Multnomah County Board briefed on Sheriff’s Office, Corrections Health collaborative efforts to prevent deaths in jail custody

September 13, 2023
From left: Multnomah County Sheriff Nicole Morrisey O'Donnell, Multnomah County Health Department interim director Valdez Bravo, Myque Obiero, director of Corrections Health and Dr. Elliott Lawson, Corrections Health medical director.

Watch the board briefing.

The Multnomah County Board of Commissioners on Sept. 12, was briefed on work by the Sheriff’s Office and Corrections Health to prevent deaths in jail custody.

The briefing followed a request from Chair Jessica Vega Pederson for an in-depth summary of the efforts intended to prevent adult deaths in custody, as well as the impacts of new mitigation strategies underway in the jails. It included presentations from the Multnomah County Sheriff’s Office and the Health Department

The briefing comes after a period when Multnomah County jails reported a record number of adults who died in custody. Since 2022, nine people have lost their lives in County jails. That’s more than the last seven years combined.

“Losing each of these people has been devastating,” said Chair Vega Pederson. “The impacts can be long-lasting for families, for victims, for the staff working in our jail facilities, other people in custody, and staff or other partners who’ve supported these individuals.

“The trend of losing so many people in our custody in such a short period of time is also devastating — and something that nobody at Multnomah County takes lightly. I hear from the community around these deaths and share the deep concern the community has around how we can quickly and strategically respond. This is a time for us to invest time and resources to make sure we’re able to meet it.” 

Multnomah County Sheriff’s Office

Sheriff Nicole Morrisey O'Donnell opened the presentation by acknowledging the difficult yet "very important" conversation surrounding the six deaths that occurred in custody at Multnomah County Jail facilities between May and August 2023.

“Someone dying in our custody has a profound impact on a person's family, the people housed with them, the victims of the alleged crimes, as well as staff working in our corrections settings," Morrisey O’Donnell said. 

“It is with accountability and transparency that the Multnomah County Sheriff's Office and Corrections Health are providing this briefing to the Multnomah County Board and the public."

Multnomah County Sheriff Nicole Morrisey O'Donnell alongside Law Enforcement Chief Deputy James Eriksen and Corrections Facilities Chief Deputy Stephen Reardon, explained various aspects of operations at Multnomah County's jails.

The Sheriff, alongside Law Enforcement Chief Deputy James Eriksen and Corrections Facilities Chief Deputy Stephen Reardon, explained various aspects of operations at Multnomah County's jails. That included an overview of the law enforcement investigation process that begins when a death in custody is reported, and the data-driven processes designed to ensure facilities are safe. 

Morrisey O’Donnell also highlighted initial steps by outside agencies invited to investigate and consult on policies and practices at the jails.

The Sheriff’s Office manages the downtown Multnomah County Detention Center and the Multnomah County Inverness Jail in Northeast Portland and “serves a population of vulnerable and high-risk people with complex needs with mental health, substance use and other chronic health conditions,” said the Sheriff.

The total funded capacity of the jails is 1,130 beds, with approximately 30,000 bookings annually. However, the impacts of COVID-19 significantly changed the population. Because higher-level service calls became the priority to minimize COVID-19 exposure for law enforcement officers, the sheriff said, the people who ended up booked in the jails tended to have higher needs.

"We're on pace to book a similar number of people as we did in 2021, about 1,000 individuals per month,” she said. “We continue to use an average of 77% of jail beds, with the current length of stay around 20 days."

Beginning in May 2023, six people died in custody, said Morrisey O’Donnell as she shared the names of the lives lost and causes of death for each person. Among them, two people passed away by suicide; one by natural causes; and three remain under investigation. 

The Sheriff also noted she could “only share details that can be publicly released by the Sheriff’s Office, County Health Department and the Medical Examiner's Office” to comply with health privacy laws, pending Medical Examiner reports and ongoing investigations. 

During 2022, three people died in custody, she added, sharing their names. One person died due to cocaine poisoning and two others passed away from natural causes.   

There were no deaths in custody in 2021 and 2020. 

“People incarcerated in Multnomah County are members of our community,” she said.  “They are brothers, sisters, parents, neighbors and co-workers.”

In August, the sheriff asked the Oregon State Police to conduct an independent review of all adult-in-custody death investigations this year. She also asked the National Institute of Corrections for an independent consultant who could assess the Sheriff’s Office’s facilities, operations, policies and services, in partnership with Corrections Health. Both the independent review and assessment were initiated by Sheriff Morrisey O’Donnell.

In September and October, the Sheriff’s Office will also participate in the yearly District Attorney’s Office Corrections Grand Jury process and the Oregon State Sheriff’s Association’s Oregon Jail Standards process. 

And finally, she added, voters last year approved Measure 26-233, which requires the Board of Commissioners to conduct an additional yearly corrections facilities tour alongside at least one member of the community.  

Morrisey O’Donnell also thanked Multnomah County Auditor Jennifer McGuirk for her role in oversight.

"Through a transparent process, we may be able to identify areas of opportunity or concern as we move forward," she said. 

"As Sheriff, I am accountable to our community, and I am committed to ensuring that this office and its employees perform at the highest standards."

Law Enforcement Response

Chief Deputy James Eriksen highlighted the law enforcement response and procedures for investigations when a death occurs in custody.

Multnomah County Law Enforcement Chief Deputy James Eriksen (center) speaks to board.

According to state law, in-custody deaths must be investigated by the District Attorney and the local Medical Examiner in the location where the death occurred, Eriksen said.

The Sheriff's Office also activates its Special Investigations Unit. If an overdose is suspected, the detective sergeant and a special investigations supervisor are notified. The Special Investigations Unit takes the lead in suspected overdose incidents.

The Special Investigations Unit includes not only Sheriff’s Office detectives, but also a Gresham police detective and two analysts from the Oregon National Guard. Depending on the circumstances, the East County Major Crimes Teams may also join the investigation, Eriksen noted.

Although each investigation is unique, notifications are generally made to the Sheriff, the Division Chief, the District Attorney's Office and the Medical Examiner Program.

Depending on the needs of the investigation, Sheriff’s Office detectives ensure:

  • Witnesses are separated and interviewed.
  • Interviews with responding fire and medical personnel are completed.
  • Closed circuit video is collected and preserved.
  • The scene is photographed
  • The decedent’s history, including all relevant records, is obtained.
  • All log books and staff written notes are examined. 
  • Interviews with correctional health staff and other staff members are conducted.

Family members are also contacted and interviewed, and investigators examine all pertinent police reports and use of force documents, said Eriksen.

These actions help to answer questions about the death and help evaluate our and our partners’ responses, he said.

"Policies, practices and procedures are reviewed as part of each investigation,” Eriksen said.

Corrections Operations 

“When a critical incident happens — especially a loss of life — we look to partners who have or are experiencing similar circumstances," said Reardon, the Corrections Facilities Chief Deputy. That includes the Oregon State Sheriff's Association, National Institute of Corrections, Corrections Health and the United States Marshal’s Office.

National data shows that drug overdose deaths are at historically high levels. The rising trend of drug use, primarily driven by opioids including counterfeit fentanyl, is apparent in corrections environments.

Multnomah County Sheriff's Office Corrections Facilities Chief Deputy Stephen Reardon (second from left) speaks to board.

Synthetic opioids like fentanyl are dramatically more potent and addictive than heroin or any other drug, he said.

In June 2023, the Multnomah County Health Department reported that overdose deaths from synthetic opioids have increased by 533% from 2018 to 2022.

We are urgently addressing the possibility that some of the deaths are drug-related, said Reardon.

The Sheriff's Office has made immediate adjustments, including modifying the physical environment of jail facilities to increase safety through steps including:

  • Evaluating the positions of cameras
  • Increasing the scope of search criteria for contraband during searches of people and within facilities
  • Expanding Narcan availability so it can be offered more quickly
  • Updating training on the use of body scanners and creating a path for staff to become certified trainers
  • Conducting daily check-ins with Corrections Health staff
  • Coordinating communications from court proceedings to identify support needs

Over the long term, the Sheriff’s Office is working on other strategies to address not only substance use and overdoses, but the overall well-being of people in custody.

Offering tablets to people in custody, for example, means someone won’t need to receive books or other physical mail that can be used to facilitate contraband. Tablets also offer expanded access to educational courses, vocational opportunities, rehabilitative programming, and easier communication with family and friends.

"There is also increased access to legal representation," said Reardon. "We hope this will lead to quicker adjudication of cases."

In addition, Reardon said the Sheriff’s Office is re-evaluating workforce models for adults in custody and focusing on the mental health of staff, with research underway into different shift models and overtime hiring practices.

Sheriff Morrisey O'Donnell said there is no one reason for the deaths, but rather  "there are many factors that may contribute to a death in custody, just as there are in the community."

"Justice-involved individuals have higher healthcare needs for several reasons, including a lack of preventative healthcare access before incarceration, the presence of chronic illness, substance use issues, mental illnesses and other socio-economic factors," she said.

Role of Corrections Health in jails 

Corrections Health’s core responsibility is to provide healthcare to adults and youth in custody that meets both constitutional and community standards.

“The impact of the health in the community, whether it’s mental health, substance abuse or chronic disease, becomes more prominent in the jail population,” said Dr. Elliott Lawson, Corrections Health medical director. 

From left: Multnomah County Health Department interim director Valdez Bravo, Myque Obiero, director of Corrections Health (speaking) and Dr. Elliott Lawson, Corrections Health medical director.

Lawson said if the County provides treatment and gets the patient’s symptoms under control while incarcerated but is not able to connect them with the resources they need in the community upon release, then “you have another patient with uncontrolled diabetes or schizophrenia that is not being cared for.”

Myque Obiero, director of Corrections Health, walked the Board through the steps his team takes after each death in custody. These include:

  • Conducting an internal review process alongside the Sheriff's Office.
  • Corrections Health Director and Medical Director immediately notified after a death in custody, who then show up to help staff navigate. 
  • Health Department director is notified and informs the rest of County leadership.
  • Staff work with the Medical Examiner’s Office to answer questions on autopsy reports. 
  • Staff conduct an internal debrief, followed by a joint debrief with Sheriff’s Office staff to provide emotional and mental support for staff. 
  • A video review is completed within 30 days of the death to determine, from a medical perspective, whether staff could have done something different or improved upon their work.

These deaths have caused “a tremendous mental and emotional toll on staff within the jails,” said Obiero.

Obiero also said changes must be structural and occur outside the jail setting — no matter how effective medical staff might be, a jail is not the most therapeutic location for someone to receive the care and treatment they might need.

“We do the best we can to serve a population that is very vulnerable, but require a lot more resources than what we can provide within the walls, within the jails,” said Obiero. 

“If we can keep people out of jail, that’s the best answer that we can provide.” 

While waiting for bigger, structural changes, Obiero suggested some short-term changes Corrections Health would like to see, starting with creating no-barrier access to treatment services for people being released from custody. 

Obiero also spoke about the need for additional medication supported recovery services to tackle the challenges of the community-wide opioid and alcohol abuse issues facing not just Corrections Health, but the entire Health Department. 

He noted that over half of people in custody who have died over the last year are in their 30s or younger, calling for upstream work to provide health education for young adults. 

“That’s really heartbreaking.”

Board remarks

Commissioner Lori Stegmann asked presenters from Corrections Health about available self-care for affected staff and for the families of those who die. 

“Adults in custody are part of our community and so are their families,” she said. “What sort of support do we offer to the families?”

For staff, Morrisey O’Donnell said, resources include the County’s Employee Assistance Program and the Trauma Informed Program team, which “does a really great job in the moment of supporting our staff. But we have to think outside the box and find better ways of supporting our staff for the long term.”

The Multnomah County Board of Commissioners on Sept. 12, was briefed on work by the Sheriff’s Office and Corrections Health to prevent deaths in jail custody.

When the Medical Examiner notifies family members, she added, the Sheriff’s Office sends them help navigating and accessing services. 

“The people I've encountered that work with adults in custody do it because they care about our community,” Commissioner Stegmann said. “Jail is not a hospital. The best way that we can respond is to prevent people from ever having to go to jail, but we know that that is a big challenge.”

Commissioner Julia Brim-Edwards inquired about the independent reviews requested by the Sheriff.

"How will those reviews be integrated with the clinical mortality reviews conducted by Corrections Health?” she asked. “How do they integrate?"

The National Institute of Corrections will provide a holistic report on how to manage adults with high needs who are in custody, while also offering insights on the differences in the County’s custody population over the past four to five years, said Morrisey O’Donnell.

“The recommendations will be implemented and shared where we can,” she said.

"This is a new process for us," added Obiero, noting any reviews involving deaths in custody are restricted by federal health privacy laws. 

“It’s entirely clinical,” he said, focusing on things such as diagnosis, medical history and past hospital visits. We’ll have to look at what information is needed and pertinent.”

Brim-Edwards also asked about staffing and vacancy rates for corrections deputies and for Corrections Health.

Morrisey O’Donnell said Multnomah County is experiencing the same challenges in hiring and retaining public safety workers that agencies are facing nationwide. 

“We have instituted robust hiring initiatives to bring new individuals into our organization,” she said, noting interim strategies to fill current staffing levels, such as working on recruiting events. 

Obiero mentioned the new Corrections Health positions that the Board recently approved and said staffing hasn’t affected “our obligation to provide the highest level of care.” 

“There’s always enough people to provide services,” he said. 

“It’s an understatement to say that this is a hard topic for all of you, your teams and the community at-large,” said Commissioner Susheela Jayapal.  

Jayapal asked about the number of overdoses over the past year and what signs deputies are trained to look for in a health-related situation.

Deputies assigned to housing units or who engage with any adults in custody, including court transfers, are trained to look for any behaviors that seem inappropriate for the situation, or behaviors that may indicate someone is under the influence or needs medical attention, said Morrisey O’Donnell.

Deputies also conduct welfare checks twice an hour and participate in training programs, including scenario-based training and educational sessions on fentanyl and exposure, she said.

Observed abnormal behavior is documented in a shared information platform, Reardon explained. Observations and requests are shared with corrections health partners and mental health teams for follow up. Corrections counselors also receive the information and follow up.  

We should not be seeing deaths in custody period,” Commissioner Sharon Meieran said. “Occasionally it can happen, but there’s something going on here that is out of the norm, and we need to address it.”

Meieran asked why the Medical Examiner has not yet released the cause of death for three most recent deaths in custody. She also asked how many overdoses have occurred in jails that do not result in death.  

“My heart goes out to the families of the people who died under our care and our frontline staff who are there and really traumatized and provided care to the best of their abilities,” she said.

Chair Vega Pederson spoke to the systemic changes that need to happen and the processes and procedures that need to be changed to create an environment and a way of working that minimizes opportunities for deaths in custody.

“We have such a crisis that’s happening in our community, and what’s happening here in the jails to our most marginalized vulnerable community members is a really distinct piece of that,” she said. “The people that are most vulnerable in our community are being impacted by these larger things.”