Medical Observation Order Destroyed By Sympathetic Guard

  1. THERE'S NOTHING I CAN DO ABOUT IT SINCE IT CAN'T BE PROVED, BUT HERE'S THE STORY. I FLY SOLO AT THE COUNTY JAIL AND WE ARE DOC HOLDING. THE MINUTE AN INMATE IS SENTENCED, THEY START IN WITH THE MEDICAL REQUESTS " I WANT MY PSYCH MEDS AND I'M DOC SO I KNOW YOU HAVE TO GIVE IT TO ME, AND IF YOU DON'T I'M CALLING MY LAWYER" EVEN THOUGH THE INMATE HAS BEEN THERE FOR SIX MONTHS AND HEALTHY AS A HORSE, OR " I AM DOC AND I WANT TO GO TO THE DENTIST NOW". I HAD THIS INMATE SNED ME A REQUEST WANTING TO GO TO THE DENTIST. I EXAMINED HIS MOUTH. HE HAD PRETTY GOOD TEETH AND A VERY SMALL CHIP OFF THE CORNER OF A MOLAR. NO INFECTION OR ANYTHING ELSE. I ADVISED HIM THAT DOC WILL NOT PAY FOR RESTORATIVE WORK. I HAVE OTHERS WHO HAVE TEETH ROTTED TO THE GUM LINE AND THEY ARE PRIORITY AS THIS POSES A HEALTH RISK. REPARING CHIPPED TOOTH WOULD BE CONSIDERED DESIRE NOT NEED. SO FOR THE NEXT WEEK HE COMPLAINS TO ANYONE WHO WIL LISTEN THAT HE IS BEING MEDICALLY NEGLECTED, HE CALLS HIS MOTHER, WRITES A GRIEVANCE TO DOC, THREATENS ME WITH A LAW SUIT. THE USUAL. SO JUST IN CASE I MISSED SOMETHING, I HAVE HIM BROUGHT TO HOLDING FOR NUTRITIONAL INTAKE MONITORING AS WELL AS FOR JAW SWELLING OR INCREASED PAIN FOR 4 DAYS. THE OFFICERS ARE TO FILL THIS PAPERWORK OUT AND TURN IT IN. I GOT WORD FROM ANOTHER OFFICER ON DAY TWO THAT A FEMALE OFFICER ON NIGHTS WAS MAD AND SAID " SO THE NURSE PUNISHES HIM FOR BEING SICK". WELL, THE INMATE ATE ALL HIS MEALS AND DID NOT SHOW ANY SIGNS OF HAVING ANY REAL PROBLEMS FROM HIS LITTLE CHIP IN HIS TOOTH. THE OBSERVATION TOOK PLACE OVER A WEEKEND AND MONDAY THE PAPERWORK THAT HAD BEEN IN BOOKING WAS MISSING. THIS HAS NEVER HAPPENED BEFOR. THE SERGENT TOLD ME HE WAS SURE THE PAPERWORK WAS DESTROYED BY THIS GIRL BUT COULD NOT PROVE IT. I DID ADVISE THE COMMANDER WHO INVESTIGATED BUT IT DIDN'T REALLY GO ANYWHERE. THIS REALLY BURNS ME. SO NOW THIS INMATES SAYS HE IS NOT ABLE TO EAT AND I HAVE NO PROOF THAT HE CAN EXCEPT VERBALS FROM THE OFFICERS WHO MONITORED HIM. WELL I TOLD THE DOCTOR WHAT HAPPENED AND WE HAVE TO SEND HIM TO THE DENTIST NOW. THE LAST TIME I SENT SOMEONE WHO WAS SCREAMING IN PAIN, THE DENTIST DIDN'T DO ANYTHING, THE KID HAD NOTHING WRONG. IT IS UPSETTING THAT MEDICAL PAPERWORK CAN BE DESTROYED LIKE THAT. ANYWAY, I DECIDED I HAVE NO CHOICE IN THE FUTURE BUT SEND ANY INMATE WHO WANTS TO GO. LET SOMEONE ELSE DEAL WITH IT. I'VE ONLY BEEN IN CORRECTIONS JUST UNDER 2 YRS. ANY SUGGESTIONS AS TO HOW I CAN HANDLE THIS TYPE OF SITUATION IN THE FUTURE? I HAVE A REAL GOOD RELATIONSHIP WITH ALL THE OFFICERS AND WE HAVE EACH OTHERS' BACKS, SO TO SPEAK. BUT IF THERE IS ONE SYMPATHETIC GUARD IN 20, WHAT ELSE MIGHT SHE BE WILLING TO DO? HER MENTALITY IS THIS, SHE USED TO BE AN EMT A LONG TIME AGO AND LET HER LICENSE GO. SHE THINKS SHE'S A NURSE. THANK YOU FOR ANY HELP. I KNOW THIS WAS LONG BUT I NEEDED TO VENT.
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  2. 11 Comments

  3. by   SFCardiacRN
    All you can do is document your observations and assessments. If you are worried about being sued by clever criminals, get a new job.
  4. by   nurseT
    Thanks for the support. The inmates don't scare me, they always say they're going to sue. I tell them to call their lawyer. I've learned in my lifetime that if you always do the right thing, then you never have to worry. But a sympathetic guard helping the inmate. That did bother me.
  5. by   SFCardiacRN
    I have an RN friend that does correctional care and he loves it. Just look out for that guard. She sounds like she has become "institutionalized"!
  6. by   crjnursewarrior
    nurseT,
    If I were in your place, I would confront this female officer. I would make it very clear to her that her job is SECURITY and that you will run the medical dept. Like you and the officers at your facility, we work very closely with our officers...and we "have each other's backs". Well, apparently this female officer does not realize what this means. It sounds like you may need to explain it to her. Also it seems like she may need a lesson in "WANTS VS. NEEDS"....keep your eye open and continue to report anything she does that seems suspect to you. Like you said, if she is taking up for him, what else is she doing? Obviously, if this inmate needed immediate treatment, you would have given it to him. He is in NO way being neglected, from the scenario you have described. SHe may be an "inmate lover"...and you and I both know that they don't make very good correctional officers OR nurses...and many times they end up losing their job over it or being prosecuted themselves for illegal activity with these inmates! Keep your eyes/ears open and document everything. Who knows what else she may try to pull!:angryfire
  7. by   nurseT
    Hi, thanks for the support. I did have to report the incident to the commander. It turns out He had a meeting with her and she admitted to verbalizing her feelings in front of the inmates, but denied doing anything to the observation order. He told her she could "Feel any way you like" but one more incident like that and she would have to look for a new job. The commander had a 2hr meeting with all the sergents and the sheriff the next day. I don't know what went on in there but the sergents are now taking the time to write a voluntary statement on any incident with an inmate that needs documentation and providing me with the copy. I bet they're not happy about all that extra work, I wonder how long it will last. At least the commander is acting like he supports the importance of the Medical Dept. It's difficult when you are the only medical professional in a non medical environment. Most employees don't have a clue. I was sort of having a pity party yesterday over it and then I remembered, I'm not nursing in the worst conditions, the nurses in Iraq.....now that has to be tough. It's a whole different animal.
  8. by   fiestynurse
    The inmate had a constitutional right of access to dental health care. This means you should have made an appointment for him to see a dentist as requested. It doesn't matter whether they are county jail inmates or DOC - they have the same right to care. This doesn't mean that you shouldn't triage and send the most emergent inmates out to the dentist first. You certainly could have made him wait for his appointment. In the future, I would just make the dental appointment - why take the legal risk of being wrong about his dental issue. So, the dentist finds nothing wrong. It's better to error on the side of caution. Don't always be so sure that the inmate is "faking it." Just because you can't always believe what the inmate is telling you, doesn't mean you shouldn't cover yourself just in case. I have seen chipped and cracked molars turn in to huge abscesses and patients can get septic very fast from infected teeth.

    In regards to the custody officer, she should have discussed her concerns about the medical observation and the dental health of the inmate with you privately. It is vital that medical and custody work together for the health and well being of the inmate and to avoid litigation. You all need to be on the same page. That's good that the Commander spoke to her, but I would probably have a talk with her also, just to clear the air.
  9. by   SFCardiacRN
    It makes me sick that the only group in America that is 100% guaranteed health care are these F******** prisoners! Triage them like anyone else and DON'T let them abuse the system any more than they allready are!
  10. by   nurseT
    I am not able to send them all just to avoid a suit. At my jail I am forced to make a decision. Our medical dept is advised that we simply have to return the inmate back to society in the same but no worse condition then when they were taken into custody. By law, We do not have to start taking care of all their health issues. Our county cannot afford to do restorative work, and must draw a line. If the condition is not posing an immediate threat, then it can wait. A chipped tooth can be chipped for 20 years and never cause immediate danger. But a tooth rotted to the gum line and has an exposed nerve root, That would take priority. If the inmate developes an infection, then we treat that right away and attempt to control pain. I have sent county inmates who were indigent that had serious dental problems that caused repeated infections. We really just follow medicaid standards. We can legally draw the line between wants vs needs. If medicaid paid for dental work, they'd all have beautiful teeth upon arrest or when they get out of DOC. The inmate in question was just throwing a temper tantrum because he thought he would get sent to DOC. Once they are sentenced, they can't wait to get out of our jail, as we are max. security and there is more freedom at DOC. My problem was the sympathetic gaurd. She has been put in her place by the commander with all others watching. I doubt if she or anyone else will try that again.
  11. by   fiestynurse
    "We really just follow medicaide standards." First of all, read the medicaide standards for dental care before making this statement.

    Secondly, the statement, " By law, We do not have to start taking care of all their health issues" You must take care of all their "medically necessary" issues, which is pretty broad. Yes, it doesn't include cosmetic or elective services, but their are few procedures that fall within that category.

    This statement does not make sense, "Our medical dept is advised that we simply have to return the inmate back to society in the same but no worse condition then when they were taken into custody." If an inmate comes in with a massive infection, I would hope that he would walk out without an infection. Actually, jails perform a public health service by releasing inmates back out to society in BETTER condition than when they walked in.
  12. by   nurseT
    Quote from fiestynurse
    "We really just follow medicaide standards." First of all, read the medicaide standards for dental care before making this statement.

    Secondly, the statement, " By law, We do not have to start taking care of all their health issues" You must take care of all their "medically necessary" issues, which is pretty broad. Yes, it doesn't include cosmetic or elective services, but their are few procedures that fall within that category.

    This statement does not make sense, "Our medical dept is advised that we simply have to return the inmate back to society in the same but no worse condition then when they were taken into custody." If an inmate comes in with a massive infection, I would hope that he would walk out without an infection. Actually, jails perform a public health service by releasing inmates back out to society in BETTER condition than when they walked in.
    ouch!
  13. by   fiestynurse
    Just trying to help you keep your license intact. Don't ever forget that you are a nurse first and foremost. You are there to provide care to the inmate/patient and be their advocate. Yes, you will get the occasional con, but don't let that get in the way of sound nursing judgements. I would recommend attending some NCCHC conferences and bringing what you learned back to your facility. Also, you may even want to consider obtaining certification in correctional health care through NCCHC. Those extra credentials give you credibility when dealing with the custody staff, like the annoying female CO that you speak of in your post.

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