with the National Commission on Correctional 4.3 Medical Care Health Care (NCCHC), and shall maintain compliance with those standards. I. Purpose and Scope 2. The facility shall have a mental health staffing This detention standard ensures that detainees have component on call to respond to the needs of the access to appropriate and necessary medical, dental detainee population 24 hours a day, seven days a and mental health care, including emergency week. services. 3. The facility shall provide communication This detention standard applies to the following assistance to detainees with disabilities and types of facilities housing ICE/ERO detainees: detainees who are limited in their English • Service Processing Centers (SPCs); proficiency (LEP). The facility will provide detainees with disabilities with effective • Contract Detention Facilities (CDFs); and communication, which may include the • State or local government facilities used by provision of auxiliary aids, such as readers, ERO through Intergovernmental Service materials in Braille, audio recordings, telephone Agreements (IGSAs) to hold detainees for more handset amplifiers, telephones compatible with than 72 hours. hearing aids, telecommunications devices for deaf persons (TTYs), interpreters, and note-takers, as Procedures in italics are specifically required for needed. The facility will also provide detainees SPCs, CDFs, and Dedicated IGSA facilities. Non- who are LEP with language assistance, including dedicated IGSA facilities must conform to these bilingual staff or professional interpretation and procedures or adopt, adapt or establish alternatives, translation services, to provide them with provided they meet or exceed the intent represented meaningful access to its programs and activities. by these procedures. All written materials provided to detainees shall For all types of facilities, procedures that appear in generally be translated into Spanish. Where italics with a marked (**) on the page indicate practicable, provisions for written translation shall optimum levels of compliance for this standard. be made for other significant segments of the Various terms used in this standard may be defined population with limited English proficiency. in standard “7.5 Definitions.” Oral interpretation or assistance shall be provided to any detainee who speaks another language in II. Expected Outcomes which written material has not been translated or The expected outcomes of this detention standard who is illiterate. are as follows (specific requirements are defined in Newly-admitted detainees shall be informed “V. Expected Practices”). orally or in a manner in which the detainee 1. Detainees shall have access to a continuum of understands about how to access, appeal or health care services, including screening, communicate concerns about health services. prevention, health education, diagnosis and 4. Detainees shall be able to request health services treatment. on a daily basis and shall receive timely follow- **Medical facilities within the detention facility up. shall achieve and maintain current accreditation 5. Detainees shall receive continuity of care from 4.3 | Medical Care 257 PBNDS 2011 (Revised December 2016) time of admission to time of transfer, release or care and treatment, as needed, that includes removal. Detainees, who have received medical monitoring of medications, diagnostic testing care, released from custody or removed shall and chronic care clinics. receive a discharge plan, a summary of medical 13. The facility administrator shall notify ICE/ERO, records, any medically necessary medication and in writing, of any detainee whose medical or referrals to community-based providers as mental health needs require special consideration medically-appropriate. in such matters as housing, transfer or 6. A detainee who is determined to require health transportation. care beyond facility resources shall be transferred 14. Each detainee shall receive a comprehensive in a timely manner to an appropriate facility. A medical, dental and mental health intake screening written list of referral sources, including as soon as possible, but no later than 12 hours after emergency and routine care, shall be maintained arrival at each detention facility. Detainees who and updated annually. appear upon arrival to raise urgent medical or 7. A transportation system shall provide timely mental health concerns shall receive priority in the access to health care services that are not available intake screening process. at the facility. Procedures for use of this 15. Each detainee shall receive a comprehensive health transportation system shall include: a) assessment, including a physical examination and prioritization of medical needs; b) urgency (such mental health screening, by a qualified, licensed as the use of an ambulance instead of standard health care professional no later than 14 days after transportation); c) transfer of medical entering into ICE custody or arrival at facility. For information and medications; and d) safety and the purposes of the comprehensive medical security concerns of all persons. examination, a qualified licensed health provider 8. A detainee who requires close, chronic or includes the following: physicians, physician convalescent medical supervision shall be treated assistants, nurses, nurse practitioners, or others in accordance with a written treatment plan who by virtue of their education, credentials and conforming to accepted medical practices for the experience are permitted by law to evaluate and condition in question, approved by a licensed care for patients. physician, dentist or mental health practitioner. 16. Qualified, licensed health care professionals shall 9. Twenty-four hour emergency medical and mental classify each detainee on the basis of medical and health services shall be available to all detainees. mental health needs. Detainees shall be referred for evaluation, diagnosis, treatment and 10. Centers for Disease Control and Prevention (CDC) guidelines for the prevention and control stabilization as medically indicated. of infectious and communicable diseases shall be 17. At no time shall a pregnant detainee be followed. restrained, absent truly extraordinary circumstances that render restraints absolutely 11. Occupational Safety and Health Administration (OSHA) and applicable state guidelines for necessary. managing bio-hazardous waste and 18. Detainees experiencing severe, life-threatening decontaminating medical and dental equipment intoxication or withdrawal symptoms shall be shall be followed. transferred immediately for either on-site or off- site emergency department evaluation. 12. Detainees with chronic conditions shall receive 4.3 | Medical Care 258 PBNDS 2011 (Revised December 2016) 19. Pharmaceuticals and non-prescription medicines of the same gender should be considered; when shall be secured, stored and inventoried. not feasible, a same-gender chaperone shall be provided. When care is provided by a health care 20. Prescriptions and medications shall be ordered, dispensed and administered in a timely manner provider of the opposite gender, a detainee shall and as prescribed by a licensed health care be provided a same-gender chaperone upon the professional. This shall be conducted in a manner detainee’s request. that seeks to preserve the privacy and personal 27. Detainees in Special Management Units (SMUs) health information of detainees. shall have access to the same or equivalent health care services as detainees in the general 21. Health care services shall be provided by a sufficient number of appropriately trained and population, as specified in standard “2.12 Special qualified personnel, whose duties are governed Management Units.” by thorough and detailed job descriptions and 28. **Adequate space and staffing for the use of who are licensed, certified, credentialed and/or services of the ICE Tele-Health Systems, registered in compliance with applicable state inclusive of tele-radiology (ITSP) and tele­ and federal requirements. medicine, shall be provided. 22. Detention and health care personnel shall be 29. All detainees shall receive medical and mental trained initially and annually in the proper use of health screenings, interventions and treatments emergency medical equipment and shall respond for gender-based abuse and/or violence, to health-related emergency situations. including sexual assault and domestic violence. 23. Information about each detainee’s health status 30. This standard and the implementation of this shall be treated as confidential, and health standard will be subject to internal review and a records shall be maintained in accordance with quality assurance system in order to ensure the accepted standards separately from other standard of care in all facilities is high. detainee detention files and be accessible only in accordance with written procedures and III. Standards Affected applicable laws. Health record files on each This detention standard replaces “Medical Care” detainee shall be well organized, available to all dated 12/2/2008. practitioners and properly maintained and safeguarded. IV. References 24. Informed consent standards shall be observed and American Correctional Association, Performance- adequately documented. Staff shall make based Standards for Adult Local Detention reasonable efforts to ensure that detainees Facilities, 4th Edition: 4-ALDF-2A-15, 4C-01 understand their medical condition and care. through 4C-31, 4C-34 through 4C-41, 4D-01 25. Medical