Friday morning I had to send an inmate out to the hospital 911. The Dx was acute exacerbation of gallstones.
As an ER nurse, I was not familiar with this inmate, but the yard nurse for his yard was in the ER at the time and explained the inmate's Hx. He was sent out to the hospital 911 two days ago for the same thing and was due for surgery. The inmate signed out AMA because he thought he could, "pee out the stones".
So, as I was prepping him prior to the arrival of the EMTs, I had a chance to advise him that when we (the DOC) send inmates out to the hospital, it's for a pretty good reason and he should think twice and a third time before signing out of the hospital against the doctor's recommendations.
Fast forward to 5:30 PM the same Friday. As I head to the pharmacy to get a stat order so that I can avoid sending a different inmate out to the hospital, I see that a transport vehicle is being inspected in the Sally-port. The officers tell me that they are taking someone back from the hospital. I don't know who it could be, so I ask to see the inmate right then and there and it's the gallstone inmate. The surgeon sent him right back to us because he does not perform surgery on Fridays (and probably because he didn't want to rearrange his schedule for someone who signed out AMA).
When I got back from the pharmacy, the inmate was still in the holding cell waiting to be seen by the doctor (who luckily for the inmate usually stays late to do charting). Since the doctor was the on-call for this weekend, I gave him a report on the inmate and as I clocked out, he was on the phone to the hospital to send him back out AGAIN!!!
As of yesterday by my quitting time, he had not returned.
The take-away is this: inmates and criminals are not for the most part very intelligent and generally very ignorant. So, when we as healthcare providers let someone refuse treatment, let's make sure he understands EXACTLY what he is refusing.
I blame this incident on the doctor/surgeon and the nurses at the hospital for not clarifying for the inmate that he had GALLstones and not KIDNEY stones!!!
May 2, '12
I work as a nurse at a hospital that has the state's contract for DOC inmates. I agree with the need for education!! We recently had an inmate being admitted basically in acute (waiting to be dx as chronic) kidney failure secondary to naproxen use. He was given naproxen as a KOP for back pain, wasn't educated, and was taking it scheduled 3-4 times a day for 2 years. He will be inpatient with us for 4-6 weeks to earn the label of chonic kidney failure, and is already on dialysis MWF. Please please please educate!!!
As an aside, we do get alot of AMA when they realize that they are still on lock down, no tv's, no clocks, and no snacks. Many times if they are told fictously medical info from other inmates ie. peeing out a gallstone, and when they aren't getting the "service" they desire, no amount of teaching can change their minds....
Last edit by MassagetoRN on May 2, '12
: Reason: typos