BJOC 2.7 - Inmate Medical

Terminal Performance Objective (TPO):

BJOC 2.7 - Inmate Medical

Enabling Objectives (EO’s):

As a result of this instruction, the student will be able to:

2.7.1        Identify procedures to be followed when an inmate has a medical complaint or shows signs of illness or injury.

2.7.2        Identify typical emergencies that occur in the jail environment.

2.7.3        Identify procedures for administering prescription and non-prescription medications to inmates.

2.7.4        Identify procedures when dealing with female inmate medical issues.

2.7.5        Identify the benefits of ethical, and the consequences of unethical, decision making and behavior as related to inmate medical services.

More than three decades ago the highest court in the land stated that inmates have a constitutional right to adequate medical care.  The Supreme Court decision on correctional health care came in the case of Estelle vs. Gamble in 1976. A Texas prisoner alleged cruel and unusual punishment in violation of the Eighth Amendment because of inadequate treatment for a back injury.  The U.S. Supreme Court held that “deliberate indifference” by prison workers to an inmate’s serious illness or injury violates the amendment. According to the decision, the primary concern of the drafters of the amendment was to prevent torture or “barbarous methods of punishment.”

Administering and supervising daily sick call is one of the critical aspects of the jail operation.  Neglect of an inmate’s health needs can lead to severe illness or even death.  Since the jail is entrusted with the welfare and safekeeping of each inmate, proof of negligence can have serious legal consequences for the jail and the personnel involved.

What are the three medically related responsibilities of a jail officer?

1.       Make certain that all inmates who have medical complaints or show signs of illness or injury receive prompt attention from a physician, nurse, or medical technician assigned to the jail.

2.       Assure that medical supplies and medications are properly stored and that medicine administered to an inmate is actually taken by the inmate; also, make certain that proper records are kept of all inmate medical complaints and treatments.

3.       Control behavior during the actual sick call procedure.

Describe four typical medical emergencies that occur in jails: (8 are provided in the manual).

·         Diabetic emergencies:  Anytime a diabetic state is suspected, the inmate will require emergency medical care so the insulin balance can be stabilized.

·         Heart attacks:  Officers should immediately summon an ambulance and follow procedures they learned for cardio-pulmonary resuscitation or for the proper handling of a suspected heart victim.

·         Choking:  Officers should attempt to immediately dislodge the obstruction in the throat by using the proper procedures recommended by the American Medical Association, American Heart Association or the American Red Cross. The victim should receive emergency medical treatment for examination once the object blocking his breathing passage has been dislodged.  He may require oxygen.

·         Fainting or blackouts:  Officers should loosen the victim’s clothing, keep him in a prone position until consciousness returns, and then transport him to a hospital emergency room for an examination.  The inmate may have internal bleeding from a head injury, which could cause sudden death.  Officers should never assume that once a fainting victim is revived, he is OK.  The fainting could be caused by a serious internal injury or medical problem.

·         Suicide attempts:  Officers should immediately act to remove the cause, such as a bed sheet around the inmate’s neck if he tried to hang himself; always assume that a hanging victim is still alive and can be revived.  Officers should follow proper emergency first aid procedures and call for an ambulance if the inmate has inflicted serious harm to himself, such as deep cuts or swallowing poison or a quantity of pills.

·         Seizure or convulsions:  Officers should help the inmate prevent bodily harm or injury by removing moveable objects and cushioning the victim with a pillow or blanket.  An ambulance should be summoned.

·         Miscarriage or attempted abortion:  If a pregnant female inmate undergoes these emergencies, officers should administer proper emergency first aid and immediately summon an ambulance.

·         Allergies:  Some inmates suffer from allergies.  If an inmate states he has an allergy, the officer should not attempt to tell him “it’s all in his head” and ignore the inmate’s pleas for help.  The inmate should be referred to a physician for treatment.  The physician might require officers to adopt procedures to make certain that the inmate is kept away from whatever causes the allergic reactions, since an allergy sufferer could become seriously ill if he comes into contact with the offending substance.  This may mean that inmates are given special diets if they are allergic to certain foods; extra blankets and clothes if they are allergic to cold air; denied outdoor work details if they are allergic to pollen or bee stings; and, housed in very clean, almost sterile cells if they are allergic to dust.  A physician will determine what special treatment the inmate requires.

 It is your job to follow the doctor’s orders and see that the inmate, now a patient, gets that treatment.  The doctor depends on you to follow his orders and expects that you will do so.  If you do not, then his efforts at trying to help the inmate are fruitless.

What information should be included on every legitimate medication label?

Every medication label should include:

·         Name of the pharmacy

·         Patient’s name

·         Prescribing doctor’s name

·         Date the prescription is filled

·         Number of the prescription

·         Name of the drug

·         Dosage

·         Instructions for taking:  number of times the drug is to be taken daily, method of taking, and any special times that the drug should be taken such as before meals, after meals, before bed.

·         Initials of the pharmacist

 Medication can enter the jail in various ways.  The prisoner may bring it in himself, especially if he has been arrested on a warrant and was at home at the time of arrest, or it may be delivered by a relative or friend of the inmate.

In any case, the medication must be verified before it is administered to the inmate.  There should be a standard procedure for verification of the legitimacy of the prescription, the drug itself, and, if necessary, the person carrying the medicine.

Here are some guidelines concerning verification of prescription medications:

·        When medication is brought in, examine it so that you can describe it over the telephone.  Note the size and shape of the tablet or capsule; its color; whether there are any words, numbers, or letters imprinted on the surface; and, if a capsule, whether it is filled with grain or powder and whether it has been tampered with.

·        If you have a copy of the Physician’s Desk Reference (PDR), try to match the pill to the corresponding picture in the book.  This will give you the name of the drug.

·        Call the pharmacy indicated on the label of the medication container.  Tell the pharmacist the name of the inmate and the prescription number.  Describe the mediation and ask for a verification of the authenticity of the prescription.

o   If he verifies the prescription, ask the pharmacist to also verify the dosage information:  timing, amount to be given, special orders, etc.  Ask him questions if you are unsure or unclear about anything.  If necessary, ask him whether or not the prescription can be refilled, and if so, how often.

o   Record that the pharmacy was called and that verification was obtained.  Write down the exact date and time of the conversation, as well as the name of the pharmacist to whom you spoke.

o   If you have any further questions, you cannot reach the pharmacy, or if there is anything which bothers you, call the inmate’s doctor.  His or her name will be on the prescription label.  Ask the doctor, for example, for any specific instructions or suggestions regarding the medication for that inmate.

o   If you cannot reach either the pharmacy or the doctor, and it may be urgent that the inmate have the medication, then call any hospital emergency room for advice.

·        If medication is brought in an unlabeled container do not administer it under any circumstances.  If the inmate claims that it is a prescribed medication which he must take, check with the doctor and if necessary, obtain a new prescription.  NEVER use medication from an unmarked container.

o   Once you have verified the authenticity of the medication, the next question is whether or not to administer that specific medication to the inmate.  Some jails simply store the medication and request the pharmacy to make up a new batch of the drug.  In this way, there is a guarantee that the drug is what it’s supposed to be.  After all, people have been known to empty capsules and then refill the capsules with another substance.

o   Other jails administer the drugs brought in by the inmate or his family.  In any case, the jail physician should advise on the most desirable policy, and that policy should then apply to every situation.

·        When any medication is received, it must be secured carefully.  All medication must be kept in a locked cabinet or drawer.  Never leave medication in an unlocked cabinet or drawer, and certainly never on an open shelf or desktop.

o   This applies to both prescription and non-prescription drugs.  Most drugs can be harmful or even fatal if taken in sufficient quantities.  Therefore it is important to lock up even such common non-prescription drugs as aspirin, antacids, laxatives, liniments, ointments, cold tablets, sleeping aids, and lozenges.  These can be administered to inmates as necessary but the best policy is to store and handle them with the same security precautions which apply to prescription drugs.

o   Never allow trustees access to locked cabinets or drawers containing medication.  Remember that the trustee is not liable for the welfare and well-being of other inmates, you are.  So if the trustee is careless or if he decides to provide another inmate with illicit medication, there could be trouble for somebody other than just that trustee.

·        Some medicines, such as insulin, may have to be refrigerated.  It will probably not be possible to control such medicines with the same standards of security as other medicines.  If possible, however, the refrigerator in which medications are kept should be located in an area inaccessible to inmates.  An officer should be assigned to be accountable for an inventory and proper storage of medical supplies.  The locked medicine cabinet should be inspected at least twice on each shift.

·        The most important thing in medication administration is to follow the label directions explicitly.  There should be no question as to dosage or the timing of the dosage before any medication is administered.  If there are questions, be sure to call the doctor or pharmacy.

Describe the procedures for medication administration.

·        Self-administered medications:  In some cases, an inmate may be allowed to keep his medication with him in order to take as necessary – if the doctor so approves.  Examples of such medications might include nitroglycerine tablets or other medications which a person with a heart condition needs to take when he feels chest pain; or an inhalant for a person with chronic lung disease, such as asthma, to take in case of a severe episode involving breathing difficulty.

A diabetic inmate might be allowed to self-administer his own insulin, if the doctor approves.  If so, he or she must be provided with a syringe and an alcohol sponge each time the insulin is to be taken.

·        As needed medication:  Sometimes the dosage directions will specify that a medication be given “as needed” or “upon request.”  In that case, it should only be administered when the inmate requests it.  Again, careful and thorough documentation of the administration is necessary.  It is also important to be sure that the inmate gets no more of the medication than might be allowed within a certain time period.  For example, the medication label might specify “two tablets as needed, not to exceed six tablets a day.”  Be sure that he gets no more than that.

·        Entire day’s dosage:  Never give an inmate an entire day’s dosage at one time and expect him to take the right amount at the correct times.  Do not entrust an inmate with this responsibility because he could abuse it by taking all of the medication at once, by selling or giving away the medication, or by storing it.  After all, it is your responsibility to see that he gets his medication, not necessarily his responsibility to take it.

The only exception would be if the doctor specifically orders an inmate to have his medication with him to take at certain times or as needed.

·        Applications:  In general, it is usually alright to allow the inmate to keep an ointment or cream or lotion in his cell so that he can apply it to his skin when necessary. Be sure that he knows how often he is to do so, and check to be sure that he is doing it.  The directions on the ointment label must, of course, be followed very carefully.  In addition, you should teach the inmate to apply a thin coat of an ointment.  It does no good to apply it too thickly.

Usually, an inmate will follow directions and use the medication correctly.  However, if he seems to have a mental or emotional problem, or is just generally an irresponsible individual, then it may not be a good idea to leave an ointment with him.  It will then be necessary to take the medication to his cell each time and watch as he applies the correct amount.

In some cases, the inmate will not be able to apply an ointment himself and will need help.  For example, he may have to apply the ointment to his back or some other hard-to-reach part of the body. Or, he may have a serious burn injury or, his hand that requires ointment.  In such cases, you will have to apply the ointment for him.

Just to be safe, it would be best to check with the jail doctor to be sure that there is no danger involved in leaving an ointment, cream, or lotion with an inmate.  Some such application medicines can be dangerous.  For example, podophyllum is a liquid which is commonly used to remove venereal warts.  However, it can burn the skin should not be left in the cell.  In other cases, an ointment might be very expensive and you should be cautious that the inmate does not waste it.

·        Suppositories:  There are a number of kinds of suppositories for various purposes. Rectal suppositories can be used to treat such problems as constipation, breathing difficulty, nausea, and hemorrhoids.  Vaginal suppositories are used to treat infections.  Some are prescription items, others are not.  Most suppositories are to be refrigerated or else they will melt.

Usually, it is alright to allow an inmate to keep two or three suppositories in his or her cell to use as directed.  Check with the doctor or nurse on this.  The inmate can insert the suppository himself.  However, do not allow him or her to keep more than three or so, because they may melt.

It is important to read the directions on the suppository container very carefully before allowing the inmate to use one.  Be sure that he understands the directions.  In general, always be sure that an inmate inserts a suppository slowly, and that he or she lies down to rest for 15-20 minutes after inserting it.

If a woman needs vaginal suppositories, the applicator should be left in the cell with her.

Give the inmate a finger cot to use for inserting the suppository if he wants one.

What information is recorded on a medication log sheet?

This information should be recorded on a medication log sheet.  The log sheet should contain the following information:

·         Inmate’s name

·         Booking or identification number

·         Date of the administration

·         Time of the administration

·         Medication administered (name of medication, dosage)

·         Initials of the person administering the medication

·         Initials of the inmate receiving the mediation

Female inmates in the jail may experience pain or discomfort resulting from a number of urgent medical situations.  In most cases, these are not life-and-death situations.  However, proper medical attention should be provided to prevent complications.

Because of the unique nature of female medical emergencies and the psychological traumas that such emergencies can produce in the inmate, it is important that jails employ women officers.  However, even if jails do employ women officers, all officers should be aware of the common signs and symptoms indicating possible gynecological/ obstetrical emergencies and know when it is necessary to summon an ambulance immediately or call a physician.

Obstetrical emergencies are usually quite serious and the inmate should receive immediate medical attention.  In most cases, pregnant inmates are identified during the booking and admissions process.  When these inmates are identified, officers can provide proper medical care for them.  However, some women who are in the early stages of pregnancy when they are admitted to the jail will not be aware of their condition until later.  Thus, officers should be prepared to consider the possibility of an obstetrical emergency if women inmates of childbearing age suddenly become ill.

 It is your legal and moral obligation to ensure inmates receive prompt and appropriate medical care.  Denying or delaying access to medical care, failure to follow doctor’s orders, or failure to properly dispense medication can result in discipline, termination, or even civil or criminal action. Following through in a thorough, professional manner will ensure you have fulfilled your obligations in providing medical care to the inmate.