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?

Prison 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 …read more

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