For Immediate Release
Yesterday, the San Diego Board of Supervisors approved a comprehensive settlement agreement to resolve Plaintiffs’ medical and dental Claims for Relief in Dunsmore et al. v. San Diego County Sheriff’s Department et al., No. 3:20-cv-00406-AJB-DDL. Dunsmore is a class action lawsuit in the U.S. District Court for the Southern District of California against the County of San Diego, San Diego County Sheriff’s Office, and San Diego County Probation Department over unconstitutional and unlawful conditions at the San Diego County Jail facilities. The First and Sixth Claims for Relief address the County’s failures to provide constitutionally adequate medical and dental care to the Dunsmore class under the Eighth and Fourteenth Amendments of the U.S. Constitution and Article I, Sections 7 and 17 of the California Constitution. The settlement agreement is here.
After months of extensive negotiation, the Sheriff’s Office has agreed to make significant changes to policies, procedures, and practices that will improve medical and dental care in the jails. The proposed settlement requires increased access to care, adherence to standards for treating chronic conditions, improvements to treatment for withdrawal and substance use disorders, increases in dental staffing, and appointment of neutral experts to monitor implementation and compliance. The proposed settlement will be submitted to the Court for preliminary approval within 30 days.
“This agreement will substantially improve the quality of medical and dental care for the Dunsmore class and help prevent unnecessary deaths, a long-standing tragedy in this County. We are thankful to Magistrate Judge David Leshner for assisting the parties in reaching this agreement. The settlement shows that Sheriff Martinez and the Board of Supervisors are committed to improving the medical and dental care systems of their jail facilities, which will increase the well-being of class members both now and upon their return to the community. We look forward to working with the Sheriff’s Office and the independent neutral experts to ensure the County comes into compliance with the agreement as soon as possible,” said Gay Grunfeld, a partner of Rosen Bien Galvan & Grunfeld LLP and counsel for the Plaintiffs and the certified class. The Plaintiffs and the class are also represented by Aaron Fischer of the Law Office of Aaron J. Fischer and Christopher Young of DLA Piper LLP (US) (“Class Counsel”).
“We have witnessed many preventable deaths and much unnecessary suffering from people receiving substandard healthcare. I anticipate that this agreement, once implemented, will lead to dramatic improvements in outcomes for class members,” said Aaron Fischer.
“DLA Piper is pleased to be part of this case and to support meaningful improvements in medical and dental care for incarcerated community members,” said Christopher Young, a partner of DLA Piper in San Diego.
Background
Originally filed by named plaintiff Darryl Dunsmore in 2020, the lawsuit became a class action in 2022. Its filing coincided with the issuance of an unprecedented California State Auditor report titled “San Diego County Sheriff ’s Department: It Has Failed to Adequately Prevent and Respond to the Deaths of Individuals in Its Custody,” which observed numerous deficiencies in the provision of medical care at the jail facilities. The Third Amended Complaint includes eight claims for class relief. In October 2023, the Court granted certification of the class and subclasses. The parties previously settled Plaintiffs’ claims under federal and state disability rights laws (Claim 3) and on behalf of class members with mental illness (Claim 2). The Court granted final approval of the disability-related settlement on August 4, 2025. The Court granted preliminary approval of the mental health settlement on February 25, 2026, and will conduct a hearing on final approval on July 16, 2026. Four other claims in the case are ongoing after the Court denied the County’s Motion for Partial Summary Judgment on August 11, 2025. Any claim that does not settle will proceed to trial.
Summary of Terms
The Joint Motion and Order re: Medical and Dental Issues and Resolving First and Sixth Claims for Relief is here. It provides relief for the entire class, consisting of thousands of individuals on any given day. The proposed settlement agreement is the product of months of negotiations between Class Counsel and the County under the auspices of Magistrate Judge David Leshner. If approved by District Judge Anthony J. Battaglia, the settlement agreement will lead to changes across all of the Jail system’s seven facilities, with oversight by two independent neutrals and continued involvement of Class Counsel. The agreement focuses on improving medical and dental care and reducing preventable deaths and suffering. Key provisions include:
- Improvements to access to care: The settlement agreement requires that a doctor or other provider evaluate all people with chronic or acute medical or dental issues at booking within one or seven days, depending on the acuity of their condition, and that the County continue medications and treatments people were receiving in the community prior to their arrest. The agreement also tightens timelines for health care staff to evaluate people who submit requests for medical or dental care.
- Improvements to treatment for people with chronic conditions: The agreement requires the County to create individual treatment plans for all people with chronic conditions, to develop disease management guidelines (DMGs) for many of the most common chronic conditions, and to treat patients consistent with the DMGs or document a clinical justification for deviation.
- Improvements in the treatment of people with substance use disorders and who are experiencing withdrawal: The agreement eliminates any policy where the County would discontinue treatment if someone is found to have diverted medication and requires that the County monitor people experiencing withdrawal at clinically appropriate intervals (a significant change from the County’s current practice of monitoring people once per day).
- Increases in dental staffing: The agreement mandates that the County have at least one dentist for every 1000 people in the Jail, which will likely lead to at least four and possibly five full-time equivalent (FTE) dentists for the Jail. Currently, the Jail only employs two FTE dentists.
- Improvements in training on some of the issues that have caused the most harm to class members: The agreement mandates that the County provide health care staff with targeted training regarding withdrawal from substances and provide officers with training regarding when to refer incarcerated people health care staff.
- Improvements to continuous quality improvement and review of sentinel events: The agreement requires that the County, on at least a quarterly basis, conduct its own review of the most important medical and dental processes at the Jail, including of the intake process, the health care request process, and the process for providing access to offsite care. In addition, the agreement requires that, when any incarcerated person dies or suffers permanent medical or dental injury unexpectedly, the County must conduct a robust sentinel event review, including performing a “root cause” analysis to identify any deficiencies in care and recommending and implementing any corrective action to ensure similar harm does not occur in the future.
- Addressing refusals of care: The agreement requires that the County provide counseling to all people who refuse any medication or treatment. And when people refuse life saving treatments or medication or off-site care, Jail staff must provide notifications to providers and additional counseling.
- Requiring that people with insulin pumps can keep them: The agreement mandates that people who enter the Jail with insulin pumps can retain possession of them and that the County will provide appropriate insulin and take reasonable steps to repair or replace broken pumps.
- Appointment of neutral experts: The agreement requires the appointment of neutral experts (medical and dental) to report twice yearly on the County’s implementation of the agreement based on inspection of the facilities, interviews with staff and class members, as well as access to and review of the County’s policies and documentation.
- Class Counsel participation: The agreement provides for the continued involvement of Class Counsel, including through regular interviews at the facilities with class members, accompanying the independent neutral on their inspection of the facilities, and access to documents.
The changes mandated by this agreement should go a long way to ensuring that San Diego never again has one of the highest in-custody death rates in the Country, as it did in 2021 and 2022. The death rate has steadily declined since Plaintiffs began litigating this class action. Class counsel is confident that Sheriff Martinez and the County are committed to full and speedy implementation of the settlement agreement for the benefit of the entire San Diego community.
Media Contacts
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Gay Crosthwait Grunfeld |
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Aaron J. Fischer |
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Christopher M. Young |