W.01.01.03 Ongoing management of Internal Concealment

If, at any time, the prisoner’s condition deteriorates the health centre manager and general manager custodial must be immediately contacted.
If custodial staff are not able to immediately contact the health centre manager (or a health professional cannot attend), they must arrange for emergency services (ambulance) to attend the prison as set out in the Incident Response - Medical Emergency (flip chart) procedures.

If the prisoner refuses to be either assessed or transported to the emergency department or after hours medical centre, the general manager custodial can direct transport to an emergency department or after hours medical centre or any agreed health care facility. If the prisoner does not consent to being transferred for further assessment or treatment the general manager custodial can over-ride that decision.

Custodial staff must arrange for emergency services to attend the site regardless of prisoner consent.

If the prisoner is refusing consent to corrections health staff, and health staff believe they require further treatment, they need to be provided with an opportunity to consent (or not) to the ambulance / hospital directly.

The prisoner has the right to sufficient information to inform their decision to consent or decline to accept an assessment, any treatment or referral by a health practitioner.

If the prisoner does not consent to a health assessment or any clinical interventions offered, the prisoner will be required to complete a [HS 2-1-3 Refusal to Receive Health or Dental Services Form] and the health centre manager and general manager custodial will be notified.

If the health centre manager recommends to the general manager custodial that the prisoner needs to be segregated for the purpose ensuring or assessing the prisoners physical health ([Section 60(1) (a) of the Corrections Act 2004]), once the direction to segregate the prisoner is made, the [W.01.01.Form.03 Internal Concealment Care Plan] must be developed.

The [W.01.01.Form.03 Internal Concealment Care Plan] is a joint document between custodial and health staff, which health staff write. It is important to remember why the prisoner is segregated when creating the plan. A prisoner who is suspected of internal concealment is not necessarily at risk of self-harm, and therefore, it may not be appropriate to subject them to at risk provisions, such as at risk clothing or finger food.

In order to manage the risk to the prisoner some minimum entitlements may be affected. Where this is the case a written record of these decisions, including the reasons why, must be recorded in the care plan.

The health centre manager must ensure a [W.01.01.Form.03 Internal Concealment Care Plan] is developed and written by health staff, with custodial staff input.

The [W.01.01.Form.03 Internal Concealment Care Plan] must include:

C.1	the reasons for the segregation direction and grounds for suspicion of internal concealment
C.2	how minimum entitlements will be provided (including any visits and phone calls)
C.3	what other items (such as a radio) the prisoner may have access to
C.4	how the prisoner will be able to use a toilet
C.5	how the prisoner can request water or other fluids
C.6	what the regime for the prisoner will be (unlock)
H.1	observation frequency for custodial staff
H.2	frequency for health observations and assessments to be performed by health staff. This will be at least once per day. If the prisoner is at risk of self harm, or if the health centre manager determines it is necessary, the assessments may be undertaken more frequently
H.3	the health risk indicators for escalation and urgent health assessment
H.4	whether the prisoner needs to be referred to the hospital for an assessment or further medical treatment
H.5	the observations or care needed should the prisoner surrender the item
H.6	other information the health centre manager requests or may be relevant (other information can include any specific staff who work well with the prisoner, or pro social supports it may be beneficial for them to have contact with).

Required items within the [W.01.01.Form.03 Internal Concealment Care Plan] are listed as [C 1-6 for custodial practice] and [H 1-6 for health practice].

Custodial staff must work with the health staff member writing the plan to determine what these will be.

A registered nurse and principal corrections officer must sign the plan, with authorisation of the health centre manager.

Health staff must provide the prisoner with a copy of their [W.01.01.Form.03 Internal Concealment Care Plan] and ask the prisoner to acknowledge receipt of a copy of the plan and that they understand the plan.
A copy of the [W.01.01.Form.02 Direction to Segregate (Suspected of Internal Concealment) Medical Oversight] must be provided and custodial staff must explain the reasons for the direction, and what effect it will have, to the prisoner.

The general manager custodial must send the senior advisor custodial operations a copy of the [W.01.01.Form.03 Internal Concealment Care Plan], and [W.01.01.Form.02 Direction to Segregate (Suspected of Internal Concealment) Medical Oversight] by email on the same day if possible, but no later than 3 working days from the time the direction was made.

The senior advisor custodial operations must consult with the regional clinical director if they have concerns or questions about the segregation direction.

If the senior advisor custodial operations does not support the decision to segregate the prisoner they may direct that the segregation be revoked (60(3) CA2004) but only after consulting with, and receiving written advice from the regional clinical director.

When the prisoner is placed in a dry cell custodial staff must place the [W.02.Form.01 Dry-Cell Regime Notice] on the exterior of the cell door and advise all custodial staff in the unit the prisoner is subject to the dry-cell regime.

The [M.05.03.Res.01 ISU Supported Decision Framework] resource can be utilised to inform the [W.01.01.Form.03 Internal Concealment Care Plan].

All liquids will be given to the prisoner by corrections staff who will supervise the drinking of the water or other liquid and remove the cup immediately.

Custodial staff must record the amount of food and water the prisoner consumes ([M.05.03.Form.01 Observations]).

All prisoners suspected of internal concealment, managed in a dry cell, must:
1. have toileting requirements supervised by custodial staff of the same sex or, for trans prisoners, by custodial staff of the sex nominated on the [I.10.Form.01 Confirmation of search choice for trans prisoners].
2. be provided with a potty or bucket and
  1. the prisoner must be instructed to keep his / her hands in sight of the custodial staff at all times (In order to prevent a prisoner from re-inserting an item whilst toileting, force and handcuffs may be used if necessary, and permitted by [sections 83 and 85 of the Corrections Act 2004]).
  2. the bucket or potty must be removed immediately after toileting
  3. once the potty or bucket is removed, the prisoner will be provided with toilet paper
  4. the prisoner will be permitted to wash his / her hands after toileting (antiseptic wipes may be more practical for this purpose).
Note: All used toilet paper and antiseptic wipes are to be placed, by the prisoner, into a refuse receptacle immediately after use.
The prisoner will be permitted to shower only under the direct observation and supervision of a corrections custodial staff of the same sex (or, for trans prisoners, by custodial staff of the sex nominated on the [I.10.Form.01 Confirmation of search choice for trans prisoners]) and at convenient times considering the needs of the unit.

The general manager custodial (or authorised delegate) must visit the prisoner at least once a day. As part of this visit they must check the [M.05.03.Form.01 Observations] sheets and confirm with staff they understand their responsibilities and the observations are being carried out appropriately.

The health centre manager or health practitioner will also visit and assess the prisoner’s health needs at the frequency outlined in the [W.01.01.Form.03 Internal Concealment Care Plan], which must be at least once per day (unless the health centre manager deems daily visits unnecessary or that more frequent visits are necessary).

The health centre manager is responsible for ensuring all relevant information and instructions for custodial staff are kept up to date and available to the general manager custodial and the custodial staff managing the [W.01.01.Form.03 Internal Concealment Care Plan].

During the period of segregation the prisoner may have visits from and may make and receive telephone calls from the Office of the Ombudsmen, Inspector of Corrections, any other statutory visitor, and/or the prisoner's legal adviser. These visits and or calls must be arranged by unit staff as soon as practicable, taking into consideration the needs of the unit.
All records must be managed on IOMS, where possible, and a copy (including custodial observation sheets and the care plan) held in the penal file. Where health information is recorded (such as health assessments / observations), the health centre manager or nurse must keep that information in medtech.
The general manager custodial may only revoke the direction for segregation under [section 60 of the Corrections Act 2004] on the advice of the health centre manager.