EFTA00110614.pdf

BP-40308 ADMINISTRATIVE DETENTION ORDER JAN 17 DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS TO: Special Housing Unit Officer FROM: LIEUTENANT SUBJECT: Placement of (Nemo/title) (a) Is pending an investigation for a violation of Bureau regulations; V (b) Is pending an SIS investigation. (c) Is pending inveSbgation 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 Insiltabn Date/Time: 07-18-2019 15:50 in Administrative Detention I hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.. Stall Witness Printed NameSignature: FM (2) Since a serious threat exists to safety as perceived by staff, although person has not requested admission; referral of the necessary information w orwarded for an appropriate hearing by the SRO. (e) Is pending transfer or is in holdover status during transfer. (f) Is pending classification; or Is terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the designee. it is this Correctional decision based on al the circumstances that the above named continued presence in the general population poses a serious threat to life. property, self, staff, other Senates, 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) AI StanWitness Signature/Printed Name Dale MI IIIIIM f/hi/7 Supervmor 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 if placement is a result of 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.) EFTA00110614 8P•ki3Ci3 ADMINISTRATIVE DETENTION ORDER M. DEPARTMENT OF JUSTICE JAN 17 FEDERAL BUREAU OF PRISONS NEW YORK MCC tnsbkton TO Sp FROM.illitis (NarneThtle) SUBJECT : Placement of Reg. No. in Administrative Detention (a) Is pending an Investigation for a violation of Bureau regulations: (b) Is pending an SIS investigation. (c) Is pending irwesbgation or trial fore amine] act. (0) Is to be admitted to Administrabve Detention Dmertype 07.18.201915:50 (1) Since the inmate has requested admissionfor protection; hereby request placement In Administrative Detention for my own protection Inmate Signature/Register No.: Staff Witness Priged NameSignature: (2) Since a serious threat vests to safety as perceived by staff. atthcugh person has not requested admission: referral of the necessary information %el be forwarded for an appropriate hearing by the SRO. (e) Is pending transfer or is in holdover status during transfer (9) Is pending classrficaton, or Is terminating confinement in Disciplinary Segregation are has been ordered into Administrative Detention by the designee. It is this ConeCbonal decision based on all the circumstances that the above named continued presence in the general populaban poses a senous threat to Ide, property, self. star, other inmates, or to the security or ordedy running of the institubOn 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 this Ceder 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 von make an independent review and deciNon. which is documented here Record Copy • inmate Conk, s.d (not necessary if placement is a resuri of holdover strew): Copy Captain. Copy • Unit Manager. Copy - Operation Supervisor - Administrative Detention Wit Copy — Psychotogy Copy - Central File PDF Prescribed by P5270 (Replaces BP-A0308 of JAN 88 ) EFTA00110615 a ads • 07-16-2019 15:47:57 NYMHJ 535.03 • INMATE PROFILE PAGE 001 OF 001 REGNO: NAME.: RSP..: NYM-NEW YORK MCC PHONE: PROJ REL METHOD: UNKNOWN PROJ REL DATE..: UNKNOWN PAR ELIG DATE..: PAR HEAR DATE..: OFFN/CHG RMKS: TITLE: 21 OFFN/CHG RMKS: TITLE: 21 FACL CATEGORY ME= NYM ADM-REL NYM CALLOUTS NYM CARE LEVEL NYM COR COUNSL NYM CMC NYM NYM NYM NYM NYM NYM NYM NYM NYM NYM NYM NYM NYM NYM CASEWORKER CUSTODY DRUG PGMS EDUC INFO FIN RESP LEVEL MED DY ST PGM REVIEW QUARTERS RELIGION SECOND RSP UNIT WAITNG LST WRK DETAIL FAX: REG FUNCTION: PRT DOB/AGE.: R/IrETH.: MILEAGE.: 03-10-1969 / 50 W/M/H WALSH: YES 11 MILES FBI NO..: 88869JA1 INS NO..: SSN • 108649131 PSYCH: NO DETAINER: USC: 846 USC: 841 CURRENT ASSIGNMENT A-PRE COURT SDNY CARE1-MH UN? 7S SEPARATION UNT 7 IN NR WAIT GED UNK UNASSG UNASSG NOT MED CL OCT G12-792L UNKNOWN 54N 7 CIM COMP UNASSG PRE-SENT ADMIT, ADULT COURT USM SOUTHERN DISTRICT CARE1-MENTAL HEALTH VACANT SEPARATION IN CUSTODY NRES DRUG TMT WAITING GED STATUS UNKNOWN FINANC RESP-UNASSIGNED UNASSIGNED NOT MEDICALLY CLEARED OCTOBER PROGRAM REVIEW HOUSE G/RANGE 12/BED 792L RELIGION UNKNOWN USM NYS 54N NEW YORK, NY UNT MGR. R. PROTO EXT 6393 CIM PACKET COMPLETE UNASSIGNED WORK DETAIL G0000 TRANSACTION SUCCESSFULLY COMPLETED NO CMC..: YES EFF DATE TIME 08-01-2018 1718 07-16-2019 0731 09-12-2018 1343 11-24-2018 1414 11-23-2018 0955 11-24-2018 1415 08-01-2018 1718 08-02-2018 1102 08-01-2018 1718 08-01-2018 1718 08-01-2018 1718 08-01-2018 1718 10-29-2019 1043 11-23-2018 1001 08-01-2018 1718 08-01-2018 1718 08-04-2018 1050 03-07-2019 1110 08-01-2018 1718 EFTA00110616 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 • 108649131 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 EFTA00110617 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 EFTA00110618 PD15 NYmG5 PAGE 001 OF 001 * ta\ INMATE DISCIPLINE DATA PENDING REPORTS Page l of l 07-16-2019 23:36:32 REGISTER NO: ea NAME. . : FUNCTION...: IS FORMAT: PENDING LIMIT TO LIT: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 EFTA00110619 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 Commantc Monthly SHU Review Note Note: This SHU review is a brief evaluation of this 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 the may suffer from a psychological disorder requiring additional psychological services. This SHU review is also not a risk assessment of an IM 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 byall, PhD/Chief Psychologist on 07/18/2019 12:26 Generated 07/18/2019 12:26 by la P h 0 /Chi. f Bureau of Prisons - NYM Page 1 of 1 EFTA00110620 BP-A295.062 APRIL 1994 SPECIAL HOUSING UNIT REVIEW fl . DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Um: 7 institution: NEW YORK MCC Date Entered Special Housing: 07-16.2019 Reason for Placement: PENDING SIS INVESTIGATION/ THREAT ASSESSMENT I. Subject (2 Or 3 Days) 3 Day Review Action Taken on the Above Date Continue In Special Housing Unit Date Reviewed 07.19.2019 Pelted Name/Signature -St IL RECORD REVIEW. (To be done weekly in U'- 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 for a Special Housing Review: REMARKS Review fly (SRO): SIGNATURE Reviewing Authority: Or Dale inmate warted right to appear': Has been seen daily by Medical Stall. K Yes; K No Has been seen daily by timpani/le officer designated by Warden: K Yes: K NO Has receMid prescribed weekly exercise: K Yes: K No Proper documentation and justification in the Central Fle Report. DHO Report, copies of Special Housing Renew Form): K Yes: K No it no, why not? Is there a written psychiatric or psychological assessment on ale Inmate who has spent 30 days in a special hOuSelg status? K Yes: K No Is there an addmonal assessment for every one month interval thereafter? K Yes: K No if no. why not? Acton taken on the above date by the Segregation Review Official or the Reviewing Authority: K Released from Special Housing: K Conbnue vi Special Housing Did inmate In Administrative Detention recent a written copy of staffs decision and the basis for the finding at each 30 day review? K Yes: K No if no. why not (Should be given provided institutional security not compromised)? Remarks' (Any change in the reason for placement is to be noted in this What If Me reason for placement changes, the inmate must receive a copy &this form): Date of Next Review. 07.23.2019 Printed Name and Signe Segregation Review Official ea the Reviewing Authority and Date Signed. M. I Record Copy - Central File TN' form replaces BP-295(52) dated January 1988 Page 1 of 1 7/19/2019 EFTA00110621 BP-A295 052 APRIL 1994 SPECIAL HOUSING UNIT REVIEW M. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Unit 7 tnstt-t:on NEW YORK MCC Date Entered SPeChil Housing: 07-16-2019 Reason for Iftecement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT 1. Sutsect (2 or 3 Days) 3 Day Review Acton Taken on the Above Date Continue in Special Housing Unit Date Redo:mixt 07-19-2019 Pnnted Nameragnature: 11. RECORD REVIEW. (To be done weekly in the DATE ACTION TAKEN REMARKS SIGNATURE 07-23-2019 Continue In Special Housing Unit .-I III. Subject (7 or 30 Days) 7 Day Review Review ay (SRO): I Reversing Authonty: Date inmate appeared for a Special Housing Review: 07-23-2019 absence. beginning after the in-person 7 day review, and oantinuing every week between each In-person 30 day review.) 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 Yet K No Has received presented 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; no, why not? Is there a written psythiatC or psychobgical assessment on the inmate who lea spent 30 days in e special hewing Status? 0 Yes: O No Is there an Ulf/Mortal assessment fox every one month interval there-after? 0 Yes; if no. why not? ONG ONO Acbon token on the above date by the Segregation Review Official or the Reviewing Authority: O Released torn Specie! Housing; El Continue in Special Housing Die inmate In AdmiNstrative Detention receive a *Mien copy of decision and me basis for the finding at each 30 day review? g yes; O No if no. why not (Snout be given provided Institutional security not CoMpronted)? Remarks- (Any change In the reason for placement is to be noted m this section. If the ratan for placement changes, the inmate must receive a copy of Cis lam): Date of Next Review 0740-2019 Paved Name and Senatue of Sewn Official or the Reviewing Authoety and Date Signed. Record Copy - Centre! Fee This form replaces EIP-295(52) dated January 1988 Page 1 of 1 7/23/2019 EFTA00110622 BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number: 86993-054 7 NEW YORK MCC Date Entered Special Houshg: 07.16-2019 Reason for Placement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT/COURTS SAY INMATE FELT THREATEN ON UNIT. I. Subject (2 or 3 Days) 3 Day Review Dale Reviewed 07-19-2019 Action Taken on the Above Date. Continue In Special Housing Unit Primed Name/Signature: 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 REMARKS SIGNATURE 07.23.2019 Continue In Special Housing Unit .-I 07-30.2019 Continue in Special Housing Unit I '.. 08-06-2019 Continue In Special Housing Unit I III. Subject (7 or 30 Days) 7 Day Review Renew By (SRO) _ ,-I Reviewing AirthOritY 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. CI Yes, Ej No Has been seen daily by capons:Isle officer designated by Warden: Li Yes, El No Has received presaited weekly exercise: CI Yes; O No Proper documentation and justification ri the Central Fib (incident Report. DHO Report. copies of Special Housing Renew Form) 0 Yes. O 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? Et Yes; O No Is there an additional assessment for every one month interval thereafter? El Yes: O No d no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: O Released from Special Housing; Q Continue In Speoal Housing (Neonate in Administrative Detention receive a written copy of- decision and me basis for the finding at each 30 day review? if no, why not (Should be given provided iniatutional security not compromised)? O Yes. O No Remarks- (My change in the tenon for placement is to be noted in this section If the reason for placement changes, the inmate must receive a copy of tnis tam): Date of Next Review. 08-13-2019 Printed Name and Sgna a alien Review Official or the Reviewing Authonty and Date Signed: Record Copy Central File This than replete* BP-295(62) dated January 1958 Page 1 of 1 8/6/2019 EFTA00110623 Lass Mom apt Nana reit HA, • Middle Seise raft., tilt. :uffiX Weight H•17ht 5'06" 180 '06" 180 Naar eye aIr ry. BLACK BROWN =LACK BROWN K.Ino NYM 000 L oot M.M. Man• ISO lint Hs Kiddie Sao Mottle tat. Mw gulf lx NYM w het Waight I.libi *sight 5'06" 180 '06" 180 Matr tye lair ry. BLACK BROWN BLACK BROWN Mips) Facility 09... recillty NYM NYM L.H. Ks Pint Us Mello Mao Su=t lx Height Uoiyht 5'06 " 180 Hair Lye BLACK BROWN Ra-no Facility NYM EFTA00110624 ar ailatsmata4ormaisma:Micsanoib...sr..- I EFTA00110625