Plastic Surgery

SUMMARY: In this document, the Bureau of Prisons is proposing revised

regulations concerning the circumstances and procedures under which the

Bureau approves plastic surgery for inmates. The proposed regulations

establish criteria under which plastic surgery may be approved: as a

component of standard medical/surgical treatment, when necessary for

the good order and security of the institution, and in other special

situations as determined by the Medical Director. Additionally, these

regulations have been reorganized to emphasize ``informed consent'' and

to remove unnecessary provisions.

DATES: Comments due by December 19, 1995.

ADDRESSES: Office of General Counsel, Bureau of Prisons, HOLC Room 754,

320 First Street NW., Washington, DC 20534.

FOR FURTHER INFORMATION CONTACT: Roy Nanovic, Office of General

Counsel, Bureau of Prisons, phone (202) 514-6655.

SUPPLEMENTARY INFORMATION: The Bureau of Prisons is proposing to amend

its regulations on plastic surgery (28 CFR part 549, subpart D). A

final rule on this subject was published in the Federal Register on

June 29, 1979 (44 FR 38236).

Under its current regulations on plastic surgery, the Bureau

provides, within available resources, corrective and reconstructive

surgery for an inmate to correct obvious disfigurement. Approval for

such surgery follows when the surgery is indicated for medical reasons

or when it is believed that such surgery will assist the inmate's

institutional or post-release adjustment.

The proposed regulations stipulate in the statement of purpose that

the Bureau ordinarily does not perform plastic surgery on inmates to

correct preexisting disfigurements (including tattoos) on any part of

the body. Plastic surgery may be performed when it is a component of

the presently medically necessary standard of treatment. Plastic

surgery may also be approved under special circumstances: Namely, for

the good order and security of the institution, or when some question

exists as to whether the surgery qualifies as a component of presently

medically necessary standard of treatment. Further revisions to the

regulations include simplification and reorganization of the procedures

for approval and ``informed consent.'' Procedures relating to staff

processing of inmate identification records have been removed and have

been made part of internal instructions to staff.

The Bureau of Prisons has determined that this rule is not a

significant regulatory action for the purpose of E.O. 12866, and

accordingly was not reviewed by the Office of Management and Budget.

After review of the law and regulations, the Director, Bureau of

Prisons has certified that this rule, for the purpose of the Regulatory

Flexibility Act (Pub. L. 96-354), does not have a significant impact on

a substantial number of small entities.

Interested persons may participate in this proposed rulemaking by

submitting data, views, or arguments in writing to the Bureau of

Prisons, 320 First Street NW., HOLC Room 754, Washington, DC 20534.

Comments received during the comment period will be considered before

final action is taken. All comments received remain on file for public

inspection at the above address. The proposed rule may be changed in

light of the comments received. No oral hearings are contemplated.

List of Subjects in 28 CFR Part 549

Prisoners.

Wallace H. Cheney,

Acting Director, Bureau of Prisons.

Accordingly, pursuant to the rulemaking authority vested in the

Attorney General in 5 U.S.C. 552(a) and delegated to the Director,

Bureau of Prisons in 28 CFR 0.96(p), it is proposed to amend part 549

in subchapter C of 28 CFR, chapter V as set forth below.

SUBCHAPTER C--INSTITUTIONAL MANAGEMENT

PART 549--MEDICAL SERVICES

1. The authority citation for 28 CFR part 549 continues to read as

follows:

Authority: 5 U.S.C. 301; 18 U.S.C. 3621, 3622, 3624, 4001, 4005,

4042, 4045, 4081, 4082, (Repealed in part as to offenses committed

on or after November 1, 1987), 4241-4247, 5006-5024 (Repealed

October 12, 1984, as to offenses committed after that date), 5039:

28 U.S.C. 509, 510; 28 CFR 0.95-0.99.

2. Subpart D, consisting of Secs. 549.50 and 549.51, is revised to

consist of Secs. 549.50 through 549.52 as follows:

Subpart D--Plastic Surgery

Sec.

549.50 Purpose and scope.

549.51 Approval procedures.

549.52 Informed consent.

Subpart D--Plastic Surgery

Sec. 549.50 Purpose and scope.

The Bureau of Prisons does not ordinarily perform plastic surgery

on inmates to correct preexisting disfigurements (including tattoos) on

any part of the body. In circumstances where plastic surgery is a

component of a presently medically necessary standard of treatment (for

example, part of the treatment for facial lacerations or for

mastectomies due to cancer) or it is necessary for the good order and

security of the institution, the necessary surgery may be performed.

Sec. 549.51 Approval procedures.

The Clinical Director shall consider individually any request from

an inmate or a BOP medical consultant.

(a) In circumstances where plastic surgery is a component of the

presently medically necessary standard of treatment, the Clinical

Director shall forward the surgery request to the Office of Medical

Designations and Transportation for approval.

(b) If the Clinical Director recommends plastic surgery for the

good order and security of the institution, the request for plastic

surgery authorization will be forwarded to the Warden for initial

approval. The Warden will forward the request through the Regional

Director to the Medical Director. The Medical Director shall have the

final authority to approve or deny this type of plastic surgery

request.

(c) If the Clinical Director is unable to determine whether the

plastic surgery qualifies as a component of presently medically-

necessary standard of treatment, the Clinical Director may forward the

request to the Medical Director for a final determination in accordance

with the provisions of paragraph (b) of this section.

Sec. 549.52 Informed consent.

Approved plastic surgery procedures may not be performed without

the informed consent of the inmate involved.

[FR Doc. 95-25913 Filed 10-19-95; 8:45 am]

BILLING CODE 4410-05-P