Wonder how often this happens

[BabyLady, BSN, RN]

I have a friend that is a physician at a hospital that is near a maximum security state prison.

She was telling me about the protocol that has to be followed when they bring in inmate in for care....which is always three guards...two in the room and one outside the door, patient has to be handcuffed to the bed at all times, etc.

What she told me next really, really shocked me.

She said that whenever a patient was discharged, even for a serious injury or surgery that may be health and not violence related, when the attending physician feels that a heavier med is needed and gives the guard a prescription, the guards hand it back and always say, "Save your paper, the only thing this guy is getting is Tylenol".

Knowing that medications are under lock and key at a prison and obviously not given to inmates to take back to their cells, my friend has always had concern over the management of pain, knowing that Tylenol isn't a cure-all for everything, especially when they have abdominal or back surgery, have broken bones, etc.

To me, I am very surprised that guards are allowed to make, what boils down to a medical decision regarding the patient.

[rjmorris]

At our facility we do give narc vicodin or tyl 3. only for a 3 day period. no longer.

[Orca, ADN, ASN, RN]

We are not allowed to dispense anything that didn't come from our own pharmacy. Inmates are not allowed to bring meds back from the hospital, regardless of who carries them. We do have some heavy-duty pain relievers available, but an inmate generally has to be admitted to the infirmary to get them. Fresh post-ops always would be.

[prisonnurse13]

At our facility when an inmate returns from the hospital with a script the MD is phoned (if not on grounds) IF it is not a medication that we have in our pharmacy (EX: Percocet) our MD will order either Vic 5/500; Vic ES; Darvocet; Ultram. These orders are for a limited time period of course. If the inmate is released to general population he is given a pass to come to medical every 6 hours as needed for the pain medication for at least the first 48 hours, then tid/prn during regular pill call times. He is re-evaluated by the MD within the alloted time period (per policy) and pain meds decreased then discontinued. I have not witnessed the security staff having any say in what ACTUALLY occurs with the inmates receiving their pain meds or any other meds -- HOWEVER, that doesn't mean they don't keep their mouths shut about what they think the inmates should receive....

[JDCitizen]

At our facility when an inmate returns from the hospital with a script the MD is phoned (if not on grounds) IF it is not a medication that we have in our pharmacy (EX: Percocet) our MD will order either Vic 5/500; Vic ES; Darvocet; Ultram. These orders are for a limited time period of course. If the inmate is released to general population he is given a pass to come to medical every 6 hours as needed for the pain medication for at least the first 48 hours, then tid/prn during regular pill call times. He is re-evaluated by the MD within the alloted time period (per policy) and pain meds decreased then discontinued.

Same here; just because the consultant / ER ordered it does not mean the inmate is going to get it as exactly written.

I have not witnessed the security staff having any say in what ACTUALLY occurs with the inmates receiving their pain meds or any other meds -- HOWEVER, that doesn't mean they don't keep their mouths shut about what they think the inmates should receive....

:-)

[deyo321]

Same here. OUR docs order the meds. Not the consulting/ER doc. Pain is rarely treated with narcotics. Our CO's though would never presume to make a medical decision. Even if they know it is highly unlikely that we will treat with scheduled drugs.

For pulled teeth, minor procedures etc we use motrin. If something stronger is indicated we will go to tramadol unless contra-indicated, (SO many of our inmates are on amitrityline). Serious post-ops are kept in the hospital as we have no infirmary or overnight medical.

So in this instance the guard was out of line if this did indeed happen. Here they would just bring back the scrip and I would call my docs, who would look up the procedure in their computers and order meds accordingly. We are tied in to our hospital.

I know we are taught in school that pain IS what the "patient" says it is. However working in corrections you need a more comprehensive assessment. Are vitals signs increased? Is the inmate complaining of severe pain then out in the rec yard playing bball? Pain in jail is not just what the IM says it is. Unfortunate or not, that is the reality. You get to know your IM's; almost like your children, you get to where you can look at them and know something is wrong (I know, ew, bad analogy, but true for me) Strong assessment skills, instinct (gut), and a good BS meter are neccessary for a good corrections nurse. Someone who is obviously in severe pain will not be ignored. You will fight to get them what they need. And your MD's will generally back you up because they trust your instinct and experience. Experience is priceless in corrections. Which is why I would not reccommend for new grad. I'm not saying it can't be done, just would seem risky to me.

[iwanna]

I think that it is horrible that inmates are treated like animals. It seems that the officers are on some big power trip. I know that my daughter is in jail for missing a court date that she thought was continued. She did not even get her psych meds. She was on Effexor and seroquel. They decided that her seroquel was not a therapeutic dose, so they omitted it. Also, she was going through methadone(legal) withdrawal. I am just apalled at the treatment she is getting.

I actually applied to this job last year. I would never want to work there. I could not stand to work in a place where the guards and officers think they are God. They must have been picked on all through high school. I just don't understand how people could be so cruel. My daughter is a tiny girl and has been intimidated by guards. They threw her in the hole because a nurse thought she was having a seizure. Then they decided that she was faking it. I know my daughter, and she did not fake a seizure. She has a drug problem and missed a court date. Probably a result of her drug problem, not comprehending what was told to her. She is not a bad person. Just a sick one with a drug problem. Her offense was drug related. A first time offense for shoplifting, she was placed on ARD program. However, she lost the ARD due to a positive drug test.

She is going through methadone withdrawal. They told her that she should not be going through withdrawal anymore, since it has been three weeks. Obviously, they are uneducated as methadone withdrawal can last 3 months to a year. I would think dealing with a large population with drug problems, they would be more educated.

I am very angry with my daughter about her drug abuse. She has put me through a lot, but she does not deserve the treatment that she is getting. I would like to see her rehabilitated from drugs, not de-humanized.

I would never, ever, ever work in jail. May all those cruel people get back to them what they have done to others.

[canoehead, BSN, RN]

iwanna-

Her offense was drug related, she was in a drug program but tested positive, missing her court date was likely drug related. Cold turkey withdrawal is nasty, and they may not be doing it out of concern or caring for her, but she'll be clean when she gets out. She'll have an opportunity for a fresh start. Hopefully she'll be smart enough to use it, and not fall into self pity, and medications to ease her troubles. I hope she gets through it and makes it an opportunity for a new start. As her mom you'll have some influence on how she approaches this very bad situation. Good luck, and strength to you.

[MadisonsMomRN, BSN, RN]

Our docs orders meds as well. We stock Vicoden, T3 and Ultram. The guards definitely do not have any say in what meds the inmate gets. These meds are given on a case by case basis and the inmate must be housed in our infirmary to get them. For example, we have a female that has breast CA and other health problems. She has had surgery and she does get T3 (she was on Vicoden but it didn't work well for her)

The only exception is Ultram. On RARE occasions an inmate will get that and not have to be in our medical dept.

If an inmate comes in and has been on drugs or is an alcoholic we will monitor them and treat them accordingly. ETOH withdrawals will be housed in our medical dept and put on titrating Librium and possibly Clonidine. Benzo withdrawals will be treated with Phenobarb... so we do treat the inmates with certain drugs. Ugh... Sorry! I am rambling!! :)

I definitely do NOT think a correctional officer has the authority to determine meds. They do not have the training to do so. Safety and security are first but doesn't give them the right to override the medical doctor.

[deyo321]

iwanna, I am sorry for what you are going through. That being said, we do not use methadone here either. I have posted before that I have had inmates thank me and say if they knew it was that easy they would have stopped years ago. They are clean and different people. Then they get out and come back and I do it again.

We have protocols for ETOH and Narcotic withdrawals. These are based on my assessments, not just on what the inmate tells me. I have had inmates sit right here and tell me they do not use drugs when I can clearly see that they are in withdrawal. Two hours later they are begging to come back and see me again.

Antipyschotics require eval by our mental health dept. They are IMO over-prescribed in the general population by pcp's.

The officers here are very professional. I am sure your daughter is miserable, she's in jail. But I would like you to consider that we are professionals and do deal with alot of drug abusers. What an inmate cries to mommy may not be the exact truth by a long shot. Drug abusers often have a victims attitude and want sympathy for what "we" are doing to "them". Not many of them take responsibility for their outcomes. Not saying that this is your daughter, just what a great deal of my experience involves. And yes I consider addiction a disease, I so often see the ravages of it. Not intended to offend, just offering the other side.

[MadisonsMomRN, BSN, RN]

iwanna, I am sorry for what you are going through. That being said, we do not use methadone here either. I have posted before that I have had inmates thank me and say if they knew it was that easy they would have stopped years ago. They are clean and different people. Then they get out and come back and I do it again.

We have protocols for ETOH and Narcotic withdrawals. These are based on my assessments, not just on what the inmate tells me. I have had inmates sit right here and tell me they do not use drugs when I can clearly see that they are in withdrawal. Two hours later they are begging to come back and see me again.

Antipyschotics require eval by our mental health dept. They are IMO over-prescribed in the general population by pcp's.

The officers here are very professional. I am sure your daughter is miserable, she's in jail. But I would like you to consider that we are professionals and do deal with alot of drug abusers. What an inmate cries to mommy may not be the exact truth by a long shot. Drug abusers often have a victims attitude and want sympathy for what "we" are doing to "them". Not many of them take responsibility for their outcomes. Not saying that this is your daughter, just what a great deal of my experience involves. And yes I consider addiction a disease, I so often see the ravages of it. Not intended to offend, just offering the other side.

You are SO right. They do play victim!

[Troublant RN]

This used to be the case in California, not any longer. First of all, upon discharge, all hospital discharge documentation is place in an envelope, sealed and handed to an officer that delivers it to medical staff where the inmate is assessed as soon as he returns to institutional grounds. Pain management will be based on those recommendations, and what is available in the formulary (Tylenol #3, Ultram, Methadone, etc.)