Today we are responding to a report that we have received from the Civil Rights Division of the United States Department of Justice that reviewed operations at the King County jail. The report is critical of past practices at the jail. We welcome the DOJ’s review of our practices, and have provided them with full access to inmates, records, and personnel. We strongly support and appreciate outside review and analysis of our program, and believe it is essential for on-going improvement of systems and operations.

We strive at all times to provide safe, secure, and humane conditions for the over 50,000 inmates for whom we are responsible each year. We disagree that the constitutional rights of inmates are being violated, but we are in complete agreement with DOJ that there is room for improvement in the areas they evaluated. We are concerned by the issues raised in the report and in fact have been planning and implementing improvement strategies even before their review began. We will be working collaboratively with DOJ in the coming months to better understand their analyses and to further develop processes and procedures that are responsive to their concerns.

Department of Adult and Juvenile Detention

The Department of Adult and Juvenile Detention is committed to providing safe, secure and humane conditions of confinement. We have policies, procedures, training and accountability measures in place to help us meet that commitment.

At the same time, we strive to continuously update and improve our practices. We have sought outside evaluation of our policies, procedures and practices. For example, in early 2006, we requested and received technical assistance from the National Institute of Corrections regarding prevention and response to staff sexual misconduct, implementing improved policies and additional training for staff.

In each of the areas of concern identified by the Department of Justice, we have been taking action to improve our practices, and will continue to do so. We are committed to working closely with DOJ to improve in each of these areas.

• Use of Force: Our policy is to only use that force which is reasonable and necessary under the circumstances. We have recently taken steps to review our policies and increase training for staff in this area. We will continue this review specifically with regard to use of pepper spray and hair holds.

• Investigation of Staff Misconduct: DAJD holds staff accountable for misconduct as a key part of providing an adequate environment for inmates. We investigate and take action when staff members are found to be in violation of our policies. For a key example, we investigated, terminated and supported the criminal prosecution of staff who engaged in custodial sexual misconduct. We have previously commissioned outside review of our investigations unit, and have added positions to address the level of workload. We are committed to continuing to improve the investigations unit in response to the DOJ recommendations.

• Suicide Prevention: Preventing inmates from self-harm while in our facilities is one of our paramount duties. We experience a low rate of suicides in our facilities. We intend to follow-up on each of the DOJ’s recommendations in this area.

• Infection Control/Cleanliness: The Department shares the DOJ’s concern and focus on preventing transmission of infectious diseases within our facilities. We have taken several steps to address this concern on the detention operations side, including replacing mattresses, using new cleaning products and taking steps to ensure they are used correctly. We are also currently working on a plan for changing out and/or cleaning inmate underwear, uniforms and linens more frequently, and other steps, including those recommended by the DOJ.

Jail Health Services:

Inmates are among the most medically vulnerable people in King County. Most have no medical insurance or ongoing medical care, and arrive at the jail with a wide range of acute and chronic medical and mental health needs.

In 2006, Jail Health Services provided over 30,000 medical visits for inmates and dispensed over 190,000 prescriptions. Despite the best efforts of our professional staff, mistakes occur, as they do in every health care setting. Our goal is to systematically identify mistakes and continuously improve our systems to minimize them.

Jail Health Services is accredited by the National Commission on Correctional Health Care (NCCHC), whose standards meet constitutional requirements for providing healthcare in a jail setting. Accreditation is based on compliance with 73 NCCHC standards as measured by 331 indicators. As an accredited institution, we are focused on delivering excellent, timely and appropriate medical care to all inmates in need. We are building the systems to support efficient and quality medical services and to identify patterns of problems so that we can make the system changes needed to minimize future errors.

In recent months, we have been focusing on new systems to further improve the quality and timeliness of medical care; support efficient and timely staff hiring, retention, and training; ensure the routine update of our clinical guidelines; and track and control skin infections.

• Electronic Health Record: Jail Health Services has recently implemented a new Electronic Health Record (EHR). This new system will allow medical providers and Jail Health Services management to systematically monitor, evaluate and improve the quality and efficiency of jail health care services.

• Clinical practice guidelines: As part of a routine review, we have updated clinical guidelines, based on NCCHC standards of care, for clinical management of diabetes, seizures and asthma, as well as for the identification and treatment of skin infections.

• Recruitment and hiring: Recruitment and retention of qualified staff has been difficult throughout the medical industry, including jail health organizations. Steps to improve our staffing shortage include raising the salaries of staff, and aggressively seeking qualified candidates through a variety of means including expanded advertising and outreach.

• Training for staff: We have developed a new orientation process for newly hired medical providers and nursing staff that ensures an in-depth understanding of Jail Health services, standards, protocols and procedures. We also require and provide ongoing staff training to support NCCHC standards for clinical practice.

• Enhanced monitoring and control of skin infections: Most inmate skin infections are already present when the inmate comes into the jail, and are diagnosed at intake. Currently, we monitor skin infections through monthly lab reports on all skin and soft tissue wound cultures. Positive cultures are reviewed for sensitivity to antibiotics and housing locations in order to identify possible clusters of cases. In addition to the measures DAJD identified above regarding infection control and cleanliness, the Electronic Health Record system will provide more detailed and timely information that will allow us continue to improve our infection control systems.

The Department of Justice will make the report available on its web site.