Right to Refuse Treatment

Idaho
Department of
Correction

Standard
Operating
Procedure

Division of
Education
and
Treatment

Operational
Services
Control Number:
401.06.03.071
Version:
2.1
Page Number:
1 of 6
Adopted:
3-1-2001
Reviewed:
9-26-2008 Title:
Right to Refuse Treatment

This document was approved by Dr. Mary Perrien, chief of the Division of
Education and Treatment, on 9/26/08 (signature on file).
BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care
POLICY STATEMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
POLICY DOCUMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
DEFINITIONS
Standardized Definitions List
Contract Medical Provider: A private company under contract with the Department to
provide comprehensive medical, dental, and/or mental health services to the incarcerated
offender population. A contract medical provider may include private prison companies and
other entities under contract with the Department to operate the Idaho Correctional Center
(ICC) and other out-of-state facilities housing Department offenders.
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 Department employee who is primarily responsible for overseeing or
managing the Department’s medical and mental health services. The health authority is
commonly referred to as the health services director.
Qualified Health Professional: A physician, physician assistant, nurse practitioner, nurse,
dentist, mental health professional or others who -- by virtue of their education, credentials,
and experience -- are permitted by law (within the scope of their professional practice) to
evaluate and care for patients.
Treatment Plan: A series of written statements specifying a patient’s particular course of
therapy and the roles of qualified healthcare professionals in carrying it out.
Control Number:
401.06.03.071
Version:
2.1
Title:
Right to Refuse Treatment
Page Number:
2 of 6

PURPOSE
The purpose of this standard operating procedure (SOP) is to establish procedures to afford
offenders the opportunity to refuse specifically recommended or prescribed healthcare
evaluations and treatments.
SCOPE
This SOP applies to all Idaho Department of Correction (IDOC) healthcare services staff,
offenders, contract medical providers and subcontractors.
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, he 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-I-05,
Informed Consent and Right to Refuse. (See section 2 of this SOP.)
Contract Medical Provider
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-I-05 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-I-05, 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.
Note: 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.
Control Number:
401.06.03.071
Version:
2.1
Title:
Right to Refuse Treatment
Page Number:
3 of 6

Facility Medical Director
The facility medical director (or designee) will be responsible for:
• Reviewing the circumstances and clinical consequences of the offender’s refusal to
accept the recommended evaluation and/or treatment, and
• Making a determination of whether the offender’s refusal to accept the recommended
evaluation and/or treatment presents significant adverse health risks.
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; and
• Establishing and monitoring applicable contract medical provider policy and
procedure to ensure that all elements of this SOP and NCCHC standard P-I-05
are accomplished as required.
Qualified Health Professional
The qualified health professional will be responsible for:
• Providing sufficient explanation and information to the offender to allow the offender
to understand the consequences of refusing the recommended evaluation and/or
treatment, and
• Documenting the refusal in the offender’s healthcare record.
Note: When an offender’s refusal to accept the recommended evaluation and/or
treatment has significant adverse health risks or consequences, the qualified health
professional shall—at a minimum of 90 days or as detailed in the treatment plan—
discuss the evaluation and/or treatment with the offender.
Table of Contents
General requirements ........................................................................................................... 3
1. Guidelines ...................................................................................................................... 3
2. Process Steps ................................................................................................................ 4
3. Compliance .................................................................................................................... 5
References ........................................................................................................................... 6
GENERAL REQUIREMENTS
1. Guidelines
• Refusing treatment at a particular time does not waive the offender’s right to
subsequent healthcare.
• The process for informing and clarifying understanding of the recommended
evaluation and/or treatment (e.g., face-to-face contact, discussion of the
alternative(s), associated risks, etc.) must be documented in the healthcare record.
Control Number:
401.06.03.071
Version:
2.1
Title:
Right to Refuse Treatment
Page Number:
4 of 6

2. Process Steps
Note: The contract medical provider is responsible for supplying and providing any
forms or lists indicated in this section.

Functional Roles and
Responsibilities Step Tasks
Qualified Healthcare
Professional 1
• Provide information sufficient enough for an offender
to make an informed decision to refuse
recommended healthcare evaluations and/or
treatment.
• If the offender requests, a more detailed explanation
must be provided to include details of the
recommended evaluation and/or treatment, the
viable alternatives, and any material risks to the
recommended evaluation and/or treatment.
Note: Treatment is mandatory for an offender who has
latent tuberculosis infection (LTBI) and/or active
tuberculosis (TB) (see SOP 401.06.03.076, Tuberculosis)
or when he does not have the mental capacity to make an
informed decision (see SOP 401.06.03.070, Informed
Consent).

Note: If an offender does not speak English, a written
interpretation or telephone interpretation service must be
provided in the language spoken.
Qualified Healthcare
Professional 2
If the offender refuses evaluation and/or treatment:
• Complete the Treatment Refusal Form,
• Secure a healthcare staff member to serve as a
witness,
• Have the offender sign and date the form in the
presence of the witness, and
• Have the witness sign and date the form in the
presence of the offender.
Note: If the offender refuses to sign the form, have the
witness sign and date the form indicating the offender’s
refusal to sign.
If the offender accepts evaluation and/or treatment:
• Take steps to obtain informed consent (see SOP
401.06.03.070, Informed Consent) and provide the
evaluation and/or treatment. (The process ends
here.)
Qualified Healthcare
Profession 3
• Document the information provided, circumstances,
and the offender’s stated reason for refusal in the
“progress notes” section of the healthcare record,
and
• Forward the healthcare record to the facility medical
director (or designee) for review.
Control Number:
401.06.03.071
Version:
2.1
Title:
Right to Refuse Treatment
Page Number:
5 of 6

Functional Roles and
Responsibilities Step Tasks
Facility Medical
Director (or designee) 4
Review the circumstances and clinical consequences of the
offender’s refusal to accept evaluation and/or treatment.
• If the refusal to accept evaluation and/or
treatment does present a significant adverse
health risk:
♦ Schedule the offender for a subsequent
appointment with the healthcare provider to
discuss the refusal, and
♦ Forward the healthcare record to the qualified
healthcare professional.
Note: If the refusal to accept evaluation and/or treatment
places others in the facility at risk of contracting infectious
disease, appropriately isolate the offender.
• If the refusal to accept evaluation and/or
treatment does not present a significant adverse
health risk:
♦ No further action is needed. (The process ends
here.)
Qualified Healthcare
Professional 5
Repeat step 1, and
• If the offender continues to refuse evaluation
and/or treatment:
♦ Consider referral to a mental health provider for
an assessment of the offender’s mental status,
♦ Document the information provided,
circumstances, and the offender’s stated reason
for refusal in the “progress notes” section of the
healthcare record, and
♦ Forward the healthcare record to the facility
medical director (or designee) for review.
• If the offender rescinds his earlier refusal to
accept the evaluation and/or treatment:
♦ Take steps to obtain informed consent (see SOP
401.06.03.070, Informed Consent) and provide
the evaluation and/or treatment. (The process
ends here.)
Facility Medical
Director (or designee) 6 Record the refusal on the Healthcare Record Problem List.

3. Compliance
Compliance with this SOP and all related Department-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 a year (or more frequently as
desired based on prior audit results). The audits must consist of monitoring applicable
contract medical provider and IDOC policy and procedures, applicable NCCHC standards,
and the review of a minimum of 15 individual records.
Control Number:
401.06.03.071
Version:
2.1
Title:
Right to Refuse Treatment
Page Number:
6 of 6

REFERENCES
National Commission on Correctional Health Care (NCCHC), Standard P-I-05, Informed
Consent and Right to Refuse
– End of Document –