BOP Program Statement 5538.09 § 2

(a) Medical escorted trips are intended to provide an inmate with medical treatment not

available within the institution. There are two types of medical escorted trips.

(1) Emergency medical escorted trip. An escorted trip occurring as the result of an

unexpected life-threatening medical situation requiring immediate medical treatment not

available at the institution. The required treatment may be on either an in-patient or out-patient basis.

When the inmate’s custody level is not readily available at the time of the emergency medical

escorted trip, the inmate is considered to have the highest custody level housed at the institution,

or will be escorted at the Warden’s discretion in accordance with Section 8 of this program

statement.

(2) Non-emergency medical escorted trip. A pre-planned escorted trip for the purpose of

providing an inmate with medical treatment ordinarily not available at the institution. The

required treatment may be on either an in-patient or out-patient basis.

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(b) The Clinical Director or designee is responsible for determining whether a medical escorted

trip is appropriate.

See the Program Statement Patient Care for utilization review procedures.

Staff seeking approval complete a BP-A0502, Escorted Trip Authorization form and route it,

along with the appropriate Bureau inmate management system information, through the:

■ Case Management Coordinator (CMC) for screening and clearance.

■ Special Investigative Supervisor, for identifying any Security Threat Group

(STG)/management interest group information.

■ Unit Manager for recommendation.

■ Captain for appropriate action.

■ Warden for review and recommendation.

In making a determination, staff must consider the inmate’s suitability for the trip and the degree

of supervision necessary.

a. Out-patient Medical Treatment. Ordinarily, treatment is considered out-patient when the

inmate departs and returns to the institution on the same calendar day. Emergency out-patient

treatment may extend beyond midnight (e.g., left institution at 11:00 p.m. and returned at 3:00

a.m.).

(c) Escorted trip procedures—out-patient medical treatment. A recommendation for an

inmate to receive a medical escorted trip is prepared by medical staff, forwarded through the

appropriate staff for screening and clearance, and then submitted to the Warden for review. The

Warden may approve an inmate for an out-patient medical escorted trip.

(1) Emergency Out-patient. Approval for an emergency out-patient escorted trip during non-duty hours may be provided by the Administrative Duty Officer (ADO) or, if the ADO is not

available, by the Lieutenant on duty.

In an emergency, the shift Lieutenant may give approval verbally, with paperwork to follow. The

approving official during non-duty hours must notify the Warden immediately.

(2) Non-emergency Out-patient. Ordinarily, approval for a non-emergency out-patient escorted

trip is obtained during regular duty hours.

The ADO may approve during non-duty hours. Authority during non-duty hours may not be

delegated below ADO level.

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An inmate with OUT or COMMUNITY custody may be approved, at the Warden’s discretion,

for a furlough to obtain local medical treatment not otherwise available at the institution. See the

Program Statement Inmate Furloughs for additional information.

b. In-patient Medical Treatment. In-patient treatment occurs when the inmate is admitted to

the outside medical facility for care that extends beyond the day of admission.

(d) Escorted trip procedures—in-patient medical treatment. A recommendation for an inmate

to receive a medical escorted trip is prepared by medical staff, forwarded through the

appropriate staff for screening and clearance, and then submitted to the Warden. The Warden

may approve an inmate for an in-patient medical escorted trip.

(1) Transfer to Medical Facility. When treatment is expected to extend beyond the day of a

transfer, the inmate is considered transferred to the medical facility for in-patient care. The

Regional Health Systems Administrator (RHSA) must be notified, ordinarily, by the institution’s

Health Services Administrator (HSA).

For a non-emergency medical escorted trip, notification should be made before the transfer has

occurred. For an emergency medical escorted trip, notification may be after the transfer has

occurred. In all cases, the HSA notifies the RHSA of the inmate’s return to the institution.

(2) Emergency In-patient. The ADO may approve an emergency escorted trip for in-patient

medical treatment during non-duty hours. If the ADO is not available, the shift Lieutenant may

approve it.

The approving official during non-duty hours notifies the Warden and, when applicable, the

ADO, as soon as possible.

(3) Non-emergency In-patient. Approval for a non-emergency escorted trip for in-patient

treatment may not be delegated below the level of Warden or Acting Warden (or ADO). Approval

must be given prior to the inmate’s transfer to a community medical facility using a BP-A0502,

Escorted Trip Authorization form.

(4) In-patient Admission. If an escorted trip for medical purposes is expected to result in the

inmate being admitted to a community medical facility for in-patient treatment, these procedures

must be followed:

■ When applicable, the Captain (or, in the Captain’s absence, the Lieutenant) contacts the

contract guard service to arrange for custodial coverage. Contract guard services will not be

used with MAXIMUM-custody inmates. If the inmate is in pretrial status, the U.S. Marshals

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Service must be contacted to provide custodial coverage. See the Program Statement Pretrial

Inmates.

■ Correctional Systems staff produce the BP-A0821, Transfer Receipt form to establish an

appropriate chain of custody. When Correctional Systems staff are not available, the

Lieutenant prepares a temporary Transfer Receipt.

■ When the inmate returns, Correctional Systems staff complete the “Return of Service”

section on the transfer order.

■ The Captain develops post orders and logbook procedures for Correctional Officers and

contract staff who provide coverage for inmates receiving in-patient care to follow.

■ The designated staff sign a statement indicating they understand the required procedures

listed on the BP-A0939, Escort Instructions form.

■ Escort officers maintain the post orders and logbook procedures during the community

placement and return them to the institution upon completing the escorted medical trip.

Contract guard services must meet the requirements in the post orders and logbook

procedures.

■ When medical treatment is expected to extend beyond one day, only the Warden may

approve reduction in restraints below the minimum requirements. When restraints are

reduced under these procedures, the escort Officer in Charge (OIC), as well as the Operations

Lieutenant, document the Warden’s approval in their official logs.

c. Maximum-Custody Inmates. The Regional Director or Regional Duty Officer during non-duty hours is notified of any medical escorted trip for a MAXIMUM-custody inmate. See

Section 4 of this Program Statement for additional information. The Regional Director has

approving authority for deviations from MAXIMUM-custody escort guidelines. Refer to Section

4 of this program statement for additional information.

d. Charging Overtime. Only when an inmate is actually released from the institution can

overtime for their security be charged to the outside medical cost center. The inmate must be

released for a visit to a medical consultant, or a hospital visit under the local hospital category of

applicable Bureau inmate management system or be released on transfer to a Medical Referral

Center (MRC). These procedures are necessary for any case in which the inmate is released from

the institution, even if only for a few hours. Institutions do not carry these temporary releases in

out-count status.

Any Bureau staff receiving overtime pay must provide security for an inmate outside the

institution while the inmate is transferred from the institution to the consultant or hospital, or

while they are transported back to the institution. A staff member may be allowed two hours of

outside medical overtime to prepare for the detail.

Medical overtime may not be charged for security provided within the institution, except if a

staff member on duty and assigned to an inside post is the only qualified, available person for the

outside escort and must be replaced.

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When overtime for a medical situation is credited to staff, a copy of the inmate history inquiry

report, generated in the applicable Bureau inmate management system, indicating the inmate’s

name and number and the time the inmate was in the local hospital release status or transferred to

an MRC, is attached to the time and attendance sheet.