EFTA00110614.pdf

BP-40308 ADMINISTRATIVE DETENTION ORDER JAN 17 DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC Insiltabn Date/Time: 07-18-2019 15:50 TO: Special Housing Unit Officer FROM: LIEUTENANT (Nemo/title) SUBJECT: Placement of Reg. No in Administrative Detention (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 (1) Since the inmate has requested admission for protection; I hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.. Stall Witness Printed NameSignature: (2) Since a serious threat exists toFM 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) Dale f/hi/7 StanWitness Signature/Printed NameAI MI IIIIIM Supervmor 24 hour review of placement Signature/Printed name review and decision, which Is ' In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor will make an Independent documented here. Captain. Copy - Unit Manager. Copy - Operation Supervisor Record Copy - Inmate Concerned (not necessary if placement is a result of holdover status); Copy - • Administrative Detention Unit; Copy — Psychology; Copy - Central Fine Prescribed by P5270 (Replaces 8P-A0308 of JAN 88.) PDF EFTA00110614  8P•ki3Ci3 ADMINISTRATIVE DETENTION ORDER JAN 17 M. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC tnsbkton Dmertype 07.18.201915:50 FROM.illit TO Sp is (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 (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 Is pending classrficaton, or (9) 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 NYMHJ 535.03 • INMATE PROFILE • 07-16-2019 PAGE 001 OF 001 15:47:57 REG REGNO: NAME.: ME= RSP. .: NYM-NEW YORK MCC FUNCTION: PRT DOB/AGE.: 03-10-1969 / 50 R/IrETH.: W/M/H MILEAGE.: 11 MILES WALSH: YES PHONE: FAX: PROJ REL METHOD: UNKNOWN FBI NO..: 88869JA1 PROJ REL DATE..: UNKNOWN INS NO..: PAR ELIG DATE..: SSN • 108649131 PAR HEAR DATE..: PSYCH: NO DETAINER: NO CMC..: YES OFFN/CHG RMKS: TITLE: 21 USC: 846 OFFN/CHG RMKS: TITLE: 21 USC: 841 FACL CATEGORY CURRENT ASSIGNMENT EFF DATE TIME NYM ADM-REL A-PRE PRE-SENT ADMIT, ADULT 08-01-2018 1718 NYM CALLOUTS COURT SDNY COURT USM SOUTHERN DISTRICT 07-16-2019 0731 NYM CARE LEVEL CARE1-MH CARE1-MENTAL HEALTH 09-12-2018 1343 NYM COR COUNSL UN? 7S VACANT 11-24-2018 1414 NYM CMC SEPARATION SEPARATION 11-23-2018 0955 NYM CASEWORKER UNT 7 11-24-2018 1415 NYM CUSTODY IN IN CUSTODY 08-01-2018 1718 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 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 Page l of l ta\ NYmG5 INMATE DISCIPLINE DATA 07-16-2019 PAGE 001 OF 001 * PENDING REPORTS 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 "SENSITIVE BUT UNCLASSIFIED** Psychology Services SHU Review 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 services. This SHU preclude the fact the may suffer from a psychological disorder requiring additional psychological review is also not a risk assessment of anIM 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. to be adequately Subjective/Objective data: Inmate displayed no evidence of depression or suicidality and appeared report and Unit adjusting to SHU placement. This adjustment was determined by clinical presentation, his self personnel statements. contact Psychology Assessment/Plan: Inmate is currently psychologically stable. He has been Instructed to Unit staff are aware of the Department staff for support should he request, or be in need of mental health services. 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 Page 1 of 1 Generated 07/18/2019 12:26 by la Ph0/Chi.f Bureau of Prisons - NYM EFTA00110620 BP-A295.062 SPECIAL HOUSING UNIT REVIEW fl . DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Um: institution: 7 NEW YORK MCC Date Entered Special Housing: Reason for Placement: 07-16.2019 PENDING SIS INVESTIGATION/ THREAT ASSESSMENT I. Subject (2 Or 3 Days) Date Reviewed 3 Day Review 07.19.2019 Action Taken on the Above Date Continue In Special Housing Unit Pelted Name/Signature -St IL RECORD REVIEW. 30 day review.) (To be done weekly in U'- absence, beginning after the in.person 7 day review. and continuing every week between each in-person REMARKS SIGNATURE DATE ACTION TAKEN Review fly (SRO): Reviewing Authority: III. Subject'. (7 or 30 Days) Date inmate appeared for a Special Housing Review: Or Dale inmate warted right to appear': Has been seen daily by Medical Stall. ❑ Yes; ❑ No Has been seen daily by timpani/le officer designated by Warden: ❑ Yes: ❑ NO Has receMid prescribed weekly exercise: ❑ Yes: ❑ No ❑ Yes: ❑ No Proper documentation and justification in the Central Fle Report. DHO Report, copies of Special Housing Renew Form): it no, why not? a special hOuSelg status? ❑ Yes: ❑ No Is there a written psychiatric or psychological assessment on ale Inmate who has spent 30 days in Is there an addmonal assessment for every one month interval thereafter? ❑ Yes: ❑ No if no. why not? Acton taken on the above date by the Segregation Review Official or the Reviewing Authority: ❑ Released from Special Housing: ❑ Conbnue vi Special Housing for the finding at each 30 day review? ❑ Yes: ❑ No Did inmate In Administrative Detention recent a written copy of staffs decision and the basis if no. why not (Should be given provided institutional security not compromised)? changes, the inmate must receive a copy &this form): Remarks' (Any change in the reason for placement is to be noted in this What If Me reason for placement 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 SPECIAL HOUSING UNIT REVIEW M. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Unit tnstt-t:on 7 NEW YORK MCC Date Entered SPeChil Housing: Reason for Iftecement 07-16-2019 PENDING SIS INVESTIGATION/ THREAT ASSESSMENT 1. Sutsect (2 or 3 Days) Date Redo:mixt 3 Day Review 07-19-2019 Acton Taken on the Above Date Continue in Special Housing Unit Pnnted Nameragnature: 11. RECORD REVIEW. 30 day review.) (To be done weekly in the absence. beginning after the in-person 7 day review, and oantinuing every week between each In-person ACTION TAKEN REMARKS SIGNATURE DATE .-I 07-23-2019 Continue In Special Housing Unit Review ay (SRO): Reversing Authonty: III. Subject (7 or 30 Days) 7 Day Review I Date inmate appeared for a Special Housing Review: Or Date inmate waived right to appear: 07-23-2019 Has been seen daily by Medical Staff. O Yes; O No 0 Yet ❑ No Has been seen daily by responsfble officer designated by warden Has received presented weekly exercise El Yes, ❑ No Proper documentation and justification In the Central Fee (Incident Report. OHO Report copies of Special Housing Review Form) Yes; ONG no, why not? spent 30 days in e special hewing Status? 0 Yes: O No Is there a written psythiatC or psychobgical assessment on the inmate who lea Yes; ONO Is there an Ulf/Mortal assessment fox every one month interval there-after? 0 if no. why not? Reviewing Authority: Acbon token on the above date by the Segregation Review Official or the O Released torn Specie! Housing; El Continue in Special Housing g yes; O No Die inmate In AdmiNstrative Detention receive a *Mien copy of decision and me basis for the finding at each 30 day review? if no. why not (Snout be given provided Institutional security not CoMpronted)? Cis lam): the ratan for placement changes, the inmate must receive a copy of Remarks- (Any change In the reason for placement is to be noted m this section. If 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 7/23/2019 Page 1 of 1 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: Reason for Placement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT/COURTS SAY INMATE 07.16-2019 FELT THREATEN ON UNIT. I. Subject (2 or 3 Days) Dale Reviewed 3 Day Review 07-19-2019 Action Taken on the Above Date. Continue In Special Housing Unit Primed Name/Signature: II. RECORD REVIEW each In-person 30 day review.) (To be done weekly in the inmate's absence. beginning after the in-person 7 day review. and continuing every week between ACTION TAKEN REMARKS SIGNATURE DATE 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 Renew By (SRO) Reviewing AirthOritY III. Subject (7 or 30 Days) 7 Day Review _ ,-I Date inmate appeared for a Special Housing Review: Or Date inmate waived nght to appear: 07-23-2019 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 copies of Special Housing Renew Form) 0 Yes. O No Proper documentation and justification ri the Central Fib (incident Report. DHO Report. 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 decision and me basis for the finding at each 30 day review? O Yes. O No (Neonate in Administrative Detention receive a written copy of- if no, why not (Should be given provided iniatutional security not compromised)? placement changes, the inmate must receive a copy of tnis tam): Remarks- (My change in the tenon for placement is to be noted in this section If the reason for 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 8/6/2019 Page 1 of 1 EFTA00110623  apt Nana Lass Mom reit HA, • tilt. :uffiX Middle Seise raft., H•17ht Weight 5'06" 180 '06" 180 aIr ry. Naar eye BROWN =LACK BROWN BLACK 000 K.Ino NYM NYM Man• L oot M.M. lint Hs ISO tat. Mw gulflx Kiddie Sao Mottle I.libi *sight w het Waight 5'06" 180 '06" 180 lair ry. Matr tye BROWN BLACK BROWN BLACK 09... recillty Mips) Facility 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