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MEDICATION PASS G-105 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS EFFECTIVE DATE: 07-25-17 REVISED: 01-27-22 AUTHORITY: Sheriff M. Mims APPROVED BY: Assistant Sheriff S. McComas REFERENCE: California Code of Regulations, Title 15, Sections 1206, 1214, and 1216. Hall v. County of Fresno, E.D. Cal. No. 1:11-CV-02047-LJO-BAM (2015); 45 CFR 164.512(k)(5); and Fresno County Administrative Officer's Management Directives, Subject 112.3. PURPOSE: The purpose of this policy is to establish guidelines for security and control during medication pass in the detention facilities. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division that custody staff shall be present during medication pass to directly observe the medication process, maintain order, and provide assistance, if necessary. It is the policy of the Fresno County Sheriffs Office Jail Division that non-medical staff (inmates and correctional officers) are prohibited from administering medications. At no time shall medication be withheld from an inmate as a punitive action. PROCEDURES: I. DEFINITIONS ADMINISTERING MEDICATION — the act in which a single dose of medication is given to an inmate. CHEEKING — Hiding medications inside the mouth rather than swallowing them. DIRECTLY OBSERVED THERAPY (DOT) - Dose-by-dose administration of medications by licensed nurse which includes observation of ingestion of the medication by the nurse. Page 1 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS ESSENTIAL MEDICATIONS—Medications that are essential to the safety or well- being of the inmate and could result in a health problem if a dose is eliminated (e.g., insulin, chronic disease, etc.). KEEP-ON-PERSON (KOP) MEDICATIONS — Medications that have been designated by the Medical Director as safe for the inmate to self-administer (e.g., inhalers, nitroglycerin, commissary medications). II. GENERAL PROCEDURES A. Routine medication passes are conducted in every housing unit, twice a day, seven (7) days a week. Additional medication passes and diabetic checks are conducted several times each day to ensure that inmates who require more frequent dosing (or have alternative medication schedules) are provided their medications as prescribed. B. Medical staff will identify the medication pass call times designated for the administration of medications to inmates in the housing units. 1. The times will be established by the Health Services Administrator (HSA) in coordination with jail management. 2. Any modifications to the prescheduled time shall be sent to the Watch Commander and the Compliance Lieutenant two (2) weeks in advance. 3. Due to circumstances in the facility, an urgent event (planned or unplanned) or an emergency may occur and alter the schedule. This shall be communicated between the Watch Commander and the Charge Nurse to ensure medication is administered as soon as practical. C. Security officers are to announce medication pass in such a fashion so as to alert all inmates in the housing units. The lights shall be turned on inside the OHU and administrative segregation lockdown cells in order for nursing staff to observe the inmates ingest their medications. (The light in an OHU cell may remain off if medically necessary.) D. An officer shall accompany the medication nurse and be present during medication pass to directly observe the medication process, maintain order, and provide assistance, if necessary. Page 2 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS 1. Whenever possible, the accompanying officer will position themselves inside the housing unit or other location (e.g., gymnasium, classroom, etc.), as applicable. [Refer to Addendum A for the Medication Pass Logistics chart.] 2. When not possible, practical or safe to be inside the housing unit, the accompanying officer will position themselves so as to view the inmate and when necessary, provide access by opening the associated feed hatch. The officer shall remain in direct proximity in order to provide safety and security for the nurse and the medication cart. E. If there is an emergency call or urgent need of the officer elsewhere, medication pass will cease until an officer becomes available to assist. III. INMATE RESPONSIBILITY A. It is the inmate's responsibility to be present for their medication and to follow any instructions during medication pass. If an inmate's medication is ordered for a specific time (for example, each morning after breakfast), that is the time that the medication will be made available. If the inmate oversleeps or chooses not to get up, they will not be offered the medication later in the day. B. General population and protective custody inmates who are scheduled to receive medications are to form an orderly line. Green lines in the dayrooms and other common areas have been added to create space for privacy. Inmates are expected to remain behind the green line until called upon to move forward. C. Inmates are expected to be dressed, show their ID wristbands and have a cup of water with them. Without doing these things, the nurse will not give the inmate their medication and the inmate will be asked to comply and return to the end of the line. 1. The medication nurse will provide water and cups for inmates who receive their medications outside of their housing unit. 2. The medication nurse may provide certain medications mixed with water ("crush and float") when prescribed. Page 3 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS D. With the exception of self-administered medications, the inmate will be required to swallow their medication in front of the nurse. Inmates in locked cells will be expected to bring a cup of water and come to the cell front to be clearly visible. The officer shall ensure that the cell light has been turned on and has not been covered. IV. OFFICER RESPONSIBILITY An officer shall accompany the medication nurse and be present during medication pass to directly observe the medication process, maintain order, and provide assistance, if necessary. A. The accompanying officer shall not engage in any activity that distracts him/her from concentrating on the medication pass process. B. It is the responsibility of the accompanying officer to ensure that the inmates obey the medication pass rules. 1. Only one inmate at a time is to approach the medication nurse. 2. Inmates are to have legible wristbands. Wristbands shall be replaced, if necessary. [Refer to C-110/Identification Wristband (FILE: WRISTBANDS).] 3. Inmates are to conduct themselves in an appropriate manner and not be disrespectful towards the nurse. Any inmate who fails to follow the rules and/or becomes abusive towards the nurse should receive a rule violation for failure to comply. At no time shall medication be withheld from an inmate as a punitive action. C. Officers shall assist the nurse in supervising the inmates and ensuring they have swallowed their medication. With the exception of Keep-on- Person medications, all medications are to be taken immediately and in front of the medication nurse and officer. (Refer to Section V, as follows.) V. DIRECTLY OBSERVED THERAPY (DOT) A. Nursing staff shall observe inmates taking medications. All medications administered by the nurse shall be considered and treated as DOT medications. Page 4 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS 1. The medication nurse will advise the officer if an inmate is suspected of cheeking, hoarding, and/or selling medication. 2. Officers will assist the medication nurses in doing a thorough check for ingestion of a medication. This may include, but is not limited to, the direct visualization of an inmate's open mouth while lifting his/her tongue, checking the contents of the inmate's drinking cup, as well as the inmate showing the nurse/officer his/her open hands. B. Any inmate suspected of not swallowing their DOT medication shall be isolated from other inmates. The officer should request assistance to isolate and search the inmate. Until the assisting officer arrives, the medication pass will be halted. The medication nurse should make an entry into the inmate's medical record noting the inmate's attempt to hoard medication. C. Officers shall notify medical staff if it is later discovered that an inmate hoards, cheeks, sells, or fails to swallow their medication. The discovering officer shall document their discovery in a rule violation report. VI. MISSED MEDICATIONS A. At the conclusion of the medication line, the medication nurse will identify any inmates who did not present to the medication line to receive their medications. B. The medication nurse will advise the officer if an inmate who is prescribed an essential medication has missed medication pass. The officer will determine if the inmate is unaware (e.g., asleep, or not expecting the medication), or otherwise unavailable (i.e., attending an event outside of the housing unit), and ensure the inmate is notified. 1. Upon request by the nurse, the officer shall check on the welfare and/or provide escort into the cell of any inmate who fails to respond for medication. 2. The refusal of the offered medication shall be done with the nurse present (at the medication pass area) whenever possible. A refusal form should only be completed when an inmate expressly refuses their medication. (Refer to Section VII, as follows.) Page 5 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS C. If an inmate misses medication pass due to attending an event outside of the housing unit, the inmate will be located and the medication provided in accordance with the Medication Pass Logistics chart (refer to Addendum A). D. If an inmate is out of the facility at the time of a medication pass, the inmate should receive their medication upon return. The medication nurse (or Charge Nurse) is to be advised of the inmate's return, and the inmate will be routed to the Main Jail 2nd floor to receive their medication. VI I. RIGHT TO REFUSE A. Health care treatment, including medications, shall not be forced over the objections of a mentally competent inmate, except when permitted by law (e.g., to prevent infectious disease). 1. Any inmate who has not been adjudicated to be incompetent may refuse non-emergency medical and mental health care. Absent informed consent in non-emergency situations, a court order is required before involuntary medical treatment can be administered to an inmate.* 'Medication can be administered for up to 72 hours without a court order if the inmate has been determined by a psychiatrist or psychologist to have a serious mental disorder, and as a result of that mental disorder is gravely disabled or a danger to self or others. [Refer to Penal Code 2603 and policy G-180/Involuntary Medication Administration(FILE: INVOLUNTARY MEDICATION).] 2. Psychotropic medications may be administered involuntarily to inmates in compliance with law and policy. [Refer to policy G-180/Involuntary Medication Administration (FILE: INVOLUNTARY MEDICATION)for the conditions under which psychotropic medications may be administered involuntarily to inmates.] B. Inmates who refuse an essential medication will be required to refuse directly to the medication nurse and to sign a refusal form. 1. The inmate should be escorted to the medication pass area to refuse in person. 2. Any deviation to this directive will require the refusal form to be signed by both the nurse and the officer. The officer shall print their name and computer identification number on the form in a legible manner. Page 6 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS Vill. INJECTABLE MEDICATIONS Injectable medications shall not be administered through the feed hatches or cell bars. If an injectable medication needs to be administered, the officer shall escort the inmate to a clinic where the health care staff can safely administer the medication. IX. COURT MEDICATION PASS A. Medical staff will print an Offendertrak report that lists all inmates attending court for the day. B. Designated medical staff will provide medications to inmates scheduled for morning court in the following locations and manner: 1. Main Jail — inmates scheduled for early morning transportation will be routed to the Main Jail 2nd floor to receive their medications prior to proceeding to court. Medical staff will administer the medication at the elevator door. 2. Annex Jails—designated medical staff will go to the housing floors and administer medications prior to the inmates leaving the floor. X. KEEP-ON-PERSON (KOP) PROGRAM Inmates may self-administer medications in limited circumstances (e.g., KOP medications and medications purchased from commissary). The Keep-on- Person (KOP) program allows inmates to maintain designated and approved medications under their control. A. The KOP program is limited to medications that have been approved by the Site Medical Director and do not have a recognized abuse potential or security problem (e.g., nitroglycerin, rescue inhalers). B. Any medications used in the KOP program must be in the inmate's possession at all times or provisions must be made for the secure storage of medication when it is not on the inmate's person. C. Health care and custody staff are to communicate with each other regarding any violation of rules regarding self-administration medications. Medication issues that involve a security or safety issue (e.g., hoarding medications) shall be documented in a rule violation report. The Watch Commander shall notify the Charge Nurse. Page 7 of 8 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MEDICATION PASS NO: G-105 FILE: MEDICATION PASS 1. The medications may be removed from the inmate's possession and/or the inmate may be referred to medical staff for assessment and modification to the medication regimen (such as discontinuing medication, or DOT), as appropriate. 2. Custody shall turn over any medication to medical staff and properly document and photograph the medication for later identification and/or auditing. XI. EXCEPTIONS Although this policy addresses the vast majority of inmates who require medication, it will occasionally be necessary for inmates to report to the Main Jail 2nd floor for their medication. Any exception/special circumstances will be dealt with on a case-by-case basis between the medical provider and custody staff. Page 8 of 8