Standard J-E-09 Segregated Inmates defines the level of monitoring based on three degrees of isolation. We believe our segregated population fits into the category described in compliance indicator #2c: “Inmates who are allowed periods of recreation or other routine social contact among themselves while being segregated from the general population are checked weekly by medical or mental health staff.” For example, our segregated inmates have daily access to the dayroom for social contact, exercise and showers. Inmates in administrative segregation are authorized access to fresh-air recreation a minimum of three individual hours per week, and some receive four or five hours per week. Segregated inmates generally aren’t allowed to attend programming in groups as programming is provided on an individualized basis. However, they are granted one-to-one religious access with approved clergy and are able to attend group worship services. Can you confirm that we are categorizing our segregated inmates correctly?
It seems as if there are varying degrees of isolation in the facility. For example, some inmates have daily access to the dayroom. You don’t specify if these inmates are allowed out in groups or individually, but if they are in groups this may fall into category c. However, recreation for ad-seg inmates is described as “individual hours,” and it seems as if these inmates may fall into category b (limited contact with staff or other inmates) or even category a (little or no contact with other individuals).
It isn’t uncommon for large facilities to have varying degrees of segregation that span all of the categories described in the standard. Ultimately, it is up to facility staff to determine the degree of isolation, then develop a system to monitor the inmates based on the standard’s requirements for each category.
— From CorrectCare Volume 30, Issue 4, Fall 2016
What is NCCHC’s position on the punitive segregation of pregnant inmates? Is this addressed in the Standards?
Health considerations for segregated inmates are discussed in standard E-09 of the 2003Standards for Health Services for adult settings. When corrections officials place any inmate in segregation, they are to notify health services. Designated health staff are to review the inmate’s health record and alert corrections if any health-related contraindications to the segregation exist or if special accommodations are required.
From best practice, general health, and emotional health standpoints, segregation is generally not the best setting for a pregnant inmate. However, the facility’s responsible physician must decide whether policy will prohibit segregation for all pregnant inmates or whether to make the determination on a case-by-case basis.
In assessing whether pregnancy is a contraindication or requires accommodation, the physician would consider such factors as the physical conditions of the segregation area and cells and whether they present any potential harm to the inmate or the fetus; the pregnancy status and anticipated delivery date; presence of complications; and presence of other medical or mental health conditions.
Health staff should consult with corrections when the behavior that would result in disciplinary action may relate to the physiological or emotional consequences of pregnancy. Given the many pressures an incarcerated pregnant patient may be experiencing, discipline may not be the best intervention to address her unacceptable behavior.
So that pregnancy is not seen as a free ticket to negative behavior, the health and correctional staff may find alternative consequences for negative behavior that is not related to health or mental health conditions, such as delaying the segregation time until after delivery or curtailing other privilege as a substitute for segregation.
— From CorrectCare Volume 21, Issue 2, Spring 2007
Please clarify standard Y-E-09 Segregated Juveniles. At our small juvenile center (average daily population usually under 50), the nurse is on duty on days, five days a week. It is rare that a youth is placed in segregation, but when it does happen, it is usually on the weekend. Compliance Indicator 3.d. states, “On days when health staff are not on site, health-trained child care workers or program staff alert health staff on call if a health problem is noted during the staff checks.” What does this mean? Does the nurse on call have to come in if there is a problem?
The answer—the on-call nurse uses clinical judgment based on the facility’s protocols—is one that you would expect when you consider the intent of this standard: “to ensure that juveniles placed in segregation maintain their medical and mental health while physically and socially isolated” from the rest of the population.
Staff training should include what to look for that would require notifying the on-call nurse, and what information the nurse requires in order to provide appropriate direction to staff. The on-call nurse will decide whether to come in based on the physical and mental health status and history of the youth involved, the resources available on site and the nurse’s distance from the facility.
— From CorrectCare Volume 20, Issue 1, Winter 2006
In our maximum security prison, the segregation area is a very controlled environment since the inmates here are considered dangerous individuals, known to attack staff and other inmates. The superintendent has asked health services to limit these inmates’ trips to the facility clinic whenever possible. We want to cooperate with security concerns, but do not wish to violate standards or give less than appropriate care. How far can we go in providing “cell-side” interventions?
The standards most directly relevant are P-A-09 Privacy of Care and P-E-07 Nonemergency Health Care Requests and Services, although several other standards come into play: P-A-01 Access to Care; P-D-03 Clinic Space, Equipment, and Supplies; P-E-09 Segregated Inmates; and P-H-02 Confidentiality of Health Records and Information. It may be helpful to share copies of these standards with the correctional authorities so that they have the “big picture” from the health services perspective.
NCCHC (P-E-07) distinguishes between triaging health care requests (“sorting and classifying ... to determine priority of need and the proper place for health care to be rendered”) and sick call (“evaluation and treatment of an ambulatory patient in a clinical setting”). Clinical setting is defined as “an examination room or treatment room appropriately supplied and equipped” to address health care needs (P-E 07). Clinical encounters are “interactions between inmates and health care providers that involve a treatment and/or exchange of confidential information” (P-A 09).
Privacy is to be respected at all times, and when security personnel must be present due to risk to the safety of the health care provider or others, efforts are made to afford partial visual and verbal privacy (P-A-09).
Cell-side triage of health care requests is fine. However, when triage indicates a need to examine, treat or delve into confidential information, the inmate must be taken to a clinical setting. So while routine blood pressure checks could be done in the cell with the door open (not by the inmate pushing his arm through a slot), an extensive examination of heart and lungs requires a clinical setting. Likewise, mental health staff may ask about the inmate’s well-being at the cell door, but if the reply to “Do you need to talk?” is positive, a clinical area is needed where confidential exchanges can take place.
A clinical area can be set up in the segregation area provided that it has the necessary equipment and supplies (see P-D-03) for evaluation and treatment. For example, if a sink is lacking, then “appropriate alternate means of hand sanitization” must be available. Otherwise, the inmate must be taken to the central clinic for assessment and/or treatment.
Officers assigned to segregation must receive training on their role in protecting the confidentiality of any health information they are exposed to because of their duties (P-H-02). In such a setting, any joking, teasing or reference to confidential health information by staff would only exacerbate tension.
As health staff aware of the potential risks these inmates present, you will want to work as a team with correctional staff without compromising the ethics of your professions. Often it is the quality of respect and nonverbal interaction between health and correctional staff that the inmates pick up on and respond to, either positively or negatively.
— From CorrectCare Volume 19, Issue 4, Fall 2005