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The Latest Column
Questions are from the latest Standards Q&A column, posted in June 2019.
Psychologists Prescribing Psychotropic Meds
Idaho has passed legislation that permits psychologists to prescribe psychotropic medication if they have certain training. Does NCCHC have a position on whether it is appropriate to have a psychologist in a correctional setting prescribing, if properly licensed?
NCCHC has no position on that specific issue, except to the extent that the facility is complying with the laws applicable in the jurisdiction.
For example, in the 2018 Standards for Health Services, standard C-01 Credentials states that “The facility’s qualified health care professionals are legally eligible to perform their clinical duties.” Compliance indicator #4 requires that qualified health care professionals not perform tasks beyond those permitted by their credentials. In standard D-02 Medication Services, compliance indicator #2 states that “Prescription medications are given only by the order of a physician, dentist, or other legally authorized individual.”
Therefore, if the psychologist is appropriately licensed and has documented proof of required training to prescribe medications per state law, this would be in compliance with the NCCHC standards.
Weekly RHA Visits at Multiple Sites
Our jail system has three facilities, and one of them is 40 miles away from the others. Standard A-02 requires that the responsible health authority be on-site at least weekly. Our designated RHA is busy at our main jail 40 hours a week and couldn’t possibly make it to all three facilities. Does the standard require that the RHA be on-site weekly at each facility?
The RHA should designate someone to be on-site at least once a week for each facility. In a system such as yours, that person may siwork under the supervision of the system’s health authority. If your outlying facility is large, it probably has a physician who vits at least weekly. Such a person, or an on-site administrator is often the one who is designated as the facility’s responsible health authority.
Annual Health Assessments
Our facility is preparing for NCCHC accreditation and we have a question about Standard E-04 Initial Health Assessment. We thought there was a requirement that all inmates are to receive an annual health assessment but cannot find that in the standard.
The standard gives jails two options. (1) “Full population assessment” requires that the initial health assessment be completed as soon as possible but no later than 14 calendar days after admission. (2) The “individual assessment when clinically indicated” must be completed within two working days after admission, and other stipulations must be met in order to qualify for this option. For prisons and juvenile facilities, the full population assessment must be completed as soon as possible but no later than seven calendar days after admission; the individual assessment when clinically indicated is not an option.
In addition, periodic health assessments should be considered an important part of ongoing disease prevention. The responsible physician should determine the frequency and content of these exams for various groups based on age and risk factors. In the 2018 Standards for jails and prisons, this requirements appears in B-03 Clinical Preventive Services, compliance indicator #2. For juvenile facilities, see E-04 Health Assessment, compliance indicator #3.