U.S. Department of Justice
Federal Bureau of Prisons

Program
Statement

OPI:
NUMBER:
DATE:
SUBJECT:

HSD/MDS
P6270.01
1/15/2005
Medical Designations
and Referral Services
for Federal Prisoners

1. PURPOSE AND SCOPE. To specify procedures and criteria for
transporting inmates who require medical care. The Central
Office Medical Designator, Office of Medical Designations and
Transportation (OMDT) makes medical designations. OMDT’s BOPNet
GroupWise address is “BOP-HSD/Medical Designations.” OMDT
assigns inmates to Medical Referral Centers (MRC), institutions
with resources, or non-Bureau community contract care resources.
The Medical Designator makes designations, referrals, and denials
based on:
!
!
!
!
!
!
!

Urgency of need;
Cost-effectiveness;
Bureau institution capabilities;
Expected service period, including recuperation;
Current bed space availability;
Security; and
Consultation with Bureau of Prisons (Bureau) physicians at
the sending and receiving institutions.

2. PROGRAM OBJECTIVES.
are:

The expected results of this program

a. Timely and appropriate health care will be given for
Federal inmates using Bureau medical, financial, and
transportation resources efficiently.
b. Timely health care will be provided at the most appropriate
location (MRC vs. institution vs. community hospital).
3.

DIRECTIVES REFERENCED
P4100.04
P5100.07

BOP Acquisitions (5/19/04)
Security Designation and Custody Classification
Manual (9/3/99)

P6270.01
1/15/2005
Page 2
P5180.04
P5212.07
P5538.04
P6010.02
P6031.01
P6090.01
4.

Central Inmate Monitoring Operations Manual
(8/16/96)
Control Unit Programs (2/20/01)
Escorted Trips (12/23/96)
Health Services Administration (1/15/05)
Patient Care (1/15/05)
Health Information Management (1/15/05)

STANDARDS REFERENCED

a. Medical Guidelines for Air Travel. Aerospace Medical
Association, Air Transport Medicine Committee, Alexandria, VA.
Aviation, Space and Environmental Medicine, Vol. 67, No. 10, II,
October 1996
b. American Correctional Association 4th Edition Standards for
Adult Correctional Institutions: 4-4348, 4-4349, 4-4351(M),
4-4399, 4-4404, and 4-4414
c. American Correctional Association 3rd Standards for Adult
Local Detention Facilities: 3-ALDF-4E-08, 3-ALDF-4E-30,
3-ALDF-4E-31, and 3-ALDF-4E-48
5.
DESIGNATION CONSIDERATIONS. The OMDT considers the
following issues when designating inmates for medical, surgical,
or psychiatric care.
a. Length of Stay. Most institutions will be able to locally
manage hospitalizations between five and 10 days for a surgical
procedure followed by one to three post-operation appointments.
!

Inpatient hospitalizations and follow-up procedures
which exceed these limits may be considered for an MRC
transfer.

!

Cases requiring long-term care are considered
appropriate MRC referrals.

b. Available Community Resources. OMDT will determine if
there are sufficient community resources to handle a specific
inmate or medical condition. If the community resources are not
available, then a referral should be considered.
c. Medical Resources Directory. Each institution’s HSA will
update this directory at least quarterly and/or as changes in
staffing patterns or the availability of community medical and
mental health resources occur.

P6270.01
1/15/2005
Page 3
!

These changes will be reported on the Revised Medical
Resources Directory, SENTRY form (EMS-206.060), and
forwarded as a BOPNet GroupWise attachment to the OMDT
quarterly.

d. Medical Risk in Transport. Under no circumstances will
inmates be transported who are not in stable condition. Acutely
ill inmates must be truly stable before transport to an MRC and
the Clinical Director must certify the inmate is stable for
medical transport. Generally, the following conditions will not
be considered for transport on the Bureau/U.S. Marshal’s Service
(USMS) airlift:
!

Unstable cardiac conditions;

!

Severe chronic obstructive pulmonary disease;

!

Pregnancy in the third trimester and those with a
history of spontaneous abortion (Exception:
authorization by an obstetrician given within 72 hours
of departure allowing air travel by direct transport
without holdover stops);

!

Acute psychosis;

!

Symptomatic sickle cell disease or previous history of
attacks with air transportation (SMD data regarding
sickle cell disease and sickle cell trait will place a
medical alert in SENTRY. Required sickle cell
documentation must be completed by the physician and a
copy attached to the Medical Summary of Federal
Prisoner/Alien In Transit form (BP-S659.060) (available
on BOPDOCS);

!

Inmates who require respiratory equipment, including
oxygen;

!

Inmates who have a history of myocardial infarction
with restricted ambulation and/or suffers from angina
with slight or moderate exertion;

!

Any inmate who is unable to walk;

!

Any dental appliance or dental wear which prevents the
mouth from opening; and

!

Hemoglobin must be at least Hgb 9gm/dL or above. If no
current laboratory information is available, travel
will be by ground transportation only.

P6270.01
1/15/2005
Page 4
e. Co-morbidities. The mere presence of multiple chronic
medical conditions are in themselves not sufficient to justify an
MRC transfer. When making a referral, the primary diagnosis and
reason for referral (e.g. surgery, chemotherapy, hospice care)
should be identified.
!

Secondary diagnoses should be noted to the extent they
will become part of the treatment regimen or are
important in understanding the primary diagnosis.

f. Case Management. When there are specific case management
reasons for transferring an inmate with medical problems (e.g.
Central Inmate Monitoring considerations, court-ordered
evaluation or treatment, mandatory participation in non-medical
programs), the circumstances must be documented.
g. Cost of Treatment. Community hospitalization may cost just
as much at an MRC as it does at the referring institution. If a
major procedure can be performed internally at an MRC, but would
have to be done externally at the referring institution, the
procedure is likely to be more cost effective at the MRC.
6. MODE OF TRANSPORTATION. An inmate’s movement to an MRC will
be done through routine transfer procedures or special
transportation depending on the inmate’s medical and
psychological condition. The Clinical Director, in consultation
with other appropriate medical/psychology staff at the referring
institution, will recommend the mode of transportation.
OMDT will determine the mode of transportation. Referring
institutions will determine appropriate correctional coverage.
(Refer to Program Statement Escorted Trips)
By virtue of an inmate's condition, medical staff may declare a
medical, surgical, or psychiatric emergency. Emergency referrals
require special transportation including:
!
!
!

air ambulance;
air charter; or
emergency-type ground transportation such as an ambulance.

If emergency air ambulance or air charter is approved, the
referring institution will:
!
!

make all charter arrangements and
notify the MRC via GroupWise with a copy to OMDT (See
Section 12).

P6270.01
1/15/2005
Page 5
Any case that can be moved via regular Bureau transit (e.g. BOP
bus, BOP/USMS airlift) cannot be declared an emergency transfer.
Inmates transferred to MRCs from the court will not receive
secondary designations. These inmates will be discharged
promptly upon completion of treatment.

7.

!

The MRC will determine the inmate is either suitable
for general population designation or for continuance
of medical treatment at another MRC.

!

Upon completing the court-ordered evaluation or
treatment, the MRC will request an appropriate level
institution be re-designated for the inmate.

TYPES OF MEDICAL DESIGNATIONS

a. Initial Designations. Initial designations are made for
inmates who have recently been sentenced by the Court. Inmates
with an acute medical/psychiatric problem(s), or those with
chronic care requirements, are referred by a Community
Corrections Office to the Medical Designator for an initial
designation. Regional Designators designate institutions for
inmates without medical issues.
The following information must be considered before making an
initial medical designation:
!
!
!
!
!

the inmate’s medical needs;
the inmate’s security needs;
proximity to the inmate's home;
transportation requirements; and
recommendations made by the sentencing judge.

OMDT may designate an MRC for these inmates or return the case
to the Regional Designator for placement in an appropriate level
institution. Long-Term Detainee (LTD) cases should be returned
to the Detention Services Branch, Correctional Programs Division,
Central Office.
b. Re-designation. Re-designations are initiated for inmates
with an acute medical, surgical, or psychiatric condition, or for
those inmates who have chronic care needs that cannot be
addressed at the parent institution.
!

Inmates are referred to the Medical Designator for
placement at one of the MRCs or for authorization to be
treated locally.

P6270.01
1/15/2005
Page 6
Most acute care requiring hospitalization of the inmate will be
provided in a community hospital near the institution.
Institutions may request an inmate’s transfer to an MRC for
health care when, in the Clinical Director's opinion, the
transfer will not result in a serious risk or adverse affect on
the inmate. Other considerations include:
!
!
!
!

8.

Prognosis for continued long-term treatment and
rehabilitation;
Treatment required is not available in the local
community;
The institution lacks the health care resources to
provide the necessary follow-up treatment; and
There are overriding case management and/or security
needs for the transfer.

TYPES OF MEDICAL RE-DESIGNATION

a. Routine. A routine transfer is initiated for medical,
surgical, or psychiatric treatment that is not an emergency and
time en route is not a major factor. Routine transfers may
travel by any available means.
b. Routine Urgent. A routine urgent transfer is initiated for
medical, surgical, or psychiatric treatment that is not an
emergency and must be transported directly to an MRC, typically
within two to three weeks upon designation.
!

Routine urgent transfers require direct transfer to the
MRC because of the acuity of their medical, surgical,
or psychiatric condition, or because MRC-based services
need to be initiated within an appropriate time frame.

!

Holdover status at a county jail or Bureau general
population institution is not permissible.

c. Emergency. An emergency transfer is a medical, surgical,
or psychiatric situation determined by medical/mental health
staff that requires immediate, direct transportation. This
includes inmates who are not medically or psychiatrically capable
of transport via routine Bureau air/surface transportation, e.g.,
bus, commercial air, or USMS/Bureau airlift.
!

Direct transportation is defined as air ambulance, air
charter, or ground ambulance and, in some instances, an
institution vehicle may be acceptable.

P6270.01
1/15/2005
Page 7
9. PROCEDURES FOR INITIATING A REQUEST FOR MEDICAL REDESIGNATION. All transfer requests for medical, surgical, or
psychiatric designations will be done via BOPNet GroupWise on the
Medical/Surgical and Psychiatric Referral Request form (BP-S770)
available on BOPDOCS. These procedures also apply to privately
operated facilities.
!

The BP-S770 serves as the designation, transportation, and
security worksheet from which the actual designation is
made.

!

It will also serve as the emergency referral request form
and is used to document the inmate's condition and the
reason for transfer.

!

The determination as to whether an inmate is transferred
depends on the BP-S770 being completed thoroughly.

The referring physician and HSA will document all essential
medical, surgical, or psychiatric information on the BP-S770 to
help OMDT and the receiving MRC process emergency transfers.
!

The CD, with input from other providers involved with the
inmate’s care (e.g. mid-level providers, psychologists,
consultant physicians), is responsible for initiating the
BP-S770. The HSA will review and complete the BP-S770.

!

The referring institution Warden must review the BP-S770 and
authorize the request for transfer.

The Medical Designator will review each request for redesignation and approve or deny the requested transfer. Based on
clinical information and in consultation with the Medical
Director, the Medical Designator may change the urgency of the
request.
If an inmate is approved for medical re-designation, the Medical
Designator will select the most appropriate MRC based on the
following:
!
!
!
!

the inmate’s medical needs;
his/her security/custody level;
CIMS considerations (e.g. separatees); and
MRC bed space availability.

a. Emergency Referrals. The Medical Director will make
designations with the receiving Warden’s concurrence. Emergency
cases will be referred to the most appropriate MRC based on:

P6270.01
1/15/2005
Page 8
!
!
!
!

the medical resources available;
proximity to the sending institution;
security/custody needs; and
bed space availability.

OMDT will review the recommended mode of transportation on the
BP-S770. The mode of transportation and referral type may be
modified after consultation with the referring Clinical Director
and the receiving MRC. The Clinical Director at the referring
institution will determine the type of health care provider, if
necessary, to act as medical escort staff.
!

OMDT will send all approvals or denials for transfer
via BOPNet GroupWise to the referring institution. If
approved, OMDT will prepare a Transportation
Authorization and route it via BOPNet GroupWise to the
originator and to the receiving MRC.

!

The Medical Designator will verify all transfers and
authorize the use of appropriate funds.

!

The referring institution is responsible for all trip
arrangements including any necessary durable medical
equipment required as well as custodial and medical
escort staff.

b. After Hour/Weekend Emergency Transfers. Except for
privately operated facilities, emergency transfers after hours
and weekends will be Warden-to-Warden transfers. The
transferring Warden or designee will notify the Medical
Designator and Medical Director the next working day. Privately
operated facilities will contact OMDT.
c. Long-Term Detainee Procedures (LTD). Procedures in this
Program Statement apply to LTDs, including Mariel Cuban
detainees, who are designated to the BOP at the request of the
Bureau of Immigration and Customs Enforcement (BICE). Designated
LTDs ordinarily are housed in general populations and participate
in institution programming. When the need for medical or mental
health treatment arises, they are managed in the same manner as
sentenced inmates.
10.

TYPES OF TRANSPORTATION USED TO EFFECT A MEDICAL TRANSFER

a. Air Ambulance. The Clinical Director must certify the
inmate is stable before a transfer. Normally, a Flight Nurse or
Physician staffs an air ambulance.

P6270.01
1/15/2005
Page 9
!

If contract medical staff are not available, the
referring institution will be responsible for assigning
medical escort staff.

!

Bureau medical staff are normally not required on these
flights.

b. Air Charter. The Clinical Director must certify the inmate
is stable before transfer. The Clinical Director at the
referring institution will determine the type of health care
provider necessary to accompany the inmate to the receiving
institution.
c. Ground Ambulance. The Clinical Director must certify the
inmate is stable before transfer. A ground ambulance may be used
to transfer inmates who are in close proximity to an MRC, e.g.
USP Leavenworth to USMCFP Springfield.
!

Emergency care while en route is normally provided by
the ambulance paramedics/EMTs.

d. Institution Vehicle. Institution vehicles may be used to
transfer inmates who are in close proximity to an MRC, e.g. USP
Leavenworth to USMCFP Springfield.
!

An institution vehicle may be used for emergency
transfers if the Clinical Director certifies this is a
safe and appropriate mode of transportation.

!

The Clinical Director at the referring institution will
determine the type of health care provider and medical
equipment necessary to accompany the inmate to the
receiving institution.

e. Commercial Air. The Warden may authorize commercial air
transportation for routine and routine urgent transfers only.
The Clinical Director must certify that the inmate’s condition is
stable.
!

Inmates for whom an MRC was designated for mental
health treatment will not be transported by commercial
air.

!

The referring Clinical Director will determine the type
of health care provider and medical equipment necessary
to accompany the inmate.

P6270.01
1/15/2005
Page 10
f. Bureau/USMS Airlift.
transfers only.

This may be used for routine

g. Bureau Bus. This may be used only for routine transfers
when it is the most efficient means of transfer.
11. GUIDELINES FOR BUREAU/USMS AIRLIFT. Routine inmate/prisoner
movement is usually accomplished via the Bureau/USMS Airlift.
A USMS-employed Flight Nurse accompanies all flights. The Flight
Nurse has the authority to exclude any inmate, including a
medically re-designated, routine level inmate, from the flight
based on:
!
!
!
!
!

information, or lack of information, presented in the
transfer packet;
evaluation of the inmate’s current condition prior to
boarding;
medical information provided on the Medical Summary of
Federal Prisoners/Aliens in Transit form (BP-S659.060);
inmate not medicated prior to transfer; and
inmates not having a seven day supply of medication.

The Clinical Director and HSA at the referring institution are
responsible for reviewing the most recent Aerospace Medical
Association Medical Guidelines for Air Travel.
12. AIR CHARTER GUIDELINES FOR REFERRING INSTITUTIONS. The use
of non-scheduled air transportation (air charter/air ambulance)
for transferring inmates will be limited to cases which cannot be
transferred by other means.
!

The Medical Designator is the only authorized approving
authority for expenditures from the Central Office airlift
fund.

The following must be completed for air charter/air ambulance
transfers.
a.

Transportation Authorization must be received from OMDT.

b. The sending institution’s HSA will contact the receiving
institution’s HSA to coordinate the details of the transfer.
c. The sending institution will make charter arrangements for
the airplane.

P6270.01
1/15/2005
Page 11
d. If not included in the contract, the sending institution
will provide:
!
!
!
!

escort personnel,
medical supplies,
necessary durable medical equipment, and
equipment for use en route.

This will include a health care provider as determined by the
Clinical Director and the appropriate number of correctional
officers.
e. The Clinical Director must certify on the BP-S659.060 that
the inmate is in stable condition and suitable for airlift.
f. The receiving institution will determine, on a case-by-case
basis, the location for the transfer of medical and custodial
responsibility.
!

If the transfer of responsibility occurs at the
airport, a health care provider from the receiving
institution will meet the plane to assume medical care
of the inmate.

!

The escorting health care provider will give an inperson verbal report to the receiving health care
provider, and transfer the inmate’s medical record,
x-ray files, medications, and medical equipment.

g. The Warden or HSA from the sending institution may be asked
to route the aircraft via another institution while traveling to
or from the receiving institution. This will use costly air
charter flights to maximum advantage.
h.

The receiving HSA must be given the following information:
!
!
!
!
!
!
!
!
!
!

name and registration number of inmate(s);
diagnosis;
expected time of arrival;
ground transportation requirements (e.g. ambulance vs.
institution vehicle, oxygen, cardiac monitor, ability
to accommodate a wheel chair or stretcher);
names of escorting staff;
type of aircraft;
registration number (tail number) of aircraft;
from whom leased;
color of aircraft;
cost;

P6270.01
1/15/2005
Page 12
!
!

are motel reservations for escorting staff required;
and
number of inmates who can be returned by aircraft.

The originating HSA will coordinate all fiscal requirements
with Financial Management at the institution.
13. MEDICAL SUMMARY OF FEDERAL PRISONERS/ALIEN IN TRANSIT FORM
(BP-S659.060). The BP-S659.060, as well as all applicable
documents described on the form, must accompany all inmates in
transit regardless of physical or mental condition or reason for
transfer.
!

Generally, the inmate’s health record, x-ray files, and
the Inmate Central File will be transported with the
inmate.

!

Tuberculosis screening must be completed prior to
transfer. Transporting officials will not accept any
inmate for transfer unless the TB clearance section of
the BP-S659.060 is completed.

The HSA is responsible for the completeness of the BP-S659.060
and ensure that each item is addressed in detail. A clinical
staff member will sign the form.
a. Requirements. In addition to general instructions, the
following specific details apply to all cases:
!

All inmate medications will be listed and instructions
for use will be written in lay terms including the
dosage, frequency, and route of administration.

!

Abbreviations will not be used when completing these
instructions on the BP-S659.060.

!

Instructions will include an expiration date, or in the
case of a chronic medication such as insulin,
directions will state clearly that the medication is to
be continued until clinically reevaluated.

b. Special Instructions. The form’s Special Instruction
Section will document clearly any specific information regarding
the inmate including;
!
!
!

suicide precautions;
psychiatric conditions;
medical care procedures to be rendered en route;

P6270.01
1/15/2005
Page 13
!
!

the criticality of certain medications; and
any information necessary for the transporting official
to provide proper care.

c. BP-S659.060 Required. No federal prisoner in transit will
leave a Bureau institution without a BP-S659.060 regardless of
the duration of stay in holdover status while en route from court
to another institution.
!

The HSA of the institution that first houses the
prisoner is responsible for preparing the BP-S659.060.

!

Each subsequent institution that houses the prisoner in
transit, and the final destination institution, will
make an entry on the BP-S659.060. This entry may be as
brief as to state that the inmate was seen in Receiving
and Discharge and had no complaints.

!

The USMS-553, Medical Summary of Prisoner/Alien in
Transit, for U.S. Marshal Service prisoners may be
utilized in lieu of the BP-S659 when prisoners are
received from the U.S. Marshals Service or JPATS
movements.

d. Court or U.S. Attorney Visits. Institutions that service
the Federal Courts by housing USMS prisoners (i.e. pretrial,
holdover, material witnesses, etc.) do not have to complete the
BP-S659.060 for inmates going to court or local U.S. Attorney
visits.
!

If the inmate has a medical condition that warrants
use of the BP-S659.060, it will be completed (i.e.
medications that must be given while the inmate is at
court).

!

Health care staff are not required to examine or
evaluate inmates returning from court, U.S. Attorney
visits, or visits with an expected same day return
unless the inmate identifies a new medical issue.

/s/
Harley G. Lappin
Director


U.S. Department of Justice
Federal Bureau of Prisons

Program
Statement

OPI:
NUMBER:
DATE:
SUBJECT:

HSD/PSY
P6340.04
1/15/2005
Psychiatric Services

1. PURPOSE AND SCOPE. To provide Psychiatric Services which
address the physical, medical, psychological, social, vocational
and rehabilitative needs of inmates in the Bureau’s custody who
suffer from mental illnesses and disorders. The Bureau provides
essential, cost-effective, high-quality, and humane diagnostic
and treatment services throughout the inmates’ incarceration.
By doing so, we strive to improve the inmates’ condition, enhance
the process of ongoing recovery and reduce the chances of
relapsing and/or re-offending. Psychiatric services provided to
inmates improves the safety and security of institutions and
communities.
!

All psychiatric services within the Bureau will be provided
in accordance with the Bureau’s overall mission, goals, and
policies, and specifically, as they are outlined in other
Program Statements on the provision of health care.

!

This Program Statement does not cover forensic services
which are covered under the Program Statement on Institution
Management of Mentally Ill Inmates.

2. PROGRAM OBJECTIVES.
are:
a.

The expected results of this program

Inmates in need of psychiatric services will be identified.

b. Essential psychiatric diagnostic and treatment services
will be available for all Bureau inmates.
c. High-quality and cost-effective psychiatric services will
be provided at all institutions where such services are rendered.

P6340.01
1/15/2005
Page 2
d. Continuity of psychiatric care during incarceration and
upon release will be enhanced.
3.

DIRECTIVES REFERENCED
P5050.46
P5070.11
P5212.07
P5270.07
P5310.12
P5310.13
P5324.05
P5566.05
P6010.01
P6027.01
P6090.01
P6270.01
P6360.01
P7331.04

4.

Compassionate Release, Procedures for
Implementation of 18 U.S.C. §§ 3582/4205 (5/19/98)
Study and Observation Report (12/31/97)
Control Unit Programs (2/20/01)
Inmate Discipline and Special Housing
Units (12/29/87)
Psychology Services Manual (8/13/93)
Mentally Ill Inmates, Institution Management of
(3/31/95)
Suicide Prevention Program (3/1/04)
Use of Force and Application of Restraints
(7/25/96)
Psychiatric Treatment and Medication,
Administrative Safeguards for (9/21/95)
Health Care Provider Credential Verifications,
Privileges and Practice Agreement Program
(1/15/05)
Health Information Management (1/15/05)
Medical Designations and Referral Services for
Federal Prisoners (1/15/05)
Pharmacy Services (1/15/05)
Pretrial Inmates (1/31/03)

STANDARDS REFERENCED

a. American Correctional Association 4th Standards for Adult
Correctional Institutions: 4-4347, 4-4368, 4-4369, 4-4370,
4-4371, 4-4372, 4-4374, 4-4376, 4-4381, 4-4382, 4-4384, 4-4392,
4-4397, 4-4399, 4-4400, 4-4401, 4-4404, 4-4405, and 4-4411
b. American Correctional Association Standards for Adult Local
Detention Facilities, 3rd Edition: 3-ALDF-4E-11, 3-ALDF-4E-12,
3-ALDF-4E-18, 3-ALDF-4E-32, 3-ALDF-4E-37, and 3-ALDF-4E-38
5.

DEFINITIONS

a. Behavior Therapy. A form of psychological treatment aimed
at modifying behavior in a direction that improves a patient’s
mental health condition. It includes specific methodology and
technology used to bring about the behavior change.

P6340.01
1/15/2005
Page 3
b. Competence to Give Informed Consent. The inmate has an
understanding of his/her diagnosis or condition, the treatment
being offered, the potential risks, benefits and side-effects of
treatment, especially serious ones, what to do in the event of
such effects, the alternatives to the treatment being offered
(including no treatment), and risks associated with the
alternatives.
c. Least Restrictive Clinical Interventions. The minimum
intervention necessary to control the situation including the use
of non-physical interventions, as well as voluntary medication,
voluntary special housing, seclusion, involuntary medications,
and restraints.
d. Mental Health Emergency. For the purposes of the potential
use of mental health seclusion or restraint, a mental health
emergency is defined as a situation in which an inmate is
suffering from a mental illness which creates an immediate threat
of:
!
!
!
!

Bodily harm toward self;
Bodily harm toward others;
Serious destruction of property which would immediately
endanger self or others; or
Serious disruption of the therapeutic milieu that
places the inmate at risk of harm by others.

For the purposes of emergency medication, a mental health
emergency includes all of the above situations, as well as a
situation in which there is an immediate risk of extreme
deterioration of functioning secondary to a psychiatric illness.
e. Mental Health Restraint. The direct application of
physical force or device(s) to an inmate without his/her
permission, to restrict his/her freedom of movement when a mental
health emergency exists.
f. Mental Health Unit. The designated part of an institution
which houses inmates with a mental health designation. This may
include units providing the following kinds of services, as
defined at the individual institution: inpatient, outpatient,
forensic, diagnostic and observation, seclusion, administrative
detention, disciplinary segregation, and other housing statuses
as defined in the institution’s policies and procedures.
g. Psychiatric Medication. Medication prescribed for the
treatment of signs or symptoms of mental disorders or illnesses.

P6340.01
1/15/2005
Page 4
h. Psychiatric Referral Center (PRC). An institution (usually
a Medical Referral Center (MRC)) which has as part of its mission
the provision of inpatient psychiatric services.
i. Seclusion. Involuntary confinement of an inmate in a
locked room when a mental health emergency exists.
6. PSYCHIATRIC SERVICES AND ORGANIZATION. Bureau Psychiatric
Services are under the direction of the BOP Chief Psychiatrist.
The Medical Director gives privileges to and supervises the BOP
Chief Psychiatrist.
Psychiatric services are delivered at PRCs and non-PRC
institutions through the services of staff and
contract/consultant psychiatrists, other mental health care
providers and allied health professionals.
a. PRCs. The Medical Director will designate the PRC’s
mission. PRCs provide a full range of psychiatric diagnostic and
treatment services consistent with their missions.
!

Psychiatric services at PRCs will be under the
direction of the institution Chief of Psychiatry. Each
Chief of Psychiatry will have a documented external
peer review at least every two years.

!

PRCs will seek and maintain accreditation by the Joint
Commission for the Accreditation of Healthcare
Organizations (JCAHO) under the appropriate behavioral
health standards.

!

PRCs will maintain accreditation by the American
Correctional Association (ACA) in accordance with the
missions the Medical Director assigned.

!

Each PRC will establish an organizational plan designed
to meet the needs of both the institution and the
Bureau. The plan is subject to the Medical Director’s
approval.

b. Other Institutions. Ordinarily, psychiatric services at
institutions other than PRCs will be under the Clinical
Director’s direction. When such institutions have more than one
psychiatrist on staff, the Warden may select a Chief of
Psychiatry with the Medical Director’s approval.

P6340.01
1/15/2005
Page 5
!

It is recommended that each institution not having a
full-time psychiatrist or regular access to
tele-psychiatry, contract for psychiatric services.

!

Inmates with severe mental illness or who are severely
developmentally disabled, will receive a mental health
evaluation and, where appropriate, will be referred for
placement in a facility or unit specifically designated
for managing this type of individual.

7. STAFFING. PRCs will have an organized medical staff subject
to medical bylaws consistent with JCAHO standards. Medical
bylaws are subject to negotiation in accordance with the Master
Agreement. Psychiatrists and licensed psychologists are eligible
for membership on the medical staff and for all privileges within
the scope of their licenses, including admitting and discharging
privileges.
!

All privileges are subject to the provisions outlined
in the Program Statement on Health Care Provider
Credential Verification, Privileges, and Practice
Agreement Program.

The roles of other staff in the psychiatric program, such as
social workers, mid-level practitioners, activity therapists,
etc., will be determined by the institution organizational plan
and approved by the Medical Director.
a. Chief Psychiatrist. The Warden will select the Chief
Psychiatrist with the Medical Director’s approval. The Medical
Director will be the privileging authority for all Chiefs of
Psychiatry. Privileging authority may be delegated to the BOP
Chief Psychiatrist.
The Chief Psychiatrist has overall responsibility for the
supervision and implementation of the psychiatric program. This
responsibility includes:
!
!
!
!

!

Supervising staff;
Overseeing contract psychiatrists;
Providing other supervisory duties as determined by the
institution’s organizational plan;
Serving as a member of the institution Pharmacy and
Therapeutics Committee, the Quality Improvement Program
Committee, and other committees as determined by the
needs of the institution and the Bureau; and
Coordinating the in-house Continuing Professional
Education (CPE) program for the psychiatrists and any
other clinical staff he/she directly supervises.

P6340.01
1/15/2005
Page 6
The Chief Psychiatrist works closely with Social Work Services,
Nursing Services, Psychology, and Correctional Services to
address issues surrounding care and treatment of inmates with
mental illnesses and disorders. He/she will be actively involved
in the education of staff in the:
!
!
!

Recognition of signs and symptoms of mental illness;
Management of the mentally ill inmate; and
Risk management issues pertaining to working with the
mentally ill.

b. Staff Psychiatrist. Mental health care will be provided by
individual professionals and/or by a multi-disciplinary team. As
a team member, the psychiatrist responsible for the psychiatric
care being provided to the inmate will provide diagnostic and
treatment services consistent with the field of psychiatry and
Bureau policy and guidelines.
!

The psychiatrist will manage those inmates with complex
psychiatric conditions directly. Complex conditions
include, but are not limited to, those requiring
multiple psychiatric medications, psychiatric illnesses
complicated by medical conditions, psychiatric symptoms
not responding to usual treatments, etc.

!

The psychiatrist will consult with, provide training
to, and mentor other team members and staff involved in
the medical care, mental health care, or supervision of
mentally ill inmates.

Psychiatrists who perform clinical services on an inpatient
psychiatric unit have responsibility for coordinating the
inmate’s psychiatric and medical care while the inmate is an
inpatient.
!

Members of the Health Services Unit may provide medical
care; however, responsibility for coordination and
continuity of medical care lies with the psychiatrist
assigned to the inmate.

8. SERVICES. The exact nature of psychiatric services available
at institutions will be based on the institution’s mission as
well as the staff and community psychiatric resources available
at the institution (including tele-psychiatry).
!

PRCs specified as forensic sites will provide forensic
evaluations pursuant to 18 U.S.C. §§ 4241 - 4247.

P6340.01
1/15/2005
Page 7
All institutions will provide the following services either
through medical and mental health care staff at the institution
or through consultation with community resources (the services
may be delivered by clinicians and staff other than
psychiatrists):
!
!
!
!
!
!
!
!

Crisis intervention;
Emergency services;
Risk assessment for acts of self-harm or harm towards
others;
Mental health screening of inmates suffering from symptoms
or behavioral disturbances indicative of possible mental
illnesses or disorders;
Detoxification from alcohol, benzodiazepines, and
barbiturates;
Diagnosis and treatment of mild to moderate mental illnesses
such as non-psychotic major depression, anxiety disorders,
or sleep disorders;
Continuation of psychiatric treatment initiated at other
institutions or prior to incarceration; and
Monitoring of inmates on psychiatric medications for sideeffects and drug interactions.

PRCs provide all services necessary to meet their mission
either on-site or through community resources. At a minimum,
this includes:
!
!

Complete diagnostic services; and
Inpatient and outpatient psychiatric treatment services for
the severely mentally ill.

9. EVALUATIONS. The Medical Director will provide guidance for
standards and formats for psychiatric evaluations.
a. Intake Screening. Staff performing intake screening will
assess and make appropriate referrals to a mental health
professional when an inmate:
!
!
!

Has a mental health designation;
Exhibits signs or symptoms consistent with a possible
mental disorder; or
Is on medication for treatment of a mental illness or
disorder.

Screening will be of sufficient detail to determine appropriate
housing for the inmate until a thorough mental health evaluation
can be completed.

P6340.01
1/15/2005
Page 8
b. Outpatient Evaluations. Institutions will have a system in
place by which inmates can be referred to a psychiatrist for a
psychiatric evaluation. At non-PRCs this will generally be
through Health Services or Psychology Services.
Inmates referred for psychiatric evaluation who have not
received a psychological/mental health evaluation within the
previous 30 days, will be seen within 14 days from the date of
referral. Inmates who have received a psychological/mental
health evaluation within the previous 30 days, will be seen in a
timely manner consistent with the inmate’s clinical needs.
!

The evaluation will be consistent with ACA standards on
mental health evaluations. Further guidance for the
content and format for psychiatric evaluations will be
provided by the Medical Director.

Inmates with a Mental Health designation who do not need
inpatient treatment or refuse admission to an inpatient unit,
will undergo a complete psychiatric evaluation by either a
psychiatrist or a licensed psychologist.
!

The psychiatric evaluation will occur within a
clinically appropriate time frame, not to exceed
14 days from arrival.

!

The evaluation will be consistent with ACA standards on
mental health evaluations. Further guidance for the
content and format for psychiatric evaluations will be
provided by the Medical Director.

Some PRCs may designate an area of the Mental Health Unit as a
“Diagnostic and Observation (D and O) Unit.” The D and O unit is
an outpatient unit with clearly established admission, transfer
and discharge criteria, reasonable time frames for completion of
psychiatric evaluations, and length of stays.
!

These criteria are subject to the Medical Director’s
approval.

!

All psychiatric treatment provided on the D and O Unit,
other than emergency treatment, will be voluntary and
with the inmate’s informed consent.

c. Inpatient Admissions. Inmates will only be admitted to an
inpatient unit after giving informed consent for admission or
under an appropriate court order (see the Program Statements on
Administrative Safeguards for Psychiatric Treatment and

P6340.01
1/15/2005
Page 9
Medication and Institution Management of Mentally Ill Inmates).
PRCs will develop and implement admission and discharge criteria
approved by the Medical Director.
(1)

Voluntary Admissions
!

The inmate will be informed of his/her rights
through the use of the Consent to Admission for
Mental Health Treatment (BP-S801) form.

!

The informed consent for admission will be in a
language understood by the inmate.

!

The completed form will be placed in the inmate’s
health record.

Inmates admitted to an inpatient unit will undergo a
psychiatric evaluation within 24 hours of admission. Either a
psychiatrist or licensed psychologist with admitting privileges
may perform this evaluation. A medical history and physical will
be performed in accordance with local policy.
(2)

Involuntary Admissions
!

Involuntary inpatient admission or treatment can
occur only with a court order under
18 U.S.C. §§ 4241 - 4247.

!

18 U.S.C. §§ 4241 - 4247 does not apply to unsentenced Bureau of Immigration and Customs
Enforcement (BICE), formerly the Immigration and
Naturalization Service, detainees, un-sentenced
prisoners in Bureau custody as a result of a court
order, and state or territorial prisoners.

!

For those persons not covered by
18 U.S.C. §§ 4241 - 4247, the decision to admit or
treat the person involuntarily must be made
through an administrative hearing in accordance
with Vitek v. Jones, 445 U.S. 480 (1980).

Pursuant to 10 U.S.C. § 876(b), military prisoners who are
incompetent to stand trial or who have been found not guilty by
reason of lack of mental responsibility may be committed to the
custody of the Attorney General and are subject to the procedures
authorized under 18 U.S.C. §§ 4241, 4243, and 4246. Similarly,
under 18 U.S.C. § 4247(j), District of Columbia Code offenders
are subject to commitment procedures specified under
§§ 4245 and 4246.

P6340.01
1/15/2005
Page 10
d. Psychiatric Evaluation for Correctional Purposes. Inmates
receiving an incident report and who are psychiatric inpatients,
or whose mental status is questionable, will be referred to a
psychiatrist or psychologist for an assessment regarding
competency and responsibility. The mental health clinician will
use the same standards that apply in establishing competency and
responsibility pursuant to 28 CFR 541.10(b)(6) (contained in the
Program Statement on Inmate Discipline and Special Housing
Units).
!

It is strongly recommended that PRCs establish separate
Special Housing Units (SHU) for inmates with mental
illnesses or disorders that are physically distinct
from the SHUs used to house general population inmates.

!

Non-PRCs are encouraged to identify a specific area in
SHU where inmates suffering from active symptoms of a
mental illness and who require SHU placement can be
housed. These inmates are at increased risk of
behaviors of self-harm or harm towards others. The
area chosen should facilitate frequent observation by
and contact with staff.

!

Whenever any inmate is transferred into a SHU, health
care staff will be informed immediately and will
provide assessment and review as indicated by local
protocols established by the local health authority.

!

A mental health professional must evaluate inmates
being referred to a control unit. Refer to the Program
Statement on Control Unit Programs for requirements and
the format of the evaluation.

10. TREATMENT. Psychiatric treatment, except in an emergency,
will begin only after a psychiatric evaluation and plan have been
completed. Inmates who have received psychiatric evaluation and
treatment services at another Bureau institution will have that
treatment continued at the new institution pending further
evaluation.
!

Further guidance on psychiatric treatment will be provided
by the Medical Director.

The timing and extent of the evaluation undertaken at the
receiving institution will depend on several factors, including:
!

Time elapsed since the last complete psychiatric evaluation;

P6340.01
1/15/2005
Page 11
!
!

The comprehensiveness of the last complete psychiatric
evaluation; and
The inmate’s clinical presentation.

Psychiatric treatment, regardless of the unit in which the inmate
resides, will be voluntary except when:
!
!

Treatment has been ordered by the court; or
A mental health emergency exists.

Pretrial inmates and inmates committed by the court can be
treated only under certain conditions and usually only after
following procedures outlined in the Program Statements on
Institution Management of Mentally Ill Inmates and Administrative
Safeguards for Psychiatric Treatment and Medication.
a. Psychiatric Medication. Except in an emergency, informed
consent will be obtained and documented prior to administering
medication for psychiatric symptoms or conditions (refer to the
Program Statement on Pharmacy Services). Ordinarily, the
prescribing physician will be responsible for obtaining the
informed consent.
Patient education for obtaining informed consent includes the
following information:
!
!
!
!
!
!
!

Symptoms of the illness;
Potential benefits of treatment;
Potential risks and side-effects (especially serious
ones);
Appropriate use of the medication;
When to notify staff of problems;
Consequences of noncompliance; and
Alternative treatments, including no treatment, and
associated risks.

The inmate’s competency to give informed consent will be
assessed and documented on the corresponding “Consent to Use
(name of medication)” form. An informed consent form will be
obtained when:
!
!
!

A psychiatric medication is prescribed for which an
informed consent has not previously been obtained;
An inmate has previously given informed consent, but
has been off the medication for at least a year;
Clinical judgment deems that a new informed consent is
appropriate because of a significant change in the
inmate’s clinical status; or

P6340.01
1/15/2005
Page 12
!

An inmate on psychiatric medication is newly committed
to the Bureau and does not have informed consent
documented on any of the standard forms noted above.

Inmates on psychiatric medication will be monitored regularly
in Chronic Care Clinics. Noncompliance should not be the
determining factor for exclusion from the Mental Health Chronic
Care Clinic. Inmates with mental illness present potentially
important risk management issues.
!

Inclusion in the Chronic Care Clinic should continue as
long as the inmate has active symptoms of mental
illness or is on psychiatric medication.

All institutions will have a system(s) in place for assuring
continuity of care for all inmates receiving psychiatric
treatment even if such treatment was started before incarceration
at the current institution.
!

Continuity of care is required from admission to
transfer or discharge from the Bureau, including
referral to community-based providers, when indicated.

!

Such a system will include monitoring compliance with
psychiatric medications and maintaining documented
informed consent in the health record.

!

At non-PRCs, timely notification of noncompliance will
be made to the Clinical Director and other relevant
mental health staff, such as the Chief of Psychology,
staff psychiatrist, or contract psychiatrist.

!

At PRCs, the treating psychiatrist and Chief
Psychiatrist will be informed of any noncompliance
issues.

b. Electroconvulsive Therapy. Electroconvulsive therapy (ECT)
will only be considered for inmates at PRCs, except in an extreme
emergency. Prior to administering any ECT, the Medical Director
must approve the procedure in writing.
!

Once it has been determined that ECT is an appropriate
treatment for the inmate and the treatment has been
approved, ECT will be performed in the community by a
qualified consultant psychiatrist privileged to
administer the treatment.

P6340.01
1/15/2005
Page 13
c. Behavior Therapy. Behavior therapy may be an appropriate
treatment for certain conditions and inmates. When this
treatment modality is used, the institution will be in compliance
with JCAHO Behavioral Health Care Standards.
!

Painful stimuli will not be used as a mental health
intervention.

d. Mental Retardation. Inmates who are considered mentally
retarded will be thoroughly evaluated for their potential
psychiatric needs. Not all inmates with mental retardation
require intensive psychiatric services.
!

Placement at PRCs will be consistent with their
clinical needs.

e. Dementia. Inmates with possible dementia will undergo a
complete psychiatric and medical evaluation. Those with
moderately severe or severe dementia should be considered for a
reduction in sentence/compassionate release. (Refer to the
Program Statement on Compassionate Release.)
!

Not all inmates with dementia will require placement at
a PRC. Designation and treatment will be consistent
with their medical and psychiatric needs.

11. EMERGENCY TREATMENT. Interventions during a mental health
emergency may include nonphysical interventions, voluntary
medication, seclusion, involuntary medication, and/or restraint.
!

The least restrictive method for controlling the situation
will be employed and documented in the inmate health record.

a. Emergency Medication. Psychiatric medication may be
administered in a mental health emergency only by order of the
physician, and if the inmate is at immediate risk of:
!
!
!
!
!

Bodily harm toward self;
Bodily harm toward others;
Serious destruction of property which would immediately
endanger self or others;
Serious disruption of the therapeutic milieu that
places the inmate at risk of harm from others; or
Extreme deterioration of functioning secondary to a
psychiatric illness.

P6340.01
1/15/2005
Page 14
Documentation of emergency medication administration will
include the following:
!
!
!
!
!

Type of emergency;
Interventions attempted and the result(s);
Reason that less restrictive interventions were not
used or were ineffective;
When, where and how the medication is to be
administered; and
Assessment and monitoring of the inmate for adverse
reactions and side-effects.

The inmate’s treatment plan will be reviewed, and, if
necessary, revised, as soon as possible.
At non-PRCs, the Clinical Director will consult with the office
of the Medical Director within 24 hours of administering
emergency medication (excluding weekends and holidays). The
Medical Director will provide guidance on further evaluation,
treatment, referral to a PRC, or other appropriate clinical
interventions.
Ordinarily, emergency treatment with psychiatric medications at
non-PRCs will not be continued for more than 72 hours without the
Medical Director’s approval.
!

Ordinarily, long-acting psychiatric medications such as
Haldol Decanoate and Prolixin Decanoate will not be
used in emergencies except at PRCs.

For guidance on emergency treatment of pretrial, pre-sentence,
and other forensic inmates, refer to the Program Statements on
Institution Management of Mentally Ill Inmates and Administrative
Safeguards for Psychiatric Treatment and Medication.
b. Seclusion. Seclusion may be an appropriate clinical
intervention during a mental health emergency. All institutions
using mental health seclusion must have an Institution Supplement
consistent with JCAHO Behavioral Health Standards.
!

The Institution Supplement will be negotiated in
accordance with the Master Agreement after approval by
the Medical Director. (Refer to the Program Statement
on Mental Health Seclusion and Restraints).

c. Restraints. Restraints may be an appropriate clinical
intervention during a mental health emergency. In many cases,
the use of restraints during a mental health emergency may be
more restrictive than the use of emergency medication.
All

P6340.01
1/15/2005
Page 15
institutions using restraints will have an Institution Supplement
consistent with JCAHO Behavioral Health Standards and ACA
standards on the use of restraints.
!

The Institution Supplement will be negotiated in
accordance with the Master Agreement after approval by
the Medical Director (see the Program Statement on
Mental Health Seclusion and Restraints).

12. DOCUMENTATION. All documentation related to psychiatric
evaluations and treatment (inpatient, outpatient, and forensic)
will be available in the inmate’s health record and the
requirements noted in the Program Statements on Patient Care and
Health Information Management will be adhered to.
!

All psychiatric diagnoses will adhere to the nomenclature
set forth in the most recent Diagnostic and Statistical
Manual of Mental Disorders.

!

All five Axes will be noted in the diagnosis section of the
evaluation.

!

The clinician performing the mental health evaluation will
be responsible for documenting Axes I, II and V on the
problem list of the inmate’s health record. When the
evaluation is completed via tele-psychiatry, or performed by
a contract psychiatrist, the physician on the inmate’s
primary care provider team will be responsible for noting
the diagnoses on the problem list.

Documentation of emergency interventions will include the
following:
!
!
!

Type of emergency;
Intervention(s) attempted and their result(s); and
Reason that less restrictive interventions were not used or
were ineffective.

If the emergency intervention includes medication, refer to
Section 11.a. If the intervention includes seclusion or
restraints, documentation will meet the requirements set forth in
the Program Statement on Mental Health Seclusion and Restraints.
!

The Medical Director will provide additional guidance
regarding documentation for psychiatric evaluation and
treatment.

P6340.01
1/15/2005
Page 16
13. EDUCATION. The Bureau will provide regular professional
training opportunities for mental health care staff consistent
with their clinical duties and responsibilities.
PRCs are encouraged to provide training for medical and allied
health care professionals, including students. They are also
encouraged to provide post-graduate training to residents and
fellows.
!

Residency programs and fellowships may be established with
the Medical Director’s approval.

/s/
Harley G. Lappin
Director