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§ 3-02 Access to Health Care Services.
   (a)   Policy. The Department of Correction and the Health Authority shall be responsible for the design and implementation of written policies and procedures which ensure that all inmates have prompt and adequate access to all health care services. Services must be available, consistent with § 1-01 of the Minimum Standards for New York City Correctional Facilities.
   (b)   Access to Care.
      (1)   Every facility must inform all inmates of their right to health care and the procedures for obtaining medical attention, as described in 40 RCNY § 3-04(b)(6).
      (2)   No inmate may be punished for requesting medical care or for refusing it.
      (3)   Under no circumstances shall an inmate's access to any health care service, including but not limited to those services described in these standards, be denied or postponed as punishment.
      (4)   Correctional personnel shall never prohibit, delay, or cause to prohibit or delay an inmate's access to care or appropriate treatment. All decisions regarding need for medical attention shall be made by health care personnel.
      (5)   Inmates shall not be discriminated against, with regard to treatment, on the basis of their medical diagnoses.
      (6)   Any correctional personnel who knows or has reason to believe that an inmate may be in need of health services shall promptly notify the medical staff and a uniformed supervisor.
      (7)   Staffing levels in the jail clinics, jail infirmaries and prison hospital wards shall be adequate in numbers and types to insure that all standards described here are met. Staffing levels refers to both clinical and correctional personnel.
      (8)   The Health Authority shall develop policies and procedures to insure that inmates have access to second medical opinions regarding clinical recommendations.
   (c)   Sick-Call.
      (1)   Sick-call shall be available at each facility to all inmates at a minimum of five days per week within 24 hours of a request or at the next regularly scheduled sick-call. Sick-call need not be held on City holidays or weekends. Facilities with capacities of over 100 people, must provide sick-call services on-site in medical treatment areas. (As defined in 40 RCNY § 3-06(b)).
      (2)   Sick-call is to be conducted by a physician or under the supervision of a physician.
         (i)   Correctional personnel shall not prevent or delay or cause to prevent or delay an inmate's access to medical or dental services.
         (ii)   Correctional personnel will not diagnose any illness or injury, prescribe treatment, administer medication other than that described in 40 RCNY § 3-05(b)(2)(iii), or screen sick-call requests.
      (3)   Requests for access to health services shall not be denied based on any prior requests.
      (4)   The Department of Correction shall provide sufficient security for inmate movement to and from health service areas.
      (5)   Adequate records shall be maintained daily which are distinguishable by housing area on a form developed by the Department of Correction. These records shall be maintained for at least three (3) years. The form shall include the following:
         (i)   the names and number of inmates requesting sick call;
         (ii)   the names and numbers of inmates arriving in the clinic; and
         (iii)   the names and number of inmates seen by health care personnel.
      (6)   The use of a sick-call sign up sheet shall not preclude the use of sick-call by inmates who are not on the list.
   (d)   Emergency Services.
      (1)   All inmate requests for emergency medical or dental attention shall be responded to promptly by medical personnel. This shall include a face to face encounter between the inmate requesting attention and appropriate health care personnel. All health care and correctional personnel must be familiar with the procedures for obtaining emergency medical or dental care, with the names and telephone numbers of people to be notified and/or contacted readily accessible.
      (2)   Correctional personnel who know or have reason to believe that an inmate is in need of emergency health services shall make the appropriate notifications pursuant to 40 RCNY § 3-02(d)(5).
      (3)   The Department of Correction, with the advice and agreement of the Health Authority, shall prepare and implement written policies and defined procedures which shall be posted in every facility and include arrangements for, at least, the following:
         (i)   emergency evacuation of an inmate from the facility when required;
         (ii)   use of an appropriate emergency medical vehicle;
         (iii)   use of a designated hospital emergency unit;
         (iv)   security procedures for the immediate transfer of inmates when necessary; and
         (v)   procedures for providing for transfer of inmates within time guidelines established by the Health Authority.
      (4)   Any correctional facility with a rated capacity of less than 100 inmates must have an agreement with one or more health care providers to provide emergency medical services and must have at least one correctional personnel on each housing unit certified in Cardio-pulmonary resuscitation (CPR).
      (5)   All uniformed correctional personnel shall be informed of and familiar with all written procedures pertaining to emergency health services.
      (6)   In each facility, the telephone numbers of the control room and the medical clinic shall be posted prominently at each correctional officer station.
      (7)   Medical personnel, with current CPR certification, trained in the provision of emergency health care shall be present at all times in each facility that has a rated capacity of 100 or more inmates. Whenever possible, health care personnel should be trained and certified in CPR.
      (8)   In the case of serious illness or injury to an inmate, all reasonable attempts shall be made by the Department of Correction to notify the next of kin or legal guardian of the inmate within the time frames established for reporting unusual incidents.
      (9)   The Health Authority shall determine the types and quantities of emergency equipment and supplies required to be available within each correctional facility in order to provide adequate emergency services and shall have written protocols regarding emergency care. An inventory shall be submitted to the Board of Correction within 90 days of implementation of the standards and updated annually or more frequently as determined by the Health Authority.
         (i)   all emergency health equipment and supplies shall be inventoried and inspected by health services personnel at least twice each year, or more frequently as determined necessary by the Health Authority to ensure that such equipment and supplies are in good working order.
         (ii)   all emergency equipment and supplies shall be easily accessible to appropriate personnel.
      (10)   A uniform logbook shall be designed and used by the Department of Correction to document all requests for emergency health care. This logbook shall be maintained in the clinic and shall contain, but not be limited to the following information:
         (i)   name, commitment number/book and case number, housing location of the inmate, and the location of the incident;
         (ii)   the date and time of referral and the referring officer;
         (iii)   the time of inmate arrival in clinic or in the event that medical personnel respond to an area outside of the clinic, the time medical personnel leave the clinic; and
         (iv)   the time the inmate is examined by health care personnel.
   (e)   Infirmaries.
      (1)   Infirmaries, with discrete nursing stations and treatment area(s), shall be utilized to provide overnight accommodations and health care services of limited duration to inmates in need of close observation or treatment of health conditions which do not require hospitalization. Housing areas shall not be used for a combination of general population and infirmary housing at any one time.
      (2)   At designated facilities, The Health Authority and Department of Correction shall develop and implement written policies and procedures for the management of infirmaries that are consistent with professional standards and legal requirements. Such procedures shall incorporate at least the following;
         (i)   allocation of space and beds to meet the needs of the inmates in DOC custody as determined by the Health Authority and other applicable regulatory agencies;
         (ii)   accommodations for providing appropriate emergency services and the timely transfer of inmates to hospital and specialty services as consistent with 40 RCNY § 3-02(d)(3) and § 3-02(f)(1) and § 3-02(f)(2); and
         (iii)   provision of 40 RCNY § 3-02 adequate space and physical plant to operate infirmary related services (such as communicable disease isolation where applicable).
      (3)   The Health Authority shall develop and implement written policies that incorporate the following:
         (i)   maintenance and inventory of sufficient supplies, material, and equipment to provide proper and timely services to inmates;
         (ii)   clinical criteria for determining the eligibility of inmates for infirmary housing;
         (iii)   appropriate methods for a daily evaluation of the medical condition of each inmate;
         (iv)   supervision of the infirmary 7 days per week, 24 hours per day by nurses, and other health care personnel as sufficient to meet the established needs of the inmates; and
         (v)   availability of an adequate number of medical personnel 7 days per week, 24 hours per day to provide appropriate coverage, including daily rounds on infirmary patients.
      (4)   Only health care personnel shall determine, after an examination of the inmate, if an inmate's condition necessitates admission to the infirmary.
         (i)   inmates shall be discharged from the infirmary only upon the written authorization of medical personnel.
         (ii)   correctional personnel shall not interfere with an inmate's access to infirmary services or the duration of confinement in the infirmary and shall transfer inmates to and from infirmaries promptly when so requested by health care personnel.
      (5)   Infirmaries shall be designed and staffed so that inmates confined therein are within the sight or sound of health care personnel at all times.
      (6)   Adequate records for each infirmary admission, evaluation, and discharge shall be maintained as part of each inmate's health record as consistent with applicable requirements of 40 RCNY § 3-07(b) and 40 RCNY § 3-07(c).
      (7)   Sufficient security measures shall be provided continuously in the infirmary to assure the health and safety of all inmates and health care personnel who provide services to such inmates.
   (f)   Outpatient Specialty Clinics.
      (1)   Outpatient specialist services shall be provided to inmates in time frames specified by the referring medical personnel upon the written determination of a physician or dentist that the treatment appropriate to the inmate's health care need is not available in the correctional facility or cannot adequately be provided at such facility. In the event that the inmate has previously been treated by the specialty clinic physician, the specialty clinic physician shall determine the medically appropriate time for the return visit(s).
         (i)   In instances where the specialty clinic physician determines the time period or date for a follow-up appointment, the jail-based physician may alter that time provided that the change in time is not medically inappropriate and shall inform the inmate of the proposed change. If the change is not medically required, the new appointment date shall be scheduled for the next available clinic, or in the alternative, shall not be scheduled for a time period greater than the original time period (for example, if the original appointment was scheduled for within one week, the rescheduled appointment cannot be more than one week from the original appointment).
         (ii)   The reasons for any change in the original plan must be indicated in the inmate's medical record with clear reasons for the change.
      (2)   The Health Authority and the Department of Correction shall devise a written plan for the timely delivery of inmates to specialty clinics. This plan shall include, but not be limited to the following procedures:
         (i)   maintenance of a current list of community clinics, approved by the Health Authority which can adequately provide specialist care and treatment;
         (ii)   the scheduling requirements for specialist services and the hours of operation;
         (iii)   the use of an appropriate vehicle for the timely transfer of inmates to and from specialty clinics;
         (iv)   security procedures and escort requirements appropriate for transferring the inmate to and from the outpatient health clinic, including shackling procedures which are medically appropriate; and
         (v)   the transfer of appropriate health records and/or other pertinent information to assure proper follow-up care for the inmate, and to avoid unnecessary duplication of tests and examinations, pursuant to 40 RCNY § 3-08(b)(4).
      (3)   The variety of outpatient services available to inmates shall be no different than those available to civilian patients.
      (4)   Correctional or health care personnel shall not deny or unreasonably delay, or cause to deny or unreasonably delay an inmate's access to specialty services at any outpatient clinic.
         (i)   sufficient Escort Officers shall be provided within the clinic or hospital to ensure that an inmate's access to specialty clinics and related diagnostic units is not denied or unreasonably delayed.
   (g)   Medical Isolation.
      (1)   Inmates in medical isolation will receive the same rights, privileges and services set forth in these standards for inmates not in isolation, provided that the exercise of such rights, privileges and services does not pose a threat to the health, safety, or well being of any other inmate, correctional staff or health care personnel. Access to rights, privileges and services of and procedures regarding inmates in segregation for mental health observation is governed by the Board of Correction Mental Health Minimum Standards for New York City Correctional Facilities.
      (2)   Medical personnel shall assess the condition of each inmate so segregated at least once each 24 hour period. At least once each week rounds on all segregation inmates must be made by a physician.
      (3)   Health care personnel must maintain a daily log that includes the name of medical personnel who made rounds on inmates in isolation and lists those inmates who required further attention in the clinic. These logs are the property of the Health Authority and subject to the confidentiality provisions described in 40 RCNY § 3-08(c). Medical services provided to individual inmates must be noted in the inmates' health records.
      (4)   Upon request of the medical staff, inmates requiring further medical evaluation outside of the housing area shall be escorted to the clinic promptly for medical attention.
      (5)   The Health Authority shall develop written policies and procedures regarding the care of inmates in medical isolation. These procedures shall include that an inmate may be placed in medical isolation only upon the determination of medical personnel that isolation of an inmate is the only means to protect other people from a serious health threat, subsequent to the examination of such inmate and pursuant to 40 RCNY § 3-06(1)(2). This disposition by the medical personnel shall be in writing in the health care record and shall state:
         (i)   the name of the inmate; and
         (ii)   the facts and medical reasons for the isolation;
         (iii)   the date and time of isolation;
         (iv)   the duration of isolation, if known; and
         (v)   any other special precautions or treatment deemed necessary by the medical personnel. Upon determination by a physician that an inmate in medical isolation no longer presents a serious threat to the health of any person that inmate shall be released from such special housing after the appropriate correctional personnel are advised.
   (h)   Special Needs.
      (1)   The Health Authority in consultation with other agencies as required will develop written policies and defined procedures insuring appropriate care of inmates with special needs requiring close medical supervision, including chronic care and convalescent care or skilled nursing care.
      (2)   A written treatment plan, developed by the health care provider, supervised by medical personnel, must exist for each special needs inmate. The plan, to be included in the health record, may include but need not be limited to instructions about diet, exercise, medication, the type and frequency of laboratory and diagnostic testing, and the frequency of follow-up for medical evaluation and adjustment of treatment modality.
      (3)   When clinically appropriate, the treatment plan shall prescribe inmates access to the range of supportive and rehabilitative services (such as physical therapy and rehabilitation therapy), that the treating medical personnel deems appropriate.
      (4)   Rehabilitation services shall be available at in-jail clinics or through the outpatient clinics at off-site facilities, as appropriate.
   (i)   Hospital Care.
      (1)   Hospital based care shall be provided for inmates in need of hospital care consistent with applicable sections of the State Health Code. The Health Authority in conjunction with the Department of Health, Health and Hospitals Corporation, and other relevant providers, shall have a written plan defining admission and discharge procedures for appropriate levels of care. These procedures shall insure that inmates are not transferred to and from health care settings unnecessarily.
      (2)   Services provided to inmates in acute care, chronic care or other non-jail health facilities must meet all applicable subdivisions of these standards.
   (j)   Punitive Segregation.
      (1)   The Health Authority shall develop policies and procedures governing the medical attention for inmates in punitive segregation. These policies shall include the requirements of 40 RCNY § 3-02(g)(2)-(4). In addition, upon determination by a physician that the health of an inmate in punitive segregation will be adversely affected by such housing, the inmate shall be released from punitive segregation housing after the appropriate correctional personnel is advised.