For years, families have looked on from afar in frustration as their incarcerated loved one suffered due to poor clinical practices. If they called the prison to find answers, they were met with an excuse such as, “Due to your son’s right to privacy, we cannot discuss his medical condition with you.”
Because of the clamor of inmates and their families for a way that medical information could be discussed with clinical staff in a timely fashion, the prison devised the “Authorization to Verbally discuss Health Information” form. This form gave a bit of autonomy to inmates who wanted their families’ help when they felt that they weren’t receiving adequate care, or had been mis-diagnosed.
However, there is a lot of unnecessary red tape associated with this form. For one thing, it is necessary to obtain the form from one’s caseworker. This requirement slows down the process considerably. Inmates cannot obtain the form on weekends or holidays. The caseworker could be in meetings, taking classes, or any one of a thousand reasons why the caseworker cannot be reached by the inmate in a timely fashion. Then the inmate has to make an appointment with the prison notary in order to have the form notarized. The requirement that the form has to be filled out anew every 90 days, adds to the problem.
So, you and your loved one cannot see the need to go to all the trouble to fill out the prison’s form every 90 days. “Why should I bother getting this form filled out, notarized, and mailed out to my family every 90 days?” you may ask. “I work out every day and I’m healthy.” Then, one day, you’re hurt in a fight, you trip and fall down the stairs, you suffer a heart attack or stroke. You are hospitalized; your family is worried about you, but nobody can get information on your condition. “Due to your son’s right to privacy, we cannot discuss his medical condition with you.”
Seeking a solution that would help families obtain timely information on their loved ones’ health and well-being, UPAN did some research, and came up with its own Medical Power of Attorney form. Our form is modeled on similar forms in use by attorneys. It does not have to be re-authorized every 90 days. One can authorize it for any length of time from a month to 10 years or longer. Permission to obtain information can be withdrawn simply by having the inmate notify the parties—his family and the prison—in writing.
This form has been vetted by UDoC’s own attorneys, and passes muster. Recently, UPAN asked a prominent Salt Lake City attorney for his opinion. He stated, “[The form] looks fine to me. The duration of the authorization (10 years) initially struck me as excessive, but perhaps given the length of sentences being served, it might not be.”
The form comes to you as a Microsoft Word document. Once the form is downloaded, change the heading information to the information for your loved one. Below is an example of what you will find:
Your Loved One’s Name Here
His/Her Number, (Utah State Prison/CUCF)
PO Box (250/550)
(Draper/Gunnison), UT (84020/84634)
Medical Power of Attorney
This document authorizes and directs employees of the Utah Department of Corrections, including Clinical Services (Medical Department), and/or other prison personnel, to release to [Your Name Here] any and all documents and other materials in their possession pertaining to me or my health care.
This document authorizes and directs doctors, nurses, case workers or other prison personnel who have knowledge of, or who have addressed or treated my health conditions, to release to [Your Name Here] or his agent or attorney, any documents pertaining to me or my health care, and to disclose to him any confidential information or privileged communications pertaining to my health and well-being.
This document authorizes [Your Name Here] or his agent or attorney to communicate with any persons or organizations involved in health and/or medical fields regarding the evaluation, progress, and/or status of my request for assistance with my medical concerns.
In all other respects, my interactions with [Your Name Here] will remain confidential.
This document authorizes [Your Name Here], or his agent or attorney to communicate with any persons or government agencies having information relevant to the evaluation of my medical condition, including, but not limited to: employees of the Utah Department of Corrections, including members and staff of Clinical Services (Medical Department) and/or outside providers of medical services. This document further authorizes [Your Name Here] to examine, receive, and/or photocopy, and/or scan onto a computer and/or USB or other storage device any and all documents pertaining to me or my case that are in the possession of such persons or agencies.
I understand that [Your Name Here] is not qualified to give legal advice, and is only gathering information for evaluation purposes. This authorization serves as authorization for [Your Name Here] for 10 years from the date this document is signed, unless authorization is withdrawn in writing.
Signed in the presence of a NOTARY, this _______ day of ______________, 20____,
Please Print your name___________________________________
(Please note that it will be necessary to go through the document and substitute your own name in each place where you see [Your Name Here] in bold, as is seen in the example above. Also, the 10 year date near the bottom of this document can be changed to a different length of time if it is desirable to do so).
After making the changes, print out the form and mail it to your incarcerated loved one to sign and have notarized. It would be a good idea to then send a photocopy of the completed form to Clinical Services at the prison with a note, asking that it be added to your loved one’s file. Also mail a copy of the form to your inmate for his file. He can let the medical provider and his caseworker know that he has a signed, notarized clinical power of attorney form on file in his medical chart, and can show his copy, if necessary.
In the case of an emergency, this form can be emailed as an attachment to the prison health-care provider, caseworker, or the hospital where a loved one is hospitalized.
It is UPAN’s hope that this form can help families get answers in a medical emergency, or to give and receive information, and discuss treatment options with prison providers, caseworkers, or other prison officials when there is a valid reason to do so.