It is the mission of the Health Services Department of FCI, Manchester, Kentucky, to provide medically necessary healthcare to inmates effectively in accordance with proven standards of care without compromising public safety concerns inherent to the Bureau of Prisons overall mission. Health care will be provided to inmates by way of Primary Care Provider Teams (PCPT), which are designed to improve the delivery of health care services by enhancing continuity of care and promoting preventive health care measures. The PCPT is designed to function in the same manner as a medical office in a community setting. Virtually all patient care provided to the inmates will be by appointment, scheduled several days to weeks in advance through written requests from the inmate, or follow-up appointments determined by the providers. Each Health Care Provider will be assigned a case load of inmates based on the inmate’s register number. This care will include both acute and chronic conditions.
By using a multi-disciplinary approach, we will strive to provide high quality health care services in a cost effective manner that increases the probability of beneficial patient outcomes, while reducing the probability of adverse patient outcomes. Health care will be rendered within the constraints of custody.
The Health Services Department is located next to R&D.
The Health Services staff consists of a physician, Health Services Administration staff, mid-level practitioner(s), health information staff, nursing staff, an x-ray technician, dentists, and a dental hygienist. We also have available as consultants, physicians of various specialties, and optometrists.
3. ACCESSIBILITY TO HEATH SERVICES ADMINISTRATIVE STAFF
A member of the Health Services Administrative Staff will stand mainline, Monday through Friday, except for holidays, to address health care questions and concerns. You may also address any health care concerns you may have in writing by completing and submitting an “Inmate Request to Staff” (cop-out) form to the Health Services.
The fastest and easiest way of addressing your health care concerns is by going to Sick Call and getting an appointment to come back and see the clinician in person one-on-one for an evaluation and to discuss your concerns.
4. HEALTH SERVICES UNIT FUNCTIONS
The Health Services Unit is the organizational unit that provides emergency and routine ambulatory health care services.
The outpatient clinic is the service area within the Health Services Unit that provides the diagnostic and support services used by the health care providers in the provision of urgent and ambulatory care services. Included are the examination rooms, treatment rooms, medication room, dental clinic, radiology and laboratory areas, pharmacy, waiting areas, storage areas, and administrative offices.
At the FCI main facility there are two respiratory isolation rooms with negative air flow, and two special observation rooms used for mental and custodial reasons.
5.MEDICAL AND DENTAL SICK CALL SIGN-UP PROCEDURES
Inmates will be interviewed in private to determine medical/dental needs. If necessary, inmates will be given an appointment slip, or placed on callout, to be seen by a clinician. If you are given an appointment or scheduled for a call-out, you are expected to show up and be on time. Failure or refusal to keep scheduled appointments may result in an incident report. It is the inmate’s responsibility to present his appointment slip to his Unit Officer or Detail Supervisor. Inmates must have their Commissary ID card with them when they come to Sick Call appointments.
For those inmates whose custody status precludes attendance at regular Sick Call, Health Services staff shall make daily rounds in the Special Housing Unit (SHU) to deliver medication and perform triage of medical complaints. Routine requests for health care, will be handled similarly to regular clinic operations. Assignment of Primary Care Provider Teams will remain the same regardless of whether the inmate is in general population or in the SHU.
MEDICAL AND DENTAL SICK CALL SIGN-UP TIMES
Medical and dental open Sick Call sign-up is held from 7:00 a.m. to 7:30 a.m., Monday, Tuesday, Thursday, and Friday. General population inmates who desire to be seen at Sick Call triage shall be triaged by a health care provider to assess whether an immediate or urgent need exists, or whether an appointment can be scheduled for that day or a subsequent day. Health Services staff shall exercise professional judgement to determine the day and time of a Sick Call appointment. Health Services staff shall give follow-up Sick Call appointments according to Sick Call Triage Guidelines established by the Clinical Director. During Sick Call appointments, inmates will be evaluated individually in a private examination area and the health care provider shall have the inmate’s medical record during all patient examinations. Inmates must have their commissary identification card to be seen.
Inmate appointments will generally be made by placing the inmate on call-out. If the inmate is determined to be unable to report to work pending his appointment, he will be held over and evaluated by medical staff, and a determination will be made as to whether he can return to work. If the inmate cannot report to work, medical staff will inform the detail supervisor that the inmate will be given a medical idle status. An appointment pass will be given to the inmate, who will then give the pass to his Detail Supervisor or Unit Officer during an open move. The supervisor will ensure the inmate is allowed sufficient time to reach Health Services for the appointment. Upon completion of the Sick Call visit or patient encounter, the inmate is to return directly to his job assignment or housing unit, as appropriate.
If given an idle or convalescent status, Health Services staff will enter the duty status on SENTRY. The inmate will be responsible for taking one copy of the slip to the Unit Officer and Detail Supervisor.
EMERGENCY SICK CALL REQUESTS
Individuals who become sick or injured after routine Sick Call, on weekends, holidays, or evenings, should request their Unit Officer or Detail Supervisor to call the Health Services Department to report the Sick Call emergency to the staff nurse. The staff nurse will screen the call for triage. It is the clinical staff’s determination whether an inmate needs to be seen immediately or a follow up appointment may be made.
Pill Lines for the FCI are:
7:00 a.m. to 7:30 a.m. – Insulin dependent Diabetic inmates and general population inmates, routine prescriptions, and refills.
After clear p.m. count – Insulin dependent Diabetic inmates, and general population inmates, routine prescriptions, and refills. A medication refill form must be submitted during pill line to obtain medication refills
Medications will be dispensed by prescription only at the pill lines.
Inmates will be allowed to purchase recommended OTC medicine from Commissary on any day, regardless of their commissary day. If you have sufficient funds in your account, you will be referred to Commissary to purchase most over-the-counter medications. Only indigent inmates will be provided OTC medications from the Health Services. Indigent inmates may request OTC medication from Health Services at 7:00 a.m. Wednesday and pick up at the 7:00 a.m. pill line on the following Friday. Refills may be picked up at the pill lines. Prescription pick-up will be allowed daily at the same pill line times. Any inmate being evaluated for a medical problem may be given any necessary prescriptions at the time of his appointment or triage, if indicated. All inmates must show their Commissary ID card to pick up medication at the Pharmacy.
PHYSICAL EXAMINATIONS AND INITIAL HEALTH STATUS ASSESSMENT Intake Screening – This will be conducted for each newly committed inmate, as well as any inmate in holdover status, upon arrival at FCI Manchester. Inmates are screened for conditions such as any urgent medical or mental health care needs, restrictions on temporary work assignments, infectious disease, and lice infestation. Lice-infested inmates shall undergo appropriate delousing procedures prior to transfer to regular housing.
Complete Physical Examination – Health Services staff shall conduct a complete health status examination on each individual in custody within 14 days of admission. This policy applies to any sentenced inmate at an institution to which he has been designated, unless Health Services staff have already completed a health status examination at a previous institution and it is documented as such.
Diagnostic procedures will only be performed as part of a physical examination, when clinically indicated. A PPD skin test is performed within two (2) working days after arrival. The PPD tests for detection of Tuberculosis and is mandatory procedure for the protection of the patient, as well as other inmates and staff.
Diagnostic procedures for other communicable diseases shall be performed at the discretion of the physician based upon clinical or historical presentation. Any inmate who refuses such diagnostic procedures shall be segregated from the general population for an appropriate clinical period of time to be determined by the Health Services staff.
For an inmate who has transferred from another Bureau of Prisons facility, Health Services staff do not need to conduct a second complete initial physical assessment, if the inmate does not present any medical problems and has already had a complete health assessment.
10. HEALTH PROMOTION/DISEASE PREVENTION – INMATE WELLNESS PROGRAM All inmates are screened for chronic illnesses and high risk factors upon their arrival to this facility. Those inmates identified as having a chronic illness or at high risk for developing a serious illness will be placed on a “Chronic Clinic List.” Their condition will be followed and monitored by Clinicians.
There are other various programs available to inmates through the Recreation Department, such as a “Walking Club,” “Fit for Life Group,” and several other organized recreational activities. Contact the Recreation staff for more information.
Also available through the Health Services Department are several patient education videos, HIV/AIDS counseling services, and informational counseling sessions on current selected health topics and nutritional counseling.
An inmate may request a pre-release medical evaluation, if he has not received one within one year prior to his expected date of release. Release physicals should be conducted within two months prior to release. To request a pre-release exam, the inmate will complete and submit a cop-out (Inmate Request to Staff). Risk factor based preventive health examinations (e.g. cancer screening) are available for the inmate population. This needs to be discussed with individual clinical provider. Periodic preventive care visits will be available every three years for sentenced inmates under age 50, and every year for age 50 and older.
IMMUNIZATIONS/VACCINATIONS – The Bureau of Prisons follows the recommendations of the Infectious Disease Technical Reference Manual and the Centers for Disease Control (CDC) for immunization schedules and doses. Various vaccinations against diseases are available to inmates, such as tetanus, Hepatitis B, influenza, and pneumococcal pneumonia. Vaccines and other immunizations may be given to inmates determined necessary by Health Services Staff. All inmates are tested on admission for tuberculosis, and yearly thereafter. Health Services staff shall maintain immunization records and may provide inmates with records of immunizations upon request.[/wptabcontent]
[wptabtitle]INFECTIOUS DISEASES AND HIV (AIDS) TESTING POLICIES[/wptabtitle]
HIV testing is available to all inmates who request a test to be done. It will be limited to one test per twelve month period. However, HIV tests are required in certain circumstances as follows:
After examination by clinical staff, who have ordered testing based on their medical judgement due to certain related medical conditions.
Those inmates selected as part of the Bureau’s annual random HIV sampling survey are required to have the HIV test.
Following an exposure incident. Exposure means specific eye, mouth, or other mucus membrane, non-intact skin or contact with blood or other body fluids.
SEXUALLY TRANSMITTED DISEASE (STD) BOOKLET
During A&O inmates will receive a copy of the STD booklet to review either before or after the infectious disease video. Inmates will again, receive this STD booklet prior to their release. The titles of the booklets are: “Sexually Transmitted Diseases – Questions and Answers as You Enter This Correctional Facility”, and “Sexually Transmitted Diseases – Questions and Answers for When You Return to the Community”.
PROCEDURE FOR GETTING RESULTS OF DIAGNOSTIC TESTS (LABORATORY, X-RAYS, MRI’S, C/T SCANS, ETC)
You will be placed on call-out to review and discuss any significantly abnormal test results. You will not be placed on call-out to review and discuss NORMAL test results; however, you may report to Sick Call and be given an appointment to review the results of completed diagnostic tests. If you want a copy of the test results, you should submit an Inmate Request to Staff Member to Medical Records for the specific test results you want.
IDLES, CONVALESCENT, AND MEDICALLY UNASSIGNED STATUS
Occasionally, it is necessary to restrict an inmate’s work and activities for health reasons. The following categories are used:
Medical Idle/Quarters – The patient is required to stay in their cubicle or room, leaving the area only for meals, bathroom, required pill lines, count, visits, and scheduled religious services. All other areas and activities are restricted. Absolutely no recreational activity is permitted.
Medical Convalescence – This patient is not required to work, but must remain in the housing unit during their normal working hours, except for medications, meals, visits, and scheduled religious services. Recovery period for operation or injury normally does not exceed 14 days. Absolutely no recreational activity is allowed.
Medically Unassigned – is a recovery period for post-operations or injuries, normally not to exceed 30 days with full institution privileges. Recreational activity may or may not be allowed, depending on the attending clinician.
Light Duty – the inmate is restricted from certain types of work or work areas due to medical limitations. Restrictions will be specific. When placed on restricted duty, the medical staff will provide the work detail, unit staff, and Control Center staff with copies of the status report.
The institution is required by policy to provide inmates with properly fitting shoes. The style of shoes available is determined by staff. If you have foot problems, they are to be addressed at routine Sick Call by the mid-level practitioner(s). However, you must be aware the criteria used to determine the need for “special shoes” includes whether or not you have a valid anatomic deformity related to a birth defect or orthopedic problem. We do not authorize “special shoes” for the following reasons: 1) Callouses, 2) Blisters, or 3) Personal dislike of the regularly issued shoes (i.e. “I don’t like these shoes, they hurt my feet.”) You may also buy athletic shoes and steel-toe tennis shoes through the Commissary via Special Purchase Order. WE DO NOT ALLOW YOU TO HAVE SHOES SENT IN FROM THE OUTSIDE.
EYEGLASSES AND CONTACT LENS
You may request to see the eye doctor via Sick Call for a routine eye examination and refraction for prescription eyeglasses. There is a waiting list for inmates requesting to see the eye doctor. Clinical staff will review your request for medical necessity. Prescription glasses will be provided by the institution.
If an additional pair of eyeglasses from an outside source is desired, the following procedures must be followed:
Inmates must obtain and receive outside glasses from a specific vendor, not through family members or friends.
Inmates will submit a Request to Staff addressed to the Health Services/Medical Records. The Request to Staff must request to purchase eyeglasses from an outside vendor and to receive a copy of their eyeglass prescription. The name and address of the vendor MUST be on the Request to Staff. If the name and address is not on the Request to Staff, the request for outside eyeglasses purchase will be deferred until name and address is provided.
Health Services Staff will complete an Authorization to Receive Package or Property Form and provide the inmate with a copy of this form as well as a copy of his eyeglass prescription. Once completed, copied of these documents will be forwarded to R&D by Health Services’ Medical Records Staff.
Eyeglasses from outside vendors will not be authorized if the prescription is over one year old.
Eyeglasses cannot be more than $100.00 in value nor have any unauthorized tint. This includes transitional lenses. No Precious Metals or Stones.
The eyeglasses will be inspected through R&D and issued to the inmate through routing procedures.
The Health Services Department will not be responsible for repairs or replacement of requested eyeglasses from an outside vendor. This care and expense will be the sole responsibility of the inmate.
Reading glasses and sunglasses are available for sale in the Commissary.
Contact lenses may only be prescribed when, in the clinical judgement of a ophthalmologist, with the concurrence of the Clinical Director. When an eye refractive error is best treated with the prescription of contact lenses, this determination also requires the approval of the Clinical Director.
ADVANCED DIRECTIVES (LIVING WILL) POLICIES
In the event you become critically ill or are hospitalized with a serious illness, you are entitled to express your wishes through advanced directives or living wills. It is a state law in Kentucky that once you enter a hospital, you are required to sign an Advanced Directive document and your wishes will be respected. If you wish to initiate any advance directives, please notify Health Information staff in the Health Services Unit.
[wptabtitle]COMPASSIONATE RELEASE PROGRAM
In the event you are found to have a terminal illness or disease, and the diagnosis is validated, and you have been given a life expectancy of less than one year, you may request to be considered for a compassionate release through the Compassionate Release Program. You should address all questions regarding this matter to the Health Services Administrator.
SMOKING CESSATION PROGRAM
FCI Manchester is a tobacco free facility. Inmates who wish to quit smoking can participate in a smoking cessation program. Nicotine replacement therapy (NRT) is available for sale in the Commissary. Inmates must first be evaluated by Health Services Staff, and Attachment A of Program Statement P1640.04, must be submitted to Commissary, prior to the purchase of NRT patches.
INMATE COPAYMENT PROGRAM
Pursuant to the Federal Prisoner Health Care Copayment Act (FHCCA) of 2000 (P.L. 106-294, 18 U.S.C. � 4048), The Federal Bureau of Prisons and FCI Manchester provide notice of the Inmate Copayment Program for health care, effective October 3, 2005.
A. Application: The Inmate Copayment Program applies to anyone in an institution under the Bureau’s jurisdiction and anyone who has been charged with or convicted of an offense against the United States, except inmates in inpatient status at a Medical Referral Center (MRC). All inmates in outpatient status at the MRCs and inmates assigned to the General Population at these facilities are subject to copay fees.
B. Health Care Visits with a Fee:
You must pay a fee of $2.00 for health care services, charged to your Inmate Commissary Account, per health/dental care visit, if you receive health care services in connection with a health care visit that you requested, except for services described in section C., below.
These requested appointments include Sick Call and after-hours requests to see a health care provider. If you ask a non-medical staff member to contact medical staff to request a medical evaluation on your behalf for a health service not listed in section C., below, you will be charged a $2.00 copay fee for that visit.
You must pay a fee of $2.00 for health care services, charged to your Inmate Commissary Account, per health care visit, if you are found responsible through the Disciplinary Hearing Process to have injured an inmate who, as a result of the injury, requires a health care visit.
C. Health Care Visits with no Fee:
We will not charge a fee for:
Health care services based on health care staff referrals;
Health care staff-approved follow-up treatment for a chronic condition;
Preventive health care services;
Diagnosis or treatment of chronic infectious diseases;
Mental health care; or
Substance abuse treatment.
If a health care provider orders or approves any of the following, we will also not charge a fee for:
Blood pressure monitoring;
Chronic care clinics;
Wound Care; or
Your health care provider will determine if the type of appointment scheduled is subject to a copay fee.
An indigent inmate is an inmate who has not had a trust fund account balance of $6.00 for the past 30 days.
If you are considered indigent, you will not have the copay fee deducted from your Inmate Commissary Account.
If you are NOT indigent, but you do not have sufficient funds to make the copay fee on the date of the appointment, a debt will be established by TRUFACS, and the amount will be deducted as funds are deposited into your Inmate Commissary Account.
E. Complaints: You may seek review of issues related to health service fees through the Bureau’s Administrative Remedy Program (see 28 CFR part 542).