The Honorable Bruce L. Woodbury
Chair, Board of County Commissioners
500 South Grand Central Parkway
Las Vegas, NV 89155-1601
Re: Clark County Detention Center
Dear Mr. Woodbury:
On December 4, 1997, we notified you of our intent to investigate the
Clark County Detention Center ("the Detention Center") in Las Vegas, Nevada,
pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"),
42 U.S.C. § 1997 et seq. On January 20-22, 1998, we
conducted an on-site inspection of the Detention Center with expert consultants
in adult penology and mental health care. On February 10-12, 1998, we conducted
a second on-site inspection with expert consultants in correctional medicine
and health and environmental safety.
The Detention Center is a multi-story building located in downtown Las
Vegas. The first floor consists of booking and holding, the second floor
contains medical, mental health, and protective custody units, and the
third, fifth, seventh and ninth floors contain general population inmates.
For general population inmates, the floor consists of six separate and
secure housing areas or modules. Four of the six modules per floor contain
24 rooms and the remaining two modules consist of 50 and 46 rooms. Each
module has adjoining day space and outdoor recreation space. On the day
of our site visit, January 20, 1998, the inmate population was 1704, with
over 200 in the holding/booking area. Of the 1704 inmates, 180 were sentenced
inmates and the remaining were pretrial detainees.
In addition to our on-site inspections, our investigation included numerous
interviews with Detention Center correctional and administrative staff,
inmates, and medical and mental health care providers. We reviewed an extensive
number of documents, including policies and procedures, booking records,
incident reports, internal investigation reports, and medical records.
We wish to thank the Detention Center staff for their professional conduct
and cooperation throughout the course of the investigation.
Consistent with the statutory requirements of CRIPA, we write to advise
you of the findings of our investigation. We find that conditions at the
Detention Center violate the inmates' federal constitutional rights with
respect to conditions of confinement in the holding area, inadequate mental
health care and suicide prevention, and inadequate environmental health
and safety in the areas of fire safety, protection from communicable disease,
I. LEGAL FRAMEWORK
The constitutional law governing conditions of confinement for inmates
has two sources. With respect to inmates who have been convicted of criminal
offenses, the Eighth Amendment's ban on cruel and unusual punishment governs
all aspects of conditions discussed here. The Eighth Amendment "imposes
duties on [prison] officials, who must provide humane conditions of confinement;
prison officials must ensure that inmates receive adequate food, clothing,
shelter, and medical care, including mental health care, and must 'take
reasonable measures to guarantee the safety of the inmates.'" Farmer
v. Brennan, 511 U.S. 825, 832 (1994) (quoting Hudson v. Palmer,
468 U.S. 517, 526-27 (1984)). Pretrial detainees "retain at least those
constitutional rights . . . enjoyed by convicted prisoners." Id. at 545. With respect
to pretrial detainees, the Fourteenth Amendment prohibits conditions or
practices not reasonably related to the legitimate governmental objectives
of safety, order and security. Bell v.
Wolfish, 441 U.S.
520 (1979). Pretrial detainees have not been convicted of anything and
therefore they may not be punished.
II. CONDITIONS OF CONFINEMENT IN HOLDING AREAS
Conditions of confinement in the first floor booking and reception area
violate an inmate's right to safe and humane conditions of confinement.
The booking and reception area has seventeen separate holding rooms where
inmates are housed for their first several days in the facility. The cells
range in size from single and double occupancy to multiple occupancy rooms
of over 20 inmates. Most cells are equipped with benches and all rooms
have toilet facilities. These cells are distant from the central booking
area and direct sight and sound supervision of the majority of the cells
is not possible. None of the cells is equipped with audible two-way communication
capability. These isolated settings make it difficult to monitor suicidal
behavior or inmate-on-inmate violence.
Moreover, the holding cells are extremely crowded and unsanitary. During
our site visit, the holding area housed 208 inmates. Many of the rooms
were so crowded that there was little visible floor space and inmates lay
underneath the benches in the room. Facility records indicate that these
booking areas are frequently crowded with as many as 300 inmates. The number
of detainees routinely processed through the booking/reception area is
simply too numerous for the resources of the facility to properly handle.
Detainees sometimes may not even shower because the shower area is used
as a staging area for moving detainees in and out of the facility. Due
to the overcrowding, routine visual checks required by security personnel
are ineffective. There are too many people to see if anything is happening
in the holding cells. We reviewed the housing cards posted outside the
rooms and noted that inmates have been held in such conditions for up to
three days. Many of the inmates confined in the rooms claim not to have
received any shower, bedding, or hygiene articles in excess of 24 hours.
The stench in the housing cells is overpowering. In one of the holding
cells there was human excrement on the walls and the toilet was filthy
and unsanitary. The overcrowding causes the temperature in the holding
areas to reach excessive levels and the lighting is inadequate.
The conditions in the holding area have caused serious harm and death
to the detainees. Fights over space and for other reasons are frequent,
occurring more often than in most areas of the jail, as do officer applications
of force. Jail staff know that the conditions in the crowded large cells
are anxiety producing and especially difficult for inmates who are particularly
vulnerable for various reasons. One frequent response is to move inmates
who "get in trouble" in the large cells to smaller, less crowded ones.
These rooms are not appropriately designed for high risk populations. In
particular, they have a partition (separating the toilet from the rest
of the cell) that obscures sight surveillance into the cell and creates
a protuberance for suicide by hanging. Furthermore, as discussed later,
suicide screening upon booking and mental health care in the holding cells
Inadequate suicide screening, inadequate supervision of the holding
areas, and failure to provide mental health care in the holding area combine
to create an especially dangerous inmate suicide risk. In 1997, there were
two completed suicides in the holding area. In each instance, the inmate
had been moved to a small holding cell, with few cell mates, and hanged
himself from the partition. Another inmate in one of these cells attempted
to hang himself from the partition in July of 1997 but the inmate's cell
mate was able to summon officers to intervene.
The two completed suicides in the holding area highlight the dangerous
features of current operations at the jail. The first suicide took place
in February 1997. The day before it happened, the inmate had been the victim
of a fight in a large holding cell. He was treated at the nursing station,
and the facility doctor ordered him housed in the medical unit for observation.
However, there was no available housing in the medical unit, so he was
placed in a small holding cell to await a bed. Late in the day, a nurse
observed him and wrote that the inmate had told her that "He is just giving
up; you're not giving medications correctly; his life is not worth anything;
just leave him alone." Despite this obvious expression of suicidal ideation,
he was not placed in a more controlled or supervised environment. He was
discovered hanging from the partition that night.
The second holding area suicide took place in October 1997. In that
case, the inmate had asked an officer to see the sergeant "before something
happened and I snap" and because he was "going crazy." He was moved from
the crowded large room where he was housed into a smaller cell. No timed
observation was done. He hanged himself less than one hour after the move.
Inmates in the holding area are given a medical and mental health screen
by a nurse, but they do not receive the opportunity for sick call. Deputies
hand out Tylenol and Maalox, but requests for other medical attention very
frequently go unanswered. Where staff know that inmates are in a medical
crisis, efforts are made to move them to the medical section of the facility.
But because of the lack of supervision, some inmates' emergency medical
needs go unobserved and unmet. For example, one inmate was discovered dead
in the late evening in one of the small holding cells. Staff concluded
that he died from a "possible drug related overdose." The Officer's Report
did not note his condition prior to placing him in the holding cell. Another
detainee was moved from the holding area to the medical floor where an
officer removed a nylon rope that had been wrapped around the detainee's
ankles. Thirty minutes after reaching the medical floor, the detainee required
emergency life-saving medical treatment. He was transported to a local
hospital where he was pronounced dead shortly after arrival. The Officer's
Report did not explain or note why the detainee had a rope around his ankles
or why he had been transported to the medical floor.
In addition, inmates in the holding areas typically do not receive needed
psychotropic medications because the detention center will not fill even
verified psychiatric prescriptions without an independent evaluation by
the facility's psychiatrist, which usually cannot be done for several days
due to inadequate staffing. Many mental health crises are precipitated
by the lengthy stays and conditions in the holding area and by the failure
to provide timely medication.
In sum, operation of the holding area violates inmates' right to adequate
safety and protection from harm, adequate medical care, and, as described
more fully below, adequate mental health care.
III. SUICIDE PREVENTION AND MENTAL HEALTH CARE
Suicide screening in the booking and holding area is inadequate. In
particular, the jail's suicide screening form lacks sufficient criteria
for mental health referrals, as well as emphasis on the history of psychiatric/mental
health treatment and medication and possible current suicide ideation.
Nursing staff who conduct the screening are insufficiently trained to perform
the brief mental health status examination needed to identify mentally
ill inmates. Moreover, they fail to conduct this examination in a setting
as private as possible given legitimate penological considerations. This
lack of privacy greatly undermines any effort to obtain sensitive information
from inmates. The result of inadequate screening is that inmates with mental
health problems slip through the booking process and remain unidentified
and untreated until their mental health problems often escalate to the
point where security staff must later call mental health personnel.
For example, one inmate was given a negative mental health screening
at intake and four days later was placed on suicide watch by an officer
because of his bizarre behavior. After being placed on suicide watch, he
had a mental health evaluation that revealed a history of depression and
substance abuse along with an extensive history of hospitalization. In
another example, our expert observed one female inmate who had been in
holding for an hour and was complaining of claustrophobia and extreme anxiety
bordering on panic. The other inmates in the holding cell indicated that
she was pacing around banging her head on the door. She stated that she
felt a nervous breakdown coming on. A review of her initial medical screening
later that day showed that the nurse had failed to refer her to the mental
health unit even though she had a history of mental hospitalization and
was extremely vocal concerning her anxiety.
In many cases, inmates who are mentally ill go unrecognized and untreated
in general population units, as well, despite obvious signs of mental health
problems. The officers in general population units are not adequately trained
to recognize and refer mentally ill inmates to the mental health professionals
at the Detention Center. A study completed by our expert of suicide attempts
from January 1994 through February 1998 revealed that officers missed important
and obvious precursor behavior to suicide attempts. Officers recorded inmates
"acting strange" and mutilating themselves but did not refer such inmates
to the mental health unit and in several instances the inmates subsequently
Supervision of potentially suicidal inmates is inadequate not only in
the holding area but also in the mental health unit (Unit 2) and the administrative
segregation unit (Unit 5) where aggressive mentally ill inmates are sometimes
housed. In particular, jail records show that numerous inmates already
on suicide watch -- and occasionally already in restraints -- have
been able to attempt suicide. This is a clear indicator of several problems:
inadequate mental health staffing; inadequate observation; absence of timely
evaluation and treatment; and unsafe cells being used for suicide watch.
As a result, acute or crisis mental health care in the mental health unit
A final problem with the mental health unit and the mental health unit
in administrative segregation, is that inmates on lengthy suicide watch
are not allowed to participate in exercise, recreation, or other out-of-cell
activities even when the inmate is not violent to others. Indeed, violent
inmates being isolated for disciplinary reasons receive more out-of-cell
time than those who are suicidal or mentally ill, despite the fact that
isolation aggravates the very condition for which the inmates are isolated.
Inadequate mental health staff not only contributes to a dangerous lack
of supervision, but also to a lack of mental health treatment and programming
and to an increased use of unnecessary restraints. Individual counseling
is rare and group counseling is non-existent. The lack of treatment and
staff results in untreated and uncontrolled mental health problems escalating
often into violent self-injurious behavior. The mental health staff admitted
that they spend most of their time at the Detention Center working in crisis
mode to handle such escalated mental health conditions. Furthermore, with
regard to the mentally ill inmates, security staff generally initiate restraints
without medical review while mental health staff are involved only in terminating
the restraints. Review of restraint use demonstrates that inmates are improperly
placed in restraints for an extended period of time where intervention
by medical and/or mental health personnel would have made the restraint
use unnecessary. Restraint use for mentally ill inmates is improperly driven
by the inability to initiate less restrictive emergency measures.
Suicide response is also inadequate due to the absence of readily available
"seat belt cutters" or other sharp cutting instruments to cut down hanging
victims. In one suicide, in 1996, staff spent several minutes attempting
to locate scissors to cut the bed sheet an inmate had used to hang himself.
Finally, inmates with mental illness leaving the jail are discharged with
a list of medications but without any supply of those medications.
IV. ENVIRONMENTAL HEALTH AND SAFETY IN CERTAIN AREAS
With regard to fire and life safety, the facility does not adequately
train its line officers in fire and emergency procedures. Furthermore,
staff do not routinely conduct and document fire drills and inspections
of fire safety equipment. The lack of adequate fire and life safety
exposes the inmates and staff to substantial risk of harm from fire and
The medical unit contains negative pressure rooms that cause the air
to flow into the room from outside the room and thus prevent contaminated
air inside the room from flowing to the outside areas. These negative pressure
isolation rooms are not being adequately maintained to provide sufficient
negative pressure in the rooms to cause the airflow to reverse. Inadequate
negative pressure rooms dramatically increase the risk of harm to staff
and inmates contracting tuberculosis and other highly communicable diseases
designed to be controlled through such isolation rooms.
Finally, because of the high inmate population, inmates sleep on mattresses
on the floor in several of the outer day rooms. By facility policy, such
inmates have access to the toilets in the inner day room and the outdoor
recreational area only when such areas are not occupied by other inmates.
In inclement weather, when other inmates occupy the inner day room, they
are forced to go outside to use the toilet but are permitted to do so only
with an escort, which often is not readily available. Furthermore, when
other inmates occupy the inner day area and the outdoor recreation area,
the inmates in the outer day rooms have no access to toilets. During our
tour, on the ninth floor in units 9C and 9D, the outer day room housed
twenty-five inmates who had access to one toilet in the outside recreation
area when the other inmates were using the inner day area. Such restricted
access to a toilet is unacceptable.
V. MEDICAL CARE
In addition to medical care in the holding areas that we found inadequate,
at the time of our tours, inmates in general population were also receiving
untimely and inadequate medical care due to inadequate access to sick call
and insufficient physician time allotted to sick call clinics. Furthermore,
physician documentation of sick call visits was inadequate and the medical
staff needed to develop and implement a better tracking system for pregnant
inmates to ensure appropriate and timely care.
Shortly after we concluded our site visit, the Detention Center notified
us that it had significantly revised the sick call procedures and that
registered nurses would conduct sick call and triage more appropriately,
thus better managing physician time. We believe such a system should be
able to meet generally accepted correctional medical practices with regard
to inmates in general population. Consequently, except for the medical
care in the holding areas already discussed, at this time, we do not make
a finding of inadequate medical care at the Detention Center subject to
our verification that the new system has been implemented and is functioning
VI. MINIMUM REMEDIAL MEASURES
To rectify the above-cited deficiencies and to ensure that the Clark
County Detention Center complies with federal constitutional requirements,
the following minimum remedial measures should be implemented:
1. The Detention Center should make conditions of confinement in the
holding and booking area safe and sanitary by reducing the inmate population
confined to the holding cells of the booking area. The Detention Center
should adequately supervise the holding cells to prevent inmate-on-inmate
violence. The Detention Center should provide the inmates in the holding
cells adequate bedding, hygiene articles, and access to showers. The holding
cells should be adequately lit and cleaned.
2. The Detention Center should provide adequate medical and mental health
care in the holding area. Such care should include adequate screening during
the booking process, adequate access to sick call while housed in the holding
area, timely and adequate observation of inmates with mental health and
medical problems, including entering the holding cells, especially the
smaller holding cells when an inmate is on suicide observation. The suicide
hazards should be eliminated from the isolation cells.
3. Detention Center staff should conduct adequate health screenings
in an area that affords sufficient privacy consistent with security requirements.
Medical staff should administer an inmate's known medications within a
reasonable period of time upon arrival to the facility.
4. The Detention Center should provide the inmates with adequate mental
health care services and suicide prevention.
5. Medical staff should be properly trained to conduct medical and mental
health screening at intake. Inmates identified with mental illness should
be promptly referred to mental health staff. Line officers in the general
population units should be adequately trained to recognize basic symptoms
of mental illness and refer such cases to the mental health staff.
6. Medical/mental health staff should evaluate persons with mental illness
being restrained prior to the restraint and should monitor such persons
regularly. Staff should not use restraints before attempting less restrictive
7. The Detention Center should hire or contract for sufficient mental
health staff to supervise and monitor adequately mental health patients
housed in the mental health unit and administrative segregation.
8. Mental health staff should provide adequate mental health treatment
and programs, including adequate individual and group therapy.
9. Inmates housed in the mental health unit and in administrative segregation
for mental health purposes should receive adequate out-of-cell time and
10. The Detention Center should implement adequate suicide response
procedures, including providing staff with readily available suicide prevention
tools such as those needed to cut down attempted suicide victims.
11. The Detention Center should adequately train its line officers in
fire and emergency procedures. Furthermore, fire drills and inspections
of fire safety equipment should be routinely conducted and documented.
12. The Detention Center should provide inmates housed in the outer
day rooms in the general population housing areas with adequate access
to the toilets.
IX. RESOLUTION OF ISSUES
Pursuant to the Civil Rights of Institutionalized Persons Act, the Attorney
General may initiate a lawsuit to correct deficiencies at an institution
49 days after notifying appropriate local officials of such deficiencies.
42 U.S.C. § 1997b(a)(1). We will, however, seek to resolve this matter in
the same cooperative spirit that has characterized the investigation to
date. To this end, we will send you the reports from our experts, Dr. Joe
Goldenson, Dr. Dennis Koson, and Steve J. Martin under separate cover.
Although their reports are their work -- and not necessarily the official
conclusions of the Department of Justice -- their observations, analyses,
and recommendations provide further elaboration of the relevant concerns,
and offer practical assistance in addressing outstanding challenges at
the Detention Center.
We look forward to your response to these findings and recommendations
and to detailed discussions leading to a final resolution of these issues.
Bill Lann Lee
Civil Rights Division
cc: Mary Miller, Esq.
Clark County Counsel
Stewart L. Bell, Esq.
Clark County District Attorney
Mr. Jerry Keller
Bill Young, Esq.
Detention Services Division
Kathryn E. Landreth, Esq.
United States Attorney
District of Nevada
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