SPONSOR: |
Sen. Henry, Copeland & Peterson; Reps. Maier & Plant |
|
Sens. McDowell, Cloutier,
Sorenson, Reps. Johnson, Keeley, Wagner |
DELAWARE STATE SENATE 143rd GENERAL ASSEMBLY |
SENATE
BILL NO. 291 |
AN ACT TO IMPROVE THE PROVISION OF MEDICAL CARE TO INMATES IN STATE CORRECTIONAL FACILITIES. |
WHEREAS, correctional officers without medical training are
placed in a position each day where they must
try to evaluate the seriousness of complaints from, and the behavior of, prisoners about whose health
and medications they have been given no information; and
WHEREAS, some correctional facilities lack evening medical
staff of any kind and even the ones that do have nurses on duty may lack enough
correctional staff to transport prisoners to the infirmary or a hospital; and
WHEREAS, complaints from the families of prisoners have
revealed a need to insure that genuinely sick prisoners are given the services
to which they are entitled, and
WHEREAS, a healthy inmate can participate in work and
counseling programs which will have long term benefits to the inmate and the
State;
NOW, THEREFORE,
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF
“Section 1. Amend
Chapter 65 of Title 11 of the Delaware Code by adding to Section 6536 the
following new Subsections (f) through (y) which shall read as follows:
“(f) The Department and the medical services provider shall
recognize that correctional officers are a part of the medical team in any
correctional institution because they are the first to hear requests for
medical assistance and they are the only persons who routinely observe the
behavior and physical condition of inmates before and after they visit the
infirmary. They control whether or not a
prisoner gets to visit the infirmary or see a medical staff member; and they
must cope with such problems as violent outbursts, fainting spells, heart
attacks, diabetic comas, inmates in labor, seizures and strokes as well as
inmates who fake these and other symptoms for various reasons. They transport contagious prisoners to
hospitals. Therefore, the medical
services provider shall inform the correctional officers of the diagnosis and
physical condition of inmates in their care where the inmate would benefit from
having his or her condition known to the officer in charge of their cell block
or building; where the officer may be endangered if a violent reaction to a
mood altering drug is experienced; or where other inmates living with them need
to be protected from a contagious disease.
Conditions such as diabetes; angina or other heart conditions; fevers;
epilepsy; pregnancy; severe allergy problems; asthma; drug addiction; mental
illness with possible presentation of
suicidal ideation, violent tendencies, or catatonia; or possibly
recurring communicable or sexually transmitted diseases, for the safety of the
inmate and the people with whom he has the closest contact, shall be made known
to officers working in the cell block or unit
where inmates with such conditions reside and by the officers to cell mates of all such prisoners with
these conditions. Failure of the medical
services provider’s staff to communicate this information to the correctional
officers as required shall be grounds for the Department’s administrator of
medical services to seek damages from the provider or have the provider
discipline the employees failing to comply.
(1) The Delaware Automated Correctional System computers
shall be programmed for communications among medical staff, correctional
officers, and supervisors. A separate, secure computer medical file shall
be maintained for all inmates and a computer bulletin board and log book set up
for correctional officers’ stations. Correctional officers shall record in the Daily
Log Book File observations of any unusual or obvious physical symptoms or
extreme changes in behavior they may observe during activity or bed counts on
their shift if they believe them to be indications of illness, a reaction to
medication, or a reaction to the withdrawal of a legal or illegal drug. The Log Book File should be available online
to the nurses in the infirmary. They
must be checked no less than every 2 hours.
After notifying the nurse or infirmary promptly, the correctional
officer on duty at a module or duty station shall record any verbal complaints
of inmates regarding their medical condition when they do not believe the
inmate needs to be seen by medical staff and a 404 Form is not submitted. All Code 4 visits and transfers of inmates to
the infirmary or a hospital shall be recorded as soon as possible in the Log
Book File and a notation made of the condition of the inmate at the time. These files shall be retained and available
for audit for as long as the inmate is in the custody of the Department or
expected to return to the custody of the Department. A registered nurse employed by the Department
and supervised by the Department’s administrator of medical services shall
routinely transfer medical observations from the officers’ log book files into
inmate files, so that an assessment
can be made by doctors when the nurse flags the file for attention by a
physician or when a medical examination of the inmate becomes necessary. When the Department acquires video diagnostic
equipment, all readings taken by the machine shall be saved in the inmates’
files. The nurse shall alert his or her
supervisor when inmates’ personal medical files show records are not being made
timely or properly by the medical services provider’s staff. Unmistakably serious symptoms of illness or
reactions to medication shall be reported verbally by phone to the medical
staff on duty immediately upon discovery by any correctional officer anywhere,
anytime.
(2) In order for
correctional officers to be more aware of the condition of inmates on night
shifts, the officer monitoring his or her unit shall do the counts and the
person acting as rover shall replace the monitor while the count is done.
(3) The role of the
correctional officer is limited to observing and describing the condition of
inmates, obtaining medical assistance where necessary, and transporting inmates
to medical assistance when required. Observations
might include, for example, shaking, tics, profuse sweating when temperatures
are not hot, yellow skin color, constant yelling, skin pallor, extreme lethargy
in a supposedly healthy individual,
extreme diarrhea, constant coughing or muscular coordination problems.
(4) Extreme
emergencies for which correctional officers shall be trained and in which
situations they should personally assist inmates shall include: a. childbirth
in progress where no medical staff has arrived and the baby’s head is
presenting; b. type I diabetic reactions where an inmate is
in such dangerously low blood sugar that the inmate cannot assist him or
herself to obtain glucose or something to raise blood sugar and medical
personnel are not immediately available; c. suicide
attempts; d. asthma attacks where the inmate needs
ventilation or he or she is so critical a nebulizer must be set up immediately
and the inmate cannot get to the infirmary until he or she uses one; e. grand mal seizures, heat strokes or heat
exhaustion; f. signs of an
imminent seizure; and g. other
events causing cessation of breathing when no medical staff is immediately
available. Correctional officers shall
not be required to personally assist an inmate when they are not sure what to
do for the inmate and when they do not have appropriate equipment for a
response. Each residential building
shall have an oxygen mask and oxygen tank available for their use where fire
extinguishers are kept. No correctional
officer shall be held personally liable for actions taken to assist any inmate
with a medical problem or for a failure to act.
The director of human resources and/or training for the Department shall
present a plan for new medical training for correctional officers within two
months following the passage of this Act even if a reorganization of duties is
required. Failure by the Department to
start medical training classes coordinated with the schedules of correctional
officers who will be attending within four months after the passage of this
bill shall result in the 1 day suspension without pay of the person to whom the
task is assigned. The plan shall require
that staff training relief officers stay at a facility where correctional
officers are receiving annual training until all the officers have been
trained. If any are unavoidably missed,
they shall be granted release time to take the training at another facility
thereafter.
(g) The Department’s education for correctional
officers shall include sufficient hours of mandatory training and testing in
monitoring reactions, side effects, and adjustments to medications to enable
all officers doing residential guard duty to assess in a general way a
medicated prisoner’s condition if behavior or symptoms indicative of serious
trouble are presented. They shall learn
the vocabulary to report accurately to the medical services provider’s staff
unless video diagnostic equipment connecting all cell blocks or units to
medical staff is made available before. The
first priority in studying medications shall be those prescribed for mental
illnesses. The second priority shall be for those antibiotics that are
known to cause severe reactions in some individuals. The third shall be the effect of insulin and
the fourth shall be the use of asthma medications and so on in order than an
inmate might not have to be transferred to the infirmary for a simple, routine
medical response for a chronic condition. This shall be part of basic training for new
officers required under Section 6565, and mandatory advanced training for
current staff. Any correctional officer
who has had the opportunity for the advanced training and failed to obtain the
training within two years shall be set back one lower level on the pay scale
for officers until he or she has attended the medical training courses. Officers who have recently completed annual
training shall be granted release time to get the new medical training required
by this Act if he or she cannot take the same training for all officers in a
facility. Where inmates who are diabetic
or asthmatic would be able to self medicate under normal conditions, the
Department shall permit them to do so while incarcerated if no other factors
are present that make having their medications on their person contraindicated. Diabetic pumps should be allowed and inhalers
permitted from the time of admission to a DOC facility. Officers shall be informed by the medical
services provider when medications that have the potential to produce severe or
dangerous side affects are changed for an inmate in their cell block, unit, or
building. They shall be specifically warned if a change in medication may
increase an inmate’s potential for suicide.
Such warnings should be recorded in the Log Book File. Any officer advised that an inmate’s risk of
suicide is changed to moderate or high may ask to have the inmate temporarily
removed to the infirmary so that more frequent checks may be made of his or her
status than may be possible in his or her regular housing given the staffing
level. No correctional officer shall be
responsible for the distribution of medication to inmates. The officer’s role shall be limited to
observing which inmates are given or obtain medication and from whom. If a correctional officer becomes aware of a
mistake in the administration of medication, he shall call a central number
which the medical services provider shall designate for such reports and the
mistake shall be entered in his Log Book File.
When a superior officer receives a verbal or written report from a
correctional officer of abnormal activity by an inmate having to do with his
medication, the superior shall be responsible for contacting the nurse on duty
or the medical services provider’s staff to follow up on the report promptly
and determine if the inmate is creating a risk to himself or jeopardizing his
treatment. If the verbal report is
followed by an order to the officer from the superior, the order shall be
specific as to the time in which it is to be carried out.
(h) Correctional
officers shall continue to be trained in understanding the physical symptoms of
type I and type II diabetes in order to recognize the onset of diabetic comas
and low blood sugar reactions. Diabetic
inmates shall be provided sheets or log books that come with test equipment so
that they may record their blood sugar tests if they are Type I, and they shall
have blood sugar test equipment available to use four times a day.
(i) Correctional
officers shall be informed of diagnoses of pregnancy in those inmates in their
care. Officers guarding female inmates
shall be trained to understand the stages of pregnancy and complications that
may call for medical intervention. They
shall be trained in assisting childbirth in an emergency when no
medical
services provider staff is available or a nurse needs their help, and they
shall be educated in recognizing spontaneous miscarriages. A miscarriage shall
be reported to the medical staff immediately upon an officer becoming aware of
one.
(1) While a pregnant woman is incarcerated, the welfare of
the fetus shall be a factor in decisions regarding her activity, medication,
medical attention and nutrition made by correctional staff. All officers and supervisors in her unit shall
be so informed. Pregnant inmates shall be required to do a minimum of one half
hour of walking or exercise twice a day unless it is prohibited by their
doctor. Pregnant inmates shall be
supplied a vitamin and mineral supplement according to obstetrical directions
immediately upon diagnosis. The
assistance of a nurse or social worker shall be obtained for the inmate to
train her to care for herself and the baby and to make decisions about the
future care of the baby if she is to remain incarcerated or is without
resources of her own or her family’s to provide for it and she intends to give
birth. If the mother is to be released
after birth, the social worker shall arrange for her to attend a parenting
class within six months of the baby’s birth.
Any indication of fetal distress or serious problems for the pregnant
inmate, such as general, abnormal swelling shall require that the inmate be
taken to medical services and, if necessary, transported to a hospital. No officer shall make decisions regarding a
response to a locked down inmate’s labor pains without the advice of a member
of the medical services provider’s staff or the inmate’s obstetrician. If an officer cannot reach a medical services
staff person or the obstetrician, the officer shall assume the labor pains
require transport to a medical facility prepared to handle childbirth. The inmate’s obstetrician’s number shall be
available for the correctional staff to call at all times.
(2) Upon learning of the pregnancy of an inmate, the medical
services provider and the warden shall develop a plan for a safe pregnancy and
birth, if the inmate wishes to continue her pregnancy, including having
sufficient correctional officers on duty when the medical services provider has
no staff at the correctional facility and transport to a medical facility may
be necessary. The warden shall see that
the medical services provider and the social worker for the inmate have a plan
in place for the baby’s care following birth and for the mother’s postpartum,
post hospital care if she is to remain confined to her correctional
quarters. If childbirth support is available from a
family member or a friend while the inmate is in labor and giving birth in a
hospital, she shall be permitted to have such assistance provided it causes no legitimate security
concerns.
(3) Except where an
inmate has arranged for the adoption of her baby or the mother suffers from a mental illness that
prevents her giving appropriate care to the baby, the mother shall be entitled
to have her baby with her for at least eight weeks postpartum. Breastfeeding shall be permitted unless the
condition of the mother would jeopardize the welfare of the infant. The women’s prison or her work release
facility shall provide suitable quarters for the mother and child to protect
the baby from harm. If the mother is
near the end of her sentence and she has a home to which she can take her baby
and wishes to take her baby, her sentence may be commuted to time served to
enable the baby to start a normal life.
For release to be arranged,
adequate income to support the mother and baby for the first two months
outside the correctional system must be available through family or other means
of support. No mother and baby may be
released from a facility to avoid the State’s financial responsibility for
postpartum care unless suitable arrangements for such outside care following
release have been made. Any violation of
this subsection shall cause a two-day suspension without pay of the warden and
the medical services provider staff
person authorizing the release if a release is involved. The rights provided to female inmates by this
Act shall be conspicuously posted in
areas where female prisoners will see them.
(4) The Department of Corrections shall provide information
and education on family planning and
sexually transmitted diseases for all prisoners who are to be released within four months. Any female inmate on work release who wishes
to have the services of a licensed
physician for family planning purposes, but is unable to pay, shall be eligible for such services at State
expense up until the time for her release.
Upon request, the Department and the medical services provider shall
make all types of family planning services and supplies sufficient for a month
after release available to inmates about to be released. Courses in parenting and care for babies shall
be available for all female inmates of childbearing age on video tape or CD or
DVD. Information from adoption agencies
also shall be provided by the Department for all pregnant women. The Department shall arrange for social
workers to inform inmates of the social service agencies that provide for
pregnancy support and assistance with the care of infants when plans are being
made for the pregnancy, and they shall be allowed to seek assistance for inmate
mothers-to-be from those agencies who
may be willing to provide services for women incarcerated.
(j) Because inmates, just as persons in the general
population, may develop autoimmune disorders that progressively handicap their
physical or mental ability to perform tasks of daily living, the Department
shall follow the Americans with Disabilities Act guidelines for these
individuals. If medication is available
that will slow the progression of their disease, it shall be made available to
inmates who wish to take it. Social
workers shall be provided with the cooperation of the Department of Health and
Social Services to assist the inmates in applying for medical disability
payments, but the State shall not keep more than fifty per cent of the monthly
payments obtained as reimbursement for medical care or medications. Once an inmate with a disorder is unable to
function without a wheelchair, is mentally and physically incapacitated so that
they are no longer dangerous, or becomes bedridden, he or she may apply for and
may receive pardon or parole if they have family or friends who can care for
them. Transfer to the
(k) An inmate shall be entitled to appropriate medical
treatment to cure any cancer diagnosed while they are incarcerated whether or
not they can pay for the treatment. If
an inmate is being treated for cancer or another terminal illness and his or
her release is scheduled, a hospital social worker shall be provided to assist
the inmate with arrangements to continue treatment. If the release is scheduled to occur before his
or her sentence has been completed, the State shall assume the financial
responsibility for the continuing treatment unless the inmate is entitled to
insurance coverage or has other personal or family resources sufficient to his
need for treatment. No inmate undergoing
disabling chemotherapy or dying may be released from prison without adequate
housing and support from family or other sources to enable continued medical
treatment and the adequate necessities of life. The State must provide timely
care for all inmates with cancer.
(l) If it appears at
intake, that any prisoner is unable to describe his or her physical and mental
condition and list medications they have been prescribed, if any, the officer in
charge of intake shall call the prisoner’s family, or a friend they suggest, to
determine if the person is on medications or has physical or mental health
issues that are not immediately apparent.
If a translator is needed, one shall be supplied at State expense. The intake officer shall inform medical
services personnel of facts he learns. The
medical services personnel must attempt to arrange for the prisoner to obtain necessary medication, if any is needed. All physician prescribed medication for new inmates
must be continued. If the prisoner is
known to have physical or mental health problems, he or she shall be placed in
an infirmary, mental health ward, or on suicide watch if the officer has any
indication that such arrangements are necessary. If the prisoner has a prescription or medication
on his person labeled with his name, the name of his physician, instructions
for use, the pharmacy that supplied it and the medical services provider shall
see that the medication is continued as prescribed without missed doses. At intake, each new inmate shall sign or fill
out a form naming his or her doctors and insurance companies, if any, and
designating a third party who should be contacted if the inmate develops a
serious health problem. Listing a third
party shall not cause that person to become financially responsible for the
inmate’s medical care or other expenses.
Any inmate arriving from another facility such as a federal prison,
shall be required to have their medical file with them at admission. Federal authorities who routinely send
inmates to
(n) From the time of
intake, all medical records of an inmate shall be kept in a manner that will
permit auditing. Whether the record is
made by computer or hard copy, duplicates of all records shall be
required. One shall be filed for the
medical services
provider and one shall be sent to the
Department’s administrator of medical services.
All complaints about medical care or the lack of it from inmates shall
also be sent to the DOC administrator in addition to going through the grievance
process.
(o) During any
transition from one correctional facility to another or upon placement in the
care of DHSS, all inmates shall be entitled to have sufficient medications and records
transported with them to insure that their medical needs are met during the
transition period.
(p) Upon intake, any
prisoner who has been identified as suicidal may not be left alone until placed
on an appropriate ward. A person shall
be considered suicidal if he or she has made recent threats to take his or her
life or to do an act which would
result
in death or if he or she has recently related stories of suicidal ideation to
anyone and the intake officer or accompanying police officer knows of the
threats or ideation. The Department
shall have at least one cell block in each county for suicidal
inmates,
and it shall be staffed twenty-four hours a day with adequate and specially
trained staff including sufficient correctional officers to provide frequent
monitoring of cells, counseling, nutritional supplements, some limited
television equipment, easy
access
to social workers and adequate windows to insure inmates see sunshine as much
as possible. The suicide cell block may
be a part of the mental health ward of a facility. All mental health wards shall be designed to
provide adequate sunshine and shall be operated to address the nutritional
needs of patients as nutrition relates to the biochemical imbalances that the
mentally ill often experience. The
medical services provider shall employ, or have available as a consultant, a
person with a doctorate in nutrition with a specialty in the relationship of
behavioral biochemistry to diet. The
recovery of normal function in inmates who are mentally ill and serving short
terms or nearing the end of time to be served shall be a goal of the Department
and the medical services provider because it will benefit the State by
lessening the need for future expenditures caused by recycling mentally ill
persons between State institutions. No
inmate who has recently threatened suicide or who has recently attempted
suicide may be transferred to any DOC facility without a suicide cell block or
ward. No inmate who is mentally ill may
be released without being provided the assistance of a social worker who shall
help find a place for the person to live if the inmate has no income and lacks
family support. The worker shall insure
that the inmate receives disability payments if eligible for them or that the
person has job interviews or training to go to after release if he or she can
work. Information on how to visit the
nearest office of the State Department of Labor shall be provided and a contact
made with rehabilitation or other specialists at the Department of Labor who
can assist with a job search or training.
The social worker shall assist in arranging an appointment with the
The State Police shall send to mental health agencies
providing treatment to inmates or patients who have been incarcerated criminal
histories of their patients upon request.
Staff members who have access to these criminal histories shall maintain
the confidentiality of the information except in an emergency where the safety
of a staff member is involved.
(q) The standards promulgated under the authority found in
Subsection (a) shall be a matter of public record.
(r) The medical services provider shall send the
Department’s administrator of medical services and the Medical Society of
Delaware’s Prison Health Committee for purposes of review a record of all
deaths of inmates within three days of the passing of any inmate in the
Department’s correctional facilities.
Recommendations by the Prison Health Committee for changes in medical or
sanitation procedures in the correctional system or a need for an investigation
of the acts of medical services providers shall be made by the Prison Health
Committee to the Department’s administrator of medical services, the Council on
Corrections, and the Chairpersons of the House and Senate Corrections
Committees.
(s) The files of the medical services provider shall be kept
in a manner permitting auditing at any time by the Department’s administrator
of medical services. The medical
services provider shall immediately report to the administrator any data
indicating new strains of illness, toxic exposure, food poisoning, or an
epidemic requiring no routine action on the part of the Department. Inmate grievances regarding medical care
shall be sent to the Department’s administrator of medical services within two
(2) hours of their being filed.
(t) Any medical services provider who contracts with the
Department shall provide people hired from the former medical services provider
the same benefits previously provided.
However, pension contributions now controlled by the current medical
services provider and all future pension contributions to these employees shall
be made to the Treasurer of the State of Delaware to maintain a pension fund
which shall be continued for these employees as long as they work for a medical
services provider under contract to the State of Delaware and for the State.
(u) Failure by the medical services provider to produce the
information required or to perform the services mandated by this Code shall be
considered a breach of contract for which the Department shall receive
liquidated damages. No future contract
for medical services between a medical services provider and the Department
shall be valid unless the contract was made after the Department advertised and
received more than one request for a proposal and the contract contains a
provision for liquidated damages for breaches of specific sections of the
contract and this law. The administrator
of medical services shall develop contract language for future contracts with
medical services providers permitting the Department to assess liquidated damages
for failures of performance by the provider.
(v) The administrator
of the medical treatment contract shall provide training to the new medical
services provider on Departmental procedures and State law relating to their services. The administrator may order the medical
services provider to remove personnel who fail to perform their duties to the
standards of their profession. He or she
may refer the professional to the Prison Health Committee of the Delaware
Medical Society for advice or discipline.
The administrator may insist that one of all of the medical service provider’s
staff members attend training sessions he or she feels are necessary to improve
their job performance or inform them of new procedures mandated by State law. The
administrator of the medical services contract may cancel the contract at any
time he or she has reason to believe the medical services provider is in
material breach of the contract and the medical care they give inmates has
become inadequate. The administrator
must consult with the Department’s legal advisor before sending notice to the
medical services provider and arrangements in compliance with these laws must
be made for the Department to make the transition to a new service provider
without disruption of care for inmates.
(w) The Department’s medical services provider shall employ
video diagnostic equipment for any facility which is not covered twenty-four
hours a day by a nurse.
(y) Because
neurological damage to humans can result from the presence of mold and toxic
chemicals in quarters where they live and work, the Department must remove
promptly and properly dispose of or destroy all materials in which mold or
toxic chemicals have become embedded. It
shall see that materials or surfaces that can be cleaned are promptly
cleaned. If inmate labor is used to do
the removal or cleaning, the inmates shall be thoroughly protected by safety
equipment, boots and clothing appropriate for the circumstances.”
Section 3. All
inmates residing in the Department of Corrections’ facilities on
Section 4. The Department
of Corrections, the Department of Health and Social Services, and the Joint
Finance Committee shall continue to study means to prevent the cycling of
mentally ill citizens of Delaware between facilities of these departments due
to release of individuals in need of supportive assistance with no preparation
or planning for aftercare. They shall
report back to the General Assembly on their conclusions within six months
following the passage of this bill. It
is the intent of the General Assembly that cost savings for the State be found
by investing in, and obtaining grants to develop, new programs that will assist
inmates and those people who can function but are mentally ill to become
productive persons and to temporarily support them into a secure work and
living environment to prevent their return to an expensive correctional or
mental health facility in the future. To
this end, sources of grants such as the Bureau of Justice Assistance and the
Council of State Governments should be identified and accessed by both
departments to the fullest extent as soon as possible.
Section 5. The
provisions of this Act shall be severable.
If any shall be found to be unconstitutional, those that may take effect
without the null and void sections shall remain in full force and effect.
Section 6. Any provision of this Act which will interfere
with the current contract of the Department’s medical services provider shall
not take affect until the current contract expires.
SYNOPSIS
This Bill is
intended to insure the inmates of the Department of Corrections adequate
medical care and an environment free of toxins. It clarifies the responsibilities of the
Department, its correctional officers, and the medical service provider’s personnel. Much more medical training is mandated for
correctional officers who now deal with a multitude of problems with little
or no knowledge of the inmate’s condition or the diseases with which they are
presented. The Bill mandates
inoculations and testing for all inmates who are medically prepared to
receive them on intake. (Laws and
regulations requiring immunizations for inmates against communicable diseases
are already in the Code, but they have been ignored.) It gives power to the Department’s
administrator of medical services. It
requires the medical services provider to keep files in a condition that can
be audited randomly. It asks for the
assistance of the Prison Health Committee of the Delaware Medical Society to
insure independent oversight. It
requires that the Department recognize that any inmate giving birth must be
allowed to bond with her child for the emotional well being of the little
future citizen of |
Author: Senator Henry