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Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of practice experience before moving full time into the practice of Correctional Medicine. He is the Medical Director of the Ada County Jail in Boise, Idaho, the Bonneville county Jail in idaho Falls, Idaho as well as several other jails and juvenile facilities.
At Jail Medicine we discuss all aspects of medicines practiced in today's jails, prisons and juvenile facilities.
This is a wonderful idea..I hope we get followers from other jails and see how they do things..Lisa, RN
Thanks Lisa! I also look forward to the exchange of ideas (which sometimes begins “That piece you just wrote is crap!”) Should be fun!
congrats on this site! thanks for the info, would not expect any less from you, Jeff!!!!
Thanks, Deb!
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!
Thanks Rona! Your approval means a lot to me!
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
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!
Very interesting JK.. Proud to be one of your badger nurses….
Hi Jeff – did you see this? Thought of your blog when I read it today
http://www.latimes.com/health/boostershots/la-heb-prison-health-20120419,0,288713.story
Take care,
Katie Clark
Great article Katie! Is it a Federal mandate that all inmates be offered at least 2500 calories a day? Where did that number come from?
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.
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.
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
Great article Jennifer! Thanks.
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
Thanks David!
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
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!
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
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 via email, Mark!
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.
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.