(A) The department of rehabilitation and correction shall provide health care to incarcerated offenders under its custody based upon individual assessment of their medical needs in accordance with the best use of available resources and recognized correctional health care standards. All care that is deemed medically necessary by departmental physicians shall be provided, with an emphasis on preventive care and with priority given to ongoing care of disease-specific, serious medical conditions. The health care services described in this rule are available only to offenders incarcerated in a department correctional institution.
(B) The term "medically necessary" as used in this rule means care without which the offender could not be maintained without significant risk of loss of life, loss of limb or significant bodily function. It also includes care without which one could expect significant pain or discomfort, further serious deterioration of the offender's medical status and/or a significant reduction in the chance of successful repair after release.
(C) Inmates incarcerated in a correctional institution operated by the department of rehabilitation and correction may expect the following health care services:
(1) Admission health evaluation
(a) Comprehensive baseline health history including inquiry into:
(i) Current illnesses and health problems;
(ii) Dental problems;
(iii) Mental health problems, including suicide assessment;
(iv) Substance abuse history;
(v) Past and present treatment or hospitalization for mental health disturbances or suicide;
(vi) Screening for past or present infectious diseases, including tuberculosis ;
(vii) Possibility of pregnancy (if applicable);
(viii) Any other health problems reported by the inmate.
(b) Comprehensive physical examination including:
(i) Examination by a physician or other advanced level health care provider;
(ii) Baseline lab work;
(iii) Screening for sexually transmitted diseases, as mandated;
(iv) Pregnancy test (females only);
(v) Other lab work deemed necessary by the physician or advanced level health care provider.
(c) Immunizations as medically necessary.
(d) Baseline dental examination including:
(i) Baseline dental screening;
(ii) Dental x-rays as indicated.
(e) Assignment of a medical classification based on the comprehensive history and physical examination.
(f) Institution assignment based on the determined medical classification.
(g) Orientation to prison health care system.
(2) Routine care:
(a) Unimpeded access to nursing and medical services through nursing sick call and medical sick call.
(b) Chronic care clinics. Care includes regular follow-up based on disease and symptom control:
(vii) Seizure disorders;
(viii) Chronic liver disease, including hepatitis C;
(ix) Other chronic medical diseases as deemed necessary by the physician.
(3) Offer of regular physical examination:
(a) For all inmates over fifty years old, annual physical examinations to include:
(i) Complete vital signs;
(ii) Cancer screening tests as medically indicated;
(iii) Lab work as indicated;
(iv) Optometry examination as indicated ;
(v) Dental examination as indicated;
(vi) Immunizations, offered as medically indicated;
(vii) Pelvic examination, pap smear and breast exam for all women;
(viii) Mammogram annually according to united states prevention services task force grade A and B recommendations ;
(ix) Testicular examination according to united states prevention services task force grade A and B recommendations ;
(x) Digital rectal examination.
(b) For all inmates between the ages of forty and fifty, physical examinations every two years, to include:
(i) Optometry examination as indicated;
(ii) Dental examination as indicated ;
(iii) Immunizations, offered as medically indicated;
(iv) Breast examination for females according to united states prevention services task force grade A and B recommendations ;
(v) Mammograms for women according to united states prevention services task force grade A and B recommendations ;
(vi) Testicular examination for men according to united states prevention services task force grade A and B recommendations;
(vii) Cancer screening tests as medically indicated.
(c) For all inmates under the age of forty, a physical examination as indicated, to include all procedures listed above for inmates between the ages of forty and fifty.
(4) Nurse's sick call, which includes:
(a) Nursing assessment;
(b) Patient education, specific to disease or condition;
(c) Referral to advanced health provider, mental health services or dietary services, as indicated.
(5) Medical sick call - by a physician or other advanced health care provider.
(a) Primary care;
(b) Chronic care clinics as outlined above;
(c) Referral for specialty consultation as deemed necessary by the provider.
(6) Mental health services:
(a) Mental health screening upon admission;
(b) Full mental health evaluation, as indicated;
(c) Crisis care;
(d) Suicide prevention services;
(e) Individual and group psychotherapy, as indicated;
(f) Mental health programming, as indicated;
(g) Residential treatment facilities when necessary;
(h) Psychiatric hospitalization, when necessary;
(i) Residential MR/DD services when necessary.
(7) Dietary services:
(a) Nutritional assessment when indicated;
(b) Customized diet plan, as ordered by a physician when medically necessary;
(c) Disease specific dietary counseling.
(8) Pharmacy services:
(a) Prescription medication provided as medically indicated, per a restricted formulary.
(b) Off formulary medications approved when medically necessary.
(c) Instructions regarding prescribed medications provided as indicated.
(9) Dental services:
(a) Admission screening;
(b) Routine dental services (restorations, extractions);
(c) Emergency dental services (for acute infection, broken teeth, fractures);
(d) Specialty dental services as deemed necessary by primary care dentist;
(i) Removable prosthodontics (dentures);
(ii) Oral surgery (for impacted teeth, pathology, and other medically necessary procedures);
(iii) Periodontal services as medically necessary.
(10) Infectious disease prevention and treatment:
(a) Screening, testing, treatment and follow-up as indicated for tuberculosis, sexually transmitted diseases, HIV, hepatitis and other infectious diseases.
(b) Infectious disease educational programming, with an emphasis on prevention.
(11) Optometry services:
(a) Optometric examination as indicated and eyeglasses as needed.
(b) Glaucoma screening as indicated.
(12) Podiatry services:
(a) Diabetic foot exams annually and treatment as needed.
(b) Orthotics when medically indicated.
(13) Dialysis services.
(14) Pregnancy management:
(a) Prenatal services;
(b) Nursery program if deemed appropriate;
(c) Delivery services at Ohio state university hospital.
(15) Audiograms and hearing aids as medically indicated.
(16) Physical therapy and/or mobility aids, as medically indicated:
(17) Specialty physician consultations as medically indicated for specific disease processes.
(18) Surgeries and treatments:
(a) Procedures or treatments approved when necessary to:
(i) Preserve life or limb;
(ii) Prevent further serious deterioration or significant reduction of the chance of possible repair after release;
(iii) Alleviate significant pain or discomfort.
(b) Procedures or treatments of an elective nature are subject to review and prior approval on a case-by-case basis.
(c) Procedures or treatments that are only marginally effective will be considered only after careful review of the procedure's effectiveness, alternatives, risks, the severity of the inmate's illness, the cost of the procedure and the likelihood of recovery.
(d) Procedures or treatments of a purely cosmetic nature will not be approved.
(e) Procedures or treatments generally considered to be experimental may be considered only after all conventional options have been exhausted and a human research review committee reviews the treatment or procedure proposed for that inmate.
(19) Prosthetic devices provided as medically indicated to support independent functioning.
(20) Primary and advanced diagnostic laboratory and x-ray services provided as necessary to support medically necessary care.
(21) Emergency services:
(a) First aid, nursing care and basic life support are provided on-site twenty-four hours a day by appropriately licensed medical staff.
(b) Transport to outside emergency care facilities provided as medically necessary.
(22) Acute inpatient and skilled nursing care:
(a) Hospital level of care at an accredited medical facility provided as medically necessary;
(b) Inpatient skilled nursing care and end-of-life care provided at the Franklin medical center;
(c) Intermediate inpatient and outpatient care provided at Frazier health center.
(23) Discharge planning services:
(a) Summary health care information available upon release to support continuity of care;
(b) Limited supply of essential medication provided on release from prison;
(c) Community linkage services provided for inmates with mental illness and, per department of health guidelines, certain infectious diseases.
(D) Preventive health care is encouraged and supported within department institutions. Each offender will be provided written and oral instruction regarding access to health care services, with an emphasis on preventive services available. preventive services include the following:
(1) Health care screenings:
(a) Screenings for infectious diseases and sexually transmitted diseases;
(b) Mental health screenings for suicide risk and mental illness.
(2) Immunizations as medically indicated.
(3) Age specific, routine physical examinations, inclusive of screenings for cancer as medically indicated.
(4) Tuberculosis surveillance program inclusive of intake and annual screening and follow-up, treatment as medically indicated, and medical isolations as necessary to prevent transmission.
(5) Chronic disease clinics inclusive of regularly scheduled evaluations, medication monitoring and disease specific patient education.
(6) Preventive patient education inclusive of, but not limited to, infectious disease prevention, smoking cessation and nutrition and dietary guidelines.
(7) Preventive dental services including instructions on dental hygiene, and routine scaling as time and resources permit.
Cite as Ohio Admin. Code 5120-9-60