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(a) Policy. Adequate health care, including follow-up care, shall be provided to inmates in an environment which facilitates care and treatment. Such care and treatment shall be provided by health care personnel in a timely fashion and shall be consistent with accepted professional standards and legal requirements.
(b) Treatment Area.
(1) Each correctional facility with a capacity of over one hundred shall establish and maintain a discrete medical treatment area (clinic) which is in accordance with all State, Federal, and local laws and all other applicable legal requirements, except where 40 RCNY § 3-06(b)(5) applies.
(2) The Health Authority shall establish written criteria defining the following:
(i) the equipment, supplies and materials necessary in each clinic to provide quality health treatment and appropriate specialty care, where applicable; and
(ii) the number of health care personnel required to provide effectively for the needs of the inmate population within appropriate time frames.
(3) At a minimum, the medical treatment areas in each clinic shall be equipped with the following:
(i) hot and cold running water in each exam room;
(ii) adequate lighting in each exam room;
(iii) an examination table;
(iv) an appropriate receptacle for infectious waste in accordance with local laws;
(v) sterilization equipment as needed;
(vi) adequate space to provide privacy for all encounters between health care personnel and inmates;
(vii) acceptable heating, air-conditioning and ventilation;
(viii) soap and paper towels, and
(ix) all other equipment, supplies and materials deemed appropriate by the Health Authority pursuant to 40 RCNY § 3-06(b)(2).
(4) Health care equipment, supplies, and materials shall be placed in an area which is easily accessible to health care personnel. Equipment used for treating inmates shall function properly and safely at all times.
(c) Dental Services.
(1) Quality dental care necessary to maintain an adequate level of dental health shall be available to each inmate under the direction and supervision of a dentist licensed in New York State.
(i) emergency dental care shall be provided as described in 40 RCNY § 3-02(d).
(ii) a dental examination shall be offered within three weeks for each inmate who so requests or upon referral by other health care personnel unless the inmate refuses the scheduled exam. There shall be a follow-up plan developed to insure that necessary services are provided in a timely fashion. In-clinic refusals or no-shows shall be documented in the inmate's health record.
(iii) the Department of Correction shall be responsible for ensuring that requests for access to non-emergency dental services are communicated to dental health care personnel within two working days of receipt by Department of Correction. In the event that dental personnel are not on duty, an inmate's request will be communicated to health care personnel, who in turn will be responsible for conveying the request to dental personnel on their next work day.
(2) A dental examination shall include, but not be limited to, the following:
(i) an examination of the internal and external structure of the mouth to detect abnormal functioning, diseases of the mucous membranes and jaws, and diseases of the teeth and supporting structures;
(ii) diagnostic X-rays when deemed necessary by the dentist;
(iii) testing of the pulp and other tissues;
(iv) caries susceptibility;
(v) cancer smears, as indicated;
(vi) taking or reviewing a dental history and noting decayed, missing, and filled teeth; and
(vii) education in proper dental hygiene.
(3) Dental treatment, not limited to extractions, shall be provided when the health or comfort of the inmate would otherwise be adversely affected for an unreasonable length of time as determined by the dentist after reviewing the results of a dental examination. Treatment may include, but not be limited to, the following:
(i) relief of pain and treatment of acute infections;
(ii) removal of irritating conditions which may lead to malignancies;
(iii) treatment of related bone and soft tissue diseases;
(iv) repair of injured or carious teeth;
(v) replacement of lost teeth and restoration of function;
(vi) oral prophylaxis;
(viii) oral surgery; and
(4) Dental treatment shall be conducted within a reasonable time as determined by the results of the dental examination.
(5) A full health record must be available to the treating dentist at the time of treatment if requested by the dentist or deemed necessary by health care personnel.
(6) Adequate dental records of each inmate's visit shall be maintained in the health record, including the following:
(i) date of the visit;
(ii) results of the dental examination;
(iii) treatment planned or provided where appropriate;
(iv) follow up plans if any; and
(v) name and signature of the dentist.
(7) Only a dentist or a dental hygienist licensed to practice in New York State may conduct dental examinations. Only a dentist so licensed may provide dental treatment.
(i) correctional personnel will not screen requests for dental services.
(ii) no person shall deny or in any way delay an inmate's request for access to dental services.
(8) A daily record or log shall be maintained by the Health Authority which lists the following:
(i) the names and number of inmate requests for dental services;
(ii) the names and number of inmates brought to the dental clinic; and
(iii) the names and number of inmates seen by dental personnel.
(d) Vision and Eye Care Services.
(1) The Health Authority shall establish written policies and procedures to provide vision and eye care services to inmates in need of such services.
(i) All inmates who in the opinion of medical personnel require vision and eye care services beyond that which is provided during the intake screening, shall be so referred and provided.
(ii) Inmates whose eyeglasses are broken, lost, or otherwise unavailable shall be entitled to a vision examination.
(2) If determined after an eye examination that an inmate is in need of eyeware, the Health Authority shall be responsible for providing the inmate with such eyeware.
(3) All incoming inmates who are in possession of corrective eyeware shall be allowed to retain such unless otherwise determined by health care personnel.
(4) Records shall be maintained in the inmate's medical chart of all ophthalmologic, optometric, and vision services. Such records will include at least the following:
(i) results of vision examinations conducted in addition to initial screening;
(ii) treatment or medication prescribed and follow-up plans; and
(iii) the name of the treating ophthalmologist/ optometrist.
(5) A daily log shall be maintained by the Health Authority to document the following:
(i) the names and number of inmates referred to or requesting vision and eye care services; and
(ii) the names and number of referrals and requests honored.
(6) Eye and vision examinations and treatment shall be conducted only by an ophthalmologist or an optometrist licensed in New York State.
(e) Pregnancy and Child Care.
(1) All pregnant inmates shall receive comprehensive counseling, assistance, and medical care consistent with professional standards and legal requirements.
(2) A pregnant inmate shall be provided with appropriate and timely prenatal and postnatal care including but not limited to the following:
(i) gynecological and obstetrical care;
(ii) medical diets for prenatal nutrition;
(iii) all laboratory tests as deemed necessary by medical personnel; and
(iv) special housing as deemed necessary by medical personnel.
(3) Upon request, and in accordance with all applicable laws, female inmates shall be entitled to receive abortions in an appropriately equipped and licensed medical facility within a reasonable time-frame. The following conditions shall apply to abortion services at a hospital:
(i) subsequent to consultation with a licensed physician, the voluntary informed consent of the inmate shall be obtained as pursuant to 40 RCNY § 3-06(j) prior to the procedure; and
(ii) the procedure shall not be performed in the correctional institution.
(4) The Health Authority shall make all reasonable arrangements to ensure that child births take place in a safe and appropriately equipped medical facility outside of the correctional facility.
(5) If an inmate decides to keep her child, necessary child care will be provided as consistent with applicable section(s) of the New York Correction Law and all other legal requirements and consistent with Department of Correction policies governing the nursery program.
(6) Upon request, pregnant inmates shall be provided access to adoption or foster care services through the Department of Correction's Social Service Unit. Under no circumstances will correctional or health care personnel delay or deny an inmate access to such services or force an inmate to utilize either service against her will.
(i) if the inmate decides on adoption or foster care for the new born child, referral services with the New York City Department of Social Services will be promptly provided for planning and placement of the infant.
(7) The Health Authority and the Department of Correction shall insure that nursing mothers admitted to the Department of Correction are screened for eligibility for the nursery program with appropriate speed. There shall be written policies and procedures defining the program and criteria for admission to and discharge, including grounds for removal from the program.
(f) Diagnostic Services.
(1) Written policies and procedures pertaining to diagnostic services, including radiology, pathology, and other medical laboratory services shall be developed and implemented by the Health Authority within the correctional facilities in accordance with legal requirements, accepted professional standards and sound professional judgment and practice.
(2) Pathology and medical laboratory procedures and policy shall include but not be limited to the following:
(i) conducting laboratory tests appropriate to the inmate's needs;
(ii) performing tests in a timely and accurate manner;
(iii) prompt distribution and review of test results and maintaining copies of results in the laboratory and in the inmate's health record;
(iv) calibration of equipment on a periodic basis;
(v) validation of test results through use of standardized control specimens or laboratories;
(vi) receipt, storage, identification and transportation of specimens;
(vii) maintenance of complete descriptions of all test procedures performed in the laboratory including sources of reagents, standards, and calibration procedures; and
(viii) space, equipment and supplies sufficient for performing the volume of work with optimal accuracy, precision, efficiency, and safety.
(3) Policies and procedures for the delivery of radiology services within the correctional facilities shall be established by the Health Authority and shall include but not be limited to the following:
(i) appropriate radiographic or fluoroscope diagnostic and treatment services;
(ii) interpreting x-ray films and other radiographs, and supplying reports in a timely manner;
(iii) maintaining duplicate reports for services and retaining film in the radiology department for a period of time that is in accordance with all applicable laws;
(iv) maintaining an adequate record of all examinations performed on each inmate in a separate log and as part of the inmate's health record; and
(v) when appropriate, prompt referral to necessary off-site radiology services.
(4) Safety issues regarding all radiology services shall be explained to all appropriate health personnel. Policies and procedures addressing these aspects shall include, but not be limited to, the following:
(i) performing radiology services only upon the written order of medical personnel or a dentist which contains the reason for the procedure;
(ii) limiting the use of any radioactive materials to qualified health care personnel;
(iii) regulating the use, removal, handling, and storage of any radioactive material;
(iv) precautions against electrical, mechanical, and radiation hazards;
(v) instruction to health care and correctional personnel in safety precautions and in the handling of emergency radiation hazards;
(vi) proper shielding where radiation sources are used, acceptable monitoring devices for all personnel who might be exposed to radiation to be worn in any area with a radiation hazard, and the maintenance of records on personnel exposed to radiation; and
(vii) ongoing recorded evaluation of radiation sources and of all safety measures followed, in accordance with all federal, state, and local laws and regulations.
(5) Pathology and radiology services shall be directed by qualified physicians licensed by New York State.
(6) Inmates will be notified promptly of all clinically significant findings and appropriate follow-up evaluation and care will be provided. This section applies to diagnostic service provided in all settings.
(g) Surgical and Anesthesia Services.
(1) Inmates shall be provided with access to adequate surgical and anesthesia services as defined in written policies and procedures developed by the Health Authority in accordance with legal requirements, accepted professional standards and sound professional judgment and practices.
(2) Minor surgical and oral surgical procedures can be performed only by medical personnel or dentists with appropriate training and appropriate levels of back up services available.
(3) The informed consent of the inmate must be obtained before an operation is performed, pursuant to 40 RCNY § 3-06.
(4) The Health Authority shall provide observation and care for inmates during pre-operative preparation and post-operative recovery periods, and establish written instructions for inmates in follow-up care after surgery.
(5) Surgical rooms, supplies, and equipment shall be properly cleaned and sterilized before and after each use.
(6) Adequate surgical and anesthesia equipment and space will be available.
(i) all equipment shall be calibrated, adjusted and tested regularly and so recorded to ensure proper functioning at all times.
(h) Medical Diets.
(1) Written policies and defined procedures shall be developed by the Health Authority and the Department of Correction and shall provide for special medical and dental diets which are prepared and served to inmates according to the written orders of the medical or dental personnel.
(2) When determined by medical or dental personnel that an inmate's health condition necessitates a special therapeutic diet, the Department of Correction shall be responsible for providing such diets promptly. Written records shall be maintained that identify the names of inmates receiving special diets, the date they are initiated, the duration and the specification of the diets.
(3) Requests for special diets or modifications of previous requests will be in writing, signed by medical or dental personnel and completely and specifically list the following: (i) levels of applicable nutrients or calories desired;
(ii) types of and quantities of food groups allowed;
(iii) special preparation restrictions or requirements if any; and
(iv) duration of the diet.
(4) Orders for special diets shall be recorded in the inmate's medical or dental record including:
(i) the purpose for such diet;
(ii) a description of the diet including duration; and
(iii) the signature of the dentist or physician ordering such diet.
(5) Inmates who are in need of long-term therapeutic diets shall be given written dietary instructions specific to their diet modification by the Health Authority.
(6) A Department of Correction registered dietician trained in the preparation of therapeutic diets shall be available for consultation to all facilities where food is prepared for inmates. This registered dietician shall oversee the staff dieticians who will be available in sufficient numbers to insure that all relevant sections of these standards are met.
(7) Special diets shall be available to inmates in general population and special housing. Special housing shall not be required in order to receive special diets.
(i) Prosthetic Devices.
(1) Medical and/or dental prostheses shall be provided promptly by the Health Authority when it has been determined by the responsible physician and/or dentist that they are necessary, unless there is a reasonable basis to assume that the inmate will not be incarcerated for sufficient time to receive the prosthesis.
(i) prostheses shall include any artificial device to replace missing body parts or compensate for defective bodily functions;
(ii) the cost for prosthetic equipment and services shall be borne by the Health Authority.
(j) Informed Consent.
(1) Informed consent will always be sought by health care per- sonnel.
(2) When an invasive procedure is indicated and except as otherwise provided in 40 RCNY § 3-06(j)(4) an inmate shall be given complete information, in a language he/she understands, pertaining to the following:
(i) the inmate's diagnosis and the nature and purpose of the proposed medical or dental treatment;
(ii) the risks and benefits of the proposed treatment;
(iii) alternative methods of treatment, if any; and
(iv) the consequences of forgoing the proposed treatment.
(3) Medical personnel or dentists shall not withhold any facts necessary for an inmate to make an informed, knowing decision regarding treatment, or minimize the risks of known dangers of a procedure in order to induce the inmate's consent.
(4) The Health Authority shall develop and implement written policies and procedures pertaining to informed consent which will be submitted for approval to the Board of Correction within 90 days and must be consistent with all applicable laws. The policies and procedures must include, but need not be limited to the following:
(i) obtaining informed consent for inmates who are minors or others who are or may be legally incapable of providing informed consent;
(ii) use of a written form to document the informed consent of inmates for special procedures beyond routine treatment; and
(iii) maintenance of detailed documentation when special procedures or surgery are performed on inmates in emergency situations pursuant to 40 RCNY § 3-06.
(5) Informed consent forms shall be maintained as part of the inmate's health record in accordance with all applicable laws.
(6) Informed consent policies shall be consistent with the informed consent policies described in The Board of Correction Mental Health Minimum Standards for New York City Correctional Facilities.
(k) Drug and Alcohol Treatment.
(1) All inmates who give empirical evidence of addiction to alcohol, drugs or both, must be observed and offered treatment to prevent complications resulting from intoxication, withdrawal and associated conditions, as appropriate and according to written protocols approved by the Health Authority.
(2) Education and referral services should be available to inmates with alcohol or drug addiction(s) who request assistance.
(l) Right to Refuse Treatment.
(1) An inmate may refuse a medical examination or any medical treatment except when medical personnel or a dentist has determined that immediate medical, surgical or dental treatment is required to treat a condition or injury that may cause death, serious bodily harm, or disfigurement to such inmate and at least one of the following applies:
(i) the inmate has been determined in accordance with all applicable laws to be incompetent to consent to the specific procedure at the time it is offered;
(ii) consistent with the provision of applicable law the inmate is a minor; or
(iii) it is demonstrated that the parent or legal guardian of incompetent inmates or minors cannot be reached.
(2) When an inmate refuses treatment for a health condition that is infectious, contagious, or otherwise poses a threat to the health, safety, or well-being of others, such inmate may, in accordance with determination made by health care personnel either:
(i) be placed in medical isolation in compliance with 40 RCNY § 3-02(g); or
(ii) be transferred to an infirmary setting.
(3) When an inmate is treated against his or her will pursuant to 40 RCNY § 3-06(l)(2):
(i) the medical personnel will use only those measures which in his or her best professional judgment are deemed appropriate in response to the emergency; and
(ii) adequate health records shall be maintained to detail the inmate's condition, the threat the inmate poses to himself and others, and the specific reasons for the inter- vention.
(4) An inmate who voluntarily refuses any health service deemed essential upon review by health care personnel shall do so after consultation with a Health Authority and shall sign a waiver form developed by the Health Authority.
(i) if the inmate refuses to sign a waiver, non-treating health care personnel shall sign the waiver as a witness, and note that the inmate has verbally refused such health services and refused to sign any waiver.
(ii) completed waiver forms shall be maintained as part of each inmate's health file in accordance with all applicable laws regarding duration of retention.
(iii) the waiver shall be specific to the procedure or care being refused and must be accompanied by a detailed and documented discussion of the procedure/treatment being refused and medical consequences of refusal and cannot be used to deny or fail to offer the inmate subsequent treatment.
(iv) Whenever required by medical personnel and practicable, all refusals for specialty clinics should be signed in the presence of medical personnel before the inmate is scheduled for transfer to the specialty clinic.
(5) Inmates refusing treatment need not remain in a medical area unless their condition, without treatment, cannot be managed in a less intensive setting.
(6) The policies developed regarding the right to refuse treatment shall be consistent with the Mental Health Minimum Standards.
(7) Care rendered under 40 RCNY § 3-06(l)(1) or 40 RCNY § 3-06(l)(3) or care refused as described in 40 RCNY § 3-06(l)(4) shall be recorded in a log specifically maintained for this purpose. The log which shall be maintained by the Health Authority in each clinic shall have sequentially numbered pages, and must at a minimum indicate the name and number of the inmate refusing care or being treated against his/her will, the name(s) of the health care personnel involved and a description of the event. This log shall be reviewed by medical personnel designated by the Health Authority on a daily basis. Nothing in this subdivision shall alter the requirements for appropriate documentation in the health care record.
(m) Acquired Immune Deficiency Syndrome.
(1) The Department of Correction and the Health Authority shall develop policies and procedures to insure that inmates with HIV disease are treated in a non-discriminatory manner. These policies shall state that discrimination against any inmate based on his/her diagnosis or unauthorized disclosure of HIV-related information will result in disciplinary action by the relevant agency.
(2) The Health Authority shall develop protocols for the prevention and treatment of HIV related illnesses that are consistent with accepted professional standards and sound professional judgment and practice. All practices affecting the treatment or care of people with HIV infection shall be in compliance with federal, state and local laws and with all other parts of these standards.
(3) Confidentiality. All services for HIV-related disease shall be provided in a manner that insures confidentiality, consistent with these standards and New York State law. Segregation based solely upon this diagnosis shall be prohibited.
(4) Testing. Testing for HIV infection will be voluntary and performed only with specific informed consent and appropriate pre- and post-test counseling.
(5) Education. There shall be comprehensive AIDS education for all inmates and personnel who work in Department of Correction facilities and on the prison hospital wards. The curriculum shall be reviewed by the Health Authority, and revised as new information and treatments become available. Education services shall be provided by the Department of Health, the Department of Correction, Health and Hospitals Corporation or their designees. The Health Authority and the Department of Correction shall maintain a schedule of training sessions which includes the number of people in each session which shall be available for review by the Board of Correction.