Perhaps the strangest aspect of practicing medicine in a jail or prison is “comfort requests.” This is when an inmate comes to the medical practitioner asking for something like a second mattress, the right to wear their own shoes, a second pillow, a second blanket, etc. This, of course, never happens in an outside medical practice. When was the last time you heard of a patient asking for a prescription for a pillow? Yet such requests are extremely common in correctional medicine. You might think, “Well, just give them the second pillow—what harm can it cause?” But it is not that simple. Like every medical issue, there is a right way and a wrong way to handle these requests. To understand why, let’s consider the single most commonly requested comfort item in a correctional medical clinic: a second mattress.Continue reading
I have a quick ‘n easy solution for those pesky requests for a second mattress that plague all correctional facilities. But before I get to that, though, there are two important points to consider in any discussion about second mattresses in correctional facilities.
First, providing inmates with mattresses, like inmate clothes and toiletries, is the purview and duty of the correctional officers, not the medical staff. What this means is that when an inmate asks for a second mattress, the question being put to us is this: Is there a medical need for this patient to have a second mattress? This is critically important. The inmate would prefer to frame the question differently, something like this: “The correctional officers only issued me one mattress, but you can over-rule them and authorize me to have a second mattress. Will you do me this favor?” This is a totally different question than “Does this patient have a medical need for a second mattress.”
Secondly, having a second mattress is a status symbol inside the correctional community. When an inmate receives a benefit that other inmates do not, he gains status and prestige. Sometimes this motivation is as important for an experienced inmate as is the extra comfort of a second mattress. I believe that if a jail provided two mattresses to every inmate in the facility, there would be requests to medical for three mattresses. (Pretty soon inmate beds would rival “The Princess and the Pea!”) So when we grant inappropriate requests for second mattresses, we are conferring status on the inmate in question. And we are denying status to those who we refuse. This also, in my mind, is important to consider.
So now to the main topic of the day: What constitutes a “medical need” for a second mattress? In my opinion—there are none! Zero. Nada. There is no medical need ever for a second mattress. I challenge anyone to find a reference in any medical literature saying that second mattresses are a treatment for anything. For example, a common reason given by inmates requesting a second mattress is that they have chronic back pain. However, if you pull out any medical textbook that deals with the treatment of chronic back pain, you will not find second mattresses mentioned in any. Go ahead! Look!