(a) The California Department of Corrections and Rehabilitation (CDCR) shall provide prescribed medically necessary medications to all patients.
(b) Medication orders and renewals. All medications shall be ordered as Keep-on-Person (KOP), unless the prescriber specifically orders Nurse Administered (NA) or Directly Observed Therapy (DOT).
(1) An order shall be obtained from a health care provider before any prescribed medication is withheld from a patient, unless administration is clinically contraindicated. Blanket orders withholding medications from groups of patients are not permissible.
(2) When prescribing medications, the prescriber shall explain to the patient how to take the medication.
(3) The prescriber shall renew medication orders to facilitate medication continuity.
(4) Patients may request medication renewals by submitting a CDCR 7362, Health Care Services Request Form.
(5) Non-urgent new medication orders received by pharmacy on any business day shall be available to the patient no later than three business days later unless otherwise ordered (e.g., order specifies medication to start today).
(6) Non-urgent renewed medication orders received by pharmacy on any business day shall be available to the patient no less than one business day prior to exhaustion of medication supply unless otherwise ordered (e.g., order specifies medication to start today).
(c) Medication for new arrivals.
(1) Patients arriving at an institution from a site other than a CDCR institution who are on prescription medications shall be seen by a health care provider or have their prescription medications ordered within eight hours of arrival. The medication shall be administered at the next dosing time and no later than the next day.
(2) Patients arriving from CDCR institutions shall have at least five days of all current KOPs and NA/DOTs (excluding narcotics). If a patient arrives with an insufficient supply of prescribed medication:
(A) Pharmacy staff shall provide medications for the patient, during working hours, if a medication order is active.
(B) Licensed nursing staff shall obtain medication from after-hours medication supplies for the patient, after-hours, if a medication order is active.
(3) New arrivals with an insufficient supply of routine medications whose orders are at or near expiration shall be seen by a health care provider or have their prescriptions renewed within eight hours of arrival.
(d) Medication administration. Licensed health care staff shall issue, administer, monitor, and document administration or delivery of all medications.
(1) General population.
(A) General Population (GP) patients shall receive all medications at a pill window. Cell front medication delivery shall not occur in a GP setting unless there is no other reasonable alternative available as determined by the Chief Executive Officer (health care) or designee in consultation with the Warden or designee.
(B) Patients shall bring a cup of water to the pill window.
(C) Medication lines shall continue until the last patient in line has received their prescribed medication, or all patients who have not received their medications have been contacted either via custody or face-to-face.
(2) Locked units.
(A) Licensed health care staff shall provide the patient's oral medication through the opened cell door, food port, or bars of the cell door.
(B) Medication administration shall continue until all patients in the unit with prescribed medications have received or refused the prescribed medication.
(3) During lockdown or modified program when no movement is permitted, medication administration shall occur at the cell front or podium pass until patients are permitted access to the pill window.
(4) DOT is required for patients:
(A) With Penal Code (PC) section 2602 or Probate Code section 3200 court orders.
(B) Receiving any narcotic or controlled medications.
(C) Receiving crush and float medications.
(D) Receiving medications for active Tuberculosis (TB) or suspected TB disease.
(E) Receiving medications for latent TB infection.
(F) Whenever specified by the prescriber.
(5) NA is required for patients:
(A) Who cannot safely or properly self-administer medications.
(B) Who are receiving medications required to be administered NA.
(C) Whenever specified by the prescriber.
(6) Keep-on-Person.
(A) Patients receiving prescribed KOP medications shall be able to produce a valid current label for each medication and may be required to return medication containers prior to receiving refills or additional medication.
(B) Patients shall be notified that their KOP medications are available for pick-up.
(C) In the event a patient does not pick up the KOP medications within four business days of the medication becoming available, licensed health care staff shall ensure the patient reports to the medication line to accept or refuse the medication.
(D) Patients who refuse KOP medications shall be referred to the Primary Care Team (PCT).
(7) Injectable medications shall not be administered through the food port or cell bars.
(8) Institutions shall ensure that patients receiving insulin receive meals within a consistent timeframe to avoid the possibility of hypoglycemia.
(e) Medication refusals. Licensed health care staff shall provide and document medication non-adherence counseling as determined by the PCT (for medical prescriptions) or the mental health prescriber (for mental health prescriptions).
(1) The prescriber shall interview the patient and provide education regarding the implications/consequences of not taking the medication and consider modification to the medication regimen.
(2) If the patient refuses life-sustaining medications, the prescriber shall assess the patient's decision-making capacity. If the patient has significant mental illness, the prescriber shall seek assistance from mental health clinicians regarding the patient's decision-making capacity. If a mental health referral is made, the Primary Care Provider shall inform the patient of the reason for the referral.
(3) When a patient has decision-making capacity and continues to refuse medication, the prescriber may discontinue the medication and have the patient sign a CDCR 7225, Refusal of Examination and/or Treatment.
(4) All refusals shall be signed by the patient and co-signed by licensed health care staff. If the patient refuses to sign the CDCR 7225, two licensed health care staff shall sign; in circumstances where the patient is in an Administrative Segregation Unit or Mental Health Crisis Bed, the CDCR 7225 may be signed by two staff members, one of whom shall be a licensed health care staff.
Credits
Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California.
History
1. New article 2 (section 3999.315) and section filed 7-1-2019 as an emergency; operative 7-1-2019 (Register 2019, No. 27). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 12-9-2019 or emergency language will be repealed by operation of law on the following day.
2. New article 2 (section 3999.315) and section refiled 12-5-2019 as an emergency; operative 12-10-2019 (Register 2019, No. 49). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 3-9-2020 or emergency language will be repealed by operation of law on the following day.
3. New article 2 (section 3999.315) and section refiled 3-9-2020 as an emergency; operative 3-10-2020 (Register 2020, No. 11). A Certificate of Compliance must be transmitted to OAL by 6-8-2020 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 3-9-2020 order, including amendment of subsection (f), transmitted to OAL 6-8-2020 and filed 7-20-2020; amendments operative 7-20-2020 pursuant to Government Code section 11343.4(b)(3) (Register 2020, No. 30).
This database is current through 5/10/24 Register 2024, No. 19.
