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'

Case Study: Captain Ben Smith was astounded one day when he was making his rounds on his correctional officers and inmates at a community hospital. The nursing staff was holding a birthday party for one of the inmate patients, complete with balloons, cake and gifts! The manipulative inmate and lax custody officers were immediately returned to the correctional facility and disciplined. The nursing staff was reoriented to the care of inmate patients.

Nursing and other hospital staff caring for forensic patients must continually negotiate the boundaries between the cultures of custody and caring. They should receive specific information about caring for these patients during their orientation and on an annual basis. For example, forensic patients should never be given specific dates or times of discharge, or when they will leave their assigned unit for tests or procedures. They should have food served on disposable plates and utensils and should never have extra supplies or items left in their rooms. Forensic patients should only be given combs, toothbrushes or safety razors with the approval of their correctional officers. All staff members are cautioned against giving any personal information to forensic patients or having contact with them once they have been discharged.

Most importantly, staff must remember that correctional officers must always have the inmate in their line of vision. They cannot assist the staff with patient care, because this can be distracting from their primary duty.

Forensic Patient Rights

Forensic patients have most of the same basic patient rights as other patients. They have the right to refuse tests, care, procedures and medications. They have the right to patient education, to sign their own informed consents and to execute "Do Not Resuscitate" documents. While correctional officers must keep these patients within their line of sight at all times, forensic patients have the right of privacy when discussing medical diagnoses with their physicians. The physician can request that the officer step away from the patient or out of immediate earshot as long as the officer can have an unobstructed view of the patient.

Delivering healthcare to inmates is carefully balanced against the need for security and is affected by the values of correctional staff, staff education, nursing and organizational practices. Hospitals must strive to assure the best possible health outcomes for inmate patients, the integrity of health care and the safety of everyone involved.

It is often overwhelming and sometimes confusing to review a policy and procedure and determine what needs to be done, and who is responsible for completing various actions. I suggest the following spreadsheet concept (see links below) which can help keep everyone on target and define what needs to be addressed, who is responsible, the target date for implementation and any measures or evaluation of effectiveness.

The Forensic Patient Action Plan spreadsheet describes nine of the most commonly identified problems and concerns that arise when dealing with Forensic Patients. It suggests a plan of action for each problem and shows the individual(s) and/or department(s) that typically have responsible charge for addressing these problems. Blank fields are provided for entering the Target Date of Implementation and an Evaluation of Effectiveness of the proposed plan of action.

The spreadsheet has been posted on SAI's website. To view or print an action plan for dealing with forensic patients, you can access either the Forensic Patient Action Plan (web/HTML version) or the Forensic Patient Action Plan (downloadable Microsoft Excel version).

While this article does not cover all of the issues or concerns that may arise in the care of the inmate patient, it is important to remember that these patients can be cared for in an acute care hospital setting with the proper preparation.