O F F I C E O F L E G I S L A T I V E R E S E A R C H
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PA 22-133—sSB 448
Public Health Committee
AN ACT REQUIRING THE DEVELOPMENT OF A PLAN CONCERNING
THE DELIVERY OF HEALTH CARE AND MENTAL HEALTH CARE
SERVICES TO INMATES OF CORRECTIONAL INSTITUTIONS
SUMMARY: This act 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 about a medical
discharge plan;
4. inmates generally 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 interviews 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
7. the York Correctional Institution provide inmates who are pregnant with
prenatal visits at a frequency consistent with community standards.
Under the act, 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.
EFFECTIVE DATE: Upon passage
DOC PLAN FOR INMATE HEALTH CARE SERVICES
Under the act, 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))
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The act’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 act, “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 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 act, 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 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 psychotropic
medication prescribed to the inmate and (b) all other medications the inmate
is taking.
Health Assessments and Physical Exams (§ 1(b)(2)-(5))
Under the act’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 not do so.
The act’s plan also must require that inmates receive annual physical exams, O L R P U B L I C A C T S U M M A R Y
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when clinically indicated, from a physician, PA, or APRN. These exams may
include (1) a breast and gynecological exam or prostate 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 act’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 act, 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 act’s required plan, a physician must be on call on weekends,
holidays, and outside regular work hours to give needed medical care to inmates.
Vaccinations (§ 1(b)(8))
Under the act’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 act’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 O L R P U B L I C A C T S U M M A R Y
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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 act’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 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 act’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. One of these providers 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 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.
Specific Services for Pregnant Inmates (§ 1(b)(14)-(15))
The act’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 O L R P U B L I C A C T S U M M A R Y
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(i.e., conditions caused by withdrawal from drug exposure 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 act’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
inmates with 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 services
for inmates, such as dental services, mental health services, and psychoactive
medication.
Related Act
PA 22-118, § 207, 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.