Current through Register Vol. XLI, No. 50, December 13, 2024
Section 95-2-14 - 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. Correctional Facility policies and procedures shall provide for unimpeded access to health care and for a system for processing complaints regarding health care. These policies and procedures which assure access to health care shall be communicated orally and in writing to each inmate upon arrival in the facility.14.2. Responsibility. Medical, dental, and mental health matters involving clinical judgments are the sole province of the responsible physician, dentist, and psychiatrist or qualified psychologist respectively; however, security regulations applicable to facility personnel also apply to health personnel. The Chief Executive Officer responsible for the facility shall provide the administrative support for the accessibility of health services to inmates.14.3. Responsible Physician. A responsible physician shall be designated to approve health care policies, procedures and agreements which can include use of hospital emergency rooms. Each correctional facility shall have agreements for 24 hours on-call physician coverage. 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. There shall be designated on-site health authorities who are responsible for arranging and making available all health care services. There shall be a health authority on site 24 hours per day. The health authority may be a physician, physician's assistant, registered or licensed practical nurse, nurse practitioner, paramedic, emergency medical technician, or a health-trained staff member. In correctional facilities with an inmate population of 600 or more inmates, a physician must be available on-site for primary care for a minimum of forty hours per week, and proportionately in terms of hours for inmate levels above and below this number.14.5. Medical Autonomy and Correctional Facility Administration. Medical decisions shall be made only by the responsible physician or his or her designee(s). It shall be made clear to the health authorities and physicians that security regulations which apply to the nonmedical facility staff also apply to them. They shall be provided with a list of these regulations and an orientation to the correctional facility system. The nonmedical staff shall have no role in authorization of medical care.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 these personnel shall be governed by written job descriptions approved by the responsible physician and the Chief Executive Officer. Verification of current credentials and job descriptions shall be on file in the facility. The provision of quality health care shall be insured by using only qualified health care personnel to determine and supervise health care procedures. Written job descriptions shall include qualifications required and the specific role in the health care delivery system in keeping with the individual's professional training. Verification of qualifications may consist of copies of current credentials.14.7. Administrative Meetings and Reports. There shall be meetings between the responsible physician and the facility administrator to discuss correctional facility health care at least quarterly. Notes of these meetings shall be kept by the administrator. The responsible physician shall submit quarterly reports on the health care delivery system and annual statistical reports. The quarterly report shall include topics such as the effectiveness of the health care delivery system, a description of any health environment factors which need improvement, any changes effected since the last reporting period and, if needed, recommended corrective action. There shall also be an annual statistical report which shall include the number and nature of sick call visits, diagnostic studies performed, emergency services rendered, specialty referral visits, hospitalizations, special procedures performed, ambulance transfers, communicable diseases reported, and deaths. The annual statistical report shall be submitted to the administrator and Commissioner of Corrections. The responsible physician shall submit an annual appraisal of the correctional facility's health care deliver to the administrator and Commissioner of Corrections.14.8. Review. Each policy, procedure, and program in the health care delivery program shall be reviewed at least annually by the responsible physician and revised if necessary. Each 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 at a minimum for the following aspects of correctional facility health care:14.9.1. Decision-making: special problem patients;14.9.2. Notification of next of kin;14.9.3. Postmortem examination;14.9.4. Minimal staff training requirements;14.9.5. Emergency services;14.9.6. Suicide prevention;14.9.8. Receiving screening;14.9.9. Health appraisal;14.9.10. Care for persons under the influence of drugs;14.9.12. Psychiatric illness;14.9.13. Access to treatment, daily health complaints;14.9.15. Health promotion;14.9.16. Disease prevention;14.9.18. Special medical programs;14.9.20. Management of pharmaceutical;14.9.21. Administration of medications;14.9.23. Transfer of records;14.9.24. Confidentiality;14.9.25. Facilities and equipment;14.9.27. Informed consent;14.9.28. Medical research; and,14.9.29. Serious illness.14.10. Decision-Making: Special Problem Patients. Before inmates with diagnosed psychiatric or significant medical illness are given housing assignments, work assignments, disciplinary measures, or transfers, consultation between the facility administrator and responsible physician or their designees shall take place to decide on any special precautions or preparations. A list of frequent illnesses which require special arrangements shall be developed. Special diets must be provided when ordered by health personnel and approved by the responsible physician.14.11. Notification of Next of Kin. Any inmate having any serious illness or injury, or who dies while incarcerated shall, with the explicit consent of the inmate, if possible, have his or her next of kin or legal guardian notified by the facility administrator, the responsible physician, or their designee.14.12. Postmortem Examination. In the event of an inmate death, the state medical examiner shall be notified immediately. If the cause of death is unknown, or the death occurred under suspicious circumstances, or the inmate was unattended from the standpoint of not being under current medical care, a postmortem examination shall be performed.14.13. Minimum Staff Training Requirements. Health trained staff is defined as correctional facility 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 dependence), basic management of seizures, medication administration, health record maintenance, recognition of potential suicides, ability to respond to health-related situations within four minutes, first aid training and procedures for patient transfers to appropriate medical facilities or health care providers. Training may be effected and approved through the responsible physician. An appropriate training course may be completed in approximately 60-80 hours. Each shift shall include at least one member who has become health-trained as described in this subsection.14.14. Emergency Services. There shall be twenty-four hour emergency medical care available. By definition, a medical emergency is an acute illness or unexpected health need that must be attended to immediately and cannot be delayed until the next scheduled sick call. The responsible physician shall approve a plan providing for the use of emergency transportation, use of a local hospital emergency department or appropriate health facility with emergency on-call physician services, procedures for the transfer of inmates to other medical facilities and security procedures.14.15. 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 staff with responsibility for inmate supervision shall be trained in the implementation of the program. Staff are responsible for preventing suicides through intake screening, identification, and supervision of suicide-prone inmates. The staff shall receive special training in the implementation of the suicide prevention program.14.16. Prohibitions. Inmates shall not be used for the following duties:14.16.a. Performing direct patient care services;14.16.b. Scheduling health care appointments;14.16.c. Determining access of other inmates to health care services;14.16.d. Handling or having access to surgical instruments, syringes, needles, medications, health records; and,14.16.e. Operating equipment for which they are not trained.The prohibitions contained in this subsection, however, shall not preclude inmates from participating in a certified vocational training program. They may perform maintenance and janitorial services under supervision of qualified staff. They shall not operate medical equipment unless appropriately credentialed and licensed, and directly supervised by the responsible physician. Inmates shall not perform direct services such as dental chair-side assistant, unless they are part of a certified vocational training program.
14.17. Receiving Medical Screening. A receiving medical screening appraisal to elicit information pertinent to the inmate's 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 inmates and staff. The goal of receiving screening is to detect any communicable diseases, chemical dependence, suicide potential, or other medical or psychiatric problems before the inmate is placed within the correctional facility 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. Receiving screening shall be conducted by a health-trained staff member. Inmates who are in need of immediate medical attention at the time of admission shall be referred immediately for emergency care after the physician on call has been notified. The screening process shall include at least an inquiry, observations and disposition.14.17.1. Inquiry. The screening process shall include, but not be limited to, an inquiry into: 14.17.1.a. Current illness and health problems, including dental problems;14.17.1.b. Venereal diseases and other infectious diseases;14.17.1.c. Medication taken and special health requirement;14.17.1.d. Use of alcohol and other drugs which includes types of drugs used, mode of use, amounts used, frequency used, date or time of last use and history of problems which may have occurred after ceasing use (e.g. convulsions);14.17.1.e. Past and present treatment or hospitalization for mental disturbance or suicide attempts; and,14.17.1.f. Other health problems designated by the responsible physician.14.17.2. Observations. The screening process shall include, but not be limited to, observations including: 14.17.2.a. Behavior, which includes state of consciousness, mental status, appearance, conduct, tremor and sweating;14.17.2.b. Body deformities, trauma markings, bruises, lesions, jaundice, ease of movement, etc.; and,14.17.2.c. Indications of recent or chronic substance abuse, i.e., needle marks.14.17.3. Disposition. The screening process shall include disposition to the following: 14.17.3.a. The general population;14.17.3.b. The general population and referral to appropriate health care services;14.17.3.c. Referral to appropriate health care services on an emergency basis; and,14.17.3.d. Medical isolation or special observation.14.18. Health Appraisal. Within seven days of admission a health appraisal shall be completed for each inmate which shall include a history and examination, 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 collected by a health-trained staff member. The health appraisal shall include: 14.18.1. Review of the earlier receiving screening by the examining clinician;14.18.2. Collection of additional data to complete the medical, dental, psychiatric and immunization histories;14.18.3. Administration of laboratory and/or diagnostic tests to detect communicable disease and tuberculosis;14.18.4. Recording of height, weight, pulse, blood pressure, temperature, and administration of other tests, and examinations; the record shall include comments about mental and dental status;14.18.5. Review of the results of the medical examination, tests, and identification of problems by a physician; and,14.18.6. Initiation of therapy when appropriate.14.19. 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 correctional facility has special facilities and constant medical supervision to perform detoxification, the process shall not be performed on site; the inmate shall be transferred to a hospital or community detoxification center designated by the responsible physician. Procedures for adequate care of persons under the influence of drugs include policies and training governing medical screening, observation, referral evaluation, and safety protection.14.20. Mentally Ill Inmates. Post admission screening and referral for care of mentally ill or retarded inmates whose adaptation to the correctional environment is significantly impaired shall be provided. Psychiatric problems identified, either during receiving screening or after admission, shall be followed up by medical staff. The urgency of the problems determines the responses. 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 for only the minimum time necessary before emergency care is rendered. All sources of assistance for mentally ill and retarded inmates shall be identified in advance of need, and referrals shall be made on all cases. No person shall be housed solely on account of involuntary commitment proceedings instituted pursuant to W. Va. Code '27-5-1 et seq.14.21. Mental Health Evaluation. A comprehensive individual mental health evaluation shall be performed on specially referred inmates by a multi-disciplinary mental health team. The evaluation shall be completed within fourteen days after the date of referral, and shall include at least the following elements: 14.21.1. A review of mental health screening and appraisal data;14.21.2. The collection and review of additional data from staff observation, individual diagnostic interviews and tests assessing intellect and coping abilities;14.21.3. The compilation of the individual's mental health history; and,14.21.4. The development of an overall treatment and/or management plan with appropriate referral.14.22. Psychiatric Illness. There shall be consultation between the facility administrator and the responsible physician or their designees prior to the following actions being taken regarding patients who are diagnosed as having a psychiatric illness: 14.22.1. Housing assignments;14.22.2. Program assignments;14.22.3. Disciplinary measures; and,14.22.4. Transfers in and out of the correctional facility.14.23. Detoxification. Procedures shall require that gradual detoxification from alcohol, opiates, hypnotics, and other stimulants, and sedative hypnotic drugs be effected as follows: 14.23.1. When performed at the facility, detoxification shall be performed under medical supervision; and,14.23.2. When not performed in the facility, arrangements shall be made for detoxification to be conducted in a hospital or community detoxification center.14.24. Chemical Dependency. Procedures shall guide the clinical management of chemically dependent inmates with the following requirements:14.24.1. Diagnosis of chemical dependency by a physician;14.24.2. Determination by a physician as to whether an individual requires non-pharmacologically or pharmacologically supported care;14.24.3. Individualized treatment plans which are developed and implemented by a multi-disciplinary team;14.24.4. Referrals to specified community resources upon release when appropriate; and,14.24.5. For purposes of this rule only, the use of or the withdrawal from the use of nicotine shall not be considered to be a chemical dependency or otherwise qualify the inmate for medical or psychological treatment or counseling.14.25. Access to Treatment. Each inmate, at the time of admission, shall be given orally and in writing, information concerning the right to medical treatment. The information sheet shall be approved by the responsible physician and shall include procedures for registering complaints and the correctional facility's sick call schedule.14.26. Daily Health Complaints. Inmate's health complaints shall be solicited daily and acted upon without delay 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.14.27. Sick Call. Sick call is the system through which each inmate reports for and receives appropriate medical services for non-emergency illness or injury. Inmates shall have daily access to sick call forms which will 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 see non-emergency problems. Minimum frequency of sick call should be as follows: 14.27.1. In facilities with fewer than fifty inmates, one day per week;14.27.2. In facilities with fifty to one hundred inmates, two days per week;14.27.3. In facilities with one hundred to two hundred inmates, three days per week; and,14.27.4. In facilities with more than two hundred inmates, five days per week. If an inmate's custody status precludes attendance at sick call, arrangements shall be made to provide sick call services in the place of the inmate's detention.
14.28. Continuity of Care; Surgery. Inmates shall be provided all needed follow-up care, laboratory services, physical therapy, physical aids and surgery, other than cosmetic surgery, as needed including referral to community care.14.29. Use of Restraints or Isolation for Out of Control Residents. The responsible physician shall approve a plan guiding the use of restraints or isolation and providing for mental health personnel to evaluate inmates who are repeatedly out of control or remain out of control for more than a short amount of time. Physical restraints for the control of inmates inside the facility may be used only for the protection of the individual or others. The use of restraints shall be recorded in the inmate's file. Any time an inmate remains out of control for more than a short amount of time, mental health personnel should be consulted.14.30. Health Promotion. The responsible physician shall consider a plan providing inmates with health education and preventive medical services, and shall review the inmates' opportunities to engage in exercise. 14.30.1. Disease Prevention. Correctional facilities shall establish a holding bed area for use by inmates having medical problems requiring separation or close observation. Inmates shall be allowed to participate in some form of exercise involving the large muscles for a minimum of one hour daily. Structured programs should be offered.14.30.2. Health Education. Procedures shall provide that a program of health education is provided to the inmates of the facility. Health education shall provide information on medical services such as immunizations, hypertension detection and instruction in self-care for chronic conditions. Subjects for health education may include the following: personal hygiene and nutrition; venereal disease, AIDS, tuberculosis and other communicable disease; effects of smoking; self-examination for breast cancer; dental hygiene; drug abuse and dangers of self-medication; family planning, including as appropriate, both services and referrals; physical fitness; and chronic diseases and/or disabilities.14.31. Physical Examinations. Procedures shall specify the conditions for periodic health examinations for inmates. Persons fifty years of age or older shall be given annual physical examinations. All other inmates shall receive thorough physical examinations at least biannually. All inmates shall be examined prior to release for the detection of diseases which may require reports to the Department of Health and Human Resources and/or the Center for Disease Control.14.32. Individual Treatment Plan. Procedures shall provide for a special health plan for inmates requiring close medical supervision. A written individual treatment plan, which shall include directions to health care and other personnel regarding their roles in the care and supervision of these patients, shall be developed for each inmate by the appropriate physician, dentist, or qualified mental health practitioner.14.33. Dental Care. Dental care shall be provided to each inmate under the direction and supervision of a dentist, licensed in the state, in the following circumstances: 14.33.1. Dental screening within fourteen days of admission as part of the health appraisal; and,14.33.2. Appropriate check-ups, examinations, extractions, emergency corrective, preventive and other dental services.14.34. Special Medical Programs. Arrangements shall be made for the provision of special medical programs, including chronic care, convalescent care and medical preventive maintenance for the inmates. The special medical program shall serve a broad range of health problems, such as, seizure disorders, hypertension, ischemic heart disease, diabetes, AIDS, potential suicide, chemical dependency and psychosis. These special medical conditions require close medical supervision. Chronic care is medical service rendered to a patient over a long period of time; treatment of diabetes, asthma and epilepsy are examples. Convalescent care is medical services rendered to a patient to assist in the recovery from illness or injury. Medical preventive maintenance includes health education and medical services, such as inoculation and immunization, provided to take preventative measures against disease, and, instruction in self-care for chronic conditions.14.35. Medical and Dental Prosthesis. As determined by the responsible physician or dentist, medical and dental prostheses shall be provided when the health of the inmate would be otherwise adversely affected. Prostheses are artificial devices to replace missing body parts or to compensate for defective bodily functions.14.36. Management of Pharmaceutical. Procedures for prescribing, dispensing and administering drugs shall be in compliance with applicable state and federal laws and rules and regulations. The responsible physician shall approve written procedures for the distribution, administration, accounting and disposal of the medical log and maintain one for each inmate receiving medication; the log shall include the date, time, name of drug and dosage administered. Any inmate refusing medication must sign a statement to that effect, which shall also be signed by a staff member, and filed in the health record. Medication shall be administered only by a physician or nurse, or, after written approval by the responsible physician, by the health authority or health trained staff members; an exception to this requirement may be made in that insulin injections may be self-administered by the inmate with the supervision of the health authority or health trained staff member. The physician shall inform correctional facility personnel of possible side effects of medication on inmates. When medications are taken by mouth, the person administering the drug will observe the inmate swallow the drug and have him or her speak after swallowing to insure ingestion of the medication. The facility shall provide a locked storage area for medications and maintain a list of medications stocked by the facility. Medications shall be refrigerated, if necessary.14.37. 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 administration of medications according to orders and the recording of the administration of medications in a manner and in form approved by the responsible physician. Training from the responsible physician encompasses the medical aspects of the administration or distribution of medications; training from the facility administrator encompasses security matters inherent in the administration or distribution of medications in a correctional facility. The concept of administration or distribution of medications according to orders includes performance in a timely manner. Medications will be administered on a schedule which is consistent with the individual's needs rather than the correctional facility's needs.14.38. Health Records. A separate health file shall be established on each inmate at the time he or she is screened. The health record shall be sufficiently detailed to enable any practitioner to give continuing care and enable him or her to determine what the inmate's condition is at a specific time and what procedures were effected, and to enable consultants to give an opinion after examination of the inmate. Entries must be legibly written in ink, signed and dated. The record shall be maintained for a minimum of seven years after the inmate's release from incarceration. The file shall contain the following information: 14.38.1. The completed receiving screening form;14.38.2. Health appraisal data (if the inmate has been incarcerated for at least thirty days);14.38.3. All findings, diagnoses, orders and treatments;14.38.4. Medication log sheets;14.38.5. Results of any laboratory, x-ray or diagnostic studies;14.38.6. Completed medical complaint forms;14.38.7. The place, date and time of health encounters;14.38.8. Dental, psychiatric or other consultation reports;14.38.9. Consent and refusal forms; and,14.38.10. Release of information forms.14.39. Transfer of Records. When off-site examination, treatment, transfer to another facility, or hospital admission occurs, the copy of the inmate's health record or a summary of the record shall accompany the inmate. 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 correctional facility with the inmate, or, in the event of transfer or hospital admission, as soon as possible thereafter. Written authorization by the inmate is required for transfer of health record information, except in an emergency situation where the inmate is unable to authorize the transfer.14.40. Confidentiality. The inmate's medical information, records, 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: 14.40.1. With the inmate's informed consent;14.40.2. Where the law requires disclosure, e.g., reporting of communicable diseases;14.40.3. When the security of the correctional facility 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 facility;14.40.4. To the chief administrative officer can review medical records but must maintain confidentiality except as provided in subsection 14.40 of this rule; and,14.40.5. The inmates shall have access to their own medical records.14.41. Facilities and Equipment. If health services are delivered on-site, the correctional facility shall have a private examination/treatment area. Basic items provided shall include: a stethoscope, a blood pressure cuff, a thermometer, tongue depressors, a flashlight, an ophthalmoscope, otoscope and ear specula, a percussion hammer, weight scales, examination gloves, a vaginal specula, and first aid kits as well other equipment designated as necessary by the responsible physician.14.42. Outside Resources. Procedures shall require that patients who need health care beyond the resources available in the facility, as determined by the responsible physician, shall be transferred under appropriate security provisions to a facility where such care is available.14.43. First Aid Kits. Each correctional facility shall have one or more first-aid kits containing, but not limited to, bandages, gauze, a sling, adhesive tape, and band-aids. The responsible physician shall designate the number, location and content of first aid kits. The health authority must periodically inspect all equipment and first-aid kits.14.44. Informed Consent. The informed consent of an inmate is necessary for all medical examinations, treatments and procedures except those which are required by law, e.g., treatment of infectious diseases where public health law requires such treatment. Informed consent is the voluntary consent to a treatment, examination, or procedure by the patient after the patient has received all the material facts regarding the nature, consequences, risks and alternatives concerning the proposed treatment, examination or procedure. When the inmate is a minor, the informed consent of a parent, guardian or legal custodian applies when required by law. Exceptions to obtaining informed consent are allowable if they are in accordance with state law (such as an emergency situation or public health matters).14.45. Medical Research. The use of inmates for medical, pharmaceutical or cosmetic experiments is prohibited. A person confined in a facility is incapable of volunteering as a human subject without hope of reward and cannot do so on the basis of fully informed consent. Therefore, inmates shall not participate in experimental projects involving medical, pharmaceutical or cosmetic research, including aversive conditioning, psychosurgery, electrical stimulation of the brain, or the application of cosmetic substance to the body that are being tested for possible ill effects prior to use in the general public. This does not preclude the use of a new medical procedure for the individual treatment of an inmate by his or her physician, subsequent to a full explanation of the positive and negative features of the treatment. This agreement is between the physician and the inmate and may not be part of a general program of medical experimentation.14.46. Trainees/Students. When the correctional facility uses students or interns in health care delivery, written policies and procedures shall provide for work experience under direct staff supervision, commensurate with their level of training.14.47. Serious Illness or Injury. A process shall be developed whereby those individuals, designated by the inmate, are notified in case of serious illness or injury. Permission for notification shall be obtained from the inmate prior to need, if possible. There may be situations in which the inmate does not want the next of kin notified of an illness or injury; therefore, the inmate's consent should be obtained whenever possible. The next of kin or other individuals designated by the inmate to receive notification shall be included on the facility admission form.14.48. Personnel. The following health care practitioners shall be provided for a facility with five hundred inmates. The staff must be adjusted proportionately for facilities with fewer than or more than five hundred inmates: 14.48.1. Medical Director: One full-time equivalent; responsible for health care and providing general physician services;14.48.2. Program Director: One full-time equivalent; responsible for program administration;14.48.3. Registered Nurse: Three full-time equivalents; responsible for primary care and infirmary care;14.48.4. Licensed Practical Nurse: Three full-time equivalents; responsible for primary care and infirmary care;14.48.5. X-ray Technician: Ten hours per week; responsible for general x-ray procedure;14.48.6. Pharmacist: Five hours per week; responsible for supervision of pharmacy operations;14.48.7. Dentist: One full-time equivalent; responsible for dental screening and primary dental care;14.48.8. Dental Hygienist: One full-time equivalent; responsible for preventive dentistry and assistance to dentist;14.48.9. Medical Records Clerk: One full-time equivalent; responsible for maintenance of medical records, administrative and clerical support; and,14.48.10. Optometrist: Eight hours per week; responsible for optometric services.