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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

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

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

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

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

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

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

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

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

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

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

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

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

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: 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

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

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

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

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

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

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

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

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

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

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 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

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

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

“Prescribing Inertia” and “Medication Reconciliation.” Familiar Terms?

The “Interesting Article of the Week” is: Knowing how to stop: ceasing prescribing when the medicine is no longer required. J Manag Care Pharm. 2012 Jan-Feb;18(1):68-72.  Ostini R, Hegney D, Jackson C, Tett SE. Pubmed citation found here. Free full text! This is a … Continue reading

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December 21, 2012

Abscess Incision and Drainage, a Photographic Tutorial

Skin abscesses are quite common in correctional facilities, especially in the MRSA era, and so all correctional practitioners need to be comfortable with the procedure of abscess incision and drainage, also known as “lancing” the abscess.  Also “Let’s cut that … Continue reading

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December 9, 2012

Interesting Article of the Week Plus Price Check!

An acquaintance complained to me recently that he was struggling to afford his medications, which cost him a couple of hundred dollars a month.  I looked at his medication list and saw (among other examples) that he had been prescribed … Continue reading

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November 29, 2012

Essential Pearls from Essentials

Essentials of Correctional Medicine was held last week in Salt Lake City, Utah and included some great talks.  Today’s post is a list of Pearls I gleaned from the conference speakers. The definition of a “Pearl” is a bit of … Continue reading

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November 13, 2012

A Daring Plan for Discharge Meds!

One of the “systems” problems that all jails have to deal with is what to do with medications when a patient is released from jail.  Prisons deal with this issue as well but tend to have fewer headaches than jails, … Continue reading

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November 5, 2012

The Specialty of Correctional Medicine

I just returned from this year’s NCCHC convention.  It was excellent, as always.  A very important announcement was made at the Society of Correctional Physicians’ meeting on Sunday that deserves more publicity than it is getting. The American Osteopathic Association … Continue reading

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October 27, 2012

Interesting Article of the Week: Gonorrhea, Superbug.

The Emerging Threat of Untreatable Gonnococcal Infection. Bolan GA, Sparling PF, Wasserheit JN N Engl J Med 2012;366(6):485 This article was generated by the CDC and is about the increasing incidence of drug resistance of Neiseria gonorrhoeae, as well as … Continue reading

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October 23, 2012

Dr Foote’s Home Cyclopedia of Popular Medical, Social and Sexual Science

I ran across this topic in the excellent Australian Emergency Medicine blog Life In The Fast Lane.  It was too good not to share.  After reading the advice of Dr. Foote, I’m sure that most of you, like me, will … Continue reading

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October 17, 2012

Diabetic Malingering, Part Two. Scams and Solutions!

My last post introduced the subject of diabetic malingering.  In this post, I present several patients I have encountered in my correctional medicine career and the various scams they have used to manipulate their blood sugars.

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October 10, 2012

Diabetic Malingering: Part One

In corrections, we see an awful lot of malingering, symptom magnification, and outright medical deception.  This comes in many forms, from alleging vomiting when none has occurred, to falsely claiming to be hearing “voices,” to deliberately abrading the skin and … Continue reading

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October 8, 2012

What’s That Skin Lesion? Plus updates.

Before we get to the cool skin lesion quiz, first a couple of updates! Get your flu shot! Influenza shots are here.  Be sure to get yours.  I didn’t get my flu shot last year and subsequently came down with … Continue reading

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October 1, 2012

Methadone? In a Jail?

The question was raised recently about how to handle inmates who prior to jail,  were enrolled in a methadone or Suboxone program to treat narcotic addiction.  Should they continue the methadone or Suboxone in jail?  Or should they instead be … Continue reading

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September 18, 2012

Obstacles to a Medical Commissary Program

Last week, I counted down the five most popular articles from JailMedicine’s first six months.  This week, I would like to revisit my own personal favorite post.  I don’t have very many really good ideas—but this is one of them:  … Continue reading

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September 13, 2012

Six Months Later–Top Posts

Well, JailMedicine is now over six months old and has been more fun to write and much better received than I had imagined it would be.  JailMedicine has had over 30,000 hits!  Thank you especially to those of you who have … Continue reading

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September 6, 2012

Question of the Week: STD’s–Test or Just Treat?

Reader Question of the Week: How do I go about convincing the management team to allow me to treat inmates for STI’s.  It is common practice to obtain a UA for c/o burning etc per protocol.  But, I am not … Continue reading

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September 4, 2012

Interesting Article of the Week: Prostate Screening?

  SCREENING FOR PROSTATE CANCER: A REVIEW OF THE EVIDENCE FOR THE U.S. PREVENTIVE SERVICES TASK FORCE Chou, R., et al, Ann Intern Med 155:762, 2011. One of my hobbies is that I do Wellness-Fitness examinations of local firefighters.  They … Continue reading

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August 23, 2012

Diuretics for Swollen Legs? Not!

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 and seems to occur … Continue reading

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August 16, 2012

Eyeglasses in Corrections: Looking out for Vision Requests

Eyeglasses were partly why I got into correctional medicine in the first place.  16 years ago my local jail was under an ACLU consent decree and was desperate to find someone willing to provide medical care to the jail inmates … Continue reading

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August 6, 2012

Interesting Study of the Week and Updates

Set your TiVos! For those interested in the Bath Salts phenomenon that I wrote about in “Bath Salts,” A Review and Bath Salts Update, CNBC is airing an hour-long program tonight about the “Bath Salts” and “Incense” phenomenon entitled Crime … Continue reading

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August 2, 2012

Reader Question About Antibiotic Use. What’s Your Opinion?

My name is Gabby and I am a ARNP working in  a rural health care setting in southern Washington and newly blessed with a county jail assignment.  I oversee 300 + inmates in a county jail setting and was turned … Continue reading

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July 31, 2012

Interesting Study of the Week–MRSA

Antibacterial drugs and the risk of community-associated methicillin-resistant Staphylococcus aureus in children. Schneider-Lindner,, Arch Pedicatr Adolesc Med, 2011 Dec:165(12):1107-14. This is a great study done in England, where a database of medical treatment for the whole country is available for … Continue reading

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July 24, 2012

Education for Correctional Medicine

One of the challenges I see for those of us who practice Correctional Medicine is that there are too few educational opportunities specifically designed for us. There are a few:  NCCHC has great conferences.  The Society of Correctional Physicians puts … Continue reading

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July 23, 2012

Don’t Get Burned by Serotonin Syndrome (like I did)

A 46 year old man comes to the medical clinic complaining of muscle aches and twitching, which he first noticed two days ago.  He had been booked two weeks ago and his prescribed outside medications were continued:  sertraline 100mg a day, amitriptyline 100mg … Continue reading

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July 18, 2012

Bath Salts Update

Last Monday, July 9th, President Obama signed the Synthetic Drug Abuse Prevention Act of 2012 (found here), which outlaws the Bath Salt ingredients MPVD and mephodrone along with 29 other synthetic chemicals.

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July 15, 2012

Thoughts on an Untreated Type 2 Diabetic

We recently had a 46-year-old male patient booked into our jail who reported a history of diabetes but who had not seen a physician or taken any medications for “years.”  He said he used to take a medication for diabetes … Continue reading

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July 9, 2012

“Bath Salts,” A Review.

It used to be that “Bath Salts” were, well, salts that you would use in a bath.  Not anymore!  Nowadays, “Bath Salts” refers to a designer drug of abuse that is marketed like traditional bath salts to give legitimacy to … Continue reading

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July 2, 2012

Three Cases (and Three Causes) of Rhabdomyolysis

Rhabdomyolysis is one of those diseases, like acute alcohol withdrawal, that I have seen much more commonly in my jails than I ever did when I worked in the emergency department. Rhabdomyolysis occurs when skeletal muscle cells die and rupture, … Continue reading

June 28, 2012

Is This Inmate Gaming Me?

I have seen several patients recently with an unusual complaint. A typical presentation would be this:  a male in his early 30s and without medical history  complains of frequent urination: “I have to get up 10-12 times a night to … Continue reading

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June 23, 2012

What is the Most Cost-Effective Treatment for Genital Warts? The Answer May Surprise You!

Aldo Torrente recently wrote, “Currently I have several patients with genital warts.  In my facility there are three alternatives: podophyline, verruca freeze, and trichloroacetic acid. In all cases, the provider ONLY can apply the topical treatment.  What is the protocol … Continue reading

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June 18, 2012

Quiz Time! Name That Rash!

A patient presents to your clinic with this rash on her arm.  She reports that it began three days ago and has steadily gotten worse.  Now, the rash is weeping and crusting a little bit.  It hurts and itches. She … Continue reading

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June 11, 2012

Tips on How to Say “No!”

One of the many things that make correctional medicine different from “outside” medicine is that we in correctional medicine have to say “No” a lot.  Doctors on the outside do not say “No” very often because they must keep their … Continue reading

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June 6, 2012

What Exactly is a “Mood Stabilizer?”

A mental health professional recently referred a patient to the medical clinic “for consideration of a mood stabilizer.”

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May 31, 2012

A Step By Step Approach to the Hunger Games

So the Detention Deputies call medical and say that there is a certain inmate who has not eaten anything for the last four days.  Not an unusual occurrence in my experience; in fact, we medical providers most often hear about … Continue reading

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May 29, 2012

The Hunger Games–Corrections Style

I have two patients in my jails right now who are not eating.  When I was told about these patients, the term “Hunger Strike” was used, as in “We have a new patient on a hunger strike.”  However, “Hunger Strike” … Continue reading

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May 22, 2012

Are There Medications that are Inappropriate for Use in Jails and Prisons?

All medications have side effects and potential complications. Of course we all know this. Whether to prescribe and what to prescribe should involve a careful weighing of the expected benefits vs. the potential harm for each individual patient.  This math—risks … Continue reading

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May 9, 2012

Do You Do Doubles? Don’t!

A frequent complaint in jails comes from inmates who request extra food for various reasons–they are underweight, they are just way hungry, whatever.

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May 2, 2012

Review Articles of the Month–Emphasis Psychiatry

Like most physicians, I subscribe to several medical education and CME sites.  One of my favorites is Primary Care Medical Abstracts.  PCMA chooses 30 papers a month of interest to primary care physicians and then these papers are reviewed by … Continue reading

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April 26, 2012

The Proper Way to Document Study Results!

So let’s say you order a lab test on a patient.  Or an X-ray.  Or let’s say you order old records.  When the results are returned to you, how do you document this?  What I have often seen is the practitioner documenting … Continue reading

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April 24, 2012

Embracing the Placebo Effect of Antidepressants.

I recently ran across this interesting article (found here) which is the latest in a long series over the years comparing antidepressant efficacy to placebos.  I know that this is a controversial subject with some believing that all (or most) of antidepressant … Continue reading

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April 19, 2012

The Concept of a “Hypertensive Urgency” is a Myth

One of my nurses called me recently worried about a patient’s blood pressure.  The patient had just recently arrived at the jail and had no complaints, but when his blood pressure was measured, it was 230/120.  The patient otherwise felt … Continue reading

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April 16, 2012

What Makes Correctional Medicine Different?

I recently read my friend Lorry Schoenley’s excellent article on Correctional Nursing is Different–Research Report which is about the differences between correctional medicine and traditional community medicine. Coincidentally, I also found myself at about the same time hiring a new full-time … Continue reading

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April 10, 2012

Diabetic Snacks: Part Two!

In my previous post on Rethinking Diabetic Snacks for Type 2 Diabetics, I mentioned that there are two theoretical justifications for the practice or prescribing bedtime snacks for type 2 diabetics.  I would like to expound on these two issues … Continue reading

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April 6, 2012

Constipation Case: What Would You Do?

I am looking for some feedback here.  How would you manage this case? A patient in her early 30s states that she has taken a Dulcolax tablet daily for over ten years.  She states she spent most of that time … Continue reading

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April 2, 2012

Constipation: Straight Talk on the Last Taboo Subject

I have decided after many years of dealing with complaints of constipation both in the ER and in correctional facilities that bowel health is the last taboo subject.  We all received “The Talk” (about sex and reproductive health) when we … Continue reading

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March 27, 2012

Is It Possible to Withdraw From both Alcohol and Opiates at the Same Time?

I recently participated in a Webinar entitled “Managing Alcohol Withdrawal in the Correctional Setting.” During the question and answer section of the Webinar, a question was posed about how to manage the patient withdrawing from both alcohol and heroin at the same … Continue reading

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March 23, 2012

Rethinking Bedtime Snacks for Type 2 Diabetics

I had an obese Type 2 diabetic patient at one of my jails recently who wrote a long grievance about not receiving a bedtime snack.  He argued in the grievance that he had received a bedtime snack at previous facilities … Continue reading

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March 20, 2012

Pop Quiz: Medication and Lab Prices

One thing that has long bugged me about how medicine is practiced in the United States is that medical professionals for the most part have no idea how much stuff costs.   Doctors prescribe medications that their patients cannot afford to … Continue reading

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March 15, 2012

Food Allergies: Sorting out Truth From Fiction

In my previous incarnation as an emergency physician (before I discovered “The Way” of correctional medicine), I saw a lot of cases of acute allergic reactions. It is a very common emergency complaint; I have probably seen hundreds in my … Continue reading


March 12, 2012

Diabetic Case Studies–The Insulin Rules in Action!

People come to jail taking the weirdest insulin regimens.  Often times, I don’t know whether these insulin schems are the result of a practitioner who does not understand insulin dosing well, or whether the patient “tinker” with their insulin dosing, … Continue reading

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March 9, 2012

A Quick-and-Easy Solution to those Pesky “Own Shoes” Requests

Everyone who works in corrections is familiar with inmates wanting medical authorization to wear their own shoes.  A typical case would go something like this:  “I have chronic back pain and walking on these hard concrete floors makes it worse. … Continue reading

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March 6, 2012

Should the Flu Vaccine be Mandatory?

So I caught the flu last week and I have been pretty miserably sick for going on 7 days; fever, achy, cough.  Also cranky, peevish, and insufferable.  My hair hurts!  Is that even possible? I usually get a flu shot, … Continue reading

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March 5, 2012

Patient Weight is a Powerful Diagnostic Tool!

Patient weight is a powerful diagnostic tool that is underutilized in corrections.  The reason for this, probably, is that not much attention is paid to weights in outside medicine.  In a general medical clinic, say, a patient’s weight could be … Continue reading

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March 2, 2012

Insulin Dosing Made Simple

I have found, in my years of practicing correctional medicine, that few practitioners who come to corrections are comfortable with insulin dosing. In my experience, this is especially true for physician assistants and nurse practitioners, but many physicians have problems, … Continue reading

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February 26, 2012

The Ankle Rules–You Don’t Always Have to Get an X-ray!

Back in the days when I worked in the ER, I ordered a lot of unnecessary x-rays.  Ankle x-rays were a particular problem.  Often I was sure that there was no fracture, but I ordered the x-ray anyway because of … Continue reading

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February 24, 2012

The Right Way to Deal with Outside Physicians

Those of us who practice medicine in jails frequently (Frequently? Daily!) run into the thorny issue of our relationship to the doctors who care for our patients outside of the jail. When patients are in our jails, we are responsible for … Continue reading

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February 18, 2012

Tasers and Narcotics

Emergency Medicine News this month had two articles of interest to corrections. The Physiology of Tasers reviewed research into the safety of Tasers including a US Department of Justice study from 2009. I think that those of us who evaluate … Continue reading

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February 16, 2012

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

All correctional medical people should be able to recognize scabies by sight.  Just to review, scabies is a tiny mite that burrows beneath the skin and causes intensely itchy lesions. Since the mite wanders (as little animals will do), scabies … Continue reading

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February 8, 2012

Is this patient psychotic? Or Delirious?

In my career in corrections, I have seen 4 or 5 cases in which a patient was thought to be acutely psychotic, but actually was suffering from delirium.  A typical case would present like this:  Deputies report that Mr. Jones … Continue reading

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February 6, 2012

“Kite?” Where did that come from?

I am wondering today where the term “kite” came from.  Everybody who works in jails or prisons is familiar with “kite,” which in jails and prisons refers to a written request for something. Inmates can “kite” for anything, but those of us … Continue reading

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January 29, 2012

Interesting Reference of the Week!

The Wall Street Journal published a little debate between two prominent physicians about whether statins are appropriately used to prevent heart disease in patients with no history of heart disease. This is an important question for jails and prisons partly because of the costs of these … Continue reading

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January 27, 2012

You Need a Medical Commissary in Your Facility!

When I was an undergraduate, before I switched to pre-med, I was an economics major.  Maybe because of that training, when I look at jail medical practices, I tend to look at all of the costs of medical practice, not … Continue reading

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January 26, 2012

Evidence Based Use of NSAIDS—Less is More

When we want to do an evidence-based approach to the use of any drug, we have to consider three factors: What beneficial effects do we want the drug to have on our patients? What harm might the drug cause?  How … Continue reading

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6 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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