Dangers of Labeling Inmates - Stories Sought

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    :typing I'm developing an inservice program for correctional nurses about the dangers of 'labeling' inmates. For example, always assuming that the inmate is 'faking' the health issue (although we know that many times this is true!). If a nurses do this one time too many it could lead to a case of negligence or even malpractice.

    I was wondering if any of you have any stories to tell about times when a 'faker' turned out to be a real issue and how you dealt with it.

    Appreciate your comments and thoughts on this issue.

    Lorry

    PS - I will only be using the information from this thread very generally and not refer to any specifics in the inservice
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  4. 29 Comments so far...

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    I have had a few incidents in which I was convinced the inmate was faking BUT thankfully I followed through with immediate MD eval. or telemed but I still felt very bad for thinking that the inmate was faking.
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    Thanks, Steri: What kinds of things seem to be the most common 'fakings'? From my experience, seizures and chest pain come to mind. But I'm not sure that is the theme everywhere...
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    I often feel like they are faking but I ALWAYS treat the problem as if they are not faking unless I feel very sure and have something to chart that will back me up. With any head injury, we ask them if they had a loss of consciousness. They almost always say yes. The arresting officer will say they witnessed the entire incident and that the inmate was conscious the entire time. First of all, is that officer going to stand up for me in court? Heck no! So we have to go by what the inmate says. He may not even have a bump on his head or a scratch, but it's best to play it safe.
    We have had incidents, but I don't want to mention them specifically.
    In one incident the nurse said "he's just drug-seeking" and he turned out to be very sick.
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    Yes, seizures and chest pain seem to be the most common types of things to "fake". Then there's my LOC story, above.
    I have never once seen a legitimate seizure from Opiate withdrawal, but many of them say they have seizures due to Heroin withdrawal.
    I find that a lot of Methamphetamine addicts will say they have asthma....I'm not saying for sure, but it seems so prevalent that I am beginning to wonder if the little surge that Albuterol gives you is better than nothing. Often they don't even know the name of their inhaler. What asthmatic doesn't know "Albuterol"?
    Ok, I suppose it's possible. But they do see the MD, and they end up getting their inhaler prescribed. It's not for me to say.
    I once referred a totally obviously fake seizure to the MD. I documented what I saw...the failed hand drop test, the flailing, the lack of a post-ictal state. The MD prescribed Dilantin.
    What can you do? There will always be people who abuse the system. For a while I wanted to catch them all, but you can't. You just do the best you can. Your license is the most important thing.
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    I would be very cautious about posting about specific incidents as we all know the internet is NOT private.
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    Truegem: Thanks for the insights and examples. It is so true! In the end, you have to document and respond to the inmate complaint, even though obviously fabricated. And...I wish we could count on our custody colleagues, but they aren't the medical professional, so it can't be the basis for the treatment decision. Correctional nurses have some special ethical situations, don't we?

    Appreciate your candid observations!
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    We treat every report as if it is the absolute truth - even in cases in which we are virtually certain that it isn't. You could easily get into trouble by dismissing a complaint as faking or exaggerating. The inmate may have done the same thing 20 times, but on time #21 it might be the real thing. Ignore it and you could find yourself on the witness stand explaining why you failed to act. That is why we tell our correctional officers not to even try to determine whether an inmate's medical complaint is legitimate.
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    I always assess and treat the same way, regardless of whether or not I think it's faked. I may be very short or even downright rude at times with frequent flyers, but I always do the same assessment that I would do on someone with an unknown history.

    Having said that, I have witnessed a number of incidents where a handful of other nurses do not do the same.

    Had one incident where an inmate was assaulted by a number of other inmates. This particular inmate was known for being very obnoxious. The inmate was brought to medical, very agitated, yelling, cursing (but not cursing at the CO's or medical staff, just being generally P.O.'d). Without even doing a set of vitals, the charge nurse in the clinic stated that the inmate was refusing medical care because of his attitude. As a side note, I'd be pretty angry myself if I'd just been assaulted. Also, the inmate never actually refused. He was just being uncooperative.

    So, she sent him back to his cell without assessing him. One of the officers asked me if I would assess him. I was working in the pill room with no equipment, just pills. I advised him that I could not assess the patient, but that the patient NEEDED to be assessed because of the assault, and if the charge nurse continued to refuse, the CO should contact his shift commander. At the time, because I was fairly new to the facility, I didn't feel comfortable going over the charge nurse's head.

    Fortunately, the officer was persistent and got the shift commander involved. It blew up into a huge deal and the inmate was finally assessed by another nurse in the clinic.

    It turned out that the inmate had been shanked in the back and his lung had been penetrated (according to the hospital he was sent to). If he had been left alone in his cell for the rest of the evening, he probably would have died.
    talaxandra likes this.
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    Oh my gosh, DonaldJ, that is scary.

    Most of the time, the inmates vital signs will direct me as to whether something is being faked or real but, I always assess and treat like the complaint is real even if I think the inmate is faking it. I had an inmate once that passed out getting back to his bed and and the PCT thought he was faking it. He had a long history of faking and lying so I went right to the arm drop and his arm went smack right on his forehead. Turns out he was over diuresed and needed IV fluids (BP was 60's systolic). Simple things can make to difference when determining whether something can be treated.

    One tip I learned early on from a seasoned correctional nurse...Whenever and inmate complains about something medical or requests something, always do something to investigate whether the complaint needs treatment such as taking a set of vitals, doing an assessment etc. It is a lot harder to defend why you did not treat a complaint or request when the only thing you did was say the words "no"


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