Procedure 403.003
MICHAEL D. CREWS
SECRETARY
PROCEDURE NUMBER: 403.003
PROCEDURE TITLE: HEALTH SERVICES FOR INMATES IN SPECIAL HOUSING
RESPONSIBLE AUTHORITY: OFFICE OF HEALTH SERVICES
EFFECTIVE DATE: FEBRUARY 26, 2014
INITIAL ISSUE DATE: APRIL 4, 2000
SUPERSEDES: HSOI NO. 82-1, HSB 15.07.01, HSC 25.07.08
RELEVANT DC FORMS: DC4-528, DC4-529, DC4-642, DC4-643A, DC4-650B, DC4-652, DC4-683 SERIES, DC4-694, DC4-696, DC4-698A, DC4-698B, DC4-701, DC4-701A, DC4-769, DC4-711A, DC6-128, DC6-228, DC6-229, AND DC6-235
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ACA/CAC STANDARDS: 4-4190, 4-4255, 4-4256, AND 4-4261
STATE/FEDERAL STATUTES: SECTION 945.6034, F.S.
FLORIDA ADMINISTRATIVE CODE: SECTIONS 33-602.210, 33-602.220, 33-602.221,
33-602.222, AND 33-601.800, F.A.C.
PURPOSE: To set forth guidelines in providing health services to inmates in special housing.
DEFINITIONS:
(1) Chief Health Officer/Institutional Medical Director, where used herein, refers to the designated health authority with which final clinical judgment rests on medical issues concerning inmates at assigned institutions and any satellite facilities. The Chief Health Officer/Institutional Medical Director is a Physician licensed in accordance with either chapter 458 or 459. F.S.
(2) Clinical Associate, where used herein, refers to an Advanced Registered Nurse Practitioner or a Physician Assistant.
(3) Comprehensive Health Care Contractor (CHCC), where used herein, refers to contracted staff that has been designated by the Department to provide medical, dental, and mental health services at designated institutions within a particular region.
(4) Health Assessment refers to a review of medical and mental health records to determine past and present health status. This health assessment may include a physical assessment and/or physical examination, and may or may not require inmate presence.
(5) Health Care Staff refers to any of the following individuals: Physicians (including Psychiatrists), Physician Assistants/Advanced Registered Nurse Practitioners (including Mental Health Advanced Registered Nurse Practitioners), Registered Nurses, Registered Nurse Specialists, Licensed Practical Nurses, Dentists, Psychologists, and Behavioral Specialists. Psychiatrists, Psychologists, Mental Health Advanced Nurse Practitioners and Behavioral Specialists are considered mental health staff. These health care staff may be employed directly by the CHCC.
(6) Individualized Service Plan (DC4-643A) refers to a dynamic, written description of problems, goals, and services, which is developed and implemented by the multi-disciplinary services team (MDST) and the close management inmate to address the inmate’s need for mental health services. An ISP will be developed and implemented for each close management inmate who suffers from a mental impairment or is at significant risk for developing such impairment, as determined by mental health staff.
(7) Institutional Classification Team (ICT) refers to the team consisting of the Warden or Assistant Warden, Classification Supervisor, Chief of Security, and other members as necessary when appointed by the Warden or designated by rule. The ICT is responsible for making work, program, housing, and inmate status decisions at a facility and for making other classification recommendations to the State Classification Office (SCO). At private facilities the Department of Corrections representative is considered a fourth (4th) member of the ICT when reviewing all job/program assignments, transfer, and custody recommendations/decisions. If a majority decision by the ICT is not possible, the decision of the Department of Corrections representative is final.
(8) Institutional Review Team, where used herein, refers to the Chief Health Officer/Institutional Medical Director/Regional Medical Director and the Assistant Warden
(9) Mental Health Special Housing Evaluation refers to an evaluation by a Psychologist or Behavioral Specialist and requires physical presence of an inmate for this documentation.
(10) Pre-Special Housing Health Evaluation (DC4-769) refers to an assessment of current physical and mental health condition by medical personnel. This assessment will require the presence of the inmate and includes, at a minimum, vital signs, weight, health related inquiry (questions), and the observation for acute mental impairment.
(11) Regional Mental Health Director, where used herein, refers to the contracted employee who is responsible for the delivery of mental health services within the designated region.
(12) Regional Medical Director, where used herein, refers to the contracted employee who is responsible for the delivery of health services within the designated region.
(13) Regional Review Team, where used herein, refers to the Regional Director for Institutions, Regional Medical Director, and the Regional Mental Health Director.
(14) Special Housing, where used herein, refers to administrative confinement, disciplinary confinement, protective management, maximum management, and close management units.
(15) State Classification Office, where used herein, refers to a staff member at the central office level who is responsible for the review of inmate classification decisions. Duties include: approving, modifying, or disapproving institutional classification team recommendations.
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SPECIFIC PROCEDURES:
(1) SPECIAL HOUSING HEALTH ASSESSMENTS:
(a) Health care staff will, as soon as possible, conduct a health assessment on any inmate prior to the inmate entering special housing.
(b) This special housing health assessment will include the following actions:
1. a review of the mental and physical health records;
2. the completion of the “Risk Assessment for the Use of Chemical Restraint Agents and Electronic Immobilization Devices,” DC4-650B;
3. a determination of any medication being taken by the inmate which will be continued while in a special housing unit;
4. identification of scheduled health appointments for callout;
5. physical assessment on a DC4-769 that determines any current health complaints;
6. evaluation of any physical/mental complaints using the appropriate DC4-683 protocol form;
7. observing the inmate for signs of acute mental impairment;
8. addressing any concerns to ensure continuity of care for the inmate in special housing; and
9. documentation of an overall statement as to the fitness of the inmate for special housing.
(c) Omission of any of the above actions during a health assessment requires written justification by health care staff.
(d) Same-day written notification on the “Staff Request/Referral,” DC4-529, will be provided by health services to mental health staff of any S-2 and S-3 inmates placed in special housing. On weekends, notification will be submitted to mental health staff by the next working day.
(e) Any inmate who exhibits an acute health problem (medical, dental, or mental) will not be placed in special housing until the inmate’s health problem has been evaluated within the respective discipline’s scope of practice by a Physician, Clinical Associate, Registered Nurse, Registered Nurse Specialist, Licensed Practical Nurse, Dentist, Behavioral Specialist, Psychologist or Psychiatrist.
1. In these instances, the inmate will be referred to the health clinic for urgent/emergent assessment by medical, dental, or mental health staff as appropriate.
2. If the appropriate staff are not available (e.g., after regular work hours), on-duty health care staff will perform urgent/emergent assessment pursuant to established protocols.
(f) Inmate medications are to be reviewed by health care staff during the health assessment to verify that there is a current (valid) order for the medication. Single-dose medications will be administered by nursing personnel and keep-on-person medications will be returned to the inmate for self-administration unless determined otherwise by health care staff.
(g) Documentation of the above information will be included on the DC4-769.
(h) If an inmate who is already in a special housing cell suddenly becomes ill or is unable to be safely treated for a health problem within special housing, s/he will be provided care at the appropriate treatment facility such as the infirmary or an emergency room.
(2) MENTAL HEALTH SPECIAL HOUSING EVALUATION:
(a) A mental health special housing evaluation is required for S-1 and S-2 inmates within thirty (30) calendar days of the inmate’s initial placement in special housing and at least every ninety (90) calendar days thereafter.
1. Documentation will be recorded on the “Chronological Record of Outpatient Mental Health Care,” DC4-642.
2. A mental health special housing evaluation may be done on a more frequent basis according to need as determined by a Psychologist.
(b) A mental health special housing evaluation will be required for S-3 inmates within five (5) calendar days of the inmate’s initial placement in special housing and at least every thirty (30) calendar days thereafter.
1. Documentation will be recorded on the DC4-642.
2. A mental health special housing evaluation may be done on a more frequent basis, according to need as determined by a Psychologist.
(c) These evaluations will include a personal interview with the inmate. The evaluating Psychologist or Behavioral Specialist will complete the “Mental Status of Confinement Inmates,” DC4-528, and send it to the institutional classification team via the Classification Supervisor, with a copy of the DC4-528 sent to the health record.
(d) The institutional classification team and the state classification office (or multiple institutional classification teams when considering placement, continuance, modification, or removal of inmates from close management units) will make a final decision regarding the continuation of special housing.
(e) Any inmate who is already in a special housing cell and who reports or displays rapid change in behavior, overt signs of mental distress/impairment, bizarre behavior, or thoughts/threats to harm her/himself, will be referred to mental health staff, if available, immediately. If mental health staff is not available, the referral will be to other health care staff. Security staff will observe the inmate continuously until s/he is evaluated as required.
(3) GROUP THERAPY:
(a) In contrast with administrative confinement, disciplinary confinement, and protective management inmates whose access to group therapy is subject to the concurrence of the Chief of Security and review by the institutional review team, group therapy access by close management inmates is not so governed. Instead, a close management inmate will be allowed out of the cell to receive mental health services (including but not limited to group therapy) as specified in the DC4-643A unless, within the past forty-eight (48) hours, the inmate has displayed hostile, threatening, or other behavior that could present a danger to others.
(b) If group therapy is prescribed in the DC4-643A, it will be considered necessary health care.
(c) When group counseling or therapy is not feasible for sound reasons, reasonable efforts must be made to provide the same or an appropriate alternative intervention, such as individual therapy, and the individualized service plan will be modified accordingly.
(d) When group counseling is feasible, the indicated group will be held in or near the applicable housing unit.
(e) Restraining devices may be used during group counseling at the discretion of security staff and in accordance with pertinent rules and procedures.
1. During group therapy sessions, security staff will generally remain in the vicinity, but not inside the group therapy room, although security staff may do so in certain situations after determining that such presence is needed to ensure order and safety.
2. Any disputes will be referred to the Warden.
(f) If the Chief of Security does not concur that the administrative confinement, disciplinary confinement, or protective management inmate may participate in group therapy because of security reasons, mental health staff will submit the “Review of Group Therapy Referral” DC4-652, to the institutional review team for consideration.
1. The institutional review team will consider the following in rendering its decision:
a. the probability of violent/assaultive behavior in the group or while in transit to the group meeting (the target of past assaultive behavior as well as the frequency, recency, and severity of its occurrence will be considered in evaluating the probability of violence);
b. the escape potential from or in transit to the group (This will be based upon history or other documentation. Security restraint devices may be used as appropriate during the escort.);
c. the likelihood of disruptive/non-compliant behavior in the group or while in transit to the group, as may be suggested by recent behavior or other documentation;
d. the potential for compromise of an ongoing investigation, as may be suggested by a serious charge and/or when the nature of the investigation requires limited access to other inmates; and
e. any other documented threats to safety or security.
2. The institutional review team will document its decision on the DC4-652.
a. If the decision is favorable, the DC4-652 will be returned to mental health staff for filing in the health record behind sub-divider Other Mental Health Related Correspondence.
b. If the decision is unfavorable, the form will be forwarded to the regional office for review.
3. A regional review team, which is comprised of the Regional Director of Institutions, Regional Medical Director, and the Regional Mental Health Director, will review the DC4-652 within five (5) working days of receipt, will record its decision on the DC4-652, and will return the DC4-652 to the Warden for follow-up action.
a. A regional review team’s decision to withhold participation in a group will remain effective until there is a significant change in the inmate’s status or circumstances.
b. Upon change in status or circumstances, mental health staff may request further consideration. If group participation is precluded, mental health staff will develop an alternative treatment plan to meet the inmate’s current mental health needs.
(g) When enrolling any administrative confinement, disciplinary confinement, or protective management inmate in group therapy, mental health staff will perform the following:
1. If the inmate in administrative confinement, disciplinary confinement, or protective management was not enrolled in group therapy prior to placement on that status, mental health staff will determine whether group therapy is needed immediately or may be postponed until the inmate returns to open population and note such in a modification on the DC4-643A.
2. If mental health staff determines that an inmate needs group therapy immediately, mental health staff will coordinate with classification staff and check the special review status of each participant, regardless of the housing assignment, to ensure that inmates who have an adversarial relationship are not enrolled in the same group.
3. Mental health staff will use the DC4-652 to notify the Chief of Security or her/his designee of the intent to enroll the inmate in group therapy and to request clearance from a security standpoint for that enrollment.
4. Based upon local circumstances and individual facts, inmates assigned to different types of confinement may be enrolled in the same group if a review indicates it can be safely and securely done. However, inmates assigned to protective management or administrative confinement pending protective management may not participate with other inmates regardless of housing status, unless a thorough review ensures that any protection needs are met.
(h) When an inmate is admitted to mental health infirmary care or inpatient mental health care (that is, to an infirmary isolation management room, transitional care unit [TCU], crisis stabilization unit [CSU], or to a Corrections Mental Health Treatment Facility [CMHTF]), her/his confinement, protective management, or close management status will be suspended so long as s/he continues to receive such care. However, an inmate transferred from protective management will still need protection while receiving inpatient mental health care.