About the Author

Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of emergency medicine practice experience before moving full time into his “true calling” of Correctional Medicine.  He is the Chief Medical Officer of Centurion as well as the Medical Director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho.

62 thoughts on “About the Author

  1. Rona Siegert

    Excellent information and of course written with your usual wit and humor! I will highly recommend the blog to the DOC contract providers. Thanks, Jeff!

    Reply
  2. Tom Moore, MD

    Dr. Keller -

    I’d love to see what other prisons are doing regarding the use of neurontin.

    Tom Moore, MD
    Medical Director
    South Carolina Department of Corrections

    Reply
    1. Jeffrey Keller Post author

      Thanks, Tom! Like you, I have noticed that Neuronitn is one of those drugs that inmates like and that has value in the correctional black market. The question is whether the therapeutic benefits of Neurontin outweigh these problems. It is interesting that Pfizer, the maker of Neurontin, was fined 430 MILLION dollars for inappropriate marketing Neurontin for off-label uses. And that is basically the only way we use Neurontin in corrections–for off-label uses!

      Reply
  3. Donna Juliano RN

    Love your site. I was wondering if you have heard that checking an inmates mouth after receiving their medication is considered a body cavity search and not a legal procedure? I have been hearing this alot from the new officers who have recently completed training.

    Reply
    1. Jeffrey Keller Post author

      I do not believe that is true–I mean that looking into mouths is a body cavity search. For that to be the case, a court would have to render such an opinion. I certainly have never heard of such a court ruling. Can your officers give you the legal reference? If so, I am interested.

      Reply
  4. Jennifer

    Great blog! I look forward to your posts. You have an excellent approach re: medicine in corrections. Your advice is also relevant to us in Canada.
    I know that in our jails in Canada, many inmates request polysporin/neosporin as the “cure all” for skin conditions. As doctors and nurses we have to be cautious when administered what might seem to be “begnin” ointments to our patients. I thought that you might find this article interesting!.

    http://vitals.msnbc.msn.com/_news/2012/06/06/12091723-prisoners-using-antibiotic-ointment-as-hair-gel-why-thats-worrisome?lite

    Reply
  5. David W. Clifton,PT

    Hello Dr. Keller

    I just discovered your blog. I truly enjoy it! Thank you

    Correctional Medicine is my latest career pursuit (I have practiced physical therapy in virtually every treatment setting. I will be practicing in soon in a large state corrections facility in California,
    In reviewing your past issues I was struck by the similarities between CM and workers compensation (an area of focus in my career both as a clinician and peer review expert).

    Most notably, are the similarities re: secondary gain and maladaptive behavior among “patients” (CM) versus “clients” (outside world). I look forward to reading and posting comments in future issues. Continued success and best regards.

    David, Physical Therapist

    Reply
  6. Nancy

    Hello Dr. Keller,
    I am an Acute Care NP that has just started working my first job in correctional medicine. I have a background in trauma as well as internal medicine private practice. I stumbled upon your site and love it! I work in a prison and have been shocked at the amount of illegal prescription drug use among inmates. Opiates, as well as Suboxone, seem to be readily available and abused. I have had multiple inmates that are using both of these IV. I am trying to prepare a presentation for our providers regarding the use of these drugs, statistics of use while incarcerated, acute/sub-acute opiate withdrawal in prisoners, etc. Can you please tell me of any resources I can find some of this information? Most of everything I come across is dealing with jails as opposed to prisons. Our guys have already been in the system for awhile, so we are not dealing with everyday acute “straight off the street” opiate addiction/withdrawal. Any information would be greatly appreciated. I have been told, that with time, I will not be as shocked at some of the things I have started seeing on a daily basis. I would like to be able to give all of us providers at our facility, a little information on signs and symptoms to look for as well as potential complications. Again, thank you so much for this site, it is wonderful!

    Nancy CRNP

    Reply
    1. Jeffrey Keller Post author

      Hi Nancy,
      Unfortunately, there are few clinical resources available for the practitioner of Correctional Medicine, especially compared to other medical specialties–such as Emergency medicine. That is one reason I started this blog! I work in jails, not prisons, so I admit that my blog has a jail bent. In your case, I assume that the opiates are being smuggled into the system and not prescribed. I also assume that this means that inmates who are purchasing the black market opiates will not have a steady, regular supply. This would mean that the inmates will not likely go through serious opiate withdrawal and will likely need no treatment. Treating addiction is something I know very little about. I leave that to my mental health colleagues.

      Thanks for the kind words!

      Reply
  7. Susan Gunn

    Thank you for sharing your wisdom and experience. I thoroughly enjoy your weekly posts and frequently refer to your articles for guidance.

    I am currently researching prison rape and would like to know your thoughts and/or policies on medical/nursing care following such events. We have difficulty providing adequate care in our facility as offenders who report sexual abuse are often segregated (by security) after examination. Have you found measures to avoid this or at least insulate the victim?

    Susan, RN

    Reply
  8. Mark Schaffield M.D.

    Jeff-thanks for your insights-they are hard to find in this line of work. I currently cover 2 county jails and one juvi unit. How do you evaluate female inmates with problems “down there”. The idea of treating women on the basis of symptoms, in my experience, does not work. That leaves me with a lot of pelvic exams-often helpful but not often diagnostic. After a search for the obvious (herpes, yeast, foreign body and adnexal tenderness) I am left with a “sniff test” for BV and the question of Trich vs GC vs Chlamydia is still unresolved. The price of NAAT puts that option out of our league and Clia requires a different certificate for Microscopy. How do you handle this? Thanks, Mark

    Reply
  9. Cheralee Worrall, RN

    I am wondering how do other facilities handle inmates who hoard medications. We normally have a no tolerance policy except for medically necessary meds (HTN, diabetes, etc). Lately our providers seem to be giving our inmates “second chance” and continuing the medications. Our nursing staff are becoming frustrated as we put forth extra effort to assure the inmates actually take their medications receiving lots of grief on a daily basis when asked to see their mouths, under their tongue, and in the cup in their hand. Inmates who hoard are referred to the disciplinary commitee but this does not seem to really bother the inmates as it is “just another write up”. Please advise.

    Reply
    1. jeffk2996 Post author

      Thanks, Cheralee! In order for med pass to work, the detention deputies have to be present and enforce the rules of med pass. These include lining up properly, wear proper attire (no coming to med cart bare-chested, for example), approaching the med cart one at a time, no “chit-chatting,” and showing your mouth appropriately after getting pills. If the inmates are giving you grief on a daily basis, it is because the deputies accompanying you are not doing their job enforcing facility rules. Don’t put up with it! Ask for a meeting with the sergeants or even higher to discuss the problem. That will work. It has when we have had similar problems in my facilities.

      As far as the “cheekers,” I will sometimes give inmates a second chance, usually with meds that I want them to continue. We sometimes crush meds of those given a second chance, for awhile at least. The problem is continuing meds that are, well, a problem–the ones with high value in the facility, like gabapentin, trazodone etc. Continuing them tells inmates that it is OK to try to game the system–if you get caught, the practitioners will just continue the med anyway. There has to be some sort of adverse consequence to getting caught cheeking. The deputies should enforce their rules, but the practitioners can also impose appropriate consequences for medication misuse.

      Reply
  10. Mike Summers

    Dr. Keller: I enjoy reading the information you post on your blog. I have looked back over the archives and can’t find anything you have addressed about the use of ammonia capsules. In our jail facilitiies, it appears they are a popular “therapeutic” tool to determine “faking” seizure, syncopal episodes and etc. I am concerned about using them and would like to hear your thoughts about the use of ammonia capsules.

    Reply
    1. Jeffery Keller MD Post author

      I actually am a big fan of ammonia capsules–properly used! Blog article on the subject coming soon!

      Reply
  11. Sarah

    Dr. Keller,

    Your blog has ultimately made my decision on what I want to do my upper-level research paper on for my last year of law school. I work in medical malpractice now and I also work in Mental Health Court- and I work at a pharmacy on the weekends. I wanted to do something…different, and I felt correctional medicine was the way to go. I am currently narrowing down topics for my paper and deciding organization. Is there any literature, published books- anything- that you would be willing to point me to to help further my legal medical research and understanding? Or anything that you feel needs addressing in the correctional medical realm (I know that is probably extremely broad!)?

    Without this blog, I would probably be writing about something boring and draining. So thanks for taking the time to write such an amazing blog. You should write a book.

    Best-
    Sarah

    Reply
  12. Todd Hilton

    Dr. Keller,

    Please send me a copy of your acne protocol; I’m a Family Nurse Practitioner at a juvenile correctional facility and any protocol would be handy.

    I love this site. It makes me feel not so alone in my field of work.

    Thanks,

    Todd H.

    Reply
  13. Jill

    Dr. Keller,

    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

    Reply
    1. Jeffery Keller MD Post author

      Ramadan is not a problem in my jails, since we have essentially no Muslims. I will put the question on the blog and we will see what kind of response we get!

      Reply
  14. than aw

    Is there some kind of course preparing MD to be director of a correction facility. Like a county Jail ?

    Reply
  15. than aw

    I am thinking about applying for medical directorship in the jail that AI am currently working at. Any suggestion to prepare me for theat venture ? I am interested in some kind of academic or didactic course if that is available on the market. I attended the jail med symposium at Utah 11/2012 and looking forwrd to atending the 2/1014 conference..

    Reply
    1. Jeffery Keller MD Post author

      The best resource, Than, would be to go to the Medical Director’s course put on every summer in July by NCCHC!

      Reply
  16. Patrick Dooley

    Dr. Keller,
    I am looking for something to present to my jail staff regarding DT’. Something like a powerpoint and something that does not get too “medical” for them. Any ideas?

    Reply
    1. Jeffery Keller MD Post author

      Hi Patrick,
      I am unaware of anything like that right now, but coincidentally, I am working right now on a training course for detention deputies/correctional officers on what they need to know about medical issues. It includes alcohol withdrawal (and DTs). I’ll try to remember to let you know when I have the PowerPoint developed!

      Reply
  17. Bruce Flitt

    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,
    BJF

    Reply
  18. Arthur Pang

    Hi Dr Keller,
    I want to say it’s great to be reading your blog from the other side of the world (i.e. Hong Kong).
    Here’s a real-life patient I’d like to seek your and the readers’ opinion.
    Facts are: (1) Tramadol is not available in the formulary of my practice. It is only available in tertiary medical centers, such as the emergency department for a short period of time say a week, (2) Tramadol has “values” in the black market according to the correctional staff.
    This is a 50-year-old male heroin addict who complains of a left nipple swelling for two months. It’s not growing and clinically it’s not an abscess. A surgical consult has been arranged. I have been giving him paracetamol and NSAID for his claim of pain over his nipple swelling. Now he insists on getting Tramadol for pain relief since my analgesic cocktail of paracetamol and NSAID is not working. This means having correctional staff escorting him to the emergency department for a prescription of Tramadol. What should I do?

    Reply
    1. Jeffery Keller MD Post author

      Hi Arthur! This is pretty easy in my mind. No Tramadol. Tramadol comes as close to being a banned substance in my jails as there is. I have written about Tramadol here. I don’t think it has any redeeming features. 1. It is addictive and, of course, abusable. 2. In studies, it has consistently been shown to be a poor pain reliever. In my opinion, it should be thought of as a narcotic, and since it is less effective than hydrocodone (but just as abusable), hydrocodone or some other effective narcotic should be used when we need a narcotic–for example, after surgery. So no Tramadol for this guy.

      I also think there is a good chance that he is causing his own nipple swelling. It is pretty easy to do this simply by squeezing the nipple repetitively. Hormonal problems (think pituitary adenoma or testicular cancer) would affect both nipples equally. Breast cancer can occur in men, but usually presents as a discrete painless mass.

      Reply
  19. Shelly

    Hi Dr. Keller,
    I am in charge of creating a protocol that would support our medical directors choice to disconintue Methadone/Suboxone when inmates are brought to our county jail. I have been compiling information to support “for” and “against” and now need to write the protocol to cover ourselves. Could you share some tips on what to include in the protocol for not using these medications….Thank you in advance for your time.

    Reply
  20. Wally Campbell

    I started as a psychologist in prison recently, and have been learning a lot – thank you so much for this blog. I just found it and I’m looking forward to reading and learning, as I’m trying to get up to speed working with our psychiatrist.

    Reply
  21. Jennifer Mroz, PA-C

    Dr Keller, Thank you so much for sharing your exeriences. It’s nice to know we are not alone in the correctional field. I was wondering if you could share the protocols you are currently using for detoxing patients from opiates, benzo’s, and alcohol? Thank you so much!

    Reply
  22. BRYAN DAVIS PA-C

    Hi Dr. Keller,

    I was hoping I could pick your brain (and those of your readers) for ideas regarding Outcome studies.

    We are an NCCHC accredited facility with a population of less than 500 inmates. We are required as part of our accreditation to complete 1 Outcome and 1 Process study annually. Outcome studies are more patient specific and Process studies are more global, referring to the process by which we deliver care.

    I don’t usually have problems developing Process Studies, but always seem to get stuck on the Outcome studies. I am wondering if you or your viewers might share any suggestions on topics for Outcome studies or comment on topics they have studied in the past.

    Thanks for your help
    -Bryan

    Reply
    1. Jeffery Keller MD Post author

      You are not alone, Bryan! Outcome studies are tough. I’ll write about this soon and we’ll see if we can generate a list of potentials.

      Reply
  23. Cheralee

    I work at a 175 bed jail facility as one of the four nurses who provide on site medical coverage from 0600 to 2200. Nursing staff are on call at nights. Recently we have had some challenges come up. I am wondering how other facilities handle these situations.
    1) Pregnant inmates. They can be difficult to manage in a jail setting with OB appt, appropriate medications, previous OB care, street drug use, etc. Recently we had a pregnant mother who approached an officer stating the baby had not moved in two days. She is 6 mo along and not her first pregnancy. Thankfully a trip to the hospital showed baby was fine. Does anyone have a protocol for managing pregnant inmates?
    2) Flu season and fevers. 50 year old female inmate with hx pulmonary issues complaining of flu like symptoms and temp of 105.9 (peers had piled five blankets on top of her because she complained of chills). We treated her with Tamiflu per our medical directors orders and we were able to bring temp down with antipyretic and cooling measures. What are some recommendations when caring for such inmates?
    3) Placing IV catheters for acute treatment in jail. For example NTG, hypoglycemia, dehydration. Looking for both pros and cons.
    I know this is a lot of information to discuss but it has been just one of those weeks.
    Thanks – Cheralee

    Reply
  24. Bruce Borkosky

    Doc, have you ever written on the ethics / legal requirements for patients who are unable to consent? I am finding that MD’s permit schizophrenics to refuse care, even in extreme cases…

    Reply
    1. Jeffery Keller MD Post author

      Hi Bruce, That actually is a quite germane topic. I have indeed written about one aspect of it–emergency sedation.

      Reply
  25. Johnny Prejean Jr. MD

    Came across one of your articles on food allergies, “I Can’t Eat That’” want to develop a policy, possibly state regulation for reported food allergy. Taking you up on your offer for assistance. Any assistance is greatly appreciated.

    Reply
  26. Todd Hilton

    Dr. Keller,

    Do you have any advice on “shaving profiles”. It seems to be a greatly abused and misunderstood area in corrections and in the military too. I am not saying there are not legit cases. I just see few legit cases in corrections. It seems more of a get a secondary gain item than a medical problem and we are inundated with several request a month with a non-existent problem…. this = malingering. As medical staff we cannot write malingering tickets….sigh. That would be punitive. Security doesn’t care enough to bother to help with the ticketing.
    Plus our facility barber ask all the kids to request one. Profiles mean every two hair/beard trimmings; which if you are contract that’s billable. Profit drives ignorance! The cycle continues. I’m trying to break it with education and stubbornness.
    I’m a Family Nurse Practitioner at a juvenile correctional facility and any protocol/advise would be handy. We (I) issue a profile for: 1). Severe acne and 2). Actual pseudofolliculitis barbae ONLY.

    I, again, love this site. Keep up the hard work.

    Thanks,

    Todd H.

    Reply
    1. Jeffery Keller MD Post author

      Hi Todd! Unfortunately, I don’t have much help for you with this one, except to say “No” a lot, and to work with admin to eliminate the profit motive for your barber to drive this waste of your time!

      Reply
  27. Donna

    Dr. Keller,
    I have had three inmates within the last two weeks having Lamictal and Keppra on their person when they were arrested. None of them have ever been prescribed these medications as far as I can tell. ( All three I have evaluated before). I’m thinking they are abusing these medications in some way. Any ideas? It just seems more than a coincidence.
    Thanks

    Reply
    1. Jeffery Keller MD Post author

      I agree with you that it seems suspicious. Gabapentin and Topamax are the two more commonly desired seizure drugs. Maybe this is a new trend!

      Reply
  28. Cissy Lowery

    Dr. Keller,

    First of all, thank you for your dedicated service in an area of medicine many medical professionals may not know about. I was happy to find your site and am sure will find this resourceful. As a National Recuiter for the Federal Bureau of Prisons, I communicate with physicians daily and who are passionate about what they do and honestly want to serve or better yet they simply just want to, “Be a Doctor.” Correctional Medicine can certainly provide job satisfaction and a wonderful work/life balance.

    My best to you!

    Alician “Cissy” Lowery

    Reply
  29. Steve Brooks

    I am attempting to write a policy manual for the correctional Center that I work in. I read the article about allergies. would you be able to help me in this?

    Thank you for your time.

    Steve Brooks

    Reply
  30. BRYAN DAVIS PA-C

    With all the news headlines hovering around Ebola, I thought I would see what other facilities are doing to screen for high risk patients.

    Are your facilities asking any pre-booking screening questions for travel in the past month? If so, how would you handle an asymptomatic patient that reports foreign travel to west Africa or major cities (like Dallas)?

    The CDC recommends BID temp checks for 21days after their last exposure to an Ebola patient. Would you think this is sufficient or would you do anything additional (i.e. separate housing, special precautions)

    Thanks for your thoughts
    -Bryan

    Reply
    1. Jeffery Keller MD Post author

      Hi Brian,

      Yes, some jails, especially in bigger cities with direct flights to Western Africa, have added some screening questions to assess risk for Ebola. There are only three categories of patients who are at risk for ebola:

      1. Just returned within the last 21 days from travel to specific countries in Western Africa (Sierra Leone, Guinea, Nigeria or whichever other countries are identified by the CDC).
      2. Close contact with someone else who returned from these countries in the last 21 days.
      3. Acted as a caregiver for someone being actively treated for ebola in this country.

      If the answer to all three questions is “NO,” the risk of Ebola is basically zero. If any answer is yes (and I am not aware of any such patients being booked into any correctional facility as of this writing), I would contact my local health department and health department and ask them what to do!

      Reply
  31. Carolyn

    Dr. Keller- Thanks for this wonderful and informative website. I am a resident at Hopkins in Baltimore, and we are working to improve our Urban Violence rotation. Would you be willing to discuss ways we could involve the residents in Corrections Medicine? Thanks

    Reply

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