The weakest part of most jail medical programs, especially small programs
without full- time physician supervision, is the evaluation and treatment of
acute injuries and illnesses. These are most common in the drunk tank: a large
room where those who are intoxicated and other prisoners are held until they
post bond. The drunk tank is an ongoing source of unnecessary deaths and
accompanying liability suits against local governments and physicians. Neither
police officers nor physicians can visually distinguish an intoxicated prisoner
with a mild bump on his head from a severe head injury patient who has had a
couple of drinks. Diabetic coma and a drunken stupor look and smell very much
alike. Most physicians know this; most police officers do not.
Considering the extent to which alcohol is involved in traffic accidents and
crimes of violence, it is hard to think of any profession with more experience
with drunkenness than law enforcement. The vast majority of those who are
intoxicated have no acute medical problems, so it is not reasonable to expect
police officers to learn to do a medical evaluation on every intoxicated person
they arrest. No one, however, should be locked up without such an evaluation.
This means that every prisoner who appears intoxicated at the time of arrest
should be taken to the jail physician or practitioner on duty before being put in
a cell. The jail physician should review the protocols for treating intoxication
frequently and should be sure that they are being followed carefully.
Evaluating a lot of prisoners is the price for preventing jail cell deaths from
diabetes, and picking up the head injuries early may protect the officers from
accusations of brutality in the jails.