"What County Jail Staff Needs to Know about the Jail Medical Care System --
An Advanced Course"


Goals

Objectives

Besides didactic information, each unit contains multiple audio-video components that allows visual learners to see examples of the medical conditions and discussions of pertinent treatment. These experiences allow reinforcement in the learning process that is integral in long time recall of information.

An example of the audio-video presentation accompanying this course in included for your inspection.  You must have a speaker system to hear the audio from the movies!  Move your mouse over the video screen to activate the controls.  Clicking on the start button play the video.



If you wish to take this course:



Prisoner Transport

Some jail programs require that medical staff come to prisoners. Others require that the patient be brought to the Medical Clinic. You must know the rules governing your specific institution and those rules do take precedence over any recommendations in this general information communication related to the “transportation of individual prisoners.”

More FYI

As Jail Staff, if you have access to Nurses, they can take vital signs. If you do not have access to Nurses, your own opinion and observations of the health of a patient can be invaluable to assessing a health care situation. The information provided is an attempt to provide some information about common illnesses and conditions. I hope it helps you.

Most Important
HIPAA

Test Explanation

There is a pre-test before each section of information.

The pre-tests are not scored, but instead they are guides to what information is considered valuable. Every individual will automatically receive a grade of P or U on their pre-test, but that grade does not count.

The post-tests are scored and a score sheet will be provided to you/your jail after all the tests are finished. Your tests will be scored at the end of each lesson.

Read the information carefully, but because this is an open-book program, you will be allowed to use the educational information while taking the test.

Test Explanation continued... Your tests will be scored at the end of each section. 70% or more correctly answered is Pass.Read the information carefully, but this is an open-book program, and so you will be allowed to use the educational information while taking the test. You can have access to your test results only when you finish the entire program. You will not be allowed to return to the educational information once you finish the 10th test (question #100).
 

Knowledge is Comfort

  1. Depending on the size of your jail, you will have many or few patients. Many of the illnesses you see will be seen multiple times. Therefore, by knowing more about these illnesses you will be more comfortable and competent to recognize emergencies when they do exist and act appropriately, depending on your jail’s individual protocols.

Communication Between Jail Staff and Medical Staff

  1. Believe it or not, medical staff and physicians have a specific form of communication that helps them think about illnesses. Because some diseases occur more frequently in certain races, certain ages and even certain sexes, it is VERY IMPORTANT to provide information to the medical staff to include these facts : Age, Race and Sex.
  2. Examples:

    The patient is a 62 year old Caucasian male with….
    The patient is a 22 year old African American female with…..
    The patient is a 19 year old Latin American male with…..
    The patient is a 41 year old Asian female with…..

    Do you see how this provides a mental picture of the patient for the medical staff? I hope so. This is the correct presentation of information, but there is more…….

  3. Now that medical staff knows who the patient is, it would be helpful to know the major symptom(s), whether it is acute or chronic and the length of time it has been present this episode:
  4. …..”chest pain never before present but starting one day ago.”
  5. …..”hand pain starting when he hit the wall this morning.”
  6. …..”headache in a patient without chronic headaches that started one hour ago.”
IF JAIL STAFF CAN PROVIDE THIS TYPE OF INFORMATION TO THE MEDICAL STAFF, INCLUDING THE PHYSICIAN, IT WOULD BE A GREAT HELP TOWARDS CREATING A MEDICAL SYSTEM THAT IS CONSTANTLY IMPROVING THE CARE IT PROVIDES!

Quiz/Example:

  1. A prisoner asks for immediate assistance with pain in his right leg. The 19 year old hit the wall with his right hand yesterday, and he kicked the wall. As a Latin American male, he has been a gang member for two years. The leg starting hurting two days ago, and it has never hurt before. He does think his right eye surgery is related, and he does have a cousin with cancer of the lung. What is the most important information you tell the medical staff or physician?

Answer

  1. We have a 19 year old Latin American male who has right leg pain for two days. This is his first episode of this pain, and it started hurting after he kicked the wall.
  2. This contains the age, sex and race of the patient plus the main symptom and the length of time that symptom has been present. It also contains mention of an event that may have caused the pain. If you got it right, good job. If not, review how to present information to the medical dept.

What is an emergency?

Important Facts

  1. Inmate/Patients may have secondary gains.
  2. Inmate/Patients may wish to escape from custody.
  3. Inmate/Patients may be dangerous.
  4. Only the naïve, the foolish or the uneducated do not appreciate that there are differences!
  5. In spite of all the above, sick patients deserve and must receive good health care.

Important

  1. As you know or will come to know, inmates can have real illnesses. However, because of the reasons in the previous slide, they may try to manipulate the jail system. The 7 Bs of Inmate Behavior is a memory device I use to try to remind myself that some medical requests for treatment could be manipulative. On the other hand, many medical requests are valid. Therefore, the difficult part of jail medicine is in making the distinction.

An Explanation of the 7 Bs of Inmate/Patient Behavior

  1. An inmate claims he has seizures: he wants a lower bunk or to receive medicines he can barter.
  2. A patient claims he has circulatory problems: he wants an extra blanket.
  3. A patient may claim multiple medical problems providing him with medications that he can “barter” or trade for food or commissary.
  4. A patient claims psychiatric illness or chronic pain: he is looking to change his mental status while incarcerated. He wants “a buzz.”
  5. A patient claims to be diabetic, hypoglycemic or have food allergy: he wishes to change his diet for better food.
  6. A patient is bored and makes a medical request
  7. A patient claims to need emergency room care or he has to see a specialist: he wishes to attempt escape or more likely just have a change of environment. He wants to “be out of here.”

REMEMBER the 7 B's. THE MEDICAL STAFF WILL MAKE ALL THE MEDICAL DECISIONS, BUT KNOWING THE 7 Bs MAY HELP YOU UNDERSTAND INMATE/PATIENT BEHAVIOR!

The 7 Bs of Inmate/Patient Behavior (Often inmate medical requests are attempts at secondary gains)

  1. Bunks -back problems, seizure.
  2. Blankets -neurological, circulatory disease
  3. Barter-whatever can be bartered will be!
  4. Buzz (medications)-sleep, “feeling good.”
  5. Better food (more, different)-diabetes, hypoglycemia, allergy
  6. Bored - therefore medical request.
  7. Be out of here-specialists, ER visits.



The Mission Statement and Principles of Practice

  1. In order for you to perform your job as efficiently as possible, it is important to know that you will know the rules on which the health care system is based. The Mission Statement and Principles of Practice are these guidelines. Please review them so that you have a good understanding of them.

Mission Statement

Every inmate/patient deserves an appropriate level of health care and it should be that level that is commensurate with the health problem(s) or condition(s) that the inmate has.

Principles of Medical Practice

  1. Always seek to provide the level of medical care commensurate with the medical need of the inmate/patient.
  2. Each inmate/patient will be evaluated within a timely manner and provided a treatment plan that is medically appropriate. Medications may be included in the treatment plan by the jail physician. Prior diagnoses and treatment of disorders do not guarantee that patients will be provided the SAME medical and/or therapeutic regimen while in jail.
  3. As do many hospitals, clinics and HMO organizations, the medical staff has developed a medical formulary for the jail. If the medication a patient is currently taking is not on the formulary, then the patient will be provided with an alternative medication, if indicated. If the patient requests a medication which they are not currently taking, then a medical decision will be made by the staff as to the appropriate action.
  4. Physicians take an oath “to help and to do no harm.” Therefore, it is in the inmate/patient’s best interest for the medical staff to know as much as possible about their patient before providing a treatment that could potentially cause harm. This is why the medical staff will do its best to obtain all appropriate medical records of each inmate/patient. We believe it is in the inmate/patient’s best interest to provide correct medical information, whenever possible.
  5. If the inmate/patient’s diagnosis is not evident, the medical staff may choose to observe the patient. During that period, objective measurements of and vital signs and observations regarding behavior will be collected and recorded, when indicated. These can lead the clinician to the correct diagnosis.
  6. The jail environment may create an atmosphere where anxiety, depression and insomnia can exist. If an inmate/patient has no prior documentable history of these problems, the medical staff may decide to observe the inmate/patient several days without medication as these symptoms may cease without treatment.
  7. The medical staff may ask inmate/patients, when medically indicated, to sign a “medical records release form.” The more information the staff has about the inmate/patient’s medical history, the easier it is to provide a correct diagnosis and appropriate treatment.
  8. The medical staff has a “medication non-compliance policy” form in place for those inmates/patients who choose not to take their prescribed medications. For non-serious medical problems, the medical staff may choose to stop offering the medications to the inmate/patient, if indicated, should the inmate/patient demonstrates non–adherence to their medication program. For more serious illnesses and regardless of the inmate/patient’s adherence regimen, the medical staff will continue to routinely offer medications.
  9. By providing the appropriate types and dosages of medications(s), when indicated, often as part of a treatment plan, the medical staff will treat the patient’s current medical condition and work towards creating a long term effective treatment program.
  10. To be absolutely clear: The medical staff has a moral, ethical, medical and legal obligation to provide care that is in the inmate/patient’s best medical interest. This may or may not be identical with complying with a request by the inmate/patient for a specific medication. The medical staff will record in the inmate/patient’s medical records their decision-making process when this occurs. To reiterate, the inmate/patient’s best medical interest must always come first.

Table of Contents

1. Diabetes Mellitus 6.  Abdominal Pain (Appendicitis)
2. Seizures 7.  Hypertension
3. Asthma 8.  Infections
4. Chest Pain 9.  Delirium Tremors
5. Head and Face Trauma 10. Malingering