in the united states district court for the … · - 2 - e. defendants in this action are dallas...

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IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS UNITED STATES OF AMERICA, ) ) PLAINTIFF, ) ) v. ) ) Civil No. 307 CV 1559-N DALLAS COUNTY, TEXAS; ) LUPE VALDEZ, ) SHERIFF OF DALLAS COUNTY, TEXAS ) (in her official capacity), ) ) DEFENDANTS. ) ___________________________________) AGREED ORDER I. INTRODUCTION A. On November 28, 2005, the United States notified Dallas County officials of its intention to investigate conditions of confinement at the Dallas County Jail (“DCJ” or “the Jail”), pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. § 1997. B. On February 20-24, 2006 and March 20-23, 2006, the United States toured DCJ with consultants in the fields of correctional health care, correctional mental health care, and environmental health. C. Throughout the course of the investigation, the United States received complete cooperation and access to all facilities and documents from the Dallas County Commissioners Court, Dallas County Sheriff’s Office, University of Texas Medical Branch at Galveston, and Parkland Hospital. D. On December 8, 2006, the United States issued a findings letter pursuant to 42 U.S.C. § 1997 that concluded that certain conditions at DCJ violate the constitutional or statutory rights of individuals confined at the Jail.

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IN THE UNITED STATES DISTRICT COURTFOR THE NORTHERN DISTRICT OF TEXAS

UNITED STATES OF AMERICA, ))

PLAINTIFF, ) )

v. ) ) Civil No. 307 CV 1559-N

DALLAS COUNTY, TEXAS; )LUPE VALDEZ, ) SHERIFF OF DALLAS COUNTY, TEXAS )(in her official capacity), )

)DEFENDANTS. )

___________________________________)

AGREED ORDER

I. INTRODUCTION

A. On November 28, 2005, the United States notifiedDallas County officials of its intention to investigateconditions of confinement at the Dallas County Jail (“DCJ”or “the Jail”), pursuant to the Civil Rights ofInstitutionalized Persons Act, 42 U.S.C. § 1997.

B. On February 20-24, 2006 and March 20-23, 2006, theUnited States toured DCJ with consultants in the fields ofcorrectional health care, correctional mental health care,and environmental health.

C. Throughout the course of the investigation, theUnited States received complete cooperation and access toall facilities and documents from the Dallas CountyCommissioners Court, Dallas County Sheriff’s Office,University of Texas Medical Branch at Galveston, andParkland Hospital.

D. On December 8, 2006, the United States issued a findingsletter pursuant to 42 U.S.C. § 1997 that concluded thatcertain conditions at DCJ violate the constitutional orstatutory rights of individuals confined at the Jail.

- 2 -E. Defendants in this action are Dallas County, Texas; the

Dallas County Sheriff; and their successors, contractors,and agents (collectively, the “County”). The County shallensure that all County agencies take any actions necessaryto comply with the provisions of this Agreed Order.

F. The Court has jurisdiction over this action pursuant to28 U.S.C. § 1331, 28 U.S.C. § 1345, and 42 U.S.C. § 1997. Venue is proper in this district pursuant to 28 U.S.C.§ 1391(b).

G. For the purposes of this lawsuit only and in order to settle this matter, the Defendants consent to the entry of a finding that the conditions at DCJ necessitate theremedial measures contained in this Agreed Order. Asindicated in Section VII of this Agreed Order, the partiesconsent to a finding that this Agreed Order complies in allrespects with the provisions of the Prison Litigation ReformAct, 18 U.S.C. § 3626(a).

H. No person or entity is intended to be a third-partybeneficiary of the provisions of this Agreed Order forpurposes of any civil, criminal, or administrative action,and accordingly, no person or entity may assert any claim orright as a beneficiary or protected class under this AgreedOrder. This Agreed Order is not intended to impair orexpand the right of any person or organization to seekrelief against the Defendants or their officials, employees,or agents for their conduct. This Agreed Order does notalter legal standards governing any such claims, includingthose standards established by Texas law.

II. DEFINITIONS

A. “DCJ” or “the Jail” shall refer to the Dallas County Jailand shall include the Suzanne Kays Detention Facility; theDecker Detention Facility; the George Allen Courts Building;and the adjoining Lew Sterrett Center Tower Facilities(“Lew Sterrett”); as well as any facility that is built,leased, or otherwise used, to replace or supplement theJail.

B. “DOJ” shall refer to the United States Department ofJustice, which represents the United States in this matter.

C. “Effective date” shall mean the date the Agreed Order issigned and entered by the Court.

- 3 -D. “Include” or “including” shall mean “include, but not be

limited to” or “including, but not limited to.”

E. “Inmate” or “inmates” shall be construed broadly to refer toone or more individuals detained at, or otherwise housed,held, in the custody of, or confined at either the existingJail or any institution that is built or used to replace the Jail or any part of the Jail.

F. Consistent with, or in accordance with, the term “generallyaccepted professional standards of care” shall mean adecision by a qualified professional that issubstantially aligned with contemporary, acceptedprofessional judgment, practice, or standards as todemonstrate that the person responsible based the decisionon such accepted professional judgment.

G. “Quality Assurance” means a system of self-audit andimprovement to assess the implementation and effectivenessof all remedies instituted pursuant to this Agreed Order, toidentify deficits that may exist, and to effectuate newmeasures to cure deficits identified.

H. "Qualified Medical Professional" shall mean a licensedphysician, licensed physician assistant, or a licensed nursepractitioner, who is currently licensed by the State ofTexas to deliver those health care services they haveundertaken to provide.

I. "Qualified Medical Staff" shall refer to qualified medicalprofessionals and qualified nursing staff.

J. "Qualified Mental Health Professional" shall refer to: a) anindividual with a minimum of masters-level education andtraining in psychiatry, psychology, counseling, social workor psychiatric nursing, who is currently licensed by theState of Texas to deliver those mental health services theyhave undertaken to provide.

K. "Qualified Mental Health Workers" and "Qualified MentalHealth Staff" shall refer to individuals with a minimum of a bachelor's degree and two years of experience providingmental health services.

L. “Qualified Nursing Staff” means registered nurses andlicensed practical nurses currently licensed by the State ofTexas to deliver those health services they have undertakento provide.

- 4 -M. “Suicide Precautions” means any level of watch, observation,

or measures to prevent self-harm.

N. “Train,” means to instruct in the skills addressed to alevel that the trainee has the demonstrated proficiency toimplement those skills as and when called for in thetraining. “Trained” means to have achieved suchproficiency.

O. Throughout this Agreed Order, the following terms are usedwhen discussing compliance: substantial compliance, partialcompliance, and non-compliance: “Substantial compliance”indicates that the Jail has achieved compliance with most orall components of the relevant provision of the agreedOrder. “Partial compliance” indicates that compliance hasbeen achieved on some of the components of the relevantprovision of the Agreed Order, but significant work remains. “Non-compliance” indicates that most or all of thecomponents of the Agreed Order provision have not yet beenmet.

- 5 -III. SUBSTANTIVE PROVISIONS

A. MEDICAL CARE

1. Intake screening:

a. Defendants shall implement and comply withpolicies to provide adequate medical and mentalhealth intake screening to all inmates; shallprovide a 14-day health assessment andexamination; shall ensure continuation ofprescription medications within 24 hours ofintake; shall comply with stated policies toscreen inmates for infectious disease; shallcontinue to provide mental health evaluations forall inmates whose histories or whose responses toinitial screening questions indicate a need forsuch an evaluation; shall provide accuratediagnoses for inmates in need of mental healthservices; and shall continue to provide timely andappropriate referrals for specialty care.

b. Records documenting the assessment and resultsshall become part of each inmate's medical record.A re-admitted inmate or an inmate transferred fromanother facility who has received a documentedfull health assessment within the previous threemonths and whose receiving screening shows nochange in the inmate's health status need notreceive a new full physical health assessment. For such inmates, qualified personnel shall reviewprior records and update tests and examinations asneeded.

c. When the initial clinical health screeningindicates that an inmate has acute health ormental health needs, Defendants shall providetimely care by trained and licensed medical staff,registered nurses, or mental health professionalsas soon as medically necessary, but no later thantwenty-four (24) hours after the initial healthscreening. Defendants shall schedule individualswith chronic health or mental health needs, andthose who are pregnant but who present in a stablecondition, to be seen by medical staff or mentalhealth professionals as soon as medicallynecessary. Incoming inmates who present withcurrent risk of suicide or other acute mental

- 6 -health needs will be immediately referred for amental health evaluation by a mental healthprofessional. Staff will observe such inmatesuntil they are seen by mental healthprofessionals. Incoming inmates reporting theseconditions will be housed under appropriateconditions unless and until a mental health careprofessional clears them for housing insegregation or with the general population.

2. Acute care:

a. Defendants shall provide adequate and timely acutecare for inmates with serious and life-threateningconditions, and ensure that such care adequatelyaddresses the serious medical needs of inmates. Adequate care will include timely medicalappointments and follow-up medical treatment.

b. Defendants shall train correctional officers torecognize and respond to medical and mental healthemergencies, and shall ensure that inmates withemergency medical or mental health needs arepromptly referred and transported for outside carewhen the facility is unable to provide appropriatecare.

3. Chronic care:

a. Defendants shall adopt and implement a system totrack inmates with serious and/or chronicillnesses, including mental illnesses, to ensurethat these inmates receive necessary diagnosis,monitoring and treatment.

b. Defendants shall implement a medication continuitysystem so that incoming inmates' medication forserious medical needs can be obtained in a timelymanner, as medically appropriate when medicallynecessary. Within twenty-four hours of aninmate's arrival at the facility, or sooner ifmedically necessary, the County shall decidewhether to continue the same or comparablemedication for serious medical needs as an inmatereports on arrival that she or he has beenprescribed. If the inmate's reported medicationis discontinued or changed by medical staff,

- 7 -medical staff shall evaluate the inmate face-to-face as soon as medically appropriate. The Countyshall develop and implement a protocol andscreening tool to guide staff in gatheringnecessary information and present such informationto medical staff for medication continuitydecisions.

c. Defendants shall ensure that inmates who need

skilled nursing services or assistance withactivities of daily living shall receive medicallyappropriate care.

d. Defendants shall maintain an updated log ofinmates with chronic illness. Defendants shallkeep records of all care provided to inmatesdiagnosed with chronic illnesses in the inmate'sindividual medical record.

4. Treatment and Management of Communicable Disease:

a. Defendants shall implement and refine theircommunicable disease testing, monitoring, andtreatment programs. Defendants shall continue totest for tuberculosis (“TB”) all inmates arrivingat the jail upon booking and will follow-up ontest results as medically indicated.

b. Defendants shall develop and implement infectioncontrol policies and procedures to prevent thespread of infections or communicable diseases,including TB and Methicillin ResistantStaphylococcus aureus (“MRSA”), consistent withgenerally accepted professional standards of care.

c. Defendants shall establish effective infectioncontrol programs, including programs for TB andskin infections, that:

i. actively collect data regardinginfections and communicable diseases;

ii. assess this data for trends; iii. initiate inquiries regarding

problematic trends; iv. identify necessary corrective action; v. monitor to ensure that appropriate

remedies are achieved; and

- 8 -vi. integrate this information into the

Jail’s quality assurance review.

d. Defendants shall develop and implement adequate guidelines to ensure that inmatesreceive appropriate wound care. Such guidelines will include precautions to limitthe possible spread of communicable diseases.

e. Defendants shall ensure that the specializedrespiratory isolation (“negative pressure”)and HVAC (heating, ventilating and air-conditioning) systems function properly.

5. Access to Health Care:

a. Defendants shall ensure that inmates haveadequate access to appropriate health care.

b. Defendants shall ensure that the medicalrequest (“sick call”) process for inmates isadequate and facilitates adequate access tomedical care.

c. The sick call process shall includeprocedures for logging, tracking, and timelyresponses by medical staff.

d. Defendants shall develop and implement aneffective system for triaging sick callrequests based upon the urgency of the

medical issue.

6. Follow-Up Care:

a. Defendants shall provide adequate follow upcare and maintain appropriate records forinmates who return to the Jail followinghospitalization.

b. Defendants shall ensure that inmates whoreceive specialty or hospital care areevaluated upon their return to the Jail andthat, at a minimum, discharge instructionsare recorded in the inmate’s medical recordsand appropriately followed.

- 9 -7. Record Keeping:

a. Defendants shall ensure that medical recordsare maintained consistent with generallyaccepted professional standards of care.

b. Defendants shall ensure that DCJ medical andmental health records are centralized,complete, and accurate. To ensure continuityof care, medical record information shall besubmitted to outside medical providers wheninmates are sent out of the Jail for medicalcare, and reports and records from thoseproviders will be returned with the inmatesto the Jail.

c. Defendants shall maintain unified medical andmental health records including documentationof inmates' psychiatric histories andindividual mental health assessments.

8. Medication Administration:

a. Defendants shall ensure that treatment andadministration of medication to inmates isimplemented in accordance with generallyaccepted professional standards of care. Defendants shall develop policies andprocedures for the accurate administration ofmedication and maintenance of medicationrecords. Defendants shall provide asystematic physician review of the use ofmedication to ensure that each inmate'sprescribed regimen continues to beappropriate and effective for his or hercondition.

b. Defendants shall ensure that medicationadministration is hygienic and recordedconcurrently with administration.

9. Medical Facilities:

a. Defendants shall ensure that sufficientclinical space is available to provideinmates with adequate medical care servicesincluding: intake screening; sick call;physical assessment; and acute, chronic,

- 10 -emergency, and speciality medical care (such

as for geriatric or pregnant inmates).

b. Defendants shall ensure that medical areasare adequately clean and maintained,including installation of adequate lightingin medical exam rooms. All hand washingstations in medical areas shall be fullyequipped, operational, and accessible.

10. Specialty Care:

a. Defendants shall ensure that inmates whoseserious medical or mental health needs extendbeyond the services available at the Jailshall receive timely referral for specialtycare to appropriate medical or mental healthcare professionals qualified to meet theirneeds, in accordance with generally acceptedprofessional standards of care.

b. Defendants shall ensure that inmates who havebeen referred for outside specialty care bythe medical staff or another specialty careprovider are scheduled for timely outsidecare appointments and transported to theirappointments. Inmates awaiting outside careshall be seen by medical staff as medicallynecessary to evaluate the current urgency ofthe problem and respond as medicallyappropriate.

c. Defendants shall obtain records of care anddiagnostic tests received during outsideappointments in a timely fashion and includesuch records in the inmate's medical recordor document the inmate's refusal to cooperateand release medical records. Following avisit to an outside specialist, medicalstaff, mental health staff, or a dentistshall review information and documentationavailable from the visit and providereasonable follow-up care.

d. Defendants shall maintain a current log ofall inmates who have been referred foroutside specialty care, including the date ofthe referral, the date the appointment was

- 11 -scheduled, the date the appointment occurredand the reason for any missed or delayedappointments, and information on follow upcare, including the dates of any futureappointments.

e. Defendants shall ensure that pregnant inmatesare provided adequate pre-natal care inaccordance with generally acceptedprofessional standards of care.

11. Staffing, Training, and Supervision:

a. Defendants shall provide adequate staffingand training of medical, mental health, andcorrectional staff necessary to ensure thatadequate medical and mental health care isprovided.

b. Defendants shall ensure that medical staffreceive adequate physician oversight andsupervision.

c. Defendants shall ensure that services andprocedures, such as medication administrationand use of cut-down tools, are performed bynurses or other properly trained staff.

d. Defendants shall provide adequate numbers ofcorrectional staff to ensure inmates haveaccess to appropriate medical care.

e. Defendants shall conduct initial and periodictraining for all correctional staff on how torecognize symptoms of mental illness andrespond appropriately. Such training shallbe conducted by qualified mental healthprofessionals and shall include instructionon how to recognize and respond to mentalhealth emergencies.

12. Quality Assurance Review:

a. The Defendants shall develop and implementquality assurance programs adequate toidentify and correct serious deficiencies inmedical care, mental health care, suicideprevention, sanitation, and fire safety.

- 12 -13. Dental Care:

a. Defendants shall ensure that inmates receiveadequate dental care consistent withgenerally accepted professional standards ofcare and that such care be provided in atimely manner.

b. Defendants shall ensure that inmates withemergency dental needs shall receive suchcare immediately. Adequate dentist hourswill be provided to avoid unreasonable delaysin dental care.

B. MENTAL HEALTH CARE

Defendants shall provide adequate mental health care toaddress inmates’ serious mental health needs.

1. Timely and Appropriate Evaluation:

a. Defendants shall provide develop and implementpolicies and procedures to appropriatelyassess inmates with mental illness, andevaluate inmates' mental health needs.

b. Defendants shall ensure that the intakeevaluation process includes a mental healthscreening, which shall be incorporated intothe corresponding inmate’s medical records. Defendants shall ensure timely access to aqualified mental health professional whenpresenting symptoms of mental illness requiresuch care.

c. Defendants shall ensure that the mental healthscreening process includes inquiry regarding:

(1) past suicidal ideation and/or attempts,(2) current ideation, threat, or plan,(3) prior mental health treatment or

hospitalization,(4) recent significant loss, such as the

death of a family member or close friend,(5) history of suicidal behavior by family

members and close friends,(6) suicide risk during any prior

confinement, and

- 13 -(7) any observations of the transporting

officer, court, transferring agency, orsimilar individuals regarding theinmate’s potential suicide risk.

d. Defendants shall ensure adequate and timelytreatment for inmates whose assessments revealserious mental illness, including timely andappropriate referrals for specialty care andregularly scheduled visits with qualifiedmental health professionals.

e. Defendants shall ensure an adequate array ofcrisis services to appropriately manage thepsychiatric emergencies that occur amonginmates. Crisis services shall not be limitedto administrative segregation or observationstatus. Inmates shall have access toappropriate licensed in-patient psychiatriccare when clinically appropriate.

2. Assessment and Treatment:

a. Defendants shall ensure that treatment plansadequately address inmates' serious mentalhealth needs and that the plans containinterventions specifically tailored to theinmates' diagnoses.

b. Defendants shall provide for an inmate’sreasonable privacy in medical and mentalhealth care, and maintain confidentiality ofinmates’ medical and mental health status,subject to legitimate security concerns andemergency situations.

c. Defendants shall provide adequate on-sitepsychiatric coverage for inmates' seriousmental health needs and ensure thatpsychiatrists see inmates in a timely manner.

d. Defendants shall ensure that disciplinarycharges against inmates are reviewed by aqualified mental health professional todetermine the extent to which the charge wasrelated to serious mental illness, to ensurethat inmates who commit infractions resultingfrom a serious mental illness are not punished

- 14 -for behavior caused by mental illness, and toensure that an inmate’s serious mental illness

is used as a mitigating factor, as appropriate,when punishment is imposed on inmates with aserious mental illness.

e. Defendants shall ensure that mentally illinmates in segregation receive timely andappropriate treatment, including completionand documentation of regular rounds in thesegregation units at least once per week by

adequately trained qualified mental health professionals in order to assess the serious

mental health needs of inmates in segregation.Inmates with serious mental illness who areplaced in segregation shall be immediately andregularly evaluated by a qualified mentalhealth professional to determine the inmate’smental health status, which shall include anassessment of the potential effect ofsegregation on the inmate’s mental health.During these regular evaluations, Defendantsshall evaluate whether continued segregation isappropriate for that inmate, considering theassessment of the qualified mental healthprofessional, or whether the inmate would beappropriate for graduated alternatives.

3. Psychotherapeutic Medication Administration:

a. Defendants shall ensure that psychotherapeuticmedication administration is provided inaccordance with generally accepted professionalmental health care standards.

b. Defendants shall ensure that pyschotropicmedication orders are reviewed by apsychiatrist on a regular, timely basis forappropriateness or adjustment.

c. Defendants shall ensure timely implementationof physician orders for medication andlaboratory tests. Defendants shall ensure thatinmates who are being treated with psychotropicmedications are seen regularly by a physicianto monitor responses and potential reactions to

- 15 -those medications, in accordance with generallyaccepted correctional mental health carestandards.

4. Suicide Prevention:

a. Defendants shall develop policies and procedures to ensure the appropriate managementof suicidal inmates, and shall establish asuicide prevention program in accordance withgenerally accepted professional standards ofcare.

b. Defendants shall ensure that suicide prevention

procedures include provisions for constantdirect supervision of actively suicidal inmatesand close supervision of special needs inmateswith lower levels of risk (e.g., 15 minutechecks). Officers shall document their checks. Suicide prevention policies shall includeprocedures to ensure the safe housing andsupervision of inmates based on the acuity oftheir mental health needs. Cells for suicidalinmates shall be retrofitted to render themsuicide-resistant (e.g., elimination ofprotrusive shower heads, exposed bars,unshielded lighting or electrical sockets).

c. Defendants shall ensure that all staff aretrained on suicide response, prevention, anddetection. Staff posts will be equipped with911 rescue tools.

d. Defendants shall ensure adequate administrativemortality and morbidity review of custodialsuicides and serious suicide attempts reviewfollowing a custodial suicide or suicideattempt. At a minimum, the review shallinclude:

(1) critical review of the circumstancessurrounding the incident;

(2) critical review of procedures relevant tothe incident;

(3) synopsis of all relevant training receivedby involved staff;

(4) pertinent medical and mental healthservices/reports involving the victim;

- 16 -(5) possible precipitating factors leading to

the suicide or attempt; and (6) recommendations, if any, for changes in

policy, training, physical plant, medicalor mental health services, and operationalprocedures.

C. SANITATION AND ENVIRONMENTAL CONDITIONS

1. Sanitation of Laundry:

a. Defendants shall develop and implement policiesand procedures for laundry procedures toprotect inmates from risk of exposure tocontagious disease, bodily fluids, andpathogens. Defendants shall ensure thatinmates are provided clean clothing,underclothing and bedding in compliance withpolicy, and that the laundry exchange scheduleprovides equitable distribution and pickupservice to all housing areas.

b. Defendants shall train staff and educateinmates regarding laundry sanitation policies.

2. Protection from Biohazards:

a. Defendants shall develop and implement policiesand procedures for cleaning, handling, storing,and disposing of biohazardous materials. Defendants shall ensure that any inmate orstaff utilized to clean a biohazardous area areproperly trained in universal precautions, areoutfitted with protective materials, andreceive proper supervision when cleaning abiohazardous area.

b. Defendants shall provide and ensure the use ofcleaning chemicals that sufficiently destroythe pathogens and organisms in biohazardspills.

c. Defendants shall ensure biohazard disposalcontainers in medical areas are properlyinstalled and positioned so as to limitunnecessary risk to staff.

- 17 -d. Defendants shall secure all sharp medical

tools.

e. Defendants shall destroy any mattress thatcannot be sufficiently sanitized to killbacteria.

3. Environmental Control:

a. Defendants shall ensure adequate control andobservation of jail cell environs, includingrazors and cleaning supplies. All cleaningtools and hazardous chemicals shall be removedfrom housing areas after use.

b. Chemical cleaning agents shall be safelystored, used, and mixed. Inmates providedcleaning agents shall receive training on thesafe storage, use, and mixture of chemicalcleaners.

4. Maintenance and Sanitation of Facilities:

a. Defendants shall immediately revise andimplement written housekeeping and sanitationplans to ensure the proper routine cleaning ofhousing and shower areas, and medical areas.

b. Defendants shall implement a preventivemaintenance plan to respond to routine andemergency maintenance needs, includingmaintenance of shower, toilet, and sink units.

5. Fire and Life Safety:

a. Defendants shall ensure that the Jail hasadequate fire and life safety equipment,including installation and maintenance of firealarms in all housing areas. Defendants shallensure that all fire and life safety equipmentis properly maintained and inspected, withadequate documentation thereof.

b. Defendants shall implement competency-basedtesting for staff regarding fire/emergencyprocedures.

- 18 -c. Defendants shall ensure that emergency keys are

appropriately marked and identifiable by touchand consistently stored in a quickly accessiblelocation, and that staff are adequately trainedin use of the emergency keys.

d. Defendants shall control combustibles andeliminate highly flammable materials throughoutinmate living areas.

IV. REPORTING REQUIREMENTS AND RIGHT OF ACCESS

A. Defendants shall submit quarterly compliance reports tothe United States, the first of which shall be filedwithin 90 days of the date of this Agreed Order. Thereafter, the quarterly reports shall be filed fifteen(15) days after the termination of each four-month periodthereafter until the Agreed Order is terminated.

B. Each compliance report shall describe the actions theDefendants have taken during the reporting period toimplement this Agreed Order and shall make specificreference to the Agreed Order provisions beingimplemented.

C. Defendants shall maintain sufficient records to documentthat the requirements of this Agreed Order are beingproperly implemented and shall make such recordsavailable to the DCJ at all reasonable times forinspection and copying by the United States. In addition,Defendants shall maintain and submit upon request recordsor other documents to verify that they have taken suchactions as described in their compliance reports (e.g.,census summaries, policies, procedures, protocols,training materials, and incident reports) and will alsoprovide all documents reasonably requested by the UnitedStates.

D. The United States and its attorneys, consultants, andagents, and any other persons authorized by the parties,shall have unrestricted access to the Jail, Jail inmates,Jail staff (including staff at DCJ employed by Parklandor any other outside medical services provider), anddocuments as reasonably necessary to address issuesaffected by this Agreed Order.

- 19 -E. Within 30 days of receipt of written questions from the

DOJ concerning Defendants’ compliance with therequirements of this Agreed Order, Defendants shallprovide the DOJ with written answers and any requesteddocuments.

F. Defendants shall appoint a compliance coordinator tooversee compliance with this Agreed Order and to serve asa point of contact.

G. The parties have, by separate agreement, agreed upon anIndependent Monitor to assist Defendants in achievingcompliance with the provisions of this Agreed Order, toreport those opinions to the parties, and to provideDefendants with technical assistance in attainingcompliance with the Agreed Order. The parties agree tofile these reports with the Court on a routine basis forthe Court’s information.

V. CONSTRUCTION, IMPLEMENTATION AND TERMINATION

A. Defendants shall implement all reforms necessary toeffectuate this Agreed Order. The implementation of thisAgreed Order will begin immediately upon the filing ofthis Agreed Order before the United States District Courtfor the Northern District of Texas. As needed,Defendants shall retain the services of third-partyconsultants to provide technical assistance regarding theimplementation of the substantive provisions contained inSection III of this Agreed Order.

B. Except where otherwise specifically provided, Defendantsshall complete implementation of all provisions of thisAgreed Order within 180 days of the entry of this AgreedOrder.

C. This Agreed Order shall terminate four years from thedate the Agreed Order is ordered by the Court. TheAgreed Order may terminate earlier if Defendants havesubstantially complied with each of the provisions of theAgreed Order and has maintained substantial compliancefor at least two years. The burden shall be onDefendants to demonstrate this level of compliance. Noncompliance with mere technicalities, or temporaryfailure to comply during a period of otherwise sustainedcompliance will not constitute failure to maintainsubstantial compliance. At the same time, temporarycompliance during a period of sustained noncompliance

- 20 -shall not constitute substantial compliance. If afterfour years Defendants have failed to comply with therequirements of this Agreed Order, the United States hasthe right to seek relief from the United States DistrictCourt of the Northern District of Texas.

D. Failure by either party to enforce this entire AgreedOrder or any provision thereof with respect to anydeadline or any other provision herein shall not beconstrued as a waiver of its right to enforce otherdeadlines or provisions of this Agreed Order.

E. If any unforseen circumstance occurs that causes afailure to timely carry-out any requirements of thisAgreed Order, Defendants shall notify the DOJ in writingwithin 20 calendar days after Defendants become aware ofthe unforseen circumstance and its impact on theDefendant’s ability to perform under the Agreed Order. The notice shall describe the cause of the failure toperform and the measures taken to prevent or minimize thefailure. Defendants shall implement all reasonablemeasures to avoid or minimize any such failure.

F. This Agreed Order shall constitute the entire integratedAgreed Order of the parties. With the exception of DOJ’sfindings letter referenced in paragraph (I)(D) herein andany DOJ technical assistance recommendations, no prior orcontemporaneous communications, oral or written, will berelevant or admissible for purposes of determining themeaning of any provisions herein in this litigation or inany other proceeding.

G. The Agreed Order shall be applicable to, and bindingupon, all parties, their officers, agents, employees,assigns, and their successors in office.

H. Each party shall bear the cost of their fees and expensesincurred in connection with this cause.

I. In the event that any provision of this Agreed Order isdeclared invalid for any reason by a court of competentjurisdiction, said finding shall not affect the remainingprovisions of this Agreed Order.

VI. STIPULATION PURSUANT TO THE PRISON LITIGATION REFORM ACT, 18 U.S.C. § 3626

A. For the purposes of this Agreed Order only and in orderto settle this matter, the Parties stipulate that this

- 21 -Agreed Order complies in all respects with the provisionsof 18 U.S.C. § 3626(a). The Parties further stipulateand agree that the prospective relief in this AgreedOrder is narrowly drawn, extends no further thannecessary to correct the violations of federal rightsalleged by the United States, is the least intrusivemeans necessary to correct these violations, and will nothave an adverse impact on public safety or the operationof a criminal justice system. Accordingly, the Partiesagree and represent that the Agreed Order complies in allrespects with the provisions of 18 U.S.C. § 3626(a).

B. The issue of liability has not been litigated.

C. This Agreed Order is not intended to have any preclusiveeffect except between the Parties. Should the issue ofthe preclusive effect of this Agreed Order be raised, theParties agree to certify that this Agreed Order wasintended to have no such preclusive effect.

- 22 -

FOR THE UNITED STATES:

/s/ Richard B. Roper RICHARD B. ROPERUnited States AttorneyNorthern District of Texas1100 Commerce Street, Suite 300Dallas, Texas 75242-1699

/s/ John R. Parker JOHN R. PARKERChief, Civil DivisionUnited States Attorney’s OfficeNorthern District of Texas1100 Commerce StreetSuite 300Dallas, Texas 75242-1699

/s/ Rena J. Comisac RENA J. COMISACActing Assistant Attorney GeneralCivil Rights Division

/s/ Shanetta Y. Cutlar SHANETTA Y. CUTLARChiefSpecial Litigation Section

/s/ Daniel H. Weiss DANIEL H. WEISSDeputy Chief

/s/ David Deutsch DAVID DEUTSCHSenior Trial Attorney

/s/ William E. Nolan WILLIAM E. NOLANTrial AttorneyU.S. Department of JusticeCivil Rights DivisionSpecial Litigation Section950 Pennsylvania Ave., NWWashington, D.C. 20530

- 23 -

FOR DALLAS COUNTY, TEXAS:

/s/ James Foster JAMES FOSTERDallas County JudgeDallas CountyCommissioners Court

/s/ Lupe Valdez LUPE VALDEZSheriffDallas County

/s/ Peter Harlan PETER HARLAN Assistant DistrictAttorney for Dallas CountyDallas County

- 24 -

SO ORDERED this 6th day of November , 2007:

_______________________________UNITED STATES DISTRICT COURTJUDGENORTHERN DISTRICT OF TEXAS