Denying Meds

LPN_mn · Jul 5, 2005

I work in a regional treatment center for the Mentally Ill and Dangerous and the Sex Offenders. I could tell you some very disturbing stories about the MI&D patients. They normally come to us after they have been to the court. They have comitted murder, rape and many other horrific acts upon innocent people. These people are very dangerous and are only med complient when they are in the institutionalized setting. One of the other posters noted that they are not med compliant because they do not like the side effects of the drugs and that is a very true statement. Some of the MI&D patients have what is Jarvis. This means if they do not voluntarily take theire meds that we can force them to take them. I understand that these people are mentally ill but I would not want them out on the streets for any reason due to the horrific crimes that they have commited because they did not take their meds. They preferred the alcohol and illegal drugs to treat their symptoms. These are very intelligent people for the most part. They know the difference between right and wrong yet they choose to not take their meds and then decompensate and that is what gets them into trouble. Don't blame corrections for their problems. They have brought their incarceration upon themselves and corrections always seem to get the blame. We are not making any money off of the people either. They are court ordered into the facility and the state is paying for them to be there. The state also pays for their medical, dental, and psychiatric treatment. I would like to know how anyone figures that we are making money off these people. I am only referring to the mentally Ill population. The sex offender programs are just as bad. But don't get me started on that one.

jamangel · Jul 5, 2005

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

BackOff · Jul 6, 2005

:angryfire I agree with NiceNurse and Jamangel. I have an inmate who returned three months after release. He fractured his hand in a fight 4 weeks ago. I have had him three days. He is threatening to sue because he was not immediately taken to an orthopedic specialist. I have sent 12 people to the dentist this week out of a population of 75. We are a small county detention. When you check with the doctor these people say they are seeing and ordering their meds, they have not been there in several years. I get so tired of being told. "You have to see I go to the doctor/dentist"

targa · Jul 9, 2005

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

Inmates (those already convicted of a crime) and pretrial detainees (those who are being held pending trial) are constitutionally entitled to adequate medical care under the 8th and 14th Amendments to the Constitution. This includes the right to medication, and the right to have already-prescribed medication continued by a detention facility.

I've 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.

These unlawful actions are often aided and abetted by nurses who should know better. One should be careful about letting his/her personal feelings influence an inmate's treatment. One MD discontinued an inmate's HIV meds, stating that he was a "drug addict" who didn't deserve them. Thank god the head nurse in the facility had the backbone to testify against the MD. You might think most/all inmates are "working the system", and some are in fact "slick". You act at your peril, though, when your cynicism and personal feelings influence your treatment decisions.

If a corrections nurse has reached the point where he/she can't be empathetic, caring, and compassionate because "these criminals don't deserve it", it's time to find another specialty to work in.

LPN_mn · Jul 9, 2005

Wow... what a bunch of judgmental nursing "professionals".
Inmates (those already convicted of a crime) and pretrial detainees (those who are being held pending trial) are constitutionally entitled to adequate medical care under the 8th and 14th Amendments to the Constitution. This includes the right to medication, and the right to have already-prescribed medication continued by a detention facility.
I've 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.
These unlawful actions are often aided and abetted by nurses who should know better. One should be careful about letting his/her personal feelings influence an inmate's treatment. One MD discontinued an inmate's HIV meds, stating that he was a "drug addict" who didn't deserve them. Thank god the head nurse in the facility had the backbone to testify against the MD. You might think most/all inmates are "working the system", and some are in fact "slick". You act at your peril, though, when your cynicism and personal feelings influence your treatment decisions.
If a corrections nurse has reached the point where he/she can't be empathetic, caring, and compassionate because "these criminals don't deserve it", it's time to find another specialty to work in.

I don't have a problem with giving these people their meds. I have a problem with the way the system is run. I work with the Sex Offender population. Let me tell you how it works. They run around molesting, raping, and ruining childrens lives. Then they go to court and are sentenced to prison time. Then they come into the Sex Offender Program where they are suppose to participate in Treatment. The way it really works after they are released from prison and get to the treatment program is that they refuse to participate in treatment because they have been "lied" about or "framed" or some other excuse. They do not accept responsibility for the lives that they are ruined. Then on top of that they are given better medical, dental, and psychiatric treatment then any law abiding citizen in the United States. When they get to my unit they get the meds that are prescribed to them and they see the dentist and any other medical needs are met. I just have to ask who is going to pay for the many years of counseling that children need because of the heinous crime that was commited to them. I am guessing that you don't work in the corrections you just litigate the cases of the inmates who complain that they are not getting everything that they want. It is a crying shame that in the United States that a criminal gets better medical care than non criminal people. May be the jails and prisons are so full because people cannot afford to get medical treatment but if they commit a crime and go to jail then they will get all the medical attention that they want.

Editorial Team / Admin · Jul 9, 2005

I have recently spoke to a nurse who works in a detention center. I was surprised to find that if you become arrested you can be denied your medication, even if it is something you cannot just d/c like Paxil. The nurse I spoke to said it's just that way; I have a difficult time accepting that answer.
My very sweet next-door neighbor was arrested for drinking and driving -- he was on injections for schizophrenia -- he committed suicide, due to the fact he was going to jail and would be denied his injections (like he has in the past for same offense). I'm really concerned, even if these people have broken the law.
Has anyone heard of this before?? And can anyone explain why this is???
Thanks in advance =)

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.

Editorial Team / Admin · Jul 9, 2005

Nice Nurse regarding what to tell the inmate who is threatening a suit,

"Please spell my name correctly"

ESK · Jul 10, 2005

I don't have a problem with giving these people their meds. I have a problem with the way the system is run. I work with the Sex Offender population. Let me tell you how it works. They run around molesting, raping, and ruining childrens lives. Then they go to court and are sentenced to prison time. Then they come into the Sex Offender Program where they are suppose to participate in Treatment. The way it really works after they are released from prison and get to the treatment program is that they refuse to participate in treatment because they have been "lied" about or "framed" or some other excuse. They do not accept responsibility for the lives that they are ruined. Then on top of that they are given better medical, dental, and psychiatric treatment then any law abiding citizen in the United States. When they get to my unit they get the meds that are prescribed to them and they see the dentist and any other medical needs are met. I just have to ask who is going to pay for the many years of counseling that children need because of the heinous crime that was commited to them. I am guessing that you don't work in the corrections you just litigate the cases of the inmates who complain that they are not getting everything that they want. It is a crying shame that in the United States that a criminal gets better medical care than non criminal people. May be the jails and prisons are so full because people cannot afford to get medical treatment but if they commit a crime and go to jail then they will get all the medical attention that they want.

Targa is right! Biases affect decisions we make in our profession. The system may not be fair and it's your right to vote for people who can make changes. We need to base our professional judgements on facts not feelings.

targa · Jul 10, 2005

Yes, inmates and detainees are the only class of citizen in the USA who are CONSTITUTIONALLY entitled to adequate medical care. Do I wish that ALL Americans were entitled to that benefit? Yes. Is it fair to deprive someone of that benefit because of a crime they committed? No. That's what is meant by "cruel and unusual punishment". It's only just and moral that the government provide for the basic needs of people it incarcerates. Providing medical care to inmates is what separates us from countries like Iran and Saudi Arabia.

By the way, the inmate I spoke of, who was denied HIV meds because of the MD's personal biases, hadn't been convicted of a crime. He was a pretrial detainee, who got no meds for seven months. When the charges were dropped, he was released, and continued his irrevocable immune decline. He died about a year later. The medical contractor paid a settlement midway through the trial. Business as usual...

LPN_mn · Jul 10, 2005

Targa is right! Biases affect decisions we make in our profession. The system may not be fair and it's your right to vote for people who can make changes. We need to base our professional judgements on facts not feelings.

My professional judgement is based on fact. Although I DO NOT feel that these criminals should be getting better health care provided to them than law abiding citizens, I do call the doctor when one of them is ill, I do address their medical concerns, and I do follow the doctor order and question it when I think it needs to be questioned. Just because I feel one way or another does not mean that I can't do my job appropriately.

soontobe_RN · Jul 11, 2005

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.

fiestynurse · Jul 15, 2005

Siri - Another answer for Nice Nurse when being threatened with a lawsuit:

"Get in Line"