Securing Forensic Patients in the Public Hospital Setting: Part 2

A look at the guidelines and patient's rights issues when working with this 'invisible population'

[Editor's Note: The first part of this article series appeared in December on The earlier portion of this article can be accessed here.]

Marty Martinez was a man who spent his life looking for opportunities, and intensely disliked serving time. One day he managed to dismantle his jail cot and swallowed one of the flat bedsprings. When he began to complain of severe abdominal pain he was taken to the local hospital where X-rays revealed the foreign body in his stomach. Endoscopy and a gastroenterologist's deft touch removed the bedspring. Marty was shocked that evening when the nurse entered his room to give him his discharge instructions. A lax correctional officer who had been dozing while working over time, reacted too slowly as Marty grabbed the nurse in an escape attempt. He was finally apprehended in a wooded area a block from the hospital. The nurse was not physically injured, but was out of work for several weeks due to stress.

General Guidelines

To prevent the kinds of scenarios like the one above and ones in the previous article, it is strongly advised that hospital operations and security staff follow some standard guidelines in the handling of forensic patients.

Hospital security staff should maintain a daily list of all forensic patients in their facility. However, no forensic patient should be listed in the hospital's patient information listing or posted by the patient's room door, and should never be acknowledged to any callers to the security department, nursing unit or switchboard.

Telephone calls from the correctional facility to the hospital about specific forensic patients can be handled by using an agreed upon password to ensure that any information is given to appropriate authorities. Prison requests for specific medical information should be made to the attending physician, the nursing supervisor or the case management department, and should be agreed upon in advance.

The hospital staff does not need to know the crime(s) of the forensic patient. It serves no purpose and has the potential to affect the care rendered by even the most conscientious caregiver.

Forensic patients are usually not allowed telephone calls or visitors unless approved by the prison warden. The correctional officers will be aware of who has this approval. The warden will communicate with the families of inmates and provide contact information for the physician.

It is often very helpful to hospital staff for the administration to devise some type of indicator or code that will appear on hospital census to indicate that a particular patient is a forensic patient. One of the most effective that I have seen is a specific middle name that all forensic patients share.

Hospital staff must also understand that JCAHO and CMS do not require the same monitoring and documentation of the physical restraints employed with forensic patients that are required for the behavioral or medical restraints that are closely monitored for other patients. Forensic restraints should only be removed for medical treatment, and be replaced as quickly as possible. Some correctional policies require that one correctional officer must have a weapon drawn while a second officer removes or replaces restraints on certain inmates.

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