Summary
Officers and staff members who work in California’s 35 state prisons and the 58 counties’ local detention facilities (correctional facilities) face threats to their health and safety, including being subject to a type of assault in which an inmate throws bodily fluids at them—commonly known as a gassing attack. A gassing attack can have serious health implications for the victim, including the potential transmission of communicable diseases from the bodily fluids and psychological trauma from the incident. Under state law, any inmate in a correctional facility who commits a gassing attack on an officer or employee of the facility is guilty of an aggravated battery, and the inmate can face an increase of two to four years to his or her current sentence. The three correctional facilities we visited—the California Department of Corrections and Rehabilitation’s California Institute for Men (CIM), the Los Angeles County Sheriff’s Department’s (LASD) Men’s Central Jail (Men’s Central), and the Alameda County Sheriff’s Office’s Santa Rita Jail (Santa Rita)—oversaw 9,900 inmates as of January 2018 and identified 111 gassing attacks during 2017. For this audit, we reviewed these correctional facilities’ policies and responses to 45 gassing attacks that occurred between 2015 and 2017—15 at each location—to determine how the facilities protect the health and safety of their correctional officers and staff. This report draws the following conclusions:
The Three Correctional Facilities Do Not Have Adequate Procedures to Ensure That They Provide Care to Victims of Gassing Attacks
Santa Rita has not consistently documented that it informed gassing victims of all available aftercare services, including medical evaluations for communicable diseases and workers’ compensation benefits. None of the three correctional facilities consistently documented that they informed gassing victims of their right to request that the inmates involved be tested for communicable diseases. In fact, CIM and Santa Rita were aware in some cases that inmates had communicable diseases at the time of the 2017 attacks but they did not notify all the victims of the exposure until August 2018 after we inquired about such notifications. Finally, none of the correctional facilities consistently documented that they notified victims of the availability of counseling services.
The Three Correctional Facilities Did Not Consistently Investigate Gassing Attacks in a Thorough and Timely Manner
To deter inmates from committing gassing attacks, the Legislature established a criminal penalty of two to four years to be added to their current imprisonment if convicted of this crime. However, only 31 percent of gassing attacks at the three correctional facilities we reviewed from 2015 through 2017 resulted in convictions. District attorneys declined to prosecute a substantial number of cases that CIM and Men’s Central referred from 2015 through 2017, 61 percent and 49 percent, respectively, in part because the correctional facilities’ investigations were not always thorough or timely. Specifically, the correctional facilities did not collect the physical evidence needed to prosecute in four of the 45 cases we reviewed. In addition, Men’s Central and CIM took an average of more than seven months and more than three months, respectively, to investigate the gassing attacks we reviewed before referring them to the district attorney, delaying resolution of the legal process. In contrast, Santa Rita took only 17 days on average to complete its investigations and refer the cases we reviewed to the district attorney. However, Santa Rita did not refer four of those 15 cases to the district attorney because of staff oversight or because the victim did not wish to file a criminal complaint.
The Three Correctional Facilities Have Not Established Adequate Internal Processes to Prevent and Respond to Gassing Attacks
We found that CIM and Santa Rita inconsistently followed their internal discipline procedures designed to deter inmates from committing gassing attacks, such as reducing privileges, placing inmates into secured housing, and revoking sentence reductions that the inmates earned. For the gassing attacks we reviewed, Men’s Central appropriately imposed disciplinary action for all inmates who committed gassing attacks while CIM and Santa Rita did not always impose discipline. Further, the three correctional facilities provided limited training to officers on how to prevent and mitigate the harm from gassing attacks, and, as a result, their officers may not be sufficiently prepared to react to gassing attacks. In addition, CIM and Santa Rita do not actively track gassing attacks or attempted attacks. Although state laws and regulations do not require such tracking, both correctional facilities asserted they know which inmates are most likely to commit these attacks. Nevertheless, such tracking could help them identify the characteristics of inmates who commit gassing incidents, inmates who are repeat offenders, and other factors that create a higher risk of gassing attacks.
Summary of Recommendations
CIM
To ensure the health and safety of its employees, CIM should do the following:
• Revise its policies to document that it notifies victims of counseling services available following a gassing attack, as well as their right to request that the inmate be tested for a communicable disease.
• Develop goals for how long investigations should take and consistently collect physical evidence of the crime.
• Impose internal discipline to deter inmates from committing future gassing attacks.
• Provide training that is specific to preventing and responding to gassing attacks.
• Consistently track all gassing attacks to use as a tool to identify best practices for preventing future gassing attacks.
Men’s Central
To ensure the health and safety of its employees, Men’s Central should do the following:
• Revise its policies to document that it notifies victims of counseling services available following a gassing attack, as well as their right to request that the inmate be tested for a communicable disease.
• Develop goals for how long investigations should take and consistently collect physical evidence of the crime.
• Provide training that is specific to preventing and responding to gassing attacks.
Santa Rita
To ensure the health and safety of its employees, Santa Rita should do the following:
• Revise its policies to document that it notifies victims of all medical and counseling services available following a gassing attack, as well as their right to request that the inmate be tested for a communicable disease.
• Refer all gassing attacks to the district attorney when probable cause exists.
• Impose internal discipline to deter inmates from committing future gassing attacks.
• Provide training that is specific to preventing and responding to gassing attacks.
• Consistently track all gassing attacks to use as a tool to identify best practices for preventing future gassing attacks.
Agency Comments
In response to the audit, CDCR and the LASD concurred with our conclusions and generally agreed to implement our recommendations at CIM and Men’s Central, respectively. However, the Alameda County Sheriff’s Office partially agreed with our recommendations for Santa Rita, asserting that it had sufficient procedures already in place.