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General Assembly Substitute Bill No. 448
February Session, 2022
AN ACT CONCERNING THE DELIVERY OF HEALTH CARE AND
MENTAL HEALTH CARE SERVICES TO INMATES OF
CORRECTIONAL INSTITUTIONS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective October 1, 2022) (a) The Commissioner of 1
Correction shall ensure that a sufficient number of licensed mental 2
health care providers, including, but not limited to, at least four licensed 3
mental health care providers with experience in substance use disorder 4
diagnosis and treatment, who are employed by or contract with the 5
Department of Correction are placed at each correctional institution 6
under its jurisdiction to provide mental health care services to inmates. 7
A mental health care provider placed at a correctional institution shall 8
provide mental health care services to any inmate who requests such 9
services or has been referred for such services by correctional staff only 10
after the provider makes an in-person assessment of the inmate's need 11
for such services and determines that the inmate requires such services. 12
Each mental health care provider shall deliver such services in concert 13
with the security needs of all inmates and correctional staff and the 14
overall operation of the correctional institution, as determined by the 15
warden of the correctional institution, in consultation with the 16
commissioner. 17 Substitute Bill No. 448
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(b) No mental health care provider who is providing mental health 18
care services pursuant to subsection (a) of this section shall prescribe or 19
administer a psychotropic medication to an inmate unless (1) the mental 20
health care provider has reviewed the full mental health history and 21
medical history of the inmate, including, but not limited to, the list of all 22
medications the inmate is taking, (2) the inmate has undergone a 23
physical examination by a licensed health care provider not more than 24
thirty days prior to the mental health care provider first prescribing or 25
administering the psychotropic medication and the mental health care 26
provider determines, based on a review of the record of such 27
examination, that it is safe to prescribe or administer such medication, 28
(3) the mental health care provider has performed a mental health 29
assessment of the inmate not more than seven days prior to first 30
prescribing or administering such medication, (4) the mental health care 31
provider diagnoses the inmate with a mental health disorder or the 32
inmate has received a previous diagnosis of a mental health disorder by 33
a licensed mental health care provider and such medication is used to 34
treat such mental health disorder, (5) the mental health care provider 35
approves the use of such medication by the inmate as part of the 36
inmate's mental health treatment plan, and (6) the mental health care 37
provider keeps a record of each psychotropic medication such provider 38
prescribes or administers to the inmate and all other medications the 39
inmate is taking. As used in this subsection, "psychotropic medication" 40
means a medication that is used to treat a mental health disorder and 41
that affects behavior, mood, thoughts or perception. 42
Sec. 2. (NEW) (Effective October 1, 2022) (a) As used in this section and 43
sections 3 and 4 of this act: 44
(1) "Advanced practice registered nurse" means an advanced practice 45
registered nurse licensed under chapter 373 of the general statutes who 46
is employed by or contracts with the Department of Correction to 47
provide health care services at a correctional institution; 48
(2) "Commissioner" means the Commissioner of Correction; 49 Substitute Bill No. 448
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(3) "Correctional institution" means a correctional institution under 50
the jurisdiction of the Department of Correction; 51
(4) "Dentist" means a dentist licensed under chapter 379 of the general 52
statutes who is employed by or contracts with the Department of 53
Correction to provide health care services at a correctional institution; 54
(5) "Inmate" means an inmate of a correctional institution; 55
(6) "Physician" means a physician licensed under chapter 370 of the 56
general statutes who is employed by or contracts with the Department 57
of Correction to provide health care services at a correctional institution; 58
(7) "Physician assistant" means a physician assistant licensed under 59
chapter 370 of the general statutes who is employed by or contracts with 60
the Department of Correction to provide health care services at a 61
correctional institution; and 62
(8) "Registered nurse" means a registered nurse licensed under 63
chapter 378 of the general statutes who is employed by or contracts with 64
the Department of Correction to provide health care services at a 65
correctional institution. 66
(b) Each inmate shall receive an annual physical examination by a 67
physician, physician assistant or advanced practice registered nurse. 68
Such examination may include, but not be limited to, a breast and 69
gynecological examination and the administration of any test the 70
physician, physician assistant or advanced practice registered nurse 71
deems appropriate. 72
(c) Each inmate shall receive a routine physical examination by a 73
physician, physician assistant or advanced practice registered nurse not 74
later than forty-eight hours after entering a correction institution to 75
serve a sentence. Each person who is detained at a correctional 76
institution shall receive a routine physical examination by a physician, 77
physician assistant or advanced practice registered nurse not later than 78
ninety-six hours after entering the correctional institution. No inmate or 79 Substitute Bill No. 448
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person described in this subsection shall be placed in a housing unit at 80
the correctional institution until the physician, physician assistant or 81
advanced practice registered nurse completes the physical examination 82
required under this subsection and approves the placement of such 83
inmate or person in a housing unit. If the physician, physician assistant 84
or advanced practice registered nurse recommends, based on the 85
physical examination of such inmate or person, that such inmate or 86
person be placed in a medical or mental health housing unit, the warden 87
of the correctional institution shall ensure that such inmate or person is 88
placed in a medical or mental health housing unit at the correctional 89
institution. 90
(d) The physician, physician assistant or advanced practice registered 91
nurse shall perform the examinations required under subsections (b) 92
and (c) of this section in a location at the correctional institution that the 93
physician, physician assistant or advanced practice registered nurse 94
deems appropriate for performing such an examination, provided the 95
analysis of any sample collected from the inmate during such 96
examination may be performed at a laboratory that is located outside of 97
the correctional institution. Any x-ray of an inmate ordered by a 98
physician, physician assistant or advanced practice registered nurse 99
shall be performed at the correctional institution if the correctional 100
institution has the equipment necessary to perform an x-ray. 101
(e) A physician, physician assistant or advanced practice registered 102
nurse shall conduct an exit interview of each inmate who is being 103
discharged from a correctional institution not later than seven days 104
prior to the date of discharge. Such exit interview shall include a 105
discussion with the inmate regarding any continued medical care or 106
treatment that is recommended by the physician, physician assistant or 107
advanced practice registered nurse for the inmate when the inmate 108
reenters the community. 109
(f) A physician shall be on call twenty-four hours a day, seven days a 110
week at each correctional institution to provide medical care to inmates 111
as necessary. 112 Substitute Bill No. 448
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(g) Only a physician, physician assistant or advanced practice 113
registered nurse may administer medication to an inmate. A physician 114
assistant or advanced practice registered nurse may administer a 115
medication to an inmate only if a physician has ordered, in writing, the 116
administration of such medication to the inmate. 117
(h) The commissioner shall ensure that each inmate has access to all 118
vaccines licensed or authorized under an emergency use authorization 119
by the federal Food and Drug Administration that are recommended by 120
the National Centers for Disease Control and Prevention Advisory 121
Committee on Immunization Practices. A physician, physician assistant 122
or advanced practice registered nurse shall administer to an inmate any 123
such vaccine that (1) the inmate requests, and (2) is recommended for 124
such inmate by said committee, as determined by the physician, 125
physician assistant or advanced practice registered nurse. 126
(i) A dentist shall perform a dental examination of each inmate not 127
later than ten weeks after the inmate enters a correctional institution. At 128
the time the dentist performs the dental examination of an inmate, the 129
dentist shall develop a dental care plan for the inmate. A dentist shall 130
provide dental care to an inmate in accordance with the inmate's dental 131
care plan throughout the inmate's sentence at the correctional 132
institution. The commissioner shall ensure, in consultation with a 133
dentist, that each correctional institution has a dental examination room 134
that is fully equipped with all of the dental equipment necessary to 135
perform a dental examination. 136
Sec. 3. (NEW) (Effective October 1, 2022) A physician, physician 137
assistant or advanced practice registered nurse shall administer an HIV 138
test to each inmate who requests an HIV test. A physician, physician 139
assistant or advanced practice registered nurse shall offer an HIV test to 140
each inmate identified as having a high risk of being infected with the 141
human immunodeficiency virus (1) at the time such inmate enters a 142
correctional institution, or (2) during the annual physical examination 143
of the inmate required under subsection (b) of section 2 of this act. As 144
used in this subsection, "HIV test" means a test to determine human 145 Substitute Bill No. 448
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immunodeficiency virus infection or antibodies to human 146
immunodeficiency virus. 147
Sec. 4. (NEW) (Effective October 1, 2022) (a) A licensed mental health 148
care provider at each correctional institution shall interview each inmate 149
regarding the inmate's drug and alcohol use history at the time the 150
inmate enters the correctional institution. If an inmate is exhibiting 151
symptoms of withdrawal from a drug or alcohol at such time, a 152
physician, physician assistant or advanced practice registered nurse 153
shall perform a physical examination of the inmate not later than 154
twenty-four hours after the inmate enters the correctional institution 155
and a licensed mental health care provider shall perform a mental health 156
evaluation of the inmate not later than five days after the inmate enters 157
the correctional institution. The correctional institution shall 158
immediately transfer each inmate who is determined by a physician, 159
physician assistant or advanced practice registered nurse to be 160
experiencing withdrawal from a drug or alcohol and each inmate who 161
requests medical treatment for withdrawal from a drug or alcohol to a 162
medical unit at such correctional institution for medical treatment of 163
such withdrawal, provided (1) if the inmate is pregnant, the inmate 164
provides informed consent to such medical treatment, and (2) if the 165
medical treatment to be provided includes the administration of 166
methadone, the inmate provides informed consent to the use of 167
methadone. A physician, physician assistant or advanced practice 168
registered nurse shall periodically evaluate each inmate who exhibits 169
signs of or discloses an addiction to a drug or alcohol or who 170
experiences withdrawal from a drug or alcohol, at a frequency deemed 171
appropriate by the physician, physician assistant or advanced practice 172
registered nurse. 173
(b) A physician with experience in substance use disorder diagnosis 174
and treatment shall oversee the medical treatment of an inmate 175
experiencing withdrawal from a drug or alcohol at each correctional 176
institution. A physician, physician assistant, advanced practice 177
registered nurse or registered nurse with experience in substance use 178 Substitute Bill No. 448
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disorder diagnosis and treatment shall provide such medical treatment 179
in a medical unit at each correctional institution. An advanced practice 180
registered nurse or registered nurse with experience in substance use 181
disorder diagnosis and treatment shall be present in the medical unit at 182
each correctional facility all times during the provision of medical 183
treatment to an inmate. If a medical unit does not contain enough beds 184
to accommodate all inmates who require medical treatment under this 185
subsection, the correctional institution shall add additional beds to the 186
unit or to another medical unit at such correctional institution to ensure 187
that each inmate who requires such medical treatment receives such 188
medical treatment. A licensed mental health care provider with 189
experience in substance use disorder diagnosis and treatment shall 190
monitor each inmate who is experiencing withdrawal from cocaine or 191
an amphetamine on a daily basis for not less than five days after the 192
inmate first exhibits withdrawal symptoms to attempt to mitigate the 193
risk of such inmate attempting suicide. A second physician shall be on 194
call twenty-four hours a day, seven days a week at each correctional 195
institution to oversee medical treatment under this section if the 196
physician assigned to oversee such medical treatment at a correctional 197
institution becomes unavailable to oversee such medical treatment. 198
(c) A licensed mental health care provider shall (1) offer mental health 199
counseling services, including, but not limited to, individual counseling 200
sessions and group counseling sessions, to an inmate who exhibits signs 201
of or discloses an addiction to a drug or alcohol and encourage such 202
inmate to participate in at least one counselling session, and (2) at the 203
time of an inmate's discharge from the correctional institution, refer an 204
inmate who has exhibited signs of or disclosed an addiction to a drug or 205
alcohol while an inmate at such correctional institution to a substance 206
use disorder treatment program in the community that is deemed 207
appropriate for the inmate by such provider. 208
Sec. 5. Section 18-69c of the general statutes is repealed and the 209
following is substituted in lieu thereof (Effective October 1, 2022): 210
(a) The Commissioner of Correction shall ensure that at least one 211 Substitute Bill No. 448
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[departmental or contracted,] licensed health care provider who is 212
employed by or contracts with the Department of Correction to provide 213
health care services at the York Correctional Institution (1) has been 214
trained in prenatal and postpartum medical care, and (2) has knowledge 215
of and the ability to educate any inmate who is pregnant concerning 216
prenatal nutrition, high-risk pregnancy and addiction and substance 217
abuse during pregnancy and childbirth. 218
(b) Upon admission to the York Correctional Institution, each inmate 219
shall be assessed for pregnancy by a licensed health care provider. The 220
licensed health care provider shall inform the inmate of any necessary 221
medical tests associated with the pregnancy assessment prior to the 222
administration of such tests. 223
(c) The York Correctional Institution shall provide each inmate who 224
is pregnant with: (1) Counseling and written material, in a form that 225
may be reasonably understood, concerning (A) the inmate's options 226
with regard to her pregnancy, (B) prenatal nutrition, (C) maintaining a 227
healthy pregnancy, (D) for any inmate who is drug or alcohol-228
dependent, the dangers of undergoing withdrawal from the drug or 229
alcohol without medical treatment, the importance of receiving medical 230
treatment during the second trimester of pregnancy for withdrawal 231
from the drug or alcohol and the effects of neonatal abstinence 232
syndrome on a newborn, (E) labor and delivery, [(E)] (F) the postpartum 233
period, [(F)] (G) the institution's policies and practices regarding the 234
care of an inmate during pregnancy, [labor and delivery and the 235
postpartum period,] and [(G)] (H) restrictions on the use of restraints on 236
pregnant inmates, (2) medical care at the correctional institution, which 237
shall include, but not be limited to: (A) Periodic health monitoring and 238
evaluation during pregnancy, and (B) prenatal vitamins or 239
supplements, as deemed necessary by a licensed health care provider, 240
(3) a diet containing the nutrients necessary to maintain a healthy 241
pregnancy, as determined by a licensed health care provider trained in 242
prenatal care, (4) the clothing, undergarments and sanitary materials 243
deemed appropriate by a licensed health care provider who has been 244 Substitute Bill No. 448
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trained in prenatal and postpartum medical care, (5) the opportunity for 245
a minimum of one hour of ambulatory movement every day, and (6) 246
access to treatment for postpartum depression by a qualified mental 247
health professional, provided such treatment is deemed necessary by a 248
licensed health care provider who has been trained in postpartum 249
medical care. If a [departmental or contracted] licensed health care 250
provider trained in prenatal and postnatal medical care, or any other 251
health care professional who evaluates or treats an inmate who is 252
pregnant, determines that the inmate's pregnancy is high risk or 253
involves any other medical complication for either the inmate or the 254
baby, [such inmate shall be immediately transferred] the York 255
Correctional Institution shall immediately transfer such inmate to the 256
medical infirmary setting or any hospital deemed appropriate, as 257
determined by such health care provider or professional. The York 258
Correctional Institution shall immediately transfer any inmate who is 259
pregnant and decides to terminate the pregnancy prior to the viability 260
of the fetus, in consultation with a physician pursuant to section 19a-261
602, to a hospital or outpatient clinic regulated by the Department of 262
Public Health pursuant to section 19a-116 where the inmate may receive 263
an abortion. The written material provided to an inmate pursuant to 264
subdivision (1) of this subsection shall be known as the "Pregnant 265
Woman's Guide". 266
(d) Except as provided in this subsection, correctional staff of the 267
York Correctional Institution shall not use any leg or waist restraint on 268
any inmate of the institution who is known to be pregnant or in the 269
postpartum period. An inmate known to be pregnant may only be 270
restrained using handcuffs that are placed on the wrists held in front of 271
the inmate's body, except an inmate may be placed in wrist, leg or waist 272
restraints if (1) there are compelling grounds to believe that an inmate 273
presents (A) an immediate and serious threat of harm to herself, staff 274
and others, or (B) a substantial flight risk and cannot be reasonably 275
contained by other means, and (2) use of such restraints is approved by 276
the unit administrator of the institution, or his or her designee, except 277
under exigent circumstances. Such restraints shall be the least restrictive 278 Substitute Bill No. 448
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kind of restraints considering the circumstances. Correctional staff shall 279
document, in writing, the reasons for such determination, the kind of 280
restraints used and the reasons staff considered such restraints to be the 281
least restrictive kind available and the most reasonable means of 282
preventing harm or escape. The correctional staff of the York 283
Correctional Institution shall ensure that any inmate, who is determined 284
to be in the second or third trimester of a pregnancy by a licensed health 285
care provider, is transported to and from visits to health care providers 286
and court proceedings in a vehicle with seatbelts. If an attending 287
physician or advanced practice registered nurse requests that the 288
inmate's restraints be removed for medical reasons, correctional staff 289
shall immediately remove the restraints. Nothing in this subsection shall 290
prohibit the use of medical restraints by a licensed health care provider 291
to ensure the medical safety of the inmate. As used in this subsection 292
and subsection (e) of this section, "restraints" means metal handcuffs, 293
metal leg restraints and waist and tether chains. 294
(e) Each pregnant inmate of the York Correctional Institution shall 295
receive labor and delivery services in a hospital deemed appropriate by 296
a [departmental or contracted,] licensed health care provider who is 297
employed by or contracts with the Department of Correction to provide 298
health care services at said institution. Notwithstanding the provisions 299
of subsection (d) of this section, an inmate who is in any stage of labor 300
or delivery, as determined by a licensed health care provider, shall not 301
be placed in restraints at any time, including, but not limited to, during 302
transportation to the hospital. If a correction officer is present with the 303
inmate during any stage of labor or delivery, such correction officer 304
shall be female, if possible. Such correction officer shall be positioned in 305
a location that ensures the inmate's privacy, to the extent possible. 306
(f) Any inmate in the postpartum period shall be assessed by a 307
licensed health care provider upon return to the correctional institution. 308
Each inmate in the postpartum period shall be housed in a medical or 309
mental health housing unit at the correctional institution until 310
discharged by a licensed health care provider. 311 Substitute Bill No. 448
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(g) The York Correctional Institution shall provide a pregnant inmate, 312
prior to the inmate's release, with counseling and discharge planning to 313
ensure, to the extent feasible, the continuity of prenatal and pregnancy-314
related care, including substance abuse programs and treatment 315
referrals when deemed appropriate. 316
Sec. 6. (NEW) (Effective from passage) (a) There is established an 317
advisory committee for the purpose of (1) advising the Commissioner 318
of Correction regarding the provision of health care services at 319
correctional institutions under the jurisdiction of the Department of 320
Correction pursuant to the provisions of sections 1 to 4, inclusive, of this 321
act and section 18-69c of the general statutes, as amended by this act, 322
and (2) evaluating whether the Department of Public Health should 323
have oversight over the provision of such services or license the facilities 324
located in such correctional institutions where inmates receive health 325
care services. 326
(b) The committee shall be composed of the following members: 327
(1) Two appointed by the speaker of the House of Representatives, 328
one of whom shall be a primary care physician, and one of whom shall 329
be a formerly incarcerated female; 330
(2) Two appointed by the president pro tempore of the Senate, one of 331
whom shall be a physician with expertise in infectious disease 332
prevention and control, and one of whom shall be a formerly 333
incarcerated male; 334
(3) One appointed by the majority leader of the House of 335
Representatives, who shall be a health care provider with expertise in 336
reproductive health care; 337
(4) One appointed by the majority leader of the Senate, who shall be 338
a representative of an advocacy organization who has knowledge and 339
an understanding of issues concerning gender-affirming care; 340
(5) One appointed by the minority leader of the House of 341 Substitute Bill No. 448
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Representatives, who shall be a current or former employee of a 342
correctional institution; 343
(6) One appointed by the minority leader of the Senate, who shall be 344
a mental health care provider; 345
(7) Two appointed by the Governor, one of whom shall be a health 346
care provider with expertise in substance use disorder treatment, and 347
one of whom shall be an advocate of racial justice; 348
(8) One appointed by the Commissioner of Developmental Services, 349
who shall be a professional with experience in communicating the needs 350
of persons with a disability, including, but not limited to, an intellectual 351
disability; 352
(9) The Commissioner of Correction, or the commissioner's designee; 353
(10) The Commissioner of Public Health, or the commissioner's 354
designee; 355
(11) The Commissioner of Mental Health and Addiction Services, or 356
the commissioner's designee; and 357
(12) The executive director of the Office of Health Strategy, or the 358
executive director's designee. 359
(c) Any appointment that is vacant for one year or more shall be made 360
by the Commissioner of Public Health. The Commissioner of Public 361
Health shall notify the appointing authority of the commissioner's 362
choice of member for appointment not less than thirty days before 363
making such appointment. 364
(d) The committee shall meet not less than quarterly. On or before 365
January 1, 2023, and once every six months thereafter, the committee 366
shall report on its recommendations regarding the provision of health 367
care services at correctional institutions under the jurisdiction of the 368
Department of Correction pursuant to the provisions of sections 1 to 4, 369 Substitute Bill No. 448
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inclusive, of this act and section 18-69c of the general statutes, as 370
amended by this act, to the department. On or before January 1, 2023, 371
and annually thereafter, the committee shall report, in accordance with 372
the provisions of section 11-4a of the general statutes, on such 373
recommendations, to the joint standing committees of the General 374
Assembly having cognizance of matters relating to public health and 375
education. On or before January 1, 2023, the committee shall report, in 376
accordance with the provisions of said section, on its evaluation of the 377
need for oversight by the Department of Public Health to such joint 378
standing committees. 379
(e) Administrative support for the activities of the advisory 380
committee may be provided by the Department of Public Health. 381
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2022 New section
Sec. 2 October 1, 2022 New section
Sec. 3 October 1, 2022 New section
Sec. 4 October 1, 2022 New section
Sec. 5 October 1, 2022 18-69c
Sec. 6 from passage New section
Statement of Legislative Commissioners:
In Section 2(c), the first two sentences were reworded for clarity; in
Section 5(c), "(H)" was deleted, "labor and delivery and the postpartum
period" was bracketed and "(I)" was changed to "(H)" for consistency;
and in Section 6(d) "to the department" was inserted after "section 18-
69c of the general statutes, as amended by this act" for clarity.
PH Joint Favorable Subst.