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  1. AvatarAlfred Cichon

    Dr. Keller; could you consider an article on a particular type of offender manipulation – offenders who use medication / treatments etc. to leverage an issue.
    Here are some examples:

    #1
    We typically provide a calculated calorie diet (based upon ideal weight) for all diabetics and have a food restricted commissary. Items that have little to no caloric / carbohydrate value are allowed.
    A diabetic patient will complain, file a grievance and finally ‘refuse’ treatment (medication, testing) if the first few efforts fail.
    NOTE: offenders are fed by trays delivered to their rooms not in a ‘chow hall’ setting so they cannot ‘select’ their diet – if we used a ‘chow hall’ it would be an education issue.

    #2
    An inmate cannot work – on disability in the community – after exam and health history a medical profile and activity restriction is accomplished. The jail has no work position available that fits the profile. The offender is refusing all medications.
    NOTE: Of interest; the diabetic / hypertensive / COPD patient has better glucometer readings, plod pressures and activity level than in community.

    My concerns are:
    First that the patient-offender will cause themselves (medical) harm
    Second the facility will be open to some level of liability
    Third that the offender is turning this into a ‘contest’ (and I’m falling for it).
    Finally, they often say (offenders) that they are ‘willing’ to sign a ‘release’ that frees the jail of any responsibility for their (offenders) choices [Not worth the paper used to write it]

    PS the notes are my personal comments and probably add nothing to the post.

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  2. AvatarDavid

    I would love to see your opinions on the Hep C treatments being mandated across the country for the inmate populations. I want to see people get treated, but budgets are not infinite, and say cost is not an excuse but how can we afford to treat hep c when in some cases its more than triple an entire states pharmacy budget.

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  3. AvatarJohn R Wood, MD

    Jeff,
    How do you handle pregnancy at your jail? None of us carry malpractice insurance that includes OB, and there isn’t an OB in my area that is willing to come to the jail to see a pregnant lady with no prenatal care, or even their own patients for that matter. We have a PA that has had some experience working for an OB and have her see them until 20 weeks and then we try to get them furloughed to see their own OB or transport them there. A community clinic is willing to see them after 20 weeks but they only give us 4 slots a month. I would like to know how other jails are handling this.

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    1. AvatarJeffrey Keller MD

      H John! Is the issue that they won’t take pregnant inmates as new patients at all or is the issue that they won’t come to the jail to see them? In my experience, medical specialists are never willing to come to the jail to see the patient–the patient must be transported to their office. WE also have a formal OB protocol that was developed for us by a local OB that tells us what routine procedures should be done (like blood pressure checks and urinalyses). The protocol specifies when to transport the patient to the OB’s office. The first visit for patients who are doing well is at 20 weeks and increases in frequency as the patient goes along. The key point is that the OB set the protocol.

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  4. AvatarScott

    Question for you (that I didn’t see addressed in the above articles – though please direct me if I’m wrong) –
    My hospital takes care of prisoners (state/federal) when critically ill. Any information you can help me find about medical decision making, especially when patient is unable to make decisions? (DNR/DNI, trach, procedure consent, etc) or about family communication? We never get formal training on this special population – I really appreciate your site for that reason!

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    1. AvatarJeffrey Keller MD

      Hi Scott, The prison systems I have been involved with usually try to contact family members to be involved in such decisions. If no family are available, then the prison medical director typically may make such decisions.

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