Caring for Custodial Patients

Incarcerated people retain their autonomy over personal medical decisions.

This includes consent for treatments, surgeries, transplantation, psychiatric care, and end of life care.
Custodial patients have the right to establish/change code status.
By extension, patients have the right to assign a surrogate decision maker in the event they become incapacitated.
- Advanced directives should still be utilized when at all possible and you can request this documentation from the correctional agency
- Process
  - Ask correctional officers to speak to the custodial supervisor in order to obtain appropriate records.
  - Reach out to VUPD to assist in facilitating this as needed
  - If this does not work, reach out to AC, ethics, legal as needed.

The Custodial Agency is responsible for the safety of the patient.

Correctional Officers are responsible for safe application and maintenance of restraints (i.e. handcuffs/ shackles). Concerns about appropriate restraints can first be addressed directly to the officers and if not resolved, VUPD
VUPD does not assume custody when patients are admitted.

Custodial patients are not allowed visitation as per VUMC policy.

Specific requests may be made and approved by VUPD and the Custodial Agency (i.e. prison/jail).

Documentation pearls:

A flag will appear in epic to notify clinicians that the patient is under custody.
Notes should only include information pertaining to the patient’s clinical care (for example: duration of incarceration may be relavent but specific charges are likely not).

Safety concerns should be addressed immediately with VUPD (call 911 or (615) 421-1911).

The AC, ethics, and legal can all be valuable resources.