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Cripa Stuart Va Investigation Findings 3-6-03

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March 6, 2003
Mr. Darrell Cockerham
Patrick County Board of Supervisors
P.O. Box 137
Stuart, Virginia 24053
Mr. David Hubbard
Sheriff, Patrick County
103 West Blue Ridge Street
Stuart, VA 24171
Re: 	 Investigation of Patrick County Jail 

Stuart, Virginia 

Dear Mr. Cockerham and Sheriff Hubbard:
On December 8, 2001, we notified you of our intent to
investigate conditions of confinement at the Patrick County Jail
("Jail"), pursuant to the Civil Rights of Institutionalized
Persons Act, 42 U.S.C. § 1997 et seq. ("CRIPA"). Our
investigation focused on issues of security and protection from
harm, access to medical care, environmental health, access to the
courts, opportunities for exercise, and release practices. We
are writing to report the findings of our investigation,
supporting facts, and recommended remedial measures, as required
We toured the Jail on four separate occasions with expert
consultants in the fields of corrections, environmental health
and safety, medical care and fire safety. These tours were
conducted on March 19-21, April 8, June 10-11 and June 25, 2002,
respectively. While at the Jail, we interviewed the Sheriff and
Chief Jailer, Jail staff and inmates; we reviewed documents
including state and county inspection reports, the policies and
procedures manual, the unusual incidents logbook, and individual
inmate records. We interviewed the community-based providers of
food services and medical and mental health care. At the end of

- 2 
each tour, our expert consultants conducted informal exit
meetings with the Sheriff in which they conveyed their
preliminary findings.
We appreciate the assistance provided to us by the Patrick
County Sheriff and staff at the Jail, who extended every courtesy
to us during our visits, and provided all documents we requested.
Based on our investigation, and as described more fully
below, we conclude that certain conditions at the Jail violate
the constitutional rights of inmates. We find that persons
confined at the Patrick County Jail risk serious injury from
deficiencies in the following areas: security and protection
from harm, access to medical and mental health care,
environmental health and safety, access to exercise, and access
to the courts.



The Jail is part of the County Courthouse building, built
in 1822; the addition containing the Jail was built in the 1920s.
The Jail contains a total of 19 bunks and has an average
population of approximately 30 inmates; inmates without a bunk
sleep on mattresses placed on the floor. The Jail houses
primarily pre-trial detainees and sentenced misdemeanants, whose
average length of stay is just short of six months.1/
The first floor of the Jail contains an office for the
Sheriff's Office dispatcher, the Jail's control room, an open
space used for processing intakes, and a single-bunked "drunk
tank." The Jail's two cellblocks are located on the second and
third floors. Female inmates are housed temporarily in the drunk
tank until they are moved to other jails with facilities for

When queried by our consultant, Jail staff did not know
the average length of stay at the Jail. From data provided by
the Jail, our consultant calculated that inmates in custody on
January 31, 2001 had an average length of stay of 166.33 days,
equal to just under 24 weeks. The average population was also
calculated by our consultant from monthly data reported by the
Jail to the Virginia States Department of Corrections.

- 3 
female inmates; the Jail otherwise houses only men. The first
floor drunk tank also serves as the Jail's only isolation cell.
The cellblocks each contain four small cells in a linear
configuration, which open onto a small day area measuring
approximately 5 by 30 feet. There is a shared toilet and sink in
each cell, and a shared shower and toilet in the day room. The
dayroom also contains a large stationary table with two benches,
where the inmates eat all of their meals. There is a narrow
catwalk between the dayroom and the exterior walls that is used
by staff and trusties for access to storage and to pipe chases at
both ends of the catwalk. Light fixtures are located in the day
room and the catwalk; there are no lights at all within the
cells. There is also a small living space with a single bunk for
an inmate trusty, located in the corner of the catwalk nearest
the exit to the stairway.
The cells in the cellblocks each contain two bunks mounted
approximately 24 to 28 inches from the floor, and mattresses on
the floor below these bunks. These "upper" bunks are
approximately knee level (for a man of average height.) Inmates
on the mattresses below these bunks have so little headroom that
they cannot sit upright on their mattresses. With an average
population regularly exceeding the total of 19 available bunks,
inmates routinely sleep on mattresses on the floor, below the
fixed bunks. When the population swells above 35, inmates also
sleep on mattresses in the day room of the cell blocks.2/
The Jail has no private area to conduct medical
examinations, medical screening or intake interviews. Officers
conduct intake interviews with the inmate standing in the public
lobby just outside the control room. The Jail also has no area
for exercise, apart from the small and crowded dayroom.


CRIPA gives the Department of Justice authority to
investigate and take appropriate action to enforce the
constitutional rights of inmates in jails. With regard to
The Jail's population counts show that inmates frequently
sleep on the dayroom floor. The Jail's inmate manual even notes
that no bed clothing is allowed on the cellblock floors "EXCEPT:
. . . For inmates assigned to sleep on the floor because of
overcrowded conditions in the jail." See Inmate Manual, p. 2.

- 4 sentenced inmates, the Eighth Amendment requires “humane
conditions of confinement; prison officials must ensure that
inmates receive adequate food, clothing, shelter and medical care
and must ‘take reasonable measures to guarantee the safety of the
inmates.’” Farmer v. Brennan, 511 U.S. 825, 832-833 (1994)
(quoting Hudson v. Palmer, 468 U.S. 517, 526 (1984)). Prison
officials have a duty to protect prisoners "from violence at the
hands of other prisoners." Farmer, 511 U.S. at 833. The Eighth
Amendment protects inmates not only from present and continuing
harm, but from future harm as well. Helling v. McKinney,
509 U.S. 25, 33 (1993).
The county must also ensure that all inmates in the Jail
receive adequate medical care, including mental health care. See
Farmer v. Brennan, 511 U.S. 825, 832 (1994); Bowring v. Godwin,
551 F.2d 44, 47 (4th Cir. 1977); Young v. City of Augusta ex rel
Devaney, 59 F.3d 1160 (11th Cir. 1995).
The majority of inmates at the Jail are pre-trial detainees,
who have not been convicted of the criminal offenses with which
they have been charged. The rights of pretrial detainees are
protected under the Fourteenth Amendment, which ensures that
these inmates "retain at least those constitutional rights . . .
enjoyed by convicted prisoners." Bell v. Wolfish, 441 U.S. 520,
545 (1979). In addition, the Fourteenth Amendment prohibits
punishment of pretrial detainees or the imposition of conditions
or practices not reasonably related to the legitimate
governmental objectives of safety, order and security. Id.
at 535-37.



Inmates at the Jail face extremely crowded conditions, no
opportunities for exercise, inadequate library resources and few
alternatives to idleness, all of which increase tensions among
inmates. Numerous lapses in basic security and supervision at
the Jail significantly increase the risk of harm faced by inmates
in this environment.

No Security Classification System

- 5 
There is no classification system used at the Jail. Inmates
are assigned to bunks based primarily on available space.3/ The
Jail reacts to reports of fighting and conflict by moving inmates
between its two cellblocks, and ultimately, by transferring some
inmates to other facilities. Although the Jail lacks a system of
records to track incidents of violence or assaults among inmates,
interviews with inmates, entries in the Jail's unusual incidents
logbook, and the practice of transferring inmates to different
floors to stop fighting each suggest that assaults among inmates
at the Jail are not uncommon. An objective classification system
is essential to minimizing assaults and violence among inmates in
shared housing. The failure to use a classification system to
assess each inmate's relative risk of violence, or, conversely,
the inmate's risk of being victimized, places inmates at
significant and unnecessary risk of harm. A classification
system would also provide a rational basis for judging which
inmates should be moved to other jails, instead of the current
practice of transferring an inmate only after the inmate
demonstrates, through his behavior at the Jail, that he poses too
great a risk or a management problem.

Inadequate Capacity to Segregate Inmates

The Jail has no ability to provide special housing for
inmates who may need it for purposes of disciplinary segregation,
protective custody, or to accommodate medical or mental health
needs. For example, inmates asserted that those charged with
sexual offenses were generally housed in the same cellblock to
avoid "trouble" from other inmates. The Jail dos not maintain
separate high and low security classification housing in its two
cellblocks. Only the single-bunked drunk tank is available to
segregate inmates, and it is often unavailable because it is also
used to house female inmates or to observe newly-admitted and
intoxicated inmates.
Of particular concern is the apparent practice of holding
female inmates for several days in the drunk tank, where they
have no access to a shower. The physical deficiencies of the
drunk tank, described infra, are such that it should house no

Staff members also rely upon their personal knowledge of
the inmates, which is considerable because they are from a small
community and because many inmates are repeat offenders.

- 6 
more than one person at a time, and should be utilized as a
temporary holding cell for no more than 24 hours at a time.

No Systematic Enforcement of Facility Rules

Jail records show that inmates are provided written notice
and a disciplinary hearing for rule violations.4/ However,
because there are so few privileges available to inmates at the
Jail, and almost no ability to segregate inmates, the Jail has
few options for imposing a penalty on those found to have
violated the rules. Instead, inmates are usually shuffled
between the cellblocks to separate antagonists from each other
and their victims.5/
Jail logbooks indicate that inmates have sustained injuries
likely associated with fighting, but there are no records of
investigations following such injuries.6/ The failure to
investigate injuries arising from potential assaults also
contributes to assaultive and predatory behavior going unchecked.
There is also no documentation that staff perform
sufficiently frequent and random searches of inmate living areas.
Such searches are essential to control accumulation of
contraband, which presents both a security and a fire hazard when
unchecked. Inmates who are found with contraband should be

Failure to Inform All Inmates of Jail Policies

We were provided copies of only three disciplinary
reports for the period October 18, 2001 through February 20,
2002. If this represents all of the hearings held during that
time, then the vast majority of violations were not the subject
of a disciplinary hearing.

The Chief Jailer stated that he seldom, if ever, takes
away good time from sentenced prisoners for rules violations.

For example, in a logbook entry on November 16, 2001, a
deputy notes that he "noticed several inmates sitting at the
table looking toward the shower" and that, upon investigation, he
found "everything was OK except [inmate D.B.] was standing in his
cell and his right eye was red and had a small cut on it." The
inmate stated he had fallen, and no further investigation was

- 7 
Inmates uniformly reported to us that manuals explaining
Jail policies were distributed just before our first visit. The
Jail must make manuals available to inmates in a timely and
consistent manner. In addition, we are concerned that the Inmate
Manual is printed only in English, and that inmates who speak
only Spanish must depend on other inmates to communicate with
staff and understand the Jail's rules. Because the Jail's
population routinely includes inmates who have a limited ability
to read and/or understand English, the Jail must provide
explanations of essential information in the inmate manual for
these inmates. The County must convey this information in order
to protect inmates' constitutional rights, including the right to
due process before imposition of discipline for rules violations,
the right to medical and mental health care for serious health
conditions and the means to access this care while in the Jail,
and the right to petition the courts and the means of doing so
while incarcerated.
In addition, the inmate grievance system does not provide a
sufficient means for inmates to challenge Jail administrators
about conditions of their confinement. The Jail has no
documentation to refute the claims of inmates that their
grievances are frequently ignored, and that responses, when
given, are often significantly delayed.7/

No Control of Caustic Chemicals and Weapons

There are no controls of caustic cleansers or equipment, and
no antidotes, eye washes or chemical control kits within easy
access. Caustic chemicals are readily available to inmate
trusties, who are supervised only loosely.8/ There are also
insufficient controls on medical wastes and sharps. All of these
items can be used as weapons to injure staff or other inmates,
and must be controlled.
Jail staff gave us different definitions of the security
perimeter of the Jail, which we define as that space within which
Staff told us that written complaints from inmates are
addressed by the Chief Jailer or the Sheriff, but that the
written complaints are not retained.

The Jail has no clear criteria for selecting inmate

- 8 
all weapons should be locked down and secured in order to
preclude inmate access. We observed officers come into the Jail
from outdoors without first securing their weapons, and move past
the drunk tank (which was unlocked on at least one occasion when
an inmate was inside) and through the open lobby on their way to
the dispatcher's office or to the control room. Inmates were
often present in the drunk tank or in the lobby through which the
officers passed, creating a clear security risk. The security
perimeter of the Jail must be clearly defined and all weapons
must be secured within that space.



The provision of medical services to inmates at the Jail is
seriously deficient and puts inmates at risk of harm. Most
fundamentally, the Jail has no on-site medical care providers.
In addition, no medical professionals are involved in screening
inmates for medical concerns or in supervising or following up on
outside medical visits. From these fundamental deficiencies,
numerous unacceptable risks follow.

Intake Screening

The intake screening process is insufficient to ensure that
inmates receive necessary medical care while incarcerated. The
most significant deficiency is the lack of oversight by a
responsible medical care provider. Although § 4.5 of the Jail's
policy and procedures manual states that a copy of the Jail's
medical screening form is made available for a physician's
review,9/ the deputies and the local physician concurred that
this practice is not followed.

The local physician sees inmate patients on an as-needed
basis at his office. Although the Jail describes him as its
medical director, he does not have a contract with the Jail, and
performs none of the functions of a medical director. He does
not review Jail policies and procedures concerning medical care,
does not review intake screening forms, and does not provide or
supervise any care at the Jail; in fact, he stated to us that he
has never been to the Jail.

- 9 
The intake screening process does not elicit10/10/ or document
sufficient relevant health information for each inmate. This
problem was first brought to our attention on our March 19th
visit; we identified this as a significant deficiency that
required immediate remediation. During our June 10 visit, eight
of eight current inmate files reviewed by our physician
consultant contained no medical screening information at all.11/
Failure to perform an intake screening and/or to record this
information presents a serious and unacceptable risk of harm to
inmates. Inmates who are injured or suddenly taken ill while in
the Jail may be denied timely and appropriate care in the absence
of basic medical information that should have been collected at
intake, including history of illness and mental illness and
identification of current medications and allergies. The risk of
such harm can be minimized, and often eliminated, by the simple
act of asking and recording basic medical information at intake.
That the Jail may at times collect intake information that cannot
be retrieved by Jail staff is as dangerous a practice as failing
to collect the information in the first place.
In addition, the physical location in which the screening by
Jail staff is conducted requires inmates to respond to questions
about confidential medical information in an open lobby space
adjacent to both the control room and to the main stairway in and
out of the Jail. The lack of confidentiality minimizes the
likelihood that inmates will respond truthfully to questions
about whether they have serious medical or mental illness.

Screening forms designed to elicit accurate information
about communicable diseases and basic medical and mental health
concerns are standard in the corrections industry, and available
from numerous public sources. The Jail's screening form is
deficient because it does not include these standard questions,
and thus, does not reliably detect medical and mental health

Jail staff explained that they had been experiencing
problems with a new computer system in which the responses to
intake screening questions were input directly into the computer.
Staff asserted that they had performed initial screening for the
inmates whose files we reviewed, but that they were unable to
access that information on the computer, speculating that either
the computer program had not saved the information, or that they
were not familiar enough with the program to be able to access
the data.

- 10 
Insufficient screening puts the booked inmate and other inmates
at risk both because inmates may not be provided with timely
medical care and appropriate housing, and because inmates with
communicable diseases, including easily-spread respiratory
infections like tuberculosis, may infect the general population.
Because the Jail has no on-site medical care, no review of
intake information by a medical practitioner, and no oversight by
a responsible medical authority, the deputies effectively serve
as the gatekeepers for medical care. Jail deputies determine
when, or if, an inmate receives medical attention from an
outsider provider, which is a significant departure from
universally accepted standards of care.


Health Assessments

The accepted standard of care is to conduct a physical
examination and take a medical history within 14 days of
admission to a correctional facility.12/ It is also standard
procedure to perform a screening test for tuberculosis at this
time. Although the Jail's Inmate Manual indicates that this
assessment will be provided without charge (pursuant to the
co-payment policy), in practice, no health assessments or
tuberculosis screening tests are provided to inmates at the Jail.
A health assessment serves the purpose of establishing a baseline
health status for an inmate, and documents health problems for
which a treatment plan should be initiated. Lacking this
baseline, the medical care provided at the Jail is only reactive
to emergent crises, placing inmates at increased risk of pain and

Access to Acute and Emergency Care

The Jail is fortunate to have nearby a local hospital with
full emergency services that can provide necessary and
appropriate emergency care. Although the Jail appears to respond
This examination is commonly referred to as a "health
assessment." In most states, a trained nurse or physician's
assistant may perform the health assessment under the supervision
of a physician; the assessment should not be performed by nonmedical staff.

- 11 
timely to most medical complaints noted in the unusual incidents
logbook, we noted several exceptions, particularly in the area of
mental health care. Moreover, it is of great concern that only
those complaints deemed significant enough to be mentioned in the
logbook are responded to at all. Complaints dismissed by
correctional staff as insignificant are not even recorded in the
logbook, much less brought to the attention of a medical
provider. Correctional staff are not trained to diagnose medical
conditions. These practices present an unacceptable risk of harm
to inmates' health, and make it likely that inmates will endure
unnecessary pain before a worsening condition is ultimately
brought to the attention of a medical care provider.
The Jail's practice of providing first aid to persons who
have been exposed to chemical agents such as pepper spray only
upon request does not comply with accepted professional
standards. First aid, including an opportunity to flush eyes and
other exposed body areas with water, should be provided as soon
practicable after an exposure to chemical agents. In addition,
if non-medical staff provide the first aide, they should receive
additional training in monitoring exposed persons for signs of
significant adverse reactions, such as allergic responses or
breathing difficulties. Any significant adverse reactions should
be evaluated by medical professionals.

Access to Routine Care

The Jail has adopted a co-payment requirement for most
medical services. The co-payment system as implemented in
Patrick County is unconstitutional because it has the effect of
deterring access to necessary medical care. The Patrick County
system is flawed for several reasons: the policy is internally
contradictory; the policy is not conveyed clearly to inmates; the
policy creates a financial disincentive for inmates to seek
treatment for chronic and pre-existing conditions, even those
which are life-threatening or a threat to the health and safety
of others; and there is no mechanism to waive the co-payment fee
completely for indigent inmates.
It appears that no written information is provided to
inmates to explain the co-payment policy,13/ and the inmates we
The Inmate Manual describes only the ways in which an
inmate may access health care services: he may fill out a sick


- 12 
interviewed had various understandings of it. Generally, inmates
believed that they would be charged a co-payment for all medical
care, unless it was ordered in an emergency.14/ The policy states
that there is no charge for initial intake medical and dental
screenings, an initial health appraisal, mental health screening
initiated by staff, follow-up visits requested by the physician,
and emergency care. In practice, however, emergency care is the
only medical service routinely provided to inmates, and thus, as
a practical matter, the inmates' understanding is correct.
Inmates also understood that they could seek care from a private
provider at their sole expense. This is problematic because
access to necessary care while incarcerated may be deficient for
those without financial resources.
The Jail's policy excepts care related to pre-existing
conditions from the general co-payment policy, making individual
inmates financially responsible for the full cost of care for all
pre-existing conditions, "including the cost of medications, such
as insulin, heart medications, etc."15/ This policy creates a
dangerous barrier to care for chronic conditions. See, e.g.,
Unusual Incidents Logbook entry dated March 7, 2001 (inmate
refused prescription medication, telling officer that if he had
to pay for his heart medication (a pre-existing condition), then
he could not get any personal hygiene items).
Each of the problems described above heightens the barrier
to an inmate's seeking necessary medical care. This is


call request form; he may inform Jail staff of an emergency; or
he may request transport to a health care provider other than the
"jail physician/dentist." It does not describe the co-payment
Before receiving non-emergency care, inmates must sign a
form entitled "Patrick County Jail Medical Co-Payment Charge
Sheet, Attachment IV," which states that the co-payment for
office visits is $10, and the prescription fee is 25% of the
total charge. These charges are half those listed in the Jail's
Policies and Procedures Manual, and introduce unnecessary
confusion to the inmate about the amount that will be charged to
his account.

Memorandum to all inmates from Sheriff David Hubbard,
dated June 6, 1997, included in the Jail Policies and Procedures

- 13 
particularly problematic in a facility like the Patrick County
Jail because, as described below, inmates are confined in small,
crowded cells with inadequate sanitation and poor ventilation.
Illnesses easily spread in such an environment, leading to
unnecessary sickness and suffering.

Chronic Care

As noted above, the screening for chronic medical conditions
is superficial, consisting primarily of a checklist asking if the
inmate has been treated for certain conditions. Jail policy also
makes the expense of care for pre-existing chronic conditions an
individual inmate's sole responsibility. This practice violates
accepted standards of care, and poses an unacceptable risk of
harm, both to inmates with untreated and/or undiagnosed chronic
illnesses, and to other inmates and staff who may be at risk of
infection if the illness is contagious. Finally, we saw no
evidence that medically-necessary restricted diets, for example,
for inmates with diabetes, hypertension or other chronic
conditions, were reviewed by a registered dietician to ensure
compliance with nutritional guidelines.



The Jail currently does not verify the licensure of its
outside medical providers. It is an accepted requirement that
these licenses be verified at least annually; that medical care
is provided off-site does not negate this requirement.

Mental Health

Mental health services at the Jail are provided through
Piedmont Community Services ("Piedmont"), one of several statemandated community service organizations that provide mental
health, mental retardation and substance abuse services to the
state's citizens. Piedmont provides its services without charge
to the Jail pursuant to a letter agreement, essentially affording
inmates access to care equivalent to what they would have outside
the Jail. However, the Jail's mental health care suffers from
the same fundamental deficiencies as its medical care, including:
an insufficient screening process; no system to ensure continued

- 14 
care for pre-existing mental illnesses; a disincentive created by
the chargeable care policy to seeking care for chronic conditions
before the inmate's condition escalates to an emergency; and,
finally, that mental health care is primarily reactive.

Screening Is Insufficient

The screening form used by deputies at intake is not
sufficient to screen for significant mental health concerns, and
the present system relies heavily upon an inmate's self-reporting
of a history of mental illness. The lack of privacy at intake
compounds the deficiencies of the current screening. As with
medical screening forms, questionnaires designed to elicit
sensitive and important mental health information are standard in
the corrections industry, and more complete and effective
screening instruments are widely available. The County must
prioritize upgrading its mental health screening, particularly
given the lack of mental health providers on staff at the Jail.

Monitoring Is Insufficient

The Jail's policies grant too much discretion to
correctional officers to assess an inmate's need for mental
health services. In addition, the policies do not always reflect
actual practice. For example, the policy manual states that the
mental health counselor will be notified immediately of all
threatened suicides, however, we noted several instances in the
logbook where a counselor was not called immediately. See,
Unusual Incidents Logbook entry dated March 15, 2001, 5:46 p.m.
(inmate with known mental illness told officer he needed help
before he "did something;" inmate placed in segregation and
logbook noted that mental health would be called "in the a.m.").
This practice shows that correctional staff may make their own
assessment of the genuineness of a threat, in effect, making Jail
staff the gatekeepers to mental health services. It places
inmates with mental illnesses at an unreasonable risk of harm.
In the March 15th incident, an hour after the initial logbook
entry, the inmate was discovered to have a swollen and possibly
broken hand from punching a wall, and was taken to the emergency
room. Jail deputies must be trained to follow policy and consult
on-call community mental health professionals for guidance
immediately whenever an inmate, through his statements or
behavior, indicates that he may harm himself.

- 15 A second example of actual practice departing from policy is
the Jail's policy to house persons in need of mental health
monitoring in the isolation cell, or drunk tank. In practice, we
were told that the Chief Jailer sees a benefit in housing
depressed inmates on the cellblocks, where fellow inmates may
alert the staff to a suicide threat. The logbook shows incidents
where inmates were placed in isolation, and other incidents where
they remained on the cellblock. The policy manual should be
revised to require that potentially suicidal inmates be monitored
by staff, and that this monitoring (whether constant or 15-minute
checks) be documented. In addition, the revised policy should
specify how the Jail will implement constant observation, when it
is required by an inmate's mental status, given that the location
of the isolation cell precludes constant observation from any of
staff's usual posts.

Provision of Continuous Care

Finally, the co-payment requirements and ineffective
screening may result in harmful delays and interruption of
care for those inmates with chronic mental illnesses. The
community mental health providers we spoke with expressed
frustration at the disruption in care caused when a client is
incarcerated, and noted that interruption of services may lead
to unnecessary deterioration in an inmate's condition before
care is re-initiated at the Jail. We agree.


Jail records indicate that, during 2001, the average
population was slightly more than 32 inmates per day, or 179% of
its design capacity of 18. This significant level of crowding,
combined with the Jail's small and outdated facility, leads to
unacceptable deficiencies in space, lighting and sanitation.

Space and Sanitation

The Jail houses inmates in extremely tight quarters. The
7 ½ by 7 ½ foot cells open onto a 5 by 30 foot dayroom, which is
surrounded on all side by a catwalk approximately 2 ½ feet wide.
When four inmates are housed in each cell, two sleep on
mattresses on the floor under the bunks; the inmates on the floor
have so little space that they cannot even sit upright on their
mattresses. Inmates reported that additional mattresses are
sometimes placed on the floor in the dayroom to accommodate

- 16 additional inmates. Professional standards require that
mattresses not be placed directly on the floor because they
impede proper sanitation and may present fire and safety hazards.
The single toilet and lavatory unit in each cell, plus a
single toilet and shower in the dayrooms provide insufficient
access to hygiene when the facility is crowded. Several of the
lavatory units in the cells were not functioning properly,
impeding inmates' ability to wash their hands and otherwise
maintain proper hygiene. The shower on the lower cellblock was
clean and in good repair, however, the shower on the top-floor
cellblock was in very poor repair. The steel walls of the unit
and the concrete floor in front of it are damaged and retain
moisture, which makes the unit impossible to clean and disinfect
Crowding may cause and exacerbate poor sanitary conditions,
which can lead to disease and vermin infestation. Current
conditions at the Jail demonstrate these sanitation hazards.
First, several of the Jail’s mattresses have cracked or torn
covers resulting from overuse. Such mattresses cannot be
effectively cleaned and sanitized between inmates. Given the
high turnover at the facility, failure to replace these mattress
could expose numerous people to disease and/or body lice.
Second, because inmates are not provided with lockers or shelves
to store personal items, the already limited floor and surface
space in many cells is littered with inmates’ personal articles,
such as clothing, hygiene materials, and magazines. The trash
and clutter attracts roaches and other vermin, and impedes
thorough cleaning. It also increases the fireload dangerously
and serves as a hiding place for contraband. Finally, inmates
eat all three meals on their cellblocks, and often keep leftover
food and food containers in their cells and the dayroom, again
attracting vermin.

Universal Precautions

No precautions against blood borne pathogens were evident.
Inmates and staff acknowledge that inmates had recently cleaned
up blood from an inmate fight without using rubber gloves or
disinfectants. Staff did not appear aware of universal
precautions for handling bodily fluids. Universal precautions is
a topic that must be included expressly in pre-service training
and orientation for new hires (who may work in the Jail for up to
one year before completing the state-mandated training). In

- 17 
addition, staff should be required to demonstrate their
competency in basic skills – i.e., demonstrate that they
understood the training presented to them, and should be provided
annual in-service refresher trainings on this issue.


Lighting is inadequate. There are no lights in any of the
cells. The only lights are flourescent fixtures affixed to the
ceiling on the catwalk and dayroom. During our visit we measured
less than five foot-candles of light in the interior of the cells
near the lavatory. In comparison, the Virginia Administrative
Code requires at least 20 foot-candles of light at desk level and
in personal grooming areas. Poor lighting contributes to
accidental injuries, inhibits personal hygiene and grooming, and
causes eyestrain. Low light also impedes staff's ability to
observe and supervise inmate activity in the cells.


The Jail's design provides only one means of egress from the
cellblocks, through a single stairwell. This is a significant
departure from national and state standards, which require two
exits.16/ In the event of a fire, smoke could easily accumulate
and travel through the single stairway, making the stairwell
impassable. The Jail's sprinkler system offsets the danger of a
single stairwell, however, other practices at the Jail exacerbate
this risk.
First, the stairwell doors at each floor are generally kept
open, and do not have automatic closing mechanisms activated by
smoke detectors. In the event of a fire, smoke could travel
unimpeded through the stairwell to both cellblocks.
Second, the Jail does not have battery-operated emergency
lights in the stairwell or elsewhere. An existing back-up
generator provides emergency power, but the loss of light while
the generator starts up could critically delay evacuation in a
fire. In addition, we note that generators are not completely
reliable, and that the Jail's own logbook on March 29, 2001 notes
an instance where the emergency generator did not function for

A minimum of two exits is required by the National Fire
Protection Life Safety Code and the Virginia Statewide Building

- 18 38 minutes during a power-outage.
Third, the keys needed to evacuate the cellblocks in an
emergency are not identifiable by touch. In the event smoke or
loss of light makes visual identification impossible, keys marked
with tactile identification can speed evacuation.
Fourth, the Jail has no smoke detectors in sleeping
quarters. Finally, we saw insufficient documentation of
sufficiently frequent fire drills, including the movement of
inmates out of the cellblocks, to ensure that staff are prepared
for emergency evacuations.


Inmates receive insufficient opportunities for exercise, and
no outdoor exercise at all. Regular large-muscle group exercise
is essential to maintaining strength and health, and its neartotal absence at the Jail is unacceptable. In addition, the
crowded conditions, small dayroom space and the dearth of
programming may heighten anxiety and depression in all inmates,
particularly those with mental illnesses.


The County has a responsibility to provide inmates with
reasonable access to the courts in order to challenge their
sentences, directly or collaterally, and the conditions of their
confinement. The County provides no assistance at all to enable
inmates to exercise this right. The Jail has no law library and
no staff trained to offer legal assistance to inmates. In
addition, inmates have extremely limited space, and their work
papers may be confiscated if they are not sufficiently contained.
Inmates depend upon deputy jailers to copy any materials needed
for legal proceedings. We did not identify any inmate whose
ability to pursue a claim was impaired because of these
deficiencies in access to legal services. Nonetheless, with no
systems in place to provide inmates with access to the courts, we
are concerned that such an injury is likely to occur.



- 19 The Jail lacks any semblance of a management information
system, which leads to poor management decisions that may deprive
inmates of their constitutional rights. One clear example is in
the calculation of release dates. The Chief Jailer handcalculates the release date for all inmates and informs the
inmate in writing.17/ Inmates and their families had relayed to
us concerns that inmates were occasionally released after the
specified date. The Jail has no data system capable of checking
this allegation by retrieving names, sentencing orders,
calculations of good time credit and the actual date of release.
We reviewed, instead, population reports which the Jail submits
to the State Department of Corrections for purposes of computing
reimbursements to the Jail. During the first two months of 2001,
three inmates appear to have been held past their expected
release date (we defined the expected release date as the
sentenced term minus good time). These discrepancies tend to
support the inmates' and family members' accusations. To
investigate release practices further would require comparing the
sentencing order, the Chief Deputy's good time calculation (which
does not appear to be retained in any file) and the actual
release dates. Although not conclusive, the variances noted from
data on the state reimbursement reports were disturbing, and
point to a need for Jail managers to collect and retain this type
of information for management purposes.
To remedy the deficiencies discussed above and to protect
the constitutional rights of Jail inmates, the County and the
Sheriff should implement the minimum remedial measures set forth

Security and Protection From Harm

The current inmate population far exceeds the capacity of
the existing Jail to provide reasonably safe and sanitary
housing. We look forward to meeting with County officials
to discuss the various options for addressing this problem.

If the inmate is being held in a neighboring
jurisdiction, the Chief Jailer informs that jail, which typically
returns the inmate to Patrick County for release.

- 20 

The County must implement an objective classification system
and house inmates accordingly.
The County must collect and analyze basic data to aid in
population management, including lengths of stay,
utilization of medical and mental health resources, and
cumulative statistics on indicators of violence and injury.


Female arrestees should be held at the Jail no longer than
necessary to arrange transport to another jail, and in no
event for more than 24 hours.


The County must create more space in which to segregate
inmates for disciplinary, security, medical or mental health


The County must investigate suspicious inmate injuries for
evidence of potential assault, and must document the result
of these investigations.


The County must take steps to limit contraband in the cells.


The County must implement controls on caustic chemicals;
must provide easily-accessible eye wash and chemical control
kits for the event of accidental spills; and must implement
procedures to control medical wastes and sharps.


The County must define the security perimeter of the Jail
and control weapons within this perimeter.

10.	 The County must revise its policy on use of pepper spray to
include a requirement that the person who is sprayed receive
first aid and an evaluation by medical personnel as soon as
possible, regardless of whether the inmate makes a request
for medical attention.
11.	 The County must inform Spanish-speaking inmates of Jail
rules in Spanish, either by translating and disseminating
the manual or by having an employee provide the information
orally. If oral translation is the chosen method, the
County must notify inmates that bilingual assistance is
12.	 The County must define the criteria for selecting inmate

- 21 
13.	 The County must implement an inmate grievance procedure and
document all grievances and the County's responses.
14.	 The County must provide all staff with orientation training
and annual refresher training in universal precautions for
handling items contaminated with bodily fluids.
15.	 The County must require supervisors to review daily logbook
entries, and document that review.


16.	 The County must immediately retain the services of a medical
doctor,18/ whose responsibilities will include: supervising
all medical care rendered to inmates; reviewing revised
medical intake screening forms and processes; monitoring
care of serious and/or chronic conditions; ensuring that all
inmates receive a health assessment within 14 days of
intake; and annually reviewing all policies and procedures
concerning medical or mental health screening and/or the
provision care.
17.	 The County must immediately implement a system to ensure
that medical intake information sheets and sick call
requests are reviewed in a timely manner by trained medical
care providers.
18.	 The County must immediately remedy problems with its intake
screening software that prevent staff from accessing intake
information on the Jail's computer.
19.	 The County must revise its co-payment policy to remove the
disincentives to an inmate's seeking and receiving necessary
medical care for chronic, pre-existing and/or lifethreatening conditions.
20.	 The County must enhance its screening for infectious
diseases, including tuberculosis.

In a facility the size of the Patrick County Jail, we
anticipate that this could be a part-time position.

- 22 21.	 The County must verify the licensure of all medical care
providers at least annually, without regard to whether the
care is provided on or off-site.
22.	 The County must revise its mental health screening process
to achieve a more thorough assessment of an inmates's
history and any current symptoms or concerns, and to
facilitate continued care for inmates with chronic mental
23.	 The County must revise its policy on supervision of inmates
identified at heightened risk of suicide consistent with
currently accepted professional practice, and implement the
policy consistently. The County must also ensure that
correctional staff follow existing policy in consulting
mental health professionals for guidance when an inmate
exhibits signs of a possible mental health crisis.


24.	 Inmates must not sleep on the floor.
25.	 All mattresses and pillows must be maintained in sanitary
26.	 Inmates must be provided sufficient lighting for personal
hygiene and for reading.
27.	 Each inmate should be provided with a locker or other fireretardant container for storage of his personal belongings.
28.	 The County must repair all broken plumbing and fixtures and
maintain them in good working order.
29.	 The County must ensure that all food service menus are
reviewed at least annually by a registered dietician.
30.	 Trash collection schedules should be augmented to prevent
the stockpiling of combustible materials.


31.	 The County must install smoke detectors in all housing
areas, consistent with state code requirements.

- 23 32.	 To mitigate the threat to life safety posed by a single exit
stairwell, the County must ensure that stairwell doors
remain closed (or, replace doors with automatically-closing
models activated by smoke) and must install battery-operated
emergency lighting on each floor and in the stairwell.
33.	 The County must mark all emergency keys so that they are
identifiable by touch as well as by sight.
34.	 The County must conduct regular fire drills, including
inmate movement.


35.	 The County must provide inmates with regular opportunities
for exercise, including outdoor exercise.


36.	 The County must provide access to a law library or legal
assistance sufficient to enable inmates to prepare their
defense and to challenge their conditions of confinement.


37.	 The County must devise a procedure to ensure that inmates
are not held past their release dates.


38.	 All revised forms, practices and policies concerning each
area of Jail operations discussed herein should be codified
in a revised Jail policy and procedures manual. All
policies should be reviewed annually by Jail management; the
review should be documented.
39.	 The County must ensure that all deputies, and particularly
those who have not yet attended the state-mandated training
course, receive sufficient orientation training to enable
them to fulfill their duties safely. In addition, all staff
must receive training on revised policies and procedures.
All staff training must be documented.
* * * * *

- 24 We appreciate the cooperative approach taken by the Sheriff
and staff at the Jail. We understand that officials are aware of
and acknowledge many of the problems discussed in this letter.
In anticipation of our continued cooperation toward a shared goal
of achieving compliance with constitutional requirements, we will
forward our expert consultants' reports under separate cover.
Although their reports are their work and do not necessarily
represent the official conclusions of the Department of Justice,
their observations, analyses and recommendations provide further
elaboration of relevant concerns, and offer practical assistance
in addressing them.
In the unexpected event that the parties are unable to reach
a resolution regarding our concerns, we are obligated to advise
you that 49 days after your receipt of this letter, the Attorney
General may initiate a lawsuit pursuant to CRIPA to correct the
noted deficiencies. 42 U.S.C. § 1997b (a)(1). Accordingly, we
will soon contact County officials to discuss in more detail the
measures that the County and Sheriff must take to address the
deficiencies identified herein.

/s/ Ralph F. Boyd

Ralph F. Boyd, Jr.
Assistant Attorney General
cc:	 Alan Black, Esquire
Patrick County Attorney
Mr. David R. Hoback

Patrick County Administrator

The Honorable John L. Brownlee 

United States Attorney

Western District of Virginia