EFTA00110601.pdf

aP4mos ADMINISTRATIVE DETENTION ORDER JAN 17 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS TO: Special Housing Unit Officer FROM. SUBJECT: Placement of (Ramon:tie) (a) Is pending an investigation for a violation of Bureau regulations: st (b) Is pending an SIS investigation. (c) Is pending investigation or trial for a criminal act: (d) Is to be admitted to Administrative Detention Reg. No (1) Since the inmate has requested admission for protection; NEW YORK MCC Incaution Date/Time: 0748-2019 15:50 in Administrative Detention I hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.. Stall Witness Printed NameSignature: (2) Since a serious threat exists to individuars safety as perceived by staff, although person has not requested admission; referral of the necessary information will be forwarded for an appropriate hearing by the SRO. (e) Is pending transfer or is in holdover status during transfer. (f) Is pending classificabon: or (g) Is terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. his this Correctional Supervisors decision based on al the circumstances that the above named inmate's continued presence In the general population poses a serious threat to life. property, self, staff, other Mutates, or to the security or orderly running of the institution because' PENDING SIS INVESTIGATION/ THREAT ASSESSMENT Therefore. the above named inmate Is to be placed in Administrative Detention until further notice. The Inmate received a copy of this Order on (date /time) StallWdness Signature/Printed Name Date 7 l IE7 (17 Supervisor 24 hour review of placement Signature/Printed name ' In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an Independent review and decision, which Is documented here. Record Copy • Inmate Concerned (not necessary it placement is a result ot holdover status); Copy - Captain, Copy - Unit Manager. Copy - Operation Supervisor • Administrative Detention Unit: Copy — Psychology; Copy - Central Fine PDF Prescribed by P5270 (Replaces 8P-A0308 of JAN 88.) EFTA00110601 8P-1-3303 ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE JAN 17 FEDERAL BUREAU OF PRISONS NEW YORK MCC tnsbkton Emsemme 07.18.201915:50 TO Spe FROM: (NameTele) SUBJECT : Placement of Reg. No. in Admiristrative Delerdion (a) Is pending an tnvestigation for a ‘iciaticn of Bureau regulations: (b) Is pending an SIS investigation. (c) Is pending mestigation or trial fore oirni nal act. (0) Is to be admitted to Administrative Detention (1) Since the inmate has requested admissionfor profet:bon: hereby request placement In Adminestrative Detention for my aim protection Inmate Signature/Register No.: Staff Witness Priried NameSignature: (2) Since a serious threat east to incfividuars safety as perceived by staff, atthcugh person has not requested admission: referral of the necessary informal= %el be forwarded for an appropriate healing by the SRO. (e) Is pending transfer or is in holdover status during transfer (I) Is pending dassrticaton, or (9) Is terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. US this Correctional Supervisors decision based on all the circumstances that the above named inmate' s continued presence in the general population poses a aenOus taffetas life, property, self, staff. other inmates, or to the seamy or °MeV oaring of the institubin because' PENDING SIS INVESTIGATION/ THREAT ASSESSMENT Therefore, the above named inmate Is to be placed In Administrative Detention unti further notice. The Inmate received a copy of tfils Oiler on (date /lime) Staff Wtness Signature/Printed Name Date Supervisor 24 hour review of placement: Signature/Printed name In the case of DHO action. reference to that order Is sufficient In other cases. the Correctional supervisor we make an independent review and decision. which is documented here Record Copy • innate Cons, Lel (not necessary if pl.scemerS s a result of holdover staius): Copy Captain. Copy • Unit Manager• Copy - Operation Supervisor - Agnarirstratie Detention Wit Copy — Psychotogy Copy - Central File PDF Prescribed by P5270 (Replaces BP-A0308 of JAN 88 ) EFTA00110602 • 07-16-2019 15:47:57 #OK NYMHJ 535.03 • INMATE PROFILE PAGE 001 OF 001 REGNO: NAME.: RSP..: NYM-NEW YORK MCC PHONE: FAX: REG FUNCTION: PRT DOB/AGE.: R/S/ETH.: MILEAGE.: 03-10-1969 / 50 W/M/H WALSH: YES 11 MILES PROJ RELME IO:D KNOWN FBI NO..: 88869JA1 PROJ REL DATE..: UNKNOWN INS NO..: PAR ELIG DATE..: SSN • 108649131 PAR HEAR DATE..: PSYCH: NO DETAINER: OFFN/CHG RMKS: TITLE: 21 USC: 846 OFFN/CHG RMKS: TITLE: 21 USC: 841 FACL CATEGORY CURRENT ASSIGNMENT NO CMC..: YES EFF DATE TIME NYM NYM NYM NYM NYM NYM NYM ADM-REL A-PRE CALLOUTS COURT SDNY CARE LEVEL CARE1-MH COR COUNSL UNT 7S CMC SEPARATION CASEWORKER UNT 7 CUSTODY IN PRE-SENT ADMIT, ADULT COURT USM SOUTHERN DISTRICT CARE1-MENTAL HEALTH VACANT SEPARATION 08-01-2018 07-16-2019 09-12-2018 11-24-2018 11-23-2018 11-24-2018 08-01-2018 1718 0731 1343 1414 0955 1415 1718 IN CUSTODY NYM DRUG PGMS NR WAIT NRES DRUG TMT WAITING 08-02-2018 1102 NYM EDUC INFO GED UNK GED STATUS UNKNOWN 08-01-2018 1718 NYM FIN RESP UNASSG FINANC RESP-UNASSIGNED 08-01-2018 1718 NYM LEVEL UNASSG UNASSIGNED 08-01-2018 1718 NYM MED DY ST NOT MED CL NOT MEDICALLY CLEARED 08-01-2018 1718 NYM PGM REVIEW OCT OCTOBER PROGRAM REVIEW 10-29-2019 1043 NYM QUARTERS G12-792L HOUSE G/RANGE 12/BED 792L 11-23-2018 1001 NYM RELIGION UNKNOWN RELIGION UNKNOWN 08-01-2018 1718 NYM SECOND RSP 54N USM NYS 54N NEW YORK, NY 08-01-2018 1718 NYM UNIT 7 UNT MGR. R. PROTO EXT 6393 08-04-2018 1050 NYM WAITNG LST CIM COMP CIM PACKET COMPLETE 03-07-2019 1110 NYM WRK DETAIL UNASSG UNASSIGNED WORK DETAIL 08-01-2018 1718 G0000 TRANSACTION SUCCESSFULLY COMPLETED EFTA00110603 PP41 Page 1 of 1 es\ NYMHJ 535.01 07-16-2019 PAGE 001 OF 001 * INMATE LOAD DATA 15:48:27 REG NO: NAME: RSP OF: NYM-NEW YORK MCC DOB(AGE): 03-10-1969(50) RACE WHITE FBI NO..: 88869)A1 SEX MALE INS NO..: ETHNIC..: HISPANIC SSN HEIGHT..: 5 06 DNA • NYm06201 WEIGHT..: 180 HAIR BLACK EYES BROWN CITIZENSHIP • CMC YES BIRTH PLACE NEW YORK MILEAGE.: 11 MILES LEGAL RESIDENCE: BRONX, NEW YORK 10460 G0005 TRANSACTION SUCCESSFULLY COMPLETED - CONTINUE PROCESSING IF DESIRED https://bopicp.doj.gov:9049/SENTRY/J1PP030.do 7/16/2019 EFTA00110604 PD15 Page 1 of 1 NYMG5 INMATE DISCIPLINE DATA 07-16-2019 PAGE 001 OF 001 * CHRONOLOGICAL DISCIPLINARY RECORD 23:36:10 REGISTER NO: NAME..: FUNCTION...: IS FORMAT: (CHRONO LIMIT TO c:::IMOS PRIOR TO p7-16-2019 RSP OF: NYM-NEW YORK MCC G5401 DISCIPLINE DATA DOES NOT EXIST FOR THIS INMATE https://bop.tcp.doj.gov:9049/SENTRY/J1PPD50.do 7/16/2019 EFTA00110605 PD15 Pagelofl rea‘ r b\ NYMG5 INMATE DISCIPLINE DATA 07-16-2019 PAGE 001 OF 001 * PENDING REPORTS 23:36:32 REGISTER NO: NAME. . : FUNCTION...: IS FORMAT: PENDING LIMIT TO L::-MOS PRIOR TO p7-16-2019 RSP OF: NYM-NEW YORK MCC G5401 DISCIPLINE DATA DOES NOT EXIST FOR THIS INMATE https://bop.tcp.doj.gov:9049/SENTRY/J1PPD50.do 7/16/2019 EFTA00110606 Bureau of Prisons Psychology Services SHU Review "SENSITIVE BUT UNCLASSIFIED•• Inmate Name: Reg #: Date of Birth: 03/10/1969 Sex: Facility NYM Unit Team: 7 Date: 07/18/2019 07:19 Provider: Placed in SHU: 07/16/2019 Type: SHU Status: ADMIN.DETENTION Threat to Self: Low Basis of Review: Inmate was Interviewed Adjustment: Satisfactory, segregation not detrimental Mental Status: No significant mental health issues. Threat to Others: Low Comments Monthly SHU Review Note Note: This SHU review is a brief evaluation of this inmate's current mental status in SHU. Although an inmate may exhibit adequate adjustment to his SHU confinement and a lack of acute distress at this current time, it does not preclude the fact s/he may suffer from a psychological disorder requiring additional psychological services. This SHU review is also not a risk assessment of an inmate's potential for violent behaviors. Rather, it Is an assessment of whether the inmate exhibits any aggressive or violent behaviors at the time of the SHU review. Subjective/Objective data: Inmate displayed no evidence of depression or suicidality and appeared to be adequately adjusting to SHU placement. This adjustment was determined by clinical presentation, his self report and Unit personnel statements. Assessment/Plan: Inmate is currently psychologically stable. He has been instructed to contact Psychology Department staff for support should he request, or be in need of mental health services. Unit staff are aware of the referral process. Inmate will be seen on an as needed basis or monthly for SHU reviews. Completed by 'hD/Chief Psychologist on 07/18/2019 12:26 Generated 07/18/2019 12:26 by Miller. Elissa PhD/Chief Bureau of Prisons - NYM Pogo 1 of 1 EFTA00110607 BP•A295 052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Date Entered Special Housing 07-16.2019 7 institution: NEW YORK MCC Reason for Placement' PENDING SIS INVESTIGATION/ THREAT ASSESSMENT I. Subject: (2 or 3 Days) 3 Day Review Action Taken on the Above Dale: Continue in Special Housing Unit Printed Name/Signature: Date Reviewed 07.19.2019 II. RECORD REVIEW. (TO be done weekly in the inmate's absence, beginning after the in-person 7 day review. and continuing every week between each in-person 30 day review.) DATE ACTION TAKEN III. Subject. (7 or 30 Days) Date inmate appeared fora Special Housing Review: REMARKS Review By (SRO): SIGNATURE Reviewing Authority: Or Dale inmate waived right to appear. Has been seen daily by Medical Stall. O Yes: O No Has been seen daily by responsible officer designated by Warden: O yes: O No Has received prescribed weekly exorcise: K Yot O No Proper documentation and justification in the Central File (Incident Report. OHO Radon, copies of Special Housing Review Form): O Yes: O No if no, why not? Is there a written psychiatric or psychological assessment on ale inmate who has spent 30 days in a special housing status? O Yes; O No Is there an additional assessment for every one month interval thereafter? O Yes: O No if no. why not? Acts) taken on the above date by the Segregation Review Official or the Reviewing Authority: O Released from Special Housing: O Continue in Speaal Housing Did inmate in Adminisuative Detention receive a written copy of staffs decision and me basis for the finding at each 30 day review? if no. why not (Should be given provided institutional security not compromised/? O Yes: ONO Remarks: (My change in the reason for placement is to be noted in this section. If the reason for placement changes. the inmate must receive a copy of this form): Dale of Next Review. 07-23-2019 Printed Name end Signe Segregation Review Official or the Reviewing Authority and Date Signed: Record Copy - Central Fae This form replaces BP-295(52) dated January 1988 Page 1 of 1 7/19/2019 EFTA00110608 OP-A295 052 APRIL 1994 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Una 7 rust:it:on NEW YORK MCC Date Entered SPedel Housing: 07-16-2019 Reason for Pticement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT 1. Subject (2 or 3 Days) 3 Day Review Acton Taken on the Above Date Continue in Special Housing Unit Date Reviewed 07-19-2019 Printed Name/Senator.: 11. RECORD REVIEW. (To be done weekly In the inmate's absence. beginning after the ireperson 7 day resew. and continuing every week between each In-person 30 day review.) DATE ACTION TAKEN REMARKS SIGNATURE 07-23-2019 Continue In Special Housing Unit III. Subject (7 of 30 Days) 7 Day Review Review ay (SRO): Reverting Authority: Date inmate appeared for a Special Housing Review: 07-234019 Or Date inmate waived right to appear: Has been seen daily by Medical Staff. O Yes; O No Has been seen daily by responsfble officer designated by Warden 0 Yes O No Has received protected weekly exercise: El Yes, K No Proper documentation and justification In the Central Fee (Incident Report. OHO Report copies of Special Housing Review Form) Yes; if no. why not? Is there a written psychiatrk or psythobgical assessment on the inmate who has sped 30 days in a special housing Status? Yes: O No Is there an addeoffal assessment for every one month interval there-after? 0 Yes if no. why not? ONO ONO Acbon taken on the above date by the Segregation Review Official or the Reviewing Authority. O Released torn Specie! Housing; El Continue in Special Housing Did inmate In AdmiNstrathe Detention meow a written copy of staffs decision and tne basis for the finding at each 30 day review? 0 yes; O No if no. why not (Should be given provided Institutional security not ocmpromised)7 Remarks- (Any change In the reason for placement Is to be noted m this section. If the reason for placement changes, the inmate must receive a copy of Cis form): Date of Next Review 0740-2019 Rented Name and Senature of aegis° Official or the Reviewing Authoaty and Date Signed. Record Copy • Central Ftie This form replaces BP.295(52) dated January 1988 Page 1 of 1 7/23/2019 EFTA00110609 BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number 86993-054 Dn.: 7 Institution: NEW YORK MCC Date Entered Special Housing 07.16.2019 Reason for Placement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT/COURTS SAY INMATE FELT THREATEN ON UNIT. I. Su*et (2 or 3 Days) 3 Day Review Dale Reviewed 07-19-2019 Acton Taken on the Above Date. Continue In Special Housing Unit Primed Name/Signature: II. RECORD REVIEW (To be done wieldy in me inmate's absence. beginning after the in-person 7 day review. and continuing every week between each in-person 30 day review.) DATE ACTION TAKEN REMARKS SIGNATURE 07.23.2019 Continue In Special Housing Unit 07-30.2019 Continue in Special Housing Unit 08-06-2019 Continue in Special Housing Unit III. Sub(ect (7 a 30 Days) 7 Day Review Review By (SRO) Roseman° AufllOrer Date inmate appeared for a Special Housing Review 07-23-2019 Or Date inmate waived nght to appear: Has been seen daily by Medical Staff. 0 Yes, 0 No Has been seen daily by responsaSe officer designated by Warden: 0 Yes, 0 No Has received presorted weekly exercise: 0 Yes; 0 No Proper documentation and justification in the Central Fib (Incident Report. DHO Report. copies of Special HOUSIN Renew Form) 0 Yes. 0 No if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? 0 Yes; 0 No Is there an additional assessmeM for every one month interval thereafter El Yes: 0 No d no, why not? Action taken on the above date by the Segregation Review Official a the Reviewing Authority: 0 Released from Special Housing; 2 continue In Special Housing Old innate in Administrative Detention recent a written copy of staffs decision and me basis for the finding at each 30 day review? if no. why not (Should be given provided In solutions] security not compromised)? Elves. 0 No Remake- (My change in the Mien for placement Is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of tie form): Date of Next Review 08-13-2019 Prated Name and Sane aloe Review Official or the Reviewing Authonty and Date Signed: Record Copy - Contra Flte nes/can replaces BP-295(62) dated January 1958 Page 1 of 1 8/6/2019 EFTA00110610 Last Masi ••• Middle ISM Natal weight 5'06" 180 Hato BLACK kaino Leaf Is Middle Sena Sunlit Molght 5'06" Haar BLACK Mr* Weight 180 eye BROWN r•ClIttY NYM grit BROWN raellIty ITYM Last Nun aim Middle Haste :affix st.icht w•tot 5'06" 180 it,,, 4. BLACK BROWN Mayne NYM Loot Nu. arm Middle Ns Mat.r.t el-Jut 5'06" 160 Hole Lye BLACK BROWN Rpm reel Ilty NYM LaSit rife; Ns Middle WOO Satflx taotgait Height 8'08" 180 Heir Lye BLACK BROWN Facility Ha -nti NYM EFTA00110611 ar ailatsmata4ormaisma:Micsanoib...sr..- I EFTA00110612