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Case study examines challenges of correctional nursing

Correctional nursing is a unique and demanding area of nursing practice.

The following case illustrates what correctional nursing, and correctional care generally, should not be.

Inmate challenges lack of care for injury

A male inmate was injured during a prison basketball game in 2010. The injury occurred to his right hand and consisted of a “torn ligament, dislocation of his thumb, tissue damage and a gaping wound between his thumb and right index finger,” as detailed in the case Perez v. Fenoglio, 792 F. 3d 768 (2015).

Since no physician was on duty at the time of the injury, a nurse saw the injured inmate. She wrapped his hand with gauze and told him she could not administer pain medication or stitch his wound because only a physician could do so.

The next day, the inmate was seen by a physician at the prison. The physician prescribed antibiotics, but did not stitch the wound. Because of the severity of the injury, the physician told the inmate he would need to go to the “outside” hospital the prison used to have a hand surgeon provide the needed care.

Such a referral needed to be approved by the prison’s healthcare administrator. This took several days while the inmate was in severe pain and tried to manage his open, bleeding wound as best he could.

Four days after the injury occurred, the inmate filed a grievance with the prison. The basis of his grievance was that the open wound and severe pain and discomfort he was experiencing was not being treated because of “retribution” for a prior grievance he filed when there was a delay in administering prescription medication for depression.

Six days after the wound occurred, a physician’s assistant at the “outside” hospital saw the inmate. The physician’s assistant determined the wound was very serious but he could not suture it because of the length of time from the date of the injury to being seen at the hospital.

The physician’s assistant also concluded a “surgical revision” or “secondary intention” was needed. The physician’s assistant did order twice-daily dressing changes and cleanings with hydrogen peroxide and suggested possible splinting for the thumb injury.

A “wound check” appointment was scheduled at the hospital within the next week.

Did prison staff follow care recommendations?

correctional nursingPrison staff failed to follow the physician assistant’s orders and did not take the inmate to his wound check appointment.

The inmate filed another grievance and requested he be seen again at the hospital. At this time, he also learned his initial grievance after the hand injury was denied.

The inmate appealed the denial, but it was upheld by prison administration, stating “the issue was appropriately addressed” by the administration.

Seven months after the inmate’s initial visit, prison staff brought him back to the hospital.

He was seen by a physician who concluded the injury could be treated by either a surgical procedure (a right thumb metacarpophalangeal fusion) or he could “live with it” and have a Thermoplast Spica splint custom made for his hand, although the latter might not be acceptable in a prison setting.

Even so, if the splint was the inmate’s choice, another appointment would be needed.

These recommendations were sent to the prison physician who initially saw the inmate. He wrapped the inmate’s hand in an Ace bandage and told him, “that’s [your] thumb-spica splint.”

After filing another grievance, the inmate had the required surgery 10 months later but with residual, “irreparable” damage to his hand.

Inmate takes legal action

The inmate filed a “pro se” (on his own) 42 U.S.C. Section 1983 complaint against various prison staff, including the nurse, alleging cruel and unusual punishment in violation of the Eighth Amendment to the U.S. Constitution.

He asserted that prison officials were “deliberately indifferent to his severe hand injury, delaying the receipt of medically necessary surgery for 10 months.” The result of this delay was needless and unnecessary pain and suffering and left him with permanent loss of hand function.

He also requested a pro bono attorney (a volunteer lawyer who does not charge a fee).

The federal district court denied his request for a pro bono attorney and dismissed his suit on its own accord (sua sponte), with prejudice, for failure to state a cause of action.

The inmate appealed that decision to the U.S. Court of Appeals, 7th Circuit.

Analysis of correctional nursing conduct

correctional nursingOf particular importance to this blog is the court’s analysis of the prison staff nurse, who allegedly acted with deliberate indifference to the inmate’s injury. The defendants contended the nurse acted appropriately by making an appointment with the physician and that she lacked the authority to provide additional care to the inmate.

Citing applicable case law, the court opined that a “nurse may not unthinkingly defer to physicians and ignore obvious risks to an inmate’s health.”

The court continued that a nurse “has a professional obligation to the patient to ‘take appropriate action,’ whether by discussing the nurse’s concerns with the treating physician or by contacting a responsible administrator or higher authority.”

As a result, the inmate’s allegations against the nurse did state a claim against her for deliberate indifference. Whether or not the nurse had the authority to stitch wounds or administer pain medication are issues that need further discovery, the court continued, as does the question of whether or not she did more to ensure the inmate would get adequate care required by the U.S. Constitution.

Final order of the court

The court carefully scrutinized the other allegations and held that the dismissal by the district court was “premature,” and that the inmate’s pro se complaint, liberally construed, states a valid Eighth Amendment claim against the prison medical staff and various grievance officials.

The case was reversed and remanded to the district court for further proceedings consistent with this opinion.

I touched on this topic more in the blog post, “Correctional Nurses Face Challenges When Treating Inmates with HIV,” for further reading.

 


Take these courses on correctional nursing:

Control and Management of Infectious Diseases in the Correctional Setting
(1 contact hr)
The number of inmates in state and federal prisons is nearly 1.6 million, making the U.S. the world leader of incarcerated citizens. The prevalence of infectious diseases in the correctional setting is four to 10 times than in the general U.S. population and is also linked to greater risk of communicable diseases, such as HIV, tuberculosis, hepatitis B and C, and sexually transmitted diseases. With more than 600,000 people released each year from state and federal prisons, correctional healthcare providers have a window of opportunity to identify and treat communicable diseases, directly affecting the health of people in surrounding communities.

Mental Health Nursing in the Correctional Setting
(1 contact hr)
A survey of state correctional facilities indicates that there are three times more mentally ill people in jails and prisons than in hospitals, making the correctional setting the de facto mental hospitals of our time. About 25% of jail and prison inmates have co-occurring addiction and mental health disorders. The psychiatric nurse’s role in a correctional setting is unique. The nurse may work as a staff nurse on an inpatient unit providing psychiatric nursing care to inmates or act as an outpatient nurse, providing evaluations, counseling or crisis intervention to inmates in the general population. The assessment techniques and interventions appropriate to psychiatric care of patients in the correctional setting are addressed.

Legal Issues and Origins Behind Correctional Nursing
(1 contact hr)
Regardless of your primary practice setting, you may come in contact with inmates requiring healthcare services. Do you know when you are allowed to disclose protected health information to law enforcement? This module will describe laws, ethics, and issues of correctional nursing key to the nurse’s role in the evolution of healthcare in adult correctional facilities.

By | 2019-04-04T21:27:34+00:00 April 3rd, 2019|Categories: Nursing careers and jobs|1 Comment

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

One Comment

  1. Paul Price April 8, 2019 at 6:17 am - Reply

    Ok so what should the Nurse done to protect the patient? It looks to me like the Physician and the Administrator both were at fault due to negligence and shoved the blame onto the Nurse. It is obvious that the nurse did not have the authority to prescribe pain medication or to stitch a wound. The rest was just pure neglect on the part of those that run that facility.

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