Number: Department of Corrections and Rehabilitation ... · CDCR Form 621-A (Rev. 09/14 ... Inquiries regarding this Notice may be dire cted to L. Saich, Chief, ... (IDSP), Policies

CDCR 7554 (REV. 07/17)

Department of Corrections and Rehabilitation

NOTICE OF CHANGE TO

HEALTH CARE REGULATIONS

Section(s): 3352.2, 3352.3, 3354, and 3355.1

Number: 17-02

Publication Date:

September 29, 2017

Effective Date:

To Be Announced

INSTITUTION POSTING AND CERTIFICATION REQUIRED

This Notice announces the proposed amendments to Sections 3352.2, 3352.3, 3354, and 3355.1 of the California Code of Regulations (CCR), Title 15, Crime Prevention and Corrections, to incorporate into the CCR, provisions concerning dental care for patients within CDCR institutions.

IMPLEMENTATION: To Be Announced

PUBLIC COMMENT PERIOD Any person may submit written comments about the proposed regulations to California Correctional Health Care Services, Health Care Regulations and Policy Section, P.O. Box 588500, Elk Grove, CA, 95758, by fax to (916) 691-3490, or by e-mail to [email protected]. All written comments must be received by the close of the public comment period, November 20, 2017, at 5:00 p.m.

PUBLIC HEARING INFORMATION A public hearing regarding these proposed regulations will be held November 20, 2017, from 10:00 a.m. to 11:00 a.m. at the Elk Grove City Council Chambers located at 8400 Laguna Palms Way, Elk Grove, CA, 95758. The purpose of the hearing is to receive oral comments about this action. It is not a forum to debate the proposed regulation change. No decision regarding the permanent adoption of this regulation change will be rendered at this hearing. Written or facsimile comments submitted during the prescribed comment period are given the same significance and weight as oral comments presented at the hearing. This hearing site is accessible to the mobility impaired.

POSTING This Notice shall be posted immediately upon receipt at locations accessible to inmates, parolees, and employees in each Department facility and field office not later than five calendar days after receipt. Also, facilities shall make this Notice available for review by inmates in segregated housing who do not have access to the posted copies and shall distribute it to inmate law libraries and advisory councils. CDCR Form 621-A (Rev. 09/14), Certification of Posting, shall be returned to the Health Care Regulations and Policy Section electronically, by fax, or by mail. See Department Operations Manual Sections 12010.12.1 and 12010.12.2 for posting procedures.

CONTACT PERSON Inquiries regarding the subject matter of these regulations may be directed to A. Garbutt, D.D.S., Chief Dentist Policy and Risk Management, Division of Health Care Services, California Department of Corrections and Rehabilitation at (916) 691-2922. Inquiries regarding this Notice may be directed to L. Saich, Chief, Health Care Regulations and Policy Section, California Correctional Health Care Services, P.O. Box 588500, Elk Grove, CA, 95758, by telephone (916) 691-2921 or e-mail [email protected]. / Original Signed By / SCOTT KERNAN Secretary California Department of Corrections and Rehabilitation

Attachments

Notice of Proposed Regulations NCHCR 17-02 September 5, 2017 Page 1

NOTICE OF PROPOSED REGULATORY ACTION

California Code of Regulations

Title 15, Crime Prevention and Corrections

Department of Corrections and Rehabilitation

NOTICE IS HEREBY GIVEN that the Secretary of the California Department of Corrections and

Rehabilitation (CDCR), pursuant to the authority granted by Government Code Section 12838.5

and Penal Code (PC) Section 5055, and the rulemaking authority granted by PC Section 5058,

proposes to amend Sections 3352.2, 3352.3, 3354, and 3355.1 of the California Code of

Regulations (CCR), Title 15, Division 3, concerning dental care for patients within CDCR

institutions.

PUBLIC HEARING:

Date and Time: November 20, 2017 - 10:00 a.m. to 11:00 a.m.

Place: Elk Grove Police Service Center

Elk Grove City Council Chambers

8400 Laguna Palms Way

Elk Grove, CA 95758

Purpose: To receive comments about this action.

The Elk Grove Council Chambers is wheelchair accessible. At the hearing, any person may present

statements or arguments orally or in writing relevant to the proposed action described in the

Informative Digest. The Department requests but does not require that persons who make oral

comments at the hearing also submit a written copy of their testimony at the hearing.

PUBLIC COMMENT PERIOD:

The public comment period will close November 20, 2017 at 5:00 p.m. Any person may submit

public comments in writing (by mail, by fax, or by e-mail) regarding the proposed changes. To be

considered, comments must be submitted to California Correctional Health Care Services

(CCHCS), Health Care Regulations and Policy Section, P.O. Box 588500, Elk Grove, CA 95758;

by fax to (916) 691-3490; or by e-mail to [email protected] before the close of the

comment period.

CONTACT PERSON:

Inquiries regarding the substance of the proposed regulatory action should be directed to:

A. Garbutt, D.D.S.

Division of Health Care Services

California Department of Corrections and Rehabilitation

(916) 691-2922

mailto:[email protected]


Inquiries regarding this Notice should be directed to:

L. Saich

Health Care Regulations and Policy Section

California Correctional Health Care Services

P.O. Box 588500

Elk Grove, CA 95758

(916) 691-2921

AUTHORITY AND REFERENCE:

PC Section 5000 provides that commencing July 1, 2005, any reference to the Department of

Corrections in this or any code, refers to the CDCR, Division of Adult Operations.

PC Section 5050 provides that commencing July 1, 2005, any reference to the Director of

Corrections, in this or any other code, refers to the Secretary of the CDCR. As of that date, the

office of the Director of Corrections is abolished.

PC Section 5054 provides that commencing July 1, 2005, the supervision, management, and

control of the state prisons, and the responsibility for the care, custody, treatment, training,

discipline, and employment of persons confined therein are vested in the Secretary of the CDCR.

PC Section 5058 authorizes the Director to prescribe and amend regulations for the administration

of prisons.

References cited pursuant to this regulatory action are as follows: Sections 3424 and 5054, Penal

Code.

INFORMATIVE DIGEST/POLICY STATEMENT OVERVIEW:

Currently, regulations concerning dental care for patients within CDCR institutions do not conform

to CDCR Inmate Dental Services Program (IDSP), Policies and Procedures, the development and

approval process which was based on the court decision dated August 21, 2006, by Judge Jeffrey

White, United States District Court for the Northern District of California, in the Perez class-action

lawsuit (Carlos Perez, et al v. Matthew Cate, et al).

In this regulatory action, the Secretary proposes to amend regulatory provisions pertaining to

dental care for patients within CDCR institutions. These amendments will establish consistency

between Title 15, Chapter 1, Subchapter 4, Article 8, and the CDCR IDSP, Policies and

Procedures, regarding the type and scope of and eligibility for dental services provided to patients

within CDCR institutions.

The CDCR IDSP, Policies and Procedures, published September 2014, are available for public

review on the Department’s internet site at:

http://www.cdcr.ca.gov/DHCS/docs/September2014IDSP_PandP_Final.pdf.

http://www.cdcr.ca.gov/DHCS/docs/September2014IDSP_PandP_Final.pdf


This action provides the following:

Authority and direction for ongoing improvements in the quality of dental care provided to

CDCR patients.

Authority for CDCR to facilitate and ensure the ongoing delivery of dental services in

accordance with the CDCR IDSP, Policies and Procedures.

BENEFITS ANTICIPATED BY THE PROPOSED REGULATIONS

Enabling regulations will provide the authority to facilitate and ensure the ongoing delivery of

dental services in accordance with the court approved CDCR IDSP, Policies and Procedures, and

as such are essential to the continued provision of constitutionally adequate dental care to CDCR

patients. The proposed changes provide a basis for demonstrating the Department’s commitment

to ongoing compliance with the Amended Stipulation and Order in the Settlement Agreement for

the Perez class action.

EVALUATION OF CONSISTENCY/COMPATIBILITY WITH EXISTING

REGULATIONS:

Pursuant to Government Code 11346.5(a)(3)(D), the Department must evaluate whether the

proposed regulations are inconsistent or incompatible with existing state regulations. Pursuant to

this evaluation, the Department has determined these proposed regulations are not inconsistent or

incompatible with any existing regulations within CCR, Title 15, Division 3.

LOCAL MANDATES:

The proposed regulatory action imposes no mandates on local agencies or school districts, or a

mandate which requires reimbursement pursuant to Government Code Section 17500 — 17630.

FISCAL IMPACT STATEMENT:

Cost or savings to any state agency: None

Cost to any local agency or school district that is required to be reimbursed: None

Other nondiscretionary cost or savings imposed on local agencies: None

Cost or savings in federal funding to the state: None

EFFECT ON HOUSING COSTS:

The Department has made an initial determination that the proposed action will have no significant

effect on housing costs.

SIGNIFICANT STATEWIDE ADVERSE ECONOMIC IMPACT ON BUSINESS:

The Department has determined that the proposed action will not have a significant statewide

adverse economic impact directly affecting businesses, including the ability of California

businesses to compete with businesses in other states.


RESULTS OF ECONOMIC IMPACT ASSESSMENT:

The Department has determined that the proposed regulations will have no impact on the creation

of new or the elimination of existing jobs or businesses within California or affect the expansion

of businesses currently doing business in California. The proposed regulations will positively

impact the health and welfare of persons housed within a CDCR institution or contract facility.

The proposed regulations will have no effect on non-incarcerated California residents, worker

safety, or the state’s environment.

COST IMPACTS ON REPRESENTATIVE PRIVATE PERSONS OR BUSINESSES:

The Department is not aware of any cost impacts that a representative private person or business

would necessarily incur in reasonable compliance with the proposed action.

EFFECT ON SMALL BUSINESSES:

The Department has determined that the proposed regulations will not affect small businesses. It

is determined that this action has no significant adverse economic impact on small businesses

because they are not affected by the internal management of state prisons.

CONSIDERATION OF ALTERNATIVES:

The Department must determine that no reasonable alternative it considered or that has otherwise

been identified and brought to its attention would be more effective in carrying out the purpose for

which the action is proposed, would be as effective and less burdensome to affected private persons

than the proposed action, or would be more cost-effective to affected private persons and equally

effective in implementing the statutory policy or other provisions of law.

The Department has made an initial determination that the action will not have a significant

adverse economic impact on businesses. Additionally, there has been no testimony, reasonable

alternative, or other evidence provided that would alter the CDCR’s initial determination to

proceed with this action as the provisions set forth in this rulemaking are based upon the CDCR

IDSP, Policies and Procedures, which establishes the responsibility, accountability, and processes

required and approved by the Perez court.

AVAILABILITY OF PROPOSED TEXT AND INITIAL STATEMENT OF REASONS:

The Department has prepared, and will make available, the proposed text and the Initial Statement

of Reasons (ISOR) of the proposed regulatory action. The rulemaking file for this regulatory

action, which contains those items and all information on which the proposal is based (i.e.,

rulemaking file) is available to the public upon request directed to the contact person listed in this

Notice as the contact person for inquiries regarding this Notice. The proposed text, ISOR, and

Notice of Proposed Action will also be made available on CCHCS’s website

http://www.cphcs.ca.gov/.

AVAILABILITY OF THE FINAL STATEMENT OF REASONS:

Following its preparation, a copy of the Final Statement of Reasons may be obtained from the

contact person listed in this Notice as the contact person for any inquiries regarding this Notice.

http://www.cphcs.ca.gov/


AVAILABILITY OF CHANGES TO PROPOSED TEXT:

After considering all timely and relevant comments received, the Department may adopt the

proposed regulations substantially as described in this Notice. If the Department makes

modifications which are sufficiently related to the originally proposed text, it will make the

modified text (with the changes clearly indicated) available to the public for at least 15 calendar

days before the Department adopts the regulations as revised. Requests for copies of any modified

regulation text should be directed to the contact person listed in this Notice as the contact person

for inquiries regarding this Notice. The Department will accept written comments on the modified

regulations for 15 calendar days after the date on which they are made available.

Initial Statement of Reasons NCHCR 17-02 September 27, 2017 1

INITIAL STATEMENT OF REASONS

The California Department of Corrections and Rehabilitation (CDCR) proposes to amend sections

3352.2, 3352.3, 3354, and 3355.1 of the California Code of Regulations (CCR), Title 15,

Division 3, Chapter 1, Subchapter 4, Article 8.

This rulemaking action will provide regulatory authority for ongoing improvements in the quality

of dental care provided to patients within CDCR institutions. Pursuant to court orders resulting

from a class action lawsuit involving dental care provided to patients within CDCR adult facilities,

the Department has revised its policies and procedures for the provision of dental care services to

patients. This process has resulted in court approved policies and procedures for dental care. The

development and approval process was based upon the court decision dated August 21, 2006, by

Judge Jeffrey White, United States District Court for the Northern District of California, in the

Perez class-action lawsuit (Carlos Perez, et al v. Matthew Cate, et al). Plaintiffs in the Perez class

action were CDCR inmates who had serious dental needs. The court approved an Amended

Stipulation and Order that addressed dental care services to patients within CDCR institutions. The

Amended Stipulation and Order required CDCR to implement a comprehensive set of policies and

procedures to guide the CDCR Inmate Dental Services Program (IDSP) in providing dental care

to patients. In order to demonstrate the Department’s commitment to ongoing compliance with the

Amended Stipulation and Order in the Settlement Agreement for the Perez class action, CDCR

filed emergency regulations with the Office of Administrative Law on March 28, 2012. These

emergency regulations served to adopt the portions of the CDCR IDSP, Policies and Procedures,

into the CCR that demanded expedited regulatory action. The present proposed rulemaking action

will adopt the remaining regulatory provisions of the CDCR IDSP, Policies and Procedures, into

the CCR to provide the necessary regulatory authority for their continued application.

ECONOMIC IMPACT ASSESSMENT

The Department has determined that the proposed regulations will have no impact on the creation

of new or the elimination of existing jobs or businesses within California or affect the expansion

of businesses currently doing business in California. The proposed regulations will positively

impact the health and welfare of persons housed within a CDCR institution or contract facility.

The proposed regulations will have no effect on non-incarcerated California residents, worker

safety, or the state’s environment.

In accordance with Government Code section 11346.3(b), CDCR has made the following

assessments regarding the proposed regulations:

Creation of New or the Elimination of Existing Jobs Within the State of California

The Department has determined that the proposed regulations will not have an impact on the

creation of new or the elimination of existing jobs within California. The proposed regulations


only affect the internal management of California prisons and will have no impact on the creation

or elimination of existing jobs within the state of California.

Creation of New or the Elimination of Existing Businesses Within the State of California


creation of new or the elimination of existing businesses within California. The proposed

regulations only affect the internal management of California prisons and will have no impact on

the creation or elimination of new or existing businesses within the state of California.

Expansion of Businesses Currently Doing Business in the State of California


expansion of businesses currently doing business in California. The proposed regulations only

affect the internal management of California prisons, and will have no impact on the expansion of

businesses currently doing business in the state of California.

Significant Adverse Economic Impact on Businesses

The Department has made an initial determination that this action will not have a significant

adverse economic impact on businesses in the state of California because those businesses are not

affected by the internal management of California prisons.

Benefits of the Regulations

Enabling regulations will provide the authority to facilitate and ensure the ongoing delivery of

dental services in accordance with the court approved CDCR IDSP, Policies and Procedures, and

as such are essential to the continued provision of constitutionally adequate dental care to CDCR

patients. The proposed changes provide a basis for demonstrating the Department’s commitment

to ongoing compliance with the Amended Stipulation and Order in the Settlement Agreement for

the Perez class action.

Consideration of Alternatives

The Department must determine that no reasonable alternative it considered or that has otherwise

been identified and brought to its attention would be more effective in carrying out the purpose for

which the action is proposed, would be as effective and less burdensome to affected private persons

than the proposed action, or would be more cost-effective to affected private persons and equally

effective in implementing the statutory policy or other provisions of law.

The Department has made an initial determination that the action will not have a significant

adverse economic impact on business. Additionally, there has been no testimony, reasonable

alternative, or other evidence provided that would alter the CDCR’s initial determination to


proceed with this action as the provisions set forth in this rulemaking are based upon the CDCR

IDSP, Policies and Procedures, which establishes the responsibility, accountability, and processes

required and approved by the Perez court.

MATERIALS RELIED UPON

These amendments will establish consistency between Title 15, Chapter 1, Subchapter 4, Article

8, and the CDCR IDSP, Policies and Procedures, regarding the type and scope of and eligibility

for dental services provided to patients within CDCR institutions.

The CDCR IDSP, Policies and Procedures, published September 2014, is available for public

review on the Department’s internet site at:

http://www.cdcr.ca.gov/DHCS/docs/September2014IDSP_PandP_Final.pdf.

The Department has not identified nor has it relied upon any other technical, theoretical, or

empirical study, report, or similar document.

SPECIFIC PURPOSE AND RATIONALE FOR EACH SECTION AMENDMENT

Chapter 1. Rules and Regulations of Adult Operations and Programs

Subchapter 4. General Institution Regulations

Article 8. Medical and Dental Services

Section 3352.2. Dental Authorization Review Committee.

New subsection 3352.2(a) is adopted to provide the definition of numerous terms that are

applicable to Title 15, Chapter 1, Subchapter 4, Article 8, sections 3352.2, 3352.3, and 3355.1.

The definitions are necessary to establish a common understanding of terms that are used

throughout sections 3352.2, 3352.3, and 3355.1.

Existing subsection 3352.2(a) is renumbered 3352.2(b) and is amended to accurately describe

the review process currently in existence, based upon the process created and approved in the

CDCR IDSP, Policies and Procedures, which establishes the responsibility and accountability

required by the Perez court. The word “departmental” is removed to eliminate redundancy and

conform usage to the existing definitions in Title 15, Division 3, Chapter 1, Article 1, section 3000.

References to the “Dental Authorization Review (DAR) Committee” are revised to be made

uniform and conform usage to the CDCR IDSP, Policies and Procedures. The word “establish” is

changed to “maintain” and the phrase “be established for the purpose of” is removed for the sake

of clarity as the DAR Committee is already in existence.

http://www.cdcr.ca.gov/DHCS/docs/September2014IDSP_PandP_Final.pdf


Existing subsection 3352.2(a)(1) is repealed as the language is incorporated into the sentence

structure of subsection 3352.2(b) and for concision and clarity regarding the DAR Committee’s

function.

Existing subsections 3352.2(a)(1)(A) – (B) are renumbered 3352.2(b)(1) – (2) and are

otherwise unchanged.

Existing subsection 3352.2(a)(1)(C) is renumbered 3352.2(b)(3) and is amended to change the

term “medically necessary” to “clinically necessary” and add the phrase “as determined by health

care staff.” This is necessary as the definition of “clinically necessary” is distinct from the

definition of “medically necessary,” and it is necessary to make clear to patients and health care

staff that only treatment that is considered clinically necessary by health care staff may be

provided. The term “contract specialist” is changed to “contracted specialist” to clarify that the

individuals referred to in this provision are contracted with the Department.

Existing subsection 3352.2(a)(1)(D) is renumbered 3352.2(b)(4) and is amended to change the

term “medically necessary” to “clinically necessary” and add the phrase “as determined by health

care staff.” This is necessary as the definition of “clinically necessary” is distinct from the

definition of “medically necessary,” and it is necessary to make clear to patients and health care

staff that only treatment that is considered clinically necessary by health care staff may be

provided. The term “diagnostic studies” and the clause “including, but not limited to, procedures

for which a request for services (RFS) has been completed by the requesting dentist” are added to

further clarify the treatment modalities the DAR Committee will review.

Existing subsection 3352.2(a)(2) is repealed to accurately reflect the purpose of the DAR

Committee’s current function, based upon the process created and approved in the CDCR IDSP,

Policies and Procedures, which establishes the responsibility and accountability required by the

Perez court.

Existing subsections 3352.2(b) – (b)(4) are repealed to maintain the integrity of the DAR

Committee’s confidentiality pursuant to Evidence Code 1157. In addition, the most effective

review body structure for the delivery of dental care may shift due to technological or

organizational changes, and the need to conform Department rules to the new structure of review

prior to implementation could potentially delay effective and timely review of dental care.

New subsection 3352.2(c) is adopted to accurately describe the review process currently in

existence, based upon the process created and approved in the CDCR IDSP, Policies and

Procedures, which establishes the responsibility and accountability required by the Perez court.


Existing subsection 3352.2(c) is renumbered 3352.2(d) and is amended to include the

timeframe of “15 business days of receipt” to clarify the deadline by which the DAR Committee

must take action. In addition, language is added regarding the Dental Program Health Care Review

Committee (DPHCRC) process which is necessary to ensure the patient is informed of the

committee’s decision by the dentist most familiar with the patient’s case factors. This subsection

also establishes that all decisions shall be documented in the patient’s health record. This is

necessary to ensure the patient’s complete dental history is available to treatment providers and to

accurately describe the review process currently in existence, based upon the process created and

approved in the CDCR IDSP, Policies and Procedures, which establishes the responsibility and

accountability required by the Perez court. The word “forwarded” is changed to the word

“submitted” for clarity and to conform usage to the CDCR IDSP, Policies and Procedures. In

addition, the word “inmate” is changed to “patient” as this provision is referring to inmates who

are seeking or receiving health care services or who are assigned to a care team. The word “section”

is changed to “subsection” for more precise reference.

New subsection 3352.2(e) is adopted to accurately describe the approval process currently in

existence, based upon the process created and approved in the CDCR IDSP, Policies and

Procedures, which establishes the responsibility and accountability required by the Perez court.

Section 3352.3. Dental Program Health Care Review Committee.

Existing subsection 3352.3(a) is amended to include language to further clarify the dental

services that require DPHCRC review. The term “decisions” is changed to “case reviews” to

accurately describe the review process and timeframes currently in existence, based upon the

process created and approved in the CDCR IDSP, Policies and Procedures, which establishes the

responsibility and accountability required by the Perez court. In addition, the word “inmate” is

changed to “patient” as this provision is referring to inmates who are seeking or receiving health

care services or who are assigned to a care team. The word “section” is changed to “subsection”

for more precise reference.

Existing subsections 3352.3(b) – (b)(4) and 3352.3(c) are repealed to maintain the integrity of

the DPHCRC’s confidentiality pursuant to Evidence Code 1157. In addition, the most effective

review body structure for the delivery of dental care may shift due to technological or

organizational changes, and the need to conform Department rules to the new structure of review

prior to implementation could potentially delay effective and timely review of dental care.

Existing subsection 3352.3(d) is renumbered 3352.3(b) and amended for clarity and concision

regarding the DPHCRC process. In addition, the word “inmate” is changed to “patient” as this

provision is referring to inmates who are seeking or receiving health care services or who are

assigned to a care team.


Section 3354. Health Care Responsibilities and Limitations.

Existing subsections 3354(a) – (b)(7) are unchanged.

Existing subsection 3354(c) is amended to change the title “chief medical officer” to “Chief

Medical Executive” to reflect the title currently in use. In addition, the words “department” and

“director” are capitalized to conform to current usage.

Existing subsections 3354(d) and (e) are amended to capitalize the word “department” to

conform to current usage.

Existing subsections 3354(f) – (f)(6) are repealed as the provisions for Dental Priority

Classification (DPC) are moved to subsections 3355.1(g) – (g)(5) and are updated according to the

requirements found in the CDCR IDSP, Policies and Procedures, based upon the process created

and approved by the Perez court, which establishes the responsibility and accountability of the

IDSP in providing dental services. The DPC codes were removed for clarity and readability as

these are technical terms utilized internally by clinical health care staff.

Section 3355.1. Dental Care.

New subsection 3355.1(a) is adopted to provide the definition of numerous terms that are

applicable to Title 15, Chapter 1, Subchapter 4, Article 8, section 3355.1. The definitions are

necessary to establish a common understanding of terms that are used throughout section 3355.1.

New subsections 3355.1(b) – (d) are adopted to capture requirements found in the CDCR IDSP,

Policies and Procedures, based upon the process created and approved by the Perez court, which

establishes the responsibility and accountability of the IDSP in providing dental services.

New subsection 3355.1(e) is adopted to incorporate the regional structure created and approved

by the Perez court which establishes the responsibility and accountability of the IDSP regarding

continuous oversight of the dental services provided.

New subsections 3355.1(f) – (g)(5) are adopted to capture requirements found in the CDCR

IDSP, Policies and Procedures, based upon the process created and approved by the Perez court,

which establishes the responsibility and accountability of the IDSP in providing dental services.

Existing subsection 3355.1(a) is renumbered 3355.1(h) – (h)(3) and is amended to add

language to capture requirements found in the CDCR IDSP, Policies and Procedures, based upon

the process created and approved by the Perez court which establishes the responsibility and

accountability of the IDSP in providing dental services. Subsection (h)(1) includes new language

to institute eligibility requirements for patients to receive a Reception Center dental screening in

keeping with the frequency of dental examinations established in the community standard of care.

Subsection (h)(2) is added to provide Reception Center patients, who for reasons beyond their


control are unable to transfer to a mainline facility, with the same access to dental care provided

to patients who transfer to a mainline facility. In addition, the abbreviation “RC” is established

following the term “reception center” to conform to current usage. The words “sixty” and “ninety”

are removed for consistency of style and clarity. Numbers zero through ten are spelled out and

numerals are used for 11 and above. The word “calendar” is added to the timeframe of 90 days for

clarity. The word “inmate” is changed to “patient” where this provision is referring to inmates

who are seeking or receiving health care services or who are assigned to a care team. References

in new subsection 3355.1(h)(3) are changed to reflect the new regulation change, and the word

“section” is changed to “subsection” for more precise reference.

Existing subsection 3355.1(b) is renumbered 3355.1(i) – (i)(1) and is amended to change the

terms “assigned facility” and “program facility” to “mainline facility” for clarity because

“mainline facility” is the fully defined term that conforms to current usage. In addition, the word

“inmate” is changed to “patient” as this provision is referring to inmates who are seeking or

receiving health care services or who are assigned to a care team.

New subsection 3355.1(i)(2) is adopted provide a triage process for patients who do not receive

a Reception Center dental screening due to other health care priorities requiring immediate transfer

from a Reception Center.

Existing subsections 3355.1(b)(1) – (3) are renumbered 3355.1(i)(3) – (5) and are amended to

change the word “inmate” to “patient” as this provision is referring to inmates who are seeking or

receiving health care services or who are assigned to a care team. In addition, references are

changed to reflect the new regulation change, and the character “%” is spelled out as “percent” for

clarity.

Existing subsection 3355.1(c) is renumbered 3355.1(t) and is amended to change the word

“inmate” to “patient” as this provision is referring to inmates who are seeking or receiving health

care services or who are assigned to a care team.

Existing subsection 3355.1(d) is renumbered 3355.1(j) and is amended to change the term

“program facility” to “mainline facility” for clarity because “mainline facility” is the fully defined

term that conforms to current usage. In addition, the word “inmate” is changed to “patient” as this


assigned to a care team.

Existing subsection 3355.1(d)(1) is renumbered 3355.1(j)(1) and is amended to remove

numeral character “(2)” and the word “fifty” for consistency of style and clarity. Numbers zero

through ten are spelled out and numerals are used for 11 and above.

Existing subsection 3355.1(d)(2) is renumbered 3355.1(j)(2) and is amended to capture

requirements found in the CDCR IDSP, Policies and Procedures, based upon the process created

and approved by the Perez court, which establishes the responsibility and accountability of the


IDSP in providing dental services. In addition, the word “inmate” is changed to “patient” as this


assigned to a care team. The term “pregnancy” was deleted from the list of diagnosed conditions

which make a patient eligible for an annual periodic comprehensive dental examination because

pregnancy is not a chronic medical condition of extended duration.

New subsections 3355.1(k) – (s) are adopted to capture requirements found in the CDCR IDSP,

Policies and Procedures, based upon the process created and approved by the Perez court, which

establishes the responsibility and accountability of the IDSP in providing dental services.

New subsection 3355.1(t) is the renumbered existing subsection 3355.1(c).

New subsection 3355.1(u) is adopted to ensure continuity of care for patients currently

undergoing dental treatment by providing dental care staff with the discretion to use dental holds

when clinically appropriate.

New subsection 3355.1(v) is adopted to ensure nutritional needs are met during dental treatment

through the provision of supplemental nutrition.

Existing subsection 3355.1(e) is renumbered 3355.1(w) and is amended to add a reference to

3268.2(e) as this is also an applicable rule in the context of this provision. In addition, the word

“inmate” is changed to “patient” as this provision is referring to inmates who are seeking or

receiving health care services or who are assigned to a care team.

Text of Proposed Regulations NCHCR 17-02 September 5, 2017 1

TEXT OF PROPOSED REGULATIONS

In the following, strikethrough indicates deleted text; underline indicates added or amended

text.

California Code of Regulations, Title 15, Division 3, Adult Institutions, Programs, and Parole

Chapter 1. Rules and Regulations of Adult Operations and Programs

Subchapter 4. General Institution Regulations

Article 8. Medical and Dental Services

Section 3352.2 is amended and renumbered to read:

3352.2. Dental Authorization Review Committee.

(a) For the purposes of sections 3352.2, 3352.3, and 3355.1 the following definitions apply:

(1) Clinically necessary means health care services or supplies that are determined by health care

staff to be needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and

that meet accepted standards of health care.

(2) Health care services means medical, mental health, dental, pharmaceutical, diagnostic, and

ancillary services to identify, diagnose, evaluate, and treat a medical, psychiatric, or dental

condition.

(3) Health care staff means persons employed or contracted by California Department of

Corrections and Rehabilitation, who are credentialed, licensed, certified, and legally able to

provide care to patients.

(4) Health record means paper-based records, electronic records, and other media that documents

the patient’s health care; providing a chronological account of a patient’s examinations and

treatments, and shall be maintained in such a manner which supports the continuity of care.

(5) Patient means an inmate who is seeking or receiving health care services or who is assigned to

a care team.

(a) (b) Each departmental institution shall establish maintain a Dental Authorization Review

(DAR) cCommittee. The DAR Committee shall be established for the purpose of approve or

disapprove requests for:

(1) Approving or disapproving requests for:

(A) (1) Otherwise excluded dental services.

(B) (2) Deviations from treatment policy.

(C) (3) Medically Clinically necessary treatment, as determined by health care staff, that requires

a contracted specialist to provide treatment at the local institution.

(D) (4) Medically Clinically necessary treatments, diagnostic studies, or consultations, as

determined by health care staff, that cannot be accomplished at the local institution., including, but

not limited to, procedures for which a request for services (RFS) has been completed by the

requesting dentist.

(2) Reviewing treatment recommendations for special dental care needs.

(b) DAR committee membership shall consist of:


(1) A staff dentist as Chairperson.

(2) A staff dentist as Vice-Chairperson.

(3) Any institutional dentist(s) providing dental services to inmates.

(4) Representatives from other institution services or divisions shall be invited, when appropriate,

to committee meetings.

(c) Procedures for which the requesting dentist has completed an RFS and that have been approved

by the DAR Committee, shall be scheduled for the requested service without undergoing the

Utilization Management review described in section 3352.

(c) (d) DAR cCommittee decisions case reviews shall be completed within 15 business days of

receipt and shall be based on criteria established in subsection 3350.1(d). Committee decisions

shall be documented in the inmate's unit patient’s health record. Cases that receive DAR

cCommittee approval and that require Dental Program Health Care Review Committee

(DPHCRC) approval, including, but not limited to, those listed in subsections 3352.2(b)(1), (2),

and (4), shall be forwarded submitted, along with all supporting documentation, to the Dental

Program Health Care Review Committee (DPHCRC). The treating dentist shall notify the inmate

patient of the committee's decision.

(e) The DAR and/or DPHCRC approval process may be bypassed if the Supervising Dentist

determines that the specialty services or consultation are required because of an Emergency dental

condition, as defined in subsection 3355.1(g)(1), or an Urgent dental condition requiring that

treatment be initiated within one calendar day, as defined in subsection 3355.1(g)(2).

NOTE: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; and

Perez, et al. v. Cate, et al., USDC no. 3:05-cv-05241-JSW (No. Cal.).


3352.3. Dental Program Health Care Review Committee.

(a) The Dental Program Health Care Review Committee (DPHCRC) shall meet as often as

necessary to review cases approved by the Dental Authorization Review (DAR) cCommittee for

otherwise excluded dental services, including, but not limited to, those listed in subsections

3352.2(b)(1), (2), and (4). DPHCRC decisions case reviews shall be completed within 15 business

days of receipt and shall be based on criteria established in Ssubsection 3350.1(d).

(b) The DPHCRC shall consist of, but not be limited to, the following:

(1) Chief Dentist, DAR, Inmate Dental Services Program (IDSP), DCHCS.

(2) Chief Dentist, Policy and Risk Management, IDSP, DCHCS.

(3) Chief Dentist, Training, IDSP., DCHCS

(4) A minimum of two (2) dentists, IDSP, DCHCS.

(c) Decisions to approve or deny requests for dental services which have been referred by the DAR

committee shall require the attendance of a minimum of three (3) dentists, IDSP, DCHCS, at the

applicable review committee, at least one of which must be a Chief Dentist or their designee, and

shall be based upon the decision adopted by a majority of the DPHCRC members present.

(d) (b) The treating dentist shall notify the inmate patient of the committee's decision regarding

dental services. All decisions shall be documented and document the decision in the inmate's

patient’s health record.




Section 3354 is amended to read:

Section 3354. Health Care Responsibilities and Limitations.

(a) Authorized staff. Only facility-employed health care staff, contractors paid to perform health

services for the facility, or persons employed as health care consultants shall be permitted, within

the scope of their licensure, to diagnose illness or, prescribe medication and health care treatment

for inmates. No other personnel or inmates may do so.

(b) Inmate Workers. Only trained or certified inmates shall operate health care equipment. Inmates

shall not be permitted to:

(1) Schedule appointments.

(2) Determine another inmate's access to health care services.

(3) Obtain blood samples.

(4) Administer blood.

(5) Introduce or discontinue intravenous infusions.

(6) Have access to surgical instruments, syringes, needles, medications, or health records except

as otherwise specified in these regulations.

(7) Perform any task identified as a health care responsibility.

(c) Private Consultants. Health care personnel not employed by the dDepartment are not authorized

to order treatment for an inmate. Such persons may offer opinions and recommendations for

consideration by dDepartment health care staff as follows: An inmate or an inmate's responsible

guardian or relative, or an attorney or other interested person wanting the inmate examined by a

private physician, shall submit a written request to the institution head. The institution head shall,

after consulting with the facility's chief medical officer Chief Medical Executive grant the request

unless convinced that specific case factors warrant denial. The fact of and reasons for such denial,

and notice of the right to appeal the decision in writing to the dDirector, shall be documented and

given to the inmate or the person requesting the outside health care service. Costs of such private

consultations or examinations shall be paid by the inmate or the person requesting the service.

(d) Emergency Health Care Attention. If an inmate is away from a facility for authorized reasons,

such as assignment to a camp or transportation between institutions, becomes seriously ill or

injured, emergency health care attention by available resources shall be obtained by the official in

charge. Community physicians and hospitals shall be used if the inmate's condition does not permit

prompt return to a dDepartment medical facility.

(e) Medical Sick Call. Each dDepartment facility confining inmates shall provide scheduled times

and locations for general population inmates. A medical doctor, registered nurse, or medical

technical assistant shall make daily visits to each nongeneral population housing unit to provide

medical attention to inmates unable to use the sick call services provided for general population.

Staff conducting sick call shall screen medical problems appearing to require further medical

attention and shall evaluate requests for appointments with other medical staff. A facility physician

shall personally visit each specialized housing unit at least once each week.

(f) Dental Priority Classification (DPC) codes: Inmates requesting dental treatment shall be

evaluated and scheduled into one of the following categories:


(1) Emergency care category: A dental emergency, as determined by health care staff, includes

any medical or dental condition for which evaluation and treatment are necessary to prevent death,

severe or permanent disability, or to alleviate disabling pain. Immediate treatment shall be

provided and will be available to such inmates 24 hours a day, 7 days a week.

(2) Urgent care category: Treatment of a dental condition of sudden onset or severe pain which

prevents the inmate from carrying out essential activities of daily living; or sub-acute or unusual

hard or soft tissue condition or pathology requiring early intervention. This category includes:

(A) DPC 1A: Such inmates shall receive treatment within one calendar day of diagnosis.

(B) DPC 1B: Such inmates shall receive treatment within 30 calendar days of diagnosis.

(C) DPC 1C: Such inmates shall receive treatment within 60 calendar days of diagnosis.

(3) DPC 2 Interceptive care category: Treatment of advanced caries, moderate or advanced

periodontal pathology, or the provision of dentures. This category requires that inmates have over

6 months remaining to serve on their sentence within the department at the time DPC 2 care is

initiated, and provides eligibility for DPC 2 care regardless of oral hygiene status. Such inmates

shall receive treatment within 120 calendar days of diagnosis.

(4) DPC 3 Routine Rehabilitative care category: Treatment of caries not likely to become advanced

within one year, mild periodontal pathology, or the provision of removable partial dentures. This

category requires that inmates have over 12 months remaining to serve on their sentence within

the department at the time DPC 3 care is initiated, and meet oral hygiene requirements. Such

inmates shall receive treatment within one year of diagnosis.

(5) DPC 4 No dental care needed: Inmates not appropriate for inclusion in DPC 1, 2, 3 or 5.

(6) DPC 5 Special needs care: Inmates with special needs. These include inmates requiring dental

care that is a deviation from treatment policy as well as treatments that may require a contract

specialist or that cannot be accomplished at the institution.




§ 3355.1. Dental Care.

(a) For the purposes of this section, the definitions pursuant to subsections 3352.2(a)(1-5) and the

following definitions apply:

(1) Mainline facility means a CDCR facility where a patient is housed and assigned after

completing the reception center initial intake process.

(2) Face-to-face triage encounter means a planned visit to assess and diagnose a patient’s chief

complaint and to provide necessary treatment following submittal of a CDC 7362 (Rev. 03/04),

Health Care Services Request Form, hereby incorporated by reference, by a patient or when dental

staff issues a ducat to a patient after performing a health record review.

(3) Limited problem focused exam encounter means an unplanned visit to assess and diagnose a

patient’s chief complaint and to provide treatment if necessary for a patient with a dental

emergency that arrives at the dental clinic unannounced without an appointment or who is referred

to the dental clinic by health care or custody staff and dental staff has not issued a ducat to the

patient and there is also no record of recently receiving a CDC 7362 from the patient addressing

the emergent condition.


(4) Plaque Index Score means a measurement used to determine a patient’s level of oral hygiene.

(5) Root Canal Therapy means a dental procedure in which the pulp chamber and canal(s) of a

tooth are cleaned, shaped and filled.

(b) Access to Dental Care.

(1) Patients shall have access to dental health care services which shall be accomplished via daily

rounds by licensed health care staff and daily collection of CDC 7362s.

(2) If a patient’s appointment for Emergency Care, as defined in subsection 3355.1(g)(1), must be

rescheduled by dental staff or if a patient unintentionally fails to show for scheduled Emergency

Care, the dentist shall see the patient within one calendar day. For all other rescheduled dental

care, the dentist shall see the patient within 35 calendar days following the rescheduled

appointment or failure to show, or consistent with the timeframe associated with the original

Dental Priority Classification assigned at the date of diagnosis, whichever is shorter.

(3) If a patient’s appointment for a face-to-face triage or limited problem focused exam encounter

must be rescheduled by dental staff, or if a patient unintentionally fails to show for a face-to-face

triage or limited problem focused exam encounter, then the patient shall be seen by a dentist within

three business days.

(c) Continuity of Care. Patients shall be provided ongoing dental care in accordance with their

Dental Priority Classification as described in subsection 3355.1(g). Dentists shall inform patients

of the result(s) of internal consultation reports, medical and oral pathology lab reports, and reports

from outside the facility that are the outcome of a Department or contracted dentist ordering the

analysis.

(d) Institution dental departments shall operate in accordance with the California Dental Practice

Act and ensure that all patient protection provisions of the Act are in force.

(e) Dental Program Organizational Structure. The dental program shall maintain a regional

administrative structure organized into four regions which shall include a Regional Dental Director

and program compliance staff consisting of clinical and non-clinical reviewers. Each Region shall

monitor quality of care and dental program policy compliance at the institutions. (f) Clinic Space, Equipment and Supplies. Examination and treatment rooms for dental care shall

be large enough to accommodate, and shall include, the equipment and fixtures needed to deliver

dental services.

(g) Dental Priority Classification. Patients shall be provided with dental care that is prioritized in

accordance with the urgency of diagnosed dental conditions. Treatment shall include:

(1) Emergency Care which is defined as treatment of a dental condition for which evaluation and

treatment are necessary, as determined by health care staff, to prevent death, severe or permanent

disability, or to alleviate severe pain. Immediate treatment shall be provided and shall be available

24 hours a day, seven days a week. All patients are eligible for Emergency Care regardless of time

remaining on their sentence and regardless of oral hygiene status.

(2) Urgent Care which is defined as treatment of a dental condition of sudden onset or that causes

severe pain which prevents the patient from carrying out essential activities of daily living; or

treatment for a sub-acute or unusual hard or soft tissue condition or pathology requiring early

intervention. Treatment shall be initiated within one calendar day or up to 60 calendar days of

diagnosis based on the urgency of the condition. All patients are eligible for Urgent Care regardless

of time remaining on their sentence and regardless of oral hygiene status.

(3) Interceptive Care which is defined as treatment of advanced caries, moderate or advanced

periodontal pathology, or the provision of complete and/or removable partial dentures. Treatment

shall be initiated within 120 calendar days of diagnosis. To be eligible for Interceptive Care,


patients must have over six months remaining on their sentence within the Department at the time

Interceptive Care is initiated and they are eligible regardless of oral hygiene status.

(4) Routine Rehabilitative Care which is defined as treatment of caries not likely to become

advanced within one year, mild periodontal pathology, or the provision of removable partial

dentures. Treatment shall be initiated within one year of diagnosis. To be eligible for Routine

Rehabilitative Care, patients must have over 12 months remaining on their sentence within the

Department at the time Routine Rehabilitative Care is initiated and with the exception of treatment

for periodontal pathology, they must meet oral hygiene requirements.

(5) Special Dental Needs Care which is defined as dental care that is a deviation from treatment

policy as well as treatment that may require a contracted specialist or that cannot be accomplished

at the institution.

(a) (h) Reception Centers.

(1) Newly arriving inmates at a reception center (RC), including new commitments and parole

violators, shall receive an initial health screening by a licensed health care provider to identify

urgent/emergent dental needs. Within sixty (60) calendar days of a an inmate's patient’s arrival at

a reception center an RC, a dentist shall perform a dental screening. for patients who qualify.

Patients who received a dental screening at an RC or a comprehensive dental examination at a

mainline facility within the past six months need not receive a new RC dental screening except as

determined by the treating dentist. This includes patients who have paroled and are rearrested as

well as those who transfer from one RC to another.

(2) Inmates remaining on RC status at an RC for 180 calendar days or longer shall be notified

within ten business days after completion of the 180th day that they are eligible to receive an initial

comprehensive dental examination performed by a dentist according to the terms described in

subsection 3355.1(i)(1).

(3) Dental treatment provided to reception center inmates RC patients shall be limited to the

treatment of Emergency and Urgent Care dental conditions, as defined in Ssubsections 3354(f)(1)

3355.1(g)(1) and 3354(f)(2) 3355.1(g)(2). Inmates Patients who remain on RC status in an

reception center RC for ninety (90) calendar days or longer may submit a CDC Form 7362 (Rev.

03/04) Health Care Services Request Form, which is incorporated by reference, to request DPC 2

Interceptive cCare, as defined in subsection 3355.1(g)(3), (excluding prosthetics). Upon receipt of

a CDC Form 7362, the dentist shall exercise professional judgment in considering treatment for a

DPC 2 condition the provision of Interceptive Care for the inmate patient.

(b) (i) Assigned Mainline Facility.

(1) Upon arrival at a mainline program facility all inmates patients shall be notified that they are

eligible to receive an initial comprehensive dental examination performed by a dentist who shall

formulate and document a dental treatment plan. The inmates patients shall be notified that no

copayment is required for this service.

(2) When dental staff becomes aware that a patient has transferred to a mainline facility without

undergoing an RC dental screening, dental staff at the receiving institution shall schedule the

patient for a face-to-face triage encounter to see if the patient has any Emergency or Urgent Care

dental conditions, as defined in subsections 3355.1(g)(1) and 3355.1(g)(2), respectively. Dental

staff shall also follow the process regarding comprehensive dental examination eligibility

notification outlined in subsection 3355.1(i)(1).

(1) (3) When a treatment plan is proposed, the inmate patient shall be provided an explanation of

its advantages and disadvantages.


(2) (4) Each inmate's patient’s dental health history shall be documented at the time of initial

examination, and signed by the inmate patient, and witnessed by the dentist. Such history shall be

available and reviewed at each dental visit.

(3) (5) Inmates Patients with a plaque index score above 20% percent or who refuse oral hygiene

instruction shall receive only Emergency Care, Urgent Care, Interceptive Care, and/or Special

Dental Needs Care, as these terms are described in Ssubsections 3354(f)(1) 3355.1(g)(1),

3354(f)(2) 3355.1(g)(2), 3354(f)(3) 3355.1(g)(3), and 3354(f)(6) 3355.1(g)(5), respectively.

(c) Within the second trimester of gestation and regardless of their plaque index score, pregnant

inmates shall receive a comprehensive dental examination, periodontal examination, oral hygiene

instruction, and the necessary periodontal treatment in order to maintain periodontal health during

the gestation period.

(d) (j) Re-examination. After the initial comprehensive dental examination, all mainline program

facility inmates patients shall be notified that they are eligible to receive a periodic comprehensive

dental examination by a dentist with no copayment required as follows:

(1) Every two (2) years (biennially), until up to the age of fifty (50).

(2) Annually after at the age of 50 and thereafter and regardless of age if the inmate patient is

diagnosed with diabetes, HIV, or seizure disorder or pregnancy.

(k) Medical Emergencies in the Dental Clinic. Each institution shall ensure that emergency

medical services are available in the dental clinic.

(l) Institution dentists shall adhere to professionally accepted protocols when providing dental

treatment to patients with:

(1) Hypertension.

(2) Anticoagulant therapy.

(3) Infective endocarditis risk.

(4) Prosthetic cardiac valve.

(5) Total joint replacement.

(6) HIV/AIDS.

(7) Bisphosphonate therapy.

(8) Diabetes.

(9) Pregnancy.

(m) Institution Orientation and Self Care.

(1) The dental clinics at each mainline facility shall ensure that all patients receive a baseline

Plaque Index score as well as Oral Hygiene Instruction at the time of their initial comprehensive

dental examination and treatment plan formulation.

(2) Toothbrushing for Inmates. All inmates shall have access to a toothbrush purchased in the

canteen or provided by CDCR if indigent and be allowed to brush their teeth at least once a day,

unless medically contraindicated.

(3) Dental Floss for Inmates. All inmates shall have access to dental flossers purchased in the

canteen or provided by CDCR if indigent and be allowed to floss their teeth once a day, unless

medically contraindicated.

(n) Periodontal Disease Program. Each institution’s dental department shall maintain a periodontal

disease program. Periodontal treatment:

(1) Is deemed Interceptive or Routine Rehabilitative Care and subject to the provisions of

subsections 3355.1(g)(3) and 3355.1(g)(4).


(2) Shall be available to all patients based on completion of a comprehensive dental examination,

the presence of a treatment plan, prior completion of Urgent Care as defined in subsection

3355.1(g)(2), and time remaining on their sentence.

(3) Shall consist of non-surgical scaling and/or root planing.

(o) Dental Restorative Services. Patients shall be provided dental restorative services utilizing

American Dental Association approved and CDCR authorized dental restorative materials. Dental

restorative services shall be limited to the restoration of teeth with enough structural integrity to

provide long-term stability.

(p) Root Canal Therapy.

(1) Root canal therapy shall only be performed for a patient on the upper and lower six anterior

teeth when all of the following conditions are met:

(A) The tooth is necessary to help maintain the integrity of the dentition.

(B) The tooth has adequate periodontal support and a good prognosis for long-term retention and

restorability.

(C) The tooth is restorable using CDCR authorized methods and materials.

(D) There are enough posterior teeth that touch together when chewing, either from natural

dentition or a dental prosthesis, to provide protection against traumatic chewing forces.

(2) Dentists shall exercise professional judgment in considering provision of root canal therapy for

a posterior tooth. Root canal therapy on a posterior tooth requires that all conditions for anterior

teeth are met as well as the following three conditions:

(A) The tooth in question is vital to the patient’s chewing ability.

(B) The tooth in question is essential as a support tooth for an existing removable cast partial

denture or is necessary as a support tooth on a proposed removable cast partial denture for that

arch.

(C) Treatment must be approved by the Dental Authorization Review Committee and the Dental

Program Health Care Review Committee prior to initiating the procedure.

(3) Root canal therapy shall not be performed when the tooth can easily be replaced by an addition

to an existing or proposed prosthesis in the same arch.

(q) Oral Surgery. A full range of necessary oral surgery procedures including biopsies shall be

available to all patients regardless of time remaining on their sentence. Any clinically necessary

oral surgery procedure, as determined by health care staff, that cannot be accomplished at the local

institution shall be made available by referring the patient to contracted oral surgeons, or to outside

facilities.

(r) Dental Prosthodontics.

(1) Dentists shall exercise professional judgment in considering a patient’s ability to tolerate and

benefit from a dental prosthesis.

(2) When a patient’s treatment plan includes a dental prosthesis, the treating dentist shall inform

the patient that the prosthesis may not be completed prior to the patient’s parole date.

(3) A dental prosthesis shall be constructed only when:

(A) A patient has no teeth, is missing an anterior tooth, or has seven or fewer upper and lower

posterior teeth that touch together when chewing.

(B) All restorative, root canal, and oral surgery procedures have been completed.

(C) Periodontal treatment has progressed to the point that the initial, active phase of treatment has

been completed and the patient is free of periodontal disease or is in periodontal maintenance.

(D) The patient has an Interceptive Care prosthetic need (e.g., complete denture) as defined in

subsection 3355.1(g)(3); or the patient has a Routine Rehabilitative Care prosthetic need (e.g.,


partial denture) as defined in subsection 3355.1(g)(4). Time requirements for fabricating a dental

prosthetic appliance are calculated from the date final impressions are taken.

(E) The patient, where applicable, has a plaque index score of 20 percent or below.

(4) All dental prostheses which are fabricated for patients shall have the patient’s name and CDCR

number embedded into the prosthesis for identification purposes.

(s) Removal of Orthodontic Bands/Brackets. Institution dentists shall exercise professional

judgment when considering a patient’s request for removal of existing orthodontic bands/brackets

and/or arch wires.

(t) Within the second trimester of gestation and regardless of their plaque index score, pregnant

patients shall receive a comprehensive dental examination, periodontal examination, oral hygiene

instruction, and the necessary periodontal treatment in order to maintain periodontal health during

the gestation period.

(u) Dental Holds. A patient shall not be transferred from his or her current institution to another

institution when the transfer is not clinically appropriate. The treating dentist in conjunction with

the Supervising Dentist (SD) shall determine if a dental hold is clinically necessary to be placed

on a patient. The treating dentist or SD shall remove the dental hold when it is no longer clinically

necessary.

(v) Supplemental Nutritional Support. Nourishments and supplements may be prescribed for

patients with dental or oropharyngeal conditions which interfere with their ability to consume food

items from the standard menu.

(e) (w) Restraints. If an inmate a patient requiring dental treatment also requires use of restraint

gear, such restraints shall be selected to enable sitting in a dental chair and shall remain in place

during the treatment. Exceptions require concurrence of the dentist, the escorting officer, and a

lieutenant. For pregnant inmates patients, the rules provided in subsections 3268.2(b), and (d), and

(e) concerning the use of restraints shall be followed.

NOTE: Authority cited: Section 5058, Penal Code. Reference: Sections 3424 and 5054, Penal

Code; and Perez, et al. v. Cate, et al., USDC no. 3:05-cv-05241-JSW (No. Cal.).

Documents

Number: Department of Corrections and Rehabilitation ... · CDCR Form 621-A (Rev. 09/14 ... Inquiries regarding this Notice may be dire cted to L. Saich, Chief, ... (IDSP), Policies