Kentucky Administrative Regulations › Title 505 - JUSTICE AND PUBLIC SAFETY CABINET - DEPARTMENT OF JUVENILE JUSTICE › Chapter 2 - Juvenile Detention Facilities › Section 505 KAR 2:110 - Medical and health care services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO: KRS 15A.210-15A.240
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.