BOP Program Statement 6031.06 § 40

a. Privacy. Staff will provide inmates the opportunity to discuss their medical complaints

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without other inmates being present. The location and degree of privacy should be appropriate to

the services being performed and should address the safety and security of the inmate, staff, and

institution.

The inmate’s right to privacy extends to receiving care in their native language to the extent

possible. Where a health care provider is not proficient in the inmate’s language, a language

translation service (e.g., telephonic, computer-based, etc.) should be utilized. Except in rare

circumstances when no staff are available to translate, inmates will not be used as interpreters,

even with the inmate’s consent.

b. Access to Medical Records. Inmates may request a copy of their immunization record

through procedures outlined in the Program Statement Health Information Management.

c. Chaperones. Chaperones will be made available during sensitive physical examinations,

including anytime a female inmate is in a state of undress as part of a medical evaluation (e.g.,

breast exam, pelvic exam, etc.). Chaperones will additionally be used for safety when a

disruptive inmate is being examined, and/or at a health care provider’s request. For sensitive

examinations, the sex of the inmate should be taken into consideration when requesting a

chaperone. If HSU staff are unable to secure a preferred-sex chaperone, the appointment may be

rescheduled if clinically appropriate. For circumstances where rescheduling may cause delay in

care, poor outcomes or harm, HSU staff will be mindful of the sex of the inmate, but the

examination may proceed with the available chaperone regardless of sex.

d. Body Searches for Contraband. Laxatives, enemas, or emetics (any form) will not be used

to induce a bowel movement or vomiting to help remove contraband. If an existing medical

condition requires the use of laxatives, enemas, or emetics for medical management, the CD

must order this medication weighing the potential danger to the inmate if contraband is present

and document an administrative note discussing the decision.

When a Warden authorizes a cavity search as defined in the Program Statement Searches of

Housing Units, Inmates, and Inmate Work Areas, qualified health care personnel will perform

the cavity search.

The use of a fluoroscope, major instrument (e.g., anoscope, vaginal speculum, etc.), urinary

catheter, or surgical intrusion will only be authorized for medical reasons and used with the

inmate’s consent.

If radiographic examination is determined to be necessary for the safety and security of the

institution, the Warden, with the Regional Director’s approval, may authorize the physician to

order a non-repetitive radiograph to determine if concealed contraband is present in or on the

inmate. The inmate does not have to consent to this imaging. Refer to the Program Statement

Searches of Housing Units, Inmates, and Inmate Work Areas for further direction. In addition

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to the preliminary screening for contraband, these x-rays will be reviewed and interpreted by a

qualified radiologist. The image and the report will be maintained in the inmate’s health record

consistent with radiography for diagnostic purposes. If contraband is confirmed (e.g., balloons of

heroin in the GI tract), the physician is to proceed with serial radiographs and any other

intervention to minimize the risk of a poor outcome for the inmate.

Refer to the Program Statements Ion Spectrometry Device Program and Whole Body Imaging

for guidance pertaining to full body scanners.

e. Treatment Refusal. Refer to the Program Statement Psychiatric Evaluation and

Treatment for guidance regarding involuntary medication and/or hospitalization for psychiatric

illness.

When an inmate refuses recommended diagnostic testing, counseling, or treatment, clinicians

document the refusal in the EHR, complete a BP-A0358, Medical Treatment Refusal form. At a

minimum, refusals should be obtained any time the inmate refuses preventive health care (e.g.,

screening tests, labs, immunizations, etc.), CCC treatment plans, consultations for inhouse or

community specialists, telehealth visits, or medication refusal. The refusal form is signed by the

inmate and the witnessing staff and scanned into the EHR. If an inmate refuses care, and the

clinician determines the clinical need continues to exist, the clinician should address the issue

with the inmate at subsequent clinical encounters and document each discussion.

An inmate’s refusal of treatment will not preclude the inmate from reconsidering their decision

and accepting care in the future. However, if the potential beneficial outcome of the proposed

diagnostic testing or treatment has been compromised by the delay resulting from the inmate’s

refusal, the inmate will be reevaluated to determine what treatment is clinically indicated. The

clinician will communicate and document this circumstance in the inmate’s EHR (e.g., delay in

accepting recommended treatment for cancer affects the efficacy of the treatment).

If the inmate refuses to sign, two staff witnesses will sign the BP-A0358, Medical Treatment

Refusal form, attesting to their observation that the clinician explained the consequences of

refusing the proposed care in a language the inmate understood.

As a general rule, medical and dental treatment, including medication, are only given when the

inmate consents to treatment. Exceptions may be made when a Bureau physician determines:

 There is a danger to life or of serious permanent injury to the inmate (e.g., refusal of

insulin by an inmate with Type I Diabetes).

 The inmate poses a risk to others by refusing treatment (e.g., infectious tuberculosis).

 There is a court order for evaluation or treatment to be provided.

 There exists a mental health emergency, as defined by the Program Statement

Psychiatric Evaluation and Treatment.

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The CD and/or HSA should consult with Bureau legal staff whenever questions arise regarding

involuntary medical treatment. However, in emergency situations, the provider renders

immediate care, then consults legal staff as needed. Consultation with Psychology Services is

strongly encouraged to increase collaboration in the mental health treatment of inmates.

Diagnostic procedures related to potentially communicable disease may be mandatory for the

protection of the inmate, other inmates, and staff. Refer to the Program Statement Infectious

Disease Management for specific transmissible infections. These procedures include, but are not

limited to:

 Tuberculin screening tests

 Chest x-rays

 Blood specimens for hepatitis or HIV (post-exposure incidents)

Refusal of these procedures will require an incident report. The CD will determine whether

medical isolation is clinically indicated.

The inmate’s right to refuse medical treatment is not absolute and, in all cases, will be weighed

against legitimate government interests, including the security and orderly operation of

correctional institutions.