MEDICAL CARE AND INFIRMARIES
(DRAPER AND GUNNISON PRISON)
The Clinical Services Bureau covers the Medical and Nursing Service. The infirmaries offer X-ray, physical therapy, vision, OB/GYN (Wasatch) and dental services. Hospice care for terminally ill inmates is available at the Draper Infirmary. Inmates who display particularly concerning behavior, such as suicidal tendencies, may be temporarily housed at an infirmary so they can be carefully monitored and access to materials that might be used in harmful ways is reduced.
The Clinical Services Bureau (Medical) operates a pharmacy to provide prescription medications to inmates. Depending on the type of medication, inmates may receive a blister pack of pills that he or she may self-administer. Pill lines are held twice a day for medications that must be more carefully monitored.
The information contained in this article comes from the corrections website as of May 2015, as well as a presentation given at the May 4, 2015 FOCUS meeting by Michelle Buswell, an RN who has worked in the DOC medical services for 18 years.
R & O MEDICAL ASSESSMENT INCLUDES
- nursing intake assessment to determine immediate health care needs;
- physical exam by a physician assistant or nurse practitioner;
- mental health evaluation;
- dental screening.
Within one week of entering Utah State Prison, a physical exam is offered and inmates are encouraged to accept the exam. USP asks inmates to sign a release of information so USP can get their medical records from the community if there are chronic medical problems.
Inmate Care Requests (ICRs) – also known as “kites”
(Note, comments in italics have been added by Molly Prince, author of this summary).
Ms. Buswell discussed an Inmate Care Request (ICR) must be submitted by the inmate to be seen by medical. When asked how this process works since UPAN participants have loved ones who have not received medical attention in a timely manner as well as receiving many letters about inmates not being seen by medical in a timely manner, she reported the following process:
- ICRs are picked up in Draper daily and delivered to the infirmary by 11 a.m. She did not detail the process in Gunnison. (This means an inmate needs to get their ICR in EARLY!)
- The ICRs are then triaged and screened by medical staff. This means they are reviewed and prioritized based on the severity of the medical issue described on the ICR. (We are still unclear on the logistics of how this is staffed and how the process is supposed to work on holidays and weekends versus how it actually works in reality.)
- The RN then calls to have the inmate brought to the infirmary and seen face to face the same day if it is an urgent situation.
- The other ICRs are forwarded to the scheduling secretary for appointment with a medical provider. (Again, we are still not clear on how this process works if the scheduling secretary is not working, or for holidays and weekends. Most UPAN participants have, over the years, had loved ones who have become ill after hours, on weekends or holidays and had to wait until a weekday and sometimes several days for attention, even in urgent cases because a physician or PA was not available to order specific treatment.)
- A provider may be a registered nurse or physician’s assistant, depending on the type and severity of the problem.
- In situations where it is an urgent or emergency situation, Ms. Buswell stated that rather than wait to process a ICR, inmates may speak to officers on the block or med techs at the nursing station to notify them about medical situations where medical attention is needed quickly. She indicated that the officers and medical staff at the nursing stations are then supposed to notify the infirmary so Nursing Services can have the patient seen quickly.
- Ms. Buswell also reported that inmates may speak about their urgent medical issues with the Med Techs (described as individuals who have EMT training) during pill lines. Then the Med Techs should facilitate the process to resolve the issues, whatever that may be.
ACCESSING HEALTH CARE AND SICK CALL
The following is taken directly from the current Offender Health Services Handbook, 11th Edition, available online at www.corrections.utah.gov . (Note for families: ICR and HCR are the same thing, both are used in corrections.) These are instructions for the INMATE.
- DO Place the Health Care Request (HCR) form in a sick-call box.
- DO NOT give Health Care Request (HCR) forms to clinic staff at pill line.
- DO NOT put a Health Care Request (HCR) in a mailbox because it could delay the HCR process. (UPAN has been told in past years that some housing units do not have separate boxes. We are not aware if that problem has been remedied.)
- DO NOT use the grievance process to request healthcare because it could delay the HCR process.
- DO NOT send a letter to a provider to request healthcare. Submit an HCR.
Questions about your medication prescriptions are best answered at morning pill line so the med tech has time to research and address the issue.
PHYSICALS for AGE 50 and OVER
UPAN has been advised that annual physical exams for screening are offered to inmates 50 and over. Not everyone accepts this opportunity. UPAN would recommend that any time a physical is offered, it should be an opportunity taken by inmates over 50. The annual over 50 physicals can include a “flex-sig” to screen for possible polyps or colon problems. If something is found then the patient would be referred to the U of U for a colonoscopy. EKG screening can also be conducted.
Women’s Health Concerns
Hormones and gynecological attention is reported to be offered for women’s concerns in Draper at the Wasatch Infirmary.
Telemedicine is used more frequently these days. Telemedicine is available for many types of medical issues and providers. Telemedicine is available in the Draper Wasatch Infirmary and uses a camera and a telephone connection to provide live-video conferences with specialists, who are able to see and converse with inmates. It is becoming more and more prevalent. It reduces the necessity of transporting inmates to outside medical providers. Some of the specialties that take advantage of the telemed process include cardiology and neurology. There is an MRI trailer that comes once a month to Draper.
CLARIFICATION ON MEDICAL INFO RECOMMENDATION AND TREATMENT BETWEEN UNIVERSITY MEDICAL CENTER (UMC) AND THE PRISON MEDICAL SERVICE.
The prison states that an inmate’s primary healthcare provider is the Prison Medical Clinical Services. Doctors and staff from the UMC make recommendations, but in practice, it is up to the Prison Medical Staff to determine the actual treatment and care the inmate receives based on the UMC recommendation.
UPAN has some concerns about this process in cases of life threatening and/or chronic medical conditions, particularly based on procedures in past years that have resulted in the patient ending up with infections or post-surgical problems due to the prison medical staff not following the recommendations for follow up care that were made in the discharge instructions by the hospital doctors. This is something that will need to be explored and addressed more fully in the future.
MEDICAL GRIEVANCE PROCESS
UPAN has received a variety of conflicting reports and responses from both inmates and prison staff over the years related to how the Grievance Process works for medical issues. We have received letters from inmates who were told that there is not a grievance process for medical and to talk to their medical provider. On the other hand, we have had inmates who have gone through the three-level grievance process report to us on the outcome of that process.
At the May 4, 2015 FOCUS meeting we were advised that the incarcerated patient who has a grievance must fill out the grievance form and it is forwarded to Medical from Corrections. However, we were also told that simply filing a grievance because an inmate patient feels they are not getting the treatment they want may not result in the inmate being seen by the provider they want or getting the prescription they are asking for and they will be referred back to their medical provider (doctor, physician’s assistant, etc).
According to the Inmate Healthcare Handbook, it is the inmate’s responsibility to schedule (via ICR) any follow up appointments for a condition that has not cleared up. The doctor / PA, or medical will not automatically schedule follow up appointments. While we at UPAN wonder why a physician would not schedule a follow up appointment for serious medical conditions at the time they are seen the first time (like doctors in the community do), we realize we are working with how the prison operates. Therefore, we encourage our incarcerated loved ones to always make sure they put their ICRs in for follow up appointments, or as soon as they know their condition is not clearing up in an expected recovery time.
MEDICAL CARE COST TO INMATES
Under State law, inmates are assessed a $5 co-pay for primary medical and dental care and are charged a $2 co-pay for prescription medication. (Note this is a law that was implemented by the Utah Legislature, not by the prison.) When an inmate receives care in the community, he or she is responsible for 10 percent of the costs, with a cap of $2,000 per fiscal year. An inmate who has assets exceeding $200,000 upon arrival at the prison is expected to pay costs of all medical and dental care up to 20 percent of his or her total asset value.
The following information is taken from the Inmate Healthcare Handbook, 11th Ed. regarding medical co-pays and costs to inmates. These charges apply to all offenders regardless of Interstate Compact/Federal status.
► $5.00 co-pay for each Doctor, Physician Assistant, Optometrist, and Dentist visit. This charge is assessed regardless of if the inmate is being seen for on-going health care problems.
If inmate submits a request to be seen there will be a charge for that visit. If Medical staff refers the inmate to another USP provider – that next appointment will be scheduled for him/her and will be free of charge. Dental staff schedule all necessary follow up visits for the inmate and he/she will be charged for each visit.
► $2.00 co-pay dispensing fee per 30-day supply (or less) of medications. ALL MEDICATIONS are assessed the dispensing fee regardless if it’s for medical, mental health, dental, etc.
► $0.00 co-pay for Mental Health Therapist, Psychiatrist, or Psychologist. There is no charge to see mental health staff.
► 10% of the bill for all outside care provided. An inmate’s maximum co-pay for outside care will be $2,000.00 per fiscal year (July – June). Outside care is anything done by non-UDC staff, which may be done on-site or off site. This includes all appointments, surgeries, tests, x-rays, etc. done at UMC and/or Gunnison Valley or at any other outside facility or on-site by any non-UDC staff.
Please Note: An inmate may receive more than one bill for a single appointment because Hospital departments bill the prison separately (doctor’s fees, lab fees, x-ray fees, etc.).
Medical Supply Costs
► 50% of the cost for glasses. In addition to 50% of the cost of glasses the inmate will be charged 100% of glasses’ extras (such as tints, frames, etc. that the inmate requests) and his/her payment must be received prior to ordering. There is a limit of one pair of glasses ordered per offender every two years.
► 50% of the cost for an inmate’s first set of dentures or partials. 50% of the cost for all repairs, adjustments, etc. The inmate will be charged 100% if he/she already received dentures/partials from UDC. Only one set or partial denture will be ordered per offender every 10 years.
► 50% of the cost for any medical supplies – shoes, pillows, braces, prosthetics, etc.
► $5 monthly rental fee on all equipment rented to the inmate with a value over $100 (wheelchairs, O2 concentrators, C-pap machines, etc.).
► $5 one-time fee on all equipment rented to an offender with a value of under $100 (crutches, walkers, etc.).
Elective services will not be provided or will require that the inmate pay the entire cost in advance.
The Handbook states: NO MEDICAL, MENTAL HEALTH, DENTAL, OPTICAL VISIT, PROCEDURE OR SUPPLIES WILL BE DENIED DUE TO LACK OF FUNDS.
If an inmate has questions or issues about the cost or their charges for medical charges they are asked to send a letter, not a grievance, to the Co-Pay Administrator. If they have questions about their offender account, would like copies of account statements, want to know how much they owe medical, or questions about the amount of money taken out of his/her account to pay for medical charges, they should send a letter to Inmate Accounting.
We encourage all inmates to read their Inmate Healthcare Handbook, 11th Edition, about patient responsibilities. This is available online for families and community support at www.corrections.utah.gov. We encourage families and friends of incarcerated loved ones to take the time to read through this handbook.
While UPAN directors and participants do not necessarily agree with each and all of the processes, policies and procedures currently required by the Clinical Services Bureau, our first step is to educate ourselves about what is required and how the processes work. Then, when it comes to our attention that the processes are not working as they are supposed to we, as family members and support systems, can do what we can to help our loved ones resolve the issue.
We can encourage our loved ones to follow these rules to try to reduce challenges in getting medical care. If the established protocols do not result in timely and effective medical care, then there is a grievance process or the possibility that family representatives can contact medical on behalf of their incarcerated loved one once the inmate has completed everything they can do on their end to try to facilitate and resolve the problems.
AUTHORIZATION TO VERBALLY DISCUSS HEALTH INFORMATION
Originally published in June 2015 UPAN Newsletter
A Major Advance In Health Care Concerns
UPAN is pleased to announce that Utah Department of Corrections has finished developing their new “Authorization To Verbally Discuss Health Information” form and procedure for inmates to use when they want to give a third-party person permission to speak with the Clinical Services Bureau (Medical) about their health information. The third-party person would be a family member or friend outside of prison, not in the medical profession, that the inmate identifies on a form that has been developed and is available to the inmates through their Case Managers.
How The Form Is Accessed
The form the inmate needs to use has been posted on the UDC’s internal website, where Case Managers will be able to access it and print it out for inmates.
Its Use Is Limited To Verbal Discussions
It is to be used ONLY to grant permission for verbal discussions about an inmate’s health situation between a Clinical Services Bureau staff member or provider and the identified third party representative.
GRAMA Still Required For Physical Copies
For physical copies of medical records, inmates still need to use the GRAMA form to request medical records; that form is also available from a Case Manager.
How It Works Internally
Acting Director David Worthington has designated a person at the Clinical Services Bureau to handle the calls from designated family members about an inmate’s medical situation.
How It Works For Inmate And Third Party
The process works like this:
- Inmate requests the form from Case Manager, who prints it out for inmate.
- Inmate fills out form which identifies the name of the third party being designated, including a phone number to contact them, and returns completed form to case manager.
- Case Manager notarizes form and submits it to the Clinical Services Bureau.
- A designated staff member at the Clinical Services Bureau will contact the inmate’s designated person to confirm telephone number, set up pass code, and provide telephone number the third-party will use to call for information. The staff member will have authority to either answer questions or get information.
- Each authorization is good for 90 days. So if an inmate has an ongoing or chronic medical conditions, the inmate would be wise to renew the authorization every 90 days so it is in place in case something comes up. It is the responsibility of the inmate, not the designated third party representative, to renew the authorization in a timely manner.
UPAN doesn’t know how long it takes for the authorization process to occur once the inmate submits the form to the Case Manager, but we are anticipating about a week, depending upon if the correctional staff from Medical can reach the designated third-party.