Banks v. Booth

ATTACHMENT B

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 1 of 51

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLUMBIA

EDWARD BANKS, ef al.,

Plaintiffs,

Vv. No. 1:20-cv-849 (CKK)

QUINCY BOOTH, in his official capacity

as Director of the District of Columbia

Department of Corrections, ef al.,

Defendants.

REPORT SUBMITTED BY AMICUS CURIAE PURSUANT

TO SEPTEMBER 16, 2020 ORDER

(Table of Contents, Report Narrative, Index to Exhibits, Appendix A Exhibits 1A — 6 and

Appendix B Exhibit 1)

December 11, 2020

IL.

IIL.

IV.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 2 of 51

TABLE OF CONTENTS

INTRODUCTION 000i ccc ccc cece cece ceteeeeceteeeestsecsetseetseeseeseetieeseetseeeenes

METHODOLOGY 000... e cece cee tects cee ceseecesetestesesteetessetetnteteeseees

BACKGROUND 0.00.00 cccccee cece tc ceeetettee testes eeesceseeeseeeesseetsesieesseeseeseetsenseeses

A. Population 2.00. c een cree e cnet ene ebne ents eectetieeetitectieetieeieeetieee

B. Single versus Double Celling....00.0000cccccecccc cece cece ese ettttstetseeteeneey

C. Operations in Response to the Pandemic.........0..000cccccccccecceceeceteeteseetteeees

D. Staffing. ccc ce een ee ieee tse cnt ebbeeeteseceetnteniseecieeseetteesieenes 10

E. Support from the DOH... ccc ccc cece eee tent ces teesseeteeeetsteneenies 11

FINDINGS 0000.0 ce cece ee cece eens ceeeneeeseeteeseeeseeeeeseeeseetsenesteeteeteeseeeenaes 11

Requirement Ome ooo... ccc cece ete eee e tei te ttt teetteeeteeenieeees 11

A. The Sick Call Process .......0ccccccccccccecceececetecetseeeecsesseeteeeseeseetseseenes 12

B. Sick Call Data oo... eee cee ce cteeesseeseeteeeseetseeieeteeneeteeniees 16

1. Sick Call at the CDF o.....00 occ cece eects ettettetttetteestetiees 18

Table One: Summary of Length of Time to be Seen By A

Provider At CDF oo......0cccccccccccecce ete eee cce cette eseeseeteettenteenieens 20

2. Sick Call at the CTF o.....0ccccccccecc cee eet ee teeteeeteeteeteetteeiees 20

Table Two: Summary of Length of Time to be Seen By A

Provider At CTF o....0.cccccccccccccceeeeeseeseeseetsetiettetteeteeteeseeeiees 21

C. Conclusion, Requirement Ome... ccc ect cc ete etteetteetteenes 22

Requirement TW0...00.00000.000000cccc ccc ccc eect e tence eee ee ents te tebe teetteenteeenieeens 23

A. Efforts to Promote Social Distancing.......0000000.o occ ccc eceeeteeteenees 23

B. Conclusion, Requirement TWo 0.0.0.0... ccc cece cece cee teteteesetteeeites 27

Requirement Three .....0.0..0000..0000000ccccccccc ccc cece eee tee eeteeeeeeeeessteetteesesieees 28

A. The Environmental Health and Safety Vendor and

Contract Cleaning Services ......00.000ccccc ccc cee cees cents ettetetseeeeenteeenieees 28

B. Hiring Registered Sanitarian ......00.000.00 ccc ccc cc eee tee eeteeeseeteenees 31

C. Access to Cleaning Materials and Related Training.......0..0000.0000... 33

Requirement Four ......0000.00000000 ccc cece cee e ete ee eet teeeteteetteeetseenneeens 34

Requirement Five ......00000000000 cocci ccc cece eee e eee e tei te tet teetteentseenneeens 35

A. Attorney-Initiated Legal Calls 00.0000 ceccc cet ceeeenetteetseenes 35

B. Inmate-Initiated Legal Calls 00.00.00 cete ete ceteeneetteeeniees 38

C. Conclusion, Requirement Five... cece cece eee ceteetsteesseceeenees 39

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 3 of 51

Requirement Six... cece eect ee eee ite te bese ttteeetteeeteeenneeees 39

A. Testing of Newly Admitted Inmates ......000000000cccc cece eceeteereees 40

B. Testing of Inmates Transferred to Saint Elizabeths Hospital ................. 4]

C. Testing of Inmates Transferred to Federal Correctional Facilities ......... 42

D. Testing of Cellmates of Inmates Who Test Positive........000.000..0cce 43

E. Testing of Inmates Who Report COVID-19 Symptoms ...........0...00.00... 44

F. Timeliness of Testing Results 00.00.0000 ccc se ccee tee ceeetettteetees 46

G. Conclusion, Requirement S1xX oo... ccc cee ttee ce teeneetteeetseenes 46

V. CONCLUSION 0.00.00 ee cee e tees eteeeeeteteeceeeeseeiestistieteeteteteeeniees AT

Index to Exhibits ...0..00.0 ccc cece ete ce cece seeeseeseeteeteesteetseesseseetsestsestetseeteeneey Index-1

APPENDIX A

Exhibits IA — 6

APPENDIX B

App. B, Ex. 1

il

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 4 of 51

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLUMBIA

EDWARD BANKS, ef al.,

Plaintiffs,

Vv. No. 1:20-cv-849 (CKK)

QUINCY BOOTH, in his official capacity

as Director of the District of Columbia

Department of Corrections, ef al.,

Defendants.

REPORT SUBMITTED BY AMICUS CURIAE PURSUANT

TO SEPTEMBER 16, 2020 ORDER

Pursuant to the September 1 , 2020 Order issued in the above-captioned matter, (D t.

Nos. 12 , 12 ),'a , traceM. opesand Mar ordan,” submit the follo in report for

consideration by the Court and the Parties.

1 The Court amended the initial order issued on September 1 , 2020 to clarify the date by hich a ere

re uired to be intheirrevie . The amended order re uired a to provide the Parties and the Court ith an oral

report no later than October 1, 2020 anda_ ritten report no later than November 1 , 2020. Thereafter, on October

2 , 2020 a Second Amended Order Appointin Amicus as entered (D t No. 129), hich as identical in all

respects to the prior order e cept, upon re uest of the a and ith the consent of the Parties, it chan ed the date

of the oral report from October 1,2020,( hich asa Saturday), to November 9, 2020, and the date for the _ritten

report from November 1 , 2020 to November 20, 2020. (D t No. 129). The Court ranted a consent motion to

further enlar ¢ the filin deadline forthe ritten report to December 11, 2020, (D t. No. 1 2), to afford a

sufficient time to complete additional unanticipated assessment activities. (D t. No. 1_ ).

> err M. . rt I a,C.A.No. 1 19-8 (D.C. Super. Ct.) is a class action la suit related to the

conditions of confinement and treatment in the District of Columbia s uvenile ustice system. race M. opes has

served as the court-appointed Special Arbiter in this la suitand Mar ordanhas or edandcollaborated ith her

on monitorin and reportin onthe District overnment s compliance ith the remedial orders issued in the case.

The plaintiff class is represented by multiple attorneys, includin counsel from the District of Columbia Public

Defender Service and the District of Columbia defendants are represented by counsel from the District of

Columbia s Office of the Attorney eneral. Pursuant to a Settlement A reement approved by the Superior Court in

uly 2020, durin ahearin conducted on December 1, 2020, the presidin ud ein err M. indicated that he found

the conditions established by the Settlement A reement had been satisfied and that he ould be issuin a

termination order later in the month. One of the conditions established by the Settlement A reement re uired the

District of Columbia s Mayor to issue a Mayoral Order establishin the Office of Independent uvenile ustice

acilities Oversi ht. A second condition re uired the Mayor to appoint Mar ordan as the E ecutive Director of

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 5 of 51

I INTRODUCTION

This is the third report submitted by a in this case. ere initially appointed

in an order issued on April 9, 2020, (D t No. 4 ), to provide specific information to the Court

re ardin medical services and environmental health and hy iene related toCO ID-19, the

disease caused by SARS-Co_ -2, the novel coronavirus, att o detention facilities operated by

the District of Columbia Department of Corrections ( DOC ), the Central Detention acility

( CD )and the Correctional Treatment acility( CT). Pursuant to that order, a

provided information to the Court and Parties durin an April 1 , 2020 teleconference and ina

ritten report submitted on April 18, 2020 (D t. No. 4 ). One day later, on April 19, 2020, the

Court issued an order rantin the Plaintiffs re uest fora Temporary Restrainin Order

( TRO )andre uirin the Defendants to ta e certain specified actions (D t. No. 48). Thereafter,

in an order issued on April 28, 2020 (D t. No. 2), a ere appointed for the second time, to

provide information to the Court re ardin certain matters related tothe TRO. ollo in

issuance of the April 28, 2020 order, a provided an oral report to the Court and Parties on

May 11, 2020, and submitted a ritten report on May 20, 2020 (D t. No. _ ).

On une 18, 2020, the Court issued a preliminary in unction in this case (D t. Nos. 99,

100). The preliminary in unction re uires the Defendants to ta e certain specified actions, hich

are described more fully in the ne t sections of this report, related to the follo in si conditions

of confinement: medical care social distancin environmental health and safety conditions in

isolation units access tole al calls and testin forCO ID-19. ere appointed for the

this oversi ht office. As re uired by the Settlement A reement, these Mayoral Orders ill become effective upon

the issuance of the termination order. At that time Mr. ordan ill become a District overnment employee, ith

uni ue authority and independence, for a three-year term sub ect to removal only for cause. The Court and counsel

for the Parties in the instant case, includin counsel for the United States, have been apprised of these circumstances.

In response, all counsel indicated that there are no ob ections to Mr. ordan s participation as an a in this

matter.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 6 of 51

third time on September 1 , 2020 (D t. Nos. 12 , 12 ), to provide information to the Court and

the Parties re ardin the Defendants compliance ith the une 18, 2020 preliminary in unction.

Pursuant to the September 1 , 2020 Order, a provided an oral report to the Court and

the Parties durin ahearin conducted by telephone on November 9, 2020. Durin that

proceedin , the Court re uested thatin their ritten report a address certain matters hich

ere not initially contemplated by the September 1 , 2020 Order, and also provide additional

details related to some of the matters that ere the sub ect of the November 9, 2020 oral report.

This report summari es a November 9, 2020 presentation and includes the

supplemental information a ere as ed to address. In addition, this report e plains the

methodolo y a relied upon to conduct their assessment, describes relevant bac round data

re ardin the facilities sub ect to the assessment, and presents updated information concernin

identified cases of CO ID-19 atboththe CD andCT .

The Defendants have continued to cooperate fully ith a re uests for information.

Asa _ eneral matter, DOC and contract staff at every level have made substantial efforts to

respond to a re uests promptly. reco ni e and appreciate the efforts the Defendants

have continued to ma e to facilitate their revie

Il METHODOLO Y

ollo in the issuance of the September 1 , 2020 order, a conducted unannounced

and unescorted site visits on multiple shifts on October 22,2 ,29, November 1 and December

2, 2020 at the CD , and on October 2 and November 2, 2020 at the CT . Durin the course of

these site visits, a visited eneral population, ma imum and medium security housin units

as ell ashousin units desi nated for enhanced monitorin , inta e, special mana ement, and

forinmates ith mental health needs. A total of 18 housin units ere visited, some on multiple

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 7 of 51

occasions on different days or shifts (NO-1, SO-1, NO- , SO- , NW-2, NW- , SW- , SW-2,

SO-2, C2A, C4C, SMUB, E2A, E4A, E4B, D A, D4B, C2B). Observations in housin units

included cells, dayrooms and case mana er s offices. At both facilities, medical units,

administrative offices, and visitor entry areas ere visited. In addition, the case mana ement

suite, here many le al calls are conducted, as_ ell as the videoconferencin and visitation areas

that are used at the CD for attorney-client videoconferences and meetin s, ere visited.

Structured in-person and or telephone intervie s ere conducted ith members of the

DOC e ecutive mana ement team, includin the DOC Deputy Directors of Administration,

Operations, Pro rams and Case Mana ement, and Professional Development and Colle e and

Career Readiness the Audit and Compliance Mana er the Sanitation Inspection Specialist the

DOC Medical Director members of the Correctional Health Pro ram at Unity Health Care, Inc.

( Unity ), includin the Medical Director, Dental Director, Mental Health Director, ead

Dentist, Director of Nursin , and other health care staff the CD and CT Warden and the

Deputy Wardens assi ned to each facility maintenance supervisors and staff records office

staff and do ens of correctional officers and supervisory correctional staff assi ned to various

posts throu hout the facilities. In-person intervie s ere also conducted ith appro imately 80

inmates at both facilities. At the re uest of the DOC Medical Director, a also intervie ed an

epidemiolo ist under contract ith the D.C. Department of Health ( DOH ), assi ned to provide

support to the DOC and several other District a encies durin the pandemic.*

In addition to the information collected durin site visits and from intervie s, a

re uested and continued to receive access from the DOC to the electronic health records

Unity provides medical services on a contractual basis to inmates at the CD and CT .

4 Atthe re uest of the DOH eneral Counsel, this intervie as conducted ith counsel present. It as the only

intervie conducted durin the assessment in the presence of counsel.

4

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 8 of 51

( EHR ) of inmates confined at the CD andCT . Revie and analysis of samples from these

records has been conducted and the results are presented herein. The follo in data for both

facilities ere also obtained from the DOC or Unity and analy ed:

e Daily census data, includin inmate housin assi nments for the period une 18, 2020 to

October 1, 2020

e Data related to admissions and len th of stay for the period une 18, 2020 to October 1,

2020

Data related to releases and transfers for the period une 18, 2020 to October 1, 2020

Date related to inmate le al status for the period une 18, 2020 to October 1, 2020

Sic call re uests and related lo s for the period une 18, 2020 to October 1, 2020

Data related to all CO ID-19 tests conducted on inmates throu h December 1, 2020 and

Data related to DOC correctional staffin levels.

I BAC ROUND

Since the issuance of a May 2020 report, there have been a number of chan es in

population levels, housin practices, housin unit operations, staffin levels, and the support the

DOC receives from the DOH. Each of these topics is addressed belo

A Pop lation

On une 18, 2020, the day the Court issued the preliminary in unction, the combined

population of the CD andthe CT as1,249 inmates. The Defendants subse uently reported

to the Court that as of une 29, 2020, the combined population of the CD andCT as 1,2 1.

Over the four-and-a-half months bet een the issuance of the preliminary in unction and October

The team a assembled for this sta e of their or includedt o additional members. The ma ority of case

record revie s ere conducted by anet Maher, an attorney ho hase tensive e perience in or in in institutional

and healthcare settin s. Ms. Maher headed the Office of Corporation Counsel s Mental Health Division from 1992

to 2000, or edas Deputy eneral Counsel and Chief of Staff for the District s Child and amily Services A ency

from 2000 to 200 and as DO Compliance Officer at Saint Eli abeths Hospital from 200 to 2014. rom 201 to

her retirement in 201 , she headed the Hospital s Performance Improvement Department. She also has provided

consultative services to the Maryland and Pennsylvania behavioral health systems and to the Office of the Special

Arbiterin err Mo. ofr t I a,C.A. No. 1 19-8 (D.C. Super Ct.) Case records ere also revie ed by

ulia Cade, a senior parale al ith substantial e perience in similar institutional conte ts.

Durin the November 9, 2020 hearin , a incorrectly reported that the lo est population count bet een une

18, 2020 and October 1,2020 as 1,2 4. Ho ever, upon further revie , 1,248 inmates on une 18, 2020, the day

the preliminary in unction as issued, represented the lo est population count for the period.

Notice of Compliance ith the Court s Preliminary In unction(D t. No. 101) at .

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 9 of 51

1, 2020, the population of the to facilities increased by 19 percent to 1,48 inmates. Based on

an analysis of data submitted by the Defendants, this as driven primarily by increases in the

number of inmates confined on pretrial felony char es and to a lesser e tent by increases in the

number of parole violators and pretrial misdemeanants confined at the CD andtheCT °

Because population increases in secure facilities are driven by either increases in the

number of admissions, increases in the amount of time admitted inmates remain incarcerated, or

a combination of thet 0, a analy ed admission and len th of stay trends of inmates housed

atthe CD andthe CT , by le al status. The analysis revealed that after une 18, 2020,

admission rates increased each month throu h September 2020, then decreased some hat in

October 2020.’ There ere increases in admission rates for all three cohorts (.e., pretrial felons,

parole violators, and pretrial misdemeanants) that drove the population increase. _ or pretrial

felons, the number of admissions per month as si nificantly hi herin Au ust, September, and

October 2020 than in the second half of une and in uly 2020.'° Amon parole violators, after

relatively fe admissions in the second half of une, admissions increasedin uly and to a lesser

e tentin Au ust, but then nearly doubled bet een Au ust and September from to 118, before

droppin some hatin Octoberto8 .'' inally, amon pretrial misdemeanants, there ere

8 E .1A,Chart, Combined Population of CD and CT ,by Day and e al Status, une 18- October 1, 2020

E . 1B, Table, Combined Population of CD and CT , by Statusand Day, une 18- October 1, 2020. Durin

this period, the population of pretrial felons increased by 1 inmates,from48 to 4 the population of parole

violators increased by inmates, from 88 to 1 1 and the population of pretrial misdemeanants increased by 8

inmates, from 8 to 10 . The Appendi to this report is divided into t o parts. Appendi A hereinafter App. A

contains the e hibits that are cited in this report. Some of the e hibits in App. A have been redacted, as appropriate,

for filin in the public record. The updated CDC uidelines are contained in Appendi B_ hereinafter App.

B . Unless desi nated by a citation to App. B, all citations to the e hibits included in the Appendi refer to App.

A.

° E .1C, Table, Admissionto CD and CT , by Status and Month, une 18, 2020 - October 1, 2020. Monthly

admissions in Au ust ere2 percent hi her than in uly, and monthly admissions in September ere 21 percent

hi her than Au ust. Althou h admissions dropped by 1 percent durin October relative to the prior month,

admission levels ere still ht her than uly and Au ust.

10

04

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 10 of 51

increases in admissions in Au ust and September before admissions dropped some hat in

October.”

The avera elen thof stay amon all inmates housed at the CD and CT increased

bet een une 18 and October 1, 2020, albeit only sli htly, by appro imately four percent.'

Amon the three cohorts that primarily accounted for the increases in population, the chan es in

len ths of stay varied. The avera elen th of stay amon pretrial felons increased by

appro imately ei ht percent bet een une 18 and October 1, 2020. or pretrial misdemeanants,

the avera elen th of stay increased by substantially more over the same period, appro imately

1 percent, from 4 daysto days. Incontrast,amon parole violators the avera elen th of

stay dropped by appro imately 28 percent over the same period.

B_ Sin levers s Do ble Cellin

also analy ed sin le versus double cellin practices at each facility durin the

period une 18 to October 1, 2020. Asa previously reported, the CD contains 18 housin

units, most ith 80 cells.‘4 Over the period revie ed, the CDs population ran ed from alo

of 819 inmates to a hi hof 1,0 9 inmates. While there are over 1, 00 cells at the CD , over the

period analy ed the avera e daily percenta e of inmates housed in sin le cells as8 percent

(.e., 1 percent of inmates had cellmates).

The double cellin practices atthe CD ere at least in part attributable to closed

housin units and cells on open housin units that ere ta en out of service due to maintenance

issues. Durin a site visits in October and early November 2020, five housin units ere

12 d.

13 E .1D, Table, Avera e en thof Stay of Inmates Housed atCD and CT , by Status and Month, une 18,

2020 - October 1, 2020.

4 ee e rt tted rae ratt rl , et rder, filed May 20, 2020

hereinafter a, e rt at4- fora more complete description of the CD .

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 11 of 51

closed, but durin a most recent site visit to the CD on December 2, 2020, only t o

housin units ere closed: NO-2' and SE-1.' A observed numerous cells that ere

unoccupied on housin units ith double-celled inmates. Maintenance and correctional staff

reported that unoccupied cells ere out of service in some instances because the metal bun sin

the cells ere dama ed. ere told that in other instances the cells ere unoccupied

because of plumbin problems. CD staff reported thaton November 0, 2020, appro imately

4 cells on open housin units ere out of service. !

Atthe CD ,a additionally analy ed sin le versus double cellin practices in SO-2,

the Inta e unit. E cept forinmates ith acute mental health issues, ho are transferred to SO-

and omen, ho are admitted at the CT , the Defendants report that ne inta es are housed on

SO-2 until they are medically cleared follo in CO ID-19testin . Bet een une 18 and

October 1, 2020, the population of SO-2 ran ed from alo of 44 inmates toa hi h of 111

inmates. The avera e daily percenta e of inmates housed in sin le cells on that unit as

percent, lo erthan the percenta e of inmates housed on sin le cells on non-Inta e housin units.

Durin a December 2, 2020 site visit, the population of SO-2. as’. At that time,

inmates ere double celled (.e., occupyin 18 cells) hile 22 cells ere unoccupied.

Atthe CT , there are2 housin units, includin the infirmary.‘ Durin a most

recent site visit to the CT on November 2, 2020, seven housin units ere closed. The CT

houses si nificantly fe erinmates than the CD . Bet een une 18 and October 1, 2020, the

1 NO-2 is desi nated to house inmates ho test positive forCO ID-19.

1 SE-1 as closed because it as bein used forstora e. CD mana ement reported that they are considerin

openin the housin unit as part of a plan to enable them to eventually open a second Inta e housin unit else here

in the facility.

1 attempted to obtain records reflectin the number of cells out of service daily ho ever, neither of thet o

CD administrative units that a ere told maintain these data (.e., Maintenance and Countboo ), ere able to

provide precise information.

18 ee May 20, 2020 Report at - fora more complete description of the CT facility.

8

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 12 of 51

facility population ran edfromalo of Oinmatestoahi hof4 4 inmates and durin that

period, it as rare for inmates to have a cellmate. Department of Corrections records indicate

that the avera e daily percenta e of inmates housed in sin le cells atthe CT durin this period

as 99 percent.

C Operations in Response to the Pandemic

Both the CD and CT have continued toimplement a2 -hour per day loc do n. In

effect, this means that most inmates remain in their cells e cept for one hour per day hen they

are released to sho er, ma e personal telephone calls, atch television, sit in the day room,

and or ma euse of small recreation areas ithin the housin units.!? Inmates assi ned to

se re ation units areloc eddo n for 24 hours per day on ee ends.

Be innin in the fall, the DOC has made tablets available to inmates that they can use in

their cells. There aret o types of tablets, one ith paid content that includes entertainment

options such as videos and ames and another ith free educational content. Ase plained

belo, the tablets include educational materials related to CO ID-19 and also can be used for

attorney-client communications. *°

Durin a prior site visits in April and May 2020, the DOC had desi nated

numerous housin units at both facilities as uarantine or isolation units. In contrast, durin site

visits conducted from late October to early December 2020, there ere no isolation or uarantine

housin units atthe CT duetothe absence of no norsuspected CO ID-19 cases. At the

CD , there as briefly an isolation unit in November after an inmate tested positive upon

admission and another housin unit as uarantined after a reported e posuretot o staff

1° Inmates in many CT housin units also spend out-of-cell time heatin meals in micro ave ovens.

20 ee ra2 and 8- 9.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 13 of 51

members ho tested positive for CO ID-19.7' In addition to uarantine and isolation units, the

DOC also established enhanced monitorin housin units at both facilities for inmates ho

return from in-person court appearances or face-to-face visits ith an attorney. Inmates housed

on enhanced monitorin units have their temperature chec ed by medical staff daily for up to a

14-day period.

D Staffin

previously reported that the lar e number of correctional staff unavailable for duty,

includin staff ho ere not available for reasons related to CO ID-19, hada si nificant impact

on facility operations. comparison of correctional staffin levels from mid-May to

staffin levels in early December 2020 indicates that the number of staff available to or

remains virtually unchan ed.

previously reported that as of May 9, 2020, the DOC had a total of 994 funded

correctional officer positions.” Of that total, 1 positions ere vacant, five percent. Moreover,

an additional 1 0 filled positions, 1 percent, ere encumbered by correctional officers ho

ere on unavailable for duty status. Thus, 22 percent of the funded correctional complement

as either vacant or not or in .

obtained updated data related to the correctional staffin complement from

December 2020. As of December 1, 2020, the DOC had a total of 1,014 funded correctional

positions, 20 more funded positions than on May 9, 2020. DOC mana ement reported that as of

December , 2020, 110 positions ere vacant, 11 percent, and an additional 1 _ staff in filled

*1 All of the inmates on the uarantined housin unit ere tested forCO ID-19 and none tested positive.

2 eeMa , e rtat -8 e rt tted rae ratt rl, rder, filed April

19, 2020 hereinafter r/ e rt at21.

> Ma e rtat . The total included 844 correctional officer positions, 9 lead correctional officer

positions, and — supervisory correctional officer positions.

10

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 14 of 51

correctional positions, 1 percent, ere unavailable for duty. Thus, hile the number of staff

ho ere unavailable for duty decreased, an increase in the number of staff vacancies left the

si eof the available or force essentially the same as it as in May.”

E S pport from the DOH

Startin atsome pointin une 2020,anurse or in ith the DOH be an providin

health education related toCO ID-19 to DOC staff and conductin audits, at times ona_ ee ly

basis, related to the use of personal protective e uipment ( PPE ) at boththe CD andCT .

Unity and DOC mana ers report that they have been re ularly briefed on the audit findin s and

recommendations. In early Au ust 2020, an epidemiolo ist under contract ith the DOH be an

to visit the CD and CT to ensure appropriate monitorin of CO ID-19 positive cases and the

related submission of data to public health officials provide consultation on uarantine, isolation

and testin practices and confer ith Unity s medical director on treatment in individual cases.

By all accounts, this increase in DOH support has served as a very helpful resource to both DOC

and Unity mana ers.

I FINDIN S

This section summari es a findin sre ardin the Defendants performance relative

to each of the si_ re uirements related to conditions of confinement addressed by the une 18,

2020 preliminary in unction.

Re _ irement One

Defendants shall implement a medical cares stem on _ eneral pop lation

nits that ens res inmates receive attention from a medical provider ithin

2 ho rsofreportin healthiss es Ifthiss stem contin esto sesic call

slips, Defendants shall ens re that inmates have consistent and immediate

access tos chsic call slips and that said slips are collected at re lar

intervals

24 ee raat2 -2 for additional information.

ll

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 15 of 51

The DOC and Unity have added resources to enhance the sic call system at the CD and

CT . The evidence sho s that for the most part, the Defendants areno providin inmates at

the CD andCT _ ith consistent access to sic call slips and they are collected at re ular

intervals ho ever, inmates are not consistently seen by a medical provider ithin 24 hours of

reportin health issues ina si nificant percenta e of cases. These findin s are described belo

A The Sic Call Process

The DOC relies on asic call system on eneral population housin units” to ensure that

inmates receive attention from a medical provider thin 24 hours of reportin a health issue.”

The Defendants have increased staffin for health services and made several modifications to

the business process related to sic call re uests in response to this re uirement.

The DOC s contract ith Unity Health Care, Inc. as modified to add fundin for the

hirin oft o additional nurse practitioners or physician assistants and t o medical assistants

for the period May 18 throu h September 0, 2020.2 The contract modification includes t o

contract line items to e tend the contract fort o additional time periods sub ect to fundin

availability: from October 1, 2020 to anuary 1,2021 and from ebruary 1, 2021 to April 14,

2021. Subse uent to September 0, 2020, the increased staffin levels authori ed by the

modification have remained in effect.7®

> Asa noted durin the November 9, 2020 hearin , a interpret eneral population units in this conte t to

mean housin units that have not been desi nated as_uarantine or isolation units.

> Inmates can also access medical care throu h the ur ent care and chronic care clinics.

2 E .2A, Amendment of Solicitation Modification of Contract Number CW 88 8, effective May 18, 2020. The

contract modification as si ned by a Unity representative on une 2, 2020 and by a District overnment

contractin officer on Au ust 11, 2020.

28 re uested that DOC mana ement produce documentation supportin thee ercise of the option for the

additional period that be an on October 1, 2020, and reflectin the associated availability of fundin . Accordin to

DOC mana ement, the a ency intends to maintain fundin to support the modification throu hout both additional

periods specified in the contract modification, fundin is available, and there is no need for supplemental

documentation reflectin the e ercise of the additional period and the availability of fundin .

12

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 16 of 51

Intervie s_ ith Unity staff indicate that this modification as intended to stren then the

business process related to sic call by addin clerical staff to collect and trac sic call

re uests obtained from the housin units on a more fre uent basis and by increasin the number

of clinicians available to deliver medical services.””? Under thisne system, hich as

implemented on une 2 , 2020, inmates are e pected to continue to obtain sic call re uest

forms from the correctional staff, and fill them out by enterin their name, date of birth, DCDC

number, housin unit, cell number, the date, and information about the nature of their re uest. °

The une 2020 revisions to the form add certain specific CO ID-19 symptoms and inmates are

as edtochec all that apply to them. ' The revised form does not provide a prompt for inmates

to indicate the time the re uest as made or for medical staff to note the time the re uest as

received.

Inmates are instructed to continue to place the sic call re uest forms in the secure

collection bo es that are maintained on the housin units. As part of the ne business process

the Defendants have implemented, medical assistants at each facility pic uptheformst ice

daily from each housin unit, enerally inthe early mornin and mid-day. The medical

assistants count the forms as they retrieve them and manually record the total number of slips

they have collected in ahand rittenlo before leavin each housin unit. After the medical

assistant has retrieved the re uest forms, a member of the correctional staff assi ned to the

°° Unity mana ers report that they be an pilotin thisne process on May 18, 2020.

° E . 2B, sample revised Sic Call ormused atCD and CT . Inmatesaree pected to chec one of the

follo in bo es: I. ishto be seenatsic call, dental treatment, mental health or other.

! The symptoms listed on the revised sic call re uest form are fever, cou hin , difficulty breathin shortness of

breath, headache body ache and upset stomach. d. Inan effort to ma e the forms more readily identifiable, DOC

and Unity mana ers report that the correctional staff have been instructed to print the forms on pin paper.

observations indicate that hile use of the revised forms is idespread, inmates also submit sic call re uests usin

a variety of documents, includin the previous version of the sic call re uest forms, random sheets of paper, and by

fillin out inmate re uest slips, hich are intended for initiatin case mana ement and other administrative

re uests. eeE .2C, Inmate Re uest Slip, fora copy of the form used at both facilities to ma e re uests that are

processed by case mana ement staff.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 17 of 51

housin unit e amines the interior of the bo and documents that there are no sic call re uest

forms remainin inthebo .

In contrast to previous site visits, sic callre uest forms ere available on most of the

housin units a visited before the November 9, 2020 hearin . In fact, of the 1 housin

units a visited up to the time of the hearin , the forms ere available on every unit other

than NO-1, ahi h security housin unit ande cept for inmates confined on NO-1, inmates at

both the CD and CT did not report difficulty accessin the sic call forms. Durin a

subse uent site visit a conducted on December 2, 2020, the forms ere available on NO-1.

Moreover, lo s and intervie s_ ith correctional officers, inmates, medical providers, and

medical assistants establish that asa eneral matter sic call re uest forms have been pic ed up

t ice daily from the housin units at both facilities since une 2 , 2020. ”

After sic call re uest forms are pic ed up from all housin units inthe mornin and

mid-day, the medical assistant assi ned to each facility transfers the tally for each housin unit

into an electronic database. The sic call re uests are then tria ed for ur ency by achar e

nurse. If the re uest is deemed ur ent, the inmate ise pected to be brou ht to the ur ent care

clinic. Ifthe char e nurse determines the re uest is routine, inmates hose sic call re uest

forms are pic ed up inthe mornin are e pected to be scheduled for a same-day sic call

appointment. Ifthe sic call form as collected mid-day, the inmate is e pected to be

scheduled for ane t-day sic call appointment.

Accordin to Unity s mental health mana er, sic call re uests for mental health services

are initially tria ed by medical staff. Any that are deemed ur ent are hand delivered to mental

health staff for immediate attention. Inmates ho submit re uests that are not identified as

* Atthe CT , in an effort to ensure access to health services, medical providers al the tiers of both special

mana ement units on a daily basis.

14

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 18 of 51

ur ent aree pected to be seen by a mental health provider ithin 24 hours.

Ifa sic call re uest indicates the inmate has a dental problem a dis in pain or has

s ellin or other indication of a possible infection, the char e nurse is e pected to schedule the

inmate to be seen by a medical provider on either an ur ent basis or the ne t day at sic call. If

there is no indication of pain, sellin or other indication of a possible infection, the sic call

re uest is e pected to be referred to the dental pro ram for follo up as either a Priority One,

T oor Three. Priority One is limited to patients ho have indicated on their sic call re uest

form that they are in pain or haves ellin or some other indication of infection. It is

anticipated that they ill be seen by a medical provider ur ently or ithin 24 hours and seen by

a dental provider ithin seven days. Priority T oisidentified ith routine dental problems

and no apparent pain. These patients are not seen by a medical provider but are scheduled to be

seen by a dental provider. Priority Three includes re uests for procedures such as routine

cleanin , and li e Priority T 0, these patients are not seen by a medical provider, but are

scheduled to be seen by a dental provider.

Unity and DOC mana ers have informed a that there have been discussions about

usin thene ly adopted educational tablets as a supplemental method (.e., it ould not replace

hard copy forms) throu h_ hich inmates could directly submit sic call re uests to the health

care staff. They have described a system in hich an inmate could complete an electronic sic

call re uest form on the tablet and transmit it electronically to a desi nated electronic inbo

available only to medical staff. Department of Corrections mana ement has reported that the

sic call re uest form has been di iti ed for use on the educational tablets. As of December 2,

2020, the electronic sic call form submission process had not been implemented.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 19 of 51

intervie ed numerous inmates atthe CD and CT re ardin sic call and access

to medical care. In contrast to earlier site visits, inmates enerally had positive impressions of

the sic call process and asserted that they e pected that if they submitted a sic call re uest

form they ould be seen by a medical provider timely.

B Sic Call Data

In order to assess the Defendants performance relative to the 24-hour re uirement, a

selected a sample of 92 sic call re uests submitted by inmates confined at the CD and CT

bet een une 18, 2020 and October 1, 2020. Thesample as selected from the ori inal hard

copies of the sic call re uest forms that are submitted by inmates. To test the completeness of

the data source provided by the Defendants (.e., hether all sic call forms submitted by

inmates durin this period ere produced for revie ), a compared the number of forms

produced by the Defendants from uly 2020 atthe CD ith the total number of sic call

re uests for the same month documented in the spreadsheet maintained by the medical assistants

ho pic upthesic call re uests atthe CD .* or the month of uly 2020, the spreadsheet

enerated by the medical assistant assi ned tothe CD indicated that atotal of 1 8 sic call

re uests ere submitted by inmates by comparison, the Defendants produced for revie by

a a total of 1,1 9 hard copies of sic call re uests atthe CD for the same period.

ere not able to reconcile this discrepancy.

dre separate samples of sic call re uests from the CD andCT . Because

medical, dental, and mental health sic call re uest forms are stored separately after they are

Durin the November 9, 2020 hearin a e plained that they had conducted arevie ofasample of sic call

re uests based on hat they believed ere allsic call re uest forms submitted by inmates bet cen une 18 and

October 1, 2020. Ho ever, a later learned that the sic callre uests from hichthey dre the sample ere

not all sic callre ueststhat ere submitted by inmates, but rather a sample selected by Unity staff. Thus, a ne

sample as selected by a

4 ee raat -14 fora more detailed description.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 20 of 51

tria ed by the char e nurse, and because some inmates reported delays in responses to sic call

re uests concernin dental and mental health services, a structured asamplin methodolo y

that ensured sic call re uests of all three types ereincludedinthe sample. Intotal, 1 sic

call re uests ererevie edfromtheCD and4l1sic callre uests ererevie ed from the

CT . The samples from both facilities ere structured to include sic call re uests from every

month in the revie period.

Because sic call re uest forms include recorded dates, but not times, it as not possible

to calculate the number of elapsed hours bet een an inmate reportin health issues and the

inmate receivin attention from a medical provider. or this reason, a analy ed the data at

the most specific time interval possible iven the available data sources: the number of elapsed

da bet eenaninmate reportin health issues and the inmate receivin attention from a medical

provider. used the date recorded by the inmate on the sic call re uest form as the basis

for the calculation of the number of elapsed days bet een an inmate reportin a health issue and

receivin attention from a provider. ® On 21 of the 92 sic call re uest forms in the sample, 2

percent, medical staff added a notation that the date recorded by the inmate asthe ron

date. In certain cases, the reason for the notation as clear (e. ., the date recorded by the

The volume of re uests for dental and mental health care is much smaller by comparison to re uests for medical

care. In order to ensure a sufficient number of sic call re uests for dental and mental health care ere included in

the analysis, a established a minimum number of each type to include in the sample.

The difference in the sample si es as principally attributable to the fact that the Defendants produced three

mental health sic callre uests fromthe CT durin therevie period, allof hich ere included in the sample.

Atthe CD , the Defendants produced a lar er number of mental health sic call re uests and a selected a

sample of 11 mental health sic call re uests from that facility.

Dates are enerally recorded int oplacesonsic callre uest forms. irst, there is a field labelled Date echa

for the inmate to record the date s he fills out the sic call re uest form. Second, medical staff typically stamp cach

form itha Received stamp and enerally, but not al ays, hand rite a date under the stamp. There is a third

field in a portion of the form desi nated for the medical provider to fill out that also includes a date and a time field

ho ever, these fields ere not completed in any of the sampled forms a revie ed. Ho ever, the EHR provides

a record of the date and time of any clinical encounters bet een inmates and medical providers.

8 Durin the sample selection process, a observed a si nificant number of sic call re uests ith no date

recorded by the inmate. These forms eree cluded from the sample because they ould notallo a toma e

any findin sre ardin timeliness.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 21 of 51

inmate asa month a fer medical staff collected the form) ho ever, in most other cases, there

as a difference of one ort o days bet een the date recorded by the inmate and the date

recorded as received by medical staff. In these cases, the basis forthe ron date notation as

not evident.

1 Sic Call at the CDF

sample of sic call re uests submitted atthe CD included 2 re uests for

medical care, 1 re uests for dental care, and 11 re uests for mental health care. °

analysis indicates that for all cate ories of sic call re uests combined, in 22 of Osic call

re uests, 44 percent, inmates ere seen by a medical provider on the day they submitted their

sic callre uest or the ne t day. An additional three sic call re uests, si percent, ere for

medication refills and the prescriptions ere refilled the day after the sic call re uest as

submitted ithout the inmate seein a medical provider.

Amon the 24 re uests for medical care, 1 re uests made by inmates (includin the

three prescriptions that ere timely filled ithout the inmate havin to see a provider), 1

percent, received attention from a medical provider ithin one day of the submission of the sic

call re uest.t? Amon the remainin seven sic call re uests for medical care, five of the

inmates ere seenbet eent oand five days follo in submission of the sic call re uest

form andt o ere seen more than five days follo in the submission of the re uest form.

Althou h the sample of sic call re uests a analy ed included re uests for dental and

mental health services, the sample si es for those sub roups_ ere not lar e enou h to reach

° One sic call re uest for medical care ase cluded from the sample because the date recorded by the inmate as

subse uent to the date medical staff collected the form.

4° ourteen of the 1 patients ere seen by aprovider ithin one day. In the other three instances, the inmate

re uested prescription refills for s in cream, eye ointment and nasal spray, respectively, and a provider ordered the

refill ithinone day ithout seein the inmate.

18

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 22 of 51

meanin ful conclusions about the timeliness of provider responses to those subcate ories of

re uests. Ho ever, because a number of inmates a intervie ed complained about delays in

responses to sic call re uests for mental health and dental services, a revie ed the EHR

related to1 sic callre uests for dental services and 11 sic call re uests for mental health

services atthe CD . The findin s from those revie s are summari ed belo

Ase plained above, sic call re uests for dental services are tria ed and re uests that

reflect pain, s ellin , or another indication of a possible infection are e pected to be seen by a

medical provider thin one day, or sooner if indicated.*' Amon the 1 sic call re uests for

dental careinthe CD sample, three inmates ere seen by asic call provider the day they

submitted the re uest or the ne tday.7 Amon the remainin 12 sic call re uests for dental

care that did not result in a timely provider visit, seven re uests included reference to a chipped

or bro en tooth, cavity, toothache, or a non-specific reference to isdom tooth. None of the

inmates associated ith these latter cate ories of re uests ere seen by a provider ithin one

day of submittin their sic call re uest. In the remainin five instances, the sic call re uest

forms referenced the need for a dental cleanin , fillin , or simply stated dental.

Amon the 11 sic call re uests for mental health servicesin the CD sample, the inmates

associated ith fourre uests ere seen the day the re uest as submitted or the subse uent day.

In the remainin seven instances, theinmate asseenany herefromt otosi days after

re uestin services. The table belo summari es the timeliness of sic call services atthe CD .

4 raat1 . While inmates ho indicate pain ors ellin are assi ned priority for services, the form does not

as ifthe inmate ise periencin dental painors ellin , but leaves it up to the inmate to specify these symptoms.

42 Only one of these three sic call re uests included a description by the inmate indicatin any painors ellin .

19

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 23 of 51

TABLE ONE SUMMARY OF LEN TH OF TIME TO BE SEEN

BY PRO IDER AT CDF

TYPE OF SER ICE lda of 2 das Morethan das Not Seenb

RE UESTED re est of re est of re est Provider

MEDICAL | 2 0

4 44

DENTAL 4

MENTAL HEALTH

COMBINED 24 14 8 4

2 Sic Call at the CTF

Atthe CT ,a sample included 2 re uests for medical care, 1 re uests for dental

care,t ore uests for mental health care, and one re uest for both medical and mental health

care. analysis indicates that at the CT , for2 ofall 41 ofthesic call re uests,

percent, inmates received attention from a medical provider on the day they submitted their sic

call re uest or the follo in day. Amon the2 re uestssee in medical care, inmates

associated ith 1 re uests, 0 percent, ere seen by aa medical provider thin one day of the

submission of the sic call re uest inmates associated ithsi re uests, 24 percent, ere seen

bet eent o and five days of the submission of the re uest and inmates associated ith four

re uests, 1 percent, ereseen any here from si to 20 days after the submission date noted by

the inmate on the re uest form.

‘ One of the five inmates did not appear for his appointment, hich as scheduled for 24 days after the sic call

re uest as submitted.

44 One of the four inmates asnotseen ithinthree ee sofhissic callre uest andt o inmates ere not seen

ithint o months of their sic call re uests as of December 1, 2020. The remainin inmate asreleased days

after his re uest ithout bein seen.

20

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 24 of 51

Thirteen of the 41 re uestsin the sample ere for dental services. Seven of those re uests

resulted in inmates bein seen by a medical provider ithin one day after the re uest as

submitted.* Amon theremainin si re uests for dental care, one re uest referenced dental

pain andtheinmate as not seen until three days after the re uest as submitted, three re uested

dental cleanin sandt o erenon-specific re uests for dental services.

Amon the three sic call re uests for mental health care,* one resulted in an inmate

bein seen the day after the sic callre uest as submitted. The inmates associated ith the

other t ore uests received attention from a providert o days and four days, respectively, after

the re uest as submitted.

The table belo summari es the distribution of time bet een the submission of sic call

re uest forms and inmates bein seen by a provider at the CT :

TABLET O SUMMARY OF LEN TH OF TIME TO BE SEEN

BY PRO IDER AT CTF

TYPE OF SER ICE Re vr t Ree s ' More ea s Not Seen b

RE UESTED es of ke es of Re es ovide

MEDICAL 1 4 0

DENTAL 4 2 0

MENTAL HEALTH I 1 0 0

MEDICAL AND 0 1 0 0

MENTAL HEALTH

COMBINED 2 12 0

4 Si of those seven sic call re uest forms included a specific description indicatin pain,s ellin orabro enor

erodin — tooth.

4 One of the three asthe sic call re uest that also includeda re uest for medical care.

21

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 25 of 51

C Concl sion, Re irement One

The Defendants have invested additional resources in the sic call process by au mentin

staffin in order to collect sic call re uest formst ice daily and increase the number of

providers available to assess and treat inmates at sic call. Inmates enerally had positive

impressions of medical staff responses to sic call re uests for medical services ho ever,

inmates reported delays accessin dental and mental health services throu h the sic call system.

These reports are enerally consistent iththesamplerevie edbya . AttheCD ,

1 percent of sic call re uests for medical services resulted in inmates bein seen ithin one

day and atthe CT , 1 percent ereseen ithin one day. reco ni e that there is some

inherent mar in of error in these calculations for several reasons. irst, the timeliness of the

responses to many sic call re uests could not be calculated because in identifyin a sample,

a determined that a si nificant number of inmates did not record a date (or time) on the sic

call re uest forms they submitted and therefore these forms ere automatically e cluded from

the sample since timeliness could not be determined. Second, none of the sic call re uest forms

included the time of submission and, as noted above, the form does not prompt inmates to record

the time of submission. inally, it is possible that submission dates recorded on some sic call

re uest forms are incorrect. Medical staff at times include a notation statin thatthe ron

date as entered by the inmate on the re uest form. Ho ever, it as not possible for a to

assess the accuracy of the submission date inmates recorded on the re uest forms nor the

accuracy of the staffs ron date desi nation.*

‘ An advanta ¢ of an electronic sic call re uest submission process ould be that it ould include data re ardin

the date and time of each sic call re uest submission, hich could serve as an audit trail. This ould also eliminate

the need for inmates to rely on correctional officers to provide sic callre uestforms. or some inmates, ho ever,

the use of tablets to complete an electronic form could present a barrier to submission.

22

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 26 of 51

Additionally, did not revie lar eenou h samples to reach conclusions about the

timeliness of responses to re uests for sic call related to dental and mental health needs.

Ho ever, there is some indication that at least ith respect to dental services, there are delays in

inmates accessin timely services. The dental sic call re uest system is desi ned so that

inmates e periencin pain,s ellin , or other si ns of infection are seen thin 24 hours, but in

the absence any indications of these symptoms, inmates are not scheduled to be seen on sic call.

If inmates are una are of the decision rules adopted by medical staff, inmates ho do have

ur ent dental problems may submit asic call re uest for dental services ithoutincludin the

appropriate information to be seen timely.

Re irement T o

Defendants shall compl _ ith District of Col mbia and Centers for

Disease Control re lations on social distancin in DOC facilities

Defendants shall address challen es hich have prevented the implementation of

social distancin incl din b tnot limited tolac of ed cation and staffin

shorta es Defendants shall provide the Co rtan_ pdate on their

improvements to enforcin social distancin b UNE2 , 2020

Ase plained belo, the Defendants have continued to promote social distancin , but

on oin limitations are evident. The a ency has bene unable to increase the complement of staff

that is available for duty. These matters are e plained belo

A_ Efforts to Promote Social Distancin

Current CDC _ uidelines applicable to detention and correctional facilities recommend

implementation of social distancin strate ies to increase the physical space bet een

incarcerated detained persons (ideally feet bet een all individuals, re ardless of symptoms),

and to minimi emi in of individuals from different housin units. *® District of Columbia

48 ee App. B,E .1, Interim uidance on Mana ement of Coronavirus Disease 2019 (CO ID-19) in Correctional

and Detention acilities, updated December _ , 2020, https: .cde. ov coronavirus 2019-

ncov community correction-detention inde _.html,

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 27 of 51

re ulations related to social distancin in the conte t of the current pandemic are consistent ith

this uidance.*”

The DOC has continued to implement strate ies intended to reduce both the number of

different inmates hocome into contact ith one another (e. ., by reducin opportunities for

inmates from different housin units to interact ith one another) and the number of inmates

ho interact ith one another at any iventime(e. ., by reducin out-of-cell time). As noted

above, ° at both the CD and CT , the DOC has continued to implement a medical loc do n,

durin hich inmates are allo ed out of their cells one hour per day in small roups. !

Department of Corrections mana ers and staff report that they limit the number of inmates out of

their cells at one time in each housin unit toama imum of si inmates in addition to four

inmates on or detail, ho are responsible for certain cleanin duties throu hout the day. ”

Durin site visits, a observed variability in the number of inmates out of their cells at

any time, ran in from one inmate to as many as1 inmates. When inmates ere out of their

cells, social distancin practices ere not consistent. Often a observed inmates con re ate

insmall roupstotal ,sometimes hile not earin amas properly coverin their noses and

mouths. At other times inmates ho ereincommon areas ould communicate ith inmates

inside of cells throu h the pass throu h slot on the cell door, often hile in close pro imity and

hile not earin amas properly coverin both their noses and mouths.

4° On November 1, 2020, a as ed counsel for both parties to identify the D.C. re ulations that ould fall ithin

the scope of this re uirement. ere informed by the Defendants that on March 1, 2020, the Department of

Health issued Emer ency Rule-ma in to order persons to stay at home due to the pandemic. The re ulation

included this definition of social distancin re uirements: Social Distancin Re uirements means maintainin at

least si ( ) foot social distancin from other individuals. D.C.Re . 829- 8 (Apr , 2020) (amendin 22B

DCMR Sections 220 and 229.1). Mayor s Order 2020-0 (une 19, 2020) adopts this definitionas ell. Mayor s

Order 2020-0 at Section II. 1.

0 raat9.

! Inmates confined on se re ation housin units are loc eddo nfor24 hourson ee end days.

* The cleanin activities performed by the inmate or details supplement the cleanin performed by the

contractors ho perform daily cleanin onthe housin units.

24

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 28 of 51

DOC e ecutive staff and other mana ers have informed a that they e pect

correctional officers to enforce social distancin re uirements or potentially be sub ect to

personnel action. They have e plained that a Correctional Surveillance Center Team ( CSC

Team ) monitors video feeds from both facilities around the cloc . Team members are

responsible for, amon other matters, reportin to DOC e ecutives if social distancin on

housin units is not bein enforced. visited the CSC Team video monitorin center.

Accordin to CSC Team staff, the CSC Team as instructed in March or April 2020 to monitor

video feeds and identify instances of inmates not earin mas s and or not properly social

distancin and for staffnot earin mas s, shields, or enforcin social distancin re uirements.

CSC Team staff reported that violations of these CO ID-19-related miti ation re uirements are

fre uent and that the CSC Team may see as many as 100 e amples per shift. Information

provided to a by the DOC Deputy Director of Operations, to hom the CSC Team reports,

indicates that bet een April and November 29, 2020, appro imately 4 disciplinary actions

ere ta ena ainst staff for violations of CO ID-19 re uirements, 84 percent of hich ere

based on CSC Team observations. While less fre uent than amon inmates, durin recent site

visits a observed correctional staff at times not earin re uired mas sand or face shields

on housin units and not maintainin social distances amon themselves and hen interactin

ith inmates and other non-correctional DOC staff. 4

The DOC has ta en steps to provide additional educational materials to inmates re ardin

CO ID-19 and the importance of social distancin . Si na e has been placed throu hout both

received a summary of the DOC s analysis of the data, but not the underlyin data itself and thus a did

not independently analy e this data.

‘ ore ample, at one point durin a site visit, a observed correctional officers respond to a medical

emer ency. Aser eant ho responded to the emer ency, entered the housin unit ithout a face shield. He as

offered a shield by a collea ue, but he refused to ear it.

2

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 29 of 51

facilities remindin inmates and staff to remain at least si feet apart. Additionally, DOC

e ecutive staff report that be innin in March 2020, educational materials are distributed to

every inmate s cell every Wednesday and those materials at times include information related to

CO ID-19.

More recently, startin at the end of September 2020, the DOC idely distributed

electronic tablets intended for educational purposes to inmates at the CD and CT . Distribution

of the tablets is e pected to be completed by December 14, 2020. The tablets, hich are

available to all inmates e cept those on inta e or se re ation status, may be used daily bet een

9:00 a.m. and 11:00 p.m. Amon other content, the tablets include educational materials

re ardin CO ID-19,includin a Quic uidetoCO ID-19, a ResponsetoCO ID-19:

Survival uide, and instructions on Wearin Personal Protection E uipment.

inally, ith respect to staffin , since a last report in May 2020, the DOC received

authori ation and fundin for 20 additional correctional officer positions ho ever, ase plained

above, * as of December 1, 2020, the si e of the correctional or force that is available for duty

has remained essentially unchan ed. While the number of staff on unavailable for duty status

decreased by ,from1 Otol — staffunavailable bet een May 9 and December 1, 2020, the

number of vacant positions increased by 9, from 1 to 110 position. ? Conse uently, the

number of staff available for duty remained virtually unchan ed. The chart belo compares

staffin levels on May 9 and December 1, 2020.

E. A, Quic uidetoCO ID-19.

E . B, Response to CO ID Survival uide.

E . C, Wearin Personal Protective E uipment.

8 raat2 -2.

° T enty of the 9 positions ere ne ly authori ed positions in fiscal year 2021, hich be anon October 1, 2020.

2

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 30 of 51

Total Authorized and Funded Correctional Staffing Complement

May 9, 2020 and December 1, 2020

1200

994 Total Positions 1014 Total Positions

x 110

1000

we 133

800

600

400

200

5/9/20 12/1/20

B Filled, Available for Duty m Filled, Not Availale for Duty @ Vacant

B Concl sion, Re irementT o

Since the issuance of the preliminary in unction, the DOC has continued to adopt

operational practices to encoura e social distancin . These practices have resulted in substantial

restrictions in the time inmates spend out of their cells. While fe er inmates are out of their

cells at any time than they ould other ise be in the absence of the out-of-cell time restrictions,

inmates ho are out of their cells often do not maintain si feet of social distance. also

observed staff members not maintainin social distance on housin units and else here

throu hout both facilities. Personal protective e uipment, includin mas s for every inmate, as

idely available and ithfe e ceptionsinmates donned mas s._ re uently,ho ever, mas s

ere not properly coverin both the inmates noses and mouths. Althou ha observed some

staff not earin appropriate PPE, these incidents ere infre uent.

2

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 31 of 51

As part of their effort to miti ate the spread of CO ID-19, the DOC has made

educational materials available to inmates in both hardcopy format and, more recently,

electronically on ne educational tablets that have been idely distributed to inmates at both

facilities. Staffin limitations have persisted, creatin challen es that impede miti ation efforts.

Re_ irement Three

Defendants shall contin e the services of their ne | contracted

environmental health and safet vendor Defendants shall f rther

contin e their contract to provide CO ID 1 cleanin services on

the sec re and non sec resides of the DOC facilit , incl din the

common areas of allho sin nits Defendants shall f rther contin e

their efforts to hire a re istered sanitarian Defendants shall ens re

that inmates have access to the necessar materials to clean their cells,

incl din cleanin sol tions hich protecta ainstCO ID1 and

ade atecleanin textiles and tools Defendants shall f rther ens re

that DOC staff and inmates are informed of and trained on the proper

techni esfor mixin and preparin cleanin sol tions as necessar

Defendants shall provide the Co rtan_pdate on their improvements to

sanitation b UNE2 ,2020

The Defendants implementation of the re uirements related to environmental health and

safety is described belo

A The Environmental Health and Safet endor and Contract Cleanin Services

The DOC s contract for environmental health and safety services be an in May 2020 and

included an initial term of three months, ith three one-month options to e tend. ° The contract

included the services of a sanitarian. In mid-Au ust 2020, the Defendants e ercised an option

toe tend the contract throu h October 1, 2020, at hich point the contract e pired. !

Durin the term of the contract, a sanitarian employed by the vendor developed a

cleanin and disinfectin protocol 7 to provide uidance to the cleanin companies that the

° eeMa_, e rt,E . 10 foracopy of the contractual a reement the Defendants entered for

environmental health-related services.

! E .4A, Au ust 18, 2020 Modification of Contract CW82 ,e tendin the contract period to October 1, 2020).

> E .4B, SARS-Co -2 (CO ID-19) Disinfection and Cleanin Protocols.

28

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 32 of 51

DOC contracted ith in response to the April 19, 2020 Temporary Restrainin Order ( TRO ),

(D t. No. 48), and later conducted site visits to monitor implementation of cleanin practices

atthe CD andCT . The vendor issued a total of four inspection reports, t oin uly 2020, 4

one in September 2020, and one in October 2020.

Department of Corrections mana ement informed a that the vendor s services ere

not e tended beyond October 1, 2020 because the a ency anticipated the environmental health

and safety services provided by the vendor ould be performed by a soon-to-be-hired DOC

employee ho ould perform ob duties associated ith a sanitarian position. As discussed

belo, the individual the Defendants hired to provide these services as not are istered

sanitarian and did not have the trainin , e perience or credentials to perform the same functions

that ere performed by the contracted sanitarian. In response to the concerns raised about this

matter at the November 9, 2020 hearin , DOC mana ement recently informed a that the

a ency has decided to contract ith the environmental health and safety vendor hose contract

e pired on October 1, 2020 and reinstitute its efforts to hire a re istered sanitarian. On

December 11, 2020, the filin date of this report, the Defendants submitted documentation to

a indicatin they had entered into a contract ith the vendor for a three-month period, ith

63 An Amended Order filed on April 19, 2020 corrected an error in the initial Order that as issued. The error as

based on a typo raphical error in a initial April 2020 report, hich a corrected. The Amended Order

addressed professional cleanin services on the secure side of the facility, and in relevant part states: In addition to

en a in asanitarian, the defendants shall consider contractin for professional cleanin services on the secure side

of the facility, at least until a sanitarian is hired to bolster the e istin environmental health and safety pro ram at

both facilities. (D t. No. 0).

* E .4C, Onsite Audit Inspection Report, Environmental Conditions Inspection for SARS-Co -2 (CO ID-19)

Disinfection and Cleanin Protocols, dated uly 2020 E .4D, ollo -Up Onsite Audit Inspection Report,

Environmental Conditions Inspection for SARS-Co -2 (CO ID-19) Disinfection and Cleanin Protocols, dated

uly 2 , 2020. Althou h these reports and the t o subse uent reports are all labelled Draft, DOC representatives

informed a that they are all considered final versions of the reports.

E .4E, ollo -Up Onsite Audit Inspection Report No. 2, Environmental Conditions Inspection for SARS-Co_ -

2(CO ID-19) Disinfection and Cleanin Protocols, dated September 2020.

E .4,, ollo -Up Onsite Audit Inspection Report No. , Environmental Conditions Inspection for SARS-Co_ -

2(CO ID-19) Disinfection and Cleanin Protocols, dated October 0, 2020.

29

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 33 of 51

three one-month option periods. The Defendants report that the vendor intends to schedule an

inspection before December 2 , 2020.

The Defendants continued the contracts for cleanin services on the secure and non-

secure sides of the CD and CT ,includin common areas of the housin units. Since

e ecutin the contracts on an emer ency basis in May 2020 for an initial three-month period,

the Defendants have e tended the contracts repeatedly for short periods, typically for one to

three months at atime. Ina November 2 , 2020 e-mail communication to a DOC e ecutive,

the Chief Procurement Officer at the D.C. Department of eneral Services, the a ency

responsible for contractin on behalf of the DOC for cleanin services at the CD and CT ,

approved e tension of the DOC cleanin contracts to ebruary 2021, statin his office ould

or ith its Bud et Team to ensure fundin is secured to ensure compliance ith the Court

Order. ® In addition, he stated that the contracts should be revie ed in anuary 2021 to

ensure that the Court Order is still valid andifso e may need to prepare a competitive

solicitation in anuary if e must continue the contract beyond ebruary 2021. °

The cleanin contractors atthe CD and CT aree pectedtofollo the disinfection and

cleanin protocols developed by the DOC s environmental health and safety vendor. The

contractors ere observed and evaluated by the DOC s contracted sanitarian on multiple

occasions bet een uly and October 2020. Based on a intervie s and observations, it

appears that by and lar e the contractors clean all of the re uisite areas of the facilities every

day. Common areas and public spaces on both the secure and non-secure sides of the facilities

One of thet ocleanin contractors the DOC en a ed asreplaced. eeE .4 , Modification of Contract

DCAM-20-NC-EM-00 9C,e tendin the performance period forthe ne cleanin contractor (at the CD ) throu h

ebruary 28, 2021 E . 4H, Modification of Contract DCAM-20-NC-EM-00 9B, e tendin the term of the cleanin

contractor (at the CT ) throu h_ ebruary 28, 2021.

8 E .41, November 2 , 2020 e-mail correspondence from eore e isto itanaSte art-Ponder.

69 d.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 34 of 51

appeared noticeably cleaner than a observed durin previous site visits at both the CD and

the CT . Department of Corrections mana ers and staff also reported a consistent

improvement in facility cleanliness attributable to the contract cleanin teams.

B Hirin Re istered Sanitarian

The Defendants posted a position vacancy announcement for a _ sanitation inspection

specialist onsi dates bet een May 21 and October , 2020. ° The ualifications and

educational re uirements for the posted position do not meet the eli ibility re uirements to sit

for the re istered sanitariane amination administered by the relevant credentialin body. !

Department of Corrections mana ement has informed a that the a ency elected to post a

sanitation inspection specialist vacancy rather than a sanitarian position vacancy in order to

e pedite the hirin process. Accordin to DOC mana ement, because the sanitarian position

did not already e ist, additional administrative or ould bere uired to develop a ob

description and classify the position and these activities ould delay fillin the vacancy.

Arevie of publicly available information concernin District of Columbia

overnment employees indicates that as of September 0, 2020, there ere District

employees ith the title sanitarian, 4o0f hom _ or ed for the Department of Health, and

t oof hom _ or ed for the Department of Youth Rehabilitation Services and the Child and

amily Services A ency, respectively. Additionally, a found a Department of Health ob

vacancy announcement for a sanitarian position that as postedin anuary 2020 *ho ever,

° E .4 , Sanitarian Inspection Specialist ob description and vacancy announcement posted on the follo in dates:

May 21,2020 unel ,2020 uly ,2020 uly 1, 2020 September 18, 2020 and September 29, 2020

! The National Environmental Health Association is the credentialin or ani ation for sanitarians. ee E . 4K,

NEHA Re istered Environmental Health Specialist Re istered Sanitarian (REHS RS) Candidate Information

Brochure at 1- forthe eli ibility re utrements to sit for the REHS RS credentials ¢ am.

> E .4 , Sanitarian ob description and vacancy announcement posted on anuary , 2020.

]

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 35 of 51

the eli ibility re uirements for that position also ere inconsistent ith the re uirements set

by the National Environmental Health Association for re istered sanitarians.

Department of Corrections representatives stated that after serially postin the ob

openin for the sanitation inspection specialist and conductin outreach to public health

net or s, thea ency did not receive any applications from re istered sanitarians from amon

those applicants ho ualified for the position. Ultimately, the DOC hired a candidate from

the pool of applicants ho asal1 -year supervisory employee of thea ency ithouta

bac round in environmental health and safety. This individual be an or in as the

sanitation inspection specialist on November 9, 2020.

intervie edthe ne ly hired sanitation inspection specialist and that person s

supervisor. The supervisor developed trainin materials that have been provided to the ne

employee. * Both the supervisor and the employee stated that trainin has be un and has

included online course or , studyin American Public Health Association Standards for

Health Services in Correctional Institutions, and on-the- ob trainin t iceper ee conducted

by a District employee ho oversees environmental health and safety pro rams in the District

of Columbia st o secure uvenile facilities. The on-the- ob trainin is anticipated to

continue for up tot o months.

As noted above, follo in the November 9, 2020 hearin , DOC mana ement informed

a that the a ency intends to post a position vacancy for are istered sanitarian. Accordin

areE .4K, ranote 1 ¢ E .4 ,supra fe 2.

4 E .4M, Trainin Plan for DOC Sanitarian.

Those facilities are operated by the District of Columbia Department of Youth Rehabilitation Services. The

individual conductin the on-the- ob trainin has the sanitarian ob title.

2

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 36 of 51

to DOC mana ement, as of December 9, 2020, a ob description had been developed and as

bein revie ed by staffin the District of Columbia s Office of Human Resources.

C Access to Cleanin Materials and Related Trainin

There asasi nificant improvement in inmate access to appropriate materials to clean

their cells since a prior site visits. The Defendants no provide inmates itha

pero ide-based cleanin and disinfectin solution and clean microfiber cloths are delivered to

housin unitst ice daily. Atthe CD , inmates and staff reported that they are re uired to

clean their cells ith these materials in the mornin at the start of the shift. Atthe CT ,

inmates reported that they had access to bottles of pero ide solution and microfiber cloths

hen they ereallo ed out of their cells. observed that an appropriate supply of clean

microfiber cloths and bottles of pero ide solution ere available on every housin unit visited

and inmates and staff consistently reported that they had access to the clean cloths and solution

on a daily basis.

The pero ide solution is purchased by the DOC in a concentrated and hi hly corrosive

form. Itis mi ed by desi nated environmental officers prior to its distribution to housin

units. The dilution of the concentrated form of the solution is performed by a machine

pro rammed to add a specified amount of ater in order to dilute the solution to levels

prescribed by the manufacturer.

DOC mana ers, detail inmates, and some housin unit staff have reported that inmate

detail or ers and correctional officers assi ned to the housin units have been trained on

cleanin protocols. Thetrainin , hich as conducted by the DOC Compliance and Revie

E .AN, Position Description (Draft) for Environmental Sanitarian CS 1801-12.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 37 of 51

Office, as based on the cleanin protocols developed by the contracted environmental health

and safety vendor.

Re_ irement Fo r

Defendants shall ens re that conditions in isolation nits are non p nitive

This incl desens rin reliable and re lar access to le al calls, personal

telephone calls, dail sho ers, and clean clothin and clean linens to all

inmates on isolation stat s Defendants shall provide the Co rt an _ pdate

on their improvements to conditions in isolation cells bb UNE2 , 2020

Since une 18, 2020, hen the preliminary in unction as issued, there have been no

isolation units in operation at the CT ho ever, an isolation unit has operated on a limited

basis atthe CD durin this period.

Ase plained in more detail belo in the narrative related to testin re uirements, a

total of 11 inmates tested positive for CO ID-19 atthe CD bet een une 18, 2020 and

December 1, 2020. All but one of these cases ere identified as a result of testin conducted at

the time of admission, and the last one appears to have been the result of ane ly admitted

inmate ithCO ID-19 ho as placed on the mental health unit upon admission and infected

another inmate. ® DOC records indicate that upon receipt of a positive test result, each member

of this cohort as transferred to NO-2, the unit at the CD desi nated for inmates on medical

isolation status.

Since the time that the preliminary in unction as issued, there have been a limited

number of inmates on isolation status. Unli e the conditions that ere evident before the

temporary restrainin order as issued, it appears that inmates on isolation status are able to

ma e personal telephone calls, ta e daily sho ers, and receive clean clothin and clean linens

raat 9-4.

8 This matter is addressed ra at 41.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 38 of 51

ona ee ly basis. ° Thereis,ho ever, some very limited evidence indicatin that inmates on

isolation status may not have access to confidential le al calls.*°

Re_irement Five

Defendants shall ens re that all inmates have access to confidential,

nmonitored le al calls of ad rations fficient to disc ss le al matters

Insofar as inmates access to confidential, nmonitored le al calls is

reliant onthe seofne technolo , Defendants shalls iftl implement

the seofs ch technolo

In the conte t of this re uirement,t o different cate ories of le al calls should be

considered: attorney-initiated le al calls and inmate-initiated le al calls. The various

processes and practices applicable to each cate ory are discussed separately belo

A Attorne Initiated Le al Calls

Currently, pursuant to a process initiated in April 2020 in response to the pandemic, an

attorney canre uestale alcall ithaclient confined atthe CD ortheCT by sendin an

email to the DOC case mana ement office. DOC case mana ement staff report that these

calls, hich arereferred toas emer ency le al calls, are enerally scheduled fora O-minute

period, but the duration may be e tended for up to one hour or more if the attorney re uests

additional time.*' After submittin are uest, attorneys are advised of the day they ill receive

ale al call from the client but not the precise time that the client ill contact them.

Reports from DOC mana ement related to the volume of attorney-initiated emer ency

le al calls indicate that a hi h number of le al calls are processed on a monthly basis at both

° ere only able to intervie oneinmate ho as recently on isolation status. Based on this intervie and

discussion ith medical, correctional and mana ement staff, tt appears that since the preliminary in unction as

issued, in the limited instances in hich an isolation unit has been operated at the CD , inmates have had access to

personal telephone calls, daily sho ers, clean clothin and clean linens.

8° One inmate on isolation status reported that hile he as able to spea_ by telephone to his la yer in the case

mana er s office, a correctional officer remained in the office durin the telephone call.

8 ere told that the re uest for additional time must be made in the initial email.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 39 of 51

the CD andCT .* Bet een April 20, 2020 and October 1 , 2020, DOC mana ement

reports that case mana ers ere responsible for facilitatin 8, 02 emer ency le al calls.*

Durin this period, DOC mana ement reports that the avera e daily volume of emer ency

le al call re uests permonthran edfromalo of Ocallstoahi hof8 calls, and the

avera enumber of case mana ers ho ere present at both facilities to facilitate these calls

durin this period asl .™

Each housin unit has an assi ned case mana er. Many case mana ers are assi ned to

cover multiple housin units. As of early November 2020, the DOC had a total of — funded

case mana er positions, nine of hich ere vacant. Pursuant to the emer ency call re uest

process initiated in April 2020, each ee day mornin case mana ers receive a list of

emer ency le al calls that they are assi ned to facilitate that day. Case mana ement staff

report that most if not all of their or days are devoted to facilitatin attorney-initiated

emer ency le al calls. As a result, they are unable tore ularly perform many of their other

ob duties,® includin the timely processin of inmate-initiated re uests for le al calls, hich

are described in more detail belo °

® E . A, chart submitted by DOC Director of Pro rams and Case Mana ement, e¢ al Calls, Emer ency Calls to

Private and Public Attorneys, April 20 - October 1 , 2020 (sho in for the 10-day period bet cen April 20 and 0,

2020, attorneys re uested 448 le alcallsof hich 8 erecompleted forthe month of May 2020, attorneys

re uested 1,28 le alcallsof hich 1,0 ere completed forthe month of une 2020, attorneys re uested 1, 0

le alcallsof hich 1, 41 erecompleted for the month of uly, 2020 attorneys re uested 1, 2 le alcalls of

hich 1,410 ere completed forthe month of Au ust 2020, attorneys re uested 1,41 le alcallsof hich1, 1

ere completed for the month of September 2020, attorneys re uested 1, 2 le alcallsof hichl, 4 ere

completed and forthe 1 -day period bet een October 1 and 1 , 2020, attorneys re uested 8 Ile alcallsof hich

89 ere completed).

8 E. B, e al Calls Cont., Number of Emer ency e al Calls Re uested by Public and Private Attorneys, April

20 - October 1 , 2020 (statin , fer al a, that of the 8, emer ency le al calls re uested durin this period, 8, 02

ere the responsibility of case mana ers).

84 d.

8 Tn addition to le al calls, case mana ers are responsible for inmate classification, reclassification, and facilitatin

various types of inmate re uests for records and services.

8 raat 8- 9.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 40 of 51

In instances in hich attorneys contact the DOC case mana ement office to re uest a

le al call, the calls are conducted in one of the follo in aysatboththeCD andCT :

1) in the case mana ers office ith the case mana er present 2)in the inmate s cell usin a

cellular telephone and )in an empty cell on the housin unitusin acellular telephone. At

the CD , these le al calls are also conducted in an office in the facility s case mana ement

suite.® received some conflictin information about hether case mana ers are present

hen ale al call is conducted in a case mana er s office. Ho ever, most of the inmates and

case mana ers intervie ed confirmed that the case mana er is present in the office hen these

calls are conducted, hichis consistent ith the observations that a have made.

As of mid-November 2020, attorney-initiated emer ency le al calls ere bein

conducted via cell phone in individual cells at both the CD and CT .** Department of

Corrections mana ers report that the introduction of the cell phones and handsets initially

presented connectivity and other challen es that have lar ely been overcome. or the most

part, inmates and staff report that the use of the cell phones in individual cells affords inmates

the opportunity to spea in aconfidential settin ith their attorneys. *

Attorneys can also re uest to spea_ to their clients atthe CD andCT via

8’ Durin anintervie a conducted in the case mana ement suite, an inmate as observed sittin in the

door ay of an open office reportedly spea in to his attorney thin audible distance of correctional and case

mana ement staff.

88 The Defendants purchased 0 cell phone and 10 ireless handsets for this purpose on May 1, 2020. All

e uipment has been delivered. ee E . C, Order Confirmation, irst Net, OrderNo. 8 40299 (cell phones) E .

D, Proof of Delivery, endorAc no led ement Acceptance orm, September 0, 2020 ( ireless handsets).

Records related to the delivery of the cell phones and the order for the handsets ere re uested but not available.

Accordin to case mana ement supervisors and staff, as of mid-November 2020, nine cell phones _ ere available for

use (si atthe CD and three at the CT ). In addition, seven ireless handsets and nine non- ireless handsets ere

also available. Department of Corrections mana ement reports that the remainin 41 cell phones ill be deployed

after the Defendants receive the supplies necessary to secure them in loc ed bo es. Department of Corrections staff

report that the bo es, hich are used for the nine phones that are in use, are intended to ensure that the cell phones

are not dama ed or used for unauthori ed purposes.

89° Some inmates reported that they could be overheard by inmates confined in ad acent cells hen spea in from

their closed cells.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 41 of 51

videoconference. These conferences are scheduled for a specific ee day time period by staff

inthe DOC eneral Counsel s Office. The Defendants report that bet een May 18, 2020 and

October 1, 2020,the eneral Counsel s Office coordinated a total of 1,209 videoconferences

for inmates atthe CD and CT . Desi nated correctional staff have been trained to help

inmates use the videoconference technolo y. have observed and participated in these

videoconferences, hich are conducted under conditions that promote the confidentiality of

attorney-client communications.”

B_ Inmate Initiated Le al Calls

Inmates at the CD and CT caninitiatele al calls ith their attorneys by submittin

an oral or ritten re uest to the case mana er assi ned to their housin unit.?' Inmates

reported substantial delays receivin responses to these re uests. i e the attorney-initiated

le al calls, these calls can be conducted in the case mana er s office ith the case mana er

present or in a cell on the housin unit. In addition, inmates can ma e free le al calls to their

attorneys durin the one-hour daily recreation period, usin the phones mounted on the alls

in the day rooms.”” While the DOC reports that these calls are unmonitored, they are not

confidential.

The DOC Office of eneral Counsel reports that inmates at the CD have been able to

ma econfidential and free le al calls from their cells usin tablets provided by the vendor that

°° Ininstancesin hich counsel re uires aclient to revie documents or other materials, they are able to do so ona

confidential basis durin the videoconference. Additionally, DOC staff report that attorneys can send documents to

case mana ers andthe eneral Counsel s Office for transmission to inmates for revie .

* SeeE .2C, ranote 1, Sample Inmate Re uest Slip. Inmates can obtain these forms, hich are used to

re uestle al calls, amon other re uests, from correctional staff and case mana ers. After the forms are filled out,

inmates are re uired to place theminabo here they are pic ed up periodically by the case mana ement staff.

Some of the case mana ers a intervie ed reported that they had difficulty ecepin up iththese re uest forms.

°2 Defendants report that these calls are free and unmonitored as lon as the attorney s name and telephone number

have been appropriately re istered in the system.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 42 of 51

provides telephone services at the CD .° Bet een une 18 and December , 2020, the

eneral Counsel s Office reports that 4le al calls eremadeusin these tablets at the

CD . In addition to telephone communications, inmates can use the DOC-issued educational

tablets to communicate ith their attorneys usin a confidential electronic messa in

platform. As of November 0, 2020, DOC mana ement reports that 18 inmates and 1

attorneys have used the messa in platform.

C Concl sion, Re irement Five

The Defendants have made a substantial investment inne technolo y to address the

attorney-client communication challen es that have emer ed as a result of the pandemic. In

addition, they have repurposed space in different parts of the CD and CT in order to

accommodate confidential attorney-client videoconferences. Moreover, in an effort to ensure

the technolo y is used appropriately, correctional staff assi ned tone ly created

videoconferencin posts have received trainin ons ills that ere not contemplated by their

ob descriptions. inally, case mana ement ob responsibilities have been restructured in

order to prioriti e the volume of attorney-client telephone and video communications

associated, at least in part, ith the reported and substantial decrease in attorney visits to the

CD andCT .

Re _irement Six

Finall , the Co rt notes that Defendants have increased testin for

CO ID1 ,no testin an_ resident to be transferred to Saint Eli abeths

Hospital or to a federal correctional facilit Defendants also test an

° Unli ¢ the educational tablets provided to inmates by the DOC, the tablets provided by the vendor contain paid

content. The tablets furnish inmates at the CD ith the ability to ma e telephone calls to the same approved

contacts they are allo ed to contact from the telephones in the dayrooms, includin their attorneys. Currently, these

tablets are only available in limited uantities at both facilities. Ho ever, althou h inmates at the CT also have

access to these tablets, they cannot use the telephonic functionality because a different vendor has the contract for

telephone services at the CT and these services are currently unavailable under that contract.

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 43 of 51

cell mate of an inmate ho tests positive and all ne residents pon

inta e Defendants contin e to test those inmates ho report positive for

CO ID1 s mptoms The Co rt ORDERS that Defendants contin e

implementin this increased testin The Co rtf rther ORDERS that

Defendants pdate the Co rtonan chan es to the testin protocol at

DOC facilities, incl din thef rther testin of as mptomatic inmates

The Defendants report that they administer CO ID-19 tests to inmates in the

follo in circumstances: upon admission prior to certain transports, includin transports to

court if inmates are symptomatic and, to any cellmate of aninmate ho tests positive for

CO ID-19. In addition to inmate testin , DOC representatives also reported that be innin in

October 2020, the Department of Health be anma in CO ID-19 testin available to DOC

staff on-site every t o ee s. Thetestin as made available durin hours that included the

mornin shift chan eto ma imi e the number of staff ho could ta e advanta e of the

testin .

A Testin of Ne 1 Admitted Inmates

orne ly admitted inmates, the Defendants report that their protocol is to administer a

rapid CO ID-19 test and a lab test simultaneously to each inmate upon inta e.°* An

additional lab test is administered to each inmate at least seven days later? _ hile the inmate

remains housed in the Inta e unit. Once cleared by medical staff, inmates may be moved

from the Inta e unit into other housin units. If an inmate tests positive for CO ID-19, they

are transferred to housin units desi nated for inmates on isolation status.

4 The lab test reportedly has a hi her sensitivity in detectin SARS-Cov-2 ho ever, results ta e lon er to process.

Thus, a rapid test is administered at the same time and the test results are available shortly after the test is

administered. If the rapid test returns a positive test result, the inmate is isolated sooner thans he ould other ise

be if alab test alone ere administered. Inmates ho refuse testin at the time of admission are cell restricted until

medical staff clear them.

° This process is intended to identify inmates ho may have been CO ID-19 positive upon admission, but ho

ere still in an incubation period ith viral levels that ere toolo to detect at the time of the initial test

administrations.

° Inmates ith acute mental health needs are moved to a speciali ed unit and do not remain on the Inta e unit.

Women are admitted at the CT .

40

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 44 of 51

obtained CO ID-19testin data throu h November 0, 2020 from Unity

representatives ho maintain clinical testin data. Accordin to that data, overthe 1 days

bet een une 18, 2020 and November 0, 2020, the Defendants administered 2, 1 tests to

inmates, anavera eof 1 . tests per day. Additionally, tests ere administered on 91 percent

of the days durin the period.

The testin records indicate that there ere a total of 11 positive tests durin the

period, fourin uly,t oin Au ust, four in September, none in October, and one in November.

All ereatthe CD . Tenofthe 11 positive tests ere detected by aCO ID-19 test

administered upon admission to the facility. Of those 10 inmates testin positive, nine ere

housed in SO-2 initially, the Inta e unit, or ere immediately placed in the isolation unit, NO-

2, before spendin ani ht in SO-2. The 10th case involved aninmate ho as placed on the

mental health unit, SO- , upon admission. When his initial test result came bac positive, he

as moved to the isolation unit.

The final positive case asnotane admission, but rather involved aninmate ho

as housed on the mental health unit for ane tended period. He as housed on the mental

health unit durin the period henthe ne ly admitted inmate referred to above (.e., the 10th

positive case) tested positive. The day after the ne ly admitted inmate received his positive

test result, the entire mental health unit as tested. One inmate onthe unit as confirmed

positive four days later and he as transferred to the isolation unit.

B_ Testin of Inmates Transferred to Saint Eli abeths Hospital

obtained data re ardin all transfers to Saint Eli abeths Hospital for the period

une 18 to October 1, 2020. There ere a total of 24 transfers to that facility.’

° Accordin to DOC staff, inmates may be transferred to Saint Eli abeths either as a permanent placement or ona

temporary basis pendin a mental health assessment.

4l

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 45 of 51

intervie ed DOC and Unity representatives re ardin the prerelease and CO ID-19 testin

processes applicable to inmates released to Saint Eli abeths.

Accordin to Unity representatives, inmates ho are released to Saint Eli abeths are

tested for CO ID-19 in advance of their transfer if Unity staff are notified in advance of the

transfer. Unity and DOC records office staff reported, ho ever, that they often are not

notified in advance of an inmate transfer to Saint Eli abeths. cross referenced the

names of the 24inmates ho ere transferred to Saint Eli abeths durin the revie period

ithCO ID-19testin data. T entyt oof the 24 transferred inmates ere tested for

CO ID-19 hilein DOC custody ate t prior to their transfer to Saint Eli abeths

ho ever, in most cases the testin as not conducted in close temporal pro imity to the

transfer. Department of Corrections records indicate that seven of the 20 inmates ere tested

ithin the ee prior to the transfer four additional inmates ere transferred bet een one and

t o ee spriorto the transfer andthe remainin 11 inmates ere tested bet een 24 and 128

days prior to the transfer to Saint Eli abeths. T o inmates transferred to Saint Eli abeths

durin therevie period ere not tested at all prior to the transfer.

C Testin of Inmates Transferred to Federal Correctional Facilities

obtained data re ardin all transfers to the United States Marshals Service for

the period une 18 to October 1, 2020: There ereatotal of 1 transfers.

intervie ed Unity staffre ardin CO ID-19testin practices prior to inmate transfers to

federal facilities, includin Unity staff involved in the health clearance process for inmates

ho are released to the custody of the Marshals Service. Accordin to Unity staff, there is a

defined process established by the Marshals Service for releasin inmates to their custody,

hich Unity follo s. Unity staff are re uired to complete a Prisoner in Transit Medical

42

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 46 of 51

Summary form for each inmate scheduled to be transferred.** Unity staffe plained that at

2

some point in early 2020, ane section, Section , Mandatory Symptom Screenin for

CO ID-19 Prior to Departure rom acility, asaddedtothe form. This ne section

includes a record of the inmate s temperature, three screenin —_ uestions, and criteria for a

certifyin health authority to medically clear the inmate for transfer. The form does not

re uireaCO ID-19 test prior to release and Unity staff stated that in practice, they complete

the form for each inmate released to the Marshals Service, but do not complete a CO ID-19

test as a matter of course. Unity representatives clarified that if are uest is made to

administera CO ID-19 test (e. ., by the facility to hich the inmate ill be transferred), they

ill conduct the test.

cross referenced arandom sample of ofthe 1 inmates transferred to the

Marshals Service bet een une 18 and October 1,2020 ithCO ID-19testin data.

T enty-one inmates received a CO ID-19 test at some point prior to their release to the

custody of the Marshals Service and 12 inmates did not. Amon_ this cohort, three inmates

received a CO ID-19 test ithin the month prior to their release (ran in from 14 days to 28

days prior to release) and the remainin 18 inmates received a test more than one month prior

to their release (ran in from days to 181 days).

D Testin of Cellmates of Inmates ho Test Positive

As noted above, the Defendants report that cellmates of all inmates ho test positive

forCO ID-19 are tested. Of the 11 inmates ho tested positive forCO ID-19 bet een une

18 and October 1, 2020, one inmate had acellmate. The t oinmates ere housed in a cell

in the Inta e unit. Testin records indicate that the cellmate of the inmate ho tested positive

°8 E . , Prisoner in Transit Medical Summary redacted. This formis referred toas orm

4

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 47 of 51

as tested the same day his cellmate received a positive test result and his test result as

ne ative.

E Testin of Inmates ho ReportCO ID 1 S mptoms

inally, a revie edasample of 49 sic call re uests submitted bet een une 18

and October 1, 2020 that reflected reported symptoms consistent ith CO ID-19 symptoms

identified by CDC _ uidelines and or reflected in Unity s reported symptom-based testin

practices.”? orty-three of the sic call re uests ere submitted by inmates confined at the

CD andsi — ere submitted by inmates confined at the CT . Because 1 ofthe sic call

re uest forms did not include the date the inmate submitted the form, they ere e cluded from

the analysis.

Amon_ the remainin sic callre uestsinthe sample, 2 erefrom the CD and

four erefromtheCT . ourteenofthe inmates ho submitted the sic call re uests, 9

percent, eretested forCO ID-19 at some point after they submitted their sic call re uest.

ive of the 14 tests ere administered ithint o days of the submission of the sic call

re uest and one as administered five days after the submission of the sic call re uest.!°°

The remainin ei httests ere administered bet een 20 and 2 days after the sic call

re uests ere submitted. There is no indication in the EHR maintained for these inmates that

these ei ht tests ere administered in response to the sic call re uests that reported CO ID-

19symptoms. Amon the 22inmates ho ere not tested after reportin symptoms, 1

°” ee App. B, E . 1, supra note 49 ( Symptoms of CO ID-19 include cou h, shortness of breath or difficulty

breathin , fever, chills, muscle pain, sore throat, and ne loss of taste orsmell . Other less common symptoms

have been reported, includin nausea and vomitin . ) Symptoms noted in the sampled sic call re uests included,

but ere not limited to, the follo in : cou hin shortness of breath difficulty breathin fever nausea vomitin

loss of appetite headache and or body aches chills and sore throat. Inmate re uests for CO ID-19 tests ere also

included in the sample.

100 Three sic call forms e plicitly included are uest fora CO ID-19 test: one reported shortness of breath, one

reported upset stomach and vomitin , and one reported nausea and loss of appetite.

44

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 48 of 51

received a CO ID-19 test at some earlier point in their confinement and five _ ere not tested

forCO ID-19 durin their confinement.

intervie ed Unity s Medical Director re ardin clinical e pectations for testin

inmates horeport symptoms consistent ith CO ID-19. The director pointed out that there

are some casesin hich there are sound medical e planations for the symptoms the inmate is

e periencin consistent ith somethin other than CO ID-19.'°' The director also

ac no led ed that providers have some clinical discretion in decidin hen to administer a

CO _ ID-19 test to inmates reportin CO ID-19 symptoms, but she indicated that if there is no

obvious or clear e planation for the symptoms, a CO ID-19 test should be administered.

did not assess the clinical decisions made by providers ith respect to

administerin CO ID-19 tests for reportedly symptomatic inmates, hich seemed beyond the

scope of this appointment and ould have re uired consultation ith a medical e pert.

Arevie of the EHR maintained for inmates in the sample sho sthatinsi cases, the inmate

reported durin the sic call visit that the CO ID-19-li e symptoms reflected on the sic call

re uest form as resolved and in five other cases the inmate reported that s he had re uested

to be seenin sic call for other reasons despite notin symptoms of CO ID-19 on the sic call

re uest form.'° The revie of the sampled cases also sho various dia noses reached

follo in the sic call visit, such as asthma, constipation, aller ies sinusitis, and acid

reflu astrointestinal reflu disease. In none of these cases, as there documentation in the

EHR that CO ID-19 as suspected but testin —_as not done.

101 The director cited ase amples inmates dia nosed ith Crohn s disease reportin _astrointestinal symptoms and

inmates dia nosed ithasthmareportin acou h. Incases such as these, a provider mi ht conclude the symptoms

ere related to the dia nosed chronic condition rather than CO ID-19.

102 These other reasons included re uests for foot cream, medicine for heartburn or treatment for constipation.

4

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 49 of 51

F Timeliness of Testin Res Its

Durin the November 9, 2020 hearin , the Plaintiffsin uired hether a ere

a are of any delays inreceivin testin results from laboratories. have revie_ ed the

available data re ardin elapsed days from test administration to receipt of testin results.

Amon the 2, 1 tests administered bet een une 18 and October 1, 2020, data ere

available for 9 percent of the test results. Be innin in Au ust 2020, the date test results

ere received as recorded much less fre uently than durin une and uly 2020. ere

not able to determine hether the tests ith data sufficient to calculate the number of elapsed

days bet een test administration and receipt of testin results(.e., the 9 percent) ere

representative of test processin timesin eneral. With that caveat, in the months of October

and November 2020, 9 percent of the tests for hich a calculation could be made resulted in

test results that ere returned thin four days of the test administration. !°

Concl sion, Re irement Six

Since the issuance of the preliminary in unction, the DOC has administered over 2, 00

CO ID-19 tests to inmates at the CD and CT , over1 tests perday. Thea ency s testin

protocols pay particular emphasis to identifyin and containin anyinmates ithCO ID-19

before they interact ith the eneral population and have an opportunity to communicate the

virus to other inmates or staff. Since the issuance of the preliminary in unction, 10 of the 11

inmates ho tested positive forCO ID-19 ere discovered durin routine inta etestin and

the 11th case, caused by ane ly admitted inmate s placement on the mental health unit, as

10 orreference, there as sufficient data for 149 of the 1,002 tests administered in those t o months. Thirty-three

of the tests ere administeredt o days before the data as provided to a and the results of those tests ere still

pendin .

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 50 of 51

uic ly contained because of the inta etestin . Inthe one casein hich aninmate ho tested

positive for CO ID-19 had a cellmate, the cellmate as also tested.

The evidence indicates that the DOC does not as a matter of eneral practice test

inmates ho are transferred to Saint Eli abeths Hospital. Medical staff indicate they often are

not informed that aninmate ill be transferred to Saint Eli abeths in advance. The data also

indicate that the DOC does not routinely test inmates ho are transferred to federal

correctional facilities. Medical staffe plained that they follo the procedure established by

the Marshals Service.

inally,arevie ofasample of sic call re uests that included symptoms consistent

ith CO ID-19 revealed that most inmates ere not tested forCO ID-19 in response to the

sic callre uest. Unity medical staffe plained that there is clinical ud ement involved in

decidin hether to administera CO ID-19 test to an inmate. did not assess those

decisions.

CONCLUSION

are available to ans er any uestions the Court or the Parties have about the

matters addressed in this report.

Respectfully submitted,

s_raceM. opes

rae

race M. opes

BarNo. 8 0O

E ecutive Director

Risin for ustice

901 4" Street, N.W., Suite 000

Washin ton, D.C. 20001

202- QO -2224

mlopes @risin for ustice.or

Case 1:20-cv-00849-CKK Document 138 Filed 12/12/20 Page 51 of 51

December 11, 2020

Washin ton, D.C.

48

Mar ordan

mar mar ordan.consultin

1220 19" Street, N.W.

Suite 00

Washin ton, D.C. 200

202-2- 2

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 1 of 63

APPENDI A

Exhibit 1A

Exhibit 1B

Exhibit 1C

Exhibit 1D

Exhibit 2A

Exhibit 2B

Exhibit 2C

Exhibit 3A

Exhibit 3B

Exhibit 3C

Exhibit 4A

Exhibit 4B

Exhibit 4C

Exhibit 4D

Exhibit 4E

REPORT SUBMITTED BY AMICUS CURIAE PURSUANT

TO SEPTEMBER 16, 2020 ORDER

Index to Exhibits

Chart, Combined Population of CDF and CTF, by Day and Legal Status, June 18,

2020 — October 31, 2020

Table, Combined Population of CDF and CTF, by Status and Day, June 18, 2020

— October 31, 2020

Table, Admissions to CDF and CTF, by Status and Month, June 18, 2020 —

October 31, 2020

Table, Average Length of Stay of Inmates Housed at CDF and CTF, by Status and

Month, June 18, 2020 — October 31, 2020

May 18, 2020 Modification of Contract CW68868

Sick Call Request Form

Inmate Request Slip

Quick Guide to COVID-19

Response to COVID Survival Guide

Wearing Personal Protective Equipment

August 18, 2020 Modification of Contract CW82753

SARS-CoV-2 (COVID-19) Disinfection and Cleaning Protocols

Onsite Audit Inspection Report, Environmental Conditions Inspection for SARS-

CoV-2 (COVID-19) Disinfection and Cleaning Protocols, dated July 2020

Follow-Up Onsite Audit Inspection Report, Environmental Conditions Inspection

for SARS-CoV-2 (COVID-19) Disinfection and Cleaning Protocols, dated July

23, 2020

Follow-Up Onsite Audit Inspection Report No. 2, Environmental Conditions

Inspection for SARS-CoV-2 (COVID-19) Disinfection and Cleaning Protocols,

dated September 2020

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 2 of 63

Exhibit 4F

Exhibit 4G

Exhibit 4H

Exhibit 41

Exhibit 4J

Exhibit 4K

Exhibit 4L

Exhibit 4M

Exhibit 4N

Exhibit 5A

Exhibit 5B

Exhibit 5C

Exhibit 5D

Exhibit 6

APPENDI B

App. B, Ex. 1

Follow-Up Onsite Audit Inspection Report No. 3, Environmental Conditions

Inspection for SARS-CoV-2 (COVID-19) Disinfection and Cleaning Protocols,

dated October 30, 2020

Modification of Contract DCAM-20-NC-EM-0079C

Modification of Contract DCAM-20-NC-EM-0079B

November 23, 2020 e-mail from George Lewis to Gitana Stewart-Ponder

Sanitarian Inspection Specialist, job description and vacancy announcement

NEHA Registered Environmental Health Specialist/Registered Sanitarian

(REHS/RS) Candidate Information Brochure

Sanitarian Job Description and Vacancy Announcement

Training Plan for DOC Sanitarian

Draft Position Description, Environmental Sanitarian CS-1801-12

Chart, Legal Calls, Emergency Calls to Private and Public Attorneys, April 20 - October

15, 2020

Chart, Legal Calls Cont., Number of Emergency Legal Calls Requested by Public and

Private Attorneys, April 20 - October 15, 2020

Order Confirmation, First Net, Order No. 587640299 (cell phones)

Proof of Delivery, Technomic, RTS No. 100561 (wireless handsets)

Prisoner in Transit Form, Redacted

Center for Disease Control, Interim Guidance on Management of Coronavirus

Disease 2019 (COVID-19) in Correctional and Detention Facilities, Updated

December 3, 2020

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 3 of 63

APPENDI A

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 4 of 63

Ex 1A

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 5 of 63

Combined Population of the CDF and the CTF, by Day and Legal Status

June 18 - October 31, 2020

700

600

500 ,

Pretrial lel eV]

400

300

200 Fugitive

@ Sentenced Misdemeanant

100

@ Other

0 Writ or Hold

oa

NaS @ Sentenced Felon

(a)

ARS

> . .

ONS uty @ Pretrial Misdemeanor

oS Nao

nil Ao Ro @ Parole Violator

SAS Ao

oaNSoaeo

Note ono

Teta sage Sie @ Hold for Transfer

o> oO :

ody Se NON

Sle ol tS AI O | | O .

mn ™N ON GO

Jul ae ata pec |e Vy LS | Sa) |) Ve | LT @ Pretrial Felony

ONAN AO mo

Om rHoOn~A OO A oO

om Se # > N GO Ao

Aug Bs Bi Lsi8 Ais

adtaeas 8

an 2 8 sia 8)\s

oO tS BR ~~ A DA oo

2020 PISS S| Alls

Sep Yoknw Sawsyg

ABS SB 8 So

So #2 8 8 &

AS 8 § 8

4 BS A ~

S|) 8 8

Oct S

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 6 of 63

Ex 1B

Distinct Count of DCDC

Row Labels

2020

Jun

6/18/2020

6/19/2020

6/20/2020

6/21/2020

6/22/2020

6/23/2020

6/24/2020

6/25/2020

6/26/2020

6/27/2020

6/28/2020

6/29/2020

6/30/2020

Jul

7/1/2020

7/2/2020

7/3/2020

7/4/2020

7/5/2020

7/6/2020

7/7/2020

7/8/2020

7/9/2020

7/10/2020

7/11/2020

7/12/2020

7/13/2020

7/14/2020

7/15/2020

7/16/2020

7/17/2020

7/18/2020

7/19/2020

7/20/2020

7/21/2020

7/22/2020

7/23/2020

7/24/2020

7/25/2020

7/26/2020

7/27/2020

7/28/2020

7/29/2020

7/30/2020

7/31/2020

Aug

8/1/2020

8/2/2020

8/3/2020

8/4/2020

8/5/2020

8/6/2020

8/7/2020

8/8/2020

8/9/2020

8/10/2020

8/11/2020

8/12/2020

8/13/2020

8/14/2020

8/15/2020

8/16/2020

8/17/2020

8/18/2020

8/19/2020

8/20/2020

8/21/2020

8/22/2020

8/23/2020

8/24/2020

8/25/2020

Fugitive

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 7 of 63

Combined Population of CDF and CTF, by Status and Month

Sentenced

Misdemeanor

BRRPAPWWWWWWWWH

OMOODRARARAORARAUUTMDMBDOORARA AR AR A

ee ee ee ee ee ee a ee a ee ee

DODO BA BAH DDO ON NNN WNWNODDDHD HD OD

Other

- - MONNNMNN PY

MN - +--+ NNH HH H KH WWWARWANNNNNM “ND

-+-NND A

Nh PDP P

PO Pp pO — A A A

June 18, 2020 - October 31, 2020

Writ or

Hold

94

94

94

94

94

94

94

94

93

93

93

93

93

93

93

93

93

93

93

93

93

93

93

92

92

92

92

91

90

90

90

90

90

91

92

90

90

89

89

89

89

87

86

86

86

86

86

86

86

86

86

84

84

84

84

88

87

87

87

87

87

87

87

87

87

87

87

87

87

Sentenced

Felon

72

72

13

13

13

13

13

74

74

75

75

75

74

75

75

75

75

75

75

75

74

75

72

72

72

72

13

72

72

72

71

71

71

71

71

71

13

74

74

74

74

75

75

13

72

72

72

67

68

68

68

69

70

70

70

70

70

72

72

72

72

72

72

13

13

71

71

71

67

Pretrial

Parole Hold for Pretrial

Grand

Misdemeanor Violator Transfer Felony Total

68

67

66

66

66

67

67

66

66

65

67

67

67

67

67

62

63

63

63

64

62

63

61

62

63

63

65

64

64

62

62

65

65

69

68

67

68

70

74

74

13

72

15

76

76

80

80

81

79

79

78

77

78

78

81

81

84

83

85

86

86

84

82

82

78

80

82

82

85

88

88

89

90

90

91

92

91

90

91

91

91

93

92

92

90

90

91

91

92

94

91

91

92

92

92

90

96

96

98

105

106

106

100

105

106

103

104

105

105

100

103

103

108

106

108

108

109

105

110

101

105

105

105

103

103

102

101

101

102

102

108

113

112

114

114

115

115

119

440

440

440

440

440

439

439

439

437

436

437

437

435

434

434

433

434

434

434

434

434

435

435

433

433

433

432

431

431

430

431

431

431

432

430

431

430

429

429

429

429

428

426

428

427

426

426

427

425

426

426

431

432

432

431

432

434

444

438

440

440

436

434

432

431

432

432

432

431

482

487

488

488

488

490

492

491

492

493

497

497

495

494

495

497

500

501

501

501

505

502

504

504

506

506

5114

5114

514

520

517

519

519

518

520

518

519

524

528

528

532

532

535

533

532

534

534

538

534

535

536

537

539

539

542

542

539

543

544

547

547

547

546

550

557

558

558

558

564

1249

1253

1255

1256

1256

1259

1262

1259

1256

1257

1264

1264

1262

1259

1260

1254

1259

1261

1261

1265

1267

1264

1263

1263

1266

1266

1271

1274

1275

1281

1283

1289

1289

1286

1292

1288

1288

1295

1305

1305

1302

1304

1307

1312

1309

1314

1314

1315

1303

1310

1301

1311

1316

1316

1318

1323

1324

1337

1339

1346

1346

1345

1346

1349

1352

1353

1357

1357

1365

Row Labels

8/26/2020

8/27/2020

8/28/2020

8/29/2020

8/30/2020

8/31/2020

Sep

9/1/2020

9/2/2020

9/3/2020

9/4/2020

9/5/2020

9/6/2020

9/7/2020

9/8/2020

9/9/2020

9/10/2020

9/11/2020

9/12/2020

9/13/2020

9/14/2020

9/15/2020

9/16/2020

9/17/2020

9/18/2020

9/19/2020

9/20/2020

9/21/2020

9/22/2020

9/23/2020

9/24/2020

9/25/2020

9/26/2020

9/27/2020

9/28/2020

9/29/2020

9/30/2020

Oct

10/1/2020

10/2/2020

10/3/2020

10/4/2020

10/5/2020

10/6/2020

10/7/2020

10/8/2020

10/9/2020

10/10/2020

10/11/2020

10/12/2020

10/13/2020

10/14/2020

10/15/2020

10/16/2020

10/17/2020

10/18/2020

10/19/2020

10/20/2020

10/21/2020

10/22/2020

10/23/2020

10/24/2020

10/25/2020

10/26/2020

10/27/2020

10/28/2020

10/29/2020

10/30/2020

10/31/2020

Fugitive

Sentenced

Misdemeanor

10

10

10

9

9

oO

THOWMDDMDANDDAWAADDMADMDA®A ©

Other

oa oo OP et

— qw pon - —

a

MNWAWH NMNAHNMNNMNNAWABRRANANA WWD

June 18, 2020 - October 31, 2020

Writ or

Hold

85

85

85

84

84

84

81

80

80

80

80

80

80

80

80

78

78

78

78

78

78

78

78

78

78

78

78

77

77

78

78

15

15

15

15

15

75

74

74

74

74

75

13

13

13

72

72

72

72

71

71

71

71

71

71

71

71

71

71

71

71

71

71

71

72

71

71

Sentenced

Felon

66

67

67

68

68

68

67

69

70

65

66

66

66

66

63

65

63

63

63

63

64

65

61

64

65

65

65

65

66

67

63

65

65

65

67

68

63

61

62

62

62

62

64

64

61

64

64

64

64

59

61

61

62

62

62

63

63

60

62

62

63

63

62

63

62

63

65

Pretrial

Parole Hold for Pretrial

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 8 of 63

Combined Population of CDF and CTF, by Status and Month

Grand

Misdemeanor Violator Transfer Felony Total

88

88

90

90

91

91

97

97

100

103

104

108

108

110

110

112

110

110

114

114

115

112

112

110

109

110

110

112

106

109

114

114

114

114

115

112

113

112

113

116

116

117

113

115

117

117

117

117

119

116

118

115

113

115

115

117

110

110

110

109

110

110

114

114

106

105

106

117

119

123

122

122

122

114

125

133

128

126

131

131

135

130

133

129

130

133

133

135

137

140

138

134

134

134

134

129

127

131

131

130

130

129

137

143

133

134

136

136

128

133

134

136

133

134

134

135

137

137

135

136

136

136

141

142

142

144

146

145

145

149

147

145

150

151

434

431

432

432

432

432

432

432

434

438

439

442

442

445

448

446

447

444

444

444

445

448

450

452

447

445

445

445

448

447

448

449

452

452

451

447

451

452

452

452

452

444

433

435

435

434

434

434

434

433

434

431

434

434

434

436

437

436

437

437

440

440

440

434

434

434

433

563

567

564

567

571

571

576

576

574

582

576

578

578

579

579

573

579

582

586

586

584

584

591

583

588

596

596

591

591

592

595

593

595

595

596

601

600

594

595

600

600

614

607

607

617

615

618

618

623

633

626

633

624

627

627

626

625

630

628

633

635

635

638

645

650

647

644

1364

1367

1371

1373

1378

1378

1375

1389

1399

1402

1398

1412

1413

1422

1419

1416

1415

1415

1426

1426

1429

1432

1441

1433

1432

1439

1440

1438

1431

1432

1436

1437

1441

1440

1444

1450

1456

1437

1440

1450

1450

1447

1435

1439

1449

1448

1452

1452

1461

1463

1464

1461

1456

1461

1461

1470

1465

1467

1468

1472

1478

1478

1487

1484

1486

1487

1487

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 9 of 63

Ex 1C

Distinct Count of DCDC

Row Labels

2020

Jun 18 - 30

Jul

Aug

Sep

Oct

Grand Total

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 10 of 63

Admissions to CDF and CTF, by Status and Month

June 18, 2020 - October 31, 2020

Column Labels

Pretrial Felony Parole Pretrial Hold for Other Sentenced Sentenced Writ or Fugitive Grand Total

Violator Misdemeanor Transfer Felon Misdemeanant_ Hold

20 22 9 3 1 2 51

74 80 41 14 13 4 6 1 199

109 63 52 31 10 13 7 5 1 246

94 118 56 55 15 9 4 1 314

113 83 46 39 15 4 6 287

409 337 198 139 54 30 25 7 1 1044

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 11 of 63

Ex 1D

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 12 of 63

Average Length of Stay of Inmates Housed at CDF and CTF, by Status and Month

June 18, 2020 - October 31, 2020

Average of LOS Column Labels

Row Labels Pretrial Felony Parole Pretrial Hold for Other Sentenced Sentenced Writor Fugitive Grand

Violator Misdemeanor Transfer Felon Misdemeanant_ Hold Total

2020

Jun 18 - 20 273 158 47 333 132 407 128 446 294

Jul 281 151 52 354 146 409 130 472 304

Aug 286 133 50 371 36 433 102 505 1 307

Sep 291 112 51 375 38 459 123 533 302

Oct 296 119 62 379 25 438 103 556 303

Grand Total 288 129 54 366 68 431 112 506 1 303

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 13 of 63

Ex 2A

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 14 of 63

1. Contract Number Page of Pages

AMENDMENT OF SOLICITATION / MODIFICATION OF CONTRACT CW68868 1 2

2. Amendment/Modification Number | 3. Effective Date 4. Requisition/Purchase Request No.

M0006 May 18, 2020 onererensive Medical Services

6. Issued by: Peter Kern Code | 7. Administered by (If other than line 6)

Office of Contracting and Procurement Department of Corrections

441 4" Street, NW Suite 330 South 2000 14° St. NW 7" Floor

Washington, DC 20001 Washington, DC 20009

8. Name and Address of Contractor (No. street, city, county, state and zip code) 9A. Amendment of Solicitation No.

Unity Health Care, Inc.

1100 New Jersey Ave SE, Suite 500 9B. Dated (See Item 11)

Washington DC 20003 ——

10A. Modif f No.

Office: 202-715-7900 x Cwesses of Contract/Order No

Attn.: Vincent A. Keane

vkeane@unityhealthcare.org

10B. Dated (See Item 13)

Code Facility 04/05/2019

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

|_| the above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers oO is extended. Ol is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing Items 8 and 15, and returning copies of the amendment: (b) By acknowledging receipt of this amendment on each copy of the offer

submitted; or (c) BY separate letter or fax which includes a reference to the solicitation and amendment number. FAILURE OF YOUR ACKNOWLEDGMENT TO

BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION

OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such may be made by letter or fax, provided each letter or

telegram makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. Accounting and Appropriation Data (If Required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS ,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14

A. This change order is issued pursuant to (Specify Authority): 27 DCMR, Chapter 36, Contract Modifications

The changes set forth in Item 14 are made in the contract/order no. in item 10A.

B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office, appropriation data

etc.) set forth in item 14, pursuant to the authority of 27 DCMR, Chapter 36, Section 3601.2.

C. This supplemental agreement is entered into pursuant to authority of:

X D. Other (Specify type of modification and authority) ) 27 DCMR, Chapter 36 Sections 3601 (a) negotiated adjustment and f8603.1 change order

clause.

E. IMPORTANT: — Contractor | is not xX is required to sign this document

14. Description of Amendment/Modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)

This modification is in response to the COVID-19 emergency at the DC Department of Corrections Central Detention

Facility and the Correctional Treatment Facility. Mod M0006 adds one CLIN funding NTE $428,672.00 for two Medical

Assistant Positions and two Nurse Practioners (NP) or Physician Assistants (PA) from 05/18/2020 through 09/30/2020

and two Option Contract Line Items (CLINSs) (see page 1 of this Mod), which are subject to the availability of funds. The

modification is authorized and executed through WebEOC-80767 16.

For this Modification only, Unity Health Care, Inc. shall submit invoices directly to Dr. Beth Jordan at

beth.jordan @de.gov and to Deborah J. White at deborahj.white@dc.gov. These invoices shall not be applied to the

existing purchase order but to the purchase order specifically designated for WebEOC-8076716. All other billing shall

continue as specified in the contract.

All other terms and conditions remain unchanged.

Except as provided herein, all terms and conditions of the document is referenced in Item 9A or 10A remain unchanged and in full force and effect.

15A. Name and Title of Signer (Type or print) 16A. Name of Contracting Officer

Vincent A. Keane Deborah J. White

15B. 15C. Date Signed 16B. District of Columbia 16C. Date Signed

I/ Ne a a Koi Deborah Uae

U June 2, 2020

(Signature of person authorized to sign) (Signature of Contracting Officer) 08/1 1 /2020

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 15 of 63

AMENDMENT OF SOLICITATION / MODIFICATION OF CONTRACT

1. Contract Number

CW68868

Page of Pages

2 12

Mod M0006 adds the following Option CLIN pricing to Section B.3.2.1 Requirements, in B.3.2 Option Year

One, in response to COVID-19 and WebEOC-8076716 approval:

Contract Line

Item No.

(CLIN)

Labor Category

Hourly

Labor

Rate*

Estimated

Labor Hours

Total Amount

CLIN 1010 For the Time Period 05/18/2020 to 09/302020

CLIN 1010A

C.3.36

2 Medical Assistants (MA) at 1,088

labor hours each.

$ 65.00

2,176

$ 141,440.00

CLIN 1010B

C.3.36

2 Nurse Practitioners (NPs) or 2

Physician Assistants (PAs) at 1,088

labor hours each.

$ 132.00

2,176

F

287,232.00

Total CLIN 1010 Not-to-Exceed

$ 428,672.00

CLIN 1011 For the Time Period 10/01/2020 to 01/31/2021

Option CLIN

1011A C.3.36

2 Medical Assistants (MA) at 984

labor hours each.

$ 65.00

1,968

$ 127,920.00

Option CLIN

1011B C.3.36

2 Nurse Practitioners (NPs) or 2

Physician Assistants (PAs) at 984

labor hours each.

$ 132.00

1,968

F

259,776.00

Total CLIN 1011 Not-to-Exceed

$ 387,696.00

CLIN 1012 For the Time Period 02/01/2021 to 04/14/2021

Option CLIN

1012A C.3.36

2 Medical Assistants (MA) at 584

labor hours each.

$ 65.00

1,168

$ 75,920.00

Option CLIN

10121B

C.3.36

2 Nurse Practitioners (NPs) or 2

Physician Assistants (PAs) at 584

labor hours each.

$ 132.00

1,168

$ 154,176.00

Total CLIN 1011 Not-to-Exceed

$ 230,096.00

Grand Total Not-to-Exceed Amount

$ 1,046,464.00

*The fixed hourly rates shall be fully loaded and include wages, benefits, overhead,

general and admnistrative expenses and profit.

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 16 of 63

Ex 2B

Case 1:20-cv-00849-CKk

paeée2/20 Page 17 of 68S 6001.1

DC Department of Corrections

Sick Call Request Form

Name/Nombre:

Date of Birth/Fecha de Nacimiento:

\o Housing

\' DCDC# Unit/Unidad Cell/Celda #

0

\ ( Check only one box per slip Marque solo una casilla por papelata

/

#, I wish to be seen at Sick Call Yo deseo el visto por el doctor

of Dental Treatment Tratamiento Dental

Mental Health Salud Mental

Other Otro

I have (check all that apply) Tengo (marque todo lo que corresponda)

A fever Una fiebre

Coughing Tos

Difficulty breathing/ Dificultad para respirar/

shortness of breath falta de aliento

Headache/Body Ache Dolor de cabeza o dolor corporal

Upset stomach Dolor de barriga

Comments/Comentarios

For any emergency ask the officer to call the medical unit.

Para cualquier emergencia, pidale al oficial que llame al medico de turno.

Patient Signature/Firma del paciente Date/Fecha

Medical Provider

Date Time ry am | pm

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 18 of 63

Ex 2C

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 19 of 63

PP 4030.1

Attachment B

DISTRICT’-OF COLUMBIA

DEPARTMENT OF CORRECTIONS

: _.= INMATE. REQUEST SLIP *

DATE

NAME DCDC UNIT CELL

{ }RECORDS OFFICE { } CASE MANAGER

{ } CHAPLAINS OFFICE { } INMATE CLOTHING

{ } FINANCIAL ACCOUNT BALANCE { } LEGAL CALL

{ } INMATE PROPERTY { }NOTARY

{ } FACE SHEET (unavalLaBte IF YOUR SENTENCE IS OVER1 YEAR) { } LAW LIBRARY

{ }OTHER :

-PLEASE'EXPLAIN THE’NATURE OF YOUR REQUEST:BELOW

OFFICIAL/CASE MANAGER COMMENTS

DATE: STAFF SIGNATURE:

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 20 of 63

Ex A

Case 1:20-cv-00849-CKK DorAarstentthterchaviindem caviney¥2O Page 21 of 63

What is a novel coronavirus? A novel coronavirus is a new coronavirus that has not been previously identified.

The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly

circulate among humans and cause mild illness, like the common cold.

Why is the disease called coronavirus disease 2019, COVID-19? On February 11, 2020 the World Health

Organization (WHO) announced an official name for the disease that is causing the 2019 novel coronavirus

outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated

as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this

disease was referred to as “2019 novel coronavirus” or “2019-nCoV”.

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract

illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen

in humans. The name of this disease was selected following WHO best practice for naming of new human

infectious diseases.

What’s the source of the virus? COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses are

a large family of viruses that are common in people and may different species of animals, including camels,

cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people. This

occurred with MERS-CoV and SARS-CoV, and now with the virus that causes COVID-19. The SARS-CoV-2

virus is a betacoronavirus, like MERS CoV and SARS CoV All three of these viruses have their origins in bats

The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single,

recent emergence of this virus from an animal reservoir However, the exact source of this virus is unknown

How does the virus spread? The virus that causes COVID 19 is thought to spread mainly from person to

person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets

can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs Spread is more

likely when people are in close contact with one another (within about 6 feet).

COVID 19 seems to be spreading easily and sustainably in the community (“community spread”) in many

affected geographic areas. Community spread means people have been infected with the virus in an area,

including some who are not sure how or where they became infected

Why are we seeing a rise in cases? The number of cases of COVID-19 being reported in the United States is

rising due to increased laboratory testing and reporting across the country. The growing number of cases in part

reflects the rapid spread of COVID-19 as many U.S. states and territories experience community spread. More

detailed and accurate data will allow us to better understand and track the size and scope of the outbreak and

strengthen prevention and response efforts.

Can someone who has had COVID-19 spread illness to others? The virus that causes COVID-19 is spreading

from person-to-person. People are thought to be most contagious when they are symptomatic (the sickest). That

is why CDC recommends that these patients be isolated either in the hospital or at home (depending on how sick

they are) until they are better and no longer pose a risk of infecting others. More recently the virus has also been

detected in asymptomatic persons.

How long someone is actively sick can vary so the decision on when to release someone from isolation is made

using a test-based or non-test-based strategy (i.e. time since illness started and time since recovery) in

consultation with state and local public health officials. The decision involves considering the specifics of each

situation, including disease severity, illness signs and symptoms, and the results of laboratory testing for that

patient. Someone who has been released from isolation is not considered to pose a risk of infection to others.

Can someone who has been quarantined for COVID-19 spread the illness to others? Quarantine means

separating a person or group of people who have been exposed to a contagious disease but have not developed

illness (symptoms) from others who have not been exposed, in order to prevent the possible spread of that

disease. Quarantine is usually established for the incubation period of the communicable disease, which is the

1/2

Case 1:20-cv-00849-CKK DoraarstentthSerchaviindem caviney¥2O Page 22 of 63

span of time during which people have developed illness after exposure. For COVID-19, the period of

quarantine is 14 days from the last date of exposure because the incubation period for this virus is 2 to 14 days.

Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to

others because they have not developed illness during the incubation period.

Can I get sick with COVID-19 if it’s on food? Based on information about this novel coronavirus thus far, it

seems unlikely that COVID-19 can be transmitted through food — additional investigation is needed.

Will warm weather stop the outbreak of COVID-19? It is not yet known whether weather and temperature

affect the spread of COVID-19. Some other viruses, like those that cause the common cold and flu, spread more

during cold weather months but that does not mean it is impossible to become sick with these viruses during

other months. There is much more to learn about the transmissibility, severity, and other features associated with

COVID-19 and investigations are ongoing.

What are the symptoms and complications that COVID-19 can cause? Current symptoms reported for

patients with COVID-19 have included mild to severe respiratory illness with fever!, cough, and difficulty

breathing.

If I recovered from COVID-19, will I be immune to it? CDC and partners are investigating to determine if

you can get sick with COVID-19 more than once. At this time, we are not sure if you can become re-infected.

Until we know more, continue to take steps to protect yourself and others.

Who is at higher risk for serious illness from COVID-19? COVID-19 is a new disease and there is limited

information regarding risk factors for severe disease. Based on currently available information and clinical

expertise, older adults and people of any age who have serious underlying medical conditions might be at

higher risk for severe illness from COVID-19. Based on what we know now, those at high-risk for severe illness

from COVID-19 are:

e People aged 65 years and older

e People who live in a nursing home or long-term care facility

People of all ages with underlying medical conditions, particularly if not well controlled, including:

e People with chronic lung disease or moderate to severe asthma

e People who have serious heart conditions

e People who are immunocompromised

e People with severe obesity (body mass index [BMI] >40)

e People with diabetes

e People with chronic kidney disease undergoing dialysis

e People with liver disease

What kind of tesng is being used t_ o diagnose if | have COVID-19? There are actually many tests being used to

diagnose COVID-19 that the U.S. Food & Drug Administration (FDA) has authorized for use during the current

emergency. All of these diagnostic tests identify the virus in samples from the respiratory system, such as from

nasal or nasopharyngeal swabs.

2/2

Case 1:20-cv-00849-CKK coo Gousmrenénitse-t4 Pretdbevbulserrbid 2therP age 23 of 63

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19),

The best way to prevent illness is to avoid being exposed to this virus.

The virus is thought to spread mainly from person-to-person:

e Between people who are in close contact with one another (within about 6 feet).

e Through respiratory droplets produced when an infected person coughs, sneezes or

talks.

e These droplets can land in the mouths or noses of people who are nearby or possibly be

inhaled into the lungs.

e Some recent studies have suggested that COVID-19 may be spread by people who are

not showing symptoms.

¢ Wash your hands often with soap and water for at least 20 seconds especially after

you have been in a public place, or after blowing your nose, coughing, or sneezing.

¢ If soap and water are not readily available, use a hand sanitizer that contains at

least 60% alcohol. Cover all surfaces of your hands and rub them together until they

feel dry.

¢ Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid close contact with people who are sick.

Put distance between yourself and other people, at least 6 feet when possible(social

distancing)

e Remember that some people without symptoms may be able to spread virus.

e You could spread COVID-19 to others even if you do not feel sick.

e Everyone should wear a cloth face cover when they have to go out in public (cloth face

coverings should not be placed on anyone who has trouble breathing, or is unconscious,

incapacitated or otherwise unable to remove the mask without assistance).

e The cloth face cover is meant to protect other people in case you are infected.

e Do NOT use a facemask meant for a healthcare worker.

e Continue to keep about 6 feet between yourself and others. The cloth face cover is not a

substitute for social distancing.

1/2

Case 1:20-cv-00849-CKK coo G@ousirenénitse-t4 Pretdbevbulserbad 2therP age 24 of 63

If you are in a private setting and do not have on your cloth face covering, remember to

always cover your mouth and nose witha __ tissue when you cough or sneeze or use the

inside of your elbow.

Throw used tissues in the trash.

Immediately wash your hands with soap and water for at least 20 seconds. If soap and

water are not readily available, clean your hands with ahand __ sanitizer that contains at

least 60% alcohol.

¢ Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs,

light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.

« If surfaces are dirty, clean them. Use detergent or soap and water prior to

disinfection.

2/2

Case 1:2Crem-+ihOeate: aii Guida cel eraiad SieniLof Cohan! 19 it/ CetetfbnareaqnetitianiFGdities

Medical Isolation—Medical isolation refers to confining a confirmed or suspected COVID-19

case (ideally to a single cell with solid walls and a solid door that closes), to prevent contact with

others and to reduce the risk of transmission. Medical isolation ends when the individual meets

pre-established clinical and/or testing criteria for release from isolation, in consultation with

clinical providers and public health officials. In this context, isolation does NOT refer to

punitive isolation for behavioral infractions within the custodial setting.

Quarantine—Quarantine refers to the practice of confining individuals who have had close

contact with

a COVID-19 case to determine whether they develop symptoms of the disease. Quarantine for

COVID-19 should last for a period of 14 days. Ideally, each quarantined individual would be

quarantined in a single cell with solid walls and a solid door that closes. If symptoms develop

during the 14-day period, the individual should be placed undermedical isolation and evaluated

for COVID-19. If symptoms do not develop, movement restrictions can be lifted, and the

individual can return to their previous residency status within the facility

Social Distancing—Social distancing is the practice of increasing the space between individuals

and decreasing the frequency of contact to reduce the risk of spreading a disease (ideally to

maintain at least 6 feet between all individuals, even those who are asymptomatic). Social

distancing strategies can be applied on an individual level (e g , avoiding physical contact), a

group level (e.g., canceling group activities where individuals will be in close contact), and an

operational level (e g , rearranging chairs in the dining hall to increase distance between them)

Although social distancing is challenging to practice in correctional and detention environments,

it is a commerstone of reducing transmission of respiratory diseases such as COVID 19

CDC guidance recommends verbal screening and temperature checks for incarcerated/detained

persons, staff, volunteers, and visitors who enter correctional and detention facilities, as well as

incarcerated/detained persons who are transferred to another facility or released from custody.

Below, verbal screening questions for COVID-19 symptoms and contact with known cases, and

a safe temperature check procedure are detailed.

\ Verbal screening for symptoms of COVID-19 and contact with COVID-19 cases should

include the following questions:

1. Today or in the past 24 hours, have you had any of the following symptoms? Fever, felt

feverish, or had chills? Cough? Difficulty breathing?

2. In the past 14 days, have you had contact with a person known to be infected with the novel

coronavirus (COVID-19)?

1/2

Case 1:2Crem-+hOente: aii Guida cel eraiad SieniLof Cohan! 19 it/ Cct/etfbnaeaqnetehiaaiFGdities

\ The following is a protocol for medical providers to safely check an individual’s

temperature:

Perform hand hygiene

Put on a face mask, eye protection (goggles or disposable face shield that fully covers the

front and sides of the face), gown/coveralls, and a single pair of disposable gloves

Check individual’s temperature

If performing a temperature check on multiple individuals, ensure that a clean pair of

gloves is used for each individual and that the thermometer has been thoroughly cleaned in

between each check. If disposable or non-contact thermometers are used and the screener

did not have physical contact with an individual, gloves do not need to be changed before

the next check. If non-contact thermometers are used, they should be cleaned routinely as

recommended by CDC for infection control.

Remove and discard PPE and perform hand hygiene

2/2

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Ex B

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Introduction

Covid-19 is a virus that has spread around the world. It has impacted every area of our daily

lives. Businesses have shut their doors, people have been asked to “shelter in place,” many

people have become unemployed, and the government has been issuing subsidy checks to

citizens just to help people get through their financial crises.

Everyone is under stress. As so often happens, people are rallying, trying to help one another

and giving lifestyle “tips” or writing self-help manuals about staying healthy. These include

advice for being healthy during Covid-19, as well as staying emotionally and spiritually well

when there is such disruption in our lives.

Unfortunately, these resources don’t tend to address the needs of those of us in community living

situations, such as jails or prisons, mental health facilities, long term rest-homes, shelters, etc.

These settings present a variety of challenges, such as “Ihave a cell mate, so it is hard to get

time alone in my room. Sometimes,

lack of personal space and privacy, rules limiting when I’m feeling stressed, | go take a

shower just so | can be alone for a few

minutes and take time to do some

breathing exercises that help me feel

better.”

personal freedom, and lack of easy access to basic

needs, such as running water or the ability to distance

yourself from others.

If you are currently in this situation, this manual is for you and it’s written by people that have

lived in these kinds of environments!!! This information is also meant to provide information to

people who may not have access to the daily news about the new coronavirus. Included is a

section on the different ways we may be experiencing stress related to all the life changes caused

by the virus. Strategies to stay well- physically, emotionally, intellectually and spiritually — in

Case 1:20-cv-00849-CKK Document 138-1 Filed 12/12/20 Page 29 of 63

challenging environments are also included. Lastly, there’s a section to inspire you to use your

wisdom and survival skills to share with others that are living in the same situation right now.

This is called “peer support” and it is powerful! Peer support, or helping one another, can be

lifesaving at times like these... It helps people we connect with and ourselves as well. With this

guide, we honor your inner survivor and value your willingness to be of service to others.

Responding to Covid-19

e

These are difficult times for everyone. COVID-19 has impacted all Ww

of us in many ways. This can be especially difficult for those of us

who don’t have a strong network of support or who are isolated in

jails, prisons, mental health facilities, shelters or living on the

streets. Because of Covid-19 people, activities and resources that

usually support our health may have been removed or changed in significant ways. Fortunately,

you are a survivor and this guide is designed to remind you of all the ways you have survived

and thrived through other difficult life situations. With this in mind, this guide asks you to share

your skills with others around you by using what you learn to help them through this tough time.

Together, you are NOT alone... you are simply people together, going through a difficult time

and relying on each other’s strength, kindness and skills to continue your journey of wellness!

Let’s start by sharing some basic information about COVID-19 and the way it may be impacting

our bodies...

What is Covid-19?

COVID-19 (also called “Coronavirus 20/9”) is a virus that is transmitted

from person to person:

o when people who are in close contact with one another

within about 6 feet or less.

o through respiratory droplets that pop out when an infected

person coughs, sneezes or is simply speaking.

o when these droplets land in the mouths, eyes or noses of people who are nearby or

when they’re inhaled into the lungs.

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Its NEW!!

The Covid-19 virus is called a “novel” or “new” coronavirus. This means that humans don’t

have any immunity (natural disease protection) and there are no treatments or vaccines for it.

Scientists have been able to create a test that can determine if someone has the virus but the tests

aren’t widely available yet. That’s one of the reasons why this virus is so different and so

dangerous. It can spread from person to person easily. Some people get really sick or die

because there isn’t any treatment available.

Of course, medical hospitals can treat the symptoms that develop, like pneumonia and other life-

threatening lung diseases. But if too many people get really sick at the same time, we don’t have

enough hospital beds and equipment needed for that kind of resource demand. Right now, the

effort is to SLOW the spread so hospitals can manage the people that are already sick with the

virus.

Why the Big Deal?

The “social isolation” (staying in your living quarters) has been important because the virus has

some sneaky ways that lead to it spreading easily:

= People can carry the virus and spread it to others without having any symptoms

themselves. Any of us could be a silent carrier, infecting others without even knowing it.

This is called being “asymptomatic”.

= Also, people who get sick may have been carrying and spreading the virus for up to two

weeks before showing symptoms.

This is why there are such dramatic efforts to keep people apart and “social distance.”

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Some Quick Facts and Myth Busters

Here are some quick facts and myth busters from the Center for Disease Control (CDC).

Because the virus first emerged in China, rumors started that this was an Asian or Chinese

Diseases can make anyone sick

regardless of their race or ethnicity.

People of Asian descent, including Chinese

Americans, are not more likely to get COVID-19

than any other American. Help stop fear by

letting people know that being of Asian descent

does not increase the chance of getting or

spreading COVID-19.

Exposure to people with Covid-19 increases

your risk of getting sick with the virus. But

for some people, the impact of the virus is

more likely to be deadly. People at greater

risk are:

= People over 65 years old

disease. Like all viruses, Covid-19

doesn’t discriminate. The coronavirus is

called a “pandemic” because it’s now a

world-wide illness that has infected about

3 % million people as of this writing. This

number continues to increase every day.

FACT Some people are at increased risk of

2 getting COVID-19.

People who have been in close contact with a

person known to have COVID-19 or people who

live in or have recently been in an area with

ongoing spread are at an increased risk

of exposure.

= Strong bodies can probably fight off the virus so people will get sick but recover.

However, people with weak bodies or immune systems can get deathly ill. People who

have pre-existing illnesses, especially lung conditions, heart conditions, diabetes, etc. are

especially vulnerable.

Since we can have the virus before we actually get any symptoms, it’s suggested that people

Someone who has completed

quarantine or has been released

from isolation does not pose a risk of

infection to other people.

For up-to-date information, visit CDC’s

coronavirus disease 2019 web page.

“quarantine” or isolate themselves for two

weeks after they know they’ve been

exposed to someone with the virus. This is

to slow down the spread. As of right now,

with what the experts have learned about

the disease so far, it’s believed that if a

person who was exposed hasn’t gotten any

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symptoms within two weeks, he or she wasn’t infected and is safe to go back out into the

community.

The symptoms of Covid-19 are very similar to other You can help stop COVID-19

common illnesses, like the yearly FLU. If you have any by knowing the signs

and symptoms:

of these symptoms, tell the correctional staff or another

« Fever

* Cough

service provider where you are housed. Testing 1s

usually available to those with symptoms and you can

find out if you do or don’t have the virus. If you’re in a + Shortness of breath

living situation where you don’t have quick access to Seek medical advice if you

- Develop symptoms

AND

medical support but think you might have the virus, it’s

probably best to assume you do and take precautions to

minimize spreading the illness to others. These are - Have been in close contact

with a person known to have

COVID-19 or if you live in or have

recently been in an area with

There is currently no vaccine to prevent the 2019 onaoina spread of COVID-19.

discussed below.

coronavirus disease (COVID-19). The best way to prevent illness is to avoid being exposed to

this virus if it’s possible. Of course, for most people total isolation from others isn’t possible.

For people currently in jails, mental health institutions or other residential facilities, isolation can

be more challenging. However, there are some precautions and recommended strategies that can

help you minimize your chances of getting the virus.

There are simple things you can

do to help keep yourself and

others healthy.

RECOMMENDED STRATEGIES

Washing your hands with soap for at least 20 seconds is recommended

because soap is a great virus killer! The virus often gets into our bodies

by traveling from our hands to our nose, mouth or eyes when we touch

our face. It can also get inside our bodies when we breathe. So, the more

you wash your hands, the more likely you are to kill any of the virus

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germs you are exposed to during the day. If soap isn’t available, using a hand sanitizer with at

least 60% alcohol can also help. Be sure to cover all surfaces of your

hands and rub them together until the hand sanitizer fully covers both

hands and they feel dry. r

Avoiding close contact with others when possible is important, especially i: | %

with people who are sick. A good way to help is putting distance ‘|

between yourself and other people (at least 6 ft), which can lessen your chance of getting the

virus. This is particularly important for people who are at higher risk of getting very sick (see

below).

Wearing a face mask is important to help minimize the chance that you

will infect other people. The Covid-19 virus is so dangerous because you

can have it and spread it to others without having any symptoms at all.

Facemasks provide a barrier for the nose and mouth to either transmit

droplets or receive them... It’s protection for everyone!

THINGS YOU CAN DO ANYWHERE

Some people don’t have the ability to follow the CDC recommendations because of the

imitations of homelessness, or living in medical or penal institutions. Here are some other ways

to keep yourself and others safe.

Can’t Wash Your Hands Often? Try these things you can do anywhere:

Hand washing decreases the risk of carrying the virus from surfaces you touched to your eyes,

nose and mouth. We tend to touch our faces, a lot — way more than we may realize — and this is

one of the quickest routes for the virus to carry from person to person. If you can’t wash your

hands often, you can still:

e Try to limit how many surfaces you touch. Things like door handles, counters and

other smooth surfaces can hold the virus for several days.

e@ Use your sleeve over your hands. When you go through doors or gates or when you

pick up something from a counter, use an article of clothing like your sleeve to cover

your hand.

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e Try to keep your hands away from your face. This sounds simple, but it’s really hard.

Try to pay attention for just 15 minutes and you’ll see how many times your hand goes to

your face. If you can’t wash your hands, keeping your hands from your face will greatly

increase your safety.

e Cover your mouth and nose with your shirt. When you’re in shared spaces where you

can’t keep at least 6 feet between you and others, you might want to pull up your shirt or

clothing up over your face to cover your mouth and nose like a mask.

@ Cough or sneeze into your inner arm or clothing. When you cough or sneeze, use the

inner space of your elbow or a piece of clothing rather than covering your mouth with

your hands. If you use tissue, throw it away as soon you’re done. Don’t save it.

e Turn your head and cover your mouth. If someone else is coughing or sneezing in

your presence, try to turn your head away from the person. Stay turned away for about 30

seconds if you can. You can also use a piece of clothing to cover your mouth.

Live in Close Contact With Others? Try these things when you can’t socially distance: You

may not have the option of keeping a good distance between you and others in your living

situation. If this is your situation, try this option:

e Ifyou share a room or cell, you might want to determine an imaginary line in the room

where each of you has your own space. You can even put something on the floor to

remind both of you about the line, such as a piece of clothing, a sock, a sheet, etc.

THINGS YOU CAN EXPECT FROM STAFF:

e If you’re in a residential living situation and everyone is on lock-down, then you’re only

exposed to each other. If you’ve been on lock-down for two weeks and no one has gotten

sick, you’re probably pretty safe.

e If staff are coming in and out, it’s important that they should be using safety

practices like wearing masks and washing their hands so they don’t bring the virus

into your living setting. This will help to make sure you’ re safe!

e Ifyou’re in a jail or prison, you should know that they’ve temporarily stopped all

transfers of people from other jails and prisons, trying to decrease any spread.

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If you’re concerned that the staff around you are not following safety protocols to keep you

healthy, you have the right to reach out to the unit supervisor. To ‘advocate’ means that you

speak up for your rights. Filling out a grievance form or talking to a floor supervisor is a way

to make sure your concerns about your health are heard.

If you feel empowered in your setting, you might also suggest some safety practices that are

being currently used in other institutions. You can also use your voice to highlight some

examples of great practices other places are doing to effectively handle this crisis in outside

hospitals, jails, etc.

Testing is slowly becoming more available to people beyond those who

= are already showing symptoms. There are groups of scientists who are

= working every day to try to create medications to lessen the symptoms of

lJ COVID-19, others are working to create a vaccine. Like you, everyone is

trying their best to slow the spread by practicing what’s in this manual.

These practices are important because our actions help keep the virus from infecting those who

are most vulnerable. These are people who are older and have already have serious medical

conditions, such as COPD, diabetes, heart conditions, HIV, immunity illnesses, etc.

How Might Covid-19 Affect Us?

STRESS is a natural response to uncertainty and disruption, and so in this time when our entire

way of life has been disrupted, everyone everywhere is feeling some level of stress.

We each experience stress in our own unique ways. As we grow up, we learn how to

respond to challenges by watching those around us for cues of what is and isn’t acceptable. In

addition, our bodies have natural defense system that sends a signal when things are out of sync

with our body and mind so we can react to keep ourselves safe. Think about what happens when

you startle a dog or cat. Their first reaction is to get into a defensive posture and hiss or bark. In

an instant, they’re ready to protect themselves. Humans are much the same way. We also get

flooded with chemicals, like adrenaline, that assist our minds and bodies to prepare to combat

danger.

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Our Internal Alarm: Those of us who have grown up in homes with violence, abuse or neglect

may have had our “danger” alert activated many times. After too many alerts over time, parts of

our system can get worn out and broken. For some of us, the “alarm bell” goes off often, even

when there’s not any danger. For example, our alarm bell may signal a five-alarm fire, when the

FiGr

i v; '

Linwiy

E

Our Response to Danger: While some of us respond to our internal alarm by going into a

situation is really only a small amount of smoke. In these cases, our

bodies are flooded with overwhelming amounts of “fight or flight”

chemicals. We’re getting ready for a battle that doesn’t exist. For

others, the alarm bell might fail to ring when needed, leaving us

vulnerable and unprepared to address a danger that may exist.

“fight” stance, others of us may respond in the opposite way by “freezing” or “checking out.”

This is known as dissociating and is an automatic biological response. In the same way a deer

freezes in the middle of the road in fear when a car approaches, we sometimes go into a freeze

mode. This can lead to brain fog, an inability to speak or speak clearly, feeling stuck in place

and unable to move, or spacing out. The spacing out or dissociating can be mild or more

extreme. It can include a complete memory loss of the time that passes like a blackout. Here’s

another way to look at it, graphically:

FLIPPING OUR LID

Make a fist with your thumb tucked inside your fingers. This is a

hand model of our brain.

THUMB

In this hand model, our fingers represent

where our emotions

and memories live. The thumb is called the

Limbic System and it is where our Fight,

Flight, Freeze reactions to danger are

triggered.

FINGERS

In this hand model, our fingers represent our Rational Brain. When our

rational brain is activated, we are able to think, reason and make

decisions about how we are going to respond to danger. As in the image

above, it covers our Limbic System (thumb) and we use it to think through situations.

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However, at times when our Limbic System (thumb) is really activated, it can cause us to

“flip our lid,” and our rational brain (fingers) can be taken over by our emotions. When the

Rational Brain loses control of emotions, we can’t think clearly.

To “un-flip” our lids, we can use the strategies included in this manual to help us feel

grounded, calm our bodies and mind, and feel more empowered to make good decisions.

Distress: What YOU Might Be Experiencing

Experts agree that a core component of stress is the perception of threat and danger.

Ironically, our “stress” system is meant to protect us when we’re in danger but it can sometimes

work against us. When we’re stressed, we tend to experience distress in our most vulnerable

personal areas. This may be physical, emotional, intellectual and/or spiritual vulnerability.

Outward Signs of Distress:

Often, when we experience distress it shows up in

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