Recent Entries

  • What Do These Five Patients Have In Common?
    What do these five patients have in common (Fill in the Blank). As you arrive to work at a jail medical clinic, you are told about five different jail patients. Each of the five carries a totally different diagnosis, but all have one thing in common. Patient one is a 52 year old man booked … Continue reading
  • Doing It for Attention
    In response to my previous post, I received a number of comments and feedback which included assertions that individuals who engage in repetitive self-injury in correctional settings are “doing it for attention.”  That got me thinking.  And the more thinking I did, the more I realized that these statements are likely true.  But, not necessarily … Continue reading
  • The Problem of Sleep
    The first patient I am going to see today wrote on his Kite: “I need something to help me sleep.” Over the course of my career in correctional medicine, I have seen literally hundreds of such requests. I have empathy for the patient who submitted this kite. There is no question that it is hard … Continue reading
  • Restraints and Self-Injury
    A few weeks ago, I received a request from a psychiatry resident working at a state prison about the use of restraints with patients who engage in severe self-injury.  He was looking for guidance on the use of physical restraints with this population in prison.  He noted that his role of ordering and monitoring patients … Continue reading
  • Reader Questions Benzo Withdrawal and Inhaler Abuse
    (With regard for The Rules for Treating Benzodiazepine Withdrawal) I practice in a jail on the East Coast. I totally agree that Benzo’s must be used, but I can’t find anything in the literature concerning length of treatment to avoid life-threatening vs. annoying symptoms. The months-long tapers are not well accepted by either Correctional Healthcare … Continue reading
  • What Does “Medically Necessary” Mean?
    Let’s say one of my jail patients has a moderate-sized inguinal hernia.  I want to schedule surgery to have the hernia fixed, but to do so, I have to get authorization.  This is not unusual.  Just like the outside, before I can do medical procedures or order non-formulary drugs, I must get the approval of … Continue reading
  • How Am I Doing? Need to Know How I’ve Been…
    According to the fitness tracker I wear on my wrist, I slept for 7 hours and 13 minutes last night.  I was restless eight times and woke up twice.  What does that tell me?  No idea.  The Centers for Disease Control tell us that adults need seven or more hours of sleep each night.  But … Continue reading
  • Documenting Test Results the Ed and Midge Way
    I have a ten-year-old Yorkie named Ed. Ed is experienced and knows the daily routine of our house. Last year, we got a Yorkie puppy named Midge. She initially knew nothing.  It has been entertaining to watch Ed educate Midge on what to do. Midge watches Ed closely and then does whatever Ed does. She is a true … Continue reading
  • Effective Mental Health Treatment Requires A Plan
    At the risk of oversimplifying, many incarcerated patients come to us with some manifestation of the following (or a combination of these): Problematic emotional experiences Problematic thought patterns Problematic behaviors Problematic relationships It is important to work with the patient to understand which of these issues is experienced by the patient as most distressing and … Continue reading
  • This Patient Needs to Be Seen by Mental Health, But When?
    This morning, inmate Gibbs had a visit.  The nurse passing medications in the housing unit noticed that he was not ready when his name was called.  Unusual.  Mr. Gibbs is typically aware of his visits and is up and ready at least five minutes before it’s time to go.  The nurse asked Mr. Gibbs if … Continue reading

2 thoughts on “Recent Entries

  1. So, given that this is national suicide prevention month – a question occurred.
    Experience reveals that, with negligible exceptions, every suicide in corrections results in a legal claim. Despite the fact that the individual who completes a suicide will make every effort to disguise their plan / intent; and every effort by the facility to keep offenders safe – the facility and its’ staff are subjected to legal assault.
    The question is – how many completed attempts in the community result is a legal claim? and the corollary is why should correction facilities face claims – unless there is some egregious failure?
    The correction and health care staff are bereaved by the event and frequently traumatized as well. The additional stressors of a legal claim, even when everything was ‘done right’, make that more traumatizing.
    There is a responsibility of the facility staff for safety and security However, human ingenuity always succeeds.
    My not humble enough opinion

    • I appreciate your thoughts. I do not know how often suicide results in legal claims inside or outside of correctional facilities, and I agree that legal claims can increase stress for all involved on top of the trauma of the death itself.

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