Commissioner's Directive 822
Medical Isolation and Modified Routine for COVID-19

Commissioner's Directive

Number: 822

In Effect: 2022-03-28

Related links

Policy Bulletin 682

Authorities

Purpose

To provide direction for the management of inmates placed on medical isolation or modified routine for health purposes to help prevent the introduction or spread of COVID-19

To ensure that the least restrictive measures are used in the implementation and use of medical isolation and modified routine for health purposes, which are informed by public health principles and guidance

To contribute to the safety of the public, staff, contractors and inmates

Applications

Applies to all CSC staff and contractors working in institutions, excluding Community Correctional Centres

Responsibilities

  1. The Assistant Commissioner, Health Services, will:
    1. authorize the development of guides and instructions that must be followed with respect to the use of medical isolation and modified routine for health purposes
    2. ensure that policies, guides and instructions related to medical isolation and modified routine for health purposes are reviewed and updated as required.
  2. The Director General, Health Policy and Programs, will ensure that direction on the management of COVID-19 is informed by the best available public health information and generally accepted public health practices.
  3. The Institutional Head will:
    1. authorize medical isolation, in accordance with the guidance documents for COVID-19 found on CSC’s Hub page
    2. upon medical clearance by a registered health care professional, authorize, without delay, the discontinuation of the medical isolation of an inmate
    3. authorize the implementation of a modified routine for health purposes upon the recommendation of the Chief, Health Services, Institutional Physician or Nurse Practitioner. However, if time does not permit waiting for the Chief, Health Services, Institutional Physician or Nurse Practitioner, the Institutional Head can authorize a provisional modified routine for health purposes upon the recommendation of a registered health care professional, pending confirmation by the Chief, Health Services, Institutional Physician or Nurse Practitioner
    4. establish an institutional Standing Order on medical isolation and modified routine for health purposes that includes a process for communicating to impacted inmates the parameters of a modified routine for health purposes, upon its implementation
    5. ensure that staff and contractors adhere to infection prevention and control measures, as per the guidance documents for COVID-19 found on CSC’s Hub page
    6. ensure completion of required documentation outlined in this policy.
  4. The Regional Director, Health Services, in collaboration with the local public health authority, the Institutional Head and the District Director, will establish a process, in the context of the COVID-19 pandemic, to support safe transition of inmates being released into the community.
  5. The Chief, Health Services/Mental Health, Manager, Integrated Health Care, and the Institutional Physician will immediately advise the Institutional Head of any concerns regarding local implementation of infection prevention and control measures, and the use of medical isolation or modified routine for health purposes.
  6. The Chief, Health Services, and the Chief, Mental Health, will ensure health care staff document all interactions with an inmate on medical isolation in the Electronic Medical Record.
  7. All staff and contractors will collaborate to support open communication with the inmate placed on medical isolation and during their reintegration following its use.

Procedures

Criteria for Medical Isolation

  1. Medical isolation measures will be implemented in accordance with the guidance documents for COVID-19 found on CSC’s Hub page.
  2. Individuals requiring medical isolation outside of the guidance documents for COVID-19 found on CSC’s Hub page will be reviewed on a case-by-case basis by the Chief, Health Services, Institutional Physician or Nurse Practitioner.
  3. The Institutional Head will make all reasonable efforts to identify and designate alternative cells/space for the medical isolation of inmates, to be utilized on the recommendation of a registered health care professional.

Authorization to Place an Inmate on Medical Isolation

  1. The registered health care professional will document their recommendation to place an inmate on medical isolation on the Medical Isolation Form (CSC/SCC 1620e) and provide this form to the Institutional Head for their authorization.
  2. In the absence of a registered health care professional, the Institutional Head will authorize interim placement on medical isolation on the Medical Isolation Form (CSC/SCC 1620e). Once a registered health care professional is on site, they will confirm the placement is consistent with the guidance documents for COVID-19 found on CSC’s Hub page.
  3. Upon the Institutional Head’s authorization of medical isolation, the Offender Management System (OMS) Medical Isolation Alert will be activated by a staff member, as determined in a Standing Order.
  4. Following the authorization of medical isolation, the Institutional Head or designate will:
    1. without delay, provide the inmate with an information package, in the official language of their choice, which will include:
      1. written notice of the decision, via the Medical Isolation Form (CSC/SCC 1620e), including the reason for the authorization of medical isolation
      2. information on COVID-19, the purpose and use of medical isolation and the nature of the required restrictions, via the COVID-19 medical isolation information sheet for inmates
    2. without delay, inform the inmate of their rights, including the right to:
      1. legal counsel
      2. contact organizations such as the Office of the Correctional Investigator of Canada, Citizen Advisory Committee, Canadian Association of Elizabeth Fry Societies, John Howard Society or any relevant community organizations which have standing with CSC
      3. submit complaints and/or grievances pursuant to Commissioner’s Directive (CD) 081 – Offender Complaints and Grievances and Guidelines (GL) 081-1 – Offender Complaint and Grievance Process
    3. provide an opportunity to contact legal counsel privately within 24 hours
    4. document provision of the requirements of paragraphs 14(a) to 14(c) on the Medical Isolation Form (CSC/SCC 1620e)
    5. move the inmate, whenever feasible, to an alternative designated cell/space identified for medical isolation.

Conditions While Placed on Medical Isolation

  1. A registered health care professional will visit daily each inmate placed on medical isolation to conduct a wellness assessment. This assessment will include consideration of the inmate’s physical and mental health, and the need for further interventions/follow-up.
  2. The Institutional Head or designate will:
    1. attend designated cells/space for medical isolation daily, when in use, to inspect the conditions of medical isolation
    2. visit each inmate placed on medical isolation daily
    3. document daily visits on the Daily Log – Medical Isolation (CSC/SCC 1627e).
  3. All reasonable efforts must be made to provide inmates with opportunities to be out of their cell to attend activities of daily living (e.g., to shower), as well as yard time and access to telephone calls with appropriate infection prevention and control measures in place. Cleaning guidelines must be followed.
  4. Inmates will be provided access to educational materials, programming and spiritual services in accordance with the guidance documents for COVID-19 found on CSC’s Hub page.
  5. Inmates will be provided their personal property, subject to safety and security concerns, and in consideration of infection prevention and control principles.
  6. Inmates will have at least two metres of physical distance between themselves and staff or contractors when out of the designated cell/space for medical isolation, where reasonably feasible. Personal protective equipment will be used in accordance with the Guidance on the Use of Personal Protective Equipment.

Medical Clearance from Medical Isolation

  1. A registered health care professional, as specified in the Health Services algorithms, must medically clear all inmates placed on medical isolation prior to its discontinuation.
  2. Once the medical clearance has been received, the Institutional Head will:
    1. authorize the discontinuation of the inmate’s medical isolation
    2. ensure the inmate returns to their normal routine as soon as practicable.
  3. Medical clearance and discontinuation of medical isolation will be documented on the Medical Isolation Form (CSC/SCC 1620e).
  4. The OMS Medical Isolation Alert will be deactivated by a staff member, as determined in a Standing Order, immediately after the medical isolation is discontinued.

Authorization of a Modified Routine for Health Purposes

  1. Upon the recommendation of the Chief, Health Services, Institutional Physician or Nurse Practitioner, the Institutional Head will authorize the implementation of a modified routine for health purposes.
  2. The Institutional Head will authorize the implementation of a modified routine for health purposes within an institution, or part of an institution, for site level assessments and implementation of infection prevention and control measures necessary to contain the spread of, and otherwise manage COVID-19, including testing and contact tracing.
  3. Inmates placed on medical isolation will remain on medical isolation should a modified routine for health purposes be implemented.
  4. Following the implementation of a modified routine for health purposes, the Institutional Head will ensure that inmates are informed of their rights, including the right to:
    1. legal counsel
    2. contact organizations such as the Office of the Correctional Investigator of Canada, Citizen Advisory Committee, Canadian Association of Elizabeth Fry Societies, John Howard Society or any relevant community organizations which have standing with CSC
    3. submit complaints and/or grievances pursuant to CD 081 – Offender Complaints and Grievances and GL 081-1 – Offender Complaint and Grievance Process.
  5. The Institutional Head will ensure documentation of the provision of the requirements of paragraph 28 on the Modified Routine for Health Purposes Form (CSC/SCC 1626e).

Conditions of Modified Routine for Health Purposes

  1. Inmates will be seen daily by a manager, identified by the Institutional Head in a Standing Order, for the purpose of providing them the opportunity to identify any needs and to facilitate referrals to services, including health care. This will be documented on the Modified Routine for Health Purposes Form (CSC/SCC 1626e).
  2. All reasonable efforts must be made to provide inmates with opportunities to be out of their cell to attend activities of daily living (e.g., to shower), as well as yard time, access to telephone calls, and interaction with others on the range, with appropriate infection and control measures in place. Cleaning guidelines must be followed.
  3. Inmates will be provided access to educational materials, programming and spiritual services in accordance with the guidance documents for COVID-19 found on CSC’s Hub page.
  4. Inmates will have at least two metres of physical distance between themselves and any other inmate or staff or contractors when under a modified routine for health purposes, where reasonably feasible. Personal protective equipment will be used in accordance with the Guidance on the Use of Personal Protective Equipment.
  5. Inmates will continue to have access to health care in accordance with professional standards and in response to identified health care needs.

Review of the Modified Routine for Health Purposes and its Termination

  1. The Chief, Health Services, Institutional Physician or Nurse Practitioner, normally in consultation with CSC’s Regional Manager, Public Health, and informed by public health principles and direction, will recommend to the Institutional Head the termination of a modified routine for health purposes, when appropriate.
  2. The decision to utilize a modified routine for health purposes, including its associated conditions, will be reviewed at least weekly, and documented on the Modified Routine for Health Purposes Form (CSC/SCC 1626e) by the Chief, Health Services, Institutional Physician or Nurse Practitioner to ensure it is implemented for the shortest amount of time clinically required. The decision to maintain the modified routine will be communicated to impacted inmates.

Commissioner,

Original signed by:
Anne Kelly

Annex A - Cross-References and Definitions

Cross-References

CD 001 – Mission, Values and Ethics Framework of the Correctional Service of Canada
CD 081 – Offender Complaints and Grievances
CD 084 – Inmates’ Access to Legal Assistance and the Police
CD 087 – Official Languages
CD 228 – Information Management
CD 566-12 – Personal Property of Offenders
CD 701 – Information Sharing
CD 710-3 – Temporary Absences
CD 800 – Health Services

Definitions

COVID-19: an infectious disease caused by a coronavirus identified in December 2019. Coronaviruses can cause symptoms ranging from those of a common cold to more severe respiratory conditions.

Medical isolation: short-term limitation to an inmate’s movement to help prevent the introduction or spread of COVID-19.

Modified routine for health purposes: changes to daily routine within an institution, or part of an institution, to help prevent the introduction or spread of COVID-19.

Registered health care professional: an individual registered or licensed for the practice of health or mental health care in Canada and preferably in the province or territory of practice (certain positions however, require registration in the province or territory of practice).

Without delay: immediately, unless there are compelling circumstances preventing immediate action and in those circumstances, the delay must not be more than 24 hours.

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