Correctional health: Medical parole

MEDICAL PAROLE

Inmates on chronic kidney dialysis

According to the Correctional Services Act a medical practitioner may lodge an application for medical parole of an inmate

The correctional medicine practitioner must supply a medical diagnosis and a prognosis of the terminal illness

The practitioner must indicate whether the inmate is so incapacitated as to limit daily activity or inmate self-care

There are multiple Independence of Daily Living IDL instruments in the disability world. These instruments are not totally applicable to the inmate population as certain aspects are questioned such as ability to shop, ability to utilise transport etc. There are however some basic parameters that are useful; (1) bathing (2) dressing (3) toileting (4) transferring from bed or chair independently (5) urinary and fecal continence (6) independent feeding (Adapted from the Katz IDL instrument). When these daily functions are compromised request for medical parole must be initiated

Similar to occupational health the concepts of impairment, disability and handicap into play. As there are many secondary advantages such as early release from prison, prisoners may want to prove that they are indeed handicapped. When inmates become disabled they become a big strain on the prison hospital.

Occupational therapy is used in prison hospitals to try and prevent disability and handicap

Diseases like chronic kidney failure patients who require dialysis  place huge logistic burdens on the prison system.  They need to be transported to a dialysis machine three times per week, accompanied by at least two custody officers.

There may be secondary gain for inmates not to become better. They can then attempt to get more ill, gain medical parole and heal outside the prison walls. One therefore has to do DOT and ensure they take their treatment. They must be observed swallowing every tablet. They must be examined to see if they are hiding the tablet in their cheeks, vomiting it out at the earliest possible chance.

The other side of the coin is also true. The inmate may genuinely be suffering from conversion disorder, undiagnosed pathology or some psychosomatic disease

Ethical questions come to mind. One believes that these issues had need teased out prior to incarceration. Did the schizophrenic patient commit the crime with the intent to do so, or did the incarceration activate or exacerbate dormant schizophrenia?

MDR has high rates of mortality and XDR is frequently incurable. MDR and XDR creates risk to other inmates