SB 448 — AN ACT REQUIRING THE DEVELOPMENT OF A PLAN CONCERNING THE DELIVERY OF HEALTH CARE AND MENTAL HEALTH CARE SERVICES TO INMATES OF CORRECTIONAL INSTITUTIONS.

(g)(6)Adischargeplannershallconductanexitinterviewofeachinmate Onlywho is being scheduled for discharge from a physician,correctional physicianinstitution assistantpriortothedateofdischarge orifsuchexitinterviewisclinicallyindicated, advancedprovided practicethe registeredlack nurseof maysuch administerexit medicationinterview toshall not delay the scheduled discharge of an inmate.

ASuch physicianexit assistantinterview orshall advancedinclude practicea registereddiscussion nursewith maythe administerinmate regarding a medicationmedical todischarge anplan inmatefor onlyany ifcontinued amedical care or treatment that is recommended by the physician, physician hasassistant ordered,or inadvanced writing,practice registered nurse for the administrationinmate ofwhen suchthe medicationinmate toreenters the inmate.community.

(h)(7) TheA commissionerphysician shall ensurebe thaton eachcall inmateon hasweekends, accessholidays to all vaccines licensed or authorized under an emergency use authorization by the federal Food and Drugoutside Administrationregular thatwork arehours recommendedto byprovide themedical Nationalcare Centersto forinmates Diseaseas Controlnecessary. and Prevention Advisory Committee on Immunization Practices.

A(8) physician,The physiciancommissioner assistantshall orensure advancedthat practiceeach registeredinmate nursehas shallaccess administer to anall inmatevaccines anylicensed suchor vaccineauthorized thatunder (1)an emergency use authorization by the inmatefederal requests,Food and (2)Drug isAdministration that are recommended by the National Centers for suchDisease inmateControl byand saidPrevention committee,Advisory asCommittee determinedon byImmunization thePractices, physician,subject physicianto assistantavailability orof advancedsuch practicevaccines, registeredunless nurse.there are substantial security concerns with providing access to such vaccines.

(i)Subject Ato dentistavailability, a physician, physician assistant or advanced practice registered nurse shall performprescribe ato dentalan examinationinmate ofany eachsuch vaccine that (A) the inmate notrequests, laterand than(B) tenis weeksrecommended afterfor thesuch inmate entersby asaid correctionalcommittee, institution.as determined by the physician, physician assistant or advanced practice registered nurse, provided the prescribing of such vaccine does not impose significant Public Act No.

At22-133 the5 time the dentist performs the dental examination of an8 inmate,Substitute theSenate dentistBill shallNo. develop a dental care plan for the inmate.

A448 dentistsafety shallconcerns. provide dental care to an inmate in accordance with the inmate's dental care plan throughout the inmate's sentence at the correctional institution.

(9) Except in exigent circumstances, a dental professional shall perform a dental screening of each inmate not later than one year after the inmate initially enters a correctional institution and at least once annually thereafter.

At the time the dental professional performs the dental screening of an inmate, the dental professional shall develop a dental care plan for the inmate.

A dental professional shall provide dental care in accordance with the inmate's dental care plan throughout the inmate's time at the correctional institution.

Sec.(10) A medical professional shall administer an HIV test to each inmate who requests an HIV test, subject to the availability of such test.

3.Except in exigent circumstances and subject to availability, a medical professional shall offer an HIV test to each inmate where it is clinically indicated (A) at the time such inmate enters a correctional institution, or (B) during an annual physical assessment.

(NEW)(11)A (Effectivemedicalprofessionalshallintervieweachinmate Octoberregarding 1,the 2022)inmate's Adrug physician,and physicianalcohol assistantuse orhistory advancedat practicethe registeredtime nursethe shall administer an HIV test to each inmate whoinitially requestsenters ana HIVcorrectional test.institution.

AIf physician,an physicianinmate assistantis orexhibiting advancedsymptoms practiceof registeredwithdrawal nursefrom shalla offerdrug anor HIValcohol testat tosuch eachtime, inmatea identifiedmedical asprofessional havingshall perform a highphysical riskassessment of beingthe infectedinmate withand communicate the humanresults immunodeficiencyof virussuch (1)assessment atto thea timephysician, suchphysician inmateassistant entersor aadvanced sSB448practice /registered Filenurse. No.

452Except 5in sSB448exigent Filecircumstances, No.a drug and alcohol counselor shall perform an evaluation of the inmate not later than five days after the inmate initially enters the correctional institution.

452The correctional institution,institution shall immediately transfer each inmate who is determined by a physician, physician assistant or (2)advanced duringpractice theregistered annualnurse physicalto examinationbe ofexperiencing thewithdrawal inmatefrom requireda underdrug subsectionor (b)alcohol ofto sectionan 2appropriate ofarea thisat act.such correctional institution Public Act No.

As22-133 used6 inof this8 subsection,Substitute "HIVSenate test"Bill meansNo. a test to determine human immunodeficiency virus infection or antibodies to human immunodeficiency virus.

Sec.448 for medical treatment of such withdrawal.

4.A physician, a physician assistant or an advanced practice registered nurse shall periodically evaluate each inmate who exhibits signs of or discloses an addiction to a drug or alcohol or who experiences withdrawal from a drug or alcohol, at a frequency deemed appropriate by the physician, physician assistant or advanced practice registered nurse.

(NEW)(12) (EffectiveA Octoberphysician, 1,a 2022)physician (a)assistant Aor licensedan mentaladvanced healthpractice careproviderateachcorrectionalinstitutionshallintervieweachinmateregistered regardingnurse thewith inmate'sexperience drugin andsubstance alcohol use historydisorder atdiagnosis theand timetreatment shall oversee the medical treatment of an inmate entersexperiencing thewithdrawal from a drug or alcohol at each correctional institution.

IfA anmedical inmateprofessional is exhibiting symptoms of withdrawal from a drug or alcohol at such time, a physician, physician assistant or advanced practice registered nurse shall performbe apresent physicalin examination of the inmate not later than twenty-four hours after the inmate enters the correctional institution andalicensedmentalhealthcareprovidershallperformamentalhealth evaluation of the inmate not later than five days after the inmate enters the correctional institution.The correctional institution shall immediately transfer each inmate who is determined by a physician, physician assistant or advanced practice registered nurse to be experiencing withdrawal from a drug or alcohol and each inmate who requests medical treatment for withdrawal from a drug or alcohol to a medical unit at sucheach correctional institutionfacility forat medicalall treatmenttimes ofduring such withdrawal, provided (1) if the inmateprovision isof pregnant, the inmate provides informed consent to such medical treatment, and (2) if the medical treatment to besuch providedinmate. includes the administration of methadone, the inmate provides informed consent to the use of methadone.

(13) A physician,drug physicianand assistantalcohol orcounselor advancedshall practiceoffer registeredappropriate nursesubstance shalluse periodicallydisorder evaluatecounseling eachservices, including, but not limited to, individual counseling sessions and group counseling sessions, to an inmate who exhibits signs of or discloses an addiction to a drug or alcohol orand whoencourage experiencessuch withdrawalinmate fromto aparticipate drugin or alcohol, at aleast frequencyone deemedcounselling appropriatesession. by the physician, physician assistant or advanced practice registered nurse.

(b)At Athe physiciantime withof experiencean ininmate's substancedischarge usefrom disorderthe diagnosiscorrectional andinstitution, treatmenta shalldischarge overseeplanner themay medicalrefer treatmentan inmate who has exhibited signs of anor inmatedisclosed experiencingan withdrawaladdiction fromto a drug or alcohol while an inmate at eachsuch correctional sSB448institution /to Filea No.substance use disorder treatment program in the community that is deemed appropriate for the inmate by such discharge planner.

452(14) 6The sSB448York FileCorrectional No.Institution shall provide each inmate who is pregnant and drug or alcohol-dependent, with information regarding thedangersofundergoing withdrawalfromthedrug or alcoholwithout medical treatment, the importance of receiving medical treatment during the second trimester of pregnancy for withdrawal from the drug or alcohol and the effects of neonatal abstinence syndrome on a newborn.

452Public institution.Act No.

A22-133 physician,7 physicianof assistant,8 advancedSubstitute practiceSenate registeredBill nurseNo. or registered nurse with experience in substance use disorder diagnosis and treatment shall provide such medical treatment in a medical unit at each correctional institution.

An448 advanced(15) practiceThe registeredYork nurseCorrectional orInstitution registeredshall nurseprovide witheach experienceinmate inwho substanceis usepregnant disorderprenatal diagnosisvisits and treatment shall be present in the medical unit at eacha correctionalfrequency facilitydetermined allby timesan duringobstetrician theto provisionbe ofconsistent medicalwith treatmentcommunity tostandards anfor inmate.prenatal visits.

If(16) aThe medicaldepartment unitshall doesissue nota containrequest enoughfor bedsinformation to accommodatewhich alla inmatesschool whoof requiremedicine medicalmay treatmentapply underfor thispurposes subsection,of theproviding correctionalpractical institutiontraining shallat addcorrectional additionalinstitutions bedsas topart theof unita or to another medical unitresidency atprogram, suchthrough correctionalwhich institutionresidents toparticipating ensurein thatsuch eachprogram inmatemay whoprovide requireshealth suchcare medicalservices treatmentto receivesinmates. such medical treatment.

A(c) licensedNot mentallater healththan careFebruary provider1, with2023, experiencethe incommissioner substanceshall usereport, disorderin diagnosisaccordance andwith treatmentthe shallprovisions monitorof eachsection inmate11-4a whoof isthe experiencinggeneral withdrawalstatutes, fromto cocainethe orjoint anstanding amphetaminecommittees onof athe dailyGeneral basisAssembly forhaving notcognizance lessof thanmatters fiverelating daysto afterpublic health and the inmatejudiciary firstregarding exhibitsthe withdrawalplan symptomsdeveloped pursuant to attemptsubsection (b) of this section, recommendations for any legislation necessary to mitigateimplement such plan and the riskdepartment's oftimeline suchfor inmateimplementation attemptingof suicide.such plan.

AApproved secondMay physician27, shall2022 bePublic onAct callNo. twenty-four hours a day, seven days a week at each correctional institution to oversee medical treatment under this section if the physician assigned to oversee such medical treatment at a correctional institution becomes unavailable to oversee such medical treatment.

(c)A22-133 licensedmentalhealthcareprovidershall(1)offermentalhealth8 counseling services, including, but not limited to, individual counseling sessions and group counseling sessions, to an inmate who exhibits signs of or8 discloses an addiction to a drug or alcohol and encourage such inmate to participate in at least one counselling session, and (2) at the time of an inmate's discharge from the correctional institution, refer an inmate who has exhibited signs of or disclosed an addiction to a drug or alcohol while an inmate at such correctional institution to a substance use disorder treatment program in the community that is deemed appropriate for the inmate by such provider.

Sec.

5.

Section 18-69c of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2022):

sSB448 / File No.

452 7 sSB448 File No.

452 (a) The Commissioner of Correction shall ensure that at least one [departmental or contracted,] licensed health care provider who is employed by or contracts with the Department of Correction to provide health care services at the York Correctional Institution (1) has been trained inprenatalandpostpartummedicalcare, and(2)hasknowledge of and the ability to educate any inmate who is pregnant concerning prenatal nutrition, high-risk pregnancy and addiction and substance abuse during pregnancy and childbirth.

(b) Upon admission to the York Correctional Institution, each inmate shall be assessed for pregnancy by a licensed health care provider.

The licensed health care provider shall inform the inmate of any necessary medical tests associated with the pregnancy assessment prior to the administration of such tests.

(c) The York Correctional Institution shall provide each inmate who is pregnant with:

(1) Counseling and written material, in a form that may be reasonably understood, concerning (A) the inmate's options with regard to her pregnancy, (B) prenatal nutrition, (C) maintaining a healthy pregnancy, (D) for any inmate who is drug or alcohol- dependent, the dangers of undergoing withdrawal from the drug or alcohol without medical treatment, the importance of receiving medical treatment during the second trimester of pregnancy for withdrawal from the drug or alcohol and the effects of neonatal abstinence syndrome ona newborn, (E) labor and delivery, [(E)] (F)the postpartum period, [(F)] (G) the institution's policies and practices regarding the care of an inmate during pregnancy, [labor and delivery and the postpartum period,] and [(G)] (H) restrictions on the use of restraints on pregnant inmates, (2) medical care at the correctional institution, which shall include, but not be limited to:

(A) Periodic health monitoring and evaluation during pregnancy, and (B) prenatal vitamins or supplements, as deemed necessary by a licensed health care provider, (3) a diet containing the nutrients necessary to maintain a healthy pregnancy, as determined by a licensed health care provider trained in prenatal care, (4) the clothing, undergarments and sanitary materials deemed appropriate by a licensed health care provider who has been sSB448 / File No.

452 8 sSB448 File No.

452 trained in prenatal and postpartum medical care, (5) the opportunity for a minimum of one hour of ambulatory movement every day, and (6) access to treatment for postpartum depression by a qualified mental health professional, provided such treatment is deemed necessary by a licensed health care provider who has been trained in postpartum medical care.

If a [departmental or contracted] licensed health care provider trained in prenatal and postnatal medical care, or any other health care professional who evaluates or treats an inmate who is pregnant, determines that the inmate's pregnancy is high risk or involves any other medical complication for either the inmate or the baby, [such inmate shall be immediately transferred] the York Correctional Institution shall immediately transfer such inmate to the medical infirmary setting or any hospital deemed appropriate, as determined by such health care provider or professional.

The York Correctional Institution shall immediately transfer any inmate who is pregnant and decides to terminate the pregnancy prior to the viability of the fetus, in consultation with a physician pursuant to section 19a- 602, to a hospital or outpatient clinic regulated by the Department of Public Health pursuant to section 19a-116 where the inmate may receive an abortion.

The written material provided to an inmate pursuant to subdivision (1) of this subsection shall be known as the "Pregnant Woman's Guide".

(d) Except as provided in this subsection, correctional staff of the York Correctional Institution shall not use any leg or waist restraint on any inmate of the institution who is known to be pregnant or in the postpartum period.

An inmate known to be pregnant may only be restrained using handcuffs that are placed on the wrists held in front of the inmate's body, except an inmate may be placed in wrist, leg or waist restraints if (1) there are compelling grounds to believe that an inmate presents (A) an immediate and serious threat of harm to herself, staff and others, or (B) a substantial flight risk and cannot be reasonably contained by other means, and (2) use of such restraints is approved by the unit administrator of the institution, or his or her designee, except under exigent circumstances.

Such restraints shall be the least restrictive kind of restraints considering the circumstances.

Correctional staff shall sSB448 / File No.

452 9 sSB448 File No.

452 document, in writing, the reasons for such determination, the kind of restraints used and the reasons staff considered such restraints to be the least restrictive kind available and the most reasonable means of preventing harm or escape.

The correctional staff of the York CorrectionalInstitutionshallensure that any inmate, who isdetermined to be in the second or third trimester of a pregnancy by a licensed health care provider, is transported to and from visits to health care providers and court proceedings in a vehicle with seatbelts.

If an attending physician or advanced practice registered nurse requests that the inmate's restraints be removed for medical reasons, correctional staff shallimmediatelyremovetherestraints.Nothinginthissubsectionshall prohibit the use of medical restraints by a licensed health care provider to ensure the medical safety of the inmate.

As used in this subsection and subsection (e) of this section, "restraints" means metal handcuffs, metal leg restraints and waist and tether chains.

(e) Each pregnant inmate of the York Correctional Institution shall receive labor and delivery services in a hospital deemed appropriate by a [departmental or contracted,] licensed health care provider who is employed by or contracts with the Department of Correction to provide health care services at said institution.

Notwithstanding the provisions of subsection (d) of this section, an inmate who is in any stage of labor or delivery, as determined by a licensed health care provider, shall not be placed in restraints at any time, including, but not limited to, during transportation to the hospital.

If a correction officer is present with the inmate during any stage of labor or delivery, such correction officer shall be female, if possible.

Such correction officer shall be positioned in a location that ensures the inmate's privacy, to the extent possible.

(f) Any inmate in the postpartum period shall be assessed by a licensed health care provider upon return to the correctional institution.

Each inmate in the postpartum period shall be housed in a medical or mental health housing unit at the correctional institution until discharged by a licensed health care provider.

(g)TheYorkCorrectionalInstitutionshallprovideapregnantinmate, sSB448 / File No.

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452 prior to the inmate's release, with counseling and discharge planning to ensure, to the extent feasible, the continuity of prenatal and pregnancy- related care, including substance abuse programs and treatment referrals when deemed appropriate.

Sec.

6.

(NEW) (Effective from passage) (a) There is established an advisory committee for the purpose of (1) advising the Commissioner of Correction regarding the provision of health care services at correctional institutions under the jurisdiction of the Department of Correction pursuant to the provisions of sections 1 to 4, inclusive, of this act and section 18-69c of the general statutes, as amended by this act, and (2) evaluating whether the Department of Public Health should have oversightover the provisionofsuchservicesor license thefacilities located in such correctional institutions where inmates receive health care services.

(b) The committee shall be composed of the following members:

(1) Two appointed by the speaker of the House of Representatives, one of whom shall be a primary care physician, and one of whom shall be a formerly incarcerated female;

(2) Two appointed by the president pro tempore of the Senate, one of whom shall be a physician with expertise in infectious disease prevention and control, and one of whom shall be a formerly incarcerated male;

(3) One appointed by the majority leader of the House of Representatives, who shall be a health care provider with expertise in reproductive health care;

(4) One appointed by the majority leader of the Senate, who shall be a representative of an advocacy organization who has knowledge and an understanding of issues concerning gender-affirming care;

(5) One appointed by the minority leader of the House of Representatives, who shall be a current or former employee of a correctional institution;

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452 (6) One appointed by the minority leader of the Senate, who shall be a mental health care provider;

(7) Two appointed by the Governor, one of whom shall be a health care provider with expertise in substance use disorder treatment, and one of whom shall be an advocate of racial justice;

(8) One appointed by the Commissioner of Developmental Services, who shallbea professionalwithexperience incommunicating theneeds of persons with a disability, including, but not limited to, an intellectual disability;

(9) The Commissioner of Correction, or the commissioner's designee;

(10) The Commissioner of Public Health, or the commissioner's designee;

(11) The Commissioner of Mental Health and Addiction Services, or the commissioner's designee;

and (12) The executive director of the Office of Health Strategy, or the executive director's designee.

(c)Any appointment that isvacant foroneyear or more shallbemade by the Commissioner of Public Health.

The Commissioner of Public Health shall notify the appointing authority of the commissioner's choice of member for appointment not less than thirty days before making such appointment.

(d) The committee shall meet not less than quarterly.

On or before January 1, 2023, and once every six months thereafter, the committee shall report on its recommendations regarding the provision of health care services at correctional institutions under the jurisdiction of the Department of Correction pursuant to the provisions of sections 1 to 4, inclusive, of this act and section 18-69c of the general statutes, as amended by this act, to the department.

On or before January 1, 2023, and annually thereafter, the committee shall report, in accordance with the provisions of section 11-4a of the general statutes, on such sSB448 / File No.

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452 recommendations, to the joint standing committees of the General Assembly having cognizance of matters relating to public health and education.

On or before January 1, 2023, the committee shall report, in accordance with the provisions of said section, on its evaluation of the need for oversight by the Department of Public Health to such joint standing committees.

(e) Administrative support for the activities of the advisory committee may be provided by the Department of Public Health.

This act shall take effect as follows and shall amend the following sections:

Section 1 October 1, 2022 New section Sec.

2 October 1, 2022 New section Sec.

3 October 1, 2022 New section Sec.

4 October 1, 2022 New section Sec.

5 October 1, 2022 18-69c Sec.

6 from passage New section Statement of Legislative Commissioners:

In Section 2(c), the first two sentences were reworded for clarity;

in Section 5(c), "(H)" was deleted, "labor and delivery and the postpartum period" was bracketed and "(I)" was changed to "(H)" for consistency;

and in Section 6(d) "to the department" was inserted after "section 18- 69c of the general statutes, as amended by this act" for clarity.

PH Joint Favorable Subst.

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452 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose.

In general, fiscal impacts are based upon a variety of informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 23 $ FY 24 $ Correction, Dept.

GF - Cost 9.6 million 12.8 million State Comptroller - Fringe GF - Cost 3.9 million 5.2 million Benefits Note:

GF=General Fund Municipal Impact:

None Explanation Thebillmakesvariouschangesregardinginmatehealthcareresulting in a FY 23 cost of $13.5 million and a FY 24 cost of $18.0 million (costs include salary and fringe benefits).

To meet the requirements of the bill the Department of Correction will have to hire 130 healthcare employees.

Below is a table showing the number of new staff needed by position, their title, and a description of why they are needed:

1The fringe benefit costs for most state employees are budgeted centrally in accounts administered by the Comptroller.

The estimated active employee fringe benefit cost associated with most personnel changes is 40.53% of payroll in FY 23.

FY 23 costs reflect nine months of salary due to the bill having an effective date of October 1, 2022.

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452 14 sSB448 File No.

452 Number of Positions Needed Why Additional Staff is Title (Annual Cost )3 Needed Bill requires annual physicals for all inmates, new inmates to receive a physical within 48 hours, exit interviews for all Advanced Nurse inmates, administration of Practitioner 73 ($9.7 million) medications and vaccines.

Bill requires a dental exam within ten weeks of inmate Dental Assistant 14 ($900,000) entering a facility.

Bill requires a dental exam within ten weeks of inmate Dentist 10 ($1.7 million) entering a facility.

The bill requires minimum staffing per facility for mental health care.

Certain examinations are required Psychiatric Advanced before prescribing certain Practice Registered Nurse 14 ($2.0 million) medications.

Bill requires one physician on call per facility and administration of Staff Physician 13 ($3.1 million) medications.

Bill requires a mental health care provider to interview an inmate on substance abuse Certified Addiction history when entering a Counselor 6 ($560,000) facility.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

3Annual cost includes salary and fringe benefits.

sSB448 / File No.

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452 OLR Bill Analysis sSB 448 AN ACT CONCERNING THE DELIVERY OF HEALTH CARE AND MENTAL HEALTH CARE SERVICES TO INMATES OF CORRECTIONAL INSTITUTIONS.

SUMMARY This bill sets various requirements related to health care for people who are incarcerated.

Among other things, it:

1.

requires the Department of Correction (DOC) commissioner to ensure that there are enough licensed mental health care providers at each correctional institution, and specifies when they may prescribe or administer psychotropic medication to inmates;

2.

requires that each inmate get a routine physical exam when entering the institution, an annual physical exam, and an exit health interview done by aphysician, physicianassistant (PA),or advanced practice registered nurse (APRN);

3.

requires these providers to administer an HIV test to each inmate who requests it, and to offer this test to inmates identified as high risk;

4.

requires that each inmate get a dental exam from a dentist within weeks of entry and dental care, as set forth in a dental care plan, throughout their sentence;

5.

requires a mental health provider to interview each inmate, at entry, on their drug and alcohol use history;

6.

generally, requires correctional institutions to transfer inmates to a medical unit if they are in alcohol or drug withdrawal;

sSB448 / File No.

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452 7.

requires the York Correctional Institution to immediately transfer to a hospital or outpatient clinic any inmate who is pregnant and seeks an abortion before the viability of the fetus;

and 8.

establishes an advisory committee to (a) advise the DOC commissioner on correctional institution health care and (b) evaluate whether the Department of Public Health (DPH) should have oversight over health care services at these facilities.

The bill also makes minor and technical changes.

EFFECTIVE DATE:

October 1, 2022, except the advisory committee provisions are effective upon passage.

§ 1 — MENTAL HEALTH CARE PROVIDERS AT CORRECTIONAL FACILITIES The bill requires the DOC commissioner to ensure that there are enough licensed mental health care providers at each DOC correctional institution to give inmates mental health care services.

This must include at least four providers at each institution with experience in substance use disorder diagnosis and treatment.

DOC may employ or contract with providers for these purposes.

Under the bill, when an inmate requests, or correctional staff refer an inmate to, mental health services the provider must do an in-person assessment to determine if the services are needed, before providing them.

The bill requires mental health care providers’ services to align with (1) the security needs of all inmates and correctional staff and (2) the institution’soveralloperation,asthewarden determinesinconsultation with the DOC commissioner.

Psychotropic Medication (§ 1(b)) The bill prohibits mental health care providers at correctional institutions from prescribing or administering psychotropic medication to an inmate unless several conditions are met.

(Another provision of sSB448 / File No.

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452 thebillallowsonly physicians,PAs,or APRNsto administer medication to inmates;

see section 2(g) below.) Under the bill, a “psychotropic medication”isoneused totreat amentalhealthdisorder andthat affects behavior, mood, thoughts, or perception.

The required conditions are as follows.

Mental Health and Medical History.

The provider must have reviewed the inmate’s full medical and mental health history, including the inmate’s current medications.

Physical Examination Review.

The inmate must have had a physical examination by a licensed health care provider within 30 days before thementalhealth care provider first prescribesor administersthe psychotropic medication.

The mental health care provider must review the exam record and find that the medication would be safe for the inmate.

Mental Health Assessment and Diagnosis.

The mental health care providermusthaveperformedamentalhealthassessment oftheinmate within seven days before first prescribing or administering the medication.

The provider also must diagnose the inmate with a mental health disorder (unless the inmate already has a diagnosis), and the medication must be used to treat that disorder.

Medication Approval Under Treatment Plan.

The provider must approve the medication as part of the inmate’s mental health treatment plan.

Recordkeeping.

The provider must keep a record of (1) each psychotropic medication they prescribe or administer to the inmate and (2) all other medications the inmate is taking.

§§ 2 & 3 — HEALTH CARE SERVICES GENERALLY AT CORRECTIONAL FACILITIES The bill sets requirements for several health care services for inmates, such as physical and dental exams, exit health interviews, and vaccine availability.

Under the bill, any of the providers referenced in these sSB448 / File No.

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452 provisions must be a DOC employee or under contract with the department.

Entry and Annual Physical Exams (§ 2(b)-(d)) Under the bill, an inmate entering a correctional institution to serve a sentence must receive a routine physical exam within 48 hours of entry.

The bill requires anyone else detained at a correctional institution to receivearoutinephysicalexaminationwithin96hoursofentry.Ineither case, the exam must be conducted by a physician, PA, or APRN.

The billprohibits inmatesor other detained people frombeing placed in a correctional institution’s housing unit until the provider completes the exam and approvesthe placement.

The warden must ensure that the person is placed in a medical or mental health housing unit if the provider recommends it based on the physical exam.

The bill also requires that inmates receive annual physical exams from a physician, PA, or APRN.

It specifies that these exams may include (1)a breast andgynecologicalexamand(2)any test theprovider finds appropriate.

The bill requires the provider to perform these physical exams (both entry and annual) in a location at the institution that the provider finds appropriate.

Any samples collected during the exam may be sent to an outside laboratory for analysis.

If the provider orders x-rays, they must be performed at the institution if it has the necessary equipment.

Exit Interview (§ 2(e)) The bill requires a physician, PA, or APRN to conduct an exit interviewofeachinmate being discharged,withinsevendaysbefore the discharge date.

During the interview, the provider must discuss their recommendations for any continued medical care or treatment for the inmate back in the community.

Physician On-Call 24/7 (§ 2(f)) The bill requires a physician to be on call 24 hours a day, seven days a week at each correctional institution to give needed medical care to sSB448 / File No.

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452 inmates.

Medication Administration (§ 2(g)) The bill allows only a physician, PA, or APRN to administer medicationtoinmates, andthelattertwo onlywithaphysician’swritten order.

Vaccinations (§ 2(h)) The bill requires the DOC commissioner to ensure that inmates have access to all vaccines licensed or authorized under an emergency use authorization by the federal Food and Drug Administration that are recommended by the National Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).

If an inmate requests a vaccine and a physician, PA, or APRN determines that ACIP recommends the vaccine for the inmate, then that provider must administer it to the inmate.

HIV Testing (§ 3) The bill requires a physician, PA, or APRN to administer an HIV test to each inmate who requests it.

These providers also must offer an HIV test to each inmate identified as high risk for infection with HIV (1) when the inmate enters a correctional institution or (2) during the inmate’s required annual physical exam.

Dental Examinations (§ 2(i)) The bill requires that inmates receive a dental examination, conducted by a dentist, within 10 weeks of entering the institution.

The dentist must (1) develop a dental care plan for the inmate when performing the exam and (2) give the inmate dental care, per the care plan, throughout the inmate’s sentence.

Under the bill, the DOC commissioner, in consultation with a dentist, must ensure that each correctional institution has a dental exam room that is fully equipped with all necessary equipment to perform dental exams.

§ 4 — SUBSTANCE USE DISORDER SERVICES sSB448 / File No.

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452 Under the bill, a licensed mental health care provider at each correctional institution must interview inmates about their drug and alcohol use history when they enter the institution.

Treatment for Drug or Alcohol Withdrawal (§ 4(a)-(b)) If an inmate shows drug or alcohol withdrawal symptoms at entry, (1) a physician, PA, or APRN must give them a physical exam within 24 hours and (2) a licensed mental health care provider must do a mental health evaluation within five days.

The bill generally requires correctional institutions to immediately transfer an inmate to a medical unit for treatment for drug or alcohol withdrawal if (1) the inmate requests that treatment or (2) a physician, PA, or APRN determines the inmate is in withdrawal.

The inmate must provide informed consent for this treatment if (1) they are pregnant or (2) the treatment includes methadone.

The bill requires a physician, PA, or APRN to periodically evaluate each inmate who shows signs of or discloses drug or alcohol addiction or who is in withdrawal.

The provider must decide how often to do these evaluations.

Under the bill, a physician with experience in substance use disorder diagnosis and treatment must oversee the medical treatment of inmates in withdrawal.

A physician, PA, APRN, or registered nurse with the same experience must give the treatment in a medical unit at the institution, and such an APRN or a registered nurse must be in the unit whenever inmates get medical treatment.

If a correctional institution’s medical unit does not have enough beds for all inmates who need this treatment, the institution must add more beds (in that medical unit or another one), so that all inmates who need this treatment get it.

Under the bill, a licensed mental health care provider with substance use disorder diagnosis and treatment experience must monitor inmates in cocaine or amphetamine withdrawal, on a daily basis for at least five sSB448 / File No.

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452 days after the first signs of withdrawal, to try to mitigate the risk of suicide attempts.

The bill also requires a second physician to be on call at all times at each correctional institution to oversee the above treatment, if the physician assigned to oversee it becomes unavailable to do so.

Counseling and Referral (§ 4(c)) For inmates who show signs of or disclosed an addiction to drugs or alcohol, the bill requires a licensed mental health care provider to do the following:

1.

offer mental health counseling services, including individual and group sessions, and encourage the inmate to do at least one counseling session;

and 2.

at discharge, refer the inmate to a substance use disorder treatment program in the community that the provider finds appropriate.

§ 5 — PREGNANT INMATES Counseling and Written Materials (§ 5(c)) By law, the York Correctional Institution (thestate’s only correctional facility for female inmates) must provide each pregnant inmate with counseling and written materials on various topics, in a form the inmate can reasonably understand.

The bill adds the following to the required topics for pregnant inmates who are drug- or alcohol-dependent:

the dangers of undergoing withdrawal without medical treatment, the importance of treatment for withdrawal during the second trimester, and the effects of neonatal abstinence syndrome on a newborn.

It also eliminates the specific requirement that the counseling and written materials cover the institution’s policies and practices on inmate care during labor, delivery, and the postpartum period (but continues to require the counseling and materials to cover these topics generally).

Under existing law, York must (1) transport pregnant inmates to hospitals for labor and delivery services and (2) place inmates during sSB448 / File No.

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452 the postpartum period in a medical or mental health unit until discharged by a licensed provider.

Transfers for Abortion (§ 5(c)) The bill requires the York Correctional Institution to immediately transfer to a hospital or DPH-regulated outpatient clinic any inmate who is pregnant and seeks an abortion, in consultation with a physician, before the viability of the fetus.

§ 6 — ADVISORY COMMITTEE The bill establishes a 15-member advisory committee to (1) advise the DOC commissioner on the provision of health care services at DOC correctional institutions (all services under the bill and existing law’s provisionsforinmateswhoarepregnant)and(2)evaluatewhetherDPH should have oversight over these services or license the facilities in correctional institutions where inmates get these services.

Membership and Procedure Under the bill, the committee includes 11 appointed members as shown in the following table.

Table 1:

DOC Health Services Advisory Committee Appointed Members Appointing Authority Appointee Qualifications House speaker (2) Primary care physician Formerly incarcerated female Senate president pro Physician with expertise in infectious disease prevention and tempore (2) control Formerly incarcerated male House majority leader (1) Health care provider with expertise in reproductive health care Senate majority leader (1) An advocacy organization’s representative with knowledge and an understanding of issues concerning gender-affirming care House minority leader (1) Current or former employee of a correctional institution Senate minority leader (1) Mental health care provider Governor (2) Health care provider with expertise in substance use disorder sSB448 / File No.

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452 Appointing Authority Appointee Qualifications treatment Racial justice advocate Department of Professional with experience in communicating the needs of Developmental Servicespeople with disabilities, including an intellectual disability commissioner (1) In addition,thecommittee’smembershipincludesthe(1)DOC, DPH, and Department of Mental Health and Addiction Services (DMHAS) commissioners or their designees and (2) Office of Health Strategy executive director or her designee.

The bill requires the DPH commissioner to appoint a member to the committee if any appointment is vacant for at least a year.

The commissioner must notify the appointing authority of her appointee’s identity at least 30 days before making the appointment.

The bill requires the committee to meet at least quarterly and allows DPH to give administrative support for committee activities.

Reporting Requirement Starting by January 1, 2023, the bill requires the committee to periodically report on its recommendations for health care services at DOC correctional institutions.

It must report as follows:

(1) to DOC, every six months and (2) to the Public Health and Education committees, annually.

The bill also requires the advisory committee, by January 1, 2023, to report to the Public Health and Education committees on its evaluation of the need for DPH oversight of health care services at DOC facilities.

BACKGROUND DOC Policies DOC Administrative Directive 8.1 requires DOC, either directly or through agents, to provide inmates with health care services that meet community standards.

The directive lists several categories of services that DOC’s contracted health services provider must provide (e.g., sick call and emergency services, pharmacy services, dental care, mental sSB448 / File No.

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452 health services, and discharge planning).

Among various other provisions, the directive requires that (1) before placing a newly admitted inmate into the general population, staff conduct a comprehensive health screening and (2) inmates receive periodic health assessments as determined by the responsible physician (specific types of assessments or examinations are required in certain situations).

Other DOC directives give more detail about certain types of medical services for inmates, such as dental services, mental health services, and psychoactive medication.

Related Bill sSB 458, reported favorably by the Judiciary Committee, requires the DOC commissioner, in consultation with DMHAS and the Judicial Department, to annually evaluate substance use disorder and mental health screening, diagnostic, and treatment services available to inmates.

COMMITTEE ACTION Public Health Committee Joint Favorable Substitute Yea 26 Nay 3 (03/25/2022) sSB448 / File No.

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