Care for the Terminally Ill

Idaho
Department of
Correction

Standard
Operating
Procedure
Title:
Care for the Terminally Ill

Page:
1 of 5

Control Number:
401.06.03.053
Version:
2.0
Adopted:
09-26-2008

Pat Donaldson, chief of the Management Services division, approved this
document on 04/27/2015.
Open to the public: Yes

SCOPE
This SOP applies to all Idaho Department of Correction (IDOC) healthcare services staff,
offenders, contract medical providers and subcontractors.

Revision Summary
Revision date (04/27/2015) version 2.0: Periodic review to include administrative updates:
• New/current SOP format
• Changed approval from Education Treatment & Reentry to Management Services
division

BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care

POLICY CONTROL NUMBER 401
Clinical Services and Treatment

PURPOSE
The purpose of this standard operating procedure (SOP) is to establish procedures to
address the needs of terminally ill offenders, including pain management.

Control Number:
401.06.03.053
Version:
2.0
Title:
Care for the Terminally Ill

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Idaho Department of Correction

RESPONSIBILITY
Health Authority
The health authority is responsible for:
• Monitoring and overseeing all aspects of healthcare services, and
• The implementation and continued practice of the provisions provided in this
SOP.
When healthcare services are privatized, the health authority will also be responsible for:
• Reviewing and approving (prior to implementation) all applicable contract medical
provider policy, procedure, and forms; and
• Monitoring the contract medical provider’s performance, to include but not limited
to reviewing processes, procedures, forms, and protocols employed by the
contract medical provider to ensure compliance with all healthcare-related
requirements provided in respective contractual agreements, this SOP, and in
National Commission on Correctional Health Care (NCCHC) standard P-G-
11,Care for the Terminally Ill. (See section 2 of this SOP.)
Contract Medical Provider
Nothing in this SOP shall be construed to relieve the contract medical provider(s) of any
obligation and/or responsibility stipulated in respective contractual agreements. When
healthcare services are privatized, the contract medical provider is responsible for:
• Implementing and practicing all provisions of this SOP, unless specifically
exempted by written contractual agreements;
• Ensuring that all aspects of this SOP and NCCHS standard P-G-11 are
addressed by applicable contract medical provider policy and procedure;
• Ensuring facility health authorities utilize all applicable contract medical provider
policy, procedure, forms, and educational information to fulfill all healthcare-
related requirements provided in this SOP, NCCHC standard P-G-11, or as
indicated in their respective contractual agreement(s); and
• Ensuring all applicable contract medical provider policy, procedure, and forms
are submitted to the health authority for review and approval prior to
implementation.
Facility Medical Director
The facility medical director (or designee) will be responsible for:
• Completing a symptom or system specific examination and plan of clinical care
detailing treatment, pain control, and resuscitation status for each offender
diagnosed with a terminal illness;
• Having, at a minimum, weekly contact with an offender diagnosed with a terminal
illness and making complete progress notes on all of the offender’s hospice care;
• Recording (a) all changes regarding the plan of clinical care in the progress notes
and, (b) the attending physician’s orders exactly as indicated (no exceptions);
and
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401.06.03.053
Version:
2.0
Title:
Care for the Terminally Ill

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Idaho Department of Correction

• Attending and participating in the Interdisciplinary Care Team hospice meetings
regarding all of the offender’s hospice care.
In addition to the above responsibilities, the facility medical director (or designee) and
the facility health authority will be jointly responsible for assigning and monitoring
hospice admissions to the infirmary for clinical appropriateness, quality of care, and pain
management.
Facility Health Authority
The facility health authority will be responsible for:
• Ensuring the presence of an adequate number of appropriately trained staff and
materials are available to meet the requirements of this SOP;
• Establishing and monitoring applicable contract medical provider policy and
procedure to ensure that all elements of this SOP and NCCHC standard P-G-11
are accomplished as required;
• Scheduling hospice Interdisciplinary Care Team meetings;
• Coordinating with security staff special visits for those offenders receiving
hospice care and their families (when appropriate);
• Ensuring that all aspects of the offender’s care is carried out and that the goals of
the interdisciplinary care treatment plan are met;
• Facilitating the early and timely release of the offender in accordance with SOP
324.02.01.002, Parole of Offenders with a Terminal Disease or Permanent
Incapacitation; and
• Tabulating hospice admissions, average daily census, and average length of stay
and for including these data in the Monthly Statistical Report for submission to
the health authority.
After the offender’s death, the facility health authority will be responsible for arranging for
(a) healthcare services staff members involved in the offender’s care to access Critical
Incident Stress Management (CISM) and (b) the offender’s hospice care volunteers to
access counseling and other bereavement services as necessary.
In addition to the above responsibilities, the facility health authority and the facility
medical director (or designee) will be jointly responsible for assigning and monitoring
hospice admissions to the infirmary for clinical appropriateness, quality of care, and pain
management.
Infirmary Nurse
The infirmary nurse will be responsible for:
• Ensuring the attending physician’s orders are processed and carried through;
• Ensuring treatment orders, medications, etc. are administered as prescribed and
documented and that all activities of daily living are met;
• Completing a daily nursing assessment, taking vital signs every shift, and
recording an entry on the progress notes at least once each shift (or as ordered
by the attending physician);
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• Providing (at the conclusion of the shift) a report to the oncoming infirmary nurse;
and
• Notifying the facility medical director (or attending physician) of any significant
changes in the offender’s condition.
•
GENERAL REQUIREMENTS
1. Guidelines
• Hospice care will be provided for offenders who are in the last stages of a diagnosed
terminal illness.
♦ Offenders become eligible for hospice care when they are diagnosed with a
terminal disease and have a prognosis of one year or less to live.
♦ The attending physician shall inform the offender of the prognosis and
treatment options, to include hospice care.
Note: Hospice care includes encouraging the offender to come to terms with his
physical, mental, spiritual, and emotional capacity, while providing a safe, pain-
controlled, and comfortable environment.
• Offenders diagnosed with a terminal illness shall have a care plan.
♦ Offenders admitted to hospice care shall have a care plan developed by the
hospice Interdisciplinary Care Team.
♦ Offenders in hospice care who require skilled nursing intervention can only be
admitted to the acute care infirmary.
♦ The hospice Interdisciplinary Care Team may include direct care healthcare
services staff, religious activities staff, mental health staff, and off-site
consulting practitioners.
• Correctional facilities shall maintain contract medical provider policy and procedure
to address, at a minimum,
♦ Nursing care;
♦ Pain management;
♦ Admission criteria;
♦ Admission procedure; and
♦ Training for staff and offenders involved in hospice care.
• Requests for early release (i.e., medical parole) for those offenders diagnosed with a
terminal illness shall be processed pursuant to SOP 324.02.01.002, Parole of
Offenders with a Terminal Disease or Permanent Incapacitation.

Control Number:
401.06.03.053
Version:
2.0
Title:
Care for the Terminally Ill

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Idaho Department of Correction

2. Compliance
Compliance with this SOP and all related IDOC-approved protocols will be monitored by the
health authority (or designee) by using various sources to include: this SOP, clinical practice
guidelines, routine reports, program reviews, and record reviews.
The health authority (or designee) must conduct two (2) audits per year, per facility (or more
frequently as desired based on prior audit results). The audits must consist of monitoring
applicable contract medical provider, IDOC policy and procedures, applicable NCCHC
standards, and the review of a minimum of 15 individual records.
DEFINITIONS
Contract Medical Provider: A private company or other entity that is under contract with
the Idaho Department of Correction (IDOC) to provide comprehensive medical, dental,
and/or mental health services to the IDOC’s incarcerated offender population.
Early Release: The release of an offender from the custody of the Idaho Department of
Correction (IDOC) before the expiration of his sentence due to the offender being diagnosed
as terminally ill or permanently incapacitated.
Facility Health Authority: The contract medical provider employee who is primarily
responsible for overseeing the delivery of medical services in an Idaho Department of
Correction (IDOC) facility.
Facility Medical Director: The highest ranking physician in an Idaho Department of
Correction (IDOC) facility.
Health Authority: The Idaho Department of Correction (IDOC) employee who is primarily
responsible for overseeing or managing the IDOC’s medical services. (The health authority
is commonly referred to as the health services director.)
Hospice Care: A set of specialized healthcare services that (a) provide support to terminally
ill offenders and their families, and (b) focus on symptom control and quality-of-life issues
(e.g., providing comfort) rather than attempting to cure conditions.
Terminally Ill: To have an illness or disease that is in an advanced stage, has an
unfavorable prognosis, no known cure, and expected to result in death.
REFERENCES
National Commission on Correctional Health Care (NCCHC), Standards for Health Services
in Prisons, Standard P-G-11, Care for the Terminally Ill
Standard Operating Procedure 324.02.01.002, Parole of Offenders with a Terminal Disease
or Permanent Incapacitation

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