(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
(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 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 inmates
serious medical and mental health needs are the sole responsibility of
qualified health care and mental health professionals.
(5) No inmate shall be
denied necessary health care, as designated by the health
(B) (Essential) Inmate pre-screen. Before
acceptance into 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 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, 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) Health appraisal. Within
fourteen days, a licensed nurse, physician, physicians assistant, or
paramedic shall complete a health appraisal to determine the medical and mental
health condition for each inmate in custody. Such appraisal shall at least
include the following:
(1) Review of receiving
(2) Collection of
additional data to complete the medical, dental and mental health
(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
(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
(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
(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
(H) (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
(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 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, 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
(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) 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
(L) (Important) Dental care. Inmates
shall 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 dentists judgment, the inmates
health would otherwise be adversely affected.
(M) (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 the
mentally ill and prevention of psychiatric deterioration in the
(5) Referral and
admission to inpatient facilities.
(N) (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
The receiving screening form contains observation and interview items
related to the inmates 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
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.
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
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
The plan specifies for ongoing communications (oral and written), notifications
between health care and correctional personnel regarding the status of suicidal
The plan addresses how to handle a suicide in progress, including first-aid
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.
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 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 shall 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 shall have a written infectious disease
control program which 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 shall develop written policy and procedure.
(Q) (Essential) Pregnant inmate. Pregnant
inmates shall receive appropriate and timely pre-natal care, delivery and
postpartum care, as determined by the health authority.
(R) (Essential) Restraints. Use of
restraints for medical and psychiatric purposes shall be applied in accordance
with policies and procedures approved by the health authority,
(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
(5) Length of time
restraints are to be applied.
(a) There shall be ten-minute, varied checks by
(b) There shall be thirty-minute checks by health-trained
(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
(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 jails 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) (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 responding to medical emergencies are certified in
cardiopulmonary resuscitation (CPR) 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
(W) (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 center.
(X) (Essential) Confidentiality.
Information about an inmates health status is confidential. Non health
trained 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
(Y) (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 jails jurisdiction.
(Z) (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 inmates privacy.
(AA) (Important) Inmate
death. In all inmate deaths, the health authority determines the
appropriateness of clinical care; ascertains whether corrective action in the
systems policies, procedures, or practices is warranted; and, identifies
trends that require further study.