§ 950-1-12-.23. Health Care
(1) RESPONSIBLE AUTHORITY
(a) Written Policy, Procedure, and practice shallprovide that the OATP program has a designated Health Authority with responsibility for Health Care pursuant to a written agreement, contract, or job description. The Health Authority may be a physician, health administrator, or a health Agency. When the authority is other than a physician, final judgment rest with a physician.
(b) Written Policy, Procedure, and practice provide that the Health Authority meets with the program administrator and submits annual statistical summaries and reports on the health care delivery system and health environment.
(2) UNIMPEDED ACCESS TO CARE
(a) Written Policy, Procedure, and practice provide for unimpeded access to Health Care and for a system for processing complaints regarding Health Care. These policies are communicated orally and in writing to juveniles on arrival in the Program and are put in a language clearly understood by each juvenile.
(3) SICK CALL
(a) Sick call for non-emergency medical services, conducted by a physician and/or other qualified medical personnel is available to each juvenile as follows:
1. Facilities of less than 50 juveniles hold sick call once per week at a minimum.
2. Facilities of 50 to 200 juveniles hold sick call at least three times per week.
(b) When sick call is not conducted by a physician, a physician is available once each week to respond to juvenile complaints regarding services that they did or did not receive from other Health Care Personnel.
(c) The specific duties of qualified medical personnel are governed by written job descriptions approved by the Responsible Physician and the program administrator.
(d) In facilities housing females obstetrical, gynecological, family planning, and health education services are provided.
(4) HEALTH TRAINED STAFF MEMBER
(a) Written Policy, Procedure, and practice, approved by the appropriate mental health authority, shall provide for all activities carried out by mental health services personnel.
(a) Written Policy, Procedure, and practice shallprovide for the proper management of pharmaceuticals and address the following subjects:
1. A formulary specifically developed for the Program prescription practices that requires
(i) Prescription, practices, including requirements that psycho tropic medications are prescribed only when clinically indicated as one facet of a program of therapy
(ii) "Stop Order" time periods for all medications
(iii) The prescribing provider to reevaluate a prescription prior to its renewal
2. Procedures for medication receipt, storage, dispensing, and its administration or distribution
3. Maximum security storage and periodic inventory of all controlled substances, syringes, and needles
4. Dispensing of medicine in conformance with appropriate federal and state laws.
5. Administration of medication by persons properly trained and under the supervision of the Health Authority and program administrator or designee.
6. Accountability for administering and distributing medications in a timely manner and according to physicians order.
(b) The person administering medications has Training from the Responsible Physician and the official responsible for the Program, and records the administration of medications in a manner and on a form approved by the Responsible Physician.
(6) HEALTH SCREENINGS AND EXAMINATIONS
(a) Written policy, procedure, and practice shallrequire that all juveniles receive written medical clearance from a health authority prior to participation in the program.
(b) Written Policy, Procedure, and practice shallrequire medical, dental, and mental health screening to be performed by health trained or qualified Health Care Personnel on all juveniles' arrival at the Program. All findings are recorded on a form approved by the Health Authority. The screening form shall include at least the following:
1. Inquiry into:
(i) Dental problems
(ii) Whether the juvenile is presently on medication
(iii) Use of alcohol and other drugs, which includes types of drugs used, mode of use, amounts used, frequency used, date or time of last use, and a history of problems that may have occurred after ceasing use (e.g. convulsions)
2. Observations of:
(i) Behavior, which includes state of consciousness, mental status, appearance, conduct, tremor, and sweating
(ii) Body deformities, ease of movement, etc.
(iii) Condition of skin, including trauma markings, bruises, lesions, rashes, infestations, and needle marks or other indications of drug abuse
3. Medical classification of juvenile:
(i) General population
(ii) General population with appropriate referral to health care service
(c) Written Policy, Procedure, and practice should provide for the collection and recording of health appraisal data and require the following:
1. Health history and vital signs are collected by health trained or qualified health personnel
2. Review of the results of the medical examination, tests, and identification of problems is performed by a physician
3. Collection of all other health appraisal data is performed only by qualified health personnel
(d) Program staff shall be informed in writing of juveniles' special medical problems. At the time of Admission, staff are informed of any physical problems that might require medical attention.
(7) DENTAL SCREENINGS AND EXAMINATIONS
(a) Dental care is provided to each juvenile under the direction and supervision of a dentist licensed in the state. This care includes the following:
1. Dental examinations within seven days, if indicated
2. Dental treatment, not limited to extractions, when the health of the juvenile would otherwise be adversely affected
(8) EMERGENCY CARE
(a) Written Policy, Procedure, and practice shallprovide for 24 hour emergency medical, dental, and mental health care availability as outlined in a written plan. The plan includes arrangements for the following:
1. Emergency First Aid and crisis intervention
2. Emergency evacuation of the juvenile from the program
3. Use of an emergency medical vehicle
4. Use of one or more designated hospital emergency rooms or other appropriate health facilities
5. Emergency access to physicians, dentists and mental health professionals
6. Security procedures providing for juveniles transfer (transport) during emergency medical situations.
(9) FIRST AID
(a) Written Policy, Procedure, and practice shallprovide that line staff and other personnel are trained to respond to health related situations within a four minute response time. A Training program is established by the responsible Health Authority in cooperation with the program administrator that includes the following:
1. Recognition of signs and symptoms and knowledge of action required in potential emergency situations
2. Administration of First Aid and cardiopulmonary resuscitation (CPR)
3. Procedures of obtaining assistance
4. Procedures for patient transfers to appropriate medical facilities or health care providers
(b) There shall be at least one staff member present on each shift trained in emergency First Aid Procedures including cardiopulmonary resuscitation (CPR).
(c) Written Policy, Procedure and practice shallrequire that First Aid kit(s) are available at all activity sites. The responsible Health Authority shall approve the contents, number, location, and Procedure for periodic inspection of the kits.
(10) PREGNANCY MANAGEMENT
(a) Written Policy, Procedure, and practice provide that pregnancy management is specific as it relates to the following:
1. Pregnancy testing
2. Routine prenatal care
3. High risk prenatal care
(11) SUICIDE PREVENTION AND INTERVENTION
(a) There shall be a written suicide prevention and intervention program that is reviewed and approved by a qualified medical or mental health professional. All staff with responsibility for juvenile supervision are trained in the implementation of the Program. The Program includes specific Procedures for intake screening, identification, and supervision of suicide-prone juveniles.
(12) SERIOUS AND INFECTIOUS DISEASES
(a) Written Policy and Procedure, and practice address the management of serious and infectious diseases. These policies and procedures are updated as new information becomes available.
(13) INFORMED CONSENT
(a) Written Policy, Procedure, and practice shallprovide that all Informed Consent Standards in the jurisdiction are observed and documented for medical care. The Informed Consent of parent, guardian, or legal custodian applies, when required by law. When Health Care is rendered against the patient's will, it is in accordance with state and federal laws and regulations.
(14) NOTIFICATION OF DESIGNATED INDIVIDUALS
(a) Written Policy, Procedure, and practice shallprovide for the prompt notification of juvenile's parents/ guardians and the responsible Agency in case of serious illness, surgery, injury, and shall specify and govern the actions to be taken in the event of a juvenile's serious injury or death.
(15) HEALTH RECORD FILES
(a) The health record file of each Program resident should contain the following:
1. The completed receiving form
2. Health appraisal data forms
3. All findings, diagnosis, treatments, dispositions
4. List of prescribed medications and their administration
5. Laboratory, x-ray, and diagnostic studies
6. Consent/refusal forms
7. Release of information forms
8. Discharge summary of hospitalization or other termination summaries
(b) Written Policy, Procedure, and practice should uphold the principal of confidentiality of the health record and support the following requirements:
1. The active health record is maintained separately from the confinement record
2. The Health Authority shares with the program administrator information regarding a resident's medical management, and ability to participate in the Program(New Rule: Filed December 17, 2004; effective January 21, 2005. Amended by Alabama Administrative Monthly Volume XXXVII, Issue No. 02, November 30, 2018, eff. December 21, 2018.)
Author: Alabama Department of Youth Services, Office of Licensing and Standards
Statutory Authority: Code of Ala. 1975, §§ 44-1-27(a)(b), 44-1-24(4)(6), 38-13-4.
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