St. Anthony Work Camp, ID
Accreditation Report #248
June 25, 2010
The National Commission on Correctional Health Care is dedicated to improving the quality of
correctional health services and helping correctional facilities provide effective and efficient
care. NCCHC grew out of a program begun at the American Medical Association in the 1970s.
The standards are NCCHC’s recommended requirements for the proper management of a
correctional health services delivery system. These standards have helped correctional facilities
improve the health of their inmates and the communities, to which they return, increase the
efficiency of their health services delivery, strengthen their organizational effectiveness, and
reduce their risk of adverse patient outcomes and legal judgments.
On May 27-28, 2010 NCCHC conducted its review for continued accreditation of this facility.
We commend the facility staff for their professional conduct, assistance, and candor during the
course of our review. The NCCHC’s team of experienced certified correctional health
professionals utilized NCCHC’s 2008 Standards for Health Services in Prisons as the basis of
its health services analysis. This report focuses primarily on issues in need of correction or
enhancement. It is most effective when read in conjunction with the Standards manual.
There are 37 essential standards; 33 are applicable to this facility and 32 (97%) were found to
be in compliance. One hundred percent of the applicable essential standards must be met.
Our findings include:
Essential Standard Not in Compliance
P-A-06
Continuous Quality Improvement Program
Essential Standards Not Applicable
P-E-02
Receiving Screening
P-E-09
Segregated Inmates
P-G-03
Infirmary Care
P-G-07
Care of the Pregnant Inmate
There are 31 important standards; 30 are applicable to this facility and 29 (97%) were found to
be in compliance. Eighty-five percent or more of the applicable important standards must be
met. Our findings include:
Important Standard Not in Compliance
P-F-02
Medical Diets
Important Standard Not Applicable
P-G-10
Pregnancy Counseling

Decision: On June 25, 2010, NCCHC’s Accreditation Committee awarded the facility
Continuing Accreditation with Verification (CAV), contingent upon receiving requested
compliance verification by September 17, 2010.

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I. Facility Profile
Type of Facility:
Total Admissions for 2009:
Design-rated capacity:
Average daily population:
Average daily intake:
Satellites:

Prison
221
240
240
1
None

Description of Facility
The two-story brick building was constructed in 1930 as a community hospital. In 1990, it was
converted in to a men’s work camp. The facility has seven dormitory-style housing units. Two
large education rooms were built to accommodate classes. The focus is to provide work
therapy programs offering full-time, constructive, paid employment to inmates through
contracted work and public service projects with governmental agencies. The program is
designed to help inmates develop good work habits and marketable skills while providing a
financial resource for immediate and future needs.
A total of 35 correctional officers (COs) are scheduled on duty during three work shifts.
Inmate Population Characteristics
On the day of the survey, there were 240 male inmates.
Facility’s Health Services
Health services have been provided by a health care contractor for the last six years.
Staffing
Health staff are on site 10 hours a day, five days a week. At the time of the survey, there were
1.5 full-time staff. The physician had just resigned due to illness and the facility had already
recruited a new physician, although he had not begun employment at the time of the survey.
II. Survey Method
The on-site survey consisted of touring the clinic area and inmate housing areas. Documents
reviewed included 21 health records; policies and procedures; provider licenses; administrative,
health staff, and continuous quality improvement (CQI) meeting minutes; job descriptions;
statistical and environmental inspection reports; and health services personnel and CO training
records. Interviews were conducted on a structured and confidential basis. Those interviewed
included the superintendent, responsible regional physician, regional health services
administrator (HSA), head nurse, RN, nurse practitioner, dentist, food services supervisor, three
COs, and five randomly selected inmates.

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III. Survey Findings and Comments
A. GOVERNANCE AND ADMINISTRATION
The standards in this section address the foundation of a functioning correctional health services system
and the interactions between custody and health services authorities. Any model of organization is
considered valid, provided the outcome is an integrated system of health care in which medical orders are
carried out and documented appropriately and the results are monitored as indicated. Policies and
procedures are to include site-specific operating guidelines.

Standard Specific Findings
P-A-01 Access to Care (E). Inmates have access to health care. Patients are seen by a
qualified clinician and receive care in a timely manner as ordered for their serious medical,
mental health, and dental needs. Inmates are assessed $3.00 for self-initiated services and
$2.00 for medications. The standard is met.
P-A-02 Responsible Health Authority (E). The responsible health authority (RHA) is the
health care contractor whose on-site representative is the HSA for a regional system. She is on
site approximately once every two weeks. The head nurse is on site daily five days a week.
Clinical judgments rest with a designated responsible physician who is on site weekly. The
standard is met.
P-A-03 Medical Autonomy (E). Qualified health care professionals make decisions regarding
inmates’ serious medical, dental, and mental health needs in the inmates' best interests. We
noted good cooperation between custody and medical staff. Administrative decisions (such as
utilization review) are coordinated, when necessary, with clinical needs so that patient care is
not jeopardized. The standard is met.
P-A-04 Administrative Meetings and Reports (E). The health staff and security staff meet
monthly to discuss administrative matters. Health staff meet monthly to discuss health services
operations. A daily log is maintained of events or items that need to be followed up. Monthly
health service statistics are maintained. The standard is met.
P-A-05 Policies and Procedures (E). The health services policy manual is site-specific. The
RHA and responsible physician last reviewed it on January 19, 2010. The standard is met.
P-A-06 Continuous Quality Improvement Program (E). The basic CQI program monitors
major aspects of health care through a multidisciplinary committee that meets monthly. The
membership includes the RN, responsible physician, HSA, nurse practitioner, and others. A
process CQI study was completed on charting weight, height, and vital signs during sick call.
An annual review of the program’s effectiveness was performed in 2009.
However, a CQI study examining compliance with a new DOC policy requiring that all the
inmates had to be cleared for kitchen duty was categorized as an outcome study. The facility
implemented a process by which to comply, made a video, and developed handouts informing
inmates of the process. This is not an outcome study. The standard is not met.

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Corrective action is required for Compliance Indicator #3b At least one process and one
outcome study should be performed each year. Outcome studies examine whether
expected outcomes of patient care were achieved. D ocumentation is required to
demonstrate that a plan is in place to implement the remaining outcome study.
Acceptable documentation includes a copy of CQI meeting minutes demonstrating that
problem identification has taken place and there is a planned date of implementation. In
order to receive accreditation, verification that this standard has been met is required.
P-A-07 Emergency Response Plan (E). An actual disaster (dormitory fight) occurred on
October 3, 2009; one inmate was injured and three inmates were maced. Actual man-down
events were documented in 2009. All drills and events were critiqued and shared with the staff.
The standard is met.
P-A-08 Communication on Patients’ Health Needs (E). Communication between
designated correctional and health staff with regard to inmates’ special health needs occurs in
writing via an offender status report. The standard is met.
P-A-09 Privacy of Care (I). Health encounters are conducted in a private examination room
where confidentiality and privacy are maintained. The standard is met.
P-A-10 Procedure in the Event of an Inmate Death (I). Since the last survey, there have
been no inmate deaths. The standard is met.
P-A-11 Grievance Mechanism for Health Complaints (I). The health-related grievance
program is integrated with the formal grievance program. There have been no grievances filed
in the last three years. During interviews, inmates had only positive comments regarding the
health services. The standard is met.

B. MANAGING A SAFE AND HEALTHY ENVIRONMENT
The standards in this section address the importance of preventative monitoring of the physical plant.
Health staff has a crucial role in identifying issues that could have a negative impact on the health and
safety of facility staff and the inmate population if left unaddressed.

Standard Specific Findings
P-B-01 Infection Control Program (E). Infection control matters are addressed during the
CQI committee meetings. Inmates with communicable diseases are transferred to the local
hospital when negative airflow isolation is required. Ectoparasites are treated as clinically
indicated. Environmental inspections are conducted monthly. The standard is met.
P-B-02 Patient Safety (I). Systems to prevent adverse and near-miss clinical events are in
place. The standard is met.
P-B-03 Staff Safety (I). Health staff appear to work under safe and sanitary conditions. Staff
reported feeling safe in this work environment. Safety inspections are completed daily. The
standard is met.

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P-B-04 Federal Sexual Assault Reporting Regulations (I). The superintendent described the
facility as compliant with the 2003 Federal Prison Rape Elimination Act. The standard is met.
P-B-05 Procedure In The Event of a Sexual Assault (I). Victims of sexual assault would be
sent to off-site hospital care and provided with mental health counseling. There have been no
allegations of sexual assault in the last three years. The standard is met.

C. PERSONNEL AND TRAINING
The standards in this section address the need for a staffing plan adequate to meet the needs of the
inmate population, and appropriately trained and credentialed health staff. Correctional officers are to
have a minimum amount of health-related training in order to step in during an emergency, if health staff is
not immediately available.

Standard Specific Findings
P-C-01 Credentialing (E). Health care personnel who provide services to inmates have
current licenses and other appropriate credentials on file. The credentialing process includes
inquiry regarding sanctions or disciplinary actions of state boards, employers, and the National
Practitioner Data Bank. The standard is met.
P-C-02 Clinical Performance Enhancement (I). All peer reviews were on file for 2009; the
regional medical director reviewed the physician and nurse practitioner, while another dentist
reviewed the work of the facility’s dentist. All results were shared with the providers. The
standard is met.
P-C-03 Professional Development (E). We confirmed that qualified health care professionals
have the required number of continuing education credits; all are current in cardiopulmonary
resuscitation (CPR) training. In-service training, including a post-test, is part of the staff
meetings. The physician and nurse practitioner have sufficient CEUs to maintain their
licensure. The standard is met.
P-C-04 Health Training for Correctional Officers (E). Correctional staff have the required
training in health-related topics and all are current in CPR training. In addition, COs are trained
in health and mental health-related illnesses, including bloodborne pathogens, stroke, influenza,
low blood sugar and withdrawal symptoms, as well as medication administration and patient
confidentiality. The standard is met.
P-C-05 Medication Administration Training (E). All medications are classified as keep-onperson (KOP). All officers have had a recent medication administration course (May 2010).
The standard is met.
P-C-06 Inmate Workers (E). Inmate workers are not used in the medical area except to clean.
A job description is available for this task. Inmates are employed in a number of activities in the
community, such as fire fighting and potato farming, and must pass a physical demonstrating
their ability to perform that specific job. The standard is met.
P-C-07 Staffing (I). Full-time equivalent health staff includes:

St. Anthony Work Camp, ID
Report #248
June 25, 2010
Head Nurse
RN
NP
Physician
Dentist
Dental Assistant

6
1.0
0.5
0.23
0.2
0.1
0.1

At the time of the survey, there were no vacancies. The standard is met.
P-C-08 Health Care Liaison (I). The shift commander is the designated health care liaison.
The standard is met.
P-C-09 Orientation for Health Staff (I). We confirmed that health staff have received
appropriate orientation, which includes an orientation manual and checklist. The standard is
met.

D. HEALTH CARE SERVICES AND SUPPORT
The standards in this section address the manner in which health services are delivered–the adequacy of
space, the availability and adequacy of materials, and, when necessary, documented agreements with
community providers for health services.

Standard Specific Findings
P-D-01 Pharmaceutical Operations (E). Pharmaceutical services, which are provided by a
contracted service and a local pharmacy, are sufficient to meet the needs of the inmates. A
current pharmacy license (2011 expiration date) was on file. A formulary is available and
providers may make a non-formulary request when indicated. We found no expired
medications. Refrigerator temperatures are logged daily. No narcotics are maintained on site.
Poison antidotes were available. Pharmacy inspections occur quarterly, most recently on April
12, 2010. The standard is met.
P-D-02 Medication Services (E). The responsible physician determines the prescriptive
practices at this facility. Because this is a transfer facility, inmates arrive with their medication.
All medications except psychotropic medications are classified as KOP. The standard is met.
P-D-03 Clinic Space, Equipment, and Supplies (I). The clinic area includes a spacious
examination room, a nurse’s station, and a dental unit. Sharps counts are conducted five days
a week. The standard is met.
P-D-04 Diagnostic Services (I). A contract with a bioreference laboratory is in place.
Radiology services are performed at the local hospital. The dental x-ray machine was
inspected in March 2010. A CLIA waiver with an expiration of January 6, 2010 was on file.
Appropriate on-site diagnostic materials are available. The standard is met.

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P-D-05 Hospital and Specialty Care (I). Arrangements with a local hospital for inpatient
medical and specialized medical outpatient care are documented by contract. The standard is
met.

E. INMATE CARE AND TREATMENT
The standards in this section address the core of a health services program: that all inmates have access
to health services, how they are to request emergency and non-emergency care, that health histories are
obtained, that assessments and care can be demonstrated to be provided in a timely fashion, and that
discharge planning is considered. In short, health care for the inmates is to be consistent with current
community standards of care.

Standard Specific Findings
P-E-01 Information on Health Services (E). Upon admission, inmates are given a handbook
(available in English and Spanish) that describes access to health care services, the fee-forservice policy, and the health-related grievance procedures. A language line is available to
assist inmates who speak other languages. The nurse practitioner is also fluent in Spanish.
The standard is met.
P-E-02 Receiving Screening (E). Inmates are only transferred to this facility; parole violators
are not accepted here. The standard is not applicable.
P-E-03 Transfer Screening (E). The transfer bus arrives each Wednesday and nurses adjust
their schedule so that the transfer screening and an orientation are provided within a few hours
of the inmate’s arrival. The standard is met.
P-E-04 Initial Health Assessment (E). Any transferred inmate who is in need of a health
assessment would receive one. The physicals are performed by the nurse practitioner or
physician. Significant findings are co-signed and reviewed by the physician. The standard is
met.
P-E-05 Mental Health Screening and Evaluation (E). The mental health screening is
completed at the intake unit and reviewed by the transfer facility. Inmates with acute
psychiatric conditions would not be sent to this facility. The standard is met.
P-E-06 Oral Care (E). Oral screening and examination, and instruction in oral hygiene are
completed at the intake facility. A dentist has been contracted to come on site every two
weeks; dental care includes extractions, fillings, and denture repair. Lists of inmates who are to
be seen are posted in the housing units so that the inmates can obtain a lay-in. At the time of
the survey, there were no inmates on the dental waiting list. The standard is met.
P-E-07 Nonemergency Health Care Requests and Services (E). Health requests are placed
in a locked box outside of the medical unit. Sick call is open and inmates can come to the clinic
at any time. The RN comes to work at 5:00 a.m. so that she can see inmates who feel they
cannot go to work. Inmates are seen the same day as their request. On weekends, COs
triage sick call slips and contact the on-call nurse to discuss disposition. The standard is met.

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P-E-08 Emergency Services (E). The RHA provides 24-hour emergency medical, dental, and
mental health services. If emergency mental health service is required, a counselor from a
neighboring facility comes on site. The standard is met.
P-E-09 Segregated Inmates (E). There are no segregation units at this facility. Inmates
requiring segregation would be transferred to another institution. The standard is not
applicable.
P-E-10 Patient Escort. Inmates are transported to off-site appointments in a timely manner.
The standard is met.
P-E-11 Nursing Assessment Protocols (I). Nursing protocols are utilized for routine sick call.
Only over-the-counter medications are used unless the situation is an emergency. The
standard is met.
P-E-12 Continuity of Care During Incarceration (E). We confirmed that continuity of care is
appropriate. Inmates received diagnostic tests as ordered. Inmates who are sent to the
emergency room or who are hospitalized are seen by health staff upon their return. Periodic
health assessments are provided. The standard is met.
P-E-13 Discharge Planning (I). Upon discharge, inmates are given contacts with local
providers or health departments from their community. A two-week prescription and an
additional two-week supply of medication is provided. The standard is met.

F. HEALTH PROMOTION AND DISEASE PREVENTION
The standards in this section address health and lifestyle education and practices, as well as patientspecific instruction during clinical encounters.

Standard Specific Findings
P-F-01 Healthy Lifestyle Promotion (I). Nurses post a variety of continuing education
program offerings on a bulletin board. A number of classes on health matters and smoking
cessation are offered. Health-related materials are available in the library. The standard is
met.
P-F-02 Medical Diets (I). Inmates may self select the diet that they wish to be on and stay on
it for a month. Their options include vegetarian, lactose intolerant, no pork, healthy heart, and
moderate consistency.
However, a registered dietitian last reviewed the menus in April 2009. The standard is not
met.
Corrective action is required for Compliance Indicator #2 A registered or licensed
dietitian should review medical diets for nutritional adequacy at least every six months,
and whenever a substantial change in the menu is made, through a documented on-site
visit or by written consultation. The following is acceptable documentation for

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compliance: (a) a copy of written documentation/consultation that includes the date,
signature, and title of the consulting dietitian; or (b) a copy of the most recently dietitian
approved and signed medical diet menu. Corrective action is required in order to meet
this standard.
P-F-03 Use of Tobacco (I). Smoking is prohibited in all indoor areas. Smoking cessation
materials are available. The standard is met.

G. SPECIAL NEEDS AND SERVICES
The standards in this section address the needs of inmates with chronic conditions or other health
conditions that require a multidisciplinary approach to treatment. These special needs include mental
health issues.

Standard Specific Findings
P-G-01 Chronic Disease Services (E). Care as reflected in the health record appears in
compliance with current community standards. Chronic illnesses are listed on the problem list.
Clinical guidelines developed by the health care contractor are in place. Laboratory work is
ordered in accordance with the guidelines and chronic care patients are seen every three
months. The standard is met.
P-G-02 Patients With Special Health Needs (E). When required by the health condition(s) of
the patient, treatment plans define the individual’s care. Treatment plans include the frequency
of follow-up, instructions, and diagnostic testing and therapeutic regimens. Special needs are
noted on the problem list. The standard is met.
P-G-03 Infirmary Care (E). There is no infirmary. The standard is not applicable.
P-G-04 Basic Mental Health Services (E). Inmates who are on psychotropic medication and
are stable are admitted to this facility. The nurse practitioner sees them regularly for
medication renewal. If an inmate experiences a crisis, a mental health worker from another
facility will come and evaluate him. On-site mental health programs include anger management
and domestic violence. The standard is met.
P-G-05 Suicide Prevention Program (E). The suicide prevention program addresses each of
the 11 key components as described by the standard. If an inmate were suicidal, he would be
maintained under an officer’s constant supervision until arrangements could be made to send
him to the local hospital. Correctional and health staff are trained annually in suicide prevention.
The standard is met.
P-G-06 Intoxication and Withdrawal (E). A policy is in place to manage inmates who are
intoxicated or withdrawing from substances. Generally, they are sent to a local hospital where
withdrawal would take place and then the inmate would be transferred to another correctional
institution. The standard is met.
P-G-07 Care of the Pregnant Inmate (E). This is an all-male inmate population. The standard
is not applicable.

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P-G-08 Inmates With Alcohol and Other Drug Problems (I). Self-help substance abuse
programs are offered on site (Road to Recovery and a Native American community, called
Medicine Wheel, which utilizes the 12-step approach). Warrior Down is a Native American
relapse prevention program. Sweat lodges are also used in ceremonies. The standard is met.
P-G-09 Pregnancy Counseling (I). This is an all-male inmate population. The standard is not
applicable.
P-G-10 Aids to Impairment (I). Aids to impairment would be provided if the health of the
patient would deteriorate otherwise. Glasses and dentures have been provided. The standard
is met.
P-G-11 Care For The Terminally Ill (I). Although it would be rare for a terminally ill inmate to
be held at this facility, procedures are in place to make the appropriate accommodations. The
inmate would be sent to another facility that has an infirmary or to a local hospital. The
standard is met.

H. HEALTH RECORDS
The standards in this section address the importance of accurate health record documentation, health
record organization and accessibility, and need to ensure that medical and mental health information is
communicated when those records are separate documents.

Standard Specific Findings
P-H-01 Health Record Format and Contents (E). Inmate medical and mental health records
are integrated in hard copy format. The charts are well-organized and contain all of the
elements required by the standard. The standard is met.
P-H-02 Confidentiality of Health Records (E). Health records are maintained under secure
conditions. Staff are instructed on maintaining patient confidentiality as part of the orientation.
The standard is met.
P-H-03 Access To Custody Information (I). Qualified health care professionals have access
to information in the inmate’s custody record when such information may be relevant to the
inmate’s health and course of treatment. The standard is met.
P-H-04 Management of Health Records (I). Health records are available for each patient
encounter. When an inmate leaves the facility, a transfer summary and the health record
accompanies him. If the inmate is discharged, records are retained on site for six months and
then are sent to a central repository. The standard is met.
I. MEDICAL-LEGAL ISSUES
The standards in this section address the most complex issues facing correctional health care providers.
While the rights of inmate-patients in a correctional setting are generally the same as those of a patient in
the free world, the correctional setting often adds additional considerations when patient care is decided.

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The rights of the patient, and the duty to protect that patient and others, may conflict; however, ethical
guidelines, professional practice standards, and NCCHC’s standards are the determining factors
regarding these interventions and issues.

Standard Specific Findings
P-I-01 Restraint and Seclusion (E). By policy, the restraints are only used during transport.
The standard is met.
P-I-02 Emergency Psychotropic Medication (E). By policy, if an inmate were in need of
forced psychotropic medication, he would be transferred to a local hospital. The standard is
met.
P-I-03 Forensic Information (I). Health staff do not collect forensic information. The standard
is met.
P-I-04 End-of-life Decision Making (I). Inmates with terminal illness would have access to
advance directives and counseling. In practice, they would not remain at this facility. The
standard is met.
P-I-05 Informed Consent and Right to Refuse (I). We noted appropriately documented
informed consents and refusals during the chart review. The standard is met.
P-I-06 Medical and Other Research (I). No health-related research is conducted at this
facility. The standard is met.
P-I-07 Executions (I). Inmates are not executed at this facility. The standard is met.