BOP Program Statement 6031.06 § 31

Regardless of housing location or type, inmates must continue to receive necessary medical and

mental health care consistent with this program statement and applicable Bureau policy within

the constraints of the correctional environment.

Inmates may require housing outside the general population for medical, mental health, or public

health reasons. The following procedures apply in these situations:

a. Medical Observation Status. Institutions may provide limited observation bed space. These

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beds are not used in lieu of transfer to a community hospital or MRC when inmates require an

immediate or long-term higher level of care. Observation beds will only provide limited

increased observation services on an outpatient basis for an anticipated short period of time. This

is not to be confused with Medical Director approved Short Stay Units that require 24-hour

nursing care services. Health Services staff will provide coverage for inmates in the observation

areas that require medical monitoring as determined by the CD.

Ordinarily, observation beds are located in the HSU. Neither examination rooms nor the Urgent

Care Room will be used as observation rooms. Inmates placed on observation status do not

require medical treatment(s) normally provided in an MRC or community hospital setting.

 Appropriate Use. HSU observation rooms may be used in cases that ordinarily do not

require 24-hour skilled nursing care. Examples of appropriate observation room use

include:

 Preparation of inmates for diagnostic studies such as upper/lower gastrointestinal (GI)

series, fasting purposes, etc.

 Return to the institution from outpatient surgery to assist with post-operative care

(e.g., monitoring new medication regimens or wound sites; assistance with

manipulating crutches, cane, casts, etc.)

 Post-operative recovery from dental surgery

 Control of pain associated with known kidney stones

 Rule out suspected non-airborne contagious condition (e.g., hepatitis A, herpes zoster,

etc.) requiring isolation procedures, but not the use of the negative pressure controlled

Airborne Infectious Isolation Room(AIIR).

 Routine post-operative care, such as managing indwelling catheters (e.g., status post

prostate surgery) or surgical drains

 Outpatient IV administration when applicable. Most inmates on short term

intermittent IV infusions do not require medical observation status, but some may

benefit from increased monitoring.

A physician will review the need for continued observation after the first 24 hours and

every 24 hours subsequently.

Observation rooms will never be used to manage inmates who require urgent evaluation

for potentially life-threatening conditions. Examples include, but are not limited to:

 Rule out myocardial infarction

 Manage inmates suddenly incontinent of bowel or urine

 Rule out stroke

 Administrative reasons (e.g., restricting an inmate from recreation or other activities

due to persistent complaints of back pain)

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Refer to the Program Statements Psychiatric Evaluation and Treatment, Use of Force

and Application of Restraints, and Treatment and Care of Inmates with Mental

Illness for management of inmates with mental health diagnoses.

For each institution using observation beds, the HSA or designee will implement standard

operating procedures delineating their use, consistent with this program statement. These

will include:

Designation of the physical location of observation beds



Admission and discharge criteria for observation beds



Frequency of evaluation by the health care provider



Sight and sound requirements (e.g., nurse call system, visual monitoring system, or



inmate companion)

 Skill level of care to be provided (e.g., inmates who need temporary assistance with

activities of daily living (ADL), inmates needing short term continuous intravenous

(IV) hydration, etc.)

 Supervision requirements. Local procedures will be developed to provide qualified

(i.e., medical versus non-medical staff) coverage for observation rooms located in

areas not already covered by staff on a continuous basis.

 30-minute irregular rounds

 Documentation requirements

 Orientation of the inmate to life safety and fire evacuation procedures

 Admission and Discharge.

 Only a physician, APP, or dental officer may authorize admission/discharge of the

inmates for medical or dental observation. A provider may admit or discharge

observation status via a telephonic order. If the provider is a non-LIP, the order must

be co-signed by an LIP.

 The CD (or Chief Dental Officer for dental cases) or designee will notify the Warden

and other appropriate institution staff (e.g., Unit Management, Captain) of the

inmate’s admission to observation status and regularly advise them of the inmate’s

health status and monitoring recommendations.

 Orders to place an inmate on observation status will be documented in EHR.

 After hours, an LIP or APP may order medical observation telephonically but must

evaluate the inmate in person within 12 hours. The CD will be notified the next

business day.

 A physician/LIP (e.g., Dental Officer for dental cases) or APP will evaluate the

inmate in person once daily, including weekends and holidays. This evaluation will be

documented in EHR.

 The institution will have a plan to transfer the inmate to a community hospital in an

emergency.

 If the room is used for suicide prevention, requirements of the Program Statement

Suicide Prevention Program apply.

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 Medical Observation Minimum Cell Standards.

 Rooms will be well-ventilated, adequately lighted, appropriately heated, and

maintained in a sanitary condition.

 Rooms will include a mattress, blankets, a pillow, and linens for sleeping. Inmates

will receive necessary opportunities to exchange linens.

 Rooms will have access to a wash basin and toilet. Inmates will receive personal

items necessary to maintain an acceptable level of personal hygiene, for example,

toilet tissue, soap, toothbrush and cleanser, shaving utensils, etc. Inmates will

ordinarily have an opportunity to shower and shave at least three times per week.

The HSA will collaborate with Correctional Services and Computer Services to manage inmates

with equipment or devices having Information Technology (IT) or wireless requirements to

ensure security issues are addressed.

b. Short Stay Units (SSU). The Medical Director may authorize the use of a SSU at a limited

number of institutions, specifically those with expanded medical missions (e.g., a Care Level 3

institution). Approval takes into consideration the physical space, monitoring systems,

community resources, and clinical staff availability, including 24-hour dedicated medical staffing

as determined by the CD, needed to support the unit. An SSU, sometimes known as an infirmary,

typically has multiple beds and is equipped to provide 24-hour medical care on a short-term

basis. At least one RN will be assigned to each shift unless otherwise approved by the RMD

when inmates are admitted to the SSU. If the CD determines an inmate’s length of stay may

exceed 90 days, they will consult with the RMD and consider alternative options (e.g., a nearby

institution having the required resources, re-designation to an MRC, transfer to a contracted

community facility, RIS request, etc.).

SSU’s are effectively utilized to manage inmates who do not require the services of a community

hospital, but who temporarily require closer monitoring than observation beds allow, including

24-hour skilled medical care.

An Institution Supplement is required for all approved SSUs. It should include the same content

as required for Medical Observation Beds, including:

 Physical location of the SSU

 Admission and discharge criteria

 Frequency of evaluation, including re-assessments

 Scope of services provided, including written protocols

 Transfer of inmates to community-based facilities when care needs exceed the resources

of the unit

 Orientation of the inmate to life, safety, and fire evacuation procedures

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SSU’s will never be used for administrative reasons (e.g., restricting an inmate from recreation or

other activities due to persistent complaints of back pain) or for medical emergencies that require

transport to a local emergency department.

SSU’s will conform to the same minimum cell standards outlined above under Medical

Observation Status.

c. Airborne Infection Isolation Room (AIIR). Refer to the Program Statement Infectious

Disease Management for proper utilization and maintenance of the AIIR. Institutions without

these rooms will isolate and immediately transfer inmates with suspected active tuberculosis or

other highly contagious airborne diseases to a community hospital or other Bureau institution

within close proximity with AIIR capability.

d. Inpatient Units (Nursing Care Centers). Inpatient units are authorized only at MRCs.

Refer to Program Statement Medical Designations & Referral Services for Federal Prisoners

for procedures governing admission and discharge criteria and management.

e. Outside Hospitalization. Inmates requiring inpatient care that cannot be safely or

appropriately provided within a Bureau facility may be admitted to outside hospitals or long-term care facilities. Such hospitalizations/placements must be managed in accordance with the

Program Statement Healthcare Utilization Management, including requirements for ongoing

review of medical necessity, routine communication with outside hospital (as outlined in

Program Statement Healthcare Utilization Management), and timely discharge planning.

Institutions remain responsible for coordination of care, continuity of treatment, and appropriate

clinical follow-up upon the inmate’s return.

f. Alternative Restrictive Unit/Cell (Restricted from General Population). All HSUs will

have standard requirements and quality control systems to ensure continuity of medical and

psychiatric care for inmates housed in restrictive units/cells. The HSA and CD will collaborate

with the Captain to develop and implement standard requirements and a system for notifying

Health Services when an inmate is admitted to a restrictive unit/cell. This notification procedure

will consider the medical and mental health needs of the inmate, such as timely delivery of

medically necessary medications and therapies.

Procedures governing care during an inmate’s assignment to a restrictive unit/cell will include:

 When notified an inmate is assigned to a restrictive unit/cell, HSU staff review the

inmate’s EHR to ensure continuation of prescribed medications, necessary prescribed

medical devices, and ongoing care on a case-by-case basis.

 The HSA or designee will, at a minimum, make weekly administrative rounds. These

rounds will be recorded using existing official monitoring systems.

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 A credentialed health care provider (e.g., APP, RN, Paramedic) will conduct daily rounds

to determine any sick call or urgent requests for care and arrange for timely evaluations

as clinically indicated. Licensed Practical Nurses (LPN)/Licensed V ocational Nurses

(LVN)/Medical Assistants cannot triage an inmate independently but can help in the

triage process (e.g., take vital signs, gather basic medical history/chief complaint, and

perform tasks per protocol or at RN/APP direction).

 The HSA will develop and implement a mechanism for inmates in restrictive units/cells

to notify medical staff about their need for health care.

 An HSU health care provider will administer DOT medications at locally established

intervals.

 All restrictive housing unit/cell inmate clinical encounters will be documented in the

EHR.

 The HSA and CD will collaborate with the Captain to designate a weekly time frame for

inmates in restrictive units/cells to access routine scheduled care, including chronic care

clinics, non-urgent laboratory/radiologic testing, dental visits, etc.

Inmates who are on suicide watch will continue to receive medical care as clinically indicated.

See the Program Statement Suicide Prevention Program.