Health staff are often asked by correctional staff to conduct tasks that might give them pause. For instance, perhaps an inmate has smuggled pills into the facility and custody asks a nurse to identify them. The primary question to ask is whether the act is medically necessary for the safety of the patient. If there is a risk that the inmate is under the influence of an unknown drug, then health staff should identify the pill to determine what actions might be needed for the benefit of the patient’s health. On the other hand, if health staff are being asked to identify pills to help in charging the inmate, they would do well to resist.
NCCHC’s standard on forensic information (I-03) requires that health services staff are prohibited from participating in the collection of forensic information. This is a topic on which we often receive questions due to the impact that such activity would have on patient–health staff relationships. NCCHC defines forensic information as physical or psychological data collected from an inmate that may be used against him or her in disciplinary or legal proceedings. Such acts are usually performed without inmate consent.
There are some exceptions to the prohibition. An example is when health staff are complying with state laws that require blood samples from inmates, as long as the inmate consents and health staff are not involved in any punitive action taken if the inmate does not participate in the collection (Compliance Indicator 1a). Another exception, noted in Compliance Indicator 1b, is the conduct of body cavity searches and blood or urine testing for alcohol or other drugs when it is done for medical purposes by a physician’s order. Other exceptions include inmate-specific, court-ordered lab tests, examinations or radiology procedures with consent of the inmate and, in the case of sexual assault, the gathering of evidence from the victim with his or her consent (Compliance Indicators 1c and 1d). Note in each exception the caveat that inmate consent or a physician order for medical purposes is required.
The intent of the standard is to ensure that the role of health staff is to serve their patients’ health needs. This means maintaining ethical boundaries and ensuring that the patient–health staff relationship is not jeopardized. Ethical conflicts arise when health staff take part in activities aimed at producing evidence that has negative consequences for the inmate. Think about it: A patient is not likely to want to see health staff for a health need if that person has helped to collect evidence. This can have bearing on access to care (see Standard A-01) by creating unreasonable barriers and deterring patients from seeking health services.
For similar reasons, the NCCHC standard on executions (P-I-07) prohibits health staff from participating in inmate executions. The ethical dilemma here relates to the same principle of maintaining an appropriate professional relationship with patients. The preservation of the therapeutic role is paramount in both the I-03 and I-07 standards.
Some facilities use the services of nonstaff or outside health professionals to collect forensic information, or someone on staff who is not in a therapeutic relationship with the inmate. Other options for accomplishing such tasks include using corrections staff to conduct oral and buccal swabs for DNA and urine testing for drug use, and using a dry cell as an alternative to body cavity searches.
Although the Forensic Information standard is classified as “important,” meaning that it is possible to achieve accreditation without meeting this standard, its significance should not be dismissed. Health staff should be educated about ethical boundaries in correctional facilities, and communication with correctional staff on these issues can help both groups to understand the intent of this standard. Orientation and in-services are opportunities to emphasize the concepts of what a correctional health professional’s role is in providing services to patients.
[This article first appeared in the Spring 2010 issue of CorrectCare.]
I-03 Forensic Information (important)
Health services staff are prohibited from participating in the collection of forensic information.
—2008 Standards for Health Services for jails and prisons