Title Xv

By Xlibris US

This book tells a story of Dr. Mel Carrs experience working in a correctional medical center. The doctor had no idea what to expect when he first took the job. He had worked at various other medical positions but found no financial or professional satisfaction. Yet he somehow found his vocational career in the correctional medical field, which contrarily offered him very little prestige or prosperity in his professional endeavors. But the experience slowly developed into a new, enthusing frontier as Carr experienced the bizarre situational calamities. It wasnt till the seasoned Dr. Austen Rider arrived and gradually revealed that these awkward disasters could be contained and even vilified and should be seen as unique challenges and not obstacles. This also tells about the uniqueness of functioning as a health care provider in a detention center and the experiences of performing there. The book is dedicated to all the providers that worked under grim and erroneous conditions, and it is an acknowledgement to those who were able to comprehend their imprudent quagmire and superseded the environmental, psychological, and physical circumstances for the benefit of society and their coworkers.

• Language: English
• Publisher: Xlibris US
• Release date: Oct 6, 2014
• ISBN: 9781499074710

Book preview

Copyright © 2014 by Dr. Mel Carr.

Library of Congress Control Number:   2014916765

ISBN:   Hardcover   978-1-4990-7469-7

   Softcover   978-1-4990-7470-3

   eBook   978-1-4990-7471-0

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Rev. date: 09/19/2014

Xlibris LLC

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CONTENTS

Foreword For Title XV

Chapter One

Chapter Two: The Arrival of the Medical Director

Chapter Three: Becoming a County Employee

Chapter Four: Mental Health

Chapter Five: The Accreditation

Chapter Six: The Isolation Cells

Chapter Seven: The New Security Chief

Chapter Eight: Visiting The Ghost of Dracula

Chapter Nine: The New Management

Chapter Ten: Hospital’s New Contract

Chapter Eleven: The Final Chapter

FOREWORD

FOR TITLE XV

The title of this book, Title XV, was chosen because it represents the codes of regulation that detention facilities must operate by. These standards and guidelines cover medical, mental health, nutrition, sanitation, and safety in context with the overall operation of a local detention center. These standards and guidelines which explain the regulation are designed to help professionals and administrators develop procedures and policies for implementation in their respective detention system. Although writing procedures and policies may be burdensome, doing so provides real benefits. They act as training resources, help with budgetary requests, and provide support in litigation. If a facility wishes to become accredited, they must pass all essential standards and at least 80 percent of important standards. Accreditation serves as recognition that an organization and its staff are performing at a level experts have determined to be acceptable.

This book tells a story of Dr. Mel Carr’s experience working in a correctional medical center. The doctor had no idea what to expect when he first took the job. He had worked at various other medical positions but found no financial or professional satisfaction. Yet he somehow found his vocational career in the correctional medical field, which contrarily offered him very little prestige or prosperity in his professional endeavors. But the experience slowly developed into a new enthusing frontier as Carr experienced the bizarre situational calamities. It wasn’t till the seasoned Dr. Austen Rider arrived and gradually revealed that these awkward disasters could be contained and even vilified and should be seen as unique challenges and not obstacles.

There was a general sentiment among the frontline staff remained that criminals do not deserve health care. The important survival skill to embrace especially for the health-care staff is that you as an individual are there to provide health care to individuals who just happen to be incarcerated; you are not there to judge them or punish them. Medical and mental health-care workers were not managed by the detention facility commanders but were under the direction of the county’s health department. They were required to wear identification badges at all times upon entering and while leaving the different detention centers. Medical section of correctional health care and mental health care were separate departments within the county health care organization. And like the security staff, mental health often discarded their responsibilities of the inmates housing problem to medical which always caused a never ending feeling of friction between the two disciplines. It was left up to the diplomacy of Carr or Rider to get the inmate admitted at the medical contract hospital. The problem with that, as far as the contract hospital was concerned, was that in their contract with the county, there was no agreement regarding hospitalization of mental health patients. Just adding another layer of chaos to the medical team’s obligation for Carr and Rider to transact with.

The inmate population is unique in that most live recklessly without much regard to their own health or safety as if they were indestructible. A high percentage of them are drug addicted and/or suffer from mental illness and grew up underprivileged. All inmates during their incarceration received a classification which distinguished their level of risk and a booking number to identify them from other inmates with the same name and from all the alias names they partook. A colored wristband with the inmates’ booking number was placed around their wrist. White color was a first time offered, yellow a repeater, blue was for protective custody, orange for inmates that had served state prison time, and red for inmates that had to be escorted by two guards. All reds and blues had to be in a single cell by themselves. It was a good system and worked well for the security staff, but it presented limitation for the medical staff when medical housing was indicated. For example, a blue-band inmate in jail who is going through heroin withdrawals cannot be placed in the medical unit with other inmates and treated but had to be admitted to the hospital, whereas white- or yellow- and some orange-band inmates could be treated in the medical unit. What classification did unintentionally was add another layer of confusion to the placement of sick inmates, and the contract hospital was accommodating but reluctant since when inundated by the inappropriate admissions to the hospital violated the original contract with the county.

The original planners of the detention center had designed the facility without taking into consideration the various levels of inmate need along with the classification system, so as the detention system grew, more and more of the housing responsibility of sick inmates became the medical team’s obligation. So what you have is a security organization that incarcerates, feeds, clothes, and transports the inmates to court and determines their classification. Any logistic problems with sick inmates and housing became the responsibility of two men—Drs. Rider and Carr—and that was a 24/7 operation. So these two doctors had to know the entire capabilities of the jail system and the cooperating contract hospital. It was Rider who was the ultimate diplomat in these frustrating endeavors. Rider was able to keep the hospital administrators placated, even though this duty should have been the obligation of his superiors who proved to be inept at understanding what their subordinates required to fulfill their purgatory duties.

The courts, lawyers, and family members provided another interacting bureaucracy with which the medical department had to contend with. It was the court orders that presented the challenge most of the time. Court orders for medications, shoes, inmate examinations, and subpoenas for staff to appear in court. The lawyer’s favorite tactic to try and get an inmate released because of his medical condition was to accuse the medical staff of deliberate indifference and volition of the inmate’s constitutional rights. Although the courts never found a medical staff member (Carr or Rider usually) guilty of this accusations, it was never pleasant to be accused. The judges, even though they signed most of the attorney’s ridiculous court orders, were themselves most accommodating and understanding once you contacted them, explained the situation, and informed them of the capabilities and incapabilities of the detention center. Even though they never wanted to admit it, neither judges nor lawyers much understood the inner workings of the jail. Most judges assumed there was an alcoholic detoxification rehabilitation program, which there never was. There was a detoxification of inmates from the symptoms of alcohol withdrawals but never a twelve-step program, except those incarcerated at the Ranch. The families were another diabolical problem. It was because one or more of the inmate’s family members are enabler that the inmates never had to feel responsible for their behavior. If you cannot control your family member and he becomes a detriment in some form or fashion, then society itself will take on the obligation to discipline that citizen. Those family members who engaged in a codependent relationship were inevitably an entity to deal with along with the manipulating detainee. The majority of inmates did their time and had little interaction with the health-care personnel. But about 15–20percent did need health-care intervention.

This book is about the uniqueness of functioning as a health-care provider in a detention center and the experiences of performing there. The book is dedicated to all the providers that worked under grim and erroneous conditions, and it is acknowledgment to those who were able to comprehend their imprudent quagmire and superseded the environmental, psychological, and physical circumstances for the benefit of society and their coworkers.

CHAPTER ONE

Jails and prisons are designed for one purpose, and that is to keep people locked up. They have become a society all to themselves. Some people may manage to pass through incarceration with only a shortened stay and escape the negativity that seems to permeate within its confines. Crime, in a sense, is the manifestation of evil, but although evil is present, not all criminals are necessarily wicked. Nonetheless, all are affected by evil’s dark presence. How medical services came to be a part of the culture, whether by design or by chance, remains to be seen.

This story tells of some of the encounters that the people in this public service must deal with because it is indeed unique—it is like no other environment in which medical service is provided. You may think of this as some noble cause, and some may be there for such a purpose, but many find themselves there precariously, not knowing how or why they came to such a position. Somehow, though, they manage to find their true calling.

So it was that Mel Carr, MD, came to work at a jail, although it was supposedly called the Best Jail in the West or BJW. Carr had never failed in his career to deserve to be in such a terrible position—quite the opposite; he was an outstanding physician with excellent training and board certified in internal medicine. What brought him to this jail was chance, maybe even destiny. At thirty-five, he had been looking for a glamorous career—a private practice, the trophy wife, and all the accolades deserving of a physician. But times had changed, and medical practices were going the way of HMO, health maintenance organization care, a disaster for the new physicians coming out of residency, not that they knew it.

Carr had drifted from different medical opportunities, but none had offered any satisfaction, not like the satisfaction he had thought he would experience during residency—caring for the patients of various private physicians. Now he was in the big city, and HMO had taken a quick and big hold. Patients would be shuttled by contracts and not because they wanted particular doctors; they now went where their HMO insurance told them to go. For many doctors, this was the changing of the independent practices and the golden age they had experienced.

Hi, I am Dr. Mel Carr here for the interview today.

Oh, said the secretary as she paged Dr. Evelyn Watts, the interim medical director. Dr. Carr is here for the interview, she said into the phone.

Well, I am at the hospital today. Have him come back another day. Carr heard Watts utter on the other end.

Dr. Watts cannot see you today. Can you come back next week?

Carr, adjusting the new tie he had bought just for the interview, replied, Well, sure.

As Carr walked out the office door, he might have thought this was not the place for him. It had taken him every minute of the extra half hour he had allowed in case of not being able to find the concrete fortress with no signs or notable landmarks. And yet they didn’t even remember they had scheduled him, a doctor, for an interview. He wasn’t upset though; he knew that persistence paid off at times.

Carr had gone to a European medical school and had had to go through all the extra credentials required to be eligible for a residency in the States. At first, he hadn’t been really sure he wanted to be a doctor; it had seemed too much of a commitment for him. He liked sports and took pride in his athletic appearance, and he didn’t want to turn into a geeky-looking doctor. But his mind had changed once he had gotten in to medical school and realized that studying ten to twelve hours a day was a must, so he did what it took.

At the second interview, the interim director, Dr. Watts, was there. We want you to work here, but you have to go through a background check by the security department.

Okay, but how long will it take? asked Carr.

Well, about three months, give or take.

Three months? Gee, I might as well look for another job, he thought. Okay, what do I do next?

Take this paperwork over to the main security office, and they will interview you.

After four months, Carr received his call and learned he had passed his background check and was hired to work, even though they only needed him for half a day. It was okay with him since he had a night job anyway, although it didn’t pay well and wasn’t very glamorous. It amounted to treating runny noses and sore throats and occasional drug seekers coming in at closing hours complaining of fictitious pain.

Hi, I am Dr. Carr.

Glad to meet you. I am the ward nurse here for the women. Joy is my name.

Cool, where do I start today?

Well, I have ten chart reviews and three new patients for you to see today.

Gee, tuberculosis, two alcoholics in withdrawal, and no medications yet—this is a strange first day. Let me get them started on meds, said Carr while he refreshed his memory on the treatment options for tuberculosis and alcohol withdrawals. It was a good thing his experience in the Veteran’s Hospital had prepared him for these sorts of situations. This would be different from treating heart failure, high blood pressure, and diabetes, which was so prevalent in the general overindulging population.

At the end of the day, Carr thanked Joy for her help and then asked for directions to his next destination.

It only took me six hours today, but it was only my first day, he thought as he left the jail and heard the heavy metal doors clamoring together behind him. He was glad the day was over and wondered how he would survive this venture. Had he made a mistake in taking this job? He had had so many options, but the pay wouldn’t be bad here, and the hours were flexible for now.

After four months at the job, Carr was starting to get the hang of things. There hadn’t been too many challenges until that morning when he walked in, and the nurses informed him that a female patient he had seen the day before had died that night from an asthmatic attack.

What? Can you bring me her chart to review?

While he reviewed the chart, he noticed that they had called the on-call physician and that he was treating the patient by phone orders. This was not a good community standard of care, especially for someone that had respiratory problems. He had seen the patient, but the nurse had said the patient was faking in order to get more medication, something Carr had been suspicious of when he listened to the patient’s lungs at the time. He had increased her medications and given her extra breathing treatments before he left, so he was off the hook, but he was shocked at the nurses’ demeanor, as if they had no responsibility in what happened. Carr’s attitude was now more suspicious of the staff. Could he trust them? Who could he trust and not trust?

Carr learned a week later that his job was still secure, and a new medical director had been hired. Carr was asked if he could be the new interim director, which shocked him. Apparently, Dr. Watts was leaving on a fellowship, and there was only the old Dr. Oldsfield, who liked to talk for an hour if you had the patience to listen.

Okay, I will be the temporary director, but when is the new guy supposed to show up?

Okay, replied Jackie, the program administrator.

Jackie was middle-aged, about five-foot-seven, divorced three times, had dyed blond hair, big white teeth, and wore too much lipstick. She was obviously trying to look younger than she was. She had a bulging stomach and flat buttocks. The rumor was she was close to the security staff and had had several sexual encounters with the macho men of the staff. She clearly liked to admire their pistols. Jackie had probably been attractive in her younger years, but the sun had taken a toll on her skin along with the booze. But she knew how to run the crew here; she had worked her way up from the bottom. She hadn’t exactly gotten the job on merits; it was more likely that there had been no one else, and her boss, Leopold, was the one who had actually promoted her. She was indebted to him.

Listen, Mel, there was this death in the women’s section. You saw the patient, and I need you to write up a summary of the events, barked Jackie as she admired herself in the compact mirror in her hand and put on more lipstick. Carr held his tongue as he noticed that she looked like a caricature from a French Cabrera.

Oh, by the way, the investigators want to interview you tomorrow. You can use my office till you get yours.

This woman was insulting, and Carr wondered how long he could tolerate her. He had too much work, and he needed to get a better understanding of how this place ran before he asserted himself. If he was going to have a confrontation, he needed to have it on even ground, not on someone else’s terms. Carr was now needed in the medical section to repair a laceration, which was not a big deal after having already worked in an emergency room for one year.

Okay, I see he needs sutures. Has the consent form been signed?

Yes, Doctor, here it is.

Okay, but this is in Spanish, and the inmate is Caucasian.

The old nurse turned and said, So what?

Yeah, well, this won’t hold up in any court, at least I know that much, he said, shaking his head while he dug through the forms to find one in English.

After the procedure, Carr answered a call from Miranda, the head pharmacist. Apparently, she wanted to talk to him about a court order from a judge concerning medication.

Hi, Miranda. You wanted to talk to me?

Yes, could you come over to the pharmacy? I want to show you something.

Sure, I’ll be there in a few minutes.

He had been in the pharmacy several times to review the evening physician and nurse practitioner’s orders and clarify them and at times change them. Since the BJW medical department used a formulary, it was necessary to keep down the cost and regulate the medications kept in stock. But this also presented problems because substitutions were necessary, and in such cases, there was always a risk of liability. The evening staff just found it easier to write whatever medications the new inmates said they were taking. They ignored the formulary altogether, knowing someone else would have to risk the liability. Carr was the only physician around during the day, except for Oldsfield, who everybody assumed had exceeded his usefulness, like an old plow horse. All were calling for the death blow, but none wanted to be the executioner.

Hi, Miranda, what do you have for me?

I have this court order for Vicodin.

What? The judges are ordering medication now?

Well, this is from the inmate’s attorney. The judges just sign the order.

Carr was at a loss as for what to do. Give me the court order. I will call the judge.

Carr left, knowing this wouldn’t be the last he would hear of it, but he wasn’t ready and didn’t know how to tackle this. He didn’t trust Jackie to help. He did trust Miranda, though.

He hadn’t really talked to Miranda a lot, but he knew her ex-husband had been a professional football player and that they had come from Texas when he was drafted by the local professional team. He had strayed too much with other women, and she could no longer stand the humiliation and had divorced him. He had used her to get his performance-enhancing drugs in order to remain in top form for competition. Carr had heard this information from other sources who knew her from Texas.

She was the Texas-like beauty— tall, athletic, and busty. A lot of the security staff approached her, but she rebuffed them gently without offending their immense egos. It was rumored that she was good friends with a captain, so it was best to stay on her good side. He had a feeling, though, that she might challenge this court order through her own administrative sources. That was fine with Carr; let someone else take the liability then.

Friday mornings were administrative meetings with just the head of each department and a few rogue staff members who somehow had a special invitation. Jackie led the meetings and gave the opening news about the budget and operation changes, and then new and old assignments were followed up and discussed. After that, each division gave a report on their department. The biggest news was a new computer system to be implemented for medications. The BJW was getting it for free with a $60,000 startup cost. The only problem was that it was an obsolete system, but there were no arguments or votes against it because Leopold had decided himself to accept it. Why not, though? That was how all the executives got their stars, by saving money.

Jackie then went on to talk about the possibility of accreditation for the BCMS (Best Correctional Medical Service) and the need to update all the procedures and protocols for nursing. The BCMS was a branch of the BHDW (Best Health Department in the West), which was an agency in the county, so the terms were frequently interchanged. An employee of BCMS was also an employee of BHDW and the county.

Well, there is money to be spent, and this place doesn’t appear to be stagnating as much as I thought. It could be fun, thought Carr.

Carr had been at his new job for six months; he had gotten a routine down and was somewhat getting a grip on working in the system. His day started by looking for a place to park and then getting his badges so he could pass through the steel gates. The guards were beginning to recognize him so that he did not have to wait while they sat in their booth staring at something on the switchboard before finally letting him through the gate. There wasn’t just one gate but two. There was a four-foot-by-four-foot space like a cage that the guards could leave you stranded in for a short time while they opened another gate, which entered at another section since the jail was a conglomerate of several jails, new and old.

The jail system was made up of an older downtown jail which consisted of the men and women’s jails and the newer receiving and intake center or the RIC. There were two separate outlying jails—an outlet jail and a ranch. You had to make sure you went to the bathroom before going into the jail, just in case the guard wanted to ignore you, or you got stuck in the holding area. Other guards, anyone with a rank or pretty women, got special treatment.

Once you entered the jail, the escalator took you up to the second floor where there was another guard in a bubble office with a view of everyone going up and down the escalators. The old building was five stories high, but medical and mental services had their offices and units on the second floor. Medical and mental services were actually separate entities; it wasn’t until you got to the chief of the BHDW that the services for medical and mental health interloped. It must have been a descendent from the Hatfield’s and McCoy’s that set up these feuding entities.

Carr was sitting at the desk in the medical director’s office when Leopold popped by to see Jackie. Leopold was tall and lean, but his head seemed to not fit his body, and his shoes did not fit with his suit. He wore gray Hush Puppies with