Issue link: https://nnumagazine.uberflip.com/i/198600
Prisons:3 6/7/07 2:57 PM Page 17 "Right now we're focused on just stopping the killing. There are too many patients in the California prison system who are still dying." Court experts in the Plata case found that a number of providers The recent implementation of triage over the last few years by Judge Henderson's order conforms to care protocols laid out in the Plata were not competent, and failed to monitor their patients' conditions. ruling, and only RNs are allowed to make assessments. As a knowl- Even now, says Alison Hardy, a Prison Law Office attorney, medication edgeable, well-trained registered nurse, Upland's presence at DVI administration is not fully documented, and inmates are still waiting three to four weeks to see a physician when it should take no more than helps them comply with the demands of the ruling. Previously, the CDCR had a history of allowing non-RN and cor- two weeks. "When I go into prisons I check distribution records and rectional personnel to either assess patients, or determine the needs we consistently see that those records are incomplete," says Hardy. Diagnostic problems are compounded, says Upland, by inapproof patients using correctional considerations as the overruling factor. Upland describes a situation in which a doctor consulted with a cor- priate medications, medications inappropriately given, or no medicarectional officer about how an inmate should receive his medication, tions at all. Within the system, says Upland, "You can't medicate rather than consult with an on-duty RN. She says this type of situa- people properly. You can't administer the five rights of medication." The five rights – the right patient, the right drug, the right dosage, tion has been common throughout her career. "RNs are supposed to at the right time, by the right route – are fundamental to the task of make assessments. That's what we're trained to do," Upland says. Other nurses who've worked in California prisons had similar nursing. They are upheld by the Board of Registered Nurses, and by experiences. "I was on a unit and I saw the MTAs doing triage," says standards of practice. All of these rights must be administered and an RN who worked at Mule Creek State Prison. "They were [the finished with the right documentation. "The majority of problems are overmedication, wrong medicaones] prioritizing the health needs of the patients. They would not allow me to be involved in the assessments." This was standard policy tion, or [the inmate] not receiving medication," Upland says. Among the harms she describes are chest pains, inmates "stroking out," and when the RN left Mule Creek one year ago. In the clinic tonight, Upland says she is "a body with a license." A blood pressure out of control. They are largely the result of county licensed RN has to be present to sign off on any doctor's orders; another jail facilities, where the inmates originate, failing to provide assessments and follow-up care due to overcrowding and understaffing. If result of Henderson's ruling intended to elevate standards of care. Upland also takes inmates' personal histories. As registry, she is these medication errors are not caught in time, they can easily result assigned to several different jobs later in the evening. In the past, she in long-term disability or even death. This deadly combination can push inmates' health into a fast says, she has been assigned to the ER, an 8 by 10-foot room with two gurneys and two supply carts. "It's not a lot of space when you're see- downward spiral, costing taxpayers thousands of dollars as prisoners ing 10, 15 gurneys a night," says Upland. The clinic is a bit bigger; a are rushed to expensive emergency rooms and procedures when room roughly 14 by 14 feet with cages on one side where inmates are medical neglect has gone too far. Working at the prison tonight, Upland sees her role as she always kept until they are ready to be seen. Officers walk in and out of the clinic throughout the evening, calling on their phones to let them has: to uphold the mandate of nursing practice standards and the directive of the Plata rulings. She holds these beliefs so dear that she know when they're bringing another inmate down. The confining environment is anathema to Upland. Care, not cor- has experienced the resentment of staff who are not accustomed to rection, is always foremost in her mind. And though she understands following the direction of an RN. She has felt the sting of working correction is necessary, when inmates fall ill, they are her patients within a system that sees the role of the RN as alien, a system that has first, and inmates second. Upland takes nursing, the profession and not yet accepted the functions of the RN within its borders. But Upland has friends inside DVI, and people she admires. One its purpose, very seriously. But within the correctional system, Upland is frustrated. She is a comrade is a nurse practitioner who's not here tonight. "We work good nurse. She prides herself on being a good nurse. The majority of very well together," Upland says. "We have the same point of view. problems she has seen in her career are problems of gross mismanagement, some of them bordering on the neglect for which the system has become famous. Among these problems is the misdiagnosis, or lack of n May 10, court receiver Robert Sillen's office filed a motion in U.S. District Court, diagnosis, of inmates who arrive in the Northern District of California, to reduce or eliminate the Prison Law Office's acprison system. Upland has seen cess to review inmate health records. According to the motion, the receiver beadvanced diabetes and other condilieves that the Prison Law Office's inspections and requests for inmate records have tions that have been left undiagnosed placed an unnecessary burden on the receiver's staff. The receiver also objects to the or poorly managed. The advanced plaintiff's counsel (Prison Law Office represented the inmates in the lawsuit triggering stages of these conditions can result in these reforms) monitoring the receivership, since the receivership was not in place when crippling conditions, and even death, the original injunction allowing plaintiff monitoring was instituted. as indicated by records on file with the The receiver wants to eliminate the current system of plaintiff monitoring and Prison Law Office. replace it with a monitoring system overseen by the California Office of the Inspector WATCHING THE WATCHDOG O General. A hearing on the motion is expected in August. M AY 2 0 0 7