| Section
A: Governance and Administration |
P-A-01
Access to Care
(Essential) |
Formerly
P-01
This essential standard has not changed from the 1997
version. It intends to ensure that inmates have access
to care to meet their serious health needs and is the
principle upon which all National Commission on
Correctional Health Care standards are based. |
P-A-02
Responsible Health Authority
(Essential) |
Formerly
P-02
This essential standard intends that there is a
coordinated health care system. It explicitly clarifies
that the RHA (or on-site designee) is expected to be on
site weekly; where the authority is regional or
corporate, a local designee is available. Where there is
a separate organizational structure for mental health
services, a designated mental health clinician
coordinates services with the RHA. |
P-A-03
Medical Autonomy
(Essential) |
Formerly
P-03
This essential standard remains basically the same. It
endorses the key principle that clinical decisions are
made for clinical purposes, by clinical staff and
without interference. It notes that health staff are
otherwise subject to the same security regulations. |
P-A-04
Administrative Meetings and Reports
(Essential) |
Formerly
P-04
This essential standard is intended to facilitate the
health care delivery system through joint monitoring,
planning, and problem resolution between the facility’s
health and correctional administrators. It is also
intended that health staff are informed of operational
and other issues. While remaining the same, the listing
of statistics to be monitored has been revised to
include: the number of inmates receiving health services
by category of care, referrals to specialists, deaths,
infectious disease monitoring (TB, hepatitis, HIV and
STDs), emergency services and dental procedures. Minutes
or summaries are kept for the quarterly meetings; the
monthly staff meetings are documented. |
P-A-05
Policies and Procedures
(Essential) |
Formerly
P-05
An intent of this essential standard is to articulate in
writing the official approved policies and procedures to
be followed by the staff in fulfilling their duties. It
explicitly clarifies that either a manual or compilation
of P&Ps is acceptable, and that systemwide or
corporate P&Ps must be site-specific. While health
services policies and procedures must be reviewed/signed
annually by the RHA and RMD, copies of the policies and
procedures included in the health services manual or
compilation that originate from a corporate, system or
corrections authority are the current version from that
authorizing authority. The P&Ps are to be readily
accessible to health staff. |
P-A-06
Continuous Quality Improvement Program
(Essential) |
Formerly
P-06
This essential standard is intended to ensure that a
facility utilizes a structured process to find areas
within the health care delivery system that need
improvement and, when found, facility staff develop and
implement strategies for improvement. This standard has
been substantially changed. Depending on the ADP of the
facility, either a Basic CQI Program (ADP is less
than 500) or a Comprehensive CQI Program is
expected (ADP is greater than 500).
The Basic Program includes the former requirement
for physician clinical chart review and adds the
requirement for documentation of an annual review of 7
basic components of the health program (access to care,
receiving-screening, health assessment, continuity of
care, emergency care and hospitalizations, and adverse
patient occurrences including deaths).
The Comprehensive Program includes the
requirement for the former quarterly multidisciplinary
CQI committee; adds requirements for annual review of 16
components of the health program; two CQI studies
annually, one of which is a process study and the other
of which is an outcome study; and an annual review of
the effectiveness of the CQI program itself. |
P-A-07
Emergency Response Plan
(Essential)
(Name change from "Emergency Plan" to better
reflect the standard’s focus.) |
Formerly
P-07
This essential standard intends to ensure that a
facility protects the health, safety, and welfare of
inmates, staff, and visitors during emergencies, and has
been changed significantly to better reflect emergencies
that occur in correctional settings.
At least one mass disaster drill is required per
facility per year. Over a three-year period, these mass
drills must be held on each shift to which health staff
are routinely assigned. The health emergency
"man-down" response is practiced at least
annually per shift on which health staff are regularly
assigned, including satellite locations. Documented
critiques of actual occurrences are acceptable.
Requirements regarding the written plan remain the same;
aspects of health care to be included in the plan are
specified. If full-time health staff are not assigned to
a particular shift, a drill on that shift is not
required. If no full-time health staff are assigned to
the facility, while the standard remains applicable, the
drill is not required but recommended. |
P-A-08
Communication on Special Needs Patients
(Essential) |
Formerly
P-08
An intent of this essential standard is to guide
facility practices regarding patients with special
needs. It remains basically the same with the addition
of 3 more explicit categories of patients who need to be
considered as having special needs: those on dialysis,
adolescents in adult facilities, and those who are
suicidal.
Note: This standard addresses necessary communication
from health staff to corrections; P-H-03 Access to
Custody Information is the "companion"
standard addressing communication from corrections to
health staff. |
P-A-09
Privacy of Care
(Important) |
Formerly
P-09
An intent of this important standard is to respect the
privacy of a health encounter and to protect a patient’s
dignity. This standard remains basically the same;
reasonable efforts to guard privacy when security is a
concern are made. |
| (DELETED:
Formerly P-10 Notification in Emergencies) |
(This
former standard is essentially a function of
correctional authorities who may ask health staff to
participate.) |
P-A-10
Procedure in the Event of an Inmate Death
(Important) |
Formerly
P-11
This important standard intends to avoid preventable
deaths via a threefold focus on the appropriateness of
clinical care provided, the effectiveness of the
facility’s policies and procedures as they are
relevant to the circumstances surrounding the death, and
the identification of trends that require further study.
Changes to this standard include no longer requiring the
autopsy unless the law requires it. However, both an
autopsy and a psychological autopsy in the event of a
suicide are recommended for the additional learning
opportunities they provide. While all deaths of inmates
for which the facility is responsible are to be reviewed
regardless of where the death took place, expected
deaths may be reviewed under a modified death review
process. Deaths by execution are exempt from review. |
P-A-11
Grievance Mechanism for Health Complaints
(Important)
(Name change from "Grievance Mechanism" to
better reflect standard’s focus.) |
Formerly
P-12
This important standard intends to protect the patient’s
right to question his/her health care and remains
basically the same. Explicit clarification is given that
grievance responses are expected to be professional and
timely. The link of the grievance program with the CQI
process is explicitly noted. |
