Wiki source code of CH 14 Health Care

Last modified by Ryan Larkin on 2022/02/16 17:35

version	line-number	content
1.1	1	Washington County Sheriff's Office
	2
	3	CORRECTIONS DIVISION
	4
	5	Policy Manual
	6
	7
	8	Volume: CH
	9
	10	Services and Programs
	11
	12	Chapter: 14
	13
	14	Health Care
	15
	16
	17	Replaces and/or Supersedes:
	18
	19	PI 01, PI 02, PI 03, PI 07, OD-09-013, OD-04-016
	20
	21	Published:
	22
	23	07/02/2012
	24
	25	Review Date:
	26
6.1	27	02/16/2022
1.1	28
	29
6.1	30	Sheriff Nate Brooksby
1.1	31
6.1	32	Chief Deputy Trevor Benson
1.1	33
	34
	35	__TABLE OF CONTENTS__
	36
	37	CH 14_101 Definitions
	38
	39	CH 14_102 References
	40
	41	CH 14_103 General
	42
	43	CH 14_104 Levels of Service & Emergency Care
	44
	45	CH 14_105 Medications
	46
	47	CH 14_106 Informed Consent
	48
	49	CH 14_107 Screening and Evaluation
	50
	51	CH 14_108 Initiating Care
	52
	53	CH 14_109 Specialized Medical Services
	54
	55	CH 14_110 Cost of Services
	56
	57	CH 14_111 Health Care Provider Qualifications
	58
	59	CH 14_112 Responsibility and Authority
	60
	61	CH 14_113 Tuberculosis
	62
	63	CH 14_114 Control Devices
	64
4.5	65	CH 14_115 Isolation
1.1	66
	67	CH 14_116 Privacy of Care
	68
	69	CH 14_117 Pregnancy
	70
	71	CH 14_118 Hospitalization
	72
	73	CH 14_119 Treatment Plans
	74
	75	CH 14_120 Health Care Records
	76
	77	CH 14_121 Forensic Information
	78
	79	CH 14_122 Hunger Strikes
	80
	81	CH 14_123 Release of Inmate
	82
	83	CH 14_124 Inmate Workers
	84
	85	CH 14_125 Terminal Illness
	86
5.1	87	CH 14_129 Gender Identity Dysphoria
1.1	88
5.1	89	CH 14_127 Suicide Prevention and Intervention
1.1	90
5.1	91	CH 14_128 Inmate Death and Advance Directives
1.1	92
5.1	93	CH 14_129 Sharps
1.1	94
5.1	95
1.1	96	CH 14_101 __DEFINITIONS__
	97
	98	1. WCSO: Washington County Sheriff's Office
	99	1. PCF: Purgatory Correctional Facility
	100	1. DIHS: Division of Immigration Health Services
	101	1. ICE: Immigration and Customs Enforcement
	102	1. PHS: U.S. Public Health Service
	103	1. BAC: Blood Alcohol Content
	104	1. GRAMA: Government Records Access and Management Act
	105	1. Serious Health Care Need: A case that has been diagnosed by a physician as mandating treatment, or so obvious that even a lay person would easily recognize the necessity for a doctor's attention. A serious health care need is a valid health condition that, without timely health care intervention, will cause: 1) Excessive pain not controlled by medication; 2) Measurable deterioration in function (including organ function); 3) Death; or 4) Substantial risk to the public health.
	106	1. TB: Tuberculosis
5.1	107	1. Gender Identity Dysphoria: A medical condition in which an individual's gender identity and their identification differ from the gender assigned at birth.
	108	1. Hormonal Therapy: The use of hormones to stimulate the development or alteration of a person's sexual characteristics in order to alter the person's physical appearance so that the person appears more like the opposite gender.
	109	1. Sexual Reassignment Surgery: Surgical procedures to alter a person's physical appearance so that the person appears more like the opposite gender, up to and including the surgical removal of the genitals and the construction of a vagina substitute out of penile tissue, and visa versa.
6.1	110	1. Medical Clearance: An examination conducted by an emergency room physician. The decision to send an inmate for clearance will be up to PCF medical staff. In the absence of medical staff, the decision will reside with the supervisor on duty.
1.1	111
	112	CH 14_102 __REFERENCES__
	113
6.1	114	None
1.1	115
	116	CH 14_103 __GENERAL__
	117
	118	1. Policy:
	119	11. Reasonable, adequate, and timely health care shall be provided to inmates (including inmates in special management units) for serious health care needs. PCF's Medical Branch should operate in compliance with state and local laws and guidelines.
	120	11. Health care should include medical, dental, and mental health care services for serious health care needs.
	121	11. Health care shall not be denied as a disciplinary punishment.
	122	1. Rationale:
	123	11. Reasonable, adequate, and timely health care for inmates' serious health care needs is required by law.
	124	11. Absolutely correct health care cannot be guaranteed.
	125	11. Ensuring that serious health care needs are met may:
	126	111. Prevent inmates from experiencing unnecessary pain and other harm; and
	127	111. Protect against liability from claims of deliberate indifference to the serious health care needs of inmates.
	128
	129	CH 14_104 __LEVELS OF SERVICE & EMERGENCY CARE__
	130
	131	1. Policy:
	132	11. PCF will provide both routine and emergency health care services to meet the serious health care needs of inmates.
6.1	133	11. PCF should provide 24-hour emergency health care and should staff at least one nurse 24 hours per day, 7 days a week. The contract physician should be on call 24 hours per day, 7 days a week. Corrections staff should be trained in CPR and first aid in order to provide a response within four minutes to health-related emergencies. The Medical Branch should clearly post a list of telephone numbers for the local ambulance and hospital services. Emergency care should include, but not be limited to:
1.1	134	111. First aid;
	135	111. CPR;
	136	111. Crisis intervention; and
	137	111. Emergency transportation to an outside health care provider if an adequate response to a serious health care emergency is not possible within the jail.
	138	11. First aid kits should be immediately available to Booking, the Kitchen, housing units, and any area where inmates are required or permitted to work.
	139	11. Staff should not provide CPR on an inmate without a breathing barrier.
6.1	140	11. Transportation for health care emergencies should be via ambulance. At least one officer should ride in the ambulance with the inmate. A minimum of two officers should be posted at the hospital, or another care facility, with each inmate.
1.1	141	11. PCF should make arrangements with medical, dental, and mental health providers for accepting inmates with emergency health care needs.
	142	11. Dental care should be provided upon request when a dental emergency exists or when otherwise necessary. The contract dentist should determine what constitutes a dental emergency.
6.1	143	11. Routine eye examinations and purchases of glasses or contact lenses are not provided by PCF. With approval from the PCF Medical Branch, inmates may be allowed to retain their personal prescription eyeglasses or contact lenses. Approvals should be documented in the PCF computer system.
	144	11. Eye injuries or diseases will be referred by the medical staff to an ophthalmologist. The scheduling and provision of these services will be at the discretion of PCF medical staff.
1.1	145	11. Inmates may be provided medications and prescriptions under the direction of the PCF contract physician.
6.1	146	11. Special medical diets may be granted to inmates after review and approval from medical staff.
	147	11. Inmates may receive involuntary health care under the direction of the contract physician. Before involuntary treatment is administered, staff should make reasonable efforts to educate and encourage the inmate to accept treatment voluntarily. Involuntary treatment should be administered in accordance with established guidelines and applicable laws and only after the contract physician determines the inmate's life or health is at risk. Medical staff should explain to the inmate medical risks associated with the refusal of treatment and document their treatment efforts in the inmate's medical file. The contract physician may recommend involuntary treatment when clinical assessment and available laboratory results indicate the inmate’s weakening condition threatens the life or long-term health of the inmate.
1.1	148	1. Rationale:
	149	11. Routine and/or emergency care may be required to meet the serious health care needs of an inmate.
	150	11. During emergency transportation, ambulances are better equipped to care for inmates during transport.
	151	11. Preparation and working arrangements must be in place at the time an emergency occurs. Once an emergency is underway, it is too late to begin learning how to deal with it.
	152	11. The use of prescription drugs within a jail setting must be considered with the security risks they may present.
	153	11. Involuntary health care may prevent serious harm or death.
	154
	155	CH 14_105 __MEDICATIONS__
	156
	157	1. Policy:
	158	11. Medications shall be stored in a secure area.
	159	11. Narcotic medications shall be stored in a locked container inside a secure area. A detailed inventory shall be maintained for all narcotic medications.
	160	11. Medications shall only be distributed by medical staff.
	161	11. A written record shall be kept of medications that are distributed.
6.1	162	11. Whenever possible, medication distribution should be done through a cuff port. Medical staff should be accompanied by a certified officer during med pass. The officer should open and control the cuff port (not the nurse).
1.1	163	11. Forced medications shall not be permitted without explicit authorization from the contract physician.
	164	1. Rationale:
	165	11. Medications should be stored in a secure area to prevent unauthorized access.
	166
	167	CH 14_106 __INFORMED CONSENT__
	168
	169	1. Policy:
6.1	170	11. A signed and dated health care consent form should be obtained from each inmate prior to the inmate receiving health care services.
1.1	171	11. Examinations, treatment, and other protocols (including hunger strike treatment) should be provided only with the informed consent of the inmate, except in cases of emergency health care.
	172	11. If the inmate is not competent to give informed consent, consent may be given by another person authorized under the Utah Code to provide consent.
	173	11. If an inmate refuses medical care or treatment, a Refusal of Treatment form should be signed by the inmate and the witnessing medical employee.
	174	1. Rationale:
	175	11. State law accords persons over eighteen years of age the right to refuse health care for personal or religious reasons. The U.S. Constitution may also provide a limited right to refuse treatment and to be informed of treatment options.
	176
4.2	177	CH 14_107 __SCREENING AND EVALUATION__
1.1	178
	179	1. Policy:
6.1	180	11. Inmates should be given a health care screening as a part of the admission process before the inmate is assigned to a housing unit and the inmate should not be accepted into PCF custody until after screening has been completed. The screening should be conducted by a health care provider or a specially trained officer. Medical Branch staff will have discretion on who is accepted into the jail. If the jail is not able to properly and safely provide for their health care needs, the inmate may be refused admittance to the jail even after a medical clearance is completed. These cases should be immediately referred to the Medical Branch supervisor. The initial screening should include medical problems, mental health problems, and suicide risk factors. The following conditions should require a medical clearance from a physician (not a paramedic):
	181	111. Intoxicated inmates with a .30 BAC or higher shall be required to have medical clearance. Factors such as coherence, slurred speech, ability to walk, and alcohol tolerance should be considered. The arresting officer should contact the PCF Medical Branch if an inmate is .30 BAC or higher or refuses to cooperate with a test and: (1) has no apparent injuries; (2) can walk under their own power; and (3) is conscious and coherent;
1.1	182	111. Altered level of consciousness or inability to walk under their own power;
6.1	183	111. An inmate who is involved in a motor vehicle accident, having consumed drugs or alcohol, should be taken for medical clearance or transported by ambulance if appropriate. An inmate who has been involved in a minor vehicle accident with no significant lacerations, obvious fractures, head trauma, serious blunt force trauma, or obvious injuries does not necessarily need to be taken for a medical clearance;
	184	111. If an inmate is pregnant, she should be treated as a healthy person unless there are known injuries or unstable medical problems affecting their current health. Just the fact that the inmate is pregnant does not mean she must have medical clearance before being booked into jail. However, the presence of high-risk factors (e.g., no prior obstetric care, previous high-risk pregnancies, drug addiction, or withdrawal) may result in the inmate being requested to have a medical clearance;
1.1	185	111. Any inmate having a seizure or who had one immediately before being transported to the jail needs a medical clearance;
	186	111. Obvious symptoms of drug or alcohol withdrawal;
6.1	187	111. All inmates suspected of an overdose of drugs or any prescription medication need to have medical clearance;
	188	111. Mentally ill subjects who would otherwise require a medical evaluation to be admitted to the mental health unit should be taken for medical clearance. Officers can talk with medical personnel at the jail if an exception is needed. Mentally ill subjects who are showing current signs and symptoms of major mental illness (i.e., psychosis or mania) will require medical clearance prior to being admitted into the jail;
	189	111. All inmates who have had a use of force (Taser, OC, BOLO Wrap, etc.) used on them and have possible injuries from a related fall should be taken for medical clearance. Just the fact that the subject has had a use of force does not mean they need a medical clearance. If the subject took a hard fall on a hard surface with the possibility of a head injury, medical clearance will be required. Arresting officers should contact the PCF Medical Branch with any questions;
	190	111. When an inmate complains of sickness or injury or appears to be sick or injured, whether complaining or not, medical clearance may be required. This includes, but is not limited to:
1.1	191	1111. Unconscious inmates;
	192	1111. Inmates with uncontrolled or serious bleeding; and
	193	1111. When it is reasonable to believe the inmate may have a highly infectious, serious disease (e.g., tuberculosis, serum hepatitis, etc.).
4.1	194	111. Any subject on whom an anti opiate, such as Narcan or Naloxone has been used must be medically cleared at the hospital prior to admittance to PCF.
6.1	195	11. Inmates found to have health care needs should be referred to the Medical Branch for applicable follow-up. Health care referrals should be conducted in a timely manner. A copy of admission screening reports should be forwarded before the end of shift to the Medical Branch for review and follow-up. Serious or obvious concerns should be relayed to medical staff immediately. A log entry of this event should be documented in the jail computer system.
1.1	196	11. Under the supervision of the contract physician, medical staff should physically examine/assess arriving ICE detainees within 14 days of arrival.
	197	11. Inmates should be notified of procedures for accessing medical care at the time of initial admission and orientation.
	198	1. Rationale:
	199	11. Intake screening is an important part of determining inmates’ medical, mental health, and suicide risks.
	200	11. The intent of the screening process is to identify problems and other matters which require attention; thus, failure to follow up limits the value of the evaluation.
	201
	202	CH 14_108 __INITIATING CARE__
	203
	204	1. Policy:
6.1	205	11. All inmates have access to health care services via the Medical Branch. Inmates may receive periodic examinations and other health care services at the request of the inmate. Inmates should be informed, orally and in writing, about how to access health care services. Inmates may request health care services via an Inmate Request. However, verbal requests should not be ignored, should be forwarded to the Medical Branch, and should be documented in the PCF computer system. Inmate requests should be screened by a nurse and/or the PCF contract physician (or the contract dentist for dental requests). The PCF contract physician or dentist should determine the necessary follow-up care.
1.1	206	11. Medical care should be initiated in a timely manner for inmates for whom it is known that there is a serious medical need.
	207	1. Rationale:
	208	11. A system of receiving, evaluating, processing, and responding to the routine health care complaints of inmates helps to ensure that inmates’ serious needs receive timely attention.
	209	11. Corrections officers and other non-medical staff have a responsibility for initiating medical care for inmates with serious medical needs because it is non-medical staff who interact most directly and frequently with inmates; thus, they are often the first persons to become aware of a serious medical need.
	210	11. Medical staff will discover serious medical needs in the ordinary course of their duties.
	211	11. In most cases, an inmate will be the first to know of personal medical problems; thus, an inmate is responsible for bringing personal medical needs to the attention of staff.
	212
	213	CH 14_109 __SPECIALIZED MEDICAL SERVICES__
	214
	215	1. Policy:
	216	11. Serious medical needs will be met even when specialized care is required.
	217	11. When specialized care is not available at PCF, arrangements will be made to resolve the need.
	218	11. Specialized medical care does not include organ transplants, cosmetic procedures, or other elective medical care and will not be provided.
	219	1. Rationale:
	220	11. Meeting inmates’ serious medical needs is constitutionally required. The medical care requirements vary according to individual health care issues.
	221	11. Providing organ transplants to jail inmates exceeds what is lawfully required.
	222	11. Cosmetic and other elective surgeries are not lawfully required.
	223
	224	CH 14_110 __COST OF SERVICES__
	225
	226	1. Policy:
	227	11. The cost of providing health care shall not be used to deny health care to which an inmate is lawfully entitled for serious health care needs; however, PCF officials may:
	228	111. Assess inmates a reasonable fee for health care services requested by the inmate; and
	229	111. Seek reimbursement for health care from the inmate's insurance carrier;
6.1	230	111. Require inmates to pay for any health care provided at the inmates' request by a personal physician or other preferred providers. Inmates may request to be treated by a physician or provider of their choice (e.g., their family doctor). Requests must be reviewed by the Medical Branch Director and the PCF contract physician. In the event that the Medical Branch Director and the PCF contract physician do not agree, the Corrections Chief Deputy will make the final determination regarding approval or denial of the request. Inmates should be responsible for all costs related to using a physician other than the contract jail physician (e.g., transportation costs).
	231	11. PCF should not be responsible for elective health care procedures (e.g., cosmetic surgery or treatments, wart removal, etc.). Determination of elective status should be done by the PCF contract physician. In the instance that a transplant or elective procedure is approved, the cost is the responsibility of the inmate.
1.1	232	1. Rationale:
	233	11. PCF cannot deny or unreasonably delay care for inmates' serious health care needs.
	234	11. Inmates who could afford to pay the costs of their health care would often receive a windfall of free medical care resulting from their own wrongful acts which necessitated incarceration. Insurers of inmates might reap the same windfall if PCF were always required to indemnify the inmate for the cost of health care.
	235
	236	CH 14_111 __HEALTH CARE PROVIDER QUALIFICATIONS__
	237
	238	1. Policy:
	239	11. Health care providers working in the jail are required to meet the same certification and licensing requirements as do health care providers who provide services to persons not incarcerated. Health care providers will have current licenses and/or certificates as required by the State of Utah to perform their services. Those requiring health care qualifications should include, but not be limited to:
	240	111. Health care administrator/coordinator;
	241	111. Health care providers; and
	242	111. Others involved in assisting roles.
	243	11. Interns, students, and other non-certified/non-licensed personnel involved in the delivery of health care services to inmates should be:
	244	111. Permitted to work only under the direct supervision of a certified/licensed health care professional (e.g., a physician, nurse, physician's assistant, or nurse practitioner); and
	245	111. Limited to those functions that are well within the limits of their training and expertise.
	246	1. Rationale:
	247	11. Certification and licensing are required by law.
	248	11. Reasonable assurance should exist that persons involved in the delivery of health care are qualified and meet licensing requirements.
	249	11. Not all tasks and functions which occur in the process of delivering health care to inmates must be done by certified or licensed personnel. There are a large number of functions which, under the direction of a health care professional, can be handled by students, interns, or others. If supervised and limited in what they can do, the students, interns, or trainees can handle such functions without risk to inmates.
	250
	251	CH 14_112 __RESPONSIBILITY AND AUTHORITY__
	252
	253	1. Policy:
	254	11. The PCF contract physician should have responsibility and authority for medical and mental health care delivery and decisions concerning the nature, necessity, urgency, and levels of medical and mental health care for inmates. Consistent with Utah law, the physician may delegate the responsibility for certain medical functions to nurses.
	255	11. The PCF contract dentist should have responsibility and authority for dental care delivery and decisions concerning the nature, necessity, urgency, and levels of dental care for inmates.
6.1	256	11. The delivery of health care to inmates should be supervised by the highest-ranking member of the medical staff (i.e., the Medical Branch Director). The Medical Branch Director should have responsibility and authority for administrative tasks and decisions regarding the Medical Branch not covered by the contract physician or contract dentist.
1.1	257	1. Rationale:
	258	11. Designation of responsibility is crucial to ensure consistent delivery of quality health care, to eliminate any question of decision-making authority in the event of questions or conflicts related to health care decisions, and generally ensure compliance with legal and medical requirements.
	259
	260	CH 14_113 __TUBERCULOSIS__
	261
	262	1. Policy:
	263	11. Every arriving ICE detainee should receive a TB test during the admission process within one business day of arrival.
6.1	264	11. ICE detainees not screened should be housed separately from the general population.
1.1	265	1. Rationale:
	266	11. TB testing of ICE detainees is required by ICE standards.
	267
	268	CH 14_114 __CONTROL DEVICES__
	269
	270	Reference policy: [[AE 02 Restraints.>>doc:Policy.Administrative.AE 02 Restraints.WebHome]]
	271
	272
	273	CH 14_115 __ISOLATION__
	274
	275	1. Policy:
	276	11. Therapeutic isolation may be used under the direction of the contract physician.
	277	11. Inmates found to have the following types of medical problems will be held in isolation until they can be fully evaluated:
	278	111. Tuberculosis;
	279	111. Hepatitis;
	280	111. HIV/AIDS;
	281	111. Open wounds or sores;
	282	111. Fractures, prosthetic limbs, canes, or casts;
	283	111. Oxygen or breathing apparatus; or
6.1	284	111. A physical disability which would prevent safe housing in general population.
1.1	285	11. Rationale:
	286	111. Isolation may prevent the spread of a disease or illness or may be necessary to maintain safety and security.
	287
	288	CH 14_116 __PRIVACY OF CARE__
	289
	290	1. Policy:
	291	11. Examinations will be conducted in private, if possible. Exams will not be observed by security personnel unless the inmate poses a risk for the health care provider. Whenever possible, two members of the medical staff will be present at these exams.
	292	1. Rationale:
	293	11. Health care should be provided with consideration for the patient's rights and dignity, within security parameters.
	294
	295	CH 14_117 __PREGNANCY__
	296
	297	1. Policy:
	298	11. Health care should be provided for female inmates who are pregnant, lactating, or in need of postpartum care.
	299	11. Pregnant inmates should be referred to the contract physician for a medical evaluation.
	300	11. Pre-natal care for pregnant inmates should be provided by PCF.
	301	1. Rationale:
	302	11. Pregnancies and the period following pregnancy are periods of time when women may require additional medical care. It makes sense to provide additional medical attention during that time to reduce the possibility of medical problems related to pregnancy.
	303
	304	CH 14_118 __HOSPITALIZATION__
	305
	306	1. Policy:
	307	11. Inmates requiring hospitalization should remain in the hospital until cleared by the attending physician.
	308	11. Hospitalized inmates should be guarded by at least two certified officers throughout the duration of the stay (unless the inmate is released from custody). At least one officer should remain in the inmate's room.
	309	11. Inmates should not be allowed to use the telephone or have visitors unless authorized by the Corrections Chief Deputy.
	310	1. Rationale:
	311	11. Hospitals are less suited for the security management of inmates than jails and prisons. Thus, increased security precautions should be taken.
	312
	313	CH 14_119 __TREATMENT PLANS__
	314
	315	1. Policy:
	316	11. Health care professionals providing medical, mental health, or dental care to inmates should document a treatment plan for each inmate requiring treatment.
	317	1. Rationale:
	318	11. To ensure continuity and appropriateness of treatment there should be a documented treatment plan to guide health care delivery to inmates.
	319	11. Treatment plans are of value to prevent inmates from manipulating medical providers or playing one against another.
	320
	321	CH 14_120 __HEALTH CARE RECORDS__
	322
	323	1. Policy:
	324	11. The health care delivery process should be documented by creating and maintaining individual health care files for each inmate.
	325	11. Health care files should include:
	326	111. Initial health screening forms completed during the admissions process;
	327	111. Medical and mental health evaluation reports, if prepared;
	328	111. Inmate sick call requests;
	329	111. A chronological health record including:
	330	1111. All contacts with jail health care providers;
	331	1111. Findings, diagnoses, prescriptions, treatments, treatment plans, and progress reports;
	332	1111. The names of health care providers responsible for each health care transaction;
	333	1111. Dates, times, and other information necessary to document the actions taken;
	334	1111. Medication records, including prescription information (frequency, dosage, etc.) and dispensing (when and by whom);
	335	1111. Records relating to outside referrals for health care; and
	336	1111. Other information related to inmate health and health care.
	337	11. Jail officials should maintain inmates' health care records in a confidential manner. Inmate health care records should be maintained and stored in a locked area within the medical unit, separate from other inmate files. Inmate medical records should not be copied and placed in other non-medical files. Access to electronic medical files should be restricted to medical personnel only.
	338	11. Access to inmate health care records should be limited to:
	339	111. PCF medical staff;
	340	111. Non-medical PCF staff to the extent that the information is needed for the staff member to properly complete required duties (e.g., staff assigned to assist health care providers, staff assigned to classify or handle persons with a communicable disease, etc.);
	341	111. Persons for whom a release has been obtained from the inmate consistent with GRAMA requirements. The release of confidential medical records to outside sources shall be authorized by the inmate and witnessed by a staff member. This should be documented in writing and signed and dated by the inmate and witness;
	342	111. Compliance with discovery requirements in preparing to defend litigation; and
	343	111. Other circumstances consistent with GRAMA requirements.
	344	1. Rationale:
	345	11. Complete and accurate health care files prepared in a timely manner are critical to documenting the health care delivery process.
	346	11. Health care records are necessary to:
	347	111. Ensure continuity of care;
	348	111. Furnish health care providers an accurate history of each inmate's health care history while in the jail;
	349	111. Provide health care providers sufficient information to make proper diagnoses and/or treatment orders; and
	350	111. Document health care transactions in the event of litigation.
	351	11. Records containing data on an individual describing medical history, diagnosis, condition, treatment, evaluation or similar medical data are deemed to be "private" under GRAMA.
	352
	353	CH 14_121 __FORENSIC INFORMATION__
	354
	355	1. Policy:
6.1	356	11. The Medical Branch staff will not routinely participate in the collection of evidence by or for outside agencies or on unbooked individuals. Exemptions may be directed by the on-duty supervisor.
	357	11. Medical staff will assist in any lawfully ordered collection of evidence including DNA, body substances, hair, body cavity searches, and other searches required for reasons of security.
1.1	358	1. Rationale:
	359	11. The liability of the WCSO in regard to collection and preservation of forensic evidence has to be limited in areas outside the WCSO jurisdiction to protect safety, security, and budgetary interests.
	360
	361	CH 14_122 __HUNGER STRIKES__
	362
	363	1. Policy:
	364	11. When an inmate has declared a hunger strike or refused food or drink for 72 hours or more, staff should immediately refer the inmate to the Medical Branch for observation, evaluation, and monitoring. This referral should be documented in the jail computer system.
6.1	365	11. An inmate on a hunger strike should be counseled and advised of the medical risks and should be encouraged to end the hunger strike or accept medical treatment. Staff should document all treatment attempts and risk counseling.
	366	11. If a detainee held for another agency declares a hunger strike or refuses food or drink for 72 hours or more, that agency should be immediately notified and should receive necessary updates.
1.1	367	11. Staff should isolate an inmate on hunger strike to an observation cell. Medical staff are authorized to place an inmate in a special management cell or locked hospital room.
6.1	368	11. Medical staff should record the weight and vital signs of hunger-striking inmates at least once every 24 hours.
1.1	369	11. Staff should record the inmate's fluid intake and food consumption.
	370	11. During the initial evaluation of an inmate on a hunger strike, medical staff should:
	371	111. Measure and record height and weight;
	372	111. Measure and record vital signs;
	373	111. Conduct psychological/psychiatric evaluation;
	374	111. Examine general physical condition; and
	375	111. If clinically indicated, proceed with other necessary studies.
	376	11. During a hunger strike:
	377	111. Staff should provide the inmate at least three meals a day and document this in the jail computer system;
	378	111. Staff should provide the inmate an adequate supply of drinking water or other beverages;
	379	111. All food items should be removed from the inmate's cell (other than provided meals during meal times).
6.1	380	11. Staff should receive training on the identification, response, and management of hunger strikers during initial orientation and annually thereafter.
1.1	381	11. Only the contract physician may order an inmate's release from hunger strike care.
	382
	383	CH 14_123 __RELEASE OF INMATE__
	384
	385	1. Policy:
	386	11. The Medical Branch should be given advance notice prior to the release, transfer, or removal of an ICE detainee.
	387	11. ICE detainee medical records (or a copy) should be transferred with the detainee. The medical records should be sealed in an envelope and the envelope will be marked: “MEDICAL CONFIDENTIAL.”
	388	1. Rationale:
	389	11. The advance notice to the Medical Branch prior to the release, transfer, or removal of an ICE detainee is required by ICE standards.
	390
	391	CH 14_124 __INMATE WORKERS__
	392
	393	1. Policy:
	394	11. Inmates should not be authorized to perform any duties related to health care including, but not limited to:
	395	111. Performing direct patient care;
	396	111. Scheduling medical appointments;
	397	111. Determining access of other inmates to health care services;
	398	111. Handling or having access to surgical instruments, syringes, needles, medications, or health records; and
	399	111. Operating health care equipment.
	400	11. Janitorial services of the treatment rooms and offices in the Medical Branch may be provided by inmate workers under the direct supervision of corrections staff.
6.1	401	11. Inmate workers will receive blood-borne pathogen training and universal precaution training before cleaning in an area that might expose them to blood-borne diseases. This training will be documented in the jail computer system.
1.1	402	1. Rationale:
	403	11. Allowing inmates to perform health care duties or to have access to health care equipment could compromise patient care or facility security.
	404
	405	CH 14_125 __TERMINAL ILLNESS__
	406
	407	1. Policy:
	408	11. Chronically or terminally ill inmates should be transferred to an appropriate medical facility.
	409	11. PCF should not accept chronically or terminally ill contract inmates. If a contract inmate becomes chronically or terminally ill while housed at PCF (or if such is discovered or diagnosed while housed at PCF), the contracting agency should be immediately notified. PCF should defer notification of next-of-kin of the inmate's condition to the contracting agency.
	410	1. Rationale:
	411	11. PCF is not properly equipped to adequately manage chronically or terminally ill inmates.
	412
5.1	413	CH 14_126 __GENDER IDENTITY DYSPHORIA__
1.1	414
5.1	415	1. Policy:
	416	11. GID must be diagnosed by the appropriate medical and or mental health providers.
6.1	417	11. As a medical or psychological issue, proper treatment will need to be determined by the appropriate medical provider on an individual basis. WCSO does not have a blanket policy allowing or disallowing any form of treatment.
5.1	418	11. The safety and security of PCF as well as the individual inmates involved must be evaluated individually when dealing with inmates experiencing GID. Housing, programming, counseling, and medical decisions for such inmates will be made in conjunction with the appropriate medical and mental health providers. Staff questions or concerns should be directed to the medical department.
	419	1. Rationale:
	420	11. Treatment for GID is a medical decision and is therefore beyond the scope of jail administration alone.
	421	11. The treatment of inmates with GID encompasses issues that are outside the norm when considering the safety and security of both the facility and the inmates themselves.
	422
	423	CH 14_127 __SUICIDE PREVENTION AND INTERVENTION__
	424
1.1	425	Reference policy: [[CG 02 Suicide Prevention and Threats of Harm>>doc:Policy.Corrections.CG 02 Suicide Prevention and Threats of Harm.WebHome]].
	426
	427
5.1	428	CH 14_128 __INMATE DEATH AND ADVANCE DIRECTIVES__
1.1	429
2.1	430	Reference policy: [[CY 09 Inmate Death and Advance Directives>>doc:Policy.Corrections.Cy 09 Inmate Death and Advance Directives.WebHome]].
1.1	431
	432
5.1	433	CH 14_129 __SHARPS__
1.1	434
	435	Reference policy: [[AF 02 Communicable Disease>>doc:Policy.Administrative.AF 02 Communicable Disease.WebHome]].