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.