Ohio Admin. Code 5120:1-8-09 - Medical/mental health
(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 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
shall be denied necessary health care, as designated by the health
authority.
(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:
(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, 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 general population.
(1) Inquiry
includes at least the following:
(a) Current
and past illness and health problems;
(b) Current and past dental
problems;
(c) Current and past
mental health problems;
(d)
Allergies;
(e) Current medications
for medical and mental health;
(f)
Hospitalizations for medical or mental health purpose(s);
(g) Special health needs;
(h) Serious infection or communicable
illness(s);
(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 authority.
(2) Observation of the following:
(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 of inmate:
(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, physician's assistant,
EMT 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 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 assessment.
(7) Initiation of therapy when determined
necessary by the examiner.
(8)
Development and implementation of a treatment plan.
(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
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 manner.
(2)
Recorded and maintained on file.
(3) Reviewed daily by qualified health care
personnel and treatment or follow-up shall 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 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 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.
(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 units.
(2)
The jail shall develop a policy, approved by the health authority, regarding
incoming medications.
(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 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 shall be referred immediately to qualified mental
health personnel. The health authority shall 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 shall have a plan for identifying and responding to
suicidal and potentially suicidal inmates. The plan components shall 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 timeframes
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 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 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 prenatal 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, 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 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
minutes.
(6)
Documentation of efforts for less restrictive treatment alternatives.
(7) An after-incident review.
(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) (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 conditions.
(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 inmate's 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 correctional
staff.
(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 jail's 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 inmate's privacy.
(AA) (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
study.
Notes
Promulgated Under: 111.15
Statutory Authority: 5120.01, 5120.10
Rule Amplifies: 5120.10
Prior Effective Dates: 01/02/1981, 06/02/1986, 07/01/1994, 09/21/1998, 02/21/2003, 09/01/2011, 04/20/2014
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