Health Care Department Operations Manual

Cancel

Chapter 3 – Health Care Operations

Article 3.5 – Dental Care: Dental Clinic Operations

View All Sections >

3.3.5.1 Priority Health Care Services Ducat Utilization

  • Policy

    • The California Department of Corrections and Rehabilitation (CDCR) shall maintain and utilize a system of priority ducats to provide patients timely access to dental care.

  • Purpose

    • To maintain a process that provides all patients with access to dental care through the successful implementation of a dental ducat delivery process within CDCR.

  • Procedure

    • General Requirements

      • Each institution shall establish procedures for processing, distributing and documenting dental ducats that:

        • Provide patients with timely access to dental care.

        • Provide a system of accountability for the distribution and delivery of dental ducats.

        • Provide a method for documenting and processing a patient’s refusal or failure to report for scheduled dental appointments.

      • These procedures shall include:

        • Provision for the Office Technician (OT), or designated dental staff, under the direction of the dentist, to enter dental appointments in the Electronic Dental Record System (EDRS) Appointment Book no later than one day prior to the scheduled encounter.  The OT, or designated dental staff, shall schedule patients for dental appointments at designated intervals in accordance with EDRS Workflow 2-1 and associated Front Office Job Aid.

        • A written methodology for the distribution of ducats within the institution, which shall include instructions that, upon receipt, the facility or program unit custodial supervisor or designated custodial staff shall be responsible for delivering the ducats to the patients in a timely manner, in accordance with the correctional facility’s local operational procedures.

        • A written methodology for documenting the delivery of the dental ducats to the patients ensuring that they shall receive a ducat prior to their scheduled appointment and shall arrive at the clinic at the specified time on the ducat.

        • A written methodology for re-routing dental ducats to patients who have received intra-facility bed/cell moves, which ensures that patients will receive the ducats with sufficient time to report for scheduled appointments.

        • Provision for Developmental Disability Program (DDP)/Disability Placement Program (DPP) designated patients to be given specific instructions concerning the time and location of their scheduled appointment(s).  Custody staff delivering the ducats to such designated patients shall utilize effective forms of communication to ensure that the patients arrive at the designated appointment location.

        • A notation that Health Care Services ducats shall be treated as priority ducats.  For the purpose of this policy, priority ducats indicate the necessity of dental care.

        • Provision for patients to bear the responsibility of reporting to the dental appointment as indicated on the priority health care ducat. (Reference the California Code of Regulations [CCR], Title 15, Division 3, Chapter 1, Article 1, Section 3014 “Calls and Passes”).

        • A system to provide patients timely access to health care services from any facilities or housing units on modified program or lock down status. (Reference the Health Care Department Operations Manual (HCDOM), Section 3.3.5.13(d)(7))

    • Dental Ducat Cancellation or Rescheduling at the Patient’s Request

      • In the event a patient informs the Correctional Officer (CO) delivering the ducat that they wish to refuse, cancel or reschedule their appointment, the CO shall advise the patient that they must report to the ducat in person to refuse, cancel or reschedule.

      • The patient’s cancellation or request for rescheduling an appointment shall be regarded as a refusal and is subject to the provisions outlined in Section (c)(4)(C)3.

    • Dental Ducat Cancellation or Rescheduling by Dental Staff

      • If a patient’s scheduled appointment for Dental Priority Classification (DPC) 1A dental care is cancelled or rescheduled by dental staff, then the patient shall be seen by a dentist within one calendar day.  For all other DPC appointments, the dentist shall see the patient within 35 calendar days of the cancelled appointment or consistent with the timeframe associated with the original DPC code assigned at the date of diagnosis, whichever is shorter.

      • If a patient’s face-to-face triage or limited problem focused exam encounter is cancelled or rescheduled by the dental clinic, then the patient shall be seen by a dentist within the following three business days.

    • Failure to Report for Dental Ducats

      • If a patient fails to report for an appointment, the CO assigned to the dental clinic area shall attempt to locate the patient and notify the custody supervisor if unable to locate the patient.

      • Unintentional Failure

        • If it is determined that the patient failed to report for reasons beyond their control, the matter shall be referred to the Health Program Manager III, who shall seek to ensure that corrective measures are taken.

        • The dentist or designee shall notify the OT or designated dental staff to reschedule the patient. 

        • If a patient unintentionally fails a dental appointment, then the dentist shall see the patient within one calendar day for a DPC 1A dental need.  For all other DPC needs, the dentist shall see the patient within 35 calendar days following the unintentional failure or consistent with the timeframe associated with the original DPC code assigned at the date of diagnosis, whichever is shorter.

        • If a patient unintentionally fails a face-to-face triage or limited problem focused exam encounter, then the patient shall be seen by a dentist for a face-to-face triage or limited problem focused exam within three business days.

        • Dental staff shall document the reason for the patient’s failure to report to the scheduled appointment and that the patient was rescheduled as appropriate in a clinical note in the EDRS, in accordance with EDRS Workflow 1-2 and associated Back Office Job Aid.

      • Intentional Failure

        • If it is determined that the failure to report was intentional on the part of the patient, then the dentist, or designated DA or OT shall request that the patient be sent or escorted to the dental clinic. 

        • If the patient refuses to go to the dental clinic, then the custody staff shall notify the dentist, or designated DA or OT. 

        • The dentist shall record the intentional failure to report as a refusal in a clinical note in the EDRS, in accordance with EDRS Workflow 1-2 and associated Back Office Job Aid, as well as complete a CDCR 7225-D, Dental Refusal of Examination and/or Treatment. (Reference the HCDOM, Section 3.3.5.6(c)(6) for other requirements concerning a patient refusal).

        • In the event a patient intentionally fails to report for a dental appointment, a dentist shall conduct a face-to-face interview and counseling session with the patient.

          • The dentist shall follow the processes described in the HCDOM, Section 3.3.5.6(c)(1) through (3).

          • Patients who are insistent in their refusing to report shall not be subject to cell extraction or use of force to gain compliance with the priority health care ducat. In these instances, a dentist must respond to the patient’s housing unit, at a time that does not interfere with patient care, to provide the necessary education regarding the refusal. Custody staff cannot accept refusals on behalf of the patient.

          • If the patient refuses the face-to-face interview and counseling session, then the dentist shall record this refusal as outlined in Section (c)(4)(C)3.

        • Patients who intentionally fail to report for a dental appointment shall be required to submit a CDCR 7362, Health Care Services Request Form, in order to access future dental care.

      • Dental staff and/or custodial staff, as appropriate, may initiate progressive incarcerated person disciplinary action, as necessary, based on the factors of the patient’s failure to report. (Reference the CCR, Title 15, Division 3, Chapter 1, Article 1, Section 3000, “Definitions – General Chrono” and/or the CCR, Title 15, Division 3, Subchapter 4, Article 5, Section 3312, “Disciplinary Methods”).

  • References

  • California Code of Regulations, Title 15, Division 3, Chapter 1, Article 1, Section 3000

  • California Code of Regulations, Title 15, Division 3, Chapter 1, Article 1, Section 3014

  • California Code of Regulations, Title 15, Division 3, Subchapter 4, Article 5, Section 3312

  • Health Care Department Operations Manual, Chapter 3, Article 3, Section 3.3.5.6, Patient’s Right to Refuse Treatment

  • Health Care Department Operations Manual, Chapter 3, Article 3, Section 3.3.5.13, Access to Care

  • Revision History

  • Effective: 04/2006
    Revised: 03/2019, 11/2020, 02/2022