Current through Register Vol. XLI, No. 50, December 13, 2024
Section 95-1-14 - Medical and Health Care Services14.1. Right to medical care. All inmates shall have prompt access to necessary medical, dental and psychiatric care provided in a reasonable manner by licensed personnel.14.2. Responsibility. Medical, dental and mental health decisions involving clinical judgements shall be the sole province of the responsible health care professional. The jail facility administrator shall provide administrative support for the availability of medical care to inmates and shall advise the health care professionals concerning jail facility security.14.3. Responsible physician. A responsible physician shall be designated to approve health care policies, procedures and agreements which may include the use of emergency rooms in local hospitals. Each jail facility shall have agreements or provisions for twenty-four (24) hour coverage by an on-call physician. All physicians and dentists examining or treating inmates shall be licensed to practice in the State of West Virginia.14.4. On site health authority. An on site health authority shall be designated and present at all times. The health authority may be a physician, physician's assistant, registered nurse, licensed practical nurse, nurse practitioner, paramedic, emergency medical technician, or a health trained staff member.14.5. Medical autonomy and jail facility administration. Medical decisions shall be made only by the physician or his or her designee. It shall be made clear to the health authorities, that security rules which apply to non-medical jail facility staff also apply to health care staff. The jail facility administrator shall provide information and orientation concerning security rules to health care staff.14.6. Duties and responsibilities. Appropriate state and federal licensure, certification or registration requirements and restrictions apply to personnel who provide health care services to inmates. The duties and responsibilities of medical care personnel shall be governed by written job descriptions approved by the responsible physician and the jail facility administrator. Verification of current credentials and job descriptions shall be on file in the jail facility. The provision of quality health care shall be ensured by the use of only qualified health care personnel to determine and supervise health care procedures. Written job descriptions shall include the qualifications required and the specific role in the health care delivery system of that position. Verification of qualifications may consist of copies of current certificates or licenses.14.7. Administrative meetings and reports. There shall be meetings, at least quarterly, between the health care staff and the jail facility administrator to review and discuss health care programs in the jail facility. Notes of these meetings shall be kept by the jail facility administrator. The responsible physician shall submit quarterly reports on the health care delivery system and annual statistical reports. The report shall include topics such as the effectiveness of the health care delivery system, a description of any environmental factors which may require improvement, changes effected since the last report, and recommendations for corrective action if needed. The annual statistical report of inmate health care shall include the number and nature of sick call visits, diagnostic studies conducted, emergency services rendered, referrals to specialists, hospitalizations, special procedures performed, ambulance transports used, communicable diseases reported and deaths. The annual statistical report, along with an appraisal of the jail facility's health care system shall be submitted to the authority having jurisdiction over the jail facility by the responsible physician.14.8. Review. Each policy, procedure and program in the health care delivery system shall be reviewed at least annually by the responsible physician and revised if necessary. Each policy or procedure document shall bear the date of the most recent review or revision and the signature of the reviewer.14.9. Policies and procedures. The responsible physician shall write or approve pre-written health policies and procedures for the following components of jail facility health care:14.9.1. Decision making for special problem inmates. Before inmates with diagnosed psychiatric or significant medical illnesses are given housing assignments, work assignments, disciplinary measures or transfers, the jail facility administrator and the responsible physician or their designees shall confer to consider any special precautions or preparations. A list of frequent illnesses which require special arrangements shall be developed. Special diets must be provided when requested by health personnel and approved by the responsible physician.14.9.2. Notification of next of kin. The jail facility administrator or responsible physician shall notify the next of kin or legal guardian of the serious illness, serious injury or death of any inmate in the custody of the jail facility.14.9.3. Post mortem examination. The jail facility administrator or responsible physician shall immediately notify the State Medical Examiner of the death of any inmate. The jail facility shall cooperate with the State Medical Examiner in the conduct of post mortem examination if found to be necessary.14.9.4. Minimum staff training requirements. Health trained staff is defined as jail personnel who have the equivalent of EMT training and also have received information regarding the symptoms of physical and mental illnesses common to the inmate population (including depression and chemical dependency), basic management of seizures, medication administration, health record maintenance, recognition of potentially suicidal behavior, ability to respond to health related situations within four (4) minutes, first aid training, and procedures for transfer of inmates to appropriate medical facilities or health care providers. Training may be effected through a local hospital, emergency room, county health department, county medical society, Red Cross chapter, or any other program approved by the responsible physician. An appropriate training course may be completed in approximately 60-80 hours. Each shift shall include at least one person who has become health trained as described in this subsection. Ideally these persons shall be from the health care profession but may be health trained jail facility personnel.14.9.5. Suicide prevention. There shall be a written suicide prevention and intervention program that is reviewed and approved by a qualified medical or mental health professional. All jail facility staff who are responsible for inmate supervision shall be trained in the implementation of the program. The staff shall be responsible for intake screening and identification of potentially suicidal inmates in an effort to prevent suicide.14.9.6. Prohibited inmate assignments. Inmates shall not be assigned the following duties: a. Performing direct patient care services;b. Scheduling health care appointments;c. Determining or controlling access to health care by other inmates;d. Handling or having access to surgical instruments, syringes, needles, medications or health records; and,e. Operating medical equipment.The restrictions of this subsection shall not be construed to preclude inmates from participation in a certified vocational training program. Inmates may be permitted to perform janitorial or cleaning services in the medical areas under the supervision of qualified staff.
14.9.7. Receiving Medical Screening. A receiving medical screening appraisal to elicit information pertinent to the inmates' health shall be performed on every inmate at the time of admission. The screening shall be recorded on a form which has been approved by the responsible physician. Screening is a means to discover and prevent health and safety threats to both inmates and staff. The goal of receiving screening shall be to detect any communicable diseases, chemical dependence, potential for suicide, or other medical or psychiatric problems before the inmate is placed within the jail population. When the inmate has been transferred from another facility and is accompanied by a previously completed screening form, the form shall be reviewed and verified. The receiving screening shall be conducted by a health-trained staff member. No inmate in obvious need of medical attention shall be admitted to any jail facility until such time as the arresting or transporting officer shall obtain written medical clearance indicating that the inmate is physically capable of withstanding incarceration. The screening inquiry shall include the following topical areas: a. Current illness and health problems, including dental problems;b. Venereal diseases and other infectious diseases;c. Current medication and special health requirements;d. Use of alcohol or other drugs, including types of drugs used, mode of use, amounts used, frequency of use, date or time of last use, and history of problems which may have occurred after cessation of use;e. Past and present treatment or hospitalization for mental disturbance or attempted suicide; and,f. Other health problems as may be identified by the responsible physician.14.9.8. Disposition. The receiving screening process shall include a recommendation to one of the following population classifications: General population, with or without referral for appropriate health care services; emergency referral to appropriate health care services; or, medical isolation and special observation.14.9.9. Health Appraisal. Within fourteen (14) days of admission, a health appraisal shall be completed for each inmate which includes a medical history and examination which is recorded on a form approved by the responsible physician. Although a physician, physician's assistant or nurse practitioner must perform the physical examination, the health history may be completed by a health trained staff member. The health appraisal shall include the following: a. Review of the earlier receiving screening by the examining clinician;b. Collection of additional data to complete the medical, dental, psychiatric and dental histories;c. Administration of laboratory and/or diagnostic tests to detect communicable diseases including tuberculosis;d. Recording of current height, weight, pulse rate, blood pressure and temperature, any other diagnostic tests administered and comments concerning mental and dental status; and,e. The results of the medical examination, test results and other information collected shall be reviewed by a physician who shall direct the initiation of appropriate medical care and treatment.14.9.10. Care for persons under the influence of drugs. The responsible physician shall approve policies and procedures for the identification of alcohol and drug dependence as well as subsequent management and/or transfer for the care of persons under a drug influence. Unless the jail facility has special facilities and constant medical supervision to perform detoxification, detoxification shall not be performed at the jail facility; inmates who require detoxification shall be transferred to a hospital or detoxification center designated by the responsible physician. Procedures for adequate care of persons under the influence of drugs include written policies and training concerning medical screening, observation, referral evaluation, and safety protection.14.9.11. Psychiatric illness. Post admission screening and referral for the care of mentally ill or retarded inmates whose adaptation to the jail facility environment is significantly impaired shall be provided. Psychiatric problems identified, whether identified during receiving screening or after admission, shall be followed up by medical staff. The urgency of the presenting problem shall determine the response. Potentially suicidal and psychotic patients are emergencies and require prompt attention. Inmates awaiting emergency evaluation shall be housed in a specially designated area with constant supervision by trained staff. Inmates shall be held only for the minimum time necessary before emergency care is rendered. All sources of assistance for mentally ill or impaired inmates shall be identified in advance of need and referral procedures shall be in place for use in cases where the need exists. No person shall be housed in a jail facility solely upon an involuntary commitment proceeding pursuant to W. Va. Code '27-5-1 et. seq..14.9.12. There shall be consultation between the jail facility administrator and the responsible physician or their designees prior to the making of housing assignment, program assignment, imposition of disciplinary measures or the transfer of any inmate who is diagnosed as having a psychiatric illness.14.9.13. Access to treatment. Upon admission each inmate shall be informed of his or her right of access to medical treatment; in addition to verbal instruction, each inmate shall receive an information sheet which includes information about the jail facility's sick call schedule, the procedures for registration for sick call and the grievance procedures concerning medical care. The medical information sheet shall be approved by the responsible physician.14.9.14. Daily health complaints. The health complaints of inmates shall be solicited daily and acted upon by trained personnel such as a licensed nurse or registered nurse and followed by appropriate triage and treatment by qualified personnel. Triage is the sorting and allocation of treatment of patients according to priorities of need.14.9.15. Sick Call. Sick call is the system through which each inmate reports for and receives appropriate medical services for non-emergency illness or injury; if an inmate's custody status precludes attendance at sick call, arrangements shall be made to provide sick call services in the inmate's place of detention. Inmates will have daily access to sick call forms which shall be reviewed that day by the health authority or other person designated by the responsible physician. All complaint forms will become part of the inmate's health record. Sick call shall be performed by a licensed physician, physician's assistant, registered nurse, or other person designated by the responsible physician. Sick call is a designated time to review non-emergency medical problems and shall be held at the following intervals:a. In jail facilities of less than fifty inmates, one time per week;b. In jail facilities of fifty to one hundred inmates, two times per week;c. In jail facilities of one hundred to two hundred inmates, three days per week; and,d. In jail facilities of more than two hundred inmates, five times per week.14.9.16. Use of restraints or isolation for out of control inmates. The responsible physician shall approve a plan which guides the use of restraints or isolation and providing for mental health personnel to evaluate inmates who are repeatedly out of control or who remain out of control for more than a short amount of time. Use of physical restraints in the control of inmates inside the jail facility may only be used for the protection of the individual or others. The use of restraints shall be recorded in the inmate's record. Any time an inmate remains out of control for more than a short amount of time, mental health personnel shall be consulted.14.9.17. Health Promotion/Wellness Promotion. The responsible physician shall consider plans which provide inmates with health education and preventive medical services.14.9.18. Prevention of the spread of disease. Jail facilities shall establish an area for use by inmates who have medical problems which require separation or close observation. Inmates in such areas shall be allowed to participate in an appropriate form of exercise, including exercise of large muscle groups, for a minimum of one hour per day.14.9.19. Dental Care. Dental care shall be provided to each inmate under the direction and supervision of a licensed dentist under the following conditions:a. Each inmate shall receive a dental examination as a component of his or her health evaluation within fourteen days of admission; and,b. Emergency dental treatment for conditions which adversely affect the inmate's health shall be provided within three (3) months of admission.14.9.20. Special medical programs. Arrangements shall be made for the provision of special medical programs, including chronic care, convalescent care and preventive medical maintenance for inmates. The special medical program shall service a broad range of health problems, e.g., seizure disorders, diabetes, potential suicide, chemical dependency, and psychosis. These special medical programs require close medical supervision. Chronic care is medical service rendered to a patient over a long period of time for conditions such as diabetes, asthma, and epilepsy. Convalescent care is medical care provided to assist a patient in the recovery from illness, injury or surgery. Preventive medical maintenance includes health education and medical services such as inoculation and immunization and is provided to take measures in advance of the onset of illness or to provide instruction in the self-care of chronic conditions. Provided that, for purposes of this rule only, use of or withdrawal from the use of nicotine shall not be considered a chemical dependency or otherwise qualify the inmate for medical or psychological treatment or counseling.14.9.21. Prostheses. The responsible physician or dentist shall determine the medical necessity for prosthetic devices. Prosthetic devices shall be provided when medically necessary to avoid adverse affect upon the inmate's health.14.9.22. Management of pharmaceutical. Procedures for prescribing, dispensing and administering drugs shall be in compliance with federal and state laws and regulations. The responsible physician shall approve written procedures for the distribution, administration, accounting and disposal of medications. The responsible physician shall approve a written medication log which shall be maintained for each inmate receiving medication. The inmate's medication log shall include the date, time, name of drug and dosage administered. Any inmate who refuses medication shall sign a statement to that effect, which shall be signed by a staff member and filed in the inmate's medical record. Medications shall be administered only by a physician or nurse, or, after written approval from the responsible physician, by the health authority or health trained staff member; exception to this requirement may be made for self administration of insulin injections by inmates who have received appropriate instruction and are under the supervision of the health authority or a health trained staff member. The physician shall inform jail facility personnel of possible side effects of medication prescribed for inmates. When medications are taken orally, the person administering the medication shall take appropriate action to verify that the medication has been swallowed, thereby ensuring proper ingestion of the prescribed medication. The jail facility shall provide a locked storage area for medications and a list of stored medications shall be maintained. Refrigeration shall be provided if needed for proper storage of medications.14.9.23. Administration of medications. Persons administering medications shall do so under the supervision of the responsible physician and shall have received training appropriate to their assignment. They are accountable for administering medications according to orders as to both frequency and dosage, and for recording the administration of medications in a manner and on a form approved by the responsible physician. Training from the responsible physician shall include the medical aspects of administration or distribution of medication. Training from the jail facility administrator shall include security matters inherent to the administration and distribution of medications in a jail facility.14.9.24. Health records. A separate file shall be established for each inmate at the time of his or her receiving screening for the collection of medical information. The health record shall be sufficiently detailed to enable a practitioner to give continuing care and permit the retrospective determination of the inmate's condition and treatment at the time of examination and treatment and to provide information which will enable consulting medical professionals to render advice on the inmate's care and treatment. Entries in this record shall be made in ink, be legible, be signed by the maker, and dated. Records shall be maintained for at least seven (7) years following the inmate's most recent incarceration. The file shall contain the following:a. The completed receiving screening form;b. The completed health appraisal, if the inmate was incarcerated for more than thirty (30) days;c. All findings, diagnoses, orders and treatments;d. A medication log sheet;e. The results of laboratory, x-ray or other diagnostic procedures;f. Any completed medical complaint forms;g. The date, place and time of health encounters;h. Dental, psychiatric or other consultation reports;i. Consent and refusal forms; and,j. Release of information forms.14.9.25. Transfer of records. When an inmate receives off-site examination or treatment or is transferred to another facility or hospital the inmate's health record or a copy of the summary shall accompany him or her. Documentation of any off-site examination or treatment shall be made in the health record by the physician or other health professional involved. Health records shall be returned to the jail facility with the inmate or, in the event of the transfer or hospital admission of the inmate, as soon as possible thereafter. Written authorization by the inmate is required for the transfer of health record information, except in an emergency situation where the inmate is unable to authorize the transfer.14.9.26. Confidentiality. The inmate's medical information, health record, and confidences entrusted to a physician or other medical care professional in the course of screening, examination or treatment are confidential and shall not be disclosed to anyone except in the following instances:a. With the informed consent of the inmate;b. When required by law, e.g., the reporting of communicable diseases;c. When the security of the institution or the safety of the individual requires disclosure, and then only to the extent necessary for the protection of the inmate and the security of the jail facility; and,d. When the chief administrative officer requests review of medical information, subject to all other requirements of this subsection.14.9.27. Facilities and equipment. When health services are provided within a jail facility the jail facility shall provide a private examination/treatment area and such equipment necessary and appropriate for the delivery of medical care as provided in this section. Medical equipment shall be periodically inspected and kept in good repair.14.9.28. First aid kits. Each jail facility shall have one or more first aid kits which contain, at a minimum, bandages, gauze, slings, adhesive tape and band-aids. The responsible physician shall designate the number, location and contents of first aid kits and shall provide for the periodic inspection and replenishment of the kits.14.9.29. Informed consent. The informed consent of inmates is necessary for all medical examinations, treatment and procedures except those required by law, e.g., the treatment of infectious diseases when public health law requires such treatment, or in the event of an emergency. Informed consent is the voluntary consent of an inmate to an examination, treatment or procedure after receiving information concerning the material facts regarding the nature, consequences, risks and alternative procedures. In the event a minor is admitted, the consent to medical care must be obtained from a parent, guardian or legal custodian.14.9.30. Medical research. The use of inmates for medical, pharmaceutical, or cosmetic research or experiments is prohibited.14.9.31. Serious illness or injury. A process to notify an inmate's next of kin in the event of serious illness or injury shall be developed. The jail facility's admission form shall provide for identification of the inmate's choice of a person to be notified in the event of serious illness, serious injury or death. When possible, permission for notification shall be obtained from the inmate.