Webinar presenter Carrie Hill answered a number of your questions after her presentation, "Issues in Today's Jail – Medical." Here are some of her responses.
Audience Question: Under AB 109, for inmates sentenced to county jails prison terms, are we required to provide screening, medical care such as pap smears, mammograms, etc.?
Carrie Hill: Once an inmate is in your facility, that duty to provide medical care is absolute. Now, on issues regarding pap smears, mammograms, OB-GYNs, there are protocols for that. Some of that is actually laid out in AB 109. I know in different states, they're starting to address some of that.
My answer is… I cannot speak to it exactly. You have the duty to provide the medical care. The length of stay is going to be very relevant. But if you do me a favor and email me, I will make sure to get that question answered.
Audience Question: What is the risk for jails that refuse to screen for medical conditions like a mental illness? On the grounds that if inmates screen positive, then they are at legal risk if they don't provide the treatment?
Carrie Hill: There's a difference between what the Supreme Court has said about medical screening versus mental health. We have a Supreme Court decision on point that talks about the time the procedure and intake screening form that deputies were using was from NCCHB. It wasn't the most updated form, and therefore, they might have missed some of the questions that might have triggered that there was a potential for suicide risk, although it caught 2 out of the 7 that would have been hit. What the Supreme Court said in that case, "We have never said that there was a constitutional right to have a mental health screening. There is a constitutional right to provide medical screening."
Knowing that we have a duty to protect, and intentionally not asking somebody these questions because if we don't know, then we can put on those blinders, I think very much sets us up. The answer may be we may not have the ability to do all of it, but at least we're doing everything we can to gain knowledge. The court is going to be suspect if you say, "We don't want to ask because we don't want to know." That's never going to fly. Rather, we have a duty to protect, and so, therefore, our arguments want to be "we welcome the knowledge. We want to know." Get all of those questions into your intake screening. It might be the initial one that the deputies do and a more exhaustive one that medical does. If it was me, I want the most thorough exhaustive medical screening so I can know. I may, or may, not have the resources. Maybe then I have to go to the court, but at least we are trying. And then we're going to do everything that we can to provide the medical care and/or treatment that is required, or heightened watches depending. But to say I don't want to know because if I don't know then I don't have to treat, it's going to come back and bite you. I want to confidently be able to say, "Your Honor, we welcome the knowledge. We welcome it from intake screening, we welcome it with our grievances". I think that's a really strong defense for your agency versus I don't want to know.
Audience Question: What is our obligation when a prisoner has special needs such as low sodium, diabetic, or gluten-free diet?
Carrie Hill: Most jails in the United States now have the regular meal as well as a medical diet, usually for diabetes, and a religious diet. That's not uncommon anymore. These are going to be clinical decisions, no matter what — whether it is low sodium. That could be a medical diet. The gluten-free for some is a choice without the doctor prescribing that, and yet those with Celiac disease — gluten may, in fact, be a significant medical risk for them. Let it be a clinical decision regarding the diet unless it is just a personal choice.
Audience Question: Using your tummy ache example, same could be said of dental care or vision care. How do we know when the medical issue is real versus faking it? Does it mean that every little thing needs to be checked by medical?
Carrie Hill: Do the inmates push the button so they can get everything they can get — of course, they do. But remember, the Supreme Court has never said toothpaste is a right. It's not. But failing to provide what is needed for periodontal care like toothbrush, toothpaste, or rinse of some sort. If you have an inmate who's going to abuse a toothbrush, you're not getting it because obviously that can be used as a weapon.
Bottomline is this, does every single instance need to go to medical — no it does not. Some of it is common sense. It never hurts to triage. I really encourage you to do more triaging. That is more defensible for you because at least you followed through. I'm not trying to extend our medical — I understand, but I would love to see more weekly meetings between medical and security — talking about ways that we can cross-train one another. So that security understands some of the medical challenges and medical understands some of the security issues. We're talking about grievances, and maybe some of these nuances that come up. For this question, I want to protect you — and the way to do it is to raise the issue with a medical personnel.
Audience Question: I am a medical provider. We have inmate medical needs that exceed our ability to provide transportation to appointments. These appointments are non-urgent. What is the best way to document these? Or document in a medical chart?
Carrie Hill: I think what I'm hearing is you are recommending as a medical provider that they see an outside physician or treatment. I am assuming that the jail is not able to provide all the transportation to meet all of these outside consults. Again, I think that's one of those that you start to triage with security staff because obviously, they're transporting to court, they may be transporting to other types of appointments. Arguably, the less that we have to transport, the better for everyone. We just had a horrific tragedy with two deputies transporting to court, and transportation staff is very cognizant of that as we all are. I think it's a matter of triaging what the seriousness is. I know you talked about this being a non-emergency. However, a consult may not be an emergency but if it gets delayed, it could rise to that.
If you're experiencing those challenges, the best thing to do is sit down with command staff and just have a talk about it. How do we work through these things? Your documentation is going to be key. "This is a non-emergency. Unable to transport at this time. We met with the inmate, consulted with x and x, told the inmate that if their symptoms increase, then x and x, we will try to reschedule." Then we talk with security staff to see if we can come up with a protocol for some of these non-medical emergency types of consult.
Click Here to Watch a Recording of "Issues in Today's Jail – Medical."