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T he "old way" of CDCR's health- care system has been the utiliza- tion of MTAs as the gatekeepers of an unorganized and undefined healthcare system. MTAs have traditionally been utilized as a medical arm for the law enforcement purposes of CDCR. Since the 1940s, the structure of access to healthcare for CDCR prisoners consisted of an MTA's decision on whether the prisoner received any type of healthcare or the ability of a prisoner to see an MD. "Assessments" of any health needs of an inmate have been conducted, first, by an MTA who passed medications in the prison housing units and filtered complaints to the physicians in the clin- ics. Access to healthcare has been based on judgment of inmate/patients as criminals and on whether the inmate was deserving of care according to the MTAs' personal and arbitrary beliefs. MTAs' judgment of inmate/patients are sanctioned by and protected under the direction of CDCR's peace officer authority and purposes. Legal Duty of Care Today, MTAs are mostly LVNs who also work as correctional officers. They are usually the medical staff of first contact, serving as gatekeepers to healthcare access. MTAs are also uniformed mem- bers of the custody staff. The MTA/LVN dual role encroaches on the RN scope of practice. Traditionally, RNs have existed as non-peace officers in the CDCR, albeit in very small numbers in relation to the number of MTAs. In the last several years, some RNs have signed up as MTAs as well. Salaries are higher for the dual MTA/RN or LVN job description, which makes this role more attractive. The utilization of RNs and LVN/PTs as MTAs is not, however, a panacea for all issues in the prison health system as this practice is not in compliance with the RN scope of practice. LVN/PTs are practicing outside the scope of their practice, and RNs jeopardize their duty and responsibility to act as a patient/inmate advocate. A legal review regarding the issue of LVN/PTs and RNs as peace officers, first and foremost, reveals there is no legal def- inition of an LVN/PT or RN peace officer in the laws governing CDCR healthcare. Conflicts are extensive. Conflicts of interest relate to LVN/PTs and RNs col- lecting evidence against their patients, participating in disciplinary processes, testifying against their patients in disci- plinary and criminal prosecutions and hearings, searching their patients for contraband and weapons, violating patients' right to confidentiality, and having the authorization as peace offi- cers to shoot their patients during cir- cumstances such as riots. This is a clear violation of the legal standard for RNs in the law as patient advocate and as the guiding measures of nursing: "Do No Harm" and "What would any prudent and competent RN do according to a community standard of care?" The issue of LVN/PTs or RNs as peace officers is a conflict of interest whose time has come to end once and for all – for LVN/PTs because they practice out- side of their scope and for RNs because they have therapeutic and restorative duties that are separate and in conflict with the functions of a peace officer in the prison system. These functions can- not coexist in the same person acting as both. According to all current standards in correctional healthcare, custody and healthcare functions are inherently opposed to one another. Furthermore, investigative, prosecu- torial, security, and disciplinary func- tions performed by MTA/RNs violate the rule of patient advocacy and confiden- tiality. There is a strong argument that knowledge of a person gained through nursing interactions and care is confi- dential and should not be gathered and used as a result of the RN-patient rela- tionship to serve penal purposes simul- taneously. One example of a major area of violation of federal and state law is by using evidence obtained through patient care interactions against patients in criminal proceedings. These LVN/PT or RN MTAs must be separated from their badges as law enforcement officers forever. It is an archaic and illegal practice contrary to the intent and purpose of any nursing practice act which is documented in lawsuit after lawsuit and in subsequent rulings from federal state courts as being inhumane and unconstitutional. In addition, law enforcement has no legal authority to expand the scope of prac- tice of LVN/PTs; this falls within the jurisdiction of the Legislature. According to the CDCR, MTAs may perform patient care activities only under the direction of a physician or an RN. The past and current system is one where MTAs are supervised by senior MTAs and technically supervised by the supervising RN II, all of whom are under the supervision of custody personnel (peace officers). CDCR currently has structured Psychiatric Technicians (LPT) and MTA/LVNs as supervisors of RNs throughout the prison system. Fur- ther, there are MTA/LVNs in positions as clinical supervisors of patient care deliv- ery of nursing services and throughout management positions in the CDCR Health Care Services Division (HCSD). Until the recently-forced implemen- tation of a federal civil rights class action lawsuit settlement with the federal court, CDCR's healthcare system in all 33 prisons has not changed in the histo- ry of California's prison system. Assessment and documentation in an organized nursing system had never existed prior to the forced implementa- tion of these class action lawsuits. Writ- ten departmental nursing policies had been nonexistent prior to Plata. Nursing assessments have been poorly docu- mented and sparsely integrated into a custody version of nursing by MTA/LVNs. There is no direct structure in which an LVN would report or refer abnormal values to an RN, nor for an RN to vali- date a basic assessment (data collection) Conflicting and Competing Interests in Correctional Nursing A BACKGROUNDER ON MEDICAL TECHNICAL ASSISTANTS (MTAs) AND RNs 24 J A N U A R Y / F E B R U A R Y 2 0 0 6 C A L I F O R N I A N U R S E CE Home Study Course