I work in a smaller county jail where we house on average 50 inmates on any given day. I am the only RN at the facility and I am only here 4 days a week. My doctor comes in once a week as well as our mental health nurse. We had an elderly IM brought in who was MI and honestly did not belong in the jail. This IM was back in holding as a safety precaution to himself as he would bang his head on the wall, urinate on the floor (then wipe it up with his sock, and refuse to hand over the sock), smear feces on the wall, and so on and so forth. I was informed by staff that he had an open wound on his ankle and after digging through his medical information I found out that he was also a diabetic. When I went back to check out his foot he would not let me close to him. He said the only way he would let someone take care of his foot was if it was a burn nurse at our local hospital. I had to stand 20 feet away and he told me if I couldn't see it from there I was blind. He also refused to take any of his medications or allow staff to check his blood sugars. After consulting with my MD we decided that it was in his best interest to send him to the hospital to have the foot taken care of as he was urinating and defecating all over the open wound. While he was at the hospital he underwent a psych consult. However, his foot was bandaged and he was sent back to the jail. I was extremely appalled at this and immediately called the ER to find out why he had not been placed on a hold. The answer I got was even more disturbing. I was told (by the MD who did the eval) that he met every qualification to be placed on a hold but they had previously tried to have him committed and "our county attorney" didn't support it and let it fall through. I explained, rather bluntly, to the MD that it was not his personal decision who gets placed on holds and that if he met all the criteria for a hold that he should be placed on one, regardless of what "our county attorney" has to say about it. I told him that when he chose to become a doctor he took an oath to provide medical care to those who need it and he was failing this man because everyone else had. So at the end of the day the county attorney was contacted and so was social services and everyone was on board to have this man committed so he could obtain the medical/mental health services that he needed. He, in fact, was committed and sent to a mental health facility. He has not returned to the jail as an IM but he has come to collect his things and he seemed to be in a better mental state. I don't know that I would say I saved his life, but I gave him another shot at having a "normal" one.