I have helped author policy on medical diets in our state prison system.
We do all we can to ensure that people who really do need special medical diets get them. But we also try to ensure that people who just don’t like a certain food don’t claim food allergy and get a special meal as a result. Those special trays are far more expensive than the standard meals. A far greater proportion people in prison claim allergies to onions, garlic, tomatoes, etc than these allergies appear in the non-incarcerated population.
Our methods for determining if a person truly has a health or life-threatening allergy involve looking at the claimed allergen, and seeing if it makes sense in terms of being a commonly occuring allergy vs. an uncommon one vs. an incredibly rare one. The inmate needs to tell us what type of reaction they had to it, where they were treated for it, how many times it has happened, etc.
Then I’ll often check the inmate’s canteen list to see if he’s buying and eating foods containing his allergen. I’ve found folks claiming to be allergic to onions buying onion dip on canteen. And no, the excuse that they’re buying it for someone else doesn’t fly; that’s against the rules to purchase canteen stuff for others.
For most allergens, we can just tell them to avoid the stuff on their tray. Many commonly claimed allergies are in such minute traces in the diet that they wouldn’t trigger a reaction in many folks, too. Granted, some can be triggered by tiny traces. That’s where medical judgement comes in.
Often I order RAST testing on their blood to confirm an allergy. If the test is negative, that’s a very reliable sign that they will NOT have an anaphylactic reaction to the substance. If it’s borderline or positive, then I’ll consider if they need a special diet. RAST testing, at about $2.35 a test is much cheaper in the long run than continuous special trays.
Lactose intolerance does NOT merit a special diet or medication for the vast majority of inmates. Lactose intolerance is the default setting for the majority of people on the planet, so it really doesn’t qualify as a disease. Avoid dairy. Problem solved.
If the patient has celiac disease, they get a gluten-free diet.
Severe reactions in the past may merit ordering an epinephrine pen be kept on their unit for them to use if they’re in trouble. They need to get it from the guard, but at least it’s nearby. I do need to make sure the patient is trained how to use it. One guy used it backwards, and the needle was propelled into his thumb instead of his thigh. The thumb bone bent the needle, barbed it at the same time, and made removal very very difficult. Also, all that epinephrine went into his thumbtip; not a useful place for it.
We now recognize sulfites as possible allergens and are creating a diet for those folks. But we need to document good evidence of reactive airways (asthma attacks) when exposed to solidly verify this.
Diets on moral or religious grounds (vegan, vegetarian, kosher, halal, etc) are handled by the chaplain’s office.
