Jail Intake Screening
By Joseph E. Paris, PhD, MD, FSCP
Posted on January 14, 2009 – Implementing a sound intake screening process has always been a challenge for jail administrators, custody and medical staff. Most jail physicians are only peripherally involved in this activity, which is usually performed by custody or nursing staff. However, because of its significant impact on inmate health care at the facility, physicians should have a clear understanding of the issues involved. The recently published 2008 NCCHC Standards for Health Services in Jails include a revised essential standard, J-E-02 Receiving Screening, which must be met to be accredited. (Note: The concepts below represent the author’s views. NCCHC accreditation staff should be contacted for official opinions on the issues.)
J-E-02 states that receiving screening is performed on all inmates at the intake facility to ensure that emergent and urgent health needs are met. This simple sentence is followed by 3½ pages describing compliance indicators, definitions, discussion and optional recommendations. Careful reading will reveal that compliance to J-E-02 entails the crafting of three distinct phases of the intake process:
1. medical clearance
2. booking performed by security staff
3. receiving screening performed as soon as possible by nursing staff or medically trained custody staff.
Medical clearance, a new concept not found in the 2003 Standards, may be performed by security or medical staff, and consists of a quick inspection of the new arrivals before they are “booked” or admitted to the facility. In some jails, medical clearance is referred to as prebooking screening. Only simple observation is mentioned specifically, because compliance with J-E-02 requires that immediate health needs (e.g., the need for life saving medications, insulin) are identified and addressed; however, a number of questions also will have to be asked. Additionally, potentially infectious individuals may need to be isolated and treated. Lastly, J-E-02 requires that medical clearance is documented in writing.
For those who work in facilities that admit patients from the street, the rationale for this early phase—medical clearance or prebooking screening—is obvious. The medical receiving screening proper can only proceed after an inmate is booked (fingerprinted, photographed and given a comprehensive evaluation of the security risk to determine what precautions should be taken by the staff). This may take 4 hours or more depending on the number of persons who present simultaneously at the facility. In some jails, the booking process may be prolonged if a judge requests that the inmate be brought to a courtroom for judicial proceedings prior to the booking. With the addition of medical clearance before booking, it is possible to rapidly screen out arrivals who may be inappropriate for admission to the facility or who have immediate health needs.
Since health care needs requiring follow up are identified during the intake process, and patients with significant needs may be lost to such follow up if the intake procedure is inadequate, jail physicians should understand the three phases of the intake receiving process at their facility. They should also be familiar with the level of personnel who are performing each phase of the screening, the information gathered, and the timeframe for each phase. Ideally, physicians would be involved in the development of the processes and training of staff. They also should participate in Continuous Quality Improvement activities regarding receiving screening, assessing whether the process in place adequately identifies all patients with medical needs. It is hoped that similar intake processes will be implemented in nonaccredited jails, as they may greatly contribute to the operation of a safe and humane receiving screening and subsequent incarceration for all inmates.
Dr. Paris is an SCP member and NCCHC surveyor. He is a busy correctional health care consultant, and part-time physician at the Dekalb County Jail in Atlanta, Georgia.
