(A) (Essential) Health authority. The
jail has a designated health authority with responsibility for health and/or
mental health care services pursuant a written agreement, contract or job
description. The health authority may be a physician, health administrator or
agency. When the health authority is other than a local physician, final
clinical judgment rests with a single, designated, responsible, local physician
licensed in Ohio. The health authority is responsible and authorized
to:
(1) Provide written
policies and procedures specifically designed for the jail for all aspects of
this standard that will be reviewed on an annual basis.
Written policies and procedures will be easily
accessible to staff and simple to understand.
(2) Arranges for all
levels of health care, mental health care and dental care and assures quality,
accessible and timely services for inmates. When necessary medical, mental
health or dental care is not available at the jail, inmates are referred to an
appropriate setting.
(3) Ensure where there is
a separate organizational structure for mental health services; there is a
designated mental health clinician.
(4) Ensure decisions and
actions regarding health care and mental health care meet inmate's
serious medical and mental health needs are the sole responsibility of
qualified health care and mental health professionals.
(5) No inmate will be
denied necessary health care, as designated by the health
authority.
(B) (Essential) Inmate pre-screen. Before
acceptance into jail, health-trained personnel will inquire about, but not be
limited to the following conditions and the health authority will develop
policies for the acceptance or denial of admission for:
(1) Suicide
thoughts/plan.
(2) Current serious or
potentially serious medical or mental health issues needing immediate
attention.
(3) The use of taser,
pepper spray or other less lethal use of force during arrest.
(4) Observe for signs of
and inquire about drug and/or alcohol intoxication or abuse.
(C) (Essential) Receiving screen. Health
trained personnel, in accordance with protocols established by the health
authority, will perform a written medical, dental, substance abuse and mental
health receiving screening on each inmate within six hours of arrival at the
jail and prior to being placed in general population unless there are emergency
circumstances preventing the receiving screen from being completed within that
time frame, in which case the reason for delay will be documented on the
receiving screen.
(1) The receiving screen
will include:
(a) Questions addressing the following, at a
minimum:
(i) Current and past
illness and health problems;
(ii) Current and past
dental problems;
(iii) Current and past
mental health problems;
(iv) Allergies;
(v) Current medications
for medical, substance use or medication assisted treatment, and mental
health;
(vi) Hospitalizations for
medical or mental health purpose(s);
(vii) Special health
needs;
(viii) Serious infection
or communicable illness(s)
(ix) Use of alcohol or
drugs including types, amounts and frequency used, date or time of last use,
and history of any problems after ceasing use, i.e. withdrawal
symptoms;
(x) Suicidal risk
assessment;
(xi) Possibility of
pregnancy;
(xii) Other health
problems as designated by the health authority;
(xiii) Date, time,
signature, and title of person completing the screening.
(b) Observation of the following:
(i) Behavior including
state of consciousness, mental health status, appearance, conduct, tremors, and
swearing;
(ii) Body deformities and
ease of movement;
(iii) Condition of skin,
including trauma markings, bruises, lesions, jaundice, rashes, infestations and
needle marks or other indications of drug abuse.
(c) Medical status will determine the inmate's
assignment into one of the following:
(i) General
population;
(ii) General population
with prompt referral to appropriate health or mental health
services;
(iii) Referral for
emergency treatment;
(iv) Medical
observation/isolation;
(v) Mental health
observation/precautions.
(D) (Essential) Health appraisal. Within
fourteen days, a licensed nurse, physician, physician's assistant, or
paramedic will complete a health appraisal to determine the medical and mental
health condition for each inmate in custody. Such appraisal will at least
include the following:
(1) Review of receiving
screen.
(2) Collection of
additional data to complete the medical, dental and mental health
history.
(3) Laboratory, and/or
diagnostic tests to detect tuberculosis and other suspected communicable
diseases as designated by the health authority.
(4) Recording the height,
weight, pulse, blood pressure and temperature.
(5) Medical examination
as determined by the examiner.
(6) Mental health and
substance use screenings.
(7) Initiation of therapy
when determined necessary by the examiner.
(8) Development and
implementation of a treatment plan.
If performed by an licensed practical nurse or
paramedic, the assessment should be reviewed and approved by a registered nurse
or more highly qualified health care professional.
(9) Other test and
examination as determined by the examiner or health authority.
(E) (Essential) Full-service scope. The
jail provides twenty-four-hour emergency medical, dental, and mental health
care services.
(F) (Essential) Sick call. A physician
and/or qualified health care professional conducts sick call.
(1) Once per week for
jails with an average daily population of less than fifty.
(2) Three times per week
for jails with an average population of less than one hundred
ninety-nine.
(3) Five times per week
for jails with an average daily population of two hundred or more.
(G) (Essential) Credentials. All health
and mental health care personnel who provide services to inmates are
appropriately credentialed according to the licensure, certification, and
registration requirements of Ohio. Verification of current credentials is on
file at the facility. Health care staff work in accordance with
profession-specific job descriptions approved by the health
authority.
(H) (Essential) Health and mental health
requests. The jail will ensure that there is a daily procedure whereby inmates
have an opportunity to report medical and mental health requests through health
trained personnel, or for urgent matters, to any jail employee. The jail
employee will contact the appropriate medical or mental health department
immediately. An inmate grievance system for medical and mental health treatment
will be established by the health authority. Both daily requests and grievances
will be:
(1) Addressed in a timely
manner.
(2) Recorded and
maintained on file.
(3) Reviewed daily by
qualified health care personnel and treatment or follow-up will be provided as
necessary.
(I) (Important) Personal physician
treatment. Inmates can be treated by a personal physician in the jail at their
own expense, upon the approval by the jail physician, provided that the current
credentials of the personal physician are verified.
(J) (Essential) Medical/mental health
record. The jail will maintain an accurate health/mental health record in
written or electronic format. The health authority will develop policies and
procedures concerning the following areas:
(1) Health records remain
confidential and are only accessible to personnel designated by the health
authority.
(2) Correctional staff
may be advised of inmates' health/mental health status only to preserve
the health and safety of the inmate, other inmates, jail staff and in
accordance state and federal laws.
(3) Retention and
reactivation of said records if an inmate returns to the facility.
(4) Transfer of
medical/mental health information or record to external care provider or other
facility.
(K) (Essential) Pharmaceuticals.
Pharmaceuticals are managed in accordance with policies and procedures approved
by the health authority and in compliance with state and federal laws and
regulations and include the following:
(1) Health-trained
personnel or professionally trained personnel dispense and administer
prescribed medications and ensure adequate management of controlled medications
and provision of medication to inmates in special management
units.
(2) The jail will develop
a policy, approved by the health authority, regarding incoming
medications.
(L) (Important) Dental care. Inmates will
be provided dental and oral care under the direction and supervision of a
dentist licensed in the state of Ohio. There is a system of established
priorities for care, when in the dentist's judgment, the inmate's
health would otherwise be adversely affected.
(M) (Essential) Mental health services.
Inmates evidencing signs of mental illness or developmental disability will be
referred immediately to qualified mental health personnel. The health authority
will develop policies for the following areas:
(1) Screening for mental
health problems.
(2) Referral to
outpatient services, including psychiatric care.
(3) Crisis intervention
and management of acute psychiatric episodes.
(4) Stabilization of the
mentally ill and prevention of psychiatric deterioration in the
jail.
(5) Referral and
admission to inpatient facilities.
(6) Informed
consent.
(N) (Essential) Suicide prevention
program. The health authority will have a plan for identifying and responding
to suicidal and potentially suicidal inmates. The plan components will
include:
(1) Identification
The receiving screening form contains observation and interview items
related to the inmate's potential suicide risk. Circumstances include but
are not limited to: profound incidents/issues, court dates, loss of significant
others either by accident, natural causes or by suicide, sentencing, divorce,
rejection, bad news, after a humiliating issue, etc. may be high risk periods
for inmates.
(2) Training
Staff members who work with inmates are trained to recognize verbal and
behavioral cues that indicate potential suicide and how to respond
appropriately. The plan includes initial and annual training.
(3) Assessment
The plan specifies a suicide risk assessment and level system. The assessment
needs to be completed every time an inmate is identified as being or
potentially being suicidal, or if circumstances change. Only a qualified mental
health professional may remove inmates from suicide risk status.
(4) Housing The
plan must designate the housing beds/units for the suicidal or potentially
suicidal inmates.
(5) Monitoring
The plan specifies the procedures for monitoring an inmate who has been
identified as potentially suicidal. A suicidal inmate is checked at varied
intervals not to exceed ten minutes. Regular documented supervision is
maintained. Inmates are placed in a designated cell, all belongings removed and
other prevention precautions initiated, as appropriate.
(6) Referral The
plan specifies the procedures for referring a potentially suicidal inmate and
attempted suicides to a mental health care provider or facility, and includes
time frames.
(7) Communication
The plan specifies for ongoing communications (oral and written), notifications
between health care and correctional personnel regarding the status of suicidal
inmates.
(8) Intervention
The plan addresses how to handle a suicide in progress, including first-aid
measures.
(9) Notification
The plan includes procedures of notifying the jail administrator, outside
authorities and family members of completed suicides. The plan will consider
safety and security issues when it comes to notification.
(10) Reporting
The plan includes procedures for documenting, monitoring and reporting
attempted or completed suicides. Completed suicides will be reported to the
bureau of adult detention within twenty-four hours of the occurrence unless the
suicide occurs on a weekend or a holiday, in which case, the report will be
made on the next business day.
(11) Review The
plan specifies procedures for medical and administrative review if a suicide or
a serious suicide attempt occurs.
(12) Critical incident
debriefing The plan specifies the procedures for offering critical
incident debriefing to affected staff and inmates.
(O) (Important) Emergency
equipment/supplies. Emergency medical equipment and supplies, as determined by
the health authority will be available at all times and replenished, as needed
and may include automatic external defibrillators (AEDs).
(P) (Essential) Infectious disease
control program. The health authority will have a written infectious disease
control program which collaborates with the local health department and will
include, at minimum, an exposure control plan and standard isolation
precautions for inmates and staff, which are updated annually. The health
authority will develop written policy and procedure.
(Q) (Essential) Pregnant inmate. Pregnant
inmates will receive appropriate and timely pre-natal care, delivery and
postpartum care, as determined by the health authority. Policies, procedures,
and practices regarding restraint of pregnant women will comply with section
2901.10 of the Revised Code.
(R) (Essential) Restraints. Use of
restraints for medical and psychiatric purposes will be applied in accordance
with policies and procedures approved by the health authority,
including:
(1) Conditions under
which restraints may be applied.
(2) Types of restraints
to be applied.
(3) Identification of a
qualified medical or mental health professional who may authorize the use of
restraints after reaching the conclusion that less intrusive measures are not a
viable alternative.
(4) Monitoring
procedures.
(5) Length of time
restraints are to be applied.
(a) There will be ten-minute, varied checks by correctional
staff;
(b) There will be thirty-minute checks by health-trained
personnel;
(c) Inmates in medical restraints, if possible, after every two
hours of continuous use, each extremity is freed or exercised for a period of
five to ten minutes.
(6) Documentation of
efforts for less restrictive treatment alternatives.
(7) An after-incident
review.
(S) (Important) Continuous quality
improvement program. The health authority will develop a continuous quality
improvement (CPI) system of monitoring and reviewing, the fundamental aspects
of the jail's health/mental health care system, including but not limited
to: access to care; the intake process; emergency care and hospitalizations;
and, adverse inmate occurrences, including all deaths. Periodic chart reviews
are included to determine the timeliness and appropriateness of the clinical
care provided to inmates. The health authority and the jail administrator or
their designees meet at least quarterly.
(T) (Important) Emergency response plan
The health aspects of the emergency response plan (mass disaster drill
& man down drill). Emergency medical care, including first aid and basic
life support, is provided by all health care professionals and those
health-trained correctional staff specifically designated by the jail
administrator. All staff performing cardiopulmonary resuscitation (CPR) are
certified in accordance with the recommendations of certifying health
organizations.
(U) (Essential) Continuing education for
health trained personnel. All qualified health care professionals participate
annually in continuing education appropriate for their position.
(V) (Essential) Special nutritional and
medical diets. Inmate diets are modified when ordered by the appropriate
licensed individual to meet specific requirements related to clinical
conditions.
(W) (Essential) Intoxication withdrawal.
The health authority will develop specific policies and protocols in accordance
with local, state and federal laws for the treatment and observation of inmates
manifesting symptoms of withdrawal from alcohol, opiates, hypnotics, or other
drugs. Specific criteria are established for immediately transferring inmates
experiencing severe, life-threatening intoxication (overdose) or withdrawal
symptoms to a hospital or withdrawal management center.
(X) (Important) Substance use care. The health authority
will develop specific policies and protocols for the care of individuals
regarding substance use care, including but not limited to:
(1) ) Continuity of care; Jails will establish systems to
ensure that patients who had been receiving medication assisted treatment (MAT)
before their arrest have MAT continued in a timely manner and have a plan
developed for continuation of treatment post release.
(2) Diversion of agonist medications: MAT programs will
have risk mitigation strategies including ongoing monitoring for individuals
receiving MAT.
(3) MAT for pregnant women: Pregnant women with opioid and
alcohol use disorders require specialized services to prevent and reduce health
risks during pregnancy.
(Y) (Essential) Confidentiality. Information about an
inmate's health status is confidential. Non-medical staff only have
access to specific medical information on a "need to know" basis in
order to preserve the health and safety of the specific inmate, other inmates,
volunteers, visitors, criminal justice professionals or correctional staff. The
active health record is maintained separately from the confinement case record
and access is controlled in accordance with state and federal
laws.
(Z) (Important) Informed consent. The health authority will
develop a policy and procedure requiring that all examinations, treatments and
procedures are governed by informed consent practices applicable in the
jail's jurisdiction.
(AA) (Important) Privacy. The health authority will develop
a policy whereby health care encounters, including medical and mental health
interviews, examinations, and procedures are conducted in a setting that
respects the inmate's privacy.
(BB) (Important) Inmate death. In all inmate deaths, the
health authority determines the appropriateness of clinical care; ascertains
whether corrective action in the healthcare system's policies,
procedures, or practices is warranted; and, identifies trends that call for
further study.
