmonary disease
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and/or head trauma). a. Valium (Diazepam) 10 mg PO with initial CIWA-Ar assessment; then,
every 6 hours x 72 hours, then, if stable every 8 hours; then discontinue if stable.
b. CIWA-Ar monitoring every 6 hours x 72 hours; then, if stable every 8 hours x 24 hours; then, if stable, discontinue the monitoring and Diazepam.
c. Push fluids, 1 quart (32 ounces) every 6 hours.
d. Clonidine (Catapres 0.1 mg PO tid x 5days (hold if systolic less than 95).
e. Multivitamins one daily PO x 5 days.
f. Thiamine (Vitamin B1) 100 mg PO every day x 5 days.
g. Folic acid 1 mg PO every day x 5 days
h. Ondansetron Hydrochloride (Zofran) ODT 4 mg PO bid PRN nausea/vomiting x 5 days.
i. Acetaminophen 500 mg. PO every 6 hours PRN for headache x 5 days.
j. Notify medical provider if CIWA-Ar score worsens or shows no improvement in one hour of protocol medication administration.
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k. Notify medical provider if inmate refuses medications and/or CIWA-Ar monitoring.
l. Consult with medical provider daily until score < 5.
m. If released prior to completion of the protocol, give written discharge instructions.
3. Level II - Alcohol Withdrawal Scale (CIWA-Ar) score 9-14 with or without risk factors as noted above.
a. Diazepam (Valium) 10 mg PO with initial assessment; then, every 2 hours until CIWA-Ar score less than 10; then, Diazepam 10 mg. PO every 6 hours to complete x five full days of protocol.
b. CIWA-Ar score assessment every 2 hours until score less than 10; then, if stable, every 6 hours to complete full five days of protocol.
c. Notify medical provider if CIWA-Ar score is 15 or greater; worsens; or shows no improvement in one hour following initiation of medications for consideration of hospital transfer.
d. PRN medication response assessment: CIWA-Ar 30-60 minutes after medication administration.
e. A Clonidine (Catapres 0.1 mg PO tid x 5days (hold if systolic less than 95).
f. Gabapentin 400mg PO qid x 5 days (for a full 5 days).
g. Continue all other medications as for Level 1.
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h. House in OPHU, Medical Observation Status. If no OPHU beds available, contact medical provider for consideration of transfer to Natividad Medical Center.
i. Next medical provider sick call.
j. If CIWA-Ar score is less than 8 x 24 hours may move to custody housing; and continue Level I protocol to complete 5 full days.
k. Must be assessed prior to release for possible transport to hospital if not stable, or in need of additional medical intervention.
4. Level III - Alcohol Withdrawal Scale (CIWA-Ar ) score 15 or greater with or without risk factors as noted above.
a. Diazepam (Valium) 20 mg PO, continue Diazepam dosing based on CIWA-Ar score every 1 hour; when CIWA-Ar score less than 15: give Diazepam 10 mg. PO every 6 hours to complete five full days of protocol.
b. Continue all medications; as for Level II.
c. CIWA- Ar assessment/ vital signs: every hour until score less than 15; then, if stable, 4 hrs x 72 hrs; then, if stable, every 6 hours to complete full five days of protocol.
d. House in OPHU, Medical Observation Status. If no OPHU beds available, contact medical provider for consideration of transfer to Natividad Medical Center.
e. Next medical provider sick call; and daily.
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f. Notify medical provider if CIWA-Ar score shows no improvement within one hour following initiation of medications for consideration of hospital transfer. Immediately contact on-call provider for any patient at any AWS level who complains of respiratory distress and/or chest pain. Immediately send patient to the emergency department for any patient failing to improve after one hour from valium dosing on any AWS level or for active seizing.
g. If CIWA-Ar score less than 8 x 24 hours move to custody housing h. Must be assessed by medical prior to release for possible transport
to hospital if remains at a protocol level II or III, or is not stable.
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VI. TREATMENT OF DRUG WITHDRAWAL
A. Policy:
This procedure is to facilitate and guide in the evaluation and treatment of drug withdrawal. Medical response will be initiated within one hour of the identification of drug withdrawal treatment need at any time during the inmate's incarceration. Drug withdrawal is characterized by physiologic changes that occur when the addicting drug is discontinued.
B. Circumstances under which the RN may perform the Function:
1. Setting - Monterey County Correctional Facilities
2. Supervision - Direct supervision required for initiation of prescription medications.
3. Patient conditions - Registered nurses may routinely evaluate and care for patients' health complaints following procedures approved by the responsible physician.
4. Access to the on-site or on-call medical provider for consultation. Medical Provider consultation is required prior to initiation of prescription medication.
C. Data Base
1. Opioids (opiates, heroin, methadone, buprenorphine):
Withdrawal from opioids can generally be managed safely in a jail setting, however, there are certain criteria for when hospitalization is the preferred setting for managing withdrawal (see below).
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a. Subjective:
(1) Patient relates history of opioid use or addiction.
(2) Patient relates one or more of the following complaints:
(a) Craving and demanding of addicting drugs (b) Lacrimation - tearing of the eyes (c) Restless sleep, insomnia (d) Gooseflesh - pilomotor erection (e) Hot and cold flashes (f) Generalized aches and pains (g) Nausea and vomiting, abdominal cramping (h) Diarrhea (i) Methadone may be asymptomatic 48-72 hours after last
dose
b. Objective
(1) Yawning (2) Diaphoresis (3) Rhinorrhea-watery discharge from the nose (4) Lacrimation - tearing of the eyes (5) Fever (6) Increased rate and depth of respirations (7) Tachycardia (8) Vomiting (9) Agitation, anxiety (10) Piloerection (11) Dilated pupils
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(12) Access previous jail medical records for history of in custody drug protocol treatment.
2. Benzodiazepines: (Klonopin, Alprazolam (Xanax), Chlordiazepoxide (Librium), Diazepam (Valium), Lorazepam (Ativan) and BARBITURATES: (Phenobarbital, Secobarbital Sodium (Seconal), and Pentobarbital (Nembutal)). Withdrawal from these sedatives can generally be managed safely in a jail setting; however there are certain conditions when hospitalization is the preferred setting for managing withdrawal that determination will be made by the medical provider.
a. Subjective:
(1) Patient relates history of benzodiazepine (barbiturate) use
(a) Name of medication.
(b) Amount, route, frequency, duration of use and last use.
(c) Other substance and/or prescription drug use/abuse (name/type, frequency and dose/amount),
(d) In the past year has patient used opioids, cocaine, amphetamines, heroin, pain pills, or marijuana. If yes, last use. If used within last week determine amount and frequency of use. Is daily drinker of alcohol, determine amount and if there is a history of withdrawal.
(2) Withdrawal symptoms per Benzodiazepine Withdrawal Symptom Questionnaire (2) (refer to questionnaire below).
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(3) Additional symptoms:
(a) Itching or peculiar feeling in the skin (e.g., hot patches, tingling, wet legs)
(b) Buzzing in the ears (tinnitus) (c) Blurred vision (d) Flu-like symptoms ( runny nose, sore throat) (e) Anxiety/irritability (f) Dizziness (g) Breathlessness (h) Vomiting, retching (i) Relates current history of possible psychotic behavior;
suicidal or homicidal thoughts: report to on-call medical provider during consultation.
(j) Relates history of current medical conditions for which receiving treatment (e.g., cardiac, pulmonary, seizure disorders): include in consultation with on- call provider.
(k) Relates history of alcohol and/or sedative withdrawal; loss of consciousness, delirium, loss of bowel and/or bladder control, etc.); ever hospitalized and/or treated for alcohol or sedative withdrawal while hospitalized for another problem: include in consultation with on-call provider.
b. Objective:
(1) Physical Assessment (2) Vital signs: elevated heart rate, blood pressure, respiratory rate,
and temperature (3) General: sweating, retching, increased motor activity.
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(4) Neuro-motor: not fully oriented, unable to track/follow commands, tremor, myoclonic jerks
(5) Other: signs of chronic or acute illness (6) Access previous jail medical records for history of in custody
drug protocol treatment.
3. Cocaine/Methamphetamine/Designer Drugs:(LSD, PCP, Ecstasy):
a. Subjective:
(1) Patient relates history of cocaine, methamphetamine, or designer drug use.
(2) Patient relates one or more of the following complaints:
(a) Drug craving (b) Paranoia (c) Desire to sleep a lot and/or insomnia (d) Loss of energy (e) Depression (f) Apathy (g) Suicidal ideation (h) Nausea (i) Palpitations (j) Increased appetite (k) Feeling cold
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b. Objective:
(1) Anxiety, agitation or lethargy (2) Tremulousness (3) Tachycardia (4) Hypertension (5) Hyperventilation (6) Diaphoresis (7) Dilated pupils (8) Psychosis (9) Seizures may be caused by severe toxicity (10) Unresponsive/coma (11) Access previous jail medical records for history of in custody
drug protocol treatment.
4. Assessment:
a. Altered Nutrition: less than body requirements related to poor eating habits
b. High risk for injury related to hallucinations, drug effects c. High risk for violence related to poor impulse control d. Ineffective individual coping related to situational crisis, withdrawal e. Sensory/perceptual alterations as evidenced by symptoms related
to substance intoxication f. Sleep pattern disturbance related to effects of drugs or medications
5. Plan:
a. Opioid (Opiates, Heroin, Methadone, Buprenorphine) Withdrawal Treatment:
While opioid withdrawal is generally considered safe, dehydration and electrolyte imbalance from prolonged vomiting can lead to serious health consequences including death. Additionally, the
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cardiovascular stress of opioid and other drug withdrawal can lead to serious health complications including myocardial infarction and cardiac arrest especially in patients with underlying chronic medical conditions such as heart disease and diabetes.
(1) If patient is pregnant or lactating consult with on-call medical provider and DO NOT USE THIS PROTOCOL as patient may need to continue or be started on methadone or buprenorphine.
(2) If patient is withdrawing from or has the potential to withdrawal from Opiates and Alcohol: include this information to medical provider when obtaining orders to initiate protocol; also, see section d. Multiple Substance Withdrawal in this protocol.
(3) The Clinical Opiate Withdrawal Scale (COWS) will be used to assess all inmates stating a history of opiate use and/or withdrawal, as well as vital signs and assessment for dehydration.
(4) Withdrawal from longer acting opioids like methadone or buprenorphine generally begin later and last longer duration than heroin withdrawal, especially when on larger doses, i.e., methadone at greater than 50 mg/day; buprenorphine at greater than 16 mg/day. For patients that admit to or are known to be using methadone or buprenorphine, COWS assessment monitoring and vital signs will continue for a full 10 days, or until discontinued by the provider. Monitoring and treatment will follow the levels described below.
(5) Consider drug-to-drug interactions and drug contraindications
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when ordering medications. Consult with medical provider prior to initial of prescription medications.

(6) Baseline labs at the discretion of the medical provider.
(7) Mild Withdrawal/Level 1 - COWS score 5-12; HIGH-RISK inmates (those having co-morbidities such as CAD, DM, COPD and/or inmates >50 years of age) should be started at LEVEL 2:

(a) Tylenol #3, 2 tabs PO bid x 3 days (b) Gabapentin 400mg PO qid x 3 days
(c) Ondansetron (Zofran) ODT 4mg PO tid x 3 days PRN (d) Clonidine (Catapres) 0.1 mg PO bid x 3 days (Hold
Clonidine if BP below 80/60) (e) Multi vitamins one PO every day x 3 days (f) Loperamide (Imodium) 2 mg PO tid x 3 days PRN. (g) Push fluids (h) COWS assessment and vital signs bid x 3 days (i) Sick Call in 72 hours for re-evaluation (j) Notify medical provider if inmate refuses medications
and/or COWS monitoring.

(8) Moderate Withdrawal/Level 2 - COWS Score 13-24 or ALL high risk (see above) inmates with score <24

(a) Tylenol #3 2 tabs PO bid x 3 days

(b) Gabapentin 400mg PO tid x 3 days

(c) Ondansetron (Zofran) ODT 4 mg PO tid x 3 days PRN

(d) Clonidine (Catapres) 0.1 mg PO tid x 3 days (Hold Clonidine

if BP below 80/60).

(e) Multivitamins one PO every day x 3 days.

(f) Loperamide (Imodium) 2 mg PO tid x 3 days PRN.

(g) Push fluids.

55

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(h) COWS assessment and vital signs tid until score <13. (i) Medical Provider Sick Call in 24 hours for re-evaluation or
contact on call provider. (j) Notify medical provider if inmate refuses medications
and/or COWS monitoring.
(9) Moderately Severe Withdrawal/Level 3 - COWS Score 25 - 36:
(a) Tylenol #3 2 tabs PO tid x 3 days, then bid x 3 days. (b) Gabapentin 400 mg PO qid x 6 days. (c) Ondansetron (Zofran) ODT 4 mg PO tid x 3 days PRN. (d) Clonidine (Catapres) 0.1 mg PO tid x 6 days. (Hold
Clonidine if BP below 80/60). (e) Multivitamins one PO every day x 3 days. (f) Loperamide (Imodium) 2 mg PO tid x 3 days PRN. (g) Push fluids. (h) COWS assessment and vital signs q 6 hours x 2 days or
until score <25, then tid until score <13. (i) Notify medical provider if inmate refuses medications
and/or COWS monitoring. (j) Medical Provider Sick Call daily for re-evaluation or contact
on-call daily until score <25. (k) Scores greater than 30 that do not improve with
medication after one hour consult with medical provider and order ambulance for transport to emergency department.
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b. Benzodiazepine and Barbiturate Withdrawal (BWS) Treatment:
(1) Conduct initial assessment which includes current symptoms and physical findings including full vital signs.
(2) Consult on-call medical provider with assessment findings for consideration of starting withdrawal protocol and baseline labs. Provider may elect to monitor only or, for high risk patients, may elect to start a diazepam (Valium) withdrawal taper.
(3) Benzodiazepine Taper:
(a) Days 1, 2 and 3: Diazepam 10 mg tid PO (total of 30mg/day)
(b) Days 4, 5 and 6: Diazepam 5 mg qid PO (total of 20 mg/day)
(c) Days 7,8 and 9: Diazepam 5 mg tid PO (total of 15 mg/day) (d) Days 10, 11 and 12: Diazepam 5 mg, bid PO (total of 10
mg/day) (e) Days 13, 14 and 15: Diazepam 5 mg day PO.
(4) Monitoring of vital signs during the withdrawal period begins with TID monitoring for the first three days and decreases to BID for an initial seven days. If patient is high risk for withdrawal complications as noted above* and diazepam (Valium) was ordered by the provider, continue the BID monitoring for nine days, then daily x 3.
(5) Attempt to confirm benzodiazepine use through pharmacy verification/outside provider office verification and/or urine toxicology, if available at your site.
(6) All inmates placed on benzodiazepine withdrawal monitoring or withdrawal medications should be housed lower bunk and lower tier.
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(7) Consideration should be made for special medical housing for withdrawal patients and especially for those abusing multiple substances.
(8) Generally, benzodiazepine withdrawal symptoms fluctuate. It is not recommended to increase the dose of Valium when symptoms worsen; instead, continue the current dosing schedule until symptoms improve.
(9) Schedule patient to see medical provider within three days and refer to psychiatrist or psychiatric NP for evaluation within seven days.
(10) If the patient is pregnant consult with on-call medical provider. Abrupt withdrawal from benzodiazepines is potentially dangerous for both patient and fetus. Patient should have urgent referral to OB provider. Onsite provider will need to give guidance on whether to continue patient’s current benzodiazepine or switch to diazepam for the process of tapering the patient off the benzodiazepine. It is suggested to reduce daily dose no more than 10% from previous daily dose. (Please also refer to the Pregnancy Standardized Procedure).
(11) If the patient is using alcohol and benzodiazepines, use the alcohol withdrawal protocol (AWS) and schedule with provider within 3 days to determine if Valium needs to be continued for an extended period beyond AWS treatment.
(12) If the patient is using opioids and benzodiazepines, use the opiate withdrawal protocol and contact on-call provider to add Valium especially for high-risk patients.
(13) Notify the medical provider immediately for possible ambulance transport to the nearest emergency room if patient shows any of the following signs of severe withdrawal:
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• Heart rate > 120 BMP • Severe prolonged vomiting greater than 4 hours • Grossly visible tremor • Profuse perspiration • Temperature > 101º F • Currently worsening sedative withdrawal despite
appropriate pharmacotherapy at the highest level of lower care. (14) Patients considered high risk for complicated benzodiazepine withdrawal (especially when confirmed on chronic high doses of a benzodiazepine) and should be considered potential candidates for hospitalization are: • History of seizure disorder including history of withdrawal seizures from any substance • History of requiring hospitalization due to withdrawal from any substance • Known diabetes, renal disease, and cardiovascular disease. • If the patient is in any of these subgroups of benzodiazepine withdrawal, notify your provider for possible hospital admission.
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c. Cocaine, Methamphetamine & Designer Drug Treatment: (1) Monitor vitals every 6 hr until stable; (2) For BP above 160/100, HR above 100, and symptomatic call medical provider; (3) Consider a urine dipstick to rule out rhabdomyolysis. (4) Watch for depression, suicidal behavior; and (5) Refer to next mental health staff sick call.
d. Multiple Substance Abuse Withdrawal: (1) Alcohol and benzodiazepine: contact on-call provider for use AWS Protocol. (2) Alcohol and opioid: Contact on-call provider for Use AWS Protocol and the addition of clonidine. (3) Opioid and benzodiazepine: Contact on-call provider for use BWS and the addition of Clonidine. (4) Other combinations of drugs of abuse: Contact on-call provider for orders.
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VII. SUICIDE PREVENTION
A. Identification
1. The receiving screening procedure completed at the time of intake into the facility by the Booking Registered Nurse shall include questions and observations regarding mental status and presence and/or potential for suicidal behavior.
2. Custody and health services staff shall be trained and alerted to the need to continuously monitor inmate behavior for suicide potential during incarceration.
B. Training
1. Regularly scheduled training for all custody and health services staff shall be provided to include identification and management of suicidal behavior in the jail setting including high-risk periods of incarceration, suicidal risk profiles and recognition of verbal and behavioral cues that indicate potential suicide. This training is an adjunct to training required by the Sheriff's Department and in no way is intended to meet all the training needs of the department.
C. Assessment
1. Initial assessment of inmates identified as exhibiting signs of or the potential risk for suicidality shall be performed by a qualified mental health provider and will include the use of CFMG's Psychiatric Suicide Assessment Tool:
2. Mental health staff shall be available on-site 7 days per week and on-call for assessment of an inmate's level of suicide risk upon referral by health services and/or custody staff.
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D. Housing and Monitoring
1. Inmates identified as potentially suicidal shall be placed on suicide watch or suicide precautions by custody, health services or mental health staff:
a. Safety cell:
In the case of an inmate who is placed in a safety cell because of suicide risk, CFMG (1) shall promptly evaluate the inmate to determine the level of suicide precautions necessary in the immediate term (promptly defined as immediately to no later than 4 hours), and (2) shall make a medical decision regarding whether the inmate needs to be transferred to an in-patient mental health facility in lieu of suicide watch/suicide precautions at the jail. If CFMG determines, based on appropriate clinical judgment informed by a suicide risk assessment evaluation, that the inmate requires prolonged suicide precautions or suicide watch (prolonged defined as longer than 24 hours) CFMG shall work with custody to place the inmate in the most appropriate setting. Options for placement include: an in-patient mental health facility; the Outpatient Housing Unit; a receiving cell located in the booking unit; or dorm A.
When CFMG determines that an inmate is no longer suicidal, and clears the inmate from suicide precautions or suicide watch, CFMG shall make a medical recommendation regarding transitioning the inmate from suicide precautions or suicide watch. CFMG shall work with custody to place the inmate in the most appropriate setting. Options for placement include: an in-patient mental health facility; the Outpatient Housing Unit; Transition Cells in Administrative Segregation; receiving cells in the booking unit; dorm A or general population. CFMG Mental Health Clinicians will provide these inmates with supportive contact and will follow-up with them until such time the clinician determines the inmate's step-down plan is discontinued.
For any inmate who has been housed in a safety cell for 24 consecutive hours or for more than 36 cumulative hours in any 3-day period, custody shall promptly begin processing the inmate for transfer to either an appropriate in-patient mental health facility or the Natividad Medical Center emergency room for assessment. It is recognized that on occa63sion
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there may be exigent circumstances which prevent compliance with these requirements. If such circumstances occur, a memo detailing the circumstances shall be written and directed to the Custody Operations Commander.
Should there be a disagreement regarding where an inmate should be placed following release from a safety cell; the on duty sergeant will be contacted in an attempt to reach an agreement. If a dispute still exists as to the placement of an inmate, an on-call commander will be contacted. The on-call commander will have final decision-making authority as to placement. However, any time there is a disagreement between medical and custody staff as to placement of an inmate following release from a safety cell, a report outlining the reasons for disagreement will be generated by the on-call sergeant. These reports will be reviewed on a monthly basis by the Operations Commander, who will meet with the medical director when necessary to identify any systemic disagreements or issues. Custody staff will be briefed at staff briefings as to any changes which need to be made or issues that are identified as a result of the meeting between the Operations Commander and medical director.
b. Open observation (occupied cell or dormitory).
2. Inmates placed on suicide watch or suicide precautions shall be monitored by custody staff twice in 30 minutes; by health services staff every six hours; and mental health staff at a minimum of once per duty shift. Precautions will be taken to ensure that the inmate has no materials on his/her person to inflict harm to his/her self or others. If necessary, dress inmate in an approved safety garment.
a. All monitoring/supervision shall be documented on a log to include date, time, patient status, intervention (when appropriate) and signature/initials of individual monitoring.
b. Nursing staff will document all monitoring findings on the CFMG Sobering/Suicide Watch/Safety Cell/Restraints Log.
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E. Referral
1. Referral of all inmates identified as displaying suicidal ideation, gestures and/or attempts shall be immediately referred to the on-site/on-call mental health staff by nursing staff.
2. Inmates on Suicide Precautions in safety cells whose condition deteriorates, or for whom the nurse is unable to complete a hands-on assessment including vital signs after six hours of placement shall be transferred to Natividad Medical Center for further assessment.
3. A qualified mental health provider is responsible for developing individual treatment plans for those inmates suffering from mental illness. A qualified mental health provider will perform a suicide risk assessment, including use of the CFMG Suicide Risk Assessment Tool, whenever an inmate is released from the safety cell.
4. In the case of an inmate who is placed in a safety cell because of suicide risk, a qualified mental health provider may recommend transfer of the inmate to an appropriate in-patient mental health facility. Depending on the assessment of the level of suicide risk, whenever possible, the inmate will be transitioned from the safety cell to an open dormitory setting until the inmate has stabilized. Other transition options may include housing in a transition cell or one on one observation in the OPHU. Mental health providers and custody will collaborate to ensure classification needs of an inmate are considered.
5. CFMG will inform classification, through medical treatment orders, as to any classification issues an inmate has due to mental illness. CFMG and custody will review the appropriateness of an inmate’s placement in a safety cell because of suicide risk at least once every twelve hours.
6. Any inmate who has been placed in a safety cell for Suicide Precautions for 24 consecutive hours shall be transferred to either an appropriate inpatient mental health facility or the Natividad Medical Center emergency room for assessment.
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F. Intervention
1. Intervention and treatment shall be carried out in accordance with direct order of the responsible medical or mental health provider and/or CFMG protocols/standardized procedures.
2. Inmates placed on Suicide Precautions will be housed as indicated in Item D above and be provided with a suitably designed safety garment to provide for their personal privacy unless specific identifiable risks to the inmate's safety or to the security of the facility are documented.
G. Communication
1. Custody, nursing and mental health staff will maintain open lines of communication to insure that all parties are kept apprised of suicide potential; suicide precaution placement, retention, and release status; monitoring findings including general status reporting through time of event and end-of-shift reporting and oncall contacts to insure appropriate continuity of care and follow-up.
H. Reporting
1. Reporting of inmates identified or suspected of being at risk for suicidal behavior will occur through the referral process. Referrals may be made by custody to nursing or mental health staff at any time. Current status reporting will be carried out as described in Communications section, above, and CFMG Safety Cell Policy and Procedure.
2. Reporting completed suicides shall be a joint responsibility of the CFMG Program Manager and Facility Manager in accordance with CFMG Inmate Deaths Policy and Procedure.
a. The CFMG Program Manager or nursing staff on duty shall be responsible for reporting all potential and/or attempted and completed suicides to the Facility Manager or Shift Supervisor.
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3. CFMG management shall be notified of completed suicides within one working day.
I. Notification Family members shall be notified in accordance with the CFMG Notification of Next of Kin Policy and Procedure.
J. Review: All completed suicides shall be subject to a medical and psychiatric review and review by the Quality Management and Peer Review Committees in accordance with CFMG Inmate Deaths Policy and Procedure.
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VIII. TUBERCULOSIS IDENTIFICATION, CONTROL AND TREATMENT PROGRAM
A. Tuberculosis screening of all inmates will be performed at the time of intake by a registered nurse using the Standardized Monterey County Jail Intake Health Screening Form. During the initial intake screening the registered nurse will ask each inmate whether they have a history of TB disease, or if they have previously been treated for LTBI or TB Disease. If possible, documentation of any such history should be obtained from an inmate's prior medical records.
B. All incoming inmates will immediately be screened for symptoms of pulmonary TB by being asked if they have had a cough lasting greater than three weeks, bloody sputum, chest pain, fever, chills, night sweats, easy fatigability, loss of appetite and weight loss. Inmates will be interviewed systematically to determine whether thy have experienced symptoms in recent weeks. Inmates will be observed for the presence of cough or evidence of significant weight loss.
C. Any inmate with positive TB screening findings at the time of intake will be followed-up by a registered nurse in accordance with the CDC recommendations. A TB screening will be considered positive when an inmate answers yes to any of the following questions: prolonged cough for greater than 3 weeks, bloody sputum, weight loss/poor appetite, fever/chills, night sweats, unexplained chest pain or unusual fatigue.
D. Inmates who have symptoms suggestive of TB disease at the time of intake or a history of inadequate treatment for TB disease, will immediately be placed in an Airborne Infection Isolation Room until they have undergone a thorough medical evaluation by a medical provider which including a TST, chest radiograph, and, if indicated, sputum examinations. If deemed infectious, these inmates will remain in isolation until treatment has rendered them noninfectious.
E. Inmates who are placed in an Airborne Infection Isolation Room because they are suspected to have Infectious TB can be discontinued when infectious TB is considered unlikely and either another diagnosis is made that explains the
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clinical syndrome or the patient had three negative acid-fast bacilli sputumsmear results. Patient for whom the suspicion of TB disease remains after the collection of three negative AFB sputum-smear results should not be released from airborne precautions until that are on standard multidrug anti-TB treatment and are clinically improving. However, these inmates should not be housed in an area in which other patients with immune-compromising conditions are housed.
F. All inmates with confirmed TB disease should remain in an Airborne Infection Isolation Room until they have had three consecutive AFB sputum-smear results collected 8 hours apart, with at least one being an early morning specimen; having received standard multidrug anti-TB treatment; and have demonstrated clinical improvement.
G. The Airborne Infection Isolation Rooms will be monitored, inspected and maintained in accordance with the CFMG ATD Procedure, a copy of which is attached as Exhibit H.
H. Tuberculosis signs and symptoms screening and skin testing (when indicated) shall be initiated within 7 days of admission to the facility; as part of the kitchen workers' clearance examinations; as a component of the six-month physical exam; and annually thereafter, for the duration of incarceration.
I. Procedure:
1. Timing of TST Testing:
a. An LVN will place the TST within seven days of incarceration.
b. An LVN will read the TST between 48 and 72 hours of placement.
2. Prior to applying the TST test the following information shall be obtained:
a. Has inmate ever had a positive reaction to TST test?
(1) If yes, when and name of clinic/jail/prison/provider?
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(2) If yes, has the inmate had a chest x-ray in the past 6 months?
(3) If yes, name of clinic/jail/prison/provider and results of x-ray.
b. Is the inmate an immigrant from Latin America, Southeast Asia, the Philippines, equatorial Africa, former Soviet Union, Eastern Europe or the Caribbean?
c. Has the inmate ever received BCG vaccine?
(1) If yes, when was vaccine given?
d. Is the inmate HIV positive or have AIDS?
3. Inmates with positive TB symptom screen (answering yes to any of the following: prolonged cough > 3 weeks, hemoptysis/bloody sputum, weight loss/poor appetite, fever/chills, night sweats, unexplained chest pain, unusual fatigue) for active TB.
a. Place surgical mask on patient.
b. Move patient to an Airborne Infection Isolation (AII) room; if no AII room is available move to well ventilated room/cell and isolate from other inmates until patient can be transferred by ambulance to the Natividad Medical Center emergency department for isolation and further evaluation. Notify emergency room staff that patient needs evaluation and isolation for possible active TB.
c. Contact provider on-call.
d. Contact local department of public health (within 24 hrs).
e. Schedule patient to be seen by provider within 24 hours; if unable to have a provider evaluate the patient within 24 hours, transfer to the emergency department for evaluation.
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f. Place TST/ppd on patient unless the inmate has a documented history of a positive TST result, a documented history of TB disease, or a reported history of a severe reaction to tuberculin. Inmates with a history of severe necrotic reactions and without a documented positive result with a millimeter reading, may have a QFT-G test.
g. If evaluation by provider and active TB is still felt to be possible, order CXR and obtain 3 (done at least 8 hours apart) sputum samples for TB testing.
h. Patient must remain in AII room until cleared by a negative chest x-ray AND three negative sputums.
i. Any staff entering the AII room must wear a N-95 fitted mask; inmate to wear a surgical mask when staff present in room and/or when out of the AII for any reason.
4. Inmates who have been re-booked into the facility or are transferring from another county or state facility; have a documented TST within the last three months and are signs and symptoms free on the TB questionnaire do not require a new skin test.
5. Verified previous positive skin test:
a. Do not apply skin test.
b. Complete CFMG TB History signs and symptoms review.
(1) Signs and symptoms free and a previous negative chest film can be verified, no further follow up is required.
(2) Signs and symptom free and no verified negative chest film: order chest x-ray.
(3) Signs and/or symptoms present: place in respiratory isolation and schedule a chest x-ray.
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6. Inmates reporting history of BCG vaccination; document BCG vaccination history, proceed with the skin test and reading using the usual norms.
7. Inmates reporting HIV/AIDS positive and those who are at risk for HIV but whose status is unknown; apply skin test; schedule a chest x-ray and follow-up by medical provider post x-ray for evaluation for further testing and/or treatment. If inmate is a re-admission with a verified negative chest film in the medical record and signs/symptom free, skin test only.
J. Application:
1. Give 0.1 ml of 5TU of purified protein derivative (PPD) slowly intradermally, right forearm, if possible. Enter information on the medical record; site of injection, solution and amount, manufacture & lot number, inmate's name, housing location, identification number (if applicable), date and time done and date and time read, signature of individual giving and reading the test, signature of individual applying the reading test.
2. Instruct inmate that test must be read in 48 - 72 hours.
K. Reading:
1. Measure all TB Skin Tests 48 - 72 hours after placement.
2. Record all test results in mm, including negative results.
a. Document induration (not erythema) on 14 day PE form. Note date and time results were read and individual responsible for reading.
3. A reaction of 5mm or more of induration should be considered positive in the following individuals who are considered high risk for TB and a CXR should be ordered and completed within 72 hours:
a. Persons with close recent (within one year) contact to a case of infectious tuberculosis.
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b. Persons with HIV infection or with behavioral risk factors for HIV infection, but decline HIV testing.
c. Persons who use intravenous drugs (if HIV status is unknown).
d. Persons with fibrotic changes on the chest radiograph consistent with previous TB disease.
e. Organ transplant recipients and inmates with other immunocompromised conditions, i.e. inmates requiring greater than 15 mg. of prednisone for greater than one month.
4. A reaction of 10mm or more induration should be considered positive in all other persons who are considered lower risk for TB and should have a CXR ordered and completed within 72 hours.
5. All individuals who have a positive tuberculin skin test should receive counseling and risk assessment for HIV infection.
L. Follow-Up to Chest X-Ray:
1. Negative chest x-rays:
a. Schedule with provider to discuss treatment options.
b. See treatment and management options below (Latent TB Infection).
2. Positive or questionable x-ray results, consult with MD/PA/NP regarding ordering sputum specimens times three and further follow-up. Reported to Public Health TB Control and isolation until results of AFB sputum return.
a. Inmate should not be cleared for kitchen duty.
b. Call County TB Control Program to check master index for previous treatment or history within the county.
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c. Close contacts, i.e., cell mates, should be followed up in accordance with CFMG Aerosol Transmissible Disease Exposure Control Plan, and recommendations from the County Public Health Officer.
d. If inmate is determined to be likely to have active TB disease, County TB Control shall be notified within 24 hours.
M. Latent TB Infection (LTBI): LTBI continues to be a major public health problem in the United States. Infected persons usually have a positive tuberculin skin test (TST) reaction or positive Immune-Globulin Release Assay (IGRA), a normal chest x-ray (any abnormal chest x-ray needs referral to your provider for sputum testing and additional imaging) and have no symptoms related to the infection and are not infectious:
1. Candidates for Preventive Therapy: All persons with suspected LTBI and normal chest x-ray should be considered for therapy and the following list are those considered to be at highest risk for developing an active infection:
a. Persons known to have HIV infection (TST result of 5mm or greater).
b. Person at risk for HIV infection (including persons who inject drugs) but whose HIV status is unknown (5mm or greater).
c. Close contact of a person with infectious TB (5 mm or greater).
d. Persons who have chest radiograph findings suggestive of previous TB and who have received inadequate or no treatment (5 mm or greater).
e. Persons who inject drugs and who are known to be HIV negative (10 mm or greater).
f. Persons who have medical conditions known to increase the risk for TB disease such as Diabetes Mellitus and other immune suppressive diseases (10 mm or greater).
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g. Persons whose TST reaction or IGRA result converted from negative to positive within the past 2 years (10 mm or greater increase if younger than 35 years of age).
2. Tracking of all TST results, chest x-ray results, and treatment must be done on all patients regardless of their expected length of stay. Tracking will occur in each patient's chart as well as in the TB tracking log which is kept in the medical department.
3. Treatment Recommendations and Medication Regimens: All persons with a positive TST or IGRA will get a chest x-ray and will be referred to the jail medical provider to discuss treatment options. An important point to remember is that starting therapy that cannot be completed is worse than not starting treatment due to the development of drug resistant strains of TB. The following categories of inmates will help guide whether therapy should be started and which therapy is preferred.
a. Pregnant women: Generally preventive therapy should not be given to pregnant women who are found to be TST or IGRA positive on screening with the following exceptions noted below. Isoniazid (INH) therapy should be considered for pregnant women who were
(1) likely to have been recently infected with TB; or
(2) who have high-risk medical conditions, especially HIV infection
(3) Pregnant minors with positive TST or IGRA will be referred to the responsible medical provider for evaluation and consultation with OB/GYN specialist for the decision of whether Isoniazid (INH) therapy is to be initiated.
b. Persons who are confirmed to be incarcerated for greater than 6 months should receive 6 months of INH therapy or, if HIV infected, 9 months of INH therapy.
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c. Persons who are confirmed to be incarcerated for greater than 3 months, but less than 6 months should receive 11 doses or 12 weeks of INH with Rifapentine (INH-RPT) weekly. Per the CDC, this must be Directly Observed Therapy (DOT).
d. If an inmate is unexpectedly released early, every effort should be made to arrange for completion of treatment on the outside, particularly if treatment was nearly complete.
e. Persons for whom INH therapy is contraindicated (such as past drug reaction, etc.), should be considered for Rifampin therapy.
4. For all persons who have no contraindications to begin therapy:
a. Obtain a signed CFMG Consent for TB Therapy Form from patient, parents or guardian; counsel patient, parents or guardian regarding the side effects and toxicity problems associated with Isoniazid (INH) or other drug therapies noted above and the need to complete the full course of therapy. Verify a normal chest x-ray and instruct patient to report any symptoms to health services staff.
b. Isoniazid (INH) 900 mg. PO bi-weekly; or, 300 mg PO daily, directly observed therapy (DOT) for 6 or 9 months, depending on immune status. Pyridoxine supplementation is not typically needed when using INH with exception of patients who are pregnant, have diabetes, HIV, renal failure, and alcoholism.
c. For those patients needing Pyridoxine (Vitamin B6) supplementation (see #2 above) 100 mg PO bi-weekly; or, 50 mg daily, for 6 or 9 months, depending on length of INH therapy.
d. Isoniazid (INH) 900mg (max dose and based on body weight) with Rifapentine 900mg (max dose and based on body weight) given once weekly with Directly Observed Therapy (DOT) for 3 months.
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e. Rifampin 600mg daily (max dose and based on body weight) for 4 months.
f. Schedule for medical provider sick call every month for evaluation for signs and symptoms of medication toxicity (i.e., loss of appetite, weight changes, nausea, vomiting, fatigue, dark urine, jaundice and/or rash.
g. Patients exhibiting any signs or symptoms of toxicity: refer to medical provider sick call as soon as possible.
h. Individuals who are released from custody prior to completion of the full course of treatment: need referral to own medical provider, health plan, or county public health agency. This is critical to avoid risk of development of resistance to any of these drug regimens.
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IX. PHARMACEUTICAL ADMINISTRATION
The procurement of pharmaceuticals is done under the supervision of a licensed pharmacist in accordance with all applicable federal and state laws. Prescription medications will be administered to inmates by licensed nursing staff in accordance with CFMG’s Implementation Plan regarding pharmacy administration. A consulting pharmacist will be used for documented inspections and consultation on a regular basis, not less than quarterly.
Administering medication, as it relates to managing legally obtained drugs, means the act by which a single dose of medication is given to the patient. The single dose of medication may be taken either from stock (undispensed), or dispensed supply.
Dispensing, as it relates to managing legally obtained drugs, means the interpretation of the prescription order, the preparation, repackaging, and labeling of the drug based upon a prescription from a physician, dentist, or other prescriber authorized by law.
Delivering medication as it relates to managing legally obtained drugs, means the act of providing one or more doses of a prescribed and dispensed medication to a patient. Delivering of medication may be done by either licensed or non-licensed personnel, e.g., custody staff, acting on the order of a prescriber.
A. Administration of Medication
To assure safe, accurate methods of administering medication, the following procedures will be strictly adhered to:
1. As a general policy, prescribed and over-the-counter medications will be administered twice daily at intervals approximately 12 hours apart. Inmates requiring more frequent medications will receive such as medically indicated.
2. All patients must be identified by the medication nurse by checking inmate's armband and/or I.D. badges. Verify last names, first name and middle where applicable. If the inmate is not wearing an armband/I.D. badge, the
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medication will be held until the inmate is identified by correctional staff and armband/I.D. badge is obtained.
3. The medication nurse is responsible for and will verify:
a. Appropriate medication, as ordered b. Proper dose c. Given to correct inmate d. Given at correct time e. Given by correct route (po, r, sq, etc.). f. Vital signs taken where indicated.
4. The medication nurse is responsible for taking every reasonable precaution to assure that the inmate actually ingests the medication by:
a. Watching the inmate take the medication. b. Checking for "cheeking" or "palming" to assure that medication has
been ingested. c. Having the inmate speak after taking the medication and/or drinks
water.
5. The medication nurse will keep the medication envelopes well out of the reach of inmates at all times.
6. The medication nurse will never:
a. Reach into a cell. b. Put face near a door opening.
7. When a prescribed substance is administered it will be recorded on the inmate's medication administration record (MAR).
8. If a prescribed substance is refused or withheld, a notation will be made on the medication administration record (MAR) and the prescribing medical provider shall be notified after three consecutive refusals.
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B. Prescription Medications
Medications, except those specifically listed on the policy regarding non-prescription drugs, will be given only on the order of the Physician. Long-term use of minor tranquilizers is discouraged. Psychotropic medications are prescribed only when clinically indicated and are not given for disciplinary reasons.
All nurses administering medications will be trained to recognize the common side effects associated with the use of psychotropic medications. If a nurse observes that an inmate is experiencing any of these side effects they will document their observations in the medical record and schedule the patient to see a medical provider at the next available sick call.
1. Medication will be ordered in writing on the patient's chart by the Physician or FNP/PA, or written as a verbal order by the nurse. Verbal orders must be co-signed by a physician within 7 days.
2. Medication orders will be transferred to the inmate's medication record and envelope. Orders will be signed off in red ink when completed with date, time and signature of the individual transcribing orders.
3. New orders will be written clearly as new orders on the medication record. Absent a change in order medication records will never be altered. No correction fluid will be used on any permanent record.
4. D/C dates will be marked clearly in red.
5. Every health care provider who gives medication will sign the medication record.
6. If a prescribed substance is refused or withheld, a notation will be made on the medication record, and the provider will be notified after three consecutive refusals.
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7. Medication may only be administered according to the direct order of the Physician or P.A./F.N.P.
8. Each nurse will set up and give his/her own medication.
C. Non-Prescription Medications
Inmates are encouraged to purchase non-prescription medications through the commissary for self-care. Indigent inmates and those requiring over the counter medications when commissary is not available may request such medications from health care staff through the sick call process. The responsible physician/health authority along with custody administration will determine what medications will be sold over-the-counter at the commissary.
1. The responsible physician/health care authority along with custody administration has determined which medications and medical supplies will be sold over-the-counter through commissary.
2. There is a limit on the amount of medications that can be purchased and held by inmates.
3. Medications are provided to the inmate with their weekly commissary purchases in unit dose, sealed, labeled packaging. The commissary vendor confirms that each inmate may only obtain maximum allowed each week, when filling the commissary order.
4. Inmates found to have more than the weekly allowed amount in their cell are subject to confiscation of the medication and disciplinary proceedings by custody staff.
5. Indigent inmates and those who are not eligible for medications from the commissary purchases are provided medications as prescribed on regularly scheduled medication pass after being seen on sick call.
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D. Medication for Inmates Going to Court

Inmates on essential medications will receive medication while in court.

1. The midnight nurse will review court lists nightly for inmates taking prescribed medications.

2. Inmates who are on essential medication will have medication set up for transportation officers to take to court with inmate.

3. Medication will be placed in envelope labeled with:
a. Patient's name b. Date c. Name of medication d. Number of tablets or capsules e. Time medication should be ingested f. Location of court
4. The court list will be marked indicating inmates who will be receiving medication.

5. If no one on the court list is to receive medication, this will be indicated on the court list.

6. The court list and medication envelopes will be left with the receiving deputy in the receiving area.

7. The officer delivering the medication will:

a. Verify correct inmate by checking name of inmate on envelope against wrist band.
b. Deliver the medication at correct time.

c. Write on envelope, date; time taken ; if not, why not, and officer's

signature.

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d. Return envelopes to nurse's box in Control I.
8. The nursing staff will pick up envelopes from box in Control I and record medication given or not given on medication sheets.
E. Management of Controlled Substances Controlled substances will be kept under maximum security storage and counted at each shift change.
1. All controlled substances will be kept in a locked narcotics drawer/cabinet, inside a locked medication room, within the locked medical office.
2. All controlled substances will be signed for when administered.
3. The nurse going off duty will count every shift with the nurse coming on duty using the End of Shift Narcotics Inventory form.
4. If count is incorrect, a report will be made using Report of Error in End of Shift Narcotics Count form.
5. Records will be kept in a 3-ring notebook in the pharmacy. 6. All controlled substances are purchased in narcotic counters. The supplying
pharmacy will note the following information on each narcotic counter: a. Name of medication b. Dosage c. Expiration date d. Lot number e. Signature of physician f. Date packaged
7. The nursing staff will administer the medication as prescribed.
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F. Medications at Time of Release from Jail
Personal medications brought in with inmate at booking will be returned to him/her at the time of discharge.
A 30-day supply of essential medications taken while in jail may be given at the time of discharge only by order of jail physician who is responsible for personally dispensing such medication or providing a written prescription.
1. Nursing staff and the responsible medical provider will identify, through discharge planning, patients who will require either a written prescription or a limited supply of essential medications upon release from custody.
2. Nursing staff will notify custody in advance of the inmate's release of the need to be cleared through medical prior to transfer or release to ensure receipt of essential medication or a prescription.
G. Procurement of Pharmaceuticals
Under the direction of the Medical Director and in accordance with Pharmacy and Business Code, the Medical Program Manager or their designee acting as an agent of the Medical Director will procure, store, and manage pharmaceuticals for use in the Monterey County Jail and Juvenile Detention Facilities.
1. All stock medication will be ordered electronically or telephonically from Diamond Pharmacy Services, Inc.
2. In cases of emergencies, the Medical Director will be contacted and a prescription will be called into a local pharmacy.
H. Storage of Drugs
All prescription and non-prescription drugs stocked for the purpose of administration to inmates will be stored in a locked area, and/or refrigerators located in the treatment area accessible only to the medical staff.
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1. Containers which are cracked, soiled or without secure closures shall not be used. Drug labels shall be legible.
2. Internal use drugs in liquid, tablet, capsule or powder form shall be stored separately from drugs for external use.
3. Drugs shall be stored at appropriate temperatures. 4. Drugs shall be accessible only to medical personnel. Only licensed nursing
personnel shall have access to controlled drugs. 5. Drugs shall not be kept in stock after the expiration date on the label and
no contaminated or deteriorated drugs shall be available for use.
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X. INVOLUNTARY ADMINISTRATION OF PSYCHOTROPIC MEDICATIONS
Involuntary psychotropic medications will only be given when a psychiatric emergency exists or when an inmate, following and Incapacity Hearing, is found to lack the capacity to consent to medications. Medications shall not be used for punishment, for the convenience of staff, as a substitute for program, or in quantities that interfere with the treatment program. The responsible physician, Program Manager and Director of Nursing in cooperation with the Facility Manager will be responsible for identifying appropriate community resources and developing procedures to obtain an Incapacity Hearing and to transfer inmates requiring involuntary psychotropic medication administration to an appropriate community facility.
PSYCHIATRIC EMERGENCY - a situation in which action to impose treatment over the inmate's objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment.

A. Medication Order

Involuntary psychotropic medications for a psychiatric emergency shall be given pursuant to a direct written or verbal one-time order from the responsible facility psychiatrist or physician following an on-site evaluation. A telephone order will not be acceptable unless the inmate in question has been personally evaluated by the prescribing physician nolongerthan24hours prior to the psychiatric emergency. If the physician is not available on-site or if the inmate has not been evaluated by the on-call physician prior to the emergency situation, physical restraint should be used and the inmate transferred to the hospital emergency department for physician evaluation.

1. At no time prior to a Court Order, will an order for involuntary psychotropic medication be a PRN (as needed) or a standing order.

2. Verbal orders shall be entered into the inmate's medical record and signed

by the prescribing physician within 72 hours.

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3. The Medical Program Manager and Custody Facility Manager will be notified in writing or by telephone if not available, within 24 hours of the administration of involuntary psychotropic medication.
B. Patient Supervision and Monitoring
Inmates receiving involuntary psychotropic medications will be admitted to the infirmary or a safety cell.
1. Intermittent supervision by the custody staff will be provided at a minimum of every 30 minutes.
2. Monitoring by nursing staff will be provided at a minimum of every 15 minutes for the first hour and every 30 minutes thereafter until otherwise ordered by prescribing physician to assess response to medication, mental status, general physical appearance, behavior, and hydration.
3. All monitoring findings will be documented in the inmate's medical record.
4. The inmate will be evaluated by the responsible prescribing physician at a minimum of every 72 hours.
C. Duration of Involuntary Therapy Prior to Riese Hearing
The determination of need for continued involuntary administration of medications shall be the responsibility of the responsible facility psychiatrist or physician commensurate with psychiatric evaluation findings and availability of timely treatment options necessary to protect the inmate from harm and consistent with CCR Title 15, Section 1217. Continued involuntary therapy thereafter is pursuant to a competency hearing and/or transfer to a clinically appropriate community treatment facility.
1. Inmates exhibiting any clinical deterioration at any time during involuntary therapy will be transferred immediately to a clinically appropriate treatment facility.
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2. The facility will manage inmates meeting the psychiatric emergency criteria as follows: a. The inmate will be transferred to a clinically appropriate treatment facility outside of the jail, or b. If the inmate, for clinical or custodial reasons must remain at the jail, the health services staff shall coordinate with County Mental Health Psychiatric Emergency Services to evaluate for competency to refuse medications pursuant to Riese v. St. Mary's Hospital (Riese Hearing).
D. Review All cases involving the need for involuntary psychiatric medication administration will be reviewed by the Quality Management Committee to evaluate the appropriateness of treatment, the process and whether or not the criteria for psychiatric emergency were met.
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XI. CFMG DENTAL SERVICES IMPLEMENTATION PLAN
CFMG will provide a tiered dental services delivery program at the Monterey County Jail. All dental services will be provided in a safe and sanitary environment.
A. Screening for All Inmates:
A qualified health care professional who has been trained by the dentist shall obtain a dental history regarding any current or recent dental problems, treatment including medications during the Receiving Health Screening at intake with follow up to positive findings; perform an initial health screening on each inmate at the time of the health inventory and communicable disease screening, the general condition of the patient's dentition, missing or broken teeth, evidence of gingival disease, mucosal lesions, trauma, infection, facial swelling, exudate production, difficulty swallowing, chewing and/or other functional impairment will be noted; urgent/emergent dental needs identified. All screening findings will be documented on the health inventory form including the odontogram. Follow up referral and/or consultation with onsite or on call medical provider and/or dental provider (if onsite) will determine treatment plan and schedule for initial provider evaluation.
Definition: Emergency care requiring immediate treatment: Inmate-patients requiring treatment of an acute oral or maxillofacial condition, which is likely to remain acute, worsen, or become life threatening without immediate intervention.
1. Results of the Initial Health Screening:
a. In the case of a dental/medical emergency, in which a licensed dentist is not present, the patient will be seen, treated and managed immediately by medical provider staff. If in the opinion of the medical staff/licensed health care provider, the dental condition is likely to respond to immediate administration with antibiotic and/or analgesic medication this will be given. If in the opinion of the medical staff person/licensed health care professional in charge, the acute dental emergency is life
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threatening, the patient will be transported to an urgent care facility or hospital to protect the life of the patient. The contracted dentist will be notified and provide necessary post-discharge dental care at the next scheduled dental clinic.
b. If the medical staff/licensed health care professional determines the dental issue to be urgent, the patient shall be referred to and evaluated by the dentist at the next scheduled dental clinic.
2. At the time of the health inventory, examination includes notation of the general condition of the patient's dentition, missing or broken teeth, evidence of gingival disease, mucosal lesions, evidence of infection, recent trauma, difficulty swallowing, chewing or other functional impairment.
B. Services for Inmates Incarcerated for less than One Year
1. Dental Hygiene:
Professional dental hygiene services are currently not provided. Inmates are given toothbrushes and can receive instruction in proper brushing technique from the medical staff upon request. Dental floss loops are available through the commissary for routine flossing. Indigent inmates shall be provided with dental care supplies.
2. Dental Treatment:
Dental floss loops are available through the commissary for routine flossing. Indigent inmates shall be provided with dental care supplies.
a. Treatment provided is based on the inmate's needs, length of stay and the priorities listed below:
(1) Relief of pain and treatment of acute infections and other urgent conditions. This would include hemorrhage, toothaches, broken, loose or knocked out teeth, abscesses, dry sockets after extractions and severe periodontal disease.
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(2) Extraction of unsalvageable teeth.
(3) Treatment of bone and soft tissue diseases.
(4) Repair of injured or carious teeth.
(5) Removal of irritation conditions which may lead to malignancies.
(6) Replacement of lost teeth and restoration of function, if dental function is markedly limited. The attending dentist will determine necessity and priority
b. Although treatment is not limited to simple extractions, elective restorative work which can reasonably be deferred without serious detriment to the patient should be considered the inmate's responsibility. Such work may, with custody's approval, be done during the period of incarceration at the inmate's expense; otherwise, appropriate referral information should be supplied upon release.
MCJ will maintain a periodontal disease program for the diagnosis and treatment of periodontal disease. Periodontal screening shall be available to all patients, regardless of length of stay. Treatment will be based on periodontal disease classification, Dental Priority code, and special medical needs (i.e. pregnancy, diabetes, HIV/AIDS).
3. Oral Surgery
a. MCJ dental clinic shall provide necessary oral surgery services to all inmate- patients onsite or through a local community provider.
b. Routine extraction of non-pathologic and/or asymptomatic erupted, partial erupted, partial impacted or complete impacted third molars is an excluded service.
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c. Removal of third molars to prevent crowding or future pathology is an excluded service.
d. Referral to and priority of offsite oral surgeon will be the responsibility of the facility dentist in accordance with the Dental Priority System.
4. All dental complaints are assessed, provided treatment for obvious infection and pain relief at regularly scheduled medical sick call by the MD, PA or RN to be seen within one day of the request. The complaint is prioritized and referred to Dental Sick call as deemed necessary. Interim treatment for pain and infection is provided until the patient is seen by the dentist.
5. Dental Priority System a. Dental treatment will be provided in accordance with the following Dental Priority System:
(1) Emergency Care (Immediate Treatment):
Inmate-patients requiring treatment of an acute oral or maxilla-facial condition, which is likely to remain acute, worsen, or become life threatening without immediate intervention.
(2) Treatment within 1 calendar day:
Inmate-patients with a dental condition of sudden onset or in severe pain, which prevents them from carrying out essential activities of daily living.
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(3) Treatment within 30 calendar days:
Inmate-patients requiring treatment for a sub-acute hard or soft tissue condition that is likely to become acute without early intervention.
(4) Treatment within 60 calendar days:
Inmate-patients requiring early treatment for any unusual hard or soft tissue pathology.
(5) Treatment within 120 calendar days:
Advanced caries or advanced periodontal pathology requiring the use of intermediate therapeutic or palliative agents or restorative materials, mechanical debridement, or surgical intervention. Moderate or advanced periodontitis requiring non-surgical periodontal treatment (scaling and/or root planing).
b. The need and schedule for follow up dental clinic appointments will be determined by the responsible dentist.
c. Complicated dental problems are referred to an oral surgeon as deemed necessary with priority determined by the responsible dentist in accordance with the Dental Priority System.
C. Services for Inmates Incarcerated for Greater than One Year
Inmates incarcerated for 12 months or greater and whose dental conditions meet treatment eligibility requirements as determined by a licensed dentist in accordance with the established definitions and guidelines within this document shall be provided such medically necessary services during their period of incarceration.
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1. Comprehensive Dental Examinations
Inmates incarcerated for 12 months or greater are eligible to receive a comprehensive dental exam. The purpose of the dental examinations shall be for the identification, diagnosis, and treatment of dental pathology which impacts the health and welfare of inmate patients.
a. Inmates will be notified of eligibility for a comprehensive examination through the inmate information booklet issued to all inmates at intake into the facility.
b. Examination findings and proposed treatment plan will be documented on standardized comprehensive dental exam, periodontal exam and treatment planning forms which will be filed in the patient medical record.
c. Panoramic radiograph may be requested from an outside source when, in the discretion of the dentist, it will assist in diagnosis and treatment planning.
2. Periodontal Disease Program
MCJ will maintain a periodontal disease program for the diagnosis and treatment of periodontal disease. Periodontal screening shall be available to all patients, regardless of length of stay. Treatment will be based on periodontal disease classification, Dental Priority code, and special medical needs (i.e. pregnancy, diabetes, HIV/AIDS).
a. MCJ will have available, either through commissary purchase or through jail-issued personal hygiene kit, interproximal cleaners (e.g. floss loops) and a flexible handled tooth brush for inmate-patient self-dental care.
b. A per diem Registered Dental Hygienist (RDH): will be scheduled, as needed, to provide dental hygiene education and periodontal
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hygiene treatment consistent with dentists' treatment recommendations.
c. Treatment regimens will provide maintenance services only. No periodontal surgery, periodontal soft tissue grafting, or reconstructive procedures will be provided.
3. Removable Prosthodontic Dental Services
CFMG shall provide limited removable prosthodontic dental services to inmate-patients in the custody of MCJ. Inmates incarcerated for 12 months or greater a completed comprehensive examination, and a treatment plan may qualify for removable prosthodontic services.
a. A patient's need for a dental prosthesis shall be based on medical necessity defined as: Medically Necessary means health care services that are determined by the attending dentist/physician to be reasonable and necessary to protect life, prevent significant illness or disability, or alleviate severe pain, and are supported by health outcome data as being effective medical/dental care. (California Code of Regulations (CCR), Title 15, Division 3, Chapter 1, Subchapter 4, Article 8, Section 3350 (b) (1) "Provision of Medical Care and Definitions".)
b. A removable dental prosthesis shall be constructed only when:
(1) The dentist believes the patient can tolerate it and can be expected to use it on a regular basis to aid mastication and support the physiologic relationships of the maxilla and mandible.
(2) A patient is edentulous or has seven or fewer posterior teeth in occlusion.
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(3) All restorative, endodontic and oral surgery procedures have been completed and adequate healing has occurred to proceed with removable prosthodontic procedures.
(4) The active phase of periodontal therapy has been completed and the patient is in periodontal maintenance.
(5) Time requirements are calculated from the date impressions are taken and are as follows:
(a) The patient has a Dental Priority 2 prosthetic need (e.g. complete denture) and a minimum of six (6) months verifiable, continuous incarceration remaining before release or parole.
(b) The patient has a Dental Priority 2 prosthetic need (e.g. partial denture) and a minimum of twelve (12) months verifiable, continuous incarceration remaining before release or parole.
(c) The patient, where applicable, has acceptable oral hygiene for long term stability of the removable prosthesis.
(6) Partial dentures for anterior cosmetic purposes are excluded.
(7) When a patient's treatment plan includes a removable dental prosthesis, the treating dentist shall inform him or her of the possibility that the prosthesis may not be completed prior to the patient's parole date. The patient shall provide the name and address of a private dentist who can be contacted by CFMG dental staff, to deliver the completed appliance, in case the patient is released before the completed appliance is delivered.
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(8) Patients are responsible for paying for the prescribed appliance by following the procedures, designated by the county and CFMG, to transfer funds from their account to CFMG, on or before dental impressions are taken for the appliance and the case is considered initiated. If a patient is indigent (wholly without funds at the time they were eligible for withdrawal of funds for canteen or other purchases) a prescribed dental prosthesis shall be provided at CFMG expense. Otherwise, patients shall purchase prescribed appliances through the department or an approved vendor as directed by the CFMG medical program manager.
(9) A patient who is purchasing a removable dental appliance with their own funds may choose an approved local dentist to construct his/her appliance. A patient who is determined indigent will choose from a list of local contract dental providers.
c. Approved, prescribed removable dental prosthesis/dentures will be provided by contract with a local dental services provider.
d. Fitting, adjustment and maintenance of removable prosthesis will be provided onsite when feasible or through contract with a local dentist.
4. Dental Restorative Services.
Inmate-patients with comprehensive examinations and treatment plans are eligible to receive permanent restorations in accordance with their established treatment plan.
a. All restorative material utilized in CFMG dental clinics shall have the approval of the American Dental Association.
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b. Acceptable materials for restorations are amalgams, light cured composites, and light cured and self-cured glass ionomers. The material of choice shall be selected by the dentist based upon clinical considerations.
c. CFMG dental staff shall verify that every patient has received a copy of the Dental Materials Fact Sheet. Prior to initiating any restorative procedure the patient shall sign the Acknowledgment of Receipt of Dental Material Fact Sheet. This signature acknowledges acceptance of possible risks, denial of alternate procedures, and consents to the proposed procedure and use of the materials as recorded in the dental record.
d. Based upon the comprehensive examination, teeth lacking adequate structural integrity for a long-term prognosis or with advanced periodontal disease shall not be eligible for permanent or temporary restorations.
e. Permanent and temporary restorations will not be provided for cosmetic purposes.
5. Oral Surgery
MCJ dental clinic shall provide necessary oral surgery services to all inmate-patients onsite or through a local community provider.
Routine extraction of non-pathologic and/or asymptomatic erupted, partial erupted, partial impacted or complete impacted third molars are an excluded service.
Removal of third molars to prevent crowding or future pathology is an excluded service.
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6. Endodontics.
All patients in custody of county detention centers with CFMG dental contracts shall be eligible to receive palliative endodontic therapy limited to upper and lower anterior teeth.
Endodontic services shall be performed in accordance with established criteria and within the specific guidelines of this section.
Palliative endodontic therapy-the procedure in which pulpal debridement is performed to relieve acute pain shall be provided to all inmate-patients.
Inmate-patients incarcerated for 12 months or greater are eligible to receive root canal therapy limited to upper and lower anterior teeth performed in accordance with established criteria and within the specific guidelines of this section. Eligibility for root canal therapy will be in accordance with their dental treatment plan, PI score, and with the approval of the treating dentist. Any routine root canal procedure that cannot be accomplished by CFMG dentist at MCJ will be referred to a contracted dentist in the outside facility.
Definition: Routine Root Canal Therapy is the procedure in which the pulpal chamber and canals undergo cleaning, shaping and obturation.
a. Endodontic procedures shall not be performed when extraction of the tooth is appropriate due to non-restorability, periodontal involvement or when the tooth can easily be replaced by an addition to an existing or proposed prosthesis in the same arch.
b. Endodontics, or root canal therapy, shall only be performed for an inmate-patient on the upper and lower six anterior teeth when all of the following conditions are met.
(1) The retention of the tooth is necessary to maintain the integrity of the dentition.
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(2) The tooth has adequate periodontal support and a good prognosis for long- term retention and restorability.
(3) The patient is maintaining an acceptable level of oral hygiene, defined as a plaque index score of 20% or less, necessary to preserve the health of his or her oral cavity.
(4) The tooth is restorable using available restorative materials approved by the American Dental Association and does not require extensive restorative treatment including pin or post retained core build up and /or a crown.
(5) There is adequate posterior occlusion, either from natural dentition of a dental prosthesis to provide protection against traumatic occlusal forces.
(6) A local contract dentist will be available for referral when in the opinion of the treating dentist the procedure could be handled more predictably by an endodontic specialist.
c. A Consent for Root Canal Treatment Form must be completed by the dentist and signed by the patient and witness (dentist) prior to the provision of root canal treatment.
d. Apicoectomies, retrograde fillings, posterior root canal therapies, hemi-sections, root amputations and re-treatment of root canal therapies are excluded procedures.
7. Fixed Prosthesis (Crown and Bridge).
Fixed prosthetic services, (i.e., lab processed crowns and bridges), shall be considered an excluded service and shall not be routinely provided to patients by dentists employed by the CFMG.
Fixed prosthetics:
a. Shall not be utilized to restore missing or defective teeth if an
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adequate restoration can be placed, (e.g., a stainless steel crown, polycarbonate crown, a bonded composite, or an amalgam with cuspal coverage), or if a removable partial denture can be fabricated to replace the missing teeth.
b. May be provided if all of the following criteria are met:
(1) The teeth involved in fixed prosthetic therapy have adequate periodontal support, with no mobility other than normally occurring physiologic movement.
(2) All Dental Priority 1 and 2 dental care has been completed prior to commencing fixed prosthetic treatment.
(3) The inmate-patient has demonstrated a PI score of 20% or less for two (2) consecutive months after the completion of all Dental Priority 2 dental care.
(4) The inmate-patient has a minimum of at least six (6) months of verifiable, continuous incarceration time remaining on his or her sentence.
c. Patients undergoing fixed prosthetics that are in progress but not completed at the time of their incarceration, shall have their dental needs met with CFMG authorized restorative materials and procedures only, (e.g., removable prosthetics, stainless steel crowns, polycarbonate crowns).
8. Implants
CFMG dentists shall not initiate the placement, completion, or repair of dental implants for patients.
a. A patient with dental implants begun but not completed at the time of his or her incarceration shall not have their dental implants completed by a CFMG dentist. The patient, at his/her own expense,
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may request to be seen by a local licensed dentist, upon authorization by the county, to complete the implant treatment.
b. Patients shall be referred to a dental specialist experienced in the management and placement of dental implants (e.g. oral surgeon, periodontist, endodontist) to have a failing dental implant evaluated for possible removal.
9. Orthodontics
The MCJ dental clinic shall not initiate orthodontic procedures, (i.e., braces), or continue orthodontic treatment for inmate-patients incarcerated while in active orthodontic treatment.
a. Inmate-patients may request to have orthodontic bands/brackets removed by the CFMG dental department.
(1) CFMG shall not be held liable for changes to the inmatepatients' dentition once the orthodontic bands/brackets are removed and shall of orthodontic bands/brackets and discontinuation of their orthodontic treatment.
(2) CFMG shall not be held liable for changes to the inmate’s dentition once the orthodontic bands/brackets are removed and shall obtain informed consent from all inmates who request removal of orthodontic bands/brackets and discontinuation of their orthodontic treatment.
(3) Every attempt shall be made to contact the treating orthodontist prior to removal of orthodontic bands or brackets.
(4) Removal of orthodontic bands/brackets and/or arch wires shall be at the discretion of the treating dentist.
(5) CFMG shall not be held liable for the replacement of orthodontic bands that are damaged or removed in the process of providing dental procedures on banded teeth.
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XII. HEALTH RECORDS
CFMG is working toward implementing an Electronic Medical Record system (EMR) for use at the Monterey County Jail that will enhance the delivery of health care services. The EMR is being designed to try and accomplish the following:
1. The EMR will contain the complete medical record of each inmate at the MCJ.
2. Health care staff will use the EMR to closely track all requests for health care including the date of submission, date of triage, date of evaluation, disposition and date of any necessary follow-up care.
3. Health care staff will use the EMR to closely track all medications administered to an inmate including the name of the medication and dose required.
4. The EMR will contain a catalog of all Standardized Nursing Procedures and the appropriate algorithm of care that must be followed and documented by the health care provider who is treating an inmate pursuant to the Standardized Nursing Procedure.
5. The EMR will identify any inmates who require Chronic Disease Management and health care staff will use it to closely track the condition/s that need to be monitored, the nature of the treatment required and the frequency of any required follow-up care.
CFMG is committed to implementing an Electronic Medical Record system at the Monterey County Jail. Until the EMR is implemented the following medical record procedures will apply.
103 CFMG’s Implementation Plan
Exhibit A 112

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 114 of 140
A. Contents of Medical Record
The health record of an inmate contains the following items as applicable to his/her case:
1. The completed Receiving Screening form. 2. Health Inventory/Communicable Disease Screening forms. 3. Problem list. 4. All findings, diagnosis, treatments, dispositions. 5. Prescribed medications and their administration. 6. Laboratory, x-ray and diagnostic studies. 7. Consent and Refusal forms. 8. Release of Information forms. 9. Place and date of health encounters (time, when pertinent). 10. Health service reports (i.e., dental, psychiatric, and other consultations). 11. Hospital Discharge Summaries. 12. Jail Medical Record Summaries (transfer forms). 13. Individual treatment plan
B. Maintenance
All health services staff is responsible for maintaining current, accurate and legible medical records.
C. The physician-patient confidentiality privilege applies to the medical/psychiatric record. Access to the inmate's medical record is controlled by the Medical Director, CFMG.
1. Medical records shall be maintained in secure, locked storage cabinets within the medical unit.
2. Access to medical records shall be limited to licensed health services personnel and medical records personnel.
104 CFMG’s Implementation Plan
Exhibit A 113

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 115 of 140
3. The health authority or his designee shall share information with the facility manager as necessary to deliver medical treatment and to preserve the health and safety of inmates and staff in accordance with state regulations.
4. All requests for medical information will require written consent of the inmates or subpoena.
5. Mental health, alcohol and drug abuse information is confidential under federal regulations and can be disclosed only by specific written consent of the inmate.
6. Release of information forms shall be processed by the program administrator or his/her designee.
D. Records Retention
Inactive medical records are to remain confidential and protected from destruction for a minimum of 7 years past the last health encounter. Retention of medical records of inmates that were pregnant during an incarceration shall be stamped to identify them as OB records and will be kept at a minimum of 25 years. CFMG will not be responsible for medical records destruction. Medical records which have been inactive three years will be returned to the County.
1. Inactive medical records are stored in a secure room designated for medical records.
2. Inactive medical records over three years will be returned to the County for storage.
3. Inactive OB records shall be stored separately from other inactive records in the storage area.
105 CFMG’s Implementation Plan
Exhibit A 114

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 116 of 140
XIII. CFMG STAFFING PLAN There shall be, at all times, sufficient staff to ensure compliance with the CFMG Implementation Plan. The CFMG Staffing Plan for the Monterey County Jail is attached hereto as Exhibit I. CFMG will ensure that staffing levels are sufficient to consistently and adequately fill all positions identified in the CFMG Staffing Plan. Relief factors for each position will be calculated into the staffing analysis to ensure staffing levels consistently meet requirements. CFMG will evaluate on an on-going basis its staffing levels to ensure that all staffing positions are filled and sufficient staff is employed to ensure compliance with the CFMG Implementation Plan.
106 CFMG’s Implementation Plan
Exhibit A 115

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 117 of 140
EXHIBIT INDEX Exhibit A MCJ Medical Intake Questionnaire Exhibit B CFMG Intake Triage Assessment form Exhibit C Guide to Developmental Disabilities Exhibit D Nursing Psychiatric and Suicidal Assessment Form Exhibit E Health Inventory & Communicable Disease Screening Form Exhibit F CFMG Referral Form Exhibit G Suicide Risk Assessment Form Exhibit H CFMG ATD Exhibit I CFMG Staffing Plan
Exhibit A 116

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 118 of 140

Exhibit Index

Exhibit A Exhibit B Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G Exhibit H Exhibit I

MCJ Medical Intake Questionnaire CFMG Intake Triage Assessment form Guide to Developmental Disabilities Nursing Psychiatric and Suicidal Assessment Form Health Inventory & Communicable Disease Screening Form CFMG Referral Form Suicide Risk Assessment Form CFMG ATD CFMG Staffing Plan

Exhibit A 117

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 119 of 140
Exhibit A
Exhibit A 118

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 120 of 140

Exhibit A 119

Exhibit A Page 1 of 1

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 121 of 140
Exhibit B
Exhibit A 120

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 122 of 140

Date:

Time:

Previous Jail Record: E No fl Yes

When & Where:

Allergies:
. :odQ
F7HI-Fz<gr f5ot==-*rX
v[L

INT
4KA DOB:

TRIAGE ASSESSMET\NT
BKG#:

Under MD care:

E No ! Yes MD Name

Tel & Address: .

gzq)

Medicati on Name&Dosase

F

Last Use

6
llJ

MD Name

acy:
D Medication verified:
Pharmacv

Cunent Rx
Ies n
Yes Z Yes J

ICS L I

Yes Z

ve: lNo nYes

LOC: A/Ox_ Painsca)e(1 - 10):_ Other

B/P: P: T:

Rl

Pulse Ox Qlhrtlcared); VS Deferred: n Reasonl

a fait; Dsteady nUnstable Assist,Device: lNo lYes What:-

Pupils: lEqual Size- lReactive

F
aF

Speech: Eclear lsluned

Skin:DWarm&Dry nDiaphoretic ChestPain:[No [Yes

soBt DNo nYes

Fz HA: ENo nYes Vertigo; ENo fl Yes BlunedVision; ENo EYes RecentHeadlniury; ENo EYes

ItUr
cc

LJ Signs of Trauma What:

o
Where:

jomments:

(drugs/alcohol)i n No n Yes Other

Alcoholl I Denies ! Yes Type;

ul
! fo Freq:
HxWD type:

UJ
f Drugs: EDenies nYes Type:

trJ

z DPo Ery lIN notner

- ! Um)

HxWD Type;

l

U) Comments:

Amt: Freq:

Last Use: Last Experienced:

Amt:

Last Use: Last Experiencedl

n ! ETOH WD Protocol(see Doctor Order)

Opiate Protocol (see Doctor Order)

CFMG-ITA-2

Exhibit A 121

Exhibit B Page 1 of 2

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 123 of 140

Hx Diabetes: ! NIooV n fon]\. Diet:

zF Insulin Type
uJ
Eoa oIIJ
@

o

-UJ
ungJ

Oral Diabetic Asent

Date & Time Last Meal:
Dose & Freq

BS (if indicutetl) Last Dose Taken

Dose & Freq

Last Dose Takon

Pregnant: ! No ! Yes HCG: X neg I pos Gravida: Para: LMP

zF FetalMovement; ENo nYes BlurredVision: n No n Yes ElevatedBlP nNo n Yes tIA: nNo n Yes

lrl E

Weightloss: lNo nYes

EpigastricPain: nNo n Yes

Edema nNo E Yes N/V nNo n Yes

vo) I Vaginal Discharge: No ! Yes Other:

oIJJ

U' Prenatal Care: nNo E Yes Physician / Clinic:

Last Exam:

zC)

Substance Use /Abuse: lNo n Yes (complete substance nse section of fonn)

z Comments
(9

IJJ

o.

Methadone: ! No I Yes

E Pregnancy Protocol initiated (See Doctor order sheet)

SEXU AL A]3USE/A-B USI\'ENESS
History of sexual victimization? X Yes* n No
*Complete Sexual Abuse/Abusiveness Assessment Form

n n History of sexual abusiveness? Yes* No

orz
LrJ
E E o

od
z

J

o-

n RoI sent

n PSYCH Assessment (See Form)

I Chronic Care Protocol

n caflocp

tlulrj

nsn

utrl

nMDSCon

n Next SC f] SCPRN
E other:

n nnS category fl -- MFI / Psych Nulse Line

zF

n House per classilication

tu

=UI

n Safety Cell (start "Safety/Sobering" log)

1

n Resp. Isolation

n rs/LT

! Sobering Cell (start "CIWA" log) n OPH / SH (Special Housing) n Other:

Sta.ff Signqhn'e & Iitle kN / NP / PA / MD Co-Sisnature

Exhibit A 122

Date &Time
Date &Time
Exhibit B Page 2 of 2

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 124 of 140
Exhibit C
Exhibit A 123

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 125 of 140

QUICK REFERENCE GUIDE TO DEVE,LOPMENTAI DISABILITIES

Name:

Date:

BK#

i!,tttt!!!e's resognse in the app.fopriatg box-

Ycs

No

1)

I have a reading problem?

tr

U

?)

Wben I went to school, I was in classes for

'slow learners

n

D

r)

I have been told I am mentally retarded.

tr

4)

I get seizures (Ppilepsy)-

J)

Do you have a disability?

tqr

tr n tr

How many months are in one year?

What time is it? (Show inmate yow watch or a clqck on the wall)

Was the answer correct?

Yes D

Calculate the values of the following coins?

No fl

The following items when pres€nt may indicate that an individunl mry have a

developmental disability :

Yes ! No tr The person is slolv in answering questions'

Yes I No f] The inmate has a difEcult time following more then one direction at a time.

Yes I No ! The inmate has difficulfy recalling his/her frll name, address, phone number, ect..

YesE No E Theinmateisunabletoreadasiponthowall,theoloclgorsigrhisAternametoaform'

Yes H No n The inmate is ulable to identiff or count various coins correctly.

E D yes

No

The inmate states tlat he/sbe is a slow leamer, was placed in special classes in school,

.

and / or attended a workshop orjob Faining for the handicapped

yes E No E The inmate is in possession of a card / ID card from a "Regional Centef"

Yes E No fl The inmate states he/she resides in a "group home" or "facility"'

Yes ! No E The inrnate's speech is unclear.

Yes E No tr The inmate's motor coordination is poor.

yes n F No The inmato hat seizures and is on medication for seizure control.

Medical Disposition:
Protective Custody n

Safety Cell n

Custodies Discretion n

fl to CVRC (central Vnllcy Regional Cenrer; COntacted? Ye s

t

n( uuo, copy form und forwnrd to Prograrn Manugcr)

Nurse Signature:

Exhibit A 124

Date:

Exhibit C Page 1 of 1

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 126 of 140
Exhibit D
Exhibit A 125

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 127 of 140

Colifornio Forensic Medicol Group

'

NURSING ASSESSMENT OF PSYCHIATRIC & SUICIDAL INMATE

Date:

Time:

Previous Jail Record: fl No E yes

DOB_ BKc#.

When &Where:

4LLERGIES:

Cooperative: lNo EYes

VS Defeued: E No E Yes Reason:

Ul )
F

B/P:

P

T:

R:

LOC: A/O x

F U'

UI (drugs/alcohol): E No fl Yes

Fz
uJ

Gait: E Steady E Unstable

t(rl.
fo,

Other:

speech: E Non-Verbal E clear E Slurred E Mumbles fl Rapid./pressured

Eye Contact: ! Good E Poor

Thought Process Organized: E No E Yes

No Medical Problems tr

E Yes If yes and new inmate, complete intake triage assessment,

Depressed/Iearful trNo EYes

EF FIat

E No EYes

Angry/Hostile E No E yes llabile/Manic
Other:

E tqo E yes

r<o :oOi rJuJ

Auditory Halluc n No EYes Grandiose Delusions E No E Yes

coFr
U)

No Under psychiatrist care: E

n Yes

Dx:

I

o

lr

F

Visual Halluc Paranoid Delusions VD Name:
Tel & Address: Hospitel(s): Reason:

E No E yes lother Halluc: E No E yes lOther Delusions:
Dates:
Dates:

=() Hospitalizations: E No fl Yes U(L) Medications ENo EYes
oU Phtrmacy:
J
o o
ut

Medication Name:

Dose

Fre q. Inrt Dorc

8a

hol: fl Denies E Yes

oF4{
6Q3u

Amt:
rqs: E Denies E Yes Type: PO aN aIN EOther_ Freq:

Last Use:

Amt:

Last IJse:

A nxwtp Z UxWtO

Past Suicidal ldeation: E No E Yes

F Past Suicidal Gesture / Attempt E No E Yes W,en.'

How:

=o o

Current Suicidal Ideation

ENo lYes Prarr.'

l
U)

Yes tr last Homicidal Ideation: E No E

Current Homicidal Ideation: No tr Yes Who/Plan:

IMPRESSION:

' Inmate is currently at risk to harm self or other(s) E No E Yes

>>oout|'JzrJt<ozour)

E Inmate to be placed / remain on Suicide
Watch ( HOUSE IN SAFETY CELL oT OBSERVATION CELL)

tr E Inmate to be housed per classification E Inmate to follow up psychiatric evaluation

oFz

I'or other ORDERS & REFERP.#.L, refer to Doctor's Order Sheet

ul

Exhibit A

oo

notffied D lVo E Yes MD Name

126

Date_Time_

Exhibit D Page 1 of 1

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 128 of 140
Exhibit E
Exhibit A 127

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 129 of 140

Exhibit A 128

Exhibit E Page 1 of 2

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 130 of 140

Exhibit A 129

Exhibit E Page 2 of 2

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 131 of 140
Exhibit F
Exhibit A 130

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 132 of 140

Exhibit A 131

Exhibit F Page 1 of 1

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 133 of 140
Exhibit G
Exhibit A 132

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 134 of 140

'
Suicide Prevention Assessment Form
Name--------------------- DOB__________________
~______________________ ID#____________________

QUESTIONS
1. Do you have serious problems that worry you? Serious health or money problems? Family or relationship problems (children, parents, significant other)? Problems in the jail? Other serious problems (drugs/alcohol)

2. Have you experienced any of the following in the past year?

Loss ofrelationship?

Loss ofjob or income?

Loss ofhousing?

Death in the family?

...,
.).

Have you ever seriously considered suicide?

Are you thinking of killing/harming yourselfnow?

What do you think you might do?

Lethal plan or refuses to answer

4. Have you ever tried to kill yourself?
Were you hospitalized? Has anyone in your family committed suicide? 5. Do you have communication with friends? Family? Will anyone visit you in jail? Will family/friends put money in your account? 6. What are your plans for the future? (Prison or no plans = 1) Will you have employment, school or financial resources? Do you have a place to live? Chemical dependency program? 7. Signs of depression:
Withdrawn, sad, tearful, psychomotor retardation, other Does not want to talk; halting or slowed speech Feels hopeless 8. Signs ofpsychosis or impaired reality contact: Agitated, responds to internal stimuli or is pressured Delusional or paranoid thoughts or bizarre thoughts/behavior 9. Charges are serious Charges include murder, attempted murder, rape, kidnapping, mayhem, child molest, domestic violence or other serious offenses Charges involve a child/minor or family member

YES

NO

1

0

1

0

1

0

I

0

1

0

1

0

I

0

1

0

1

0

2

0

2

0

I

0

I

0

0

1

0

1

0

1

0

1

0

1

0

1

1

0

1

0

3

0

1

0

1

0

1

0

2

0

1

0

Exhibit A 133

Exhibit G Page 1 of 2

... •

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 135 of 140

QUESTIONS 10. What will (or has) happen to you if convicted?
Expect sentence ofat least 90 days? Expect to be sent to prison? Expect more than 3 years? 11. Arresting/transporting officer reports that: Arrestee may be at risk of self-harm/suicide Arrestee made suicide threat 12. Inmate is under the influence of alcohol and/or drugs
13. Inmate anticipates problems with withdrawal
14. Inmate is dependent on alcohol and/or drugs
15. Inmate has a position of respect in the community
16. Inmate feels embarrassed, ashamed or humiliated
17. Inmate is anxious, afraid or angry
18. Inmate is impulsive or unable to cope with jail (e.g. first arrest)
19. Inmate has significant health problems
20. Prior records suggest suicide risk
21. Inmate has history ofmental health treatment or counseling
22. Inmate has a serious mental disorder
23. Inmate is male = 2 female= 0
Total Points

YES NO

1

0

1

0

1

0

1

0

1

0

2

0

2

0

2

0

1

0

2

0

1

0

1

0

1

0

1

0

2

0

2

0

2

0

Suicide risk level is determined by clinical evaluation of the inmate. A higher number ofpoints suggests a higher risk level. Protective factors such as supportive relationships and positive future plans may reduce the risk level. Assign a higher risk level if you are unable to obtain sufficient information to complete the assessment. The risk level can be reduced when you acquire additional information that indicates a lower risk.

No Precautions

Minimal Risk

Moderate Risk

High risk Acute risk

Comments:

Clinician: --------------------------------------- Date:---------

Exhibit A 134

Exhibit G Page 2 of 2

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 136 of 140
Exhibit H
Exhibit A 135

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 137 of 140 1. ATD Plan Implementation Checklist
Exhibit A 136

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 138 of 140
Exhibit A 137

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 139 of 140
Exhibit I
Exhibit A 138

Case 5:13-cv-02354-BLF Document 532 Filed 04/01/16 Page 140 of 140
MONTEREY COUNTY JAIL STAFFING PLAN

POSITION Program Manager Director of Nursing RN RN PA/FNP PA/FNP LVN LVN PSYCH RN/LCSW PSYCH RN/LCSW Medical Record Supervisor Clerk CNA/MA CNA/MA
LVN RN RN RN LVN LVN CNA/MA CNA/MA RN RN RN LVN LVN CNA/MA Medical Director/ Physician Psychiatrist Dentist Dental Assistant Physician On-Call Psychiatrist On-Call

S
7-3 7-3
7-3 7-3
7-3
7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

M

T

W

T

F

8-4

8-4

8-4

8-4

8-4

8-4

8-4

8-4

8-4

8-4

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3

7-3 7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

7-3 7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

7-3 7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

7-3 7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

7-3 7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

40 hours To Be Determined

40 hours To Be Determined 12 hours To Be Determined 12 hours To Be Determined 24 hours a day, seven days a week 24 hours a day, seven days a week

S
7-3 7-3
7-3 7-3
7-3
7-3 7-3 1-9 3-11 3-11 3-11 3-11 3-11 3-11 3-11 11-7 11-7 11-7 11-7 11-7 11-7

HRS 40 40 56 56 40 40 56 56 40 40

FTE

FAC

1 Jail

1 Jail

1.4 Jail

1.4 Jail Booking

1 Jail

1 Jail

1.4 Jail

1.4 Jail

1 Jail

1 Jail

40 1 Jail 40 1 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail Booking 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail Booking 56 1.4 Jail 56 1.4 Jail 56 1.4 Jail 40 1 Jail
40 1 Jail 12 0.3 Jail 12 0.3 Jail
Jail Jail

Days Evenings Nights

Exhibit A 139

Exhibit I Page 1 of 1

 </s> 1

2

3

4

UNITED STATES DISTRICT COURT

5

NORTHERN DISTRICT OF CALIFORNIA

6

7 JESSE HERNANDEZ, et al.,

8

Plaintiffs,

9

v.

10 COUNTY OF MONTEREY, et al.,

11

Defendants.

12

Case No. 5:13-cv-02354-PSG
ORDER GRANTING-IN-PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR APPROVAL OF IMPLEMENTATION PLAN
(Re: Docket No. 514, 517, 532)

United States District Court Northern District of California

13

Defendants County of Monterey and California Forensic Medical Group move for

14 approval of their plans implementing the settlement agreement between them and Plaintiffs Jesse 15 Hernandez et al.1 As an initial matter, CFMG has two motions for approval pending.2 CFMG 16 first moved for approval of its implementation plan on Feb. 19, 2016,3 and then moved for 17 approval of a revised implementation plan after meeting and conferring with Plaintiffs.4 The court

18 DENIES CFMG’s Feb. 19 motion as moot in light of CFMG’s revised plan. With respect to

19 CFMG, this order relies on CFMG’s revised implementation plan, filed as Docket No. 532.

20

The court has considered all of Plaintiffs’ objections to Defendants’ proposed

21

22 1 See Docket Nos. 514, 517, 532.
23 24 2 See Docket Nos. 517, 532. 25 3 See Docket No. 517.
26 4 See Docket No. 532.

27

1

Case No. 5:13-cv-02354-PSG

28 ORDER GRANTING-IN-PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR

APPROVAL OF IMPLEMENTATION PLAN

1 implementation plans, as presented in Plaintiffs’ briefing and at oral argument.5 The court

2 GRANTS-IN-PART Defendants’ motions for approval of their implementation plans and

3 overrules Plaintiffs’ objections except as follows:

4 1. Meet and confer process: the meet and confer process for each implementation plan shall

5

include all Plaintiffs’ counsel.

6 2. Diamond Pharmacy license: the Diamond Pharmacy pharmacist that dispenses medications

7

to the Monterey County Jail in bulk or stock supply shall hold a California pharmacist license.

8 3. Pharmacy pill transfer: Plaintiffs object that the licensed vocational nurses that transfer

9

medication from the stock supply do so by pouring out pills, putting them by hand in

10

envelopes for each patient and putting leftover pills back in the stock supply bottles.6

11

Plaintiffs argue that this practice endangers patient safety.7 CFMG states that its LVNs are

12

trained to take out a single dose of medication from the stock supply at a time.8 This objection

United States District Court Northern District of California

13

is resolved as follows: LVNs may transfer medication from the stock supply so long as they do

14

not engage in the practice complained of.

15 4. Suicide Risk Assessment Tool: Plaintiffs object that Dr. Hayward’s Suicide Risk Assessment

16

Tool lacks guidance on how to use the assessment results and request that the court order

17

Defendants to develop instructions for using the risk assessment tool.9 At oral argument,

18

Plaintiffs stated that Hayward was available to train CFMG and the County on the tool’s use.

19

This objection is resolved as follows: Hayward shall offer Defendants training on how to use

20

21 5 See Docket Nos. 531, 538.
22 6 See Docket No. 531 at 4.
23 24 7 See id. at 5-6. 25 8 See Docket No. 532 at 3.
26 9 See Docket No. 531 at 8-9.

27

2

Case No. 5:13-cv-02354-PSG

28 ORDER GRANTING-IN-PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR

APPROVAL OF IMPLEMENTATION PLAN

1

the suicide risk assessment tool. Defendants may use their clinical discretion in relying on the

2

results of the suicide risk assessment tool.

3 5. Administrative segregation classification: when inmates are placed in segregation,

4

Defendants shall conduct a classification review within seven days of the placement and every

5

14 days thereafter.

6 6. Restraint chairs: individuals placed in a restraint chair shall be under constant supervision for

7

the entire time they are in the restraint chair. The restraint chair may be placed in a safety cell

8

or another location in the jail.

9 7. Telepsychiatry: Defendants’ implementation plans must have standards for when they can

10

deviate from a typical in-person encounter and use telemedicine or telepsychiatry.

11 8. Violence Reduction Implementation Plan: at oral argument, the County requested a four-

United States District Court Northern District of California

12

month extension of the implementation plan’s deadline for installing a new camera system, so

13

that the County also could install new control panels for the camera system. Plaintiffs agreed

14

to the four month extension. The four month extension is granted.

15 9. Disability access plan: the County shall provide a copy of the neutral ADA expert’s report to

16

the neutral disability access monitor and to Plaintiffs’ counsel. The neutral monitor shall

17

assess the adequacy of the County’s ADA modifications.

18 10. Implementation deadlines: At oral argument, the County requested a 60-day extension to all

19

expired deadlines in the implementation plan. Nearly a month has passed since oral argument.

20

The County shall have a 90-day extension of all expired deadlines in the implementation plan.

21

CFMG requests 45 days to train its staff on the implementation plan, before requiring its

22

implementation.10 CFMG shall have 45 days for training.

23

24

25 26 10 See Docket No. 532 at 1.

27

3

Case No. 5:13-cv-02354-PSG

28 ORDER GRANTING-IN-PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR

APPROVAL OF IMPLEMENTATION PLAN

1 SO ORDERED.

2 Dated: May 27, 2016 3 4

_________________________________
PAUL S. GREWAL United States Magistrate Judge

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United States District Court Northern District of California

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Case No. 5:13-cv-02354-PSG

28 ORDER GRANTING-IN-PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR

APPROVAL OF IMPLEMENTATION PLAN

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[3236003.1]

1 MICHAEL W. BIEN – 096891

ERNEST GALVAN – 196065

2 VAN SWEARINGEN – 259809

ANDREW G. SPORE – 308756

3 ROSEN BIEN

GALVAN & GRUNFELD LLP

4 50 Fremont Street, 19th Floor

San Francisco, California 94105-2235

5 Telephone: (415) 433-6830

Facsimile: (415) 433-7104

6 Email:

mbien@rbgg.com

egalvan@rbgg.com

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vswearingen@rbgg.com

aspore@rbgg.com

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ERIC BALABAN (admitted pro hac vice)

9 NATIONAL PRISON PROJECT of the

AMERICAN CIVIL LIBERTIES UNION

10 915 15th Street N.W., 7th Floor

Washington, D.C. 20005-2302

11 Telephone: (202) 393-4930

Facsimile: (202) 393-4931

12 Email:

ebalaban@aclu.org

ctakei@aclu.org

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Attorneys for Plaintiffs

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ALAN SCHLOSSER – 049957

MICAELA DAVIS – 282195

AMERICAN CIVIL LIBERTIES UNION

FOUNDATION OF NORTHERN

CALIFORNIA, INC.

39 Drumm Street

San Francisco, California 94111-4805

Telephone: (415) 621-2493

Facsimile: (415) 255-8437

Email:

aschlosser@aclunc.org

mdavis@aclunc.org

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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JESSE HERNANDEZ et al., on behalf of

Case No. CV 13 2354 BLF (NC)

18 themselves and all others similarly situated,

SECOND STIPULATION AND

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Plaintiffs,

[PROPOSED] ORDER REGARDING

TELEPSYCHIATRY ISSUES

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v.

Judge: Hon. Nathanael Cousins

21 COUNTY OF MONTEREY; MONTEREY

COUNTY SHERIFF’S OFFICE;

22 CALIFORNIA FORENSIC MEDICAL

GROUP, INCORPORATED, a California

23 corporation; and DOES 1 to 20, inclusive,

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Defendants.

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CV 13 2354 BLF (NC) SECOND STIPULATION AND [PROPOSED] ORDER REGARDING TELEPSYCHIATRY ISSUES

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 2 of 24

[3236003.1]

1 THE PARTIES THROUGH THEIR COUNSEL HEREBY STIPULATE AS FOLLOWS:

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WHEREAS, on May 27, 2016, the Court entered an Order Granting-In-Part

3 Defendants' Motions for Approval of Implementation Plans and Denying as Moot CFMG's

4 First Motion for Approval of Implementation Plan, Docket No. 549, ruling under the

5 heading “Telepsychiatry” that “Defendants’ implementation plans must have standards for

6 when they can deviate from a typical in-person encounter and use telemedicine or

7 telepsychiatry.” Dkt. 549 at 3.

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WHEREAS, on June 17, 2017, the Plaintiffs filed a Motion to Enforce Settlement

9 Agreement Regarding Psychiatric Staffing and Telepsychiatry. Dkt. 599.

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WHEREAS, on November 1, 2017 after full briefing and a hearing, the Court

11 entered an Order Granting in Part and Denying in Part Plaintiffs’ Motion to Enforce

12 Settlement Agreement, finding that CFMG had come into compliance with the staffing

13 requirement after Plaintiffs’ filed their motion by hiring a full-time on-site psychiatrist, and

14 directing the parties to finalize their tentative agreement as to certain issues regarding the

15 use of telepsychiatry, and referred the remaining issues to Magistrate Judge Cousins for

16 disposition. Dkt. 619.

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WHEREAS, on December 8, 2017, the Court approved a Stipulation and Order

18 Regarding Telepsychiatry, setting forth specific requirements regarding patient informed

19 consent, access to medical and mental health records, documentation of patient sessions,

20 technological standards, quality assurance monitoring, and confidentiality of telepsychiatry

21 sessions. Dkt. 622.

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WHEREAS, while preparing for the evidentiary hearing on the remaining issues,

23 the parties continued meeting and conferring over additional standards and policies for the

24 use of telepsychiatry at the Monterey County Jail that could resolve the remaining issues.

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WHEREAS, on March 21, 2018, counsel reached agreement on a single policy

26 document to incorporate the December 8, 2017 Stipulation and Order Regarding

27 Telepsychiatry, as well as additional requirements to resolve the remaining issues.

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CV 13 2354 BLF (NC)

SECOND STIPULATION AND [PROPOSED] ORDER REGARDING TELEPSYCHIATRY ISSUES

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THEREFORE, THE PARTIES HEREBY JOINTLY REQUEST THAT THE

2 COURT:

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(1) Vacate the Evidentiary Hearing now set for May 1, 2018, and associated dates;

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(2) Approve the attached Telepsychiatry Policy as an amendment to the

5 Implementation Plans approved by the Court on May 27, 2016.

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7 8 DATED: March 21, 2018
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Respectfully submitted, ROSEN BIEN GALVAN & GRUNFELD LLP

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By:

/s/ Van Swearingen

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Van Swearingen

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Attorneys for Plaintiffs

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14 DATED: March 21, 2018
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OFFICE OF THE COUNTY COUNSEL COUNTY OF MONTEREY

By:

/s/ Susan K. Blitch

Susan K. Blitch

Senior Deputy County Counsel

Attorneys for Defendants COUNTY OF MONTEREY and MONTEREY COUNTY SHERIFF’S OFFICE

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BERTLING LAW GROUP

By:

/s/ Peter G. Bertling

Peter G. Bertling

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Attorneys for Defendant

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CALIFORNIA FORENSIC MEDICAL GROUP,

INC.

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CV 13 2354 BLF

SECOND STIPULATION AND [PROPOSED] ORDER REGARDING TELEPSYCHIATRY ISSUES

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 4 of 24

[3236003.1]

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[PROPOSED] ORDER

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Pursuant to the parties’ stipulation, Defendants’ use of telepsychiatry services with

3 patients at the Monterey County Jail must comply with the attached requirements. These

4 requirements are amendments to the Implementation Plans approved by the Court on May

5 27, 2016. The Evidentiary Hearing now set for May 1, 2018 as well as the associated dates

6 set forth in ECF 629 are vacated.

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IT IS SO ORDERED.

8 DATED: March __, 2018 9 10

Nathanael M. Cousins United States Magistrate Judge

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CV 13 2354 BLF (NC)

SECOND STIPULATION AND [PROPOSED] ORDER REGARDING TELEPSYCHIATRY ISSUES

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 5 of 24
ATTACHMENT

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Tele‐Psychiatry Program
I. Standards for Use of Tele‐Psychiatry
CFMG provides 40 hours of on‐site psychiatric services at the Monterey County Jail. However, there are circumstances when a psychiatrist is unavailable to provide on‐site services and inmates will then have access to a tele‐psychiatrist. The circumstances when a psychiatrist is unavailable to provide services include, but are not limited to:
(1) Weekend, holidays or any other time a psychiatrist in not on‐site;
(2) Gaps in on‐site staffing which may be due to recruitment delays, vacations, illnesses or emergencies. Such circumstances are addressed by the attached CFMG policy on gaps in psychiatric staffing, which describes a variety of measures that CFMG employs to ensure coverage, including temporary staffing as well as telepsychiatry. See Exhibit A.
According to the American Telemedicine Practice Guidelines for Video‐Based Online Mental Health Services “no studies have identified any patient subgroup that does not benefit, or is harmed by, mental health care provided through remote videoconferencing,” including patients with psychosis and phobic disorders.1 Tele‐psychiatry, however, is not well‐studied in jails and prisons. Nearly all of the research has been in community settings.
Tele‐psychiatry, when employed as part of an overall system of medical and mental health care, is an acceptable supplement and sometimes alternative to in‐ person on‐site encounters with a psychiatrist. The decision regarding whether an inmate is an appropriate candidate for tele‐psychiatry will be determined by the tele‐psychiatrist following evaluation and referral by on‐site medical and mental health staff or on‐site psychiatrist who is scheduled to see the inmate.
Tele‐psychiatry may be used to provide psychiatric services which include, but are not limited to: initial psychiatric consultations; diagnostic and treatment evaluations; formulation of individual treatment plans; medication management; emergency psychiatric assessments including patients who are suicidal or at risk
1 American Telemedicine Association, Practice Guidelines for Video‐Based Online Mental Health Services (May 2013) at 3.

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for suicide; patients who are a danger to themselves or others; patients who may require the administration of involuntary medications; other crisis interventions and patient education. Special caution, however, is necessary for patients who are actively engaging in self‐harm or towards others.
Consistent with national standards and guidelines for telemedicine, the telepsychiatrist shall be considered an active part of the patient’s treatment team and shall be available for discussion of the case with local clinicians at the Monterey County Jail.2 Telepsychiatrists shall prepare appropriate progress notes and ensure that they are included in the patient’s Monterey County Jail medical record.
Any telepsychiatrist who treats patients at the Monterey County Jail shall become familiar with the general living conditions of the patients, so that the provider can understand the context in which the patients’ conditions arise, and in which treatment must take place.
Any telepsychiatrist who regularly treats patients at Monterey County Jail shall participate in an in‐person tour of the jail once in the first year of their employment, and once within six months of substantial architectural changes, such as the opening of the new Jail facilities. Telepsychiatrists shall have the ability to request photos and/or video of physical spaces within the Jail to better understand the layout and other physical attributes of the housing units and medical treatment areas. Absent a compelling reason for non‐attendance, telepsychiatrists shall participate in quarterly Quality Assurance meetings.
CFMG shall provide all telepsychiatrists with:
(1) a written description of the jail’s housing assignments and programs, so that providers will understand patient references to their living conditions;
(2) a list of all clinical staff at the Monterey County Jail, with phone numbers, which shall be kept updated to reflect staff change and vacancies;

2 American Telemedicine Association, Practice Guidelines for Video‐Based Online Mental Health Services, August 2009, Guideline (e) “Communication and Collaboration with the Patient’s Treatment Team.”

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(3) the formulary, procedures for ordering non‐formulary medications, and the medication pass procedures, including information on the availability of direct observation treatment (DOT);
(4) an emergency management protocol, which is described in more detail below.
CFMG and its telepsychiatrists shall develop an emergency management protocol to ensure that the telepsychiatrist is familiar with the emergency resources and response times available should the need for emergency services arise during a telepsychiatry session.3
The emergency management protocol shall inform telepsychiatrists that Monterey County Jail patients can be treated at Natividad Medical Center, located in the same county complex as the jail. The emergency management protocol shall also inform telepsychiatrists that they are able to order the patient transferred to Natividad Medical Center, including the Mental Health Unit therein, when the patient requires acute mental health services that are beyond those available on site.
In order to ensure effective differential diagnosis, management of medication side effects, management of elevation in symptoms, and/or issues related to medication non‐compliance, the telepsychiatrist shall be familiar with the patients’ prescribed medications, the availability of specific medications at the Monterey County Jail, and the extent to which the patient already has an active relationship with a prescribing professional at the Monterey County Jail. The telepsychiatrist shall coordinate with the prescribing professionals at the jail, to ensure that the inmate’s medical and psychiatric treatment is well‐coordinated, and to ensure that possible organic causes for psychiatric symptoms are detected and addressed, or ruled out.
Telepsychiatry practice at the Monterey County Jail shall be structured so as to ensure that the telepsychiatrist has access to the medical information necessary to make a complete evaluation and diagnosis, recognizing the importance of the

3 American Telemedicine Association, Practice Guidelines for Video‐Based Online Mental Health Services, August 2009, Guidelines (a)(A)(2)(b); (f).

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medical component of a psychiatric examination.4 The telepsychiatrist, being remote, cannot perform a physical examination him or herself, and thus must rely on information obtained by an on‐site physician or mid‐level provider5 and their independent observations during the telepsychiatry session.
Telepsychiatry practice at the Monterey County Jail shall be structured so as to ensure that the telepsychiatrist is able to make effective referrals for medical care, including laboratory and bloodwork as well as immediate and emergency care, and for the results to be communicated effectively back to the telepsychiatrist. The telepsychiatrist provider has the same authority and ability to make referrals and timely receive results as does the on‐site psychiatrist.
The safe management of psychotropic medications requires affirmative steps to diagnose side effects, including movement disorders, which can cause life‐long harm if not detected and controlled by the prescribing psychiatrist in conjunction with medical staff. Where telepsychiatry is used for medication management at Monterey County Jail and there is a history of antipsychotic prescribing, telepsychiatry sessions shall either be preceded by a movement disorder screening by a qualified medical clinician using the Abnormal Involuntary Movement Scale (AIMS), or, if pre‐screening is not practicable, then the patient shall be accompanied in the telepsychiatry session by a qualified medical clinician who can assist the telepsychiatrist in conducting the AIMS screening.

4 See American Telemedicine Association, Practice Guidelines for Video‐Based Online Mental Health Services, August 2009, Guideline (g) [Medical Issues] (“Patients receiving treatment through telemental health should have an active relationship with a prescribing professional in their physical vicinity.”]. See also, American Psychiatric Association, Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition, Guideline VI, Assessment of Medical Health, at 32: “[A]n an understanding of the patient’s medical status is important to 1) properly assess the patient’s psychiatric symptoms and their potential cause, 2) determine the patient’s need for medical care, and 3) consider potential effects on the patient’s medical conditions or related treatments when choosing among psychiatric treatments.”
5 See American Psychiatric Association, Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition, Guideline VI, Assessment of Medical Health, at 34: “The physical examination may be performed by the psychiatrist, another physician, or a medically trained clinician. Elements of the examination, such as vital signs, height, and weight, may also be obtained by nursing staff or a medical assistant. The results of the patient’s most recent physical examination may also be relied on in obtaining information about the patient’s physical status.”

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In order to achieve the necessary levels of coordination, the list below provides examples of the most common types of psychiatric encounters at the jail, and the steps ordinarily necessary to ensure coordination of on‐site care.

Description

Local coordination steps

Follow‐up After Continuity of Psych Meds from Community. Newly arrived inmates who were on psych meds in the community to be seen by psychiatrist within 5‐ 7 days after Booking RN continues medication based on psychiatrist verbal order. (CFMG Implementation Plan at 9.)

Where the 5‐7 day follow‐up is by telepsychiatry, the patient shall be seen locally by a physician or mid‐level provider before the session to rule out organic causes of psychiatric symptoms and to administer the AIMS for patients already on antipsychotic medications. If pre‐ screening is not practicable, then the patient shall be accompanied in the telepsychiatry session by a qualified medical clinician who can assist the telepsychiatrist in conducting the necessary screening.

Initial Evaluations, for example per Mental Health Referral at 14‐Day Health Inventory is followed by “a baseline history and … psychiatric examination” if the clinician makes a psychiatric referral. (CFMG Implementation Plan at 20‐21.)

Where the baseline history is by telepsychiatry, the patient shall be seen locally by a physician or mid‐level provider within 24 hours (before or after) the telepsychiatry session. If this evaluation occurs after the telepsychiatry encounter, the local physician or mid‐level provider shall have access to and consult the telepsychiatric progress notes of the preceding session.

Evaluation of Patients in Safety Cells.

Where telepsychiatry is used to evaluate a patient after safety cell placements, a psychiatric nurse shall be present locally to assist with the evaluation, and to follow‐ up on treatment recommendations and/or emergency hospital referrals.

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Description

Local coordination steps

Patients returned from NMC after mental health crisis admission.

Where telepsychiatry is used to evaluate a patient following return from NMC for psychiatric evaluation and/or treatment, a psychiatric nurse shall be present locally to assist with the evaluation, and to follow‐ up on treatment recommendations and/or emergency hospital referrals.

Medication Checks Every 30 Days Until Stable. “Patients on psychiatric medications will be seen by the psychiatrist every thirty days until determined stable ….” (CFMG Implementation Plan at 21.)

Where the 30‐day medication checks are performed by telepsychiatry, the patient shall be seen locally by a physician or mid‐ level provider to rule out organic causes of psychiatric symptoms and to administer the AIMS for patients already on medications if requested by the telepsychiatrist. A qualified medical clinician who has received appropriate training6 shall be present in the session to assist the telepsychiatrist in observing the patient’s behavior and gait upon entering the treatment area, and to assist the tele‐ psychiatrist in examining the patient.

6 Annual training shall include: (1) identifying symptoms of mental illness that may not be observable to telepsychiatry provider (such as whispering to oneself); (2) identifying symptoms of medical illness that may not be observable to telepsychiatry provider (such as the smell of diabetic ketones, indicative of diabetic ketosis); (3) methods to facilitate and/or improve the therapeutic alliance; (4) methods of operating the telepsychiatry machinery to better capture patient symptoms (including the patient’s gait and hand tremors); (5) protocols for emergency treatment and transfer; and (6) methods to improve coordination of care between on‐site and off‐site providers. Trainings should include the participation of one or more telepsychiatrists that provide services to patients at the Jail.

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Description

Local coordination steps

Medication Checks Every 60‐90 Days When Stable on Meds. “Patients on psychiatric medications will be seen by the psychiatrist every thirty days until determined stable and then at least every 60 to 90 days. More frequent evaluations by a psychiatrist will be scheduled if necessitated by the patient’s condition.” (CFMG Implementation Plan at 21.)

See above for same procedure as 30‐day medication checks.

Chronic Care 90‐Day Checks.

See above for same procedure as 30‐day

“Patients with identified chronic medication checks .

medical/mental health conditions

shall be scheduled for Chronic Care

Clinic and seen by the physician or

the psychiatrist at least every

ninety days if condition is stable or

more frequently if condition is

unstable while in custody.” (CFMG

Implementation Plan at 21.)

Involuntary Medication Order. Monterey County Jail is not licensed for involuntary medication. Involuntary medication may be ordered only when “immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others.” (CFMG Implementation Plan at 86.)

If involuntary medication is initiated at Monterey County Jail due to emergency, patient shall be transferred to NMC for further treatment.
If involuntary medication is being continued at Monterey County Jail pursuant to prior involuntary medication orders, follow procedures set forth above for medication management by telepsychiatry.

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Description

Local coordination steps

Involuntary Medication Follow‐Up. “The inmate will be evaluated by the responsible prescribing physician at a minimum of every 72 hours.” (CFMG Implementation Plan at 87.)

Where telepsychiatry is used for involuntary medication follow‐up, a Qualified Medical Professional shall be present locally to assist with the evaluation, and to follow‐up on treatment recommendations and/or emergency hospital referrals.

Culturally competent interpreter services shall be provided in the patient’s preferred language when the patient and the telepsychiatrist do not speak the same language.7
Patients with disabilities shall receive reasonable accommodations/modifications as necessary to ensure that they receive equally effective communication in the delivery of mental health services. In some cases such reasonable accommodations/modifications may preclude the use of telepsychiatry where the patient’s communication needs are not consistent with this mode of treatment. For example, for some patients who rely on sign language interpreters, the video arrangement may not adequately convey the range of gestures needed for effective interpretation, and in such cases the patient will need to be treated by an on‐site provider.
II. Additional Requirements
A. Informed Consent
Telepsychiatry shall not be used without the patient’s informed consent, documented in writing in the patient’s medical record. Informed consent for use of telepsychiatry with a patient shall include, at minimum: discussion of the structure and timing of services; procedures for coordination of care with other professionals; scheduling, including a protocol for contact between sessions; record keeping, including the process by which patient information will be documented and stored; privacy and confidentiality; potential risks; an agreed

7 American Telemedicine Association, Practice Guidelines for Video‐Based Online Mental Health Services, August 2009, Guideline (i).

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upon emergency plan; and information specific to the nature of videoconferencing, inducing the potential for technical failure. An informed consent form to be reviewed with the patient prior to providing psychiatric services via telepsychiatry is attached as Exhibit B.
B. Telepsychiatrist Access to Records
The telepsychiatrist shall have access to relevant clinical data of the patient as if they were being seen in person. Relevant clinical data may be provided to the telepsychiatrist by (1) facsimile transmission, (2) secured encrypted HIPAA compliant internet based formats including email, or (3) direct discussions with any of the patient’s medical or mental health care providers. Relevant clinical data on each patient will be provided to the telepsychiatrist at least 1 hour before the start of the telepsychiatry session. All pertinent information, i.e., pertinent history, lab results, progress notes from mental health provider, medication compliance, etc., will be included. This information may be provided either by: (1) providing the patient’s entire medical and mental health file to the telepsychiatrist; or (2) providing pertinent records documenting the patient’s active psychiatric and medical conditions (including treatments and responses), past medical and psychiatric treatments (including treatments and responses), pertinent lab results and progress notes, and an abbreviated social history to the telepsychiatrist. Information provided by way of the second option shall be captured and documented in a chart review form. Additional clinical data may be sent to the telepsychiatrist during or after the telepsychiatry session as necessary.
C. Telepsychiatry Provider Charting
Telepsychiatrists must adequately document each patient session, and transmit the documentation electronically to the facility for inclusion in the patient’s medical record within 24 hours of the clinic visit. Such documentation shall include the date and duration of the encounter, the psychiatrist’s assessment, patient history, treatment plan, and informed consent.
D. Technical Requirements
Defendants’ Telepsychiatry facilities and technological capabilities must be regularly vetted to ensure: the normal operation of the devices do not have technological difficulties; up‐to‐date antivirus software and a firewall is installed; reliable management software is used to provide consistent oversight of

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applications; adequate security by using point‐to‐point encryption; and the maintenance of the most reliable connection method to access the Internet. Technical problems that interrupt or prevent adequate patient assessment shall be documented in a log as well as the patient record.
E. Quality Assurance
Telepsychiatry care is subject to Quality Assurance monitoring that addresses the particular requirements for telemedicine, including but not limited to whether records are being reviewed as appropriate, whether the technology is working, and whether patients are consenting to telemedicine sessions and getting timely access to on‐site care when they do not consent.
F. Confidentiality
Telepsychiatry sessions shall be conducted so that clinical discussion cannot be overheard by other patients. Custody staff may maintain visual supervision but may not be close enough to overhear communication, absent security concerns based on an individualized determination of risk which includes consideration of a request by a qualified mental health practitioner requiring that custody staff be closer at hand for that specific inmate.
III. Tele‐Psych Clinic Procedure
(1) Inmates being referred to the clinic will be placed on the sick call list.
(2) The mental health worker, who will be a Qualified Mental Health Professional, will set up the clinic for the scheduled day. The tele‐ psych referral form will be completed and sent to the psychiatrist for each individual patient being seen.
(3) The telepsychiatrist shall have access to relevant clinical data of the patient as if they were being seen in person, as described in Section II.B above. Once the clinic begins the mental health worker will facilitate the process:
(a) Provide privacy for the patient, as described in Section II.F above. The medical assistant will work with the facility staff to do everything possible to ensure privacy for the patients. If at any time the patient requests to speak to the doctor privately,

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the medical assistant will advise the appropriate detention staff and leave room.
(b) Assist the inmate by explaining the process and providing support during the procedure.
(4) Medication
(a) Informed consent for medication
(i) The psychiatrist will verbally provide the inmate with the rationale for the use of the specific medication, the benefits, and potential side effects; the potential risks of refusing to take the medication; and document this information and the patient's level of understanding in the medical record.
(ii) The medical assistant will complete the consent form, obtain the patient's signature and fax the consent form to the psychiatrist for signature. The completed, signed form will be faxed back to the county and filed in the inmate's medical record.
(b) Medication monitoring
(i) All patients on medications will be seen by an on‐site psychiatrist or telepsychiatrist and re‐evaluated every 30 days until condition stable; then every 60 to 90 days at the clinical discretion of the psychiatrist. More frequent evaluations will be scheduled as indicated by the patient's condition.
(5) On‐site monitoring/follow up of patient status
(a) The on‐site mental health provider will routinely monitor patient status and report significant changes to the psychiatrist between scheduled tele‐psychiatry clinics.

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(b) Urgent or emergent patient conditions will be referred to local community providers through consultation with the on‐site medical director.

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Exhibit A

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This policy addresses vacancies in the on‐site psychiatrist position at the Monterey County Jail.
CFMG provides 40 hours of on‐site psychiatric services at the Monterey County Jail. In addition CFMG supplements psychiatric staffing at Monterey County Jail with tele‐ psychiatrist services.
For any vacancy in which the on‐site psychiatrist is unable to provide the required 40 hours of on‐site psychiatric services, or any part thereof, CFMG will first attempt to have the on‐call psychiatrist fill the vacancy. In the event that the on‐call psychiatrist is not able to fill the vacancy (or only partially fill the vacancy), the below procedures will be followed, according to type of vacancy. For purposes of this policy, the following types of vacancies are defined:
(1) “Scheduled vacations/leaves” (2) “Illnesses/emergencies” (3) “Termination/Separation”
1. Scheduled Vacations/Leaves
Whenever possible, the on‐site psychiatrist will notify the CFMG Program Manager within 30 days of any Scheduled Vacation/Leave.
Upon receipt of the notice, the Program Manager will:
a. Notify the CMGC Medical Director of the on‐site psychiatrist's planned absence; and
b. Attempt to hire a qualified psychiatrist to provide on‐site psychiatric services at the Monterey County Jail during the planned absence. CFMG maintains an up‐to‐date panel of at least one psychiatrist who is capable of filling such vacancies. CFMG will attempt in good faith to recruit three
psychiatrists who will agree to be a part of their on call psychiatrist panel.
c. If the Program Manager is unable to hire a qualified psychiatrist, CFMG will employ a staffing agency, such as Aligned Telehealth, to provide a qualified tele‐psychiatrist or on‐site psychiatrist who is able to perform psychiatric services at the Monterey County Jail during the on‐site psychiatrist's planned absence.

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d. If the Schedule Vacation/Leave is for a period of more than two weeks (14 calendar days), CFMG shall not rely on tele‐psychiatry for the entire period, but instead will ensure that the staffing agency provides an on‐site psychiatrist to perform psychiatric services at the Monterey County Jail until the CFMG‐employed on‐site psychiatrist resumes work at the Jail.
2. Illnesses/Emergencies
If the on‐site psychiatrist has an unplanned or unforeseen absence (e.g., emergency or illness), the Program Manager will attempt to cover the absence with the on‐call psychiatrist position described above, and then with the panel coverage described in 1.b above.
If for some reason, neither the on‐call nor the panel coverage can fill the absence, then CFMG will employ a staffing agency, such as Aligned Telehealth, to provide a qualified tele‐psychiatrist or on‐site psychiatrist who is able to perform psychiatric services at the Monterey County Jail during the on‐site psychiatrist's unplanned absence.
If the illness/emergency absence is persists for more than two weeks (14 calendar days) CFMG will ensure that the staffing agency provides an on‐site psychiatrist to perform psychiatric services at the Monterey County Jail until the CFMG‐employed on‐site psychiatrist resumes work at the Jail.
3. Termination/Separation
a. If CMGC/CFMG receives notice that the on‐site psychiatrist will be terminated, or intends resign or otherwise stop practicing at the Monterey County Jail for an indeterminate period of time, the following shall occur: Within 3 business days of the notice, CFMG/CMGC through counsel shall provide notice to the Court and counsel in Hernandez v. County of Monterey, Case No. CV 13‐2354 BLF (N.D. Cal.).
b. CMGC/CFMG shall take all reasonable steps to fill the on‐site psychiatry position.
c. If the position is not filled during the notice period before the on‐site psychiatrist’s departure, CFMG shall ensure that a staffing agency provides an on‐site psychiatrist to perform psychiatric services at the Monterey County Jail until the position is filled.

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 21 of 24
This policy and procedure applies only to the Monterey County Jail. It is not intended to apply to any other County where CFMG or CMGC provides mental health services, including tele‐psychiatry.

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 22 of 24
Exhibit B

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 23 of 24
Confidentiality Disclosure and Consent for Treatment by Telepsychiatry
Inmate Name: ____________________________________ Booking #: ___________________ Housing Unit: _________________
Confidentiality Disclosure Statement
I understand that Telepsychiatry sessions shall be conducted with adequate privacy so that clinical discussion cannot be overheard by other patients and/or correctional officers. I understand there are limits to the confidentiality within a correctional setting. I understand that the treating Telepsychiatrist is required to disclose any information regarding: Suicidal, Homicidal, and Self Injurious Ideation; Unreported Child or Elder Abuse/Neglect; as well as Safety and Security Issues. I understand that the treating Telepsychiatrist may disclose information to on-site staff for the purposes of coordinating my mental health care and/or housing placement. I understand that, in rare cases, a poor Internet connection or equipment failure may make it difficult for the Telepsychiatrist to communicate with me or make an appropriate medical decision. Additionally, in rare cases, security protocols could fail, causing a breach of privacy of my personal medical information.
Consent to Treatment by Telepsychiatry
I understand that I may refuse Telepsychiatry at any time and will then be scheduled to see an on-site psychiatrist. I understand that I have the right to refuse any medications that I am prescribed, and that I may withdraw my consent to treatment with my prescribed medications at any time. The Telepsychiatrist has explained to me the structure and timing of my treatment, including the procedures for coordinating my care with on-site mental health staff and the scheduling of my next appointment. I have been informed of how to access mental health staff if I have a crisis or emergency, including an urge to hurt myself or others. The Telepsychiatrist and I have agreed upon a plan in the event that I undergo a psychiatric emergency. The Telepsychiatrist has explained to me that details of this appointment, including the date and duration of the encounter, my patient history, the Telepsychiatrist’s assessment, treatment plan, and my informed consent, will be documented in my medical record, a copy of which will be stored on-site at the Monterey County Jail. I understand my responsibilities include participating in the treatment program and alerting medical staff to any problems or issues that may arise as a result of treatment.

Case 5:13-cv-02354-BLF Document 632 Filed 03/21/18 Page 24 of 24

This informed consent process included the opportunity for me to ask questions in regard to my treatment. My questions have been answered and the risks, benefits, and any practical alternatives have been discussed with me in a language in which I understand. I voluntarily consent to treatment provided by the Telepsychiatrist identified below.

I consent to treatment by Telepsychiatry

I reject treatment by Telepsychiatry and demand an on-site psychiatrist

____________________________ Patient Signature

___________________________ Date

Patient Refused to Sign

Provide Reason:

____________________________ Clinician Name (Print)
____________________________ Clinician Signature

___________________________ Title
___________________________ Date

 </s> Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 1 of 82
ADRMOP,CONSENT,PRVADR,REFSET−NC,RELATE
U.S. District Court California Northern District (San Jose) CIVIL DOCKET FOR CASE #: 5:13−cv−02354−BLF

Hernandez et al v. County of Monterey et al Assigned to: Judge Beth Labson Freeman Referred to: Magistrate Judge Nathanael M. Cousins (Settlement) Relate Case Cases: 5:16−cv−00945−BLF
5:14−cv−05481−BLF
5:16−cv−04221−BLF Cause: 29:791 Job Discrimination (Rehabilitation Act)
Plaintiff

Date Filed: 05/23/2013 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: Federal Question

Jesse Hernandez

represented by Carl Takei American Civil Liberties Union National Prison Project 915 15th St., NW 7th Floor Washington, DC 20005 United Sta 202−393−4930 Fax: 202−393−4931 Email: ctakei@aclu.org TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Donald Earl Landis , Jr. Monterey County Public Defender's Office 111 W. Alisal Monterey, CA 93901 831−784−5651 Fax: 831−755−5873 Email: landisde@co.monterey.ca.us TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Gay Crosthwait Grunfeld Rosen Bien Galvan and Grunfeld LLP 50 Fremont Street, 19th Floor San Francisco, CA 94105 415−433−6830 Fax: 415−433−7104 Email: ggrunfeld@rbgg.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Krista Michelle Stone−Manista Rosen Bien Galvan and Grunfeld 50 Fremont St 19th Floor San Francisco, CA 94105 415−433−6830 Email: KStone−Manista@rbgg.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael Louis Freedman Rosen Bien Galvan and Grunfeld

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 2 of 82
101 Mission Street, 6th Floor San Francisco, CA 94105−1738 United Sta 415−433−6830 Fax: 415−433−7104 Email: mfreedman@rbgg.com TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser ACLU Foundation of Northern California, Inc. 39 Drumm Street San Francisco, CA 94111 415−621−2493 Fax: 415−255−1478 Email: aschlosser@aclunc.org TERMINATED: 07/29/2019
Andrew Glenn Spore Rosen Bien Galvan & Grunfeld LLP 101 Mission Street, 6th Floor San Francisco, CA 94105−1738 415−433−6830 Fax: 415−433−7104 Email: aspore@rbgg.com TERMINATED: 10/17/2018
Cara Elizabeth Trapani Rosen Bien Galvan Grunfeld LLP 101 Mission Street, 6th Floor San Francisco, CA 94105−1738 415−433−6830 Fax: 415−433−7104 Email: ctrapani@rbgg.com ATTORNEY TO BE NOTICED
Eric Balaban American Civil Liberties Union National Prison Project 915 15th St., NW 7th Floor Washington, DC 20005 (202)393−4930 Fax: 202−393−4931 Email: ebalaban@aclu.org ATTORNEY TO BE NOTICED
Ernest James Galvan Rosen Bien Galvan & Grunfeld LLP 101 Mission Street, Sixth Floor San Francisco, CA 94105−1738 (415) 433−6830 Email: egalvan@rbgg.com ATTORNEY TO BE NOTICED
James Samuel Egar Monterey County Public Defender's Office 111 W. Alisal Salinas, CA 93901 831−755−5806 Fax: 831−755−5873 Email: egarjs@co.monterey.ca.us TERMINATED: 06/23/2016

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 3 of 82

Plaintiff Robert Yancey

Kathleen Guneratne ACLU Foundation of Northern California 39 Drumm Street San Francisco, CA 94111 (415) 293−6312 Fax: (415) 255−1478 Email: kguneratne@aclunc.org ATTORNEY TO BE NOTICED
Micaela Davis 39 Drumm Street San Francisco, CA 94111 415−621−2493 Email: mdavis@aclunc.org TERMINATED: 07/29/2019
Michael William Bien Rosen Bien Galvan & Grunfeld LLP 101 Mission Street, 6th Floor San Francisco, CA 94105−1738 415−433−6830 Fax: 415−433−7104 Email: mbien@rbgg.com ATTORNEY TO BE NOTICED
Sarah Pascal Alexander Constantine Cannon LLP 150 California Street Suite 1600 San Francisco, CA 94111 United Sta 415−766−3564 Email: spalexander@constantinecannon.com TERMINATED: 08/02/2016
Sumana Cooppan Rosen Bien and Galvan LLP 315 Montgomery Street Tenth Floor San Francisco, CA 94104 415−433−6830 Fax: 415−433−6830 Email: scooppan−wolf@rbgg.com TERMINATED: 08/02/2016
Van Swearingen Rosen Bien Galvan & Grunfeld LLP 101 Mission Street, Sixth Floor San Francisco, CA 94105−1738 415−433−6830 Fax: 415−433−7104 Email: vswearingen@rbgg.com ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 4 of 82

Plaintiff Richard Murphy

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 5 of 82
LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 6 of 82

Plaintiff Sarab Sarabi

represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 7 of 82

Plaintiff
Glenda Hunter on behalf of themselves and all others similary situated

TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 8 of 82

Plaintiff Cain Aguilar

TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 9 of 82

Plaintiff Dennis Guyot

(See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 10 of 82

Plaintiff Albert Key

TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 11 of 82

Plaintiff Cobb (Tran) Ha

Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 12 of 82

Plaintiff Jeff Nichols

Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 13 of 82

Plaintiff George Greim

Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 14 of 82

Plaintiff Wesley Miller

Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Carl Takei (See above for address) TERMINATED: 12/20/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 15 of 82

Plaintiff Susan Dilley

Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 16 of 82

Plaintiff Connie Dobbs

ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 17 of 82

Plaintiff Sean Esquivel

(See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 18 of 82

Plaintiff Ramona Gist

Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 19 of 82

Plaintiff Martha Gomez

Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 20 of 82

Plaintiff Jason Hobbs

TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 21 of 82

Plaintiff Brandon Mefford

(See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 22 of 82

Plaintiff Angel Perez

Van Swearingen (See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 23 of 82

Plaintiff Clyde Whitfield

(See above for address) ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED
represented by Donald Earl Landis , Jr. (See above for address) TERMINATED: 06/07/2017 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Krista Michelle Stone−Manista (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Louis Freedman (See above for address) TERMINATED: 08/02/2016 LEAD ATTORNEY
Alan Lawrence Schlosser (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Cara Elizabeth Trapani (See above for address) ATTORNEY TO BE NOTICED
Ernest James Galvan (See above for address) ATTORNEY TO BE NOTICED
James Samuel Egar (See above for address) TERMINATED: 06/23/2016
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED
Micaela Davis (See above for address) TERMINATED: 07/29/2019 ATTORNEY TO BE NOTICED
Michael William Bien (See above for address) ATTORNEY TO BE NOTICED
Sarah Pascal Alexander (See above for address) TERMINATED: 08/02/2016
Sumana Cooppan (See above for address) TERMINATED: 08/02/2016
Van Swearingen (See above for address)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 24 of 82
ATTORNEY TO BE NOTICED
Gay Crosthwait Grunfeld (See above for address) ATTORNEY TO BE NOTICED

V. Defendant County of Monterey
Defendant Monterey County Sheriff's Office

represented by Susan K. Blitch County Counsel Office of the County Counsel County of Monterey 168 West Alisal Street, 3rd Floor Salinas, CA 93901−2680 831−755−5045 Fax: 831−755−5283 Email: blitchsk@co.monterey.ca.us LEAD ATTORNEY ATTORNEY TO BE NOTICED
Anne Kristen Brereton Monterey County Counsel 168 West Alisal Street Third Floor Salinas, CA 93901 831−755−5045 Fax: 831−755−5283 Email: breretona@co.monterey.ca.us ATTORNEY TO BE NOTICED
Janet L. Holmes County Counsel's Office County of Contra Costa 651 Pine Street, 9th Floor Martinez, CA 94553 (925) 335−1800 Fax: (925) 335−1866 Email: HolmesJL@co.monterey.ca.us ATTORNEY TO BE NOTICED
Mary Leeann Hapte Best, Best & Krieger LLP 300 S. Grand Avenue Floor 25 Los Angeles, CA 90071−3169 213−787−2572 Fax: 213−617−7480 Email: leeann.Habte@bbklaw.com ATTORNEY TO BE NOTICED
Michael Rudolph Philippi County of Monterey County Counsel 168 West Alisal Street 3rd Floor Salinas, CA 93901 (831) 755−5045 Email: PhilippiMR@co.monterey.ca.us ATTORNEY TO BE NOTICED
represented by

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 25 of 82

Defendant California Forensic Medical Group

Susan K. Blitch (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Anne Kristen Brereton (See above for address) ATTORNEY TO BE NOTICED
Mary Leeann Hapte (See above for address) ATTORNEY TO BE NOTICED
Michael Rudolph Philippi (See above for address) ATTORNEY TO BE NOTICED
represented by Jemma A. Parker Saunders Bertling Law Group 15 West Carrillo Street, Suite 104 Santa Barbara, CA 93101 805−879−7558 Fax: 805−962−0722 Email: jemma@bertlinglawgroup.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Peter G. Bertling Bertling Law Group, Inc. 15 West Carrillo Street, Suite 104 Santa Barbara, CA 93101−8215 (805) 879−7558 Fax: (805) 962−0722 Email: peter@bertlinglawgroup.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Paul David Singer Bertling and Clausen LLP 15 W. Carrillo St., Suite 100 Santa Barbara, CA 93101 805−892−2100 Fax: 805−963−6044 Email: pds@bertling−clausen.com ATTORNEY TO BE NOTICED

V. Movant Mark Vasquez Pajas, Sr.

represented by Cindy Panuco Hadsell Stormer and Renick LLP 128 N. Fair Oaks Ave. Pasadena, CA 91103 626−585−9600 Email: cpanuco@publiccounsel.org ATTORNEY TO BE NOTICED
Kathleen Guneratne (See above for address) ATTORNEY TO BE NOTICED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 26 of 82

Date Filed 05/23/2013
05/23/2013 05/23/2013
06/04/2013 06/06/2013 06/06/2013 06/06/2013 06/06/2013 07/26/2013 07/26/2013 07/29/2013 07/31/2013 10/08/2013 10/08/2013 10/09/2013 10/31/2013
10/31/2013

# Docket Text
1 COMPLAINT (summons issued) against California Forensic Medical Group, County of Monterey, Monterey County Sheriff's Office ( Filing fee $ 400, receipt number 34611086344.). Filed byRichard Murphy, Sarab Sarabi, Glenda Hunter, Jesse Hernandez, Robert Yancy. (cv, COURT STAFF) (Filed on 5/23/2013) (cv, COURT STAFF). (Entered: 05/28/2013)
2 Summons Issued as to California Forensic Medical Group, County of Monterey, Monterey County Sheriff's Office. (cv, COURT STAFF) (Filed on 5/23/2013) (Entered: 05/28/2013)
3 ADR SCHEDULING ORDER: Case Management Statement due by 8/20/2013. Case Management Conference set for 8/27/2013 10:00 AM in Courtroom 5, 4th Floor, San Jose. (Attachments: # 1 Standing Order, # 2 Standing Order, # 3 Standing Order, # 4 Standing Order)(cv, COURT STAFF) (Filed on 5/23/2013) (Entered: 05/28/2013)
4 CLERKS NOTICE re: Failure to E−File and/or Failure to Register as an E−Filer (cv, COURT STAFF) (Filed on 6/4/2013) (Entered: 06/04/2013)
5 NOTICE of Appearance by James Samuel Egar (Egar, James) (Filed on 6/6/2013) (Entered: 06/06/2013)
6 NOTICE of Appearance by Michael William Bien , Michael Freedman, and Krista Stone−Manista (Bien, Michael) (Filed on 6/6/2013) (Entered: 06/06/2013)
7 NOTICE of Change In Counsel by Gay Crosthwait Grunfeld (Grunfeld, Gay) (Filed on 6/6/2013) (Entered: 06/06/2013)
8 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by Jesse Hernandez, Glenda Hunter, Richard Murphy, Sarab Sarabi, Robert Yancy.. (Grunfeld, Gay) (Filed on 6/6/2013) (Entered: 06/06/2013)
9 STIPULATION WITH PROPOSED ORDER filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 7/26/2013) (Entered: 07/26/2013)
10 CERTIFICATE OF SERVICE by Jesse Hernandez re 9 STIPULATION WITH PROPOSED ORDER (Grunfeld, Gay) (Filed on 7/26/2013) (Entered: 07/26/2013)
11 ORDER GRANTING 9 STIPULATION entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 07/29/2013)
12 CERTIFICATE OF SERVICE by Jesse Hernandez CIVIL DOCKET TEXT RE ORDER GRANTING STIPULATION (Grunfeld, Gay) (Filed on 7/31/2013) (Entered: 07/31/2013)
13 STIPULATION WITH PROPOSED ORDER Protective Order filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 10/8/2013) (Entered: 10/08/2013)
14 CERTIFICATE OF SERVICE by Jesse Hernandez re 13 STIPULATION WITH PROPOSED ORDER Protective Order (Grunfeld, Gay) (Filed on 10/8/2013) (Entered: 10/08/2013)
15 ORDER ENTERING STIPULATED PROTECTIVE ORDER by Judge Paul S. Grewal granting 13 Stipulation (psglc3, COURT STAFF) (Filed on 10/9/2013) (Entered: 10/09/2013)
16 AMENDED COMPLAINT against All Defendants. Filed byRichard Murphy, Sarab Sarabi, Glenda Hunter, Jesse Hernandez, Robert Yancey, Cynthia Aguilar, Dennis Guyot, Albert Key, Ha Cobb, Jeff Nichols, George Greim, Wesley Miller. (Attachments: # 1 Exhibit A, Part 1 of 3, # 2 Exhibit A, Part 2 of 3, # 3 Exhibit A, Part 3 of 3, # 4 Exhibit B)(Grunfeld, Gay) (Filed on 10/31/2013) (Entered: 10/31/2013)
17 MOTION for leave to appear in Pro Hac Vice for Carl Takei ( Filing fee $ 305, receipt number 0971−8125794.) filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 10/31/2013)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 27 of 82

10/31/2013 11/01/2013 11/01/2013 11/08/2013 12/03/2013
12/03/2013
12/03/2013 01/15/2014 01/16/2014 02/28/2014 03/14/2014 03/14/2014

(Entered: 10/31/2013)
18 MOTION for leave to appear in Pro Hac Vice for Eric Balaban ( Filing fee $ 305, receipt number 0971−8125804.) filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 10/31/2013) (Entered: 10/31/2013)
19 ORDER GRANTING LEAVE TO APPEAR PRO HAC VICE by Judge Paul S. Grewal granting 17 Motion for Pro Hac Vice; granting 18 Motion for Pro Hac Vice (psglc3S, COURT STAFF) (Filed on 11/1/2013) (Entered: 11/01/2013)
20 CERTIFICATE OF SERVICE by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey of First Amended Complaint and Related Documents (Grunfeld, Gay) (Filed on 11/1/2013) (Entered: 11/01/2013)
21 NOTICE of Appearance by Micaela Davis , Alan L. Schlosser and Lillian C. Chen of the ACLU Foundation of Northern California (Davis, Micaela) (Filed on 11/8/2013) (Entered: 11/08/2013)
22 *** POSTED IN ERROR *** please see 23 WAIVER OF SERVICE Returned Executed filed by Richard Murphy, Cynthia Aguilar, Ha Cobb, Sarab Sarabi, George Greim, Jeff Nichols, Glenda Hunter, Jesse Hernandez, Albert Key, Dennis Guyot, Wesley Miller, Robert Yancey. Service waived by California Forensic Medical Group waiver sent on 10/31/2013, answer due 12/30/2013; County of Monterey waiver sent on 10/31/2013, answer due 12/30/2013. (Freedman, Michael) (Filed on 12/3/2013) Modified on 12/27/2013 (cv, COURT STAFF). (Entered: 12/03/2013)
23 WAIVER OF SERVICE Returned Executed filed by Richard Murphy, Cynthia Aguilar, Ha Cobb, Sarab Sarabi, George Greim, Jeff Nichols, Glenda Hunter, Jesse Hernandez, Albert Key, Dennis Guyot, Wesley Miller, Robert Yancey. Service waived by Monterey County Sheriff's Office waiver sent on 10/31/2013, answer due 12/30/2013. Service waived by County of Monterey waiver sent on 10/31/2013, answer due 12/30/2013. CORRECTION OF DOCKET # 22 (Freedman, Michael) (Filed on 12/3/2013) (Entered: 12/03/2013)
24 WAIVER OF SERVICE Returned Executed filed by Richard Murphy, Cynthia Aguilar, Ha Cobb, Sarab Sarabi, George Greim, Jeff Nichols, Glenda Hunter, Jesse Hernandez, Albert Key, Dennis Guyot, Wesley Miller, Robert Yancey. Service waived California Forensic Medical Group waiver sent on 10/31/2013, answer due 12/30/2013 (Freedman, Michael) (Filed on 12/3/2013) (Entered: 12/03/2013)
25 STIPULATION WITH PROPOSED ORDER filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 1/15/2014) (Entered: 01/15/2014)
26 ORDER GRANTING STAY UNTIL FEBRUARY 17, 2014 by Magistrate Judge Paul Singh Grewal granting 25 Stipulation.(psglc3S, COURT STAFF) (Filed on 1/16/2014) (Entered: 01/16/2014)
27 STATUS REPORT AND REQUEST TO SET DEADLINES by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 2/28/2014) (Entered: 02/28/2014)
28 STIPULATION WITH PROPOSED ORDER filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 3/14/2014) (Entered: 03/14/2014)
29 CERTIFICATE OF SERVICE by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey re 28 STIPULATION WITH PROPOSED ORDER (Grunfeld, Gay) (Filed on 3/14/2014) (Entered: 03/14/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 28 of 82

03/17/2014 03/17/2014
03/21/2014 03/25/2014 04/01/2014 04/01/2014
04/01/2014 04/02/2014 04/04/2014 04/04/2014 04/08/2014
04/11/2014 04/21/2014 04/24/2014 04/25/2014

30 ORDER GRANTING 28 STIPULATION entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 03/17/2014)
31 CLERK'S NOTICE SETTING CASE MANAGEMENT CONFERENCE: Case Management Conference set for 4/8/2014 at 10:00 AM in Courtroom 5, 4th Floor, San Jose. Case Management Statement due by 4/1/2014. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 3/17/2014) (Entered: 03/17/2014)
32 NOTICE of Appearance by Susan K. Blitch (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 3/21/2014) (Entered: 03/21/2014)
33 NOTICE of Change In Counsel by Alan Lawrence Schlosser (Schlosser, Alan) (Filed on 3/25/2014) (Entered: 03/25/2014)
34 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by County of Monterey, Monterey County Sheriff's Office.. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 4/1/2014) (Entered: 04/01/2014)
35 STIPULATION and Proposed Order selecting Private ADR by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey , County of Monterey, Monterey County Sheriff's Office, and California Forensic Medical Group, Inc. filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 4/1/2014) (Entered: 04/01/2014)
36 JOINT CASE MANAGEMENT STATEMENT filed by Cynthia Aguilar, Ha Cobb, George Greim, Dennis Guyot, Jesse Hernandez, Glenda Hunter, Albert Key, Wesley Miller, Richard Murphy, Jeff Nichols, Sarab Sarabi, Robert Yancey. (Grunfeld, Gay) (Filed on 4/1/2014) (Entered: 04/01/2014)
37 ORDER GRANTING STIPULATION by Magistrate Judge Paul Singh Grewal granting 35 Stipulation selecting Private ADR.(psglc3S, COURT STAFF) (Filed on 4/2/2014) (Entered: 04/02/2014)
38 NOTICE of Appearance by Peter George Bertling on behalf of Defendant California Forensic Medical Group, Inc. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 4/4/2014) (Entered: 04/04/2014)
39 CERTIFICATE OF SERVICE by California Forensic Medical Group re 38 Notice of Appearance Amended Certificate of Service re Notice of Appearance of Defendant California Forensic Medical Group, Inc. (Bertling, Peter) (Filed on 4/4/2014) (Entered: 04/04/2014)
40 Minute Entry: Case Management Conference held on 4/8/2014 before Magistrate Judge Paul S. Grewal. Plaintiffs plan to file amended complaint by 4/11/2014. Rule 26(f) conference to be held by 4/18/2014. Supplemental case management statement to be submitted by 4/25/2014. Court to issue case management scheduling order upon receipt of supplemental statement. The court will schedule a telephonic hearing if necessary. (Court Reporter FTR: (10:00 to 10:08) (ofr, COURT STAFF) (Date Filed: 4/8/2014) (Entered: 04/09/2014)
41 AMENDED COMPLAINT (Second) against All Defendants. Filed byJesse Hernandez. (Attachments: # 1 Ex. A, Part 1 of 3, # 2 Ex. A, Part 2 of 3, # 3 Ex. A, Part 3 of 3, # 4 Ex. B)(Grunfeld, Gay) (Filed on 4/11/2014) (Entered: 04/11/2014)
42 NOTICE of Appearance by Van Swearingen (Swearingen, Van) (Filed on 4/21/2014) (Entered: 04/21/2014)
43 STIPULATION WITH (PROPOSED) ORDER ALLOWING THE FILING OF OVERSIZED BRIEFS filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 4/24/2014) Modified on 4/25/2014 (bw, COURT STAFF). (Entered: 04/24/2014)
44 MOTION to Dismiss Rule 12(b)(6) filed by County of Monterey, Monterey County Sheriff's Office. Motion Hearing set for 6/3/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 5/9/2014.

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 29 of 82

04/25/2014 04/25/2014 04/28/2014 04/29/2014 04/29/2014
04/29/2014 04/29/2014 04/29/2014
04/29/2014

Replies due by 5/16/2014. (Attachments: # 1 Declaration Cmdr. James H. Bass, # 2 Exhibit 1−9 to Declaration of Bass, # 3 Request for Judicial Notice, # 4 Certificate/Proof of Service)(Blitch, Susan) (Filed on 4/25/2014) (Entered: 04/25/2014)
45 Request for Judicial Notice re 44 MOTION to Dismiss Rule 12(b)(6) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Cmdr. James H. Bass, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Related document(s) 44 ) (Blitch, Susan) (Filed on 4/25/2014) (Entered: 04/25/2014)
46 SUPPLEMENTAL JOINT CASE MANAGEMENT STATEMENT filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 4/25/2014) Modified on 4/28/2014 (bw, COURT STAFF). Modified on 10/8/2014 (cv, COURT STAFF). (Entered: 04/25/2014)
47 ORDER GRANTING LEAVE TO FILE OVERSIZED BRIEFS IN MOTION FOR CLASS CERTIFICATION by Magistrate Judge Paul Singh Grewal granting 43 Stipulation.(psglc3S, COURT STAFF) (Filed on 4/28/2014) (Entered: 04/28/2014)
48 MOTION to Certify Class Certification filed by Jesse Hernandez. Motion Hearing set for 6/3/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 5/13/2014. Replies due by 5/20/2014. (Grunfeld, Gay) (Filed on 4/29/2014) Modified on 1/21/2015 (cv, COURT STAFF). (Entered: 04/29/2014)
49 Declaration of Gay Crosthwait Grunfeld in Support of 48 MOTION to Certify Class and Notice of Motion filed byJesse Hernandez. (Attachments: # 1 Exhibit A−E, # 2 Exhibit F−H, # 3 Exhibit I−J, # 4 Exhibit K, Part 1 of 3, # 5 Exhibit K, Part 2 of 3, # 6 Exhibit K, Part 3 of 3, # 7 Exhibit L−V, # 8 Exhibit W−Y, # 9 Exhibit Z, Part 1 of 4, # 10 Exhibit Z, Part 2 of 4, # 11 Exhibit Z, Part 3 of 4, # 12 Exhibit Z, Part 4 of 4, # 13 Exhibit AA−BB, # 14 Exhibit CC, Part 1 of 2, # 15 Exhibit CC, Part 2 of 2, # 16 Exhibit DD−GG, # 17 Exhibit HH−II, # 18 Exhibit JJ)(Related document(s) 48 ) (Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)
50 Declaration of James Egar in Support of 48 MOTION to Certify Class and Notice of Motion filed byJesse Hernandez. (Related document(s) 48 ) (Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)
51 Declaration of Pablo Stewart in Support of 48 MOTION to Certify Class and Notice of Motion filed byJesse Hernandez. (Related document(s) 48 ) (Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)
52 Administrative Motion to File Under Seal filed by Jesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen in Support of Plaintiffs' Administrative Motion to File Under Seal, # 2 Proposed Order, # 3 Declaration of Cain Aguilar Without Exhibits, # 4 Declaration of Cain Aguilar With Exhibits, # 5 Declaration of Ha Cobb Without Exhibits, # 6 Declaration of Ha Cobb With Exhibits, # 7 Declaration of Susan Dilley Without Exhibits, # 8 Declaration of Susan Dilley With Exhibits, # 9 Declaration of Connie Dobbs Without Exhibits, # 10 Declaration of Connie Dobbs With Exhibits, # 11 Declaration of Sean Esquivel Without Exhibits, # 12 Declaration of Sean Esquivel With Exhibits, # 13 Declaration of Ramona Gist Without Exhibits, # 14 Declaration of Ramona Gist With Exhibits, # 15 Declaration of Martha Gomez Without Exhibits, # 16 Declaration of Martha Gomez With Exhibits, # 17 Declaration of George Greim Without Exhibits, # 18 Declaration of George Greim With Exhibits, # 19 Declaration of Jesse Hernandez Without Exhibits, # 20 Declaration of Jesse Hernandez With Exhibits, # 21 Declaration of Jason Hobbs Without Exhibits, # 22 Declaration of Jason Hobbs With Exhibits, # 23 Declaration of Brandon Mefford Without Exhibits, # 24 Declaration of Brandon Mefford With Exhibits, # 25 Declaration of Angel Perez Without Exhibits, # 26 Declaration of Angel Perez With Exhibits, # 27 Declaration of Clyde Whitfield Without Exhibits, # 28 Declaration of Clyde Whitfield With Exhibits, # 29 Declaration of Robert Yancey Without Exhibits, # 30 Declaration of Robert Yancey With Exhibits)(Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)
53 Declaration of Nichele Hubbs in Support of 48 MOTION to Certify Class and Notice of Motion filed byJesse Hernandez. (Related document(s) 48 ) (Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 30 of 82

04/29/2014 04/29/2014 04/29/2014 04/30/2014 05/02/2014
05/02/2014
05/02/2014 05/05/2014 05/09/2014 05/13/2014 06/04/2014
06/05/2014
06/09/2014

54 Request for Judicial Notice in Support of 48 Motion for Class Certification filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 4/29/2014) Modified on 4/29/2014 (cv, COURT STAFF). (Entered: 04/29/2014)
55 Proposed Order 48 MOTION to Certify Class by Jesse Hernandez. (Grunfeld, Gay) (Filed on 4/29/2014) Modified on 10/8/2014 (cv, COURT STAFF). (Entered: 04/29/2014)
56 Brief re 48 MOTION to Certify Class and Notice of Motion filed byJesse Hernandez. (Related document(s) 48 ) (Grunfeld, Gay) (Filed on 4/29/2014) (Entered: 04/29/2014)
57 CERTIFICATE OF SERVICE by Jesse Hernandez re 52 Administrative Motion to File Under Seal (Grunfeld, Gay) (Filed on 4/30/2014) (Entered: 04/30/2014)
58 First MOTION to Dismiss Second Amended Complaint filed by California Forensic Medical Group. Motion Hearing set for 6/10/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 5/16/2014. Replies due by 5/23/2014. (Saunders, Jemma) (Filed on 5/2/2014) (Entered: 05/02/2014)
59 Memorandum of Points and Authorities in support of 58 MOTION filed by California Forensic Medical Group. Motion Hearing set for 6/10/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 5/16/2014. Replies due by 5/23/2014. (Attachments: # 1 Proposed Order, # 2 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 5/2/2014) Modified on 5/2/2014, (counsel selected incorrect event.) (cv, COURT STAFF). (Entered: 05/02/2014)
60 ORDER GRANTING 52 ADMINISTRATIVE MOTION TO FILE UNDER SEAL entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 05/02/2014)
61 STIPULATION WITH PROPOSED ORDER RE: BRIEFING SCHEDULE AND HEARING DATES FOR MOTION FOR CLASS CERTIFICATION AND MOTIONS TO DISMISS filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 5/5/2014) (Entered: 05/05/2014)
62 ORDER GRANTING STIPULATION by Magistrate Judge Paul Singh Grewal granting 61 Stipulation.(psglc3S, COURT STAFF) (Filed on 5/9/2014) (Entered: 05/09/2014)
63 NOTICE of Appearance by Eric Balaban Notice of Appearance of Counsel (Balaban, Eric) (Filed on 5/13/2014) (Entered: 05/13/2014)
64 MOTION for Extension of Time to File for Hearing and Briefing on Plaintiffs' Motion for Class Certification filed by California Forensic Medical Group. (Attachments: # 1 Declaration of Peter G. Bertling, # 2 Exhibit A to Declaration, # 3 Exhibit B to Declaration, # 4 Exhibit C to Declaration, # 5 Certificate/Proof of Service)(Bertling, Peter) (Filed on 6/4/2014) (Entered: 06/04/2014)
65 MOTION to Continue Enlarge Time for Hearing and Briefing on Motion for Class Certification filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: *** # 1 Declaration Susan K. Blitch DOCUMENT REMOVED − SEE ORDER 72 *** , # 2 Certificate/Proof of Service)(Blitch, Susan) (Filed on 6/5/2014) Modified on 6/10/2014 (ewn, COURT STAFF). (Attachment 1 replaced on 6/11/2014) (sp, COURT STAFF). Modified on 6/11/2014 (sp, COURT STAFF). (Entered: 06/05/2014)
66 RESPONSE (re 65 MOTION to Continue Enlarge Time for Hearing and Briefing on Motion for Class Certification, 64 MOTION for Extension of Time to File for Hearing and Briefing on Plaintiffs' Motion for Class Certification ) filed byJesse Hernandez. (Attachments: # 1 Declaration Declaration of Michael W. Bien IOT Defs Mot to Enlarge Time, # 2 Declaration Declaration of Van Swearingen IOT Defs Mot to Enlarge Time, # 3 Proposed Order Proposed Order)(Bien, Michael) (Filed on 6/9/2014) (Entered: 06/09/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 31 of 82

06/09/2014 06/10/2014 06/10/2014 06/10/2014 06/10/2014
06/11/2014 06/25/2014
06/25/2014
06/27/2014
06/30/2014
07/03/2014 07/03/2014 07/03/2014 07/03/2014

67 Notice of Supplemental Authority (Bien, Michael) (Filed on 6/9/2014) Modified on 6/16/2014 (cv, COURT STAFF). (Entered: 06/09/2014)
68 Proposed Order re 64 MOTION for Extension of Time to File for Hearing and Briefing on Plaintiffs' Motion for Class Certification by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 6/10/2014) (Entered: 06/10/2014)
69 Proposed Order re 65 MOTION to Continue Enlarge Time for Hearing and Briefing on Motion for Class Certification by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 6/10/2014) (Entered: 06/10/2014)
70 STIPULATION WITH PROPOSED ORDER to Remove Incorrectly Filed Document filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 6/10/2014) (Entered: 06/10/2014)
71 Declaration of Susan K. Blitch in Support of 65 MOTION to Continue Enlarge Time for Hearing and Briefing on Motion for Class Certification Redacted filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Related document(s) 65 ) (Blitch, Susan) (Filed on 6/10/2014) (Entered: 06/10/2014)
72 ORDER GRANTING STIPULATION by Judge Paul S. Grewal granting 70 Stipulation (psglc3S, COURT STAFF) (Filed on 6/11/2014) (Entered: 06/11/2014)
73 Declaration of Peter G. Bertling in Support of 64 MOTION for Extension of Time to File for Hearing and Briefing on Plaintiffs' Motion for Class Certification Supplemental Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit A, # 2 Certificate/Proof of Service)(Related document(s) 64 ) (Bertling, Peter) (Filed on 6/25/2014) (Entered: 06/25/2014)
74 Supplemental Brief re 65 MOTION to Continue Enlarge Time for Hearing and Briefing on Motion for Class Certification, 66 Opposition/Response to Motion,, 64 MOTION for Extension of Time to File for Hearing and Briefing on Plaintiffs' Motion for Class Certification filed byJesse Hernandez. (Related document(s) 65 , 66 , 64 ) (Freedman, Michael) (Filed on 6/25/2014) (Entered: 06/25/2014)
75 Renotice motion hearing re 44 MOTION to Dismiss Rule 12(b)(6) Amended filed byCounty of Monterey, Monterey County Sheriff's Office. Motion Hearing set for 8/12/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 7/3/2014. Replies due by 7/29/2014. (Attachments: # 1 Declaration Supplemental of Cmdr. James H. Bass, # 2 Supplement Request for Judicial Notice, # 3 Certificate/Proof of Service)(Related document(s) 44 ) (Blitch, Susan) (Filed on 6/27/2014) (Entered: 06/27/2014)
76 ORDER GRANTING DEFENDANTS MOTIONS TO ENLARGE TIME FOR HEARING AND BRIEFING ON PLAINTIFFS MOTION FOR CLASS CERTIFICATION by Judge Paul S. Grewal granting 64 Motion for Extension of Time to File; granting 65 Motion to Continue (psglc3S, COURT STAFF) (Filed on 6/30/2014) (Entered: 06/30/2014)
77 RESPONSE (re 44 MOTION to Dismiss Rule 12(b)(6) ) filed byJesse Hernandez. (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
78 Declaration of Van Swearingen in Support of 77 Opposition/Response to Motion filed byJesse Hernandez. (Related document(s) 77 ) (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
79 Declaration of Martha Gomez in Support of 77 Opposition/Response to Motion filed byJesse Hernandez. (Related document(s) 77 ) (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
80 Declaration of Wesley Miller in Support of 77 Opposition/Response to Motion filed byJesse Hernandez. (Related document(s) 77 ) (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 32 of 82

07/03/2014 07/03/2014
07/03/2014 07/03/2014 07/03/2014
07/09/2014 07/22/2014 07/28/2014 07/29/2014 07/29/2014 07/31/2014 08/01/2014

81 Request for Judicial Notice re 77 Opposition/Response to Motion filed byJesse Hernandez. (Related document(s) 77 ) (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
82 Administrative Motion to File Under Seal Declaration of Michael Freedman in Opposition to Defendant County's Motion to Dismiss with All Exhibits filed by Jesse Hernandez. (Attachments: # 1 Declaration Michael Freedman in Support of Plaintiffs' Administrative Motion to File Under Seal, # 2 Proposed Order Granting Plaintiffs' Administrative Motion to File Under Seal, # 3 Declaration of Michael Freedman in Opposition to County's Motion to Dismiss Without Exhibits A−W, # 4 Declaration of Michael Freedman in Opposition to County's Motion to Dismiss with All Exhibits)(Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
83 RESPONSE (re 58 First MOTION to Dismiss Second Amended Complaint ) Pls Opposition to Def CFMG's Motion to Dismiss filed byJesse Hernandez. (Schlosser, Alan) (Filed on 7/3/2014) (Entered: 07/03/2014)
84 CERTIFICATE OF SERVICE by Jesse Hernandez re 82 Administrative Motion to File Under Seal Declaration of Michael Freedman in Opposition to Defendant County's Motion to Dismiss with All Exhibits (Bien, Michael) (Filed on 7/3/2014) (Entered: 07/03/2014)
85 First MOTION for Extension of Time to File Response/Reply as to 48 MOTION to Certify Class and Notice of Motion Pls.' Motion for Additional Time to File Reply Brief filed by Jesse Hernandez. (Attachments: # 1 Declaration of Gay Crosthwait Grunfeld in Support of Pls' Mot. for Additional Time, # 2 Exhibit A to Decl. of Gay Crosthwait Grunfeld in Support of Pls' Mot. for Additional Time, # 3 Exhibit B to Decl. of Gay Crosthwait Grunfeld in Support of Pls' Mot. for Additional Time, # 4 Exhibit C to Decl. of Gay Crosthwait Grunfeld in Support of Pls' Mot. for Additional Time, # 5 Proposed Order Granting Pls' Mot. for Additional Time)(Grunfeld, Gay) (Filed on 7/3/2014) (Entered: 07/03/2014)
86 ORDER GRANTING PLAINTIFFS' ADMINISTRATIVE MOTION FOR ADDITIONAL TIME TO FILE REPLY PLEADINGS IN SUPPORT OF CLASS CERTIFICATION by Magistrate Judge Paul Singh Grewal granting 85 Motion for Extension of Time to File Response/Reply re 48 MOTION to Certify Class and Notice of Motion.(psglc3S, COURT STAFF) (Filed on 7/9/2014) (Entered: 07/09/2014)
87 ORDER GRANTING ADMINISTRATIVE MOTION TO FILE UNDER SEAL by Magistrate Judge Paul Singh Grewal granting 82 Administrative Motion to File Under Seal.(psglc3S, COURT STAFF) (Filed on 7/22/2014) (Entered: 07/22/2014)
88 ORDER by Judge Paul S. Grewal DENYING (9) Motion to Relate Case in 5:14−cv−02730 BLF. NOT Related to 5:13−cv−02354−PSG. Signed by Judge Paul S. Grewal on 7/28/2014. (ofr, COURT STAFF) (Filed on 7/28/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 07/28/2014)
89 REPLY (re 58 First MOTION to Dismiss Second Amended Complaint ) to Plaintiffs' Opposition to Defendant's Motion to Dismiss Second Amended Complaint filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 7/29/2014) (Entered: 07/29/2014)
90 REPLY (re 44 MOTION to Dismiss Rule 12(b)(6) ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Susan K. Blitch, # 2 Certificate/Proof of Service)(Blitch, Susan) (Filed on 7/29/2014) (Entered: 07/29/2014)
91 CLERK'S NOTICE Continuing Motion Hearing, continuing 44 MOTION to Dismiss: 8/12/2014 Motion Hearing is continued to 8/14/2014 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofrS, COURT STAFF) (Filed on 7/31/2014) (Entered: 07/31/2014)
92 CLERK'S NOTICE Continuing Motion Hearing, continuing 58 First MOTION to Dismiss Second Amended Complaint: 8/12/2014 10:00 AM Motion Hearing is continued to 8/14/2014 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 33 of 82

08/05/2014
08/06/2014 08/12/2014 08/12/2014 08/12/2014 08/12/2014 08/13/2014 08/14/2014
08/18/2014 08/18/2014 08/19/2014

Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 8/1/2014) (Entered: 08/01/2014)
93 MOTION for Leave to File Sur−reply and Declarations in Support Thereof in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey filed by Jesse Hernandez. (Attachments: # 1 Declaration Supplemental of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey, # 2 Declaration of Glenda Hunter in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey, # 3 Proposed Order Granting Plaintiffs' Motion for Leave to File Sur−reply and Declarations in Support Thereof in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey)(Bien, Michael) (Filed on 8/5/2014) (Entered: 08/05/2014)
94 RESPONSE (re 93 MOTION for Leave to File Sur−reply and Declarations in Support Thereof in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey ) Declaration of Susan K. Blitch filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 8/6/2014) (Entered: 08/06/2014)
95 MOTION to Continue Hearing on Class Certification Motion filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael R. Philippi, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Philippi, Michael) (Filed on 8/12/2014) (Entered: 08/12/2014)
96 Request to Appear Telephonically at its August 14, 2014 Motion to Dismiss (Attachments: # 1 Proposed Order, # 2 Certificate/Proof of Service)(Bertling, Peter) (Filed on 8/12/2014) Modified on 8/12/2014 (cv, COURT STAFF). (Entered: 08/12/2014)
97 Joinder re 95 MOTION to Continue Hearing on Class Certification Motion CFMG's Notice of Joinder and Non−Opposition to County's Motion to Continue Hearing and Briefing on Plaintiff's Class Certification Motion by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 8/12/2014) (Entered: 08/12/2014)
98 ORDER GRANTING LEAVE TO FILE SUR−REPLY by Magistrate Judge Paul Singh Grewal granting 93 Motion for Leave to File.(psglc3S, COURT STAFF) (Filed on 8/12/2014) (Entered: 08/12/2014)
99 ORDER GRANTING CFMG'S REQUEST TO MAKE A TELEPHONIC APPEARANCE AT THE AUGUST 14, 2014 MOTION TO DISMISS by Judge Paul S. Grewal, granting 96 : Counsel is instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. (ofr, COURT STAFF) (Filed on 8/13/2014) (Entered: 08/13/2014)
100 Minute Entry: Motion Hearing held on 8/14/2014 before Magistrate Judge Paul S. Grewal re 44 MOTION to Dismiss AND 58 MOTION to Dismiss: The court takes matters under submission; written order to be issued. 9/23/2014 10:00 AM Motion for Class Certification is continued to 10/28/2014 at 10:00 AM. Opposition due by 9/30/2014. Reply due by 10/21/2014. Parties to discuss trial schedule by 8/15/2014 and reach out to the court if unable to reach agreement. (Court Reporter: Lee−Anne Shortridge) (ofr, COURT STAFF) (Date Filed: 8/14/2014) (Entered: 08/14/2014)
101 STIPULATION WITH PROPOSED ORDER re: Trial and Pre−Trial Schedule filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 8/18/2014) (Entered: 08/18/2014)
102 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Lee−Anne Shortridge. (Grunfeld, Gay) (Filed on 8/18/2014) (Entered: 08/18/2014)
103 ORDER GRANTING STIPULATION AS AMENDED BY THE COURT by Magistrate Judge Paul Singh Grewal granting 101 .(psglc1S, COURT STAFF) (Filed on 8/19/2014) (Entered: 08/19/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 34 of 82

08/21/2014 08/22/2014
08/22/2014
08/25/2014 08/26/2014
08/26/2014 08/27/2014 08/27/2014 08/27/2014 09/02/2014 09/03/2014

104 CLERK'S NOTICE RESETTING SEPTEMBER 7, 2015 TRIAL: Due to a court holiday, 9/7/2015 trial is continued to 9/8/2015 at 9:30 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 8/21/2014) (Entered: 08/21/2014)
105 ***FILED IN ERROR − SEE DOC #106***Transcript of Proceedings held on 8−14−14, before Judge Paul S. Grewal. Court Reporter/Transcriber Lee−Anne Shortridge, Telephone number 408−287−4580 email: lee−anne_shortridge@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 102 Transcript Order ) Release of Transcript Restriction set for 11/20/2014. (Related documents(s) 102 ) (las, ) (Filed on 8/22/2014) Modified on 8/25/2014 (sp, COURT STAFF). (Entered: 08/22/2014)
106 Transcript of Proceedings held on 8−14−14, before Judge Paul S. Grewal. Court Reporter/Transcriber Lee−Anne Shortridge, Telephone number 408−287−4580 email: lee−anne_shortridge@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 102 Transcript Order ) Release of Transcript Restriction set for 11/20/2014. (Related documents(s) 102 ) (las, ) (Filed on 8/22/2014) (Entered: 08/22/2014)
107 MOTION for Leave to File Excess Pages filed by Jesse Hernandez. (Attachments: # 1 Stipulation & Proposed Order)(Grunfeld, Gay) (Filed on 8/25/2014) (Entered: 08/25/2014)
108 MOTION for Preliminary Injunction filed by Jesse Hernandez. Motion Hearing set for 9/30/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 9/9/2014. Replies due by 9/16/2014. (Attachments: # 1 Proposed Order, # 2 Memo of Pts & Auth, # 3 Declaration of Bradley Buell, # 4 Declaration of James Lewis, # 5 Declaration of Juan Sanchez, # 6 Supp Decl of Juan Sanchez, # 7 Declaration of Robyn Woods, # 8 Declaration of Robert Cohen)(Grunfeld, Gay) (Filed on 8/26/2014) (Entered: 08/26/2014)
109 Declaration of Eric Balaban in Support of 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Attachments: # 1 Exhibit A−J, # 2 Exhibit K−Z, # 3 Exhibit AA, part 1, # 4 Exhibit AA, part 2)(Related document(s) 108 ) (Grunfeld, Gay) (Filed on 8/26/2014) (Entered: 08/26/2014)
110 ORDER GRANTING 107 MOTION FOR LEAVE TO FILE EXCESS PAGES entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 08/27/2014)
111 MOTION to Continue Preliminary Injunction filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Susan K. Blitch, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Blitch, Susan) (Filed on 8/27/2014) (Entered: 08/27/2014)
112 STATEMENT of non−opposition to Defendants' and joinder 111 Motion (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 8/27/2014) Modified on 8/28/2014 (cv, COURT STAFF). (Entered: 08/27/2014)
113 OPPOSITION (re 111 MOTION to Continue Preliminary Injunction ) filed by Jesse Hernandez. (Attachments: # 1 Declaration of Michael Freedman # 2 Proposed Order (Freedman, Michael) (Filed on 9/2/2014) Modified on 9/3/2014 (cv, COURT STAFF). (Entered: 09/02/2014)
114 MOTION for Leave to File Second Supplemental Declaration of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey filed by Jesse Hernandez. (Attachments:

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 35 of 82

09/03/2014 09/18/2014 09/24/2014 09/24/2014
09/24/2014 09/25/2014 09/25/2014 09/25/2014 09/26/2014
09/26/2014 09/26/2014
09/29/2014

# 1 Declaration Second Supplemental of Michael Freedman # 2 Proposed Order (Freedman, Michael) (Filed on 9/3/2014) Modified on 9/3/2014 (cv, COURT STAFF). (Entered: 09/03/2014)
115 ORDER GRANTING IN−PART MOTION TO ENLARGE TIME by Magistrate Judge Paul Singh Grewal granting in part and denying in part 111 . (psglc1S, COURT STAFF) (Filed on 9/3/2014) (Entered: 09/03/2014)
116 ORDER GRANTING MOTION FOR LEAVE TO FILE by Magistrate Judge Paul Singh Grewal granting 114 . (psglc1S, COURT STAFF) (Filed on 9/18/2014) (Entered: 09/18/2014)
117 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Lee−Anne Shortridge. (Blitch, Susan) (Filed on 9/24/2014) (Entered: 09/24/2014)
118 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 9/26/2014 at 1:30 PM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Joint letter brief, not to exceed 5 pages, to be submitted no later than 9/25/2014 by 5:00 PM. Parties requesting to appear telephonically are instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 9/24/2014) (Entered: 09/24/2014)
119 NOTICE of Appearance by Sarah Pascal Alexander and Aaron J. Fischer (Alexander, Sarah) (Filed on 9/24/2014) (Entered: 09/24/2014)
120 Joint Discovery Letter Briefof All Parties filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/25/2014) (Entered: 09/25/2014)
121 Declaration of Michael Freedman in Support of 120 Joint Discovery Letter Briefof All Parties in support of Plaintiff's Position filed byJesse Hernandez. (Related document(s) 120 ) (Alexander, Sarah) (Filed on 9/25/2014) (Entered: 09/25/2014)
122 Declaration of Sarah P. Alexander in Support of 121 Declaration in Support, 120 Joint Discovery Letter Briefof All Parties in support of Plaintiffs' Position filed byJesse Hernandez. (Related document(s) 121 , 120 ) (Alexander, Sarah) (Filed on 9/25/2014) (Entered: 09/25/2014)
123 Minute Entry: Discovery Hearing (In Re: Docket No. 120 ) held on 9/26/2014 before Magistrate Judge Paul S. Grewal: Hearing held. Protective order amended as recited in court. Proposed protective order submitted in open court for the court's review. Parties may reach out to the court & file letter brief to address any discovery disputes. (Court Reporter: Summer Fisher) (ofr, COURT STAFF) (Date Filed: 9/26/2014) (Entered: 09/26/2014)
124 STIPULATION WITH PROPOSED ORDER Allowing the Filing of Oversized Briefs filed by County of Monterey, Monterey County Sheriff's Office. (Philippi, Michael) (Filed on 9/26/2014) (Entered: 09/26/2014)
125 MOTION for Leave to File Third Supplemental Declaration of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey filed by Jesse Hernandez. (Attachments: # 1 Declaration Third Supplemental of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey, # 2 Proposed Order Granting Plaintiffs' Motion for Leave to File Third Supplemental Declaration of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey)(Freedman, Michael) (Filed on 9/26/2014) (Entered: 09/26/2014)
126 OPPOSITION (re 125 MOTION for Leave to File Third Supplemental Declaration of Michael Freedman in Opposition to Defendants' Motion to Dismiss Plaintiffs Esquivel, Hobbs, Hunter, Key, Miller, Murphy, Nichols, Sarabi, and Yancey ) filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 9/29/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 09/29/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 36 of 82

09/29/2014 09/29/2014 09/30/2014 09/30/2014
09/30/2014
09/30/2014
09/30/2014 09/30/2014 09/30/2014 09/30/2014 09/30/2014 09/30/2014

127 STIPULATION AND ORDER ALLOWING THE FILING OF OVERSIZED BRIEFS by Judge Paul S. Grewal, granting 124 . (ofr, COURT STAFF) (Filed on 9/29/2014) (Entered: 09/29/2014)
128 ORDER DENYING DEFENDANTS' MOTIONS TO DISMISS by Judge Paul S. Grewal denying 44 and 75 ; denying 58 . (psglc1S, COURT STAFF) (Filed on 9/29/2014) (Entered: 09/29/2014)
129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed by California Forensic Medical Group. (Attachments: # 1 Declaration, # 2 Proposed Order, # 3 Declaration Unredacted Version of Declaration of J. Roof, M.D., # 4 Exhibit Exhibit A to Roof Decl.)(Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
130 EXHIBITS B re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed by California Forensic Medical Group. (Attachments: # 1 Exhibit unredacted version of exhibit C to Roof's Declaration, # 2 Exhibit unredacted version of exhibit D to Roof's Declaration, # 3 Exhibit Unredacted version of exhibit E to Roof's Declaration, # 4 Exhibit Unredacted version of Exhibit F to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified on 9/30/2014,(incorrect event selected.) (cvS, COURT STAFF). (Entered: 09/30/2014)
131 Administrative Motion to File Under Seal the Declaration of Peter G. Bertling, the declarations of Kathryn J. Wild, R.N., M.P.A., C.C.H.P. and Jason Roof, M.D., along with the attached exhibits, filed by California Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Exhibit B to Roof's Declaration, # 2 Exhibit Unredacted Version of Exhibit G to Roof's Declaration, # 3 Exhibit Unredacted Version of Exhibit H to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified text on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
132 Administrative Motion to File Under Seal the Declaration of Peter G. Bertling , the declarations of Kathryn J. Wild, R.N., M.P.A., C.C.H.P. and Jason Roof, M.D., along with the attached exhibits, filed by California Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Exhibit I, Part 1 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
133 OPPOSITION (re 48 MOTION to Certify Class filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Request for Judicial Notice, # 2 Objections to Evidence)(Blitch, Susan) (Filed on 9/30/2014) Modified text on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
134 Declaration of Cmdr. James Bass in support of 133 OPPOSITION filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) Modified text on 9/30/2014 (incorrect event selected.) (cv, COURT STAFF). (Entered: 09/30/2014)
135 Declaration of Michael R. Philippin re 126 filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) Modified on 9/30/2014 (cvS, COURT STAFF). (Entered: 09/30/2014)
136 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Exhibit I part 2 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
137 Exhibits A−F to Philippi Declaration 133 OPPOSITION filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) Modified on 9/30/2014,(to conform with document posted by counsel.) (cv, COURT STAFF). (Entered: 09/30/2014)
138 Exhibits G−M to Philippi Declaration in support of [ 133 OPPOSITION filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)

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139 Exhibits N−X to Philippi Declaration filed bym County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) Modified text on 9/30/2014 , (Entered: 09/30/2014)
140 Declaration of Susan K. Blitch in support of 133 OPPOSITION filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Exhibits A−O to Blitch Dec)(Blitch, Susan) (Filed on 9/30/2014) Modified on 9/30/2014(incorrect event selected.) (cv, COURT STAFF). (Entered: 09/30/2014)
141 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion ) Exhibits P−X to Blitch Declaration filed byCounty of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) (Entered: 09/30/2014)
142 Declaration of Irven L. Grant in support of 133 filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Exhibits 1−18 to Grant Declaration)(Blitch, Susan) (Filed on 9/30/2014) Modified on 9/30/2014(incorrect event selected.) (cv, COURT STAFF). (Entered: 09/30/2014)
143 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Unredacted version of Exhibit I Part 3 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
144 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion ) Certificate of Service filed byCounty of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 9/30/2014) (Entered: 09/30/2014)
145 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit I part 4 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
146 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted Version of Exhibit I Part 5 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex I to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
147 Administrative Motion to File Under Seal the Declaration of Peter G. Bertling , the declarations of Kathryn J. Wild, R.N., M.P.A., C.C.H.P. and Jason Roof, M.D., along with the attached exhibits, filed by California Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex. I, part 6 to Dr. Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
148 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Ex. I, Part 7 to Dr. Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
149 Administrative Motion to File Under Seal the Declaration of Peter G. Bertling , the declarations of Kathryn J. Wild, R.N., M.P.A., C.C.H.P. and Jason Roof, M.D., along with the attached exhibits, Exhibit J, Part 1 to Decl. of Roof, M.D. filed by California Forensic Medical Group. (Attachments: # 1 Unredacted Version of Exhibit J, Part I to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified on 9/30/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
150 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex. J, Part 2 to Roof's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
151 Administrative Motion to File Under Seal the Declaration of Peter G. Bertling , the declarations of Kathryn J. Wild, R.N., M.P.A., C.C.H.P. and Jason Roof, M.D., along

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with the attached exhibits, filed by California Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version Ex L, Part 1 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) Modified on 9/30/2014,(to conform with document posted by counsel.) (cv, COURT STAFF). (Entered: 09/30/2014)
152 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex L Part 2 to Roof's Dec)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
153 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex K to Roof's Dec)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
154 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted Version of Ex K Part 2 to Dr. Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Ex K Part 2 to Roof's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
155 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex K, Part 3 to Dr. Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
156 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex L, Part 3 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
157 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex M to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
158 EXHIBITS re 131 Administrative Motion to File Under Seal filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit N part 1 to Roof's Decl.)(Related document(s) 131 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
159 EXHIBITS re 147 Administrative Motion to File Under Seal filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Unredacted version of Exhibit N part 2 to Roof's Decl.)(Related document(s) 147 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
160 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit N part 3 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
161 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit N part 3 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
162 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O part 1 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)

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163 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O part 2 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
164 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O part 2 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
165 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O part 3 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
166 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit P part 1 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
167 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit P part 2 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
168 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit P part 3 to Roof's Decl.)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
169 OPPOSITION (re 48 MOTION to Certify Class and Notice of Motion filed by California Forensic Medical Group. (Attachments: # 1 Declaration of Daniel Hustedt, # 2 Declaration of Taylor Fithian, # 3 Exhibit A to Declaration of Taylor Fithian, # 4 Exhibit B to Declaration of Taylor Fithian)(Bertling, Peter) (Filed on 9/30/2014) Modified on 10/1/2014 (cv, COURT STAFF). (Entered: 09/30/2014)
170 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion ) filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration of Daniel Hustedt, # 2 Exhibit A to Declaration of Daniel Hustedt, # 3 Exhibit B to Declaration of Daniel Hustedt)(Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
171 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit O, Part 2 to Decl of Roof filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O to the Declaration of Jason Roof)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
172 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Version of Ex O Part 2 to Roof's Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
173 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Exhibit O, part 3 to Roof's decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
174 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex P, #1 to Roof's

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Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
175 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex P, #2 to Roof's Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
176 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted version of Ex P, #1 to Roof's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex P, #3 to Roof's Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
177 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted version of Ex P, #4 to Roof's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex P, #4 to Roof's Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
178 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted version of Ex P, #5 to Roof's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted version of Ex P, #5 to Roof's Decl)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
179 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion ) Declaration of Peter G. Berlting and Exhibits in Support of Opposition to Plaintiffs' Motion filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration of Peter G. Bertling in Support of Opposition, # 2 Exhibit A & B to Declaration of Peter G. Bertling in Support of Opposition, # 3 Exhibit C to Declaration of Peter G. Berlting in Support of Opposition, # 4 Exhibit D to Declaration of Peter G. Berlting in Support of Opposition, # 5 Exhibit E to Declaration of Peter G. Berlting in Support of Opposition, # 6 Exhibit F to Declaration of Peter G. Berlting in Support of Opposition, # 7 Exhibit G to Declaration of Peter G. Berlting in Support of Opposition, # 8 Exhibit H to Declaration of Peter G. Berlting in Support of Opposition, # 9 Exhibit I to Declaration of Peter G. Berlting in Support of Opposition, # 10 Exhibit J to Declaration of Peter G. Berlting in Support of Opposition, # 11 Exhibit K to Declaration of Peter G. Berlting in Support of Opposition, # 12 Exhibit L to Declaration of Peter G. Berlting in Support of Opposition, # 13 Exhibit M to Declaration of Peter G. Berlting in Support of Opposition, # 14 Exhibit N to Declaration of Peter G. Berlting in Support of Opposition, # 15 Exhibit O to Declaration of Peter G. Berlting in Support of Opposition, # 16 Exhibit P to Declaration of Peter G. Berlting in Support of Opposition)(Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
180 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration of Wild in Support of Motion to File Under Seal)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
181 First MOTION to Strike Dr. Puisis' Report filed by California Forensic Medical Group. Motion Hearing set for 10/28/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 10/14/2014. Replies due by 10/21/2014. (Attachments: # 1 Memo of Points & Authorities)(Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
182 Notice of Motion to strike the report of M. Puisis, D.O. filed by California Forensic Medical Group. (Attachments: # 1 Declaration Peter G. Bertling # 2 Exhibit A to Declaration of Peter G. Bertling # 3 Exhibit B to Declaration of Peter G. Bertling (4) Exhibit C to Declaration of Peter G. Bertling # 5 Exhibit D to Declaration of Peter G. Bertling # 6 Exhibit E to Declaration of Peter G. Bertling (Bertling, Peter) (Filed on 9/30/2014) Modified text on 10/1/2014,(to conform with document posted by counsel.) (cv, COURT STAFF). (Entered: 09/30/2014)

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183 EXHIBITS re 180 Exhibits to an Administrative Motion to File Under Seal, to Declaration of Kathryn J. Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit C Part 1 to Declaration of Wild)(Related document(s) 180 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
184 Declaration of Peter G. Bertling in Support of 181 First MOTION to Strike Dr. Puisis' Report Exhibits F−H filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex F in Support of Decl of Peter G. Bertling in Support of CFMG's Motion to Strike, # 2 Exhibit Ex G in Support of Decl of Peter G. Bertling in Support of CFMG's Motion to Strike, # 3 Exhibit Ex H in Support of Decl of Peter G. Bertling in Support of CFMG's Motion to Strike)(Related document(s) 181 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
185 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex O − Part 3 to Decl of Jason Roof, M.D. filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex O − Part 3 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
186 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling, 131 Administrative Motion to File Under Seal Exhibit C part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit C Part 1 to to Declaration of Wild)(Related document(s) 129 , 131 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
187 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit C Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit C Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
188 AFFIDAVIT in Support re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−1 to Declaration of Jason Roof filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−1 to Roof's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
189 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit C part 3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit C Part 3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
190 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit C Part 4 filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit C Part 4 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
191 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−4 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−4 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
192 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−5 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−5 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
193 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit D Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit D part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)

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194 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−6 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−6 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
195 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−7 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−7 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
196 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit D Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit D Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
197 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−8 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−8 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
198 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−9 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−9 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
199 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex P−10 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex P−10 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
200 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit E Part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
201 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−1 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex Q−1 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
202 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit E Part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
203 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−2 to Roof's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex Q−2 to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
204 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit E Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
205 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex R and S to Roof's Declaration filed

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byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex R to Roof's Declaration, # 2 Exhibit Ex S to Roof's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 09/30/2014)
206 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E Part 3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit E Part 3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
207 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
208 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
209 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
210 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 4 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 4 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
211 EXHIBITS re 131 Administrative Motion to File Under Seal Exhibit F Part 6 filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 5 to Declaration of Wild)(Related document(s) 131 ) (Saunders, Jemma) (Filed on 9/30/2014) (Entered: 09/30/2014)
213 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex G−1 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex G−1 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 9/30/2014) (Entered: 10/01/2014)
212 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 6 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 6 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
214 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 7 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 7 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
215 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex G−2 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex G−2 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
216 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit F Part 8 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit F Part 8 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on

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10/1/2014) (Entered: 10/01/2014)
217 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex G−4 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex G−3 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
218 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex G−4 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex G−4 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
219 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex I to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex I to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
220 EXHIBITS re 131 Administrative Motion to File Under Seal Exhibit H Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit H Part 1 to Declaration of Wild)(Related document(s) 131 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
221 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex K−1 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex K−1 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
222 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex K−2 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex K−2 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
223 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex K−3 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex K−3 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
224 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit H Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit H Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
225 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex K−4 to Wild's Decl filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex K−4 to Wild's Decl)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
226 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit H Part 3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit H Part 3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
227 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex M−1−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex M−1−1 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
228 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit J Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit J Part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)

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229 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex M−1−2 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex M−1−2 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
230 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit J Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit J Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
231 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit J Part 3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit J Part 3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
232 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex M−1−3 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex M−1−3 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
233 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit J Part 4 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit J Part 4 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
234 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex M−2−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex M−2−1 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
235 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit L Part 1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit L Part 1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
236 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex M−2−2 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex M−2−2 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
237 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit L Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit L Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
238 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex O Part 1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex O Part 1 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
239 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit L Part 2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit L Part 2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
240 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex O Part 2 to Wild's Declaration filed

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byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex O Part 2 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
241 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit N to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit N to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
242 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex O Part 3 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex O Part 3 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
243 Request for Judicial Notice re 181 First MOTION to Strike Dr. Puisis' Report filed byCalifornia Forensic Medical Group. (Related document(s) 181 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
244 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
245 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
246 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
247 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling P−4 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−4 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
248 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−6 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−6 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
249 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−7 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−7 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
250 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−8 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit P−8 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
251 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit R−1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit R−1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)

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252 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit R−2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit R−2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
253 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit R−3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit R−3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
254 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Ex Q−1 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
255 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
256 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−2 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex Q−2 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
257 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−3 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex Q−3 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
258 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
259 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex Q−4 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex Q−4 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
260 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex S−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex S−1 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
261 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Ex S−2 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex S−2 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
262 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−3 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−3 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
263 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit S−3 to Wild Declaration filed

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byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Ex S−3 to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
264 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−4 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−4 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
265 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit S−4 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit S−4 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
266 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−6 saundersjp12 filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−6 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
267 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−1 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−1 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
268 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−7 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−7 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
269 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−2 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−2 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
270 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−3 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−3 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
271 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−8 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−8 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
272 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−4 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−4 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
273 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−9 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−9 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
274 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−5 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−5 to

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K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
275 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−10 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−10 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
276 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−11 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−11 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
277 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−6 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−6 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
278 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−12 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit V−12 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
279 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−7 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−7 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
280 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit X to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit X to to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
281 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−8 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit U−8 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
282 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit Z−1 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Z−1 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
283 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−9 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−9 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
284 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit Z−2 to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Z−2 to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
285 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit U−10 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit U−10 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on

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10/1/2014) (Entered: 10/01/2014)
286 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit BB to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit BB to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
287 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit DD to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit DD to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
288 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit FF to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit FF to to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
289 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit W to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit W to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
290 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit HH to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit HH to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
291 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit y to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit y to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
292 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit JJ to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit JJ to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
293 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit AA to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Exhibit AA to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
294 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit KK to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit KK to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
295 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit II to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit II to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
296 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit CC to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit CC to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)

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297 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit EE to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit EE to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
298 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit GG to Declaration of Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit GG to Declaration of Wild)(Related document(s) 129 ) (Saunders, Jemma) (Filed on 10/1/2014) (Entered: 10/01/2014)
299 OPPOSITION (re 48 MOTION to Certify Class and Notice of Motion ) Certificate of Service filed by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 10/1/2014) Modified on 10/1/2014 (cv, COURT STAFF). (Entered: 10/01/2014)
300 EXHIBITS re 181 First MOTION to Strike Dr. Puisis' Report Notice of Errata re Exhibits to Declaration of Peter Bertling re Motion to Strike filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Notice of Errata re Exhibits E, F, G and H to Declaration of Bertling in Support of Motion to Strike Puisis' Report, # 2 Exhibit Corrected Exhibit E to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report, # 3 Exhibit Corrected Exhibit F to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report, # 4 Exhibit Corrected Exhibit G to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report)(Related document(s) 181 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
301 Declaration of Peter Bertling in Support of 181 First MOTION to Strike Dr. Puisis' Report Notice of Errata re Exhibit H−1 filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Notice of Errata re Exhibits to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report, # 2 Exhibit Corrected Exhibit H Part 1 to Declaration of Bertling in Support of Motion to Strike)(Related document(s) 181 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
302 Declaration in Support of 181 First MOTION to Strike Dr. Puisis' Report Notice of Errata re Exhibits; Corrected Ex H to Declaration of Peter G. Bertling filed in Support of Motion to Strike Puisis' Report filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Notice of Errata re Exhibits to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report, # 2 Exhibit Cprrected Exhibit H−2 to Declaration of Peter Bertling in Support of Motion to Strike Puisis' Report, # 3 Certificate/Proof of Service Re Notice of Errata)(Related document(s) 181 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
303 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling −Certificate of Service filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service Cert of Service to Administrative Motion to File Documents Under Seal)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/1/2014) (Entered: 10/01/2014)
304 STIPULATION WITH PROPOSED ORDER re 123 Discovery Hearing filed by Jesse Hernandez. (Grunfeld, Gay) (Filed on 10/1/2014) Modified on 10/2/2014 (cv, COURT STAFF). (Entered: 10/01/2014)
305 STIPULATION AND PROTECTIVE ORDER by Judge Paul S. Grewal, granting 304 . (ofr, COURT STAFF) (Filed on 10/1/2014) (Entered: 10/02/2014)
306 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling re the Declaration of Kathryn Wild, Exhibit A filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata Notice of Errata re Exhibits to K. Wild's Declaration, # 2 Exhibit A to Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
307 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted Version of Exhibit B−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted Exhibit B−1 of Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)

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308 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted Exhibit B−2 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Unredacted Exhibit B−2 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
309 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit B−3 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit B−3 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
310 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E−3 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit E−3 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
311 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit E−4 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit E−4 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
312 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Unredacted version of Exhibit I to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit I to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
313 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit L−3 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit L−3 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
314 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit P−5 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit P−5 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
315 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Exhibit V−5 to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Exhibit Unredacted version of Exhibit V−5 to K. Wild's Declaration)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
316 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Certificate of Service to Notice of Errata to Administrative Motion Exhibits filed byCalifornia Forensic Medical Group. (Attachments: # 1 Errata, # 2 Certificate/Proof of Service)(Related document(s) 129 ) (Bertling, Peter) (Filed on 10/2/2014) (Entered: 10/02/2014)
317 ***FILED IN ERROR − SEE DOC 318 ***TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Lee−Anne Shortridge. (Alexander, Sarah) (Filed on 10/6/2014) Modified on 10/7/2014 (sp, COURT STAFF). (Entered: 10/06/2014)
318 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Summer Fisher. (Alexander, Sarah) (Filed on 10/6/2014) (Entered: 10/06/2014)
319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction filed by California Forensic Medical Group. (Attachments: # 1 Declaration Peter G. Bertling, # 2 Proposed Order, # 3 Declaration K. Wild)(Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
320 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction A to Wild's Declaration filed

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byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit A to Wild's Declaration)(Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
321 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction B−1 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
322 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Exhibit B−2 to K Wild's Declaration filed byCalifornia Forensic Medical Group. (Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
323 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Ex B−3 to Wild's Declaration filed byCalifornia Forensic Medical Group. (Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
324 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Exhibits C, D, and E to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit D to Wild's Declaration, # 2 Exhibit E to Wild's Declaration)(Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
325 OPPOSITION (re 108 MOTION for Preliminary Injunction ) filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Susan K. Blitch, # 2 Declaration Irven L. Grant, # 3 Declaration Michael R. Philippi, # 4 Certificate/Proof of Service)(Blitch, Susan) (Filed on 10/7/2014) Modified on 10/8/2014 (cvS, COURT STAFF). (Entered: 10/07/2014)
326 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Exhibits, F, G, H, I, and J to K. Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit G to Wild's Declaration, # 2 Exhibit H to Wild's Declaration, # 3 Exhibit I to Wild's Declaration, # 4 Exhibit J to Wild's Declaration)(Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
327 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Exhibits K, L, M, and N to Wild's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit L to Wild's Declaration, # 2 Exhibit M to Wild's Declaration, # 3 Exhibit N to Wild's Declaration)(Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
328 EXHIBITS re 319 First Administrative Motion to File Under Seal Documents Re Opposition to Motion for Preliminary Injunction Unredacted Declaration of Goldman with Unredacted Exhibit C to Goldman's Declaration filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit Unredacted Exhibit C to Goldman Declaration)(Related document(s) 319 ) (Bertling, Peter) (Filed on 10/7/2014) (Entered: 10/07/2014)
329 MEMORANDUM in support of Opposition to 108 Motion for Preliminary Injunction filed by California Forensic Medical Group. (Attachments: # 1 Declaration Redacted Declaration of Golman)(Bertling, Peter) (Filed on 10/7/2014) Modified on 10/8/2014,(incorrect event selected.) (cvS, COURT STAFF). (Entered: 10/07/2014)
330 Exhibit A−F to Goldman's Declaration 108 filed by California Forensic Medical Group. (Attachments: # 1 Exhibit B to Goldman's Declaration, # 2 Exhibit Redacted C to Goldman's Declaration, # 3 Exhibit D to Goldman's Declaration, # 4 Exhibit E to Goldman's Declaration, # 5 Exhibit F to Goldman's Declaration)(Bertling, Peter) (Filed on 10/7/2014) Modified on 10/8/2014,(incorrect event selected.) (cvS, COURT STAFF). (Entered: 10/07/2014)
331 <Declaration of Fithian in support of Opposition filed byCalifornia Forensic Medical Group. re: 108 (Attachments: # 1 Exhibit A to Fithian's Declaration)(Bertling, Peter) (Filed on 10/7/2014) Modified on 10/8/2014,(incorrect event selected.) (cvS, COURT

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STAFF). (Entered: 10/07/2014)
332 Exhibit B−K to Fithian's Declaration in support of Opposition filed by California Forensic Medical Group. 108 (Attachments: # 1 Exhibit C to Fithian Declaration, # 2 Exhibit D to Fithian Declaration, # 3 Exhibit E to Fithian Declaration, # 4 Exhibit F to Fithian Declaration, # 5 Exhibit G to Fithian Declaration, # 6 Exhibit H to Fithian Declaration, # 7 Exhibit I to Fithian Declaration, # 8 Exhibit J to Fithian Declaration, # 9 Exhibit Redacted Exhibit K to Fithian Declaration)(Saunders, Jemma) (Filed on 10/7/2014) Modified text on 10/8/2014 ,(incorrect event selected.) (cvS, COURT STAFF). (Entered: 10/07/2014)
333 Declaration in Support of Opposition with exhibits A−C related to 108 filed by California Forensic Medical Group. (Attachments: # 1 Exhibit A to Bertling's Declaration, # 2 Exhibit B to Bertling's Declaration, # 3 Exhibit C to Bertling's Declaration)(Bertling, Peter) (Filed on 10/7/2014) Modified on 10/8/2014(incorrect event selected.) (cvS, COURT STAFF). (Entered: 10/07/2014)
334 Certificate of Service filed by California Forensic Medical Group. (Bertling, Peter) (Filed on 10/8/2014) Modified on 10/8/2014,(incorrect event selected.) (cv, COURT STAFF). (Entered: 10/08/2014)
335 MEMORANDUM in support of (re 108 MOTION for Preliminary Injunction ) Certificate of Service filed by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service Regarding Opposition to Plaintiffs' Motion for Preliminary Injunction)(Bertling, Peter) (Filed on 10/8/2014) Modified on 10/8/2014,(incorrect event selected.) (cv, COURT STAFF). (Entered: 10/08/2014)
336 Letter from Corizon Health, Inc., dated 9/30/14. (cv, COURT STAFF) (Filed on 10/8/2014) (Entered: 10/08/2014)
337 ORDER GRANTING 125 MOTION FOR LEAVE TO FILE entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 10/08/2014)
338 ORDER GRANTING 129 ADMINISTRATIVE MOTION TO FILE UNDER SEAL entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 10/08/2014)
339 Joinder in CFMG's Opposition to 108 Motion for Preliminary Injunction filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Philippi, Michael) (Filed on 10/8/2014) Modified on 10/8/2014 (cv, COURT STAFF). (Entered: 10/08/2014)
340 First MOTION for Leave to File Excess Pages for Reply Memorandum in Support of Motion for Preliminary Injunction filed by Jesse Hernandez. (Attachments: # 1 Proposed Order and Stipulation)(Grunfeld, Gay) (Filed on 10/8/2014) (Entered: 10/08/2014)
341 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Summer Fisher. (Blitch, Susan) (Filed on 10/9/2014) (Entered: 10/09/2014)
342 STIPULATION AND ORDER ALLOWING THE FILING OF OVERSIZED BRIEF by Judge Paul S. Grewal, granting 340 . (ofr, COURT STAFF) (Filed on 10/9/2014) (Entered: 10/09/2014)
343 NOTICE of Appearance by Paul David Singer for Defendant California Forensic Medical Group (Attachments: # 1 Certificate/Proof of Service)(Singer, Paul) (Filed on 10/9/2014) (Entered: 10/09/2014)
344 EXHIBITS re 129 First Administrative Motion to File Under Seal the Documents Listed in the Declaration of Peter G. Bertling Notice of Errata to correct missing pages 201−204 of Declaration of K. Wild filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration UNREDACTED DECLARATION OF WILD, R.N., IN SUPPORT OF CFMG'S OPPOSITION TO PLAINTIFFS' MOTION FOR CLASS CERTIFICATION, # 2 Certificate/Proof of Service)(Related document(s) 129 ) (Singer, Paul) (Filed on 10/9/2014) (Entered: 10/09/2014)

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345 Transcript of Proceedings held on 09/26/14, before Judge Paul S. Grewal. Court Reporter/Transcriber Summer Fisher, Telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 318 Transcript Order ) Release of Transcript Restriction set for 1/8/2015. (Related documents(s) 318 ) (Fisher, Summer) (Filed on 10/10/2014) (Entered: 10/10/2014)
346 ORDER GRANTING 319 ADMINISTRATIVE MOTION TO FILE UNDER SEAL entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 10/14/2014)
347 ANSWER to Amended Complaint byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Philippi, Michael) (Filed on 10/14/2014) (Entered: 10/14/2014)
348 RESPONSE (re 181 First MOTION to Strike Dr. Puisis' Report ) filed byJesse Hernandez. (Attachments: # 1 Declaration of Michael W. Bien, # 2 Exhibit A−F to Declaration of Michael W. Bien, # 3 Exhibit G to Declaration of Michael W. Bien, # 4 Exhibit o Declaration of Michael W. Bien, # 5 Proposed Order Denying Defendants Motion to Strike)(Bien, Michael) (Filed on 10/14/2014) (Entered: 10/14/2014)
349 Declaration of Gay Crosthwait Grunfeld in Support of 348 Opposition/Response to Motion, to Strike Report of Dr. Puisis filed byJesse Hernandez. (Attachments: # 1 Exhibit A−H to Declaration of Gay C. Grunfeld, # 2 Exhibit I−R to Declaration of Gay C. Grunfeld)(Related document(s) 348 ) (Grunfeld, Gay) (Filed on 10/14/2014) (Entered: 10/14/2014)
350 CLERK'S NOTICE Continuing Motions, continuing 48 MOTION to Certify Class and 181 First MOTION to Strike Dr. Puisis' Report: 10/28/2014 Motions are continued to 10/29/2014 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 10/15/2014) (Entered: 10/15/2014)
351 ANSWER to Amended Complaint byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 10/15/2014) (Entered: 10/15/2014)
352 CLERK'S NOTICE Re−scheduling Motions, rescheduling 48 MOTION to Certify Class, 108 MOTION for Preliminary Injunction and 181 First MOTION to Strike Dr. Puisis' Report. Motions set for 10/29/2014 at 1:00 PM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 10/15/2014) (Entered: 10/15/2014)
353 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 10/29/2014 at 1:00 PM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 10/16/2014) (Entered: 10/16/2014)
354 RESPONSE (re 181 First MOTION to Strike Dr. Puisis' Report ) Reply Brief in Support of Motion to Strike Dr. Puisis' Report filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service Reply in support of Motion to Strike Dr. Puisis' report)(Bertling, Peter) (Filed on 10/21/2014) (Entered: 10/21/2014)
355 REPLY (re 48 MOTION to Certify Class and Notice of Motion ) in Support of Plaintiffs' Motion for Class Certification filed byJesse Hernandez. (Attachments: # 1 Proposed Order Revised Proposed Order Granting Plaintiffs' Motion for Class Certification and Plaintiffs' Request for Judicial Notice)(Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 56 of 82

10/21/2014 10/21/2014 10/21/2014
10/21/2014 10/21/2014 10/21/2014 10/22/2014 10/23/2014 10/23/2014
10/24/2014 10/24/2014 10/24/2014 10/24/2014

356 Declaration of Pablo Stewart in Support of 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Related document(s) 48 , 108 ) (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
357 Declaration of James Egar in Support of 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Related document(s) 48 , 108 ) (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
358 Declaration of Gay Crosthwait Grunfeld in Support of 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Attachments: # 1 Exhibit Exhibits A−W to Reply Declaration of Gay Crosthwait Grunfeld in Support of Plaintiffs' Motions for Class Certification and for Preliminary Injunction, # 2 Exhibit Exhibits X−LL to Reply Declaration of Gay Crosthwait Grunfeld in Support of Plaintiffs' Motions for Class Certification and for Preliminary Injunction, # 3 Exhibit Exhibits MM−RR to Reply Declaration of Gay Crosthwait Grunfeld in Support of Plaintiffs' Motions for Class Certification and for Preliminary Injunction, # 4 Exhibit Exhibits SS−WW to Reply Declaration of Gay Crosthwait Grunfeld in Support of Plaintiffs' Motions for Class Certification and for Preliminary Injunction)(Related document(s) 48 , 108 ) (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
359 Declaration of Sarah P. Alexander in Support of 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Related document(s) 48 , 108 ) (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
360 Declaration of Robert L. Cohen, M.D. in Support of 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction filed byJesse Hernandez. (Related document(s) 48 , 108 ) (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
361 REPLY (re 108 MOTION for Preliminary Injunction ) filed byJesse Hernandez. (Grunfeld, Gay) (Filed on 10/21/2014) (Entered: 10/21/2014)
362 MOTION to Continue Hearings on Class Certification and Preliminary Injunction filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael R. Philippi, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Philippi, Michael) (Filed on 10/22/2014) (Entered: 10/22/2014)
363 RESPONSE (re 362 MOTION to Continue Hearings on Class Certification and Preliminary Injunction ) Joinder and Non−Opposition filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 10/23/2014) (Entered: 10/23/2014)
364 CLERK'S NOTICE RE RESPONSE DEADLINE TO DEFENDANTS' MOTION TO CONTINUE CLASS CERTIFICATION & PRELIMINARY INJUNCTION HEARING: The court sets deadline for Plaintiffs to file response to Defendants' Motion to Continue Class Certification & Preliminary Injunction Hearing (In Re: Docket No. 362 ). Plaintiff to file response no later than 10/24/2014 by 3:00 p.m. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 10/23/2014) (Entered: 10/23/2014)
365 RESPONSE (re 362 MOTION to Continue Hearings on Class Certification and Preliminary Injunction ) filed byJesse Hernandez. (Grunfeld, Gay) (Filed on 10/24/2014) (Entered: 10/24/2014)
366 ORDER RE: MOTIONS TO SEAL by Judge Paul S. Grewal granting−in−part and denying−in−part 131 ; granting 132 ; granting 147 ; granting 149 . (psglc1S, COURT STAFF) (Filed on 10/24/2014) (Entered: 10/24/2014)
367 ORDER DENYING MOTION TO CONTINUE AND GRANTING LEAVE TO FILE A SUR−REPLY by Magistrate Judge Paul Singh Grewal granting−in−part and denying−in−part 362 . (psglc1S, COURT STAFF) (Filed on 10/24/2014) (Entered: 10/24/2014)
368 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction ) Objections to Reply Evidence filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration, # 2 Certificate/Proof

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 57 of 82

10/28/2014 10/28/2014 10/29/2014 10/30/2014 10/30/2014 10/30/2014 10/31/2014
11/04/2014
11/04/2014
11/07/2014

of Service)(Blitch, Susan) (Filed on 10/24/2014) (Entered: 10/24/2014)
369 RESPONSE (re 48 MOTION to Certify Class and Notice of Motion, 108 MOTION for Preliminary Injunction ) Sur−Reply filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael R. Philippi, # 2 Certificate/Proof of Service)(Philippi, Michael) (Filed on 10/28/2014) (Entered: 10/28/2014)
370 Letter Brief re QA Minutes filed byJesse Hernandez. (Attachments: # 1 Declaration of Sarah P. Alexander in Support of Plaintiffs' Position, # 2 Exhibit A−G to Alexander Declaration, # 3 Exhibit H part 1 to Alexander Declaration, # 4 Exhibit H part 2 to Alexander Declaration)(Alexander, Sarah) (Filed on 10/28/2014) (Entered: 10/28/2014)
371 Minute Entry: Motion Hearing held on 10/29/2014 before Magistrate Judge Paul S. Grewal re 48 MOTION to Certify Class, 108 MOTION for Preliminary Injunction, 181 First MOTION to Strike Dr. Puisis' Report and 370 Re: Quality Assurance Minutes. The court takes matters under submission; written order to be issued. (Court Reporter: Summer Fisher) (ofr, COURT STAFF) (Date Filed: 10/29/2014) (Entered: 10/29/2014)
372 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Summer Fisher. (Alexander, Sarah) (Filed on 10/30/2014) (Entered: 10/30/2014)
373 TRANSCRIPT ORDER by California Forensic Medical Group for Court Reporter Summer Fisher. (Bertling, Peter) (Filed on 10/30/2014) (Entered: 10/30/2014)
374 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Summer Fisher. (Blitch, Susan) (Filed on 10/30/2014) (Entered: 10/30/2014)
375 Transcript of Proceedings held on 10/29/14, before Judge Paul S. Grewal. Court Reporter/Transcriber Summer Fisher, Telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 372 Transcript Order ) Release of Transcript Restriction set for 1/29/2015. (Related documents(s) 372 ) (Fisher, Summer) (Filed on 10/31/2014) (Entered: 10/31/2014)
376 MOTION to Strike 347 Answer to Amended Complaint filed by Jesse Hernandez. Motion Hearing set for 12/9/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 11/18/2014. Replies due by 11/25/2014. (Attachments: # 1 Declaration of Gay Crosthwait Grunfeld In Support of Plaintiffs' Motion To Strike Affirmative Defenses And Jury Trial Demand In Defendants Monterey County and Monterey County Sheriff's Office's Answer, # 2 Proposed Order)(Swearingen, Van) (Filed on 11/4/2014) (Entered: 11/04/2014)
377 MOTION to Strike 351 Answer to Amended Complaint filed by Jesse Hernandez. Motion Hearing set for 12/9/2014 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 11/18/2014. Replies due by 11/25/2014. (Attachments: # 1 Declaration of Gay Crosthwait Grunfeld In Support of Plaintiffs' Motion To Strike Affirmative Defenses And Jury Trial Demand In Defendant California Forensic Medical Group's Answer, # 2 Proposed Order)(Swearingen, Van) (Filed on 11/4/2014) (Entered: 11/04/2014)
378 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 11/12/2014 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Each side to submit a 3−page letter brief no later than 11/10/2014 by 5:00 p.m. Parties requesting to appear telephonically are instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 11/7/2014) (Entered: 11/07/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 58 of 82

11/10/2014 11/10/2014 11/10/2014 11/10/2014 11/11/2014 11/12/2014 11/12/2014 11/12/2014 11/13/2014 11/17/2014 11/18/2014 11/19/2014
12/08/2014

379 *** POSTED IN ERROR *** please see 381 Letter Brief filed by California Forensic Medical Group. (Attachments: # 1 Declaration of Peter G. Bertling, # 2 Exhibit A to Declaration of Peter G. Bertling, # 3 Exhibit B to Declaration of Peter G. Bertling)(Related document(s) 378 ) (Bertling, Peter) (Filed on 11/10/2014) Modified on 11/10/2014 (cv, COURT STAFF). (Entered: 11/10/2014)
380 Letter Brief Regarding Plaintiff's Motion to Compel Documents filed byJesse Hernandez. (Attachments: # 1 Declaration of Sarah P. Alexander in Support of Plaintiffs' Motion to Compel and Exhibits A−R, # 2 Proposed Order Granting Plaintiffs' Motion to Compel)(Freedman, Michael) (Filed on 11/10/2014) (Entered: 11/10/2014)
381 Letter Brief Correction of Docket # 379 filed by California Forensic Medical Group. (Related document(s) 379 ) (Bertling, Peter) (Filed on 11/10/2014) Modified on 11/10/2014 (cv, COURT STAFF). (Entered: 11/10/2014)
382 Declaration of Jemma Parker Saunders in Support of 381 Letter Brief filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit A to Declaration of Jemma Parker Saunders, # 2 Certificate/Proof of Service)(Related document(s) 381 ) (Bertling, Peter) (Filed on 11/10/2014) (Entered: 11/10/2014)
383 STIPULATION WITH PROPOSED ORDER re 377 MOTION to Strike 351 Answer to Amended Complaint Stipulation and [Proposed] Order to Allow Defendants to File Amended Answers to Plaintiffs Second Amended Complaint filed by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 11/11/2014) (Entered: 11/11/2014)
384 ORDER GRANTING STIPULATION AS AMENDED AND DENYING MOTIONS TO STRIKE by Judge Paul S. Grewal denying 376 ; denying 377 ; granting as amended 383 . (psglc1S, COURT STAFF) (Filed on 11/12/2014) (Entered: 11/12/2014)
385 Minute Entry: Motion to Compel (In Re: Docket No. 380 ) held on 11/12/2014. The court issues ruling from the bench. The court's transcript will serve as the order. (Court Reporter: Summer Fisher) (ofr, COURT STAFF) (Date Filed: 11/12/2014) (Entered: 11/12/2014)
386 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Summer Fisher. (Freedman, Michael) (Filed on 11/12/2014) (Entered: 11/12/2014)
387 TRANSCRIPT ORDER by California Forensic Medical Group for Court Reporter Summer Fisher. (Saunders, Jemma) (Filed on 11/13/2014) (Entered: 11/13/2014)
388 AMENDED ANSWER to Second 41 Amended Complaint byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Philippi, Michael) (Filed on 11/17/2014) (Entered: 11/17/2014)
389 AMENDED ANSWER to Second 41 Amended Complaint byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 11/18/2014) (Entered: 11/18/2014)
390 Transcript of Proceedings held on 11/12/14, before Judge Paul S. Grewal. Court Reporter/Transcriber Summer Fisher, Telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 386 Transcript Order ) Release of Transcript Restriction set for 2/17/2015. (Related documents(s) 386 ) (Fisher, Summer) (Filed on 11/19/2014) (Entered: 11/19/2014)
391 MOTION to Strike 389 Amended Answer to Complaint filed by Jesse Hernandez. Motion Hearing set for 1/13/2015 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 12/22/2014. Replies due by 12/29/2014. (Attachments: # 1 Proposed Order)(Swearingen, Van) (Filed on 12/8/2014) (Entered: 12/08/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 59 of 82

12/08/2014 12/08/2014 12/09/2014
12/10/2014 12/10/2014 12/10/2014 12/12/2014
12/12/2014 12/19/2014 12/22/2014 12/22/2014 12/23/2014

392 MOTION to Strike 388 Amended Answer to Complaint filed by Jesse Hernandez. Motion Hearing set for 1/13/2015 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 12/22/2014. Replies due by 12/29/2014. (Attachments: # 1 Proposed Order)(Swearingen, Van) (Filed on 12/8/2014) (Entered: 12/08/2014)
393 Declaration of Van Swearingen in Support of 392 MOTION to Strike 388 Amended Answer to Complaint , 391 MOTION to Strike 389 Amended Answer to Complaint filed byJesse Hernandez. (Related document(s) 392 , 391 ) (Swearingen, Van) (Filed on 12/8/2014) (Entered: 12/08/2014)
394 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 12/12/2014 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Each side to submit a 3−page letter brief no later than 12/10/2014 by 5:00 p.m. Parties requesting to appear telephonically are instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 12/9/2014) (Entered: 12/09/2014)
395 Discovery Letter Brief filed by California Forensic Medical Group, County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Susan K. Blitch)(Blitch, Susan) (Filed on 12/10/2014) (Entered: 12/10/2014)
396 Discovery Letter Brief in Support of Plaintiffs' Motion for Notice and Right to Accompany Defendants Expert Tours filed by Jesse Hernandez. (Attachments: # 1 Proposed Order)(Alexander, Sarah) (Filed on 12/10/2014) (Entered: 12/10/2014)
397 Declaration of Michael W. Bien in Support of 396 Discovery Letter Brief in Support of Plaintiffs' Motion for Notice and Right to Accompany Defendants Expert Tours filed byJesse Hernandez. (Related document(s) 396 ) (Bien, Michael) (Filed on 12/10/2014) (Entered: 12/10/2014)
398 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Discovery Hearing held on 12/12/2014 re 395 and 396 : The court denies Plaintiffs' Request for Notice & Right to Accompany Defendants' Expert Tours. Defendants' and Plaintiffs' Experts are permitted to tour the facility without accompaniment by opposing counsel. Any interviews beyond tour management and safety shall be reserved for depositions. As to the records of Ida Parker, CFMG shall produce all records responsive to Plaintiffs' requests, redacted as required, pursuant to the court's order at Docket No. 385 . CFMG shall receive a one week extension on the deadline for these records. Court Reporter: Summer Fisher. Plaintiff Attorney present (telephonically): Sarah Alexander. Defendant Attorney(s) present (telephonically): Peter Bertling, Susan Blitch, Michael Philippi & Janella Simpson. Also present: Irven Grant. This is a text only Minute Entry (ofr, COURT STAFF) (Date Filed: 12/12/2014) (Entered: 12/12/2014)
399 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Summer Fisher. (Alexander, Sarah) (Filed on 12/12/2014) (Entered: 12/12/2014)
400 STIPULATION WITH PROPOSED ORDER Stipulation and Proposed Amended Protective Order filed by Jesse Hernandez. (Stone−Manista, Krista) (Filed on 12/19/2014) (Entered: 12/19/2014)
401 ORDER GRANTING STIPULATED AND AMENDED PROTECTIVE ORDER by Magistrate Judge Paul Singh Grewal granting 400 . (psglc1S, COURT STAFF) (Filed on 12/22/2014) (Entered: 12/22/2014)
402 RESPONSE (re 392 MOTION to Strike 388 Amended Answer to Complaint ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael R. Philippi, # 2 Certificate/Proof of Service)(Philippi, Michael) (Filed on 12/22/2014) (Entered: 12/22/2014)
403 RESPONSE (re 391 MOTION to Strike 389 Amended Answer to Complaint ) Opposition to Plaintiffs' Motion to Strike Its Amended Answer to Second Amended Complaint filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 12/23/2014) (Entered: 12/23/2014)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 60 of 82

12/29/2014 12/29/2014 12/29/2014
12/30/2014 12/31/2014 01/07/2015 01/08/2015
01/08/2015 01/13/2015
01/16/2015 01/20/2015 01/20/2015 01/20/2015

404 REPLY (re 391 MOTION to Strike 389 Amended Answer to Complaint ) filed byJesse Hernandez. (Swearingen, Van) (Filed on 12/29/2014) (Entered: 12/29/2014)
405 REPLY (re 392 MOTION to Strike 388 Amended Answer to Complaint ) filed byJesse Hernandez. (Swearingen, Van) (Filed on 12/29/2014) (Entered: 12/29/2014)
406 Transcript of Proceedings held on 12/12/14, before Judge Paul S. Grewal. Court Reporter/Transcriber Summer Fisher, Telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 399 Transcript Order ) Release of Transcript Restriction set for 3/30/2015. (Related documents(s) 399 ) (Fisher, Summer) (Filed on 12/29/2014) (Entered: 12/29/2014)
407 TRANSCRIPT ORDER by California Forensic Medical Group for Court Reporter Summer Fisher. (Bertling, Peter) (Filed on 12/30/2014) (Entered: 12/30/2014)
408 ORDER GRANTING MOTION TO RELATE CASE by Magistrate Judge Paul Singh Grewal on December 31, 2014. Case No. 14−cv−05481 related to Case No. 13−cv−02354. (psglc1S, COURT STAFF) (Filed on 12/31/2014) (Entered: 12/31/2014)
409 MOTION to Appear by Telephone at the Plaintiffs' Motion to Strike Defendants' Answers to the Second Amended Complaint, set for January 13, 2015 filed by California Forensic Medical Group. (Attachments: # 1 Proposed Order, # 2 Certificate/Proof of Service)(Bertling, Peter) (Filed on 1/7/2015) (Entered: 01/07/2015)
410 ORDER GRANTING CFMG'S REQUEST TO MAKE A TELEPHONIC APPEARANCE AT THE JANUARY 13, 2015, MOTION TO STRIKE DEFENDANTS' ANSWERS TO SECOND AMENDED COMPLAINT by Judge Paul S. Grewal, granting 409 . Counsel is instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. (ofr, COURT STAFF) (Filed on 1/8/2015) (Entered: 01/08/2015)
411 CLERK'S NOTICE SETTING CASE MANAGEMENT CONFERENCE FOLLOWING REASSIGNMENT: Case Management Conference set for 4/28/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose. Case Management Statement due by 4/21/2015. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 1/8/2015) (Entered: 01/08/2015)
412 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Motion Hearing held on 1/13/2015 re 391 MOTION to Strike and 392 MOTION to Strike: The court takes matters under submission; written order to be issued. Court Reporter: Lee−Anne Shortridge. Plaintiff Attorney present: Van Swearingen. Defendant Attorney(s) present: Michael Philippi. Also present: Peter Bertling, telephonically. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 1/13/2015) (Entered: 01/13/2015)
413 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Lee−Anne Shortridge. (Swearingen, Van) (Filed on 1/16/2015) (Entered: 01/16/2015)
414 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Lee−Anne Shortridge. (Blitch, Susan) (Filed on 1/20/2015) (Entered: 01/20/2015)
415 MOTION for Leave to File Motion for Reconsideration of Part of Dec. 12, 2014 Order filed by Jesse Hernandez. (Attachments: # 1 Declaration Michael W. Bien, # 2 Declaration Pablo Stewart, # 3 Proposed Order)(Bien, Michael) (Filed on 1/20/2015) (Entered: 01/20/2015)
***Setting Hearing as to 415 Motion for Reconsideration of Part of Dec. 12, 2014 Order: Motion Hearing set for 2/24/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Pursuant to ECF No. 415 . (ofr, COURT STAFF) (Filed on 1/20/2015) (Entered: 01/21/2015)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 61 of 82

01/21/2015 01/21/2015 01/21/2015
01/21/2015 01/21/2015 01/22/2015
01/23/2015
01/23/2015 01/26/2015 01/27/2015 01/27/2015 01/27/2015 01/27/2015

416 MOTION for Leave to File Additional Documents in Support of Opposition to Plaintiffs' Motion to Strike Answer to Complaint filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael R. Philippi, # 2 Certificate/Proof of Service)(Philippi, Michael) (Filed on 1/21/2015) (Entered: 01/21/2015)
417 Proposed Order re 416 MOTION for Leave to File Additional Documents in Support of Opposition to Plaintiffs' Motion to Strike Answer to Complaint by County of Monterey, Monterey County Sheriff's Office. (Philippi, Michael) (Filed on 1/21/2015) (Entered: 01/21/2015)
418 MOTION for Joinder to 416 Defendants County of Monterey and Monterey County Sheriff's Office's Administrative Motion to Submit Additional Documents in Support of Opposition to Plaintiffs' Motion to Strike Amended Answer to Second Amended Complaint filed by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 1/21/2015) Modified on 1/21/2015 (cv, COURT STAFF). (Entered: 01/21/2015)
419 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Summer Fisher. (Blitch, Susan) (Filed on 1/21/2015) (Entered: 01/21/2015)
420 ORDER GRANTING DEFENDANTS' MOTIONS FOR LEAVE TO FILE AND FOR JOINDER by Judge Paul S. Grewal granting 416 ; granting 418 . (psglc1S, COURT STAFF) (Filed on 1/21/2015) (Entered: 01/21/2015)
421 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 1/28/2015 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Each side to submit a 3−page letter brief no later than 1/27/2015 by 5:00 p.m. Parties requesting to appear telephonically are instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 1/22/2015) Modified on 1/22/2015 (ofr, COURT STAFF). (Entered: 01/22/2015)
422 CLERK'S NOTICE ADVANCING MOTION HEARING, advancing 415 MOTION for Leave to File Motion for Reconsideration of Part of Dec. 12, 2014 Order: 2/24/2015 Motion Hearing is advanced to 1/28/2015 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 1/23/2015) (Entered: 01/23/2015)
423 CLERK'S NOTICE RE COURT DEADLINE FOR PARTIES TO SUBMIT BRIEFS ON MOTION FOR RECONSIDERATION: Parties to submit briefs on Motion for Reconsideration (ECF No. 415 ) no later than 1/27/2015 by 5:00 p.m. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 1/23/2015) (Entered: 01/23/2015)
424 NOTICE of Appearance by Ernest James Galvan (Galvan, Ernest) (Filed on 1/26/2015) (Entered: 01/26/2015)
425 RESPONSE (re 415 MOTION for Leave to File Motion for Reconsideration of Part of Dec. 12, 2014 Order ) filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration of Peter G. Bertling, # 2 Exhibit A)(Bertling, Peter) (Filed on 1/27/2015) (Entered: 01/27/2015)
426 Letter Brief re Discovery Hearing filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration Peter G. Bertling, # 2 Exhibit A, # 3 Exhibit B, # 4 Exhibit C, # 5 Exhibit D, # 6 Exhibit E, # 7 Exhibit F, # 8 Certificate/Proof of Service)(Bertling, Peter) (Filed on 1/27/2015) (Entered: 01/27/2015)
427 Discovery Letter Brief Discovery Stay filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael Philippi, # 2 Certificate/Proof of Service)(Philippi, Michael) (Filed on 1/27/2015) (Entered: 01/27/2015)
428 RESPONSE (re 415 MOTION for Leave to File Motion for Reconsideration of Part of Dec. 12, 2014 Order ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Michael Philippi, # 2 Proposed Order, # 3

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 62 of 82

01/27/2015 01/28/2015
01/29/2015 01/30/2015
02/02/2015 02/02/2015 02/02/2015 02/05/2015 02/05/2015
02/12/2015

Certificate/Proof of Service)(Philippi, Michael) (Filed on 1/27/2015) (Entered: 01/27/2015)
429 Letter Brief Opposing Defendants' Requests to (1) Stay Discovery Pending a Decision on Plaintiffs' Motion for Class Certification and (2) Modify the Scheduling Order filed byJesse Hernandez. (Attachments: # 1 Declaration of Ernest Galvan in Opposition to Defendants' Requests to Stay Discovery and to Modify the Scheduling Order)(Galvan, Ernest) (Filed on 1/27/2015) (Entered: 01/27/2015)
430 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Motion Hearing held on 1/28/2015 re 415 MOTION for Leave to File Motion for Reconsideration of Part of Dec. 12, 2014 Order and 426 MOTION to Stay Discovery. The court denies Plaintiffs' Motion for Leave to File Motion for Reconsideration. Previous order to remain in effect. The court denies Defendant California Forensic Medical Group's Motion to Stay Discovery. Court Reporter: Summer Fisher. Plaintiff Attorney(s) present: Ernest Galvan, Sarah Alexander & James Egar. Defendant Attorney(s) present: Michael Philippi. Also present: Peter Bertling, telephonically. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 1/28/2015) (Entered: 01/28/2015)
431 ORDER GRANTING MOTION TO CERTIFY CLASS AND DENYING MOTION TO STRIKE granting 48 ; denying 181 . (psglc1S, COURT STAFF) (Filed on 1/29/2015) Modified on 2/19/2015 (psglc1S, COURT STAFF). (Entered: 01/29/2015)
432 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 2/3/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Parties to submit 3−page letter brief no later than 2/2/2015 by 5:00 p.m. Parties requesting to appear telephonically are instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 1/30/2015) (Entered: 01/30/2015)
433 STIPULATION WITH PROPOSED ORDER re 432 Clerk's Notice,, Joint Request to Vacate Feb. 3, 2015 Discovery Hearing filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 2/2/2015) (Entered: 02/02/2015)
434 ORDER GRANTING STIPULATION by Magistrate Judge Paul Singh Grewal granting 433 . (psglc1S, COURT STAFF) (Filed on 2/2/2015) (Entered: 02/02/2015)
435 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Summer Fisher. (Galvan, Ernest) (Filed on 2/2/2015) (Entered: 02/02/2015)
436 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Summer Fisher. (Blitch, Susan) (Filed on 2/5/2015) (Entered: 02/05/2015)
437 Transcript of Proceedings held on 1−13−15, before Judge Paul S. Grewal. Court Reporter/Transcriber Lee−Anne Shortridge, Telephone number 408−287−4580 email: lee−anne_shortridge@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 414 Transcript Order ) Release of Transcript Restriction set for 5/6/2015. (Related documents(s) 414 ) (las, ) (Filed on 2/5/2015) (Entered: 02/05/2015)
438 Transcript of Proceedings held on 01/28/15, before Judge Paul S. Grewal. Court Reporter/Transcriber Summer Fisher, Telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 435 Transcript Order ) Release of Transcript Restriction

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 63 of 82

02/24/2015 02/25/2015 02/27/2015 03/03/2015
03/06/2015 03/06/2015
03/06/2015 03/09/2015 03/09/2015 03/09/2015 03/11/2015 03/11/2015

set for 5/13/2015. (Related documents(s) 435 ) (Fisher, Summer) (Filed on 2/12/2015) (Entered: 02/12/2015)
439 STIPULATION WITH PROPOSED ORDER regarding settlement conference filed by Jesse Hernandez. (Bien, Michael) (Filed on 2/24/2015) (Entered: 02/24/2015)
440 ORDER GRANTING STIPULATION SELECTING ADR PROCESS by Magistrate Judge Paul Singh Grewal granting 439 . (psglc1S, COURT STAFF) (Filed on 2/25/2015) (Entered: 02/25/2015)
441 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Telephonic Settlement Conference session held on 2/27/2015. Plaintiffs' Attorney Michael Bien. Defendants' Attorneys Michael Philippi, Peter Bertling. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 2/27/2015) (Entered: 02/27/2015)
442 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 3/13/2015 at 1:00 PM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Parties to submit a 3−page joint letter brief no later than 3/11/2015. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 3/3/2015) (Entered: 03/03/2015)
443 MOTION to Appear by Telephone at the March 13, 2015 Discovery Hearing filed by California Forensic Medical Group. (Attachments: # 1 Declaration Peter G. Bertling, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Bertling, Peter) (Filed on 3/6/2015) (Entered: 03/06/2015)
444 MOTION for Leave to File Supplemental Evidence In Support of Plaintiffs' Motion for Preliminary Injunction filed by Jesse Hernandez. (Attachments: # 1 Declaration of Jennifer Davenport ISO Pls' Motion for Leave to File Supplemental Evidence ISO Pls' Motion for Preliminary Injunction, # 2 Declaration of Gay Crosthwait Grunfeld ISO Pls' Motion for Leave to File Supplemental Evidence ISO Pls' Motion for Preliminary Injunction, # 3 Declaration of Don Landis ISO Pls' Motion for Leave to File Supplemental Evidence ISO Pls' Motion for Preliminary Injunction, # 4 Declaration of William Pernik ISO Pls' Motion for Leave to File Supplemental Evidence ISO Pls' Motion for Preliminary Injunction)(Grunfeld, Gay) (Filed on 3/6/2015) (Entered: 03/06/2015)
445 ORDER GRANTING CALIFORNIA FORENSIC MEDICAL GROUP'S REQUEST TO MAKE A TELEPHONIC APPEARANCE AT THE MARCH 13, 2015 DISCOVERY HEARING by Judge Paul S. Grewal, granting 443 . Counsel is instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. (ofr, COURT STAFF) (Filed on 3/6/2015) (Entered: 03/06/2015)
446 RESPONSE (re 444 MOTION for Leave to File Supplemental Evidence In Support of Plaintiffs' Motion for Preliminary Injunction ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration Cmdr. James Bass, # 2 Certificate/Proof of Service)(Blitch, Susan) (Filed on 3/9/2015) (Entered: 03/09/2015)
447 RESPONSE (re 444 MOTION for Leave to File Supplemental Evidence In Support of Plaintiffs' Motion for Preliminary Injunction ) Declaration of Cmdr. James Bass filed byCounty of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 3/9/2015) (Entered: 03/09/2015)
448 NOTICE OF SETTLEMENT CONFERENCE AND ORDER − Settlement Conference set for 3/30/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Signed by Judge Nathanael Cousins on 3/9/2015. (Attachments: # 1 Standing Order)(lmh, COURT STAFF) (Filed on 3/9/2015) (Entered: 03/09/2015)
449 Letter Brief re 442 Clerk's Notice, Discovery Hearing Re Rule 34 Inspections filed byJesse Hernandez. (Attachments: # 1 Declaration of Ernest Galvan, # 2 Exhibit A−BB, With Linked Index, # 3 Proposed Order)(Related document(s) 442 ) (Galvan, Ernest) (Filed on 3/11/2015) (Entered: 03/11/2015)
450 Discovery Letter Brief re FRCP Rule 34 Inspections filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Philippi, Michael) (Filed on 3/11/2015) (Entered: 03/11/2015)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 64 of 82

03/13/2015 03/13/2015 03/13/2015
03/18/2015 03/21/2015
03/26/2015 03/30/2015 04/10/2015

451 TRANSCRIPT ORDER by Jesse Hernandez for Court Reporter Lee−Anne Shortridge. (Galvan, Ernest) (Filed on 3/13/2015) (Entered: 03/13/2015)
452 TRANSCRIPT ORDER by County of Monterey, Monterey County Sheriff's Office for Court Reporter Lee−Anne Shortridge. (Blitch, Susan) (Filed on 3/13/2015) (Entered: 03/13/2015)
453 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Discovery Hearing held on 3/13/2015 (In Re: ECF Nos. 449 and 450 ). Plaintiffs' request to observe operations of the jail is granted. The County is to identify for Plaintiffs any scheduled operations that will take place 72 hours in advance of inspection. Plaintiffs' request for review of logs and class member records is granted−in− part. Daily logs during the day may be inspected on−site. Documents should be produced to the extent they are responsive to any outstanding Rule 34 request. Experts may also inspect binder of materials gathered during the day. Each expert shall have one day for inspection. The court is open to entertain any request for additional inspection if inspection not informative or problematic. Experts will be permitted to take photographs with facial features of inmates blurred. 72 hours prior to inspection, the County shall identify individuals currently housed in the jail, their status and any particular location information reasonably available to the County. During inspections, experts shall be permitted to identify up to 30 class member files to be pulled for review. If not possible to be pulled during the day, files to be produced at a later date. Court Reporter: Lee−Anne Shortridge. Plaintiff Attorney present: Ernest Galvan. Defendant Attorney(s) present: Michael Philippi. Also present (telephonically): Peter Bertling. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 3/13/2015) (Entered: 03/13/2015)
454 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Settlement Conference session held on 3/17/2015. Plaintiff's Attorneys Ernest Galvan, Sarah Pascal Alexander. Defendant' Attorney Michael Philippi. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 3/18/2015) (Entered: 03/18/2015)
455 Transcript of Proceedings held on 3−13−15, before Judge Paul S. Grewal. Court Reporter/Transcriber Lee−Anne Shortridge, Telephone number 408−287−4580 email: lee−anne_shortridge@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerks Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction.After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 451 Transcript Order ) Release of Transcript Restriction set for 6/19/2015. (Related documents(s) 451 ) (las, ) (Filed on 3/21/2015) (Entered: 03/21/2015)
456 ORDER GRANTING−IN−PART 444 Motion for Leave to File entered by Magistrate Judge Paul Singh Grewal. The newspaper articles are out as inadmissible hearsay under Fed. R. Evid. 801 and 802. But leave to file is granted as to all other evidence identified in the motion. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 03/26/2015)
457 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Settlement Conference held on 3/30/2015. Discussions continue. Further Settlement Conference set for 4/17/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Plaintiffs' Attorneys: Jim Egar, Ernest Galvan, Michael Bien. Defendant CFMG: Peter Bertling; Monterey County Defendants: Michael Philippi, Irven Grant, Susan Blitch. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 3/30/2015) (Entered: 03/30/2015)
458 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 4/17/2015 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Each party to submit a 3−page letter brief no later than 4/15/2015 by 5:00 PM. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 4/10/2015) (Entered: 04/10/2015)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 65 of 82

04/14/2015 04/14/2015 04/14/2015 04/14/2015 04/15/2015
04/15/2015 04/15/2015 04/17/2015
04/17/2015
04/21/2015 04/23/2015
04/24/2015 04/27/2015

459 MOTION to Appear by Telephone at the April 28, 2015 Case Management Conference filed by California Forensic Medical Group. (Attachments: # 1 Declaration Jemma Parker Saunders, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 4/14/2015) (Entered: 04/14/2015)
460 ORDER GRANTING MOTION FOR PRELIMINARY INJUNCTION by Magistrate Judge Paul Singh Grewal granting 108 . (psglc1S, COURT STAFF) (Filed on 4/14/2015) (Entered: 04/14/2015)
461 ORDER GRANTING 459 MOTION TO APPEAR BY TELEPHONE entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 04/14/2015)
462 ORDER GRANTING MOTIONS TO STRIKE by Judge Paul S. Grewal granting 391 ; granting 392 . (psglc1S, COURT STAFF) (Filed on 4/14/2015) (Entered: 04/14/2015)
463 CLERK'S NOTICE RE TELEPHONIC APPEARANCE AT APRIL 28, 2015 CASE MANAGEMENT CONFERENCE (IN RE: ECF NO. 461): Counsel for Defendant California Forensic Medical Group, Inc. is instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 4/15/2015) (Entered: 04/15/2015)
464 Letter Brief re 458 Clerk's Notice, Re Discovery Hearing filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Related document(s) 458 ) (Bertling, Peter) (Filed on 4/15/2015) (Entered: 04/15/2015)
465 Letter Brief re 458 Clerk's Notice, Re: Discovery Hearing filed byJesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen ISO Letter Brief)(Related document(s) 458 ) (Swearingen, Van) (Filed on 4/15/2015) (Entered: 04/15/2015)
466 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Discovery Hearing (In Re: ECF Nos. 464 and 465 ) held on 4/17/2015. Defendant California Forensic Medical Group to produce any relevant documents without redaction. Court Reporter: Irene Rodriguez (Time in Court: 10:03 to 10:16). Plaintiff Attorney present: Ernest Galvan. Defendant Attorney present: Peter Bertling. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 4/17/2015) (Entered: 04/17/2015)
468 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 4/17/2015 and continued to 4/23/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Plaintiff s' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Peter Bertling, Susan Blitch, Michael Philippi. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 4/17/2015) (Entered: 04/22/2015)
467 JOINT CASE MANAGEMENT STATEMENT filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 4/21/2015) (Entered: 04/21/2015)
469 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 4/23/2015. Discussions continue; County to provide line edits by 4/25. Further Settlement Conference set for 4/27/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Plaintiff s' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Peter Bertling, Susan Blitch, Michael Philippi, Charles Mckee, Irven Grant. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 4/23/2015) (Entered: 04/24/2015)
470 STIPULATION WITH PROPOSED ORDER DIRECTING PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS. filed by County of Monterey, Monterey County Sheriff's Office. (Philippi, Michael) (Filed on 4/24/2015) (Entered: 04/24/2015)
471 ORDER GRANTING STIPULATION DIRECTING PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS by Magistrate Judge Paul Singh Grewal granting 470 . (psglc1S, COURT STAFF) (Filed on 4/27/2015) (Entered: 04/27/2015)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 66 of 82

04/27/2015 04/27/2015 04/27/2015 04/28/2015
04/29/2015 04/30/2015 05/01/2015 05/04/2015 05/04/2015 05/12/2015

472 MOTION to Appear by Telephone at the April 28, 2015 Case Management Conference filed by Jesse Hernandez. (Attachments: # 1 Declaration of Michael W. Bien ISO Plaintiffs' Request for Telephonic Appearance, # 2 Proposed Order)(Bien, Michael) (Filed on 4/27/2015) (Entered: 04/27/2015)
473 ORDER GRANTING PLAINTIFFS' REQUEST TO MAKE A TELEPHONIC APPEARANCE AT THE APRIL 28, 2015 CASE MANAGEMENT HEARING, granting 472 . Counsel is instructed to contact CourtCall at 866−582−6878 to arrange for telephonic appearance. Signed by Judge Paul S. Grewal on 4/27/2015. (ofr, COURT STAFF) (Filed on 4/27/2015) (Entered: 04/27/2015)
474 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 4/27/2015. Discussions continue; parties to contact this Court by 4/29 4:00 PM if they wish to schedule further conference for 5/1 9:30 AM. Plaintiffs' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Jemma Parker Saunders, Susan Blitch, Charles McKee, Irven Grant. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 4/27/2015). (Entered: 04/27/2015)
475 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Case Management Conference held on 4/28/2015 as to 5:13−cv−02354−PSG and 5:14−cv−05481−PSG. As to Case No. 5:14−cv−05481−PSG, Jury Trial set for 11/7/2016 at 9:30 AM in Courtroom 5, 4th Floor, San Jose. Case management scheduling order to issue. As to 5:13−cv−02354−PSG, case schedule to remain as presently set. Parties may submit a stipulated request to modify schedule for the court's review. FTR Time: (10:02 to 10:16). Plaintiff Attorney(s) present: Lori Rifkin. Also present (telephonically): Michael Bien and Josh Piovia−Scott. Defendant Attorney(s) present: Michael Philippi. Also present (telephonically): Irven Grant and Jemma Saunders. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 4/28/2015) (Entered: 04/28/2015)
476 CLERK'S NOTICE SETTING Further Settlement Conference for 5/1/2015 09:30 AM before Judge Cousins in Courtroom 1/05/2015 09:30 AM. (This is a text−only entry generated by the court. There is no document associated with this notice). (lmh, COURT STAFF) (Filed on 4/29/2015) (Entered: 04/29/2015)
477 CLERK'S NOTICE SETTING DISCOVERY HEARING: Discovery Hearing set for 5/19/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Each party to submit a 3−page letter brief no later than 5/15/2015. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 4/30/2015) (Entered: 04/30/2015)
478 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 5/1/2015. Discussions continue. Defendants comments on settlement due by email 5/2 5:00 PM. Plaintiffs' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Jemma Parker Saunders, Susan Blitch, Charles McKee This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 5/1/2015) (Entered: 05/01/2015)
479 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference sessions held on 5/2 and 5/3. Discussions continue. Response to mediator proposal due 5/4 noon. Plaintiffs' Attorneys Enrest Galvan, Michael Bien. Defendants' Attorneys Susan Blitch, Michael Philippi, Jemma Parker Saunders. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 5/4/2015) (Entered: 05/04/2015)
480 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference sessions held on 5/4/2015. Discussions continue by phone. Plaintiffs' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Susan Blitch, Michael Philippi, Jemma Parker Saunders. This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 5/4/2015) (Entered: 05/05/2015)
481 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference session held on 5/8/2015. Case settled subject to approval by Judge Grewal. Plaintiffs' Attorneys Ernest Galvan, Michael Bien. Defendants' Attorneys Susan Blitch, Michael Philippi, Jemma Parker Saunders (FTR Time: Not recorded) This is a text only Minute Entry. (lmh, COURT STAFF)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 67 of 82

05/14/2015 05/14/2015 05/14/2015 05/15/2015 05/27/2015 06/23/2015
06/30/2015 07/28/2015 07/28/2015 07/28/2015 07/28/2015 08/18/2015

(Date Filed: 5/12/2015) (Entered: 05/12/2015)
482 CLERK'S NOTICE VACATING MAY 19, 2015 DISCOVERY HEARING. In light of settlement, the 5/19/2015 discovery hearing is hereby vacated. (This is a text−only entry generated by the court. There is no document associated with this entry) (ofr, COURT STAFF) (Filed on 5/14/2015) (Entered: 05/14/2015)
483 STIPULATION WITH PROPOSED ORDER for Preliminary Approval of Settlement Agreement filed by Jesse Hernandez. (Attachments: # 1 Declaration of Ernest Galvan, # 2 Exhibit A, Settlement Agreement, # 3 Exhibit B, Form of Notice, # 4 Proposed Order)(Galvan, Ernest) (Filed on 5/14/2015) (Entered: 05/14/2015)
484 Second Amended ANSWER to Second Amended Complaint by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 5/14/2015) Modified on 5/15/2015 (cv, COURT STAFF). (Entered: 05/14/2015)
485 ORDER GRANTING STIPULATED MOTION FOR PRELIMINARY APPROVAL OF CLASS ACTION SETTLEMENT AND EXTENSION OF TIME FOR PRELIMINARY INJUNCTION COMPLIANCE by Magistrate Judge Paul Singh Grewal granting 483 . (psglc1S, COURT STAFF) (Filed on 5/15/2015) (Entered: 05/15/2015)
486 AFFIDAVIT Declaration of Cmdr. James Bass Affirming Publication of Notice of Class Settlement by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 5/27/2015) (Entered: 05/27/2015)
487 CLERK'S NOTICE RESETTING AUGUST 4, 2015 FINAL APPROVAL HEARING: Due to the court's unavailability, the 8/4/2015 Final Approval Hearing is reset to 8/18/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 6/23/2015) (Entered: 06/23/2015)
488 Letter dated 6/23/15 by S. Adams. (cv, COURT STAFF) (Filed on 6/30/2015) (Entered: 06/30/2015)
489 STIPULATION WITH PROPOSED ORDER Joint Motion for Final Approval of Settlement Agreement filed by Jesse Hernandez. (Attachments: # 1 Proposed Order)(Bien, Michael) (Filed on 7/28/2015) (Entered: 07/28/2015)
490 Declaration of Michael W. Bien in Support of 489 STIPULATION WITH PROPOSED ORDER Joint Motion for Final Approval of Settlement Agreement filed byJesse Hernandez. (Related document(s) 489 ) (Bien, Michael) (Filed on 7/28/2015) (Entered: 07/28/2015)
491 Declaration of Susan K. Blitch in Support of 489 STIPULATION WITH PROPOSED ORDER Joint Motion for Final Approval of Settlement Agreement filed byCounty of Monterey, Monterey County Sheriff's Office. (Related document(s) 489 ) (Blitch, Susan) (Filed on 7/28/2015) (Entered: 07/28/2015)
492 Declaration of Peter G. Bertling in Support of 489 STIPULATION WITH PROPOSED ORDER Joint Motion for Final Approval of Settlement Agreement filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Related document(s) 489 ) (Bertling, Peter) (Filed on 7/28/2015) (Entered: 07/28/2015)
493 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Motion Hearing held on 8/18/2015 re 489 Joint MOTION for Final Approval of Settlement Agreement. Joint Motion for Final Approval is granted. The court will post an order. Court Reporter: Lee−Anne Shortridge. Time in Court: (11:13 to 11:22). Plaintiff Attorney(s) present: Ernest Galvan, Michael Bien and James Egar. Defendant Attorney(s) present: Peter Bertling and Susan Blitch. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 8/18/2015) (Entered: 08/18/2015)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 68 of 82

08/18/2015 09/08/2015 09/11/2015 09/25/2015 10/02/2015
10/02/2015 10/02/2015
10/16/2015 10/16/2015 10/19/2015
10/21/2015 11/03/2015
11/03/2015

494 ORDER FOR FINAL APPROVAL OF SETTLEMENT AGREEMENT by Magistrate Judge Paul Singh Grewal granting 489 . (psglc1S, COURT STAFF) (Filed on 8/18/2015) (Entered: 08/18/2015)
495 Declaration of Cmdr. James Bass Affirming Publication of Notice of Class Settlement by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 9/8/2015) Modified on 9/8/2015 (cv, COURT STAFF). (Entered: 09/08/2015)
496 CLERK'S NOTICE SETTING Further Settlement Conference for 10/19/2015 09:30 AM before Judge Cousins in Courtroom 7, 4th Floor, San Jose. (This is a text−only entry generated by the court. There is no document associated with this notice.) (lmh, COURT STAFF) (Filed on 9/11/2015) (Entered: 09/11/2015)
497 NOTICE of Change of Address by Krista Michelle Stone−Manista for Rosen Bien Galvan & Grunfeld (Stone−Manista, Krista) (Filed on 9/25/2015) (Entered: 09/25/2015)
498 CLERK'S NOTICE RESETTING NOVEMBER 6, 2015 MOTION HEARING, resetting 485 MOTION for Attorneys Fees and Expense: Due to the court's unavailability, the 11/6/2015 Motion Hearing is reset to 11/10/2015 at 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 10/2/2015) (Entered: 10/02/2015)
499 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Telephonic Settlement Conference session held on 10/2/2015. Joint report re mediation topics to be submitted (not filed) by Oct. 13; Oct 19 meeting remains on calendar. (FTR Not recorded) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 10/2/2015) (Entered: 10/02/2015)
500 MOTION for Attorney Fees and Expenses filed by Jesse Hernandez. Motion Hearing set for 11/10/2015 10:00 AM in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. Responses due by 10/16/2015. Replies due by 10/23/2015. (Attachments: # 1 Memorandum of Points and Authorities, # 2 Declaration of Michael W. Bien, # 3 Exhibit A−P to the Bien Declaration, # 4 Declaration of Eric Balaban, # 5 Declaration of Alan L. Schlosser, # 6 Declaration of Richard M. Pearl, # 7 Proposed Order)(Bien, Michael) (Filed on 10/2/2015) (Entered: 10/02/2015)
501 RESPONSE (re 500 MOTION for Attorney Fees and Expenses ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration of Susan K. Blitch, # 2 Certificate/Proof of Service)(Blitch, Susan) (Filed on 10/16/2015) (Entered: 10/16/2015)
502 Joinder re 501 Opposition/Response to Motion, by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Saunders, Jemma) (Filed on 10/16/2015) (Entered: 10/16/2015)
503 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 10/19/2015. Counsel to provide status update by 10/30/2015. Further Settlement Conference set for 11/3/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Plaintiffs' Attorneys: Michael Bien, Ernest Galvan. Defendants' Attorneys: Susan Blitch, Michael Philippi, Peter Bertling. (FTR Time Not recorded.) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 10/19/2015) (Entered: 10/19/2015)
504 REPLY (re 500 MOTION for Attorney Fees and Expenses ) filed byJesse Hernandez. (Bien, Michael) (Filed on 10/21/2015) (Entered: 10/21/2015)
505 CLERK'S NOTICE ADVANCING NOVEMBER 10, 2015 MOTION HEARING, advancing 500 MOTION for Attorney Fees and Expenses: 11/10/2015 Motion Hearing is advanced to 11/9/2015 at 4:45 PM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 11/3/2015) (Entered: 11/03/2015)
506 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 11/3/2015. Updates due

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 69 of 82

11/05/2015 11/06/2015 11/09/2015
11/09/2015 11/23/2015
01/05/2016
01/08/2016 02/19/2016 02/19/2016

11/20/2015. Settlement Conference set for 11/23/2015 09:30 AM in Courtroom 7, 4th Floor, San Jose. Plaintiffs' Attorneys: Michael Bien, Ernest Galvan. Defendants' Attorneys: Susan Blitch, Michael Philippi, Peter Bertling. (FTR Not recorded) This is a text−only Minute Entry.(lmh, COURT STAFF) (Date Filed: 11/3/2015) (Entered: 11/03/2015)
507 MOTION to Appear by Telephone at the November 9, 2015 Hearing re Motion for Attorneys' Fees filed by California Forensic Medical Group. (Attachments: # 1 Declaration Peter G. Bertling, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Bertling, Peter) (Filed on 11/5/2015) (Entered: 11/05/2015)
508 STIPULATION re 500 MOTION for Attorney Fees and Expenses Resolving Dispute Re Interest filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 11/6/2015) (Entered: 11/06/2015)
509 CLERK'S NOTICE VACATING NOVEMBER 9, 2015 MOTION FOR ATTORNEY FEES AND EXPENSES AND COURT TAKING MATTER UNDER SUBMISSION: Plaintiffs' Motion for Attorney Fees and Expenses (In Re: Dkt. No. 500 ) presently set for 11/9/2015 at 4:45 PM before Magistrate Judge Paul S. Grewal is hereby submitted without oral argument pursuant to Civil Local Rule 7−1(b). Accordingly, the 11/9/2015 hearing is vacated. ***This is a text only docket entry, there is no document associated with this notice.*** (ofr, COURT STAFF) (Filed on 11/9/2015) (Entered: 11/09/2015)
510 ORDER GRANTING ATTORNEY'S FEES AND EXPENSES by Magistrate Judge Paul Singh Grewal granting 500 . (psglc1S, COURT STAFF) (Filed on 11/9/2015) (Entered: 11/09/2015)
511 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Further Settlement Conference held on 11/23/2015 and continued to 1/5/2016 09:30 AM in Courtroom 7, 4th Floor, San Jose; implementation plans due 12/18/2015. Plaintiffs' Attorneys: Michael Bien, Ernest Galvan. Defendants' Attorneys: Susan Blitch, Michael Philippi, Peter Bertling. (FTR Not recorded.)This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 11/23/2015) (Entered: 11/24/2015)
512 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Further Settlement Conference held on 1/5/2016: discussions re settlement implementation plans continue; Further Settlement Conference set for 2/18/2016 10:00 AM ; briefing to be submitted (not ECF filed) 1/12, 1/26, 2/2, with 20 page memo cap. Hearing before Judge Grewal on motion for approval of implementation plans to be set 2/23/2016 10:00 AM or upon further court order. Plaintiffs' Attorneys: Michael Bien, Ernest Galvan, James Egar, Krista Stone−Manista. Defendants' Attorneys: Susan Blitch, Peter Bertling, Michael Philippi. (FTR Time Not recorded.) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 1/5/2016). (Entered: 01/06/2016)
513 CLERK'S NOTICE RESETTING Further Settlement Conference to 2/19/2016 10:00 AM before Magistrate Judge Cousins in Courtroom 7, 4th Floor, San Jose. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 1/8/2016) (Entered: 01/08/2016)
514 MOTION for Hearing TO APPROVE IMPLEMENTATION PLAN AS PART OF SETTLEMENT AGREEMENT filed by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 2/19/2016) (Entered: 02/19/2016)
515 RESPONSE (re 514 MOTION for Hearing TO APPROVE IMPLEMENTATION PLAN AS PART OF SETTLEMENT AGREEMENT ) filed byJesse Hernandez. (Attachments: # 1 Declaration of Krista Stone Manista in Support of Plaintiffs' Response to Defendants' Motion for Approval of Implementation Plans, # 2 Declaration of James Egar in Support of Plaintiffs' Response to Defendants' Motion for Approval of Implementation Plans, # 3 Proposed Order Granting in Part Defendants' Motion Regarding Implementation Plans)(Galvan, Ernest) (Filed on 2/19/2016) (Entered: 02/19/2016)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 70 of 82

02/19/2016 02/19/2016 02/19/2016 02/19/2016 02/19/2016
02/22/2016 02/24/2016
02/24/2016 02/24/2016 02/26/2016

516 Declaration in Support of 515 Opposition/Response to Motion,, for Approval of Implementation Plans filed byJesse Hernandez. (Attachments: # 1 Exhibits 1−10, # 2 Exhibit 11, # 3 Exhibit 12, Part 1, # 4 Exhibit 12, Part 2, # 5 Exhibits 13−47)(Related document(s) 515 ) (Galvan, Ernest) (Filed on 2/19/2016) (Entered: 02/19/2016)
517 MOTION for Hearing to Approve Implementation Plan as Part of Settlement Agreement filed by California Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 2/19/2016) (Entered: 02/19/2016)
518 REPLY (re 517 MOTION for Hearing to Approve Implementation Plan as Part of Settlement Agreement ) REPLY OF CFMG TO PLAINTIFFS RESPONSE TO DEFENDANT CFMGS MOTION FOR APPROVAL OF IMPLEMENTATION PLANS filed byCalifornia Forensic Medical Group. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 2/19/2016) (Entered: 02/19/2016)
***Setting hearing as to 514 and 517 MOTIONS to Approve Implementation Plan as part of Settlement: Motion Hearing set for 2/26/2016 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. (ofr, COURT STAFF) (Filed on 2/19/2016) (Entered: 02/22/2016)
520 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Further Settlement Conference held on 2/19/2016: Parties to file updated joint statement or separate proposed order(s) by 2/24; hearing (non−evidentiary) requested before Magistrate Judge Grewal 2/26 at 10:00 AM; mediation efforts to continue. Plaintiffs' Attorneys: Ernest Galvan, Michael Bien, Krista Stone−Manista, Van Swearingen. Defendants' Attorneys: Susan Blitch, Michael Philippi, Peter Bertling. (FTR Time Not recorded.) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 2/19/2016) (Entered: 02/23/2016)
519 REPLY (re 514 MOTION for Hearing TO APPROVE IMPLEMENTATION PLAN AS PART OF SETTLEMENT AGREEMENT ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration of Susan K. Blitch, # 2 Declaration of Carl P. Holm, # 3 Declaration of Captain James Bass, # 4 Certificate/Proof of Service)(Blitch, Susan) (Filed on 2/22/2016) (Entered: 02/22/2016)
521 CLERK'S NOTICE ADVANCING TIME ON FEBRUARY 26, 2016 MOTION HEARING, advancing time as to 514 and 517 MOTIONS to Approve Implementation Plan as part of Settlement: 2/26/2016 10:00 AM Motion Hearing is advanced to 9:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 2/24/2016) (Entered: 02/24/2016)
522 STATUS REPORT JOINT STATEMENT RE IMPLEMENTATION PLAN MOTIONS SET FOR FRIDAY, FEB. 26, 2016 AT 09:00 by Jesse Hernandez. (Galvan, Ernest) (Filed on 2/24/2016) (Entered: 02/24/2016)
523 Proposed Order re 514 MOTION for Hearing TO APPROVE IMPLEMENTATION PLAN AS PART OF SETTLEMENT AGREEMENT, 515 Opposition/Response to Motion,, PLAINTIFFS' REVISED PROPOSED ORDER by Jesse Hernandez. (Galvan, Ernest) (Filed on 2/24/2016) (Entered: 02/24/2016)
524 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Motion Hearing held on 2/26/2016 re 514 and 517 MOTIONS to Approve Implementation Plan as Part of Settlement Agreement: Parties to meet and confer and submit a proposed briefing schedule setting deadline for supplemental briefing on implementation plan issues still in dispute, including page limits. Once parties have submitted their briefs, the court will immediately proceed to issue its ruling. Total Time in Court: 23 minutes (9:01 to 9:24). Court Reporter: Irene Rodriguez. Plaintiff Attorneys present: Ernest Galvan, Michael Bien and James Egar. Defendant Attorneys present: Peter Bertling and Susan Blitch. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 2/26/2016) (Entered:

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 71 of 82

02/26/2016 02/29/2016 03/18/2016 04/01/2016 04/01/2016
04/01/2016
04/01/2016
04/01/2016 04/06/2016 04/06/2016 04/06/2016

02/26/2016)
525 STIPULATION WITH PROPOSED ORDER re 514 MOTION for Hearing TO APPROVE IMPLEMENTATION PLAN AS PART OF SETTLEMENT AGREEMENT filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 2/26/2016) (Entered: 02/26/2016)
526 STIPULATION AND ORDER REGARDING IMPLEMENTATION PLAN SCHEDULE by Magistrate Judge Paul Singh Grewal granting 525 . (psglc1S, COURT STAFF) (Filed on 2/29/2016) (Entered: 02/29/2016)
527 STATUS REPORT Joint Letter Regarding Implementation Plans by Jesse Hernandez. (Galvan, Ernest) (Filed on 3/18/2016) (Entered: 03/18/2016)
528 Brief re 526 Order on Stipulation filed byMonterey County Sheriff's Office. (Attachments: # 1 Declaration of Susan K. Blitch, # 2 Exhibit to Declaration of Susan K. Blitch, # 3 Exhibit to Declaration of Susan K. Blitch, # 4 Declaration of Captain James Bass, # 5 Declaration of Dewayne Woods, # 6 Declaration of Kim R. Blackseth, # 7 Declaration of Carl P. Holm, # 8 Certificate/Proof of Service)(Related document(s) 526 ) (Blitch, Susan) (Filed on 4/1/2016) (Entered: 04/01/2016)
529 Administrative Motion to File Under Seal filed by Jesse Hernandez. (Attachments: # 1 Declaration of Ernest Galvan ISO Pls' Admin Motion to File Under Seal, # 2 Proposed Order Re Pls' Admin Motion to File Under Seal, # 3 Unredacted Version of Expert Declaration of Wendy Still and Exhibits, # 4 Unredacted Version of Exhibit A Part 1 to Galvan Declaration, # 5 Unredacted Version of Exhibit A Part 2 to Galvan Declaration, # 6 Unredacted Version of Exhibits B−E to Galvan Declaration, # 7 Unredacted Version of Exhibits F−M to Galvan Declaration, # 8 Unredacted Version of Exhibits N−Q to Galvan Declaration)(Galvan, Ernest) (Filed on 4/1/2016) (Entered: 04/01/2016)
530 EXHIBITS re 529 Administrative Motion to File Under Seal filed byJesse Hernandez. (Attachments: # 1 Unredacted Version of Exhibit R to Galvan Declaration, # 2 Unredacted Version of Exhibits S−T to Galvan Declaration, # 3 Unredacted Version of Exhibit U to Galvan Declaration, # 4 Unredacted Version of Exhibits V−Y to Galvan Declaration, # 5 Unredacted Version of Exhibits Z−DD to Galvan Declaration, # 6 Unredacted Version of Exhibits EE−OO to Galvan Declaration, # 7 Unredacted Version of Exhibits PP−RR to Galvan Declaration, # 8 Unredacted Version of Exhibit VV to Galvan Declaration, # 9 Certificate/Proof of Service)(Related document(s) 529 ) (Galvan, Ernest) (Filed on 4/1/2016) (Entered: 04/01/2016)
531 Brief Regarding Enforcement of Settlement Agreement's Implementation Plan Requirements filed byJesse Hernandez. (Attachments: # 1 Declaration of Ernest Galvan with Exhibits, # 2 Declaration of Robert Cohen with Exhibits, # 3 Declaration of Donald T. Sauter with Exhibits, # 4 Declaration of Pablo Stewart with Exhibits, # 5 Declaration Redacted Declaration of Wendy Still with Exhibits, # 6 Proposed Order re Enforcement of Settlement Agreement)(Galvan, Ernest) (Filed on 4/1/2016) (Entered: 04/01/2016)
532 Brief re 517 MOTION for Hearing to Approve Implementation Plan as Part of Settlement Agreement filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit B, # 2 Certificate/Proof of Service)(Related document(s) 517 ) (Bertling, Peter) (Filed on 4/1/2016) (Entered: 04/01/2016)
533 MOTION to Relate Case C16−945 LHK filed by Mark Vasquez Pajas, Sr. (Panuco, Cindy) (Filed on 4/6/2016) Modified on 4/6/2016 (cv, COURT STAFF). Modified on 4/6/2016 (cv, COURT STAFF). (Entered: 04/06/2016)
534 CLERK'S NOTICE SETTING MOTION HEARING, setting hearing as to 514 and 517 MOTION to Approve Implementation Plan as Part of Settlement Agreement: Motion Hearing set for 4/21/2016 at 10:00 AM (SPECIAL SET) in Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 4/6/2016) (Entered: 04/06/2016)
535 CLERK'S NOTICE RESETTING APRIL 21, 2016 MOTION HEARING, resetting 514 and 517 MOTION to Approve Implementation Plan as Part of Settlement: 4/21/2016 Motion Hearing is reset to 4/28/2016 at 10:00 AM (SPECIAL SET) in

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 72 of 82

04/06/2016
04/14/2016 04/28/2016
04/29/2016 04/29/2016
05/18/2016 05/20/2016 05/23/2016 05/24/2016 05/24/2016 05/24/2016 05/24/2016 05/25/2016

Courtroom 5, 4th Floor, San Jose before Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (ofr, COURT STAFF) (Filed on 4/6/2016) (Entered: 04/06/2016)
536 ORDER DENYING MOTION TO RELATE CASE, denying 533 : The court has reviewed the motion and determined that no cases are related and no reassignments shall occur. 5:16−cv−00945−LHK is NOT RELATED to 5:13−cv−02354−PSG. (ofr, COURT STAFF) (Filed on 4/6/2016) (Entered: 04/07/2016)
537 ORDER GRANTING 529 ADMINISTRATIVE MOTION TO FILE UNDER SEAL entered by Magistrate Judge Paul Singh Grewal. (This is a text−only entry generated by the court. There is no document associated with this entry.) (Entered: 04/14/2016)
538 Minute Entry for proceedings held before Magistrate Judge Paul Singh Grewal: Motion Hearing held on 4/28/2016 re 514 and 517 MOTION to Approve Implementation Plan as Part of Settlement Agreement: Counsel present oral arguments. The court will issue a written order. FTR Time: 10:04 to 11:38. Plaintiff Attorney(s) present: Michael Bien, James Egar and Ernest Galvan. Defendant Attorney(s) present: Susan Blitch and Peter Bertling. This is a text only Minute Entry. (ofr, COURT STAFF) (Date Filed: 4/28/2016) (Entered: 04/28/2016)
539 TRANSCRIPT ORDER for proceedings held on April 28, 2016 before Magistrate Judge Paul Singh Grewal by Jesse Hernandez, for Court Reporter FTR − San Jose. (Galvan, Ernest) (Filed on 4/29/2016) (TRANSCRIBER: KELLY POLVI) Modified on 4/29/2016 (sms, COURT STAFF). (Entered: 04/29/2016)
540 TRANSCRIPT ORDER for proceedings held on 04/28/2016 before Magistrate Judge Paul Singh Grewal by County of Monterey, Monterey County Sheriff's Office, for Court Reporter FTR − San Jose. (Blitch, Susan) (Filed on 4/29/2016) (TRANSCRIBER: KELLY POLVI)Modified on 4/29/2016 (sms, COURT STAFF). (Entered: 04/29/2016)
541 ORDER RE CONSENT/DECLINATION. Signed by Hon. Phyllis J. Hamilton on 5/18/2016. (ofr, COURT STAFF) (Filed on 5/18/2016) (Entered: 05/18/2016)
542 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by County of Monterey, Monterey County Sheriff's Office.. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 5/20/2016) (Entered: 05/20/2016)
543 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by California Forensic Medical Group.. (Attachments: # 1 Certificate/Proof of Service)(Bertling, Peter) (Filed on 5/23/2016) (Entered: 05/23/2016)
544 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by Jesse Hernandez.. (Galvan, Ernest) (Filed on 5/24/2016) (Entered: 05/24/2016)
545 MOTION to Relate Case filed by Jesse Hernandez. (Swearingen, Van) (Filed on 5/24/2016) (Entered: 05/24/2016)
546 RESPONSE (re 545 MOTION to Relate Case ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 5/24/2016) (Entered: 05/24/2016)
547 CONSENT/DECLINATION to Proceed Before a US Magistrate Judge by County of Monterey, Monterey County Sheriff's Office.. (Attachments: # 1 Certificate/Proof of Service)(Philippi, Michael) (Filed on 5/24/2016) (Entered: 05/24/2016)
548 NOTICE by County of Monterey, Monterey County Sheriff's Office re 546 Opposition/Response to Motion NOTICE OF ERRATUM RE DEFENDANT'S OPPOSITION TO PLAINTIFFS' ADMINISTRATIVE MOTION AND PROPOSED ORDER TO CONSIDER WHETHER CASES SHOULD BE RELATED (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 5/25/2016) (Entered: 05/25/2016)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 73 of 82

05/27/2016
06/06/2016 06/08/2016
06/15/2016 06/22/2016 06/23/2016 07/25/2016
08/02/2016 08/02/2016 08/04/2016 08/08/2016 08/08/2016

549 ORDER GRANTING−IN−PART DEFENDANTS' MOTIONS FOR APPROVAL OF IMPLEMENTATION PLANS AND DENYING AS MOOT CFMG'S FIRST MOTION FOR APPROVAL OF IMPLEMENTATION PLAN by Judge Paul S. Grewal granting−in−part and denying−in−part 514 ; denying as moot 517 ; granting−in−part and denying−in−part 532 . (psglc1S, COURT STAFF) (Filed on 5/27/2016) (Entered: 05/27/2016)
550 ORDER REASSIGNING CASE. Case reassigned to Judge Hon. Beth Labson Freeman for all further proceedings. Magistrate Judge Paul Singh Grewal no longer assigned to the case.Signed by Judge The Executive Committee on 06/06/2016. (tsh, COURT STAFF) (Filed on 6/6/2016) (Entered: 06/07/2016)
551 CLERK'S NOTICE RESETTING CASE MANAGEMENT CONFERENCE FOLLOWING REASSIGNMENT. Joint Case Management Statement due by 8/04/2016. Case Management Conference set for 8/11/2016 11:00 AM in Courtroom 3, 5th Floor, San Jose before Hon. Beth Labson Freeman. All other deadlines associated with the initial case management conference are adjusted accordingly. The Court does not issue a revised Initial Case Management Scheduling Order with ADR Deadlines. Standing orders can be downloaded from the court's web page at www.cand.uscourts.gov/blf This is a text only docket entry, there is no document associated with this notice.(tsh, COURT STAFF) (Filed on 6/8/2016) (Entered: 06/08/2016)
552 ORDER DENYING 545 MOTION TO RELATE CASES. Signed by Judge Beth Labson Freeman on 6/15/2016. (blflc1S, COURT STAFF) (Filed on 6/15/2016) (Entered: 06/15/2016)
553 ADMINISTRATIVE MOTION Withdrawal of James Egar As Counsel for Plaintiffs filed by Jesse Hernandez. Responses due by 6/27/2016. (Attachments: # 1 Proposed Order)(Galvan, Ernest) (Filed on 6/22/2016) (Entered: 06/22/2016)
554 ORDER RE WITHDRAWAL OF JAMES EGAR AS COUNSEL (granting 553 ). Signed by Judge Beth Labson Freeman on 6/23/2016. (blflc1S, COURT STAFF) (Filed on 6/23/2016) (Entered: 06/23/2016)
555 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Telephonic settlement session held on 7/25/2016: Further joint settlement call set for 8/8/2016 02:30 PM. Counsel to contact the Courtroom Deputy for the call−in number. Plaintiffs' Attorneys: Ernest Galvan, Michael Bien. Defendants' Attorneys: Susan Blitch, Peter Bertling. (FTR: Not recorded) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 7/25/2016) (Entered: 07/26/2016)
556 NOTICE of Appearance by Andrew Glenn Spore (Spore, Andrew) (Filed on 8/2/2016) (Entered: 08/02/2016)
557 NOTICE of Change In Counsel by Andrew Glenn Spore (Spore, Andrew) (Filed on 8/2/2016) (Entered: 08/02/2016)
558 CASE MANAGEMENT STATEMENT (Joint) filed by Jesse Hernandez. (Swearingen, Van) (Filed on 8/4/2016) (Entered: 08/04/2016)
559 CLERK'S NOTICE RESETTING CASE MANAGEMENT CONFERENCE. Case Management Statement due by 12/8/2016. Further Case Management Conference set for 12/15/2016 11:00 AM. (This is a text−only entry generated by the court. There is no document associated with this entry.) (tshS, COURT STAFF) (Filed on 8/8/2016) (Entered: 08/08/2016)
560 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Telephonic Settlement Conference call held on 8/8/2016:

In accordance with Settlement Agreement, 5 monitors selected: Medical: Bruce Barnett Mental Health: Kerry Hughes Disability: Tim Gilbert

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 74 of 82

Corrections: Michael Hackett Dental: Viviane Winthrop Parties expected to provide additional information about monitors to Judge Freeman before 8/11 CMC.

08/09/2016
08/10/2016 08/11/2016 08/11/2016
08/11/2016 08/31/2016 09/01/2016 09/12/2016 10/05/2016 10/24/2016 11/01/2016 11/09/2016
11/28/2016

Plaintiffs' Attorneys: Ernest Galvan, Michael Bien. Defendants' Attorneys: Susan Blitch, Peter Bertling. (FTR Time Not recorded.) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 8/8/2016) (Entered: 08/08/2016)
561 ORDER RESETTING CASE MANAGEMENT CONFERENCE FOR AUGUST 11, 2016 AS PREVIOUSLY SCHEDULED. Further Case Management Conference set for 8/11/2016 11:00 AM in Courtroom 3, 5th Floor, San Jose. Signed by Judge Beth Labson Freeman on 8/9/2016. (blflc1S, COURT STAFF) (Filed on 8/9/2016) (Entered: 08/09/2016)
562 Proposed Order Appointing Neutral Monitors and Order of Reference (Jointly Filed) by Jesse Hernandez. (Spore, Andrew) (Filed on 8/10/2016) (Entered: 08/10/2016)
563 ORDER APPOINTING NEUTRAL MONITORS AND ORDER OF REFERENCE (approving 562 ). Signed by Judge Beth Labson Freeman on 8/11/2016. (blflc1S, COURT STAFF) (Filed on 8/11/2016) (Entered: 08/11/2016)
564 Minute Entry for proceedings held before Hon. Beth Labson Freeman: Further Case Management Conference held on 8/11/2016.FTR Time: 11:01 − 11:18. Plaintiff Attorney: Michael Bien, Andrew Spore. Defendant Attorney: Susan Blitch, Peter Bertling. This is a text only Minute Entry (tshS, COURT STAFF)(Date Filed: 8/11/2016) (Entered: 08/12/2016)
565 CASE MANAGEMENT re 564 Case Management Conference − Further. Signed by Judge Beth Labson Freeman on 08/11/2016. (tshS, COURT STAFF) (Filed on 8/11/2016) (Entered: 08/15/2016)
566 MOTION to Relate Case filed by County of Monterey. (Attachments: # 1 Certificate/Proof of Service)(Holmes, Janet) (Filed on 8/31/2016) (Entered: 08/31/2016)
567 Statement of Non−Opposition re 566 MOTION to Relate Case filed byJesse Hernandez. (Related document(s) 566 ) (Spore, Andrew) (Filed on 9/1/2016) (Entered: 09/01/2016)
568 ORDER SETTING STATUS CONFERENCE. Status Conference set for 12/1/2016 11:00 AM in Courtroom 3, 5th Floor, San Jose before Hon. Beth Labson Freeman. Signed by Judge Beth Labson Freeman on 9/12/2016. (blflc1S, COURT STAFF) (Filed on 9/12/2016) (Entered: 09/12/2016)
569 ORDER DENYING WITHOUT PREJUDICE 566 ADMINISTRATIVE MOTION TO CONSIDER WHETHER CASES SHOULD BE RELATED. Signed by Judge Beth Labson Freeman on 10/5/2016.(blflc1S, COURT STAFF) (Filed on 10/5/2016) (Entered: 10/05/2016)
570 ADMINISTRATIVE MOTION Relate Case filed by County of Monterey. Responses due by 10/28/2016. (Attachments: # 1 Certificate/Proof of Service)(Holmes, Janet) (Filed on 10/24/2016) (Entered: 10/24/2016)
571 ORDER GRANTING 570 ADMINISTRATIVE MOTION TO CONSIDER WHETHER CASES SHOULD BE RELATED. Signed by Judge Beth Labson Freeman on 11/1/2016.(blflc1S, COURT STAFF) (Filed on 11/1/2016) (Entered: 11/01/2016)
572 CLERK'S NOTICE SETTING Further Settlement Conference for 1/12/2017 09:30 AM before Magistrate Judge Cousins in Courtroom 7, 4th Floor, San Jose. Updated settlement conference statements due by 1/5/2017. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 11/9/2016) (Entered: 11/09/2016)
573 JOINT CASE MANAGEMENT STATEMENT filed by County of Monterey, Monterey County Sheriff's Office. (Blitch, Susan) (Filed on 11/28/2016) (Entered:

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 75 of 82

12/01/2016 01/12/2017
01/12/2017 01/20/2017 01/25/2017 02/06/2017 03/06/2017
04/04/2017 04/28/2017

11/28/2016)
574 Minute Entry for proceedings held before Hon. Beth Labson Freeman: Status Conference held on 12/1/2016.FTR Time: 11:13 − 11:25. Plaintiff Attorney: Van Swearingen. Defendant Attorney: Peter Berling, Susan Blitch. This is a text only Minute Entry (tshS, COURT STAFF)(Date Filed: 12/1/2016) (Entered: 12/02/2016)
575 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Further Settlement Conference held on 1/12/2017: Discussions continue; Further Settlement Conference set for 2/6/2017 02:00 PM at the Monterey County Jail. Plaintiffs' Attorneys: Ernest Galvan, Van Swearingen. Defendants' Attorneys: Peter Berling, Susan Blitch. (FTR Not recorded.) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 1/12/2017). (Entered: 01/12/2017)
Settlement Conference set for 2/6/2017 02:00 PM before Magistrate Judge Cousins at the Monterey County Jail. (lmh, COURT STAFF) (Filed on 1/12/2017) (Entered: 01/18/2017)
576 CLERK'S NOTICE SETTING TELEPHONIC CASE MANAGEMENT CONFERENCE. Further Case Management Conference set for 1/25/2017 10:00 AM in Courtroom 3, 5th Floor, San Jose. (This is a text−only entry generated by the court. There is no document associated with this entry.) (tshS, COURT STAFF) (Filed on 1/20/2017) (Entered: 01/20/2017)
577 Minute Entry for proceedings held before Hon. Beth Labson Freeman: Further Case Management Conference held on 1/25/2017.FTR Time: 10:00 − 10:22. Plaintiff Attorney: Van Stromer. Defendant Attorney: Dan Swearingen, Susan Blitch, Jemma Saunders, Peter Bertling. This is a text only Minute Entry (tshS, COURT STAFF) (Date Filed: 1/25/2017) (Entered: 01/26/2017)
578 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins: Settlement Conference meeting with plaintiffs, County, CFMG, and Natividad held on 2/6/2017; Next joint confidential status report due by 4/7/17. (FTR Not reported) This is a text only Minute Entry. (lmh, COURT STAFF) (Date Filed: 2/6/2017). (Entered: 02/21/2017)
579 Transcript of Proceedings held on January 19, 2017, before Judge Beth Labson Freeman. Court Reporter/Transcriber Joan Marie Columbini, CSR, telephone number joan.columbini.csr@gmail.com 510−367−3043. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerk's Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction. After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re (73 in 5:14−cv−05481−BLF) Transcript Order, ) Redaction Request due 3/27/2017. Redacted Transcript Deadline set for 4/6/2017. Release of Transcript Restriction set for 6/5/2017. (Columbini, Joan) (Filed on 3/6/2017) (Entered: 03/06/2017)
580 CLERK'S NOTICE EXTENDING date for the parties to submit joint confidential status report to 4/14/2017. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 4/4/2017) (Entered: 04/04/2017)
581 Minute Entry for proceedings held before Magistrate Judge Nathanael M. Cousins. Telephonic Settlement Conference session held on 4/28/2017: See attached Minute order. Plaintiff's Attorneys: Van Swearingen, Andrew Spore. Defendants' Attorneys: Susan Blitch, Peter Bertling. (FTR Time Not recorded.) (lmh, COURT STAFF) (Date Filed: 4/28/2017) (Entered: 04/28/2017)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 76 of 82

05/16/2017 05/16/2017 06/01/2017 06/06/2017 06/07/2017 06/23/2017
06/23/2017 06/23/2017
06/27/2017 06/27/2017 06/27/2017
07/05/2017 07/06/2017 07/10/2017 07/14/2017

582 Sua Sponte Judicial Referral for Purposes of Determining Relationship of Cases. Signed by Judge Lucy H. Koh on May 16, 2017. (lhklc2S, COURT STAFF) (Filed on 5/16/2017) (Entered: 05/16/2017)
583 ORDER DENYING RELATION. Signed by Judge Beth Labson Freeman on 5/16/2017. (blflc2S, COURT STAFF) (Filed on 5/16/2017) (Entered: 05/16/2017)
584 CLERK'S NOTICE: Plaintiffs' request to extend time to file for motion for enforcement, from June 2 to June 16, 2017, GRANTED by Magistrate Judge Cousins. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 6/1/2017) (Entered: 06/01/2017)
585 ADMINISTRATIVE MOTION for Withdrawal of Donald E. Landis, Jr. and Office of Public Defender as Counsel filed by Jesse Hernandez. Responses due by 6/12/2017. (Attachments: # 1 Proposed Order)(Galvan, Ernest) (Filed on 6/6/2017) (Entered: 06/06/2017)
586 ORDER RE WITHDRAWAL OF DONALD E. LANDIS, JR., AND OFFICE OF THE PUBLIC DEFENDER AS COUNSEL (granting 585 ). Signed by Judge Beth Labson Freeman on 6/7/2017.(blflc1S, COURT STAFF) (Filed on 6/7/2017) (Entered: 06/07/2017)
587 MOTION to Enforce Judgment (Settlement Agreement) filed by Jesse Hernandez. Motion Hearing set for 9/20/2017 09:00 AM in Courtroom 3, 5th Floor, San Jose before Hon. Beth Labson Freeman. Responses due by 7/7/2017. Replies due by 7/14/2017. (Attachments: # 1 Mem. of Points and Authorities, # 2 Declaration of Dr. Pablo Stewart, M.D., # 3 Declaration of Van Swearingen, # 4 Proposed Order)(Swearingen, Van) (Filed on 6/23/2017) (Entered: 06/23/2017)
588 MOTION to Enforce Judgment (Settlement Agreement) filed by Jesse Hernandez. Responses due by 7/7/2017. Replies due by 7/14/2017. (Attachments: # 1 Declaration of Ernest Galvan, # 2 Proposed Order)(Galvan, Ernest) (Filed on 6/23/2017) (Entered: 06/23/2017)
589 Administrative Motion to File Under Seal (Declarations in Dkts. 587 & 588) filed by Jesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen, # 2 Proposed Order, # 3 Declaration Stewart Decl. (Without Exhibits 2−30), # 4 Declaration Stewart Decl. (With Exhibits 2−30), # 5 Declaration Galvan Decl. (Without Exhibits A−F), # 6 Galvan Decl. (With Exhibits A−F))(Swearingen, Van) (Filed on 6/23/2017) (Entered: 06/23/2017)
590 ASSOCIATION of Counsel by County of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 6/27/2017) (Entered: 06/27/2017)
591 NOTICE of Appearance by Anne Kristen Brereton (Brereton, Anne) (Filed on 6/27/2017) (Entered: 06/27/2017)
592 ORDER STRIKING 587 , 588 PLAINTIFFS' MOTIONS TO ENFORCE SETTLEMENT AGREEMENT; AND TERMINATING AS MOOT 589 PLAINTIFFS' ADMINISTRATIVE MOTION TO FILE UNDER SEAL. Signed by Judge Beth Labson Freeman on 6/27/2017. (blflc1S, COURT STAFF) (Filed on 6/27/2017) (Entered: 06/27/2017)
593 STIPULATION WITH PROPOSED ORDER Re Attorneys' Fees and Costs filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 7/5/2017) (Entered: 07/05/2017)
594 STIPULATION AND ORDER REGARDING ATTORNEYS' FEES AND EXPENSES FOR PLAINTIFFS' COMPLIANCE MONITORING FOR PERIOD ENDING MAY 26, 2017 (granting 593 ). Signed by Judge Beth Labson Freeman on 7/6/2017.(blflc1S, COURT STAFF) (Filed on 7/6/2017) (Entered: 07/06/2017)
595 ADMINISTRATIVE MOTION to exceed page limits filed by Jesse Hernandez. Responses due by 7/14/2017. (Attachments: # 1 Declaration of Van Swearingen, # 2 Proposed Order)(Swearingen, Van) (Filed on 7/10/2017) (Entered: 07/10/2017)
596 OPPOSITION/RESPONSE (re 595 ADMINISTRATIVE MOTION to exceed page limits ) filed byCounty of Monterey. (Attachments: # 1 Certificate/Proof of Service)(Brereton, Anne) (Filed on 7/14/2017) DOCUMENT(S) #1 REMOVED

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 77 of 82

07/14/2017 07/17/2017 07/17/2017
07/17/2017
07/18/2017 07/19/2017 07/25/2017 07/26/2017 07/31/2017
07/31/2017 08/03/2017 08/03/2017 08/04/2017

PURSUANT TO ORDER 602 (jy, COURT STAFF). Modified on 7/20/2017 (jy, COURT STAFF). (Entered: 07/14/2017)
597 ORDER ALLOWING THE FILING OF OVERSIZED BRIEFS (granting 595 ). Signed by Judge Beth Labson Freeman on 7/14/2017. (blflc1S, COURT STAFF) (Filed on 7/14/2017) (Entered: 07/14/2017)
598 ADMINISTRATIVE MOTION Delete Exhibit re 596 Opposition/Response to Motion filed by County of Monterey, Monterey County Sheriff's Office. Responses due by 7/21/2017. (Attachments: # 1 Certificate/Proof of Service)(Blitch, Susan) (Filed on 7/17/2017) (Entered: 07/17/2017)
599 MOTION to Enforce Judgment (Settlement Agreement) filed by Jesse Hernandez. Motion Hearing set for 9/20/2017 09:00 AM in Courtroom 3, 5th Floor, San Jose before Hon. Beth Labson Freeman. Responses due by 7/31/2017. Replies due by 8/7/2017. (Attachments: # 1 Declaration of Dr. Pablo Stewart, M.D., # 2 Declaration of Van Swearingen, # 3 Declaration of Ernest Galvan, # 4 Proposed Order, # 5 Proposed Order ([Proposed] Protective Order))(Swearingen, Van) (Filed on 7/17/2017) (Entered: 07/17/2017)
600 Administrative Motion to File Under Seal Declarations in Dkt. 599 filed by Jesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen, # 2 Proposed Order, # 3 Declaration of Dr. Pablo Stewart, M.D. (without Exhibits 2−30), # 4 Declaration of Dr. Pablo Stewart, M.D. (with Exhibits 2−30), # 5 Declaration of Ernest Galvan (with Redacted Exhibits), # 6 Declaration of Ernest Galvan (with Unredacted Exhibits))(Swearingen, Van) (Filed on 7/17/2017) (Entered: 07/17/2017)
601 Statement re 598 ADMINISTRATIVE MOTION Delete Exhibit re 596 Opposition/Response to Motion (Statement of Support) by Jesse Hernandez. (Spore, Andrew) (Filed on 7/18/2017) (Entered: 07/18/2017)
602 ORDER GRANTING 598 ADMINISTRATIVE MOTION TO REMOVE INCORRECTLY FILED DOCUMENTS RELATING TO RESPONSE TO PLAINTIFF'S ADMINISTRATIVE MOTION TO EXCEED OTHERWISE APPLICABLE PAGE LIMITS. Signed by Judge Beth Labson Freeman on 7/19/2017.(blflc1S, COURT STAFF) (Filed on 7/19/2017) (Entered: 07/19/2017)
603 NOTICE by California Forensic Medical Group Notice of unavailability (Bertling, Peter) (Filed on 7/25/2017) (Entered: 07/25/2017)
604 ORDER GRANTING 600 PLAINTIFFS' ADMINISTRATIVE MOTION TO FILE UNDER SEAL. Signed by Judge Beth Labson Freeman on 7/26/2017.(blflc1S, COURT STAFF) (Filed on 7/26/2017) (Entered: 07/26/2017)
605 OPPOSITION/RESPONSE (re 599 MOTION to Enforce Judgment (Settlement Agreement) ) filed byCounty of Monterey, Monterey County Sheriff's Office. (Attachments: # 1 Declaration of Anne K. Brereton, # 2 Proposed Order, # 3 Certificate/Proof of Service)(Blitch, Susan) (Filed on 7/31/2017) DOCUMENT(S) 605−1 Exhibits A and B REMOVED PURSUANT TO ORDER 609 (jy, COURT STAFF). Modified on 8/7/2017 (jy, COURT STAFF). (Entered: 07/31/2017)
606 OPPOSITION/RESPONSE (re 599 MOTION to Enforce Judgment (Settlement Agreement) ) filed byCalifornia Forensic Medical Group. (Attachments: # 1 Declaration of Fithian, # 2 Declaration of Tran, # 3 Declaration of Yellowlees, # 4 Certificate/Proof of Service)(Bertling, Peter) (Filed on 7/31/2017) (Entered: 07/31/2017)
607 ADMINISTRATIVE MOTION Delete Exhibits re 605 Opposition/Response to Motion, filed by County of Monterey, Monterey County Sheriff's Office. Responses due by 8/7/2017. (Attachments: # 1 Certificate/Proof of Service)(Brereton, Anne) (Filed on 8/3/2017) (Entered: 08/03/2017)
608 Statement re 607 ADMINISTRATIVE MOTION Delete Exhibits re 605 Opposition/Response to Motion, by Jesse Hernandez. (Swearingen, Van) (Filed on 8/3/2017) (Entered: 08/03/2017)
609 ORDER GRANTING 607 ADMINISTRATIVE MOTION TO REMOVE INCORRECTLY FILED DOCUMENTS. Signed by Judge Beth Labson Freeman

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 78 of 82

08/07/2017 08/15/2017 09/19/2017 09/20/2017
09/21/2017 09/21/2017 09/22/2017 09/22/2017 10/06/2017
11/01/2017 12/05/2017
12/07/2017

on 8/4/2017.(blflc1S, COURT STAFF) (Filed on 8/4/2017) (Entered: 08/04/2017)
610 REPLY (re 599 MOTION to Enforce Judgment (Settlement Agreement) ) filed byJesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen)(Swearingen, Van) (Filed on 8/7/2017) (Entered: 08/07/2017)
611 STATUS REPORT (Joint) by Jesse Hernandez. (Swearingen, Van) (Filed on 8/15/2017) (Entered: 08/15/2017)
612 ORDER RE HEARING SET FOR SEPTEMBER 20, 2017. Signed by Judge Beth Labson Freeman on 9/19/2017. (blflc1S, COURT STAFF) (Filed on 9/19/2017) (Entered: 09/19/2017)
613 Minute Entry for proceedings held before Hon. Beth Labson Freeman: Motion Hearing held on 9/20/2017 re 599 MOTION to Enforce Judgment (Settlement Agreement) filed by Jesse Hernandez. Total Time in Court: 2:42. Court Reporter: Summer Fisher. Plaintiff Attorney: Van Swaringen. Defendant Attorney: Peter Bertling, Leeann Hapte, Anne Brereton, Michael Philippi, Gene Tanaka. This is a text−only Minute Entry (tshS, COURT STAFF) (Date Filed: 9/20/2017) (Entered: 09/20/2017)
614 TRANSCRIPT ORDER for proceedings held on 09−20−2017 before Hon. Beth Labson Freeman by California Forensic Medical Group, for Court Reporter Summer Fisher. (Bertling, Peter) (Filed on 9/21/2017) (Entered: 09/21/2017)
615 TRANSCRIPT ORDER for proceedings held on 09/20/17 before Hon. Beth Labson Freeman by Jesse Hernandez, for Court Reporter Summer Fisher. (Swearingen, Van) (Filed on 9/21/2017) (Entered: 09/21/2017)
616 TRANSCRIPT ORDER for proceedings held on 09/20/2017 before Hon. Beth Labson Freeman by County of Monterey, Monterey County Sheriff's Office, for Court Reporter Summer Fisher. (Philippi, Michael) (Filed on 9/22/2017) (Entered: 09/22/2017)
617 ORDER REFERRING SPECIFIED ISSUES RAISED IN 599 PLAINTIFFS' MOTION TO ENFORCE SETTLEMENT AGREEMENT TO MAGISTRATE JUDGE COUSINS FOR DISPOSITION. Signed by Judge Beth Labson Freeman on 9/22/2017. (blflc1S, COURT STAFF) (Filed on 9/22/2017) (Entered: 09/22/2017)
618 Transcript of Proceedings held on 09/20/2017, before Judge Beth Labson Freeman. Court Reporter/Transcriber Summer Fisher, telephone number 408−288−6150 summer_fisher@cand.uscourts.gov. Per General Order No. 59 and Judicial Conference policy, this transcript may be viewed only at the Clerk's Office public terminal or may be purchased through the Court Reporter/Transcriber until the deadline for the Release of Transcript Restriction. After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction, if required, is due no later than 5 business days from date of this filing. (Re 614 Transcript Order ) Release of Transcript Restriction set for 1/4/2018. (Related documents(s) 614 ) (Fisher, Summer) (Filed on 10/6/2017) (Entered: 10/06/2017)
619 ORDER GRANTING IN PART AND DENYING IN PART 599 PLAINTIFFS' MOTION TO ENFORCE SETTLEMENT AGREEMENT. Signed by Judge Beth Labson Freeman on 11/1/2017.(blflc1S, COURT STAFF) (Filed on 11/1/2017) (Entered: 11/01/2017)
620 Minute Entry for proceedings held before Judge Nathanael M. Cousins. Telephonic Scheduling Conference held on 12/5/2017: Parties to continue conferring and by 12/12 to submit proposal for procedures on Dkt. 619 (discovery proposed, briefing schedule, hearing schedule). Plaintiffs' Attorney: Van Swearingen. Defendants' Attorneys: Susan Blitch, Peter Bertling. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Date Filed: 12/5/2017) (Entered: 12/05/2017)
621 STIPULATION WITH PROPOSED ORDER Re Telepsychiatry filed by Jesse Hernandez. (Swearingen, Van) (Filed on 12/7/2017) (Entered: 12/07/2017)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 79 of 82

12/08/2017 12/20/2017 01/03/2018
01/04/2018 01/08/2018 01/17/2018 01/18/2018 01/19/2018
03/16/2018 03/19/2018 03/21/2018 03/22/2018 09/11/2018 09/13/2018

622 STIPULATION AND ORDER REGARDING TELEPSYCHIATRY (granting 621 ). Signed by Judge Beth Labson Freeman on 12/8/2017.(blflc1S, COURT STAFF) (Filed on 12/8/2017) (Entered: 12/08/2017)
623 NOTICE of Change In Counsel by Carl Takei (Takei, Carl) (Filed on 12/20/2017) (Entered: 12/20/2017)
624 CASE MANAGEMENT ORDER: The Court sets these deadlines (all in year 2018): Discovery to conclude 2/16; Telephonic Status Hearing set for 3/14 01:00 PM; Evidentiary Hearing set for 3/21/2018 09:00 AM, continuing 3/21 (morning only) and 3/22 in Courtroom 7, 4th Floor, San Jose. See order for additional deadlines. Signed by Judge Nathanael Cousins on 1/3/2018. (lmh, COURT STAFF) (Filed on 1/3/2018). (Entered: 01/03/2018)
625 Letter Brief re 624 Order,, Set Deadlines/Hearings, (Joint Letter Brief Re Evidentiary Hearing) filed byJesse Hernandez. (Related document(s) 624 ) (Swearingen, Van) (Filed on 1/4/2018) (Entered: 01/04/2018)
626 NOTICE of Change of Address by Peter G. Bertling (Bertling, Peter) (Filed on 1/8/2018) (Entered: 01/08/2018)
627 STIPULATION WITH PROPOSED ORDER re NMC Records filed by Jesse Hernandez. (Spore, Andrew) (Filed on 1/17/2018) (Entered: 01/17/2018)
628 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS (approving 627 ). Signed by Judge Beth Labson Freeman on 1/18/2018.(blflc1S, COURT STAFF) (Filed on 1/18/2018) (Entered: 01/18/2018)
629 STIPULATION AND ORDER RE EVIDENTIARY HEARING ON TELEPSYCHIATRY: Discovery to conclude by 3/9/2018; Telephonic Status Hearing 4/4/2018 02:00 PM; Evidentiary Hearing set for 5/1/2018 09:00 AM in San Jose, Courtroom 7, 4th Floor. **See order for further deadlines** Signed by Judge Nathanael Cousins on 1/19/2018. (lmh, COURT STAFF) (Filed on 1/19/2018) (Entered: 01/19/2018)
630 Letter from Counsel re telepsychiatry. (Swearingen, Van) (Filed on 3/16/2018) (Entered: 03/16/2018)
631 CLERK'S NOTICE: Parties to file update on settlement status by 3/23/2018, as ordered by Judge Cousins. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 3/19/2018) (Entered: 03/19/2018)
632 STIPULATION WITH PROPOSED ORDER REGARDING TELEPSYCHIATRY ISSUES filed by Jesse Hernandez. (Swearingen, Van) (Filed on 3/21/2018) (Entered: 03/21/2018)
633 ORDER GRANTING SECOND STIPULATION Regarding Telepsychiatry Issues 632 . The Evidentiary Hearing set for 5/1/2018 and the associated dates set forth in ECF 629 are vacated. Signed by Judge Nathanael Cousins. (lmh, COURT STAFF) (Filed on 3/22/2018) (Entered: 03/22/2018)
634 STIPULATION WITH PROPOSED ORDER Re: Monitoring Fees for Period Ending May 26, 2018 filed by Jesse Hernandez. (Galvan, Ernest) (Filed on 9/11/2018) (Entered: 09/11/2018)
635 STIPULATION AND ORDER REGARDING ATTORNEYS' FEES AND EXPENSES FOR PLAINTIFFS' COMPLIANCE MONITORING FOR PERIOD ENDING MAY 26, 2018 (granting 634 ). Signed by Judge Beth Labson Freeman on 9/13/2018.(blflc1S, COURT STAFF) (Filed on 9/13/2018) (Entered: 09/13/2018)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 80 of 82

09/17/2018 10/12/2018
10/17/2018 10/17/2018 11/02/2018 11/15/2018 11/16/2018 11/19/2018 11/19/2018
11/30/2018 12/03/2018 12/04/2018 01/25/2019 01/28/2019

636 CLERK'S NOTICE SETTING Further Settlement Conference for 10/12/2018 at 02:00 PM before Judge Cousins in Courtroom 7, 4th Floor, with a joint brief (up to 7 pages per side) due by 9/28. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 9/17/2018) (Entered: 09/17/2018)
637 Minute Entry for proceedings held before Judge Nathanael M. Cousins. Mediation on attorneys' fees under Par. 63 of Settlement Agreement held: No resolution; Plaintiff to file motion to trial judge by November 2. Attorney for Plaintiff: Van Swearingen. Attorneys for County Defendants: Michael Philippi, Anne Brereton. Attorney for CFMG: Peter Bertling. FTR Time: Not recorded. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Date Filed: 10/12/2018) (Entered: 10/12/2018)
638 NOTICE of Change of Address by Van Swearingen (Swearingen, Van) (Filed on 10/17/2018) (Entered: 10/17/2018)
639 NOTICE by Jesse Hernandez Change in Designation of Counsel for Service (Swearingen, Van) (Filed on 10/17/2018) (Entered: 10/17/2018)
640 MOTION for Attorney Fees filed by Jesse Hernandez. Motion Hearing set for 5/16/2019 09:00 AM in San Jose, Courtroom 3, 5th Floor before Judge Beth Labson Freeman. Responses due by 11/16/2018. Replies due by 11/23/2018. (Attachments: # 1 Declaration of Van Swearingen, # 2 Declaration of Richard Pearl, # 3 Proposed Order)(Swearingen, Van) (Filed on 11/2/2018) (Entered: 11/02/2018)
641 STIPULATION WITH PROPOSED ORDER re 640 MOTION for Attorney Fees filed by Jesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen)(Swearingen, Van) (Filed on 11/15/2018) (Entered: 11/15/2018)
642 STIPULATION AND ORDER TO ENLARGE TIME FOR DEFENDANTS' OPPOSITION AND PLAINTIFFS' REPLY (granting 641). Opposition due by 11/19/2018. Reply due by 11/30/2018. Signed by Judge Beth Labson Freeman on 11/16/2018. (blflc1S, COURT STAFF) (Filed on 11/16/2018) (Entered: 11/16/2018)
643 OPPOSITION/RESPONSE (re 640 MOTION for Attorney Fees ) filed byCalifornia Forensic Medical Group. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7 Exhibit G)(Bertling, Peter) (Filed on 11/19/2018) (Entered: 11/19/2018)
644 Administrative Motion to File Under Seal in Support of Opposition to Motion for Attorneys' Fees filed by County of Monterey. (Attachments: # 1 Declaration of Anne K. Brereton ISO Administrative Motion to File Under Seal, # 2 Proposed Order, # 3 Memorandum of Points and Authorities ISO Opposition to Motion for Attorneys' Fees, # 4 UNDER SEAL −Declaration of Anne K. Brereton ISO Opposition)(Brereton, Anne) (Filed on 11/19/2018) (Entered: 11/19/2018)
645 REPLY (re 640 MOTION for Attorney Fees ) filed byJesse Hernandez. (Attachments: # 1 Declaration of Van Swearingen)(Swearingen, Van) (Filed on 11/30/2018) (Entered: 11/30/2018)
646 STIPULATION WITH PROPOSED ORDER re Production of Natividad Medical Center Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 12/3/2018) (Entered: 12/03/2018)
647 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS (granting 646 ). Signed by Judge Beth Labson Freeman on 12/4/2018.(blflc1S, COURT STAFF) (Filed on 12/4/2018) (Entered: 12/04/2018)
648 STIPULATION WITH PROPOSED ORDER re Production of Natividad Medical Center Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 1/25/2019) (Entered: 01/25/2019)
649 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS (granting 648 ). Signed by Judge Beth Labson Freeman on

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 81 of 82

02/13/2019 02/21/2019
02/22/2019 05/01/2019 06/06/2019 06/07/2019 07/29/2019 07/30/2019 07/30/2019 09/19/2019
09/20/2019 01/16/2020 01/17/2020 01/21/2020 01/21/2020 03/05/2020

1/28/2019.(blflc1S, COURT STAFF) (Filed on 1/28/2019) (Entered: 01/28/2019)
650 ORDER DENYING 644 COUNTY'S ADMINISTRATIVE MOTION TO FILE UNDER SEAL. Signed by Judge Beth Labson Freeman on 2/13/2019.(blflc1S, COURT STAFF) (Filed on 2/13/2019) (Entered: 02/13/2019)
651 Memorandum of Points and Authorities in Support of Opposition to ( 640 MOTION for Attorney Fees ) filed by County of Monterey. (Attachments: # 1 Declaration of Anne K. Brereton in Support of Opposition to Motion for Attorneys' Fees)(Brereton, Anne) (Filed on 2/21/2019) Modified text on 2/22/2019 (dhmS, COURT STAFF). (Entered: 02/21/2019)
652 NOTICE of Appearance by Cara Elizabeth Trapani (Trapani, Cara) (Filed on 2/22/2019) (Entered: 02/22/2019)
653 ORDER VACATING HEARING ON 640 PLAINTIFFS' MOTION FOR ATTORNEYS' FEES AND EXPENSES; AND GRANTING 640 MOTION. Signed by Judge Beth Labson Freeman on 5/1/2019. (blflc1S, COURT STAFF) (Filed on 5/1/2019) (Entered: 05/01/2019)
654 STIPULATION WITH PROPOSED ORDER re Production of Natividad Medical Center Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 6/6/2019) (Entered: 06/06/2019)
655 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS (granting 654 ). Signed by Judge Beth Labson Freeman on 6/7/2019.(blflc1S, COURT STAFF) (Filed on 6/7/2019) (Entered: 06/07/2019)
656 NOTICE of Substitution of Counsel by Kathleen Guneratne (Guneratne, Kathleen) (Filed on 7/29/2019) (Entered: 07/29/2019)
657 STIPULATION WITH PROPOSED ORDER Appointing Neutral Monitors and Order of Reference filed by Jesse Hernandez. (Swearingen, Van) (Filed on 7/30/2019) (Entered: 07/30/2019)
658 STIPULATION AND ORDER APPOINTING NEUTRAL MONITORS AND ORDER OF REFERENCE (granting 657 ). Signed by Judge Beth Labson Freeman on 7/30/2019.(blflc1S, COURT STAFF) (Filed on 7/30/2019) (Entered: 07/30/2019)
659 STIPULATION WITH PROPOSED ORDER Regarding Undisputed Attorneys Fees filed by Cain Aguilar, Susan Dilley, Connie Dobbs, Sean Esquivel, Ramona Gist, Martha Gomez, George Greim, Dennis Guyot, Cobb (Tran) Ha, Jesse Hernandez, Jason Hobbs, Glenda Hunter, Albert Key, Brandon Mefford, Wesley Miller, Richard Murphy, Jeff Nichols, Angel Perez, Sarab Sarabi, Clyde Whitfield, Robert Yancey. (Galvan, Ernest) (Filed on 9/19/2019) (Entered: 09/19/2019)
660 STIPULATION AND ORDER REGARDING ATTORNEYS' FEES AND EXPENSES FOR PERIOD ENDING MAY 26, 2019 (approving 659 ). Signed by Judge Beth Labson Freeman on 9/20/2019.(blflc1S, COURT STAFF) (Filed on 9/20/2019) (Entered: 09/20/2019)
661 STIPULATION WITH PROPOSED ORDER re Production of Natividad Medical Center Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 1/16/2020) (Entered: 01/16/2020)
662 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL RECORDS (granting 661 ). Signed by Judge Beth Labson Freeman on 1/17/2020.(blflc1S, COURT STAFF) (Filed on 1/17/2020) (Entered: 01/17/2020)
663 STIPULATION WITH PROPOSED ORDER re Production of NMC Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 1/21/2020) (Entered: 01/21/2020)
664 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL RECORDS ( granting 663 ). Signed by Judge Beth Labson Freeman on 1/21/2020. (blflc1S, COURT STAFF) (Filed on 1/21/2020) (Entered: 01/21/2020)
665 STIPULATION WITH PROPOSED ORDER re Production of NMC Records filed by Jesse Hernandez. (Swearingen, Van) (Filed on 3/5/2020) (Entered: 03/05/2020)

Case: 5:13-cv-02354-BLF As of: 04/13/2020 02:38 PM PDT 82 of 82

03/06/2020 03/17/2020

666 STIPULATION AND ORDER RE PRODUCTION OF NATIVIDAD MEDICAL CENTER RECORDS (granting 665 ). Signed by Judge Beth Labson Freeman on 3/6/2020.(blflc1S, COURT STAFF) (Filed on 3/6/2020) (Entered: 03/06/2020)
667 CLERK'S NOTICE SETTING Further Settlement Conference for 4/23/2020, at 09:30 AM before Judge Nathanael Cousins. Conference will be held by TELEPHONE ONLY. In the interest of public health, this conference will not be held in person. The Court will send an email with additional logistics for the settlement conference call. (This is a text−only entry generated by the court. There is no document associated with this entry.) (lmh, COURT STAFF) (Filed on 3/17/2020) (Entered: 03/17/2020)


[CONTENT] May 23, 2013 | Monterey County Jail | the U.S. District Court | the Northern District | California ||| the County of Monterey | the California Forensic Medical Group | 42 | 1983 ||| the American Civil Liberties Union | ACLU | Northern California | the ACLU National Prison Project ||| Monterey County Jail | Jail ||| April 25, 2015 | CFMG | May 2, 2014 ||| The District Court | Magistrate | Paul Singh | September 29, 2014 ||| 2014 WL 4843945 | 2014 ||| First | Court ||| Second | Court | Americans | ADA ||| Court | CFMG | Title III | ADA ||| Court | Title II | ADA ||| April 29, 2014 ||| August 26, 2014 | Court | six | Jail ||| January 29, 2015 | Magistrate | Grewal ||| 2015 | 399975 | N.D. Cal | 2015 ||| April 14, 2015 | Magistrate | Grewal ||| May 11, 2015 |||  |||  ||| the Settlement Agreement | five years ||| this five year ||| August 18, 2015 | Magistrate | Grewal ||| $4.8 million ||| November 6 |||  ||| May 27, 2016 ||| June 6, 2016 | Beth Labson Freeman ||| 2017 | 2018 ||| March 19, 2018 |||  ||| March 22, 2018 ||| ECF ||| the following months ||| March 6, 2020 [SUMMARY] On May 23, 2013, prisoners and recently released prisoners from Monterey County Jail filed this lawsuit in the U.S. District Court for the Northern District of California. The plaintiffs sued the County of Monterey and the California Forensic Medical Group (CFMG) under 42 U.S.C. § 1983 and state law. The plaintiffs, represented by attorneys from the American Civil Liberties Union (ACLU) of Northern California, the ACLU National Prison Project, the Monterey Public Defender, and private attorneys, asked for declaratory and injunctive relief.  Specifically, the plaintiffs claimed that the conditions in the Monterey County Jail (the "Jail") violated federal and state law due to failures to protect prisoners from violence, provide adequate medical and mental health care, and provide reasonable accommodations to prisoners with disabilities. 

On April 25, 2015, the County and Sheriff's Office filed a motion to dismiss, and the CFMG filed a motion to dismiss on May 2, 2014. The District Court (Magistrate Judge Paul Singh Grewal) denied both motions on September 29, 2014. 2014 WL 4843945 (N.D. Cal. 2014). First, the Court found that the plaintiffs had standing even if they were no longer incarcerated, due to the short average length of stay of prisoners in the putative class and the slow speed of legal action. Second, the Court addressed the issue of whether a private provider of jail medical facilities are "services" that can face scrutiny under Title III of the Americans with Disabilities Act (ADA). The Court found that the plaintiffs sufficiently pleaded that CFMG was subject to Title III of the ADA because it operates a "professional office of a health care provider, hospital, or other service establishment" within the jail.  The Court further explained that, although the "place" of a jail fell under Title II of the ADA as a public entity, courts had consistently found that Title III applied to "places of public accommodation" within places that normally don't fit under Title III either because they are owned by or operated for other purposes by a public entity.

On April 29, 2014, the plaintiffs filed a motion seeking certification of a prisoner class consisting of all current and future prisoners in the jail, and a subclass of prisoners with disabilities, consisting of all current and future prisoners who have a qualifying disability.  Then, on August 26, 2014, the plaintiffs filed a motion for preliminary injunction, requesting that the Court order defendants to fix six of the conditions at the Jail that placed the plaintiffs and class members at risk of serious injury and death. 

On January 29, 2015, Magistrate Judge Grewal certified the class. 2015 WL 399975 (N.D. Cal. 2015). Then on April 14, 2015, Magistrate Judge Grewal also granted the plaintiff's motion for a preliminary injunction. 

On May 11, 2015, the parties settled the case. The jail agreed to set new standards for the medical and mental health care provided to inmates and to expand accessibility for prisoners with disabilities. The parties agreed to retain experts as neutral monitors for a limited term of oversight. The parties planned for the jail to come into compliance with the Settlement Agreement within five years, unless they moved for an extension. The court was to retain jurisdiction over the settlement for this five year period.

On August 18, 2015, Magistrate Judge Grewal approved the settlement. Litigation continued over attorneys' fees as the settlement agreement only set upper limits for attorneys' fees of $4.8 million. On November 6, the parties stipulated to an agreement of how they would address the issue of interest on attorneys' fees.

The parties then litigated the implementation plan. After briefing and hearings, the court approved an implementation plan on May 27, 2016. 

On June 6, 2016, the case was reassigned to Judge Beth Labson Freeman.

In 2017 and 2018, there was some litigation over compliance issues. On March 19, 2018, the plaintiffs proposed an order regarding the use of telepsychiatry by the defendants, as per the settlement agreement. The court had instructed the parties that the defendants needed to have standards for when they could deviate from the typical in-person encounter and instead use “telemedicine or telepsychiatry.” After counsel met and decided on these issues, plaintiffs’ proposed order was signed and ordered by the judge on March 22, 2018. (ECF 632). Over the following months, parties handled various settlement agreement enforcement issues, such as attorneys fees and costs, the production of medical records, and neutral monitors. The docket remains active with these issues as of March 6, 2020. 
