Responsible Health Authority

Home Standards Q&A Responsible Health Authority

I work in a jail, and I am confused about something. Who is the facility administrator? Is it the same person as the responsible health authority?

This question comes up periodically; you are not alone in your confusion. The two roles are not the same person. The facility administrator is a custody-specific role, generally the top custody administrator (for instance, the warden or chief) who is specifically assigned to oversee facility operations. The responsible health authority (RHA) is a health services-specific role, generally the top health services person (for instance, the health services administrator or nursing supervisor) who is assigned to oversee health services operations. There are instances in which the RHA is a company (a private health services vendor), an agency (a local health department), or a regional- or corporate-level person (usually for small sites that do not have an on-site nursing supervisor). In these instances, the RHA must be designated to be on-site at least weekly.

From CorrectCare Volume 36, Issue 2, Fall 2022

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 work under the supervision of the system’s health authority. If your outlying facility is large, it probably has a physician who visits 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.

— From CorrectCare Volume 33, Issue 2, Spring 2019

Can a licensed practical nurse serve as a facility’s health services administrator? Or would the LPN be working beyond his or her scope of practice, for example, by performing health assessments? In this facility, the LPN is the only health worker.

Standard A-02 Responsible Health Authority defines a health administrator as a person who by virtue of education, experience or certification is capable of assuming responsibility for arranging all levels of health care and ensuring quality and accessible health services for inmates. While an LPN may serve as the health services administrator, final clinical judgments must rest with a single, designated, licensed responsible physician.

Your second question refers to Standard E-04 Initial Health Assessment. While states vary in the scope of practice for LPNs, NCCHC standards are clear. An LPN may collect additional data to complete the medical, dental and mental health histories, and may take and record vital signs, but the hands-on physical must be performed by a physician, physician assistant, nurse practitioner or trained RN.

— From CorrectCare Volume 30, Issue 3, Summer 2016

What exactly do you mean by the term “responsible mental health clinician”? I can’t find a definition in the Standards.

I assume that the mental health authority is separate from that of health services in your facility. Just like health services are required to have a responsible physician, there should be a similar counterpart for mental health services; in the Standards, the term used is “designated mental health clinician” (A-02 Responsible Health Authority, compliance indicator #6). Here’s the definition: A designated mental health clinician refers to a psychiatrist, psychologist or psychiatric social worker who is responsible for clinical mental health issues when mental health services at the facility are under a different authority than the medical services.

— From CorrectCare Volume 25, Issue 3, Summer 2011

Our prison recently received its accreditation survey report, which states that we need to take corrective action. When we send documentation of that action to NCCHC, who must sign off on the document? The DOC’s chief medical director? Our facility medical director? The health services administrator? Does it matter that the latter two work for a contract services company?

NCCHC accredits individual facilities, not systems, so the correspondence must come from the responsible health authority’s designee at the facility (standard A-02 Responsible Health Authority, Compliance Indicator 4). Usually this is the facility health services administrator. When materials are sent by contracted, system-level or regional providers, the facility-based designee must verify the documentation, usually by a cosignature. It doesn’t matter that the designee’s employer is a contractor.
— From CorrectCare Volume 24, Issue 1, Winter 2010

Is it OK for our sergeant to be the health services administrator?

Standard A-02 Responsible Health Authority states that a health administrator is a person who by virtue of education, experience or certification (e.g., MSN, MPH, MHA, FACHE, CCHP) is capable of assuming responsibility for arranging all levels of health care and ensuring quality and accessible health services for inmates. If the sergeant is a Certified Correctional Health Professional (CCHP) or has other relevant educational credentials, then by virtue of his or her education, experience or certification this position would be appropriate.

— From CorrectCare Volume 23, Issue 4, Fall 2009

Responsible Health Authority

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