How the correctional health care system negatively affects COs

In addition to their usual daily responsibilities, COs assigned to medical housing units are also acting as a substitute nurse or physician


A correctional officer, like many law enforcement professionals, wears several hats. COs are an authoritarian, a parent, a disciplinarian, a security officer, an observer, a report writer and a counselor. We wear these hats every day we show up to work.

And if wearing all these hats isn’t exhausting enough, COs who are typically assigned to medical housing units are also acting as a substitute nurse or physician. 

Medical unit detail

I am currently assigned to my facility’s medical unit, and I have done several different stints there over the course of my career. 

We must find success by working together with our healthcare personnel and doing the best we can with what we have. (Photo/Pixabay)
We must find success by working together with our healthcare personnel and doing the best we can with what we have. (Photo/Pixabay)

I remember the challenging inmates and their medical or mental issues. During these times, there is no doubt the medical unit was aggravating and stressful. Often this was because of challenges with managing severely mentally ill inmates as they are screaming and pounding their cell doors, witnessing many code blues resulting in emergency room runs, ERT activations, taking care of needy inmates and even several deaths while in custody. 

Throughout the years, I can vividly recall when I was attacked by a Borderline Personality inmate in crisis, when my partner and I were involved in a physical altercation with a schizophrenic, when I had to conduct CPR, when I watched an inmate in his last hours suffering from a massive heart attack, when I caught an inmate puking up his liquid methadone and passing it along to other inmates, and when an inmate with AIDS was cheeking and selling his narcotic medication.

These are the realities in the corrections profession, they are part of the job and they will never change. 

What has changed and has COs working fiercely these days are the new challenges they are facing with inmates and their healthcare issues that they have never seen before.

Aging inmates

Baby Boomers are growing older and correctional facilities are now seeing a high rate of older offenders - inmates with multiple medical problems, inmates who do not have full mobility and those who need assistance with their daily living needs. Correctional facilities now have inmates wearing diapers who need assistance with being changed multiple times a day. My facility has a paraplegic, two amputees, and until a few weeks ago, four inmates each in different stages of dementia.   

Medical burdens on COs

Since my facility does not have medical staff full-time on the housing unit and there is a nurse shortage, many of the medical responsibilities fall on the one or two COs assigned to the pod. There are many things that need to be addressed on a daily basis, and we are unable to contact medical each time. They simply would not be able to respond or their ETA would be unreasonable.

While I feel I have learned a lot over the years, it does not make me credible or trained as medical personnel. 

An example of this is I have never learned how to communicate or most efficiently manage a non-verbal person suffering from dementia. Currently, my most challenging inmate is a demented child molester whose health has declined immensely since his arrival in-custody over a year ago. 

Sometimes while the nurses are changing his diaper, he is confused, scared and becomes violent. Because of this, COs have to hold his hands and legs down so that he does not hurt the nurses assisting him. Unfortunately, he recently caused a nurse to suffer a herniated disk when he punched at him because he was scared.

The inmate is now at the point where he has forgotten how to eat and needs to be fed. He needs to be showered and we have to stand by to protect the nurses while they bathe him. 

These daily duties are extremely time consuming. In addition to our daily correctional duties, we are regularly tending to these types of medical conditions.

One inmate in our jail is awaiting a bed in a care facility. Medical administration attempted to locate a bed for him by contacting nine care facilities, who all denied him due to his violent sexual history. Criminals need facilities regardless of their crimes. The burden will remain on us until a bed is located, and right now that time frame is virtually unknown. He will remain in our care for as long as it takes before the courts release him from our custody to that bed.

There are several factors influencing our correctional healthcare challenges.

1. Inmates lack good health care 
Health care is costly and many individuals cannot afford steep insurance costs. Most convicted criminals cannot hold down a job or find work with healthcare benefits. And as a result, many neglect their health while on the streets. Many of them are not on proper medication or seeking care when necessary. Some prior offenders even commit crimes specifically to return to jail when their conditions worsen to receive priority medical treatment. And some do not care about their medical problems until they step foot into the jail.

2. Medical statistics
Health issues are more complex and compounded today. Inmates are, generally, in worse health than we’ve ever seen. Today’s community population rates are high for diabetes and high blood pressure. Inmates have a lack of access to healthcare at a higher rate than before. 

3. Nursing staff levels  
Due to a nurse shortage, there is not enough time to tend to all of the inmates. For example, some inmates in diapers need to be changed more than four times a day. Usually when there is a diaper change, we also have to change the inmate’s bedding and clothing. This requires more CO resources and time to get the inmates cleaned up. It takes extra time to properly bag the items safely for laundering and requires a CO to stand by or to assist with these duties.

4. Medication challenges
Our facility is dispensing medication and narcotics at an alarming rate. The time it takes to pass medication on the housing unit is time consuming and complicated. Many inmates are addicts and seek pain medication for unnecessary care. When this happens, it trickles into their locked up demeanor. Being incarcerated, medical staff must tend to each concern and condition when they report an issue. Because of an overwhelming number of daily forms sent to the nurse, medical staff is bogged down to contacting inmates about their medical requests. The cheeking of medication (for various reasons) is a cat-and-mouse game – nurses and COs have to remain constantly vigilant on every pill call. 

Regardless of how and why medical units at correctional facilities got to this point, COs are left having to deal with these challenging inmates each day. With an increase in homelessness and inmates living longer due to medications and better detoxification programs upon entering custody, this appears to be the new norm.

We must find success by working together with our healthcare personnel and doing the best we can with what we have.

What hardships are you facing in your facilities and what are you doing to manage the challenges?

About the author

Harriet Fox is working as a Correctional Officer in a county jail in California. She is a Jail Training Officer, Emergency Response Team (ERT) member, Honor Guard member, and has worked as an Intake Classification Officer. Having an inquisitive mind, Harriet is intrigued by the criminal mind, gangs and mental illness within the walls of the correctional system. Prior to becoming a Correctional Officer, Harriet had the opportunity to delve into the law enforcement field experiencing positions including: Reserve Police Officer, 9-1-1 Communications Dispatcher, Crime Prevention Officer, and Police Cadet. Almost twenty years into a law enforcement career, Harriet is still passionate about the work and interested in always learning. Harriet is the bestselling true crime author of The Alcohol Murders: The True Story of Gilbert Paul Jordan. Harriet is also published in Justice Shall Be Served: An Anthology (written by police officers, correctional officers and military personnel). Both books can be found on Amazon.com. Harriet has a Bachelor’s Degree in Criminal Justice with a minor in Sociology.

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