Inmates as Patients in Hospital
An issue arose at my hospital during my consolidation as a student, and it had both ethical and legal concerns. I was being trained on a medical/surgical floor, and one of the nurses on the floor believed that inmates were only permitted to ambulate on the floor with their guards after visiting hours were over. Inmates are commonly put on our floor as there are a couple of prisons in the vicinity of the hospital.
The clinical educator and I looked into this in the policy manual, and could only find two items that were relevant:
- "While attending the Hospital Inmates shall remain in restraints, except as provided by section 6.3 of this policy. Any deviation shall be a result of consultation between Hospital Security, the appropriate Program Manager/Delegate, and the appropriate Correctional Service."
- "Inmates in restraints shall be transported by wheelchair or stretcher at all times unless ambulation is a necessary component of their health care."
After telephone calls to hospital security, the prison officials, and other managers responsible for policy, it turns out that this is an unwritten rule that the guards choose to follow, and is not formal policy by any of the agencies. Therefore there are no legal concerns for the nurse if she wishes to insist that the patient ambulate during visiting hours, although she may feel ethically concerned for the fear that may arise in the other patients on the floor. Legally, the guards may be at risk for restricting the freedom of the patient in a manner that is not part of their prison sentence. The hospital too may be taking a legal risk by not addressing the situation -- what if a patient died due to something that could have been prevented had the patient been ambulatory more often? Nurses often deal with conflict between the rights of the individual over the greater good of the group, and this is one more example of both the ethical and legal aspects of so many of the issues that nurses face on a daily basis.
The ethical concern arises in the second statement listed above. It is absolutely necessary that a person ambulate after surgery, and therefore wheelchairs/stretchers are only necessary when arriving on or leaving the floor. To restrict a patient to a few hours in the evening is an ethical dilemma for the nurses. On the one hand you wish to provide the best care for your patient (the inmate) and in order to do this they must be able to ambulate as much they can whenever possible. However, the stress level of seeing an inmate flanked by two large guards walking the halls will increase significantly for the other 30+ patients on the floor. Whose needs to you consider first? What are your legal obligations to the other patients and their safety? What is your obligation to the inmate? Are the guards legally allowed to restrict the patient? How do you reconcile this issue in an equitable manner?
In the article, "Caring for the incarcerated in the intensive care unit", the author describes the many aspects of nursing care that differs in a standard hospital rather than in the infirmary of a prison. However, the theme throughout the article is summarized in the conclusion: "the nurse must respect the worth, dignity, and rights of all patients, regardless of the individual's lifestyle, values, or state of health". Adopting this as a personal policy will only benefit a nurse who must work with incarcerated and non-incarcerated patients.
Graves KE. Caring for the incarcerated in the intensive care unit, Dimensions of Critical Care Nursing. 26(3):96-100, 2007 May-Jun.Last edit by Joe V on Apr 29, '09
Apr 22, '09Thanks for sharing your article. I did my clinicals in a county hospital, and we had several inmates.Apr 26, '09Very interesting article. We have several inmates in our hospital and actually have a floor devoted to inmate care. Very rarely, if at all, are they allowed to walk outside of their room for ANYTHING during any time of day. Our hospital also has the policy that inmates must be restrained and in wheelchairs if they are to be moved.Apr 27, '09I work at a county type facility that provides care to many inmates and if thier plan of care includes ambulation, then it is carried out accordingly. The gaurds follow the inmates through the hospital where ever they(inmates) need to go, even surgery.Apr 27, '09Thanks for posting. I frequentally take care of teens from various area detention facilities. It's interesting that which facility the youth is from seems to affect how strict they treat them in the hospital. Some youth are kept shackled to the bed all the time, while other are only shackled when being discharged. Some facilities allow the kids to be in double rooms, while others only let them stay in privates. It's interesting caring for these patients, I have never had any issues in providing their needs.Apr 28, '09In the facility where I used to work, they had a locked jail ward for prisoners. People in the ED who were under arrest were required to have a police officer in attendance with them at all times. They were not allowed to handcuff a person to the stretcher unless they were beside the person and could unlock the cuffs in an emergency if needed.
On the floor, when someone is a prisoner or who are under arrest, they must have a police officer guarding them outside the door at all times. Hospital security cannot perform this function. Staff are not allowed to relieve the police officer under any circumstances. As they are prisoners or under arrest, they are under the control of law enforcement and they have the right to take the prisoner where ever they want to take him/ her.Apr 29, '09This is a very contraversal issue in most hospitals. I have seen this issue from both sides. I was a correctional officer for the state of Texas for three years, but now I am a nurse. You have to look at the fact that this patient is an "inmate" and has commited some form of crime to with degree you as nurses will not be informed of. But you will also have to take care of the inmate as a patient and their needs as far as their health is concerned. You also have to take into account that the other patients on the floor have the right to their safety at all times. So when I was a correctional officer I did transports to the hospitals and stayed with inmates while they where admitted. We had very strict rules as guards that we had to follow no matter what the severity of the crime. Meaning a murder was treated the same as a one taken in with too many DWIs. The rules where never changed and they where at all times inforced. For us there had to be two guards at all times one in the room who was unarmed and one outside the door armed. The inmate was to be restrained at all times, unless there was an emergancy that needed to be tended to (like the inmate was coding or something along those lines). But you also could not interfer with the inmates medical treatment. If the nurses wanted the inmate to ambulate in the hall then his wrist would remain handcuffed but his legs would not be and the unarmed guard would be at their side at all time while the armed guard would be behind just incase the inmate tryed anything. As a nurse I have also taken care of a few inmates in the hospital. I have never had a issue with the guards trying to interfer with the needs of the medical professionals. I really think that both sides (meaning the hospital and the correctional facility) have to find a middle ground, and that both the nurses and all attending medical staff as well as the guards must be properally informed of the conditions that are agreed on by the two facilities. There should be time frams set forth for such things as PT or ambulation so that the inmate is getting the proper care that they need to get well, but that at no time is the safety of the other pts or staff compermised in anyways. And like I said these are guidlines that the two facilities should have in place before inmates are ever accepted into the hospital as pts.Apr 29, '09Thanks for sharing the article - it is an interesting concern.
The hospital I work in also has a floor dedicated to inmates - they get the entire floor to ambulate on and their guards are there too. They are in leg irons until they are under anesthesia and the leg irons are put back on when they wake up. They can ambulate with their guards - who wear weapons. It can be intimidating, we - as well as the other patients - are all safe.Apr 29, '09I am Radiology manager for Department of Corrections in Oregon. And I appreciate this article. We do need to treat them as patients as above stated. Staff and other public safety comes above all. You have to remember that the living quarters they are assigned to are very small especially if they are in a segregation cell only out in a small exercise area for 1 hr a day. If in general population it is somewhat bigger some institutions have large yards for sports. It is easier for the transort officers to assure the safety of others when there are less others in the vacinity. Depending on circumstances someone could recognize them and let someone else know where they are etc. to use for escape or to harm. Working in this environment you always expect the worst case to be prepared for anything.Apr 30, '09I also was a nurse in a hosp with 2 prisons close by, and occ saw inmates as pt's there! They always had correctional officers assigned to their Rms. If memory serves me right on chemo floor one shared a semi private with another pt. In the med/surg unit I also worked usually they were in private, or isolation for whatever appropriate reasons, or ailments!May 1, '09As a nurse, you should look at any correctional officer with a inmate as being present to a. maintain your safety b. prevent prisoner escape and c. make sure you go home at night to your family. You should bless the floor they walk on as they are protecting society.
Remember, you as a taxpayer are both paying the bill for the inmates care (they have a RIGHT to free medical care) as well as the hourly pay for the officer.
I would insure the officer approves of any care, movement, or provision of nicities before you provide them. The prisoner may be in a hospital, but they are still doing time.
You cannot differentiate between a murderer or a drug dealer.
Whether written policy or not, the correctional officer has the final say. Any effort to circumvent that is counter productive.
Just my inputMay 5, '09"Whether written policy or not, the correctional officer has the final say. Any effort to circumvent that is counter productive."
I dont agree entirely with that statement. I was starting an IV on a shackeled to the bed inmate and one of the two armed correctional officers pulled his weapon and pointed it at the inmate. I was on the opposite side of the officer. I asked him not to point his weapon in my direction and he continued. I stood up and TOLD him to point the weapon in another direction or he and I were going to have MAJOR problems and this inmate was not going to get an IV. The other officer stepped in and told the first to holster his weapon, which he did.May 15, '09Quote from HarleyBikerNurse"Whether written policy or not, the correctional officer has the final say. Any effort to circumvent that is counter productive."
I dont agree entirely with that statement. I was starting an IV on a shackeled to the bed inmate and one of the two armed correctional officers pulled his weapon and pointed it at the inmate. I was on the opposite side of the officer. I asked him not to point his weapon in my direction and he continued. I stood up and TOLD him to point the weapon in another direction or he and I were going to have MAJOR problems and this inmate was not going to get an IV. The other officer stepped in and told the first to holster his weapon, which he did.
Wow, I can definitely see where that could be a bit intimidating and scary! I think I would have said exactly the same thing. Good for you, to stand up to him like that.
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