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The Best of Jail Medicine: An Introduction to Correctional Medicine has been published!

Those of us who have practiced medicine in jails and prisons (correctional medicine) know this is a great job! We often see patients who have never had easy access to medical care. As a result, we get to diagnose and … Continue reading

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November 15, 2022

JailMedicine and ACCP

I recently turned 65 and decided that it was time to slow down a little bit. Part of this slowing down is to retire from the administration of JailMedicine and turn JailMedicine over to a new caretaker. Fortunately, I have … Continue reading

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October 13, 2021

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 … Continue reading

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February 22, 2021

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 … Continue reading

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January 26, 2021

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 … Continue reading

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January 18, 2021

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 … Continue reading

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December 14, 2020

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 … Continue reading

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December 11, 2020

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 … Continue reading

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November 17, 2020

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 … Continue reading

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November 10, 2020

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 … Continue reading

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October 27, 2020

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 … Continue reading

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October 22, 2020

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 … Continue reading

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September 30, 2020

What is the most common mistake made when treating withdrawal?

What is the most common mistake made when treating withdrawal in a correctional facility? Consider these two patients: A jail patient booked yesterday is referred to medical because of a history of drinking.  He has a mild hand tremor and … Continue reading

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September 21, 2020

Suicide – Don’t Be Afraid to Ask

It’s September, which is National Suicide Prevention Awareness Month.  Let’s start with awareness. According to the Centers for Disease Control, rates of death by suicide have increased in this country by 35% from 1999 to 2018.  More specifically, the rate … Continue reading

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September 18, 2020

Mental Health Screening – Set Up for Success

It was a holiday weekend in the middle of the night.  The booking area of the jail was a big, open, noisy pit with people sitting in plastic chairs, watching TV or on phones and the officers either behind desks … Continue reading

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September 9, 2020

Beware the Bounce-Back!

I learned about Bounce-Backs back in my Emergency Medicine days.  A bounce-back is a patient who you saw in the ER and discharged but then returned within 48 hours with the same complaint.  A lot of time is spent in … Continue reading

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September 8, 2020

Introducing Sharen Barboza

I am pleased to be joined on JailMedicine by my colleague Dr. Sharen Barboza! Dr. Barboza has been providing correctional mental health care for more than 20 years. Her complete bio can be found in the About The Authors tab … Continue reading

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September 2, 2020

Covid Fatigue and Leadership

When Covid-19 burst onto the scene three months ago, the jail administrators and the medical teams in my jails initiated several common sense practices to reduce the possibility of Covid infiltrating the jails.  These included screening and quarantining new inmates … Continue reading

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July 22, 2020

Using a Wrench Instead of a Hammer for Alcohol Withdrawal

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 … Continue reading

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June 15, 2020

ACCP Position Paper on the Funding of Hepatitis C Treatment

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), … Continue reading

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May 21, 2020

Keep Covid Out of the Jail!

“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 … Continue reading

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April 27, 2020

You Don’t Need Fasting Labs

If you are a prison doc, I am about to solve one of your vexing nuisances, so pay attention.

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April 22, 2020

You Need a Plan for Corona virus in your Facility

Unless you’ve been living under a rock, you have been hearing about the threat of a Corona virus pandemic. Every day, the evening news anchor breathlessly gives an update of the number of new cases, the number of new countries … Continue reading

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March 5, 2020

The Rules for Treating Benzodiazepine Withdrawal

Patients are dying in correctional facilities from benzodiazepine withdrawal!  This is not just a theoretical observation; this really is happening. This fact bothers me since benzo withdrawal deaths are preventable.  Benzodiazepine withdrawal is easy to treat!  It is certainly easier … Continue reading

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February 27, 2020

How Can You Violate the Hippocratic Oath by Providing Medical Care to the Needy?

Five months ago, the Journal of the American Medical Association (JAMA) published an editorial entitled “Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?”  (Spiegel, Kass and Rubenstein, JAMA online August 30, 2019). This article generated … Continue reading

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February 11, 2020

Gabapentin for Musculoskeletal Pain?

At one of my recent jail medical clinics, three patients in a row requested prescriptions for gabapentin.  One was a patient newly arrived from the Idaho Department of Corrections to be housed at my jail due to prison overcrowding.  He … Continue reading

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January 9, 2020

Oral Testing of Reported Penicillin Allergies?

Penicillin is miraculous.  It was discovered in 1928 by Alexander Fleming (founding the modern era of antibiotic medicine) and is still the most common antibiotic prescribed in my jails.  The dentist and I use Penicillin VK as our preferred initial … Continue reading

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December 19, 2019

Reducing NSAID Use PLUS NSAID Prescribing Guideline

Through many years of experience in correctional medicine, I occasionally have come up with a speech or dialogue that works especially well with patients; a speech which I then use over and over again. One of these speeches is one … Continue reading

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December 5, 2019

Prescribing Without an Exam?

The State Board of Medicine in my home state recently sent out a bulletin about the practice of “friendly prescribing” to people who the practitioner has not examined.  For example, a friend might call me and say something like “I … Continue reading

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November 14, 2019

When Should Medical Clearance Be Done? PLUS Sample Guideline!

When arresting officers arrive with their charges at a certain large urban jail, the first person they see when they come through the doors is a nurse. The nurse quickly evaluates the arrested person to determine whether a medical clearance … Continue reading

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October 24, 2019

Words Matter. “Inmate” or “Patient?”

Words matter.  What we write about our patients in our medical notes to a great degree reflects how we feel about them. Our words also mold our future relationship with our patients. One good example cited by Jayshil Patel, MD … Continue reading

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October 1, 2019

Do You Understand the Requirements for Multiple DEA Licenses?

I have found that many correctional practitioners, especially in jails, do not understand the license requirements of the federal Drug Enforcement Agency (DEA) and, as a result, do not have all of the DEA licenses that they are legally obligated … Continue reading

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September 17, 2019

Constipation Plus Sample Guideline

Today’s post is a repost of an article I wrote previously about Constipation. Concurrent with this article, I have added a Sample Guideline on Constipation to the Guideline Section of JailMedicine (found here). I have decided after many years of … Continue reading

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September 16, 2019

Skeletal Muscle Relaxant Guideline

Today’s post is a repost of an article I wrote previously about Skeletal Muscle Relaxants (SMRs). Concurrent with this article, I have added a Sample Guideline on prescribing Skeletal Muscle Relaxants to the Guideline Section of JailMedicine. Personally, I think … Continue reading

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September 8, 2019

The Root Cause of Jeffrey Epstein’s Suicide

The recent suicide of Jeffrey Epstein while in custody at a Manhattan detention facility has focused intense media scrutiny into jail suicide prevention procedures. Suicide is the biggest cause of death in jails in the United States—by far.  Because of … Continue reading

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August 22, 2019

The Art Of Meeting New Patients in a Jail

I will be meeting a new jail patient with multiple medical problems today in my clinic.  I know this much before I even meet him:  He will almost certainly be scared, especially if this is the first time he has … Continue reading

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August 19, 2019

Comfort Items: Why Not?

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 … Continue reading

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July 31, 2019

Reader Question: Don’t Be the Decider

I work at a prison and your blog has been such a resource for our unique niche of medicine. There’s nothing like practicing “behind the walls!” . . . Recently I’ve been incorporating more conversations about functionality and short-term/long-term goals … Continue reading

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July 22, 2019

Why Correctional Medicine is often Driven by Lawsuits

Imagine, if you will, a nurse who is assigned to take care of 50 patients on a medical floor—by herself. Clearly, this is an impossible task.  There are just too many patients for one nurse to adequately monitor.  But this … Continue reading

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July 5, 2019

Transforming Our Approach to Chronic Pain

One of the most fearful and frustrating events in my correctional medicine world used to be when a new chronic pain patient would arrive in my clinic.  A typical patient would be a “Ralph,” a middle-aged man who has had … Continue reading

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June 18, 2019

Top 2018 Medical Research Articles for Corrections

One thing I look forward to each day is looking through my medical feeds that keep me up to date with medical research.  Most of this content ranges from bogus to unhelpful (in my opinion), but every once in a … Continue reading

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June 6, 2019

MAT in Jails. Response to Reader Questions

My last post about MAT in jails generated a lot of excellent responses–so many, in fact, that I realized that my discussion of MAT in jails was incomplete. I would like to enlarge the discussion about the proper role of … Continue reading

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May 23, 2019

My Thoughts on MAT in Jails

I recently ran across this news article on NPR (found here) about the problem of treating the large number of opioid addicted patients who are coming to our jails. There is a growing movement that all opioid addicted patients should … Continue reading

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May 8, 2019

Shoulder Dislocations

NP here….What are your thoughts on shoulder dislocations? Does an anterior dislocation require immediate reduction? What if they go out to ED and come back dislocated again? It is thought that these offenders dislocate on purpose in order to go … Continue reading

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April 25, 2019

Reader Question: How does a KOP Policy Work?

Hi Dr Keller, I work in the prison system in the UK. I wanted to ask you if the prisoners have in-possession medication in America or is it all supervised?  If you do have in-possession medication, have you seen or … Continue reading

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April 4, 2019

Can the Oakland Raiders Be Saved Using the Principles of Medical Research?

One of my good friends is a die-hard Oakland Raiders fan.  Those of you who follow pro football know that Oakland has fallen on hard times recently.  They went from being one of the best teams in the league two … Continue reading

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March 25, 2019

How to Write an ATP (Alternative Treatment Plan)

Many of us in supervisory positions in correctional medicine have Utilization Management (UM) duties. One common duty is to review requests from primary care practitioners for patient care procedures like a referral or, say, an MRI. We must then decide … Continue reading

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March 15, 2019

Utilization Management is Different in Corrections

This is an important fact that I have learned from many years working in prisons and jails: Most correctional practitioners do not understand how Utilization Management in a prison system works. They misunderstand what the goal of the UM process … Continue reading

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February 28, 2019

Guest Post–How I Assess Weight Loss in Correctional Facilities

Today’s Post was written by Todd Wilcox, MD.  Todd is the Medical Director of the Salt Lake County Jail in Salt Lake, Utah. He is a past president of the American College of Correctional Physicians and a frequent–and excellent–lecturer.  This article … Continue reading

February 13, 2019

Is a Concrete Cell Really the Best We Have To Offer Our Mentally Ill?

Consider the case of a 60-year-old patient I will call “Library Man.” While at the public library, Library Man took off most of his clothes and was talking loudly to no one in particular. The police were called, of course. … Continue reading

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February 7, 2019

Grievance Responses PLUS Sample Grievance Guideline

Benjamin Franklin once famously quipped “nothing is certain but death and taxes.” However, Franklin did not work in a jail, otherwise he would have said: “Nothing is certain except death, taxes and grievances.” On the outside, patients do not write … Continue reading

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January 30, 2019

Guest Post: A Prescription for Dog Food

Today’s Post was written by Rebecca Lubelzyk MD.  Rebecca works in the Massachusetts prison system. She is a past president of the American College of Correctional Physicians and the editor of CorrDocs, the official publication of ACCP.  This article was … Continue reading

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January 12, 2019

Is My Patient Faking?

This article was initially published on MedPageToday, found here. I remember walking into one of my jails and seeing a patient on the floor of his cell twitching and shaking. “Don’t worry about him,” said the sergeant on duty. “He’s … Continue reading

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December 13, 2018

Sample Guideline: Bottom Bunk Requests

This clinical guideline is intended to be used as a template to help clinicians and administrators create their own policies. This sample guideline must be modified to make it applicable to each unique correctional facility. This guideline is not intended … Continue reading

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December 6, 2018

Opioid Withdrawal Not Deadly? Wrong!

One thing I always tell practitioners who are beginning a jail medical practice: you’re going to see a lot of withdrawal cases — study up! In particular, since the opioid epidemic hit, the number of patients I’ve seen in my … Continue reading

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November 12, 2018

Sample Food Allergy Guideline

Today’s post is the second in a series of sample clinical guidelines.  All of these sample guidelines will be placed under the “Guidelines” tab (above) as they are published. I view these sample guidelines as a group effort!  If you … Continue reading

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November 1, 2018

Gabapentin in the News!

2018 has been a remarkable year for news and research into gabapentin, and the year is not even over yet! That is great news for those of us (myself included) who puzzle over the proper role of gabapentin within correctional … Continue reading

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October 5, 2018

My jail Is Safer Than Your ER! from MedPage Today

This article was first published here on MedPage Today. How safe is correctional medicine? People naturally assume that working in a jail or prison is dangerous. “Aren’t you nervous about working there?” they ask me. What people have seen of … Continue reading

September 17, 2018

Sample Clinical Guideline: Medical Approval of Personal Footwear

Today’s post is the first in a series of sample clinical guidelines.  These will be placed under the “Guidelines” tab (above) as they are published.  These guidelines are open access; you may use them in whole or in part as … Continue reading

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August 20, 2018

How Did I End Up in Jail? from MedPage Today

I have begun a new blog that is being published on MedPage Today entitled “Doing Time:  Healthcare Behind Bars.” The difference between that blog and JailMedicine is the audience.  JailMedicine is written for medical professionals already working in a jail … Continue reading

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July 31, 2018

NSAIDs Essentials of Prescribing for Inflammation

In the last JailMedicine post, I discussed the use of NSAIDS for pain. Pain management is probably accounts for 90+% of NSAID prescriptions in primary care. Oftentimes, though, we delude ourselves into thinking that we are also treating inflammation. Usually … Continue reading

July 11, 2018

NSAIDs. The Essentials of Prescribing for Pain

After many years of reviewing prescribing practices of physicians both within correctional systems and outside of the walls, here is something that I strongly believe: Non-Steroidal Anti-inflammatory Drugs (NSAIDS) just may be THE most misunderstood and overprescribed drugs in clinical … Continue reading

June 4, 2018

Handling the Manipulation of Confrontation

You are seeing a newly booked patient in your jail medical clinic. He states he has been in jails before, many times, and is always given a second mattress and an extra pillow because he had surgery on his back … Continue reading

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April 24, 2018

Manipulation Defined

One of the more common complaints that I hear from correctional practitioners (especially new practitioners) is “Manipulative patients are driving me crazy!” To be honest, I ran into a lot of manipulative patients when I worked in the ER, as … Continue reading

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March 17, 2018

Bad Medicine is Expensive!

In the last JailMedicine post, I introduced the subject of Utilization Management (UM) in Corrections. To some, Utilization Management has earned the reputation of being too focused on money and not enough focused on patients. But after I had been … Continue reading

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February 25, 2018

Controlling Health Care Costs: Utilization Management

Consider two people standing outside of a grocery store. Person one is told: “Here is $200.00 for groceries for one month. You may buy any food you wish—but you may not spend more than this $200.00. So, make your purchases … Continue reading

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January 21, 2018

Is this a Medical Refusal–or Manipulation?

My good friend Al Cichon writes: Dr. Keller – would you consider a discussion of balancing the autonomy of patient decision-making and the risk to the facility for not providing appropriate care. Examples 1. Individual is on disability but wants … Continue reading

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December 3, 2017

Random Thoughts on Alcohol Withdrawal

I had a lot to learn when I began practicing medicine in county jails. One of the most important of those lessons was how properly to assess and manage alcohol withdrawal. In my previous life as an ER physician, I … Continue reading

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October 24, 2017

Price Check! Are analogue insulins worth their hefty price?

The analogue insulins were introduced into the United States in the late 1990s and early 2000s. They are called “analogue” insulins because their chemical structure is subtlety different than native human insulin, which gives them different, advantageous properties. Analogue insulins … Continue reading

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September 14, 2017

Inmates cannot go out to find good doctors in the community. Good doctors have to choose to go to them!

I remember the first time someone told me that I was “wasting my talents” by working in a jail. At that time, I had no ready witty rebuttal. I love my job and I especially appreciate working with a patient … Continue reading

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August 7, 2017

Treating Heroin Withdrawal: Methadone, Suboxone and . . . Tramadol?

In my last JailMedicine post, I wrote that clonidine is an excellent drug for the treatment of opioid withdrawal. In response, several people have asked about methadone and Suboxone. Why not use one of those drugs instead of clonidine? The … Continue reading

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July 16, 2017

Effective Treatment of Heroin Withdrawal in Corrections

Imagine this: You’re practicing medicine and a patient comes to you with an illness. You make the diagnosis and then say to the patient, “I can see that you are very sick. And there is a highly effective treatment for … Continue reading

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May 26, 2017

Medications at High Risk for Diversion and Abuse In Correctional Facilities

The practice of Correctional Medicine has many strange differences from medicine outside the walls. It took me a couple of years to get comfortable with the various aspects of providing medical care to incarcerated inmates. Of all of these differences, … Continue reading

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April 14, 2017

A Better Way to Drain Abscesses: The Berlin Technique

One of the consequences of the heroin epidemic we all are experiencing is a marked increase in the number of skin abscesses presenting to the jail medical clinics.  Jails have always had to deal with skin abscesses.  In fact, the … Continue reading

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February 28, 2017

ACCP Conference!

The list of educational opportunities specifically geared towards correctional medicine is woefully short.  We correctional specialists need to take advantage of as many of our own conferences as we can. One excellent resource for several years has been the one … Continue reading

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February 5, 2017

Correctional Medicine is a Great Job! Who Knew?

I have a confession to make.  Before I knew anything about Correctional Medicine, I had a bad opinion about it.  I’m not proud of this.  I even turned down my first opportunity to get into Correctional Medicine because of my preconceived … Continue reading

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January 16, 2017

Correctional Medicine Is Different: Our Patients Don’t Go Home!

This post is the final in a series exploring how Correctional Medicine is different than medicine practiced outside of jails and prisons.  The previous three differences were The Principle of Fairness and All Clinical Encounters are Discussed Back in the … Continue reading

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December 7, 2016

Correctional Medicine is Different: We Can’t Fire Our Patients—and They Can’t Fire Us!

This post is the third in a series exploring how Correctional Medicine is different than medicine practiced outside of jails and prisons.  The previous two differences were The Principle of Fairness and All Clinical Encounters are Discussed Back in the … Continue reading

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October 7, 2016

Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm

On my last post, I began a series discussing how Correctional Medicine is different from medicine in the “outside world.”  The first (and arguably the most important difference) is that medicine inside corrections has to be fair, whereas the bigger … Continue reading

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September 12, 2016

Correctional Medicine: The Principle of Fairness

I am often asked by my non-correctional colleagues what it is like to work in a jail. I tell them that practicing correctional medicine is different in many ways than medicine in the “free” world. Many of them scoff at … Continue reading

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July 26, 2016

Do Uncomplicated Lacerations Need To Be Closed Within Six Hours?

Dr. Keller, What do you think of the rule for lacerations that says a laceration has to be sutured within six hours or it cannot be sutured at all? At our facility, we send lots of inmates to the ER … Continue reading

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June 26, 2016

The M-Word–Malingering

I went to the always excellent NCCHC spring convention in Nashville last month. One of the many outstanding presentations was done by frequent lecturer Deana Johnson. Deana talked about the risks of using the word “malingering.” Her basic message was … Continue reading

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May 22, 2016

An Introduction to Correctional Medicine–A Guest Post by Bruce Boynton, MD

Today’s JailMedicine post was written by Bruce Boynton, MD.  Dr. Boynton has been a Regional Medical Director of the prisons in New Mexico and currently is the Statewide Medical Director in Mississippi.  He wrote this article to help introduce newly … Continue reading

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March 5, 2016

Taming the Beast—Gabapentin. Ban It or Regulate It?

In my last post, I began with a question from Christy.  Her facility was considering banning gabapentin from their facility due to rampant abuse and diversion problems.  My last post dealt with gabapentin’s interesting history and the evidence base for … Continue reading

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February 7, 2016

Taming the Beast: Gabapentin

A reader recently wrote At our facility, one of the most abused drugs in Neurontin. I am the trying to formulate when this medication will be continued. My question is if the following is acceptable in your opinion: Neurontin will … Continue reading

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December 27, 2015

Proton Pump Inhibitors: Dependency and Risk

I recently saw yet another patient come into the jail who was worried about one particular drug in a long list of medications he was taking—his Nexium. “I can’t miss a day of taking Nexium” he said, “It has to … Continue reading

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November 3, 2015

Improving the Reputation of Correctional Medicine

A noteworthy event happened last June that you may have missed. For the first time ever, an Emergency Physician was elected as president of the American Medical Association . “So what?” you might ask. Well, not that long ago, Emergency Medicine … Continue reading

September 13, 2015

Reader Question: How Should We Handle Inmate Requests for their Medical Records?

Dr. Keller, We have recently had inmates requesting copies of their medical records. We have not been releasing those records but we now have a new jail commander that feels we should release those records. Also, what about after an … Continue reading

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July 10, 2015

Removing Microdermal Implants, A Photographic Tutorial

A couple of years ago, I first started to see microdermal implants in my jail patients.  This is, of course, jewelry that is implanted in the skin.  These have become so popular as to be almost universal.  If you work … Continue reading

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May 30, 2015

How Does Jail Medicine Differ From Prison Medicine?

I was talking to a physician colleague of mine the other day and he was quite interested in what I was doing and in correctional medicine in general. Like most people (it seems), he had no idea what the difference … Continue reading

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May 11, 2015

Book Review: Correctional Health Care Patient Safety Handbook

If you’ve ever gone looking for books, articles, or–well anything! written about correctional medicine, you will quickly notice that there really isn’t very much out there. The specialty of correctional medicine is in its infancy. You can count the number of … Continue reading

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April 10, 2015

Game Changer! The New ACA/AHA Cholesterol Guidelines

About a year ago, the American Heart Association released new cholesterol management guidelines. These guidelines changed how we practitioners should deal with cholesterol evaluation and management almost to a revolutionary degree. They are a BIG departure from past thinking. For … Continue reading

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January 24, 2015

Book Review: “Jailhouse Doc”

Everyone who has worked in corrections for any length of time accumulates a litany of anecdotes about the funny and crazy things that go on. These tend to get passed around whenever correctional personnel get together at parties or conferences. … Continue reading

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December 11, 2014

Grody Feet and Heel Cracks

Back when I worked in the ER, we often would have patients come to the ER who were homeless or otherwise had not been taking care of themselves. Of particular concern was their feet—many had not removed their shoes for … Continue reading

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November 17, 2014

How Effective is the Influenza Vaccine? How About Tamiflu?

One of the greatest concepts I have run across since I finished school is the Number Needed to Treat (abbreviated NNT). NNT was never taught back when I went to medical school (we had barely given up The Four Humors!). … Continue reading

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October 15, 2014

Reader Question: Must Uncomplicated Lacerations Be Repaired Within Eight Hours?

Dr. Keller, What do you think of the rule for lacerations that says a laceration has to be sutured within six hours or it cannot be sutured at all? At our facility, we send lots of inmates to the ER … Continue reading

September 22, 2014

Diuretics for Swollen Legs? Not!

Originally printed September 2012 I recently had several women inmates at one of my jails complain that their legs were swollen and request a “water pill” to get rid of the swelling. This happens now and again at the jails … Continue reading

September 4, 2014

Hernia Repair in Corrections: Now? Later? Never?

For most medical conditions, incarcerated inmates receive care that is equal to, if not better, than what is available to the average American. I think so, anyway. Often, in fact, inmates have easier access to medical services and receive even … Continue reading

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August 4, 2014

Ammonia Capsules Are a Great Tool for Assessing Pseudoseizures

The question of whether a seizure-like event is a true epileptic seizure or some type of pseudoseizure is often very hard to sort out. Oftentimes (in fact, most of the time) these events do not happen in front of us. … Continue reading

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July 15, 2014

Pseudoseizures–Achieving Accurate Diagnosis

You are called by jail deputies to see a patient who had a short seizure and now is having another. The patient has only been in jail for a couple of days. He did not mention a seizure disorder at … Continue reading

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June 23, 2014

Pseudoseizures—the Right Approach

I recently had to mediate a complaint from a jail deputy about a jail nurse. The jail deputy had called the nurse in to evaluate an inmate who was having seizures. The nurse said that they were pseudoseizures. The deputy … Continue reading

June 5, 2014

Price Check! Extended Release Antidepressants

Every once in a while, because of changing drug prices, I discover that my formulary has become outdated. More expensive medications are on my formulary and less expensive equivalents are non-formulary. Depending on how long the price change occurred before … Continue reading

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May 19, 2014

Changes in Hypertension Treatment? Why Yes! The Recommendations of JNC 8

As we all know from long experience, hypertension is the single most commonly seen and treated condition in primary care medicine. It is an important risk factor for strokes, heart attacks, kidney failure and overall death. It has been exhaustively … Continue reading

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May 7, 2014

Interesting Article: Antipsychotic Efficacy

I ran across a quite interesting article this past week that had been recently published in the Lancet. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Leucht S,, Lancet. 2013 Sep 14;382(9896):951-62. doi: 10.1016/S0140-6736(13)60733-3. … Continue reading

April 28, 2014

Verbal Aikido: A Guest Column by Dr. Bill Wright

Today on JailMedicine, I am happy to present a guest post by Dr. Bill Wright.  As you may remember, Dr. Wright is the author of Maximum Insecurity: A Doctor in the Supermax, which I reviewed here and which you can … Continue reading

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April 24, 2014


Today, I am adding more sites to the CFOAM page found at the top of the blog. Remember that FOAM stands for Free Online Access to Medicine and is a movement that seeks to utilize the full potential of the … Continue reading

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April 18, 2014

Skeletal Muscle Relaxers Do Not Relax Skeletal Muscles!

Today’s post is an opinion piece. Personally, I think that skeletal muscle relaxers like cyclobenzaprine, methocarbamol and chlorzoxazone are over prescribed for acute and chronic musculoskeletal pain, both in the outside world but especially in corrections. The main reason for … Continue reading

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April 8, 2014

Hepatitis C: Between a Rock and a Hard Place

As you probably know, Sovaldi (sofosbuvir) is an important new treatment for Hepatitis C infection that was released this last December and has been aggressively marketed by its maker, Gilead, ever since. The problem is that Gilead is charging an … Continue reading

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March 20, 2014

Ingrown Toenail Removal: A Pictographic Tutorial

Ingrown toenails are a common presenting complaint in my jail medical clinics, just as they were when I worked in the ER back-in-the-day. Of course, not all toe infections are due to an ingrown toenail (which I will talk about … Continue reading

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March 10, 2014

Price Check! Genital Herpes. How Much is Nursing Time Worth?

It is worthwhile to check drug prices now and then (once a quarter seems about right) to see what is happening in the pharmaceutical world.  When you do this, you will find some drugs that have inexplicably shot up in … Continue reading

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February 28, 2014

A Quick Spin Around Dizziness–a guest post by Dr. Bill Wright

My good friend Dr. Bill Wright guest-wrote this post about dizziness.  He is the author of Maximum Insecurity: A Doctor in the Supermax, which you should read if you have not!  Thanks, Dr. Wright!  –Jeff Keller “Can’t you understand? I’m … Continue reading

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February 18, 2014

Reader Question: Xanax Withdrawal

I am looking for a withdrawal protocol for benzos. I have patients that have been on Xanax 2mg for 3-5 years and now I need to detox them. We all know how difficult this is with people in the community … Continue reading

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January 29, 2014

Essentials of Correctional Medicine . . . Final Agenda

I am excited to be part of the Essentials of Correctional Medicine conference! It is only five weeks away, February 19, 20 and 21. Click here for more information! As it was last year, Essentials will be held at the … Continue reading

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January 14, 2014

Do Not Use Hydroxyzine for Alcohol Withdrawal!

We correctional practitioners get to see a wide range of medical practice as we review the medical histories of inmates arriving at our facilities. I myself have seen many prescribing practices that make me scratch my head. One example I … Continue reading

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January 9, 2014

Top Posts from 2103 and New Year Resolutions

Thanks to everyone who has read JailMedicine this past year!  I have to admit that when I started writing JailMedicine, I never thought it would be as successful as it has been. Total readership should exceed 200,000 by the time … Continue reading

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January 3, 2014

Understanding Breast Cancer Screening Recommendations

Who knew that setting up a breast cancer screening program for corrections could be such a big deal?  Fortunately, I don’t have to deal with screening mammograms much in my jails.  But we have been wrestling with this subject for … Continue reading

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December 19, 2013

The Bright Side of Metabolic Syndrome!

I have been doing yearly wellness exams for the local fire fighters for many years now.  I quite enjoy it.  Many of them are in such good physical shape that I pronounce them to be “Mary Poppins” fire fighters, meaning  … Continue reading

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November 25, 2013

Help a Brother Out! Outcome Studies

Hi Dr. Keller, I was hoping I could pick your brain (and those of your readers) for ideas regarding Outcome studies. We are an NCCHC accredited facility with a population of less than 500 inmates. We are required as part … Continue reading

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November 11, 2013

Book Review. Maximum Insecurity: A Doctor in the Supermax

Quick!  Name a book that describes the experience of being a medical professional in a jail or prison!  . . . Can’t do it, can you?  There are lots of books that talk about the life of a lawyer or … Continue reading

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October 30, 2013

Antibiotic Over-prescribing and The Looming Threat of Resistance

I ran across a couple of interesting articles about antibiotics recently. In the first article, entitled We Will Soon Be in a Post-Antibiotic Era, CDC researchers predict that the end of the antibiotic era is coming quickly. Antibiotic resistance is … Continue reading

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October 17, 2013

Reader Question: How to Handle Swearing in the Medical Clinic?

My good friend Al Cichon in Maine writes: Dr. Keller, What are your thoughts regarding disrespect? As health care providers we are trained to be tolerant when patients are less than pleasant – excusing their behavior as a result of … Continue reading

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October 1, 2013

You’ve Heard of Placebo. But What About the Nocebo Effect?

I ran across a quite good article the other day entitled A Powerful Tool in the Doctor’s Toolkit written by Dr. Danielle Ofri. It was about how the placebo effect is underappreciated in medicine. Far from being an esoteric “Gee-Whiz!” … Continue reading

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September 2, 2013

Rectal Contraband. What Would You Do?

Hey Jeff,
 like you I am an ER doc and am the Medical Director of a 550 bed jail. I would like you thoughts on body cavity searches. We had a case last week where an inmate was seen putting … Continue reading

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August 22, 2013

Reader Question: How Do You Handle Ramadan At Your Facility?

Dr. Keller, I am curious to see how other jails/prison handle fasting during Ramadan. We only KOP inhalers and creams at my facility and have no medical commissary. We do a very early medication pass for those who are fasting, … Continue reading

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August 17, 2013

Beware of Lithium Toxicity!

If you have read the title of today’s blog post, you already know the answer to today’s case.  The answer is “Lithium Toxicity.”  I could have instead presented a “Can you figure this case out?” type of format.  But I … Continue reading

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August 7, 2013

Interesting EKG. What is Your Interpretation?

Your patient is a 29-year old male who presents to the medical clinic stating that he has been having a feeling of a racing heart off-and-on for the last couple of months.  It comes and goes, maybe two or three … Continue reading

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July 25, 2013

Should Inmates Bring Their Own Prescriptions to the Jail?

In response to my last post, one reader wrote to tell me that the jail where she works does not accept medications brought in by inmates or their families. They consider this a security risk.  All medications are ordered and supplied … Continue reading

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July 17, 2013

Reader Question: Medication Approval

My friend Al Cichon recently asked the following questions: What ‘authority’ does a jail provider have to change the prescription of an inmate coming into the jail? I have been asked when I would not approve an existing prescription – … Continue reading

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July 6, 2013

Do Fish Oil Capsules Prevent Heart Disease?

Sometimes, good ideas just don’t turn out as we expect. This Interesting-Article-of-the-Week is one such case and is, perhaps, the death knell for fish oil capsules so long prescribed for heart disease.

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June 24, 2013

Beware of “Friendly Prescribing!”

Imagine that you are a healthcare provider in a jail medical clinic. One of the jail nurses comes to you and says “Will you call me in a prescription for my hypertension meds? I have no more refills and my … Continue reading

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June 11, 2013

Beware the Fecal Veneer

Over the weekend, my family and I went to see the “Mummies” exhibition at the local museum. One display invited participants to feel squares of leather that were said to feel like mummy skin. As I watched the family of … Continue reading

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May 31, 2013

Essentials Of Correctional Medicine, February 2014

I am pleased to announce the Essentials of Correctional Medicine Conference 2014! It will be held February 18-21, 2014 in the Downtown Hilton Hotel in Salt Lake City, Utah. Last year’s conference was a great success.  We had much greater … Continue reading

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May 22, 2013

A Low Salt Diet. Do You Really Need One?

So here is a report that actually can have immediate impact on correctional medicine: NYTimes: No Benefit Seen in Sharp Limits of Sodium in Diet For many years, the American Heart Association and other Big Hitters in medicine have extolled … Continue reading

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May 16, 2013

Price Check! Estrogens.

I don’t have a lot of women in my jails who take estrogen.  The post-menopausal women I see usually are not prescribed replacement hormones by their outside doctors very often.  The main reason for this is the momentum generated by … Continue reading

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May 15, 2013

Case Study: “I Fell and Hurt My Hand”

An inmate presents to the medical clinic with a laceration on his hand overlying the knuckle of his small finger.   He insists that he fell getting off of his bunk.  He has no other injuries on examination.  What do you … Continue reading

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May 9, 2013

Chemical Sedation–Right Follow Up

Remember our patient?  He was the guy who repeatedly ran his head into the wall.  Probably everyone in corrections (if you have worked in the field long enough) has seen someone like this guy , who is working hard to … Continue reading

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May 2, 2013

Judges Practicing Medicine Continued

With regard to the recent article about judges issuing court orders for medical treatments while in jail, I wanted to get a legal perspective, so asked my friend David Tatarsky, who is General Council for the South Carolina Department of … Continue reading

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April 25, 2013

Inmate or Convict? What’s in a Name?

For many years after I came to work in jails, I was confused as to why those incarcerated in my jails were referred to with such varied and stilted names.   IDOC (the Idaho Department of Corrections) calls its charges offenders.  … Continue reading

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April 19, 2013

Involuntary Chemical Sedation–The Right Medications

Let’s start by setting the stage:  Our patient is a 35 year-old man who is angry that he has been arrested in a domestic dispute case.  He cooperated with the booking process, but then, several hours later, began to repeatedly … Continue reading

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April 13, 2013

Involuntary Chemical Sedation–The Right Patient

In my last blog post, I argued that chemical sedation was safer that prolonged physical restraint for patients who represent an acute threat to themselves or others.  Today, I would like to explore who is an appropriate candidate for involuntary … Continue reading

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April 1, 2013

Judges Practicing Medicine–The Right Response

I received a court order last week, ordering me to provide a certain inmate with several medications (some of them misspelled) during her six month incarceration.  Upon investigation, it turned out that she did not even have a current prescription … Continue reading

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March 25, 2013

Chemical Sedation is Safer than Prolonged Physical Restraint

Here is the clinical scenario:  You have an inmate in your facility who is running his head into wall, bull-like, at full speed.  He then backs up and does it again.  He may be suicidal.  He may be high on … Continue reading

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March 17, 2013

Nurses and Chronic Care Clinics. What Do You Think?

In my last post, I discussed the differences between how nurses are used in Acute Care Clinics in the community versus how they are used in corrections.  Today, I would like to discuss the differences between the community and corrections … Continue reading

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March 6, 2013

Nursing Clinics and Scope of Practice. What Do You Think?

At the last Essentials of Correctional Medicine conference, Dr. Marc Stern gave a thought-provoking lecture about the proper use of nurses in the correctional setting. I have to admit that his talk was a bit controversial; some of the nurses … Continue reading

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February 23, 2013

What Makes a Good Medical Scoring System?

My good friend Al Cichon wrote the following comments to me about my article on the 10 Point Pain Scale. Use of a ‘scale’ to measure subjective factors is a true oxymoron (heavy on the moron part). The ‘fifth vital … Continue reading

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February 11, 2013

Understanding Pharmacy Prices. Can It Be Done?

There are several good reasons to know what your pharmacy is charging you for each of the drugs you order. You need to know actual prices in order to assess the value of similar drugs, like two different first generation … Continue reading

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February 8, 2013

What Do You Think of The 10 Point Pain Scale?

I was asked via email what I thought of the 10 Point Pain Scale.  I have never been a big fan of the 10 Point Pain Scale, but I think that it is a particularly poor fit for Correctional Medicine and I … Continue reading

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January 31, 2013

Interesting Articles of the Week: Prescriber’s Letter and Medical Letter

The saying goes that just half of what we were taught in medical school is wrong.   Also half of what we think we know about medicine now is wrong.  The problem is that we don’t know which half!  But this does … Continue reading

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January 17, 2013

Reader Question: How Safe Is Correctional Medicine?

Ryan writes: Hi Dr. Keller. I am a third year Physician Assistant student at the Rochester Institute of Technology. I am beginning to write a research paper, for which I have chosen to write about Correctional Medicine. Your blog appears … Continue reading

January 14, 2013

The F-Word. “Formulary!”

Back when I worked in the Emergency Department of a large hospital, my medical staff assignment for many years was to the Pharmacy and Therapeutics Committee.  The P&T committee’s assignment was to develop a hospital Formulary and to establish guidelines … Continue reading

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January 5, 2013

Page 1 of 2

7 thoughts on “Complete Article List

  1. 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:

    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.

    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.

  2. 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.

  3. 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.

    • 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.

  4. 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!

    • 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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