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Rules and Regulations of the State of Georgia
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Subject 125-4-4 MEDICAL SERVICES

Rule 125-4-4-.01 Responsibility

When a person is committed to a correctional institution it becomes the responsibility of the correctional authorities to provide the necessary health care for the inmate. Medical and hospital care as required shall be provided for all inmates assigned. In no instance shall an inmate, his family or other individual be required to pay any portion of the fee or expenses for the inmate's medical or dental treatment, except as otherwise provided by law.

(a) Definitions:
1. Medical Emergency: A medical emergency is any condition which, in the judgment of a health care provider, poses an immediate threat to life or limb.
2. Chronic illness: An illness requiring care and treatment over an extended period of time. Chronic illness includes, but is not limited to, hypertension, diabetes, pulmonary illness, a seizure disorder, acquired immune deficiency syndrome, cancer, tuberculosis B, hepatitis C, rheumatoid arthritis, a autoimmune disorder, and renal disease.
(b) The Commissioner may establish procedures for a reasonable deduction from money credited to the money account of a prisoner to defray the costs paid by the Department or its contractor for medical care and/or prescription medication for a prisoner.
1. If the prisoner is incarcerated in a state prison or facility operated by a contractor of the state it shall be the responsibility of the state or its contractor to render any needed medical or hospital care.
2. The Department and its contractors are authorized to make reasonable deductions from money credited to the money account of a prisoner to defray the costs paid by the state or its contractors for:
(i) Medical treatment for a prisoner when the request for medical treatment has been initiated by the prisoner; and
(ii) Medication prescribed for treatment of a medical condition unrelated to pregnancy or a chronic illness.
3. The Department and its contractors are authorized to make reasonable deductions from money credited to the money account of a prisoner to repay the Department or its contractors for the cost of medical treatment and prescription medication for injuries inflicted by the prisoner upon himself or herself or others unless the inmate has a severe mental health designation as determined by the department.
4. The amount to be charged by the Department on individual prisoner accounts shall be established by Department policy and operating procedure. However, the Department will not deduct a medical charge amount from a prisoner's account when the account balance on the date medical care is provided is less than ten dollars ($10.00) until such time that further deposits to the account raise the balance above ten dollars ($10.00). Individual prisoner money accounts shall be frozen until all medical charges incurred by the individual prisoner have been fully paid.
5. Nothing in this rule shall be construed to relieve the governing authority, governmental unit, subdivision, or agency having the physical custody of a prisoner from its responsibility first to provide and initially pay for any needed medical and hospital care rendered to such prisoner.
(c) If the state prisoner is incarcerated in a county facility and requires emergency medical or hospital care, the Department or its contractor shall bear the costs of direct medical services required for emergency medical conditions posing an immediate threat to life or limb if the inmate cannot be placed in a state institution for the receipt of this care. The responsibility for payment will commence when the costs for direct medical services exceed $1,000.00. The Department will pay only the balance in excess of this amount. The Commissioner shall establish regulations relative to payment of such medical and hospital costs by the Department.
1. The Department of Corrections shall bear the cost of any reasonable and necessary emergency medical and hospital care which is provided to any prisoner eligible for transfer to the Department but remaining in the physical custody of a county jail. The Department shall also bear the cost of any reasonable and necessary follow-up medical or hospital care rendered to any such prisoner as a result of the initial emergency care and treatment.
2. When admission of a prisoner to a hospital becomes necessary, for any reason, the Department will be notified by the authority having physical custody of the prisoner. Such notification should be made at the time of admission to the hospital.
3. Claims received by the Department for payment under the terms of this rule will be subject to medical review. This review will address the following issues: Appropriateness of the services provided and verification of charges as being within the range of usual or customary rates for comparable services.
4. All claims for reimbursement must be submitted in accordance with instructions established by the Department of Corrections, Health Services Division. The Department will provide for the payment of medical bills by reimbursing each county on a monthly basis for expenditures incurred. The Department will not make direct payment to an individual doctor or hospital.
5. Payment will be made for medical and hospital care provided to any prisoner alter receipt by the Department of the following documents: Certified copy of sentence, certified copy of indictment, certificate of revocation (when applicable), affidavit of custodian, and personal history.

Rule 125-4-4-.02 Physician

Each institution, as a minimum, shall employ a licensed physician, or ensure access to a licensed physician, either on a full or part-time basis depending on the services provided locally and the case load. In some institutions, additional medical staff will be required, in a strength depending on the health needs of the inmate population and the medical mission of the institution.

Rule 125-4-4-.03 Facilities

As a minimum, each institution shall maintain adequate space, equipment and medical supplies for physical evaluations, administering first aid, and for the examination of inmates by the institutional physician. On the recommendation of the department Medical Administrator and at the discretion of the Commissioner, existing medical facilities and equipment at an institution, or available to an institution, may be designated as adequate for the anticipated medical requirements.

Rule 125-4-4-.04 Health Services

(1) Health Services will be furnished to provide treatment for discovered illnesses, injuries, immunizations and vaccinations, and psychiatric and psychological studies and/or treatment as recommended by the institutional physician.
(a) Under exclusive procedures to be followed by the Commissioner and the Chief Executive Officer of another State Department, services of a licensed physician or psychologist may be obtained on a part-time basis where the services will be in the best interest of the State.
(2) Each inmate who has a remediable physical or mental condition shall be offered suitable treatment at the institution or through extension, at other facilities accessible to the State Board of Corrections.

Rule 125-4-4-.05 Physical Examinations

Inmates processed through diagnostic programs will normally arrive at their assigned institutions after having been medically examined and classified. As a minimum, the physical examination shall include recording of physical measurements, blood pressure, visual and hearing examinations, clinical evaluations, and laboratory examinations to include testing for Human Immunodeficiency Virus (HIV), urinalysis, and serology. An executed report of the completed physical examination and a physical profile report shall be included in each inmate's medical file.

(a) The institutional physician shall provide the same minimum physical examination for inmates assigned directly to the institution from a jail.
(b) An inmate's medical records will accompany him (her) to the institution to which he (she) is assigned. Inmates who are assigned to an institution without having had a complete physical examination shall be subjected to examination by the institutional physician for the purpose of completing the examination and report. The supplementary examination should be completed as soon as practical following the inmate's arrival.
(c) In order to assure continuing validity on an inmate's work assignment or detail, the pertinent parts of a physical examination and a re-evaluation of the inmate's physical profile shall be accomplished following any serious illness or injury and prior to his (her) return to duty status.
(d) A general physical re-evaluation shall be performed to the institutional physician when requested by the Commissioner, the Departmental Medical Director, or, by the Warden/Superintendent for inclusion in the case recording program, and the results shall also be entered into the inmate's medical files.
(e) A copy of any permanent change in an inmate's physical profile shall be forwarded to the central office.
(f) Medical records shall be established and maintained as prescribed in directives and procedural guides published by the Department of Corrections.

Rule 125-4-4-.06 Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) will be managed medically in accordance with clinical guidelines issued by the Medical Director of the Health Services Section. Administrative policies and procedures will be in accordance with standard operating procedures issued by the Health Services Section and by the Division of Facilities. Departmental policies will comply with requirements of Georgia Code Sections 42-5-52 and 42-9-42, as amended during the 1988 General Assembly.

Rule 125-4-4-.07 Dental and Optical

All inmates shall receive dental and optical treatment including dentures and glasses, as required. Such treatment shall be provided irrespective of the length of an inmate's sentence or the proximity of his discharge date. The following procedures shall apply:

(a) Inmates in state institutions shall receive dental and optical treatment locally or at an appropriate institution designated by the Commissioner of Corrections.
(b) Inmates in county institutions shall receive dental and optical treatment locally. The expenses of such care shall be borne by the institution concerned.

Rule 125-4-4-.08 Special Examinations and Inspections

When an inmate is placed in administrative segregation or disciplinary isolation, security shall notify a member of the medical staff. A licensed health care provider will review the inmates' medical record to determine if the inmate would be medically or mentally harmed by the environment of disciplinary isolation. The review of the medical record shall be completed by the close of the next business day. A licensed health care provider shall make medical checks of inmates in administrative segregation and disciplinary isolation three times weekly. The institutional physician shall advise the Warden/Superintendent as to whether or not in his/her judgment the inmate can tolerate the physical and mental stress of such confinement. If medically required, the Warden/Superintendent shall remove the inmate from disciplinary isolation.

(a) In addition to his/her other duties, the institutional physician or licensed health care provider shall inspect or cause to be inspected those institutional activities which could result in health hazards and advise the Warden/Superintendent on sanitary considerations including, but not limited to, food handlers, actual or potential food and water contaminants, and other sanitation matters which could seriously affect the health of those at the institution.

Rule 125-4-4-.09 Medical Transfers

The following procedures shall be observed should transfer of an inmate be required in order to assure proper medical care.

(a) An inmate within a state institution who develops an illness or sustains an injury which requires medical care that is unavailable at the institution shall be provided the necessary care by placement in the local hospital, transfer to another state, correctional facility, placement in the Eugene Talmadge Memorial Hospital, or treatment elsewhere as required, and determined by the Commissioner of the Department of Corrections upon recommendation by the Departmental Medical Director or the institutional physician.
(b) A state inmate who is incarcerated in a county institution and develops and illness or sustains an injury which requires treatment unavailable at that institution shall be provided any needed medical or hospital care in the local hospital or elsewhere as required by his condition. The expenses of such care shall be borne by the institution concerned.
(c) A state inmate who develops a chronic illness while incarcerated at a county institution may be transferred to a department institution for treatment provided that prior consultation between the county institution physician and the staff of the state correctional facility has determined that the inmate is classified as chronically ill and transportation of the inmate to the state correctional facility will not constitute an unacceptable risk to the health or life of the inmate.
(d) A state inmate may be transferred for specialized medical treatment to another party state or Federal Correctional Institution under the interstate corrections compact when authorized by the Commissioner of the Department of Corrections.

Rule 125-4-4-.10 Injury, Illness and Death

If any state inmate develops an illness or sustains any injury that requires immediate emergency attention, the Warden/Superintendent shall arrange to provide that attention immediately at the nearest facility. The action taken will then be reported through established channels to the Commissioner of Corrections and guidance solicited as to further action.

(a) If an inmate is severely injured or develops a seriously acute illness, the Warden/Superintendent shall notify the inmate's next of kin or other individual(s), designated by the inmate. The Warden/ Superintendent shall keep such individual(s) apprised of any significant change in the inmate's condition, including death.
(b) In all such cases of serious injury or severe illness, the Warden/ Superintendent shall expeditiously notify the Commissioner of Corrections, and shall forward a summary report to the Commissioner of Corrections, after the necessary treatment has been completed.
(c) In all cases of death, the Warden/Superintendent shall immediately notify the Commissioner of Corrections, and shall provide a copy of the Certificate of Death.

Rule 125-4-4-.11 Unusual Death

Whenever any inmate in an institution under the control of the State Board of Corrections dies suddenly or under unusual circumstances, the Warden/Superintendent shall promptly notify the Commissioner of Corrections, the Director of the State Crime Lab, and the Coroner of the county in which the death occurs. Additionally, the Warden/Superintendent will provide the Commissioner of Corrections with a copy of the findings of the Coroner's inquest and furnish any other information which would be helpful in identifying the cause of death. A Death Certificate shall be furnished to the Commissioner of Corrections.

Rule 125-4-4-.12 Medical Research

Medical experimental and/or research activities involving either inmates or staff shall not be undertaken without the prior written approval of the Commissioner of Corrections for each project proposed. Such approval shall clearly define the type of research approved, the exact methodology to be utilized, the length of time of the project and shall require regular periodic reports during the course of the project.