Interim Policy bulletin 651

Commissioner’s Directive (CD) 800 – Health Services

Guidelines (GL) 800-9 – Medical Assistance in Dying

CD 081 – Offender Complaints and Grievances

On June 21, 2019, Bill C-83, An Act to amend the Corrections and Conditional Release Act and another Act, received Royal Assent. The amendments to the Corrections and Conditional Release Act (the Act) are now in effect, and the corresponding changes to policy are addressed in this bulletin. The Act strengthens the provision of health care by affirming CSC's responsibility to support the professional autonomy and clinical independence of registered health care professionals; requiring that CSC support patient advocacy; and, allowing the Commissioner to establish Health Care Units to provide inmates with an appropriate living environment to facilitate their access to health care. The Act also abolishes the use of administrative and disciplinary segregation.

As well, additional changes for health services can be found in CD 711 – Structured Intervention Units; GL 711 1 – Structured Intervention Unit (SIU) Transfer Procedures – SIU Sites; GL 711-2 – Structured Intervention Unit (SIU) Transfer Procedures – Non-SIU Sites; CD 578 – Intensive Intervention Strategy in Women Offender Institutions/Units; CD 041 – Incident Investigations; Interim Policy Bulletin 649; and Interim Policy Bulletin 653.

The following changes, related to health care, are in effect immediately and will be incorporated in relevant CSC policy instruments as the instruments are updated:

• Within professionally accepted standards and health care governance, the Service supports the professional autonomy and the clinical independence of registered health care professionals, including their ability to exercise, without undue influence, their professional judgement in the care and treatment of inmates.
• Consistent with the requirements of professional health regulatory colleges, the role of health care professionals includes a patient advocacy function for the provision of care that advances health and well-being.
• CSC supports person-centred care based on appropriate medical, dental, and mental health care criteria.

• The intake health assessment process includes:
  • referral for health assessment, including mental health, within the first 24 hours of admission to federal custody
  • Computerized Mental Health Intake Screening System within 14 days of intake, and
  • mental health assessment by identified health professionals.
• The health assessment process is outlined in the Integrated Mental Health Guidelines.

• A physician/psychiatrist is the Health Services Official with the authority to admit and discharge to and from tertiary care within the Health Care Unit. The Senior Clinical Manager/Chief of Mental Health (in Health Care Units where there is no Senior Clinical Manager) has the authority to admit and discharge inmates to and from secondary care within the Health Care Unit.
• The physician/psychiatrist and the Senior Clinical Manager/Chief of Mental Health must be employed or engaged by the Correctional Service of Canada to provide services to the Health Care Unit to which they are authorizing admission or discharge.
• The admission process to a Health Care Unit begins with a clinical referral. Other than in exceptional circumstances, the referral will be done by the inmate's most responsible health care provider, following consultation with the interdisciplinary health care team.
• Following the clinical referral, the admission and discharge to a Health Care Unit is a two-step process. A clinical admission is required by Health Services, followed by a transfer decision by Operations.
• Inmates will only be admitted to a Health Care Unit (Regional Treatment Centre), if they meet the clinical admission criteria and are clinically admitted by the designated health official.
• The clinical admission criteria includes:
  • inmates with mental illness or cognitive impairment that impacts their ability to function in a mainstream institution
  • inmates who require 24-hour clinical care
  • inmates that require access to clinical programming (only available in the Health Care Unit)
• inmates will be given written notice, by a health care professional, of any decision with respect to their clinical admission or refusal to a Health Care Unit, including reasons for the decision.
• The Executive Director of Treatment Centre at the receiving Health Care Unit, and the Manager, Health Services/Chief Mental Health from the referring institution will establish a process to complete the written and verbal notification of any decision to the inmates.
• In cases where the admission or transfer is not approved, all staff involved in the inmate’s case will collaborate on a plan to facilitate continuity of care for the inmates.
• Inmates will be discharged from a Health Care Unit (Regional Treatment Centre) if they meet the clinical discharge criteria and are clinically discharged by the designated health official.
• The clinical discharge criteria includes:
  • mental health needs have been sufficiently addressed
  • transfer to another more appropriate health care facility is required
  • alternate level of care is clinically appropriate
• Inmates will be given written notice of any decision with respect to their discharge from a Health Care Unit (Regional Treatment Centre), including reasons for discharge.
• The Executive Director of Treatment Centre will establish a process to complete the written and verbal notification of any clinical discharge decision to the inmates.

• Paragraph 23 is replaced by the following: After the death of an inmate through MAID, there is no requirement for CSC to convene a board of investigation or a quality of care review.

• Health Services supervisors (complaint level), Regional Directors of Health Services (initial grievance level), and the Assistant Commissioner, Health Services (final grievance level), will be the decision makers for inmate complaints and grievances related to health services.

The revised policies were developed by the Health Services Sector in consultation with various NHQ sectors, RHQ, as well as the Strategic Policy Division.

All staff, contractors, volunteers and offenders are affected by the policy changes.

Commissioner,

Original signed by:

Anne Kelly