Corrections Community

I have a post that includes performing medline for general population. I am aware that a lot of other institutions require inmates to do full mouth gum sweeps, using the fingers to clear the mouth. An inmate was caught, "cheeking", his meds and because of that the OIC oredered the thourough inspection of all inmates mouths before returning to their units. Many inmates complained of the unsanitary consequences of sticking their hands in their mouths, they complained and got their way. Has anyone else encountered this issue, and if so is there a way to handle this situation and still be effective. What does your institution require?

If possible have your nursing staff crush the inmates medication.

The inmate must open his mouth and lift his tongue for a visual inspection. Additionally, we require that inmates use only water with which to take their medication so that if they spit it into their cup, it can be easily seen.

if they know that they are going to have to do a mouth sweep then they should wash their hands. they can open any doors etc between them and where they get meds with one hand leaving the other hand clean. inform them ahead of time that this is going to be the rule and then proceed. not all meds can be crushed so this can be a problem. in our facility two favorites to crush and snort are welbutrin and seroquel. they were recently removed from the first choice on the formulary. deb

in our facilities, seroquel and wellbutrin have been removed from the formulary completely 

Follow is our procedure Direct the inmate to get a full glass of water; we only allow water becuase you can see if an inmate spits the medication into the glass Watch while the inmate puts the medication into their mouth and swallows it. Watch for swallowing movement. Have the inmate drink the entire glass of water. (we use 8oz clear glasses) Require the inmate to show you the empty glass; Check the inmate’s mouth by looking into it, use a flashlight. Do not put your fingers into the inmate’s mouth. Direct the inmate to move their tongue and pull the lips away from the teeth in order to fully check their mouth; Require the inmate to show their hands to you with fingers spread far apart to indicate that they have not “palmed” the medication; Tell the inmate to say something to you to be doubly sure that they have swallowed the medication

At our facility....we are to watch if Inmate does indeed take medicine, to my knowledge we do not do a mouth sweep.Sometimes without doing a visual inspection it is hard to tell wheter medicines are being taken or palmed and taken back to cell  perhaps to barter...I will check with the Head of Nursing at our facility and get more input......policy and procedure...and follow up...Have a great day.

David 

We have encountered similar issues with our medicaion passes. We are moving to administering all medications floated. We supply paper cups (small cone cups) pour water into the cup and then put the medication into the cup. The inmate/patient must drink all of the water and dispose of the cup at the medication cart. This seems to be working well. The cup is checked to ensure no meds were left in it and the inmate/paitent must open their mouth and lift their tongue for inspection.

We crush whatever medications that can be crushed. We also use our own small clear plastic med cups pre filled with water and all medication crushed or not gets put in that cup of water and then it is given to the inmate to take. After they take it we also do a visual check of their mouth and under thier tongue. We also have 2 officers present at all medication passes to have an extra set of eyes on someone who attempts to cheek their medications. The only medication that doesn't get put in the water is Suboxone which has to be disolved under the tongue. By the time we put the meds in the water and then they take them most of it disolves making it nearly impossible to cheek anything.

Did you take your medication today sweetheart??  Almost a daily event, I hear the OIC on the radio, directing custody supervisors to ensure inmates who are on controlled medication get to the pill window.  Locate them, find them, escort them!   These inmates are adults.  They committed adult-type crimes on society, now they are in a adult prison.....grown men!  As long as I inform my area of responsiblility that it's time to go get your medication, that's where my job (for that) should end.  I couldn't care less if they EVER take their medication, let alone making sure that they swallowed the crap.  Full mouth and gum sweeps, if required, will be done by medical personnel.  Trust me, an inmate that does not want to take medication on any given day, will not.  I don't care what kind of inspection you do.  Rather than cover all the angles against this opinion, I'll cut this short and remain open for any opinions against.  I'll be glad to listen.

William after reading two of your posts sounds like you don't care for your job or the people you are in charge of caring for. Like I tell all of my officers, remember you are a volunteer for this position, no one is forcing you to work here.

Exactly Matthew, you've hit the nail on the head.  The highway goes both ways, just like the door swings both ways.  But that doesn't stop me from being a realist.  Despite how it sounds, I perform my duties in the manner my supervisors see fit.  But to this position, I bring more than 20 years of Corrections experience from another state. Combined with 6 years in my current position, I'm close to 29 years in Corrections.  Please read my post again and respond with specifics.  I would be very interested in the logistics of a training supervisor.

 

Curious if the inmates legal duty to care would be completed by simply saying that it was time for medication and your job for that being finished and caring less if they EVER took thier medications. Or if that would fall under negligence or deliberate indifference.

Well...I'm not exactly sure of your point.  But trust me on this...nowhere in any operating procedure or written political jargon does it say the the Correction Officer must 'care.'  I fullfil my obligations under our operating procedures and/or under the direction of management.  I give the inmate what the state says I must, nothing more...nothing less.  The moment you allow emotions to come into play...ie..by 'caring'...is the moment you become vulnerable.  I'm not sure if your time is more spent on training, but if you were/are "in the trenches" I would think that your view would be a bit different.  If working with juveniles mandate that a Correction Officer must "care", then I'll be glad to stay where I am, with the adult-male offenders.  Therefore, there's no deliberate indifference or negligence here.

mkuehl:

Curious if the inmates legal duty to care would be completed by simply saying that it was time for medication and your job for that being finished and caring less if they EVER took thier medications. Or if that would fall under negligence or deliberate indifference.

Hi William I am a 181/2 year Correctional Officer, at our academy we were taught to provide care,custody and control. When we have med call we are given a list by the med dept who gets meds either scheduled or prn on the sceduled med list these inmates are to get there meds the inmates listed as prn get the meds when they ask us prior to med call. The officer standing at the med cart monitors the inmates for complience and to insure that the meds are not cheeked or inapropratley taking the meds. We work in open population usually two officers with an average of 50 inmates, My experience with inmates is knowing the inmates and if possible if there on a pych med that is keeping him stable,, Making my job alot easier and less dangerous, we pop there cell doors when they are locked in to notify them of med call, or yell out med call when they are out of there cells,, on my part if I know an individual is a nut case without his meds,,, yep I will pop his door a couple more times or yell out med call again,, this helps making my job safer for me and other inmates!!!

I know med calls are difficult in the long list of things that officers must do. I think there should be a balance between the belief that inmates need to be responsible and the reality that psych patients are a mixed lot. some are quite functional and likely would do okay if they miss meds but some become downright dangerous off them. I have seen officers out on disability and some unable to return to duty after dealing with an out of control person who didn't get or didn't take their psych meds. There also the reality that physically ill people who don't get or don't take their meds can have expensive medical interventions - so as a tax payer it pays to care at least about that. And lets not forget - those who have illnesses that you could contract if they don't get or don't take their meds Unfortunately there also are the officers (the exception not the rule) who do not do anything to encourage med compliance. giving psych patients enough grief that they stop the meds rather than endure the grief. Because you as officers are the front lines you are the eyes and ears for medical and psych providers. And you bet it is appreciated or at least should be. You have difficult jobs! David - proud to serve with you! Deb, a psych provider at the Concord facility NH

Hi David.  Thanks for the feedback.  Care, Custody and Control.  Intrinsic in the Custody, Control, and implementing procedure is the "care" that is spoken of.  One need not care from the heart in order to care for the inmate.  I agree whole-heartedly with your mode of operation.  The part that begins to make my blood curdle is when a supervisor makes it "my mandate" that the inmate is seen by medical for the distribution of medicine.  Missed your medication today, tomorrow you'll be taking your medication in confinement.  Discipline the inmate, don't make the officer's job any more difficult than it has to be.  And while I wait for even more angles on this subject, let me say David...stay safe out there!  Thanks again.

Let's see...how about this.  Deb, it sounds like we should be segregating the 'off meds, out of control' psychologically impaired from the 'treatable with medication' prison inmate.  The authority who makes such a classification of people (PHD's?) will need to take a closer look into making this distinction.  I admit there may be some who border this category, bouncing back and forth.  Some inmates who have been determined to need a broader spectrum of treatment are sent to a Crisis Stabilization Unit to receive the help they require.  I stedfastly disagree, however, with being the eyes and ears for medical and psych providers.  If need be, I make a referral by way of a detail report and that's where it ends.  I can't be the eyes and ears for every facet of every inmate's life, this is why many professionals are employed.  Correction Officers need to stay focused on the protection of people, the taxpayer, by enforcing the rules and regulations of the institution.  If the rule is that an inmate must follow a regimen of taking medication, and the inmate has broken or failed to follow this regimen, then the medical department must decide the best course of action to take in consideration of consequences arising from this failure.  If the inmate must be placed in an environment for better compliance, then that's what should be done.  If officers are out on disability after dealing with an out of control inmate/person who didn't get or didn't take their psych meds, then most certainly there was a certain period of time between when the inmate failed or stopped taking his meds and the time he became out of control.  And there lays the quin-essential question.  Who is responsible for this detection or lack of ?  I should only be responsible for providing the "opportunity" for this inmate to take his medication, not that he actually takes it. Free will exists, even in our prisons.  Choices are made.  Consequences should be applyed to those making the wrong choice.  Forcing a consequence upon an officer for an inmate failing to take his medication is ludicrous.  And yes Deb, allow me this opportunity to thank you for all you do, because after all, we are on the same page...in the same book.   :-)