[Flowan]

I am not sure where you are getting making money off inmates with mental illness. I do back flips everytime these individuals get released or sent to the pen. My budget has skyrocketed because opf drugs like Zyprexa, seroquel and Cymbalta. County government loses all the way around in this and there isn't anything that can be done. Also counties aren't the ones placing the charges, it is individuals, family members thinking jail can help their family and business trying to keep patrons safe.

Originally Posted by stephera

I understand every thing you are saying, I am just mad because there would be a lot less criminals if they were locked up getting the right treatment instead of having a crisis all the time and the county pressing charges for things they tear up or break. They just want to make money off of them!! Is this really legal if it happens in your own home, can the county press charges for a mental person breaking a window out of his own home?

[NiceNurse]

[quote=fiestynurse]Targa states that she has "personally litigated a dozen cases against detention facilities on behalf of inmates who were denied medical care. For the most part, the facility's MD discontinued medication that the inmate/detainee's personal physician had prescribed, without consulting with the personal physician. This happens so often and in so many facilities that I could have a law practice specializing in it, if I wanted it."

Have you ever worked in a correctional facility because you seem to have a "

Is Targa a lawyer? Is he/she here doing research for lawsuits? That is a scary thought.

[Nurse Ratched]

Folks, enough of the bickering and accusations. Attacks on others' motives and professionalism, regardless of who they are from or toward, do violate the TOS.

No one is saying that inmates don't deserve care while under the guardianship of the state/feds - just that the manipulation that is more common in that setting necessitates an even higher degree and acuity of assessment skills to perform our jobs.

[TxCCNurseMedic]

Originally Posted by crjnursewarrior

I have to get on my soapbox here! Fiestynurse and the others that are defending the healthcare in the jail/prison systems....you are so RIGHT! I think that these people who are complaining about the people who do not get the appropriate meds in jail/prison need to take into consideration the fact that most of these people, when they were not incarcerated, NEVER went to the doctor! They NEVER would have gone to the store and bought Tylenol...but now that they are incarcerated they have become such health conscious individuals! UNREAL! I am not saying that anyone's brother should have been neglected their insulin and it is certainly sad if someone commits suicide when they are faced with imprisonment, but that person had more problems that obviously contributed to suicide than just the prospect of not being given his "injections". The problem with most situations where someone is not given the adequiate medical attention or medication they need is when the facility they are incarcerated in does not have a medical staff available 24/7. Many of the city/county facilities only have officers available that are not trained adequately to deal with these medical problems. Again, as Fiestynurse mentioned, HIPPA laws prohibit us from telling these people's families how they complain and complain and after after being seen on nurse sick call and prescribed medication they refuse to get up in the morning and take the medication. Yes they ALL want extra mattresses and pain meds for their backs, but have no trouble in the rec yard...ANOTHER factor I think these whining naysayers and family members need to consider is cost...most of these inmates get this care for FREE!!!! Law-abiding citizens must PAY for their healthcare. Considering the price they pay for it, I feel the care they receive is MORE than adequate. I have NEVER seen an inmate be denied medication that he truly needs.

You are so right crjnursewarrior, these guys come in through intake and are put through a complete physical which includes meds being ordered. Many have not seen a Dr. in years and right at intake/processing that pain in his ankle for 3 yrs, broken tooth for 2 yrs, etc, has now become an immediate life threatening event as far as the offender is concerned. Not all are like this though. As far as offenders not getting their meds, we run pill windows for these guys to go to and pick up their meds. Some decide not to get out of bed or they find other things to do besides getting to the pill window. The insulin dependant diabetics also don't show up many times for their finger sticks or their insulin. They receive lay-ins (appts) for their fingersticks and insulin. We don't have the staff to chase down 1000's of guys to find out why they didn't show up at the pill window or the clinic and then give them the meds or treatment that they didn't want to go get. Most of the time it is the offenders decision if he is going to be compliant or not, but most of the families are not aware of this.

[crjnursewarrior]

Originally Posted by fiestynurse

Targa states that she has "personally litigated a dozen cases against detention facilities on behalf of inmates who were denied medical care. For the most part, the facility's MD discontinued medication that the inmate/detainee's personal physician had prescribed, without consulting with the personal physician. This happens so often and in so many facilities that I could have a law practice specializing in it, if I wanted it."

Have you ever worked in a correctional facility because you seem to have a lack of understanding as to who is medically responsible for the inmate once he is incarcerated. It is the jail doctor who is responsible for assessing the inmate and determining what needs to be prescribed. (The HIV medication incident was unfortunate, but is not the norm) Many times we have information that the personal physician does not have, such as heavy illegal drug and alcohol use. Or the inmate has not seen his personal physician for many years and his symptoms and situation has changed. Or the personal physician is a quack! Every jail doctor that I know will request for old records and consult with outside physicians, if necessary (however he is under no obligation to consult or agree with the outside physician) to determine what the medical history actually is. It is always the jail doctor's legal liability that is at stake here. He has to properly prescribe the correct medication based on his own hands-on exam, experience, and education. Inmates tend to not give accurate medical histories and tend to exaggerate their symptoms. They play a lot of games in order to gain control or get out of jail. It is not an easy environment to work in.

And there are many attorneys specializing in the litigation of Correctional Facilities and every inmate has an attorney at his diposal, which is part of the problem.

All of what FiestyNurse is saying here is SO TRUE...what these people who do not work in a correctional facility fail to understand is that inmates are NOT denied medical care that they NEED...they are sometimes denied medical care they WANT!! They ALL want Hydrocodone or Oxycontin for their back pain...none of them NEED it and it is not given. Why would you perpetuate someone's chemical dependency problem? We detox the inmate off this stuff per our protocol and then they stay off of it while they are incarcerated. Once they get out, they go back to these legalized drug dealers they call doctors and they get them started on it all over again. These are the people that should be the subject of lawsuits...the doctor who is ignorant and negligent enough to prescribe oxycontin for back pain...it is a drug for people with terminal illnessess...back pain is NOT terminal.

[crjnursewarrior]

Originally Posted by TxCCNurseMedic

You are so right crjnursewarrior, these guys come in through intake and are put through a complete physical which includes meds being ordered. Many have not seen a Dr. in years and right at intake/processing that pain in his ankle for 3 yrs, broken tooth for 2 yrs, etc, has now become an immediate life threatening event as far as the offender is concerned. Not all are like this though. As far as offenders not getting their meds, we run pill windows for these guys to go to and pick up their meds. Some decide not to get out of bed or they find other things to do besides getting to the pill window. The insulin dependant diabetics also don't show up many times for their finger sticks or their insulin. They receive lay-ins (appts) for their fingersticks and insulin. We don't have the staff to chase down 1000's of guys to find out why they didn't show up at the pill window or the clinic and then give them the meds or treatment that they didn't want to go get. Most of the time it is the offenders decision if he is going to be compliant or not, but most of the families are not aware of this.

EXACTLY!! We have only 300 inmates at our facility, but it would be IMPOSSIBLE to chase that many people around and beg them to take their meds. These people are ADULTS! They need to take RESPONSIBILITY for their healthcare...here enlies the problem...they don't ever want to take responsibility for anything including their healthcare...that is why they are criminals!!! There is one fact that these naysayers who do not work in a correctional environment fail to understand. These people are not housed in our facility FOR healthcare...they are not there BECAUSE they are sick...if they have chronic or acute medical problems while they are incarcerated, it is our job and our responsibility to care for them...which is done 99.99% of the time far better than they EVER would have gotten on the streets. But it is NOT our job to give them anything and everything their little drug-seeking hearts desire. A lot of these people are career criminals and they manipulate the system to get whatever they can from it...and you and I, as taxpayers, are footing the bill!!!! STOP THE INSANITY!!

[crjnursewarrior]

Originally Posted by jamangel

Most inmates aren't med compliant until they are institutionalized or incarcerated.

And 90% of them are non-compliant then!!!

[crjnursewarrior]

Originally Posted by siri

I am a NP and tried correctional medicine last year. I HATED it. Yes, the meds will be changed and/or denied in alot of instances. Even in long term care and for inmates in the system for life. If the med is on the formulary, it will be used, and if not, nope. And the substitutions are a joke. Very narrow list of drugs used to treat a wide variety of illnesses and/or disorders, physical and/or mental, I might add. And, if they have a probable disease process requiring long term care and due for parole soon (soon could mean within the next year or so), they will be denied referral. Or, if referral is done and a chronic problem is found requiring surgery, this will be postponed until it progresses to the point of almost emergent care.

I hate to give the state that this is going on. It is the truth, although. Hard to believe, but true.

This is not true in ALL states/correctional facilities. Yes, we only give formulary meds, but our formulary is not a very narrow list of drugs, infact it is about 25 pages long and the meds on it are comparable to anything the inmates are Rx'd on the streets. I think you fail to see the point that MOST of this litigation against correctional facilities has to do with inmates not getting what they WANT...they are given the treatment they NEED, it is just not what they WANT. My boss, the Medical Administrator, works for HOURS on end sending out inmates to any specialty appointments they NEED. Why should taxpayers money be wasted on frivilous unfounded medical complaints and then again on lawsuits over it? You don't think these inmates are paying for these lawyers do you?

[crjnursewarrior]

Originally Posted by soontobe_RN

I work at a drug and alcohol inpateint facility for adults. Out of approx. 100 clts, half are level fours, meaning they came from prison and if they are kicked out or try to leave on their own, they are sent back to prison. At my work I am what thy call a chemical dependency techincian (CDT, for short). My duties consist of observing and reporting, however, we are also med certified to assist the clt with medication. I have been there for over 3 years now. We have nurses on staff but they are not there around the clock. My point for explaining all this is, that we are not allowed to deny any clt their medication, this includes inmates. Even if it is a PRN. In fact, about a year ago, a CDT told a clt that they had to come back later for their PRN b/c she was busy, and needless to say she did get into trouble for this.
To deny a pt or clt medication is considered a PM-46 in the state which I live. The PM-46 is basicaly, abuse, maltreatment, or neglect to the pt or clt, and this again, includes inmtes.
Now, I have never worked in a prison, so, I do not know how they handle this there, but I would be surprised if they are actually allowed by law to deny an inmate their med. I do know that for meds like, methadone, they are not given in prison.
I must say that for me, even if a person is convicted of a crime they still do not deserve to be neglected. Granted, some of them may be really horrible people, but we still are there to care for them in this manner. Again, though, I have never been in that situation, so I couldn't say what I would or wouldn't do.

You are right...these inmates are NOT denied their meds, sometimes there is a substitution from a formulary...if they NEED it they are given it. Also any inmate that is chemically dependent is detoxed from the substance. They may NOT like it because they are not given Methadone or whatever else they are given on the streets to feed their addiction, but they are safely detoxed from any drugs/alcohol.

[crjnursewarrior]

[quote=jamangel]

Originally Posted by targa

Wow... what a bunch of judgmental nursing "professionals".

Personally, I don't care what they've done or have been accused of doing. In the county jail setting, most of them have only been charged and not tried or sentenced. I give them the SAME care and consideration I give now that I work with a different population. I personally made sure ANY inmate who wished to see the doctor or should see the doctor was placed on the sick call list. I am especially pushy about HIV + inmates even if I know they are known drug users and don't comply with thier med regimen. Nonetheless, this a nursing forum and where we are all professionals, we are all human first. Everyone has the right to vent their frustrations from time to time without their professionalism being questioned. Anyway, when you note judgement aren't you in fact passing judgement as well? Corrections is not the easiest place to work for ANY nurse unless you are void of feeling anything at all. Either you hate it or you love it. If you hate it, go and if you love it, stay and and make a difference.

EVERYONE is entitled to adequate medical care NO MATTER WHAT!

Jamangel is right on here....good correctional nurses treat the patient, not the charge. What they are convicted of is IRRELEVANT to the treatment they get. Targa acts as if we actually treat them based on our opinions. This is simply not so. We are duty-bound, if nothing else, to treat illness and do no harm. We take an oath. We treat all inmates based on assessment of the facts and their actual NEEDS...again...NOT their WANTS. I have said this OVER and OVER. They ALL WANT 2nd mattresses and Oxycontin for their back pain, but NONE of them NEED that. If an inmate NEEDS a 2nd mattress or narcotic pain medication, they get it. This is based on the assessment of the doctor and the nurses working with him/her. We see these people on a daily basis. We have learned to weed out the garbage, to sift through the manipulation to see the REAL medical problems. This is something a good correctional nurse HAS to become adept at. 90% of the complaints you hear from inmates are garbage...trying to get something thaty don't really NEED. It is our job to differentiate between WANT and NEED. It is our job to see that the 10% who are NOT faking get what they really NEED. And they are given that. As I have said, I feel that the care inmates get is more than adequate, especially since they pay NOTHING for it. Just a few more rantings from my soapbox!!