ACCP Position Paper on Hepatitis C Infection

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.

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Top Five Articles from 2018

2018 was a great year for JailMedicine! Noteworthy events from the year include:

I introduced a new feature–Sample Guidelines–which turned out to be very popular. I intend to add many more sample guidelines this year. Please let me know what guidelines you would like to see!

I began a new blog on MedPage Today entitled “Doing Time: Healthcare Behind Bars” (found here) that introduces our world of Correctional Medicine to outside medical professionals who have no idea what we do. This has also been well read.

Readership increased substantially in 2018. This may be because I published more articles . . . Thank you to everyone who read JailMedicine this year!

Without further ado, these are the five most read articles from 2018:

Abscess Incision and Drainage, a Photographic Tutorial

I was given the opportunity to create a tutorial of the classic method of lancing an abscess when a friend of mine came to my office with a great cutaneous abscess on his back.  This has been, by far, the most read JailMedicine article of all time.

Removing Microdermal Implants, A Photographic Tutorial

Microdermal implants are so common as to be ubiquitous.  Almost all of th jewels can be unscrewed from the base, which is my preferred way to deal with them in a jail setting.  However, occasionally, patients want to have the implant removed entirely. It is not hard, but many practitioners have never done it and so do not know how.

A Better Way to Drain Abscesses: The Berlin Technique

I have a confession to make.  I no longer (usually) incise and drain abscesses in the manner that I taught on the photographic tutorial above.  My dermatologist friend and colleague, Neelie Berlin, showed me this nifty technique that uses a 4mm punch biopsy tool  It is quicker, easier and just as effective for the majority of uncomplicated skin abscesses you will see in your clinics.  You just have to order the punch biopsy tool!

What’s the most cost-effective way to treat scabies? The answer might surprise you

Scabies is so common in jails that every jail medical professional should know how to recognize this itchy little pest. It is not too hard as this post points out.  Also, It turns out that treating scabies with oral ivermectin is less expensive and easier than using topical permethrin cream.

Medications at High Risk for Diversion and Abuse In Correctional Facilities

Many seemingly benign medications are commonly diverted and abused in correctional facilities.  The risk of abuse for some of them so overwhelms any potential benefits of these drugs that I argue that they should rarely be used in jails and prisons.

What was your favorite post from JailMedicine?  What should I address in future articles? Please comment!

Best Practices: Inmate Satisfaction Surveys!

As I have traveled around visiting various jails and prisons, I sometimes run across a practice that I have not seen before; something cool; something that works better than what is typically done at other facilities.  I think such practices can be called “Best Practices.”  One great example of a “Best Practice” is the Inmate Satisfaction Surveys begun by Sheriff Gary Raney at the Ada County Jail in Boise, Idaho.

Of course, when I tell people about a jail inmate satisfaction survey, the typical response is incredulity.   “Satisfaction surveys?  In a Jail? Whadaya, nuts?”

Well, the answer is “Yes!”  Inmate satisfaction surveys!  In a jail.  And it works!  You should consider doing this at your facility!  Really! Continue reading

Introducing C.F.O.A.M. (and Other Changes)

It is June, 2012 at a pub in Dublin, Ireland. During a break in an international Emergency Medicine conference, and over a pint of Guinness stout (what else?), several doctors were discussing how much medical information was freely available online. Everyone in attendance agreed that the way that medical information is shared has changed radically in the last 30 years—from a few choice textbooks on the office bookshelf and subscriptions to a few medical journals to the availability of most textbooks and journals instantly, online. Not only that, but instant messaging services like Twitter make it possible to get medical help from experts almost instantly—even if the expert is on the other side of the world! In fact, the main problem now is harnessing the incredible potential of the internet to improve medical knowledge and decision-making. Where are the really good reservoirs of medical information online? How can we more easily communicate with our colleagues and friends when we need help with a vexing case?19970122 Continue reading

Price Check! Antibiotics.

Do you remember when doxycycline used to be 5 cents a pill?  Not anymore!  Doxycycline has been relatively expensive for a few months now.

Do you remember when drug reps incessantly touted Rocephin as the antibiotic “Wonder Drug” that would kill any bacteria and also clean your kitchen?  It was ridiculously expensive but sold very well! Now it is not so expensive—and nobody is promoting it.

How about Levaquiin and Zithromycin?  Those are really expensive drugs–right?  Wrong!

Antibiotic drug prices are a-changing. images Continue reading

Patient Satisfaction? In a Jail?

I think everybody would agree that in the wide world of medicine outside of jails and prisons, patient satisfaction is critically important.  Partly this is because patients are not just patients, they are also business clients.  If they are not happy, they will go to some other doctor and some other hospital.  Many studies have shown that patient satisfaction scores have a strong correlation to revenue and market share.  That is why hospitals routinely track patient satisfaction scores.  Studies have also shown that roughly 80% of patient complaints are generated by less than 10% of practioners.  These complaint-prone physicians, PAs and NPs are often “shown the door” by hospitals and practice groups.  Their negative impact on revenue is just too great to ignore, even if they otherwise practice good medicine.  images-2

But, as I have often heard, correctional medicine is different.  Our patients are a captive group (literally!).  They cannot go to a different practitioner if they are unhappy.  We do not have to please our patients to stay in business.  Our “market share” does not rely on patient satisfaction.  Plus, because of safety and security issues, we have to say “No” to patient requests more than outside physicians; and, of course, inmate patients are not going to be happy about that.  So who cares if inmate patients are unsatisfied?

The answer is:  We all should care.  A very lot.  Continue reading

Get Updated Information Here…

We have added an ‘event’ on our Facebook page for the Essentials of Correctional Medicine Conference.  Make sure to jump over there and join the event for all of the latest information regarding the conference next month. Continue reading

Jail Medicine Is Now On Facebook

In an effort to increase our visibility and make Jail Medicine more accessible online, we are pleased to announce that you can now follow us on Facebook. We plan to post special articles, videos, training information, solutions and answer the many questions we have been receiving and much more on the Facebook page, which you can find here: