My friend Sherry Stoutin, Medical Director of the Nez Perce County Jail in Lewiston, Idaho, shared an interesting case.
She sent a patient in her jail to the Emergency Department to be evaluated for chest pain. He was cleared in the ER but was sent back to the jail with six hydrocodone tablets to be used PRN for chest pain as well as a prescription for 20 more. The patient actually had no further complaints of chest pain when he returned to the jail, so whether to give the six tablets to him was a moot point.
The real question is what to do now with the six hydrocodone tablets and the prescription for 20 more. Should they be placed in his property and given to him when he is released from jail?
What would you do? Read on for my thoughts, such as they are:
In my opinion, the medication tablets and prescription do NOT have to be placed in the inmate’s property and given to him when he is released from jail; they may be destroyed. My justification for this follows:
1. Dr. Stoutin is the Medical Director of the Jail and directly responsible for the care of the patient. It is her job to weigh the long-term risks and benefits of a particular therapy for individual patients under her care. And she has a better understanding of this patient than the ER Doc does. She is ultimately responsible for him. As an example, let’s say that this patient has an allergy to sulfa and the ER Doc, not knowing this, sends him back to jail with six Bactrim tablets. Should Bactrim tablets be put into his property and given to him when he leaves the jail? Of course not–knowing the danger that Bactrim could be to a sulfa-allergic patient, it is, in fact, the duty and obligation of the jail doctor NOT to give the patient these tablets. It is the same thing with the hydrocodone tablets for a patient with a drug abuse history.
2. Dr. Stoutin sent this patient to the ER with a specific question–is this patient’s chest pain being caused by coronary artery disease? The ER doctor did an appropriate work up and answered that question “No.” However, Dr. Stoutin did not ask the ER doctor for advice on how to mange the patient’s non-cardiac pain. She did not need or even want his assistance with pain management.
3. I don’t think that the hydrocodone tablets belong to the patient, they belong to the county as a result of his custodial status in the jail. Do any attorneys want to comment on this one?
4. Keeping the six tablets would have been quite a hassle for the jail medical staff because , as controlled substances, they would have to be counted and accounted for every day. This adversely impacts the safety and security of the facility (to a small degree admittedly).
I don’t know for sure what Dr. Stoutin did in this case, but in my opinion, the hydrocodone and the prescription should be destroyed.
But I could be wrong! What would you do?