BUREAU DIRECTIVE: BOC - 7:001

REFERENCES:

 

 

 

FMJS 7.12 and

 

 

 

7.29.04 thru 7.29.10

 

RESCINDS:

 

ALDF-4C-38-39

 

 

 

Armor J-D-02

 

BUREAU:

Corrections

NO. OF PAGES: 2

MONROE

 

 

 

CHAPTER: Medical

 

COUNTY

 

 

 

 

SHERIFF’S

 

 

 

 

 

 

OFFICE

TOPIC:

Distribution of Medication

_____________________

 

 

 

 

Sheriff of Monroe County

PURPOSE:

The purpose of this directive is to establish policy for the Monroe County Detention Facilities to regularly distribute required medication.

SCOPE:

This directive applies to all Medical Personnel and Dorm/Unit Deputies.

PERSON RESPONSIBLE:

Medical Personnel and Dorm/Unit Deputies.

DEFINITIONS:

Float Method - The nurse will float the medication in the inmate's medication cup with water. The inmate will consume same.

Crush Method - The nurse will crush the medication and place the medication in the inmate's medication cup with water. The inmate will consume same. The crush method can only be used with medication that is not affected by being crushed.

POLICY AND PROCEDURES:

Dorms

The nurse will inform the Dorm Deputy as he or she enters the dorm that he or she is there for distribution of medications. The Dorm Deputy will then announce "Medication Call" to the inmates.

The nurse will position the medication cart by the Deputy's Station or the Doorway.

Inmates will assemble at the location of the medication cart in a single file.

The nurse will check the inmate's name by utilizing the inmate's identification tag.

All inmates will take the medication in front of the nurse.

The nurse will collect the medication cups from each inmate prior to allowing them to walk away.

Units

The nurse will inform the Unit Deputy as he or she enters the unit that he or she is there for distribution of medications. The Unit Deputy will then announce "Medication Call" to the inmates.

The nurse will position the medication cart at the doorway of an exam room.

BOC - 7:001

Date of Original: Jan 1994

1

 

Previous Revision Date(s): 9/15/99, 1/10/08, 1/19/11, 7/29/13

 

Dissemination Date: 5/18/16

Effective Date: 5/25/16

 

 

 

The inmates will assemble in front of the exam room in a single file.

The nurse will check the inmate's name by utilizing the inmate's identification tag.

All inmates will take the medication in front of the nurse.

The nurse will collect the medication cups from each inmate prior to allowing them to walk away.

Unit(s) in Lock Down

The nurse will place the medication cart in an exam room.

The nurse will retrieve the medication to be passed out for one floor at a time and place it in a carry tray.

The deputy will ensure that the exam room is locked before beginning the rounds.

The deputy will escort the nurse from door to door while the nurse passes out the medication.

The nurse will observe the inmate taking the medication.

The nurse will collect the medication cups from each inmate prior to allowing them to walk away.

Over the Counter Medications Available through Commissary Division [ALDF-4C-39]

Some nonprescription medications are available through the Commissary Division. These items and access will be approved jointly by the facility administrator and the health authority and reviewed annually thereafter.

Keep on Person Over the Counter (OTC) Medications [ALDF-4C-38][Armor J-D-02]

The Marathon (KV) and Plantation Key (PK) facilities will follow the procedures and complete the documentation outlined in the “Over the Counter (OTC) Drug Administration Procedure for Corrections Officers” written directive that was issued by the Medical Division.

All correction deputies in the KV and PK facilities will receive “Keep on Person OTC Medications” in-service training by the Medical Division. The KV and PK correction deputies will not dispense any OTC drugs until they receive this training.

When issuing the OTC medication, deputies will verify that the daily medication issued to the inmate matches the daily order prescribed (ex. two (2) Tums daily prescribed, two (2) Tums given).

When the inmate is transferred from KV/PK, the KV/PK nurse will collect the unused medication.

BOC - 7:001

Date of Original: Jan 1994

2

 

Previous Revision Date(s): 9/15/99, 1/10/08, 1/19/11, 7/29/13

 

Dissemination Date: 5/18/16

Effective Date: 5/25/16

 

 

 

 

BUREAU DIRECTIVE: BOC - 7:002

REFERENCES:

 

 

 

FMJS 2.15

 

 

 

F.S. 901.35 & 951.033

 

RESCINDS:

 

ALDF-4C-02, 6A-09

 

 

 

CORE-4C-01, 6A-08

 

BUREAU:

Corrections

NO. OF PAGES: 2

MONROE

 

 

 

CHAPTER: Medical

 

COUNTY

 

 

 

 

SHERIFF’S

 

 

 

 

 

 

OFFICE

TOPIC:

Inmate Medical Fees

_____________________

 

 

 

 

Sheriff of Monroe County

PURPOSE:

The purpose of this directive is to establish policy for the Monroe County Detention Facilities that the Medical Division will provide each inmate the opportunity for medical, dental, and mental health services. Reimbursement for medical or dental services, medications, and transportation provided to the inmate may be levied against the inmates commissary account. Mental health services will not require a reimbursement. This is to offer the inmates the same right to self medicate as do individuals in the free community and choose if they need to see the medical staff. At no time will the inmate be denied access to the medical system for lack of funds. The level of medical care will be the same regardless of the ability to pay. [ALDF-6A- 09] [CORE-6A-08]

If the inmate has sufficient funds in his

commissary account to cover the reimbursement, it will be deducted. If the inmate does not have sufficient funds, the account will be debited. As money is placed in the account at a later date the debited amount will be deducted.

Inmates will have access to designated "over the counter drugs" that will be offered through the Medical and/or Commissary Divisions.

SCOPE:

This directive applies to all Medical Personnel and Inmates.

PERSON RESPONSIBLE:

All Medical Personnel.

POLICY AND PROCEDURES:

Inmates will be advised of the Inmate Medical Fee Schedule and Policy during the screening process. Also, all inmates will be given an Inmate Handbook during the admission process which advises them of all the medical co- payment fees. [ALDF-4C-02] [CORE-4C-01]

Sick Call

If the inmate is examined by the doctor, physician assistant (P.A.), or nurse, a fee will be accessed according to the Inmate Medical Fee Schedule and deducted or debited against the inmate's account.

A fee will not be assessed if the inmate is requested back for a follow-up exam of an existing condition within thirty days. [ALDF-4C- 02]

Dental

Inmates that are treated by the facility dentist will be assessed a fee according to the Inmate Medical Fee Schedule and deducted or debited

BOC - 7:002

Date of Original: 9/15/99

1

Dissemination Date: 12/12/14

Previous Revision Date(s): 1/19/11, 7/29/13

Effective Date: 12/19/14

 

 

 

 

against the inmate's account.

If the inmate is seen by the dentist and decides not to be treated, the same fee will be assessed as if the treatment had been done.

Medications

Prescription and over the counter medications will be charged against the inmate’s account. An inmate will not be denied over the counter medication received from the Medical Division or prescription medication due to lack of funds.

Over the counter medication will be available through the Medical and/or Commissary Divisions.

Non-Chargeable Services [CORE-4C-01]

Initial screening.

Follow-up treatment ordered by the Medical Division within thirty (30) days after initial problem.

VDRL or TB Tests.

Mental Health Services or Psychotropic Medications.

H.I.V. Screening, if requested by the Medical Division.

Use of Force or inmate confrontations.

Injuries other than recreational or self-inflicted.

Chronic medical care such as blood sugar monitoring or blood pressure, if ordered by the Medical Division.

Appointments or services, including follow-up appointments, are initiated by medical staff. [ALDF-4C-02]

True medical emergencies as determined by the Medical Division.

chiropractor or other outside doctor for a workman's compensation related injury, or a request comes from an insurance company for a physical exam, the inmate will be charged an $80.00 per local trip fee. This may be reimbursed by the workman's compensation insurance carrier. All outside visits will have to be approved by medical personnel. The transportation fee must be paid prior to making the appointment. All court ordered evaluations, or jail physician requests for outside evaluation, will have the fee waived.

The inmate will sign the voucher completed by the nurse when he or she has been seen by the doctor or P.A. to acknowledge receipt of treatment. If the inmate refuses to sign after seeing the doctor or dentist, the nurse and detention deputy will sign the Receipt for Health Services slip and mark that the inmate refused to sign.

The Receipt for Health Services slips will be submitted to the Commissary Clerk. This must be done without fail to assure proper deductions from the inmates' commissary accounts.

DISBURSEMENT POLICY:

A complete list containing the names of inmates being assessed fees shall be completed and submitted to the Medical Clerk, along with the Receipt for Health Services slips each day after charges are incurred.

Prior to submission of the list, the Medical Supervisor or designee shall verify the accuracy of the list.

The Medical Clerk, after verification of the charges, shall submit the Receipt for Health Services slips to the Commissary Clerk who will then expeditiously deduct each inmate's medical charge(s) from his or her account.

The Commissary Clerk will generate a check in the total amount of the inmate's liens and forward the check to Finance for deposit into the designated account.

Medical Transportation

If an inmate requests to be seen by his

BOC - 7:002

Date of Original: 9/15/99

2

Dissemination Date: 12/12/14

Previous Revision Date(s): 1/19/11, 7/29/13

Effective Date: 12/19/14

 

 

 

 

 

BUREAU DIRECTIVE: BOC - 7:003

REFERENCES:

 

 

 

FMJS 7.09 & 7.10

 

RESCINDS:

 

Consent Decree 124 & 137

 

 

 

 

 

 

 

 

BUREAU:

Corrections

NO. OF PAGES: 1

MONROE

 

 

 

CHAPTER: Medical

 

COUNTY

 

 

 

 

SHERIFF’S

 

 

 

 

 

 

OFFICE

TOPIC:

Sick Call

_____________________

 

 

 

 

Sheriff of Monroe County

PURPOSE:

The purpose of this directive is to establish policy for the Monroe County Detention Facilities to hold daily sick call, at regular hours, and it shall be conducted for all inmates. Medical will review inmate medical request slips the day the slip is completed or within twenty-four hours if the request is not urgent. Medical Personnel shall conduct screening, referrals, and providing basic treatment for ongoing or emergency health care problems.

SCOPE:

This directive applies to all Medical Personnel.

PERSON RESPONSIBLE:

Medical Supervisor.

POLICY AND PROCEDURES:

Dorms/Units

The Medical Personnel will supply a sick call list to each Dorm/Unit Deputy.

The Dorm/Unit Deputy will announce "sick Call" and the names of the inmates on the list.

Unit Lock Down

Sick call for inmates in lockdown status will be conducted daily by Medical Personnel making rounds of the Unit at the individuals’ cells.

Medical Deputy

The Medical Deputy will notify Dorm/Unit Deputy(s) to prepare inmate(s) for transport to medical.

Inmate(s) will be placed in the medical holding cell awaiting doctor’s call.

Upon completion of doctor’s call, the Medical Deputy will notify the Dorm/Unit Deputy(s) of returning inmate(s).

Sick Call for Marathon and Plantation Key

Sick call will be administered by the Shift Supervisor and the on-duty Nurse.

BOC - 7:003

Date of Original: Jan 1994

1

Dissemination Date: 9/1/00

Previous Revision Date(s): 9/15/99

Effective Date: 9/29/00

 

 

 

 

 

BUREAU DIRECTIVE: BOC - 7:004

REFERENCES:

 

 

 

FCAC 15.04, 18.05

 

 

 

FMJS 5.04 & 7.03(c), 8.07

 

RESCINDS:

 

ALDF-2A-52, 4C-33, 5A-03

 

 

 

 

 

 

 

 

BUREAU:

Corrections

NO. OF PAGES: 6

MONROE

 

 

 

 

 

 

COUNTY

CHAPTER: Medical

 

SHERIFF’S

 

 

 

 

OFFICE

 

 

 

TOPIC:

Suicide Prevention

_____________________

 

 

 

 

Sheriff of Monroe County

PURPOSE:

The purpose of this directive is to establish policy for the Monroe County Detention Facilities that All Certified Personnel will be provided special training by qualified instructors in order to observe inmates for suicide potential during intake processing and for the identification and supervision of suicide-prone inmates during their incarceration. The suicide prevention and intervention program shall be developed, reviewed, and approved by a qualified medical or mental health professional.

SCOPE:

This directive applies to all Personnel.

PERSON RESPONSIBLE:

All Personnel.

DEFINITION

Continuous Observation - means the deputy always has the inmate in sight 24 hours per day. One deputy can stand a continuous observation watch while continuously observing one or more inmates in one or more cells if there are no blind spots from where the deputy is observing.

Suicide gown - smocks/blankets

POLICY AND PROCEDURES:

NOTE: The first forty-eight (48) hours of incarceration are the most critical. Special attention must be taken during this period.

Training

All Certified Personnel will receive special training in suicide prevention provided by the Training Division during the Annual Retraining Module (ARM). Correction Deputies also receive suicide prevention training in the Field Training Program.

Additionally, the Mental Health Team will conduct at least two training sessions for all certified detention deputies on suicide and mental health issues each year.

Staff is available to counsel inmates on request. Provisions are made for counseling and crisis intervention services. [ALDF-5A-03]

Recognizing Suicide Potential during the Admissions/Classification Process

Medical screening is conducted by trained nurses or Intake Personnel in regard to the following factors:

Severe alcohol/drug dependence

BOC - 7:004

Date of Original: Jan 1994

1

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18

 

 

 

The first 24 hours of incarceration

Psychiatric potential suffering from impaired judgement

Chronic physical problems

Classification Interview - Classification Clerks shall consider inmates a suicide risk if they possess the above risk factors and state that they:

Have a history of recent or recurrent suicide attempts

Have seriously contemplated suicide in the past

Have extreme depression or impulsiveness, including feelings of hopelessness which appear to be chronic

Post Admission Indicators of Suicide Potential

Post Admission Indicators of Suicide Potential

Some inmates, during their incarceration, may begin to experience suicidal thoughts or conversations, and those who are contemplating suicide will display signs of depression.

During a suicidal crisis, most persons will display either some or all of the following signs of depression:

Sadness or crying

Withdrawal or silence

Loss or gain of appetite marked by noticeable weight gain or loss

Insomnia

Mood variation (in many cases, extreme and unexplained)

Lethargy (slowing of physical movements such as walking and talking)

Changes in behavior such as giving away personal possessions, planning a funeral, putting affairs in order, etc.

Additionally, many inmates may give a housing Dorm/Unit Deputy verbal cues that indicate a suicide crisis is impending, such as:

Projecting feelings of hopelessness and helplessness

Speaking about getting out of jail unrealistically

Not effectively dealing with the present and being preoccupied with the past

Explaining intentions to commit suicide

Increasing difficulty relating to others

Exhibiting sudden changes in behavior (e.g., makes an unprovoked attack on a deputy)

Inmates who should be observed closely for possible suicidal tendencies are, but not limited to, the following:

Older inmates (Senior Citizens)

Chronically or terminally ill inmates

Inmates recuperating from major surgery

LGBTQ or anyone subjected to sexual assault

New mothers

Incarcerated law enforcement deputies

Incarcerated professionals

Persons who have committed a crime of passion

If a deputy has reason to believe that an inmate fits any of the aforementioned profiles he or she shall:

Immediately implement crisis intervention techniques

Notify the Medical Staff

BOC - 7:004

Date of Original: Jan 1994

2

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18

 

 

 

Notify the Classification Division

Notify the Shift Supervisor

Document all information on an Incident Report

Crisis Intervention Techniques [ALDF-5A-03]

NOTE: The decision to take one's own life comes from within and it is possible for one to help change that decision by offering the inmate alternate solutions and by introducing the concept of hope.

When there is reason to believe that an inmate fits a suicide potential profile, put crisis intervention techniques into effect.

Do not judge the inmate.

Talk, listen, discuss, keep lines of communication open, and be supportive.

Ask pertinent questions; be direct.

Do not leave the inmate alone; do not isolate.

Do not give advice.

Do not dare the inmate.

Do not act shocked.

Refer for professional help.

The following are guidelines to assist in a suicide crisis:

Recognize the clues - hopelessness, haplessness, helplessness.

Trust your judgement - you have observed inmates and can recognize changes in behavior.

Stay with the potential victim - do not leave him/her alone or isolated.

Listen and be supportive.

Attempt to diffuse the tension and agitation: Inject a feeling of hope, but do not lie to the inmate.

Notify Medical and Supervisory Personnel.

Document all pertinent information on an Incident Report.

Suicide Risk Assessment/Precaution Protocols

If any individual suspects that an inmate is depressed and/or suicidal, the Medical Division shall be notified immediately. The Medical Division will assess the inmate and determine what actions need to be taken. [ALDF-5A-03] When possible, suicidal inmates should be housed with another inmate(s).

Suicidal inmates will be under continuous observation until seen by a mental health professional. Subsequent supervision routines are in accordance with what is ordered by the mental health professional. [ALDF-2A-52]

When the standard issued uniform presents a suicidal or medical risk per the Medical Division, the inmate will be supplied with a paper/cloth suicide gown and/or suicide blanket that promotes inmate safety and prevents humiliation and degradation. [ALDF-4C-33]

Any of the following levels of precaution may be recommended: [FCAC 18.05]

SUICIDE WATCH [FCAC 18.05]

This level will pertain to inmates who have actually recently attempted suicide or to inmates who are considered at high risk for suicide. The on-call psychiatrist will have been notified by the Medical Division. If necessary, efforts will be made to have the inmate committed to a mental health facility.

Safety precautions shall be taken. These precautions shall include:

o The inmate shall be under continuous observation at all times, and this shall

BOC - 7:004

Date of Original: Jan 1994

3

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18

 

 

 

be supported by documentation on the 15 Minute Watch Form at increments not to exceed 15 minutes.

oThere should be no pipes from which sheets could be hung.

oSearch of the inmate's cell and clothes for removal of all potentially harmful objects such as glass, eyeglasses, pins, pencils, pens, unauthorized items (e.g., matches, lighters), etc. Plastic bags shall be removed.

oA mattress in a boat or on a cement bed will be provided; no pillow.

oThe inmate shall be placed in a suicide prevention gown and a suicide prevention blanket provided.

oShower slides are to be left outside the cell door after they finish their shower.

o Feed on styrofoam tray. If being

transported, give bag lunch. No utensils; no staples in bag; and deputy must remove plastic wrap before giving to inmate.

oNo razors.

o Toilet paper provided only when needed.

o Inmate may shower while deputy maintains constant observation.

oToothpaste and toothbrush only during use. Deputy must remove immediately after use.

oFemales will be provided with tampon if necessary.

oNo recreation, no programs, no canteen, no visitation, no newspapers, no books, no privileges of any kind.

oCalls to attorney ONLY, and dialed by the deputy.

oIf the inmate verbalizes or demonstrates immediate intent to harm himself or herself, bedding should be removed and

the Medical Staff notified.

oTransport in a suicide gown and shower slides only.

The inmate may have uniform, linen, regular blanket, and/or other items only at the order of the doctor, psychiatrist, psychologist, or mental health team member. Changes to the above listed items will be noted on a Special Instruction Confinement Sheet (i.e., give and take sheet) that will be completed by Medical and attached to the door. [FCAC 18.05]

PSYCH LEVEL 1 [FCAC 18.05]

This level may pertain to inmates whom the physician or on-call psychiatrist feels are at moderate risk for suicide. They may be inmates who have previously been on Suicide Watch and whose mental status is improving. This level may pertain to inmates who never were, or who are no longer at risk for self-harm but they may be emotionally upset, verbalizing feelings of hopelessness, are under the influence of drugs or alcohol, or have made statements indicating a need for close observation.

Safety precautions shall be taken. These shall include:

o The inmate shall be monitored and checked visually on an unpredictable, staggered schedule with no more than 15 minutes between checks, and this shall be documented on the Special Confinement Form.

o There should be no pipes from which sheets could be hung.

o Search of the inmate's cell and clothes for removal of all potentially harmful objects such as glass, pins, pencils, pens, unauthorized items (e.g., matches, lighters), etc. Plastic bags shall be removed.

o A mattress in a boat or on a cement bed will be provided; no pillow.

o The inmate shall be placed in a

BOC - 7:004

Date of Original: Jan 1994

4

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18

 

 

 

paper/cloth suicide gown and a paper/cloth suicidal blanket provided.

o Feed on styrofoam tray. If being

transported, give bag lunch. No utensils; no staples in bag; and deputy must remove plastic wrap before giving to inmate.

oNo razors.

oToileting may be done as in the normal routine.

o Inmate may shower while deputy maintains constant observation.

oToothpaste and toothbrush only during use. Deputy must remove immediately after use.

oFemales will be provided with feminine hygiene products if necessary.

oNo recreation, no programs, no canteen, no visitation, no newspapers, no books, no privileges of any kind.

oCalls to attorney ONLY, and dialed by the deputy.

oThe inmate may have writing materials, if on Special Instructions Confinement Sheet, but these should be removed when not in use.

oTransport in suicide gown and shower slides only.

The inmate may have uniform, linen, regular blanket, and/or other items only at the order of the doctor, psychiatrist, psychologist, or mental health team member. Changes to the above listed items will be noted on a Special Instruction Confinement Sheet (i.e., give and take sheet) that will be completed by Medical and attached to the door.

NOTE FOR ALL LEVELSs: Only a licensed physician, psychologist, or psychiatrist can remove an inmate from suicide watch or change an inmate’s suicide watch or psych level. These removals may be relayed through the mental health team. [FCAC

15.04c]

The mental status of any given inmate may vary greatly from day to day and sometimes from hour to hour; therefore, it is imperative that personnel have good observational skills and knowledge of signs and symptoms to look for. If any personnel member has reason to feel that an inmate who is already on a precaution level should be moved to a higher level of precaution, the Medical Division shall be notified, and the physician and/or psychiatrist again consulted by the Medical Division.

Housing Assignment and Watches for Suicidal Inmates

Each shift will conduct a cell search of any and all inmates on a suicide watch at least once per shift. The cell searches will be recorded in the logbook belonging to the area where the inmate is on suicide watch. If any deputy discovers an unauthorized item in the cell or on the inmate's person, the deputy shall immediately contact his or her immediate supervisor.

All inmates will have a Special Instruction Confinement Sheet attached to their door listing items that they can or cannot possess if different that their level of watch.

Inmates assigned to the Plantation or Marathon facilities who display suicidal tendencies shall be transferred to the Key West Facility for evaluation by the Medical Division for housing assignment. The inmate shall be placed on a continuous observation watch until transferred. [FCAC 15.04]

Protection of Suicidal Inmates

Inmates at risk for suicide are monitored by the Mental Health Team. The Psychiatrist is involved in the evaluation process for all suicidal inmates. Most inmates are seen personally and evaluated by the psychiatrist within 24 hours. All inmates are evaluated by the psychiatrist either through personal contact or by consultation and review of facts gathered by the Mental Health Team within 24 hours. All inmates are personally seen by the Psychiatrist on the next scheduled visit to the jail, or on an emergency basis if necessary. Also, in extreme or

BOC - 7:004

Date of Original: Jan 1994

5

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18

 

 

 

emergency cases inmates can be evaluated at the Emergency Room at the local hospital, or by Baker Act trained corrections’ deputies for transport to the Guidance Clinic of the Middle Keys. No inmate who is placed on a suicide watch is removed from same, or even moved to a less restrictive level within the suicide watch levels, except upon the direction of a licensed physician, psychologist, or psychiatrist.

BOC - 7:004

Date of Original: Jan 1994

6

Previous Revision Date(s):

9/15/99, 9/29/00, 9/24/01, 6/14/06, 1/19/11, 5/18/12, 517/13, 8/17/17

Dissemination Date: 3/15/18

 

Effective Date: 3/22/18