Navigating Outside Provider Appointments in Correctional Health Care

Written by: Beth Boone, Esq.

Getting appointments with a health care provider can be challenging for anyone, and it can be much more complicated for individuals who are in custody — especially when the matter requires a specialist or diagnostic procedure performed with specialized equipment.

The National Commission on Correctional Health Care, the National Institute of Corrections, the Correctional Leaders Association and other organizations have policies in place that recommend continuity and coordination of care during incarceration, but there are admittedly hurdles. The Federal Bureau of Prisons and NCCHC supporting organizations also have clinical practice guidelines for chronic diseases such as diabetes or hypertension that are updated frequently.

Integrating medical care, mental health, dental and nursing services — as well as any specialty consultations or treatment — results in improved clinical outcomes and evidence-based treatment orders, but can be extremely challenging.

Orders should be handled and acted upon in a reasonable time period, and any delays due to staff shortages, lack of available health records, transportation, lack of available appointments, or other hurdles should be addressed swiftly by health authorities and facility administrators. Importantly, it should be documented.

A frequent claim in lawsuits by people in custody is alleged deviation from the standard of care or the standard of practice without a clinical justification. The health record should confirm that the patient was informed of treatment plans, test results, diagnostic or screening visits and other major appointments.

Correctional health care professionals should carefully document and review records pertaining to:

• Diagnostic visits, including diagnostic tests performed
• Treatment plans, or modifications of previous treatment plans (and whether it was due to results or new diagnostic tests)
• The condition of patients returning from outside appointments (including hospital visits, specialty consults, treatment, etc.)
• Review and implementation of specialty consultation and treatment recommendations
• Implementation of discharge orders
• Follow-up care plans
• Whether there were any clinically justified deviations from the standard of practice

Taking these steps can help reduce the risk of litigation and strengthen the defensibility of any claims that may arise.