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4.7 Terminal Illness, Advance Directives and Death

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4.7 Terminal Illness, Advance Directives and Death standards set by the National Commission on 4.7 Terminal Illness, Correctional Health Care (NCCHC) in its Advance Directives provision of medical care to terminally ill detainees. and Death 3. In the event of a detainee’s death, or a detainee becomes gravely ill, specified officials as listed I. Purpose and Scope herein and required by ICE policies and the This detention standard ensures that each facility’s detainee’s designated next of kin shall be notified continuum of health care services addresses terminal immediately; illness and advance directives, and provides specific 4. In the event of a detainee’s death, required guidance in the event of a detainee’s death. notifications shall be made to authorities outside This detention standard applies to the following of ICE/ERO (e.g., the local coroner or medical types of facilities housing ICE/ERO detainees: examiner), and required procedures shall be followed regarding such matters as autopsies, • Service Processing Centers (SPCs); death certificates, burials and the disposition of • Contract Detention Facilities (CDFs); and decedent’s property. Established guidelines and applicable laws shall be observed in regard to • State or local government facilities used by notification of a detainee death while in custody; ERO through Intergovernmental Service Agreements (IGSAs) to hold detainees for more 5. The health services administrator (HSA) at the than 72 hours. facility where the detainee was housed at the time of his/her death shall ensure the decedent’s Procedures in italics are specifically required for medical record is reviewed for completeness and SPCs, CDFs, and Dedicated IGSA facilities. Non- closed out; and dedicated IGSA facilities must conform to these procedures or adopt, adapt or establish alternatives, 6. In the event of a detainee death, all property of provided they meet or exceed the intent represented the detainee shall be returned within two weeks by these procedures. to the detainee’s next of kin, unless property of the decedent is being held as part of an Various terms used in this standard may be defined investigation into the circumstances of death; in standard “7.5 Definitions.” 7. The facility shall provide communication II. Expected Outcomes assistance to detainees with disabilities and detainees who are limited in their English The expected outcomes of this detention standard proficiency (LEP). The facility will provide are as follows (specific requirements are defined in detainees with disabilities with effective “V. Expected Practices”). communication, which may include the 1. The continuum of health care services provided to provision of auxiliary aids, such as readers, detainees shall address terminal illness and materials in Braille, audio recordings, telephone advance directives. Appropriate to the handset amplifiers, telephones compatible with circumstances, each detainee shall be provided hearing aids, telecommunications devices for deaf with an option to complete an advance medical persons (TTYs), interpreters, and note-takers, as directive; needed. The facility will also provide detainees who are LEP with language assistance, including 2. **The facility shall be in compliance with 4.7 | Terminal Illness, Advance Directives and 338 PBNDS 2011 Death (Revised December 2016) bilingual staff or professional interpretation and The facility administrator, or designee, shall translation services, to provide them with immediately notify ICE/ERO and IHSC. meaningful access to its programs and activities. A detainee in a community hospital remains All written materials provided to detainees shall detained under ICE/ERO authority, such that generally be translated into Spanish. Where ICE/ERO retains the authority to make practicable, provisions for written translation shall administrative, non-medical decisions affecting the be made for other significant segments of the detainee (visitors, movement, authorization of care population with limited English proficiency. services, etc.). However, upon physical transfer of Oral interpretation or assistance shall be provided the patient to the community hospital’s care, the to any detainee who speaks another language in hospital assumes: which written material has not been translated or 1. medical decision-making authority consistent who is illiterate. with the contract (drug regimen, lab tests, x-rays, treatments, etc.); and III. Standards Affected 2. authority over the detainee’s treatment, which is This detention standard replaces “Terminal Illness, exercised by the hospital’s medical staff once Advance Directives and Death” dated 12/2/2008. IHSC is notified of admission. However, IHSC managed care and the facility’s HSA shall follow IV. References up on a daily basis to receive information about National Commission on Correctional Health Care, major developments. Standards for Health Care in Jails (2014). To that end, the hospital’s internal rules and ICE/ERO Performance-based National Detention procedures concerning seriously ill, injured and Standards 2011: “4.3 Medical Care.” dying patients shall apply to detainees. The Field Office Director or designee shall immediately notify ICE Directive on “Notification and Reporting of (or make reasonable efforts to notify) the detainee’s Detainee Deaths,” Directive 7.9-0, October 1, 2009 next-of-kin of the medical condition and status, the detainee’s location, and the visiting hours and rules V. Expected Practices at that location, in a language or manner which they A. Terminal Illness can understand. When a detainee’s medical condition becomes life- ICE/ERO, in conjunction with the medical provider, threatening, the facility’s clinical medical authority shall provide family members and any others as (CMA), or HSA, shall: much opportunity for visitation as possible, in keeping with the safety, security and good order of 1. Arrange the transfer of the detainee to an the facility. Facility staff shall be reminded to observe appropriate off-site medical or community facility and maintain safety and security measures while if appropriate and medically necessary; and finding ways to respectfully accommodate the family 2. Immediately notify the facility administrator and detainee needs at this sensitive time. and/or ICE/ERO Field Office Director both B. Living Wills and Advance Directives verbally and in writing of the detainee’s condition. The memorandum shall describe the Once a detainee is diagnosed as having a terminal detainee’s illness and prognosis. illness or remaining life expectancy of less than one year, the medical staff shall offer the detainee access 4.7 | Terminal Illness, Advance Directives and 339 PBNDS 2011 Death (Revised December 2016) to forms or other related materials on Advance 1. a DNR written by a staff physician requires the Directives or Living Wills, including the appropriate CMA’s approval; translation services when needed. Likewise, when 2. the policy shall protect basic patient rights and the detainee is held at an off-site facility, staff at that otherwise comply with state requirements and facility may assist the detainee in completing an jurisdiction in which the facility is located; Advance Directive and/or Living Will. 3. a decision to withhold resuscitative services shall All facilities shall use the State Advance Directive be considered only under specified conditions: form, appropriate to the state in which the facility is located, for implementing Living Wills and Advance a. the detainee is diagnosed as having a terminal Directives, the guidelines for which include illness; instructions for detainees who wish to: b. the detainee has requested and signed the 1. have a living will other than the generic form order (if the detainee is unconscious, made available by medical staff; or incompetent, or otherwise unable to participate in the decision, staff shall attempt 2. appoint another individual to make advance to obtain the written concurrence of an decisions for him/her. immediate family member, and the attending At any time, a detainee may request forms or other physician shall document these efforts in the related materials on Advance Directives or Living medical record); and Wills. These may be prepared by the detainee’s c. the decision is consistent with sound medical attorney at the detainee’s expense. practice, and is not in any way associated with When the terms of the Advance Directive must be assisting suicide, euthanasia or other such implemented, the medical professional overseeing measures to hasten death; and the detainee’s care shall contact the appropriate 4. the detainee’s medical file shall include ICE/ERO representative. documentation validating the DNR order: ICE/ERO may seek judicial or administrative review a. a standard stipulation at the front of the in­ of a detainee’s Advance Directive as appropriate. patient record, and explicit directions: “do not C. Do Not Resuscitate (DNR) Orders resuscitate” or “DNR”; and Each facility holding detainees shall establish written b. forms and memoranda recording: policy and procedures governing DNR orders. Local 1) diagnosis and prognosis; procedures and guidelines must be in accordance 2) express wishes of the detainee (e.g., living with the laws of the state in which the facility is will, advance directive, or other signed located. document); Health care shall continue to be provided consistent 3) immediate family’s wishes, if immediate with the DNR order. If the DNR order is not family has been identified; physically present or there is any question about the
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