SETTLEMENT AGREEMENT

I. INTRODUCTION

A. On April 11, 2006, the United States notified Wilson County

Officials of its intention to investigate conditions at

Wilson County Jail (“Wilson” or the “Jail”), pursuant to the

Civil Rights of Institutionalized Persons Act (“CRIPA”),

42 U.S.C. § 1997.

B. Between June 27 and 29, 2006, the United States conducted an

on-site inspection of Wilson with consultants in the fields

of medical care and correctional management.

undertake measures to improve conditions at Wilson.

Consequently, the Parties enter into this Settlement

Agreement (“Agreement”) for the purpose of avoiding the

risks and burdens of litigation.

E. Defendants in this action are Wilson County, Tennessee;

Wilson County Mayor, in his official capacity; Wilson

County, Tennessee Sheriff, in his official capacity; County

Commissioners, in their official capacities; and their

successors, contractors, and agents (collectively, the

“County”). The County shall ensure that all County agencies

right as a beneficiary or protected class under this

Agreement. This Agreement is not intended to impair or

expand the right of any person or organization to seek

relief against the County or their officials, employees, or

agents for their conduct. This Agreement does not alter

legal standards governing any such claims, including those

standards established by Tennessee law.

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G. This Agreement is not intended to have any preclusive effect

except between the Parties. Should the issue of the

B. “Effective date” shall be the date the Agreement is signed

by all Parties.

C. Consistent with, or in accordance with, the term “generally

accepted professional standards of care” shall mean a

decision by a qualified professional that is

substantially aligned with contemporary, accepted

professional judgment, practice, or standards as to

demonstrate that the person responsible based the decision

on such accepted professional judgment.

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

F. “Wilson” or “the Jail” shall refer to the Wilson County

Correctional Facility as well as any facility that is built,

leased, or otherwise used, to replace or supplement the

Jail.

G. “Security staff” means all employees, irrespective of job

title, whose regular duties include the supervision of

inmates at Wilson.

H. “Quality Assurance” means a system of self-audit and

improvement to assess the implementation and effectiveness

of all remedies instituted pursuant to this Agreement,

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J. “Train” means to instruct in the skills addressed to a level

that the trainee has the demonstrated proficiency to

compliance, and non-compliance: “Substantial compliance”

indicates that the Jail has achieved compliance with most or

all components of the relevant provision of the Agreement.

“Partial compliance” indicates that compliance has been

achieved on some of the components of the relevant provision

of the Agreement, but significant work remains.

“Non-compliance” indicates that most or all of the

components of the Agreement provision have not yet been met.

III. SUBSTANTIVE PROVISIONS

A. MEDICAL CARE

1. The County shall designate a health authority who is a

qualified, licensed, and trained medical professional.

The health authority shall be in charge of medical care

c) ensuring that all inmates receive a health

assessment within fourteen (14) days of intake;

d) conducting clinical encounters with inmates as

e) reviewing and approving all prescription

medication dispensed at the Jail;

f) approving revised medical intake screening forms

and processes, including confiscated medications

upon arrival;

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2. The County shall increase the services of a physician

and/or physician assistant to an appropriate number of

are taking place, are documented, and properly referred

for secondary level review as appropriate.

4. The County shall develop and implement policies,

procedures, protocols for all medical care and services

at the Jail, including, but not limited to,

documentation and record-keeping, medical triage and

physician review, intake screening, infection control,

quality improvement, and emergent response.

5. The County shall develop appropriate job descriptions,

including duties and responsibilities, for all relevant

medical care providers, including, but not limited to,

physicians, nurses, mental health providers, and

medical assistants.

6. The County shall develop and implement a program to

train all security staff and medical personnel

regarding all policies, procedures, protocols, and use

of emergency equipment.

program that ensures timely identifying, tracking and

monitoring of chronic illnesses.

9. The County shall revise the sick-call system to ensure

confidentiality, prompt delivery and review by medical

staff, and appropriate triage. The County shall remove

the disincentives to an inmate's seeking and receiving

necessary medical care for chronic, pre-existing and/or

life-threatening conditions, such as multiple and

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varying levels of payment requirements and charges for

necessary follow-up care and services.

11. The County shall develop and implement a system for

monitoring and reviewing the administration and control

of medications, including documentation and

distribution.

B. MENTAL HEALTH CARE

1. The County shall retain the services of a licensed

Jail.

2. The County shall develop and implement an appropriate

intake screening instrument that identifies inmates’

mental health needs and risks of suicide behavior and

ensures timely access to the mental health professional

when presenting symptoms require such care.

3. The County shall ensure that all staff are regularly

trained regarding suicide and suicide prevention and

that the shift supervisors take an active role in

ensuring that inmates on suicide watch are adequately

monitored.

appropriate and adequate staffing levels.

2. The County shall develop and implement policies and

procedures requiring all tools, utensils, equipment,

securely at all times.

3. The County shall develop and implement a use of force

policy, consistent with generally accepted professional

standards, including an adequate use of force

definition and requirements for all staff involved in a

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use of force to write a timely use of force report

regarding the incident.

used, whether a referral should be made to a local law

enforcement agency or district attorney for possible

criminal action, whether remedial training is

necessary, or whether facility policies should be

revisited. Consistent with generally accepted

professional standards, the level of investigation

required will be based upon the severity of the force

used.

the following information: the inmate(s) name, housing

secondary staff directly involved, reviewing

supervisor, external reviews and results (if

applicable), remedy taken (if appropriate) and

administrative sign-off.

trained regarding the Jail’s use of force policy.

7. The County shall develop and implement policies and

procedures for an objective classification system that

separates inmates in housing units by classification

9. The County shall develop and implement policies and

inventory, and assignment of chemical and mechanical

restraints.

10. The County shall develop and implement policies and

procedures to ensure inmates have access to an adequate

grievance process.

11. The County shall ensure that inmates placed in lock

down status are provided with appropriate due process

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that has been developed and implemented in policies and

procedures.

including emergency planning and regular and periodic

drills.

2. The County shall regularly inspect all fire and life

safety equipment to ensure they are in working order.

3. The County shall inventory and store all flammable,

toxic, and caustic materials in a well ventilated, but

electrical wires in the Jail and establish a preventive

5. The County shall ensure that inmates are provided with

adequate clean clothing and underclothing.

6. The County shall inspect and replace as often as needed

E. QUALITY ASSURANCE

1. The County shall develop and implement written quality

assurance policies and procedures to regularly assess

during the course of quality assurance activities.

A. The County shall submit periodic compliance reports to the

United States, the first of which shall be filed within

90 days of the effective date of this Agreement, and the

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B. Each compliance report shall describe the actions the County

has taken during the reporting period to implement this

implemented and shall make such records available at all

reasonable times for inspection and copying by the United

States. In addition, the County shall maintain and submit

upon request records or other documents to verify that they

have taken such actions as described in their compliance

reports (e.g., census summaries, policies, procedures,

protocols, training materials, and incident reports) and

will also provide all documents reasonably requested by the

shall have unrestricted access to the Jail, Jail inmates,

by Jail Health Services, and documents as reasonably

necessary to address issues affected by this Agreement,

including the right to conduct confidential interviews with

inmates, and to conduct interviews with facility staff

outside the presence of other staff or supervisors.

E. The County, and its agents, agree that they shall not

retaliate against any person because that person has filed

or may file a complaint, provided information or assistance,

or participated in any other manner in an investigation or

proceeding relating to this Agreement.

effectuate this Agreement. The implementation of this

Agreement will begin immediately upon its effective date.

B. Except where otherwise specifically provided, Defendants

shall complete implementation of all provisions of this

Agreement within 180 days of its effective date.

C. This Agreement shall terminate four years from its effective

date. The Agreement may terminate earlier if Defendants

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have substantially complied with each of the provisions of

the Agreement and have maintained substantial compliance for

time, temporary compliance during a period of sustained

noncompliance shall not constitute substantial compliance.

If after four years Defendants have failed to comply with

the requirements of this Agreement, the United States has

the right to seek relief from the United States District

Court of the Middle District of Tennessee.

D. If, after reasonable notice to Defendants, and a reasonable

States may pursue litigation against Defendants.

the right to file an action under CRIPA alleging a pattern

or practice of unconstitutional conditions at the Jail at

any time if it believes Defendants are not making a good

faith effort to substantially comply with this Agreement.

The United States shall give Defendants thirty (30) calendar

E. Failure by either party to enforce this entire Agreement or

any provision thereof with respect to any deadline or any

other provision herein shall not be construed as a waiver of

its right to enforce other deadlines or provisions of this

(20) calendar days after Defendants become aware of the

ability to perform under the Agreement. The notice shall

describe the cause of the failure to perform and the

Defendants shall implement all reasonable measures to avoid

or minimize any such failure.

G. This Agreement shall constitute the entire integrated

agreement of the Parties. With the exception of DOJ’s

findings letter referenced in Section (I)(C) herein and any

DOJ technical assistance recommendations, no prior or