Tenn. Comp. R. & Regs. 1400-01-.13 - MEDICAL SERVICES
(1) Type I, II,
III, and IV Facilities shall meet the following requirements unless otherwise
specified.
(2) The provision of
medical services for the facility shall be the responsibility of a designated
health authority such as a hospital, clinic, or physician. There shall be an
agreement between the governmental funding agency responsible for the facility
and the hospital/clinic/physician responsible for such services. The designated
health authority must be notified in instances where an inmate may be in need
of medical treatment and the facility shall document this notification. The
health authority shall meet with the Sheriff and/or facility administrator at
least annually.
This requirement applies only to Type I, II, and III Facilities.
(3) Medical
decisions are the sole province of the responsible health care provider and
shall not be countermanded by non-medical personnel.
This requirement applies only to Type I, II, and III Facilities.
(4) All health
care professional staff shall comply with applicable state and federal
licensure, certification, or registration requirements. Verification of current
credentials shall be available upon request from the provider. Health care
staff shall work in accordance with profession-specific job descriptions
approved by the health authority. If inmates are assessed or treated by
non-licensed health care personnel, the care shall be provided pursuant to
written standing or direct orders by personnel authorized to give such orders.
This requirement applies only to Type I, II, and III Facilities.
(5) Continuity
of care is required from admission to transfer or discharge from the facility,
including referral to community-based providers, when indicated. When health
care is transferred to providers in the community, appropriate information
shall be shared with the new providers in accordance with consent requirements.
Prior to release from custody or transfer, inmates with known serious health
conditions shall be referred to available community resources by the facility's
health care provider currently providing treatment.
This requirement applies only to Type I, II, and III Facilities.
(6) Written
policy and procedure shall prohibit inmates from performing patient care
services, scheduling health care appointments or having access to medications,
health records or medical supplies and equipment.
This requirement applies only to Type I Facilities.
(7) First aid kits shall be
available and a physician shall approve the number, contents, and location of
such kits on an annual basis. Documentation of such approval must be in the
facility's permanent records or attached to the kit itself.
This requirement applies only to Type I, II, and III Facilities.
(8) Receiving
screening shall be performed on all inmates upon admission to the facility and
before placement in the general housing area. The findings shall be recorded on
a printed screening form. The officer performing this duty shall check for:
(a) A serious illness;
(b) A comatose state;
(c) Obvious wounds;
(d) Prescribed medications; and
(e) Suicide risk assessment, including
suicidal ideation or history of suicidal behavior or other mental health
illness.
These requirements apply only to Type I, II, and III Facilities.
(9)
A more complete examination shall be completed on inmates within fourteen (14)
days of the inmate's initial confinement date. If the facility can document
that a health appraisal was conducted within the previous ninety (90) days,
this fourteen (14) day physical is not required unless medical conditions
dictate otherwise. This examination shall be performed by a physician or a
person who has been designated by a physician as capable of performing such
examination. If a designee performs the examination, he/she must do so under
supervision of a physician and with a protocol or set of instructions and
guidelines from the physician. This examination shall include:
(a) Inquiry into current illness and health
problems, including those specific to women;
(b) Inquiry into medications taken and
special health requirements;
(c)
Screening of other health problems designated by the responsible
physician;
(d) Behavioral
observation, including state of consciousness and mental status;
(e) Notification of body deformities, trauma
markings, bruises, lesions, jaundice, ease of movement, etc.
(f) Condition of skin and body orifices,
including rashes and infestations;
(g) Disposition/referral of inmates to
qualified medical personnel on an emergency basis;
(h) A review of the initial intake receiving
screening; and
(i) An individual
treatment plan as appropriate.
These requirements apply only to Type I Facilities.
(10)
All intersystem transfer inmates (transferred from one confinement facility to
another within the same county's jurisdiction) shall receive a health screening
by trained or qualified health care personnel, upon arrival at the facility.
All findings are recorded on a screening form approved by the health authority.
At a minimum, the screening includes the following:
(a) A review of the inmate's medical, dental,
and mental health problems;
(b)
Current medications; and
(c)
Current treatment plan.
These requirements apply only to Type I, II, and III Facilities.
(11)
Sick call, conducted by a physician or other person designated by a physician
as capable of performing such duty, shall be available to each inmate according
to written procedure for sick call. The inmate shall be informed of these
procedures, including any copayment requirements, as well as procedures for
submitting grievances, upon admission.
This requirement applies only to Type I, II, and III facilities.
(12) Inmates
shall have access to mental health services as clinically warranted in
accordance with protocols established by the health authority that include:
(a) Screening for mental health
problems;
(b) Referral to
outpatient services, including psychiatric care;
(c) Crisis intervention and management of
acute psychiatric episodes;
(d)
Stabilization of the mentally ill and prevention of psychiatric deterioration
in the facility;
(e) Referral and
admission to inpatient facilities; and
(f) Informed consent for treatment.
These requirements apply only to Type I, II, and III Facilities.
(13)
A suicide prevention program shall be approved by the health authority and
reviewed by the facility administrator. All facility employees responsible for
supervising suicide-prone inmates shall be trained annually on program
expectations.
This requirement applies only to Type I, II, and III Facilities.
(14) All
facilities shall have a suicide prevention plan which must include specific
procedures for handling intake, screening, identifying, and continually
supervising the suicide-prone inmate.
(15) At least one (1) person per shift,
assigned to work at the facility, shall be trained in First Aid/CPR, as defined
by the American Red Cross or American Heart Association, and CPR, as defined by
the American Red Cross or American Heart Association. Training shall also
cover:
(a) Awareness of potential emergency
situations;
(b) Transfer to
appropriate health care provider;
(c) Recognition of symptoms of illness most
common to the facility; and
(d)
Giving of medication to inmates.
In addition, the health authority shall approve policies and procedures that insure that emergency supplies and equipment are readily available and in working order.
These requirements apply only to Type I, II, and III Facilities.
(16)
Detoxification from alcohol, opiates, hypnotics, and other stimulants shall be
conducted under medical supervision in accordance with local, state, and
federal laws. When performed at the facility, detoxification shall be
prescribed in accordance with clinical protocols approved by the health
authority. Specific criteria shall be established for referring symptomatic
inmates suffering from withdrawal or intoxication for more specialized care at
a hospital or detoxification center.
This requirement applies only to Type I, II, and III Facilities.
(17) Facilities
shall provide dental treatments, not limited to extractions, when the health of
the inmate would otherwise be adversely affected during confinement, as
determined by a physician or dentist.
This requirement applies only to Type I Facilities.
(18) Facilities shall confiscate
all medications in the possession of an inmate at the time of admission to the
facility. The identification of and the need for such medication shall be
verified by a physician or qualified health care personnel before it is
administered.
This requirement applies only to Types I, II, and III Facilities.
(19)
Medications issued to inmates shall be strictly controlled and shall be kept in
a secure place within the administrative or medical offices in the facility.
This requirement applies only to Types I and II Facilities.
(20) All
medications shall be prescribed by a physician or his/her designee at the time
of use. An officer or qualified health care personnel shall verify that the
medication is taken as directed and a medication receipt system established.
This shall include controlled drugs and injections.
This requirement applies only to Type I and II Facilities.
(21) Medical
and mental health records on the inmate's physical condition on admission,
during confinement, and at discharge shall be kept in a separate file from the
inmate's other facility records. The medical record shall indicate all medical
orders issued by the facility's physician and/or any other health care
personnel who are responsible for rendering health care services. These medical
records shall be retained for a period of ten (10) years after the inmate's
release.
This requirement applies only to Type I, II, and III Facilities.
(22) Informed
consent standards of the jurisdiction shall be observed and documented for
inmate care in a language understood by the inmate. In the case of minors, the
informed consent of a parent, guardian, or a legal custodian applies when
required by law. Inmates routinely have the right to refuse medical
interventions. When health care is rendered against the inmate's will, it shall
be in accordance with state and federal laws and regulations.
This requirement applies only to Type I, II, and III Facilities.
(23)
Involuntary administration of psychotropic medication(s) to inmates shall be
authorized by a physician and provided in accordance with policies and
procedures approved by the health authority, and in accordance with applicable
laws and regulations of the jurisdiction.
This requirement applies only to Type I, II, and III Facilities.
(24) The use of
inmates in medical, pharmaceutical, or cosmetic experiments is prohibited. This
does not preclude inmate access to investigational medications on a
case-by-case basis for therapeutic purposes in accordance with state and
federal regulations.
This requirement applies only to Type I, II, and III Facilities.
(25) In case of
medical emergencies, there shall be specific information readily accessible to
all employees, such as telephone numbers and names of persons to be contacted
so that professional medical care can be received. There shall also be
available the names and telephone numbers of persons to contact in case of
death.
(26) Inmates suffering from
communicable diseases and those who are sick but do not require hospitalization
shall be housed separate from other inmates as recommended by health care
authorities.
This requirement applies only to Type I, II, and III Facilities.
(27) When an
inmate is placed in segregation for health concerns, health care personnel
shall be informed as soon as practical and provide assessment and review as
indicated by the protocols established by the health authority.
This requirement applies only to Type I and II Facilities.
(28)
Medical/dental instruments and supplies (syringes, needles, and other sharp
instruments) shall be inventoried, securely stored, and their use shall be
controlled.
This requirement applies only to Type I and II Facilities.
(29) Pregnant
inmates shall have access to obstetrical services (prenatal, partum, and
post-partum care) by a qualified health care provider.
This requirement applies only to Type I and II Facilities.
(30) Inmates
with chronic medical conditions, such as diabetes, hypertension, and mental
illness shall receive periodic care by a qualified health care provider in
accordance with individual treatment plans that include monitoring of
medications and laboratory testing.
This requirement applies only to Type I, II, and III Facilities.
(31)
Information shall be provided to inmates about sexual abuse/assault including:
(a) Prevention/intervention;
(b) Self-protection;
(c) Reporting sexual abuse/assault;
and
(d) Treatment and counseling.
This information shall be communicated in writing or electronically, in a language clearly understood by the inmate, upon arrival at the facility.
These requirements apply only to Type I, II, and III Facilities.
(32)
Sexual conduct between facility employees, volunteers or contract personnel and
inmates is prohibited and subject to administrative, disciplinary and criminal
sanctions. The prohibition applies regardless of consent.
(33) The health authority shall develop and
approve protocols for identifying and evaluating major risk management events
related to inmate health care, including inmate deaths, preventable adverse
outcomes, and serious medication errors.
This requirement applies only to Type I, II, and III Facilities.
Notes
Authority: T.C.A. ยง 41-4-140.
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