Medical & Mental Health

Health Services

Matters of judgment regarding health services will be the sole province of the Health Services staff. Security regulations will be adhered to at all times by the Health Services staff. Health Services personnel will not be asked to provide inappropriate non-medical duties. The primary responsibility of medical personnel is to provide required health services for the entire incarcerated person population who have medical/mental health needs.

Facility medical services include:

• Screening of new bookings
• Pill call rounds in housing areas
• Physician sick call
• Coverage of medical infirmary when incarcerated person occupied
• Referral service for hospitalization and specialty clinics as needed
• Dental services
• Mental Health Services

Medical/Mental Health staff will make timely room visits to non-ambulatory or bed rest recovery room patients in order to complete interviews and/or counseling sessions.

incarcerated persons will not be used for the following duties:

• Performing direct patient care services
• Scheduling health care appointments
• Determining access of other incarcerated persons to Health Care services
• Handling or having access to surgical instruments, syringes, needles, medications, and health records
• Operating equipment for which they are not trained

Scheduled medical and dental appointments will be conducted in designated areas. Health Services personnel will assist in the management of incarcerated persons with medical and mental health problems. The sobering of intoxicated incarcerated persons will be done under the close care of custody staff with medical assistance. Medical detoxification of incarcerated persons will be done under the supervision of Medical staff. Medical and dental prostheses will be authorized when the health of the incarcerated person would otherwise be adversely affected, as determined by a responsible Physician or Dentist. The Medical/Mental Health Program Supervisor or designee, and the Classification Deputy will consult with each other regarding incarcerated persons who are diagnosed as having a psychiatric illness. When appropriate, such consultation could include:

• Housing assignments
• Program assignments
• Disciplinary measures
• Transfers in and out of the Facilities

incarcerated persons will not be used for medical, pharmaceutical, or cosmetic experiments. This does not preclude individual treatment of an incarcerated person based on their need for a specific medical procedure which is not generally available. Incarcerated person health complaints (sick call) will be solicited daily and acted upon by health-trained personnel and followed by appropriate triage and treatment by qualified medical personnel.

incarcerated person initiated medical visits will result in a charge to the inmate of $3.00 per visit. Incarcerated person health service co-pay charges will be exempted for the following care:

• Intake medical screening
• Health appraisals (14-day physicals)
• Public Health evaluations
• Prenatal services and all services related to pregnancy
• Public Health programs that are funded by other sources
• Laboratory and diagnostic services
• Life threatening emergency services
• Follow-up monitoring of chronic health conditions (e.g. hypertension services, seizure monitoring, medications monitoring)
• Mental health services
• Six Month and Annual Physicals

Dental services that are inmate-initiated and are non-emergency or non-life threatening will result in the $3.00 co-pay as an incarcerated person-initiated request for medical service unless the dental service is the result of a medical referral. Medical staff will complete a log of co-pay charges and forward the log daily to Custody Administration. Custody Administration will assign Custody staff to debit the inmate account for the $3.00 co-pay for medical services and for any medication charges.

No incarcerated person will be deprived of medical service as a result of being indigent or for any other purpose. No essential medication will be withheld due to a lack of incarcerated person funds. Rev. Indigent incarcerated persons’ accounts will be debited and the co-pay will remain on the books for no longer than three months or until the inmate’s account receives funds against which the payment can be made.

Inmates desiring the name of a Health Services employee should be given the first name or employee number only. This will allow the inmate to file his writs, but will afford the employee protection and privacy.

Informed Consent

An incarcerated person may refuse both emergency and non-emergency treatment, medical, or psychiatric care. Incarcerated persons are to be informed that they may refuse treatment and that they may be treated by their own private doctor at the Facility, but the incarcerated person or their insurance carrier shall be liable for any charges for the services of the doctor. Use of over the counter medications is not included in this requirement. This includes aspirin, laxatives, and antacids, etc.

Detoxification

Incarcerated persons who are so intoxicated as to be a danger to themselves, shall be placed in a detoxification cell and evaluated by medical staff. Any incarcerated person whose condition requires them to remain in the detoxification cell in excess of six (6) hours shall be observed and examined by medical staff to ascertain if there is a medical problem. Incarcerated persons who are undergoing acute withdrawal reactions, upon the direction of medical staff, shall be transferred to the designated medical facility.

In the absence of medical staff, incarcerated persons who are determined to be undergoing acute withdrawal reactions shall, at the direction of the Shift Sergeant, be transferred to the designated medical facility.

Mentally Disordered Persons

Any staff member who has reason to believe an incarcerated person is suffering from a mental disorder shall immediately report this to a supervisor who shall take appropriate action to segregate the incarcerated person and to arrange for an evaluation as soon as practical. At the request of the medical/mental health staff, arrangements shall be made to transfer a mentally disordered incarcerated person to the proper facility for diagnosis, evaluation, and treatment under the authority of 4011.6 of the Penal Code. If an incarcerated person is transferred to such a facility, the Director of Mental Health is to be notified as soon as possible. If local charges are pending against the incarcerated person, the court shall also be notified of the transfer.

The Suicidal Incarcerated person

Use of Safety Cell - Incarcerated persons who display bizarre behavior which results in the destruction of property or reveals an intent to cause self-inflicted physical harm shall be placed in a safety cell only with the approval of the facility commander or the shift sergeant. Retention of an incarcerated person in a safety cell must be reviewed by the facility commander or the shift sergeant at a minimum of every eight hours. Medical/Mental Health staff will be notified of the placement within one hour. The incarcerated person shall be medically cleared for continued retention every 6 hours thereafter. A mental health assessment and evaluation shall be conducted within the first 12 hours of placement into the safety cell. Direct visual observation shall be provided at least twice every thirty minutes.

The decision to remove all clothing shall be individualized and based on the clear justification of the shift sergeant that retention of the clothing represents a risk to the safety of the individual or facility security.

Where necessary, a suitably designed "safety garment" may be substituted for incarcerated person clothing as a humane alternative to nudity.

If an incarcerated person has injured themselves in any way, this should be reported immediately to Medical.

If an incarcerated person makes a suicidal threat while intoxicated or on drugs, the above procedure should be followed as well as notifying Medical.
Incarcerated persons will remain in protective security as long as the Mental Health Team assesses them to be a danger to themselves.

Notifications sent to Mental Health should be as explicit as possible about the nature of the behavior and the threat.

If an incarcerated person declares themselves "suicidal" at booking, Medical will be called immediately. The on-call Mental Health Provider will be called as soon as possible.

When an incarcerated person continues to be a danger to themselves and is kept in the Safety Cell over a period of time, an Incarcerated person Worker or Jail staff should monitor their use of eating utensils and retrieve articles when the incarcerated person has completed the meal.

Levels of Suicide Precaution

The Jail staff has been instructed to place any person who threatens or gestures suicide into a Safety Cell (see above) until seen by Mental health staff, thereby alleviating a clinical judgment call on their part. Incarcerated persons will remain in protective security as long as the Mental Health Team assesses them to be a danger to themselves.

Heat Plan for Incarcerated person on Psychotropic Medications

For those incarcerated persons taking psychotropic medications it is important that they do not become overly exposed to direct sunlight without proper protection, or heat in excess of 86 degrees Fahrenheit without relief. Medical precautions for an incarcerated person on neuroleptic medication due to the increased photosensitivity and heat sensitivity will be made.

In the event of an air conditioning failure at any facility, a staff member will be assigned a room thermometer to monitor the temperature in the immediate area where incarcerated persons taking psychotropic medications are housed. If the room temperature reaches 86 degrees Fahrenheit action will be taken as follows:

• The temporary rise in temperature: incarcerated persons will be observed closely for complaints of being too hot at which time they will be placed immediately into a cool shower where they can remain until the air conditioning is repaired.
• Long term problem with cooling: incarcerated persons will be transported via air-conditioned vehicle to a facility where air conditioning is functioning properly until the affected facility’s temperature returns to 86 degrees Fahrenheit or below.

Dental

Necessary dental care shall be provided. This includes removal of the tooth and pain reducing care, or any other medically required treatment.

An incarcerated person may refuse county treatment and request treatment by their own local dentist at their own expense. The Facility Commander, upon conference with the medical staff, may authorize the removal to the private dentist for treatment. The incarcerated person shall be required to pay the cost for a guard and transportation.

Arrangements with the private dentist must be made in advance, and the cost for the guard and transportation shall be paid in advance of the date and time of the appointment.

Management of Pharmaceuticals

The prescribing, dispensing, and administering of drugs will be done in compliance with appropriate Federal and State laws by qualified medical health personnel. All administered medication is to be taken immediately and in front of Health Services personnel after they have confirmed the identity of the incarcerated person. Psychotropic medications are prescribed only when clinically indicated as one facet of a program of therapy. They will not be used as a means of chemical restraint. Medical staff prescribing medication to inmates will include a "stop order" date for the medication and re-evaluate the prescription prior to renewal.

All controlled substances, syringes, and needles will be stored in the Medical Room (nurse’s station) when not in use. The Medical Supervisor / Supervising NP/designee will be responsible for assigning a staff member to inventory weekly the narcotics, syringes, needles, and blades.

First aid kits are available in designated areas, approved by the Medical Supervisor, of the Facilities. The Operations Deputy will be responsible for checking and ordering supplies for the first aid kits as they are used through the Medical Department in the respective facility. First aid supplies are for the use of both staff and incarcerated persons.

Emergency Services

Incarcerated persons will normally be transported by staff to the specified medical facility in county vehicles. The on-call ambulance services will be requested via County Communication if required. If the emergency medical service can be provided at the Facility by the Adult Detention medical staff, and they are available, do not transport the inmate to the hospital.

The Shift Supervisor responsible for authorizing the transfer to Stanislaus Medical Center shall make a determination as to whether a guard is needed. They shall consider the charges against the incarcerated person, the incarcerated person’s prior record, the incarcerated person’s physical condition, and any recommendations of other staff members. (Refer to section 8-3 Guarding Inmates at Medical Facilities).

Incarcerated person Medical Records (Confidentiality)

Incarcerated person medical records will be maintained separately from the incarcerated person booking pouch by Medical staff. Access to the incarcerated person medical records will be controlled by Medical staff. Health Services staff will share with the Facility Commanders/designee any information which the Health Services staff determines to be necessary for the management of incarcerated persons security status and ability to participate in programs.

The incarcerated person's consent is required for transfer of health services records unless the records are transferred directly from one Health Services provider to another for the express purpose of providing continued patient care. Other releases of confidential information will be controlled by the patient's consent unless otherwise stated by law. (W & I 5328)

Summaries or copies of incarcerated person health services records will be routinely sent to the Facility Health Services Department to which the incarcerated person is transferred, in a confidential manner.

Emergency Contact of Incarcerated person’s Next of Kin

In the case of serious illness or injury of an incarcerated person, their next of kin will only be notified by the Shift Sergeant or designee. Should an incarcerated person desire notification of next of kin in an emergency situation, the incarcerated person must provide information on whom to contact. The incarcerated person’s willingness to provide emergency contact information indicates the incarcerated person's permission for emergency notification of next of kin by Facility staff.

The Shift Sergeant or designee will only notify an incarcerated person’s next of kin in cases where the incarcerated person is not physically able or mentally capable of making the notification on their own volition. An incident report will be completed regarding the emergency contact notification indicating the necessity for same.

Mentally Disordered Incarcerated Person - Transfer to Treatment Facility

A mentally disordered incarcerated person who appears to be a danger to themselves or others, or to be gravely disabled, shall be transferred to a treatment facility designated by the County and approved by the State Department of Health Services for diagnosis and treatment of such apparent mental disorder.

Incarcerated persons found unable to be cared for adequately within any Jail shall be transferred to a designated treatment facility as soon as possible.
If there is a need for Jail staff to stay at Doctors Behavioral Health Center (DBHC) with the incarcerated person, the following criteria are to be considered:

• Incarcerated person’s level of agitation and/or aggressive behavior. i.e., DBHC cannot manage.
• Need for restraint.
• Known potential escape risk.
• Acuity level of DBHC (this criterion is not to be used alone to determine the need for Jail staff but in combination with the above).

Vermin Control

Any incarcerated person who has or is suspected of having vermin (body, head or pubic lice), shall be reported immediately to the medical staff who shall prescribe treatment. The medical staff shall arrange for treatment and control of the areas where the incarcerated person had contact with other incarcerated persons. Each Facility has scheduled pest control service. Additional pest control service shall be requested when it appears to be needed.