Current through Register Vol. 51, No. 6, December 1, 2024
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
15A.210 requires the Department of Juvenile
Justice to promulgate administrative regulations governing the operation of
juvenile detention centers and juvenile holding facilities, including medical
and health services. This administrative regulation governs medical and health
care services at juvenile detention centers and juvenile holding
facilities.
Section 1.
(1) Medical treatment and services, including
emergency psychiatric and dental matters involving medical judgment shall be
the sole province of the responsible physician and dentist, respectively.
Security regulations that are applicable to the facility personnel shall also
apply to health personnel.
(2) The
facility shall issue and enforce written policies and procedures which:
(a) Specify the provision of emergency mental
health services for juveniles in need of the services including services
provided by qualified mental health professionals who meet educational and
licensure or certification criteria specified by their respective professional
disciplines, such as psychiatry, psychology, psychiatric nursing and social
work;
(b) Govern the relationship
between the responsible physician and physicians in private practice working in
the facility;
(c) Require that
first aid kits shall be available. The responsible physician shall approve the
contents, number, location and procedure for periodic inspection of the
kits;
(d) Provide for medical
examination of any employee or juvenile suspected of a communicable
disease;
(e) Require medical
screening to be performed by health-trained staff or qualified health care
personnel on all juveniles, including intrasystem transfers, upon arrival at
the facility. All findings shall be recorded on a printed screening form
approved by the Department of Juvenile Justice;
(f) Ensure that juveniles shall be informed
orally and in writing of the procedures required for gaining access to medical
services;
(g) Provide for the
prompt notification of a juvenile's parent or guardian and the responsible
agency if serious illness, surgery, injury or death;
(h) Provide that youth care staff and other
personnel are trained to respond to health-related situations within a four (4)
minute response time. A training program shall be established by the
responsible health authority in cooperation with the facility administrator,
which 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. Methods of obtaining assistance;
4. Signs and symptoms of mental illness,
retardation and chemical dependency; and
5. Procedures for patient transfers to
appropriate medical facilities or health care providers;
(i) Provide that emergency dental care is
made available to each juvenile under the direction and supervision of a
dentist licensed in the state;
(j)
Provide for screening, and referral for care for mentally ill or retarded
juveniles. The responsible physician shall have designated, in advance,
specific referral sources;
(k)
Ensure a special program for juveniles requiring close medical supervision. A
physician shall develop a written medical treatment plan for each of these
patients that includes directions to medical and nonmedical personnel regarding
their roles in the care and supervision of these patients;
(l) Provide that juveniles in need of
detoxification for chemical impairment shall not be admitted to the facility,
but shall be referred for appropriate medical care;
(m) Provide for the proper management of
pharmaceuticals and address the following subjects:
1. A formulary specifically developed for the
facility;
2. Prescription practices
that require that:
a. Psychotropic medications
are prescribed only if clinically indicated as one (1) facet of a program of
therapy;
b. "Stop order" time
periods shall be required for all medications; and
c. The prescribing provider reevaluates a
prescription before its renewal;
3. Dispensing of medicine in conformance with
appropriate state and federal law;
4. Administration of medication, which shall
be carried out by persons properly trained and under the supervision of the
health authority and facility administrator or designee;
5. Accountability for administering or
distributing medications in a timely manner, according to physician
orders;
6. Procedures for
medication receipt, storage, dispensing and administration or
distribution;
7. Maximum security
storage and periodic inventory of all controlled substances, syringes and
needles;
(n) Uphold the
principle of confidentiality of the health record and support these
requirements:
1. The active health record
shall be maintained separately from the confinement record;
2. Access to the health record shall be
controlled by the health authority; and
3. The health authority shall share with the
facility administrator information regarding a juvenile's medical management,
security and ability to participate in programs;
(o) Provide that if a juvenile is in need of
hospitalization, a staff member or a designee approved by the court accompanies
him and stays with the juvenile at least during admission;
(p) Provide that all informed consent
standards in the jurisdiction shall be observed and documented for medical
care. The informed consent of parent, guardian or legal custodian applies if
required by law. If health care is rendered against the patient's will, it
shall be in accord with state and federal laws and regulations.
(3) Written health care policy and
procedures shall be approved by the responsible physician or medical
administrator.
(4) The specific
duties of qualified medical personnel shall be governed by written job
descriptions approved by the responsible physician and the facility
administrator.
(5) Treatment by
health care personnel other than a physician, dentist, psychologist,
optometrist, podiatrist or other independent providers shall be performed
pursuant to written standing or direct orders given by personnel who, by law,
may give the orders. Nurse practitioners and physician's assistants may
practice within the limits of applicable laws and regulations.
(6) Arrangements shall be made with health
care specialists in advance of need.
(7) A written agreement shall exist between
the facility administration and a nearby hospital for all medical services
which cannot be provided within the facility.
(8) Appropriate state and federal licensure,
certification or registration requirements and restrictions apply to personnel
who provide health care services to juveniles. Verification of current
credentials and job descriptions shall be on file in the facility.
(9) If medical services are delivered in the
facility or through contract services, adequate space, equipment, supplies and
materials, as determined by the responsible physician, shall be provided for
the performance of primary health care delivery.
(10) Program staff shall be informed of
juveniles' special medical problems. When a juvenile is admitted, staff shall
be informed of any physical problems that might require medical
attention.
(11) The facility shall
issue and enforce written policy and procedure for the collection and recording
of health appraisal data which requires that:
(a) The process shall be completed in a
uniform manner as determined by the health authority;
(b) Health history and vital signs shall be
collected by health-trained or qualified health personnel; and
(c) Collection of all other health appraisal
data shall be performed only by qualified health personnel.
(12) Juveniles' medical complaints
shall be monitored and responded to by medically trained personnel.
(13) Sick call for nonemergency medical
service, conducted by a physician or other qualified medical personnel, shall
be available to each juvenile at least once per week.
(14) If sick call is not conducted by a
physician, a physician shall be available once each week to respond to juvenile
complaints regarding service they did or did not receive from other health
personnel.
(15) The facility
administration shall provide access to twenty-four (24) hour emergency medical
and dental care as outlined in a written plan which includes:
(a) Arrangements for the emergency evacuation
of the juvenile from the facility;
(b) Arrangements for the use of an emergency
medical vehicle;
(c) Arrangements
for the use of one (1) or more designated hospital emergency rooms or other
appropriate health facilities; and
(d) Arrangements for emergency on-call
physician and dental services if the emergency health facility is not located
in a nearby community.
(16) Medical maintenance shall be provided to
juveniles of the facility if medically indicated by written medical
order.
(17) The person
administering medications shall:
(a) Have
received training from a responsible physician and the official responsible for
the facility;
(b) Be accountable
for administering medications according to orders; and
(c) Record the administration of medications
in a manner and on a form approved by a responsible physician.
(18) Stimulants, tranquilizers and
psychotropic drugs requiring intramuscular administration shall be prescribed
only by a physician, following a physical examination of the juvenile by the
physician, and shall be administered by a physician or registered nurse. Drugs
and medications, including stimulants, tranquilizers, and psychotropics,
usually administered by parents may be administered to juveniles by facility
staff pursuant to a physician's prescription.
(19) Under no circumstances shall a
stimulant, tranquilizer or psychotropic drug be administered for purposes of
program management and control, or for purposes of experimentation and
research.
(20) The facility shall
have a written policy involving the location of the health record file. The
health record file shall contain the following:
(a) The completed receiving screening
form;
(b) Health appraisal data
forms;
(c) All findings, diagnoses,
treatments, disposition;
(d)
Prescribed medications and their administration;
(e) Laboratory, x-ray and diagnostic
studies;
(f) Signature and title of
documentor;
(g) Consent and refusal
forms;
(h) Release of information
forms;
(i) Place, date and time of
health encounters;
(j) Health
service reports, e.g., dental, mental health and consultations;
(k) Treatment plan, including nursing care
plan;
(l) Progress reports;
and
(m) Discharge summary of
hospitalization and other termination summaries.
The method of recording entries in the records, the form and
format of the records, and the procedures for their maintenance and safekeeping
shall be approved by the Department of Juvenile Justice.
(21) Programs and training shall
be provided for the development of sound habits and practices regarding
personal hygiene.
(22) For
juveniles being transferred to other facilities, summaries or copies of the
medical history record shall be forwarded to the receiving facility prior to or
at arrival.
(23) Written policy
shall prohibit the use of juveniles for medical, pharmaceutical or cosmetic
experiments. This policy shall not preclude individual treatment of a juvenile
based on his need for a specific medical procedure that is not generally
available.
(24) The facility may
seek reimbursement for medical care from the parent, person exercising similar
custodial control, the state or any other party who may be financially
responsible.