EFTA00110601.pdf

aP4mos ADMINISTRATIVE DETENTION ORDER JAN 17 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC Incaution Date/Time: 0748-2019 15:50 TO: Special Housing Unit Officer FROM. (Ramon:tie) SUBJECT: Placement of Reg. No in Administrative Detention (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 (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 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 will make an Independent review and decision, which Is ' In the case of DHO action, reference to that order is sufficient. In other cases, the Correctional supervisor documented here. status); Copy - Captain, Copy - Unit Manager. Copy - Operation Supervisor Record Copy • Inmate Concerned (not necessary it placement is a result ot holdover • Administrative Detention Unit: Copy — Psychology; Copy - Central Fine Prescribed by P5270 (Replaces 8P-A0308 of JAN 88.) PDF EFTA00110601  8P-1-3303 ADMINISTRATIVE DETENTION ORDER JAN 17 U.S. DEPARTMENT OF JUSTICE 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 oirninal 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  #OK NYMHJ 535.03 • INMATE PROFILE • 07-16-2019 PAGE 001 OF 001 15:47:57 REG REGNO: FUNCTION: PRT DOB/AGE.: 03-10-1969 / 50 NAME.: R/S/ETH.: W/M/H WALSH: YES RSP. .: NYM-NEW YORK MCC MILEAGE.: 11 MILES PHONE: FAX: 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: 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 UNT 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 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 "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 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 SHU preclude the fact s/he may suffer from a psychological disorder requiring additional psychological services. This of review is also not a risk assessment of an inmate's potential for violent behaviors. Rather, it Is an assessment whether the inmate exhibits any aggressive or violent behaviors at the time of the SHU review. be adequately Subjective/Objective data: Inmate displayed no evidence of depression or suicidality and appeared to report and Unit adjusting to SHU placement. This adjustment was determined by clinical presentation, his self personnel statements. Psychology Assessment/Plan: Inmate is currently psychologically stable. He has been instructed to contact staff are aware of the Department staff for support should he request, or be in need of mental health services. Unit 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 Pogo 1 of 1 Generated 07/18/2019 12:26 by Miller. Elissa PhD/Chief Bureau of Prisons - NYM EFTA00110607 BP•A295 052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. 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 Dale: Continue in Special Housing Unit Printed Name/Signature: II. RECORD REVIEW. week between 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 ACTION TAKEN REMARKS SIGNATURE DATE Review By (SRO): Reviewing Authority: III. Subject. (7 or 30 Days) Date inmate appeared fora Special Housing Review: 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: ❑ Yot O No Housing Review Form): O Yes: O No Proper documentation and justification in the Central File (Incident Report. OHO Radon, copies of Special if no, why not? status? O Yes; O No Is there a written psychiatric or psychological assessment on ale inmate who has spent 30 days in a special housing 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 finding at each 30 day review? O Yes: ONO Did inmate in Adminisuative Detention receive a written copy of staffs decision and me basis for the if no. why not (Should be given provided institutional security not compromised/? the inmate must receive a copy of this form): Remarks: (My change in the reason for placement is to be noted in this section. If the reason for placement changes. 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 7/19/2019 Page 1 of 1 EFTA00110608 OP-A295 052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number. Una rust:it:on 7 NEW YORK MCC Date Entered SPedel Housing: Reason for Pticement 07-16-2019 PENDING SIS INVESTIGATION/ THREAT ASSESSMENT 1. Subject (2 or 3 Days) Date Reviewed 3 Day Review 07-19-2019 Acton Taken on the Above Date Continue in Special Housing Unit Printed Name/Senator.: 11. RECORD REVIEW. In-person 30 day review.) (To be done weekly In the inmate's absence. beginning after the ireperson 7 day resew. and continuing every week between each ACTION TAKEN REMARKS SIGNATURE DATE 07-23-2019 Continue In Special Housing Unit Review ay (SRO): Reverting Authority: III. Subject (7 of 30 Days) 7 Day Review Date inmate appeared for a Special Housing Review: Or Date inmate waived right to appear: 07-234019 Has been seen daily by Medical Staff. O Yes; O No 0 Yes O No Has been seen daily by responsfble officer designated by Warden Has received protected weekly exercise: El Yes, ❑ No Report copies of Special Housing Review Form) Yes; ONO Proper documentation and justification In the Central Fee (Incident Report. OHO if no. why not? sped 30 days in a special housing Status? Yes: O No Is there a written psychiatrk or psythobgical assessment on the inmate who has Yes ONO Is there an addeoffal assessment for every one month interval there-after? 0 if no. why not? Reviewing Authority. Acbon taken on the above date by the Segregation Review Official or the O Released torn Specie! Housing; El Continue in Special Housing and tne basis for the finding at each 30 day review? 0 yes; O No Did inmate In AdmiNstrathe Detention meow a written copy of staffs decision if no. why not (Should be given provided Institutional security not ocmpromised)7 Cis form): the reason 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 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 7/23/2019 Page 1 of 1 EFTA00110609 BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Inmate Name: Register Number Dn.: Institution: 86993-054 7 NEW YORK MCC Date Entered Special Housing Reason for Placement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT/COURTS SAY INMATE 07.16.2019 FELT THREATEN ON UNIT. I. Su*et (2 or 3 Days) Dale Reviewed 3 Day Review 07-19-2019 Acton Taken on the Above Date. Continue In Special Housing Unit Primed Name/Signature: II. RECORD REVIEW between each in-person 30 day review.) (To be done wieldy in me inmate's absence. beginning after the in-person 7 day review. and continuing every week ACTION TAKEN REMARKS SIGNATURE DATE 07.23.2019 Continue In Special Housing Unit 07-30.2019 Continue in Special Housing Unit 08-06-2019 Continue in Special Housing Unit Review By (SRO) Roseman° AufllOrer III. Sub(ect (7 a 30 Days) 7 Day Review 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. 0 Yes, 0 No 0 Yes, 0 No Has been seen daily by responsaSe officer designated by Warden: Has received presorted weekly exercise: 0 Yes; 0 No of Special HOUSIN Renew Form) 0 Yes. 0 No Proper documentation and justification in the Central Fib (Incident Report. DHO Report. copies if no, why not? in a special housing status? 0 Yes; 0 No Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days El Yes: 0 No Is there an additional assessmeM for every one month interval thereafter d no, why not? Authority: Action taken on the above date by the Segregation Review Official a the Reviewing 0 Released from Special Housing; 2 continue In Special Housing for the finding at each 30 day review? Elves. 0 No Old innate in Administrative Detention recent a written copy of staffs decision and me basis if no. why not (Should be given provided In solutions] security not compromised)? section. If the reason for placement changes, the inmate must receive a copy of tie form): Remake- (My change in the Mien for placement Is to be noted in this 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 8/6/2019 Page 1 of 1 EFTA00110610 Last Masi Last Nun ••• aim Middle ISM Middle Haste :affix Natal weight st.icht w•tot 5'06" 180 5'06" 180 Hato eye it,,, 4. BLACK BROWN BLACK BROWN kaino r•ClIttY Mayne NYM NYM Leaf Is Loot Nu. arm Middle Sena Sunlit Middle Ns Molght Weight Mat.r.t el-Jut 5'06" 180 5'06" 160 Haar grit Hole Lye BLACK BROWN BLACK BROWN Mr* raellIty Rpm reel Ilty ITYM NYM LaSit rife; Ns Middle WOO Satflx Height taotgait 8'08" 180 Heir Lye BLACK BROWN Ha -nti Facility NYM EFTA00110611  ar ailatsmata4ormaisma:Micsanoib...sr..- I EFTA00110612