“I’m Not Taking That”
Sally is diagnosed with bipolar disorder. She takes lithium to manage her symptoms. Recently, she has been refusing her medication during med pass because she “doesn’t like how it makes her feel.” At this point, Sally has refused her meds 7 days in a row, so it’s been discontinued and no longer offered. Now, Sally is going through a manic episode and has caused injury to herself and others.
Ask WHY
Only competent detainees have a right to refuse medication and treatment in jail. Once a detainee loses the mental capacity and ability to make their own decisions, they no longer have that right. For example, a detainee experiencing hallucinations may refuse their medication because they think it’s poisoned. It’s important to understand why a detainee is refusing. Once a detainee has been deemed incompetent by a professional, partner with the medical team to re-evaluate their fitness for confinement. When a detainee refuses medication, ask WHY.
Document refusals
When a competent detainee refuses medication at med pass, the officer or nurse should encourage the detainee to take their meds, but ultimately respect their right to refuse treatment if they are still functioning in the jail. For example, a detainee may choose not to take allergy medication.
Watch for changes in detainee mental status, such as confusion and disorientation, to inform whether a detainee is competent and functioning. These changes can happen suddenly or over a period of time. When a detainee is no longer competent or functioning, send them out for treatment and re-evaluate their fitness for confinement.
Document each refusal. Have the detainee sign each time they refuse. If a detainee refuses to sign, have a witness sign. Asking a detainee if they will initial that they are refusing to sign can sometimes encourage them to acknowledge the refusal.
Documentation helps ensure that the health care team and jail staff are aware of a detainee’s noncompliance with their treatment. Refusing medication can be a symptom of an underlying medical issue and the practitioner should be made aware of any refusals before it becomes a security issue. A medication refusal can turn into a security issue when:
A detainee is refusing treatment for a health issue.
A detainee has a reaction to discontinuing treatment.
Refused meds aren’t wasted properly.
Documentation can help determine the security considerations of a medication refusal. It also gives the practitioner insight into the appropriate medical response. If a detainee is refusing medication, a practitioner should evaluate the care plan. These documents can be added to a patient’s medical record and serve as your facility’s account of attempts to provide care. Have a process to document refusals.
Don’t discontinue
Ensure that officers and nurses keep offering medication to detainees who refuse. Announce med pass more than once, if possible. A practitioner should evaluate if a medication should be discontinued, replaced, or continued on a case-by-case basis. Discontinuing medication without a practitioner’s evaluation can pose medical and security considerations. For example, discontinuing medication to treat Opioid Use Disorder (OUD) can lead to withdrawal symptoms or death.
Ask your medical team if they have provided patient education on WHY they should take their meds; detainees should understand any potential consequences of not receiving treatment. If a detainee is refusing medication and can’t function without it, send them out for care. Provide ample opportunities for detainees to accept treatment, even if they are functioning and have the right to refuse. Don’t discontinue.
Screen for suicide risk
Do not threaten or use suicide watch as punishment for refusing medication. Refusing medication can be a warning sign of suicidality. Use an evidence-based screening tool like the ASQ for detention facilities to assess suicide risk. If a detainee does not screen positive for suicide, trust your gut. Suicide watch protocols should not be a one-size-fits all approach. Assess detainees individually to determine if a suicide watch should be initiated. Clinical judgement overrides a negative screen. Screen for suicide risk.
Click HERE for a med refusal job aid.
For more information, contact us at training@sparktraining.us
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. WHEN IN DOUBT, SEND THEM OUT. ®