I do that too. We also have a similar system. It still needs the kinks worked out of it but it works over all. Most things are not an emergency and can be treated by the nurse. We have clinical pathways that direct the nurse in appropriate treatment. The problem is the officers get kind of wrapped up in the inmate issues and often call medical for irrelevant things……………………..

If it would help our head nurse devised a system for inmates to request medical care. Each unit has a steel box that is locked (small metal safe with key) that is bolted to the wall. If an inmate requests either medical or psychiatric services they fill out one simple form with their name, block or tier, date and what they need. The head nurse goes the day before doctor call (Tues or Sat) pulls all those sheets then reviews them. If an inmate is coming for something that is in her opinion not an emergency and something that she can discuss with the doctor (such as a refill) she will tell the inmate the issue is resolved and they don’t need to come to sick call. It works really well.

@jamestown- Love it!!!! Our doc will give an inmate darned nearly everything they ask for. I have to put my foot down and see most patients before he sees them so I can make an assessment of what’s going on. You are absolutely right about the young ones and the back problems and the scoliosis (crooked spines). They want medicine and they want double mattresses. When I got to the jail I am currently at, about a third of the inmates were on muscle relaxants and had double mattresses.The nurses didn’t like me, the inmates didn’t like me and the jail administrator thought I was a renegade. I am slowly earning the respect of my staff and the jail administration because I can back up most of what I do with data that I get out of medical journals and correctional journals. I have a bad back and I work 10-12 hours a day everyday and have to live with some discomfort, if I can, than they can too!

Oh I love the excuses they give to the doctor. Almost every inmate (even younger boys) claim an old back injury. Amazing that they had back injury from 15 years ago and now since they are incarcerated they need meds. They also demand a back brace. Our PA tells them no back brace unless you had recent surgery and your doctor that did the surgery recommends one. You would laugh at this one: An inmate came in one sick call and told the doctor this: “I really need medical help doc, you know a couple of years ago I was riding my motorcycle at 60 MPH when I hit a moving train head-on. I broke ALL 300 BONES!” The doc looked at him and said, “Wow…all 300 hundred bones, it’s amazing you are able to walk. Now get lost.”

I honestly think that is why some inmates wait until they come to jail to complain about things that have been wrong with them forever. They know that they can get their issues treated and not have to pay an astronomical amount for the care. I do everything in my power not to have to send an inmate to the hospital because I hate getting a $2000+ bill for unnecessary treatment. Every headache does not need an MRI but if you come to the ER for treatment of a headache they have to rule out a bleed in the brain with an MRI. We have become so lawsuit happy in this country that any doctor is terrified of being sued and will do ANYTHING to keep from being sued like ordering tests that he suspects strongly will come back negative. We sent an inmate who was behaving bizarrely to the ER and the bill I got back was almost $5000 for CT of head, labs, ER wait time, radiologist bill and ER doctor fees. They gave him some oral potassium because his labs showed he needed some and gave him nothing for the psychotic episode! Go figure!

Mta, I do think the public in general really wants inmates to pay something toward their medical care, even if it seems token compared to the actual cost. What gets me is why we send an inmate to the hospital for tests that cost $2,000 (MRI for example) when individuals have a difficult time getting approval from insurance companies for doing the same test. In addition we estimated that medicine costs for inmates was averaging $60,000 a month even for a small facility.

I find it so odd that some states charge for certain things and some don’t. When I worked in Virginia, the jail there charged a $10 booking fee for the privilege of coming to jail!

Oh we tried to charge the inmates $3.00 per visit but the State Commission said absolutely not. Odd because the state prisons all charge $3.00 for medicine and haircuts..figure that out.

Wow, $20!!! Our inmates complain about paying $5 to see the doctor or the dentist. I like the way your facility thinks!!!! Wish I could get that here.

If our inmates refuse their meds it is documented and they are no longer able to get them until they see a doctor or psych doc to have them reinstated. The problem for them there is they have to pay $20 to see the docs!

We aren’t fortunate enough to actually have a psychiatrist that is willing to work with the nursing staff at my facility. The doc that we have has her staff come in when they can to give injections to willing inmates. She continues to agree that we must send the inmate to the emergency room for treatment. Our medical director really does not want to take on any more responsibility than is necessary and I can’t blame him in many ways. However, I think when one looks at the cost of transporting an inmate to the hospital and the labs and tests that are done, the cost is almost prohibitive. Healthcare in general is in such a state of chaos that getting the kind of care that these inmates need is difficult at best.

We are the same if the Psych Doc say he has to take it he gets it if he wants it or not. Once the Doc gives us the green light game on.

You are very fortunate to have such a policy and a psychiatrist willing to stand by her beliefs as a practitioner. When I worked at another facility in another state, we had a SERT team that would accompany the nurse to medicate inmates whose behavior warranted further intervention. She would give them a shot of Ativan or Haldol ordered by the physician while the SERT officers held the inmate down. It worked!!!
I don’t have that luxury where I am now. I have to send the inmate to the emergency room where they do a “million dollar work up” which ends up costing me thousands of dollars and all I really needed was an $50 injection of Haldol or Ativan. Oh well……….

How we get away with those inmates is having the staff psychiatrist make them take the meds. She will not take no for an answer. I have seen her literally inject meds to calm an inmate down, it saved us from getting injured by an obviously mentally ill inmate. If they refuse the meds make sure you document that every time. Trouble with our facility is the COs have to dispense meds, something I never agreed with.

I wonder if anyone thinks that it’s fun dealing with inmates that won’t take medication although everyone else knows they need it? Being the head nurse means I have to make the determination whether an inmate gets sent to the ER for medication to “calm” him/her down because my staff and I cannot give any medications against an inmate’s will. So until they are seen by a doctor in the emergency room and determined to be “out of control”, the inmate can do whatever they want. Every state is different and in the state where I currently work, the ER is the ONLY alernative I have. I cannot give any sedatives or antipsychotics without the inmate agreeing to it. This causes a waste of correctional staff’s time as they have to transport the inmate to the hospital, wait for them to get treated and then return. That can take hours. Some systems were obviously designed to protect individuals in one or two situations but don’t look at the big picture. Just my two cents.

You are right Mick,they are not responsible for their own actions which in my opinion makes them unpredictable.Remenber one particular one on lockout.Wanna a cigarette,told him no,so he began banging his head on the cell door until he get one.Keep my calm,when over to him calming him by asking him how was his bleeding forehead “.it hurts co”. Told him they where going to pick him up,extraction,sent him to the nurse,and probably strip him and putting him in the chair strapping him down,told him it was for his own safety",and he should probably think about quitting smoking",is bad for you,look what it got you the chair and is the middle of winter."I’m sorry co.Ya you are right they don’t know what they are doing.

LOL I was I/C the “Mad Landing” for 5 years so I know all about their quirks. I had one guy try and strangle me and 10 mins later he was sweetness and light. But there is no point in being angry with the looneys because most of the time they are not responsible for their actions.

Mick and Canus be careful around mentally ill inmates. Some of them display a “quirk” just before they attack. For example I was in the booking room one day with an inmate (not restrained) when he suddenly “quirked or twiched” on the side of his face. Right after that he hit the Sgt in the mouth and it was a battle to restrain him. Stay safe.

Nowadays Mick and Jamestown I often feel liked a jack of all trade and a master of none.One moment dealing with am inmate breaking a rule,and the next one going of the reservation.Here in NJ we are the phys. and nurses eyes and ears with this mentally Ill inmates.
Do I think they are harmless,nope.I don’t take my eyes of them for one minute.Crisis intervention experience is a plus with these mentally ill.

We go one better. Our Central Mental Hospital (Secure Hospital) send us those that are criminally insane who are too violent for them to handle.

Oh nothing like the state deciding that it’s cheaper to close mental health hospitals to save money. Now we have someone who has every mental disease in the psychiatric book loose on the streets with no meds. Obviously someone who is off their meds is noticed by the public, who call the police and eventually we get them in the jail. What fun. If you are a new CO on the job or not familiar with mentally ill inmates you certainly should be aware of how dangerous they are. The saying is that a man who is nuts has three times the strength of a normal person. Believe me from experience that is absolutely true. Be safe my fellow COs, when you are around an inmate who you know is mentally gone blade yourself and watch them constantly, these inmates can be very dangerous. So, as I was saying in my title…send us your mentally ill. Thanks a lot NY state..