Inmate X has charges of XYZ. At another jail, this inmate was allowed a kind of informal undeclared PC status because there were multiple assaults and threats to the inmate's life. When he went to a different facility, they sent him to a GP unit and began treating him as such. He was assaulted the first day he was on the compound, and so was sent to a seg unit. Since then, this Inmate states unable to care for self. Urinates on himself and refuses to do any self care. Refuses to feed himself or do more than defecate in the toilet. Security ignores him, except to hose him down every now and then, and he does not complain to the nurse during any tier rounds. Inmate eventually Brought to medical because of the stench and psych referral. Admitted into infirmary. For three weeks inmate is not bathed or helped feed himself because the Medical Director says there is nothing wrong with him. No condom catheter care is performed. Then nurse T comes along, she is only there every couple of weeks and so has not had to deal with this inmate yet. She refuses to be denied. She forces CNA M to help clean Inmate X ( That is another story). The two of them lift X into a shower chair, where RN T procedes to begin removing X's diaper and cath. The cath will not unroll properly because of the hair that is caught in the cath roll, so she pulls it from X's penis. CNA M is not doing much beyond saying ewww yuck at this point. RN T pushes X into the shower and turns on the water. She douses X with antibacterial soap, and scrubs him roughly all over. Then she rinses him and pours straight hibicleanse over the areas that are still not coming clean, and washes him again. She then rinses him and he is still not clean of the dried urine, feces and food matierial that is stuck in his beard and hair and to his skin, so she takes another wash cloth and washed him yet again with regular soap. RN T argues with the inmate through out the showering that he can do things for himself if only he will try. RN T appeared to me to be trying to provoke X into doing something for himself. She pushed him upright by the back of his neck using just her one hand. She must not have been holding on because he went too far forward and bumped his head on the shower wall. She apologized, but he said he wasn't hurt. She pulled up his arms and found a HUGE yeast infection. He yelled about having his arms brought above his head. Said no one had done any kind of range of motion with him. Ever. RN T finishes shower and goes to clean his perianal area. she suggests that the area may need trimmed or shaved because of the condom cath not being on properly and not being taken care of properly. When she goes to wash his penis, she finds an area on the underside of his penis that is about the size of a quarter that is into the meat of the inmate's penis. It appears to have a lot of skin cells built up around it. RN T says she would like to see the inmate have an indwelling catheter and calls the MD who says, no, this inmate is able to care for himself and it would be for convinence only. The next day the inmate was discharged to the Special Observation housing unit in preparation for movement back to the seg unit. In the SOH unit, the officers are once again hosing the inmate down and mostly ignoring the inmate.
So, this situation presents lots of ethical delimmas. I could sure use some input. Anyone have any thoughts on this one?