Monthly Archives: August 2013

Rectal Contraband. What Would You Do?

Hey Jeff,
 like you I am an ER doc and am the Medical Director of a 550 bed jail. I would like you thoughts on body cavity searches. We had a case last week where an inmate was seen putting a baggy in his rectum. A search warrant was issued and the inmate was sent to the ER for a body cavity search. The inmate refused to let the ER personal touch him. He told the ER doc that it was a baggy of tobacco. The ER observed him for several hours and sent him back to the jail. No cavity search was done. The ER doc felt she would have to sedate the inmate to do the search and felt uncomfortable doing this against his will. The NCCHC frowns on the jail medical providers doing evidence related procedures or searches. My policy is to do the searches if the inmate will sign an informed consent and allow it to be done. If the inmate were to have a complication of sedation or the removal procedure that was done against his will, I would think a malpractice claim could be supported. How do you handle these types of situations in your jail?
 Thanks,
BJFUnknown Continue reading

Reader Question: How Do You Handle Ramadan At Your Facility?

Dr. Keller,
I am curious to see how other jails/prison handle fasting during Ramadan. We only KOP inhalers and creams at my facility and have no medical commissary. We do a very early medication pass for those who are fasting, but it does cause occasional problems with the management of diabetics and some other chronically ill patients. How do other facilities handle this?
Thanks,
 Jill McNamaraimages-2 Continue reading

Beware of Lithium Toxicity!

If you have read the title of today’s blog post, you already know the answer to today’s case.  The answer is “Lithium Toxicity.”  I could have instead presented a “Can you figure this case out?” type of format.  But I did not want to do that because, really, what was causing this particular patient’s symptoms is not obvious, especially early on.  This is an introspective learning case.  I want you to read the case knowing the answer.  The answer is “Lithium Toxicity.”  As you read this case presentation, I want you to ask yourself when the possibility of lithium toxicity would have first entered your head and when you would have stopped this patient’s lithium?lithium1 Continue reading