Department Operations Manual

53130.9.2.2 Credit Earning/Work Group Criteria The credit earning status and work group designations for the above listed special assignments shall be determined by the following: Light Duty Assignments Inmates determined to have long-term medical/psychiatric work limitations shall be processed in the following manner: • The inmate shall receive a medical/psychiatric evaluation to determine the extent of the disability and to delineate the capacity to perform work and/or training programs for either a full or partial workday. If the inmate is deemed capable of working only a partial work program, full credit shall be awarded for participation in such a program. • The medical/psychiatric evaluation shall be reviewed by a classification committee. • If the classification committee concurs with the light duty recommendation, the case shall be referred to the institution assignment officer. The assignment officer shall make an effort to provide an assignment which is within the institution ’ s resources and the inmate ’ s capabilities. Upon placement in the assignment, the inmate shall be reclassified into work/training group A-1. Such cases shall be scheduled for semi-annual review by medical staff and a unit classification committee. • If the classification committee disagrees with the medical program recommendation, the case shall be returned to the medical department with a CDC 128-G describing the difference of opinion or the rationale for the request for the second medical evaluation. Upon receipt of the second medical evaluation, the unit classification committee shall again review the case. If the committee disagrees with the second medical evaluation, it shall refer the matter to the institution classification committee for final determination of the inmate ’ s work group/credit earning status. Short-Term Medical/Psychiatric/Dental Unassignments or Lay-Ins Inmates who are sick and require a medical/psychiatric lay-in or a medical unassignment for 29 days or less shall retain their existing work group and utilize ETO during the authorized absent period. Sick time must be approved/authorized by the appropriate institution medical authority. The appropriate medical staff shall initiate a CDC 128-C specifying the reasons for the approval and the expected date that the inmate shall be able to return to work. The original shall be sent to the records office. The inmate shall be responsible for notifying their work supervisor. Sick time must be approved/authorized by the appropriate institution medical authority. The work supervisor shall record each day of the inmate's absence with the symbol “ E ” (excused). Long-Term Medical Psychiatric Unassigned Cases In cases where the medical condition necessitates that the inmate become medically unassigned for 30 days or more, the doctor shall initiate a CDC 128-C which shall indicate a date that the inmate shall be able to return to work. The original CDC 128-C shall be sent to the records office with copies to the assignment lieutenant and the classification committee coordinator in the inmate ’ s housing/program unit. The assignment lieutenant shall change the inmate ’ s status to medically unassigned pending reclassification. The classification committee shall confirm the inmate ’ s medical/psychiatric unassigned category and change the inmate ’ s work/training group status as follows: • Inmates in the general population shall be changed to work/training group A-2, involuntary unassigned, to be effective the thirtieth day of unassignment. • Inmates in lockup units who are in work/training group A-1 or B shall be changed to work/training group D-1, to be effective the first day of placement into Administrative Segregation. • Inmates in lockup units who are in work/training group D-1 or D-2 shall be retained in their respective D-1 or D-2 work/training group. Medical/Psychiatric DisabilityStatus Determination When an inmate has a disability that limits his/her ability to participate in a work, academic, vocational or other such program, medical/psychiatric staff shall document the nature, severity, and expected duration of the inmate’s limitations on a CDC Form 128-C. Medical/psychiatric staff shall not make program assignment recommendations/decisions on the form. The form shall be forwarded to the inmate’s assigned correctional counselor who will schedule the inmate for a classification committee review. The classification committee shall: • Have sole responsibility for making program assignment and work group status decisions. • Determine the inmate’s program and work group status based on the information on the CDC Form 128-C and feedback from staff from the affected work area, academic/vocational program, and the Inmate Assignment Lieutenant or Work Incentive Coordinator. Only when an inmate’s documented limitations are such that the inmate, even with reasonable accommodation, is unable to perform the essential functions of any work, academic, vocational or other such program, will the inmate be placed in one of the two following categories by the classification committee: • Temporary medical/psychiatric unassignment. When an inmate’s medically determinable physical/mental impairment is expected to last for less than six months. Inmates in temporary medical/psychiatric unassignment shall: • Be scheduled for classification review any time there is a change in his/her physical/mental impairment or no less than every six months for reevaluation. • Be assigned work group A-2 credit earning status if unassignment is for less than six months. • Be assigned work group A-1 credit earning status and appropriate privilege group retroactive to the first day of the temporary medical/psychiatric unassignment if the inmate’s condition lasts six months and the classification committee still cannot assign the inmate due to his/her impairment. • Medically disabled. When an inmate’s medically determinable physical /mental impairment is expected to result in death or last six months or more. The inmate’s credit earning status shall be in accordance with work group A-1 and privilege group A. On-The-Job Injuries On-the-job injuries shall be documented on CDCR Form 7219 by the CMO. With the exception of inmates assigned to work group F, inmates shall be retained in their existing work group until medically approved to return to work. Work group F inmates shall revert to work group A-1 effective on the date the CMO determines the on-the-job injury excludes the inmate from conservation camp placement providing that the CMO’s exclusion determination is within 29 days following the date of the inmate’s removal from co nservation camp assignment. If the CMO’s exclusion determination Operations Manual DEPARTMENT OF CORRECTIONS AND REHABILITATION Chapter 5 Page 449 is not within the 29 days, the inmate shall revert to work group A-1 effective the thirtieth day following the date of the inmate’s removal from conservation camp assignment. Medical/Psychiatric Inpatient Hospitalization Inmates determined to be in need of short-term (29 calendar days or less) inpatient care shall be retained in their existing credit earning category. In the event that a longer period of inpatient care is required, the attending physician/psychiatrist shall prepare a CDC Form 128-C for referral to a unit classification committee. The classification committee shall confirm the inmate ’ s inpatient unassigned category and change the inmate ’ s work/training group status as follows: • Inmates in the general population shall be changed to work/training group A-2, involuntary unassigned, to be effective the thirtieth day of unassignment. • Inmates in lockup units who are in work/training group A-1 or B shall be changed to work/training group D-1, to be effective the first day of placement into Administrative Segregation. • Inmates in lockup units who are in work/training group D-1 or D-2 shall be retained in their respective D-1 or D-2 work/training group. Medical/Psychiatric Treatment Categories Inmates who are assigned into the below list of medical/psychiatric treatment categories or transferred to a state hospital, unless otherwise specified, shall be deemed incapable of performing a work/training assignment. Inmates so designated shall be classified as work/training group A-1. Category H For inmates who require medical services and/or surgical care in an acute general hospital. This category is provided at CMF, CIM, COR, and CMC- East. Inmates with medical needs that cannot be met in CDCR hospitals may be transferred to a community hospital with the Warden ’ s approval. Category N For inmates with chronic medical illnesses requiring skilled nursing or intermediate level medical care. This program has licensed nursing staff on duty at all times and is provided at CMF, CMC-East, and CCWF. Female inmates requiring this level of service shall be transferred to a community hospital unless special arrangements can be made at the CIW ’ s infirmary. This category is not for inmates in infirmaries for undergoing short-term treatment of minor illnesses. Category I For inmates with major mental illness of psychotic magnitude requiring inpatient psychiatric hospitalization such as those with an acute, recurrent, or chronic illness which requires intensive treatment. This category includes inmates who are determined to be: • Acutely psychotic, severely depressed or suicidal. • Mentally ill inmates who are management problems, providing the psychosis warrants treatment in a hospital setting. Category I is provided at CMF and the Salinas Valley Psychiatric Program (SVPP) at SVSP and this designation shall be made by CMF or SVSP staff. Other institutions with inmates who appear to meet category I criteria shall transfer such cases to CMF or the SVPP for inpatient psychiatric observation pending category classification. Females requiring treatment in this category shall be referred to a state hospital. DMH The DMH also provides inpatient services for inmates who may be transferred from any CDCR adult institution pursuant to PC §§ 2684 and 2690. Inmates transferred to DMH and retained under the jurisdiction of the Department per PC §§ 2684 and 2690 shall be deemed incapable of performing a work/training assignment. Inmates so designated shall be classified as work/training group A-1. Experimental Treatment Inmates transferred to DMH to participate in a voluntary experimental treatment program per PC § 1364 shall be required to participate in a full-time credit qualifying work/training assignment in order to earn full work- time credit. For details concerning specifics of DMH psychiatric placements, refer to DOM § 53130.12. 53130.9.2.3

91080.12 Inmate TB Alert System Reports The Inmate Alert System provides two reports, 1) Medical Alert List by Arrival Date and 2) Medical Alert List by Medical Code and two screens 1) Medical Information Screen History − Diagnosis and 2) Medical Information Screen History − Movement. The reports and screens are useful in monitoring an inmate's TB status. Medical Alert List By Arrival Date The user of the Inmate TB Alert System selects the desired inmate arrival date. The selected date may be either one single day or a sequence of many days. The Medical Alert List by Arrival Date Report provides the following data elements for every inmate in the facility by date of arrival: • Bed/Cell--Most current housing status. • CDC Number. • Inmate Name. • Birth Date. • Age. • Medical Code. The Medical Alert List by Arrival Date Report may be generated daily and used for: • Inmate Tracking--Immediate action shall be taken if the inmate's TB Alert Code remains 11 after 72 hours. • Case contact investigation information. • Identification of inmates with TB Alert Code 22 who require annual PPD skin testing. • Identification of inmates with TB Alert Code 31, 32, 33, or 43 who require yearly evaluations for symptoms of coughing, night sweats, fever, and weight loss. • Assistance with identifying inmates who require Directly Observed Therapy. • Assistance in Confidential Morbidity Report and Verified Case Report card generation. Medical Alert List by Medical Code The Medical Alert List by Medical Code Report provides a list of every inmate grouped by TB Alert Codes. The report may be generated by selecting one or a combination of TB Alert Codes. Operations Manual Chapter 9 830 This report, sorted by medical alert code and description of code, provides the following data elements for every inmate in the facility: • Bed/Cell--Most current housing status. • CDC Number. • Inmate Name. • Birth Date. • Age. • Arrival. The Medical Alert List by Medical Code Report may be generated daily and used for: • Follow-up of inmates with a TB Alert Code 11 that should have progressed into another code. • Data surveillance on a daily, weekly, monthly, and annual basis. • Expediting follow-up care on inmates with TB Alert Code 21, 31, or 32. Screens The Medical Information Screen History--Diagnosis. Medical Information Screen History Diagnosis The user will read information regarding the inmate's TB history provided on the Medical Information Screen History--Diagnosis screen. Refer to the Medical Alert System User's Manual for detailed instructions. This screen provides the following data elements for every inmate in the facility: • CDC Number. • Inmate Name. • Bed/Cell--Most current housing status. • Current TB Alert Code. • Previous medical diagnosis and date of entry. Uses of the Medical Information Screen History--Diagnosis screen include: • Current TB Alert Code and date entry. • Previous medical diagnosis history. Once this screen is displayed on the DDPS terminal, a screen print may be executed on the printer. Refer to the Medical Alert System User's Manual for detailed instructions. Medical Information Screen History Movement The user will read information regarding an inmate's movement history provided on the Medical Information Screen History − Movement screen. Refer to the Medical Alert System User's Manual for detailed instructions. This screen provides the following data elements for every inmate in the facility: • CDC Number. • Inmate's Name. • Bed/Cell--Most current housing status. • Current TB Alert Code. • Transaction Message. • Facility. • Cell. • Location. • Date. • Previous CDC Number. Uses of the Medical Information Screen History − Movement include: • Assistance with case contact investigations. Once this screen is displayed on the DDPS terminal, a screen print may be executed on the printer. Refer to the Medical Alert System User's Manual for detailed instructions. 91080.13

31040.4.11 Medical Termination For an employee who, due to a disability or medical condition, has work restrictions that prevent him or her from performing the essential functions of his or her job, or any job in CDCR, either with or without a RA, and is not vested through CalPERS, or otherwise waives his or her right to disability retire, it is the policy of the CDCR to process a medical termination from State employment. This is an administrative action that separates an employee when all other medical options (e.g., RA, medical leave of absence provided under CFRA or FMLA, or disability retirement) have been exhausted, or discussed with the employee and determined inappropriate under the specific circumstances of the employee’s employment status and medical condition or disability. A medical termination shall be considered only if all of the following apply: • The employee can no longer perform the essential functions of his or her classification with or without a RA; • There are no funded, vacant positions in the employee’s current classification for which the employee is qualified and can perform the essential functions with or without a RA; • The employee is unable to perform the essential functions of any other position in the CDCR anywhere in the State, for which he or she meets the minimum qualifications, with or without a RA; • CDCR cannot provide an RA without undue hardship; and • The employee: is ineligible for, or waives the right to, disability retirement; refuses to cooperate when CDCR files for disability retirement on his or her behalf or has been denied disability retirement (after waiving or exhausting his or her appeal rights), and still refuses; or is unable, for medical reasons, to return to work. Prior to the HA serving a notice of medical termination on an employee, consultation with the EHW, Associate Director, or RTWSS Chief, shall occur, including the review of appropriate documentation (including, but not limited to, the employee’s request for RA, documentation of the interactive process, medical reports, and a list of essential functions of the employee’s job/position). OEW, in consultation with the OLA, will draft the appropriate Notice of Medical Action – Termination document and forward it to the HA for finalization, signature, and service to the employee. This document shall give the employee written notice of the medical action and appeal rights, at least 15 calendar days prior to the effective date of the medical termination. 31040.4.12

91080.10 Reviewing Scheduled Inmate Movement on the CDC Form 7343, Medical Advance Transfer Notice General Requirements A CDC Form 7343 generated at each facility shall contain the TB Alert Transportation Instruction for every inmate listed. The facility's Associate Information System Analyst (AISA) routinely extracts (downloads) information from the DDPS and enables the ATS access to this information during the generation of the CDC Form 7343. ATS reads each inmate's TB Alert Code from the extracted information, generates the appropriate TB Alert Transportation Instruction based on the TB Alert Code, and prints the TB Alert Transportation Instruction on the CDC Form 7343. Medical Care Services staff shall review the CDC Form 7343 to ensure the appropriate TB Alert Transportation Instructions have been identified and medications are prepared for transfer if appropriate. CDC Form 7343 Medical Advance Transfer Notice Distribution Instructions The Inmate TB Alert Coordinator shall walk to Case Records and obtain a copy of the CDC Form 7343 as soon as it is printed and as subsequent changes occur. CDC Form 7343 Review Instructions Medical Care Services staff shall review the CDC Form 7343. It is not necessary to compare the TB Alert Transportation Instruction with the DDPS TB Alert Code or documentation in the medical record. A visual check of the names and TB Alert Transportation Instructions printed on the CDC Form 7343 along with Medical Care Services staff's knowledge of inmates who are in the infirmary, quarantine, etc., shall be sufficient. This review is intended to ensure all inmates have a Clear For Transportation status and to identify that any recent change in the TB Alert Code not yet entered in DDPS can be identified and arrange transportation arrangements, if necessary . Medical Care Services staff shall follow instructions for placing Special Transportation Requirements, as described in DOM 91080.11, for any inmate who is TB Alert Code 31, Infectious TB Disease. Medical Care Services staff shall be responsible for securing medications for inmates who are TB Alert Code 33, TB Infection, Noninfectious, On Medication; or TB Alert Code 43, Diagnosis of Noninfectious TB Disease, On Multiple Medication. Medical Care Services staff shall be responsible for ensuring transfer medications are at Receiving and Release (R&R) at the time of inmate transfer. If medications are not transferred on the bus, Medical Care Services staff shall telephone Medical Care Services staff at the receiving facility that medications did not transfer with the inmate. If a TB Alert Code requires change, Medical Care Services staff shall contact Case Records before the end of the shift and document the name of the person contacted and the date of the contact next to the inmate's name on the CDC Form 7343. Upon completion of review, Medical Care Services staff shall sign the CDC Form 7343 denoting approval and route the CDC Form 7343 to Case Records. If Medical Care Services staff does not have 24 hours to review the CDC Form 7343, changes and approvals shall immediately be communicated with the appropriate staff by telephone. 91080.11

62090.6.4.4 BPH Attendees with Disabilities and Medical Conditions Attendees with disabilities and medical conditions may present medical documentation regarding their medical condition or disability to custody staff to help inform him or her of their situation and facilitate the screening process. This documentation is not required and will not exempt the attendee from the security screening process. Attendees should advise custody staff of an implanted pacemaker, other implanted medical device, or metal implant and where that implant is located. Attendees who have a pacemaker should (but are not required to) carry a Pacemaker Identification Card when going through security screening and shall be screened with a full body pat-down search instead of walking through the metal detector or being screened with a hand-wand. If an attendee states that he or she should not go through the metal detector or be screened with a hand-wand because it could affect the functionality of their implanted medical device or the magnetic calibration of their implanted medical device, custody staff shall conduct a full body pat-down search prior to the attendee being permitted to enter the institution. Prostheses, Assistive Devices, and Mobility Aids Custody staff are to visually and physically inspect prosthetic devices, assistive devices, mobility aids , casts or support braces as part of the screening process. Custody staff will not ask nor require removal of prosthetic device(s), casts, orthopedic shoes or support braces. Attendees may be asked to lift specific clothing to effect a visual inspection of the prosthesis or support brace, i.e., lift pant leg or sleeve to expose the prosthetic device. Attendees will not be required to remove medical devices, such as an insulin pump, feeding tube, ostomy or urine bag at any time during the screening process. Attendees are to advise screeners if they have an ostomy or urine bag. Attendees are not required to expose these devices for inspection unless the hand held metal detection device is set off, at which point a visual and physical inspection (pat-down of the area, over top of clothing) will be conducted to ensure there are no prohibited items being concealed in the area. Attendees who require use of a wheelchair shall not be required to pass through the metal detector nor be asked to transfer to another wheelchair for screening purposes. Custody staff shall affect a visual and physical inspection of their wheelchair. Custody staff shall then use a hand held wand to search the attendee. Augmentation devices attached to wheelchairs are permitted through the screening process once they have undergone visual and physical inspection. The following medical and disability-related assistive devices needed by attendees during the BPH process are permitted into the institution; however, they are subject to inspection and search. The assistive devices will be itemized on CDC Form 1000. Smaller items, such as necessary medications, scissors, and syringes shall be placed in a container provided by the institution and carried into the institution/hearing. The contents of the container will be accounted for via the CDC Form 1000 upon exiting the facility. All other items that are not needed during the hearing will be either left in the entrance building in a locker or returned to the attendees’ vehicle: • Wheelchairs, scooters, crutches, casts, canes, walkers, prosthetic devices, support braces, exterior medical devices. • Orthopedic shoes and appliances, augmentation devices, Braille note takers, slate and stylus. • Ostomy-related supplies such as positioning plates (wafers), collection pouches and scissors (blunt tipped.) • Service animals such as dog guides, assistance, hearing and seizure alert dogs, monkey helpers. • Supplemental personal medical oxygen containers/systems and other respiratory-related equipment and devices. • All diabetes related equipment and supplies, including: • Insulin and insulin loaded dispensing products (vials, jet injectors, pens, infusers, and preloaded syringes). • Unused syringes when accompanied by insulin or other injectable medication. • Lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, meter-testing solutions. • Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter, and needle). • Glucagon emergency kit. • Urine ketone test strips. • Sharps disposal containers or similar hard-surface disposal container for storing used syringes and test strips. • All types and forms of medication, dispensers, and related supplies necessary for the attendee during the BPH process. All medications, including insulin, in any form or dispenser must be clearly identified. Attendees who are concerned about going through the walk- through metal detector with their insulin pump may request a full-body pat- down search and a physical inspection of their pump instead. Insulin pumps and supplies must be accompanied by insulin. Hearing and Visual Disabilities Attendees are not required to remove hearing aids or the exterior component of a cochlear implant during the screening process. Exterior components of a cochlear implant are to be visually and physically inspected while it remains on the attendee’s body. Custody staff are to explain the security process to persons with visual disabilities and verbally communicate with them throughout each step of the screening process. Screeners are to provide persons with visual disabilities with assistance by providing them with an arm, hand, or shoulder as they move through the process. White collapsible canes are to be physically inspected after attendees have passed through the walk-through metal detector so that attendees can guide themselves through the walk-through metal detector. Equipment such as Braille note-takers are to be physically inspected. Medical Oxygen and Respiratory-Related Equipment Supplemental personal medical oxygen and other respiratory-related equipment and devices (e.g. nebulizer, respirator) are permitted through the screening process once they have undergone screening. All respiratory equipment and oxygen will be visually and physically inspected. Attendees are not required to disconnect from their oxygen or respiratory device. Service Animals Attendees using an animal for assistance should carry appropriate identification. Identification may include: cards or documentation, presence of a harness or markings on the harness, or other credible assurance of the attendee using the animal for their disability. At no time during the screening process will attendees be required to be separated from their service animal. Custody staff will not touch service animals. Attendees are required to maintain control of the animal in a manner that ensures the animal cannot harm the screener. Attendees are to advise the screener how they and their animal can best achieve screening when going through the metal detector as a team (i.e., walking together or with the service animal walking in front of or behind the attendee). If the walk-through metal detector alarms in the situation where the attendee and the animal have walked together, both the attendee and the animal must undergo additional screening. If the walk-through metal detector alarms on either the attendee or the animal individually (because they walked through separately), additional screening must be conducted on whoever alarmed the walk-through metal detector. If the animal alarms the walk- through metal detector, custody staff will ask the attendee or companion to re move the animal’s collar, harness, leash, backpack, vest, etc., for staff inspection prior to being permitted into the institution. 62090.6.4.6

91080.13 Weekly Code Review General Requirements Medical Care Services staff shall conduct a weekly review of inmates with a TB Alert Code of___ (blank), 11, 21, or 31. This review shall provide Medical Care Services staff with the ability to ensure that coding and medical follow- up is properly maintained. Each facility shall identify the Medical Care Services staff who will generate, review, and follow-up on those inmates who are identified with TB Alert Codes 11, 21, or 31. Weekly Code Review Instructions Medical Care Services staff shall generate the Medical Alert List by Arrival Date Report on the DDPS each Monday morning using the arrival date for the Monday of the previous week and selecting TB Alert Codes of 11, 21, and 31. Refer to Medical Alert System User's Manual for details. Medical Care Services staff shall review medical records for each inmate who reports a TB Alert Code of 11, 21, or 31. If the TB Alert Code is 11, the Mantoux PPD skin test shall be read and interpreted or re-administered as appropriate. If the TB Alert Code is 21, the reviewing Medical Care Services staff shall determine if the diagnosis has been confirmed. If the TB Alert Code is 31, the reviewing Medical Care Services staff shall determine if the diagnosis can be updated. If the TB Alert Code is updated to Code 31, Medical Care Services staff shall issue a medical hold pending special transportation arrangements as defined in DOM 91080.11. Any TB Alert Code changes shall be documented and entered in the DDPS as described in DOM 91080.8. Route and file the documentation as described in DOM 91080.9. 91080.14

52030.3.13 Employee Medical Record A record concerning the health status of an employee which is made or maintained by a physician, technician, or other health care personnel. • Employee medical record includes: • Medical and employment questionnaires or histories (including job description and occupational exposures). • The results of medical examinations (pre-employment, pre-assignment, periodic, or episodic) and laboratory tests (including x-ray examinations and all biological monitoring). • Medical opinions, diagnoses, progress notes, and recommendations. • Descriptions of treatments and prescriptions. • Employee medical complaints. • Employee medical record does not include: • Physical specimens; e.g., blood or urine samples which are routinely discarded as a part of normal medical practice and are not required to be maintained by other legal requirements. • Records concerning health insurance claims if maintained separately from the employer’ s medical program and its records, and not accessible to the employer by employee name or other direct personal identifier; e.g., social security number, payroll number, etc. • Records concerning voluntary EAPs (alcohol, drug abuse, or personal counseling programs) if maintained separately from the employer ’ s medical program and its records. 52030.3.14

54020.11.2 Processing Visitors with Medical Implants, Prosthetic, or Assistive Devices Revised April 3, 2014 Visitors with temporary medically implanted or prosthetic devices, wheelchairs, or other assistive devices who cannot clear contraband/metal detection devices shall be required to present a signed letter which includes the address, telephone number, and the California Medical License number (if applicable) of their physician, physiatrist, prosthetist, or orthotist. Visitors with permanent medically implanted or prosthetic devices shall be required to present a letter with the initial submission of an application requesting visitation with an inmate. A visitor who had already been approved to visit and later has a permanent or prosthetic device(s) installed shall be required to submit medical verification as prescribed in CCR Subsection 3173.2(d). Once accepted, this verification will be incorporated into SOMS Operations Manual DEPARTMENT OF CORRECTIONS AND REHABILITATION Chapter 5 Page 466 and will only require update to coincide with changes to the visitor’s permanent implanted or prosthetic device(s). The verification letter shall: • Be renewed at least every two years or coinciding with the requirement for updating visitor information. • Detail the specific location of the medical implant or prosthetic device in or on the body. • Detail the specific type of mobility impairment and verify the need for a wheelchair or assistive device. Processing Visitors with Medical Implants or Prosthetic Devices Staff shall conduct an inspection of the prosthetic device to the extent possible without the removal of clothing. A hand-held contraband/metal detection device shall be utilized to process visitors with medical implants. Any required removal of prosthetic and medical implants for inspection will be done in private setting or area. If reasonable suspicion exists to believe that a visitor is attempting to introduce contraband or substances into or remove contraband out of the institution and the visitor has a medical implant, prosthetic device, or uses a wheelchair or assistive device(s), a search will be initiated in accordance with this Section. Licensed physician and/or nursing staff of the same sex shall be present to assist with the unclothed body search consistent with the duties of their classification. Processing Visitors with Wheelchairs or Mobility Assistive Devices The visitor shall be asked to temporarily transfer from his/her personal wheelchair to an institutional wheelchair while an inspection of the visitor ’ s wheelchair is conducted. Institution/facility staff are not authorized to physically assist the visitor with the wheelchair transfer. Hand-held contraband/metal detection devices shall be used to process the visitor during the transfer from his/her personal wheelchair to the designated wheelchair. If the visitor provides no written verification of impairment and/or need for assistive device and/or refuses to comply with the transfer, the visit shall be denied by the appropriate staff. Visitors who present letters signed by their physician, etc., which details a specific type of mobility impairment which precludes the wheelchair transfer or verifies the need for using battery-powered or custom designed wheelchairs, shall be exempt from the wheelchair transfer requirement. When an institutional wheelchair is not available or the visitor is unable to transfer to another wheelchair, the visitor is exempt from the transfer requirement. Visiting staff shall conduct a visual inspection of the wheelchair and hand- held contraband/metal detection devices shall be used to process visitors deemed exempt from the wheelchair transfer requirement. 54020.12

62070.9.4 Emergency Removal Procedures/Responsibilities Medical Staff (Emergencies After Normal Hours, Holidays/Weekends) When medical emergencies occur during other than normal work hours requiring an inmate(s) removal to a community medical facility, the senior medical staff person on duty shall: • Contact the assigned medical officer-of-the-day (MOD) and describe the medical circumstances. • Receive emergency medical/treatment instructions from the MOD. • Obtain verbal approval from the MOD to remove the inmate(s) to an appropriate community medical facility based on circumstances of the injury/illness. • Notify the watch commander and report all details and instructions. Watch Commander/AOD The institution/facility watch commander shall be responsible to coordinate and effect emergency medical removals during non business hours. The watch commander shall assume the responsibilities outlined for the AW in DOM 62070.9.2 for medical removals under these described conditions. The AOD, if present or in contact during the emergency, shall assume responsibility for authorizing the removal. Custodial Coverage Community Hospital The AOD and watch commander shall ensure that appropriate custodial coverage is provided at the community hospital as outlined in DOM 55060, Transportation of Inmates. 62070.10

54040.8.3 Medical Services Responsibilities California Correctional Health Care Services (CCHS) medical staff will provide indicated emergency medical response. The assigned Registered Nurse will initiate the CDC Form 7252, Request for Authorization of Temporary Removal for Medical Treatment and have it delivered to the Watch Office or designated area to expedite the transportation process. To the extent possible, staff in the Triage and Treatment Area (TTA) will maintain physical separation and visual separation between the victim and suspect(s). CCHCS medical staff will conduct follow-up testing for sexually transmitted infections/diseases, HIV, Hepatitis B and/or C, and pregnancy (if appropriate) as indicated. As required in Penal Code Section 2638, immediate HIV/AIDS, and sexually transmitted infections prophylactic measures will be provided. In addition, information regarding sexually transmitted infections, HIV and pregnancy options, will be discussed with the victim and suspect. Licensed health care staff shall determine and identify any injuries sustained by the alleged victim and suspect, assess and identify if they are urgent/emergent, and provide immediate emergency medical care to the alleged victim and suspects. The injuries sustained by the alleged victim and suspect shall be documented on a CDCR Form 7219, Medical Report of Injury or Occurrence and CDCR Form 837-C for use in the inmate disciplinary process and provide to custody. The Chief Medical Executive, or designee shall review the medical documentation of the incident. 54040.8.4

31080.9 Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA)/Pregnancy Disability Leave (PDL) Revised December 29, 2023 (a) FMLA and CFRA established an entitlement for employees who have a minimum of 12 months of State service and who have physically worked a minimum of 1250 hours in the year immediately preceding the date the leave is to begin, to a job-protected leave, for up to 12 work weeks in a calendar year (January to December) due to any of the following reasons (except for military caregiver leave): (1) Health conditions relating to pregnancy or childbirth (FMLA and PDL). (2) Birth and care of a newborn child or placement of a child in the employee’s home for adoption or foster care (known as bonding leave). (3) Care for the employee’s qualifying family member or designated person (CFRA only) who has a serious health condition. Qualifying family members are as follows: (A) Spouse, child, or parent (FMLA and CFRA). (B) Domestic partner, grandparent, grandchild, sibling, or designated person (any individual related by blood or whose association with the employee is the equivalent of a family member (CFRA)). (4) Employee’s own serious health condition (FMLA and CFRA). (5) Qualifying Exigency Leave related to the covered active duty or call to covered active duty of an employee’s spouse, domestic partner, child, or parent in the Armed Forces of the United States. (b) FMLA and CFRA established an entitlement for employees who have a minimum of twelve (12) months of State service and who have physically worked a minimum of 1250 hours in the year immediately preceding the date the leave is to begin, to a job-protected leave, for up to 26 work weeks within a twelve-month period, for Military Caregiver Leave to care for ill or injured family members in the military. (c) Twelve work weeks means the equivalent of 12 of the employee's normally scheduled work weeks. (d) A presumption of a serious health condition exists under the definitions of the FMLA and CFRA after an absence of more than three consecutive days of work because the employee or employee’s family member is incapacitated or the employee or the family member is hospitalized overnight. A serious health condition may also exist if the absence involves ongoing or follow-up care by a health care provider, or if a chronic health condition is so serious that, if not treated, could reasonably be expected to result in the employee or the employee’s family member being absent from work for more than three consecutive days. (e) An employee may elect to use any accrued leave credits in lieu of taking an unpaid leave. When FMLA, CFRA, and/or PDL is for the employee’s own serious health condition, sick leave credits shall be used first before using other leave credits. The employee may choose to take unpaid leave (i.e., dock) for any approved FMLA, CFRA, and/or PDL time usage. (f) The employee will not be required to use sick leave credits when caring for a family member with a serious health condition. The use of other leave credits for such an absence shall be at the employee’s discretion. However, sick leave credits cannot be used for the employee bonding with a new child, or the placement of a child with an employee in connection with adoption or foster care. (g) Leave taken for bonding must be taken within one year of the birth of the child, or from the date of the child’s placement in the home for adoption or foster care placement. Intermittent bonding leave is leave taken in separate periods of time, or leave t hat reduces the employee’s normal weekly or daily work schedule. Intermittent bonding leave must be taken in a minimum of two week increments up to the maximum of 12 weeks; however, a request for leave of less than two weeks on any two occasions may be granted. (h) Approval to use leave credits for bonding with a new child of the employee, placement of a child in the employee’s home for adoption or foster care, or to care for a family member with a serious health condition is subject to the provisions of collective bargaining agreements, California Department of Human Resources (CalHR) rule, and Labor Code, section 233. (i) PDL is part of California’s Fair Employment and Housing Act (FEHA). It entitles a pregnant employee to four months (17.33 weeks) of leave while disabled by pregnancy- related health conditions. The employee’s benefits are covered for up to four months. PDL runs concurrently with FMLA but not CFRA since CFRA does not consider pregnancy-related disabilities a serious health condition. The requirements for PDL are: (1) being pregnant, and (2) employed by the State for one day. Qualifying events for PDL: (1) Prenatal visits and care. (2) Severe morning sickness. (3) Any pregnancy-related disability. (4) Bed rest ordered by the doctor. (5) Child birth and recovery from child birth. (6) Employee is unable to perform one or more essential functions of their job due to pregnancy or pregnancy-related conditions. (j) Time taken for a pregnancy, or a pregnancy-related condition, does not count toward the 12 work week CFRA entitlement, however, such a leave is protected by the PDL provisions of the FEHA, and under FMLA. (k) Employees seeking to use FMLA and/or CFRA leave are required to provide 30 days advance notice of the need to take FMLA and/or CFRA leave when the need is foreseeable and such notice is practicable. When intermittent leave is needed to care for one’s self or a family member’s serious health condition, and if for planned medical treatment, the employee must try to schedule treatment so as not to unduly disrupt the work place operations. If leave is unforeseeable, the employee must provide notice as soon as practicable. (l) When provided with sufficient information of an employee’s need for leave, or if an employee is absent for more than three consecutive days of work, the supervisor shall contact the FMLA Coordinator to request the employee be provided with an FMLA packet. To request a packet an employee or supervisor may complete the CDCR Form 3051, Employee Request for FMLA, CFRA, and/or PDL, and submit to the FMLA Coordinator, or send a request via email to the FMLA Coordinator. The FMLA Coordinator shall be informed immediately as the employee shall be notified of their eligibility for FMLA, CFRA, and/or PDL within five business days. The supervisor is responsible for making sure the FMLA Coordinator has been notified of the employee’s need for FMLA, CFRA, and/or P DL. (m) If the request for use of FMLA, CFRA, and/or PDL appears to meet the qualifying criteria and the employee is eligible for FMLA, CFRA, and/or PDL, the employee is to be provided with the CDCR Form 2201, Certification of Health Care Provider for Family and Medical Leave Act and/or California Family Rights Act, or the CDCR Form 3052, Certification of Health Care Provider for Pregnancy Disability Leave, to forward to the treating health care provider. The employee is responsible for providing a complete and sufficient health care certification to the FMLA Coordinator within 15 calendar days. In certain instances an extension maybe granted beyond 15 days. The CDCR Form 2201 and CDCR Form 3052 are not mandatory, and another version of certification can be issued by the health care provider. The certification will be sufficient if the following is indicated: (1) Contact information and signature of the health care provider. (2) The date the serious health condition commenced. (3) The probable duration of the condition. (4) For the employee’s own health condition, information showing that the employee cannot perform the essential functions of the job. (5) For leave to care for a family member or designated person (CFRA only), a statement of the care that is needed, or that the serious health condition warrants the participation of a family member to provide care during the treatment or supervision of care. (6) For intermittent leave, information showing the medical necessity and the frequency and duration for intermittent or reduced schedule leave. (n) The employer cannot require the employee or health care provider to indicate a specific diagnosis of the condition necessitating the leave. The treating health care provider will determine, based on an evaluation, if the employee (or the employee’s fam ily member or designated person) has a health condition that qualifies as “serious” under the definition of the FMLA, CFRA, and/or PDL. The certification must be maintained as a confidential document. (o) Medical recertification for FMLA, CFRA, and/or PDL is required for the following reasons: (1) Upon expiration of the time originally estimated for the leave duration, and additional leave is requested. (2) A change in the duration of the leave or frequency of intermittent absences. (3) A change in the nature or severity of the condition. (4) Leave is grossly exceeding the approved frequency and duration. (5) Information has been received casting doubt on the validity of the certification or reason for absence. (A) If there is a good faith, objective reason to doubt the validity of a medical certification for the employee’s medical condition, then CDCR/CCHCS may require a second or third medical opinion, at the department’s expense. In all cases, the requirement to furnish a health care recertification can be no more restrictive than that outlined in the applicable collective bargaining agreements. (p) Absences which qualify for leave taken under the provisions of FMLA, CFRA, and/or PDL, will not be counted against an employee for purposes of determining excessive sick leave use or abuse or when considering the employee for promotion, out-of-class assignment, or used as a basis for adverse actions. (q) When an employee is grossly exceeding the frequency and duration of leave they are approved for under FMLA, CFRA, and/or PDL, their supervisor may request an FMLA Coordinator to contact the employee and request a recertification be completed. A recertification request may be requested if there is a documented pattern of overuse. Example: Approval of 1-2 days per month. Employee uses 4-6 days per month for 3 consecutive months. The employee is allowed a minimum of 15 calendar days to provide the rece rtification after the employer’s request. Absent extenuating circumstances, if the employee fails to timely return the recertification, despite the opportunity to cure any deficiencies, the employer may deny FMLA and/or CFRA leave until a sufficient certification or recertification is provided. (r) Additional details for processing FMLA, CFRA, and/or PDL are included in the CDCR FMLA Desk Manual. Each Personnel Officer, Employee Relations Officer, FMLA Coordinator, and Return to Work Coordinator has copies of this manual. 31080.10

53130.9.2.1 Medical/Psychiatric Special Assignments Medical/psychiatric categories to be considered as special assignments are as follows: • Light duty. • Short-term medical/psychiatric or dental unassignments/lay-ins. • Long-term medical/psychiatric unassigned cases. • Temporary medical/psychiatric unassignment. • Medically disabled. • On-the-job injuries. • Inpatient hospitalization cases. • Medical/psychiatric treatment category cases; “ H, ” “ N, ” and “ I. ” • DMH placements per PC §§ 2684, 2690, and 1364. 53130.9.2.2

54045.3 Medical Care – Reception The pregnant offender’s medical care is initiated in Receiving and Release (R&R) when it is determined, by self report or physical appearance that the offender is pregnant, confirmed by physical examination and laboratory test results. A Registered Nurse (RN) or Medical Technical Assistant (MTA) shall conduct the initial health screening in R&R. The health care staff shall notify the Obstetrical (OB) Coordinator by telephone or written documentation of the offender’s name, CDC number, a nd any pertinent medical information regarding the offender’s pregnancy status. The R&R RN shall notify the Supervising Obstetrician if information provided by the offender or from written information indicates that the offender has any medical conditions that place the patient in a high-risk status. The RN shall notify the Supervising Obstetrician, Health Care Manager/Chief Medical Officer (HCM/CMO) or designee if the offender needs to be seen for any urgent/emergent conditions. A priority ducat for laboratory work to verify the pregnancy will be issued to all suspected pregnant offenders within three (3) business days of arrival at the institution. A priority ducat for an examination by the OB Physician or OB Nurse Practitioner (NP) will be issued to all pregnant offenders within seven (7) business days of arrival at the institution. A CDCR form 7410, Comprehensive Accommodation Chrono, for lower bunk and lower tier housing, if housed in a multi-tier housing unit, will be issued to all pregnant offenders. Pregnant offenders on methadone maintenance shall be recommended for immediate transfer to the California Institution for Women (CIW) through the CMO to CMO transfer process. (Refer to methadone treatment for pregnant offenders later in this Article). 54045.4

62080.3 Treatment Categories Revised November 20, 2012 Medical Assignment into and out of all medical treatment categories shall be through the classification process and endorsement by a CSR. Classification committee referrals to a CSR shall also include the appropriate medical recommendation on a CDCR Form 128-C3, Medical - Classification Chrono, signed by a physician and/or psychiatrist dated within 90 days of the CSR's review. The CDCR Form 128-C3 shall indicate that an agreement has been reached between sending and receiving physicians. Inmates endorsed for specific medical treatment categories shall receive at a minimum an annual medical evaluation to determine if continued medical placement is appropriate. The case shall be submitted to a CSR for review and endorsement at least on an annual basis. 62080.4

91020.18.1 Review of Medical/Psychiatric Records Custodial Staff A taser shall not be utilized until the following occurs: • Custodial staff shall notify the CMO or designee that use of the taser is being considered on a particular inmate. Custodial staff shall identify the inmate to medical staff by name, CDC number, and housing location. CMO • The CMO or designee is responsible to review the medical and psychiatric sections of the inmate's health record to ascertain whether there are any medical conditions that preclude the use of the taser. Use of the taser is prohibited if the inmate received any psychotropic medication in the prior six weeks, is being treated for a cardiac arrhythmia, or has a pacemaker. • If no prohibitive medical or psychiatric condition exists, medical staff shall inform the appropriate custodial authority that there are no medical/psychiatric factors which preclude the use of the taser on the inmate at this time. 91020.18.2

54020.19 Visitor Emergency Medical Assistance Emergency medical attention may be provided to visitors who become ill, injured, or require medical attention while on institution/facility property. The responding staff member shall make every effort to preserve life. • This may include first aid, CPR, and other life-saving measures for which the employee is trained and/or certified. Life support measures shall be continued until the medical personnel arrive. • Staff may contact a visitor’s relative or friend to assist in the transportation of the visitor. An ambulance may be summoned for visitors requiring emergency medical attention. The institution/facility is not responsible for payment of services provided by outside agencies. • The watch commander shall immediately be notified, and the appropriate documentation shall be completed. If a visitor alleges injury, or was involved in an accident on institution/facility property, a STD Form 268, Accident Report, shall be completed by visiting staff. 54020.20

54045.6 Emergency Transport The HCM/CMO shall ensure that all institution medical staff are instructed in the emergency protocol. In the event of an emergency transport for the delivery of a baby, the Supervising Obstetrician, Physician, or RN shall immediately be notified and provide appropriate assistance and/or orders. A pregnant offender in labor shall be treated as an emergency and shall be transported immediately via ambulance. The HCM/CMO or supervising Obstetrician shall be informed of all emergencies by the medical staff on duty and be appraised of the offender’s labor status. The RN in the OHU, CTC, or OB clinic shall prepare all copies of prenatal forms that shall accompany the offender to the hospital. These prenatal forms shall be taken to the Watch commander’s office immediately. Custody staff shall prepare and accompany the offender for transportation to the outside facility via ambulance following emergency transport procedures. All emergency medical transports shall take immediate priority and be expedited through the Vehicle Sallyport. The Watch Commander must take all necessary steps to ensure the emergency transport is processed as quickly as possible. Emergency medical transports shall be allowed to depart institutional grounds before, during, or after any institutional count. The Outside Patrol Sergeant shall coordinate with the Central Control Sergeant and the Watch Commander for clearance of the offender being transported through the Vehicle Sallyport. The Watch Commander shall immediately notify the Correctional Captain/Administrative Officer-of-the-Day (AOD) in the event an emergency medical transport is delayed for any reason. The Watch Commander shall notify the AOD of a child’s birth. Notification shall include the name and CDC number of the offender, time of departure, location of transport, and time of delivery. The medical department shall notify the Watch Commander of any non-routine deliveries. 54045.7

62050.8.2 Voluntary and Emergency Medical/Psychiatric Care Revised April 5, 2015 Whenever a parolee requires medical care, it shall ordinarily be provided by private physicians and facilities in the community. Costs for such care shall be provided by the parolee ’ s own resources or community welfare funds. If the parolee is without sufficient funds, every effort shall be made to establish their eligibility for financial assistance (such as Medi-Cal) to enable utilization of local resources. Return to prison for health care services that are normally available in the community shall be utilized only if all other efforts to obtain health care fail. Medical/Surgical/Dental Cases When a parolee requires medical, surgical, psychiatric or dental care of an emergency nature, and all efforts to obtain community services have failed, the parolee may consent to be returned to a correctional institution. The parole unit supervisor or designee shall contact the CMO, Medical Officer-of-the- Day (MOD) or Chief Psychiatrist of the institutions designated: • Males to CIM, California Mens Colony – East (CMC-E), CMF or females to CIW. If the patient ’ s condition does not permit transfer to one of the above facilities, any institution may be utilized. On the next business day, the appropriate parole authority shall be notified of the return. Psychiatric Cases Males from Parole Northern Region are placed at CMF. Males from Parole Southern Region are placed at CIM-RCC for initial custody/treatment screening prior to transfer to CMF or CMC-E or CIM. Females from Parole Northern and Southern Region are placed at CIW. Transfer Requests Transfers shall be made during regular work hours. When necessary to effect a move during other than normal hours (nights, weekends or holidays), approval for the acceptance of a parolee shall rest with the institution ’ s Administrative Officer-of-the-Day and/or the MOD. The administrator who approves an emergency transfer shall follow up by notifying the institution ’ s C&PR on the next workday for purposes of attaining necessary records and to ensure the case is brought to the attention of the appropriate parole authority. When the parolee is medically cleared the C&PR of the holding institution shall notify the parolee ’ s district administrator to effect removal from the institution by reinstatement on parole or other appropriate action. Such notification shall be made a matter of written record. 62050.8.3

62080.15 Medical and Psychiatric Transfers/ Non-Emergency Routine medical/psychiatric transfer requests shall be referred to a CSR with a recommendation from an appropriate classification committee. Routine transfers for medical/psychiatric reasons generally are to resolve a specific short-term medical problem, psychiatric problem, or evaluation as a "medical/psychiatric return" placement or for special prolonged placement needs. 62080.15.1

62080.15.1 Medical/ Psychiatric and Return No medical transfer for evaluation and/or short-term treatment shall be approved until a statement of acceptance has been obtained from the receiving institution's Chief Medical Executive (CME) or Chief Psychiatrist as appropriate. If the transfer request is within CDCR policy, the CSR shall indicate endorsement in the usual manner. If the inmate is to be returned to the sending institution upon completion of evaluation or treatment, it shall be indicated on the CDC Form 128-G, Classification Chrono, by "Medical (Psychiatric) and Return." Male inmates serving life without possibility of parole in need of emergency medical/psychiatric care shall be exempted from Departmental Review Board review requirements and shall be presented to a CSR for transfer approval. 62080.15.2