Difficult IM

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Specializes in Corrections and Long term care mostly.

I am so frustrated. We have an IM here who has been given way too many special treatments.. He is diabetic and takes N insulin Bid. He gets an accucheck and sliding scale coverage at the same time as his N insulin befor breakfast and befor supper. And here is the kicker... We had several MDs over the past 6 months and one of them gave him a med pass stating he did not have to get his accuchecks at the same time as everyone eles . He would be allowed to wait untill after breakfast and supper trays arrive on the floor.. Of course he states he is so brittle that taking his N insulin too early is dangerous because his blood sugar will drop befor he can eat.. Now our new MD has come to his senses and written a new order stating he is to be checked at the same time as the rest of the Inmates. Of course he is non-compliant and then calls out because his sugar is high and needs coverage. So what can I do? I can't refuse to see him because he is diabetic and is noncompliant with his diet as well. He will not be here much longer this time around so most of the nurses here just think we should let it go...but I think we are setting a bad example.. He threatens the whole "get my lawyer on it" ( my eyes are rolling) unfortunatly it worries some of the new MDs and Nurses. So what do you do in this situation? This is a county jail with just under 2000 IM. On nights we have 4 LPNs and 1 RN supervisor..Now there is someone who does NOT want to get involved in this mess.. Thoughts and opinions on this would be welcome

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Specializes in forensic psych, corrections.

Well, you're right. That is difficult. If an IM refused to come down to medical for insulin rollout I would document him as a refusal. Of course that doesn't help if you have to keep going to him around his meal times.

I would say if he is so brittle he needs that much medical attention then maybe he should be in the infirmary. You have enough to do without catering to him after each meal. If someone pulled that with me they would be at medical at insulin rollout or in the infirmary or not getting insulin at all.

Just my .02.

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I agree with you 100% humglum. I have had similar situations myself and as frustrating as it is documentation is very important. Also, even though at our facility diabetes is considered a specialty clinic (meaning inmates don't get charged for any care r/t the enrollment) we have wrote them up on a notice of charges for manipulation and also charged them with an AB389 (self-inflicted injury). You might want to check your facility policies to see if you can charge this IM. I have found that this can be a great deterrent. Hope this helps.

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I agree with you 100% humglum. I have had similar situations myself and as frustrating as it is documentation is very important. Also, even though at our facility diabetes is considered a specialty clinic (meaning inmates don't get charged for any care r/t the enrollment) we have wrote them up on a notice of charges for manipulation and also charged them with an AB389 (self-inflicted injury). You might want to check your facility policies to see if you can charge this IM. I have found that this can be a great deterrent. Hope this helps.

And if he keeps at it, maybe pursuing an order to treat would be an option?

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Just remember, you are not working in the service industry in corrections. Tell him he will comply with what you are able to provide and if he doesnt comply order him to move bag and baggage to your infirmary or holding cell. Keep him there where you can tend to his "special" needs. He will protest immediatley. If he threatens to sue, tell him to make sure he spells your name right. Remind him you are the only person in the entire building who gives a crap weather he lives or dies and he's trying to manipulte you! He does still the right to refuse medical treatment. Have him sign a refusal form and document everything. Make sure you give him teaching materials to refer to and put a copy of that in his record so he can't play dumb. It won't take long for word to spread that you will not play this game. Keep the ball in his court.

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Specializes in Corrections and Long term care mostly.

Thank you for your suggestions. I have been keeping the pressure on about the refusals and him getting to medical with everyone eles with mixed success. He comes and takes his meds and signs refusals for insulin and accuchecks. He is not brittle, he is only manipulative. In the four years I have been here I have never seen any one get charged for non compliance for meds etc. But I am going to approach my superviser Mon.am about this guy and all of your suggestions. Most of these guys just take their stuff on go on. We have almost no KOP here not even tylenol. Although it can be bought through canteen most of the guys come to med for it at least first time around. (canteen is only once a week) Our diabetics do not get charged for tx but if he continouse to call out for non emerg. tx after a refusal I am going to see if we can charge for that. That might get him to comply. Anyway thanks again for all your input.

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I agree with the other posters. Where I work and inmate can not dictate on where he will be housed. So signing out of the infirmary is not an option until the Dr. makes rounds the next day or Mon.. He can however refuse any treatments at any time. Also I would do a mental health referal so that he can explain his actions or impulses to the 'expert' and it's a follow through on your end too. Even though you know he's playing games you need to CYA.

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