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OLR Bill Analysis
sSB 448 (File 452, as amended by Senate “A”)*
AN ACT CONCERNING THE DELIVERY OF HEALTH CARE AND
MENTAL HEALTH CARE SERVICES TO INMATES OF
CORRECTIONAL INSTITUTIONS.
SUMMARY
This bill requires the Department of Correction (DOC) commissioner,
by January 1, 2023, to develop a plan for providing health care services
to inmates at DOC correctional institutions (i.e., prisons or jails under
the commissioner’s jurisdiction), including mental health, substance use
disorder, and dental care services.
The plan must include guidelines to implement several requirements
that ensure, among other things, the following outcomes:
1. there are enough mental health therapists at each correctional
institution to provide mental health care services to inmates;
2. these therapists prescribe psychotropic medication only under
specified conditions;
3. each inmate receives an initial health assessment, and when
clinically indicated, an annual physical exam and an exit
interview concerning a medical discharge plan;
4. inmates have access to vaccines that are licensed or authorized
under an emergency use authorization;
5. each inmate generally receives an annual dental screening and
dental care as set forth in a dental care plan;
6. a medical professional interview each inmate, at entry, on their
drug and alcohol use history, and correctional institutions
immediately transfer inmates to an appropriate area for
treatment if they are in withdrawal; and 2022SB-00448-R01-BA.DOCX
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7. the York Correctional Institution provide inmates who are
pregnant with prenatal visits at a frequency that is consistent
with community standards.
Under the bill, by February 1, 2023, the commissioner must report to
the Public Health and Judiciary committees on the plan along with
recommendations for any legislation needed to implement it and an
implementation timeline.
*Senate Amendment “A” replaces the underlying bill, which would
have established (1) various requirements for health care at DOC
correctional institutions and (2) an advisory committee to advise the
commissioner on these issues and evaluate whether the Department of
Public Health should oversee health care at these facilities. The
amendment includes provisions requiring the DOC commissioner to
develop and report on a plan for health care services. (The plan
addresses generally similar topics as the underlying bill’s
requirements.)
EFFECTIVE DATE: Upon passage
DOC PLAN FOR INMATE HEALTH CARE SERVICES
Under the bill, the DOC commissioner’s required plan for health care
services must include guidelines for implementing requirements in
several areas, set forth below.
Mental Health Services (§ 1(b)(1))
The bill’s plan must include several requirements related to mental
health care at correctional institutions.
The plan must require that there are enough mental health therapists,
as the commissioner determines, at each correctional institution to
provide mental health care services to inmates. Under the bill, “mental
health therapists” are psychiatrists, psychologists, advanced practice
registered nurses (APRNs) specializing in mental health, clinical or
master social workers, or professional counselors.
Under the plan, when an inmate requests, or correctional staff refer 2022SB-00448-R01-BA.DOCX
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an inmate to, mental health services, the mental health therapist must
conduct an assessment to determine whether the services are needed
before providing them. The mental health therapists’ services must
align with the (1) security needs of all inmates and correctional staff and
(2) institution’s overall operation, as the warden determines.
Psychotropic Medication. Under the bill, for mental health
therapists who are licensed to prescribe medication, the required plan
must prohibit them from prescribing psychotropic medication to an
inmate unless several conditions are met. A “psychotropic medication”
is one used to treat a mental health disorder that affects behavior, mood,
thoughts, or perception.
The required conditions are as follows:
1. Mental Health and Medical History: the therapist must have
reviewed the inmate’s full medical and mental health history,
including current medications.
2. Risk-Benefit Determination: the therapist must determine, based
on the review of the inmate’s medical and mental health history,
that the benefits of prescribing the medication outweigh the risks
of doing so.
3. Mental Health Diagnosis or Emergency Assessment: (a) the
therapist must diagnose the inmate with a mental health
disorder, (b) the inmate has a previous diagnosis of a mental
health disorder (from a psychiatrist or an APRN specializing in
mental health) and the medication is used to treat that disorder,
or (c) in an emergency, the therapist determines that the inmate’s
mental health is substantially impaired and psychotropic
medication is needed.
4. Medication Approval Under Treatment Plan: the therapist must
approve the medication as part of the inmate’s mental health
treatment plan.
5. Recordkeeping: the therapist must keep a record of (a) each 2022SB-00448-R01-BA.DOCX
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psychotropic medication prescribed or administered to the
inmate and (b) all other medications the inmate is taking.
Health Assessments and Physical Exams (§ 1(b)(2)-(5))
Under the bill’s required plan, each inmate must receive an initial
health assessment from a medical professional (i.e., a physician, APRN,
physician assistant (PA), or a registered or practical nurse) within 14
days after the inmate’s intake into the institution. Based on that
assessment, if a physician, PA, or APRN recommends that the inmate
be placed in a medical or mental health housing unit, then DOC must
ensure that this happens unless there are significant safety or security
reasons to do not so.
The bill’s plan also must require that inmates receive annual physical
exams, when clinically indicated, from a physician, PA, or APRN. These
exams may include (1) a breast and gynecological exam or prostrate
exam, where appropriate, and (2) any test the provider finds
appropriate.
Under the required plan, medical professionals must perform inmate
health assessments in a location at the institution that the warden finds
appropriate. Any samples collected during the assessment may be sent
to an outside laboratory for analysis.
Exit Interview With Discharge Planner (§ 1(b)(6))
The bill’s plan must require a discharge planner to conduct an exit
interview of each inmate before the inmate’s discharge if it is clinically
indicated. But if this does not occur, then the scheduled discharge
cannot be delayed. During the interview, the discharge planner must
discuss any recommendations from a physician, PA, or APRN for
continued medical care or treatment for the inmate when back in the
community.
Under the bill, the discharge planner must be a registered or practical
nurse, clinical or master social worker, or professional counselor.
Physician on Call (§ 1(b)(7))
Under the bill’s required plan, a physician must be on call on 2022SB-00448-R01-BA.DOCX
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weekends, holidays, and outside regular work hours to give needed
medical care to inmates.
Vaccinations (§ 1(b)(8))
Under the bill’s required plan, the DOC commissioner generally must
ensure that inmates have access to all vaccines licensed or authorized
under an emergency use authorization by the federal Food and Drug
Administration that are recommended by the National Centers for
Disease Control and Prevention’s Advisory Committee on
Immunization Practices (ACIP). This applies (1) subject to vaccine
availability and (2) unless there are substantial security concerns with
providing access to these vaccines.
Subject to availability, if an inmate requests such a vaccine and a
physician, PA, or APRN determines that ACIP recommends it for the
inmate, then that provider must prescribe it for the inmate unless doing
so would impose significant safety concerns.
Dental Care (§ 1(b)(9))
The bill’s plan must require that, except in exigent circumstances,
inmates receive a dental screening, conducted by a dental professional,
within one year after first entering the institution and at least annually
after that. For these purposes, dental professionals are dentists, dental
hygienists, and dental assistants.
Under the plan, the dental professional must develop a dental care
plan for the inmate when performing the screening. The inmate must
receive dental care, per the care plan, throughout the inmate’s time at
the institution. The DOC commissioner, in consultation with a dentist,
must ensure that each correctional institution has a dental exam room
that is fully equipped with all necessary equipment to perform dental
exams.
HIV Testing (§ 1(b)(10))
The bill’s plan must require a medical professional to administer an
HIV test to each inmate who requests it, subject to test availability.
Except in exigent circumstances and subject to test availability, these 2022SB-00448-R01-BA.DOCX
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professionals also must offer an HIV test to each inmate where it is
clinically indicated (1) when the inmate enters a correctional institution
or (2) during an annual physical assessment.
Substance Use Disorder Services (§ 1(b)(11)-(13))
Under the bill’s required plan, a medical professional must interview
inmates about their drug and alcohol use history when they first enter
the institution. If the inmate shows drug or alcohol withdrawal
symptoms at that time, a medical professional must perform a physical
assessment and communicate the results to a physician, PA, or APRN.
Except in exigent circumstances, a drug and alcohol counselor must also
evaluate the inmate within five days after first entry.
The plan must require correctional institutions to immediately
transfer an inmate to an appropriate area for medical treatment if a
physician, PA, or APRN determines the inmate is in withdrawal. A
physician, PA, or APRN must periodically evaluate each inmate who
shows signs of or discloses drug or alcohol addiction or who is in
withdrawal. The provider must decide how often to do these
evaluations.
Under the plan, a physician, PA, or APRN with experience in
substance use disorder diagnosis and treatment must oversee the
medical treatment of inmates in withdrawal. A medical professional
must also be in the medical unit whenever these inmates get medical
treatment.
For inmates who show signs of or disclosed an addiction to drugs or
alcohol, the plan must require a drug and alcohol counselor to (1) offer
substance use disorder counseling services, including individual and
group sessions and (2) encourage participation in at least one session.
At discharge, a discharge planner (see above, Exit Interview with
Discharge Planner) may refer these inmates to a substance use disorder
treatment program in the community that the discharge planner finds
appropriate.
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Specific Services for Pregnant Inmates (§ 1(b)(14)-(15))
The bill’s plan must also include certain requirements for pregnant
inmates at the York Correctional Institution (the state’s only correctional
facility for females).
Under the plan, York must provide inmates who are pregnant and
drug- or alcohol-dependent with information on the (1) dangers of
undergoing withdrawal without medical treatment, (2) importance of
treatment for withdrawal during the second trimester, and (3) effects of
neonatal abstinence syndrome on a newborn (i.e., conditions caused by
withdrawal from a drug exposed to in the womb).
The plan also must require York to provide inmates who are pregnant
with prenatal visits at a frequency that an obstetrician determines is
consistent with community standards.
Medical School Residency Training (§ 1(b)(16))
Under the bill’s required plan, DOC must issue a request for
information for medical schools to apply to provide practical training at
correctional institutions as part of a medical residency program, in
which participating residents provide inmate health care services.
BACKGROUND
DOC Policies
DOC Administrative Directive 8.1 requires DOC, either directly or
through agents, to provide inmates with health care services that meet
community standards. It lists several categories of services that DOC’s
contracted health services provider must provide (e.g., sick call and
emergency services, pharmacy services, dental care, mental health
services, and discharge planning). Among various other provisions, the
directive requires that (1) staff conduct a comprehensive health
screening before placing a newly admitted inmate into the general
population and (2) inmates receive periodic health assessments as
determined by the responsible physician (specific types of assessments
or examinations are required in certain situations).
Other DOC directives give more detail about certain types of medical 2022SB-00448-R01-BA.DOCX
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services for inmates, such as dental services, mental health services, and
psychoactive medication.
Related Bill
sSB 458 (File 523), passed by the Senate, requires the DOC
commissioner, in consultation with the Department of Mental Health
and Addiction Services and the Judicial Department, to annually
evaluate substance use disorder and mental health screening,
diagnostic, and treatment services available to inmates.
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 26 Nay 3 (03/25/2022)