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-Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19
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46 of - 93
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CONFIDENTIAL SUBJECT TO GENERAL PROTECTIVE ORDER
M

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·Pr ov i·d er H8n_
dbOok
. v-fr

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Phy.siciaris, P_
sychiatris~, D.entists,.Nurse Practitioners, and.
Physician
Assistan
ts ·
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Wexford Health Sources, Inc.

Fosler Plaza 2 ·
425 Hollday Drive
Pittsburgh, PA 15220

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Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 47 of 93 Page ID #1047

CONFIDENTIAL - SUBJECT TO GENERAL PROTEC
TIVE ORDER
Provider Handbook·
.

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HIS TOR Y OF WEXFORD HEA LTH SOURCE

S

A divis ion of the Benny Grou p (located in Pitts
burg
· med ical management servi ces in the corre ction elindh, Penn sylva nia), Wexford Heal th Sour ces, Inc. provides
ustry . The firm. has over thirty-five (35} year s expe
. in_heal,:11 servi ces rnan agem i:nt, hlclu ding long
rienc e
..term care, psychiatric, and subp tance a.buse prog
rams . In
1992 , Wexford Heal th seize d the oppo rbmi ty
to use this expe rtise in the corrections industey'.
·

I.

Phll osop ~y of Medical Prac tice

innovati~ ~dic al ~ t
servi ce to incar cerat ed patie nts. I n ~ patie organ izatio n specializing in prov iding qual ity medical
nts are ward s of their respective state or cqan tywi
alter nativ es for care- othe r than aeni cea the insti
th no
tutio
n provides.
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••

Wex ford Heal th is an

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The 'c lrcum stanc es that brou ght the p,itient.t<> incar
cerat tan are inclc vant , The.medical. 'llllit shou ld
provide
an -area where ~te s are treated, with respect and
conc
ern,
even
if
•extr
a
effor
t'
is·:be
ceasm
y
tr.>
mak
e that
happ en; Any att;itud~ that ~MnC 9!18 ~ statu
s of an inma te-pa tient is unacceptable. Medi
cal l!lervice is NOT
the miss ion of carrc ct:lon a (~g h ~ insti
tutio n is required to prov ide such). Med ical care
,is a aupp qrt
service. The mission. of the Oep' art:m =t of C
~ s ia sec:Urlty and c:Uacipllne. .··
. . . . .: l · :··~·' , ... .

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our·"Pra..ctlce.." Popu
. latio
. n

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Our patient.ii are inrn~tes tn correctlonal centers, havi ng been.

convicted.of various crbe a agai nst socie tysam e ofwh ich were quite hein ouii.
con ~ andr eapo naib ility! awit h theirmcdicalc
are. We aren otth e
Judges ·qe ~ guilt ~ U1I1Cp~ce, .OUr
:, , . ·
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·· ·
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. Mos t .inm ates are cooperative. They'1"Jl t to
complete their .sent ence and get on with their lives
coop erate with medi cal instruction and are usua
. They
lly compliant. Abo ut 15% of any givcm popu latkm
marginally (or completely) ·unco oper ative and .crea
are-.
te 90% of the heal th servi ce detn and. They are
chall
enge
the
of
medi
cal
man
agem
ent.
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Ofte n inrna tea have had little or no access to medi
cal
care
prior to fncarceration~ and are not certa in when
or how to uae the services. Som e are emb arras sed,
and some ~st don' t lmow wha t to say or ask.
q'hef r
resp onse to your servi ce may appe ar unus ual,
m: even bizarre. They often (more often than in priva
. ~ c c } will aay wha t th~-~
te
YoU want to hear, ratb ~ than wh at~ to
their ¢.ol:]lema.
Inma tes can be very manipula.tlve. ~ l e in
geneJ8). man ipula te their environment: to their
own end.
. Inma tes tend to enga ge their environment with
skilled adep tness . Every institution prov ides an
"Inm ate
Hand book " listin g the' rules and cond uct expe
cted of the inrnateA, You 'Should read and unde
rstan d this
document..Never take anyt hmg from or bring anything
_to an inma te. Do not authome spec ial
Anyt hing tliat raisc a a ques tion abou tinm ate
reJat1onsbips shou ld be diacu saed with your hi;al privtlegea.
th care unit
adm inist rator , or the reapcmaible: aasia tant ward
en.. .
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In spite of their situatlon, inrnate11 deserve to be
treat
priso n. How muc h resp ect~ recei ve will be clirec ed.w ith respect end concern. They wei-e not raise d 1n
tly relat ed to how faJr, just and profe ssion al you
are with
your.inm ate pati ents .~ imna te/ph yaicl an relat
kmah ip dem ands "fair and firm• - t h i s ~
rei,pe
ct.
They ere your prac tice• treat them as auchl
:.::;;-~~-=7
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Approved by thl Wexford Medical AdvlsOIY Co~l lH on June 8, 2012

...

PagU

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Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 48 of 93 Page ID #1048

CONFIDENTIAL- SUBJECT TO GENERAL PROTECTIVE ORDER
Provider Handbook

LEVELS OF SERVICE .
Medica l and health care should be deliVCl"Cd by a team
levels of care as follows:
••

ofmedical professionals. The services are organized into

Self Care. Iridivid uala arc person ally respon sible for seekin g medica

l advice

regard ing their health
care concerns. Jmnate s do not lose this responsibility. They ere the managers
of theh' general
· health and lifestyle. Every effort must be made to teach and ~orc
e person al. respon sibility .

•:

Nursing Bick Call, This service is provid ed daily by staff nursei ,. Tnmete
usually. sign up-for Sick Call the day before. Often, protoc ols are used .s des.iring to be 13een
to guide the nurse s triagiDg
Sick Call. Buch protoco ls should first be read and approv ed by the
medica l director. Once in use,
they ~ be revi.ewe~ by ~ medica l dircctq r to assure cbmpli
mJ~e. · .
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. Emerg ency Care. Eii>.ergency c~ is availab le twmfy-foqr (24)
a day, seven days a week. ·
Any inmate must have access to health care unit personn!=l for
immed iate medica l service any .
time an ~ c y arises. Medica l personnel
teams) are a}so availab le to respon d to a cell or
other areas in the prison to meet medica l needs. Another. op!ion 'for Emcr
~cy care is referra l to· ·
a. local emergency department if a ph~ci an is not on site ANq the
medica l person nel deems this
appropriate., or if the needed medical service is beyond the capabi lity of tha:
unit

hours

(or

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person nel, ·,
.Medical person nel must contac t the medica l director/d~si$D~e first
unless·the ~en cy is
life/lim b threate ning.
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· · Docto r's Sick Call. An µimate has the ~ght .to reques t to see a ·ph},sic
ian. This reques t should be
honoi,::d within seventy~two (72) hours. Inmate s seen in Sick Call
by the nurses are freque ntly
"referr ed•. to Doctor 's Call for evaluatimi, cliagnQ,., and/o r trratrn
cnt· ·
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Specia lty Care, This is provideq, in various ways. This includ ~s onsite
clinics, ofl'sitc referral to ·
their offlce, and emergency depart ment or a hospita l. Refen, d may
be made to hospit als or
ambul atory center s for sw-gery• special ized testing , .o r othet service
s 88 mdicated.
·
Note: All referrals·that are not an emergency must be discus sed
in Wexford Health's collegial review.
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"leve l of Community Caren

contra.ct

Both by
and by decree of the federa l courts , correct ions depart ments must
provid e inmate s•
medic al care that is •equal to that available in the local commu nity.•
Genera lly this _m eans "usual and
custom ary" medica l service, Althou gh a progra m of comprehensiv
e medica l care is require d, not every
diagnosis mandates treatment, nor is repair done on every existing conditi
on. The medica l staff should
identif y mcdict tl condit ions on entry, or 88 early 88-poasible, and design:
a progra m of indivic;lual care that
seeks ta mainta m inmate health during incarce ration. Illness.or
injuzy occuni ng g.~g , or aggrav ated by
incarc eration should be promptly. and approp riately attend ed.
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These objectives can be met.in many ~s, includ ing proper chmsification
, iornatc educat ion, alterat ivc of
work and recreational assigQDients, freque nt observ ation and evmiu
atinn, adjust ments of medication
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and/o r diet, and adjust ments of a multitu de of other variabl e!:.£.
o.!!,sideration shou!g._~.siJS\_\o..J;l~Y. .__..
~~ ~-=--= altcm a:tive ~py..
tlUtt. pmM titlie -'fillt iffifa ffil,,~ e·corrc ctiona l·seiili ir,Plea
se-disc uss'wi th--·
the ~giona l ~dica l directDr and/or corporate ~edical director any unusual alternatives therap
y being
considered before it is started.
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lnnµlte health problems arl!i consid ered somewhat like 8worker's compensation
in conjun ction with, or is aggrav ated py incarce ration, it is the respon • cases, If a condition occurs
sibility of the Depart ment of
Corrections (thus the medical contractor) to treat c;,r correc t it. Many inmate
s, however,.ent er with pre.
.

Aoorovad bv lhR WAvl'nrrl Mlllffr•I 4,t,,lcnN t'nnu,dlla a "" ,...... •

•n•..

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 49 of 93 Page ID #1049
CONFIDENTIAL- SUBJECT TO GENERAL PROTECTIVE ORDER

Provider Handbook
existing problems that require significan t care. Random examples include diabetes mcllitus, hypertens
· cancer, cbrcmic renal problcma, cardiac diacase; utlmla, seizures, paralytlc conditions ; and many ion,
other ·
· significan t debilitatin g condition s. Condition s that arc pre-existi ng, cbronic, and stable require monitorin
g
• only.
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Longstand ing problems, e.g., artbrltis, old lmce and ankle injuries, recurrent low b~ ache,
flat feet,

clilldhood eyeproblc maresultin ginamblyo pia,presby cum,harnr neril>es," t:rlggerfin gcra,11 persisten

tacne,
hemiaa,
uncompli cated umbilical hernia.II, and a multitude of other auch conditions may receiVI" minima],
but
· reasonable support or observatio n.

· tinea versicolar , inguinal hemlea (J!long duration without complication, uncompll catcd
ventml

A.

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Many variables must be considere d when deciding a course of trca.tmen~ These include, but are

not limited to the following:
B.

When thew long ago) did the problem. begin?

C.

The chroniclty of the problem

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Whether ~e problt;m initiated. in the. Departme nt of Corrections, o r ~ to ~ t i ~ n ·

E.

What !s the problem?

F.

How long is the inmate'.9 sentence? When will he (she) be rcleeaed?

G.

Wm the treatmen t -make a difference?"

H.

wm it improve the inrnate's iimction?

I.

wm the treatmen t make the care of th~ inrnate easier for the medical or correctiom l eta.fl?
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What fs the simplest, moat b • , and •safest means of managing this -pro~?

As physician s ofleadership represent ingboth Wexford Health and the Departme nt of Correction

work, you are responsib le for provklfng a level of care that at least meets these- requireme nts.

AppnlVad by Iha Wexford Medical Advisory Clllll'pllae onJ1111 a, 2012

s where you

Pagt4

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 50 of 93 Page ID #1050

CONFIDE~TIAL ~ SUBJECT TO GE
NERAL PROTECTIVE ORDER

Provider Handbook

STANDARDS AND-GUIDELINES

.

I.

Na tion al Commission of Co rre

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ctio nal He alth Oa re (NCCHO)

Sta nda rds
Wh ere ver Wexford He alth Sou rce
s, Inc . assumes rcs p~ ibi lity for
me dic al car e ma nag em ent , a con
cfi'o rt is ma de to me et and exc
cer ted
eed the Sta nda rds for Medical Car
e in Prisons and Jai ls as est abl ish
Nat ion al Com mis sion of Cor rec tion
ed by the
al Hea lth Car e, A copy of the se stan
hea lth car e uni t administrator~
dar ds is available in the office of
you r

II.

American Correctional Associatio
n (AOA) Standards
•
I,
An o~ imp ort ant set of sta nda
rds app lied to hea lth serv ices ere

tho se of the ACA. The adm inis trat
the cor rec tion al dep artm ent wil
ion of
l be par ticu larl y inte res ted tha
t the me dic al staff' comply. wit
sta nda rds . ·
h
the se
.
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Wexford Standards
•
•

the

Wexford sup por ts
hig hes t lev
. coi ltra cte d:·ACA sta nda rds ere el of sta nda rds demred by the sta te/cou nty where tho se serv ices
hav
.the rninirneJ level acc ept abl e to We
xford; however, the pre ferr ed lev e bee n
at'l eaa t should me et NCCHC Sta
el of car e
nda
rds
.
In
ma
ny
uni
ts,
We xfo rd has me~ and ope rate s
NCCHC. . .
und er ACA and
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Co ntr act i>eflnitlona

.

In any given cor rec tion al car e faci
.
lity; the serv ices req uire d, the stan dar
exp ect ed are def ine d in the neg otia
ds of car e and the qua lity ass ura
nce
ted ~t h service con trac t. The hea
cop y of tha t specific con trac t. The
lth cann1nit adr nin istr ato r will hav
se
ea
def
init
ion s mu at be me t to aas ure con tinu
of the services.
atio n ofW ¢or d as ma nag er
·
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v.

Chain of Command
It hi imp era tive for all pro vid ers
'
to
cor nrn end tha t exists at eac h faci und ers tan d the var iou s org ani zati ona l cha rts and rep orti ng cha
lity, Ple ase be sur e to
in of
ope rati ons s.t you r _
facility wit h you r Regional Medica review the following cha in ofcom ma nd stru ctu res in
l DirectQr or site Medical Directo
r:
A.
Sec uri q l~adcrsbip (s ~

or county) .

B. ..

Medical lea der shi p (sta te of cou

nty

d. .

Wexford me dic al lea der shi p
.
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D. . Wexf'orri adm inis trat ive
end nur sin g lea der shi p

Pro

tocols may be dev elo ped and use d
to gui de the car e given by nur ses . The
and the app rop riat e rou tine s in
y are also use d to gui de nur ses
the chr oni c clinics. All protocols
mu
st
dire cto r. As par t of the uni t Qu
be
app rov ed by the un it medical
ality Ass ura nce Program, bot h acu
te car e and chr oni c clinic pro toc
def ine d sam ple ) wil l be review
ols (or a
ed ea.ch mq nth by the uni t me
dic al director. Wexford haa pre
pro toc ols tha t may be use d or
-pr epa red
rev ised for use at the discretion
of the un it me dic al director.
ApprliVld by the Wexford Medical AdvlsoryC
ommlllaa an June 8. 2012

Case 3:19-cv-00681-MAB
Document 68 Filed 10/10/19 Page 51 of 93 Page ID #1051
CONFIDE

NTIAL - SUBJECT TO GENERAL PROT
ECTIVE ORDER

.

VII. Professional Dresa Cada
'
How you dre ss baa a dire' ct rela tion
ship to how the.inm ate s trea t you.
Pat
and pre fer the .ph ysic ian to dre sa
in a professional ma nne r. Dlscretlan ient s, includine
per son al dre ss; how eve r, as a gen
ia given to the
eral
Wh atev er the dre ss, be profcsaio.na gu id~ , ties are app?Qprlate, and blu e jea ns sho ~
l,

VIII. Continuing Medical Education
. (CME) ·
Phy sici ans , by ~ cho ice' of the ir
~es aio n, sho uld be lif'etime· stud ent
s. Ongoing stud }
cumm.t in medicine. The use of jou
mal a, libraries, approved textboo
pro gra ms ate enc our age d. Am mg
ks, and o
eme nts ma y be available for you to
attend me dica l edu
ple ase cht; t;k wit h you r Regl.onal
Med ical Dir ecta r far deta ils. You are
also enc our age d to at
.programs offered by 1 ~ hos pits la
and stat e medical societies. ·
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·
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A unit in-s erv ice trai nin g pro gra
m aho\lld be led by par tici pati on
of the phy sici an ata
sup por t me dica l ~u nd ers tan ds
wh at y o u ~ and 1ea ma you
r
pra
the y can ass ist you .
ctice pat ter ns, ~
·.
· . . : ..
·
rem ain

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IX.

Relationships

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4

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. Dev elop ing ~t ive pro feas ion ;d
rda
spe clel lsta •grc atly hel ps to eas e you tton abl p~ wit h you r med ical staf f, ~rr ect lon al atafl
. development&, sec urit y, and oth r wor k. Dia cua sion a about}'O)ll'.pat icnt a' problems, trea
eria sue s wtn·hel pyo u and yoU r ataf
f'be
· and wh en it sho uld be ~- Aga
in, it ia imp orta nt to con side r the pub ttcr und era tan d wl
lic hea lth and matiti.
cor rec tion al mcdiclISe. The adm
fnis
doc um ent s tha t mu st be app lied to trative directivea of the Dep artm ent of Correction
you r deciskm~maldng. Developmg~
Jattonabips wit:}1 tht
~ ~ :fm p~ t • the med ical
staf f. ·
.
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X.

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Early Release from OUstody for Tem
ilnally III lnmataa
•

W~ ord Health ma kes eve ry effiJ
rt to facilitate the ear ly rele ase of tho se inm ates who
term ina lly ill. A tcn nin ally U1 inm
ate is defi ned aa one who has bee
n given a pro gno sis oflc
live. Phy sici ans arc req ues ted to
diac usa ind ivid ual cas es• wit h the
acc ord anc e wit h sta te regulattons,
facillty med.ical ,
~ sub mit reco mm end atio ns
to the correctional aut b

XI.

....

Provtdlng Medical Cara to S~ ff
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.
Wexford Health Sources carries
gen era l and profesalonal liability
phy sici ans , phy aicl an aaaiatants
inau
ran
c~ tha t •cc
and oth er hea lth car e staf ffor wo
rk per1prmed on beh alf 1
The Company, of cou rse, 1s con
trac
. appropriate f'or a site phyaicl.an to ted to provide car e to the · inm ate population. The:
deli ver car e to a fellow employee
~ ta a cor rect ion s aJ
suc h car e be "covered" und er the
exis ting insu ran ce poll cy. Perscma
oth er ·than inm ate s
car e should be dire cted to the ir
pen san al phy aici ana . Exceptiona
' wou ld incl ude : 1) in'
eme rge ncy wher"! hnm ccti atc car
e is nee ded , aru:l 2) rou tiDc ac:n icea
tha t ma y be inc lud e
con trac t, Le., rou tine ~ t i o n
of coaect:

________

--·_,... ............
--.,.--·.....,...
_,..,.
·----,·.,...._ --·..·-- - ~-r-r--

~

lons o ~ . ·

·
•-..,,......._,_ ...._.......... ....
__ __ __ __
;__
..._.,____
·- .._=
-- •.:...-- •··..::
·---- ::-..--.:-_
--......-...-:
-- ·--

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 52 of 93 Page ID #1052

CONFIDENTIAL - SUBJECT TO GENE
RAL PROTECTIVE ORDER
Provider Handbook

HEALTH CARE ROLES
I.

Cor por ate Medical Dir ect or.

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The corp orat e med ical dire ctor is
prlm aril y resp ons ible for med ical
policy dev elop men t, pro fess iona l
dev elop men t, and qua lity ae,eurancc.
A furt her role is sup por t and oversig
ht ofthe util had on man age men t
pro ces s. You are welcome (and encoura
ged) to co n~ the corp orat e m e~
director for any 8.f!Sistance or
que stio ns you may hav e rega:tding
med ical policy or dec iai on- ~g .

II.

...

Reglon~I Medical [!!r ecto r

. ,.
The ~gi ona l med ical ~c tor is the
imm edia te sup ervi sor for the uni
t med ic~ dire ctor . He con duc ts pee
~e w ()J1 the uni t med ical director
r
and
assists i n ~ util izat ion man age men
the corp orat e med ical dire ctor .•
t iasu es, at the _disc reti on or
•
l

..
•._
~.· ..... ·~·•-' . ~ '
·: ·
}'fote tha t the un! t med ical dire

•

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·.. · .... . .t . ,

-. •
•

~- . .. .

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, ·• ..

• ••

t

••,
ctor con duc ts the ~ revi ew on uni
t staf f prov ider s and is resp ons ible for
th~ pee r
(exc ludh ig psy chia trist s). Gen eral ly,
pee r revi ew sho uld be perf mm ed at
the regi ona l med ical dire ctor (or
le~ t ann uall y by
his dcsignec) and the uni t medical
dJrector or as ctesigna.tc;d by the
DOC/counfy~ All pee r review& sho uld
glye fee d~ to thos e hea lthc are prov ider
be kep t con fide ntia l. A cop y of the pee
s bein g reviewed and mu st
· for use as arrefcrcnce dur ing the ,;ea r revi ew sho uld be forw arde d to Wexford's cred enti alin g dep artm ent
ppo intm ent proccss.
·
·
·

~ew

t\

" I

Ill.

..

Agency Mectlcal Director

... ·
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.
•
In stat es whe re the Dep artm ent of Cor '
.
.
.
'
rections has an age ncy med ical dficctor
. resp ons ibil ity for esta blla bing med
,
tha
t
pos
itio n has the prim e ·
ical poli cy, The corp orat e med ical dire
ctor will asllUl'C tha t all corporate
medical policies comply with the stat e medical
~

t •

•

dire ¢ve s,· All uni t med ical
reg ion al and the age ncy p:iedical di
re~ info rme d of crit ical prob lem s. dire ctor a will kee p bot h the
sho uld be·c onta ctcd firs t to allo w
The regional med ical dire ctor
for inte rnal reso luti on of as·many pro
blem s as pos sibl e. Dis cret ion is
given, however, to uni t medical dirc
ctora to directly con tact the agency
medical director whe n·it see ms
appropriat~.

IV.

. ..

Correctional Staff

1

Coo per atio n wit h the corr ecti ona l staf
f is ~ d and nec casm y. The med
ical program in a pris on system
has a 'rote sim ilar to the mil itm y- it
is a sup por t elem ent, not the prim ary
force. Eve ry inst itut ion has a set
of DO C/cou nt; ypo ~, usually call
ert
policies. In bot h caae-, som e of the poliadr niu is~ ve directives as wel l as Wexford's own set of ope rati on~
cies app ly to the medical and men tal
femiHar wit h all of thea e ~c s.
hea lth services. You mu st be

· ·

·
·
The wap ien of a pris on uni t is resp
ons ible !or everything tha t hap pen s
in the uni t. Alth oug h on occ asio n a
med icaI dec isio n JDS¥ be in confltct
with his (her) express wis hes , moa t
dec isio ns sho uld resp ect his (her)
man age men t responsibility. Usu ally
an assi stan t war dcn ia resp ons ible for
the med ical service area , and you
will wor k moa t dire ctly with tha t pos
ition.
..

... ~: ~;;.-.; = .fl ~~ ~- ;;9 ~~ tlv ~.

f.@

resp ons ibil ity. Security is the firs t issu .~ JJ .ll d~ == cd :ta ii. iid .m ~~ ct .ll fa t~
e of ~c em to moa t cor r~o nal staf
f. On occasion, secu rity l:Uld
hea ltli serv ice arc, in conflict. The
se
mu st be add ress ed on an individual
nat ure req uire you r use of reas ona
bas is. Decisions of this
ble judg men t, We dep end on you to
und erst and bot h the med ical and
sec urit y role s. ·
·
·

issues

Approved by Iha Wexford Medical AdvlsorJ Comm
ltlee on

J111118, 2012

Case 3:19-cv-00681-MAB
Document
68 CT
Filed
10/10/19
Page ECTIV
53 of 93
Page ID #1053
CONFIDENT
IAL- SUBJE
TO GENE
RAL PROT
E ORDE
R

Pn
•·

V.

Pittsb urgh ancl Regions~ Staff
The Pittsbu rgh and regional staff are incant to provide suppo rt and
resour ces to the unit Opt
not availab le to make .the decisio ns that should be made at the unit
level. The best clinic
declsiaaa· vc ~ e.1:>J the staff clos~ to the patien t.
.
•:

I

•

,

~

•

1

•

I

'

t

•

•

Health Cara Unit Admin istrato r (HCUA)/Health Services Administrato

VI.

•

•

'

•

I

I'

•

••

•

:

• •

•

r (HSA)/Slte
~

•

For bptim alunit efflcfency, 'the key.leadership ,person nel need to becom
e a tl~tly lmit team
objecti ve of providing high qQ.alltymedical service at the beatpo sail,Jcp
rice. Th~ administrat
unit,js the health
unit edrniniAtra.tor (HCUA )/health semce s~edrn tnistra tor (HBAl
~ the admimstratlve aspects of tho medlce:1 operati on. He·(ahe
) deals most freq
correct ions staff, regiona l staff ~d the local health s ~ ~ t o
r
a
. •
.
··
- ..
.
~
.
.
~ .
.
•

•

care

manages

.

.

.

..

Since the ~ - i s expected to manag e ell the unit
and o'rch
functio ns, it is eaay.to unders tand the necess ity of.developing a, ~
e and interde penden t .n
· this person . The f{CUAIHSA deals ~ Y w i t l l th~ conect:kinal
~ end solves most of
'im;,blema. He (she) ia_ the.one most ~ y .to.repr esent your h!~t a rm4/ot
. concc:ma to

~

s~;· ... :•··. ·: : .. ' / :.: .. :: .·•·,:,:: ·.:.:: ·,•·'.

For the ~ cft~ e1 efflclmit a n d ~ o p ~ ,
·.· suppor tive .inten:lcpcndent team• ., ·.. · · ·
· ·
.

.,

..

1

1

o

l

•

:,

.

' t ••

I I

••

vu:· oi~cta~ofN~ralng.(DON)
•

-

\

•.

•• "

':

•

•

•

._;· :.:'.. ,· - '·:.. ·.,.~ :-; ...

you, the HCUA/HSA. mid ~ b

.

•

-details

•

•

'

•

•~

,•

1

••

o

.: . . ·:_. .. ·.

'

•

'

• •

•

:' ·

• ·· · . ' . . . . ·.- · · •

.

. ..

•

. ··. · ·;.

•

•

•

J

•

•

• •••

-, •

The Nll:f8lni Dire=r p~de a the lcad;craldp, trainin g and nursin g dJrection to the ataf
•

rcspQlllible far aallllri ng the nu,ndn g staff .ia capabl e and attenti ve in thdr
efl"orta to.provk
hirnaf:e nursin g care. She ia ~ b l e 101' the staff schedules ~
the in-acrv ice ~ ( .
the.Jqedical directo r with the quali1if aal9Q1'8Jlce responaibilitiea. . ·
•

•

•

•

•

•

o

")

•

•

..•

.,.

I

I

.

}

A close· ~kin g relathmahip with the DON.'W01ili1 greatly ease ~:med
ical ciliector's·j~
consta nt accesa tci the inmate needs from her staff. The •dally reports
" from her staff gl•
comm unicat ions flCJVf, Thia po'1tlo n can be a grel¢ help to your work.
Rcapcc t thia poaitim:
.
.
.

.

··. . ..

.,

ym•.~~~part ~edloat Staff

.

.

.
•

• •

.· . . .
I

: .. ~
· • •· .
_.. •
.. .
If you are.the medica l director, you ·maY have the respon.sibllity of manag
ing staff phyai
· .expect to be cmiatd ered aa co~gu es. 'Ibey will.hav e variable abilitie
s • .Leal11 to unders ta
·· streng ths md suppo rt that akin. If they need skill trainmg, mapg
.. or pbysic lena ,at·ano ther unit who can teach; or you can send.te it. There may be other
he phyaic fdn to a aem
program. Encou rage them, have faith in.thei r decisions, tell them what is expect
ed and exp
~ with yo,.ir_confide nce in them. • ·
.
. : . ·.
.
· .
.
'
.:
'

.

Occasions.will.t>CC\U'when you muat correc t~ discipl ine them. Exp~ what ~scd
the.pi

a proble m, and how it must be corrected. Many physic ian problc ma
in the correc tional med
proble ms for the medical 'lervice, the DOC, and the individ ual physic
ian. Theref ore, pron
import ant,
·
·
·
.

.

•'

•••1

I

'

•

.,_,_...,

•, .

~.,.n-,-,ii.,...:;;:;i;:.t'lifmcliuir,Sfiiifiiieiiirl fr~1 mte pem ient ;"3tr ml~' Or18
"Wh tnfl
•

_• __

•

aneljZ e events and make decisions, These abilities are positiv e end-de
sirable. They also
EGO feeling s. Althou gh. ~ medica l dJrecto r. you will spend consid
erable ~ msneg lns
must also respec t them ~d 1cam how to direct them in a poaitiv~ directio
n.
·
. '
'

.' . '

-

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 54 of 93 Page ID #1054

CONFIDENTIAL - SUBJECT TO GENERAL PROTECTIVE O~DER
Provider Handbook

IX. . Community Physicians
Since it is not feasible to provide all the necessa ry medica l services within the
institut ion, Wexfor d depend s
on the sldlla of commu nity physici ans. These physici ans are usually sub-spe
clalists , emerge ncy physici ans
or obstetri ciana. They BUpply specialt y services end hospita limtion s; offer procedu
res end evaluat ions; and
direct consultations•. They not only fill importa nt service needs, but they
alsb bring a private practice
perspec tive into the institut ion that adds validity (or reinforc ement) to the
decisio ns of the correcti onal
m ~ staff. If you practice appropr iate medica l care, they~ reinforce your
medica l decisio ns.

J N'ote:

Every effort must be made to use Wexford Health' s contrac ted·prov
iders. The use of commu nity
physician~ must be cif::1cussccl in the collegial review process .
'.

.

Even though we depend on the service s of the private commu nity physici
ans, this is a referra l relation ship.
YQU are !lot •giving up• the ~tient. The referred inmate is.still yaur (and the
DOC's/ county' s) respons ibility. .
The speclaliat has

a respons ibility, as in private practice , to·mfonn you of the treatme nt plans,
propoiaed
surgeri es and the ~edica l strategy being conside red for the pa~cnt. They must
send you promp t reports of
theirca re. ·
· ••.
·. · ·
•· ·
·
·· ·
-.. .
.
A.a fn ~vate practice , it µi·impo rtant for you to infqrm ~ consult ant of
the patienf s history, physica l and
laborat ory findings; and your reasons . for referral. You also have a·legiti
mate right to disagre1 ; with a
special ist's position . Do not abdicat e your medica l ju(lgme nt ,simply becaus
e you are referrin g !l patient.
Most of the time, you will agree witq the consult ant, but do not hesitate to
~ if you baye a reason.
Dmcusa the difference of opinion with the consult ant. Often, circums tances
of the confbic mcnt or security
. are not unders tood by the consult ants. Y.ou are expecte d. to undent and these
isaues and work around or
through them. DO NOTBLA.Ml!l'HEPROBLEM ON THE DEPARI'MENT/COUNT
Y' -simply explain that you
have policy respons ibilities .that must be addresa ed. •
.'
.
.
·
-.
.
'
If you do ttot underatanc;l a policy, 'either an institut ional or a Wexford policy, ask
for an explana tion. Often,
the policies are in place to protect the staff and finance s of the commu nity
provide rs; ·we place a high
prlority on protect ing the commuJJity provi~ers. · .
'
·
.

.

•

,

.

•

•

I

'

,

•

o

.

I

.

When an inma~ ~ be~ admitted to a local hospita l, call the attendin g physici
an daily and ch~ on your
patient . You need to unders tand what is happen ing; and they need to know
you are interested. You .must
.initiate dischar ge plannm g immedi ately and explain your in1limmy capabil
ities. No one will fault you for
. being interes ted in yow' patient . .
.
,I• •
•
•

'

'

.

.

.

.
- 4.....,.:,,
- ...
·- ••'1.'•
... •\.&.,.,,""',..,_..,-··-·-,.n......,..,.,.,."
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t..,t...._...
....w.i~_,. ..._...... ,.~----_ __... .___..._,-..,,\_.....,...____..._
~~

Approved by Iha Wexford Madk:al Advfsorv CommlllH.on Junt 8. 2012

..... - ... ---,..·-· •-· ,--•,--- ._...,.. •---- ·

____.._..,,.,,_♦..,.~Y-•........,.~---

.......

■

- " ' • • r•·L

Case 3:19-cv-00681-MAB
68 Filed 10/10/19 Page 55 of 93 Page ID #1055
CONFIDEDocument
NTIAL- SUBJ
ECT TO GENERAL PROTECTIVE ORDER

Pr

MEDICAL ADMINISTRATIVE PROTOCOLS .
I.

Inmate Interview Tips and Tact,nlquea
A.

Basic Point s Direc tly Affecting the Interv iew Process

1.

Inma tes~ patl~ ts and deserve to betrc a.tcd as pa.tic

2.

Some inma tes do not know how to relate to healt h profea
aionala, thus their ci
~m3 icet e may appea r bizatr c.
As a group
tes ere cctrrm ely manipulative. ·
. , inma
.

3.

n~.

.

.

-

4.

Generally, the," tigb ~ the assign ed secur ity housi ng,
the greater the inmat e
healt h services. I;>eath row mmetea ere usual ly an e:xcep
tion to this. They USl
demo nstrat e medi cal usage direct ly propo rtiona l
to
thejr
idep.tilied medic al Pl
. .. ..
.
,•
..
5.
To some hmm.tea, medic al .service ls the only area where
they feel they have e
control. Thus , 8IlSW erJ BJid actions may reflect control ~
rathe r than me
.
'
6. . ~ a officers (CO) ~ttm ea in~ e·wit
h the: intervicw· Jilroceiis.-'.fhc

. .

.

7.

a.

B.

~

a.

They must ~e prescmt - ~ protect

b.

They can't remo ve the restra inta

c.
They must assur e aecur ity
Medic al std too often asaume a CO's role by btocorning
very dfrectlve~ or atte
enfor ce secur ity. CO'a too often aaaum e medic al role1
by judgi ng inmat e med
preju dging the prcaence or.e.baence of ilJn.esa.
·
.
.
. ·
Each level of mcdk:al team suppo rt tends to feel
they know th~ inma tes 1Jette
traine d profe ssion al who is their auper via·o r (also, jumpi
ng two super visory le
mysu ;rious ly anoin ts an assist ant as an absol ute exper
t).
Positive suppo rt fm
very :impo rtant.
.

Interv iew Techn iques

1.

As ;c;mcli and as often ~ pos1ible, an inma te dca~

ea priva cy during intervif

eurni netto ns. Such ~ of pcraanal dipit y

2..

and tespe ct ~ limite d h

Have aa much·knowledge as·possible at han d~ yi:Ju. start
the interview. F
inmate chart (if one is available), A few minutes of chart
review will eave

you
··
.
· ,
··
complsh1ta ·end des cri~ of their ~b ~:.

dupli catlon of work and evaluation..

3.

Listen

CAREFULLv to -

accept their claims ·and deacriptiona, but main tain
a health y amou nt of daub
Rememb.,, ths most difflw lt ~ is the separmtan ofths
presence from tl
pathology. •ooea this patien t truly have a medic al condi
timi?• !a a tough quc1

Not ell inmates are being ~ v e . Many ere correc
t in their description.
incorrect, l1Ut truly believe some condition exiata ( a ~ ?
a?), Some 1
.-::, ... ~.,-~~-·~•-•w . . . __.~..: ;7.: ~o.: m!l ~~o ~sc ri~ .Jlr ~~ ~~ r.J asthm
·
they should 8have something,• No diagnoae19 • no treatment.m. ttsl t!!
Observation Dl1
cOUl'Se
of action .

4.

:• . . , . . .

~o

·.:

·

·

. • ·

Requ ire~ inrnate!II rela ted ~ -d ~pti ons 'm ~uat
ions
treatm
received when pre-existing conditions are claimed. Document
those
descr
ipti
verbatim as posaible, Document all medical devices, prosthetics,
and medi ca

and

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 56 of 93 Page ID #1056

CONFIDENTIAL- SUBJECT TO GENERAL PROTECTIVE
ORDER

Provider Handbook
broug ht to the facilit y by the inma te. Have the unit staff
obtain outsi de records on all
probl ems claimed by the inmate.
5.

Be carefu l of prom ising treatm ent, surge ry, or relief. You
may not cc in a positi on to deliver
what la prom ised. There ere many contin genci es over which
you have little or no contr ol. Be
fair - be just - but be hones t.
6.
Do not genera.t~ intcr. perao nal •game s" with inmat es. Taunt
ing, teasin g, end use of obliq ue
innue ndo are poorl y under stood and usual ly misin terpre
ted by inma tes. They have a high
level of negative suspi cion as a protective tool
·
7. · Inma tes may ~ t e their conditions. On the
other hand, under statin g signi fican t
aspec ts of their' healt h conditi0Jl8 is equal ly comm on, e.g.,
denia l of seriou s diabe tic
probl ems or past high- risk activities, IV drug use or homo
aexua l activity, etc. Often the
prese nce, or absence,.of sigaa found at phyaicl!l exam
or by chart review helps to sort out
incon sisten cies. The best tool you have is a sensitive, profe
ssional and analy tical revie w of
each inmate's statu s. ·
·
"18.
DO NOT EVER
symp toms you would~exp~ to see to c ~ a diagnos~.
to en ·
inmat e. If you should, those symp toms will liJcely be pres
~t
with the next yisit. Do not
prompt, lead, sugge st, or d~cri be symp tom seqi, Prison life is
its own specia l sets of rules. Thf'! mrna t~ discu ss their treatm a special· social socie ty with .
enbs and symp toms and
comp are the care they get. Interview techn ique should
be non-d irecti ve·with' perso nal
descr iption s being encou raged and RECORDED.• What
happe ned? How did ~·bo ther you?
Old you ~ve paip? ~ere ? WSJt ~ t the only place
it
hurt? What .did your docto r say?
What did they do? Hew did yoti n;spond?. Did the treatm
ent work ? How long? '!'pis
_me ~ is.m ~ timtr consu ming, ~ut overall it requi res
leas total efl'ort.enli follow-i,ip.
9.
Be straig htforw ard with inma te patienta. llthei r "problem•
doesn 't requi re treatm ent, tell
them that, end stick to yout d e ~ . Trea.t 'or rcmmrnem:
I on the basis of ident ified mecilcal
need. Any inma te r.an dema nd all\ aorta of treatm ent or
situation.a, but th~ dema nds - in
the absen ce of a medic al need - do not justif y supplying
the servic e. Again, be sensi tive and
analytical. Never withholcl a servic e wheth er dema nded
or not, aa a punfa brnen t, nor to •
manip ulate the inma te. Since the hlmat es ere incarc erated
as ward.a of the state. they have
no medic al altern ative, and theref ore requi re more patien
ce and latitu de from the healt h
care profeaaionaJ. Do not promfae·wh at you may not have
the autho rity to deliver.
Frequently, inma te nan-compliance or over utilization is due
to. poor unde rstan ding of their
probl em; weak or auper ficial expla nation , or simpl y negle
ct m;i the part of tlie medi cal staff
to deal with the inma te or his probl em in ·a clirec t mann
er, .
·
'
.
.
10, Look for specific symp tom sets and discipline youra
eJf to require the inma te to ident ify and
valida te those symptoms ea he dcsdibcs his medical
history. Then· back up the history with
corro borati ve physi cal findin gs and/o r labor atory testin
g to assur e yours elf that a condi tion ·
actua lly ddata. We are all aware that disea se states vmy
from patie nt to patien t; .the basic ·
unifo rmity of major diaca ae prese ntatio n and expre ssion
la incredibly stand ard. Remember
the old medic al schoo l adage , • When you hear hDofbeats
in thB stre~ don't think of zebra s."
Dellf er service on the basis of identified medical need,
and you will·be offering excel lent
care.

expWJ:L

II;
•

Charting ,:echnlque

.. ··-- ........... .n,.,...
ir---._u
-u-,,;rbr--=:-r
::-~-.;;n~
- N~~ =-r-:·=--;"~..-;.-;n~.i.,u11,-.,-.......
-pcni
..year
s.,w.u
.... merr-r;:li
1ca1u-::...-i
1;,ans.

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a~u..Q.,___ ~ - . . ... ._•
Wexf ord's charting expec tation s a helpf ul guide. A chart 3
is an extrem ely impo rumt perm anen t
docum ent. It is a journ al of aocia1 histor y. It is a linea
r act of snap- shots into the deepe st shado ws
of personality. lt is, above all, a legal docum ent. Please respe
ct its power•

.

B.

The chart is the mcdie al servic e memo ry of what the patien
t told you, what you found on physical
exam inatio n, what diagn ostic strate gies were used, and
what treatment progr ama·w cre appli ed.
Approvtd bylhe Wilford lledlcal Ad'41scnCorniltMon 11111111,

,m,

Case 3:19-cv-00681-MAB
Document
68BJEFiled
10/10/19 Page 57 of 93 Page ID #1057
CONFIDE
NTIAL - SU
CT TO

GENERAL PROTECTIVE ORDER

bth cr practitioners will review you r

dat a and add the irs. In this ins titu
tion al Bettin
hea lth per son nel and oth er official
s·m ay ma ke entr.
Th ose entries pro vid e you , aa the
medical aut hor ity, wit h mu lt1f ace
ted mfOrmation
oth er me ans of obt ain ing . It is ~
imp orta nt info rma tion . Ifyou are
par am edi cal ent ries in the med
not farntliar ·
ical record, you wil l quickly lea rn
the val ue of the ir
Oth er tha n pre par ed for ms for ape
ciflc me dic al tnformatl.on, ell rou
tine ent ries sho
the "SOAPE- f'ormat. The sub ject
ive (S), Objective (0) Ass ess me nt
(A), and (E) Edw
com pon ent s me p ~ on the left
~e of the pro gre ss &beet, Wit
h the Pla n (P) com
on the righ t.
cMT •9, edrnfntsti:atortl, :nientel

C.

D.

Ch art ALL JnrnErte ."'.ncounteral
Inm
see kin g you r opi nio n and advice. ates will freq uen tly ato p you out sid e of the hea
If tho se •cu rb- sid e con sult s• hav
e any slgnificanc
inm ate to com e to the hea lth ca
re ~ and formally add res s the pro
ble m. Do No r
thi nk ia informal mfcmnatton wit
hou t documenta.tlon. It will ~o w
wh en you l_east _
up
in som e futu:
e xpe ct it. . .
.·
·

· . . . ·· ·

.

.,

.

E.

Rec ord adverse events proiuptly
.
~ acc ura tely . Far examp
le, rda aal s of ttea tmm r
effo rts ~ alte r tha t de¢ sia n; rcQ
OD
t9 yaµ, pth er imn ate s or staff;. see 8 far·-nc rah ow ' at chn mic climes or medicatlml
mingly bizarre stat em ent s or action
c o n ~ ~ e cla ime d me dia
s and activitit
u
pri:>blcms•.The ,t! ere bui a few
~ it isn 't rec ord ed, it did
of
the
poa sibi litk
n~ hap pen l
.

F.

Keep you r -~t ries .o bj ~, des
criptive, and con cise~Per son al con
ilic ts hav ~ no plt
.~ s . Resolve cimiUct:s ~
ma kin g a not e. Lea ve you r per son
al
Do no t crlt
feellnsa !or dh1
. ldz c eith
. , er med ical or car rec tkm al sta
ff 1n an indi'Vidual'a me dic al cha
.
rt.
.
. .
.
.
.
'
. Wr lte so
.
read wh at yo11 wrote, An illegible mectical '!fl.try ia
wri te legibly, ~t . If you can 't
wor
tblc
as.
prm t leg ibly - tea m ta prmt.·Your
ent ry ta me ant ~
the re ilf no com mu nic atio n if an
. . ent ry CBI111ot be read.
· J.
Ch arts
CONFIDENTIAL fa1'ormat:lon. Phy
sici an- pat ien t 'Vief.ts are
dat a arc not for com mu nity d
i ~ Please hel p to keep the inte prl'Vileged infm
grit y of the me d

G.

H.

..

others can

.

are

.,

·'

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 58 of 93 Page ID #1058

CONFIDENTIAL~ SUBJECT TO GENERAL PRO
TECTIVE

ORDER
Provider Handbook

.

.

HE ALT H CARE UN IT SERVICES
I.

Inta ke Reception and Classlflcatlon (R&
C)

Eac h inm ate, whe n first inca rcer ated and
at the star t ofthe Reception and dlasstfic
a.iion
scre ene d by qualified ·hea lth care stafl
' to iden tify the pres ence of any ·conditio proc ess, is initially
n need ing imm edia te
atte ntio n; for exam ple: pedi culo sia, insu lin
depe nden t diabetes mell itus, active seiz ures
exis ting inju ry. If an lnm atc ente rs on
, e.cu.tc asth ma or an
a given medi!:ation, it shou ld be cont inue
d unti l the cond ition is
. doc ume nted or vali date d thro ugh secu ring
outs ide reco rds. Oth er nece ssar y trea tme
nt shou ld be star ted as
indicatec;l or as.i n~t cd_by the DOC /cou
nty. · .
Wit hin fQUrteen (14) days following the
intake screening, a complete bist my and phy sica l f'TB
· · · sho uld be completed, incl udin g wha
rnination
tever rout ine and othe r indi cate d labo rato
ry and biom etric test ing ia
indi cate d to esta blish claimed•prtiblems
, The se ~ta shou ld be cons olid ated ; a heal
th stat us dete rmin ed,
and a care plan: esta blis hed to mai ntai n the
opp ortu nity to addr ess s,dvance directives inm ate's heal th duri ng bis pris on stay . Thia is an exce llent
, if apprQpru¢e.
·
·

II.

Preventive Care "

.

.

'

Emp hasi s .if. plac ed oii preyenti~e 'me,;iicin
e .duri ng. the inmate's inca.rceration. Pris
mcd ipm e.wi th inst ituti onal expo sure s.
on
insti tutio xud
The indi vidu al inm ate mus t be prot ecte
d, as mus t the inma te
popuJation.ummnnfaatto11&(flu, pneu mon
ia), edttcattona1 directives, adju sted activ
ities, alte rnat e hou sing or
wor
k asai gnm ~ta ~ all part of tbe preventiv
; '
.. .
. ..
·
. . e opti.ons.
I
Inm ates with in-e -~ti ng pro b!~ · ahoµ
ld ~ave ~ plan desi gned to correct or keep the
beco min g worse (ace ~ ~lfl J)et ton
cond ition from
of ·prc ~ms ting ·conditions pres ente d later
). The thlr d preventive
stra tegy is. a syatem. for freq uent .obs
~tio n· and earl y !i{agn.oeia. Thia is emb
odie d in the following
proc edu res for simp le and freq uent acce
ss ta mul tiple levels of med ical service. F()r
specific uni t oper ation s,
you sho uld cons ult the poli cy and pro ced
ure ·~u ala and the inst ituti onal cUrcctive
.
s in you r insti tutio n.
.
.

is

~

r.

Ill.

•

• •

•

•

•

•

Ro4Une Ambulatory Oare
'

:.
.
The re are three (3) ba:mc s ~ rout es
for Rou tin~ Care , 1) Sick,Call, 2) Phy ai~
can, and 3) Pill Call. A
four th, Chtcmic Clinics, cou ld also be incl
uded here .
·
.
.
.
I
Sick Call is usually held by nurs es or PA
's. Inmates are usually reqwred ta sign up·
for the
the reas on for the requ est. Sch edul ed inm
ates are seen and scre ened by nUl'Bes or CMT service indicating
's usin g auth oriz ed
prot ocol s. Only OTC med icat ions Ul9.Y be
used by.th ese personnel• unl~ ss the spec
lege nd med icati on. ·
ific
prot
ocol auth oriz es a
·
·
.- .
· ·· · ·
•
•
.
I
.
" 1,
•
•
•
·
.
: • •
•
·
t
•
•
If ·a scre ened prob lem is not covered by
prot ocol and is beyo nd the skill of the
triag e, the pa~ ts are
referred to_the Physician C$lll l.Qlc. They mus
t be seen with in 72 hours of referral. If they
they may be seen imm edia tely (see Eme
are seri ousl y ill,
rgen
to the loea l hospital emergency room. •· : ·cy Service below) by the plly sicia n, or in bis (her) al;,senc:e, sent
'
· ··
. ·, .
. . .
.
:. .
.
.
~

.

.

-~==~~ ~ i~J!J1~t!lr!½=f.1;e-~~~~~~1t~t~~~
~?r;:
1

eval~ations; fo\low~up treattti.ents, clarificat

ion of sym ptom complab1ts; diagnostic stud
y, etc. Phy sicia n Call
in ~~ Down• should be limited to screenin
g
I4en tiile d problems should.b e brou ght to the and the discovery of prob lem s needing furt her attention.
heal th care unit late r for prop er evaluation
~
and trea tme nt.
•

I

•

o

t

•

•

I

:::::

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 59 of 93 Page ID #1059

CONFIDENTIAL- SUBJECT TO GENERAL PROTECTIVE ORDER

.

Pr

.

.

Pill Call is scheduled delivery of prescribed medicatio n, and may occur either inside the hea

at the assigned cell blocka. Thia is managed differently at diff'erent wlits. Medicatio n is \l
nurses or corrections medical trcbniclans, (CMT'a).
·

IV.

Emergency Service
Inmate$ have_access to emergenc y service any ,time there is no scheduled service avails
service can be pr,ovided anaite by whatever level of provider able to meet the level of care 1
unit has iufflclen+ equipment and personnel skill to meet the patient's problem, it should be
Ifthe fecllity, equipmen t, or skill level of the onsite personnel is lnadcqaat e, the patient ms
to-the nearest hospital emergenc y department.
I

If no staff physidan_is on.site and the situation ia:Ufe-1:hreatening, the attending nurse
decision to transfer the pe.ticnt. In such an event; the unit medical director mqst be notifil
possible time. Wexford must authorize payment for this aervi~ !IO en Emergeilcy Referral
fe:ed to th~ W ~ ~~burgh office as aoOD as reasonabl y poam'ble. . . · · · · · · :

v., l~~ary eara· .
•

,f'

~

•

i,

•

4 •

.. .,

..

I

O

Th~ inpatient unit ts aveµai,1e to provjp.c limited medical·imd nuratng sern.cea·ror"patteg.ta
•

I

t

'

o

probleuis ~ an inpatie;it setting. Inpatient semces ma, inc:1'1~ meclli:a) care, isolation, •

aid,.nurai ng care and poat-:opcrative care. Patients may also be a.asigned to the inpatient ,
· housing." In~patient cei'e is not used as a sub~tute to hospital level care (ICUjmedica.1/ sur
or a licensed nursing care. facility. lt .iJ gencrelly recommen ded· that all patients dische
inpatient facilities be p4'ccd b;i the µuhmmy
obilervatia n, Wlle8a such a patient ia decn
general, populatim1;, CHnf~, iaaues ere the responalb 'llity of the' Site .Medlcal DJre«;:tor
operaticm el issues are the responaib ilfg' of the He_alth Services Administr ator end the Dir
••
• t
.
•

for

• . •

VI.

'

•

~

•

•

•

•

•

•

Chronic Cara
Services ere provided on site to m'cmitar thi: status of inrnstes with identified c:lmmic m
Chronic Clinics for patien~ with the following are nmmelly required: cardiac-hype:ru
asthma and seizures. Any other such clinic could be establishe d ·at your discretion . ~
gell,.el"&lly defb;led by a mandated protocol. Any ~t:kme l clinic ahould have a similar pm
approved prior to mitiation of the clinic.
· ·
. . . .
..
.

Chronic Diaeese·~
·ere normally ·conducted every three to four· months, and prov
pii:_vcut1ve end prospectiv e care ofthe patient's pi::oblem. Refer to Wexford Heslth's Chronh
manual for ttirther guidance on Chronic care.

VII. Spaclal!,Y Ca~.
It is impractica l, to have apeclaliata in every unit, aa 'arrangem ents BfC.made to support tl:
serticca with specialty consultation. Actually, you may seekcona ultatlon for en fnmeh: ~
is medically indicated for an imnate. The key l.asua is medical necessity, Many inmates
specialist for JDhul;' events, arjust to get a second opinion. Ifyou, aa respODBible physician
. services are indicated and identify a medk:el need, the cue must be cUacuaaed in colleg

~-·.:·..;-;::::,:-.:~ c.w..tli f!ll~lit!b t'-ffittM _,,,t:lff iJWfl~l ii"~etiU tccmr:~ we,"'--:., _-=:
'

A.

.

,.

Onsite Spe~ty Care · ·:'

.

,,

umts

1specielty phyaiciam cpme on·site and hold scheduled clinics, 'l'hls° is fn
with ~ ' g~eral surgery and optometry. This sllowa more inmates to be
setting, ·and decreases the transportation demands on the departme nt, The speclel1

At some

lvlr.nmf'!!I

mtm'!

fRmilfR1" with thl'! ~nmat,.ca anrl +1,,. _ , ;_ _ ._ ...~ +i.. ,. --~--•

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 60 of 93 Page ID #1060

CONFIDENTIAL· SUBJECT TO GENERAL PRO
TECTIVE ORDl:R
Provider Handbook

..

phys ician s a.re •con sulta nts• and requ ire supe
rvisi on by the facility medical.director for appr
opri aten ess
·· of reco;:amendations.

B.

Off'site Specialty Care
Whe n specialists arc not avai lable for •ons
1te• clinics, inma tes may be sche dule d to
be seen in the
spec ialis t's office, in the local hosp ital eme rgen
refer rals mus t be arranged thro ugh the corr cy depa rtme nt or othe r amb ulato ry care facility. All such
ectio ns depa rtme nt, and pre- appr oved thro
ugh Wexford's
utili zatio n rnag eme nt/collegial review proc
ess. Every effort mus t be made' to use cont racte
d providers.

VIII. ttaapltal
. At time s; spec ialty care requ ire, hosp italiz
ation . Tbis may be requ este d on eithe r a rout
ine or eme rgen cy
basi s. Whe n.an emergency BmDi;ssion occu
rs, Wex ford mus t be notif ied as soon as prac
tical . Sche dule d
adrnissi"11s shou ld be requestC;d thro ug4 rout
ine utili zatio n man agem ent/c olleg ial review. Su~
sl;iould clea rly~ ~tif y the med ical nece ssity
requ ests
for the admission - ~eyn nd '"the inma te itgre
es to (or wants) the ·
s~ .•
. . . :. .
~
, .

.

.

. .. ,

-

Tiie 'rec~rnmendattnn for a proc edur e (or serv
i~) }1y a spec ialis t shou ld be given slgn ifica
nt weig ht whe n
dc;cidlng to prqvide that service; however, thi;
_unit phys ician mus t agre e that auch a proc edµr
and nece ssar y•.All inmates are the patie nts
e is indicated
of
does not remo ve the unit phys ician from. the them edic al director, NOT the spec ialla t. Usin g a speciaUat
prirn my resp onsi bilit y for care. The spec ialis t
does not (or may:
not) · ~de rsta nd the ape ~ requ irem ents
of' the corre ction al setti ng, and you mus t
mak e treat men t
deci sion s with in that cont ext. In addition,
the trea tmen t or repa ir may not be the resp
onsi bilit y of the
D c p ~ t of Con -ect i~, Tha t is an intci
yretation -you mus t mak e,
·

. IX.

Hospital Care

...

As 'refle cted above, hosp ital care is. a nece
soa.r

y part of our·resp0113ibllity. This is· done in
in.any ways;
however, mos t of the time , this is done by referral.
Again,

refer ral for hosp itali mtio n does not remo
from resp onsi bilit y for tile patie nt. Spea k to
ve you
tlie cons ultin g phys ician to who m you are refer
ring the pati ent
Lear n of his (her) trea tmen t plan s and joint
ly crea te the disc harg e plan s. Follow up on
the stat us of the
· pati ent, and info rm the phys ician of the capa
bilit ies of the unit to provide convalescence
or othe r care .
Mak e arra ngem cn~ to get an immediate disc
harge sum mary when the pati ent is released.

X..

Dlalysls

Som e unit s ha~ dialy sis unit s where inma tes
may be clialyzed when the man agem ent and cont
C?d stag e rena l dise ase has exce eded the abili
ty of the unit staff', Acu te dialy sis for toxic over rol of thei r
rena l failure is usua lly accomplished thro
dose or acut e
u~ hoa pi~ refe qal.

XI.

AID S

Tcst fn'g to identify HIV posi tive inmates,
with furth er testi ng to validate the pres enc~
of AIDS, varie s
depe ndin g on the tJtatutea and rcg1,llations of the
state where you are assig ned. All services that
_"_ .~;,;,:·n •~~Ja.~ ~ ~ ~!l ~aU lD~ P'J
arc need ed
aV8ilabl~Effo.rtaate mad<:-to.aharc.andkeep..CUII'ent
· ...,.,.. -~- :r--wg Jni tan Tfr eamcnnome-adc
.on.t
he.
a-epart:fnentsiircstlllvelf'!mtittfcMt»lSUrA1IJS""a1ttr,'"a statu s .of_ . tid"'kt!ep ..an- -·
inf ~o n as ctmfid:e:ntial po~m'ble. As
with othe r ilh;icsscs, conf iden ~elit y mus t be
main taine d.

as

XII. TSO (~butine, MAI, Multlr~slstant)
All inm ates receive scrc cnin g TB skin testi
ng upo n adm issio n to thei r insti tutio ns. Follow-up
testmg is
usua lly done annu ally. Each insti tutio n has
a TB prog ram to identify, follow up, and trea
APll(UVld bv Iha Wuford UMb14,1u1cnrur11......itt....
t
inma
tes.
This is
~- •·- ~ n ~-~

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 61 of 93 Page ID #1061
CONFIDENTIAL - SUBJECT TO GENERAL PROTECTIVE ORDE
R

an impot pmt survei llance progra m. In the face of AIDS immu
ne incom petenc e plus a
compl etion of INH therap y, the incidence ofresist ant TB is rapidl
y rising. Every diligent cffi
to protec t our popul ation from TB. Remember, inmat es leave
the prison and carry their 1
comm unitie s.

XIII. Pharmaceutical Servi ce
Medications are provided throu gh the pharmaceutical service, Medic
ation mayb e otd~ d l
ARNP, physic ian asaist ant (with the appro val of the medic
al director, 2) a nurse /CMT u1
protoc ol when the medic ation is includ ed in the protocol, or 3)
using the appmv ed protocc
count er (OTC} reque

st.

·

The autho rized ,mcdi cetfon a arc. includ ed in an approved
formulmy. .Although sam
medic ation may be ueed, all efforts must·be made to adher
e to the offlcial formulal'l'
~ e d in a b~a pac kf~ .· .,
l

•

Pleaac bejud iciaua·in the preacribing of PAIN MEDICA'nONS
due to poten tial of abuse . Tl
.population, ~ the major ity are incarc erated for drug -~d
Qdmes . The use ofhard nm,
not forbid den, but s1:iou1d be string mtly contro llect These mcds
More are traded than .an: ever taken 'by the ~ten ~ patient. · becom e a valuable trade
·
. ., ,
'

.
Stop datca should be writte n on all orders . OUr patien ts
may lmow more than all ofua e
and disad. wntag ea of thesf'! medica~nns.
·

Medication should be prescr ibed baaed on indtcaticma .imd~
object iw ~cllng a aa a gul
.on a patien t's subjec tive com ~ts. .
··
A ·Pharniacy and Thera peutic s Committee is part of the ongoin
g QA at a unit. Medfcattc
chang es can appro priate ly be made in that meetin g.
·

XIV. Labo ratory Servi ce
Routi ne labora tmy servic es are available on site. A reference
lab is contm cted to 'proviclt
Any appropriate teat may be•done. Please share the result s of
your testin g with your inm
lab servic es are availa ble throu gh the 1acal hospit al and should
be utilize d only i f ~
Speci men collectkm. shoul d be done under closely conµolled.co
nditions. kJ.y urine sE
comp laints of " h ~ • must be coUectcd. under direct observ
ation of the MEDICAL E

XV. Radlalogy Service
Routi ne radiology may be dane on site or at ~e lcca1hospital.
Do Dot initiat e any contraat1
unles s you are able 1:fl mena ge the ~vers e impac t of allergic
reactio
n. Thia dQCa not acct
any such occum :nce can b~ devastating. •
·

Not many conditions requir e immcdiatc radiographic ~ur ea.
As you know, with cert
situat iona (e.g., apraixled ankles , routin e chest ft]ms, head
injurie s in young people, km
. -·- -- -·---~ --hi~s nt:ap ..aranel!. ..or-,n on-oo ntribu tfn~to -thi,. ev.aluQ.tion-When-thes~
·-~·· ---rT.•·····~~....~ven1em-;;e:g-Uon
::;eveiiliigi or=tw

i'rla"~1fiariu-61y neceasaiyfo~lrnrncdfilmaJ

The patlei; its may be place d at bed rest; the area immobilized,
iced and elevat ed and xbut at a more conve nient time, Of course , circumatances
occur when the degi
suffic ient to·requir e immediate review. Such decisi ons arc left
for
you
to discer n and jus
'
•
I

soon~

'
You may
be.,.a__radiol
ogist,
and,,_,_
Wexfo
1..,....,..
...... not
,~-, - __
..,,41__
•• rd. does
• not expect~ to be the definitive interpre

-

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 62 of 93 Page ID #1062

CONFIDENTIAL.: - SUBJECT TO GENERAL PROTECTIVE
ORDER
Provider Handbook

ADMINISTRATIVE SERVICES
I.

Pollcles and Procedures
The basic · polic ies guidi ng the correctional •oper
ation s arc found in the depa rtme nt's edmj nfsh'
ative
direc tives wher e you are work ing. lt is vital that you
read, know and devel op the.m edica l oper ation withi
n
the guide lines of these direc tives . Ther e will be a secti
on that addre sses the gene ral opc:rational polii;ica
of
the med iau unit. Specific medi cal op~t ions in
your. assig ned :unit are descr ibed in the instit ution
direc tives of each indiv idual unit.
al
· :

·

Wexf ord provi des a, set of medi cal policies end proce
dures as well as opera tiona l polic ies from whic h
the
medi cal staff can develop their OWil, These are
prepa red with cross -refe rence s betw een the vario
stand ards to facilitate comp lianc e.
us
·
·

II.

Referrals .

.

.
As part of your medi cal supp ort syste m, you
will be reque sting refer rals to speci alists , sub-s pecia
lists,
emer genc y dep ~ts•.hosp itals, ai;nbulatory
facili
colle gial revie w along with a ,,ttJfntion managemeties and other . provi ders. E~. refer ral requi res a
nt foi:m to be comp leted and subm itted for an

autho riiati on numb er. That niim ber.auth o~s Weip'
orq, to reimburse for the servi ce. . ....
~.., . '
.
.
Ifyou.decid e a referral is indic ated, comp lete the refer
ral.fo rm with brlct:but perti nent infor matio n abou t.
t he
case and what is being reque sted. The following discu
ssion s will give you a sense of~ cot)a fdera tions
for
maki ng decis ions abou t refer rals. The initia l'portf
,on deals with a most difficult qecis ion area. - appro
tare for
priat
pre-e xistin g cond itions .

Annmvllll hv tho llllavrnn l 11• .11.w1 a.i..,•••• ,...__ ,,.__

•

·

·

e.

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 63 of 93 Page ID #1063
CONFIDENTIAL - SUBJECT TO GENERAL PROTECTIVE
ORDER
p

PRE-EXISTING MEDICAi. CONDITION~
. I.

The Basis far Care
A.

Upon incarc eratio n, thP. inma te becom es a ward of the

cQ!:11 imnat e~ and baa •pann ta1• rcspo naibil ity.

state. The DOC becom es tht
·

B.

Incarc cra.tio n limits the "med ical altern atives • of the inmat
e, thus incur ring a higbl
from the medic al service.

c.

The DOC/ COUJl ty (and medic ah:on tractc r)· is prohi bited
11
from
to·ser loua mecllcal needan in the caura e of medic al &cni!= practi cing dollbe rati
e. We are obliga ted to pr
neces sary care consistel1t '9ith ~omm unity atand arda.
..

ti.

By mean s of contr act defini tion (and the.su pport
of federa l court decisions) medic s
Jntezprcted. as •comprehensive medic al servic es equal
to those availa ble in the loca
It is under stood that "local comnwnib.t may be more libera
lly interp reted aa the cu:
the art aa gener
. ally practi
· .
. ced acroai-the. coun ay.
·

.

E.

~

Contr acting for mi=cllcal aemcc does not reliev e the state
inrna te, The medic al service, contr actor has a direc t respo of their respcmsiollity aa '
nsibil ity to repre sent the
. prope r provi sion of medical servicca to the inma te. Also,
each medical staff memb e

respo nsibil ity to respe ct the imnat e•a alvil right for fCllll"
•

F.

11.

J:

.

• •

!'eble m-,lic al ~ •

• • ..

.

•

•

The •deliberate 1ndif.ferenca" term is not a mand ate ~to
cunr,• it is.a mand ate requir:
addre ssed in an appropriate and profe ssfm• l rnaoo er. Furth
er, the dictum.relate~
is to be dkect ed to •seriow, medical neec1.• Conditiona
of leaser l"lgniflcan~, of cou
.be negle cted.· (By PMOd ettan, auch negle ct r::ould and
shoul d be augge stive that sei
migh t also be neglected.) But the major conce rn waa
for seriou s medic al needs - tJ
threatcmns a patient's llf~ ~d/o r limb, .
I

The State Department of Corrections Responalblllty
A.

state

As gener ally noted above, the
b~cornea the • ~ •
provi de a comprehenatve medic al servic e ·c qua1 to •that foundof the inmat e. Therefor
in ths local communtq
priva te contr actor ia utlllzed, 1;ha.i contr actor must meet
the·sa me responiribility r~
state . Thus , decisi ons made ~ the ~ a l conµ- actor
reflec t the state' s role. .

.

.

B.

Wexford Healt h's ~ e phil(laophy is t o ~ the.re
quired comprehensive me<
•equal to (or better , than) ths leuel auaila bls in tits local comm
unity.• .The ptogr am is
desig ned to suppo rt with preve ntativ e care those inma
tes who enter with prc-md.sti
ccind.itiona.·
·
·
•
·

c.

.1nrn a~ problems in the instit ution are treated with.a •wor
br's
conditions which occur in the DOC, or which are dJrectly &ggr11compensatton• pbJk
.vated by incar cerati

-·-·-

- ·-····-... resp on~
biUt y_Q (.thi ,.~-- -.:..--•- - - - - - - - - - .... •" '• .,,._..,..,
....1 -..,..,.. ...- -..:..
"_~ u , . ~
.
D.

However; inmates pi'csent with
Many o~ these

-'--..... ..--...,. :

-*•

many condi~B that are totally'unrelated~ their i
F

c~tl ona have never been addre ssed prior to incarc
diagnosed and treate d prior to incarceration. Many inmat es claim eratio n. Many l
to have been die,
treate d, but 'no evidence can be found to validate the probl
ems. For some conditiOll
cosm etic probl ems, it is rarely appro priate for the DOC
tci accep t a treat:Dient ~ c

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 64 of 93 Page ID #1064

CONFIDENTIAL - SUBJECT TO GENERAL PROTECTIVE
ORDER

.
The state docs NOT have a respo nsibil ity to provide a
servic e simply becau se an inma te dema nds
it be done. Nor does the state have a. responsibility to CURE
, only to appropriately diagn ose and
treat.

E.

.

Provider Handbook

.

'

·

·

111: Individual Respan~lbllity
A.
'

-Unde rstand ing that the state has a •guardian• role to
care for the inmate, and the inma te has
limite d alternative choic es for medic al servic e, there is
still a. maj!Jl' perso nal respo nsibil ity on the
inmat e to seek to prese rve his/h ~ health , This mean
s an inmat e is respo nsible fi;>r comp lying with
medical plans and treatm ent presc ribed .· .

B. · The .inma te is respo nsible for perso nal hygl.en.e and
other norm al activities of daily living that
pi:omote his/he r_.own healt h.
·

C.
D.

Inmates

have the responsibility ta bring to :incdical staff attent ion
the fact that they believ e a
pcrs o~ medic al probleu:J, exists .
·
•·
.
· . ·· · ·,
.
.
.
'
.
.
Tninate,i may refuse.medi cal scrvic c,.but their refus al
does not
to a •delibemte indijJenmce11
in that case. Documcntatiori of all refused cere'i a neces
sary a n d ~ t;V&luation of
comp etenc y shoul d be obtsi ned :when .in quest ion. ·
·
·
·
·' .

.

f

'

I

speak

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o

•

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...

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• ·•-

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•

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All inma tes have a •public health:' respQnsibility to side.
in the protec tion of the healt h of the other
inrnate!J, Just like citize ns in "free--world' comm unitie
s, they must subm it to individual pract ices,
. which help assur e the healtl?- of the instit ution , e.g.,
TB testin g and treatm ent.
'
"

.

IV.

Summary

• •

I

No inrns te who 'has a problem. will· be denied treatm
ent 'simp ly becsu ~e the condition mate d prior fa
incar cerati on. Treat ment will be offered on the basis ofmc
dfcal need; appro priate diag nosi s~ the degree
of objcctfye ~ of functi on. Furth er consideration will
b~ applie d to the treatm ent plan ifincmt :erati on
· activities migh t aggravate or haste n deterioration of the
condition. Pain will be given seriou s consi derati on
as an aggra vating factor , but must be evalu ated in the
light of the patiCJ?.t'e depen dency histor y,
An addit ional facto r with significant weight is the antici
pated progn osis of the propo sed treatm ent. ODly if
there is a reaso nable expec tation that the outco me of
the treatm ent will make a signif icant difference for a
reaso nable durat ion will a proce dure be given seriou s consi
deration. Recommended appro aches that •migh t
give some relier are reviewed and' consi den:d , but ere.n
ot given subst antial suppo rt.
·

..
.
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..U ~ N / A •

.

.

CONFIDENTIAL
- SUBJECT
TO GENERAL
ORDER
Case 3:19-cv-00681-MAB
Document
68 Filed
10/10/19PROTECTIVE
Page 65 of 93
Page ID #1065

QUALITY ASSURANCI!
It is difficult to maintain a quality practice in correctional medicine. Staffing; equlp.m ent, sccu.ritJ
cumbersome policies, conflicting operational objectives, unrelenting and often unrealistic inmate der
ever-present shadow of litigation combine to promote fra~tation end frustration. These varl
controlled by consistent leadership which identifies quality medical service, persistently pursues
goals and maintains the. levels acbie.ved. Part of that p'l"Ocess is the .candid review of error,
disappointing outcomes. Ifwe do not face our failures, we will continue to fail tbroUgh ignoranc~. Cm
through_quality assurance serves to identify deficiencies and improves patient outcomes,

It is. expected that all clinical providers (MD/Dentist/PA/NP) will actively_"participate in their
Management Program or meetin~•.The site Medical Director (or designee) will co-chair the Quality
Program meetings.
·
·

I. .

Peer Reviews

medical

One responsibility of b~th the unit ~ -the corporate
directoris the rcvi~ ofprovi.dei
Although this is usually physician - physician review1 in our units, physician - nurse or CM'I
included. Generally, ·p eer review sho~ be perfor.tned at least annually by the ~onal medit
his designee) and the unit medical director or as designated by the DOC/county. All pef:l' r
give feedback to those healthcare providers being reviewed and must be kept confidential. Ac
review should be forwarded to W.exford's credentialing department "for use as· a .referen
reappointment process..
·
·

Death R.evlews

II.

The occurrence ofan inmate p.eath in the institution is always accompanied by suspicion. Tl:
mmates, and sometimes even DOC and medical stail' are suspect Uiat unusual events l
Realistically, death ·is inevitable. Most deaths are for obvious or expected reasons. Howevei
death must be reported as soon as reasonable to the regional office and the ·corporate medical
death is unexpected, or you percei~ unusual events, immediate notification is indicated. Tl:
. director m~st. file a complete chart summe.ry within a week of the day of death. This su;
include:· 1) patient identification, 2) all listed problems, 3) c;:ause death, 4) a history c
incarceration and medical care with an emp},la.sis on the, care preceding ~e death,
circumstances you believe accompanied the event, ~ any information from •outside" provic
that ere important, end 6) all pertinent laboratory, radiographic, pathologic, or other studl

of

••

This report is both an inf9rmational and a legal document that becomes a part of the perman
part of ourmeclical review. Please treat it as such. We expect a high degree ofcandor in the t

document. There is no place for unfounded incrirninetions or sper!1JJatlons. 'Ibis must be a fal
with your best effort at reasonable analysis and detail, The degree of detail is left to you
thorough, but concise. Above all, include ONLY what is supported by existing, documented
evidence, an~ validated information sources.

Ill. ·. High-Risk ~opulatlan
•

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Thepopuiatlono~ectfunafultl"iiias~almo;'tinypatnoiogic'coriilitfonYou;
The lifestyles, persQna1ities1 socio-economic pathology and· circumstances of illegal traffic
huge physiologic price tag. As responsi~le professionals; we are here to maintain the beir.
possible for as long as is reasonable. Personal judgments regarding the basis for the pro·
place in the treatment of these problems.

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 66 of 93 Page ID #1066

,.

CONFIDENTIAL - SUBJECT TO GENERAL PROTECTIVE ORDER

.l

Provider Handbook

ATTESTATION

..

I, _ _ _ _ _ _.....__ _ _ _ _ _ _ _ _ _ _d.o attest that the Wexford Health Sources ,
Inc. handboo k has been read by me. I underst and and agree to abide by the procedu res and
policies set forward in this handbo ok Furtherm ore, I have been allowed to ask question s and I
have been given appropr iate answers to those question s.
)

--- ,-

Provider

Date

Facility Medical Director

Date

Regional-Level Operato r

Date

Regional Medical Director

Date

.... , .... -

•·•·-

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"~~•~,._._~.r..-...."',..,,.u.,.-.•
.,.__-41,, ,....--......u-...-........A ,....tW-

Approved by the Wexford Medlcal Advisory Committee on June 8, 201Z

CaseNo.~

Page23

WEX191

,I

Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19 Page 67 of 93 Page ID #1067
CONFIDENTIAL - SUBJECT TO GENERAL PROTEC
TIVE ORDER

Prt
Patients with AIDS, end-s tage rena l disea se, failin

g cardio-vascular supp ort, unco ntrol led di&
and many other term inal probleu;is that may gene
rate from poor lifestyles shou ld finr
reaso nable comf ort in the healt h care staff, Thes
e patie nts often. pose the great est chE
healt hcare staff'. Neverthclcsa, we must exten d our
care and atten tion FAR beyo nd the usua l l
pract ice. Thes e patie nts have no place to go- YOU
may be their final provider. Rega rdles s of
done , they deser ve your best care. Judg ment of their
prior acts .shou l!i be left to those ca1
ju4P ent.

IV.

Experla:n~nb\l Care Services
~te a may ~ot parti cipat e in an exper imen tal study
witho ut the specific writt en appro val c
medi cal direc tor. Further appro val will be requi red
by the agen ty medi cal d1rec tor or the state
Corre ction s.

V.

~ransportaUon
Tran sport of inma tes for outsi de medi cal servi ce
is usua lly the task of the Depa rtme nt or C
contr actor , we are usua lly resp o~bl e for emer genc
y trans porta tion. However, thcae.issue a
addr essed in the contr act.

VI.

Coat Considerations
A critic ism frequ ently dlrec tcd toward priva te mana
ged care progr ams like Wexford Heal th i
arc withh eld to ·in)prove profit s, Simil ar critic ism
bas been dlrec tca·a t the medi cal indu s
iIXlplying that cost - mone y- shou ld neve r be a consi
derat
alwa ys .been a consi derat ion in treatm ent, and with ion in regar ds to provi ding medi cal
progressive gove rnme nt •Hea lth Cu
beco me fl far P,at er facto r than it has ever been
unde r the •cont rol or the- healt h profe ssio
.Cons idera tion in decid ing treat ment is given .t o
·whet her or not the Depa rtme nt of Corr e
respo nsibi lity to provide a treat ment . The mere
exist ence of a.con ditio n DOE S NOT c,
RESPONSIBILITY for repairf
4

O

I

•

p

Whe n cons ideri ng altern ative treat ment appro aches
, coat beco mes a consi derat ion. Even tlie:
deter mina nt, but only ONE of sever al possi ble varia
blea
consi qered . Cost, per se, usua lly be
varia ble considered.,.belyi ng its Jmpo rtanc e.
Mean while , the role of the medi cal ataff is to: l) provi
de .medical care to indiv idual patie nts, e
~st quali ty we can afford and sprea d our healt
h care budg et to effectively cover as IDSJ
possi ble. Cost has been and must conti nue to be a
consi derat ion. The •cost of service- rema ins
facto r to be shou ldere d by each healt h care profe ssion
al, Being fisca lly respo nsibl e build s a hr
treat ment altern ative s.
·
·

.

-•
•, ... ...... •-• - - •· " .....-••~,.--,-,.....,..r-aJ.t••·· .. --~,-- .,.......• ,.. "'" ~..,.,,,t lr.-~l'lf ,........,
- •...

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........"""' ........................_ .......~ "........,..

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, .....

·- - --· - -Page--68 of- 93 Page ID #1068
Case 3:19-cv-00681-MAB Document 68 Filed 10/10/19
...

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CONFIDENTIAL- SUBJECT TO GENERAL PROTECTIVE ORDE

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