Monthly Archives: May 2012

A Step By Step Approach to the Hunger Games

So the Detention Deputies call medical and say that there is a certain inmate who has not eaten anything for the last four days.  Not an unusual occurrence in my experience; in fact, we medical providers most often hear about Hunger Games participants in this way, sometimes several days into their fast.  At this point, we do not know if this is a real fast (maybe the inmate is gaming), a true suicide-by-starvation patient, some who is just dieting to lose weight, or a psychotic inmate.  Today I would like to go through a step-by-step approach to the Hunger Games participants. Continue reading

The Hunger Games–Corrections Style

I have two patients in my jails right now who are not eating.  When I was told about these patients, the term “Hunger Strike” was used, as in “We have a new patient on a hunger strike.”  However, “Hunger Strike” does not seem to be the right term to me for these two patients.   I prefer “Hunger Games” for the majority of the patients who stop eating for awhile.  “Hunger Strike” evokes memories of people like Bobby Sands.

I am old enough to remember when Bobby Sands starved himself to death. Continue reading

Where Should the Hydrocodone Go?

Do these go into property?

My friend Sherry Stoutin, Medical Director of the Nez Perce County Jail in Lewiston, Idaho, shared an interesting case.

She sent a patient in her jail to the Emergency Department to be evaluated for chest pain.  He was cleared in the ER but was sent back to the jail with six hydrocodone tablets to be used PRN for chest pain as well as a prescription for 20 more.  The patient actually had no further complaints of chest pain when he returned to the jail, so whether to give the six tablets to him was a moot point.

The real question is what to do now with the six hydrocodone tablets and the prescription for 20 more.  Should they be placed in his property and given to him when he is released from jail?

What would you do?  Read on for my thoughts, such as they are: Continue reading

Inappropriate Drugs in Jails and Prisons–Continued!

Matt, Correctional Pharmacist. Everyone Needs One!

In my last post on this subject (found here), I mentioned three medications that I think should rarely, if ever, be allowed in correctional institutions.  I would like to expand this list today.

In my personal protocol on this subject, I break problem medications into four categories, depending on three criteria:

1.  The risk of abuse the medication has in a correctional setting.

2. How much potential benefit the medication has.

3.  Whether there is ready availability of other, less problematic, substitute medications. Continue reading

Tips for Diagnosing Appendicitis

Paramedic Rob's appendix ruptured. Six months later, he had surgery. Now that's tough!

One of the last remnants of my previous life as an Emergency Physician is that I am still to this day the Medical Director of the local fire department and paramedics.  I also do the fire fighters’ yearly wellness physical exams.

(As an aside, my wife helps me by drawing blood, doing EKGs, getting patients’ prepped, etc.  She tells everyone who will listen: “I have the best job in the world.  I tell fire fighters to get naked—and they do!  Every woman wants my job.”)

Anyway, recently, a paramedic came to me with this nagging abdominal pain that he had had for over six months.  It was never so bad as to make him quit working, but it never went away either.  After I looked him over, I thought he might have appendicitis—but for six months?  I sent him for a CT and sure enough he went straight to surgery.  It turns out that he had actually ruptured his appendix six months ago and he had been walking around ever since with a walled-off intra-abdominal abscess. Continue reading

Are There Medications that are Inappropriate for Use in Jails and Prisons?

All medications have side effects and potential complications. Of course we all know this. Whether to prescribe and what to prescribe should involve a careful weighing of the expected benefits vs. the potential harm for each individual patient.  This math—risks vs. benefits—can change for many reasons.  For example, drug X may be great for most people but this patient has kidney disease and should not take drug X.  This patient does well on drug Y but that patient has no health insurance and cannot afford drug Y.

Being incarcerated changes the risk-benefit equation for many drugs.  This is especially true for drugs that are addictive or have the potential to be abused.  Some medications may be inappropriately used by inmates to continue or maintain their drug addiction while incarcerated. Such medications have value in the jail system and are commonly shared and sold.  Individuals taking these medications may be at risk from other inmates, who may coerce patients to “cheek” and share.  This additional extraordinary risk must be considered when prescribing medications in a correctional setting and for many drugs, the risks always (or almost always) outweigh any benefit a patient may derive from them. Continue reading