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Hernandez v. County of Monterey

United States District Court, N.D. California, San Jose Division

January 29, 2015

JESSE HERNANDEZ et al., Plaintiffs,
COUNTY OF MONTEREY, et al., Defendants.


PAUL S. GREWAL, Magistrate Judge.

On any given day, approximately 1000 adult men and women find themselves in the Monterey County Jail.[1] This is a case about their custody and care at the hands of Defendants County of Monterey, Monterey County Sheriff's Office and California Forensic Medical Group, Inc.

Plaintiffs are current or former inmates who allege that a variety of jail policies and practices regarding inmate safety, medical care, mental health care and disabilities expose them to a substantial risk of serious harm to which Defendants are deliberately indifferent. The inmates seek declaratory and injunctive relief from the alleged constitutional violations.

After reviewing the substantial record compiled by the parties, which includes four neutral expert reports, two outside expert reports commissioned at the County's request, declarations from two experts retained by Plaintiffs and various inmates, the court finds that Plaintiffs meet the standard for class certification set forth in Federal Rule of Civil Procedure 23 and as construed by the Ninth Circuit. It therefore certifies a class of inmates challenging jail safety and health care policies and practices, and a subclass of inmates challenging jail disability policies and practices.[2]


The United States and California Constitutions require California's counties to provide for the safety and well-being of inmates housed in county jails.[3] To meet these obligations, as well as those imposed by federal and state statutes, [4] Monterey County has promulgated extensive policies governing health care and conditions of confinement. These policies apply to all of the inmates in its custody and all of its staff throughout its main jail in Salinas.

Since 1984, Monterey County has contracted with CFMG, a private health care provider, to provide medical, dental and mental-health care services to inmates. Under the terms of its contract, CFMG agreed to follow all County policies and to work with the County to implement additional policies governing such matters as health care staffing, access to prescriptions, emergency care, and mental health services. Monterey County regularly monitors CFMG's compliance with these policies.

Twenty-one current or former inmates brought this suit. Plaintiffs allege a variety of jail policies and practices "fail to keep [inmates] safe from violence, to deliver adequate medical and mental health care or to provide required assistance to [inmates] with disabilities."[5] Plaintiffs support these general allegations with detailed references to dozens of specific jail policies and practices, including inadequate staffing, training, space, inmate classification, intake health screening, care scheduling, medication, infection control, emergency response and suicidal inmate segregation.

Plaintiffs also claim that inmates are routinely denied reasonable accommodation for their disabilities. They allege, for example, that inmates who cannot climb stairs spend months without going outside because the exercise yard can only be accessed up a flight of stairs. Inmates who use sign language to communicate are not provided interpreters for the intake process, doctor's appointments and disciplinary hearings. Defendants are further alleged not to maintain any central list, electronic or otherwise, of inmates with disabilities and the accommodations they require. The result, say Plaintiffs, is that "because Defendants completely lack policies and practices for evacuating and communicating with [inmates] with disabilities in case of emergencies, including natural disasters and security incidents, [inmates] with disabilities are at increased risk of injury in such circumstances."[6]

With respect to all these claims, Plaintiffs allege that Defendants are aware of these constitutionally defective conditions and tolerate the resulting risk to which inmates are exposed. For example, Plaintiffs allege that in 2007, the County commissioned a third-party evaluation of the jail, which resulted in a June 19, 2007 report called "County of Monterey, Office of the Sheriff, Needs Assessment." The 2007 report concluded that "[t]he current combination of insufficient beds, an inadequate detention facility and understaffing has resulted in an almost untenable situation. In 2011, the County asked the third-party consultant to update the 2007 report to reflect amendments to state law and changes within the Sheriff's Office and the jail population. This updated report, dated December 30, 2011, reached the exact same, word-for-word conclusion: "The current combination of insufficient beds, an inadequate detention facility and understaffing has resulted in an almost untenable situation."[7]

Plaintiffs seek a declaration that Defendants are violating federal and state law and an injunction compelling Defendants to provide inmates with adequate protection from violence from other inmates, to provide inmates with adequate medical and mental health care, and to provide reasonable accommodations to and cease discriminating against inmates with disabilities.[8]


Shortly after filing their second amended complaint, [9] Plaintiffs moved for class certification. In addition to the detailed allegations of their complaint, Plaintiffs cite thousands of pages of documents that they secured by investigation and from public records requests, expert reports by four neutral specialists in prison medical care and conditions of confinement retained by mutual agreement of the parties, two reports on conditions at the jail commissioned by the County in 2007 and 2011, two declarations from experts they retained and their own declarations. The investigation and records requests produced (1) more than one hundred interviews of former and current inmates in the jail; (2) tens of thousands of pages of medical and custody records for current and former inmates in the jail; (3) documents produced by the County in response to three requests for information pursuant to the California Public Records Act and (4) hundreds of Sheriff's Office reports of incidents that occurred in the jail.

In their responses, Defendants submit declarations from attorneys, jail staff and medical experts, news articles, depositions, declarations, grievance and medical records of Plaintiffs, board orders for improvements and a letter from Monterey County Public Defender James Egar praising CFMG's work.[10] They claim conditions have improved, despite difficulties due to inmate realignment resulting from the enactment of Assembly Bill 109.[11]


The 135-page second amended complaint in this case sets out detailed factual allegations concerning the existence of jail policies and practices impacting the safety, health and disability accommodations of all inmates. According to Plaintiffs, these policies and practices expose all jail inmates to a substantial risk of harm.

Regarding their safety claims, Plaintiffs allege the following policies and practices: (1) insufficient custody staffing; (2) inadequate inmate classification system; (3) dangerous and inadequate jail facilities that are difficult to safely monitor; (4) housing more inmates in the jail than the jail's rated capacity and (5) inadequate training of custody staff.

Regarding their medical care claims, Plaintiffs allege the following policies and practices: (1) failure to provide timely access to health care; (2) insufficient custody staffing to ensure inmates receive necessary health care; (3) insufficient health care staff to ensure the timely and appropriate treatment of inmates' serious medical needs; (4) failure to adequately supervise health care staff; (5) failure to provide adequate, clean and confidential clinical spaces;(6) inadequate or non-existent written policies for intake health screening, health care requests, emergency response, continuity of medications, care for inmates with chronic illness, housing of inmates in segregation, care for developmentally disabled inmates, care for patients on dialysis, care for elderly patients, care for patients with dementia, care for patients requiring wheelchairs, care for inmates who have physical disabilities, housing for pregnant women, persons with communicable diseases, the mentally ill and the terminally ill; (7) failure to adequately identify inmates in need of health care, including inmates with chronic illness, during the intake process and thereafter; (8) use of inadequately trained custody staff to conduct intake health screening; (9) failure to provide adequate treatment to inmates with chronic diseases; (10) failure to provide adequate treatment to inmates with infectious diseases; (11) failure to provide timely and appropriately treatment by outside medical providers and specialists when necessary; (12) failure to provide timely and adequate treatment for inmates experiencing withdrawal; (13) failure to provide necessary medication and medical devices; (14) failure to timely and adequately respond to requests for health care; (15) failure to provide a confidential means for inmates to request health care; (16) failure to timely and adequately respond to health care emergencies; (17) failure to provide appropriate and timely post-operative and post-hospital discharge care; (18) failure to maintain adequate health care records; (17) failure to operate an adequate quality improvement program; (18) failure to adequately train medical and custody staff regarding the provision of health care to inmates and (19) failure to provide timely and appropriate dental care.

Regarding their mental health claims, Plaintiffs allege the following policies and practices: (1) failure to provide mentally ill inmates medically necessary mental health treatment such as psychotropic medication, therapy and inpatient treatment; (2) failure to provide inmates access to timely and appropriate inpatient mental health care; (3) inadequate suicide prevention policies and practices; (4) failure to provide suicidal and self-harming inmates adequate mental health care; (5) housing inmates with mental illness in administrative segregation because they have mental illnesses; (6) failure to provide a clean, safe and therapeutic location for the housing of inmates at risk for suicide; (7) inappropriate use of safety cells, restraints and restraint chairs; (8) failure to adequately monitor inmates at risk of suicide and (9) failure to eliminate suicide hazards in administrative segregation.

Regarding their disability accommodation claims, Plaintiffs allege the following policies and practices: (1) failure to identify and track inmates with disabilities; (2) failure to identify and track the accommodations that inmates with disabilities require; (3) failure to ensure that inmates with disabilities receive and retain needed assistive devices and auxiliary aids; (4) failure to ensure that inmates with disabilities that require accommodations in housing receive and retain appropriate housing assignments; (5) housing inmates with disabilities in administrative segregation, where inmates have less access to programs, services, activities and privileges; (6) failure to provide sufficient housing for inmates in wheelchairs; (7) failure to ensure that each program, service or activity offered to inmates in the jail, when viewed in its entirety, is readily accessible to and usable by individuals with disabilities; (8) failure to ensure that each part of the facilities at the jail altered after January 26, 1992, in a manner that affects or could affect the usability of all or part of the jail, complies with relevant accessibility standards, including the Uniform Federal Accessibility Standards, the Americans with Disabilities Act Accessibility Guidelines and the 2010 Americans with Disability Act Standard for Accessible Design; (9) failure to provide effective communication to inmates with disabilities that affect communication; (10) failure to adequately take disabilities into account in the disciplinary process; (11) failure to provide sign language interpreters to inmates who use sign language as their primary method of communication; (12) failure to ensure the safe evacuation of inmates with disabilities in an emergency and (13) failure to operate an effective and prompt grievance system for inmates to request accommodations for their disabilities.

For each of these alleged policies and practices, the second amended complaint sets out multiple paragraphs or pages of particularized factual allegations. For example, regarding Defendants' alleged safety policies and practices, Plaintiffs allege roughly 150 separate instances of violence were reported from (presumably January) 2011 to September 2012, occurring in nearly every area of the jail, and most requiring medical attention at the jail or the local hospital. Weapons such as shanks and Tomahawks are "readily available" in the jail.[12] Surveillance is inadequate, as many assailants remain unidentified, most cameras do not have recording capabilities, and the jail's understaffing means officers are rarely positioned to visually identify the attackers. Reporting is inadequate for fear of retaliation given the lax conditions. Undertraining of staff means inadequate intervention and confiscation of weapons. Plaintiffs say that despite incident reports and the 2007 and 2011 Jail Needs Assessments, Defendants lack policies and practices for regularly reviewing incident reports to identify systemic problems.[13]

As another example, regarding the alleged medical care policies and practices, Plaintiffs claim that "[t]hough Defendants have a policy that all [inmates] are supposed to be seen by medical staff on the next available sick call day after submitting a sick call slip, in practice, Defendants use Licensed Vocational Nurses (LVNs) to screen the sick call slips and determine whether the [inmate] should actually be seen by medical or mental health care staff. No standardized protocols exist to guide LVNs' exercise of discretion in determining when [inmates] should receive a face-to-face appointment with a nurse or other medical or mental health care clinician."[14] Plaintiffs further allege that "[c]onsequently, LVNs arbitrarily determine whether the content of a sick call slip, often written by [an inmate] who can barely read or write, warrants an appointment with a nurse or physician." Plaintiffs also detail the harm that members of the proposed class suffer as a result of these policies.[15]

As still another example of Plaintiffs' medical care claims, Plaintiffs allege that "Defendants have failed to implement appropriate triage procedures to ensure that non-emergency medical needs are attended to before they develop into emergencies." According to the complaint, Methicillin-resistant Staphylococcus aureus (commonly known as "staph") infections are frequently reported at the jail. Many inmates report filing multiple sick call slips for emerging and beginning staph-related wounds, but are not seen until their wounds develop into serious and emergency conditions requiring intense treatment.[16] The complaint explains that "one [inmate] was not seen for a staph-infection-caused wound until it developed into cellulitis and a necrotizing soft tissue infection, requiring intensive and invasive treatment. Another [inmate] had a staph infection-caused abscess that required the insertion of a surgical drain into the wound, which Defendants then failed to properly monitor and cleanse following the procedure."[17]

Yet another example of Plaintiffs' medical care claims concern Defendants' alleged policies and practices for medical screening. Plaintiffs allege "Defendants fail to adequately train custody and medical staff in how to timely and appropriately identify medical problems during the screening and intake process. When [an inmate] is newly booked into the jail, medical staff may not even play a role in screening the [inmate]."[18] Plaintiffs further allege that "[c]ustody staff (who are not sufficiently trained to identify medical needs) complete a brief one-page health screening form during a cursory interview with the [inmate] in a non-confidential space. Medical staff only evaluate [inmates] at intake if the custody staff note a problem on the screening form. The screening form used by custody fails to capture critical and basic information necessary to identify [inmates] in need of medical attention."[19]

Regarding Defendants' alleged mental health policies and practices, in addition to intake and tracking problems, Plaintiffs allege that "Defendants sometimes place [inmates] who arrive at the jail and who are prescribed psychotropic medications on what Defendants call a detoxification treatment. The detoxification treatment involves refusing, for up to 90 days, to provide [inmates] with the psychotropic medications they were taking before they were booked into the Jail.... [Inmates] placed on the detoxification treatment and removed from psychotropic medications experience unnecessary pain and increases in psychiatric symptoms including paranoia, hallucinations, and suicidality.... They are also at heightened risk of failing to respond to medications once they are restarted."[20] As one example, Plaintiff Murphy's January 18, 2013 Intake Health Screening Form (completed by custody staff) and his Intake Triage Assessment form (completed by medical staff of CFMG) indicated self-reported mental health problems. Further, medical records in CFMG's possession from a prior term Murphy had spent in the jail indicated he suffered from mental illness and had received psychiatric medications. Only four days after intake did Murphy have an appointment with a Licensed Psychiatric Technician who lacked authority to prescribe treatment or medication. Murphy submitted several sick slips from that day on, stating: "need psych meds - seeing and hearing things"; "need psych meds or psych hospital, Attn: head psych please"; "I take varies physch medication... for hearing voices and seeing demons coming out of the walls driving me crazy, can't sleep or eat right at all. Ive been trying to see a physch doctor, PLEASE help if possible"; "placing my life in serious danger and possible death after many attempts to receive my medications during and after intake. I'm a disabled vet who served my country with honorable discharge and should not be treated like trash over a officers attitude." On January 28, 2013 he informed staff that he was hearing demonic voices that were telling him to kill himself. Consequently, Defendants placed Murphy in a rubber room, from which he was not released until three days later. Murphy was not seen by mental health care staff with authority to prescribe treatment until January 29, 2013.

As another example, Plaintiffs allege that Defendants house inmates with mental illness in administrative segregation units in such a way that inmates suffer substantial risk of serious harm.[21] Plaintiffs describe how "Jessie Crow and Daniel Lariviere committed suicide by hanging in administrative segregation in 2010 and 2011 respectively.... [I]f Defendants had conducted safety checks every half hour at intermittent and unpredictable times, they may have been able to prevent Mr. Crow or Mr. Lariviere from committing suicide."[22]

Plaintiffs allege inmates with mental illnesses are punished and discriminated against. For example, after engaging in self-harming behavior, Plaintiff Mefford has been placed on suicide watch and put in an "unsanitary" rubber room at least five separate times for varying lengths of time since entering the jail. Mefford "was able to continue engaging in self-harming behavior inside the rubber room, by banging his head repeatedly against the door until he was bleeding."[23] Custody staff responded by placing Mefford in a restraint chair. Mefford freed himself from the restraint chair at least once, and began again hurting himself. "Custody staff has routinely failed to conduct safety checks twice every thirty minutes as required by the Jail's own policies. The Jail has also failed to provide him with adequate food and water during these periods of time. Plaintiff MEFFORD has informed the Jail medical and custody staff repeatedly that sensory deprivation and particularly a lack of light make his anxiety and other psychiatric conditions much worse. He has also stated a reluctance to express his true level of suicidality to staff because of fear of being placed in a rubber room. Despite this, custody staff continues to place him in rubber rooms."[24] These experiences show inadequate training, identification, tracking, treatment, suicide-watch, facilities, housing, prescription, monitoring, evaluation, records, as well as apparent discrimination and punishment of inmates with mental illnesses.[25]

Regarding Defendants' alleged disabilities accommodation policies and practices, Plaintiffs claim Defendants' failures to accurately identify new inmates' disabilities and needed accommodations during the intake process result in the denial of accommodations mandated by the ADA, Rehabilitation Act, and California disability rights law, placing inmates at risk of discrimination, injury, and exploitation. For example, during booking into the jail in August 2012 and again in December 2012, custody staff completed Monterey County Sheriff's Office Intake Health Screening forms for Plaintiff Yancey. Despite Yancey's complete hearing impairment, staff did not indicate on the forms that he had a hearing disability. Accordingly, staff throughout the jail were unable to identify Yancey as hearing impaired, and he received no accommodations for his disability.[26] Yancey was not provided with a sign language interpreter for his communications with jail staff, including at medical appointments, at a disciplinary hearing, during the booking and classification process[27] or for church services.[28] Yancey submitted a grievance, requesting accommodations relating to his hearing impairment, but he received no response.[29]

Another inmate who was booked into the jail in January 2012 with a mobility impairment required a cane to help him safely ambulate and access his housing unit and required safe access to a bed. During the intake process, the jail failed to identify him as having a mobility impairment requiring those accommodations; he was not provided with a cane and he was placed in the only available bed in his housing unit on the upper bunk of a triple bunk. Without a cane, the inmate fell and injured himself on a number of occasions. He slept on the floor because it was too difficult to access his bunk.[30]

The sum total of all this is that Plaintiffs allege a variety of jail policies and practices applying to all inmates and staff dealing with safety, health care and disabilities, and that these policies and practices expose all members of ...

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