(1) Type I, II, III, and IV Facilities shall meet the following requirements unless otherwise specified.(2) The provision of medical services for the facility shall be the responsibility of a designated health authority such as a hospital, clinic, or physician. There shall be an agreement between the governmental funding agency responsible for the facility and the hospital/clinic/physician responsible for such services. The designated health authority must be notified in instances where an inmate may be in need of medical treatment and the facility shall document this notification. The health authority shall meet with the Sheriff and/or facility administrator at least annually. This requirement applies only to Type I, II, and III Facilities.
(3) Medical decisions are the sole province of the responsible health care provider and shall not be countermanded by non-medical personnel. This requirement applies only to Type I, II, and III Facilities.
(4) All health care professional staff shall comply with applicable state and federal licensure, certification, or registration requirements. Verification of current credentials shall be available upon request from the provider. Health care staff shall work in accordance with profession-specific job descriptions approved by the health authority. If inmates are assessed or treated by non-licensed health care personnel, the care shall be provided pursuant to written standing or direct orders by personnel authorized to give such orders. This requirement applies only to Type I, II, and III Facilities.
(5) Continuity of care is required from admission to transfer or discharge from the facility, including referral to community-based providers, when indicated. When health care is transferred to providers in the community, appropriate information shall be shared with the new providers in accordance with consent requirements. Prior to release from custody or transfer, inmates with known serious health conditions shall be referred to available community resources by the facility's health care provider currently providing treatment. This requirement applies only to Type I, II, and III Facilities.
(6) Written policy and procedure shall prohibit inmates from performing patient care services, scheduling health care appointments or having access to medications, health records or medical supplies and equipment. This requirement applies only to Type I Facilities.
(7) First aid kits shall be available and a physician shall approve the number, contents, and location of such kits on an annual basis. Documentation of such approval must be in the facility's permanent records or attached to the kit itself. This requirement applies only to Type I, II, and III Facilities.
(8) Receiving screening shall be performed on all inmates upon admission to the facility and before placement in the general housing area. The findings shall be recorded on a printed screening form. The officer performing this duty shall check for: (d) Prescribed medications; and(e) Suicide risk assessment, including suicidal ideation or history of suicidal behavior or other mental health illness. These requirements apply only to Type I, II, and III Facilities.
(9) A more complete examination shall be completed on inmates within fourteen (14) days of the inmate's initial confinement date. If the facility can document that a health appraisal was conducted within the previous ninety (90) days, this fourteen (14) day physical is not required unless medical conditions dictate otherwise. This examination shall be performed by a physician or a person who has been designated by a physician as capable of performing such examination. If a designee performs the examination, he/she must do so under supervision of a physician and with a protocol or set of instructions and guidelines from the physician. This examination shall include: (a) Inquiry into current illness and health problems, including those specific to women;(b) Inquiry into medications taken and special health requirements;(c) Screening of other health problems designated by the responsible physician;(d) Behavioral observation, including state of consciousness and mental status;(e) Notification of body deformities, trauma markings, bruises, lesions, jaundice, ease of movement, etc.(f) Condition of skin and body orifices, including rashes and infestations;(g) Disposition/referral of inmates to qualified medical personnel on an emergency basis;(h) A review of the initial intake receiving screening; and(i) An individual treatment plan as appropriate. These requirements apply only to Type I Facilities.
(10) All intersystem transfer inmates (transferred from one confinement facility to another within the same county's jurisdiction) shall receive a health screening by trained or qualified health care personnel, upon arrival at the facility. All findings are recorded on a screening form approved by the health authority. At a minimum, the screening includes the following: (a) A review of the inmate's medical, dental, and mental health problems;(b) Current medications; and(c) Current treatment plan. These requirements apply only to Type I, II, and III Facilities.
(11) Sick call, conducted by a physician or other person designated by a physician as capable of performing such duty, shall be available to each inmate according to written procedure for sick call. The inmate shall be informed of these procedures, including any copayment requirements, as well as procedures for submitting grievances, upon admission. This requirement applies only to Type I, II, and III facilities.
(12) Inmates shall have access to mental health services as clinically warranted in accordance with protocols established by the health authority that include: (a) Screening for mental health problems;(b) Referral to outpatient services, including psychiatric care;(c) Crisis intervention and management of acute psychiatric episodes;(d) Stabilization of the mentally ill and prevention of psychiatric deterioration in the facility;(e) Referral and admission to inpatient facilities; and(f) Informed consent for treatment. These requirements apply only to Type I, II, and III Facilities.
(13) A suicide prevention program shall be approved by the health authority and reviewed by the facility administrator. All facility employees responsible for supervising suicide-prone inmates shall be trained annually on program expectations. This requirement applies only to Type I, II, and III Facilities.
(14) All facilities shall have a suicide prevention plan which must include specific procedures for handling intake, screening, identifying, and continually supervising the suicide-prone inmate.(15) At least one (1) person per shift, assigned to work at the facility, shall be trained in First Aid/CPR, as defined by the American Red Cross or American Heart Association, and CPR, as defined by the American Red Cross or American Heart Association. Training shall also cover:(a) Awareness of potential emergency situations;(b) Transfer to appropriate health care provider;(c) Recognition of symptoms of illness most common to the facility; and(d) Giving of medication to inmates. In addition, the health authority shall approve policies and procedures that insure that emergency supplies and equipment are readily available and in working order.
These requirements apply only to Type I, II, and III Facilities.
(16) Detoxification from alcohol, opiates, hypnotics, and other stimulants shall be conducted under medical supervision in accordance with local, state, and federal laws. When performed at the facility, detoxification shall be prescribed in accordance with clinical protocols approved by the health authority. Specific criteria shall be established for referring symptomatic inmates suffering from withdrawal or intoxication for more specialized care at a hospital or detoxification center. This requirement applies only to Type I, II, and III Facilities.
(17) Facilities shall provide dental treatments, not limited to extractions, when the health of the inmate would otherwise be adversely affected during confinement, as determined by a physician or dentist. This requirement applies only to Type I Facilities.
(18) Facilities shall confiscate all medications in the possession of an inmate at the time of admission to the facility. The identification of and the need for such medication shall be verified by a physician or qualified health care personnel before it is administered. This requirement applies only to Types I, II, and III Facilities.
(19) Medications issued to inmates shall be strictly controlled and shall be kept in a secure place within the administrative or medical offices in the facility. This requirement applies only to Types I and II Facilities.
(20) All medications shall be prescribed by a physician or his/her designee at the time of use. An officer or qualified health care personnel shall verify that the medication is taken as directed and a medication receipt system established. This shall include controlled drugs and injections. This requirement applies only to Type I and II Facilities.
(21) Medical and mental health records on the inmate's physical condition on admission, during confinement, and at discharge shall be kept in a separate file from the inmate's other facility records. The medical record shall indicate all medical orders issued by the facility's physician and/or any other health care personnel who are responsible for rendering health care services. These medical records shall be retained for a period of ten (10) years after the inmate's release. This requirement applies only to Type I, II, and III Facilities.
(22) Informed consent standards of the jurisdiction shall be observed and documented for inmate care in a language understood by the inmate. In the case of minors, the informed consent of a parent, guardian, or a legal custodian applies when required by law. Inmates routinely have the right to refuse medical interventions. When health care is rendered against the inmate's will, it shall be in accordance with state and federal laws and regulations. This requirement applies only to Type I, II, and III Facilities.
(23) Involuntary administration of psychotropic medication(s) to inmates shall be authorized by a physician and provided in accordance with policies and procedures approved by the health authority, and in accordance with applicable laws and regulations of the jurisdiction. This requirement applies only to Type I, II, and III Facilities.
(24) The use of inmates in medical, pharmaceutical, or cosmetic experiments is prohibited. This does not preclude inmate access to investigational medications on a case-by-case basis for therapeutic purposes in accordance with state and federal regulations. This requirement applies only to Type I, II, and III Facilities.
(25) In case of medical emergencies, there shall be specific information readily accessible to all employees, such as telephone numbers and names of persons to be contacted so that professional medical care can be received. There shall also be available the names and telephone numbers of persons to contact in case of death.(26) Inmates suffering from communicable diseases and those who are sick but do not require hospitalization shall be housed separate from other inmates as recommended by health care authorities. This requirement applies only to Type I, II, and III Facilities.
(27) When an inmate is placed in segregation for health concerns, health care personnel shall be informed as soon as practical and provide assessment and review as indicated by the protocols established by the health authority. This requirement applies only to Type I and II Facilities.
(28) Medical/dental instruments and supplies (syringes, needles, and other sharp instruments) shall be inventoried, securely stored, and their use shall be controlled. This requirement applies only to Type I and II Facilities.
(29) Pregnant inmates shall have access to obstetrical services (prenatal, partum, and post-partum care) by a qualified health care provider. This requirement applies only to Type I and II Facilities.
(30) Inmates with chronic medical conditions, such as diabetes, hypertension, and mental illness shall receive periodic care by a qualified health care provider in accordance with individual treatment plans that include monitoring of medications and laboratory testing. This requirement applies only to Type I, II, and III Facilities.
(31) Information shall be provided to inmates about sexual abuse/assault including: (a) Prevention/intervention;(c) Reporting sexual abuse/assault; and(d) Treatment and counseling. This information shall be communicated in writing or electronically, in a language clearly understood by the inmate, upon arrival at the facility.
These requirements apply only to Type I, II, and III Facilities.
(32) Sexual conduct between facility employees, volunteers or contract personnel and inmates is prohibited and subject to administrative, disciplinary and criminal sanctions. The prohibition applies regardless of consent.(33) The health authority shall develop and approve protocols for identifying and evaluating major risk management events related to inmate health care, including inmate deaths, preventable adverse outcomes, and serious medication errors. This requirement applies only to Type I, II, and III Facilities.
Tenn. Comp. R. & Regs. 1400-01-.13
Original rule filed August 9, 1982; effective September 8, 1982. Repeal and new rule filed June 29, 1984; effective September 11, 1984. Amendment filed July 2, 1985; effective October 14, 1985. Repeal and new rule filed October 29, 2014; effective January 27, 2015. Amendments filed September 1, 2017; effective 11/30/2017.Authority: T.C.A. § 41-4-140.