Inmates as Patients in Hospital

[4cas2]

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:

1. "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."
2. "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 ambulates 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 of 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 the 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 ambulates 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 do 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.

Reference

Graves KE. Caring for the incarcerated in the intensive care unit, Dimensions of Critical Care Nursing. 26(3):96-100, 2007 May-Jun.

[Orca, ADN, ASN, RN]

I think it's just wrong....If they are that ill and don't even have the strength to get up, they shouldn't be restrained like that

It's a legal issue. The state is liable if the inmate escapes and something happens. There are many documented cases of inmates who duped everyone into thinking they were much sicker (or weaker, which is easier to fake) than they actually were, then they escaped as soon as they were left without restraints.

I invite you to plug the words "inmate escape from hospital" into a search engine and see if you still feel sorry for inmates after reading the results - and if you gain a new appreciation for those who keep the restraints on. When I did this a few minutes ago, the second article on the list was about an inmate who escaped from a hospital in Brooklyn, NY and raped a woman in her apartment three hours later. The officer guarding him briefly left his post, and the inmate wasn't restrained.

It may sound inhumane, but these people brought these conditions upon themselves by committing crimes.

[kwkrnc]

So, I will keep this simple and to the point...if a facility is going to have inmates in the facility then there should be a very detailed policy that dictates exactly how the inmates are to be handled. Without that policy everyone is at risk and it is merely a tragedy waiting to happen.

[nursinunderpressure]

I am glad this has come up as a topic. I am a nurse that works in a prison. I have worked there for 5 years, and my husband has worked their as a correctional supervisor for 23 years. I see both sides of this issue. Correctional Managed Care (is what we call it) is a totally different kind of nursing than any kind of nursing. It does go against certain rules we are taught as nurses. And, I wish there would be more education and teaching on this type of nursing care.

You do the best you can. I know who my patients are and I choose not to know what they did. Fortunately, we have a hospital near by that is just for prisoners. The number of officers guarding a prisoner depends on their level of security. And, take it from someone who knows, that is a tax expense I don't mind paying. There is a reason they need that much security and you probably don't want to know why. Some of these individuals are extremely dangerous. Not all of them, but some are.

You do your nursing to the best of your ability, and you can be the patient's advocate, but the security is a necessity. That officer is also under stress, worrying about themselves, their co-workers, their families, and the public in general. In this type of nursing, you must be as professional as possible. And, in most cases, you can explain to the officers what you need as far as the patient's medical needs, and they will accommodate those requests to their best of their abilities.

We actually have an opposite problem. When we are unable to send an inmate to our specific prisoner hospital, they are sent to local hospitals. And, it is the staff at the hospitals that treat the patient badly, and it is not only the patients that tell us what happened, it is also the officers who tell us that the patient was treated awful.

I just believe that if we were all more educated on both sides, we would be able to come up with solutions that could benefit everyone involved. Thanks. :)

[Zookeeper3]

We have a cardiologist whom only sees prisioners and we get his patients for admits frequently. We have come across this many times. Our sheriff dept. does duty with the prisioner. On bed rest both legs and one arm are in cuffs. (high security prison). To ambulate, it needs to be coordinated with the police dept. to have two sherifs on duty.

Call me harsh, but it is not in my obligation as a nurse, morally or ethically to hide the fact that this is a prisioner. The safety of everyone is paramount and I defer to the sherif dep. to guide the rules for ambulation. Because John ! public, sees the prisioner in the unit is something they must get over, everyone is entitled for care. What John Q thinks of it is something to write to their congressmen. The politics play no role, in my role, I don't give a flip what visitors or patients think....... it is..... what it is... These prisioners deserve care per our laws and I follow them. I am not here to get in the middle or hide a "potential situation".

Family..."is that a prisioner that just walked by?", my response, "mamn, due to hippa laws I am unable to comment.

[prison_nurse]

We get patients from the State hospital which they are accompanied by two armed guards. The prisoners from the federal prison comes with 4 armed guards! Seems overkill with our taxes but what can you do. Most of the guards are regulars and know the rules but you do get the occasional one with an attitude. We work it out though and things proceed well.

It's not overkill if one tries to escape.

[miss-vikki68]

..i work in a public hospital in NZ..policy in this hospital states that prisoners - either male or female - must have 24 hr - round the clock - supervision.. an accompanying prison warden or police officer is in attendance during the prisoners hospital stay.. this appears to work well with the safety of patients and staff considered..

[mwboswell]

Interesting, I wonder when "ambulation is a necessary part of their health care" is not true????

[OldMareLPN]

source: http://www.nytimes.com/2006/03/05/opinion/05sun3.html

A report by Amnesty International U.S.A. finds that nearly half the state corrections departments — and the Federal Bureau of Prisons — have policies that expressly permit this practice. Prison officials justify the policy by saying that the women are a flight risk, even though many of them are nonviolent offenders who would present little risk, even if they were not doubled over with labor pains or strapped down on a delivery table.

It should not take a genius to see that chaining a woman's feet together or handcuffing her arm and leg to the side of a bed is not a smart thing to do during labor or childbirth. Yet doctors and nurses must sometimes fight with reluctant corrections officers if they want their pregnant patients unchained and effectively treated.

Reality sometimes is not what we want.....

[Babs0512]

I've taken care of prisoners on many occasions, as we too, have several prisons in the area. On one particular occasion, I had a patient that was handcuffed to the bed by his ankles and his wrists. The patient couldn't move, not only was this contra-indicated for the patients well being, I also could not properly assess my patient in this manner.

I said to the prisoner, "I'll treat you with respect, if you'll treat me with respect, do we have a deal?" The prisoner stated "yes". I asked the guards to take off his restraints, and explained the reasons - they were hesitant, but finally relented. I thanked them and continued to assess my patient which included getting him OOB and into a chair. The prisoner was cooperative and respectful. The guards wanted to handcuff him again, I said "look, you two are sitting by the only exit with big guns, is it really necessary to restrain him? They again saw things my way.

The prisoner and I got along great. He thanked me for my care and consideration. He remained cooperative and respectful throughout his stay, without problem.

I believe we have a responsibility to our patients, regardless of what they may or may not have done. It is irrelevant - and often non of our business.

I literally ran into this patient on the street while my children were with me about six months after I took care of him. He said "Yo! What's up?" I groaned inside. We chatted for a minute and he thanked me again saying I was the "best nurse he every had" - and the "he'll never forget me". Unsure if I was flattered or not, I thanked him and ushered my kids into our car. Never saw him again after that.

My motto is and always will be, "treat others as you would want to be treated".

Blessings

[prison_nurse]

I've taken care of prisoners on many occasions, as we too, have several prisons in the area. On one particular occasion, I had a patient that was handcuffed to the bed by his ankles and his wrists. The patient couldn't move, not only was this contra-indicated for the patients well being, I also could not properly assess my patient in this manner.

I said to the prisoner, "I'll treat you with respect, if you'll treat me with respect, do we have a deal?" The prisoner stated "yes". I asked the guards to take off his restraints, and explained the reasons - they were hesitant, but finally relented. I thanked them and continued to assess my patient which included getting him OOB and into a chair. The prisoner was cooperative and respectful. The guards wanted to handcuff him again, I said "look, you two are sitting by the only exit with big guns, is it really necessary to restrain him? They again saw things my way.

The prisoner and I got along great. He thanked me for my care and consideration. He remained cooperative and respectful throughout his stay, without problem.

I believe we have a responsibility to our patients, regardless of what they may or may not have done. It is irrelevant - and often non of our business.

I literally ran into this patient on the street while my children were with me about six months after I took care of him. He said "Yo! What's up?" I groaned inside. We chatted for a minute and he thanked me again saying I was the "best nurse he every had" - and the "he'll never forget me". Unsure if I was flattered or not, I thanked him and ushered my kids into our car. Never saw him again after that.

My motto is and always will be, "treat others as you would want to be treated".

Blessings

The officers broke the rules and put people at risk....

[Birdbr]

I personally think that every patient that is in jail or prison should be in restraints, the patient may seem sweet, but in a second they could snap and try to kill you. So I would feel much safer if the patient was in restraints.