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BOP Medical CARE LEVELS I-IV 

Federal PSR / Sentencing Preparation 

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I.              Medical CARE LEVELS I-IV

How and where inmates are placed according to their medical and mental healthcare needs is via the BOP’s CARE LEVEL I-IV structure.

Medical CARE LEVEL I [under 70, healthy, needing limited to no medical contact].

• • Inmates are generally healthy but may have limited medical needs that can be easily managed by clinician evaluations every 6 months and are located approximately one hour or more from community medical centers.
  • Inmates are less than 70 years of age.
  • Examples: mild asthma or diet-controlled diabetes not requiring medications.
    • FCI Manchester, Medium [Includes Satellite Camp], KY.
    • FCI Three Rivers, Medium [Includes Satellite], TX.
    • FCI Bennettsville, Medium [Includes: Satellite Camp], SC.
    • FCI Williamsburg, Medium [Includes Satellite Camp], SC.
    • FCI Herlong Medium [Includes Satellite Camp], CA.
    • FPC Yankton, SD.
    • FCI McKean, Medium [Includes Satellite Camp], PA.
    • USP Atwater, [Includes Satellite Camp], CA.
    • FCI Oxford Medium [Includes Satellite], WI.
    • USP Big Sandy, [Includes Satellite Camp], KY.
    • FCI Ray Brook,[Includes Detention Ctr], NY.
    • USP Lee,[Includes Satellite Camp], VA.
    • FCI Safford ‘Low’, AZ.
    • USP Pollock,[Includes Satellite Camp], LA.
    • FCI Sandstone Low, MN.
    • USP Yazoo City, Yazoo City FCC[Low-Med] MS.

 

Medical CARE LEVEL II – the majority of BOP facilities, overall healthy with routine medical visits.

• • Inmates are stable outpatients who require at least quarterly clinician evaluations and are located within one hour of major regional medical centers.
  • Can be managed in chronic care clinics, including mental healthcare issues.
  • Examples: medication-controlled diabetes, epilepsy, and emphysema.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

Example of CARE LEVEL III Requirements

e.g.: Psychiatric Outpatients, Unable to perform their Activities of Daily Living (ADL)

Example of CARE LEVEL IV Requirements

e.g.: Dialysis, or needing inpatient hospital care; 24/7

Medical CARE LEVEL III – outpatient care or unable to perform ADL.

• • Inmates are fragile outpatients who require frequent clinical contact to prevent re-hospitalization and may be located within Level IV institutions.
  • May require assistance with activities of daily living, but does not need daily nursing care.
  • Examples: cancer in remission of less than a year, advanced HIV disease, severe mental illness in remission and on medication, severe congestive heart failure, and end-stage liver disease.
  • The designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).
    • FCC Butner (other than Low, FMC) NC.
    • USP Terre Haute (Minimum, Medium & High) IA.
    • USP Tucson FCC (Female); AZ.
    • FCI Terminal Island (Low) CA.
    • FCI, Med, USP: Allenwood, Pa.
    • FCI Tucson,[Medium w/Detention Ctr] AZ.

Medical CARE LEVEL IV – Hospitalization required

• • Functioning is severely impaired.
  • Requires 24-hour skilled nursing care or assistance.
  • Examples: cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical patients, acute psychiatric illness requiring inpatient treatment, and high-risk pregnancy.
  • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels, including both violent and non-violent offenders.
  • There are seven Federal Medical Centers (A brief overview)
    • FMC Butner (North Carolina); the cancer center for the BOP, provides inpatient mental healthcare and houses all security levels.
    • FMC Carswell (Texas); is the only facility just for women.
    • FMC Devens (Massachusetts); provides dialysis, one of several facilities that provide a residential sex offender program, along with inpatient mental healthcare.
    • FMC Forth Worth (Texas)
    • FMC Lexington (Kentucky); for lower security inmates.
    • FMC Rochester (Minnesota); contracted with the Mayo Clinic providing all levels of complex medical care along with inpatient mental healthcare.

Plus FMC, Springfield (Missouri), a higher security facility provides; dialysis, and inpatient mental healthcare services.

II         Mental Healthcare (MH) – CARE LEVELS I-IV

(Location Levels I-IV are the same as above)

Unfortunately, in general, the BOP is not equipped to provide any meaningful treatment for the following underlying disorders, several examples:

□ Post-traumatic stress disorder

□ Major depressive

□ Bipolar

□ (Eye Movement Desensitization and Reprocessing) for treatment of PTSD is not available.

As medical staffing differs from one facility to another, and if the care by chance is available within the BOP; this may necessitate a transfer to a facility further away from their home.

MH CARE LEVEL I – under 70, healthy with limited medical visits

• • No Remarkable Issues, no significant level of functional impairment.
  • No history of regular Mental Illness Interventions, seeking help should there be a returning episode.

MH CARE LEVEL II – the majority of BOP facilities, overall healthy with routine medical visits

• • ‘Routine and/or Infrequent Crisis Oriented Outpatient’ Care.
  • Treatments are controlled with medication.
  • May require a suicide watch or brief observation.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

MH CARE LEVEL III – outpatient care, not able to perform ADL.

• • ‘More Severe Outpatient’ or Residential Mental Healthcare.
  • May require weekly mental healthcare visits or Residential Psychology Treatments.

MH CARE LEVEL IV – Hospitalization required

• • ‘Inpatient’ Psychiatrist Monitored, include those who are:
    • Gravely disabled and cannot function in the general population as in MH Care Level III.
    • Has a current or recent historical need for inpatient psychiatric care.
    • Requires psychotropic medication control may require MH Care Level IV.
    • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels that include both violent and non-violent offenders.

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UpToDate – What are the links between violence and mental illness? 

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