Restrictive Housing Legislative Working Group

Good morning everyone. Today is Thursday, October 16th. It's 9:30am. We are in Conference Room 229 at the Hawaii State Capitol. This is our Working Group on Restrictive Housing Legislative Working Group which is Act 292, Senate Bill 104, Session Law of 2025. And I just want to welcome our Members and those in the audience and those joining us on zoom.

I do note that there is a quorum present. I won't go into the details of the agenda as they are listed on our posted agenda. So at this time we'll do welcome and introduction. So in the room we'll start off to my right. To my right. To your left with Dr. Kamisato.

And it will just kind of go down and it will introduce the Members on Zoom.

Dr. Kevin Kamisato, Department of Health, representing Kenneth Fink.

Aloha kakahiaka. McKenna Woodward, Public Policy Advocate with the Office of Hawaiian Affairs. Happy to be here.

Dr. Michael Champion, Senior Advisor on Mental Health and Justice representing the Governor and the Governor's office.

Good morning. Tommy Johnson, Director Department of Corrections and Rehabilitation.

Good morning. Brandon Elefante from the State Senate. Co-Chair.

Good morning. Della Au Belatti from the State House. Co-Chair.

Good morning. Kim Coco Iwamoto, District 25. Non-voting Member.

Aloha. David Tarnas, Chair of the Judiciary and Hawaiian Affairs Committee, joining to participate in today's meeting. Thank you.

Good morning. Kat Brady, Community Alliance on Prisons.

Good morning. Tuli Tafai on behalf of UPW. Non-voting Member.

Okay. And we'll move online to Mr. Alcubilla.

Morning. Sergio Alcubilla. Representing ACLU of Hawai‘i Director Salmah Rizvi.

Okay. Their microphone came in a little staticky, so I'm not sure if that's on your end, but if IT you could work that out with Sergio, that'd be great. Okay, Mr. Patterson.

Hello everyone. Mark Patterson, Hawaii Correctional System Oversight Commission.

And did I miss anyone online on Zoom that if you're a Member whether you're voting or non-voting? Okay. If not, I think we're good. Co-Chair. Any other opening remarks that you have?

Nope, just want to jump right in. Okay. Have the agenda.

Okay. So that's our welcome and introductions. Members, we're moving on to item number 2 which is approving minutes from the August 21st 2025 meeting. Those were sent out. Co-chair also has some hard copies if you want to

I have hard copies and I'll pass it down. And we will make these available once approved on on the website.

And thank you to you and your staff, Christine, for formulating those draft minutes. With that being said, is there a motion for approval?

I move to approve.

Is there a second?

Second.

Okay. Moved and seconded. Any discussion? Okay. If not, any objections or reservations to approving the minutes? If not, so ordered, we'll post that as well. Before we move on, I'm sorry, I have to go back. Is there any public testimony on the minutes? Okay. Seeing none. Will move on.

Okay. Item number3, discussion on time limit and testimony procedure. So just to set a little context, our office did have an opportunity to meet with the Office of Information Practices regarding sunshine and time limit testimony procedure. So we do have to take public testimony on each item before we decide and take action.

So one of the recommendations I have Co-Chair and to the Members is we set up a policy and procedure for time limit and testimony. So if there are no objections, we'll take testimony for every item.

And if it's okay with the Members and you Co-Chair if we set a time limit at 2 minutes per each testifier. Is there any discussion for that?

I am comfortable with the two minutes. I think if the Chairs can retain some flexibility if there is further questioning by Members of the Committee to engage in some conversation that we be able to exercise some discretion.

Yep. Any other discussion on the two limit? Okay. Any objections to setting our time limit and testimony procedures? Okay. If not, so order. So we'll have it two minutes and testimony at each item. And is there any comments on that particular item from the public? Okay. Hearing none.

We'll move on to agenda item number four, which is a presentation by the State of Hawaii Department of Corrections and Rehabilitation regarding restrictive housing policies. Thank you to Director Johnson and your team for providing us the PowerPoint slide.

Members, we did distribute this and it is posted on our capital website under Special Studies under our Restrictive Housing Group. And they do have a presentation today.

So at this time, if you could keep your presentation to about 20 minutes and then Members at the end will open it up for questions and comments from the Members and the public.

Okay, I just want a quick introduction. I'm Tommy Johnson, the Director of Department of Corrections and Rehabilitation. Here today with me is my leadership team, Deputy Director for Administration, Melanie Martin. Deputy Director for Rehabilitation Services and Programs, Sanna Munoz.

Presenting here today will be our institution division administrator, Mr. Michael Hoffman on the restrictive housing and our Health Commission Corrections Healthcare Administrator Romey Glidewell. With that said, I'll let them come up and get into it.

Thank you.

Good morning, Chairs. I'm Romey Glidewell of Department of Corrections, Rehabilitation Correctional Healthcare Division Administrator. And I will be beginning this presentation to get us going, we can go ahead and move on to the next slide. So I'm going to begin by commenting on a report that was given to you guys that we received on September 22nd.

In 2025, the DCR requested to engage in an assessment with nationally recognized correctional mental health care experts to determine the extent to which DCR would need to reform the mental health policies and practices. We had recognized that the system needed to be redone. It was pretty easy for us to identify the problems.

Every district has different challenges to solving these problems. So we really wanted to seek out some experts who worked with many districts who could recognize some of the distinct challenges that we faced and not just identify problems, but actually kind of help us with solutions that we could execute at the end of it.

So I'm going to go through some of the results of the report. This is a summation. The report was very long. We have produced a 47, 42 line workflow tracker of discrete items that we're going to be working on. I didn't want to bury you guys in that, so I'm just going to go through some highlights.

Next slide, please. So I do want to start with some highlights. Both Dr. Metzner and Agharkar recognized some things that we were definitely doing right. And it's important that my staff hear that there are some things that they are doing very successfully. One of them is medication initiation. Continuation and administration is very consistent.

At the two facilities that were assessed, which was HSCF and OCCC. That is a problem in most facilities because of lockdowns, staff shortages. All of those items make medication passes. Anybody on an antipsychotic medication or a mental health medication, they don't carry their own meds. We have to give them to them sometimes three times a day depending.

So getting access to them in all of our facilities has been very successful and that's a team effort.

They also identified that all the staff interviewed from Security Medical and Mental Health showed a genuine high level of care for the well being of the incarcerated people in their facilities and that they all expressed a desire to know more and improve their practices. They found that same thing with the wardens and with the Department Administration.

They found no pushback on things that they suggested. The things that they identified. We were all very much on the same page with the problems they found. And then also potential solutions and working together on them, which they found refreshing and was nice for me to see as well. Next slide please.

So some of the recommendations that we've addressed to date is, there was a high level mental health administrator position that had been vacant for several years that has been filled by a tremendous candidate with over 30 years of administrative mental health experience with the VA and with the Peace Corps.

She is with us now, boots on the ground, getting to know our facilities, getting to know our staff, hiring people and working on policy reform with me. She's been a tremendous asset and that's made a huge benefit and crucial to our moving things forward quickly is just having that critical person filled.

HCF and OCCC were both identified as having physical plant conditions that will only be resolved with our new construction. And both those proposals are deep underway, as many of you guys know, one being the consolidated healthcare unit at Halawa and the proposed construction of the new OCCC.

The identification that many inmates require a higher level of care than is possible at a correctional facility is currently being addressed by a working group between DoH and DCR to update very outdated workflows and transfer processes. There are several items that were identified in the report and several different populations that need particular problem solving.

So I know DoH and DCR got on that very quickly with the assistance of Dr. Champion as well. Short staffing and the recommendations for licensed providers are being addressed in a budgetary request that. I'll go over that a little bit in detail later on. And then we did adjust the evening medication pass to later in the evening.

We found that was a holdover from before we were 24 hours. Nurses used to leave at 5, so med pass was at 4. We never adjusted that when we went 24 hours. One of those things that just kind of stuck around, very easy fix.

They also identified in both of our facilities that Suicide and Safety Watch is, or we address the fact that the Suicide and Safety watch was very similar to the restrictive housing by a lot of the amenities being removed for safety reasons and individual treatment plans weren't being addressed. It was kind of like a one size fits all.

So we're approaching an individuated treatment plan for each person in that level of care, which then very much changes Suicide and Safety Watch under the restrictive housing designations. So, next slide. So specific to OCCC, some of the findings and resolutions that we're suggesting. So the physical plant was described as decrepit and overcrowded.

And as you guys know, we have submitted a proposal for a new building design and are awaiting approval for that. They identified an inappropriate use of suicide and safety cells for inmates with personal safety concerns. This will be addressed in the accordance with Act 292.

We do find that inmates will identify themselves as requiring suicide or safety watch cells because they're having personal problems in the housing units.

And we're going to do a better job working with security to address that rather than bringing them into the fold of suicide and safety watch, which exhausts our mental health staff essentially and pulls resources away. It was also identified that there is a higher level of care needed for a significant amount of mental health patients.

And again DoH and DCR are working on the MOU that will expedite transfers and referrals in that direction. It was also identified that we need a better screening tool which we will be working on in December.

We're getting a new EMR and so many of our screening tools and protocols are going to be changed this December and we're getting the opportunity to rework a lot of things. They identified that our screening tool yielded about an over 80% need for mental health services which is not discreet enough as they found. So we're going to be working on a better tool.

Can you tell them what the EMR stands for?

Oh Electronic Medical Records. Yeah.

Each EMR has a template built in and workflows will be built in directly into it. They also identified for OCCC that an additional training for ACOs in that who will be working in the mental health modules.

DCR is going to be approaching HEA and UPW to negotiate additional training and selection for those posts as recommended in the report. And we've also contacted ACA, the American Correctional Association on a training program that would be a train the trainer program that's specific for ACOs and mental health staff working with this population in particular.

Next slide, please.

So these are the findings and resolutions that we're recommending for Halawa Correctional Facility. Again, the physical plant was referred to as dismal as well as lacking quads and appropriate milieu for rehabilitating the mental health population. They also identified that the layout does not offer confidential assessments in the housing modules which requires movement.

It requires ACOs moving and staff available. It also limits the amount of inmates that can be seen by a provider or nursing in any given day because of how long the movement takes.

They also identified that there's a need to increase the quantity of mental health beds and to create a step down unit for transitioning populations that also comes up in our Act 292 conversation later. Some of you may know that we have a consolidated healthcare unit proposal plan. I think we're pretty far along in that.

That will give us an extra 43 beds. It will give us private confidential examination rooms, easy access to the patients who are in the mental health module, easy access to the patient who are in Suicide and Safety Watch. It gives us a cool down room for deescalation and several other things. It's really a beautiful plan.

Can you please clarify how many of those 43 beds are for mental health?

Technically all of them because the Suicide and Safety Watch. So it's both acute and chronic and currently we're toying with the idea of mental health also being considered those with dementia, Alzheimer's and significant cognitive impairment. It's kind of a middle line of medical mental health.

But anybody who needs that additional supervision and rehabilitation essentially will qualify for that housing unit. They also identified the insufficient staffing and again I'll go over that on slide seven where they give us an actual breakdown and a ratio.

And they also identified inappropriate use of suicide and safety cells similar to occc which we're going to be working on with our workflows, policy changes and in accordance with Act 292. Next slide please. So this slide is a little small.

You may not be able to see it, but this is the staffing requests based on the recommendations that the experts made. Typically it is very difficult to get anybody to put down a census to provider ratio. But they were willing to do it in this scenario.

I think they wrote two pages on why people normally don't do it. And then they offered it up for me, which I appreciate. Their recommendation, which we are requesting, is one full time psychiatrist or mental health provider with prescriptive authority for every 100 patients on antipsychotics.

One full time mental health provider with prescriptive authority for every 50 in a mental health module and one for every 15 in an infirmary level of care. This slide actually gives us an average census of the amount of patients that we have on antipsychotics, those in the mental health modules and those in the infirmaries.

And then the calculation of how many providers that equals to and how many nurses it would take for each provider. We need a nurse to run the clinic and take the orders off. Right. The more nurses I have, the more clinics I can actually run. So that's what that that table kind of explains based on their recommendations.

Next slide please. So Act 292. I have been spending the last couple of weeks. My job, right, is to implement the laws and implement and make the workflows real on the floor for my staff.

I spent the last couple of weeks looking over the current version of Act 292 and I found it very difficult to put an actual workflow and implementation together based on the way that it's currently written.

So I spent some time going over DOJ, ACA, the American Correctional Association and the NCCHC recommendations on restrictive housing just to kind of get to the heart of what the Bill was really trying to get across.

Because I really do feel that the Bill was written with the same heart that everything else out there is having is identifying these vulnerable populations, ensuring that the care is appropriate, ensuring that we aren't having extended stays that are unnecessary and that the review process is really being implemented and perpetuated in a real way.

But and I very much respect that I identified at the top there, the DOJ recommendations I decided are the most important because they actually have legal grounding over us. But our goals would always be the NCCHC ones and then using ACA as an additional guideline.

So there are some areas that we are very much in align with with the DOJ. That being the definition of restrictive housing, which is 22 to 24 hours of confinement with limited access to programs and meaningful contact along with diminished amenities.

They also recommend the shortest term being 15 consecutive days with reviews every 30 days and the need to identify vulnerable populations and exclude them from the practice whenever possible.

They also recommend weekly physical, medical, mental health assessments and the use of a step down unit which are all essentially in there, which would very much be our goals moving forward. I will say that Act 292 has two distinct items that I find very challenging to implement and I have great concerns for litigation on the other side.

Just in full honesty, I don't see how I'm going to execute two of these items. One of them being that the vulnerable population be referred to DoH for confinement.

That process actually takes time and they are, they're if it's a suicide or safety concern, I have to do something with them before that referral happens and that confinement takes place. And what if DoH decides not to accept that body? There's nothing really in it that then allows me to care for them appropriately.

It also I have a significant number of inmates, patients that qualify for vulnerable population. So it would be a big lift every week to be making those referrals and having DoH come and assess and making those transfers. The second one being that a clinical assessment is required every 12 hours by a provider.

I don't disagree with the request. I just don't know how I will be able to physically execute it without a team of doctors on standby. So those two items, I have tremendous concern for extensive litigation if we are required to abide by them. I. That is the conclusion of my presentation.

I'm here for questions, but I would like to turn this over to Mick Hoffman, who has line items specific to our requests.

Why don't we, if it's okay with you, Chair, maybe Members might have some questions. So at this time, is there any questions for DCR?

Yes, Member Iwamoto.

Thank you. Thank you for your presentation. So when.

If you want to speak into the mic, if you don't mind.

Thank you. Okay. Thank you so much. Oh okay. I get the difference. You mentioned, okay, about the Act 292 and how difficult it is. I appreciate that. And when we did a site visit, we heard directly from the staff that it is almost impossible given.

And specifically the feedback I got was that it was about staffing shortages. And one of the reasons why they have to triple, put three people into a cell that was originally designed for one person and squish them all into one module is because of staffing. Right. And so to me, when we passed

When the Legislature passed this Bill and sends it to the Governor and the Governor signed it, to me it's a conversation saying, hey, this is what we expect. How much money do you need?

And I feel like it's us, the Legislature, we're responsible for raising the revenue so that the Executive branch can actually act on the bills we pass or. And the bills that the Governor signs. So how much money do you need? How much. What do you need to implement this?

I mean, I feel like the agreement between the Legislature and the Executive branch is like, hey, we're both committed to raising the funds and to then expending the funds. And if that has to do with raising, doing collective bargaining, so we can actually recruit more staff, whatever it takes. But we need to know.

I think it's a combination of things. When I really do think about it, and I've gotten to tour a lot of districts and the way that their other units function. We're a state with sort of a limited capacity. There's only so many people who are going to want to work in corrections.

We have to kind of acknowledge that both as doctors, medical providers, and ACOs. Unfortunately, the two structures that we're talking about were not designed with the kind, they increase our staffing needs. If we had better structures, we actually wouldn't need more staff. We could actually manage a pretty decent population.

If I could see them in house because I have vacant positions. I need the funding for the staff for sure because I need them be more mobile. Right now they're spread way too thin. But at the same time, I still need access to them, which means I need ACO staff as well.

And we have vacancies and we're not necessarily filling them and we do need to do recruitment but we also need a structure that's more conducive to the way that we are moving towards in caring for this population. Access.

Right. But I would imagine that it would be a quicker fix. It takes a long time to design, build.

Yeah. I think that I have a budget request in with the Director.

If I may, we submitted what's called a form, a request for the 35 positions to address the recommendations from the two experts and it comes to about $8.6 million. That request was submitted last week.

There will be a need for funding though to also try to find community based beds for some of these folks because I don't think jail restoration is going to help. You can't put somebody who's stable from the state hospital and send them to a jail setting and think that they're not going to decompensate.

So there will be a request for funding for bed space and or to, while we look at recruiting to contract for services for some of the medical professionals we need.

Thank you.

Members, any other questions? Member Brady.

Aloha. Romey, I'm wondering, I'm glad that you are listening to the experts and I'm wondering the recommendations that they're making, will that apply to all facilities? Because there's a big medication problem at Saguaro.

So, medication problem at Saguaro. I will have to look into that just because I don't have. I have authority over what they're supposed to be doing, but I don't have boots on the ground. So it's always helpful to know what's happening. I do have direct line of communication with their Director.

So when I do hear things from you. Oversight Commission, there's been some letters from the governor's office, I fire off an email to her right away because she is very eager to make sure that we are getting the services that we are requesting because we are requesting the NCCHC standard of care.

So I appreciate you bringing that up, but it does. I only have authority to write policies for my facility, but the contract does require that their policies follow mine. So in essence, yes, the reinforcement. We do do quarterly audits.

And honestly, you guys letting us know what you're hearing is really helpful to us because we do need those individual stories to kind of go back and keep everything working the way it's supposed to.

Okay. Tommy knows. I emailed him. Okay.

Co Chair Biladi, you had a question?

I think I have some quick fire questions. May we have a copy of the Opulento assessment and report?

Yes.

Okay. So the Committee will get a copy of it? You know this is a two year

Yeah, sorry, I assumed you guys had it. Yeah

Also the 42 line workflow tracker.

Okay, question about the MOAs between the Department of Health and DCR. Who are the Members of the working group who are working on that?

Believe that's you, Dr. Champion. Dr. Fink. I'll let you answer.

It would be myself as Director of DCR, Dr. Michael Champion, Dr. Scott Miscovich, and Dr. Kenneth Fink from DoH, and Dr. Matsu from Department of Health as well. DoH as well.

Dr. Miscovich is a private

He's a private provider working with the governor's office. To be clear, though, we have an MOU in place. Now, what we're doing is rewriting the MOU, update it for stronger language or on the DCR side of the house, and we will be providing that to DoH to open a discussion to amend the current MOU.

Okay, so can we, as a Committee, have a copy of the current MOA?

So we can understand what the process is. In slide OCCC findings and resolutions, what is the timeline for this new MOA with the doh?

Yes.

I have a first round draft completed, so we're doing our editing rounds at this time.

We should have it in place before the end of the year.

So December 31st?

Yes.

Okay. Does Department of Health confer with that? That it will be done by the end of the year and the Committee will have a copy of it?

Yes, that is. Mine is done as well.

Okay, thank you. Workflows with UPW and HGA. I know, Director. Thank you. Because I know that you reported to the oversight clinician that you've had conversations with UPW, but how are those going?

Because, like as Vice Chair Iwamoto said, one of the things that we're learning is that it's really staffing that's the most challenging at times, that's causing the lockdowns to occur.

So what we're doing is we're working on an MOU with them for an ACO attendance program. So right now we're waiting to hear back from UPW to schedule the next meeting or on the edited version that they provided some changes, some we agree with, some we don't.

So we will be meeting with them soon, hopefully to get that in place. There is no MOU with ACA because it's not needed. It's needed for the ACOs. But also I wanted to clarify that we've increased our recruitment classes from on the ACOs from 5 last year to 8 this year.

And so we've cut the vacancy rate from 34% to 24%. But we still have a long way to go. And I also want to emphasize that the facilities schedule enough ACOs to run the facility and the programs. The problem we have is while we have a lot of dedicated staff who come to work, we have some that do not. And we only have so much money in the budget.

To give you an example. Right now for OCCC, which is our largest staff facility, they're projected to be a $7.1 million shortfall at the end of the year. At the current rate of spending, they were spending $21,000 a day for overtime. So we had to curb the overtime.

But in doing so, we have to close some posts, non essential posts, and we have to also curtail some programs. So we would hope that the ACOs, who we believe may be playing games with sick leave and FMLA will then come to work.

Hawaii has the greatest, has the best benefit package in the nation of 21 days vacation, 21 days sick leave a year, 13 days paid holidays. So we did talk to them about some incentive programs. I can go over those now or at another time.

I think that's a staffing issue and maybe that's something that we take up for another matter because I think that does have impact.

Impact just generally on flow of folks. But I think that's something that we should continue to monitor.

Before you continue, Members, do you have any other questions? Yes, Member Woodward.

Thank you. So I'm seeking clarification on the recommendation changing screening tools and protocols for electronic medical records. Did you say 80% of the population with those current protocols came back with mental health health struggles?

Yes, and that may be accurate. And I do need to look into what the recommendations were. Just what the experts said. They said it's not discreet enough, which is fair. I also think that we may have 80% of our population that has a certain level of mental health needs. I do believe that.

I think that my solution is going to be a combination of those two things which is creating a screening tool that develops a level of care that's needed as opposed to like yes, I do think we have 80%.

However, I need a better discrete tools so that I'm grabbing that 20 to 30 that are have high acute needs right now to make sure that they aren't getting lost in the 80% because that's a big lift on a 900 to thousand person facility.

Thank you. Could you expound a little bit more as to what the current screening tools and protocols include and then as you mentioned, what specifically would need to be changed, how to parse those out.

So right now we have what's called a post admission mental health screen that's asked in the first 14 days and we also have six kind of. It's like the KJ. It's a nationally recognized questionnaire.

The questions are, are pretty broad and one of the things that we're, I, we're finding with the questions, and this again is specific to Hawaii, is that anybody who's used amphetamines would say yes to most of the questions. That does not mean that they have a severe persistent mental illness.

So we are getting a high number of positives because have you heard voices? Do you hallucinate? Have you heard command voices? That that is a side effect of extensive amphetamine abuse. So they're saying yes and then they're falling into that category.

And it's only after they've been without the amphetamines for a while they kind of like, oh yeah, well not necessarily. And then we have to kind of like unpack that.

So that's sort of what I mean by discreet is that we're recognizing that those questions, they're fairly old tools and the amount of amphetamine use wasn't quite as significant. It was. And it really was for a mental health population, not a prison population that's being incarcerated for drug use, essentially.

Thank you.

Okay, back to you, Co Chair. If you have a few more questions.

Yes, and I promise there just a few more. This theme that keeps coming up of identifying folks for suicide and safety cells, but they have other safety concerns. As I look through the policies and part of the KANA of this Committee is actually to also not just dig into Act 292, but to dig into policies.

So as I looked over the policies currently are the policies that cover this kind of group of people who are being segregated. Cor 11.01. Administrative segregation and disciplinary segregation is the second policy. Protective custody management.

No, neither of those are the policies that I would be referring to. It would be the suicide intervention and Prevention Policy. Cor10.1 G05 or B05. I can't remember those.

Those policies are confidential, so you will not find those on our website.

So you said it's Cor 10 core. 10.1 either G or B. It's G.05. So G. Yeah. And then this is for suicide. Suicide prevention intervention. And it's currently in its first round draft of being rewritten.

And we do still have contracts with Dr. Metzner who did our report, and he'll be reviewing the three policies that he recommended rewrites on. He's offered to review them and make suggestions before finalized.

And this is a policy that's been in place for long. This is. This is long.

It has been. Yeah. Recently signed, but it has been in place for a long time. And it's. It mostly follows the NCCHC recommendations, but has also been historically difficult for staff to implement as a practical workflow. It's. It's a little bit confusing the way that it's currently written, but this is.

Something that they've been tasked with doing for the last. Yeah. What is the training like on this?

So we do have policies and procedures and this is one of the reasons we actually started rewriting this policy before Dr. Metzner came on board. Because I would sit in rooms with three or four of us and we would interpret several of the lines differently. And I'm like, we can't interpret this in a linear fashion.

Then I know that my staff on the ground cannot. I like all of my policies to be able to be made into a decision tree. Like if this then that and be very clear. And if it doesn't fit that way, I know that there's misinterpretation.

So we've been trying to approach this several times we pause on our rewrite because of the assessment and then we pause on the rewrite because of Act 292.

The way Act 292 is currently written, it directly affects my suicide and Safety watch policy because by definition anybody on suicide and safety watch also is included in the restrictive housing bill, which makes it very challenging for me to care for those patients the way that that bill is currently written, which is kind of why I'm hoping to separate that population out a little bit.

Okay. I understand that this policy is non. Is confidential. We do have powers as a Committee to take in so we can, we can cross that. We'll look into some, some research to determine if, how we can maybe take a look at that and understand.

Because if our laws are impacting that policy, then we need, we need to have eyeballs on the language.

So separate and apart from that and just because I'm trying to do our due diligence for this Committee, we do have three policies that are, are available to the public that to me, as I read them, affect all of the content of Act 292.

It is administrative segregation and disciplinary segregation, Protective custody management and special problem inmate management. The intersection of those three plus this other one is are the policies that are effective. Okay.

We don't have to go line by line, but I'm expecting that the, that further presentation because that's a presentation on the laws that we need to fix, those law should actually comport with the, should mirror parallel the procedures.

And so as we talk through those things, I do have for members of the Committee and we can make this available. I have the biggest policy is Core 11.01. Is that accurate to say I do have copies for the members if you want that. It's available online.

But I think these are going to be the documents of the Committee that we'll be looking at in addition to HRS and Act 292 and all of these things that are going to be part of our work. That's it for me I think at this point. Sorry.

Okay. No, no. Good questions. Yes, Member Iwamoto.

Thank you, co Chair. You mentioned early on that we're doing really great on medicate medicating inmates who need medication.

When I was doing the, I guess the walkthroughs asking about individuals who come in higher addicted to crystal methods ampetamines and then I think you, I think my understanding is that you shift them onto a prescription medication to help deal with that.

But they're on it the whole, my understanding is then they're put on it the whole time they're incarcerated and then they're kind of released. And, and also one of the, the individuals who's giving us a tour mentioned that, zero yeah, it's an addictive substance. It's an addictive prescription medication.

So you take them from an illegal addictive medication to a legal but prescription and then you release them and they're still addicted, but they're not getting scripts nor maybe can't afford the prescription. So they go, they come out, they come out still addicted. Missing something?

No, you're not missing something. This is a very large conversation. I would be happy to meet with you like and really go over it because it has been a very complicated program for us to roll out. The use of Suboxone is a community standard and it is recommended by the FDA, all the regulatory groups.

We don't really have the choice to not offer them at this point. Anybody with a substance use disorder is considered protected under the ADA because that diagnosis qualifies them. Not giving them the standard of care opens the state up to tremendous liability.

The standard of care is for them to be on that prescription sometimes for their whole lives. And it's a, it's a harm reduction model and there's all kinds of moral, ethical and personal opinions.

I'm going to leave off to the side right now and just really relay the, the science of it, which is it is a harm reduction model. If they are on this medication, they cannot use illegal substances like, like opioids and they cannot die.

It has a ceiling effect and it will not allow them to take enough of anything that will stop their heart rate. So part of the prescription for that is the risk for overdose and death. As you guys know, most people OD right after we release them. We Release them with 30 days of medication.

We make an appointment for them to go to facility or not of next facility, but a community partner who prescribes and we make sure that they have insurance. If they don't, you do that. We, we kind of, I mean DCR is sort of, it's as far as we can go. We rely on our community partners.

We try to do warm handoffs. Opioid use disorder and amphetamine use disorder is a very complicated disease and it is rampant. It is truly rampant. The use of fentanyl is skyrocketing. I, I personally prescribe this on a regular basis. I still see patients on Fridays and particularly this population.

This is also the population when, when we treat them, they end up in my suicide cells because their withdrawals do create psychosis because of the amphetamine abuse with the fentanyl. It is a very complicated process. My friends at UH Jamsum are also seeing the same things. So our jails are withdrawal units. They are. They just are. And.

And we haven't treated them as such, and we need to start treating them as such. That medication is complicated. It's. It's not perfect, but it does keep people from dying right now.

I appreciate that explanation. Thank you so much.

Okay. Any other questions? And then we'll go back to Co Chair Belatti and the Chair has a few questions, and then I'd like to continue DCR's presentation. Yeah, that's okay. Co Chair.

Thank you. Last simple question. I hope the last two slides where you compare what are the DOJ recommendations and the Act 292 requirements. I find it interesting that on one level, on 1.0 DOJ recommends no more than 15 consecutive days, and we have no more than 30. Yeah.

So actually our Act 292 is not in alignment with DOJ best practices. Correct.

Okay. And one other entity also does the. I think it's. NCCHC is 14 or 15 days as well, and then ACA is 30 plus. So. And I. And that may have been part of the decision. I don't know.

Okay. And then the vulnerable populations and the referral to DOH, it's. That seems like something that we need to flag and try to like, that's. That's where we might. This is the solution is to. For you to have your staff making those assessments and not bringing in another agency.

Well, I think that the agency will. Should be involved when clinically indicated versus I think the way that it's written is anybody who is of the vulnerable populations that are outlined who would be going into restrictive housing, which includes suicide and Safety watch, would then be referred to DOH, which is a significant portion of our population.

I mean, literally dozens a day.

Okay. And then the last kind of big one that you popped out for us was that DOJ recommends weekly mental health checkups, but we are suggesting clinical assessments, and we've mandated it every 12 hours, I think in the law. Yeah, it's for folks who are suicidal, like acute. But I. We'd have to go back and check that.

So I think we need to, as a Committee, look at what the basis of that was.

And the writing of the bill was a little bit convoluted for me, unpacking which populations we were talking about.

And that was sort of my appeal to you guys in recon, if I can't make a workflow because I'm not really tracking which population each line is referring to, I think we can get ourselves into trouble down the road. So.

So maybe the best thing is at some point, because I don't know that I've ever saw the DOJ recommendations. I've seen versions of DOJ recommendations. I've looked at different standards and of course, you know, this is. There's different things to pick for best practice.

But if we could have your basis of these DOJ recommendations, that would help us.

Yeah, I have. I have a time, a table of comparing all of them and the only. I will just fairly point out that my version and interpretation of 292 needs some assistance. So you'll see the standards that are there in their comparison and then me trying to fit them in. So. Thank you. You.

And that's why we have two years to do this.

Thanks.

Before the Chair has questions of any other Members that have questions, those online. Do you have questions? Okay. If not, the Chair has a few questions. First of all, thanks. Oh yes, Dr. Kamisato, I do have one question.

The new proposed mental health unit at. Halaba. Is there a record attached to it?

They do have a rec yard because the rec yard to the current infirmary is attached to it. So this. The new consolidated infirmary is attached to the current infirmary. So the infirmary yard is attached. Yeah, they do have to walk to it, and I believe they will use an elevator to get to it.

But they do have one attached. Yeah.

Okay.

Thank you. Thank you.

Okay, so I just want to go back to a portion of the bill, a portion of the law that's already in effect, which is on page eight on July 1, where, except as otherwise provided, a committed person who's 21 years of age or younger or is pregnant or in postpartum period or recently suffered a miscarriage or terminated pregnancy shall not be placed in restrictive housing, provided that a committed person.

And goes into the details, which I won't repeat, but it's in the law. Are we implementing the law? I am charged with the restricted.

That would be a question for Mr. Hoffman.

Excuse me. If I'm not mistaken, though, if you go into the details, it is defining that that person at 21 years or younger has a mental health issue. That's. So it does go back to them.

So if there's anything I can try to clarify at this point, we don't put anybody into restrictive housing unless they're cleared by our health care units. That's, that's a first and foremost thing that happens before anybody is put into restrictive housing.

Which would also include not. Just the under 20, any and all.

Everybody will get a review by a clinician or somebody in the healthcare unit prior to being placed into any sort of restrictive housing. Okay. Yeah.

And sort of piggybacking off Dr. Kamisato's question on the medical unit. So the medical unit as you described with your most vulnerable population is something that you're also attempting to address because it's different needs and whatnot as it relates to this issue of solitary confinement.

Is that accurate to say that when you build the new medical unit, that would help address some of the concerns with this population?

So the residents, it'll be an open door unit because the way that it's designed is that they can have their doors open a significant amount of time. The suicide and Safety Watch patients is a little different of a population. Right.

Because there's acute concern for either their safety or the safety of those around them because they could be acutely psychotic. I mean, we have genuinely schizophrenic bipolar patients who when they decompensate, they're essentially up for weeks at a time. They disassociate so severely they don't recognize friend or foe.

A lot of our homicides in facility have been at the hands of these patients when they've decompensated and we haven't recognized it soon enough. They're also very difficult to assess because we can't safely physically be around them. So that's.

And again, I don't like getting into, like, anecdotes, but in corrections, a lot of it is anecdotal because we are talking about the outliers of our society and even the outliers within our facility that fall into these categories. So it is very individual sometimes.

And I do believe the Bill does identify, you know, except in extreme cases kind of a thing. But those are really what we're talking about is, is the people in these situations are the extreme cases. That is why they're there.

Are you able to provide this working group a breakdown or percentage of what would fall into these categories?

The category. Which categories? The. The Suicide Safety Watch. Yes.

Like a percentage that you have who.

Have severe mental illness.

Yes.

At a point in time or over.

A year or just sort of an average.

So one of.

If you're not able to provide that and you get back to us, that's. That's perfectly fine.

To be fair. This goes back to the amphetamine Abus. So one of the things that we've recognized and I've had conversations with Dr. Champion about, is that a lot of. Our. Our society Members, when I do their histories, they've been using amphetamines since they were 111213 years old.

They were diagnosed schizophrenic or bipolar in their 20s or 30s. We don't know how to unpack that diagnosis because it may have been amphetamine abuse that caused the psychosis. And not until we've got them clean for a couple of years can we actually start to like unpack that. So I love data.

When I look at my data as a provider, I am a nurse practitioner, I am, I do have prescriptive authority. These are my patients. I consider them my patients. It's kind of convoluted. Okay. Yeah.

Okay. That's all the questions I have now. Any other further questions before we continue? Co CHAIR Yeah, so I think the.

Question that chair was asking is at page 8, line 14. A committed person who's 21 years of age or younger shall not be placed in restrictive housing. That's the policy. So that is being followed, correct, Mr. Hoffman?

Not necessarily.

And the reason I say that is, I'm sorry if it's graphic, but if we have a 21 year old comes in and he stabs you in the eye with a pen, pushes it into your brain, he's not going to be running around in GP until we figure out now what we're going to do with this person.

Because he's actually a risk to the population. GP as in General. Sorry, General population. Yeah.

Okay, so in that sense then he's put into restrictive housing, solitary confinement.

He may be, it may be he's still going to go through a process with the health care to do a screen to determine if he's appropriate to go into a, a placement as such.

Protective custody. Also.

He could be. I mean, because he then. I mean, and those are going to be all the nuances. I mean he could end up looking at a PC. If he did something like that to a certain gang Member, the other, the gang Members of that person that just got harmed are now going to want to greenlight him.

And so there could be that as well. I mean, but until we sort out exactly where he's at or why he did what he did and then what is the danger of this individual either to self or others, they normally would go into a restrictive housing.

I guess I'm trying to understand this. Right. So the issue with the 21 and under 21 or younger. Right. We want to ensure that at some point the policies are kicking in where they're not in solitary confinement for months at a time. Right.

And so that's, that's, that's the place where I'm kind of confused about how fast are you and I understand the safety concerns. Absolutely. They're a danger. So then that's when the protective custody kicks in and the other policies kick in. But if that person is in what's essentially solitary confinement for months at a time, that is the.

What this Bill was trying to address and that is what we're trying to unpack and ensure that people who are 21 years and under, who are not suffering from a mental illness, because that kicks them into the, that kicks them into the assessment level and the segregated unit for medical reasons.

But a person who is 21 years or younger has stabilized is not a danger to anybody else. His is himself, not him or herself, not a danger because they're going to be a victim of some gang violence. They need to not be in solitary confinement for months at a time. That's what this Bill was trying to address.

So can you tell me that that process is being upheld now or you don't have a way to track it?

Zero, no, no. I, I can tell you that it's rare to see somebody in solitary for months at a time. So normally it's incident specific and then you're going to look at the characteristics of the individual if there's a issue with the healthcare side, but most do not.

And I think when we get into my presentation, there's going to be a lot of discussion surrounding these nuances of not only the law, but then actual procedures and why we do what we do. So I don't, I mean, I can keep talking or we could move forward.

Can I kiss? Because this is work. This is important work.

I think at some point DCCR needs to be able to come back to us and tell us for the population 21 or younger, we have X amount who's been in solitary confinement for three days, moved to population, we have X amount in, that's been in solitary confinement for whatever reason for three months, six months.

I mean, we need to have those statistics to understand and then that will illustrate your nuances.

If I might, if I might interject. Anytime someone goes into any type of segregated housing, we do have a policy on segregated housing where they're checked on and we get a weekly report from the facilities on that also.

Anyone under 21 in our custody, we have a duty to try to keep them separated via sight and sound from the other inmates. So we may not have a choice but to keep them. It's not solitary confinement. It's to protect them, to keep them integrated housing, because they are considered not an adult yet.

And anyone who comes in our custody that has not been waived by the courts that's under 21, we work closely with the Office of Youth Services to try to transfer them to a different facility.

Yeah, Representative. That's what I wanted to say about protective custody, because I've actually done the physical assessments on some of the younger inmates who've been in this situation, and they prefer to stay in solitary situations because the General population is a much more dangerous environment to them.

I. I literally had patients where I was like, are you sure? And he's like, I don't want to go out. And I was like. And they were in protective custody, and I just continued to assess them. But that really was their wish is because they did feel much safer in a single cell separated from the population.

And we do have to consider that that is often their wish.

And maybe what we need to also understand it is a protective custody is not solitary confinement where they're, like, locked in a cell for 23 hours. What we need to understand is what is the parameters of protective custody. They're isolated from population, but do they have the same amount of rect. Time, all those things? We need to.

We need to drill down and understand that. Yeah. Or is there. Is there restrictive housing where they are, in fact isolated and in their cells for 23 hours of the day? That is. That is not acceptable.

Correct. But the way that the Bill is written is when we don't have the staff to let them out, that because of the way that our structures are built and because they're literally let out one at a time, we have to have an ACO to wreck each one individually. They don't wreck together.

Okay, so then that goes back. That expounds the whole problem. Yeah, exactly. Okay.

Yeah. If. If I may too, Just a comment. In order to do that, we would probably need a lot of money to start building specialized units. We just don't have those. PC is normally a unit that is protective custody, and it would run like a regular unit. They would just be living with each other.

They have similar circumstances. They're separated from the gp. We don't have the facilities for that right now. And in order for us to really carry that out, we'd have to start building. I mean, we'd have to start building.

We just don't have what everybody really wants to achieve, but we just don't have the facilities to do some of that.

Protective custody.

Correct. So if I had to have a protective custody unit for every. Every facility or at least a portion thereof. Right now we have a problem because we just. We don't have those kinds of facilities.

Which facilities have protective custody facilities?

We have protective custody, but the majority of them will end up in a segregated unit because that's the safest unit we can put them in. So it's very difficult. zero, I'm sorry.

I'm just trying to get a baseline. You said that not all the facilities have protective custody beds.

They'll deal with protective custody, but it's not actually a individual unit identified as protective custody.

Yeah, but. So every facility has protective custody.

Zero, they'll. They'll. Yeah, we will deal with it.

It was inaccurate to say that they need to build more. They have them because they. They through policy.

Well, I don't consider segregation or, you know, our holding units as APC unit. That's not a regular housing unit for guys that are PC, but they're placed in there because we don't have that and that's the safest place to put them.

So when our PC unit is full, it overflows into what's called the segregated housing unit or otherwise. And that has currently been the practice lately, is that our PC units have been.

I believe what Mr. Hoffman is trying to get across is that our facilities are not built to have separate units for protective custody. So what the facilities do.

What the facilities do is they make best do with the cell space they have and create spaces that are not generally really protective custody, but we have to because of the population we have.

Members. If there are no further questions, I'd like to have dcr. If you could please continue your presentation. Sure. I believe we left off on page 10.

And if I just may real quick to open this. I agree with Romy that this was very. This was a very difficult Bill even for me to try to understand, try to maintain it in the best way I could, but then actually have it apply operationally. Very, very difficult.

So, you know, I, I apologize if some of this doesn't, you know, set well, but it's the best we could do at this point in time. So obviously it's the purpose.

So the purpose is to amend Section 353-41 to align practices for the use, implementation and monitoring the most difficult population within the jail and prison settings through various types of restrictive housing and will keep staff and offenders safe and free from harm, predatory behavior, and victimization within the correctional institutions.

So I tried to just outline this by identifying the page and then the line where the changes were made. So page one, line 16, we added the word self, and that was Romy wanted self placed in there. And that's, you know, obviously, so it applies to an individual as well as the group.

Page five, lines 5 and 7, we deleted, provided that the correctional facility shall bear the burden of establishing the. The foregoing by clear and convincing evidence. You know, best correctional practices we operate under the preponderance of evidence.

We felt that that was raising the bar, and it was a little bit confusing to even read that and fully understand what that would actually mean. Next slide.

Page 5, line 13. We took out the right to. We deleted that. The language is too stringent in setting a standard of legality. Parts of the requirements mentioned are not always necessary. Being represented is determined through due process. And only allowed at the request of the inmate. And only if necessary.

Most offenders will represent themselves to say, now there's going to be a right to have us try to give them representation. They may not even want it. Page five, line 14. We deleted the word hearing and replaced it with a review. It's going to be merely impossible to have a hearing in 24 hours.

It's just, we're not going to be able to do it. Part of the due process for us internally is we have to serve an offender with a 24 hour notice.

If, if they don't want to waive that 24 hour notice, we could, but normally we're not even going to have the paperwork all put together ready to serve the offender to give the waiver the 24 hour notice. And so, you know, we were looking at that. We do a review though.

So if somebody gets segregated, there's a review done at 24 hours, 72 hours to determine if it's still appropriate to keep them in that segregation or not. So we change the hearing to do the reviews, which we already do by policy as it is. Next slide. Page five, line 18.

We took out appear at the hearing because if we go with the first change that I just described, there will be no hearing in 24 hours. Page 5, line 19. Be represented at the hearing. We deleted that. And again, representation is only granted if. Requested by the offender and it is found to be necessary for reasons the.

Inmate is not able to represent themselves. Page six, line two. Again, we deleted at the hearing because there won't be one at 24 hours. Proposed changes. Oh, next slide. I'm sorry, proposed changes. Again, page 6, line 5. We added unless medically indicated, and that. Was in conjunction with our health care. We believe that that was clarifying language.

Page 6, line 9. Unless medically determined by a clinician. And again, that was in consultation. So, you know, we do not put anybody into a restrictive housing on any of those. And so we had to include language to make sure they're going to have certain authority to do so. We do not put somebody into a suicide watch.

That's all clinically ordered and we just follow the orders by a physician or the medical unit themselves. Next slide, please. Page six, lines 10 through 13. It says a dis. We deleted a disciplinary sanction of restrictive. Housing imposed on a Committed person who is subsequently renewed from restrictive housing pursuant. To the subsection shall be deemed completed.

So if I may just try to quickly explain, if somebody was in a serious incident and they require lockup, they go into segregation. When they go into medical or the next day when the medical professional will come in and meet with them face to face cell front, they may say, I feel like hurting myself.

I'm going to commit suicide. They'll be pulled out of that disciplinary area and put into suicide lodge. So by trying to say they would be done, they've never even faced a disciplinary hearing on the misconduct that they committed to bring them initially into segregation.

And so there's a lot of differences where, you know, if they're pulled out and it, it could be, I'm in mis. Misinterpreting the language and I apologize if I am. But to me, that would be, if they did something like that, they would come out, they're done.

So they're not even going to have any accountability for the behaviors that they, they, they committed. Next slide, page 6, 4 through 17. During a facility wide lockdown, a committed person shall not be placed in restrictive housing for more than. 30 consecutive days. We were really confused on this part of the act.

We didn't, we didn't understand the nexus. Between a facility wide lockdown and then having to segregate. If there was a facility lockdown and then somebody really beat up their roommate, they would be moved to segregation and they would just follow the regular processes regardless of the facility lockdown.

Even if they're in segregation, there's a facility lockdown in place, but he comes out, he's done. He comes out, he doesn't stay in there because there's a facility lockdown. So we were kind of confused as to what that really meant. We didn't quite understand that. Page seven, line one. I added the term.

We totally agree with it, but we added the term to strive to try to implement that programming a lot of our facilities is we just do not have adequate facilities to say somebody in segregation. We're going to let them go and do education. It's very difficult to do that.

And so we're going to strive to try to meet what the bill is asking us to do. But I didn't want it to be so directatory that we'd be in violation of the law if it wasn't done.

So just to clarify, we have. We're entering into a contract with Fusion to try to get tablets one on one for every convicted felon. That would do Things like telephone calls. They can do programming. They can file a grievance. They can ask for case management assistance. A multiple pronged approach using one device.

So that's what we're doing now. We plan to implement next year. I think we'll roll it out. So far, we got Fusion to agree to give us 1000 tablets. We need about 1400, so we're working on the other 400 with them. Okay, good. Sorry.

No, no, that's. That's good. And. And they could also then directly contact the medical unit as well. Page five, line two. Reduce the committed person's violations. We deleted that. And again, it's. We're not sure really what that meant to reduce their violations.

Normally there is a institutional file that can be reviewed to determine how an offender is programmed or program needs different case plans, ET and so to.

I mean, if he punches somebody and breaks the jaw, I was thinking this is trying to say, well, maybe we would reduce it to harassment or something, but we would hold them accountable to the level of the behaviors that they exhibit.

Okay, just to clarify though, for those with mental health illness issues, then if the behavior is linked to the illness, then the way we would address the issue would be completely different.

Yes. Yeah. It would take in account that it's the mental illness that is driving that behavior and symptom. Yeah. Okay. I think we are. Is that page. Page eight, line five. Yes, I. We added facilities will attempt to ensure. Again, rather than it being directatory and then we violate.

Will do our best to do those things that are being requested of it. Page eight, line six through eight. It was during the final 180 days of the committed person's term of incarceration. We deleted it. That doesn't take into account anything that we go through at the jail.

We could have somebody in jail and he goes into segregation and gets bailed right out of segregation. We don't have control over that. So I think partially where we lose the ability to apply certain things is jail operations are a little bit different than a prison operation. More unstable, more unpredictable, more stable.

And you can say, okay, well, maybe we have this 180 days. Because it did give clarifying language at the end of that paragraph where, unless it's necessary, if you got someone who's really hostile, he's very violent toward people, he's just not responding, etc.

Well, then, I mean, the Act 292 does allow us to keep him in there and he would be released, but it really has no application at all toward the jails.

Clarify before you go on. The other concern we had with that was if someone has a parole hearing coming up with 180 days, we don't know that they're going to be released or not. Yeah, we would know if they're going to max out in 180 days, but we would know about the parole decision.

And we only have about 10 max outs, 10 to 15 max outs a month. But we release a lot more because of other reasons that we don't have those, those dates.

That's mostly on the jail side. Or even if the courts overturn, they may overturn.

I've seen them overturning some convictions comes. Up and they walk out and we have like two weeks notice sometimes. Yeah, got it.

Page 993 or related conduct. You know, we believe that that's so open for interpretation. Next slide. Page nine, line four. Unless medically determined was added. If self harm leads to, you know, suicidality, it would allow for the medical determination of placement. Page 9, lines 9 and 10 added. We added facility warden as ordered by the clinician.

This is where we started getting confused. It would give the Director or the Deputy Director or the warden authority to put people in segregation. But if it's medically indicated, we don't do anything unless the health care unit clears that and gives us the directive that this is what needs to be done. So that's henceforth that change.

Next slide please. Page 9, line 4. Oh no, I just did that one. I'm sorry not to go back to the same one. Page 9, lines 9 and 10. We added facility warden as ordered. Again, it's, it's kind of redundant, but it's same thing. Page 9, line 11, we added by the courts.

This is where we really got confused. Jurisdictionally, if the court hands off an offender to be committed to Department of Corrections and Rehabilitation to the Director of the Department of Corrections, rehabilitation jurisdiction is handed off to us. Judiciary doesn't even have jurisdiction over the body anymore. They have that now.

The people have the right to have prosecutor there. Their motion go before the court and, and it gets argued in front of the court. If the judiciary, if he's pretrial and he's still on, on bail, that's jurisdiction of the court. They can grab that body, bring them back in court and dismiss bail or do whatever.

They still have jurisdiction. So we were kind of not fully. Understanding how does somebody get civilly committed. And then determined by the Director of DOH. This is really a court issue. This is purely legal jurisdictions in terms of who has legal jurisdiction. Of the body.

In this instance, it was a little bit, for lack of a better term, a little convoluted in terms of who had authority to, you know, put people here or put people there. Because normally, even if it's pre trial, they'll do a 704. The, the courts will order a 704.

That 704 will determine as a pretrial status if they're going to be committed to the state hospital or not.

If it's our person in terms of he's committed to our Director, then what Romy was covering earlier, they're trying to look at those processes now, trying to work with DOH to figure out then how do they then get transferred to the state hospital as opposed to being in our. In our care.

Okay, just to clarify, if someone is committed to the, to the custody of Director of the Department of Health, Department of Health, the Director determines where they go. They don't necessarily have to go to the state hospital.

But what they cannot do if they are committed to the Department of Health by the courts, the courts have to then change the jurisdiction to Department of Correction, Rehabilitation. Department of Health can't just transfer the body to us because the court has jurisdiction, has ordered that person with the Department of Health and vice versa.

This situation of civilly committed who does it by the court, is this being addressed by the new MOAs that are being now proposed between Department of Health and DCCR?

What we are trying to address is to make the language stronger that if we refer someone, the Department of Health has to take the body.

Okay, so. But back up in the presentation by Dr. Romy, DOH and DCCR are now working out MOAs to deal with these individuals who have mental illness. And so some of that the MOA processes that are going to be worked out is going to address this what you call ambiguity of the law to some degree.

Yes.

Okay. So I think we need to hold that as we hold you folks accountable to give us that policy.

And then as you folks implement it, that actually may help us understand what we need to do with the section of the law, because that sorting out of what happens when we transfer from DCR to DOH often involves some kind of judicial process.

It always involves.

And so Dr. Champion, am I. And what I saying, does that ring true?

And that we certainly then really need the policies that you folks are working on to be provided to this Committee to understand what is happening with these individuals who may have at some point be subject to the civil commitment process and then transferred from DCCR to DOH custody.

The MOA actually refers to a third population that hasn't been identified or requested a 704 examination and hasn't been flagged for jail diversion program. So we do find that some people aren't put into either of those categories that we recognize and identify that they need a higher level of care.

And so then the MOA actually allows us to refer directly to DOH. If DOH assesses the person and identifies them to be a viable candidate to come over, then it's approached Director to Director on the judiciary level for civil commitment. But. But it's a third population outside the 704 and the JDP program that's established.

But I'm flagging this for us as a Committee to understand.

And that's why we need to have that MOA and understand as you folks implement that moa, how it's impacting, because then it also frees up space for other people who need other kinds of segregation, but not the medically necessary ones based upon a medical assessment that then DOH takes over. Okay, thanks, Chair.

Yep. If you can continue on your presentation. Okay, I believe it would be. Next slide, slide 19, page 9, lines 19 and 20. We removed the Director, Deputy Director, we deleted that and we added the facility. Warden again as ordered by the clinician. Or whatever the appropriate medical term or position in the medical.

And that's allowing them to have the delegated authority. The warden should not be putting anybody on a medical type segregation. That's just. We don't do that. Next slide, page 10, line 6 through 20. Boy, this really got small. My glasses. The warden or the warden's designee determines that a facility. Oh, it's again, that facility wide lockdown.

We were. Yeah, we just weren't really sure what that nexus was for the two. Next slide, page 11, lines 1 and 2. Notice to the Legislature of the reasons for lockdown. We deleted that. We weren't sure. I mean. To. To report every time there may be a lockdown. We consider lockdown even. What? Change of watch.

A change of watch. We go into a lockdown. So we're just going to be notifying people on things that may not. The intent may not have actually been covered in this language. Page 11, line 3, we added. Or the clinician. It again, delegates authority. You know, clear medical. Clear. Place somebody into restrictive housing.

And normally they don't put them into restrictive housing. They're putting them into a suicide or a safety watch type. But we got pigeonholed a little bit. In defining restrictive Housing.

And henceforth I just like to reiterate, if we could move the medical portion out of this law and separate that to be on itself, that is a whole different process. And it's not necessarily kind of a jail function anymore. It's almost a medical function that we're performing at that point. Page 11, line 3.

We added or the clinician. Again it delegates, you know, clear to clear somebody. Page 11 for lines 4 and 5. Emergency confinement. We changed it to restrictive housing because everybody was kind of scratching their heads not really understanding what an emergency confinement was.

It can all be put under a restrictive housing if we can separate medical out for the medical function. And then even on our side of the house we would have pure misconduct oriented restrictive housing as opposed to long term administrative housing, which is much different.

And that then requires a plan as requested for them to be able to get out, go back into gp that would be worked with our case plans and whatnot. I mean we agree with a lot of these things.

I think we just got to kind of put it so our people can fully understand it and make it simple. And this was kind of a little bit confusing. Next slide, page 11, line 6 and 7. We deleted. A committed person shall not be held in emergency confinement for more than 48 hours.

Again, we weren't really sure what the emergency was. There's always a legitimate reason for somebody going in either medical or it's a misconduct that places somebody into that situation. Page 11, lines 8 and 9. We again deleted emergency confinement. We added restrictive housing. Page 11, line 10. We deleted evaluation and added a screen.

And that was a little bit of a consult with health care as well. There is a difference between a full evaluation as opposed to a screening. Page 11, line 13. We deleted 20. Let me see here. We deleted 20 or deleted 24 and added 72.

And the only reason we did that is right now we know we in many instances may not be in compliance to meet that 24 hour notice. If somebody goes into lock up on the midnight watch on a Friday night, they may not be able to see somebody. They'll see a nurse or somebody like.

That, but they're not going to have that. What they called out for, which was a full like comprehensive physical, all this other more extensive types of procedure. Page 11, lines 13 through 15, reports. Of the evaluation shall be immediately provided. To the warden or the warden's designee. I mean we deleted that because the.

Provision is unnecessary and it also may. Bring up HIPAA issues. We weren't sure why they would need to be provided a mental health evaluation of somebody, it would be irrelevant even to their position and authority regarding this matter. Next slide, page 11, line 19 through page 12.

Or I'm sorry, page 11, line 19 through Page 12, line 2. Provided that the decisions to place or hold a committed person in the medical isolation due to a mental health emergency shall be made by a clinician and based upon the clinician's personal examination of. The committed person, it started getting a little bit redundant. And it was.

I mean, that's. That. That's is already what happens. They wouldn't be placed in there unless it was done by the medical unit. Page 12, lines 4 and 5. At least every 12 hours I consulted. And that would almost be impossible for us to do that every 12 hours.

So we added, as clinically indicated, if the physician or psychiatrist or whatever says, well can review every 24, they may say, I want it reviewed every 12. And if they do, then. Then we'll do it every 12. I mean, but it should be by clinically indication, not necessarily a law. Yeah. Page 12, lines 8 and 9.

We deleted. Designated the Director or Deputy Director for alignment of positions with the appropriate authority. For the Director to have to carry that responsibility or the Deputy Director. It really is at the line level. I mean, that's the appropriate level. That's why we have wardens of institutions and it should be at that level.

Next slide, page 12, line 9. We added mental health clinician again to. Align the appropriate authority. Page 12, line 9. We added if a unit is not available at the facility, a committed person may be transferred to a facility with a higher level of care.

I think, Romy, I mean, we already do it, but I just thought if we're going to make a law, it should be in there that if a facility cannot provide the level of care that they need where they're at, we can bring them to another facility, give them the level that they need.

Page 12, lines 515 and 16. We added the word information. We deleted informed and written consent. So this is now the responsibility for the safety of offender. It falls on the Administration. And what this was starting to do was basically an individual would tell you if they need PC or they don't want PC.

And so the effective changes here. And there's a couple more that I. Can explain as we move on. Next slide, page 12, lines 19. We deleted. Makes a and added provides. We deleted informed and added information.

If offender comes to us and gives us information that we believe is reasonable, doesn't have to be an evidentiary type hearing or we have to have exact evidence. If he says, hey, you know, I've been borrowing a lot of store and I'm going to get rolled up.

I can't pay it back, we're going to accept that at face value and we're going to initially act on that and then do the investigation to determine do we really have that or not? Because he obviously is worried. He's concerned that he's come to staff and said, hey, I'm about to get rolled up.

So we made those changes.

Can you clarify? Rolled up store.

Oh, I'm sorry. Beat up. Beat up or. Yeah, I'm sorry. Anytime you need to let me know. Next slide. Page 12, line 19. Oh, no, that's. I'm sorry. That's where we're at. So page 13, line 6. It deleted evidence and replaced it with information. That's really all we need. Page 13, lines 10 and 11.

The Department should strive again. We. We put that language in. If we're really not going to be able to do something and that makes us violate the law. We. You know, I mean, I think that may be a little bit unfair to our. Our people that work in this system.

Well, one second. I think we should further change that. The Department will for not should.

Oh, okay. I mean, that's fine. Next slide. Page 14, line 2. We added requests to. And you know, an offender may. May want out of protective custody. And I will try to. We had that in the past and it ended up in a very devastating outcome. Sure. Offender may.

Because we don't have regular PC units per se. Sure, he may want to get out of that segregation unit, but we had somebody didn't last two hours because that is what we were doing to codify something that may lead to somebody ending up where they ended up. You know, we.

We would ask that that would just be removed. They can request to opt out, but we then have to go and determine is the threat that.

Because we did an investigation to determine if the threat was realistic for them to go in, we need to do the investigation to determine is it really safe to put them back out. I mean, that's for their safety. Of course they want it to be the way they want it to be.

But I can tell you we had a devastating effect. And I changed. I personally changed that. I said, this cannot be anymore. This is not going to happen again. Page 14, line 4. We added information stipulating the person's request for refusal. Again, we're trying to just make it to where, you know, we deleted informed.

And written refusal of that status. So even if we get information through our STG operations, etc. That somebody is about to seriously be harmed, we're going to act on that and then try to really determine what's going to be best for this individual. I mean, we're trying to protect everybody, sometimes from each other. Next slide.

Page 14, line 7. We added fully review the information surrounding the reasons and the use of the protective custody and if possible implement. And that is the lesser. What was the language? A less. A lesser option than restrictive housing. And if we can, we would. If we cannot, then we may not be able to.

And again, I think we're hindered at times on the facilities we have. They're just not appropriate for all the separations. Page 14, line 8. We added less restrictive interventions may include. And we. We deleted including because we thought that was more directatory. So we can try to implement those lesser strategies.

We may be able to carry out some, we may not be able to carry out others. Page 15, lines 1 and 2. In an emergency situation or is. And I apologize, I don't have the. Rest of that to explain why we did that language so I can get back to you on that next slide.

Page 15, lines 13 through 16. The committed person's placement in restrictive housing shall not revert to another form of segregation after initial sanction has been served. Again, there's.

So if somebody harmed somebody seriously and they went into a restrictive housing on a misconduct side, they themselves may have to resort to an administrative segregation depending on what the issue is. This person may have a. An order out. We call it a green light, but he. A hit. If. Well, that may.

People may not understand what that means either, but they may be in danger to themselves. So I mean, we're trying to manage that. And some of the language began to restrict that which may have then opened us up to litigation because we didn't take action on something we knew. We became now vicarious, reliable vicariously.

We were aware of something, but we would have to look and say, well, we were following the law. That's not a good place to be in for I think any of us.

If I might. I think the concern was that, according to Cannon spoke to me one time about this, that she felt that some inmates at Saguaro were being taken out of one disciplinary housing and placed into another restrictive housing immediately, as if they were stacking the violations. That's what the concern was.

I'm sorry, I'm unaware. I'm not aware of that complaint, but I'll be going there. I can take a look at that if, you know, I'm not sure if that's actually the case or if it's what kind of one instance that I just described?

No, I think it's more along the lines of what you were describing, but I think, but it's still worth us looking into, because at the time, I did look into it at Saguaro, and it was a case like this right here. Ah, okay.

That was a mentally ill person.

See? So that should have been taken out.

Of one form of segregation for a day.

And then was put back into another and hung himself.

Yeah. And seeing that we don't want problems.

Yeah. And I would concur with, I think anybody that's reasonable and rational doesn't want to see people hanging themselves in a facility or harm being done to them or them being harmed because they're weaker or whatever. It's a difficult issue, but I don't believe we have people wanting that outcome. I just,

It's hard to believe. I cannot say it's not. I don't know what goes through everybody's mind, but we certainly don't want to see that harm to people. I mean, it's unnecessary, it's unreasonable, and it's uncalled for. They didn't come to us to then be harmed more. Okay. Page 16, line 7.

"If the review of the initial incident and the threat to the safety of the inmate staff, other inmates, and the general facility would not be jeopardized, we still, we need to ensure that that person can be released." Page 6. Next slide. Page 16, line 8, I added "and the threat thereof has been mitigated."

We need to determine that that person does not have the initial threat that they had to be put into PC. If they're coming out of PC, we got to make sure that they're clear of that. Otherwise, it's really on us.

Page 17, lines 5 and 7 "shall be imposed only when necessary to ensure the safety of the committed person or other persons." We deleted that language.

Since restrictive housing may be utilized for purposes other than actual safety. We could have an individual who is just a chronic, even though maybe only a moderate misconduct, but chronic. Just always constantly violating, violating, violating. Less restrictive implementation of the result of that is not working. Eventually, a Committee may say, 18 times, hey, 18 times.

What aren't you getting? Why do you just keep doing this? So that is the reason for the change. Next slide, page 18, line 7 through 21 through page 20, lines 1 through 16.

And I know this is information you guys all want, but right now it would take staffing to be able to start collecting that data, do the analysis, get it to you. Hopefully, what may happen. We're going into a new OMS, which is a fender management system. We're getting that, it's coming in, it's been awarded.

Hopefully the new OMS system, we can work with the vendor to be able to query this type of information to pull out, and it'll be very easy for us to do. Hopefully, you know, that system is going to allow us to do it. And I don't have any reason to believe that it won't. Page 21, line 4.

We added 2 to 20 hours. ACA, DOJ, 22 to 24 hours. So this was lowering the bar, and even though I would love to be able to do that, sometimes it's very difficult. Page 22, lines 6 and 7. To be perceived to be lesbian, gay or, or the other identified transgender or intersex.

To be perceived might not be the way we measure that. It may be actually getting the information. I just think people will be different in terms of how they perceive somebody. I'm not sure if that should be the standard to implement this piece, but I understand what they're trying to achieve.

So, you know, there may be better language that we could use. Page 22, lines 8 through 11, and that was by January 8th of 2027, make recommendations to the ledge regarding more comprehensive laws, policies, procedures, etc. I deleted it. You know, I think clearly though, everybody should purely understand restrictive housing.

If it's not clinical, it's totally based on behavior, it's not based on anything else, and the behavior is misconduct, or safety. So I'm not sure what we do with this. I was a little bit confused. Page 22, lines 12 through 14. "And any other individuals identified by the chairperson" that was adding to the Committee..

We only had concerns chair committees, but we had concerns if everything starts changing. And it may or may not, but it had the ability where someone else comes in, someone else comes in, someone else comes in, someone else comes in. I'm not sure if that's going to get us to where we need to be.

I don't mean to interrupt. I think the concern we had was that if the Committee becomes too large, we won't be able to come to a consensus on making recommendations or changes. And so, but we understand that the legislatures here, the Chair and Vice Chair may want to add other legislators.

And so we were just asked to be cognizant of the fact that we need to come to consensus on changing it and we want to not have an unruly mob.

Sure. So if I may, part of the reason to that was the Co Chair and I felt that rather than just have a certain finite amount of Members that we include other stakeholders, which some of them are here today.

So if you were to change that, and I understand the concern, you don't want a large group because then you don't come to consensus and get to that. But we felt other voices at the table were important and to provide that flexibility for the pairs to add that. And that's the reason for that.

And we didn't want to make it too large because sometimes you are not able to be productive.

Co chairs, may I get a clarification? Because I think it's a really important definition of restrictive housing. From my understanding, it could be solitary confinement. It could be being in your cell for 23 hours out of 24 hours. It could be, I would imagine it would be shoving three bodies into a small cell. That's not restrictive.

Yeah. So the definitions by the national standards and the DOJ are pretty clear. And it has to do with the hours, 22 to 24 hours of lockdown, the diminishment of amenities. So like no access to store, for instance, and the no access to meaningful contact. So maybe phone calls, visitations.

It also has to do with the restriction of educational programs and other programs that are available to general population.

You just, you just made a comment that it's only because of bad behavior that somebody may be experiencing or their behavior or some bad behavior happening peripheral to them that's causing people to be in restrictive housing. But that's not what we saw because, and we discussed this earlier, it has to do with staffing shortages.

I mean, so this is the arbitrariness of it. From what I saw when I visited was that people are being put into restrictive housing purely because the staffing has nothing to do with their own behavior or anything else. And so when you're put into restrictive housing randomly, how does that then change behavior?

It's like, kind of like it's a punishment, but it's happening arbitrarily. That's nothing to do with an individual's behavior. So do you see how it gets really frustrating and confusing? And I did hear people yell, why are we being locked up for so many hours of the day? We didn't do anything wrong. You know what I mean?

So when you make the statements like.

Well, if I may clarify, I'm sorry. So what you're referring to is probably a lockdown because there wasn't enough staffing coming in that day. But it's not. It could be defined as restrictive housing if they were locked down for eight hours, but it's normally usually 22 to 24. But there will be lockdowns.

So they may be locked down on the second watch. People didn't come to work, but then they come out on third watch. So they'll be open from 2 to 10. They'll be down from 6 to 2.

And we're working with UPW on, on some other staffing issues and whatnot to try to at least at a minimum, if we had to, we could move people from one housing unit that's locked down for four hours to another housing unit to open that up and vice versa.

That way maybe at most, unless there's, I don't know, I hate to say it, super bowl or something, people just don't come work. We'll at least get them open where they can use the telephone, they can shower, they can watch a little bit of TV, they can get out of their cell, they can mingle, etc.

And so just for that's the record, and I think this bill want, this act wanted to get not changing ships, there's a lockdown. But you know, Super Bowl, zero, you know, eight hour shift, that's a lot dumb.

We, we have a very liberal, we have a very liberal leave policy within the state. And I'm not sure how you get past that when people are exercising their rights under their contract. I mean I, you know, I concur. I wish we had staffing every day and our facility would be running 16 hours just like a clock.

We're not kind of there.

If I may add something, I already asked staff to put together information for me for, from last year, from January last year through September of this year to show how many ACOs were scheduled to come to work on all three shifts versus those that showed up.

And of the ones that didn't show up, how many called in for sick and or fmla. So you'll be able to see that on average no less than 30% of the people called in sick. And on some days it's up to 60%. On Super Bowl, 60 or 70% of the people called in sick and on major holidays.

Yeah, and I got to.

Can I will that report include the amount of shifts that those ACOs are working? Because a lot of times that they're working 24 hours and so they're calling in sick because they just went through working 24, 32.

We can, that would be separate, but we can try to see if we can pull that. And I agree that a lot of the ACOs are working 24 hours, 16 and 24. But the reason they're working is because their brethren are calling in sick. And that's part of the problem.

That's why we're trying to work on the MOU with upw. We have some of the most dedicated staff in the country. Don't get me wrong, we have ACOs that come to work, they know they're going to get stuck, they're going to miss the anniversary, they might miss a child's birthday.

But the bottom line is we schedule enough people to come to work, but unfortunately a lot of them don't show up for work.

Okay, why don't we finish off your last, I think, slide that. You're on, Mr. Hoskins. Okay. You're good. That was it. Yeah. Okay, so Members, what I like to do is if there.

So we did not receive any written testimony, but is there anyone in the audience, whether online or in person, that wishes to testify on this particular item on item four? Okay. Hey, if not, then we'll now open it up to questions and I'll kind of start off by kind of setting the context here.

So thank you for the presentation. I know you folks worked really hard to come up with this and have these proposed changes. Is it my. To help me understand this better? So DCR has a report due 40 days before the next legislative session. Is that correct? Under. Under recommendations.

So these recommendations would be included in the report and anything that's required of. Is that how I understand it?

Well, yes, but we also submitted a legislative proposal to make the changes that we indicated here. But I did ask the governor's office to hold off on doing it because I wanted to.

We want to work with the working group to make sure we agree on any of the changes to the law before we let the legislative proposal go forward.

Okay, so your. So your intent is to submit a legislative proposal? Yes. Okay. Questions? Members? Member Brady.

Thank you and thank you for your presentation. I know it takes a lot to actually make this happen. I just want to say that a substantial part of this bill was changed and has had no community input because it was the HD3 that was changed and that is a huge problem for the community.

So how often do we have 24 hour lockdowns?

You know, I mean, I don't have that with me right now, Kat, but normally in the day, obviously you're going to be locked down eight hours at night. I mean, that's, that's a gimme. So we got 16 hours to play with. We do our best to kind of look at if someone was locked down on.

On the second watch, then we'll make sure they're not locked down on the third watch. We do our best to do that, but we do get handcuffed from time to time, depending on how many people come to work. So if you look at our essential, non essential posting.

If we're only posting at essential posts, that's basically like a midnight shift lockdown. That's what it is. It's purely just to be able to clothe them, feed them, give them access to medical. And it's, you know, again, I, you know, I, I have to iterate it. I, you know, it's disappointing.

It's very disappointing not, not to have our facilities wide open. Two shifts a day, here we are. But I, I honestly believe that the solutions is going to take a much broader ancillary effort of some other organizations and agencies to try to bring this to fruition.

And it's splitting the baby. I mean, sometimes I get calls because we need to send a patient out to the ER and the watch commander is like, okay, I have to shut this unit down. If that patient has to go to the ER, are you sure? And we have to make the call. Right.

And we know that we're now locking a housing unit down. But I'm like, no, I'm sorry, this cannot wait. And those are the choices that we make literally on a daily basis. And it's difficult for medical staff to make those choices, for security staff to make those choices because it's always a hard call.

So do the people inside understand that you're bringing somebody to emergency and you have to lock down? There's just not enough. I hope, I don't think we're walking them down for our.

I have tried to tell people, look, and I did it even when I was on the line. You tell the population a sorry guys, they're going to pull an ACO because somebody's got to go to the emergency room. It could be you one day. No, you don't want to go lock down. But we're going to have to.

They got to pull this guy and they got to take a guy to the hospital. You know, do some people understand it? Yeah. Do some people care? No. But you know, this, you know, we're dealing with a very diverse and complicated population.

And this goes back to the physical plant.

I got to be with ACA when they walked through Halawa and OCCC and the special housing units in particular, they were concerned about the way that the OCC special housing unit works and significantly requires a large amount of staff to actually let everybody out, shower everybody, chow, everybody at the same time.

Of all of the units that when you go to the whole.

Not at the same time.

Not the same time. Exactly. Because none of it can be at the same time. If you go to The Halawa Correctional Unit, the way that it's designed, it has an anteroom, so they unlock the door. They don't even need to go in there. It doesn't take an ACO to escort them. They get that out of cell time.

And so it's less staff serving a higher function where these older plants were not designed that way. So it takes a much larger amount of bodies that we may never have. You know, we just aren't necessarily going to recruit doing our best efforts. And I think that that's where that change needs to happen as well.

And another point I'd like to make is that every incarcerated person is a human being. So when you keep referring to them as bodies as so offensive, I apologize.

Not you. We've been working on that. Just saying we've had so many conversations about this and even incarcerated person, it's so hard to say. We really would like some word that we all. Because we are. We've talked about it all the time. What's this word that we can use that distinguishes jail from prison?

That identifies them as human that I, that can really like. I use patient a lot, but then they're not all patients and sometimes these guys get frustrated with that as well. But I do hear what you say and I totally agree.

Okay, thank you.

And what does you guys get frustrated?

What's that?

Patience. And just check.

Member Brady, do you still have any more follow up questions?

I have two more things. Okay. The community has been constantly calling for accountability and transparency. So it seems like the segregation units are kind of the black hole and people don't know. So many times I get calls from families who have no idea where their loved one is. And maybe he's in lockdown.

I don't even know if he's at that facility or what to do. And I think other jurisdictions have actually put on their websites the people who are in no names, but people who are in segregation. And I think it's really important that people understand that there's a certain percentage of the population that's going to be unreachable.

So I think that's really pushing for accountability and transparency. And then lastly, about vulnerable populations. I've been sitting on three, uh, institutional review boards for 24 years. Every month we deal with vulnerable populations. So there are even more vulnerable populations than this Bill, the original Bill actually named. But lgbtqi, that's really. They are vulnerable.

And I have received calls at 10 o' clock at night from people who've been beaten up. And just what do I do As a community member. So this, you know, you need to understand that. Another thing is our facilities are kind of unique in that we have eight different languages spoken in our facilities.

So when people are in Saguaro, all the information is on closed circuit TV and many people from other places can't even read it. And if our people try to help them, they both get sent to the Hole. And I'm like, we shouldn't be sending people to the Hole for helping each other.

That's something we should be encouraging that, you know, you're part of a community here and when somebody needs help, it's good to help them. So I want to know what we're going to do about having all these different languages and you know, when the. The information is in English. So I. I hope that medical pamphlets.

Or television programming, if I might, we. Could take Circuit Kat was good to help us when we did the seven brochures in different English. So thank you. And, uh, did I think for information that passed on the circ. On the closed circuit television, I think we can work with Saguaro to put that in the different languages.

We can do that because it's not that difficult, actually. I did it during Covid and I just. I translated the Covid things into eight different languages. I worked with the University and universities in the South Pacific, and so everybody could understand.

And people were like, you know, why are you sending stuff that, you know, has pregnancy to a men's prison? I'm like, because they have partners and because they're part of the community and they want to know. So it's not that difficult.

Yeah. Now, on behalf of healthcare, we've talked about having educational pamphlets in different languages. If you'd be willing to assist us in some of those translations, it would be really helpful. Yeah.

So call me.

Okay. We're gonna go to Member Patterson, then we'll go to Member Tuli and then Member Iwamoto, Member Patterson. Oh.

I have no questions at this time, Senator.

Okay, okay, sorry. Okay. Member 25.

I have you just. Sorry, I just had to comment. I did, actually. I am here for upw, but I was also an ACO for seven years.

And they did actually want to agree with a lot of what Mr. Hoffman has shared, that a lot of these things do not occur unless it's been brought down from our medical unit. And so it's not things that occur normally, it's things that are come down once they're. They've been seen by our medical unit.

But I did want to share with comment on Something Kat just said, I believe that even when they're in our segregated units that they're afraid supported the opportunity to write letters that actually still have a phone call.

So I don't know that they're not completely can get a hold of, but those things are still afforded to them while they're in, in custody.

Thank you for sharing that Member Iwamoto and followed by Co Chair Belatti.

Thank you very much. So, you know, I don't remember when, when it went through public safety, when this as a bell went through Robert. I don't remember this level of detailed, constructive kind of feedback on the bill.

It was because I was the lone Ranger. I was the only one testifying for the bill, against the Bill. But I did provide our policies and procedures during every testimony.

Right, yeah, because, and, and the reason why I bring that up is because one of the things I'd like to see, I mean, and this is why I think it's so important that we have white papers because fiscal white papers on the budget concerns, wherever you made a change or proposed a change, it would have been great to see we can do what is written.

If you give us this amount of. Money, you know what I mean? And if you change it from a shall to a should it cost us this much, you know, like that would really help us as the people who raise revenue.

It'll help the, the Governor who you know, basically the budget, it starts with him, he needs to request from us certain dollar amounts to execute these kinds of apps. Then we raise the revenue and whatever. But it starts with the Governor. So that would really help some of this stuff.

And like even the hearing, like they should, they would, they'll get a review but not a hearing. Well, but what if we want them to have a hearing?

They do get it. I'm sorry, but they do get a hearing.

Okay.

Yeah. It's just in that initial 24 hour period. Got it. Yeah. But they will get the hearing.

Ok. Okay. Yeah, yeah. But if there is, if there's some reason why they only could get a review then, then what is the price bump for that? That's what I'm getting at is that it's really important for us to hear and for the Governor to hear how much the cost is going to be like that's really important.

And, and, and, and even when we try to extend sentencing, make mandatory minimums to change the different classification of time served for every crime, and if we're increasing the prison population, then we need to know from your Department, hey, it's going to cost us this much more.

So when you testify on any criminal bill that's going to increase your population, let us know how much it's going to cost us so that we, you know, put our money where our vote is. Thank you. Vote on a Bill, let us know.

Okay, Co Chair Belatti. And we'll go to the right if there's any questions.

I have just two very quick observations. I think one of the things that I'm taking away from the proposals is that we're using terms differently. We're using terms differently. So I think this exercise is positive and that what we need to do is we need to again, crosswalk the three different policies, because that's what's getting confusing.

The second thing that I would comment on and observe is that there was a moment in your testimony when you were talking about you making the choice to override the inmates request. And that has to do with protective custody.

What I'm interested in, and I really appreciate it because what you're doing is you're looking out for the safety of the entire community. But what I think in the practices, we have to go back and see what the practice is for corrections. And at what points does the Administration, by best practice allow to override the request?

Because at certain times it's, it just, you know, if there's serious threat, then I, I would agree with that. But I don't know that you just give carte blanche authority without some kind of appeals process.

So that's, that's where I would, would want us to like, kind of dig into more of these recommendations to push it against what is best practice through the experts, through DOJ.

And one last thing is that, you know, reading these amendments, I think what we need to do is we need to push this through our drafting agency just so we can have a document to look at and understand. Because a lot of this is, it may not be. It's legislative drafting.

If I may. We have, we have the, the proposed changes we made that we can provide to you. Yes.

And then what we should do is we should actually push it through one of our drafting agencies, because then, then we have like a document that we can manipulate and work with as a Committee. If the goal is to, as a Committee, have maybe some consensus legislation for, for next session.

But that's something I think we should offer and possibly do just to make it easier to work with documents.

Thank you. Well, on the right, is there any questions? Member Woodward?

Yes, I was just looking for clarification.

So either in the report that you included in your presentation and mahalo for providing to the Committee once appropriate or in your report to the Legislature before this next session, will there be an inclusion of, you know, kind of either a point in time of those who are currently in restrictive housing?

So again, not necessarily identifying information, but, you know, the reason. The reason. So whether that is for medical or for concerns, you know, with the General population, age, duration and restrictive housing and whether or not and when a hearing was conducted or review was conducted.

Because I think that information, as well as transparency on lockdowns, as you mentioned, those can happen frequently depending on staffing. But I think as a Committee, it would be helpful to know, you know, to inform policy exactly what we're looking at. Right. And how to respond appropriately.

So, you know, if there, there are, you know, 200 in the population who are in restrictive housing, if 150 of those are in restrictive housing for, you know, medical purposes or mental health, then that, that would be a different policy solution than, you know, if it's concerns with the General population.

So I was just curious if that information included in either report.

We could do our best to. To give you what's being asked. Again, we're going to have. That's a whole nother set of data, you know, that we're going to have to. To do. And I mean, we could do our best to give you something.

There's no doubt now she'll have to give you the, the health care side because we don't look at people in safety watch or suicide watch as being restrictive housing. It got kind of pigeonholed into the definition because of, you know, the situation they're in.

But, you know, in corrections, we looked at that as it's, it's a clinical, it's all clinical decisions. But we can try to do something. I mean, it's, we do our best perhaps on that.

To further expand. Would DCR be able to provide maybe average monthlies based on Member Woodward's question, for each of the facilities? Yeah, I think so in the report.

Yeah. Now, now mind you though, that could.

Also be if it's medical, obviously there's HIPAA things. Right. You can't share names in that sense. But also, you know, what, what is the other type of population going to. That I think that would be helpful for. Yeah. For the working group to, to know.

I think we can get that from the weekly comic coning. No, no, not comic con. The weekly segregation reports that we receive from the facilities. Everybody goes see the.

Yeah, the. I, I think the issue will be those because we do the 24, 72 hour review, 15 day review, they may get locked up for the night. 24 hour, I don't know. The combatant was bailed out. So. Okay, well, you got any problem? Well, he's bailed out, we let him out. But then he will have the hearing.

He'll have a hearing. He may go back in if they sanction him to any kind of restrictive housing for, for the fist fight he got into. So we just got to make sure we're going to give you not double counting and it looks like it's.

Yeah, yeah. I will say it's been hard to pull that kind of data.

When I became the administrator about a year and a half ago, I actually recognized that in reading the policies I knew I was a provider for and I knew what my policies were as administrator, I started to engage with more of the policies and I did recognize that by definition of our segregation policy that you identified suicide safety watch did count.

So I did implement like a crisis log for my staff to put forward and to put their length of stay and the actions just kind of like dovetailing off of what was in policy but historically had not applied to my population.

So we did recognize that this needs to be changed and evolved and considered in a different way. It has been really difficult to aggregate data and to track because of our OMS system. We can't pull reports on housing. Like historically we'll say how many people are housed in this area?

How long have they been housed in that area? Then I could take that information and I could get ages and all these other items. Our system doesn't allow that right now. So the data has been a little bit challenging.

Yeah. To add to that, when somebody goes into a unit, the people that are running the unit, they don't have, they don't have the institutional file, so they really don't know how old this person is. And a lot of that other data that you're looking for.

Somebody's going to have to have access to records and do a record review to determine, okay, they were in restrictive housing. And then here's all the data points that they want, you know, so I wouldn't trust saying self report, that's for sure. But I mean we can try to do something.

That being said, both of our departments have new electronic software coming on board this next like year or two that's very much going to change this landscape and the way that we communicate, including we're developing a mental health and medical code. One of the things like he said is perceptions.

Security is not allowed to perceive or know any medical diagnosis or mental health disorder or anything like that because of HIPAA. And so we've developed a mental health and medical coding system that security will have access to. And one of the codes is restrictive housing. Yes or no.

So even if there isn't somebody available to do an assessment, they will be able to just know at least that much going forward. So these next 24 months are going to be very different for our Department. Okay, thank you.

Yeah. Any further questions here on the right?

I just wanted to clarify the ask of the DCR. Yes. So I want to make sure again. Right.

A copy of the experts report, a copy of our spreadsheet of recommendations, a tracking sheet, a copy of our current MOU with DOH and when we finalize the MOU, a copy of the new MOU, a copy of the DOJ ACA and comparisons that Romy did.

And the last thing I got here is a copy of the draft drafts amendments to Act 92 in word format.

And the confidential policy.

Well that we have to talk about.

Okay. And you can send it to all the Members of the working group voting and non voting. Okay with that. Any. We do have a few more items on agenda. Any further questions on this topic, Members?

I have a really quick one. Go back to the restrictive. My perception of what restrictive housing that it possibly should include.

I'll allow for you to have that question and then. And then we still need to go through a few more items, but go ahead.

It's the, the idea of possibly expanding restricted housing to include the. The concept of putting three people into a cell that was designed for one person actually felt more restrictive when I observed it than the people who are in solitary. One person to a really big cell. I was like whoa.