Correctional Nursing 102: Jailhouse Corruption and Violations

In the early 90s, I prepared to embrace a long career in correctional nursing; unfortunately, I was unaware of the corruption and violations that occurred at the jail. Not only was the medical department completely disorganized but dishonest correctional officers (COs) constantly interfered with the inmate's rights to prompt health care. Allegations abound of fraud, drug use, inmate abuse, and denial of health care.

Employee Drug Use and Abuse

The excitement of my first day blinded me from seeing the prominently waving red flags in the medical department. When I arrived, the nurse manager who hired me was missing in action; I never saw her again. Apparently, just days after hiring me, an investigation revealed that she and others used and abused inmate narcotics, especially Valium.

The manager's friend, Sally, a secretary, remained behind, publically withdrawing from the drug. Once, during a full capacity clinic day, she leaned against an open door and fell straight down, on her buttocks, to the floor still thumbing through a rolodex. She nonchalantly continued the task on the floor for another 5-10 minutes as inmates laughed.

For days, Sally anxiously paced in and out the office looking haggard (with constantly damp hair) and confused. Her days of drug misappropriation and abuse effectively ended the day I started. Apparently, her affair with an inmate also ended as he prepared for transfer to prison. She visited him often during the day while COs looked the other way. Sally also used her position to consult expensive outside medical specialists for certain inmates, bypassing our clinic doctor. She knew how to fix the paperwork for priority care.

Fraud and Corruption

The medical department was staffed chiefly by inexperienced agency nurses and lacked oversight, and proper management. Somehow, one of the jail's drug counselors, who did not have any experience in medical administration, promoted himself to director of the department. Nurses were not invited to jail meetings so, because of his counselor status, he was allowed to represent the medical department. He was eventually fired for smuggling drugs to an inmate.

I did not know who was responsible for the department's budget or anything else for that matter. I became the only permanent dayshift registered nurse who had to work and cover all shifts yet I was denied a pay raise because of the budget. I petitioned the jail's director but another scandal erupted (nepotism, kickbacks, etc.) and he was suspended then replaced.

The contract pharmacist, when he decided to come in, rarely filled prescriptions in a timely manner, which required the correctional nurses to dispense medications. It is illegal when nurses remove more than one dose of an inmate's medication from the pharmacy; the nurse is dispensing rather than administering. In addition, the pharmacist would purchase medications and remove them from the jail.

Our clinic doctor's only interest was in competing for the contract to oversee the department; he tried to keep things disorganized to prove a need for new management. He eventually lost the bid. Clinic days were three times a week; occasionally, he would call in, arrive too late, or not answer when on call. The part time on-call physician resigned due to the poor organization; he rightfully feared malpractice lawsuits

Inmate Abuse

One day, the clinic was suddenly inundated with injured inmates when a CO conspired with a jail trustee against another inmate who apparently angered him. He allowed the trustee into the cellblock to injure the inmate when a riot erupted. The officer was summarily fired after 15 years of service. Fortunately, none of the injuries was life threatening.

As a correctional nurse, inmates frequently request assessment during booking with complaints of police brutality. Otherwise, each inmate received a medical exam and assessment by the nurse within 24-48 hours after arrest. One day, officers informed me that one male nurse, "George", examined female inmates differently than other nurses. First, he would always bring them candy and have them reach inside his pants pockets. Then they all would remove their shirts for lung exams.

When I arrived for my shift, I saw George leaning against the clinic door looking quite worried, and guilty. He quietly signed out without uttering a word. I discovered why when I made my rounds to the female inmate cellblock. George committed the worse crime a correctional nurse could commit. He overdosed an inmate by illegally administering an antipsychotic medication without a doctor's order. Read on.

When COs Deny Inmate Health Care Rights

"Betty", a female inmate, was nonresponsive to the COs request to get out of bed. They were angry, thinking of her as a malingerer. On assessment, I discovered a low blood pressure, 70/40; her skin was cool, clammy, and she could not open her eyes nor verbally respond. Over the protests of the correctional officers, "she always faking, wanting to stay in bed all day", I called for an ambulance.

The emergency room reported that Betty's blood Thorazine level was extremely elevated; Betty was not on Thorazine. Apparently, she asked George to give her something for sleep and he obliged by illegally administering the antipsychotic medication. I discovered the container (a Maalox bottle) he used making it appear he was treating heartburn.

I removed the container from the garbage and noted it contained pink residue (Thorazine turns pink in liquid). It was sent for analysis, which confirmed the drug's presence. George was not arrested, reported, or charged; he could not return to the jail. Betty recovered and filed a malpracticelawsuit that was settled out of court.

It was early afternoon when the COs brought a female inmate, "Susan", from court into the clinic. They reported vaginal bleeding during her hearing; so profusely, that she required at least three of their T-shirts as pads. The courthouse was less than a mile from the hospital but the jail more than three. COs do not normally have medical training but sometimes they can lack common sense. Then there are times when the inmates rights to proper and prompt health care is blatantly violated.

Susan appeared weak with general malaise. She was a crack addict who could not remember when she last menstruated but she reported a recent miscarriage. Her vital signs were unstable with a very low blood pressure. With signs of hemorrhaging, large clot particles in her underwear, I knew this was a possible spontaneous abortion. Susan was either too sick to care or she cared less but her affect was flat.

The problem began when I requested she be transported immediately to the emergency room, preferably by ambulance. I had to go up the CO ranks and even threaten to announce, publically, that Susan was being denied prompt medical care before the Lieutenant allowed her transport. The ER called to inform me that as soon as Susan undressed, an aborted fetus (less than 2 months of age) was expelled.

There always seemed to be a conflict between the COs and nurses because of the autonomy correctional nurses are afforded. The officers did not think the nurse was capable, knowledgeable, or able to make an independent decision without consulting the doctor. This dilemma was amplified when less experienced nurses made bad decisions or requests for ER transport for non-emergent care. Medical malpractice and lawsuits were inevitable with this type of health care system.

Never Again

So much occurred in the 8 months I worked as a correctional nurse at the county jail. The pay, at that time, was so poor that I literally cried all the way to the bank. The doctor asked me to turn down a federal job (paying thousands more) to stay on as nurse manager if he got the contract, of course, I declined his offer. I love my nursing license. Luckily, I escaped without being involved in the frequently filed lawsuits at the jail. Eventually, the jail underwent reconstruction; it is now operated by the Sheriff department.