Medical care and health services

Adequate medical care shall be provided in a facility. The administrator shall develop and implement written policies and procedures for complete emergency medical and health care services. Policies and procedures shall include at least the following: (1) The administrator shall be responsible for the facility's medical services and shall develop, with the assistance of a designated medical authority, the facility's health care plan. Security restrictions shall be considered in the development of the plan, and any medical personnel included in the plan shall have their responsibilities regulated by written job descriptions. The health care plan shall cover at least the standards outlined in this section. (2) Intake screening shall be performed on all inmates immediately upon admission to the facility and before being placed in the general population or housing area. An inmate whose screening indicates a significant medical or psychiatric problem, or who may be a suicide risk, shall be observed frequently by the staff consistent with the facility's policy and the identified need until the appropriate medical evaluation has been completed. After medical evaluation , these inmates may be assigned to housing consistent with the medical evaluation. (A) Medications in the possession of the inmate at the time of the booking, whether prescription or over-the-counter shall be logged, counted and secured. Prescription medications shall be provided to the [inmate] as directed by a physician or designated medical authority. The [inmate] shall be observed to ensure the prisoner takes the medication. The physician or designated medical authority shall be particularly aware through his or her training of the impact of opiate or methadone withdrawal symptoms that may occur in regard to the mental and physical health of the [inmate]. The physician or medical authority shall prescribe and administer appropriate medications to the [inmate] pursuant to Section 5-204 of Title 43A of the Oklahoma Statutes as the medical authority deems appropriate to address those symptoms. Neither prescription nor over-the-counter medications shall be kept by [an inmate] in a cell with the exception of prescribed nitroglycerin tablets and prescription inhalers. Over- the-counter medications shall not be administered without a physician's approval unless using prepackaged medications [57 O.S. § 4.1(1)]. This authorization to allow certain medications in a cell does not require a facility to allow the medications in a cell where inmate safety is threatened or abuse of the medication is documented. Prepackaged over-the-counter medications are those medications provided in single-dose packaging. (B) Medical reception information shall be documented in a format approved by the designated medical authority which shall include inquiry into: Unofficial Rules Effective September 13, 2019 17 (i) Current illnesses and health problems including medications taken and any special health requirements; (ii) Behavioral observation, including state of consciousness and mental status; (iii) Notation of body deformities, trauma markings, i.e., bruises, lesions, ease of movement, and jaundice; (iv) Condition of skin and visible body orifices, including infestations; and (v) Disposition/referral of inmates to qualified medical personnel on an emergency basis. (3) Delousing procedures shall be developed in coordination with the designated medical authority and used whenever vermin are detected. (4) Inmates are informed upon admission to the facility about the procedures for gaining access to medical and health care services. These procedures shall be posted in a conspicuous place. (5) Each facility shall have a plan and provide twenty-four (24) hour emergency medical and dental care. Emergency plans shall at least include arrangements for: (A) The use of one (1) or more hospital emergency rooms or other appropriate health care facility; (B) The use of an emergency medical vehicle; and (C) An emergency on-call physician and dentist when the emergency health care facility is not located in a nearby community. (6) If the need is indicated by the intake screening at booking, inmates held for forty-eight (48) hours or more, shall be scheduled for a medical examination which shall be conducted by licensed medical personnel. (7) An appointment shall be made with a physician or other licensed medical personnel, as defined at Title 57 O.S. § 4.1(3), within forty- eight (48) hours of a valid written request unless more immediate action is dictated by the severity of the current situation. (8) If medical services are delivered in the facility, adequate space, equipment, supplies and materials as determined by the designated medical authority, shall be provided for primary health care delivery. (9) First aid kits approved by the designated medical authority shall be available in each facility. They shall be located in an area(s) also approved by the designated medical authority. (10) Referral sources shall be identified in advance by the designated medical authority or administrator. (11) The administration of medications, and the date, time and place of medical encounters shall be documented. (A) The facility may maintain bulk supplies of nonprescription drugs for dispensing to inmates if ordered or otherwise authorized by a physician or other licensed medical personnel, currently licensed to practice medicine in this state. Nonprescription drugs may be dispensed to an inmate for nonscheduled dosage regimens. (B) A facility may maintain nonprescription drugs for dispensing from a common or bulk supply if all of the following are accomplished: (i) The facility must have and follow a written policy and procedure to assure safety in dispensing and documentation of medications given to each resident. (ii) The facility shall maintain records which document the name Unofficial Rules Effective September 13, 2019 18 of the medication acquired, the acquisition date, the amount and the strength received for all medications maintained in bulk. (iii) Only licensed nurses, physicians, pharmacists or certified medication aides (CMA) may dispense for administration these medications and only upon the written order for as needed (p.r.n.) or nonscheduled dosage regimens, as documented in the clinical record of the inmate. (iv) The facility shall maintain records of all bulk medications which are dispensed on an individual signed medication administration record (MAR). (v) The original labels shall be maintained on the container as it comes from the manufacturer or on the unit-of-use (blister packs) package. (vi) The maximum size of packaging shall be established by the facility in its policy and procedures and shall insure that inmates receive the correct dosage; provided however, that no liquid medications shall be acquired nor maintained in a package size which exceeds 16 fluid ounces. (vii) Facilities may have only oral analgesics, antacids, and laxatives for bulk dispensing and/or drugs listed in a facility formulary developed or approved by the medical director. (C) Facilities are not required to package nonprescription drugs in individual containers with individual labels. (D) These provisions shall not prohibit authorized over the counter sales, from the commissary, of medications prepackaged for use by the consumer and labeled in accordance with the requirements of the statutes and regulations of this state and the federal government. (12) Copies of the medical record, or a discharge summary if any, shall accompany an inmate upon transfer to another facility. (13) Any remaining medications, for which the inmate has been charged, shall accompany the inmate upon transfer to another facility or upon release, or those charges shall be reversed. Medications that were in the possession of the inmate on admission, and were not dispensed, and for which the inmate has a lawful prescription, shall be returned unless there is documentation of abandonment. The amount of medications provided shall be documented. The count at that time shall be logged. Continuity of care is required when transferring or discharging inmates from the facility, including when referring an inmate to community- based providers. When health care is transferred to another facility or to providers in the community, appropriate information shall be shared with the new providers in accordance with consent requirements. Sufficient medications shall be provided upon transfer or release for inmates with known serious health conditions. Sufficient medication should be coordinated with the receiving facility. The inmate is liable for payment of the cost of these medications pursuant to Oklahoma statute [Title 19 O.S. § 746(B)]. (14) Staff shall wear disposable gloves when dealing with possible exposure to an inmate's body fluids. (15) Biomedical waste shall be stored and destroyed in compliance with state and federal requirements. (16) Sharps, i.e., needles, lancets and scalpels shall be disposed of in a puncture-proof container. (17) Staff shall receive a TB skin test as a part of the pre-employment Unofficial Rules Effective September 13, 2019 19 evaluation and each twelve (12) months as long as the test is negative. Individuals with positive skin tests shall be referred to the local health department or personal physician for evaluation. Employees will also be offered hepatitis B vaccination within one month of employment, at no cost to the employee. (18) Universal precautions shall be used at all times by all employees. (19) Medication aides are restricted in the scope of activities they may perform. Those restrictions are established in Title 63 O.S. § 1- 1950.3(E). (20) County jails, under the authority of the sheriff and Title 19 O.S. § 531(B), may deduct monies collected from an inmate as a medical payment on account for each medical services visit the inmate receives while incarcerated in the county jail, except as otherwise provided in Title 19 O.S. § 531(B). (21) Inmates are responsible for the costs of incarceration, medical care and treatment as provided in Section 979a of Title 22 of the Oklahoma Statutes.