FRESNO COUNTY SHERIFF' S OFFICE

JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

EFFECTIVE DATE: 01- 01- 93 REVISED: 12- 25- 94, 02- 01- 98, 01- 01- 00, 06- 15- 18

AUTHORITY: Sheriff M. Mims APPROVED BY: Assistant Sheriff T. Gattie

REFERENCE: Penal Code Sections 3407, 3440, 4011, 4011. 2, 4011. 5, 4015, 4023,
4023. 5, 4023. 6, and 4028; Government Code Sections 26605 and 26605. 5;
Health and Safety Code Section 123462; California Code of Regulations, Title
15, Sections 1041, 1058. 57 12027 12037 12047 12057 12067 12077 1207. 57 12087
1208. 57 12107 12117 12137 12147 12157 12167 1240, and 1248; Prison Rape
Elimination Act of 2003 ( 42 USC 15601); 28 CFR 115. 327 115. 357 115. 817
115. 827 115. 83; 45 CFR 164. 512; Estelle v. Gamble, 420 U. S. 97 ( 1976); and

Hall v. County of Fresno, E. D. Cal. No: 1: 11- CV- 02047- LJO- BAM ( 2015).

PURPOSE:

The provision of adequate health services in a custody setting is a constitutional right

afforded to all inmates.
The purpose of this policy is to establish guidelines for the
adequate medical health care of inmates housed in the Fresno County Sheriff' s Office
Detention Facilities.

POLICY:

It is the policy of the Fresno County Sheriffs Office Jail Division to provide necessary,
adequate, and timely medical care to all inmates in custody in a manner consistent with
all applicable standards of medical care and in accordance with applicable federal,
state, and local laws, codes, regulations, directives, and court orders.

The Fresno Sheriff' s Office is responsible for the on- site and off-site medical health care
services for the inmates at the Fresno
County Jail. With the approval of the Fresno
County Board of Supervisors, such services may be contracted to a private service
provider. The service provider shall operate a medical health care program that meets
the local community standards of care and supply all services under the terms of the
negotiated contract.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

PROCEDURES:

I. MEDICAL HEALTH STAFF

A. Health care staff shall be appropriately credentialed according to the

licensure, certification, and registration requirements for the state of
California.

B. The Jail Medical Director shall be Board Certified or Board eligible in

Internal Medicine or Family Practice.

C. Health care performed by personnel other than a physician shall be

performed pursuant to written protocol or order of the responsible health
care staff. Assessment and treatment shall be performed by either
licensed health personnel or by persons operating under the authority
and/ or direction of licensed health personnel.

D. Medical health staff will coordinate with mental health staff to ensure
that health care is appropriately integrated, and that medical and mental
health needs are met for all inmates.

E. Medical staff will coordinate with correctional staff so that inmates

receive safe and timely access to care and medications.

II. HEALTH CARE RESPONSIBILITIES

The medical services provider/ contractor has the responsibility for the
overall administration of the medical clinics in the Jail facilities.

A. Specific medical services provided on- site at each facility shall include,
but may not be limited to:
1. Health care intake screening
2. Health appraisals/ behavioral health assessments

3. Sick call

4. On- call emergency coverage 24/ 7

5. Psychiatric crisis intervention

6. Physician services

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

7. Pharmaceuticals ( and pharmacist consulting services)

8. Pharmaceutical distribution/ monitoring
9. Chronic conditions care ( i. e., chronic disease management program)
10. Infectious diseases prevention ( i. e., Infection Prevention Plan)

11. X- ray and EKG services

12. Laboratory services
13. Communicable disease control

14. First aid and emergency response / minor trauma capabilities ( e. g.,
sutures)

15. Outpatient Housing Unit

16. Dental services

17. Medical and dental prosthetic devices and durable medical

equipment

18. Optometric and optician services ( including glasses)

19. Prenatal, pregnancy, postpartum, counseling, and obstetrical care
20. Health education

21. Physical therapy

22. Suicide prevention program
23. Chemical dependency/ substance abuse / detoxification

24. Medical diets

25. Nursing Encounter Protocol/Tools that are appropriate to the level

of skill and preparation of the nursing personnel who will carry them
out and comply with the relevant state practice acts.
26. Health care maintenance for inmates undergoing prolonged
incarceration

B. Complete and accurate medical health, behavioral health, optometry

and dental records shall be maintained.

C. The County will provide an adequate number of clinic examination

rooms to deliver adequate health care.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

D. Medical equipment and medical exam rooms/ clinics are to be

maintained in a hygienic and adequate manner. Clinic rooms shall have
standardized equipment and par levels of supplies in a standardized
presentation.

E. The quality and adequacy of health care and pharmaceutical services

are to be audited and assessed annually. A written report on health

care and pharmaceutical services delivered shall be provided to the

Sheriff on an annual basis.

F. With the exception of elective abortions, the medical services provider

shall not be responsible for elective medical care. Elective medical care
is defined as medical care, which, if not provided would not ( in the
reasonable medical opinion of the contractor' s medical director) cause
the inmate' s health to deteriorate or cause definite harm to the inmate' s
well- being. Examples of such elective medical care includes: breast

reduction, gastric bypass, or facelift surgery.

III. INITIAL HEALTH CARE SCREENING FOR ARRESTEES

A. All arrestees shall be screened by the Booking Nurse ( i. e., registered

nurse or nurse practitioner) prior to their acceptance for booking.

B. All inmates shall receive a thorough nursing intake screening to include,

but not be limited to, medical and mental health problems,
developmental disabilities, tuberculosis and other communicable

diseases, vital signs, capillary blood glucose testing for persons with
diabetes, peak expiratory flow rate for persons with asthma, and oxygen
saturation for persons with emphysema.

1. The Intake/ Receiving Screening Form includes questions on the

history of HIV/ AIDS, tuberculosis, kidney disease, legal and illegal
drug use ( e. g., type, time of last use, and quantities), as well as

questions regarding history of mental health problems or treatment,

hospitalizations, and current or previous thoughts of self- harm.

2. Tuberculosis screening shall include the following:

a. Screenings provided in accord with Centers for Disease Control

and Prevention guidelines.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

b. Inmates shall receive either Mantoux skin testing or Interferon-

gamma release assays ( IGRAs) within five ( 5) days of intake.
c. Inmates who present with an initial positive tuberculosis

screening result shall receive a chest radiograph.

3. Inmates identified having developmental disabilities, mental
as

retardation, and/ or learning disabilities will be referred to mental

health staff for assessment. Mental health staff will be responsible to

contact the Central Valley Regional Center for the purpose of

diagnosis and/ or treatment within twenty- four ( 24) hours of such

determination, excluding holidays and weekends.

4. Inmates displaying signs of suicide risk at intake screening will be
referred for mental health evaluation.

C. The Booking Nurse may recommend that any arrestee who is in need of
obvious acute medical attention not be accepted into custody. ( The
screening shall be fully completed, so that all detectable medical needs
can be addressed prior to acceptance.)
1. The recommendation will be reviewed and approved by the Watch
Commander.

2. The arresting/ transporting officer shall be responsible to transport

the arrestee to Community Regional Medical Center ( CRMC) or
other medical facility so that his or her medical needs can be
addressed prior to
booking into the Jail.
The transporting officer will
be required to provide a copy of the CRMC medical clearance
paperwork, upon return.
3. If the Booking Nurse again finds the arrestee not fit for confinement,
the nurse shall consult with the on- duty ( or on- call) physician ( or

psychiatrist, as applicable).
4. If the physician/ psychiatrist concurs with the Booking Nurse and
rejects the arrestee, the Watch Commander will " override" the

decision and accept the arrestee into custody.

5. The Watch Commander will coordinate with Medical/ Mental Health

to transport the inmate back to CRMC via the site Emergency Room
transfer process to address the inmate' s medical care and fitness for
confinement needs.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

6. The contracted medical provider will be responsible to coordinate

with CRMC regarding subsequent care of the inmate, to ensure their
fitness for confinement upon discharge from the Emergency Room,
as necessary. [ See flowchart on Addendum A.]

D. If the arrestee is found fit for incarceration but requires further medical
attention, he/ she shall be treated by the jail medical staff. If the arrestee
requires psychiatric treatment, he/ she shall be provided a mental health
evaluation by health services staff, who shall consult with Population
Management staff regarding appropriate housing for the inmate.

IV. SPECIAL MENTAL DISORDER ASSESSMENT

An additional mental health screening will be performed on women who

have given birth within the past year and are charged with murder or
attempted murder of their infants. Such screening will be performed at
intake and, if the assessment indicates postpartum psychosis, a referral for
further evaluation will be made.

V. ACCESS TO MEDICAL TREATMENT

A. Access to medical care may be accomplished through various methods-

1. Licensed health care initiated appointments. Access to care

includes planned health care encounters, scheduled and initiated as

part of
ongoing treatment planning and care management to
address health care needs.

2. Inmate request for services. Access to care also includes episodic

encounters requested by inmates either through written request, or

verbal report/ demonstration of urgent/ emergent health care needs.

3. Emergency care. Inmates with life- threatening medical symptoms

shall receive immediate medical attention.

4. Urgent care. Inmates with urgent medical symptoms will be

scheduled for a same day face-to- face visit with appropriate health
care staff as indicated by symptoms.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

B. Medical service requests for non- emergent illnesses and injuries are to
be made in writing, utilizing a Health Services Request Form.
Exceptions will be made when the request involves the need for
immediate medical attention, or involves the personal safety of staff,
inmates, or the public.

1. Supplies of blank request forms should be available inside the

housing unit, or will be provided by correctional staff, upon request.

Only health care staff shall collect completed health service request
forms.

2. Inmates are to place the completed forms in the locked boxes

located inside each pod. Health Service Request Forms will be

collected by health care staff during medication passes at least twice

a day. Health care staff will pick up completed health service request
forms directly from inmates in lockdown units during medication
passes twice a day.
3. Any inmate requesting medical attention shall be given such
attention.

C. Any inmate who attempts to submit an emergency medical request to

staff shall be interviewed in person by the floor officer ( or present

medical staff) to determine the seriousness, nature, and validity of the

request.

1. In the event the request for emergency medical treatment appears

to be valid, or the floor officer cannot determine whether the request
constitutes an emergency, the on- duty Charge Nurse ( or present
medical staff) shall be immediately notified.
2. In the event the request is clearly not an emergency ( e. g., if an

inmate attempts to expedite a routine request by misrepresenting it

as an emergency), the request form shall be submitted via normal
channels to medical staff.

D. The Charge Nurse shall review and triage each request prior to
placement of the inmate' s name on the sick call list and/ or scheduling
an appointment.

1. Completed health service request forms will be triaged at least twice

a day to determine the urgency based on the complaint.
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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

2. All inmates with emergent issues shall be seen immediately, urgent

issues within 24 hours, and routine requests shall be scheduled
within 72 hours.

3. All inmates experiencing symptoms shall have vital signs taken

during their face-to- face evaluations.
4. Nurses shall review the charts of the inmates being evaluated during
all triages.

E. When a nurse determines clinician follow- up is necessary for diagnosis

and treatment of an inmate' s condition, the inmate shall be referred to a

physician, physician' s assistant, or nurse practitioner for a face-to- face

evaluation that takes place immediately for emergent concerns, within
24 hours for urgent concerns, and within 14 days for non- emergent or
non- urgent concerns.

F. Medical problems which are cosmetic, elective or long standing, and

are not a threat to the inmate' s overall health condition may not be
treated.

VI. SICK CALL

A. Sick call is conducted on a daily basis by qualified medical staff.

B. All nursing sick call encounters shall occur in a room with an

examination table, sink, proper lighting, proper equipment, and with a

medical record.

C. Sick call is conducted in as much privacy as security concerns will

allow. ( Refer to section XV/ Privacy.)

D. A confidential and accurate medical record shall be kept on each

inmate assessed during sick call. Inmate medical records shall be kept
separate from all other Jail Division and Sheriffs Office records.

E. Inmates scheduled for sick call and a court appearance on the same

day will be sent to the Main Jail 2nd floor to be seen by medical staff
before court, or upon their return from court, whenever possible.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

F. If an inmate refuses to attend scheduled sick call, an officer assigned to

the inmate' s housing floor shall cancel the event via Offendertrak
Miscellaneous4Scheduling) and notify medical staff. The inmate

should be escorted to the sick call area to refuse in person and to sign a
refusal form. If the inmate refuses to sign, the refusal must be
witnessed by a second person ( usually the floor officer). Medical staff
will make an appropriate notation in the inmate' s medical chart/ record.

VI I. HEALTH SERVICES CO- PAYMENT

A. Inmates are required to reasonably contribute to the cost of providing

their health care. Inmates who have $ 5 or more in their personal
accounts are charged $ 3 for inmate- initiated medical and dental visits.

The co- payment fees are billed to their accounts within thirty ( 30) days
of their medical appointments. If an inmate does not have any money
at the time of the appointment, but money is later added to the inmate' s
account, the co- payment fee will be subtracted from the inmate' s
account within the 30- day billing cycle period.

B. Exceptions to the co- payment are as follows:

1. Services for emergencies or life- threatening conditions ( i. e., to

prevent death, permanent disability,

severe or or to alleviate or

lessen objectively apparent and disabling pain).

2. Follow- up or referral visits made by the health services staff.
3. Communicable disease testing or treatment.
4. Any and all services related to pregnancy, including testing.

5. The visit was for the initial booking/ screening of the inmate.

Vill. OUTPATIENT HOUSING UNIT ( OHU)

A. Only those inmates who are currently receiving medical care or

treatment are to be assigned to the Outpatient Housing Unit ( OHU)
located on the Main Jail 2nd floor.
An exception shall only apply if there
is no other housing location where the inmate can be reasonably
accommodated.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

B. The following procedures for inmates housed in the OHU for medical
treatment shall be followed-

1. Physicians, nurse practitioners, or physician' s assistants shall sign

an admittance order for inmates housed in the OHU. This shall be

followed by a complete history and exam within 72 hours.

2. Inmates admitted to the OHU shall receive daily checks to include
review of symptoms and vital signs by RNs. This shall be
documented in the inmate' s medical record.

3. Physicians shall examine inmates who have been admitted to the

OHU no less frequently than every 14 days.

4. Correctional officers shall notify medical staff immediately if an
inmate in the OHU requests medical assistance.

IX. SAFETY CELL

A. A medical assessment shall be completed prior to the initial placement

absent exigent circumstances) but no later than a maximum of two ( 2)
hours from the time of initial
placement. Inmates shall be medically
cleared by qualified medical staff for continued retention every four ( 4)
hours thereafter.

B. The inmate must be reviewed for continued retention in the safety cell a
minimum of every four ( 4) hours by the on- duty Watch Commander.

However, nothing shall preclude correctional, medical, or mental health

staff from recommending removal prior to that time.

C. Whenever health care staff members wish to recommend either the

placement of an inmate into a safety cell, or the removal of an inmate

from a safety cell, they shall contact the Watch Commander. The Watch
Commander will then approve or refuse safety cell placement or
removal and ensure all subsequent custody notifications are made.

D. Health care staff shall use Crisis Management Plan forms ( commonly
referred to as " Restriction forms") to document inmate safety cell

placement and removal and to indicate if an inmate requires to be

placed onany restrictions (
g., e. full restriction, " no sharps" restriction,

etc.)following the safety cell removal. Crisis Management Plan forms

shall be submitted to the Watch Commander for approval/ signature and
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TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

the signed forms are then delivered ( by the mental health staff) to
Population Management staff. Upon safety cell removal, Population

Management will house the inmate accordingly.

E. Inmates will not be housed in safety cells for medical reasons.

X. DETOXIFICATION

A. Detoxification shall occur only under medical supervision in accordance

with local, state, and federal laws.

B. Detoxification from alcohol, opiates, hypnotics, other stimulants, and

sedative hypnotic drugs shall be conducted under medical supervision

when performed at the detention facility.

C. Inmates being detoxified shall be monitored by a physician.

D. Specific guidelines shall be followed for the treatment and observation

of inmates manifesting mild or moderate symptoms of intoxication or
withdrawal from alcohol and other drugs.

E. Monitoring shall be structured and documented in accordance with the

Clinical Institute Withdrawal Assessment ( CIWA) or the Clinical Opiate
Withdrawal Scale ( COWS).

F. Inmates arrested for PC647( f) and/ or those who appear to be inebriated

on alcohol or drugs will be placed into the sobering units on the Main
Jail 1st floor. They shall be checked by a member of the medical staff a
minimum of once every two ( 2) hours. If
inmates are held in sobering
units more than 6) hours, they shall
six ( receive a recorded medical
examination by a medical staff member to determine if they have urgent
medical problems.

G. Inmates experiencing severe, life threatening intoxication ( an overdose)

or withdrawal shall be transferred under appropriate security conditions
to a facility where specialized care is available.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

XI. PHARMACY AND MEDICATION DISTRIBUTION

A. Prescription medications shall only be prescribed by licensed

physicians, physician' s assistants, or nurse practitioners, within the

scope of their licensures.

B. Continuity of medications shall occur within twenty-four ( 24) hours for

inmates with chronic illness, unless there are extenuating
circumstances that prevent the prescription of such medications, in

which case the inmate shall be evaluated by a physician or mid- level

practitioner within twenty- four ( 24) hours to determine an alternative

treatment plan.

C. Medications shall be distributed to the inmates twice a day, seven ( 7)

days a week at designated times by a medication nurse. Inmates who
require more frequent dosing ( or alternative medication schedules) will
be routed to the Main Jail 2nd floor to receive their medications, or
housed in the Outpatient Housing Unit ( OHU), as appropriate. [ Refer
to policy G- 105/ Medication Pass ( FILE: MEDICATION PASS) for

procedures.]

D. All hygiene practices while dispensing and administering medications

shall conform to nationally accepted professional standards.

E. All methadone treatment services for inmates shall conform with state
and federal regulations.

F. Access to pharmacy keys shall be limited only to health care staff

assigned to work in the pharmacy and the Director of Nursing. The

pharmacy door shall remain closed and locked when pharmacy staff is
not present. All medication cabinets shall remain locked at all times.

Nursing Supervisors and the Director of Nursing shall monitor control

of the pharmacy daily by direct observation.

XII. INFORMED CONSENT

A. General consent for medical treatment is explained to each inmate at

the time of intake in a language understood by them.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

B. Inmates are provided information necessary to give informed consent

before a treatment, examination, or procedure.
1. Written consent is not required in every instance, but information is
presented to allow the inmate to make an informed decision.
2. For invasive procedures or any treatment where there is some risk
to the inmate, informed consent is documented on a written form

containing the signatures of the inmate and health services staff

witness.

C. Consents for off- site procedures are obtained by and are the

responsibility of the off- site provider.

D. In the event of an emergency where informed consent cannot be

immediately obtained and the inmate' s life is in danger, informed
consent will be implied and consent to treatment will be obtained from
the Watch Commander.

XIII. RIGHT TO REFUSE

A mentally competent inmate has the constitutional right to refuse medical

treatment.

A. Health care treatment, including medications, shall not be forced over

the objections of a mentally competent inmate, except when permitted
by law ( e. g., to prevent infectious disease). A court order is required
before involuntary medical treatment can be administered to an
inmate.

B. Inmates who refuse an essential medication will be required to refuse

directly to the medication nurse and to sign a refusal form. The inmate
should be escorted to the medication pass area to refuse in person.
Any deviation will require the refusal form to be signed by both the
nurse and the officer.

XIV. RESTRAINTS

A. Restraints shall not be used for medical purposes or during any

medical procedures.

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JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

B. Medical staff shall not participate in decisions to initiate use of

restraints by correctional staff.

C. Medical staff shall take all necessary measures to maintain proper

peripheral circulation during the use of restraints.

D. A registered nurse ( RN) or LVN under the supervision of an RN shall

document vital signs, mental status, sensation of limbs, and check for
injuries incurred during the restraining application within the first hour
of placement. Medical staff shall check all restraints to ensure the
inmate has proper circulation and document vital signs, mental status,
and sensation of limbs at least once every sixty ( 60) minutes

thereafter.

XV. PRIVACY

A. Health care encounters and discussions, including medical and mental

health interviews, examinations, and procedures, are to be conducted
in a setting that respects the inmate' s privacy. To the degree permitted

by security considerations, clinical encounters are conducted in

private, without being observed or overheard.

1. Officers are to remain in close proximity only if the urgent or
emergent nature of the clinical encounter warrants such, or the

inmate poses a probable risk to the safety of the health care

provider or others.

2. If the officer is satisfied that the safety of medical staff will not be
jeopardized, the officer may permit an inmate who requires escort
to be consulted, examined, and/ or treated outside of the officer' s
view. The officer is to remain outside the curtain/ door or in close
proximity to the place of treatment at all times.

3. Officers shall stand- by anytime an inmate deemed to be high

security ( i. e., wearing a yellow jumpsuit) is not fully restrained in
shackles, handcuffs and/ or belly chain.
B. Any information overheard during a health encounter shall remain
confidential, unless the information is necessary to preserve the health
and safety of the inmate, other inmates, volunteers, visitors, contracted
employees, or correctional staff. Information provided to correctional

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TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

staff addresses only the medical needs of the inmate as it relates to

housing, program placement, security and transport.

C. If the exam requires the inmate to disrobe and/ or expose the buttocks
or genitalia ( or breasts, if female),
and the health provider is the
opposite sex of the inmate, a witness of the same sex shall be present.
The witness may be another health care staff member.

XVI. INMATE INJURIES AND EMERGENCY MEDICAL CARE

A. When an officer becomes aware that an inmate has sustained an

injury, the officer' s first concern should be to secure the scene and
obtain treatment for the inmate' s injuries.

B. Verbal inmate involving a medical emergency

reports shall be

immediately investigated by staff for appropriate action.

C. In the event the verbal request for medical treatment appears to be

valid, medical staff shall be
immediately notified. If the request does
not appear to be an emergency, the inmate will be advised to submit a
Health Service Request Form. Written inmate requests will be

reviewed by the Charge Nurse.

D. In the event of any serious emergency illness or injury, discovering

correctional
staff should call ( via radio) for a medical emergency, and
depending the severity,
on may request an ambulance to respond.
Responding medical staff will evaluate the situation and may also
recommend ( to the Watch Commander) that the inmate be transported
to CRMC for further treatment.

E. An incident report shall be written by the correctional officer in ALL

cases where an inmate is provided with immediate medical
attention/ sent to Main Jail 2nd floor unless the medical attention is
provided during inmate' s scheduled sick call.

XVII. PRIVATE MEDICAL TREATMENT

A. When an inmate desires to be attended by his/ her private physician

and/ or at a hospital other than one normally utilized by the Fresno
County Sheriff' s Office, he/ she will need to obtain a court order.

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TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

B. In the event an inmate elects to decline treatment by medical staff and

is willing to provide medical treatment at his/ her own expense, the
inmate may be transported from the jail to a privately owned and
operated medical facility or hospital that is located in the County and
approved by a judge of the Superior Court for such treatment.

C. The inmate shall be liable for the costs incurred by the County in
providing the necessary transportation and security of the inmate only
to the extent that such costs exceed the costs which would have been

incurred by the County in providing such custody and security if it had

provided treatment for the inmate.

D. The inmate shall at all times remain in the location specified by the
court and will not be permitted to be housed, treated, or detained at
any facility other than that designated.

E. The private physician shall coordinate with the Watch Commander

when an inmate is to be moved from the jail to any medical facility.

F. The inmate' s private physician may choose to examine and treat the
inmate at the jail. Appointment time should be arranged with a Charge
Nurse. The inmate and/ or his/ her family shall be responsible for all
charges incurred. The physician shall be required to provide proper

photo identification before being permitted to enter the jail.

XVIII. INDIVIDUALIZED TREATMENT PLANS

A. For each inmate treated for health conditions for which additional
treatment, special accommodations and/ or a schedule of follow- up
care is/ are needed during the period of incarceration, medical staff

shall develop a treatment plan. Custody staff shall be informed of the

treatment plan when necessary, to ensure coordination and

cooperation in the ongoing care of the inmate.

B. Treatment plans may include medical, dental, or mental health

referrals, initiation of treatment, and any recommendations regarding

housing, work, or program participation.
1. Development and implementation of a treatment plan shall be done
within the scope of state licensure.

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TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

2. Only practitioners licensed to diagnose may diagnose.

C. The minimum time period between intake screening and the first
history and physical examination shall be specified and based on
acuity ( not to exceed 14 days for all inmates).

D. The minimum time period between physician evaluations shall be

specified based on acuity.

XIX. SUICIDE PREVENTION

A. All arrestees and inmates are medically screened at the time of intake
by the Booking Nurse for possible signs and symptoms of suicidal
behavior.

B. Inmates displaying signs of suicide risk are referred to a mental health

clinician for an evaluation.

C. Mental health clinicians are responsible to complete a comprehensive

suicide risk assessment form for all inmates who display signs of
suicide risk to determine if the inmate presents a low, moderate, or
high risk of suicide. ( Refer also to policy D- 260/ Suicide Prevention
FILE: SUICIDE].)

XX. SERIOUS MENTAL ILLNESS

Serious mental illness ( SMI) is defined as any mental disorder that results
in comparatively severe impairment in major areas of functioning, such as
cognitive capabilities or disruption in normal developmental processes and
requires significant mental health treatment. The term is synonymous with
severe mental illness."

A. Mental health staff shall create an " SMI" Alert in Offendertrak for all
SMI inmates.

B. SMI inmates shall receive an evaluation from health care staff ( i. e., an

LMFT or RN) prior to their release to the community. The LMFT/ RN will
review the discharge plan with the inmate and ensure that any
medication order is called in for the inmate by the appropriate

personnel. ( Refer also to policy G- 130/ Mental Health Services [ FILE:

MENTAL].)

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

XXI. LOCKDOWN INMATES

Medical staff shall complete health checks on all inmates in any locked
down administrative segregation or disciplinary housing unit in the Jail
system at least three ( 3) times a week and document the checks to include

any verbal exchange allowing inmates to report any health or mental health
needs or concerns.

XXII. SEXUAL ABUSE VICTIMS

A. If an inmate indicates during intake screening that they have

experienced prior sexual victimization, whether it occurred in an

institutional setting or in the community, the inmate shall be offered a

follow- up meeting with a medical or mental health practitioner to take
place within fourteen ( 14) days of the intake screening.

B. If an inmate is a victim of sexual assault that occurs while in- custody,

the inmate/ victim must be provided with timely, unimpeded access to
emergency medical treatment and crisis intervention services.

C. Medical staff shall assess the inmate' s acute medical needs.

1. If any life- threatening injuries exist, response may include the need
to request emergency transportation ( i. e., ambulance). When the
call is made to request an ambulance, the dispatcher should be
informed that the injured inmate is the victim of sexual assault.

2. Medical staff shall be cognizant to maintain intact any physical

evidence which may be found on the victim' s person or clothing.
3. Inmates shall be offered timely information about and timely access
to emergency contraception and sexually transmitted infections
prophylaxis, in accordance with professionally accepted standards
of care, where medically appropriate.

D. The ongoing evaluation and treatment of such victims shall include, as

appropriate, follow- up services, treatment plans, and when necessary,
referrals for continued care.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

E. If the alleged sexual assault is reported or discovered more than

seventy- two ( 72) hours after the incident, a medical opinion shall be
obtained to determine whether the victim is to be taken for a forensic
examination. ( Refer also to D- 360/ Sexual Misconduct and Abuse
FILE: SEXUAL ABUSE].)

XXIII. MEDICAL DIETS

A. Medical diets are special diets ordered for temporary or permanent

health conditions that restrict the types, preparation, and/ or amounts of
food. Medical diets do not include special diets ordered for religious or

security reasons. Medically necessary diets shall be made available to

inmates.

B. The medical diets shall be planned, prepared, and served with

consultation from a registered dietitian. The medical diet manual, which
includes sample menus of medical diets, shall be available in both the
medical unit and the food service office for reference and information.

C. A registered dietitian shall review, and the responsible physician shall

approve, the diet manual on an annual basis.

XXIV. CHRONIC CONDITIONS CARE

Medical staff is responsible for consistency of care for inmates with chronic
conditions ( e. g., diabetes, epilepsy, asthma, etc.).

A. Health care services shall include a chronic disease management

program.

B. The chronic disease management program shall conform to

contemporary standards of care such as the National Health Lung and
Blood Institute; asthma, hypertension, and lipid guidelines; and
American Diabetes Association guidelines.

C. All inmates with chronic illness shall be tracked on a chronic illness

roster by medical staff.

D. The chronic disease management program shall measure the number

of inmates with chronic illness who receive their medication within a day
of incarceration.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

XXV. INFECTIOUS DISEASES PREVENTION

Medical staff is responsible for consistency of care and prevention for

inmates with infectious diseases.

A. The Infection Prevention Plan shall include procedures for identification,

treatment, isolation, surveillance, immunization ( when applicable),

prevention, education, and follow- up related to infectious diseases.

B. All tuberculosis screening and management shall be conducted in

accordance with the American Correctional Association ( ACA) and the
National Commission on Correctional Health Care ( NCCHC),
Standards for Health Services," as endorsed under recommendations

of the Center for Disease Control ( CDC) guidelines.

XXVI. DENTAL CARE

Dental staff is responsible to provide timely access to adequate dental care.

A. Routine dental services are available Monday through Friday, and some
Saturdays. Emergency care is available on a 24- hour, seven ( 7) days
per week basis.

B. Emergency and medically required dental care shall be provided to

each inmate, upon request, under the direction and supervision of a
dentist licensed in the state.

C. In order to receive dental care, inmates must complete a Health

Services Request Form.

D. A qualified or appropriately trained clinician shall triage dental care

requests to identify emergent or urgent issues that require treatment of
pain or infection.

XXVII. VISION CARE

Health staff is responsible to provide timely access to adequate vision care.

A. All inmates are screened for vision problems at the time of the initial
health assessment, and may again be screened at the time of the

periodic health assessment. Inmates who are:

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

1. Aged 65 and older will be referred to the optometry clinic annually.

2. Aged 40- 64 will be referred to the optometry clinic every 2- 4 years.

3. Aged 18- 39 will be referred to the optometry clinic as clinically
indicated.

4. Diabetic will receive a dilated exam annually.

5. Designated by the optometrist as having a higher risk for glaucoma

will receive a dilated exam every two ( 2) years.

B. Inmates who complain that they are having difficulty with visual acuity
will be advised to submit a Health Services Request Form to obtain a
Snellen vision screening. Inmates may request vision screening
annually.

XXVIII. CARE OF PREGNANT INMATES

A. Upon identification of a pregnant inmate by pregnancy test, the inmate

will be seen by medical staff within twenty- four ( 24) to forty- eight ( 48)
hours of arrival, or within seventy- two ( 72) hours if incarcerated over the
weekend. A list of all pregnant inmates and their disposition, including
their release, will be maintained by medical staff.

1. Upon confirmation of an inmate' s pregnancy, the inmate must be

advised orally or in writing of the standards and policies governing
pregnant inmates. The Pregnancy Services pamphlet contains the
required information and should be given to all pregnant inmates.
2. Pregnant inmates with a recent
history of opiate, methadone,
buprenorphine, or similar drugs will be reported to the physician on
site or the on- call physician is called if no physician is on- site for
appropriate treatment which may include referral to the BAART
Opioid Treatment Program ( OTP).

B. Pregnant inmates will receive timely and appropriate prenatal care,

postpartum care, counseling, and specialized obstetrical services when
indicated, to include:

1. Initial and regular prenatal exams

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

2. Laboratory and diagnostic testing, including syphilis testing

3. Immunizations, including TDAP ( Tetanus, Diphtheria, and Pertussis)
4. Management of high risk pregnancies
5. Management of obstetrical emergencies

6. Drug and alcohol detoxification

7. Opioid Treatment Program ( OTP)

8. Prenatal diet, vitamins, and exercise

9. Abortion

10. Postnatal care, including accommodation for lactating women

11. Monitoring for postpartum depression
12. Initiation of contraception as needed

13. Perinatal education

C. Pregnant inmates will be provided with educational classes/ pregnancy

management services that include: self-care, nutrition, parenting skills,
medications, pregnancy testing, immunizations, routine and high- risk

prenatal care, labor and delivery, postnatal care, identification of

postpartum depression, and counseling.

D. Pregnant inmates shall be provided a balanced, nutritious diet approved

by a doctor.

E. Pregnant inmates will be transported to Community Regional Medical

Center ( CRMC) for labor and delivery whenever possible. Pregnant

inmates who require transport due to imminent delivery or other

emergent condition will be taken to the nearest emergency department
with obstetrical services. ( Refer also to D- 230/ Use of Restraint Devices
FILE: RESTRAINTS] for the use of restraints on pregnant inmates.)

F. Sterilization for the purpose of birth control, including, but not limited to,
during labor and delivery is prohibited.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

XXIX. SPECIALTY CARE

A. Specialty care appointments ( to include pulmonology and

ophthalmology) shall be tracked in a log that identifies the referral date,

the date the referral was sent to the clinic, the date the appointment
was confirmed, and, if the appointment was rescheduled or canceled,
the reason it was rescheduled or canceled.

B. Inmates whose specialty appointment exceeds three ( 3) months should

be examined by a physician, physician' s assistant, or nurse practitioner
monthly and evaluated to determine if urgent evaluation is indicated.

XXX. HEALTH CARE RECORDS

A. Medical staff shall maintain accurate records on each individual inmate,

in compliance with state statute and IMQ/ CMA accreditation guidelines.

Complete and dated health records shall include, but not be limited to:

1. Receiving screening form/ history.

2. Health evaluation reports.

3. Complaints of illness or injury.

4. Names of personnel who treat, prescribe, and/ or administer/ deliver
prescription medication.

5. Location where treated.

6. Medication records.

7. Diagnostic studies.

8. Individual treatment plans.

9. Records of services provided by the various mental health staff
members in sufficient detail to make possible an evaluation of
services, and contain all the data necessary in reporting to the state,
including records of inmate interviews and progress notes.

B. Health care record and health information, both oral and documented, is
confidential protected health information. The minimum necessary
health information is to be disclosed to health care staff providing health
care or to jail authorities when necessary for the protection of the
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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

welfare of the inmate or others, management of the jail, or maintenance

of jail security and order.

C. All health care records must comply with state and federal regulations
pertaining to access, disclosure, and/ or use of health information.

D. Each inmate' s health care record ( paper or electronic) shall be

maintained separately from and in no way be part of the inmate' s other

jail records.

E. Correctional staff shall not have access to the completed intake

screening form.

XXXI. TRAINING

A. All health care staff shall receive structured orientation and training
specific to providing health services in a correctional setting.
B. All health care staff shall receive training regarding suicide prevention
during new employee orientation, and updated training annually. The
training shall be provided by a licensed clinician having expertise in
correctional suicide prevention and the use of a suicide risk assessment
form.

C. All full- and part-time medical care practitioners shall be trained in how
to detect and assess signs, preserve physical evidence, respond
effectively, and report allegations or suspicions of sexual abuse and
sexual harassment.

D. Mock fire drills are conducted by the Jail Division at least twice a year to
ensure all staff members are familiar with safety procedures and
evacuation methods. Health care staff shall participate in the fire drills
at least once each year.

XXXII. STAFF ACCESS TO MEDICAL SERVICES

A. All jail medical areas are off limits to jail personnel with the exception of
jail staff members specifically assigned to work in that area.

B. Medical staff shall not provide medical services, including drugs or any
other medication to employees, except in emergency situations.

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 FRESNO COUNTY SHERIFF' S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES

TITLE: MEDICAL HEALTH SERVICES NO: G- 120

FILE: MEDICAL

C. In the event of an emergency, the first concern shall be to have the jail
staff member evaluated and first aid
provided, if indicated.
Subsequently, the following reports shall be completed and forwarded
to the Watch Commander:

1. An incident report detailing the circumstances of the illness/ injury.

2. A Supervisor' s Investigation Report ( SIR).

D. A Worker' s Compensation Package shall be provided to the staff

member and a receipt for same shall be signed by the injured employee
and forwarded to the Watch Commander.

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