what would happen if I had to go to prison - I have stage 3 colorectal cancer that is currently in the 5 year countdown - I have a power port, which needs to be flushed every 6 weeks, and I need quarterly bloodwork, and frequent sigmoidoscopies and an annual colonoscopy to make sure that nothing sneaks back in [the aggressive monitoring is to allow me to not have the distal 15 cm of my guts removed and a bag installed …] in addition to high blood pressure and diabetes with the additional fun of anaphylactic allergy to mushrooms, and serious gastric meltdown for shellfish and palm/coconut which makes dietary considerations interesting. Would they remove the power port and go ahead with the surgery and give me an ostomy? Take my crutches and wheelchair away? Just say hell with it and give me a bed and job in the infirmary? [I do good paperwork]
How exactly would this be handled once I rolled in your gates [for example … Don’t need answer fast, though perhaps I should restrict my criminal activities to your state…]
We’d handle it pretty much the way it’s handled for non-incarcerated patients; i.e. providing community standard medical care. We regularly do all those things you describe in your post for our patients when necessary. You won’t get enrolled in any experimental drug/procedure protocols, but we work with specialists around the state, including at major teaching centers, and send our inmates there at need. HIV patients get the meds recommended for them by their immunologists, Hep C is being treated with the new curative drugs, colonoscopies are being performed, ports being flushed, insulin pumps are being refilled, canes and wheelchairs issued for legit need, etc. etc. As long as it’s medically necessary.
And who determines if it’s necessary? Me and colleagues, mostly. So stay on my good side . . .
I assume the patient doesn’t have a say or influence in what is needed as they might have in the outside world, nor can they opt for something that may give a higher quality of life, but it is not medically necessary? So perhaps the list of what you think is necessary now may be determined unnecessary and a different treatment may be prescribed?
I believe that the Supreme Court has ruled that prisoners must receive medically-necessary care, as to withhold that would be cruel and unusual punishment. So to that extent, it should be the same in every state in the Union. Though I expect that there are differences in the details between the states, probably expressed in deciding just what counts as “medically necessary”.
The actual quality of prison health care varies tremendously from one jurisdiction to another, and there have been a number of lawsuits alleging that various facilities do deny medically-necessary care.
For example, the State of Arizona settled a lawsuit in 2014 alleging systematic violation of inmates’ 8th amendment rights, due to inadequate health care and a punitive approach to mental illness in the correctional system. The department didn’t admit fault, but they agreed to a settlement requiring improvements. Progress has been uneven; the federal court has repeatedly found the department in contempt for failing to comply with the settlement (cite), including millions of dollars in fines. Some of the testimony has been damning.
Even Wisconsin has been the target of complaints; in 2016 the ACLU and Wisconsin reached a settlement in a long-running lawsuit concerning medical treatment at Taycheedah Correctional Institution, a women’s prison.
For profit prison healthcare companies tend to make their money on ‘denial of service’ and that has resulted in more lawsuits than at typical state run prison healthcare systems. Also more bad outcomes, IMHO.
The WI Taycheedah lawsuit was based much more on mental health care than primary care, but the outcome of the state losing the lawsuit was a blessing for health care professionals at Taycheedah; they got many, MANY new resources funded and quality of care was improved as a result. The ACLU was quite laudatory about the improved system there. That suit did not apply to the rest of the system, so the men’s side of things did not get such a bump in resources.
It’s tough for dedicated health care workers to take care of necessary stuff when they’re underfunded and understaffed.
As for ‘comfort care’ requests from inmates, I’ve had patients tell me they’d sleep better if only they had MRI scans so they knew nothing was wrong. I’d check them over, find no indications for an MRI scan, then get sued by them for not providing them with such a scan. They’d lose but it ate into my practice time, filling out depositions. Tho I’ve gotten quite good at it.
Other cases/disputes are more nuanced. But our cadre of practitioners tries hard to meet our patients’ legitimate medical needs. As judged by us practitioners, not by the patient’s perceived needs.
QtM, there have been reports in Illinois about an alleged “one good eye” policy. As one entrusted to make the determination regarding what is “necessary” any thoughts?
Yeah, that’s crazy. We fix both eyes, if they’re both bad enough. But it’s elective surgery and we won’t do it for mild cataracts that don’t impair the ability to read, work, or drive (assuming they’ll be driving after their release). Nor do we rush to do it. But we get to it.
Now some folks only get one hearing aid, as the worse ear is often so bad that a hearing aid won’t help it, so they just get one for the ear that said aid will improve. But others do qualify for two hearing aids when needed.
Basically, in our system, if Medicare provides coverage for it, we will too. So we treat cancers with current treatments, are working to treat all our patients who have HCV infections with the new curative meds, do joint replacements when the dysfunction is severe enough AND they have time to complete post op rehab in prison before releasing (some guys got major elective surgery just weeks before discharge from prison, didn’t follow up on their aftercare, and had horrible catastrophic consequences as a result). HIV patients are on whatever meds the community immunologists/ID docs are prescribing for them, etc.
What is common prison policy, or even QtM policy, on providing palliative treatment for prison patients who are in severe pain? (a) …in terminal cases? (b) …in on-going chronic non-terminal cases?
Do patients have the right to decline medical care? Can they decline “heroic” interventions? Can they choose whether and when to “pull the plug”?
QtM, seems now the right time to dredge up your eldritch tale of the patient with the bagel dog – not only for the benefit of those readers who haven’t seen it or who may have forgotten, but because of a point that has nagged me all this time.
You stated that the State had no interest in providing reparative surgery for his damaged dog, it being adequately functional for the most likely imprisoned purposes. Which I took to mean that you, as the medical agent of the State, had so recommended. (True?)
Yet you also noted that said dog caused him a lot of physical pain at times, despite patient’s incentives and efforts to avoid such occasions. I found it disturbing that the State, and you as an agent of the State, would have allowed that situation to persist, rather than offering the necessary surgery. Comment?
(BTW, the link to the bagel dog pic is long defunct, but here is an article containing a substantially similar pic.)
Also: I’ve heard tales, from law enforcement types, of the gruesomely minimal and perfunctory medical care that prisoners might expect. (This is in California.) Heaven help the inmate who gets a toothache.
Oh, his pain was treated medically. It was related to sustained erections during intercourse anyway, which he no longer tended to experience in prison. But there was little likelihood that surgically reconstructing his schlong would have relieved his pain; it probably would have made it worse. The only thing surgery would have accomplished was to make it (perhaps) more aesthetically pleasing. THAT was not on our agenda.
And I’m constantly called upon by nurses thruout the system to treat toothaches with analgesics and possibly antibiotics until they can be seen by our dentists. Same for other acute situations.
And yes, we have a hospice unit in our system, where terminal patients go. I helped set it up and oversaw it for a decade plus. It has inmate hospice volunteers who find the work extremely rewarding, and it has provided end of life care for hundreds of folks by now.
And in our system, if a patient has malignant pain there is no special approval or authorization needed for a doc to prescribe opioids. We have morphine and oxycodone and fentanyl and other potent meds available for such situations.
Don’t judge Corrections medicine by its outliers and horror stories (many of which don’t hold up that well to closer examination).
They have the right to decline. But they are wards of the state, and if they use that right to try to manipulate the system the courts do intervene. If they have kidney failure and decide to not start dialysis, that’s generally ok. But if refuse to dialyze because the want to be dialyzed on a different shift or by a different dialysis nurse or at a different dialysis center, a court order will be gotten.
And we issue DNR orders for folks who meet the legal standards as qualified patients. Same as in the community
So you use the same HIPAA and request for records to my current batch of doctors to help decide a plan of care? I know my PoC calls for lots of testing instead of surgery, would hate to go to prison and have them decide to give me a bag instead of monitoring frequently … sort of a serious reason not to get enslammered any time soon =)
[I had fun playing with the imaging from my latest CT scan, scrolled top to bottom and right to left to see the changes =) trippy … wish they were in come sort of color instead of grey and white tones *sigh*]
HIPAA applies in prison too. And where relevant, we get records from other doctors to see what was done before.
But make no mistake, they’re our patients now, and we’re not required to follow past treatment plans of previous physicians. I don’t care if their provider gave them oxycodone for their excruciating musculo-skeletal non-malignant low back pain, that’s not going to apply here. Especially when I see them on the basketball court going in for another layup.
To the contrary: many of the “outliers” are not really outlying in jurisdictions with for-profit health care contracts. For example, one of my relations is in prison in Kansas (where Corizon has the contract). He had a heart attack awhile back and a stent implanted in the middle of the night; the cardiologist wanted to see him for a follow-up in a certain number of weeks (two, I think, but I may be misremembering). Six months later, he gave up asking, because all they’d ever say was that the follow-up would be “soon.” (Even better, Corizon didn’t bother to pay the hospital bill on time either, so the inmate kept getting collections notices even though Corizon and the prison agreed it wasn’t his obligation.)
Inmate: “I think my blood sugar is too high.”
Med-staff: “It’s not time for blood sugar check, come back in three hours.”
I: “I really think my blood sugar is really really high.”
M: “It’s another hour until time for blood sugar check, return to your cell immediately or be written up.”
I: “I think I’m sick.”
M: “OMG, your blood sugar is over 600!! Why’d you let it get that high?”
(Of course, this is the same facility that nearly lost one of their nurses because they didn’t recognize a diabetic crisis until nearly too late.)
Wisconsin may have decent care; Kansas doesn’t (and we’re not the worst by a long shot.)
They have the legal right to decline care. But there is a theoretical limit. The state can decide that the prisoner is not legally competent enough to make the decisions he’s making and override him.
However, as I said this is mostly theoretical. Overriding a prisoner’s medical decisions requires the prison to obtain a court order and it’s extraordinarily rare for it to happen.
In most cases, a prisoner can decline any medical procedures he wishes to. That includes being able to sign a DNR order.
A personal anecdote. I once had a situation where a prisoner needed to have an appendectomy but was refusing to give his permission for it because he was scared of having the operation.
My boss was trying to call around and make arrangements for a judge to sign a court order allowing us to perform the operation without the prisoner’s permission.
I got a hold of the prisoner’s mother’s phone number and called her. I explained the situation to her and then put the prisoner on the phone. His mother told him he needed the operation and to sign the paperwork. Which he did.
