LEGAL ADVOCACY UNIT
1330 Broadway, Ste. 500
Oakland, CA 94612
Tel: (510) 267-1200
TTY: (800) 719-5798
Fax: (510) 267-1201
www.disabilityrightsca.org

Via email
March 18, 2020									

Rick Heyer
Supervising County Counsel
P.O. Box 988 
Sacramento, CA 95812-0988
heyerr@saccounty.net 
Chief Deputy Santos Ramos
Correctional Services
Sacramento County Sheriff’s Office
sramos@sacsheriff.com

Re: 	Mays v. County of Sacramento (E.D. Cal.), No. 2:18-cv-02081-TLN-KJN
Necessary Actions at County Jail for COVID-19 Pandemic
Dear Mr. Heyer and Chief Ramos:
We write as class counsel in Mays v. County of Sacramento (E.D. Cal., Case No. 2:18-cv-02081-TLN-KJN), representing people held in custody at the Sacramento County Jail (the “Jail”).  The Mays case seeks to remedy well-documented and longstanding deficiencies in the conditions and access to health care that people incarcerated at the Jail experience.  As you know, a federal court approved the parties’ settlement, including a Consent Decree and detailed remedial plan, in January 2020. 
We recognize that efforts to implement provisions of the remedial plan will be impacted by the COVID-19 pandemic.  At the same time, this public health crisis poses extraordinary risks to the health and safety of Mays class members. The Consent Decree in the Mays litigation addresses deficiencies addressed in the Mays lawsuit, some of which directly apply to this pandemic.  See, e.g., Remedial Plan § VI.B.3 (requirement for adequate medical intake screening consistent with community standards); § VI.K.1 (requirement to address issues of cleanliness and sanitation that adversely impact health); § VIII.A.3 (requirement to end prolonged solitary confinement for people with acute medical needs that require an inpatient care); § VI.G (requirement to ensure that patients in acute medical or quarantine placements have appropriate access to property and privileges).
COVID-19 is extremely dangerous for people in certain population groups that are remarkably prevalent in the Jail.  People over the age of fifty are considered to be at substantial risk, and people over 70 are at the most serious risk.  The Centers for Disease Control and Prevention (CDC) has issued guidance that certain medical conditions and disabilities increase the risk of COVID-19 for people of any age, including: lung disease, heart disease, diabetes, conditions that make a person immunocompromised (e.g., cancer, HIV/AIDS, autoimmune disease), blood disorders (including sickle cell disease), chronic liver or kidney disease, metabolic disorders, stroke, developmental delay, and pregnancy.
The CDC has identified COVID-19 as spreading easily from person-to-person.  It has warned that the risk of exposure is greatest in crowded, confined spaces with limited ventilation and air circulation.  The federal government has indicated that crowds of more than ten people should be avoided for the next several weeks, at a minimum.
The Jail’s crowded, confined, and limited-ventilation facilities create a grave risk of COVID-19 transmission to a Jail population with high risk factors. The risk of mass transmission is heightened by the number of Jail staff coming in and out of the facility and the poor sanitation and hygiene in the facilities.  
The County is aware that the Jail’s health care facilities are ill-equipped even in normal times. The former chief of correctional services stated that the facilities are “severely outdated and inadequate for providing services to our inmate population.”  Notably, as part of the Mays settlement, the County agreed to “consult with an Environment of Care expert to evaluate facilities where patients are housed and/or receive clinical treatment, and to make written recommendations to address issues of cleanliness and sanitation that may adversely impact health.”  Remedial Plan § VI.K.1.  Unfortunately, this Environment of Care evaluation and any consequent remediation efforts have not yet occurred.
The Jail also lacks adequate facilities to quarantine or medically isolate people who have symptoms of COVID-19 or report recent exposure to the virus.  We are aware of multiple people in custody at the Sacramento County Jail in recent days who have been subject to “Total Separation” in non-medical isolation units based on possible COVID-19 exposure.  While we do not endorse exposing potential COVID-19 patients to other people detained or working in the Jail, it is important to note that prolonged and harsh solitary confinement practices were among the most serious constitutional violations at issue in the Mays lawsuit.  To the extent that isolation is necessary in the Jail to reduce the likelihood of transmission it should be in line with medical isolation protocols and based on an individualized clinical determination.  (Our current understanding is that people are held in isolation if they are identified as having symptoms of or possible exposure to the virus and are awaiting COVID-19 test results, which can take up to four days.  For anyone who receives a negative test result, they are returned to normal housing.  If anyone receives a positive test result, they will be placed in a designated quarantine housing unit that allows for daily and regular out-of-cell time.)
Staff should ensure that isolated individuals have additional property and privileges, such as iPads, books, and writing materials, to compensate for the social isolation.
In short, the consequences of COVID-19 spreading through the Jail population would be devastating.  If the virus does spread through the Jail, the likelihood that numerous Mays class members would require acute medical care is substantial.  Such care would necessarily require transport to emergency medical facilities in the community, risking significant strain on health care resources that would adversely impact the general public.
It is critical to the protection of Mays class members, Jail staff, and the broader community to take bold action now.  This requires reducing the existing Jail population (in particular, of people in high-risk groups), limiting the flow of new people into Jail custody, and taking proactive measures in the Jail to ensure people’s health and well-being.
Safe Reductions to the Jail Population.  We were pleased to see that the Sheriff’s Department received authorization from the Sacramento Superior Court to grant accelerated release of prisoners, up to thirty days early on a person’s sentence, effective through May 31, 2020.  3/17/20 Standing Order, No. SSC-20-__.  We strongly encourage the County to explore and implement other mechanisms to safely reduce the jail population, including through (1) a broader early release order, (2) work release arrangements (see, e.g., Penal Code § 4024.2, including subsection (b)(1)(F) addressing people with special needs related to medical condition, physical disability, or age), and (3) expanded pretrial release.  Procedures akin to compassionate release should be strongly considered for people in high-risk groups.
The Mays Consent Decree and Remedial Plan expressly recognize that Jail population reduction measures designed to promote public safety are a cost-effective means to achieve constitutional and statutory standards.  Remedial Plan § I.B.  The current public health crisis serves only to accentuate this fact. 
Limiting Flow of New People into Jail Custody. The County should direct law enforcement to cite and release all those who are eligible pursuant to Penal Code § 853.6, rather than booking them and potentially introducing COVID-19 into the Jail system. 
Incarceration for technical or other non-violent parole or probation violations should also cease.
Proactive Measures in the Jail to Ensure Health and Well-Being.  The most basic aspect of infection control is hygiene, including ready access to soap (for handwashing and for cleaning) and hand sanitizer, timely access to medical advice and care, and comprehensive sanitation and cleaning of facilities. These products should be provided to all people incarcerated in the Jail, free of charge, absent an individualized determination regarding substantial likelihood of misuse. 
Any plan to address this crisis must provide for additional precautions for those people who remain in the Jail and are at high risk if infected by the virus, such as older adults, pregnant women and people with chronic illnesses, compromised immune systems, or disabilities.
People housed in the jails must be informed about the virus and the measures they can take to minimize their risk of contracting or spreading the virus.  The California State prison system’s California Correctional Health Care Services (CCHCS) has created a Coronavirus/COVID-19 Facts and FAQs document (attached) that can be distributed and posted in a manner accessible to all people in custody at the Sacramento County Jail.  Verbal or other means of communication of this information should be provided for people with disability or other individual needs (visual or intellectual disabilities, etc.). These materials offer a useful model for you to use.
Finally, we understand that the Sheriff’s Department has taken the step to suspend in-person visitation at the Jail to prevent the spread of COVID-19.  While in-person visitation raises virus transmission risk, incarcerated people must be able to communicate with their families, loved ones, and legal counsel, particularly under these stressful and constantly evolving circumstances.  We strongly encourage the County to provide all people in Jail custody phone and/or video calls free of cost during this crisis.  Other jurisdictions, such as CDCR, Shelby County, Tennessee and others, have already taken this simple and important step.  (New York City has shifted to free phone calls permanently.)
As the County of Sacramento and the Sheriff’s Department consider the steps we urge in this letter, we ask that you provide a response to the following questions as soon as possible.  We are available for a phone call to discuss these important matters.
1.	Have the Sheriff’s Department and Adult Correctional Health (ACH) developed specific COVID-19 written policies or protocols? If yes, please provide a copy. 
2.	What steps, in addition to the Superior Court’s March 17 standing order authorizing early releases, have been taken or will be taken in light of the COVID-19 pandemic to reduce the Jail population and to limit the flow of new people into the Jail?
3.	What measures is the Jail taking to protect people with elevated COVID-19-related health risks, including pregnant women and people with chronic illnesses, compromised immune systems, or disabilities?
4.	What measures is the Jail taking to identify people with COVID-19 exposure, both at booking/intake and inside the Jail housing units?
5.	What steps have been taken to ensure that Jail facilities have adequate soap, handwashing stations, wet wipes, and sanitizer readily available to people in custody as well as staff?  Are there any restrictions or costs related to the provision of these supplies?  If so, does the Jail intend to modify those policies?
6.	What updates has the Jail made to cleaning practices (wiping down of surface areas, durable medical equipment/assistive technology, hand rails, grab bars, door handles, phones, tables, etc.)?
7.	How is information about COVID-19 being provided to people in custody at the Jail?  Is the information provided in accessible locations and formats?
8.	What is the Sheriff’s Department and ACH’s capacity to test for COVID-19?  How many people in Jail custody have been quarantined based on possible COVID-19 exposure? How many have received COVID-19 testing?  Have any COVID-19 cases amongst people who are or recently have been inside the Jail been confirmed? If so, how many, and what steps were taken in response?  (We request updated information on these matters as events unfold.)
Thank you, as always, for your attention and ongoing efforts.

Sincerely, 
/s/ Aaron J. Fischer			/s/ Margot Mendelson
Aaron J. Fischer				Margot Mendelson
Disability Rights California		Prison Law Office

Encls.: CCCHS COVID-19 FAQs, Standing Order of the Hon. Nathanael Cousins
Cc: 	Sandy Damiano, Adult Correctional Health
	Alex McCamy, Sacramento County Sheriff’s Department
	Timothy Zindel, Federal Defenders
	Steven Garrett, Sacramento County Public Defender’s Office
	Anne-Marie Schubert, Sacramento County District Attorney