Dental Services – Mission Complex (Mission Medium Institution and Mission Minimum Institution)

1. Introduction:

   1.1 The Correctional Service Canada (CSC), Health Services requires Dental services for Mission Medium Institution, Mission Minimum Institution, and Kwìkwèxwelhp Healing Village in the Pacific Region. The Contractor must provide Dental services to inmates in collaboration with the institution’s multi-disciplinary health services team that includes but is not limited to, Nurses, Institutional Physicians, Psychologists, Dieticians and other allied health professionals.

2. Background:

2.1 CSC has a legal obligation, under the Corrections and Conditional Release Act (CCRA), to “provide every inmate with essential health care and reasonable access to non essential mental health care”.

2.2 The Commissioner’s Directives 800 series are the key references on essential health services covering Clinical services, mental health and public health services.

2.3 The mission of Health Services is to provide offenders with efficient and effective health services that encourages individual responsibility, promotes healthy reintegration and contributes to safe communities.

2.4 Consistent with its transformation agenda, CSC recognizes that health outcomes are a shared responsibility between service providers and inmates. Inmates must be involved in taking responsibility and proactive measures to safeguard their health, which includes dental health.

2.5 Health Services are provided in ambulatory Health Service Centres in institutions, regional hospitals and regional treatment / psychiatric centres. Inmates may have to go to the community for emergency services, specialized health care services and for hospitalization that cannot be accommodated in CSC’s regional hospitals. In CSC, health care is provided by a wide range of regulated and non-regulated health professionals.

2.6 In broad terms health care means medical, dental, mental health care and public health services. During the period of incarceration, inmates are provided with a range of coordinated health services that are accessible, affordable, and appropriate to the correctional environment.

1. Objective:
   1. Provide and coordinate essential dental services to inmates at Provide and coordinate essential dental services to inmates at Mission Medium Institution and Mission Minimum Institution (including Kwìkwèxwelhp) offenders, that will attend the clinic at Mission Minimum).
2. Performance Standards:

4.1 The Contractor must provide dental services that respect gender, cultural, religious and linguistic differences, and are responsive to the special needs of women and Aboriginal people.

4.2 Dental Care:

The Contractor must provide primary dental care, including x-rays and health promotion, to inmates that complies with relevant federal legislation, provincial standards and CSC policies and guidelines.

4.3 Compliance with provincial/national dental guidelines.

The Contractor is expected to consult with the Chief Health Services to ensure that dental practices are consistent with the relevant and most current legislation and practice standards.

4.4 The following is a list of key relevant legislation and CSC Policy/Guidelines but should not be considered an exhaustive list. CSC's policies and guidelines can be found on the CSC internet website at www.CSC-SCC.GC.ca or available in hard copy.

• Corrections and Conditional Release Act - Section 85 Health Care
• Commissioner’s Directive 800, Health Services
• Guidelines 800-1 Hunger Strike: Managing an Inmate’s Health
• Commissioner’s Directive 803, Consent to Health Service Assessment, Treatment and Release of Information
• Commissioner’s Directive 805, Management of Medication
• Commissioner’s Directive 821, Management of Infectious Diseases
• Protocol 821-1, Post Exposure Protocol (PEP) and Managing Significant Exposure to Blood and/or Body Fluids
• Commissioner’s Directive 835, Health Care Records
• Commissioner’s Directive 840, Psychological Services
• Commissioner’s Directive 843, Management of Inmate Self-Injurious and Suicidal Behaviour
• Commissioner’s Directive 850, Mental Health Services
• National Essential Health Services Framework
• Emergency Medical Directives
• CSC’s Sterilization Quality Assurance Program in Health Facilities
• National Formulary
• Clozapine Protocol
• Medication Reconciliation Guidelines
• Neurontin (Gabapentin) Protocol
• Procedures to Obtain Nutritional Supplements
• Managing Medication Events Guidelines
• Documentation for Health Services Professionals
• Abbreviations for Health Services
• Guidelines for Sharing Personal Health Information
• Tuberculosis Prevention and Control Guidelines for Federal Correctional Institutions
• Canadian Tuberculosis Standards (6^th Edition)
• Management of Viral Hepatitis Guidelines
• CSC Sexually Transmitted Infections Clinical Practice Guidelines
• Health Canada – Canadian Guidelines on Sexually Transmitted Infections
• Discharge Planning Guidelines: A Client Centred Approach
• Clinical Discharge Planning and Community Integration Service Guidelines
• Institutional Mental Health Services (Primary Care) Guidelines
• Accreditation Standards and Required Organization Practices

4.5 Documentation on CSC Dental Records:

a) The Contractor must document all dental care in the inmate’s Dental Record Folder in compliance with relevant legislation, professional standards of practice and CSC’s Documentation for Health Services Professionals guidelines. 

b) As an accountability and quality assurance measure, the Chief, Health Services will periodically review the Contractor's documentation for quality, consistency and completeness.

c) All of the inmates’ Dental records must remain at the institution.

5. Tasks:

5.1   The Contractor must provide essential Dental services to inmates, as requested by the Chief Health Services, in accordance with the National Essential Health Services Framework, including any amendment to this Framework issued by CSC during the contract period and any optional period if and when exercised by CSC.

5.2   The Contractor must prepare dental clinic lists and appointment schedules triaged based on requisitions received and dental emergencies as they arise.

5.3   The Contractor, in their role as dentist, must manage all aspects of dental care services including coordination of care provided by dental specialists to inmates to ensure continuity and integration of care. This includes, but is not limited to, approval of all recommendations made by dental care providers outside of CSC.

5.4   The Contractor must document dental assessment, treatment, and consultations in the inmate’s Dental Record Folder.

5.5   The Contractor must consult with the Chief Health Services regarding requirements for dental supplies and equipment. Any requests for equipment and supplies must be submitted to, and approved by, the Chief Health Services.

5.6   The Contractor must provide the following:

a) A Dental Assistant; and,

b) Backup personnel to ensure that there will not be any interruption in service and that Canada’s operational requirements are met when the Contractor is unable to provide services (including but not limited to, due to vacation or illness).

5.7   The Contractor must supervise the activities of the Dental Assistants the Contractor is providing under this contract. 

5.8   The tasks the Dental Assistants must perform include, but are not limited to the following:

1. Preparing the treatment/clinical area;
2. Cleaning and sterilization of instruments and hand pieces;
3. Passing instruments to the dentist or hygienist (Single and Two handed technique);
4. Making proper use of High Volume Evacuator within the Oral Cavity;
5. Preparing restorative materials;
6. Performing simple laboratory procedures such as the pouring and trimming of study models;
7. Maintaining supplies and equipment (stocks and replenishes supplies provided by CSC);
8. Monitoring Inventory of dental supplies and equipment;
9. Assessing emergency situations, being aware of, and able to implement, emergency protocols, being able to provide First Aid and CPR;
10. Assisting in maintaining emergency drug kits;
11. Interpreting Material Safety Data Sheets;
12. Conducting spore/biological indicator tests;
13. Recording data on patient’s record or chart as directed by the Dentist;
14. Providing inmate education on oral health (extra-oral);
15. Providing instruction on care and maintenance of pre-fitted appliances; and
16. Obtaining Vital Signs.

5.9   The Contractor must ensure that dental instrument sterilization is done only by dental staff that is trained according to Provincial sterilization standards.

5.10 Recommendations for Non-formulary medication and Special Authorization Items:

a) The Contractor must ensure that:

i) Requests for non-formulary medications are made in accordance with CSC’s National Formulary.

ii) Requests for Special Authorization items that are being recommended by the Contractor are made in accordance with CSC’s Essential Health Services Framework.

6. Grievance and Investigation Processes:

6.1 The Contractor must participate in various CSC internal inmate grievance/investigation processes which may include a review of the Contractor's documentation on the Health Care Records. Upon request from the Chief, Health Services, the Contractor may have to undergo interviews as a result of an inmate grievance/investigation process.

7. Services related to the provision of Health Services in CSC:

7.1 The Contractor must have knowledge of and provide input into CSC’s Accreditation Standards,  Required Organizational Practices and other CSC quality improvement/assurance initiatives.

8. Licensing and Notification Requirements:

8.1 The Contractor must be licensed to practice dentistry in the province of British Columbia for the duration of the contract.

8.2   The Contractor must notify the Chief, Health Services of any issues that may call into question the competency of the Contractor and/or Contractor's resources and any restrictions imposed by the licensing body affecting the Contractor's and/or or Contractor's resources ability to provide dental services to inmates.

8.3 The Contractor must notify the Chief, Health Services immediately of any significant complaints lodged against the Contractor and/or or Contractor's resources.

9. Security:

9.1 All equipment including communication devices the Contractor wishes to bring into the Institution must be approved by the Chief Health Services and CSC Security in advance.

9.2 As a visitor to a CSC correctional institution, the Contractor will be subject to local security requirements that can vary from moment to moment depending on inmate activities. The Contractor may be faced with delay or refusal of entry to certain areas at certain times although prior arrangements for access may have been made.

10. Language of Work:

10.1 The work must be performed in English.

11. Hours of work:

11.1  The Contractor must provide inmate care during clinics held at Mission Medium Institution and Mission Minimum Institution, up to a maximum of thirty-eight (38) hours per month.

11.2  In the event of an unexpected delay or cancellation of the clinic the Contractor will be paid an one hour charge calculated from the time the clinic was scheduled to begin.

11.3  In case of delays, the Chief Health Services reserves the right to cancel the remainder of the clinic at no additional cost to CSC.

11.4  The Chief, Health Services may, at their discretion, change the clinic schedule and number of hours per week during the course of the contract, including any options if and when exercised by CSC.

11.5  The Chief Health Services will notify the Contractor of any changes to clinic schedules a minimum of one week prior to implementation of the change.

12. Meetings:

12.1  At the discretion of the Chief Health Services, there will be an initial meeting at the beginning of the contract to finalize the scope of services to be provided under the contract.

12.2  At the request of the Chief, Health Services, the Contractor must attend meetings at Pacific Regional Headquarters.

12.3  The Contractor must attend Institutional Health Services team meetings when requested by the Chief, Health Services. The Contractor may be requested to attend meetings once per quarter. The Contractor may bill time spent attending meetings at 75% of the firm hourly rate.

13. Reporting Requirements:

13.1  As part of an effective ongoing oversight mechanism to ensure accountability, consistency, cost effectiveness and best practices specific to the needs of CSC’s population, the Contractor must provide procedure information to the Chief Health Services once a month.

13.2  At the request of the Chief, Health Services, the Contractor must produce or contribute to regional reporting.

14. Constraints:

14.1 Working within a correctional institutional environment:

a) In a Correctional Environment there is the possibility of diversion of high abuse potential medications and for security reasons there are restrictions with respect to prescribing that may not exist in the community. Issues surrounding potential diversion, high abuse potential of narcotics and other security issues may occur in CSC Institutions.

b) While the expectation is that dental practices are generally consistent with community practice, because the care provided as part of this contract is within a prison setting, there are some limitations with respect to practice. CSC policy and guidelines are developed in order to provide direction to health care professions regarding these limitations.

15. Support to the Contractor:

15.1 CSC will provide the supplies and equipment required for dental services to inmates.