our findings. On April 2, 2008, we notified officials of Miami-Dade Calmty ("County") of our intent to investigate the MDCR corrections facilities pursuant to the Civil Rights oflnstitutionalized Persons Act ("CRIPA"), 42 U.S.C.§ 1997. CRIP A gives the Department of Justice authority to seek a remedy for a pattern or practice of conduct that violates the constihltional rights of prisoners in adult detention and corrections facilities. CRIP A requires that we advise you of the findings of our investigation, the facts supporting them, and the minimum remedial steps that are necessary to address the de-£iciencies we have identified. 42 U.S.C. § 1997b. I. SUMMARY OF FINDINGS AND CONCLUSIONS We conclude that that there is a pattern and practice of constitutional violations in the correctional facilities operated by MDCR, and as a result of the unconstitutional operation of the Jail, prisoners suffer grievous harm, including death. As described more fully below, our specific findings include: • MDCR is deliberately indifferent to the suicide risks and serious mental health needs of its prisoners. At least eight prisoners have committed suicide since 2007, and thousands of prisoners have suffered from inadequate mental health crisis services. • MDCR fails to provide adequate acute care, chronic care, outpatient treatment, and - 2 discharge services to prisoners with mental illness. Instead, MDCR inappropriately relies on medication management that fails to consistently incorporate diagnoses or treatment plans, even for prisoners with the most serious mental illnesses. • MDCR is deliberately indifferent to the serious medical needs of prisoners including access to care for acute medical needs, management of chronic health problems, and record keeping and quality assurance. Prisoners wait weeks and even months to receive consultations for care from HIV, cardiology, and neurology specialists. • MDCR fails to provide adequate intake screening, initial health assessments and acute care for newly incarcerated prisoners. Since 2008, at least five prisoners have died from MDCR's failure to identify and treat prisoners withdrawing from drugs or alcohol. • MDCR is engaged in a pattern or practice ofusing excessive force against prisoners. MDCR corrections officers openly engage in abusive and retaliatory conduct, which frequently causes injuries to prisoners. • MDCR is deliberately indifferent to the serious risk ofharm to prisoners posed by fellow prisoners. Corrections officers fail to supervise prisoners, particularly prisoners known to be violent, resulting in ongoing harm and serious risk ofharm. There is significant evidence to be concerned that the Jail fails to take reasonable steps to protect prisoners from sexual assault. • The conditions of confinement within the Jail expose prisoners to an umeasonable risk of hann from inadequate fire and life safety systems and environmental health and sanitation deficiencies, including umeasonable risk of infection from overcrowding and inadequate laundry, housekeeping, and pest controL II. INVESTIGATION On June 9-13, 2008, June 16-20,2008, and April 7-8,2009, we inspected the facility together with consultants in the fields of corrections, custodial medical and mental health care, suicide prevention, and environmental health and sanitation. We interviewed administrative and corrections staff, medical and mental health care providers, prisoners, and members of the Miami-Dade community. Our investigation also included the review of policies and procedures, incident reports, grievances, medical records, and use of force records and investigations, including documents provided by the County subsequent to our on-site visits. In keeping with our pledge of transparency and providing technical assistance where appropriate, our consultants conveyed their preliminary impressions and concerns to County officials and the MDCR command staff at the conclusio
Same source, country, and finding where possible.