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evidence and documentation will be preserved to provide data and support for subsequent investigators doing a
psychological reconstruction."
Further, a review of the attorney log books identified many errors and signify a systemic concern. For example, there
were two concurrently open attorney log books in the Attorney Visiting area. Further, the different purposes of the
two attorney log books, one in the Attorney Visit area and one in the Front Lobby, could not be explained. BOP staff
were unable to articulate a system of control for the log books, and during the reconstruction, some of the log books
could not be accounted for. Within the log books, entries were made out of chronological order, attorneys did not
consistently sign in and out, significant information was illegible or missing, columns were not consistently labeled,
log book opening and closing dates were inconsistent, and the cover had been tom off of several books. At the
current time, these log books are not functioning as an adequate system of control and monitoring.
Institution Response: 9. Attorney Log Books:
On August 10, 2019, log books deemed relevant to the investigation were removed from various locations
throughout the facility. The Reconstruction Team did identify pertinent logbooks that had not been secured. At this
time, all relevant logbooks have been removed and replaced. In addition, a logbook audit was conducted to ensure
accuracy of the documentation and compliance with policy. Measures are being taken to ensure in the future that all
relevant logbooks are identified, secured immediately and replaced with new ones to ensure the institution can
continue to run efficiently.
10. Automatic External Defibrillators: A review of available AEDs in the institution revealed that the list used for
accountability and inspection purposes was inaccurate and incomplete.
Institution Response: 10: Automatic External Defibrillators:
A review of the Automatic External Defibrillators (AED) report presented by Great Lakes Biomedical Services
dated July 22, 2019, revealed that all AEDS were accounted for and were placed in the correct respective areas. The
report was accurate and complete. New AEDs have been purchased and will be inspected Great Lakes Biomedical
Services upon their arrival. The list reviewed by the reconstruction team was an old and outdated list from January 8, ”
2018.
Medical staff provides training and conducts monthly inspections of all AEDs in the institution. Great Lakes
Biomedical Services, an outside contractor, conducts a bi-annual inspection and provides a report. Procedures on
inspecting all AEDS in the institution have been prepared and are awaiting approval. These procedures are attached
hereto.
11. Post Orders & SHU Training: SHU Post Orders Sign- -In Sheets were reviewed for the 3rd Quarter, spanning June
9, 2019, to September 7, 2019. Offices?"
Quarterly SHU Training Sign-In Sheets were reviewed. The 2019 3rd Quarter SHU Training was conducted on June
6, 2019. Three staff assigned to the 3rd Quarter SHU Roster in SHU did not attend or receive the SHU Training:
Institution Response: |1. Post Orders & SHU Training:
The Suicide Watch Post Orders are located in the Lieutenant’s Office and SHU with a quarterly sign-in sheet. A
copy of the Suicide Watch Post Orders will also be placed in a secure container outside of the suicide watch cells
on Tier H in SHU. This container will also hold signature sheets and additional Staff Suicide Watch Log Books.
TEL
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Document Details
| Filename | DOJ-OGR-00025124.jpg |
| File Size | 948.9 KB |
| OCR Confidence | 95.4% |
| Has Readable Text | Yes |
| Text Length | 3,546 characters |
| Indexed | 2026-02-03 20:54:36.406215 |