(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 shall be reviewed on an annual basis.
Written policies and procedures shall 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
(3) Ensure decisions and
actions regarding health care and mental health care meet inmates
serious medical and mental health needs are the sole responsibility of
qualified health care and mental health professionals.
(4) No inmate shall be
denied necessary health care, as designated by the health
(B) (Essential) Inmate pre-screen. Before
acceptance into the jail, health-trained personnel shall inquire about, but not
be limited to the following conditions and the health authority shall develop
policies for the acceptance or denial of admission for:
(2) Current serious or
potentially serious medical or mental health issues needing immediate
(3) The use of an
electronic weapon, pepper spray or other less lethal use of force during
(C) (Essential) Receiving screen. Health
trained personnel, in accordance with protocols established by the health
authority, shall perform a written medical, dental and mental health receiving
screening on each inmate upon arrival at the jail and prior to being placed in
(1) Inquiry includes at
least the following:
(a) Current and past illness and health
(b) Current and past dental problems;
(c) Current and past mental health problems;
(e) Current medications for medical and mental
(f) Hospitalizations for medical or mental health
(g) Special health needs;
(h) Serious infection or communicable
(i) Use of alcohol and 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;
(j) Suicidal risk assessment;
(k) Possibility of pregnancy;
(l) Other health problems as designated by the health
(2) Observation of the
(a) Behavior including state of consciousness, mental
health status, appearance, conduct, tremors and sweating;
(b) Body deformities and ease of movement;
(c) Condition of skin, including trauma markings, bruises,
lesions, jaundice, rashes, infestations and needle marks or other indications
of drug abuse.
(3) Medical disposition
(a) General population;
(b) General population with prompt referral to appropriate
health or mental health services;
(c) Referral for emergency treatment;
(d) Medical observation/isolation;
(e) Mental health observation/precautions;
(f) Documentation of date, time and signature and title of
person completing screening.
(D) (Essential) Scope of service. The
jail shall provide, or make provisions for, twenty-four hour emergency health,
dental and mental health care.
(E) (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 works in accordance with
profession-specific job descriptions approved by the health
(F) (Essential) Sick call. The health
authority shall develop a policy and procedure for sick call whereby a
physician and/or qualified health care professional conducts sick
(G) (Essential) Health and mental health
complaints. The jail shall ensure that there is a daily procedure whereby
inmates have an opportunity to report medical and mental health complaints
through health-trained personnel, or for urgent matters, to any jail employee.
The jail employee shall contact the appropriate medical or mental health
department immediately. An inmate grievance system for medical and mental
health treatment shall be established by the health authority. Both daily
complaints and grievances shall be:
(1) Addressed in a timely
(2) Recorded and
maintained on file.
(3) Reviewed daily by
qualified health care personnel and treatment or follow-up shall be provided as
(H) (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.
(I) (Essential) Medical/mental health
record. The jail shall maintain an accurate health/mental health record in
written or electronic format. The health authority shall develop policies and
procedures concerning the following areas:
(1) Health records remain
confidential and are only accessible to personnel designated by the health
(2) Correctional staff
may be advised of inmates health/mental health status only to preserve
the health and safety of the inmate, other inmates, and jail staff and in
accordance with 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
(J) (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) The policies require
dispensing and administering prescribed medications by health-trained personnel
or professionally trained personnel, adequate management of controlled
medications, and provisions of medication to inmates in special management
(2) The jail shall
develop a policy, approved by the health authority, regarding incoming
(K) (Essential) Mental health services.
Inmates evidencing signs of mental illness or developmental disability shall be
referred immediately to qualified mental health personnel. The health authority
shall develop policies for the following areas:
(1) Screening for mental
(2) Referral to
outpatient services, including psychiatric care.
(3) Crisis intervention
and management of acute psychiatric episodes.
(4) Stabilization of
inmates with mental illness and prevention of psychiatric deterioration in the
(5) Referral and
admission to inpatient facilities.
(L) (Essential) Suicide prevention
program. The health authority shall have a plan for identifying and responding
to suicidal and potentially suicidal inmates. The plan components shall
(1) Identification. The
receiving screening form contains observation and interview items related to
the inmates potential suicide risk.
(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
shall designate the housing beds/units for the suicidal or potentially suicidal
(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
(7) Communication. The
plan specifies for ongoing communications (oral and written), notifications
between health care and correctional personnel regarding the status of suicidal
(8) Intervention The plan
addresses how to handle a suicide in progress, including first-aid
(9) Notification. The
plan includes procedures of notifying the jail administrator, outside
authorities and family members of completed suicides. The plan shall 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 are immediately reported to the
coroner/medical examiner and the division of parole and community services
within thirty days of the incident.
(11) Review. The plan specifies procedures for medical and
administrative review if a suicide or a serious suicide attempt
(12) Critical incident debriefing. The plan specifies the
procedures for offering critical incident debriefing to affected staff and
(M) (Important) Emergency equipment/supplies. Emergency
medical equipment and supplies, as determined by the health authority shall be
available at all times and replenished, as needed and may include automatic
external defibrillators (AEDs).
(N) (Essential) Infectious disease control program. The
health authority shall have a written infectious disease control program that
collaborates with the local health department and shall 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
(O) (Essential) Pregnant inmate. pregnant inmates shall
receive appropriate and timely pre-natal care, delivery and postpartum care, as
determined by the health authority.
(P) (Essential) Restraints. Use of restraints for medical
and psychiatric purposes shall be applied in accordance with policies and
procedures approved by the health authority, including:
(1) Conditions under which restraints may be
(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
(4) Monitoring procedures.
(5) Length of time restraints are to be
(a) There shall be
ten-minute, varied checks by correctional staff;
(b) There shall 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
(6) Documentation of efforts for less restrictive treatment
(7) An after-incident review.
(Q) (Important) Emergency response plan. The health aspects
of the emergency response plan (mass disaster drill and 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 responding to
medical emergencies are certified in cardiopulmonary resuscitation (CPR) in
accordance with the recommendations of certifying health
(R) (Essential) Continuing education for health trained
personnel. All qualified health care professionals participate annually in
continuing education appropriate for their position.
(S) (Important) Continuous quality improvement program. The
health authority shall develop a continuous quality improvement (CPI) system of
monitoring and reviewing, at least annually, 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.
(T) (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.
(U) (Essential) Intoxication and detoxification. The health
authority shall develop specific policies and protocols in accordance with
local, state and federal laws for the treatment and observation of inmates
manifesting symptoms of intoxication or detoxification from alcohol, opiates,
hypnotics, or other drugs. Specific criteria are established for immediately
transferring inmates experiencing severe, life-threatening intoxication
(overdose) or detoxification symptoms to a hospital or detoxification
(V) (Essential) Confidentiality. Information about an
inmate's health status is confidential. Non health trained staff only has
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
(W) (Important) Informed consent. The health authority
shall develop a policy and procedure requiring that all examinations,
treatments and procedures are governed by informed consent practices applicable
in the jail's jurisdiction.
(X) (Important) Privacy. The health authority shall 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.
(Y) (Important) Inmate death. In all inmate deaths, the
health authority determines the appropriateness of clinical care; ascertains
whether corrective action in the system's policies, procedures, or
practices is warranted; and identifies trends that require further