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(a) Policy. The Department of Correction, the Health Authority, and the Health and Hospitals Corporation shall develop and implement procedures governing the shackling of inmates who are receiving medical treatment and are housed in beds outside secure medical wards at the municipal hospitals. Inmates housed outside secure medical wards shall not be routinely shackled. The decision to shackle shall be made on a case by case basis and shall not serve as a substitute for appropriate security precautions or as punishment or for the convenience of staff. Shackling of inmates being transported between clinical settings shall be the least restrictive possible. All non-emergency decisions to shackle inmates must not be medically contraindicated.
(b) Definition. Shackling includes the use of all devices which encircle the ankle or wrist of an inmate and restrict movement.
(c) Procedures. The procedures developed for inmates housed in hospitals in beds outside of secure medical wards must include the following:
(1) Shackling shall be used only upon the direction of the Chief Correctional Officer or his/her designee after a review of the individual case. Pending the receipt of security-related information necessary to perform the review, an inmate may be shackled unless he/she falls into categories listed in (3)(i) through (iv) below. This security-related information must be obtained promptly.
(2) Shackling shall only be used when a Chief Correctional Officer or his/her designee demonstrates with clear and articulable facts that twenty-four hour officer coverage may be insufficient to protect the safety of others or to prevent escape.
(3) An inmate who is to be restrained shall be seen by a physician. DOC will not shackle an inmate where a physician has determined that the inmate is:
(i) pregnant and admitted for delivery of a baby; or
(ii) dependent on a ventilator or respirator; or
(iii) in imminent danger or expectation of death (unless the inmate while in the condition described by (i)-(iii) above attempts to escape or engages in violent behavior at the hospital which presents a danger of injury); or
(iv) where shackling is medically contraindicated. Provided, however, that should an inmate, while in a condition described by (iv) above, attempt to escape or engage in violent behavior at the hospital which presents a danger of injury, he/she may be restrained pending an immediate review of his/her medical condition by a physician to determine whether the use of shackles threatens the inmate's life. DOC shall promptly make alternative security arrangements before the restraints are removed, unless a life-threatening condition exists. In the case of a life-threatening condition, the shackles shall be removed immediately.
(4) At least daily, physicians shall update and review the medical condition of shackled inmates. They shall convey their findings to the Department of Correction including whether the use of mechanical restraints, while the inmate ambulates is medically contraindicated.
(5) A shackled inmate shall be given the opportunity to use the bathroom as often as the need arises unless the physician has ordered the use of bed pans instead.
(6) The decision to shackle an inmate shall be reviewed on a daily basis by a Chief Correctional Officer or his/her designee and must be revised immediately if a physician determines that the shackles have become medically contraindicated. In the latter case, unless a life-threatening medical emergency exists, DOC shall have the opportunity to make alternative security arrangements, if necessary, before the shackles are removed. These arrangements must be made promptly.
(7) All decisions to apply mechanical restraints will be made by the Department of Correction's office of operations.
(8) Written records shall be maintained at the hospitals which indicated the reason for shackling, the time and date of the approval for shackling, the name and title of the person giving approval, and the inmate's name, book and case number and medical status.
(9) Hospital-based physicians caring for inmates outside secure medical wards at the municipal hospitals shall receive training in this standard.