Download T - Florida Department of Corrections

FLORIDA DEPARTMENT OF CORRECTIONS
OFFICE OF HEALTH SERVICES
_______________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 1 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
EFFECTIVE DATE: 04/01/08
_______________________________________________________________________________
I.
PURPOSE:
The purpose of this health services bulletin is to provide information and guidelines for
testing, diagnosis, and treatment of Human Immunodeficiency Virus for inmates at
all correctional facilities and to provide for continuity of medications for Human
Immunodeficiency Virus/Acquired Immunodeficiency Syndrome patients.
II.
TESTING:
A.
Confidential testing for Human Immunodeficiency Virus is to be encouraged to all
inmates on a voluntary basis upon intake or during incarceration. Mandatory testing
for Human Immunodeficiency Virus is a component of end-of-sentence
requirements. No co-payment is to be charged for Human Immunodeficiency
Virus testing, pre-test, or post-test counseling.
B.
Human Immunodeficiency Virus tests can be requested by any inmate. Each
institution will be responsible for testing its own permanent-party inmates and those
of the community facilities for which the institution is responsible. See attachment
“1” Notice to Inmates (English/Spanish) for bulletin board notifications.
C.
Human Immunodeficiency Virus tests shall be conducted with prior informed
consent of the inmate. The inmate shall be informed of the right to confidential
treatment concerning the inmate's identity and test results. The inmate shall also be
informed prior to testing about prevention of exposure to and transmission of
Human Immunodeficiency Virus and shall have a return visit for the purpose of
disclosing test results and conducting post-test counseling. If the test result is
positive, the counselor must advise the inmate of the availability of mental health
counseling and partner notification services by the Department of Health Sexually
Transmitted Disease staff (as per the Department of Health Model Protocol for
Human Immunodeficiency Virus Test Counseling, see attachment “2”).
D.
Pre-test and post-test counseling and the inmate's signed consent for Human
Immunodeficiency Virus testing will be documented on “Consent for Human
Immunodeficiency Virus Testing,” DC4-783 which is to be filed in the health
record behind pink divider “Communicable Diseases Record,” DC4-710.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 2 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
E.
All Human Immunodeficiency Virus test results must be reviewed by a physician or
clinical associate.
F.
No Human Immunodeficiency Virus test result shall be determined as positive or
revealed to any person as positive without confirmatory testing.
G.
Inmates who are negative upon testing may request that another Human
Immunodeficiency Virus test be done in six (6) months. Subsequent testing will be
based on clinical judgment and justification by the clinician.
H.
All Human Immunodeficiency Virus positive results will be entered on the
“Problem List,” DC4-730.
I.
All inmates with a positive Human Immunodeficiency Virus result will be referred
to the physician/clinical associate for further workup and enrolled into the
Immunity Clinic.
J.
All admissions to reception centers must have documentation of Human
Immunodeficiency testing recommendation. This can be accomplished thru
documentation of Inmate Reception Orientation.
K.
When an inmate reports the history of a positive Human Immunodeficiency Virus
test, an attempt will be made to obtain a copy of the test result from a previous
departmental chart or the previous medical care provider. The inmate must sign a
“Consent for Authorization for Use and Disclosure Inspection and Release of
Confidential Information,” DC4-711B before the department makes contact with
an outside provider.
L.
All inmates involved in a situation where there has been a significant exchange of
body fluids will be tested, except for those who are known to be Human
Immunodeficiency Virus positive. Human Immunodeficiency Virus screening
will be repeated at six (6) weeks, three (3) months, and six (6) months if the
affected inmate remains negative. Inmates who are exposed shall be offered a
preventive treatment based on a medical evaluation of the exposure.
M.
Mandatory Human Immunodeficiency Virus testing is to be performed within one
(1) year of end-of-sentence.
1.
The senior health services administrator is responsible for taking reasonable
steps to ensure that Human Immunodeficiency Virus testing is completed on
every inmate within one (1) year of end-of-sentence, and not less than sixty
(60) days before the inmate's tentative release date.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 3 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
III.
2.
Inmates refusing the mandatory end-of-sentence test will be counseled by
the nursing supervisor. If the inmate continues to refuse, the inmate's name
and circumstance of the refusal will be reported to the senior health services
administrator, regional health services office and the assistant secretary of
health services.
3.
Inmates with positive confirmatory test results are to be reported to the
designated medical case manager. Pursuant to section 381.004, Florida
Statutes, a written consent is not needed provided there is documentation in
the record the test has been explained and that a verbal consent was given.
Staff will document on the DC4-783 under the consent section that verbal
consent was given and that two (2) staff members witnessed the consent.
4.
The senior health services administrator will report each month to the
regional health services administrator the total number of end-of-sentence
tests performed, the total number with positive and negative test results, the
number who refused, the number who received medication, and the number
who did not need end-of-sentence testing.
CARE PLAN:
A.
All Human Immunodeficiency Virus positive inmates will be followed in the
Immunity Clinic for assessment, clinical evaluation, and monitoring. Periodic
examinations, laboratory testing, tuberculosis screening, x-rays, and vaccinations
will be provided as outlined in health services bulletin “Chronic Illness Monitoring
and Clinic Establishment Guidelines,” 15.03.05. Clinicians are expected to utilize
specialty consultation when needed.
B.
Prophylaxis against opportunistic infections will be provided for all Human
Immunodeficiency Virus positive inmate patients as clinically indicated:
1.
Pneumocystis carinii pneumonia prophylaxis will be provided for persons
with CD4<200 cells/ul (or <14%). Prophylaxis can be discontinued for
those responding to treatment with a CD4 level >200 cells/ul sustained
more than three (3) months. (Note: Glucose-6-Phosphate Dehydrogenase
determination must be normal before commencing Dapsone therapy.)
2.
Toxoplasma gondii prophylaxis will be provided for persons with
CD4<100 cells/ul. Prophylaxis can be discontinued for those responding
to treatment with a CD4 level >200 cells/ul sustained more than three (3)
months.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 4 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
C.
IV.
3.
Mycobacterium avium prophylaxis will be provided for persons with
CD4<50 cells/ul. Primary prophylaxis can be discontinued for those
responding to treatment with a CD4 level> 1 00 cells/ul sustained more than
three (3) months.
4.
Mycobacterium tuberculosis prophylaxis will be provided for Human
Immunodeficiency Virus infected persons with a tuberculin skin test result
of 5mm or greater, or those who are close contacts of persons with
infectious tuberculosis.
Antiretroviral therapy will be considered for Human Immunodeficiency Virus
positive inmate patients who:
1.
Have a Human Immunodeficiency Virus Ribonucleic Acid (RNA) viral load
>100,000 copies/mL and/or CD4 <350 cells/ul
2.
Have acute Human Immunodeficiency Virus syndrome or within six (6)
months of seroconversion
3.
Demonstrate symptoms of Human Immunodeficiency Virus infection
4.
Are pregnant
D.
Patients considered for antiretroviral therapy must commit to medication
adherence. All antiretroviral medication is to be single-dose administration with the
exception of inmate patients in work release centers or those participating in
discharge preparations. Inmate patients who are non-adherent will be reviewed by
the clinician and antiretroviral therapy medication may be discontinued.
E.
Special diets are only indicated with clinical justification.
F.
Dental service guidelines are provided in “Dental Services/Standard
Operating Instructions,” 15.04.13.
REPORTING:
A.
All newly identified Human Immunodeficiency Virus infected inmates and all new
cases of Acquired Immunodeficiency Syndrome diagnosed in accordance with
CDC standards must be reported to the Department of Health using the "Acquired
Immunodeficiency Syndrome Adult Confidential Case Report" form (CDC 50.42A)
or Acquired Immunodeficiency Syndrome case report form. A copy of the report
form should be filed in the medical record behind “Communicable Diseases
Record,” DC4-710 (pink chart divider). Additionally, all newly identified Human
Immunodeficiency Virus-infected inmates must be reported to the Department of
Corrections Human Immunodeficiency Virus Prerelease Planner for the appropriate
Region.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 5 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
B.
V.
Reporting by a local hospital does not replace DC reporting.
WORK RELEASE:
Inmates who are Human Immunodeficiency Virus infected and on medications may be
placed in work release settings.
VI.
A.
When the decision is made to transfer a Human Immunodeficiency Virus infected
inmate to a work release center, plans will be made to provide Human
Immunodeficiency Virus-related medications.
B.
Medication related to Human Immunodeficiency Virus disease will be provided on
a monthly basis by the major institution that is responsible for the work
release center.
C.
The inmate will continue to be followed at the major institution for Immunity
Clinic.
DISCHARGE PLANNING:
Discharge planning must be done for Human Immunodeficiency Virus infected inmate
patients.
A.
In order to prepare and better educate inmates who have controlled Human
Immunodeficiency Virus Infections/ Acquired Immunodeficiency Syndrome to
prepare for their own care after release (end-of-sentence), six (6) months prior to
end of sentence inmate patients on medications who have demonstrated adherence
will be offered the opportunity to keep medications on persons. The clinician
should schedule reevaluation in one month after this change to assess adherence.
B.
Within six (6) months of end-of-sentence, the assigned Human Immunodeficiency
Virus prerelease planner will coordinate continuity of care with a community care
provider, and/or county health department. The assigned Human
Immunodeficiency Virus prerelease planner communicates verbally with the
assigned classification officer and provides requested documentation.
C.
Refer to health services bulletin “Prerelease Planning Continuity of Health Care,”
15.03.29 for guidelines on planning for continuity of care.
D.
Inmates who receive any medication(s) which is approved by the Department of
Health Acquired Immunodeficiency Syndrome Drug Assistance Program will be
referred to this program for follow-up care after release from a Department of
Corrections facility.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 6 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
E.
A MAXIMUM THIRTY (30) DAY SUPPL Y OF CURRENTLY PRESCRIBED
MEDICATIONS (SUFFICIENT TO PROVIDE THE EXITING INMATE WITH
TREATMENT UNTIL TREATMENT IS RECEIVED FROM A NONDEPARTMENT OF CORRECTIONS PROVIDER) WILL ACCOMPANY THE
INMATE, ALONG WITH A REFERRAL TO AN APPROPRIATE MEDICAL
FACILITY.
F.
If the inmate is on any Human Immunodeficiency Virus-related medications, the
designated medical case manager for Human Immunodeficiency Virus prerelease
planning will contact the Department of Health Acquired Immunodeficiency
Syndrome Patient Care Office in Tallahassee at 850/413-0674 or SC 293-0674 to
establish preliminary eligibility and discharge plans. The Department of Health
office will be provided with the information needed to establish eligibility for the
Acquired Immunodeficiency Syndrome Drug Assistant Program and the name of
the county where the inmate will reside after release and where s/he will obtain
health care.
G.
The medical case manager will establish an appointment for the inmate at the
county health department as soon as the end-of-sentence date is known.
H.
The following information shall be copied from the medical chart and such
information shall be transmitted to the appropriate county health department, and/or
community care provider where the inmate will receive health care after release:
1. Human Immunodeficiency Virus test result showing a Western Blot
confirmation of a positive result.
2. The latest Cluster of Differentiation (CD4) count.
3. The latest Viral load test result.
4. Any information that documents an Acquired Immunodeficiency Syndrome
related opportunistic infection (see Infection Control Program Manual for a
list).
5. Chart forms or an accurate listing of medication history.
6. A list of current medications related to treatment of Human Immunodeficiency
Virus infection.
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 7 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
VII.
EDUCATION:
A.
Florida statutes mandate education on Human Immunodeficiency Virus and
Acquired Immunodeficiency Syndrome for Department of Corrections staff and
inmates. Education will be provided to inmates at reception, transfer to a
permanent institution, and prior to release. Periodic updates will be offered as
needed. This education must be provided and documented (see attachment “3”
Inmate Reception Orientation:
Human Immunodeficiency Virus Infection
Education Lesson Plan and Curriculum).
B.
Annual documentation of training for medical and nonmedical staff is required, and
Human Immunodeficiency Virus counselor training is to be provided for staff who
perform the pre-test and post-test counseling. In March of each year, Office of
Health Services staff will prepare an annual report to the legislature on staff and
inmate educational efforts.
VIII. RELEVANT FORMS AND DOCUMENTS:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
DC4-710 Communicable Disease Record
DC4-711B Consent for Authorization for Use and Disclosure Inspection and
Release of Confidential Information
DC4-730 Problem List
DC4-783 Consent for Human Immunodeficiency Virus Testing
Health Services Bulletin 15.03.05 Chronic Illness Monitoring and Clinic
Establishments Guidelines
Health Services Bulletin 15.03.29 Prerelease Planning Continuity of Health Care
Health Services Bulletin 15.04.13 Dental Services/Standard Operating Instructions
CDC 50.42A Department of Health Acquired Immunodeficiency Syndrome Adult
Confidential Case Report
Infection Control Manual
Notice to Inmates (English and Spanish) Attachment “1”
Department of Health Model Protocol for Human Immunodeficiency Virus Testing
Counseling - Attachment “2”
Inmate Reception Orientation: Human Immunodeficiency Virus Infection
Education Lesson Plan and Curriculum - Attachment “3”
________________________________________
Assistant Secretary of Health Services
_________________________
Date
_____________________________________________________________________________
HEALTH SERVICES BULLETIN NO: 15.03.08
Page 8 of 8
SUBJECT: DC POLICY ON HUMAN IMMUNODEFICIENCY VIRUS DISEASE AND
CONTINUITY OF CARE
_____________________________________________________________________________
This Health Services Bulletin Supersedes:
HSOI 87-05 dated 3/27/87
Interoffice Memorandum dated August 7, 1990
Re: DC Policy on Human Immunodeficiency Virus Disease
HSAM 97-4 dated 9/12/97 and 5/21/98
HSB 15.03.08 dated 4/1/88, 5/2/88,
12/5/88, 5/26/89, 1/29/92, 11/8/93,
3/31/94, 5/20/96, 3/5/97, 9/11/01, and 06/08/04