Segregation inmates are those who are isolated from the general population and who receive services and activities apart from other inmates. Whether you call it administrative segregation, protective custody, disciplinary segregation or even “the hole,” standard E-09 Segregated Inmates is about the conditions of living and confinement, not the reason for the segregation or what the area is called.
First, let’s define the degrees of isolation as set forth in this standard’s compliance indicators.
• Extreme isolation refers to situations where inmates are seen by other staff or other inmates fewer than three times a day. Compliance indicator 2a addresses this category.
• The middle degree of isolation, which we find to be the most common, refers to inmates who are segregated and have limited contact with staff or other inmates. These conditions are addressed in compliance indicator 2b.
• The least restrictive category refers to inmates who are allowed periods of recreation or other routine social contact among themselves while segregated from the general population. This is addressed by compliance indicator 2c.
In supermax or lockdown facilities or tiers all inmates are in a segregated status and, therefore, all should be monitored under the auspices of this standard.
Review and Monitoring
The intent of the standard is to ensure that inmates placed in segregation maintain their medical and mental health while physically and socially isolated from the rest of the inmate population. To ensure this, appropriate monitoring and health record review procedures should be in place.
The first step is the health record review. Compliance indicator 1 states: “Upon notification that an inmate is placed in segregation, a qualified health care professional reviews the inmate’s health record to determine whether existing medical, dental, or mental health needs contraindicate the placement or require accommodation. Such review is documented in the health record.”
Custody and health staff should have an effective system to communicate when an inmate is about to be, or has just been, placed in segregation. It is important for health staff to quickly determine whether there are contraindications or necessary accommodations to the segregation to minimize the risk of harm to the inmate’s health. Documentation of this review (in the health record) prior to, or soon after, the placement is vital. NCCHC recommends that the responsible health authority be involved in the development of segregation policies and procedures so that appropriate accommodations for health conditions can be addressed.
Due to the complex conditions of segregation, health staff should review the health status of their patients prior to their placement into segregation to ensure continuity of care and services. Take care when reviewing health records of inmates with serious mental illnesses to assess the risk of exacerbation of the mental illness. Medical staff reviewing the record should notify mental health staff when the inmate is currently under the care of mental health services.
Next, frequent monitoring based on the degree of isolation should be initiated. Inmates under extreme isolation should be monitored daily by medical staff and at least once a week by mental health staff (category 2a). Segregated inmates who have limited contact with staff or other inmates should be monitored three days a week by medical or mental health staff (category 2b). Inmates in category 2c should be checked weekly by medical or mental health staff.
The quality of the health round in segregation is key. Checks by health staff ensure that each inmate has the opportunity to request care for medical, dental or mental health problems. These individual visits also enable health staff to ascertain the inmate’s general medical and mental health status. Inmates often experience irritability, anxiety or a dysphoric mood within weeks of placement in social isolation. Special attention should always be given to vulnerable populations, such as adolescents and the mentally ill. Due to the possibility of injury and depression during isolation, the evaluations by health staff should include notation of bruises or other trauma markings, comments regarding the inmate’s attitude and outlook (particularly as they might relate to suicidal ideation) and any health complaints.
Inmates with serious mental disorders often experience an exacerbation of their underlying illness when segregated. NCCHC recommends that the health rounds on patients with serious mental illness in segregation take place at the beginning, middle and end of each week to decrease the likelihood of problems during weekend hours.
Simply initialing a housing roster upon entering the unit is not enough. Segregation rounds should be documented on individual logs or cell cards (and when filled should be filed in the inmate’s health record) or in the health record, and include date and time of contact and the signature or initials of the health staff member making the rounds. Significant findings should be documented in the health record.
Health staff should note every time they make rounds, whether or not there is a health-related interaction or observation. However, necessary clinical encounters should not take place cellside but in an appropriate clinical setting and noted in the patient’s health record. When a segregated inmate requests health care, arrangements should be made for triage, examination and treatment in an appropriate clinical setting. Note that the segregation rounds are required in addition to whatever mechanism is in place for inmates to request health services daily (see E-07 Nonemergency Health Care Requests and Services).
Notably, this standard is considered essential for prisons and important for jails with regard to accreditation due to the extended lengths of stay in prisons versus jails.
[This article first appeared in the Spring 2012 issue of CorrectCare.]
Standard E-09 Segregated Inmates (jail: important; prison: essential)
When an inmate is segregated, health staff monitor his or her health. — 2008 Standards for Health Services for jails and prisons