Medically necessary care

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Specializes in ER, Corrections, Mental Health.

Let me just preface this all by saying I am new to corrections. My previous field was ER, so I am having to learn and adjust to the prison culture.

I am the sick call nurse where I work, so I am lucky and get to see a lot of different things. One of the things I am having to get used to is the art of saying no, and learning not to let them back me into a corner. I am also having to learn that the only treatment provided in the prison system is medically necessary care.

One of the biggest things that everyone wants a script for is dandruff shampoo. Apparently it was something that they used to prescribe for the inmates, but as of recently, they no longer do it. The only way that we give them dandruff shampoo is if the dandruff becomes so bad that it causes open sores on their heads. Otherwise, even if we see the flaking, we have to tell them that the dandruff shampoo is available in the canteen and that their condition does not warrant prescription shampoo. When I explained this to an inmate the other day, he said "so the D.O.C. is just gonna wait until I get open sores before they do anything to help me" and then he just got up and walked out of my office.

Is this how it is at your prisons? Do you treat them for things that are not currently medically necessary? What do you say to them and how do you handle these situations?

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Specializes in school nurse.

I probably wouldn't have even mentioned the threshold symptom of when the RX would be allowed. Now the patient has a goal to achieve if they really want that shampoo.

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As my mother used to say, I hope this is the worst thing that ever happens to this guy in prison.

And you will soon see much worse.

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Specializes in Critical Care.

While open sores can result from the use of dandruff shampoo they aren't a normal progression of dry scalp with dandruff. If open sores are present then dandruff shampoo should not be used and the cause of the open ulcers should be evaluated (fungal infection, parasites, scratching, etc).

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Specializes in Critical care, Trauma.

Maybe in this situation it would be helpful to mention that people outside of prison don't seek medical attention for their dandruff, they just buy the OTC shampoo. This frames it as, "you're not going to get special treatment just because you're in prison and have more time and free access to healthcare".

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.
I probably wouldn't have even mentioned the threshold symptom of when the RX would be allowed. Now the patient has a goal to achieve if they really want that shampoo.

I would simply have stated that the medical department no longer orders dandruff shampoo and let it go at that. We got away from most of what I call "convenience ordering". Inmates would claim that they were indigent, and since my system does not charge for medications, getting the doctor to order things like moisturizers was a way for inmates to get them for free. When the economy tanked, we had to look at a lot of ways to save money, and that was one of the casualties.

At a facility where I worked a few years ago, the warden wanted us to put on a health fair for the inmates. We walked a fine line between giving them information that they needed and giving them a new list of symptoms to show up with at sick call.

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Specializes in corrections and LTC.

I would not get into any kind of a discussion. I would say 'medical doesn't provide dandruff shampoo'. If the try to continue I would repeat that statement and let the officer know that the appointment is completed. I don't let them get into a conversation with me while I am getting their vital signs, I tell them we will discuss their complaint after vital signs are done. That lessens the time that they have to try and argue or make their point.

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On 11/26/2018 at 1:27 PM, Ddestiny said:

Maybe in this situation it would be helpful to mention that people outside of prison don't seek medical attention for their dandruff, they just buy the OTC shampoo. This frames it as, "you're not going to get special treatment just because you're in prison and have more time and free access to healthcare".

Say this if you want a fight.

My main goal was always to go home in one piece, under my own steam. Upsetting the inmates does not help achieve this.

You might possibly mention that the shampoo is available, if it is, in the Canteen. Of course, not all inmates have money.

Maybe the person has need of medical attention for some other cause. Tell him to ask about dandruff shampoo, too, while he sees the doctor.

It's called punting. This inmate might help you or, at least, not hurt you if a fight or a riot goes down.

If you don't like this approach, then still be civil and tell him you are sorry but they have changed the rules and you are no longer allowed to give it out without a prescription.

In other words, don't make an enemy. Realize that not everyone in jail or prison is guilty. Realize that God loves all of them as much as He does you. Pick your battles. Treat them as you would want to be treated if you were locked up.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.
On ‎11‎/‎24‎/‎2018 at 1:04 AM, Jedrnurse said:

I probably wouldn't have even mentioned the threshold symptom of when the RX would be allowed. Now the patient has a goal to achieve if they really want that shampoo.

Bingo.

Several years ago, our warden asked us to do a health fair for inmates. We had to carefully edit the material that we used to educate them on a number of topics. You want to give them enough information to protect their health, without giving them a whole list of symptoms to show up at sick call with. We are going through this issue with Hepatitis C right now. The informational material that is given out tells inmates exactly what symptoms to claim to have if they don't meet the criteria for treatment.

On ‎3‎/‎18‎/‎2019 at 1:00 PM, ocean.baby said:

I would not get into any kind of a discussion. I would say 'medical doesn't provide dandruff shampoo'.  If the try to continue I would repeat that statement and let the officer know that the appointment is completed. I don't let them get into a conversation with me while I am getting their vital signs, I tell them we will discuss their complaint after vital signs are done. That lessens the time that they have to try and argue or make their point.

I also agree with this. You don't owe them an explanation if something isn't medically necessary. I will venture a guess that if any of these men were on the outside and asked their personal physician for an order for dandruff shampoo, they probably wouldn't be leaving with a prescription unless it had progressed to the point that it was a genuine health hazard.

"Medically necessary" is the primary benchmark for anything that we do. In years past, a lot of things were done for convenience, such as issuing lotions (we are in a very dry climate), special soaps, special shoes and so forth. We have been officially out of the personal convenience business for several years now. We should never have been in it.

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.

I usually managed to maintain a good working relationship with the inmates by stating "I'm not allowed to......or policy does not allow me to......" If you say, "I can't...." it makes it seem like YOU are making a decision, and being mean or whatever. And there will be times that the inmates get angry and belligerent and take it out on you. As previous poster said, if your visit is completed, let security know they can escort inmate out of the clinic. Don't argue, don't let things escalate. A lot of inmates have anger management issues (which is why they end up in prison anyway) and explode very quickly, but I found that many times they would come back and apologize.

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