“I’m Not Taking That”
Ask WHY they are refusing
A competent detainee has the mental capacity and ability to make their own decisions. Competent detainees have a right to refuse medication and treatment in jail. An incompetent detainee does not have the mental capacity and ability to make their own decisions. Incompetent detainees do not have a right to refuse medication and treatment in jail. For example, a schizophrenic detainee may refuse their medication because they think it’s poisoned.
It’s important to ask and understand WHY the detainee is refusing their medication and treatment.
Document each refusal
Ask the detainee to sign the refusal. If they refuse, document this, write “refused”, and ask them to initial that they refused to sign. If they refuse to initial, have 1-2 witnesses sign the refusal. File each refusal in the detainee’s medical record. Document each refusal.
Do not use blanket rules; continue offering medication and treatment
Communicate the refusal to the practitioner and refer the detainee to mental health. The practitioner should review all refusals. The practitioner will make the medical decision on whether to continue or discontinue medication. Do not use blanket rules such as “if they refuse it 3 times, it’s discontinued.” For example, medications for serious medical illnesses should not be stopped just because the detainee is non-compliant.
“Why do we have to keep offering him his medication? It’s a waste of time. We all know he’s not going to take it!”
There is a greater chance a detainee will take their medication if it’s offered 100 times compared to 14 times. Continue offering medication and treatment despite refusals, unless and until the practitioner decides to discontinue the medication.
Confused + Disoriented = Hospital
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. Watch for changes in mental status, such as confusion and disorientation. This can happen suddenly or over a period of time. At that point, the detainee should be taken to the hospital for evaluation and treatment. The hospital may require a court order for treatment, so it’s a good idea for jail administration to develop a good relationship with local judges ahead of time.
DNRs are honored at the hospital
Detainees have a right to refuse medication and treatment in jail, but they do not have a right to die in jail. Custody, medical, and mental health teams should work together with the judicial system to develop a plan if a detainee starts refusing medication and treatment.
A detainee has a legal right to sign a do-not-resuscitate (DNR) order, but there is no legal right to die in jail. If this situation should occur, jail staff should respond by activating EMS and performing CPR until EMS takes over. Once at the hospital, the detainee’s DNR may be honored.
Click HERE to view a sample refusal form
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. ®