Medical staff sued for inmate's death

Go slow --

A lawsuit gives you one side of the story. There are facts that are not disclosed. It is easy to ASSUME that the patient (prisoner) was mistreated - but I have to wonder with THAT many healthcare professionals involved:

Did they all just CHOOSE to ignore the clinical presentation or COULD this patient have had an ICB and died suddenly - prior presentation not related?

Just something to think about - sure, it is a sad situation - but, I will not form an opinion until I have more facts.

There is something wrong with this report: head CTs are done to check for ICB- not to determine brain function. If the CT found no bleed, the patient likely would have been given a fibrinolytic. If it had found a bleed, he would have likely been admitted and monitored/treated for that. In the absence of either intervention and considering his symptoms, the wife may have a case.
He could have possibly been given a fibrinolytic after the CT failed to find an occurring bleed, and then bled out as well.

This is all guesswork from the article, though- we don't know all the details. I'm wondering if all the other stroke interventions were done or not, and if this hospital was a stroke-certified facility.

In my experience, here's what happens in a situation like this:
The guard finds something wrong with the inmate or the inmate c/o something is wrong. The guard, if new, if totally uninformed medically, if he's with his fellow guards who are telling him the inmate is a jerk, the inmate is lying, the inmate is just trying to get out of work or out of solitary or out of whatever the inmate might be finding distasteful, decides to side with his buddies. Just to be safe, though, he runs it by his Sergeant, who tells him to summon the nurse.

The nurse is afraid to cross the guards, upon whom she is dependent for her safety. Or she is lazy or busy or otherwise disinclined to keep an open mind, call a doctor, or do much in the way of assessment, including a very basic set of VS and neuro system / mental status / chart review evaluation.

Just to be safe, though, they get the guy to a hospital. At that site, a bunch of people totally screw up. Why? I do not know. But once the hospital has said the inmate is full of beans, well, the rest is easy to figure out. The inmate is judged to be defiant, thus is peppersprayed and eventually dies.

My stress here is on the bully mindset, the groupthink of some guards and on the mindset of the nurse and the reasons for their behavior. They want to avoid work and fit in with their peers and coworkers. It is costly to tell the guards they are wrong. Very wrong. Even if you don't say, "You are wrong, Guard." Even if your actions speak it, you are going to become questionable in their eyes, an inmate lover, someone they don't quite trust. You are spending County, State, or Federal money on an inmate.

Or the nurse is, as I said, busy, not good at assessment, lazy.

rn i worked with, at a previously job in a prison had a pt c/o of right flank pain..she said that that particular person was a chronic complainer and frequent flyer and she did not follow through
when day nurse came on she sent convict to hospital..with an inflamed appendix,,her license was suspended for 6 months

The problem is multi-fold, but a bigger part of it too is that well, think of who these patients ARE. Many of them DO complain chronically -especially if it means getting out of the cell and a bit of better treatment for a short period of time. The problem with this is that sometimes the complaints really ARE real. The time you ignore it as 'just another whine' will be the time it was the 'real deal' (as in the post above). Many of these folks are NOT stupid, they know the proper signs and symptoms. Had a patient (back in my EMS days) who was a 'frequent flier' -his uh 'specialty' was seizures. He would run the whole route -including wetting his pants at the end. He was pretty impressive to watch. I remember one time (when I had a student on board) we got this guy, he was really shaking to beat the band -he wanted our standard treatment -valium. I don't care if you're playing a game, I still treat it as though it were real unless there is just no shadow of a doubt -and then you had be willing to stand up to the consequences (since I'm not a gambling man, I don't take chances and would rather feed a junkies need than risk not treating a real event). This guy was shaking pretty well, and I told the student to go ahead and get the IV, get his medication ready etc. When the kid grabbed ahold of the patients' arm, and was attempting to stabilize it, the guy suddenly held just that arm still (while the rest of his body was shaking) long enough to get the iv started and secured -and THEN began shaking that arm as well.
No, that guy did not get the drug.

I work in a prison and I've actually been surprized by the fact that most of the inmates we treat aren't faking. Maybe it's because in my facility ... there's a $5 co-pay to be seen, unless it's an emergent situation or follow up for the previous complaint. Five dollars is a lot of money for inmates so ... it probably weeds out a lot of fakers.

Nevertheless, I've been guilty of this attitude myself. A couple of inmates were complaining about genital problems and, my first thought was ... great ... I'm the new nurse so, they must be wanting some female attention for their private parts. So many inmates come on to you that it was easy for me to jump to that conclusion.

I was wrong. One of the inmate's testicles was very swollen. We got that inmate on the bus to the medical hub right away. And, another inmate did have genital warts.

In a previous case that occurred before I worked there, which is being litigated right now, an inmate actually lost his testicle after my facility sent him to the medical hub for additional treatment. While he sat in a cell for three days and was ignored, the blood flow was eventually compromised and he lost his testicle.

So ... obviously I'll never make that assumption again. While I'm still new to this job ... I've actually seen more fakers in the ER than in prison. But, on the other hand, we don't have narcotics in my facility so ... maybe that's why I've seen more fakers in the ER because they can get much better drugs there.

Regardless ... you've got to treat everybody just to CYA.

It's not just the guards but, some of the doctors frown upon you also. The doctors at the medical hub where we have to send inmates for additional treatment are always complaining to us about sending them inmates.

But, the entire correctional medical system in my state is now under federal receivership because there has been so many deaths and lawsuits. What's worse? Treating some fakers who slip through the cracks or having to deal with a lawsuit and possibly losing your license ... not to mention a federal judge breathing down your neck for malpractice.

At least the CO's in our medical department understand it because they see what we are dealing with every day.

I will say that with only one exception, all of my patients who were sick inmates, were very compliant while in my facility. With the one exception, I never had any problems treating them.

Whether or not inmates are fakers the fact is they can,t fake your assessments, and in any case you are there for them, so always never neglect them give them the benefit of the doubt .Always remember the code of ethics and that we are all flesh and blood.Sometimes all they need is someone to talk to ,they have their own problems and must be comfortable talk to you .
As nurses we must also remember assessment assessment assessment.We are suppose to be our patients advocate and many times doctors failed to do their role effectively ,if you as the nurse has doubts and are not comfortable with doctor,s plan let them know .If they retaliate, report to your immediate supervisor and complain to your staff get byour staff to understand your point and over power doctor ,he will respect you because you seem to master this area more than him.
Remember also we are a team no one is incharge ,we are working together to achieve one goal.The doctor,s sometimes don,t know what they are doing ,often times they ask us for opinions ,we are spending the most times we our patients so we knows them best.
It is no crime to turn to your text or ask questions but it is a crime when we don,t do what is expecting of us and that which an ordinary person under normal circumstance will do.

From the information provided, a "newbie" could have made a tentative diagnosis of stroke. He was evaluated by a physician who felt it okay to discharge him back to an environment that was not equipped to care for the eventual complications, that is negligent in my opinion as is the guards and health care providers response at the jail. It does not sound as if a thorough reassessment was completed, and if an assessment was done it was not completed by competent professionals. I say that because I work with the criminally ill and I see every day a callousness from physicians and other caregivers that comes directly from the patient's diagnosed criminal behavior.It would be wonderful If I could(as a nurse professional) say that we "all" treat the person and not the awful behaviors that bring them to us, but I can't so my support is with the families. Someone must stand up and advocate for the "inmate" they are people too.