Hospital and Specialty Care - National Commission on Correctional Health Care

Hospital and Specialty Care

For each community hospital or off-site specialty service used regularly for medical and mental health care, there needs to be a written agreement that outlines the terms of the care to be provided. Written agreements include a contract, letter of agreement or memorandum of understanding between the facility and the hospital, clinic or specialist. Agreements should require that the off-site facilities or health professionals give the inmate a summary of the treatment given and any follow-up instructions. In other words, those treatment summaries and discharge instructions should accompany the inmate back to the facility. This provision should be in writing, even if it happens in practice. A written agreement with this language will help to ensure that the practice continues, regardless of leadership or procedural changes. Keep in mind that this is an “important” standard, so if your MOU isn’t being revised soon, it is possible to not meet this standard and still achieve accreditation.

— From CorrectCare Volume 26, Issue 2, Spring 2012

The phrasing is not meant to imply that the inmate should literally take possession of the documents. Rather, such documents should be given to health staff. Our intent with this standard is to convey the importance of having the outside provider send this information at the same time that an inmate is returned to the facility so that it can be reviewed immediately by facility health staff (see also J-E-12 Continuity of Care, Compliance Indicator 3).

— From CorrectCare Volume 24, Issue 1, Winter 2010

No. According to the Hospital and Specialty Care standard (D-05), for each community hospital or off-site specialty service used regularly for medical and mental health care, there should be a written agreement that outlines the terms of the care to be provided. Such a written agreement could be a contract, but it could also be a memorandum of understanding (MOU) or letter of agreement. The intention is that the responsible health authority anticipates and resolves problems in advance of the delivery of specialty care or hospitalization by having written agreements in place.

— From CorrectCare Volume 23, Issue 3, Summer 2009

Two standards apply to this question. C-01 Credentialing, Compliance Indicator #3: “Health providers do not perform tasks beyond those permitted by their credentials”; and D-05 Hospital and Specialty Care, Compliance Indicator #4: “For on-site specialty services used regularly for medical and mental health care, there are appropriate licenses and certifications.” So if the staff doing the procedure on-site would be able to do it in a community setting, and the facility’s setting/tools/supplies/etc. would meet credentialing requirements if credentialing were needed to perform the service, then NCCHC’s Standards for Health Services would allow the practice. The responsible health authority and responsible physician (when the RHA is not a physician) must determine that there are appropriately credentialed and trained health staff, and appropriate direct and auxiliary services and supplies on-site (x-ray, casting materials, etc.). If you are not sure what is needed, an orthopedic specialist could assist.

— From CorrectCare Volume 22, Issue 1, Winter 2008

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