findings of the Civil Rights Division's investigation of conditions at the Robertson County Detention Center ("RCDF" or "Jail"), conducted pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. § 1997 ("CRIP A"). The Civil Rights Division commenced its investigation at the request of the United States Attorney's Office for the Middle District of Tennessee, after that office received complaints from prisoners regarding RCDF's provision of nutrition and medical care. During our investigation, we assessed RCDF's compliance with the Constitution, which requires the Jail to provide detainees with humane conditions of confinement, including adequate medical and mental health care, food, clothing, and shelter. While we found RCDF's practices with respect to nutrition, medical care, and environmental health and safety adequate or minimally adequate to comply with the Constitution, we found a pattern or practice of constitutional violations in RCDF's provision of mental health care. Specifically, RCDF's mental health practices place prisoners at a substantial and unreasonable risk of serious harm. In the other areas we investigated, we have serious concerns that do not yet rise to the level of constitutional violations, including numerous medical practices that could result in constitutional violations if left unremedied. By implementing the remedies set forth below, the County will fulfill its duty to uphold the Constitution and protect the health and safety of those in its custody. In making these findings, we note that RCDF has been cooperative throughout our investigation and receptive to our preliminary findings and initial recommendations. We are thus I. -2- confident that RCDP will take appropriate measures to remedy the deficiencies we detail in this letter, and look forward to working cooperatively with RCDP as it does so. Summary of Findings and Conclusions We have concluded that Robertson County ("the County") fails to provide mental health care to prisoners at RCDP in violation of the Pourteenth Amendment to the Constitution. Addressing these deficiencies should be RCDP's highest priority, as we believe that these lapses, if not corrected, have a strong likelihood of resulting in unnecessary injury and/or loss of life. Our specific findings of practices that do not comport with the requirements of the Constitution include: • RCDP fails to protect prisoners from harm by permitting Licensed Practical Nurses ("LPNs") - individuals with little or no mental health training - to independently manage suicide precautions. The Constitution requires the Jail to provide prisoners with mental health needs with access to medical personnel who are qualified to diagnose and treat mental illness. • RCDP fails to provide prisoners with serious mental illnesses with timely and competent mental health care. Specifically, (a) prisoners with chronic mental illnesses who are not capable of requesting mental health care are effectively denied treatment; (b) prisoners who request mental health care experience delays that violate constitutional standards; and (c) nurses are responsible for providing mental health care beyond their training and qualifications. While we do not find a current violation of the Constitution, we find that certain medical practices at RCDP may pose unreasonable risks to prisoners' safety and health and, ifleft mrremedied, may violate the Constitution. Additionally, we find that while the Jail's nutrition and sanitation meet minimum constitutional requirements, certain ofRCDP's practices in these areas are deficient or cause us concern. II. Investigation On July 13, 2010, we notified you that we were opening an investigation of conditions at RCDP pursuant to CRIP A. Based on the allegations and information we received from the United States Attorney's Office, the initial focus of our investigation was the nutritional adequacy of the diet provided to RC
Same source, country, and finding where possible.