Chapter 3 – Health Care Operations

3.1.17 Palliative Care and Treatment

• Policy

  • California Correctional Health Care Services shall provide palliative care and treatment when the patient’s terminal condition results in pain or disability to such an extent that the Primary Care Provider (PCP) and the patient determine that only palliation shall be provided.

• Purpose

  • To provide comfort, relief from pain, and support when the patient has received a terminal diagnosis.

• Responsibility

  • The Chief Executive Officer (CEO), or designee, is responsible for the implementation, monitoring, and evaluation of this policy and procedure.

• Procedure

  • The PCP shall evaluate the patient and prescribe a treatment plan as warranted for palliative or comfort care.  The ordered treatment shall be documented in the patient’s health record.

  • A pain control plan (including narcotics) will be developed with the assistance of a specialist, as appropriate.

  • If the patient meets the criteria for hospice care, the PCP shall complete a referral to California Department of Correction’s and Rehabilitation’s hospice at the California Medical Facility.

  • Hospice Admission Criteria are as follows:

    • The hospice has obtained written acceptance for hospice care from the Chief Medical Executive (CME) or designee.

    • The hospice PCP and/or CME, or designee, certifies a prognosis six months or less if the disease follows its expected course.

    • The patient and/or designated legal representative agrees to palliative goals/philosophy of hospice services.

    • The custody level generally cannot be greater than a Close A and there cannot be any other precluding custody considerations (such as enemy situations).

    • The hospice has the ability to meet the needs of the patient according to the level and intensity of care required.

    • There are adequate, cooperative efforts by the patient to follow safety measures and the plan for medical and non-medical emergencies.

    • The hospice has adequate, suitable personnel and resources to provide the services required by the patient.

  • Patients receiving palliative care shall continue to receive medically necessary treatment for other medical conditions that may occur or coexist such as injuries, infections, and chronic conditions (e.g., hypertension, diabetes). 

  • Refusal of medically necessary care shall be documented in the health record. 

  • Health care staff shall inform patients that they may obtain a consultation with the Mental Health Services Department or Chaplain of their choice within the institution.  Upon the patient’s request, an appointment shall be made with the requested discipline.

  • The CEO shall request a Compassionate Release when appropriate.

  • Health care staff shall follow the Department’s procedure for Advance Directives.

• References

  • Health Care Department Operations Manual, Chapter 1, Article 2, Section 1.2.14, Medical Classification System

  • Health Care Department Operations Manual, Chapter 2, Article 4, Section 2.4.1, Advance Directive for Health Care

• Revision History

  • Effective: 01/2006
    Revised: 09/2015