Chapter 9 – Health Care Services

The Department shall receive, evaluate, house, treat, and/or refer all psychiatrically disturbed inmates who by virtue of their mental illness are unable to appropriately function within the constraints of the usual correctional processing or program assignments.

To provide for the detection, diagnosis, treatment, and referral of inmates with mental health problems and to assist each facility’s Warden during all stages of each inmate’s period of incarceration.

The Deputy Director, HCSDHealth Care Services Division (see DCHCS), shall maintain the delivery of mental health services and programs to inmates and parolees. Such services and programs shall include the following:

• Provisions for mental health care to all inmates and parolees with emphasis on identification of need while in reception and prerelease processing.

• Provision for diagnosis and treatment of voluntary patients.

• Provision for involuntary diagnostic and treatment services with appropriate safeguards against abuse and means for appeal and relief.

• POCs shall provide mental health services to parolees, reporting administratively to P&CSDParole & Community Services Division (see DAPO), and reporting professionally to the Deputy Director, HCSDHealth Care Services Division (see DCHCS).

• An ongoing program to assess the needs of current departmental population.

• Priorities for the use of limited resources and plans for improving existing programs or initiating new programs.

• Criteria for referring for services within the Department and to other agencies.

• A program review and evaluation activity.

Each institution shall provide staff, space, equipment, and supplies for the treatment and/or referral of inmates with mental disorders requiring care. Each institution shall provide 24-hour emergency service.

• All departmental staff, by their supervisors, shall apprise institutional management when this procedure and/or professional standards are not being followed or met.

Departmental employees may refer an inmate to an institution’s mental health services or the inmate may submit a request for such services.

Inpatient psychiatric services shall be provided at the:

• CMFCalifornia Medical Facility.

• CIMCalifornia Institution for Men.

Outpatient services or arrangements for appropriate referrals shall be provided at all institutions.

The treating physician at any facility may initiate a referral to any psychiatric resource by contacting the designated facility Chief Psychiatrist (CP) or equivalent. The referring facility shall arrange transportation. The receiving facility may request further evaluation prior to transfer.

Placement and assignment procedures for psychiatric treatment categories, including documentation and CSRClassification Staff Representative endorsement, shall be as outlined in the DOMDepartment Operations Manual 62050 and 62080.

A classification of Category “I” for males and “I” or “Psychotic” for females is assigned to inmates who are believed to be:

• Acutely psychotic, severely depressed, or suicidal.

• Mentally ill inmates who are management problems, providing the psychosis warrants treatment in a hospital setting.

Category “I” care is provided at CMFCalifornia Medical Facility or at the CIWCalifornia Institution for Women. Category “I” designation shall only be made by CMFCalifornia Medical Facility or CIWCalifornia Institution for Women staff. Other institutions with inmates who appear to meet Category “I” criteria shall transfer such cases to CMFCalifornia Medical Facility or CIWCalifornia Institution for Women for psychiatric observation.

When an inmate believed to be mentally ill is transferred to a psychiatric program and later found not to be mentally ill, they shall be returned to the sending institution without CSRClassification Staff Representative review.

The DMHDepartment of Mental Health (see Department of State Hospitals DSH) provides inpatient services for inmates transferred from the Department in accordance with PCPenal Code 2684 and at CMFCalifornia Medical Facility by interdepartmental contract.

When an inmate is transferred for a comprehensive mental health evaluation by a multiple disciplinary mental health team, it shall take place within 14 days after the date of transfer. The evaluation shall include at least the following:

• Review of mental health screening and appraisal data.

• Collection and review of additional data from staff observation.

• Individual diagnostic interviews and tests assessing intellect and coping abilities.

• Compilation of individual’s mental health history.

• Development and overall treatment/management plan with referrals.

The Department maintains interdepartmental agreements to transfer mentally ill or mentally deficient inmates or parolees to DMHDepartment of Mental Health (see Department of State Hospitals DSH) or the Department of Developmental Services for treatment.

Records for each inmate housed by DMHDepartment of Mental Health (see Department of State Hospitals DSH) shall be maintained by therespective “hub” institution (refer to DOMDepartment Operations Manual 62030). The “hub” institution and P&CSDParole & Community Services Division (see DAPO) staff shall make all contacts with the designated DMHDepartment of Mental Health (see Department of State Hospitals DSH) facility to secure reports, schedule BPT hearings, and to process an inmate’s parole or discharge. Any report needed for BPT hearings, Superior Court, or other such proceeding shall be requested of DMHDepartment of Mental Health (see Department of State Hospitals DSH) to prepare the report or send the departmental staff person to the hospital to complete the report.

The psychiatric inpatient unit shall treat mentally disordered patients with any psychiatric illness or disease, whether functional or of organic origin, requiring inpatient-level care.

The CP shall:

• Administer medical care and services for the unit, including all acts of diagnosis, treatment, prescribing, and ordering of drugs.

• Develop a plan for treating and/or referral of patients with emergency medical problems.

• Chair a committee to identify and recommend to administration necessary equipment and supplies.

The psychiatrist shall:

• Prepare the diagnostic formulation for each inmate.

• Develop and implement individual treatment plans.

• Determine frequency of medical examinations.

Reports of all medical examinations shall be placed in the inmate’s medical record file.

Only medical staff shall order an inmate removed from general housing status for medical or psychiatric reasons.

Psychological services shall be provided by clinical psychologists. Clinical psychologists are members of the medical staff and shall have admitting privileges within departmental medical facilities.

A social worker shall be used for the rendering of social services:

• At the request of the patient’s attending physician.

• At the request of management staff.

A nurse with at least two years experience in psychiatric nursing shall provide the nursing management of the psychiatric unit.

There shall be an RNRegistered Nurse with training and experience in psychiatric nursing on duty at all times in an institution having a psychiatric unit.

There shall be sufficient nursing staff including RNs, MTAs, Licensed Vocational Nurses (LVNLicensed Vocational Nurse), and mental health workers to meet the needs of inmates. Nursing activity documentation shall be forwarded to the unit CP.

Every inpatient unit shall:

• Provide and conduct organized programs of therapeutic activities in accordance with the interests, abilities, and personal and custodial needs of the inmate.

• Develop and record an individual evaluation and treatment plan which is correlated with the total therapeutic program.

Qualified therapists shall be employed to conduct the therapeutic activity program that may include:

• Occupational.

• Music.

• Art.

• Dance.

• Recreation.

Each inmate patient shall have the same rights as all other inmates unless the physician has good cause to deny an inmate any of the rights specified. The denial and reasons shall be entered in the inmate’s medical record.

Due process for inmates transferred to CMFCalifornia Medical Facility for psychiatric reasons shall be accomplished by CMFCalifornia Medical Facility staff.

• The inmate shall:

  • Be given written notice indicating a hearing shall be held within seven days after arrival at CMFCalifornia Medical Facility.

  • Be assisted by his caseworker for and at the hearing which includes available documentation relating to the transfer.

  • Have the information and/or justification for ordering the transfer disclosed at the hearing.

  • Have the opportunity to present either oral or written testimony of witnesses.

  • Be informed in writing of the decision.

• The chairperson shall:

  • Be an independent decision maker.

  • Not be the treating psychiatrist at the referring or treating facility.

  • Have the discretion to limit witnesses.

  • Have the discretion to continue the hearing if additional information is needed.

The inmate may appeal the decision within 30 days using CDC Form 602, Inmate/Parolee Appeal Form.

Note: DOMDepartment Operations Manual 54060.15 through 54060.34 are now incorporated into DOMDepartment Operations Manual 91090.

Refer to the CCRCalifornia Code of Regulations, Title 15, Section 3268, Use of Force policy.

Contained or controlled situations (such as a recalcitrant inmate in a locked cell or room) with no apparent likelihood of immediate danger or injury to any person shall be evaluated and alternatives to the use of force, considered. In such controlled non-emergency situations, the use of force may be authorized only by personnel at the level of lieutenant or above. On psychiatric wards, the approval of a psychiatrist shall be required.

Staff persons shall:

• Orally report to the immediate supervisor all incidents where physical force is used to subdue, contain, or control an inmate.

• Fully document the incident prior to leaving the facility.

Supervisors shall:

• Provide supervision of the incident, when possible, to ensure only minimum amount of force is used to control the situation.

• Not become actively involved in the use of force unless absolutely necessary.

• Report incident verbally and in writing to the immediate supervisor.

Supervisor in charge shall:

• Ensure medical attention and care is provided.

• Have personnel evaluated by medical staff and first-aid administered if required.

• Have injured inmates treated by medical staff and documented on a CDCRCalifornia Department of Corrections and Rehabilitation Form 7219.

• Have photographs taken of all persons involved and verify photographs are true depictions.

• Log and maintain negatives and pictures for two years before obliteration.

Application of mechanical equipment and/or seclusion for psychiatric reasons shall be:

• Used only to protect the inmate and others from injury.

• To prevent property damage.

Mechanical Equipment

• An inmate shall:

  • Be placed in restraint only by written order of a physician.

  • Be placed in restraint at the discretion of a RNRegistered Nurse, MTA, or LVNLicensed Vocational Nurse and an oral order obtained, recorded, and signed by a physician.

  • Be observed every 15 minutes by medical staff.

  • Be easily removable in the event of fire or other emergencies.

• A record of type of restraint, application, and removal shall be in the inmate’s medical record.

Seclusion

• An inmate placed in seclusion requires the same orders as mechanical equipment restraint.

Procedures for the use of an Electronic Control Device (ECD) are contained in the Restricted Volume (55000 Series) of the DOMDepartment Operations Manual.

Custodial Staff

• A taser shall not be utilized until the following occurs:

  • Custodial staff shall notify the CMOChief Medical Officer or designee that use of the taser is being considered on a particular inmate. Custodial staff shall identify the inmate to medical staff by name, CDC number, and housing location.

CMOChief Medical Officer

• The CMOChief Medical Officer or designee is responsible to review the medical and psychiatric sections of the inmate’s health record to ascertain whether there are any medical conditions that preclude the use of the taser. Use of the taser is prohibited if the inmate received any psychotropic medication in the prior six weeks, is being treated for a cardiac arrhythmia, or has a pacemaker.

• If no prohibitive medical or psychiatric condition exists, medical staff shall inform the appropriate custodial authority that there are no medical/psychiatric factors which preclude the use of the taser on the inmate at this time.

CMOChief Medical Officer

• The CMOChief Medical Officer or designee is responsible to document their findings in the general medical and psychiatric sections of the inmate’s health record.

Facility Administrative Staff

• The facility administrative staff is responsible to document compliance with these procedures within the CDCRCalifornia Department of Corrections and Rehabilitation Form 837 series, Crime/Incident Report, which is submitted to the Institutions Division at headquarters.

See DOMDepartment Operations Manual 32010, Taser Certification/Recertification Requirements; 51030, Reportable Incidents; and 55050, Authorization/Use/Limitations and Storage, for additional information on the taser.

When an inmate remains in AD-SEGAdministrative Segregation beyond 30 days, a personal interview shall be conducted and a written report, CDC Form 128-C, shall be prepared by a psychologist or psychiatrist to evaluate any psychological sequel, need for medications, and/or reassurance about external circumstances. If the inmate confinement continues beyond three months, a psychological assessment shall be made every three months.

There may be occasions when large numbers of psychiatric referrals and limited psychiatric staff may require that qualified CCCorrectional Counselor-IIs prepare clinical records in lieu of psychiatric evaluations for selected cases and under supervision of a psychologist or a psychiatrist. A psychiatric council shall be established to review such evaluations prepared by counselors. The council shall be comprised of:

• Chairperson: facility’s chief or program psychiatrist/consulting psychiatrist.

• Clinical psychologist.

• PAProgram Administrator, CCCorrectional Counselor-III, or CCCorrectional Counselor-II who prepared the evaluation.

Three appointed psychiatrists shall:

• Conduct a psychiatric examination and submit a written report to the Warden in time for the report to be transmitted to the Governor at least 20 days prior to the scheduled execution date.

• Have all information available pertinent to the inmate’s sanity.

• Prepare a report at least 20 days prior to scheduled execution to be submitted in triplicate to the Director.

• Evaluate the electroencephalogram examination with an interpretation of the results in lay wording.

For serious disciplinary hearings in a psychiatric unit, a subcommittee shall include a psychiatrist or psychologist. A full disciplinary committee shall include a psychiatrist and a psychologist.

For efficient use of evaluations for BPT, Superior Court, etc., the psychiatric/psychological portion of the cumulative case summary shall:

• Be brief and concise.

• Use lay terminology and explanations.

• Avoid detailed recapitulation of material available elsewhere in the cumulative summary.

  • If the previous report is virtually identical to the current evaluation, do not rewrite the entire report.

  • Indicate the case has been reviewed, the previous report is still applicable, and there is no significant change.

The evaluation shall also indicate:

• Whether this is the first, second, etc., report to the authority.

• Length of time since the last report.

• What was the nature of author’s contact with the inmate.

• If first report, note pertinent previous psychiatric history with a short digest of essential conclusions and treatment.

• Summarize current essential development and progress.

• Delineate the psychopathology present which supports the diagnosis and prognosis.

• Reevaluate previously reported psychiatric conclusions.

• Comments on causative factors, self-understanding, attitudes, motivation for change, emotional stability, social identification, sincerity, and rehabilitation.

• A neurological appraisal (or reference to prior appraisal or note that such appraisal is needed) if organicity is present.

• The observed effect of medication or note if not on medication.

All evaluations shall list the reasons for general conclusions. The diagnosed psychopathology is related to criminal behavior:

• Directly, the offense or offenses were largely a function of the psychopathological state.

• Indirectly, the psychopathology directly and clearly predisposed to the offenses but did not determine them.

• No significant relationship, criminal behavior, and psychopathology have been unrelated. Continuation of the psychopathology does not substantially increase the likelihood of criminal behavior.

Observation in the Facility

• During observation in the facility, the inmate has:

  • Psychiatrically improved slightly, moderately, greatly, or entirely.

  • Psychiatrically deteriorated slightly, moderately, or greatly.

  • Psychiatrically has shown no significant change.

  • No conclusions may be drawn because of insufficient time and observation by evaluation.

Return to Community

• In a less controlled setting such as return to the community, the inmate is:

  • Considered likely to continue improvement.

  • Considered likely to hold present gains.

  • Considered in all probability to deteriorate because of (listreasons).

From a psychiatric standpoint, the inmate should:

• Remain in present rehabilitation program as continued benefit is likely. State recommended specific treatment.

• Be removed from special (psychiatric evaluation) calendar because:

  • Psychopathology is not significantly related to future criminal behavior and psychiatric opinion will not contribute to release decision.

  • Two or more favorable psychiatric reports (having conclusions favorable for release) have been written within the last three years. The two favorable reports shall have been written by more than one examiner or had psychiatric council review.

  • There have been repeated psychiatric reports describing chronic mental pathology which cannot be expected to change. The conditions under which parole would be possible or become possible shall be spelled out with this recommendation.

• Be considered for transfer to DMHDepartment of Mental Health (see Department of State Hospitals DSH) as needing treatment not available in the Department. Recommendations shall state whether it is anticipated that such treatment may result in the inmate being able to be returned to society.

If the inmate is to be paroled or released, consideration shall be given to the following:

• Violence potential outside a controlled setting in the past considered to have been serious (specify) and at present estimated to increase, decrease, or be comparable. In this context, violence is equated with inflicting physical harm on others or great emotional harm, as by creating fear.

• Conditions of parole such as outpatient clinic (parole or local), halfway house, no alcohol, and other special attention or special supervision needs. Indicate whether evaluator recommends:

  • Mandatory for parole from facility.

  • Necessary after release to parole.

  • Desirable.

• Continuation of medication on parole. Specify name of medication, dosage, frequency, and route of administration.

Indicate recommendations to the classification committee if parole is denied. If a parole date is set, give pertinent information for the period in the facility prior to parole (e.g., whether further psychiatric evaluation should be made prior to release). Indicate basis for all recommendations.

After the report is written, new psychiatric developments in the case shall be reported on CDC Form 128-C and sent to the C&PRClassification & Parole Representative for inclusion in the report.

A full psychiatric evaluation on life prisoners shall be prepared for all initial and subsequent parole hearings. An evaluation shall be prepared for any rescission hearing based on psychiatric problems or assaultive/sexual behavior. Inmates shall be retained on psychiatric referral status unless specifically removed by a BPT panel and the reasons specified in the hearing decision.

Inmate cases ordered to category X shall be calendared to appear in one year, unless the panel specifically instructs that the inmate be calendared upon completion of the evaluation. Inmates who refuse to cooperate with a requested evaluation shall also be retained on psychiatric referral status and calendared on the one-year schedule.

Psychiatric evaluation reports shall be completed and copies distributed to the inmate, their attorney, and the DA at least 15 days before the hearing.

When a request for a PCPenal Code 1170(d) is received, staff shall prepare a diagnostic study and recommendation. This report, together with the current psychological evaluation if indicated, and a transmittal letter shall be reviewed by the program’s Associate Warden. If any staff recommendations are in conflict, the method by which this conflict was resolved shall be described in the transmittal letter to the court. Excluding reception centers and emergencies, inmates shall not be transferred until the PCPenal Code 1170(d) report is completed.

Reception center staff shall prepare a psychiatric/psychological evaluation for each PCPenal Code 1203.03 case and each inmate who, after observation or based on the information from the county, appears to have a psychiatric problem that may affect facility placement. Prisoners convicted of PCPenal Code 273(a) (willful cruelty toward child/endangering life, limb, or health) and/or PCPenal Code 273(d) (inflicting corporal punishment upon a child resulting in traumatic injury) shall undergo a psychiatric/psychological evaluation to determine whether counseling may be recommended as a condition of parole.

An inmate with documented long-term medical/psychiatric work limitations shall be processed in the following manner:

• The inmate shall receive a psychiatric or psychological evaluation to determine the extent of the inmate’s disability and to delineate the inmate’s capacity to perform work and/or training programs for either a full or partial work day. If the inmate is deemed capable of working only a partial work program, they shall be awarded full-time credit for participation in such a program.

• The psychiatric or psychological evaluation shall be reviewed by the facility’s classification committee.

The Director, DHCSDivision of Health Care Services (Formerly Division of Correctional Health Care Services, DCHCS), or designee is responsible for ensuring that the contents of this article are kept current and accurate.

PCPenal Code §§ 273, 1170, 1203.03, 2600, 2602, 2684, 2685, 2690, 3002, 3501, 5068, and 5068.5.

CCRCalifornia Code of Regulations (15) (3) §§ 3342, 3362, 3364, 3364.1, and 3364.2.

CCRCalifornia Code of Regulations (22) §§ 70577 and 70579.

W&I §§ 5000 et seq., and 7301.

H&SCHealth and Safety Code § 1316.5.

B&PCPenal Code §§ 2900 – 2912.

Youngberg v. Romero.

DOMDepartment Operations Manual §§ 32010, 51030, 55050, 62030, 62050, and 62080.

The Inmate Tuberculosis (TBTuberculosis) Alert System is a critical component of the Department overall efforts to identify an inmate’s TBTuberculosis status and to control TBTuberculosis within CDC.

The Inmate TBTuberculosis Alert System will ensure that inmates with unknown or questionable TBTuberculosis status are moved appropriately, and those on treatment regimes do not have interruptions in the treatment.

The Inmate TBTuberculosis Alert System is designed to address several major problems in controlling TBTuberculosis among inmates. The system will:

• Provide a rapid method for Medical Care Services, Classification Services, Case Records, and CDC Transportation staff to determine the most current TBTuberculosis status of an inmate.

• Provide a rapid method for Medical Care Services staff to identify inmates that require ongoing TBTuberculosis treatment at the receiving facility.

• Allow CDC Transportation, C&PRClassification & Parole Representative, and/or the CCCorrectional Counselor-III to schedule transportation by the most appropriate method given the inmate’s TBstatus.

• Provide reports that will assist facilities in the tracking and control of TBTuberculosis.

TBTuberculosis is an infectious airborne disease that is a serious public health problem in correctional facilities around the country. The control of TBTuberculosis requires a program that emphasizes testing, treatment, and tracking.

Testing

• CDC facilities have established TBTuberculosis testing programs to ensure that inmates are tested on an annual basis, as well as when circumstances warrant additional testing. The testing program ensures that inmates with TBTuberculosis are identified as quickly as possible.

Treatment

• Control of TBTuberculosis requires aggressive and continuous treatment for extended periods of time. TBTuberculosis can be broadly divided into two stages: TBTuberculosis Infection and TBTuberculosis Disease. Unlike the sound of its name, TBTuberculosis Infection is not infectious. During this early stage of TBTuberculosis, the individual has been infected but has no symptoms. Without treatment, 10 percent of the individuals infected with TBTuberculosis will develop the more severe stageTB Disease.

• With treatment, only 2 to 5 percent will develop TBTuberculosis Disease. It is extremely important in TBTuberculosis control that individuals with TBTuberculosis Infection undergo a full course of treatment. Treatment for TBTuberculosis Infection requires regularly administered oral medications for up to 12 months. Interruptions in therapy can cause a multiple drug resistant strain of TBTuberculosis requiring more aggressive and expensive therapy. Inmates with TBTuberculosis Infection can be moved; however, the Medical Care Services staff at the receiving facility shall be notified that an inmate requiring continuous TBTuberculosis treatment has been transferred to the facility.

• TBTuberculosis Disease is initially infectious. After diagnosis and initial treatment, it becomes noninfectious but requires aggressive treatment for up to 24 months. Inmates with TBTuberculosis Disease cannot be moved without respiratory precautions until the disease is noninfectious. Medical staff at the receiving facility must be notified prior to the inmate with TBTuberculosis Disease being transferred to the facility.

Tracking

• Controlling movement of the inmate population is critical to TBTuberculosis control. The Inmate TBTuberculosis Alert System addresses the need to control this movement. No inmate shall move on regular CDC transportation until it is determined that the inmate’s TBTuberculosis status allows movement without respiratory precautions. When an inmate is moved without knowledge of TBTuberculosis status, there is increased potential for the spread of TBTuberculosis Infection. This could result in unnecessary exposure to the staff and inmate population, and require extensive testing of all exposed inmates and staff.

The Inmate TBTuberculosis Alert System will implement the following major components:

• TBTuberculosis Alert Code

  • The Department’s DDPSDistributed Data Processing System and Automatic Transfer System (ATS) shall contain a TBTuberculosis Alert Code for every inmate. This code shall be accessible to designated Medical Care Services, Classification, Case Records, and CDC Transportation staff. The code shall alert Classification, Case Records, and CDC Transportation of movement limitations and special transportation requirements. It shall alert Medical Care Services staff of the need to follow-up on inmates with unknown status, and shall alert Medical Care Services staff when an inmate on therapy is transferred to their facility.

• CSRClassification Staff Representative Endorsements

  • CSRClassification Staff Representative endorsements for movement shall require the inmate’s C-File contain the inmate’s TBTuberculosis Alert Code in order to complete the endorsement. This policy requires that the CDC Form 128-C, Medical/Psychiatric/Dental Chrono, or CDC Form128C-1, Reception Center Medical Clearance/Restriction Information Chrono, documenting the inmate’s TBTuberculosis Alert Code be filed in the inmate’s C-File at the time of endorsement. The inmate shall not be endorsed for movement if the C-File lacks a CDC Form 128-C or CDC Form 128-C-1 documenting the inmate’s TBTuberculosis Alert Code.

• Special Transportation Requirements

  • Inmates with special transportation restrictions shall not be moved on regular CDC transportation. Inmates that have an unknown TBTuberculosis status shall not be transported on regular CDC transportation. These inmates, as well as infectious inmates, require special transportation using respiratory precautions. Special transportation is other than regularly scheduled CDC bus transportation which is normally arranged by the sending facility and provides medical respiratory precautions where required by the referring physician. Respiratory precautions require that masks are worn by those who come close to the patient, hands are washed after touching the patient or potentially contaminated articles and before taking care of another patient, and articles contaminated with infective material be discarded or bagged and labeled before being sent for decontamination and reprocessing.

• Medical Advance Transfer Notice

  • The CDC Form 7343, Medical Advance Transfer Notice, shall contain the most current TBTuberculosis Alert Code and TBTuberculosis Alert Transportation Instruction for each inmate. The TBTuberculosis status of all inmates scheduled for movement shall be reviewed by the facility’s Medical Care Services staff prior to movement. This is to ensure that changes in TBTuberculosis status have not occurred since endorsement.

• Transfer Record

  • The CDC Form 135, Transfer Record, shall contain the most current TBTuberculosis Alert Code and TBTuberculosis Alert Transportation Instruction for each inmate. CDC Transportation Sergeants shall be required to review the TBTuberculosis Alert Transportation Instruction of each inmate. Any inmate without a Clear for Transportation Instruction shall not be allowed to board the bus.

• Telephone Alert System

  • Each facility shall be required to implement a telephone alert system that allows Medical Care Services staff to quickly alert Classification and Custody staff of the need to schedule an inmate for special transportation. When Medical Care Services staff determine that an inmate is going to be moved inappropriately, a medical hold process shall be in place to allow the scheduled movement to be delayed or postponed. Since inmates can move at odd hours, a telephone alert procedure shall be rapid and responsive to the need in stopping inappropriate inmate movement.

The reports associated with the Inmate TBTuberculosis Alert System shall provide Medical Care Services staff with information necessary for immediate follow-up on inmates with unknown TBTuberculosis status. Medical Care Services staff’s access to DDPSDistributed Data Processing System bed assignments should make reading TBTuberculosis tests more efficient. The transfer endorsement policy and the inclusion of the TBTuberculosis Alert Transportation Instruction for each inmate on the CDC Form 135 and the CDC Form 7343 shall provide additional security in stopping the transmission of TBTuberculosis through inappropriate inmate movement.

The current DDPSDistributed Data Processing System and ATS are used to collect information, transfer data, and track inmates throughout the CDC system. The DDPSDistributed Data Processing System is updated every day and selected information is downloaded to the ATS as required. When an inmate transfers to another facility, the DDPSDistributed Data Processing System information follows the inmate within 24 hours. The Inmate TBTuberculosis Alert System is an enhancement to the DDPSDistributed Data Processing System and ATS.

The Inmate TBTuberculosis Alert Code is a two-digit code that shall be entered in the Inmate TBTuberculosis Alert System daily by Medical Care Services staff. The code shall then be printed on the CDC Form 7343 and the CDC Form 135, along with the TBTuberculosis Alert Transportation Instruction for each inmate. DDPSDistributed Data Processing System shall also generate two reports that will be useful to Medical Care Services staff in monitoring testing activities and tracking inmates with TBTuberculosis Infection and TBTuberculosis Disease.

Every inmate at any CDC facility shall be assigned a TBTuberculosis Alert Code to identify their TBTuberculosis status. When an initial TBTuberculosis Alert Code is established and every time the code changes, it shall be documented on a CDC Form 128-C or CDC Form 128-C-1.

The TBTuberculosis Alert Codes are described below:

• Code _ _

  • Status Unknown

    • No entry has been made into the Inmate TBTuberculosis Alert System. This code indicates the TBTuberculosis status of an inmate is unknown. Blank codes require immediate action of the Medical Care Services staff designated as the facility’s Inmate TBTuberculosis Alert System Coordinator.

    • Inmates arriving at CDC reception centers can remain Code __ (blank) until the initial Mantoux Purified Protein Derivative (PPD) skin test has been read. The Code __ (blank) remains until the skin test has been read/interpreted. After test interpretation, the Code __ (blank) becomes either a Code 21 or Code 22. An inmate’s TBTuberculosis Alert Code should not remain blank for over 72 hours.

    • Since an inmate entering the reception center shall be a Code __ (blank) until the PPD is read, it is imperative that designated Medical Care Services staff administer and interpret the Mantoux PPD skin test within 72 hours of inmate arrival. Failure to promptly administer, read, and document the PPD result could result in serious inmate movement problems.

      • TBTuberculosis Alert Transportation Instruction: Transfer and endorsement shall be deferred. Please refer to DOMDepartment Operations Manual 91080.16.

  • Code 11

    • Status Unknown/PPD Test Performed.

    • Code 11 denotes that the PPD skin test has been administered, but not yet read and/or interpreted. The inmate’s TBTuberculosis status is unknown. Inmates should remain a Code 11 no more than 72 hours. This code is used when an inmate with an already established TBTuberculosis Alert Code has a subsequent skin test. The inmate must be coded as a Code 11 after the skin test is administered to assure that the inmate is not moved and to document the change in TBTuberculosis Alert status. After the PPD is read/interpreted, the inmate shall be assigned one of the appropriate TBTuberculosis Alert Codes: 21 or 22.

    • Code 11 is used when:

      • Inmates with a Code 22 receive their annual PPD skin test.

      • When an inmate is given a PPD skin test as part of a case contact investigation.

      • Any time an inmate with an existing TBTuberculosis Alert Code is given a skin test or becomes unknown status.

    • As specified under Code __ (blank) above, mandatory use of Code 11 in newly arriving reception center inmates is no longer required.

      • TBTuberculosis Alert Transportation Instruction: Inmates with unknown TBTuberculosis status shall be transported/moved by special transportation using respiratory precautions.

  • Code 21

    • TBTuberculosis Screening Test Result Significant–Inmate Under Diagnosis.

    • A Code 21 is used when the clinician has determined that an inmate requires diagnostic TBTuberculosis testing. While this is generally done in response to a significant PPD skin test, any time a clinician considers an inmate “under diagnosis” for TBTuberculosis, the inmate should be coded as a Code 21.

    • A Code 21 is used when:

      • An inmate has a PPD skin test induration of 10 mm or more.

      • An inmate has a PPD skin test induration of 5 mm or more and risk factors specified in the CDC TBTuberculosis Guidelines exist.

      • An immunosuppressed inmate is determined skin test positive (without regard to the mm induration) based on anergy testing.

      • An inmate with a previously significant PPD (prior history of TBTuberculosis Disease or TBTuberculosis Infection) is undergoing annual or other periodic TBTuberculosis evaluation. Inmates with a prior history of TBTuberculosis Disease or TBTuberculosis Infection should be evaluated once a year. At the time the inmate is ducated for evaluation, the inmate’s TBTuberculosis Alert Code should be changed to Code 21. It should remain a Code 21 until the medical evaluation is completed and the inmate is determined free from the disease.

    • A Code 21 is used only until appropriate diagnostic procedures establish a subsequent TBTuberculosis Alert Code.

    • After diagnostic procedures, the inmate shall be assigned one of the appropriate TBTuberculosis Alert Codes: either 31, 32, or 33.

  • Movement from Code 21 to Code 31:

    • Inmates should be coded 31 any time a clinician suspects infectious TBTuberculosis Disease, based on either symptoms, sputum smears, x-rays, or any combination. The inmate should be changed from Code 21 to Code 31 as soon as the clinician suspects that the inmate could be infectious. For example, if a sputum smear for Acid Fast Bacilli (AFB) returns as positive and the inmate is considered a suspect for infectious TBTuberculosis Disease, they should be immediately coded as a Code 31. It is not appropriate for the inmate to remain a Code 21 while awaiting confirmatory results of the culture and sensitivity.

  • Movement from Code 21 to Code 32:

    • Inmates should be moved from a Code 21 to a Code 32 when:

      • Written documentation establishes that the positive skin test is the result of a prior exposure and the inmate does not require current prophylactic treatment.

      • A clinician determines that a new exposure will not receive prophylactic treatment due to medical contraindications.

  • Movement from Code 21 to Code 33:

    • Inmates should be moved from a Code 21 to a Code 33 after the initiation of TBTuberculosis Infection prophylactic medication or upon a signed refusal by the inmate to take prescribed medications. Inmates with a negative chest X-ray must remain a Code 21 until the medical evaluation is complete and the medication initiated or refused.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 21 shall be transported/moved by special transportation using respiratory precautions.

  • Code 22 PPD Test Result Non-significant.

    • Code 22 is used when the PPD skin test is not significant and no follow-up treatment is required. Inmates with a Code 22 require annual PPD skin testing or testing upon exposure.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 22 shall be transported/moved by regular CDC transportation.

  • Code 31 Infectious TBTuberculosis Disease Suspected.

    • Code 31 is used when an inmate is suspected of having infectious TBTuberculosis Disease. An inmate should be made a Code 31 as soon as the clinician suspects infectious TBTuberculosis Disease. The inmate shall remain a Code 31 until they have received appropriate treatment and are no longer considered infectious.

    • Inmates that are considered a Class V TBTuberculosis case would immediately be coded as a Code 31. The inmate would remain a Code 31 until the clinician determines they are no longer infectious. After the inmate has been placed on TBTuberculosis Disease treatment and is no longer considered infectious, the inmate should be coded as a Code 43. (Please note that the inmate is still a Class V TBTuberculosis case until culture confirms the diagnosis. In most cases, however, the inmate’s TBTuberculosis code would change to a Code 43 several weeks before obtaining the culture results.) The inmate should not remain a Code 31 until culture confirmation of the case. They should be coded as a Code 43 (TBTuberculosis Disease-On Medication) as soon as the inmate is no longer considered infectious.

    • Should an inmate initially considered infectious (and Coded 31) and later have TBTuberculosis Disease ruled out, the inmate would be coded to the appropriate TBTuberculosis Alert Code.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 31 shall be transported/moved by special transportation using respiratory precautions.

  • Code 32 PPD Test Result Significant From Prior Infection/Disease–Noninfectious.

    • Code 32 is used when:

      • An inmate has a significant PPD reaction from prior exposure to TBTuberculosis that has already been prophylactically treated.

      • An inmate has a significant PPD reaction from a prior case of TBTuberculosis Disease and the inmate has completed the required treatment.

      • An inmate has a diagnosis of TBTuberculosis Infection, but after medical evaluation, is not receiving prophylactic treatment due to medical contraindications.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 32 shall be transported/moved by regular CDC transportation.

  • Code 33 TBTuberculosis Infection–Noninfectious, On Medication.

    • Code 33 is used when:

      • An inmate has a diagnosis of TBTuberculosis Infection and is receiving prophylactic treatment.

      • TBTuberculosis medication has been prescribed but the inmate refused the medication.

      • TBTuberculosis medication has been prescribed but the inmate is only intermittently or partially compliant with the treatment regime.

      • HIVHuman Immunodeficiency Virus inmates receiving multiple medication as prophylactic treatment for TBTuberculosis Infection.

    • When an inmate completes the course of prophylactic treatment for TBTuberculosis Infection, the inmate’s TBTuberculosis Alert Code should be changed to Code 32.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 33 shall be transported/moved by regular CDC transportation. Medication shall be transported on the bus or Medical Care Services staff shall ensure the medication is available at the receiving facility.

  • Code 43 TBTuberculosis Disease, Not Infectious.

    • Code 43 is used for inmates currently under treatment for TBTuberculosis Disease when the inmate is no longer considered infectious. Inmates shall remain Code 43 through the entire treatment period for this episode of TBTuberculosis Disease. Upon completion of TBTuberculosis curative treatment, the inmates shall be coded Code 32.

    • Inmates receiving curative treatment for TBTuberculosis Disease should be coded Code 43 while the result of the culture is pending. If the culture result confirms TBTuberculosis Disease, the inmate will remain a Code 43 throughout the treatment period. If the culture rules out TBTuberculosis Disease, the inmate should, at that time, be coded Code 33 to reflect the inmate’s TBTuberculosis Infection status. If the inmate is diagnosed with atypical Mycobacterium infection, the code should be changed to either Code 32 if the PPD status is positive or Code 22 if the PPD status is negative.

    • Code 43 is used for:

      • Confirmed cases of TBTuberculosis Disease currently receiving curative treatment.

      • Suspected cases of TBTuberculosis Disease (awaiting culture confirmation) currently receiving curative treatment and not infectious.

      • Extrapulmonary TBTuberculosis Disease (confirmed Mycobacterium TBTuberculosis in other than a pulmonary site).

    • Upon completion of treatment for TBTuberculosis Disease, the inmate shall be coded as Code 32.

    • TBTuberculosis Alert Transportation Instruction: Inmates with a Code 33 shall be transported/moved by regular CDC transportation. Medication shall be transported on the bus or Medical Care Services staff shall ensure the medication is available at the receiving facility.

Every time an inmate’s TBTuberculosis Alert Code changes, Medical Care Services staff shall complete a CDC Form 128-C or CDC Form 128-C-1. This shall be done within 24 hours of reading the PPD skin test results and diagnosing the inmate’s TBTuberculosis status.

If the TBTuberculosis Alert Code is 31, the TBTuberculosis Alert Code shall be documented on the CDC From 128-C or CDC Form 128-C-1 by the end of the shift in which the diagnosis was made.

The TBTuberculosis Alert Code shall be identified on the CDC Form 128-C or CDC Form 128-C-1.

Medical Care Services staff shall input the inmate’s TBTuberculosis Alert Code into the DDPSDistributed Data Processing System file within 24 hours of reading the PPD skin test results, diagnosis, or any change in the TBTuberculosis Alert Code.

If the TBTuberculosis Alert Code is 31, the TBTuberculosis Alert Code shall be entered into the DDPSDistributed Data Processing System by the end of the shift in which the diagnosis was made.

Mainline Facilities:

• Medical Care Services staff in mainline facilities shall route the CDC Form 128-C documenting the TBTuberculosis Alert Code to Medical Records by the end of the shift in which the PPD skin test result was read, diagnosis made, or any change to the TBTuberculosis Alert Code.

• Medical Records in mainline facilities shall file the CDC Form 128-C in the inmate’s Medical Record within 24 hours of receipt (or by the end of the next business day if received on a weekend or holiday) from Medical Care Services staff.

• Medical Records in mainline facilities shall route the CDC Form 128-C to Case Records within 24 hours of receipt (or by the end of the next business day if received on a weekend or holiday) from Medical Care Services staff.

• Case Records in mainline facilities shall file the CDC Form 128-C in the inmate’s C-File as soon as possible. The CDC Form 128-C must be filed prior to transfer endorsement.

Reception Centers:

• Medical Care Services staff in reception centers shall route the CDC Form 128-C or CDC Form 128-C-1 documenting the TBTuberculosis Alert Code to Medical Records after reading the PPD skin test result, diagnosis, or any change in the TBTuberculosis Alert Code.

• Medical Records in reception centers shall file the CDC Form 128-C or CDC Form 128-C-1 in the inmate’s Medical Record within five days of reading the PPD skin test, diagnosis, or any change in the TBTuberculosis Alert Code.

• Medical Records in reception centers shall route the CDC Form 128-C or CDC Form 128-C-1 to Case Records before the transfer endorsement can be completed.

• Case Records in reception centers shall file the CDC Form 128-C or CDC Form 128-C-1 in the inmate’s C-File before the transfer endorsement can be completed.

General Requirements

• A CDC Form 7343 generated at each facility shall contain the TBTuberculosis Alert Transportation Instruction for every inmate listed.

• The facility’s Associate Information System Analyst (AISAAssociate Information Systems Analyst) routinely extracts (downloads) information from the DDPSDistributed Data Processing System and enables the ATS access to this information during the generation of the CDC Form 7343. ATS reads each inmate’s TBTuberculosis Alert Code from the extracted information, generates the appropriate TBTuberculosis Alert Transportation Instruction based on the TBTuberculosis Alert Code, and prints the TBTuberculosis Alert Transportation Instruction on the CDC Form 7343.

• Medical Care Services staff shall review the CDC Form 7343 to ensure the appropriate TBTuberculosis Alert Transportation Instructions have been identified and medications are prepared for transfer if appropriate.

CDC Form 7343 Medical Advance Transfer Notice Distribution Instructions

• The Inmate TBTuberculosis Alert Coordinator shall walk to Case Records and obtain a copy of the CDC Form 7343 as soon as it is printed and as subsequent changes occur.

CDC Form 7343 Review Instructions

• Medical Care Services staff shall review the CDC Form 7343. It is not necessary to compare the TBTuberculosis Alert Transportation Instruction with the DDPSDistributed Data Processing System TBTuberculosis Alert Code or documentation in the medical record. A visual check of the names and TBTuberculosis Alert Transportation Instructions printed on the CDC Form 7343 along with Medical Care Services staff’s knowledge of inmates who are in the infirmary, quarantine, etc., shall be sufficient. This review is intended to ensure all inmates have a Clear For Transportation status and to identify that any recent change in the TBTuberculosis Alert Code not yet entered in DDPSDistributed Data Processing System can be identified and arrange transportation arrangements, if necessary.

• Medical Care Services staff shall follow instructions for placing Special Transportation Requirements, as described in DOMDepartment Operations Manual 91080.11, for any inmate who is TBTuberculosis Alert Code 31, Infectious TBTuberculosis Disease.

• Medical Care Services staff shall be responsible for securing medications for inmates who are TBTuberculosis Alert Code 33, TBTuberculosis Infection, Noninfectious, On Medication; or TBTuberculosis Alert Code 43, Diagnosis of Noninfectious TBTuberculosis Disease, On Multiple Medication.

• Medical Care Services staff shall be responsible for ensuring transfer medications are at Receiving and Release (R&RReceiving and Release) at the time of inmate transfer. If medications are not transferred on the bus, Medical Care Services staff shall telephone Medical Care Services staff at the receiving facility that medications did not transfer with the inmate.

• If a TBTuberculosis Alert Code requires change, Medical Care Services staff shall contact Case Records before the end of the shift and document the name of the person contacted and the date of the contact next to the inmate’s name on the CDC Form 7343.

• Upon completion of review, Medical Care Services staff shall sign the CDCForm 7343 denoting approval and route the CDC Form 7343 to Case Records.

• If Medical Care Services staff does not have 24 hours to review the CDC Form 7343, changes and approvals shall immediately be communicated with the appropriate staff by telephone.

General Requirements

• Every inmate who has been diagnosed as Code 31, TBTuberculosis Disease, Infectious, shall be moved only by special transportation using respiratory precautions.

• Each facility shall identify Medical Care Services staff who may issue and remove telephone medical holds pending special transportation arrangements. The facility shall also identify Classification and Custody staff who may receive special transportation instructions. The names and telephone numbers of all staff identified in this process shall be documented and distributed.

• Medical Care Services staff shall place medical holds pending special transportation arrangements by the end of the shift in which the status was diagnosed. Once an inmate’s TBTuberculosis status has changed, a release of special transportation arrangements shall be placed by the end of the shift in which the status was diagnosed.

Placing A Medical Hold Pending Special Transportation Arrangements

• Every inmate who has been coded with a TBTuberculosis Alert Code 31, TBTuberculosis Disease, Infectious, shall have a medical hold pending special transportation arrangements. Medical Care Services staff shall place a telephone call to the C&PRClassification & Parole Representative, the CCCorrectional Counselor-III, or their designee during regular business hours (the Administrator on Duty [AODAdministrative Officer of the Day] or their designee during non-business hours) and:

  • Identify the inmate as currently infectious.

  • Require that the inmate be transferred using special transportation and using respiratory precautions until further notice.

• Document the TBTuberculosis Alert Code as described in the DOMDepartment Operations Manual 91080.8.

• Enter the TBTuberculosis Alert Code as described in DOMDepartment Operations Manual 91080.8.

• Route and file the documentation as described in DOMDepartment Operations Manual 91080.9 .

Removing A Medical Hold Pending Special Transportation Arrangements

• When an inmate is no longer Code 31, TBTuberculosis Disease, Infectious, the special transportation requirement shall be removed. Medical Care Services staff shall place a telephone call to the C&PRClassification & Parole Representative, the CCCorrectional Counselor-III, or their designee during regular business hours (the AODAdministrative Officer of the Day or their designee during non-business hours) and:

  • Identify the inmate as no longer infectious.

  • Remove the special transportation requirement.

  • Discuss any additional special transport requirements if appropriate.

• Document the TBTuberculosis Alert Code as described in DOMDepartment Operations Manual 91080.8.

• Enter the TBTuberculosis Alert Code as described in DOMDepartment Operations Manual 91080.8

• Route and file the documentation as described in DOMDepartment Operations Manual 91080.9.

The Inmate Alert System provides two reports, 1) Medical Alert List by Arrival Date and 2) Medical Alert List by Medical Code and two screens 1) Medical Information Screen HistoryDiagnosis and 2) Medical Information Screen HistoryMovement. The reports and screens are useful in monitoring an inmate’s TBTuberculosis status.

Medical Alert List By Arrival Date

• The user of the Inmate TBTuberculosis Alert System selects the desired inmate arrival date. The selected date may be either one single day or a sequence of many days.

• The Medical Alert List by Arrival Date Report provides the following data elements for every inmate in the facility by date of arrival:

  • Bed/Cell–Most current housing status.

  • CDC Number.

  • Inmate Name.

  • Birth Date.

  • Age.

  • Medical Code.

The Medical Alert List by Arrival Date Report may be generated daily and used for:

• Inmate Tracking–Immediate action shall be taken if the inmate’s TBTuberculosis Alert Code remains 11 after 72 hours.

• Case contact investigation information.

• Identification of inmates with TBTuberculosis Alert Code 22 who require annual PPD skin testing.

• Identification of inmates with TBTuberculosis Alert Code 31, 32, 33, or 43 who require yearly evaluations for symptoms of coughing, night sweats, fever, and weight loss.

• Assistance with identifying inmates who require Directly Observed Therapy.

• Assistance in Confidential Morbidity Report and Verified Case Report card generation.

Medical Alert List by Medical Code

• The Medical Alert List by Medical Code Report provides a list of every inmate grouped by TBTuberculosis Alert Codes. The report may be generated by selecting one or a combination of TBTuberculosis Alert Codes.

• This report, sorted by medical alert code and description of code, provides the following data elements for every inmate in the facility:

  • Bed/Cell–Most current housing status.

  • CDC Number.

  • Inmate Name.

  • Birth Date.

  • Age.

  • Arrival.

• The Medical Alert List by Medical Code Report may be generated daily and used for:

  • Follow-up of inmates with a TBTuberculosis Alert Code 11 that should have progressed into another code.

  • Data surveillance on a daily, weekly, monthly, and annual basis.

  • Expediting follow-up care on inmates with TBTuberculosis Alert Code 21, 31, or 32.

Screens

• The Medical Information Screen History–Diagnosis.

Medical Information Screen History Diagnosis

• The user will read information regarding the inmate’s TBTuberculosis history provided on the Medical Information Screen History–Diagnosis screen. Refer to the Medical Alert System User’s Manual for detailed instructions.

• This screen provides the following data elements for every inmate in the facility:

  • CDC Number.

  • Inmate Name.

  • Bed/Cell–Most current housing status.

  • Current TBTuberculosis Alert Code.

  • Previous medical diagnosis and date of entry.

• Uses of the Medical Information Screen History–Diagnosis screen include:

  • Current TBTuberculosis Alert Code and date entry.

  • Previous medical diagnosis history.

• Once this screen is displayed on the DDPSDistributed Data Processing System terminal, a screen print may be executed on the printer. Refer to the Medical Alert System User’s Manual for detailed instructions.

Medical Information Screen History Movement

• The user will read information regarding an inmate’s movement history provided on the Medical Information Screen HistoryMovement screen. Refer to the Medical Alert System User’s Manual for detailed instructions.

• This screen provides the following data elements for every inmate in the facility:

  • CDC Number.

  • Inmate’s Name.

  • Bed/Cell–Most current housing status.

  • Current TBTuberculosis Alert Code.

  • Transaction Message.

  • Facility.

  • Cell.

  • Location.

  • Date.

  • Previous CDC Number.

• Uses of the Medical Information Screen HistoryMovement include:

  • Assistance with case contact investigations.

• Once this screen is displayed on the DDPSDistributed Data Processing System terminal, a screen print may be executed on the printer. Refer to the Medical Alert System User’s Manual for detailed instructions.

General Requirements

• Medical Care Services staff shall conduct a weekly review of inmates with a TBTuberculosis Alert Code of___ (blank), 11, 21, or 31. This review shall provide Medical Care Services staff with the ability to ensure that coding and medical follow-up is properly maintained.

• Each facility shall identify the Medical Care Services staff who will generate, review, and follow-up on those inmates who are identified with TBTuberculosis Alert Codes 11, 21, or 31.

Weekly Code Review Instructions

• Medical Care Services staff shall generate the Medical Alert List by Arrival Date Report on the DDPSDistributed Data Processing System each Monday morning using the arrival date for the Monday of the previous week and selecting TBTuberculosis Alert Codes of 11, 21, and 31. Refer to Medical Alert System User’s Manual for details.

• Medical Care Services staff shall review medical records for each inmate who reports a TBTuberculosis Alert Code of 11, 21, or 31.

• If the TBTuberculosis Alert Code is 11, the Mantoux PPD skin test shall be read and interpreted or re-administered as appropriate.

• If the TBTuberculosis Alert Code is 21, the reviewing Medical Care Services staff shall determine if the diagnosis has been confirmed.

• If the TBTuberculosis Alert Code is 31, the reviewing Medical Care Services staff shall determine if the diagnosis can be updated.

• If the TBTuberculosis Alert Code is updated to Code 31, Medical Care Services staff shall issue a medical hold pending special transportation arrangements as defined in DOMDepartment Operations Manual 91080.11.

• Any TBTuberculosis Alert Code changes shall be documented and entered in the DDPSDistributed Data Processing System as described in DOMDepartment Operations Manual 91080.8.

• Route and file the documentation as described in DOMDepartment Operations Manual 91080.9.

General Requirements

• Each facility shall generate the Medical Alert List By Medical Code Report at the month’s end and use the data to complete the Interim Tuberculosis Case Report. This report shall be submitted to the Infectious Disease Control Unit in headquarters.

Monthly Report Instructions

• On the morning of the first day of each month, Medical Care Services staff shall generate the Medical Alert List by Medical Code Report. Refer to the Medical Alert System User’s Manual for details for report generation.

• Medical Care Services staff shall complete the Interim Tuberculosis Case Report using the information contained in the Medical Alert List by Medical Code Report.

• Medical Care Services staff shall submit the Interim Tuberculosis Case Report to the Infectious Disease Control Unit in headquarters by the close of business on the 5th of the month.

General Instructions

• As soon as a diagnosis of Infectious TBTuberculosis Disease is reasonably established on laboratory, clinical and/or radiographic basis, investigation of contracts shall begin. The TBTuberculosis Alert System can assist facilities to manage case contact investigations.

  • The Medical Alert List by Arrival Dates Report from the Inmate TBTuberculosis Alert System can assist in verifying all inmates (close contact) who were in the facility during the “period of infectivity.”

  • The Medical Alert List by Medical Codes Report from the Inmate TBTuberculosis Alert System can assist in identifying the TBTuberculosis status of all identified close contacts.

• All inmates who have been identified as a close contact to the source inmate should immediately be coded TBTuberculosis Alert Code 11 with the appropriate documentation on the CDC Form 128-C or 128-C-1.

• Documentation, coding, routing, and filing for this and subsequent TBTuberculosis Alert Code changes follows the procedures specified in DOMDepartment Operations Manual 91080.8 and 91080.9.

General Requirements

• An inmate’s transfer endorsement shall be deferred if the TBTuberculosis Alert Code is not documented on a CDC Form 128-C or CDC Form 128-C-1, Medical/Psychiatric/Dental Chorine, and filed in their C-File at the time of endorsement. The CSRClassification Staff Representative or CCCorrectional Counselor-III (for DPUDetention Processing Units cases) shall be responsible for deferring endorsement of any case with incomplete TBTuberculosis status information. The inmate’s C-File shall have a documented TBTuberculosis Alert Code of 21, 22, 31, 32, 33, or 43. The C&PRClassification & Parole Representative or CCCorrectional Counselor-III shall notify Medical Care Services staff of any missing documentation.

• Medical Care Services staff is responsible for reviewing the inmate’s Medical File, completing or providing the appropriate copy of the CDC Form 128-C or CDC Form 128-C-1 and forwarding it to Case Records within 24 hours from the date of notice by the C&PRClassification & Parole Representative or CCCorrectional Counselor-III. Case Records shall file the CDC Form 128-C or CDC Form 128C1 in the inmate’s C-File within 24 hours.

Classification Referral Instructions

• As is current practice, the C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee shall audit all files prepared for CSRClassification Staff Representative review and endorsement to ensure proper casework. No case shall be presented for CSRClassification Staff Representative action without a valid TBTuberculosis Alert Code of 21, 22, 31, 32, 33, or 43 documented on a CDC Form 128-C or CDC Form 128-C-1 in the inmate’s C-File.

• The C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee shall notify the Inmate TBTuberculosis Alert System Coordinator in Medical Care Services of the missing CDC Form 128-C or CDC Form 128-C-1 within 24 hours of review. The Inmate TBTuberculosis Alert System Coordinator shall provide the CDC Form 128C or CDC Form 128-C-1 within 24 hours of notification.

• Should a case inadvertently be presented to a CSRClassification Staff Representative for transfer endorsement and lack a valid TBTuberculosis Alert Code of 21, 22, 31, 32, 33, or 43 documented on a CDC Form 128-C or CDC Form 128-C-1, the case shall be deferred. The CSRClassification Staff Representative shall notify the C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee of the missing information that same day. The C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee shall follow step two above.

Special Transportation Instructions

• If an inmate with a TBTuberculosis Alert Code of 11, 21, or 31 requires movement, special transportation arrangements are required. A CDC Form 128-C or CDC Form 128-C-1 shall document a doctor-to-doctor agreement for appropriate housing, type of transportation, and any medical concerns and restrictions per DOMDepartment Operations Manual 62080.16. Following transfer endorsement by a CSRClassification Staff Representative, transportation arrangements shall be coordinated by the C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee.

• The C&PRClassification & Parole Representative or CCCorrectional Counselor-III shall refer to DOMDepartment Operations Manual 91080.19 for specific guidelines.

• If an emergency transfer of an inmate is required for other than medical reasons and the TBTuberculosis Alert Code does not authorize a normal move, the C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee shall contact Medical Care Services staff during regular business hours (the Medical Officer on Duty [MODMedical Officer of the Day] during non-business hours) and receive verbal TBTuberculosis Alert Code verification for inclusion on the CDC Form 135, Warden’s Check-out Order. If the transfer takes place after regular working hours, arrangements shall be made through the Watch Commander, AODAdministrative Officer of the Day, MODMedical Officer of the Day, and Supervising RNRegistered Nurse (SRNSupervising Registered Nurse) if applicable. Transportation precautions shall be taken accordingly. Within 24 hours of verbal verification, Medical Care Services staff shall provide appropriate documentation on a CDC Form 128-C or CDC Form 128C1 to Case Records for inclusion in the inmate’s C-File and update the TBTuberculosis Alert Code in DDPSDistributed Data Processing System if required. They will also contact the receiving facility’s Medical Care Services staff with any relevant medical information pertaining to the transferred inmate.

A CDC Form 7343 generated at each facility shall contain the TBTuberculosis Alert Transportation Instruction for every inmate listed.

The facility’s AISAAssociate Information Systems Analyst routinely extracts (downloads) information from DDPSDistributed Data Processing System and enables the ATS access to this information during the generation of the CDC Form 7343. The ATS reads each inmate’s TBTuberculosis Alert Code from the extracted information, generates the appropriate TBTuberculosis Alert Transportation Instruction based on the TBTuberculosis Alert Code, and prints the TBTuberculosis Alert Transportation Instruction on the CDC Form 7343.

Medical Care Services staff shall review the CDC Form 7343 to ensure the appropriate TBTuberculosis Alert Transportation Instructions have been identified and medications are prepared for transfer if appropriate.

A description of the TBTuberculosis Alert Transportation Instructions can be found in DOMDepartment Operations Manual 91080.19.

• CDC Form 7343 Using ATS

  • AISAAssociate Information Systems Analyst shall download DDPSDistributed Data Processing System to ATS before the CDC Form 7343 is generated.

  • Follow the normal process to generate the CDC Form 7343.

• CDC Form 7343 Distribution Instructions

  • The Inmate TBTuberculosis Alert System Coordinator shall walk to Case Records and obtain a copy of the CDC Form 7343 as soon as it is printed and as subsequent changes occur.

• CDC Form 7343 Review Instructions

  • Medical Care Services staff shall immediately notify Case Records of any TBTuberculosis Alert Transportation Instruction changes by telephone.

  • Upon completion of review, Medical Care Services staff shall sign the CDC Form 7343 denoting approval and route the CDC Form 7343 to Case Records.

  • If Medical Care Services staff do not have 24 hours to review the CDC Form 7343, changes and approvals shall immediately be communicated with the appropriate staff by telephone.

Medical Care Services staff shall notify Case Records if an inmate’s TBTuberculosis Alert Code has changed.

Inmates remaining on the CDC Form 7343 with a TBTuberculosis Alert Codeof 11, 21, or 31 shall not be moved on regular CDC transportation. The inmate’s name shall be deleted from the CDC Form 7343 by telephone request. See DOMDepartment Operations Manual 91080.4 for additional information.

If it is necessary to move the inmate, a CDC Form 128-C or CDC Form 128C1, documenting the special transportation instructions, shall be requested from Medical Care Services staff.

The TBTuberculosis Alert Transportation Instructions shall be found on the CDC Form 135. A description of each TBTuberculosis Alert Transportation Instructions is as follows:

• TBTuberculosis Alert Transportation Instruction: Med Alert Sp Trans 11.

  • Meaning: TBTuberculosis status unknown.

  • Action: Inmates with Code 11 have an unknown TBTuberculosis status, either because their screening test has not yet been performed or has not been read and interpreted. These inmates pose a high risk of transporting TBTuberculosis Infection and cannot be put on regular CDC transportation, including buses and transportation used to move inmates from CDC facilities to CCFs. These inmates shall be transferred by special transportation using respiratory precautions.

• TBTuberculosis Alert Transportation Instruction: Med Alert Sp Trans 21.

  • Meaning: The inmate’s PPD was significant and the inmate is being diagnosed for suspected TBTuberculosis Disease.

  • Action: Inmates with Code 21 had a significant PPD and remain under diagnosis. These inmates pose a high risk of transporting TBTuberculosis Infection and cannot be put on regular CDC transportation, including buses and transportation used to move inmates from CDC facilities to CCFs. These inmates shall be transferred by special transportation using respiratory precautions.

• TBTuberculosis Alert Transportation Instruction: Clear For Transportation 22.

  • Meaning: The inmate’s PPD was non-significant and the inmate is cleared for transportation.

  • Action: Inmates with Code 22 had a non-significant PPD and are not infectious. These inmates shall be transferred by regular CDC transportation.

• TBTuberculosis Alert Transportation Instruction: Med Alert Sp Trans 31.

  • Meaning: The inmate has been diagnosed with infectious TBTuberculosis Disease. Transfer should be done only under the approval and direction of Medical Care Services.

  • Action: Inmates with Code 31 have TBTuberculosis Disease and are currently infectious. These inmates pose a high risk of transmitting TBTuberculosis Infection and cannot be put on regular CDC transportation, including buses and transportation used to move inmates from CDC facilities to CCFs. These inmates shall be transferred by special transportation using respiratory precautions.

• TBTuberculosis Alert Transportation Instruction: Clear For Transportation 32.

  • Meaning: The inmate’s PPD was significant due to prior infection. The inmate is cleared for transport.

  • Action: Inmates with Code 32 had a significant PPD from prior TBTuberculosis Infection and are not currently infectious. These inmates shall be transferred by regular CDC transportation.

• TBTuberculosis Alert Transportation Instruction: INH Medication 33.

  • Meaning: The inmate has TBTuberculosis Infection but is not infectious. The inmate is on INH medication.

  • Action: Inmates with Code 33 have TBTuberculosis Infection but are not infectious. Medications shall be transferred with the inmate or Medical Care Services staff shall arrange for medications with the receiving facility. These inmates shall be transferred by regular CDC transportation.

• TBTuberculosis Alert Transportation Instruction: Multiple TBTuberculosis Medication 43.

  • Meaning: The inmate has TBTuberculosis Disease but is not infectious. The inmate is on medication.

  • Action: Inmates with Code 43 have TBTuberculosis Disease but are not infectious. Medications shall be transferred with the inmate. These inmates shall be transferred by regular CDC transportation.

The CDC Transportation Sergeant shall be required to review the TBTuberculosis Alert Transportation Instructions of each inmate before boarding the bus. Inmates with TBTuberculosis Alert Codes of 11, 21, or 31 shall not be put on regular CDC transportation, which includes movement from CDC facilities to CCFs. These inmates shall be transferred by special transportation using respiratory precautions.

If an inmate arrives at the receiving facility with a TBTuberculosis Alert Code 11, 21, or 31, R&RReceiving and Release staff shall immediately notify Medical Care Services staff. The inmate shall be placed in a separate cell until Medical Care Services staff move the inmate to the facility’s infirmary.

If an emergency transfer of an inmate is required for other than medical reasons and the TBTuberculosis Alert Code does not authorize a normal move, the C&PRClassification & Parole Representative, CCCorrectional Counselor-III, or their designee shall contact Medical Care Services staff during regular business hours and receive verbal TBTuberculosis Alert Code verification for inclusion on the CDC Form 135 or Warden’s Check-out Order. If the transfer takes place after regular working hours, arrangements shall be made through the Watch Commander, AODAdministrative Officer of the Day, MODMedical Officer of the Day, and SRNSupervising Registered Nurse if applicable. Transportation precautions shall be taken accordingly. Within 24 hours of verbal verification, Medical Care Services staff shall provide appropriate documentation on a CDC Form 128-C or CDC Form 128-C-1 to Case Records for inclusion in the inmate’s C-File and update the TBTuberculosis Alert Code in DDPSDistributed Data Processing System if required. They will also contact the receiving facility’s Medical Care Services staff with any relevant medical information pertaining to the transferred inmate.

The Deputy Director, HCSDHealth Care Services Division (see DCHCS), or designee shall be responsible for ensuring that the contents of this article are kept current and accurate.

PCPenal Code §§ 3053, 5054, 5058, 6006, 6007, and 6008.

Medical Alert System User’s Manual.

W&I § 1768.10

The Department may administer involuntary psychiatric medication to an inmate only if the procedures in Penal Code (PCPenal Code) Section 2602 are followed.

The purpose of this article is to set forth CDCRCalifornia Department of Corrections and Rehabilitation’s operational procedures and expectations of its employees concerning all aspects of involuntary psychiatric medication, including proper pre-court and post-court documentation, criteria for initiation, criteria for renewal, scheduling, initiation, renewal, non-renewal, interface with the inmate’s attorney, interface with the Office of Legal Affairs (OLAOffice of Legal Affairs), interface with the Office of Administrative Hearings (OAH), inmate post-hearing remedies, and proper use of electronic charting resources to document assessments, both what is observed and court results.

Involuntary psychiatric medication should not be used in a psychiatric context:

• To control behavior that is not related to a diagnosable psychiatric disorder.

• When an inmate is capable of giving informed consent and objects to such medication, unless the inmate is a danger to self or others.

• Unless called for in a medical emergency as defined in CCRCalifornia Code of Regulations, Title 15, Section 3351, (a).

• In doses other than that for which the drug is approved by the Food and Drug Administration (FDA) or by community standards of professional practice or by nationally recognized guidelines or by legitimate scientific and medical opinion.

• In doses that diverge widely from appropriate dose recommendations, as defined by CCHCS care guidelines, nationally recognized guidelines, legitimate scientific and medical opinion, and by parameters provided by the FDA.  Formulary decisions should conform to the CCHCS statewide formulary.

When filing a non-emergency initial petition, clinical staff may not administer involuntary medication beyond the initial 72-hour emergency period.

When filing an emergency initial petition, clinical staff should administer no medications involuntarily that have substantial, clinically relevant actions due to the fact that they stay in the bloodstream longer than 10 calendar days, including the initial 72-hour emergency period. The medication or medications that cause the least restrictive effects yet accomplishes their purpose should be chosen. After the conclusion of the administrative hearing, if the court order is granted, clinical staff may administer long-acting medication.

A physician, psychiatrist, licensed vocational nurse, registered nurse, licensed psychiatric technician, or psychiatric nurse practitioner should be physically present to observe the emergency administration of involuntary medication. That person should create a note in a health record, which should include:

• Personnel administering medication.

• Observation.

• Physical room or setting in institution where medication was administered.

• Resistance.

• Reason for medication.

• Time.

• Date.

• Form of medication (tablet, liquid, injection) and dosage.

• Injury.

• Force.

• Reaction.

If the inmate is not already in an inpatient setting, the inmate should be observed twice per day by a health care staff to monitor for side effects until the inmate is deemed at low risk for side effects by a psychiatric physician, medical physician, or nurse practitioner. Observations will be noted in appropriate health records.

Anytime force is observed or used by health care staff, the procedures and documentation requirements referenced in DOMDepartment Operations Manual Chapter 5, Article 2, Section 51020.17.6 must be followed.

Danger to Self

• Clinical and custody staff has an obligation to observe inmates and to note, document, and promptly report to their superiors, behavior that could be classified as a danger to self. Danger to self means the inmate has made a credible threat or has attempted to engage in an act of self-harm and the threat is ongoing; or has threatened, attempted, or inflicted serious physical injury to self, and, as a result of a serious mental disorder, the dangerous behavior is expected to likely reoccur given the limits of what can reasonably be predicted. Demonstrated danger to self may be based on an assessment of the inmate’s present mental condition, including consideration of the inmate’s historical course of serious mental disorder to determine if the inmate currently presents an elevated chronic risk or an imminent risk to his or her own safety. If these signs or symptoms of dangerousness to self are observed by any employee at any time, an immediate mental health referral should be made and the patient should be observed until a clinician makes an assessment. If a licensed clinician evaluates the inmate and believes there is an emergency, elevated chronic risk, or an imminent risk, psychiatry personnel should be contacted, psychiatric medication should be considered, and if it is thought that medication will help but the patient refuses these medications and is expected to continue to refuse medications, a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363, Involuntary Medication Notice, or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368, Renewal of Involuntary Medication Notice, should be started with inputs from any staff member familiar with, or observing, the inmate’s behaviors. Referral to the crisis bed should be considered.

Danger to Others

• Clinical and custody staff has an obligation to observe inmates and to note, document, and promptly report to their superiors, behavior that could be classified as a danger to others. Danger to others means the inmate has inflicted, attempted to inflict, or made a credible threat of inflicting physical harm upon the person of another, and as a result of a serious mental disorder, the inmate presents a demonstrated danger of inflicting physical harm upon others. Demonstrated danger may be based on an assessment of the inmate’s present mental condition, including consideration of the inmate’s historical course of serious mental disorder, to determine if the inmate currently presents an elevated chronic risk or an imminent risk of harming another person. If these signs or symptoms are observed by any employee at any time, an immediate mental health referral should be made. If a licensed clinician evaluates the inmate and believes there is an emergency, elevated chronic risk, or an imminent risk, psychiatry personnel should be contacted, psychiatric medication should be considered, and if it is thought that medication will help but the patient refuses these medications and is expected to continue to refuse medications, a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 should be started with inputs from any staff member familiar with, or observing, the inmate’s behaviors.

Grave Disability

• Clinical and custody staff has an obligation to observe inmates and to note, document, and promptly report to their superiors, behavior that could be classified as gravely disabled. Photographs of trash in the cell, organic material on walls or windows, flooding of the cell, or unflushed toilets should be taken, if there is suspicion of grave disability. If a psychiatrist, medical physician, psychologist and/or social worker suspects that a patient is gravely disabled he or she must order relevant recording of information which may include: logs of missed showers, records of weights and weight loss, documentation of catatonic behavior, documentation of the patient being taken advantage of by others, and/or other recording of relevant behavior or speech that corroborates grave disability. If the inmate is being victimized, or subject to being victimized, due to diminished cognitive capacity or due to mental health issues that diminish appropriate responses, being Developmentally Disabled (DD) or due to other diminished mental capacity, the circumstances demonstrating the lack of capacity and the ensuing dangerous victimization should be documented and steps should be taken to prevent victimization. Gravely Disabled means there is a substantial probability, due to a serious mental disorder and incapacity to accept or refuse psychiatric medication, that serious harm to the physical or mental health of the inmate will result. Serious harm means significant psychiatric deterioration, debilitation, or serious illness as a consequence of his or her inability to function in a correctional setting without the supervision or assistance of others, inability to satisfy his or her need for nourishment, and/or inability to attend to needed personal or medical care, seek shelter, and/or attend to self-protection or personal safety. The probability of harm to the physical or mental health of the inmate requires evidence that the inmate is presently suffering adverse effects to his or her physical or mental health, or evidence that the inmate has previously suffered these effects in the historical course of his or her mental disorder and that his or her psychiatric condition is again deteriorating. The fact that an inmate has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the inmate. If these signs or symptoms are observed by any employee at any time, an immediate mental health referral should be made. If a licensed clinician evaluates the inmate and believes there is an emergency, elevated chronic risk, or an imminent risk, psychiatry personnel should be contacted, psychiatric medication should be considered, and if it is thought that medication will help but the patient refuses these medications and is expected to continue to refuse medications, a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 should be started with inputs from any staff member familiar with, or observing, the inmate’s behaviors. Consideration should be given to referring the patient to a crisis bed.

Elevated Chronic Risk

• Elevated chronic risk means the serious and persistent presentation of clinical factors that suggests an inability to adequately navigate within society or inability to effectively navigate within a structured environment such that, based on historical course of mental disorder, there is a reasonably foreseeable elevated risk of self-harm, violence, or grave disability.

Imminent Risk

• Imminent risk means the presence of clinical and situational factors that suggest a significant risk of violence toward others, self, or grave disability and requires immediate intervention.

Determination of Capacity or Lack of Capacity

• Clinicians must make a good faith attempt to engage the inmate to determine the inmate’s capacity to voluntarily consent to medication, which requires capacity, other than in an emergency situation. Capacity should be evaluated by reviewing the inmate’s (a) ability to communicate a choice; (b) ability to understand relevant information; (c) ability to appreciate the nature of the situation and its likely consequences; and (d) ability to use the information rationally.

Reporting Serious Mental Illness

• Clinical and custody staff has an ethical obligation to observe inmates in all treatment and custody settings and to note, document, and promptly report to their superiors, behavior that aligns with the description of a serious mental disorder, danger to self, danger to others, or grave disability, as defined above.

• A serious mental disorder means an illness or disease or condition that substantially impairs the person’s thought, perception of reality, emotional process, or judgment; or which grossly impairs behavior; or that demonstrates evidence of an acute brain syndrome for which prompt remission, in the absence of treatment, is unlikely. Qualifying behaviors include, but are not limited to, clinical and custody staff observation of delusional behavior, catatonia, responding to internal stimuli, auditory or visual hallucinations, and paranoia.

• When an inmate exhibits the above symptoms, an immediate mental health referral should be made. If a medical emergency, elevated chronic risk, or imminent risk exists, psychiatric medication should be considered if there are no less restrictive alternatives, and if it is thought that medication will help but the patient refuses these medications and is expected to continue to refuse medications a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 should be started with inputs from anyone familiar with the inmate’s behaviors.

Consent and Refusal

• Involuntary psychiatric medication should not be given to an inmate who has the capacity to consent to medication. Clinical staff should document the offer of medication and an inmate’s refusal to consent to medication before proceeding to the involuntary medication process under PCPenal Code 2602, except in the case of a medical and/or psychiatric emergency.

Initiation of involuntary medication is accomplished by completing a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 (initial petition) and CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7366, Inmate Rights Notice – Involuntary Medication, and serving the inmate, the inmate’s attorney, the OLAOffice of Legal Affairs, and the OAH via electronic transmission.

The OLAOffice of Legal Affairs will maintain a master calendar of the available inmate calendar for PCPenal Code 2602 hearings and the attorney rotation for the various high-volume institutions. Institutions that have only an occasional need for hearings should coordinate with the OLAOffice of Legal Affairs first to arrange for attorney coverage to avoid calendar conflicts.

If an institution is re-filing on a specific inmate who was the subject of a court proceeding in the immediately preceding 60 calendar days (court denial, withdrawal, request for dismissal), either the doctor filling out the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or the OLAOffice of Legal Affairs shall disclose this in one of the pleadings so that all parties are aware of the history of the case.

If the institution submits an emergency initial petition asking for authority to administer involuntary medication pending the administrative hearing, the Medication Court Administrator (MCA) must scan the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 and Ex Parte Request (included in CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363) into the health records the same day it is filed so that physicians and pharmacists are aware of the pending request.

The MCA must then follow-up within ten calendar days and scan in the resulting order from the OAH either granting, or denying, interim medication authority, so that physicians and pharmacists will know the status of the case.

The OLAOffice of Legal Affairs will prepare a Supplemental Initial Petition for each case submitted by an institution, and may add or drop cases based upon legal review of the health records. This document should be served on the OAH and upon the inmate’s attorney no later than three business days prior to the scheduled hearing, but optimally ten business days before the hearing.

Every case currently pending or filed in the future should terminate with either (1) a court order signed by an Administrative Law Judge (ALJ), (2) a Withdrawal Notice prepared by the OLAOffice of Legal Affairs, (3) a Request for Dismissal prepared by the OLAOffice of Legal Affairs, or (4) a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370, Notice of Non-Renewal of Involuntary Psychiatric Medication form completed at the institution and submitted to the OLAOffice of Legal Affairs documenting the reasons the case was not renewed.

Institutions who know an inmate is paroling or moving to Mentally Disordered Offender (MDOMentally Disordered Offender) status should complete the necessary forms documenting why a case is not being renewed before the inmate departs.

No later than 90 calendar days before an order authorizing the administration of involuntary medication is due to expire, the clinical staff of the facility where the inmate is currently housed should assign the matter to a psychiatrist to interview the inmate and determine if the filing of a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 is warranted. Renewal is appropriate if the inmate, even after administration of psychiatric medication, has documented insufficient insight regarding his/her mental illness, refuses to accept that he or she has a mental illness, states that he or she knows that a court order is required to ensure medication compliance, or if it is clear from documented behaviors or statements over the past twelve months that the inmate, but for the medication, would become a danger to self or others, or gravely disabled and lacking capacity to accept or refuse psychiatric medication.

If a determination is made to renew involuntary medication, a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 and CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7366 should be prepared and served on the inmate, the attorney for the inmate, the OAH, and the OLAOffice of Legal Affairs no later than 30 calendar days before the current order expires.

If an individual psychiatrist does not want to renew the involuntary medication order, the institution should convene an Interdisciplinary Treatment Team (IDTT) and pursue the process described in DOMDepartment Operations Manual Section 91090.9, below.

The OLAOffice of Legal Affairs will prepare a Supplemental Renewal Petition for each case submitted by an institution, and may add or drop cases based upon legal review of the health records. This document should be served on the OAH and upon the inmate’s attorney no later than three business days prior to the scheduled hearing, but optimally ten business days before the hearing.

Every case currently pending needs to either to be renewed or not-renewed. Legitimate reasons not to renew a case include, but are not limited to, that the inmate has gained insight that he or she has a mental illness and is willing to reliably take medication, or that the inmate is transferring to another program that will take over the court order, such as an MDOMentally Disordered Offender program.

The starting point for a non-renewal is the treating psychiatrist, if available, who must fill out a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370 documenting the reasons that non-renewal is being considered. The treating psychiatrist can recommend the non-renewal take effect immediately or upon the natural expiration of the existing court order. If the inmate transfers to a new institution prior to the effective date of the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370, the receiving institution may independently review the case factors and may elect to rescind it based on the inmate’s psychiatric case factors and presentation.

If an individual psychiatrist does not believe that renewal of an involuntary medication order is beneficial to the overall health of the patient, he or she should consult with treatment team members.

If there is disagreement amongst treatment team members, additional consultation from mental health statewide leadership can be sought, but ultimately the final decision about renewal or non-renewal lies with the evaluating psychiatrist.

The non-renewal shall be recorded in the electronic health record. This is accomplished using one of two methods A CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370 is considered local to the institution that adopted it. That institution can make the non-renewal effective immediately, in which case the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370 must be scanned into the health records and central file within 24 hours. Alternately, an institution can make the non-renewal effective at the natural end date of the PCPenal Code 2602 court date. In such cases, the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370 shall be filed as of the effective date of the expiration.

If an institution’s IDTT approves a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7370, and deems it active and ready to be scanned into the health records and central file, a copy should immediately be sent to the OLAOffice of Legal Affairs. This form is not to be sent to the OAH.

Attendance and Timing

• Every inmate scheduled for a hearing will be contacted by a sworn correctional officer or sworn MCA on the day of the hearing to determine if the inmate wishes to attend the hearing, refuses to attend, or to meet with their attorney. The inmate’s capacity to engage in the conversation should be documented by the custody officer going to the cell on the OLAOffice of Legal Affairs PCPenal Code 2602 Refusal form or an institution equivalent refusal form. An inmate’s request to meet with his/her attorney on the day of the hearing will be honored by facilitating an attorney client meeting. An attorney’s request to force or impose a visit upon an inmate who has already waived the right to a hearing on the day set for the hearing will be evaluated by the ALJ, who will take into account the data pertaining to the inmate’s waiver or refusal, as well as institutional security and operation. If the need arises and the ALJ agrees, the hearing may be conducted at cell side.

• If an inmate lacks capacity to attend, the hearing should be conducted cell side or continued due to the inmate’s medical inability to participate, and the reasons for the continuance should be documented on the record by a doctor or psychiatrist familiar with the inmate’s condition.

• The attorney for the inmate should meet with the clients in advance of the date set for the hearing so that hearings start at the scheduled time.

• Institutions must permit attorneys to meet with clients in advance of the PCPenal Code 2602 hearing. This is a due process requirement for the inmate and must be accommodated separate and apart from any legal visiting program. Attorney-client meetings should be handled according to local institution operating protocol, generally in a legal visiting room and not at cell side. If an inmate refuses to meet with the attorney, it will be documented and can be reviewed by the ALJ on the day of the hearing. If an inmate appears to be unable to communicate or attend to activities of daily living on the day of the attorney’s visit, or on the day of the hearing, the attorney should be informed.

Recording

• The attorney from the OLAOffice of Legal Affairs should bring the necessary equipment into the institution and record each proceeding. Those recordings should be maintained in digital archives by CDCRCalifornia Department of Corrections and Rehabilitation for a minimum period of five years, provided to the OAH annually, or individually upon request.

Copies of Filings

• Legal filings with the OAH are deemed public documents and are not filed under seal.

Transcripts

• Paper transcripts of administrative hearings are not prepared. Inmates may purchase paper transcripts from the OAH with funds from their inmate trust account or request alternative accommodation upon proof of indigence. Other parties may obtain copies of transcripts under the policies and pricing structure the OAH prescribes upon request.

Facilities

• Each institution should provide a room, or rooms, on the day of the hearing that can accommodate an administrative hearing with seven to ten persons, including correctional officer escorts, with adequate room to maneuver and adequate space to provide security for the judge and attorneys.

Custody Escorts

• Each institution should provide at least two correctional officers to bring inmates to and from the hearing room, or to and from the holding cells outside the hearing room. At least one correctional officer should stay in the room with the inmate during the hearing.

Telepsychiatry Declarants and Testimony

• If an inmate’s psychiatric care has been primarily assigned to a telepsychiatrist for delivery of care, and specifically if a telepsychiatrist is the declarant on a CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368, then the Department should coordinate any hearing for the inmate so that said telepsychiatrist is available to present the involuntary medication case. This presentation occurs via remote video or telephone connection into the hearing room on the day set for the hearing. The telepsychiatrist shall be available and prepared for cross-examination. The institution shall make every attempt to schedule on a day when the presenting witness is available. If the assigned telepsychiatrist is not able to appear, the ALJ has the discretion to grant up to one continuance not to exceed 14 calendar days to allow a new clinician at the inmate’s institution to review the inmate’s central file, health records, meet with the inmate, and prepare to present the case.

Notification of Next-of-Kin

• The inmate’s next-of-kin will not be notified of the hearing unless the inmate requests to have the specified individuals audit the hearing. The inmate will submit the request in writing and complete a waiver of confidentiality. The inmate will be responsible for supplying an address where the next-of-kin in the first-degree or second-degree can be contacted. The MCA will send a notice to the identified next-of-kin stating the type of hearing, date and time of hearing. Any questions regarding the upcoming hearing will be referred to the inmate’s appointed attorney.

• Requests by an inmate to have next-of-kin attend the hearing will be contingent upon those individuals completing a gate clearance packet and the subsequent approval of the gate clearance by the Chief Deputy Warden’s office. Only the identified next-of-kin in the first or second-degree will be considered for approval. These individuals will be escorted directly to the hearing room by the MCA (or designee) when their relative’s case is ready to begin. The next-of-kin will not be allowed to speak during the hearing unless directed by the ALJ to give sworn testimony. The inmate and next-of-kin will not be allowed to exchange any property. If these conditions are breached, the next-of-kin will be removed from the hearing by a custody escort. Upon completion of the hearing, the next-of-kin will be escorted out of the institution.

Appointment of Attorney

• For every scheduled hearing, the MCA should assign an inmate attorney from the rotation calendar available from the OLAOffice of Legal Affairs and the OAH, unless one of the following situations occurs:

• If the inmate desires to retain an attorney or has retained an outside attorney, the MCA will verify that the outside attorney is in fact taking the case, and then serve the paperwork accordingly on the outside attorney.

• If the inmate desires to appear in propria persona (as their own representation), the MCA should assign an inmate attorney from the rotation calendar available from the OLAOffice of Legal Affairs and the OAH, and the matter of the inmate’s capacity to engage in self-representation will be brought up at the first hearing with the ALJ.

Pre-Hearing

• Institutions should provide supporting documentation to independently verify what is alleged in either the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368. The CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 and CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 are not evidence, and must be independently supported by health records, chronos, photographs, or other documentary evidence of the criteria alleged.

• Such supporting documentation should be securely uploaded as a PDF to a secure Sharepoint or other secure site within three business days of the filing of either an initial or renewal petition, unless there is a justifiable business reason for not doing so. If the discovery cannot be provided to headquarters staff and to the inmate attorney within three business days of the filing of the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 or CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368, the institution should make a workstation available to the inmate’s attorney to review the discovery on site, unless other arrangements are made with the inmate attorney for delayed electronic discovery.

• Discovery will include six months of CDCRCalifornia Department of Corrections and Rehabilitation 7230 Interdisciplinary Progress Notes, any recent discharge summaries from the Department of State Hospitals, six months of psychiatrist progress notes, six months of primary clinician progress notes, recent suicide risk assessments, six months of relevant nursing notes documenting observations of behavior that could be classified as danger to self, danger to others or grave disability, any relevant Triage and Treatment Area or Mental Health Crisis Bed admission notes, and any relevant refusals of medication, food, showers, etc. Additionally, as relevant to the case(s) alleged, items from the central file may include a probation officer’s report, Rules Violation Reports, CDC 128-G, Classification Chrono, or CDC-114A, and Isolation Log. Photographs will be provided, where relevant.

• Institutions may supply discovery to the inmate attorney on CD-R media, or via secure electronic transmission media.

Post-Hearing

• All court orders resulting from a hearing before an ALJ should be forwarded to the OLAOffice of Legal Affairs either electronically as individual PDF files or by overnight mail within 24 hours of the conclusion of the hearing.

• All court orders resulting from a hearing before an ALJ should be scanned into both the health records and the central file within 24 hours, with the appropriate alert sheet. This includes the ex-parte interim court ruling from the OAH, as well as continuance orders.

• If the court has denied a case, the order for involuntary medication must be discontinued from the electronic record as soon as possible and the order for discontinuation added to all available charting resources and health records within 24 hours.

The MCA is the liaison between the institution and headquarters OLAOffice of Legal Affairs, the inmate attorney, and the OAH for all matters pertaining to involuntary administration of psychiatric medications to inmates pursuant to PCPenal Code 2602. Each institution shall maintain a local operating procedure or duty statement setting forth the duties and responsibilities of the Medication Court Administrator to ensure that Penal Code section 2602 matters are timely served and filed pursuant to statutory mandate and in conjunction with the requirements set forth by the OLAOffice of Legal Affairs and the OAH.

Pre-Hearing

• Prior to the day of hearings, the MCA is responsible for completing or monitoring the following:

  • Knowing which inmates at the institution need renewal notices started (assign renewal to psychiatrist 90 days before expiration of current order).

  • Giving assignments to psychiatrists and tracking progress.

  • Helping psychiatrists initiate new proceedings.

  • Tracking whether an emergency petition has been submitted within the 72-hour deadline with ex parte request properly filled out.

  • Checking that fillable CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363/CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7366/CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 forms are filled out correctly and completely.

  • Helping obtain and print declarations created through central dictation as part of the CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363/CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368; service of papers on inmates.

  • Determining if an inmate needs assistance responding to CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 within two business days of being served.

  • Determining if Ex Parte Request for Interim Medication Order has been granted or denied within three business days after the inmate’s time period has run and promptly notifying pharmacy whether or not emergency medication can be continued.

  • Filing all needed paperwork with OAH.

  • Selecting inmate counsel based on master calendar sent by headquarters; properly using the statewide list created by OLAOffice of Legal Affairs.

  • Using the Sharepoint site maintained by OLAOffice of Legal Affairs.

  • Supplying timely copies of all petitions to headquarters staff the same day they are sent to OAH and inmate counsel.

  • Supplying health records and ERMSElectronic Records Management System information noted in DOMDepartment Operations Manual Section 91090.11 (Documentation of Legal Paperwork, Pre-Hearing), to inmate counsel and to headquarters staff, with available copy to testifying psychiatrist.

  • Arranging for inmate counsel to meet confidentially with the inmate before the hearing.

  • Ensuring, in cases where the inmate has private counsel, that private counsel sees the inmate, receives all discovery, and integrates seamlessly into the PCPenal Code 2602 process.

  • Tracking which CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7363 and CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 were sent to OAH (and the date), and knowing which have been completed by OLAOffice of Legal Affairs (Supplemental Petition) and which have had Notice Setting Hearing (NSH) issued by OAH.

  • Monitoring arrivals and departures from the institution, per the Strategic Offenders Management System (SOMSStrategic Offender Management) Daily Movement Report, for any inmate on PCPenal Code 2602 order. If an inmate departs, it is the responsibility of the sending institution’s MCA to notify the receiving institution of the PCPenal Code 2602 inmate and forward the most recent CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7368 and order.

  • Contacting headquarters and arranging to move up the PCPenal Code 2602 hearing, if an inmate on emergency interim medication is deteriorating and needs to go to a higher level of care, rather than transfer the inmate.

  • Placing a “hold” on an inmate, if the inmate is stable and is scheduled to move before a hearing date, unless medical conditions, or Coleman considerations, justify moving the inmate elsewhere.

  • Notifying an institution of any inmate transfers if an inmate, with a case in process, transfers to another institution, and sending all supporting documentation to the receiving institution.

  • Taking the lead and immediately gathering required material if an ALJ orders document production.

  • Processing change orders timely when a hearing date or location needs to be changed.

  • Monitoring psychiatry assignments to ensure psychiatric consults are completed on time and submitted to OAH/OLAOffice of Legal Affairs within specified timelines to avoid a procedural default. Contacting, if necessary, the Chief of Psychiatry or a Senior Psychiatrist at the institution.

  • Maintaining a current weekly log of all PCPenal Code 2602 inmates for psychiatric staff, and monitoring as needed, to generate information necessary for Coleman reports.

  • Responding to headquarter requests for information for copies of a missing order or other documents.

  • Assisting with Probate 3200 service of documents and collection of medical documentation on patients as needed.

  • Arranging for esoteric hearings, such as cell side hearings or hearings at a local hospital.

  • Monitoring inmate’s medical and dental appointments to ensure the inmate is present on the date scheduled for a hearing. Consulting with psychiatry and primary care providers to ensure the inmate is not subject to side-effects of other medications.

Day of Hearing

• On the day of the administrative hearing, the MCA is responsible for monitoring or completing the following:

  • Arranging for proper entry and clearance for the judge and inmate attorney (including requisite number of copies for gate passes).

  • Arranging for proper and timely queuing of inmates.

  • Checking accuracy of hearing results on the written court order, both on the day of hearing and subsequently on the statewide list, ensuring the results are properly recorded.

  • Arranging to have necessary and late-developing documentation present.

  • Filling out alert sheets correctly after a hearing and properly placing alert sheets in the electronic medical record health records and electronic ERMSElectronic Records Management System promptly after the hearing.

  • Inputting data and the scanning of records as needed.

  • Updating the inmate’s Unit Health Record (UHR) immediately and accurately to properly reflect PCPenal Code 2602 status (i.e. emergency petition filed, non-emergency petition filed/do not medicate/do not extract, hearing date, ex parte order granted, ex parte order denied, etc, ALJ order granted, ALJ order denied).

  • Preparing packets for psychiatrists to use for testifying in court.

  • Arranging schedules and assignments to ensure psychiatrists are present in court for the hearing at the appointed time.

  • Investigating, if an inmate is not attending a hearing, the reason for not attending, via inmate interview, and preparing a statement of reasons for the judge.

  • Testifying as a special investigator for all refusals and non-attending inmates with detailed information on the inmate’s medical, verbal, and behavioral responses as to capacity.

  • Obtaining physician prescription orders sent to pharmacy/UHR for renewal of psychiatric medications on granted petitions and stop orders for denied hearings from psychiatrists.

  • Ensuring Notice Setting Hearing and Proposed Order is printed for ALJ to sign for each case.

  • Facilitating patient consent forms on dropped petitions.

  • Notifying pharmacy and yard staff on the day of hearings when petitions are dropped or denied to ensure an inmate is not involuntarily medicated when there is no involuntary medication order.

  • Scanning all court orders to PDF, filling out alert sheets and emailing to headquarters, and delivering to health records personnel.

  • Sending all court orders to headquarters staff within 24 hours as PDF files.

Inmates seeking superior court review of a PCPenal Code 2602 order should be directed to file a petition for habeas corpus or petition for writ of mandate in their local superior court. Inmates seeking to have the same ALJ take another look at the case should be provided a form CDCRCalifornia Department of Corrections and Rehabilitation MHMental Health-7369 Penal Code 2602 Reconsideration form. The inmate is responsible for filling out the form and returning the form to OAH.

The Division of Health Care Services, and the Office of Legal Affairs, or designee is responsible for ensuring that the contents of this article are kept current and accurate.

PCPenal Code §§ 2600 and 2602 CCRCalifornia Code of Regulations (15) (3) §§ 3364, 3364.1, and 3364.2