Section 2602.90  Medical and Health Care


a)         Introduction


1)         Courts in several states have ordered direct and substantial medical services to be provided persons in detention.  Detention staff cannot risk the consequences in refusing a youth's need of or request for medical attention.


2)         Health services should reflect the desire of the community to provide health care equivalent to that accorded its citizens in the free community.


3)         The American Medical Association Standards for health services for juvenile correctional facilities should be consulted as guidelines.


b)         Minimum Standards


1)         Medical and Health Services

All facilities shall provide a competent medical authority to ensure that the following medical services are available:


A)        Collection and diagnosis of complaints.


B)        Treatment of ailments.


C)        Prescription of medications and special diets.


D)        Arrangements for hospitalization.


E)        Liaison with community medical facilities and resources.


F)         Environmental health inspections and procedures.


G)        Supervision of special treatment programs, as for drug addicts, alcoholics, etc.


H)        Administration of medications.


I)         Maintenance of accurate medical records.


J)         Maintenance of detailed records of medical supplies, particularly of narcotics, barbiturates, amphetamines, and other dangerous drugs.


2)         Physician and Dental Services

A medical doctor shall be available to attend the medical and mental health needs of youth.  Arrangements shall be made for a dentist to provide emergency dental care.


A)        General medical physician services shall be provided by one or more of the following procedures:


i)          On salary, in accordance with locally established personnel pay plan.


ii)         A contract with a local physician or clinic for full-time coverage at specific hours and for emergencies.


iii)        A contract with a local physician to conduct sick call, to be on call for emergencies, and to examine newly admitted youth.


iv)        Arrangements with a nearby hospital to provide all needed medical services.


v)         Services rendered, without cost, by another agency or department or with costs prorated.


B)        Access to psychiatric and/or psychological services shall be provided in individual cases as needed.


3)         Medical Examination Room

A medical examining room shall be located close to or be part of the admissions area.  This standard is waived for existing facilities.


4)         Medical Examination

All youth admitted to detention shall undergo a physical examination as prescribed in Section 2602.50(b)(9).


A)        Newly admitted youth suspected of having any type of communicable disease shall be isolated and an immediate referral shall be made to the facility physician for possible transfer to a medical facility, unless the admitting facility can safely and effectively segregate and maintain a medically prescribed course of treatment.


B)        All youth confined for more than seven days shall be given a medical screening by a medical doctor, registered nurse or physician assistant.


5)         Sick Call

A schedule and procedure shall be established for daily sick call.


A)        The names of youth reporting to sick call shall be recorded in the medical log.


B)        Youth with emergency complaints shall receive attention as quickly as possible, regardless of the sick call schedule.


C)        Nonmedical detention staff may issue any form of over-the-counter medication, providing the facility physician gives prior written approval to the facility for such issue.


6)         Written Record or Log

A written record, in ink, shall be maintained as part of the youth's personal file of all treatment (including special diet) and medication prescribed, including the date and hour such treatment and medication is administered.  A written record shall be maintained of over-the-counter medication, i.e., aspirin, cough medicine, etc., issued by detention staff.  A youth's treatment and medication program shall be a part of the summary to the probation officer.


7)         Medical Security

Security of supplies must be maintained at all times.


A)        When a physician or other medical personnel attends patients at the facility, a staff member shall be present to assure an orderly process.


B)        Drugs, including over-the-counter medication and other abusable medical supplies, shall be secured and accessible only to designated staff.


C)        Youths shall receive one dose of medication at a time and shall be required to ingest medication in the presence of a medical staff member or detention staff member.


8)         First Aid Training

One person on duty, per shift, shall have basic first aid and cardiopulmonary resuscitation (CPR) training.


9)         First Aid Supplies

Those facilities not having a dispensary shall maintain a stock of first aid supplies for the treatment of cuts, bruises, sprains, and other minor injuries.  First aid supplies must be secured and not accessible to youth.


10)         Parental Notification

Recommendations of the facility physician shall be reported to parents or guardians, in writing, through the probation officer.  Parents or guardian, the probation officer, and the court shall be immediately notified of a youth's serious illness or accident.


c)         Recommendations


1)         Medication to be ingested should, whenever possible, be in liquid form.


2)         Conditions requiring immediate attention by a physician include, but are not limited to:  head injuries, coma, broken bones, open wounds, history of diabetes, epilepsy, tuberculosis, venereal disease, fever or bleeding.


3)         The Department of Public Health may be requested to assist detention facilities by:


A)        Providing immunization.


B)        Investigating epidemics, contagious diseases, food poisoning and providing environmental inspections.


C)        Providing health education literature, lectures, and staff in-service training consultation.


4)         The Department of Human Services may be requested to assist detention facilities.  Since many youth may be emotionally disturbed, pre-psychotic or psychotic but in a temporary state of remission, the Department of Human Services may provide:


A)        Mental health staff members for detention facilities.


B)        Hospitalization of psychotic youth.


C)        In-patient and out-patient treatment of discharged youth.


D)        Mental health education.


E)        Diagnostic examinations for reports and commitments.


5)         Existing facilities should provide a private area for a medical examining room.


6)         Detention personnel should receive instruction for emergency care of epileptics during seizures.  Specialized care for epileptics will be determined by the detention physician.


7)         Diabetics and epileptics should be closely supervised as they may fail to follow their diet, react to an overdose of medication or, conversely, ignore necessary medication.  Diabetics and epileptics should be regularly seen by the detention physician.