Sick Call

The standard on medical autonomy (A-03) addresses clinical decisions and actions regarding health care provided to inmates. However, the time that sick call is held is not a clinical issue. The scenario you describe best fits under A-01 Access to Care. This standard requires the responsible health authority to identify and eliminate any barriers to inmates receiving health care. As mentioned in the discussion section of that standard, an unreasonable barrier includes deterring inmates from seeking care for their serious health needs, such as holding sick call at 2 a.m., when this practice is not reasonably related to the needs of the institution. It would be important to explore the reason for the proposed change during administrative meetings and that the decision be made jointly by the corrections administration and the responsible health authority.

— From CorrectCare Volume 32, Issue 1, Winter 2018

The answer is twofold—from the perspective of good clinical practice, and from the perspective of confirming compliance for accreditation purposes.

Essential standard P-E-07 Nonemergency Health Care Requests and Services requires that inmates’ routine health care needs are met and specifies that inmates are to have the ability to request services directly from health staff daily; that sick-call slips are picked up at least every 24 hours; that inmates are seen within 24 hours of triage if the request does not provide enough information to make an informed assessment; and that clinical need dictates the timing of a midlevel, physician or specialist provider appointment. Without documentation of these steps, it is not possible to evaluate the responsiveness of your sick-call system, and if you are seeking accreditation, to determine if you are in compliance.

Request slips are usually filed in the health records and begin the documentation trail. If you do not file the slips in the record, a log may be kept to monitor the stages of the response. The log needs to include the request date, date and result of triage, date of the sick-call visit if required, etc.

For accreditation purposes, you should have documentation of compliance, either through the health records or through logs spanning three years (the time between surveys). Surveyors will look for information on the timeliness of response to sick-call slips, and if it is not in the record the facility may need to show source documents. Beyond that, it is up to the health and/or mental health authority how to ensure and verify that the standard’s requirements are being met and that inmates are receiving needed care in a timely and professional manner.

— From CorrectCare Volume 22, Issue 1, Winter 2008

There is no typical rate of no-shows that I am aware of. From NCCHC’s standpoint, any failure to show for sick call is a red flag that should be looked into. Of particular concern would be rising percentages or numbers of no-shows, or development of patterns with individual inmates, specific practitioners, specific clinics, inmate housing units, etc.

Several NCCHC standards address various aspects of a no-show problem. Please see A-01 Access to Care, A-06 Continuous Quality Improvement Program, E-07 Nonemergency Health Care Requests and Services, E-10 Patient Escort and I-06 Right to Refuse Treatment. (They are the same in both the jail and prison versions of the 2003 Standards for Health Services.)

The bottom line is to view no-shows as an indicator of a potential problem with access to care in which systemic issues or staff behavior may contribute to no-shows. Rather than blaming individual inmates, an exploration of the root causes of their failure to show up for sick call can lead to resolution of the underlying problems, not just the symptoms.

— From CorrectCare Volume 21, Issue 1, Winter 2007

How to promote appropriate sick-call requests is a complex issue and one not addressed by NCCHC standards. You might want to consult B. Jaye Anno’s book Correctional Health Care: Guidelines for the Management of an Adequate Delivery System (2001), which is available from NCCHC. The book offers several suggestions for ensuring that the sick-call process is both efficient and effective.

One suggestion is a “face-to-face triage” of sick-call requests. With this approach, a nurse goes to the housing areas and in a private area (often a small office) sees inmates who are requesting services. Those who require further assessment can be scheduled for evaluation in the clinic, those who require nonemergency mental health or dental care can be scheduled based on their needs, and those with minor problems (such as colds) can be taken care of then and there according to your protocols.

Here are some other suggestions:

Some facilities use health staff to deal with issues unrelated to health care, such as approval of extra blankets, so if your facility uses health staff in this manner, you may wish to discontinue that.
For common complaints, permit inmates to purchase from the commissary OTC medications such as pain relievers, laxatives, antidiarrheic agents and cold medications.
Consider offering health classes that address self-care issues or that explain health topics of interest or concern to the population (HIV, hepatitis C, alcohol use, sprained ankles, etc.).
Some facilities have instituted fee-for-service programs in the belief that they help to control the volume of sick-call use. Such co-pay systems may not be the best solution, however. For more advice on this topic, see NCCHC’s position statement.

— From CorrectCare Volume 17, Issue 3, Summer 2003