Foundational Right to Care
SOP 507.01.01 (Philosophy and Right to Treatment) declares flatly: "Adequate health care is a basic right to which every offender is entitled." It requires that all employees — including contractors — treat offenders "with professional consideration while practicing within the fullest extent of their knowledge and expertise." Clinical encounters must be conducted in private and not observed by security personnel unless the offender poses a documented security risk.
SOP 507.04.07 (Scope of Treatment Services) reinforces this standard by requiring that offenders "receive the full range of treatment services necessary to meet contemporary standards in the community." The ultimate arbiter of what that standard requires is the GDC Statewide Medical Director.
Both SOPs affirm that inability to pay a co-pay cannot be used to deny care. SOP 507.01.01 states: "Needed offender health care is not denied due to the lack of funds. Copay fees are charged to the offenders account until such a time, if ever, funds are available."
Intake: Screening, Orientation, and Initial Assessment
Receiving Screening and Orientation
SOP 507.04.07 states that "all offenders will receive an intake screening, physical assessment, mental health assessment, appropriate lab tests, indicated vaccinations, and infectious disease screening on intake." The mechanics of each element are distributed across several other SOPs.
SOP 507.04.20 (Offender Orientation for Access to Health Services) requires that on the day of arrival at a diagnostic center or permanent facility, each offender receive written orientation materials, followed by a verbal or video orientation within 72 hours. The orientation must cover: sick call; medication administration; chronic care clinics; infirmary care; urgent and emergent care; HIV, hepatitis, other STDs, and TB education; offender health care concerns procedures; co-pay requirements; and the GDC Summary of Healthcare Benefits. The offender must sign an acknowledgment; if they refuse to sign, two staff members must document the refusal. This orientation requirement is cross-referenced in SOP 507.04.27 (Sick Call) and SOP 507.04.07, giving it redundant citation authority.
SOP 507.04.20 also requires that orientation materials be developed for offenders with hearing or vision impairments and language barriers, in collaboration with the Statewide ADA Coordinator.
Health Assessment and Diagnostics
SOP 507.04.21 (Health Assessment and Medical Diagnostics) sets the timeline: a full health assessment must be completed within seven (7) calendar days for offenders and fourteen (14) calendar days for probationers. The initial receiving health screening must occur "as soon as possible upon arrival" and may be performed by a Licensed Health Care Provider, a medical/nursing assistant, or a trained correctional officer.
Upon arrival, offenders are asked to sign a General Consent for Medical Treatment (Form P82-0001.01 English / P82-0001-02 Spanish), which covers non-invasive examinations, procedures, and treatments including physical examinations and vaccinations.
Mental Health Evaluation at Intake
SOP 507.04.50 (Mental Health Evaluations) requires that all inter-system and intra-system transfer offenders receive an initial mental health screening at the time of admission by a Qualified Mental Health Professional. The screening must address: current suicidal ideation; history of suicidal behavior; current psychotropic medications; current mental health complaints; history of inpatient or outpatient treatment; substance use history; and direct observation of general appearance, level of consciousness, and signs of psychosis, depression, anxiety, or aggression.
Periodic Physical Examinations
SOP 507.04.36 (Periodic Physical Examinations) establishes age-based intervals for ongoing examinations: every three years for offenders age 40 and under; every two years for ages 41–50; and annually for offenders over age 50. Examinations must be performed by a physician, physician assistant, or nurse practitioner. Required laboratory studies include a fasting biochemical profile with lipid panel, CBC with differential, and urinalysis. Offenders age 50 and above additionally require a baseline chest X-ray, EKG, fecal occult blood test, and digital rectal exam. Tuberculin Skin Testing (TST) is required annually unless a prior positive is documented.
Sick Call
SOP 507.04.27 (Sick Call) is the primary governing document. It requires that offenders have the opportunity to request non-emergent health services on a daily basis through written Health Service Request forms. Key definitions under this SOP:
- Urgent Referral: the Licensed Health Care Provider will conduct an evaluation within the same day.
- Emergent Referral: the Licensed Health Care Provider will conduct an immediate evaluation.
- Triage: the sorting and classification of health complaints to determine priority of need.
Access to sick call must be provided regardless of ability to pay, though co-pay charges may be assessed. SOP 507.04.05 (Charges to Offender Accounts) sets the standard co-pay at $5.00 per visit for self-initiated visits (not emergencies, not chronic care). Co-pays cannot be deducted when an offender's account balance is $10.00 or less. Transitional center offenders are charged $10.00, per SOP 507.04.02.
For offenders in restrictive housing, SOP 507.04.27 and SOP 507.04.33 (Health Evaluation of Offenders in Restrictive Housing) together require daily health care rounds by medical staff. SOP 507.04.33 specifies that upon placement in restrictive housing, the correctional officer must immediately notify a licensed health care provider, who must review the health record for medications, ongoing medical conditions, mental health history, and any contraindications to placement. A medical assessment must be completed within 24 hours of placement at facilities without 24-hour medical coverage. SOP 507.04.33 explicitly states that offenders in restrictive housing retain "equivalent access to medical, dental, and psychiatric services as general population inmates."
Chronic Care
SOP 507.04.07 identifies "Chronic Clinic Care" as a distinct required service: "Evaluation and rendering appropriate care for an offender with a chronic illness as defined by chronic care clinic protocols." Chronic illness is defined in SOP 507.04.05 as "any condition that requires periodic monitoring and treatment in order to prevent deterioration of health, minimize pain and maintain activities of daily living," encompassing hypertension, cancer, diabetes, pulmonary conditions, seizure disorders, HIV, TB infection, Hepatitis C, rheumatoid arthritis, renal disease, Crohn's disease, and joint disorders with objective data.
SOP 507.04.02 (Transitional Center Health Services) requires that chronic illness clinics be provided through on-site or regional catchment services, with routine physicals and chronic illness clinic visits due within three months of arrival scheduled within 30 days of arrival at a transitional center.
Specialty Referrals and Utilization Management
SOP 507.04.07 requires that "all offenders requiring subspecialty consultation will receive those services either locally or through ASMP." The requirement for subspecialty services is determined by the Utilization Management (UM) Office, or by the GDC Statewide Medical Director in disputed cases.
SOP 507.04.16 (Utilization Management) defines UM as "a prospective evaluation of the appropriateness, medical need, and efficiency of health care services." UM staff — licensed nurses called Nurse Analysts — conduct prospective, concurrent, and retrospective reviews of hospital admissions, emergency room visits, specialty consultations, and medical bed space usage. UM is available 24 hours per day; after business hours, an on-call UM Nurse Analyst provides coverage (on-call phone: 404-863-3079, per SOP 507.04.16).
SOP 507.04.14 (ASMP Medical Bed Space) establishes Augusta State Medical Prison as the system's primary acute care and specialty inpatient facility. External admissions are coordinated through the ASMP Medical Director. If the ASMP Medical Director and site Medical Director cannot agree on the appropriateness of an admission, the matter escalates to the Contract Vendor Statewide Medical Director, and ultimately to the GDC Statewide Medical Director for final disposition.
Refusal of Treatment
SOP 507.04.86 (Right to Refuse Treatment) governs refusals comprehensively. Offenders have the right to refuse health treatment and care. Any refusal must be documented and must include: a description of the service being refused; evidence the offender was informed of adverse health consequences; the offender's signature; a health care staff witness signature; and, for medication refusals, a notation on the Medication Administration Record (MAR).
The SOP distinguishes two categories:
- Non-serious medical conditions: Offenders may refuse on a case-by-case basis after the clinician explains nature, benefits, and risks. Blanket refusals for all treatment are not permitted.
- Serious medical conditions (those for which non-treatment "may result in irreversible loss of life, limb, or function"): The clinician must counsel the offender about the consequences and document the counseling in progress notes. If the offender still refuses, a formal refusal form is completed. If the clinician questions the offender's competency as a "Competent Adult," a referral to mental health is required. If the offender refuses to sign the form, the clinician writes "patient refuses to sign" and a second witness also signs.
High-risk medication refusals (e.g., insulin, antiretrovirals, TB medications, anticoagulants, and mental health medications for Level 3/4 patients) are addressed in SOP 507.04.45 (Nonadherence with Medications), which defines nonadherence thresholds — missing one or more doses in a seven-day period for high-risk medications — and requires immediate escort to the medical section for counseling and re-offer of medication.
Psychotropic medications carry a specific prohibition against use for disciplinary purposes under SOP 508.24, which also requires informed consent in a language understood by the offender before initiation of any psychiatric medication.
Clinical Standards: Who May Give Orders and How
SOP 507.04.30 (Direct Orders) requires that all treatment be performed pursuant to verbal or written orders signed by personnel authorized by law. All orders must be documented in the physician's orders section of the health record with date and time. Verbal or telephone orders must be signed by the clinician within five days. STAT and "Now" orders must be transcribed immediately by the receiving nurse.
SOP 507.04.32 (Transcription of Medical Orders) requires routine medication orders to be transcribed within eight hours (four hours at ASMP inpatient units and infirmaries). STAT orders must be transcribed immediately.
SOP 507.04.31 (Nursing Protocols) requires that all nursing protocols be written by the contract vendor, approved and signed by the GDC Statewide Medical Director, and reviewed at least annually. Nursing protocols may not direct the use of prescription (legend) medications except in emergency, life-threatening situations — and only nurses who are ACLS-certified and have an order from an advanced clinical provider may initiate emergency drug protocols. Standing orders are explicitly prohibited in all GDC facilities.
SOP 507.03.08 (Nurse Practitioner or Physician's Assistant Practice) defines the scope of practice for NPs and PAs, who function under collaborative practice agreements or physician-delegated job descriptions. NPs may write orders under jointly signed protocols without physician countersignature; PAs require physician delegation in a job description approved by the Georgia Board of Medical Examiners.
SOP 507.01.02 (Medical Autonomy) establishes that all clinical decisions "shall not be compromised for security reasons." If conflicts between security requirements and medical management cannot be resolved at the facility level, the matter escalates to the GDC Statewide Medical Director or Assistant Commissioner for Health Services for final resolution.
Continuing Education Requirements for Health Staff
SOP 507.03.10 (Continuing Education for Qualified Health Services Personnel) requires all qualified health services personnel to complete 40 hours of annual training, including CPR/BLS with AED, facility security training, and all licensure-required continuing education units. Each facility medical unit must maintain a medical library including, at minimum: a current medical dictionary, Physician's Desk Reference, pharmacology reference, nursing reference textbooks, and the NCCHC Standards for Health Services in Prisons.
Patient Tracking Systems
SOP 507.04.04 (Patient Tracking Systems) requires each facility to maintain 17 mandatory logs covering: diagnostic intake, intra-system transfers, annual physical examinations, PPD tracking, chronic illness clinic visits, sick call encounters (separately for general population and restrictive housing), consultations, urgent/emergent encounters, infirmary stays, and health care grievances. Logs must be retained for a minimum of three years. Computerized systems may substitute for paper logs if they produce equivalent output.