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NCCHC Standards: A Summary Guide to the Revisions

2003 Standards for Health Services in Jails

Section A: Governance and Administration
Section B: Managing a Safe and Healthy Environment
Section C: Personnel and Training
Section D: Health Care Services and Support
Section E: Inmate Care and Treatment
Section F: Health Promotion and Disease Prevention
Section G: Special Needs and Services
Section H: Health Records
Section I: Medical-Legal Issues

Section I: Medical-Legal Issues
J-I-01
Use of Restraint and Seclusion in Correctional Facilities
(Essential)

(Name change from "Medical Restraints and Therapeutic Seclusion" to better reflect the content of the standard.)
Formerly J-64
This essential standard intends that when restraints are used for clinical or custody reasons, the inmate is not harmed by the intervention. The reworking of this standard makes explicit the different roles health staff have depending on why restraint or seclusion is used.

When restraints or seclusion are used for clinical reasons, it must be as the intervention of last resort, by physician order, for the shortest time necessary with an individual treatment plan developed. Restraints used are to be those employed in community settings.

When restraints or seclusion are employed by security for security reasons, security must notify health staff who will evaluate the health status of the inmate involved initially and periodically, notifying corrections if health problems exist or develop. These requirements are not new but are articulated explicitly here.
J-I-02
Emergency Psychotropic Medication
(Essential)

(Name change from "Forced Psychotropic Medication" to better focus on the applicability of the standard.)
Formerly J-65
This essential standard’s intent is to prevent harm in emergency situations when an inmate is dangerous to self or others due to a medical or mental illness. By physician’s specific order, psychotropic medication may be forced during the emergency. This standard does not address, nor is it intended to address, the issue of forced medication as an ongoing treatment intervention, which, depending on the jurisdiction, may require a court order. This is not a new emphasis for the standard and its content remains the same.
J-I-03
Forensic Information
(Important)
Formerly J-66
The intent of this important standard is to ensure that the role of the health services staff in serving the needs of their patients is not compromised by their involvement in the gathering of forensic information. One change has been made to previous versions. In those jurisdictions where DNA testing is required by law, with consent of the inmate, and provided that health staff are not involved in any punitive action taken if the inmate refuses, it is now permissible for facility health staff to do the blood draws.
J-I-04
End-of-Life Decision Making
(Important)
New
The intent of this new important standard is that inmates retain their medical-legal rights regarding end-of-life decisions. It focuses on decisions to be made regarding plans for the end of life so inmates are afforded the same options as they would in the community. After receiving appropriate information regarding these decisions, inmates are to be permitted to execute advance directives including living wills, health care proxies and "do not resuscitate" orders. Specific guidelines are offered regarding these options.
J-I-05
Informed Consent
(Important)
Formerly J-67
This important standard intends that inmates retain their right to make informed decisions regarding health care. Requirements remain basically the same.
J-I-06
Right to Refuse Treatment
(Important)
Formerly J-68
The intent of this important standard is to support the ethical principle that patients have the right to refuse health interventions. It remains basically the same. The need for the refusal to take place before health staff is made explicit.
J-I-07
Medical and Other Research
(Important)

(Name change from "Medical Research" to better reflect content of the standard.)
Formerly J-69
The important standard intends to support legitimate research initiatives while protecting inmates from being taken advantage of due to their status as inmates. It remains basically the same. The need to arrange for appropriate interventions for arriving inmates who are already participating in research not done at the facility has been made explicit.

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Summary Guide Introduction
General Changes in Format

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