Who’s Minding Your Patients? Scopes of Practice Issues in Corrections

Fran Tompkins, RN, MS, CCHP, CCN/M, is Nurse Training and Education Supervisor for Correct Care Solutions in Nashville, TN. This post is based on the session “Who’s Minding Your Patients? Understanding Licensed and Unlicensed Scopes of Practice” that she is presenting at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Scope of practice can be described as those activities health care staff are permitted to legally perform based on licensure and training. All nurses need to understand their scope of practice to be able to stay within the boundaries of licensure. Correctional nurses, though, can encounter significant challenges to keep within the bounds. First of all, correctional nurses can have significant autonomy in make care decisions based on the setting. There may be few other health care providers onsite. In addition, officer colleagues may expect nurses to deliver health care beyond licensure limits, unaware that a request is inappropriate.

Nurses have a responsibility to dissect scope of practice as it applies to their particular state of licensure, understand it, and ensure that they are practicing within the boundaries of their license and fulfilling the requirements and conditions of the applicable regulations for the state.

Scope of Practice and Delegation

When using unlicensed assistive personnel (UAP) such as nurses’ aides, medication techs, or emergency medical technicians, it can be difficult to determine what they can legally do. The American Nurses Association and Council of State Boards of Nursing provide some guidance for determining delegated activities within a scope of practice for these individuals. In particular, registered nurses need to uses critical thinking and professional judgment while considering the 5 rights of delegation:

  1. The right task
  2. Under the right circumstances
  3. To the right person
  4. With the right directions and communication; and
  5. Under the right supervision and evaluation

Considerations when deciding to delegate a task include the potential for patient harm, the task complexity, amount of problem-solving needed in the situation, and the predictability of the outcome.

When Delegation is Not a Good Idea

Based on the above considerations, delegation is not always the best decision; especially when the patient situation is acute. For example, first responder events in corrections, like man downs, require nurses to think critically about patients who are acutely injured or become acutely ill. Other nursing processes also require complex evaluation and intervention. Besides emergency response, highly developed assessment skills are needed for intake screening and nursing sick call. In these examples, staff must often make autonomous decisions and intervene based on clinical judgment. Delegation to lesser-licensed staff can be risky.

Nursing staff must be prepared to offer the best care to all patients, recognize those individuals who are critically ill, and determine the best interventions for them; all within the boundaries of their scope of practice.

How do you handle scope of practice issues and delegation in your setting? Share some insights in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.


Lateral Violence in Nursing (Podcast Episode 107)


Tara Taylor, BSN, RN, CCHP, Regional Director of Nursing, and Mariann Burnetti-Atwell, PsyD, Director of Operations, Behavior Health Services, for the Missouri State Department of Corrections through Corizon Health, join Lorry to discuss lateral violence and bullying in nursing. They are presenting the session Lateral Violence in Nursing: How to Prevent Bullying and Create a Healthy Work Environment at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Lateral violence is also called horizontal violence or workplace bullying. It can happen in any profession but is especially troubling in nursing. This summer the American Nurses Association published a position statement on Incivility, Bullying, and Workplace Violence. The ANA sees these as ethical issues and the statement quotes the Code of Ethics for Nurses with Interpretive Statements that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect” (ANA, 2015a, p. 4).

Affects Staff and Patients

An unhealthy work environment affects both staff and patients. Here are just a few of the effects of bullying on staff morale and patient care.

  • Medication errors: 40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague.
  • Staff health issues: Unmanaged anger contributes to hypertension, coronary artery disease, depression, psychological problems or other health problems.
  • Staffing issues: Low staff morale, increased absenteeism, attrition of staff, deterioration in the quality of patient care.
  • High staff turnover: Nurses leave the profession due to lateral violence and bullying contributing to the nursing shortage.

Preventing Lateral Violence

Both employers and staff have opportunities to intervene to prevent lateral violence. Employers can make it clear that bullying will not be tolerated through policy enforcement. Education about and role-modeling of respectful interactions is also important. Poor behavior needs to be addressed rather than ignored. The ANA provides posters graphically representing various prevention mechanisms for use in the clinical setting.

Is lateral violence an issue in your setting? How do you handle it? Share your tips in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Nursing Assessment of Dental Problems

Julia Buttermore, DMD, is Chief Dental Officer, Federal Medical Center, Carswell, Fort Worth, TX. This post is based on her session “Nurses’ Assessment of Dental Problems” taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Dental conditions can be a great concern for correctional nurses, yet, most received little or no training about dental conditions in nursing school. Most traditional nursing positions don’t involve dental assessments so many nurses enter the correctional specialty unprepared.

What’s the Big Deal?

First of all, a nurse is most often the first person an inmate sees about a dental concern. This is usually at a receiving screening or through the nursing sick call process. So, nurses must be able to determine the nature of the issue and make a decision about urgency of treatment. A dental episode might be remedied with instruction on self-treatment, may need assignment to the next available dental appointment, may need urgent evaluation by a dentist, or may need emergency treatment in the acute care setting. It requires significant clinical judgment abilities to appropriately manage dental issues.

Another reason dental conditions are a concern for correctional nurses is because there are so many of them in our patient population. Our patients are less likely to have received dental care in the past and many have a lifestyle that does not include high levels of dental hygiene. Therefore dental decay and periodontal disease are seen frequently. Our patients come from violent backgrounds that can result in tooth trauma. They also indulge in high levels of alcohol, tobacco, and drug use. All these substances have a negative effect on dental health.  Methamphetamine use, in particular, can cause severe dental erosion and decay. Self-medicating with alcohol and drugs can mask tooth pain. Once incarcerated and withdrawn from these substances, inmates feel increasing mouth pain that leads to dental requests for evaluation and treatment.

Finally, systemic chronic conditions and infections affect dental health. Nurses who understand the relationship of dental conditions to systemic disease can often activate medical evaluation when a dental manifestation is observed. For example, canker sores or herpes can appear on the mouth of an immunosuppressed individual and periodontal infection might exacerbate blood glucose levels in diabetics.

Where to Start

A good assessment starts with an evaluation of the patient’s mouth pain. Here are some important questions to ask.

  • How long has it been hurting? (Just now? 24 hours? 3 months? Years?)
  • Does it hurt spontaneously or when eating, drinking?
  • Does the pain wake you up at night?
  • Describe the pain quality: aching, throbbing, pressure, tingling
  • How long does it hurt? (<1 minute? 30 minutes to 1 hour? all day?)
  • Does anything help the pain?
  • Use the pain scale of 0-10 to determine a baseline level of discomfort

Dental conditions can affect the ability to breathe and swallow. These are two immediate concerns in evaluating any dental condition. Ability to breathe and swallow is affected by infection, traumatic injury, persistent bleeding in the oral cavity, or swelling. Impairment of breathing or swallowing needs immediate emergency treatment. Inspect the mouth for swelling. Take the patient’s temperature.

If this is a traumatic injury, check for a broken jaw. Mandibular fracture is a common injury due to assault or falling. Malocclusion (teeth not fitting together normally) is an indication of a mandibular fracture.

A New Skill

Since most correctional nurses come to the specialty with little training or experience with dental assessment, you may need to develop your own dental training program to develop skill in this important area of nursing practice behind bars. This can involve encouraging your facility dentist to provide in-services and hands-on practice assessing patients under their direction. You may also be able to discuss dental assessments and findings as a debrief of urgent or emergent evaluations. Dental trauma and infections tend to be the most common conditions requiring nursing assessment so these are good places to start.

Do you assess dental conditions in your practice? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Intensive Medical Management: How to Handle Prisoners Who Self-Mutilate, Slime, Starve, Spit and Scratch (Podcast Episode 106)


Todd Wilcox, MD, MBA, CCHP-A, Medical Director of the Salt Lake County Jail System, joins Lorry to discuss managing some difficult correctional patient situations. He is presenting the session Intensive Medical Management: How to Handle Prisoners Who Self-Mutilate, Slime, Starve, Spit and Scratch at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Providing health care in the criminal justice system brings with it some interesting and challenging patient situations. Patients present with unusual medical conditions, for sure, but also have some difficult behavioral and psychological profiles that lead to safety issues for both the patient and the staff. Dr. Wilcox shares insights on dealing with these patients and provides treatment recommendations based on best practices and clinical experience.

Often, disruptive inmates who slime, spit, or scratch incur charges, restricted contact, and lost of privileges. Extreme outbursts and violent behavior can lead to physical restraint. However, treating these individuals punitively rarely has a good outcome; and can sometimes end in injury or death. Things can get out of control with escalation on both sides. A measured approach, focusing on de-escalation and crisis intervention is warranted.

Self-injury, whether mutilation or starvation, are two of the most challenging behaviors to manage successfully. An understanding of mental illness is needed by both healthcare and security staff. While policy and procedure are important to set a framework for managing these behaviors, a one-size-fits-all approach will not work. Often interventions for individual patients must be tested out to determine response. For example, some patients respond well to increased stimuli while others need to be taken away from noise and audience.

Crisis Intervention Training (CIT) is recommended for those who deal with behaviorally challenging inmates. Dr. Wilcox initiated the training for staff working in the Salt Lake County Jail System and they have seen a 95% reduction in the use of force to manage behavioral issues.

How do you handle patients who self-mutilate, slime, starve, spit or scratch? Share your tips in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Caring for Pregnant Women

Caring for Pregnant WomenDonna Jackson-Kohlin, MSN,CNM, CCHP, is a Certified Nurse Midwife (CNM) providing ob/gyn care at the Western MA Regional Women’s Correctional Center. This post is based on the session “Increasing Staff Comfort Levels in Caring for Pregnant Women” that she is presenting with colleagues Theresa Coley-Kouadio and Carly Detterman; one of many valuable sessions taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

If you work with female inmates, you are likely to regularly care for pregnant patients. It is estimated that 6-10% of incarcerated women are pregnant at any time in the criminal justice system as almost 80% of female inmates are of child-bearing age. Many of us enter our correctional practice with little experience caring for pregnant women yet we need to manage prenatal and post-natal care while dealing with women at high-risk for premature labor, ectopic pregnancy, and precipitous delivery.

There are plenty of reasons to be uneasy about caring for pregnant Incarcerated women. Many have had past complicated high-risk pregnancies, with preterm births, multiple emergency cesarean sections, miscarriages, or stillbirths. Then there are the additional concerns of substance abuse, minimal medical or prenatal care, and undiagnosed medical conditions. Chaotic life situations such as homelessness and abuse add to the complications of care. Recovery from substance abuse, regular meals, and a stable living situation during incarceration can decrease the chances for pregnancy problems, especially for women with high-risk histories..

Common Pregnancy Issues

The incarcerated patient population is less likely to have had regular medical care and more likely to be practicing poor health habits such as drug and alcohol use. Here are several common inmate pregnancy issues.

Substance Use: Possibly topping the list of pregnancy risks is substance use. For many reasons, pregnant women can be reluctant to reveal accurate levels of drug and alcohol involvement.

Chronic Medical Conditions: Undiagnosed and untreated chronic conditions such as diabetes and hypertension must be evaluated and managed to minimize risks to the developing fetus.

Mental Health: Undiagnosed depression or mental health diagnoses are common in the general population, and more so for incarcerated women. Many women and many medical staff are hesitant to treat depression and anxiety during pregnancy, but untreated mental health conditions lead to poor outcomes.

Bleeding:  Bleeding can occur at various stages in pregnancy and can be caused by sexually transmitted infections, preterm labor or placental problems.

Be Prepared

“Be prepared” is a good motto for correctional nurses, as well as scouts. Here are some recommended skills and supplies needed for pregnancy care.

Fetal Heart Beat: Be sure to have a fetal doppler in good working order and know how to use it. Check out this prior post on nursing care for pregnant patients for some information links.

Emergency Birth Kit: Know the location and contents of an emergency birth kit. Review the policy and procedure on dealing with a precipitous delivery. This might be a good “man down drill” to practice once or twice a year to make sure all staff are familiar with what to do.

Learn and Practice: Request inservices from your obstetric care providers to better understand normal pregnancy, delivery, and post-partum care. Take advantage of their knowledge and perspective. Ask for hands-on training with any procedure or assessments you will be asked to perform on your own.

Keep ‘Care’ in Your Nursing Care: Listen to your pregnant patients and objectively evaluate their symptoms. Understanding normal and abnormal symptoms is helpful, as is remembering that pregnant inmates may have experienced prior pregnancies numbed by drugs and alcohol. In a drug-free state they may feel increased symptom intensity. Empathy and compassion go a long way in supporting recovery and rehabilitation. In fact, pregnancy and motherhood can be a motivating opportunity for change.

Keep Resources Handy

Have good obstetric resources available for consultation, if at all possible. Here are a couple resources recommended by Jackson-Kohlin for your unit library:

In addition, you can find education and resources such as position statement and patient materials at:

Do you care for pregnant inmates? What tips do you have to help staff feel more comfortable with obstetric patients?

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Common Pitfalls in Interpreting NCCHC Standards (Podcast Episode 105)


Episode 105Tracey Titus, RN, CCHP-RN, Manager of Accreditation Services for the National Commission on Correctional Health Care joins Lorry to discuss common pitfalls in interpreting the National Commission’s Accreditation Standards. She is presenting the session Tips, Tricks and Troubleshooting: Common Pitfalls in Interpreting NCCHC Standards at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

The National Commission accredits jails, prisons, juvenile facilities, and opioid treatment programs through a voluntary program based on quality standards developed by experts in the field. Facilities seek accreditation to establish a system for providing health care services to incarcerated populations. Preparing for accreditation includes accurately interpreting the Standards and then applying them to the specific setting. Misinterpretation of the intent of any standard can lead to inappropriate application.

Common Reason for Misinterpretation

NCCHC has analyzed implementation of standards in a wide range of facilities and has found that standards can be misinterpreted by being only partially applied or even omitted. In addition, now that there are new editions of the standards (2014 for Jails and Prisons, 2015 for Mental Health and Juvenile, and (soon) 2016 for Opioid Treatment Programs), one common mistake is applying the older standards rather than the most recent ones. To help with correct interpretation and implementation, the Standards themselves offer compliance indicators, definitions, and a discussion section, often with examples of how to comply. It’s important to keep in mind, however, that a common misinterpretation is to consider an example prescriptive when the example might not be the best or only way to apply a standard in a particular context.

The Most Difficult Standard to Interpret

Based on NCCHC surveys, the most often misinterpreted NCCHC standard is Continuous Quality Improvement. This may be because leaders see CQI as a simple audit of their health care system rather than a process designed to focus on problem issues and develop meaningful solutions. Other common standards where compliance has proved challenging for some facilities are Chronic Disease Services, Initial Health Assessment and Health Record Format and Contents.

Tips for Interpreting the Standards

Here are some tips for better standards interpretation.

  • Read the intent of the standard (first sentence of Discussion) within the context of the standard itself
  • Determine what the standard is attempting to achieve
  • Consider how it could be achieved in your facility
  • Review the examples provided for common facility solutions

Where to Get Additional Help

NCCHC offers several ways to obtain assistance with interpretation and application of the Standards and to increase your knowledge.

  • Email NCCHC for help: info@ncchc.org or http://www.ncchc.org/contact
  • Attend the preconference seminars at NCCHC’s Spring and Fall conferences
  • Read the Standards Q&A topics for specific questions about various standards
  • Read the Spotlight on the Standards column for in-depth discussion about selected standards

Are you preparing for an NCCHC accreditation visit? Share your tips for preparing and interpreting the standards in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Your Next Steps in Professional Development: Certification!

Your Next Steps in Professional Development-Matissa Sammons, CCHP, is Director of Certification at National Commission on Correctional Health Care. This post is based on her session “Your Next Steps in Professional Development: CCHP and Specialty Certifications” taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Correctional health care is a specialty like no other. Where else do health care staff get a pat down on the way into work, account for every needle used in the delivery of care, care for people who have been living on the street, or administer medications through a letter-sized metal door flap? Of course, those are only a few of the peculiarities of the field. The patient population and environment of care result in an unusual mix of conditions and situations. Those who enter the corrections field often need to seek out professional development to gain the knowledge to operate in the specialty. One way to establish expertise in a specialty like correctional health care is to seek certification.

Value of Certification

Why should you consider putting in time and effort to become certified? Here are a few reasons professionals seek out certification.

  • Professional Recognition: First and foremost is professional recognition among employers, peers, and consumers.
  • Professional Credibility: Certification denotes a proven knowledge base and documented experience in a given specialty.
  • Sense of Accomplishment: Preparing for a certification exam can be hard work; requiring diligence and perseverance. Completing the process can provide a sense of accomplishment.
  • Knowledge Validation: Certification validates foundational knowledge for the particular specialty – above and beyond initial general professional knowledge for licensure.
  • Marketability: Certified professionals stand out in a crowd of candidates vying for a particular position. It not only validates knowledge but also motivation and perseverance in the specialty.

Correctional Health Care Certification Categories

There are several types of correctional health care certifications. The advanced and specialty certifications build on the foundational Certified Correctional Health Professional (CCHP) designation. Here is a brief overview of the various categories. Full eligibility requirements can be found on the NCCHC website – ncchc.org.

Certified Correctional Health Professional (CCHP): Anyone of good character and fitness with interest in correctional health care is eligible to apply for CCHP certification. The certification exam consists of 80-100 multiple choice questions.

Certified Correctional Health Professional – Advanced (CCHP-A): Those with CCHP certification can seek advanced certification after 3 years. This process for advanced certification involves an extensive application detailing the individual’s experience and contributions to the field of correctional health care followed by a four-hour proctored examination consisting of eight essay questions.

Specialty Certifications

Certified Correctional Health Professional – Mental Health (CCHP-MH): CCHP certified mental health professionals must be a qualified mental health professional as defined by NCCHC’s Standards for Mental Health Services in Correctional Facilities with a graduate degree, professional licensure, and the equivalent of three years of full-time practice experience in a correctional setting may sit for the CCHP-MH certification. The exam consists of 80-100 multiple-choice questions.

Certified Correctional Health Professional – Physician (CCHP-P): CCHP certified physicians with an unrestricted license who have practiced in the correctional environment for at least three years are eligible to sit for the CCHP-P certification. The exam consists of 70-100 multiple-choice questions.

Certified Correctional Health Professional – Registered Nurse (CCHP-RN): CCHP certified registered nurses with an unrestricted license and the equivalent of two years of full-time practice as an RN with at least 2000 hours of correctional practice are eligible to sit for the CCHP-RN certification. The exam consists of 70-100 multiple-choice questions.

Are you certified in correctional health care or one of the specialties? What motivated you to prepare and take the examination? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Med Math Help for Correctional Nurses (Podcast Episode 104)


Ep104Jamie Davis, a registered nurse and paramedic, discusses medication math and the help provided by his book – Med Math Simplified: Dosing Math Tricks for Students, Nurses and Paramedics. Jaime podcasts on the ProMed Network hosting shows like the Medicast podcast and the Nursing Show podcast. Jaime is open about his own struggles with math concepts as a nursing student and how that helped him to develop an easy-to-read guide for other students, nurses, and paramedics.

We talk about the challenges of medication calculation and apply it to the correctional setting. Correctional nurses don’t always have the luxury of unit dosing or pharmacy calculation. In fact, some settings are still providing a lot of medication from a stock supply. There are plenty of opportunities for error. So brushing up on math is important when moving into a new position in a jail or prison. Even seasoned nurses can use some help when the rare IV is started in the infirmary and a drip rate needs calculated.

Do you find med math challenging? How do you manage math calculations in your setting? Share your thoughts in the comments section of this post.

A Pre-Flight Checklist Before Rolling Out of the Med Room

A Pre-Flight Checklist Before Rolling OutMedication administration is a common and frequent nursing task in most settings. There are plenty of opportunities to get things wrong….even when surrounded by fantastic resources like an onsite pharmacy and electronic information sources. Correctional nurses don’t often have these advantages, though, and medication administration can take on some interesting configurations. I’ve been in quite a few jails and prisons in my correctional consulting career and have seen many a method for medication delivery to overcome environmental and security challenges. Here are just a few of the ways medication may be delivered behind bars.

  • A window in the med room. Patients may line up outside the room in a hallway or in an outdoor area
  • A medication cart rolled to the housing unit and stationed in the common area or a small room in the housing unit
  • A cart, room, or even table near the dining hall
  • A larege utility shed in the recreation yard

In most of these cases (except the first one, maybe) the nurse must take all the medications and supplies out away from the medical unit and must be prepared for any situation. There is little opportunity to ‘run back to the unit’ for something forgotten or unexpectedly needed. This made me think of airplane pilots who need to know they have everything checked out and ready to go before they take to the air. As a passenger on these flights, I am glad the captain doesn’t rely on memory to be sure everything is in order. Cruising altitude is not a good place to be finding out the gas tank is low.

Here are my suggestions for a pre-flight checklist before you take-off on your medication flight.

  1. Check that the cart is properly stocked.
  • Patient medications
  • Medication administration record
  • Pen, highlighter, notepad
  • Current drug book
  • Pill crusher
  • Calculator
  • Pill cups
  • Water/drinking cups
  • Waste receptacles
  • Any access keys needed such as access to the narcotics box
  1. Perform the following activities while in the Medication Room.
  • Scan MARs for
    • Any new medication orders since last administration.
    • Any new patients
    • That all patients have drug allergies listed or NKA (no known allergies) identified
  • Check to see that new medications are available or, if being processed, are added to the cart before starting administration
  • Check a drug reference book on any new medications that are unfamiliar
  • Perform any calculations for odd dose orders
  • Perform hand hygiene
  1. Each single episode of medication administration should follow the same path in order to habituate safety principles. Here is an example of a workable medication line episode path that includes the safety mechanisms of checking the medication three times and involving the patient in medication verification.
  • Ask the patient to recite their full name while checking ID band or card.
  • Locate correct MAR page
  • Scan page for medications due at this administration time
  • Locate patient medication group in medication cart drawer
  • Take first card and check against MAR while popping pills into medication cup
  • Take next card and check against Mar while popping pills into medication cup
  • Continue in like manner until all pills for this administration time are in the medication cup
  • Recite medications to the patient while preparing them
  • Recheck cup of pills against MAR before handing to the patient
  • Ask patient if he/she has any questions about their medications while pouring water
  • Watch patient take medication. Perform oral check or confirm officer is doing oral check
  • Observe that cups are deposited in waste receptacle and not taken by the patient
  • Move to the next patient
  1. Additional steps in the process might be needed depending on the patient or situation.
  • Crushing some or all medications.
  • Responding to a patient question or confirming a medication if questioned.
  • Unlocking and signing out any narcotics.
  • Obtaining a double-check on high risk medications and complex calculations.

Do you have a mental checklist you use when preparing for and administering medications? Share your tips in the comments section of this post.

July 2015 Correctional Health Care News Round Up (Podcast Episode 103)


Ep103Gail Normandin-Carpio and Denise Rahaman join Lorry to talk about top correctional health care news items for July, 2015.

Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons

Our first story is a report out of Human Rights Watch about the use of force against inmates with mental disabilities in US Jails and Prisons. We have been discussing the plight of the mentally ill in the criminal justice system for some time. Our jails and prisons are not organized to effectively treat mental illness, yet growing numbers of inmates have serious mental illness such as schizophrenia and bipolar disorder. The mentally ill are less likely to adjust to conditions of confinement and have difficulty following all the rules that must govern life behind bars. That puts them into confrontational situations with officers who must keep order and control. This report paints a grim picture but also provides some hopeful recommendations.

Bill would give inmates’ families access to prison medical records

New York has passed a bill that would require the State Department of Correction and Community Supervision to provide medical information disclosure forms as a routine procedure for all incoming or transferring inmates. This would give inmates the option of appointing a family member or other person to receive their medical information.

Dating a prisoner: What attracts people on the outside to fall in love with convicted criminals?

This next story is about dating prisoners and comes from a British news source. The recent NY Prison Escape story and follow-on investigation as brought to light something we see in practice all too often – staff getting intimately involved with criminals. Hybristophilia is described as a condition whereby women are sexually aroused by and responsive to men who commit heinous crimes. Often referred to as the ‘Bonnie & Clyde Syndrome’, the person who is the focus of the sexual desire can be someone who is in prison. In some cases, the hybristophile may urge and coerce their partner to commit a crime. This may somewhat explain staff attraction to our patient population.

Florida prisoners train therapy dogs to help veterans

In our final story, a group of Florida prisoners are training therapy dogs for veterans suffering from Post-Traumatic Stress Disorder as part of a new program. Prisoners from the Blackwater River Correctional Facility will train three puppies for America’s Vet Dogs Veteran’s K-9 Corps with plans to expand to 10 dogs by the end of the year. The training program will teach the K-9s to do everything from retrieving medication, to turning lights on and off, to waking veterans from nightmares. Sounds like a nice idea for both the veterans and the inmates.

What is your take on these news items? Share your thoughts in the comments section of this post.