I am seeing a 52-year-old male in my jail medical clinic who was booked yesterday on a felony DUI charge. He says he drinks “a lot of beer” but denies having a drinking problem. He is cranky and not really cooperative. He does not want to be here. However, the deputies tell me that he did not sleep much last night and did not eat breakfast. I note that he has a mild hand tremor and a heart rate of 108. According to the clinical Institute Withdrawal Assessment for Alcohol–revised version (the most common tool used in the United States to assess the severity of alcohol withdrawal since 1989) my patient needs no treatment for alcohol withdrawal. But this is wrong! In actuality, my patient is experiencing moderate withdrawal and should be treated immediately and aggressively.
Using CIWA is like using a wrench to pound in a nail. It can be done, but it is not really efficient or accurate. A different tool (a hammer) could drive the nail much more quickly and effectively. CIWA is simply not the right tool to assess alcohol withdrawal. We should be using something better.
I recently published the official position paper of the American College of Correctional Physicians (ACCP) on the treatment of Hepatitis C in incarcerated patients (found here). However, some state legislatures (and others who which authorize funds for inmate medical care), have been reluctant to fully fund Hepatitis C treatment. Because of this, ACCP has formally approved the following Position Paper to encourage full funding of HepC treatment among incarcerated inmates.
“We’ve got another one,” My nurse told me on the phone. “He says he was exposed to Covid.”
Ever since Covid-19 came to my town, many people being arrested have begun to say that they have Covid or have been exposed; the thought being that “If I have Covid, they can’t put me in jail.” Of course, it doesn’t work that way. They go to jail anyway.
If you are a prison doc, I am about to solve one of your vexing nuisances, so pay attention.
Recently (just before the Covid-19 tsunami hit) I was privileged to chair the American College of Correctional Physicians (ACCP) committee tasked with writing an official position paper on the treatment of Hepatitis C infection in corrections. The exact wording of the paper required some delicacy because treating Hepatitis C in incarcerated inmates can be controversial. No one disagrees that patients with Hepatitis C infection should be treated, whether incarcerated or in the free world, but because the drugs used to treat Hepatitis C are so horrifically expensive. Some state legislatures, which authorize funds for inmate medical care in their prison systems, have been reluctant to fully fund Hepatitis C treatment. More on this in a future post. In the meantime. I believe this is an important document that all correctional medical professionals should read.