April 26, 2024

The Multnomah County Board of Commissioners on April 23 received updates from the Sheriff’s Office and Corrections Health on several reports and policy recommendations responding to a sharp increase in deaths in custody during 2023. The Sheriff’s Office operates and manages the jails, but works closely with the Health Department’s Corrections Health Division to provide medical care to the adults in custody. 

The briefing comes after Multnomah County jails reported a record number of adults who died in custody. Since 2022, 10 people died in County jails — more than the previous seven years combined.

Beginning in May 2023, seven people died in custody, said Sheriff Nicole Morrisey O’Donnell as she read the names of those who died and their causes of death. Three people died by suicide; one from natural causes; and two by fentanyl toxicity. One death remains under investigation.

“Someone dying in our corrections facilities has a profound impact on the individual’s family, the people housed with them, victims and survivors of their alleged crimes, as well as the staff working in our corrections system,” Sheriff Morrisey O’Donnell said. “These losses have had a devastating impact on families and loved ones and also on crime victims, staff and partners who work in jail facilities,” said Chair Jessica Vega Pederson. “And they have an impact felt throughout our community. We have a responsibility to provide safety and care in our corrections facilities and this is a responsibility I know all of us take very seriously.”

Multnomah County Sheriff’s Office

In August 2023, the Sheriff asked the Oregon State Police to conduct an independent review of all adult-in-custody death investigations in 2023. She also asked the National Institute of Corrections (NIC) for an independent consultant who could assess the Sheriff’s Office’s facilities, operations, policies and services, in partnership with Corrections Health. Both the independent review and assessment were initiated by Morrisey O’Donnell.

“It is through these transparent processes that we are engaging in, and our annual independent evaluations, that we’ll continue to identify areas of opportunity as we move forward,” Sheriff Morrisey O’Donnell said. “As Sheriff, I am accountable to our community and I’m committed to ensuring that this office and its employees are performing to the highest standard.”

In September and October 2023, the Sheriff’s Office also participated in the annual District Attorney’s Office Corrections Grand Jury process and the Oregon State Sheriff’s Association’s Oregon Jail Standards process.

Those reports have since been released. The Sheriff’s Office, in collaboration with Corrections Health, is taking all of the recommendations from the reports and compiling them into a project titled “corrections recommendations” that will focus on addressing issues with staffing, operations and facilities.

The recommendations project provides a “tremendous opportunity to address many areas within our corrections scope that will have significant and long-lasting positive impacts for the adults in custody and the staff who are responsible for their care,” said Sheriff Morrisey O’Donnell.

The project, which is led by newly appointed deputy chief of staff Jenny Carver, will include developing goals for implementing improvements, an operations plan accomplishing the improvements, engagement with leaders and partners, evaluation, and finally creating the project framework. 

“As we move through the over 100 individual recommendations within assigned work teams, we’ll condense to align actionable project tasks and address areas related to policy impacts, equity and inclusion, and community engagement,” said Corrections Facilities Chief Deputy Stephen Reardon.

Immediate adjustments based on the reports’ recommendations include expanded mental health training, facility upgrades, search procedures, and expanded Narcan access.

“The flood of fentanyl in our community has changed the landscape in an urgent and deadly way — this includes our jail settings,” said Morrisey O’Donnell. “I have asked the National Institute of Corrections to return to partner with the Sheriff’s Office to look at ways we can be better in our efforts to detect and control the introduction of contraband in our jails.” 

Responding to a request from the Sheriff, the NIC has identified two technical resource providers to work with the Sheriff’s Office in the coming weeks. Over the long term, the Sheriff’s Office is pursuing other strategies that include contraband detection and control, technology tools, and staffing models.

“I am committed to identifying and implementing solutions to prevent deaths in our custody,” said Sheriff Morrisey O’Donnell. “And with our health partners, my team and I will continue to work with our local, state and federal partners to help achieve our collective health and safety goals.” 

Role of Corrections Health in jails 

Corrections Health’s core responsibility is to provide healthcare to adults and youth in custody that meets both constitutional and community standards.

Corrections Health Director Myque Obiero began the presentation by addressing the systemic challenges the division has faced in recent years, including highly potent illicit drugs in the jails, increased acuity of behavioral health needs for adults in custody, workforce capacity, and the need for more specialized staff training.

“What we see in the community is seen within the jails but in a more concentrated way, in a difficult environment for a population that finds themselves at the lowest point of their lives for most of them,” said Obiero.

Corrections Health Medical Director Dr. Eleazar Lawson said behavioral health assessments at the jails have increased 50% since Fiscal Year 2020-21.

“As we see more mental illness and substance disorder in our community, and a lot of those patients are coming to us in the jail, we’re seeing a dramatic increase in the number and the acuity that we’re having to address,” Lawson said. “We recognize the challenges that we are seeing.” 

Even before the NIC report and subsequent changes to address the challenges, Lawson said, Corrections Health developed a suicide prevention training for staff in June 2022, formed a suicide prevention workgroup in June 2023, recruited and hired a medical director in August 2023, and recently restarted behavioral health first-aid training with the Sheriff’s Office, which had been on hold due since COVID-19. 

Lawson said Corrections Health is acting on the immediate recommendations made in the NIC report. One recommendation was to improve communication with the Sheriff’s Office. One of the biggest initiatives taken to meet that recommendation was creating a multi-agency release of information form that allows for more efficient communication between Corrections Health and the Sheriff’s Office while also maintaining patient confidentiality.

Other immediate actions drawn from the NIC report include:  

  • Creating a staff document for suicide checks; 
  • Developing and posting anti-suicide signage throughout the jails;
  • Assigning a full-time behavioral health clinician to the intake unit to provide consultation coverage during the busiest intake hours; 
  • Assigning full-time behavioral health clinicians to the units where significant behavioral health challenges are housed;
  • Working to expand behavioral health coverage during evening hours and weekends.

“Many of these processes we started before the report,” Obiero said. “For us as a division, we feel very vindicated as a lot of the things that we had started as projects were brought up in this report, and it just showed that we were going in the right direction. Seeing them highlighted meant a lot for our team.”

Both Obiero and Lawson stressed the importance of ongoing work to de-silo Corrections Health and the Sheriff’s Office.

“A lot of collaboration and coordination will only function to be able to keep people safer and healthier while they’re incarcerated,” Obiero said. “We have always embraced collaboration with partners across not only the law enforcement but the health continuum as well.”

Board comment

“I appreciate the presentation and the seriousness with which you’re taking the loss of life that has occurred in the facilities and the approach to looking at it from a systemic standpoint, in addition to the care for the individual,” said Commissioner Julia Brim-Edwards.

She asked the Sheriff if corrections facilities around the state or region have seen a similar increase in deaths in custody.

Sheriff Morrisey O’Donnell said her peers in other major counties have also reported challenges and deaths in their jails.

“Not exactly at the same time that we were experiencing ours, in that time frame, but there has been a trend with the flood of fentanyl and the acuity of the individuals that we’re all managing, making sure that their health and wellbeing, that we’re able to care for all their needs,” she said.

“I want to acknowledge the humanity that seven people from our community are no longer with us,” said Commissioner Lori Stegmann. “I want to recognize the families of those folks who are probably watching this and offer my condolences.”

Commissioner Stegmann asked Obiero about the use of private agency nurses to fill staffing gaps in Corrections Health to meet the mandatory overtime that is required for medical personnel working in correctional settings. “What pressure does that cause? What does staffing look like when you’re so understaffed?” she asked. 

“It’s kind of a double-edged sword, because if we don’t have the agency nurses, then the mandatory overtime will be unmanageable,” said Obiero. “Then people would have to be working 16-hour shifts on a regular basis, which is not sustainable. We also recognize that we can’t just say, ‘We have agency nurses; now we are fine.’ We’ve continued our aggressive approach in weekly interviews.”

Commissioner Sharon Meieran asked the Sheriff what measures her office has taken to prevent fentanyl or other substances from reaching people in custody.

Sheriff Morrisey O’Donnell responded that the National Institute of Corrections is bringing in national experts to help identify what other agencies are doing that are seeing similar challenges regarding fentanyl. “We are trying to identify how we can work on all avenues to stop any introduction of contraband given that fentanyl could be grains of salt,” she said. “That will continue to be an extremely challenging situation for our entire system as well as everyone else that’s working through this right now in a corrections facility.”

“There were plenty of instances in the NIC report where it talked about the siloing and the one-way communication but not feeling two-way communication,” said Commissioner Jesse Beason. “I’m wondering if you can talk about how you see the recommendations project being a place to address those concerns about those silos and how do you intend to approach that work?” 

“We meet very frequently — most of the time every day — and discuss complex situations with the Sheriff’s Office,” said Obiero. “We’re creating natural relationships with our changing leadership that will hopefully remove a lot of those concerns, but we are very committed to working together and sharing information. Hopefully the project really does alleviate some of that concern.” 

“When the Sheriff reached out to Corrections Health leadership about the (NIC) opportunity, it really was embraced,” said Health Department Deputy Director Valdez Bravo. “In the past, we’ve been an accredited corrections health facility by the (National Commission on Correctional Health Care), and they’ve come in and done visits and the Sheriff’s Office has had the state come in and do those inspections. 

“But to do it together, in tandem, one person looking at both sides of the house all at once, now that we are going through the recommendations report, and operationalizing and implementing those solutions together, it’s really a different day than it has been in the past. The communication and the relationships are real.”

“We all take this very seriously because it is a tragedy when deaths in custody happen but it’s especially concerning when they are happening so often and so close together,” said Chair Vega Pederson. “I want to appreciate the way that you and your team have been responding to this and working in partnership with us. I’m committed to continuing to work forward as we work on these issues both from the Sheriff’s Department and with our Corrections Health.”

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