Part VII. Health Care Services
Article 4
Work Programs
6VAC35-101-930. Health authority.
The facility administrator shall designate a physician, nurse, nurse practitioner, government authority, health administrator, health care contractor, or health agency to serve as the facility's health authority responsible for organizing, planning, and monitoring the timely provision of appropriate health care services, including arrangements for all levels of health care and the ensuring of quality and accessibility of all health services, consistent with applicable statutes and regulations, prevailing community standards, and medical ethics.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-940. Provision of health care services.
Treatment by nursing personnel shall be performed pursuant to the laws and regulations governing the practice of nursing within the Commonwealth. Other health trained personnel shall provide care within their level of training and certification.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-950. Health care procedures.
A. Written procedures shall be developed and implemented for:
1. Providing or arranging for the provision of medical and dental services for health problems identified at admission;
2. Providing or arranging for the provision of on-going and follow-up medical and dental services after admission;
3. Providing or arranging for the provision of dental services for residents who present with acute dental concerns;
4. Providing emergency services for each resident as provided by statute or by the agreement with the resident's legal guardian;
5. Providing emergency services for any resident experiencing or showing signs of suicidal or homicidal thoughts, symptoms of mood or thought disorders, or other mental health problems; and
6. Ensuring that the required information in subsection B of this section is accessible and up to date.
B. The following written information concerning each resident shall be readily accessible to staff who may have to respond to a medical or dental emergency:
1. Name, address, and telephone number of the physician and dentist to be notified;
2. Name, address, and telephone number of a relative or other person to be notified; and
3. Information concerning:
a. Use of medication;
b. All allergies, including medication allergies;
c. Substance abuse and use; and
d. Significant past and present medical problems.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-960. Health trained personnel.
A. Health trained personnel shall provide care as appropriate to their level of training and certification and shall not administer health care services for which they are not qualified or specifically trained.
B. The facility shall retain documentation of the training received by health trained personnel necessary to perform any designated health care services. Documentation of applicable, current licensure or certification shall constitute compliance with this section.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-970. Consent to and refusal of health care services.
A. Health care services, as defined in 6VAC35-101-10 (definitions), shall be provided in accordance with § 54.1-2969 of the Code of Virginia. The knowing and voluntary agreement, without undue inducement or any element of force, fraud, deceit, duress, or other form of constraint or coercion, of a person who is capable of exercising free choice (informed consent) to health care shall be obtained from the resident or parent or legal custodian, as required by law.
B. The resident and parent or legal guardian, as appropriate and applicable, shall be advised by an appropriately trained medical professional of (i) the material facts regarding the nature, consequences, and risks of the proposed treatment, examination, or procedure and (ii) the alternatives to it.
C. Residents may refuse in writing medical treatment and care. Facilities shall have written procedures for:
1. Explaining the implications of refusals; and
2. Documenting the reason for the refusal.
This subsection does not apply to medication refusals that are governed by 6VAC35-101-1060 (medication).
D. When health care is rendered against the resident's will, it shall be in accordance with applicable laws and regulations.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-980. Health screening at admission.
A. To prevent newly arrived residents who pose a health or safety threat to themselves or others from being admitted to the general population, all residents shall immediately upon admission undergo a preliminary health screening consisting of a structured interview and observation by health care personnel or health trained personnel, as defined in 6VAC35-101-10 (definitions), as approved by the health authority.
B. Residents admitted who pose a health or safety threat to themselves or others shall be separated from the detention center's general population but provision shall be made for them to receive comparable services.
C. Immediate health care is provided to residents who need it.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-990. Tuberculosis screening.
A. Within five days of admission to the facility each resident shall have had a screening assessment for tuberculosis. The screening assessment can be no older than 30 days.
B. A screening assessment for tuberculosis shall be completed annually on each resident.
C. The facility's screening practices shall be performed in a manner consistent with any current recommendations of the Virginia Department of Health, Division of Tuberculosis Prevention and Control and the federal Department of Health and Human Services Centers for Disease Control and Prevention for the detection, diagnosis, prophylaxis, and treatment of pulmonary tuberculosis.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1000. Residents' medical examination; responsibility for preexisting conditions.
A. Within five days of admission, all residents who are not directly transferred from another detention center shall be medically examined by a physician or a qualified health care practitioner operating under the supervision of a physician to determine if the resident requires medical attention or poses a threat to the health of staff or other residents. A full medical examination is not required if there is documented evidence of a complete health examination within the previous 90 days; in such cases, a physician or qualified health care practitioner shall review the resident's health record and update as necessary.
B. A detention center shall not accept financial responsibility for preexisting medical, dental, psychological, or psychiatric conditions, except on an emergency basis.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1010. Infectious or communicable diseases.
A. A resident with a communicable disease shall not be housed in the general population unless a licensed physician certifies that:
1. The facility is capable of providing care to the resident without jeopardizing residents and staff; and
2. The facility is aware of the required treatment for the resident and the procedures to protect residents and staff.
B. The facility shall implement written procedures approved by a medical professional that:
1. Address staff (i) interactions with residents with infectious, communicable, or contagious medical conditions; and (ii) use of standard precautions;
2. Require staff training in standard precautions, initially and annually thereafter; and
3. Require staff to follow procedures for dealing with residents who have infectious or communicable diseases.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1020. Suicide prevention.
Written procedure shall provide for (i) a suicide prevention and intervention program developed in consultation with a qualified medical or mental health professional and (ii) all direct care staff to be trained and retrained in the implementation of the program.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1030. Residents' health care records.
A. Each resident's health record shall include written documentation of (i) the initial physical examination, (ii) an annual physical examination by or under the direction of a licensed physician including any recommendation for follow-up care, and (iii) documentation of the provision of follow-up medical care recommended by the physician or as indicated by the needs of the resident.
B. Each physical examination report shall include:
1. Information necessary to determine the health and immunization needs of the resident, including:
a. Immunizations administered at the time of the exam;
b. Vision exam;
c. Hearing exam;
d. General physical condition, including documentation of apparent freedom from communicable disease, including tuberculosis;
e. Allergies, chronic conditions, and handicaps, if any;
f. Nutritional requirements, including special diets, if any;
g. Restrictions on physical activities, if any; and
h. Recommendations for further treatment, immunizations, and other examinations indicated.
2. Date of the physical examination; and
3. Signature of a licensed physician, the physician's designee, or an official of a local health department.
C. Each resident's health record shall include:
1. Notations of health and dental complaints and injuries and a summary of the residents symptoms and the treatment given; and
2. A copy of the information required in subsection B of 6VAC35-101-950 (health care procedures).
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1040. First aid kits.
A. A well-stocked first aid kit shall be maintained, with and in accordance with an inventory of contents, and readily accessible for dealing with minor injuries and medical emergencies.
B. First aid kits should be monitored in accordance with established facility procedures to ensure kits are maintained, stocked, and ready for use.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1050. Hospitalization and other outside medical treatment of residents.
A. When a resident needs hospital care or other medical treatment outside the detention center:
1. The resident shall be transported safely; and
2. A staff member or a law-enforcement officer, as appropriate, shall accompany the resident until appropriate security arrangements are made. This subdivision shall not apply to the transfer of residents under The Psychiatric Inpatient Treatment of Minors Act (§ 16.1-355 et seq. of the Code of Virginia).
B. In accordance with applicable laws and regulations, the parent or legal guardian, as appropriate and applicable, shall be informed that the resident was taken outside the facility for medical attention as soon as is practicable.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-101-1060. Medication.
A. All medication shall be properly labeled consistent with the requirements of the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia). Medication prescribed for individual use shall be so labeled.
B. All medication shall be securely locked, except (i) as required by 6VAC35-101-1250 (delivery of medication in postdispositional programs) or (ii) if otherwise ordered by a physician on an individual basis for keep-on-person or equivalent use.
C. All staff responsible for medication administration who do not hold a license issued by the Virginia Department of Health Professions authorizing the administration of medications shall, in accordance with the provisions of § 54.1-3408 of the Code of Virginia, either (i) have successfully completed a medication training program approved by the Board of Nursing or (ii) be licensed by the Commonwealth of Virginia to administer medications before they can administer medication as stated in 6VAC35-101-190 (required initial training). Such staff members shall undergo an annual refresher training as stated in 6VAC35-101-200 (retraining).
D. Staff authorized to administer medication shall be informed of any known side effects of the medication and the symptoms of the effects.
E. A program of medication, including procedures regarding the use of over-the-counter medication pursuant to written or verbal orders issued by personnel authorized by law to give such orders, shall be initiated for a resident only when prescribed in writing by a person authorized by law to prescribe medication.
F. All medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the requirements of § 54.2-2408 of the Code of Virginia and the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia).
G. A medication administration record shall be maintained of all medicines received by each resident and shall include:
1. Date the medication was prescribed or most recently refilled;
2. Drug name;
3. Schedule for administration;
4. Strength;
5. Route;
6. Identity of the individual who administered the medication; and
7. Dates the medication was discontinued or changed.
H. In the event of a medication incident or an adverse drug reaction, first aid shall be administered if indicated. Staff shall promptly contact a poison control center, pharmacist, nurse, or physician and shall take actions as directed. If the situation is not addressed in standing orders, the attending physician shall be notified as soon as possible and the actions taken by staff shall be documented. A medication incident shall mean an error made in administering a medication to a resident including the following: (i) a resident is given incorrect medication; (ii) medication is administered to the incorrect resident; (iii) an incorrect dosage is administered; (iv) medication is administered at a wrong time or not at all; and (v) the medication is administered through an improper method. A medication error does not include a resident's refusal of appropriately offered medication.
I. Written procedures shall provide for (i) the documentation of medication incidents, (ii) the review of medication incidents and reactions and making any necessary improvements, (iii) the storage of controlled substances, and (iv) the distribution of medication off campus. The procedures must be approved by a health care professional. Documentation of this approval shall be retained.
J. Medication refusals shall be documented including action taken by staff. The facility shall follow procedures for managing such refusals which shall address:
1. Manner by which medication refusals are documented; and
2. Physician follow-up, as appropriate.
K. Disposal and storage of unused, expired, and discontinued medications shall be in accordance with applicable laws and regulations.
L. The telephone number of a regional poison control center and other emergency numbers shall be posted on or next to each nonpay telephone that has access to an outside line in each building in which residents sleep or participate in programs.
M. Syringes and other medical implements used for injecting or cutting skin shall be locked and inventoried in accordance with facility procedures.
Statutory Authority
§§ 16.1-309.9, 16.1-322.7, and 66-10 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.