Access to Care

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We have a question about compliance with standard A-01 Access to Care during the coronavirus emergency or any similar pandemic in the future. Patients’ ability to access health care services in a timely manner is central to compliance with the standards. However, with the COVID-19 situation, we are finding it necessary to change the way we provide health care in order to respond appropriately to the more vulnerable populations’ needs while also actively working to reduce potential exposure to the virus. What is NCCHC’s stance on the situation with regard to access to care?

We don’t want this new reality to affect our accreditation status.  Given the increased challenges of the coronavirus pandemic, and during any emergency like this, triaging is always the top priority. You need to direct your staff accordingly. This is truly a mass disaster scenario.

NCCHC surveyors are health care professionals who know what you are going through: many have been through similar crises themselves. They will consider the unusual circumstances you are facing and the adjustments you are having to make. That said, be sure that your technical response to the crisis is thoughtful, and document, document, document.   

— From CorrectCare Volume 34, Issue 2, Spring 2020

 
 

Our prison has a shortage of custody staff right now. As a result, inmates sometimes miss their on-site clinic appointments for annual assessments. Since we can document that the patients were scheduled for the assessment, would this meet the standard?

This problem could affect two standards. P-A-01 Access to Care requires that the responsible health authority identify and eliminate any unreasonable barriers, intentional and unintentional, to inmates receiving health care. P-D-06 Patient Escort states in compliance indicator #1 that patients are transported safely and in a timely manner for medical, dental and mental health clinic appointments inside and outside the facility. Compliance with these standards could be compromised if custody is not transporting patients to the clinic in a timely fashion. Custody staff shortage is not an acceptable justification for missing appointments.

— From CorrectCare Volume 33, Issue 4, Fall 2019

 
 

We have been holding sick call in the afternoons. The warden now wants sick call held at 5 a.m. so that inmates can be screened before the workday starts. Isn’t it a violation of the standard on medical autonomy for the warden to tell us to change our sick call time when the existing schedule is preferred by the health professionals?

The standard on medical autonomy (A-03) addresses clinical decisions and actions regarding health care provided to inmates. However, the time that sick call is held is not a clinical issue. The scenario you describe best fits under A-01 Access to Care. This standard requires the responsible health authority to identify and eliminate any barriers to inmates receiving health care. As mentioned in the discussion section of that standard, an unreasonable barrier includes deterring inmates from seeking care for their serious health needs, such as holding sick call at 2 a.m., when this practice is not reasonably related to the needs of the institution. It would be important to explore the reason for the proposed change during administrative meetings and that the decision be made jointly by the corrections administration and the responsible health authority.

— From CorrectCare Volume 32, Issue 1, Winter 2018

 
 

In talking with health staff at the local hospital emergency room, the question arose as to whether there is a definition of “fit for confinement” that ER physicians could refer to when deciding if an inmate can be cleared for a jail. Can NCCHC help?

I assume this is a situation in which an inmate was sent to the ER for an evaluation for a medical and/or mental health problem, and the ER is trying to decide if the inmate can be sent back to the jail.

Your best bet is to consult NCCHC’s Standards for Health Services in Jails, specifically essential standards J-A-01 Access to Care and J-E-02 Receiving Screening and important standard J-D-05 Hospital and Specialty Care. Here is a summary of how these standards address your question.

Inmates have a constitutional right to access to care for their significant health problems. If the level of care needed is not available at the facility, inmates are to be treated in a setting that can meet their specific health needs, such as a community hospital or ER, or perhaps a better equipped (i.e., health staff and services) correctional facility with which the original facility has transfer arrangements.

The ER physician involved in deciding if the inmate can be appropriately treated at the jail must consider several things. Foremost is the level of health or mental health services needed for follow-up if the inmate-patient is released, and whether the available jail health resources are at that level.

Sometimes when opinions differ between community ER physicians and jail physicians, it is because the ER physician does not really know what is available at the jail. A visit to the jail and an exchange of information about its health staffing and capabilities are essential to good planning between jail and ER health administrators and physicians.

One way for the ER physician to think about a return to jail is to regard it as a return to home care. That is, if the inmate were a regular community patient with a home and minimally supportive situation, would the hospital send the patient home? Does the inmate-patient simply need observation that could be done by minimally trained correctional officers, or does he or she inmate-patient need nursing care that is (or is not) available on-site? If the jail has an infirmary, what scope of care is available? Is there a sheltered housing area where the inmate can receive the necessary services? For example, is there a negative-pressure room to house contagious TB patients, or does the patient need to stay at the hospital until the contagious phase has passed?

Some ER physicians mistakenly assume that jails have 24/7 health staff and supports. While that may be true in a few jails, particularly in the mega-systems, most have limited on-site health resources. On the other hand, if you or I were treated in an ER and then sent home and not hospitalized, jails should expect that the ER will want to do the same for inmate-patients treated for the same conditions.

Given the possibility that little attention may be given to a returning inmate, the ERs may be advised to hold the inmate-patient for a little longer observation if there is any doubt. Some jails and ERs create a “locked ward” at the hospital when such patient volume is high.
— From CorrectCare Volume 21, Issue 3, Summer 2007