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.

114 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
    1. Darin Haugland PT

      This reply is to David. I am a practicing PT working full time in the Minnesota Correctional facility for the last 18 years. I just found this blog as Dr. Keller is now one of my medical supervisors. I am reaching out to you as in reality- there is very little help/resources for we Correctional Physical Therapy. I have worked in all of correctional facilities which range from Geriatrics, acute care, Boot Camp, women patient, and obviously outpatient Ortho. I would be more than interested in communicating/discussion any correctional PT issues you may have. I would be interested to hear how other states provide PT. Feel free to contact me: dhaugland@centurionofmn.com

      best regards,

      Darin Haugland PT

      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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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. Jeffrey 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
  32. kyle strickland

    I am a paramedic in Atlanta, Ga and commonly respond to jails and prisons in Atlanta. Unfortunately I do not get to spend much time in these facilities to learn about how health care inside jails and prisons work. how do the capabilities of a jail or prison differ from hospitals? do they provide everything but speciality care? Im sure this differs from facility to facility of course but I was just wondering in general? It seems like a sector of health care that is in the shadows. Thank you

    Reply
    1. Jeffrey Keller MD Post author

      In general, think of your typical jail or prison medical clinic as being equivalent in capability of an urgent care center. some of the larger facilities may have an infirmary, which is more like a general hospital floor.

      Reply
  33. Steve Stiles

    Thank you for the copious and interesting material you have created and posted here!

    I’m a PA in Florida and have an interview coming up in a local county jail. Your posts are helping me gain a glimpse into correctional medicine and hopefully some insight into what to be cognizant of during my interview!

    I did EM for 5 years in the past and had the benefit of working with some great doctors who were true logical minimalists… We would say “no” when patients needed a “no”, without hesitation. Many of those doctors are being driven out of emergency medicine and that is why I have moved away from it as well.

    I was wondering if you have any advice for me?

    Thanks for everything!

    Reply
    1. Jeffrey Keller MD Post author

      Well, Steve, as a former ER doctor myself, I can say that the ER is the best training ground for correctional medicine for the very reasons you mentioned. And, yes, I can understand why there is pressure on ER docs to provide “customer satisfaction” and so may get penalized for saying “No.” Life is very different in corrections. The best way to experience it is to do it! If you have developed some Verbal jujitsu skills in the ER, you should do well in the jail. I suspect that you, like me, will really like it!

      Reply
  34. Al

    Diabetics are often a challenge and create a great deal of ruckus. What would your thoughts be about stopping the use of a ‘Diabetic Commissary’? and maybe even diabetic diet? Provide the information / education and hold the inmate responsible for their own choices…

    We currently use a fairly consistent process with diabetic diet / commissary and have such mixed success we can clearly see that those who wish to take care of themselves do (often with glucose meter readings that are consistently below 150) and those who do not don’t – and complain the most that they are not being cared for correctly.

    Your thoughts…?

    Reply
    1. Jeffrey Keller MD Post author

      Excellent question, Al. In a nutshell, in my opinion, diabetic diets don’t work. Restricting diabetic choices in the commissary doesn’t work, either. I’ll answer in more detail soon.

      Reply
  35. Mary Ackley

    Do you have any information on the use of intranasal medication use in the jail setting? It seems like it could be a better way to administer medications to a psychiatric inmate who is a harm to himself or others. It would seem this could be a better practice than trying to give an IM injection in an urgent situation. It also would seem to have a lesser chance of injury to the inmate, medical staff or correctional staff. Any thoughts on this newer type of medication administration and its possible use in the jail setting?

    Reply
  36. Bruce Flitt

    Jeff,
    Do you have a protocol for pregnant inmates who are addicted to opiates? The NCCHC is recommending that they be put on either Methadone or Buprenorphine so they don’t withdrawal. What do you do in your facilities?

    Thanks,
    Bruce

    Reply
    1. Jeffrey Keller MD Post author

      Thanks Bruce. This would be a great topic for an upcoming post. In a nutshell, I do not want pregnant inmates to go through opioid withdrawal, but I prefer that the obstetrician prescribe methadone, buprenorphine or whatever they want rather than me. These are, of course, high risk pregnancies and I want the obstetrician to manage all of the high risk therapies. I have not had a problem coordinating this care with my local obstetricians.

      Reply
      1. Bruce Flitt

        Jeff,
        What are your thoughts on using intraosseous IV’s in corrections? I have had several cases of IV drug users with no peripheral access needing IV fluids and had thought about popping in an IO but wonder if that is going too far in the correctional setting.
        Bruce

        Reply
        1. Jeffrey Keller MD Post author

          Hi Bruce! IO is definitely going too far in a correctional environment. But I feel your pain about the difficulty of IV access in IV drug users!

          Reply
  37. Cheralee Worrall

    We have a contracted OB/Gyn practitioner in our community (we are a small jail – about 100 daily census) who all our OB patients see. We only use methadone as it is cheaper and the half-life is much longer. We have some who choose to wean off all opiates while pregnant and in an environment where they cannot get them.

    Reply
    1. Jeffrey Keller MD Post author

      Thanks Cheralee! Sounds like you have an easy-to-work-with OB! For those pregnant inmates who choose to wean off opiates while pregnant, I assume that you meticulously document that they accept the risk of miscarriage!

      Reply
      1. Cheralee

        That is another nice thing about working closely with our OB – we have good communication with his office staff. They explain the risks so the patient may make an informed decision. This example was a mom who was pregnant with her second child (she delivered the first in prison) and was given the option of rehab or prison. Rehab would not take her while on narcotics so she was really pushing to get off the methadone (even though our provider was reluctant). We do monitor our pregnant women asking them daily about cramping, baby movement, etc as we have had women in the past tell us the baby has not moved in 3 days and now it is an emergency. We hope to get a fetal Doppler at some point to use as needed. One more note – we have sent a RN with patients to the OB apt in the past as our addicted patients are often not honest with our provider asking for more narcotics.

        Reply
  38. GANESH

    Dear Dr. Jeff,
    I found your website when I typed “prison residency” on google and honestly going through it made me very excited. Im thrilled 🙂
    Wow,! Correctional Medicine!! an independant field with Its very own formal structured residency training with eventual board certification.

    Im Dr.Ganesh, an IMG from Malaysia. I have 2 years work experience in the Emergency Department and another 2 years in General Surgery. My dad
    was a prison doctor for 10 years. Ive always been interested in working as a prison doctor.

    Is it possible for an IMG such as myself to apply for and join a corrective medicine residency program in the United States?

    please advice
    dr.ganesh1985@yahoo.com

    Reply
  39. Gary White MD

    I am a family practice physician who has accepted a part to e job as a contractor for our county jail. We have a protocol book for correctional medicine for various problems that we face on a daily basis. I am trying to see if there is a protocol that is available for purchase or otherwise that would furnish a look at other protocols as opposed to ours alone. I am new at this and as a family doc I find myself dealing in a jail with a host of psychiatric problems. Thanks Gary White MD

    Reply
    1. Jeffrey Keller MD Post author

      Hi Gary,

      There is no published general correctional guideline/protocol book that I am aware of. Various jail, prisons and correctional medicine company have their own guidelines, but I am not aware of any who freely publish.

      Reply
  40. Charles

    The NCCHC standards for jails, prisons & juvenile facilities would be a good place to start. There texts that may help: “Essentials of Correctional Nursing” & “Clinical Practice in Correctional Medicine”. By participating in NCCHC’s activities, and conferences as well as becoming certified as a CCHP will go a ling way.

    Reply
  41. Cheralee

    We recently had an inmate who was given intranasal Versed (midazolam) by paramedics for repeated seizures (9 seizures in 20 min). We have also discussed having intranasal Narcan (naloxone) on hand for opioid overdose emergencies. Are any other facilities using either of these products? If so, how is it working for them, what challenges/successes have they had, any policies to share?
    Thanks – Cheralee

    Reply
    1. Jeffrey Keller MD Post author

      Hi Cheralee, I know of correctional facilities that have Narcan for emergency use, but injectable Narcan, not the intranasal kind. I’ll send you a general draft protocol that you can modify for your own use.

      Reply
  42. christopher chow

    Dear Dr. Keller:

    I am an undergraduate student at University of Colorado Denver. I am hoping to have a group of pre-health students begin to volunteer at various correctional facilities throughout Denver. In what capacity do you think these students can serve and what sorts of issues or topics do you think are important for these students to bring to the inmates and understand for themselves? Any advice for us? Thank you so much!

    Reply
    1. Jeffrey Keller MD Post author

      Hi Chris! Do you already have a jail that has agreed to use volunteers? I am interested! I have not heard of a jail using volunteers before. In what capacity will you be volunteering? Tutors maybe? Anyway, most jails require that everyone entering the facility have a security clearance. Everyone probably will have to have federally mandated PREA training. If you were coming to one of my facilities, I would want to do at least a day long orientation that would include security procedures, rules for interacting with inmates, confidentiality, etc. Please let me know how this works! If it becomes a successful program, I would like to write about it!

      Reply
  43. Jordan

    Hi Dr. Keller,

    I am a third year medical student beginning to plan my fourth year electives. I worked in juvenile corrections before medical school after receiving my social work degree and continue to be interested in the criminal justice system. I was wondering if you knew of any facilities that accepted visiting/rotating medical students, or of any resources/contacts to continue my search. I am particularly interested in women’s health in the prison system and am hoping I can find a rotation focused on that.

    Thanks for writing!

    Reply
    1. Jeffrey Keller MD Post author

      Sure, there are lots of jails and prisons willing to accept and mentor medical students. I don’t know about your area, though (Oakland California)? You’ll have to call around and ask–but I bet you can find a place to do a rotation!

      Reply
  44. christopher chow

    Hi Dr. Keller:
    Thanks for getting back to me. Would you be interested in looking at my project proposal and providing me some feed back about its feasibility?
    In short, we hope to serve as a bridge for jail inmates and access to health information. Under the guidance of a healthcare professional, we would bring in informational pamphlets, brochures, on conditions like diabetes, high blood pressure, detrimental effects of smoking, benefits of exercise, etc. that could normally be found at one’s PCP. We would do this under caveat that we are not making any health care advice. Would I be able to email you about this? Thanks so much!

    Reply
  45. Al

    I’m not sure how involved you become in the financial side of correctional health care…
    There are occasional issues that arise regarding the funding of certain circumstances. Most of the issues are fairly straightforward: acute care illness / condition / injury – the jail pays; medically necessary chronic care (DM, HTN, etc.) the jail pays – otherwise not. Care that occurred on the way to jail – not so much either. There are situations – auto accident on the way to jail that requires follow on care… that are different (usually we resolve that referring to who ever was the auto insurer. Recently had a case of an offender who had arranged for ‘free care’ to have a series of procedures… then was arrested. Is the jail obliged to provide ‘funding’ for these situations or just access to care that someone else pays for? Usually one of the criteria is ‘Medical Necessity’. Another concern is ‘pre-existing’ condition.
    Thoughts?

    Reply
  46. Erica Moyer RN

    Mr. Keller, I would like to know your thoughts on the current heroin epidemic, and the best way to treat withdrawals. Any information you can provide will be greatly appreciated.

    Reply
    1. Jeffrey Keller MD Post author

      Hi Erica! We use clonidine for opioid withdrawal at my jails, and in my experience, it works very well. It is certainly the best option out there for heroin withdrawal in a jail setting. Blog post detailing how I do it coming soon.

      Reply
      1. Erica Moyer RN (corrections)

        Thank you Dr. Keller, I will be anxiously awaiting the blog on your clonidine protocol. We currently use gabapentin and clonidine.

        Reply
  47. Charles Lee

    Wow! Very interesting. I’d love to know your thoughts on this. Can you summarize, and post details later.

    Reply
  48. Dr. Kay Haw

    Dr. Keller will you be putting on the correctional healthcare conference again that you used to do and had here in Salt Lake City? It was a great networking and learning opportunity for those of us who can’t get to the NCCHC conferences.

    Reply
  49. Cheralee

    Recently there was a question as to why the nurses in our jail do not participate in defensive tactics/physical restraints. It seems the nurses are often present when help is needed. From what little info I have found, this is outside of our scope of practice as nurses. I have previous experience working 6 years as a detention officer so this is hard for me not to jump in to help. I have received verbal warning from running in to save the day without security staff present. We do not have policy to cover this subject? So what is it – medical personnel need to participate in these types of training/maneuvers or not?

    Reply
    1. Jeffrey Keller MD Post author

      Well, one consideration is that if it is not in your job description, and you get hurt, you and your employer would not be covered by Workman’s Compensation.

      Reply
  50. Laurie Dansby

    Dr. Keller, is there a way I can contact you? My name is Laurie Dansby, Nurse Paralegal at Lewis Brisbois in Dallas, Texas. I am trying to find the best way to find an expert witness in the area of jail medicine for one of our cases. We do represent the defense. You can contact me at the above e-mail or 214-722-7124. You are out of state, but thus far I have been unable to find anyone in this area. I didn’t know if you have a national list or could point me in the right direction. Thank you.

    Reply
    1. Jeffrey Keller MD Post author

      I am too busy to work on your case Laurie. I also do not know of any “Clearing House” for correctional expert witnesses.

      Reply
  51. Laura

    Dr. Keller, you mentioned that you might write a post about withdrawal treatment. I have a related question. I would love to know your thoughts on county programs involving Vivitrol shots at discharge for inmates who were addicted before incarceration. The primary decision-making seems to be out of the hands of medical care providers, yet the orders themselves are expected to come from us. Are other people in this situation, does it make them nervous, and what do they do? Anything other than just checking the blood work and writing the order?

    Reply
    1. Jeffrey Keller MD Post author

      Thanks, Laura. It is true that Vivitrol is mandated in some states. It would make me nervous, too, to be ordered to provide medical treatment that perhaps I did not believe in. You should document clearly that you are writing the order per the county or state mandate. By the way, Vivitrol does not have a great evidence base: http://www.nejm.org/doi/full/10.1056/NEJMoa1505409 The effects of Vivitro in preventing relapse are not impressive, especially in the long term.

      Reply
  52. Tavi

    Hi Dr Keller. I have run across your website before while searching for anything related to EMS in jails. I am a paramedic at Cook County in Chicago. I have worked in two other smaller jails, but I am finding many more issues here than I ever have before! There does not seem to be any kind of set guidelines or SOP’s for jail/prison paramedics anywhere, and nobody really seems to know what to do with us. We are categorized under nursing staff, expected to respond to emergencies like our counterparts on the streets, but we are not given the proper equipment, medical guidance, or standing orders to do so! Do you know of any resources or have any ideas on this subject? Paramedics can be such an asset at bigger facilities like mine, but we are underutilized and overlooked most of the time! Thanks for your time, and the website is wonderful!

    Reply
    1. Jeffrey Keller MD Post author

      Thanks for the post, Tavi. It all boils down to the rules governing paramedic practice written by your state’s legislature and Boards of Medicine and Nursing. It varies from state to state.

      Reply
  53. S. Kellstrom

    Dr. Keller,

    What is a prison pap? The version I heard involved six prison guards, two who had been reported by the prisoner, and a nurse.

    Reply
  54. Jim Bleeke

    Dr. Keller:

    I just read your articles on malingering and fairness. Both of them are excellent. Honestly, I think you have the beginning of a handbook that would be very useful reading for all physicians, nurses and jail medical officers who practice in the correctional medicine setting.

    Let me know if you are ever in Indiana. I would enjoy taking you to lunch or dinner.

    Jim Bleeke

    Reply
  55. Walter Lawrence Campbell

    Dr. Keller, I’m the psychologist at the Idaho DOC who was stumbling around, trying to recall why I recognized you. It took me a while to place you, but I wanted to say I’ve been reading and valuing your blog for a number of years now. It was great to meet you in person, even if I made a bit of a mess out of that introduction!

    Sincerely,

    Wally Campbell

    Reply

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