1. Milano, Carol

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Inmates in Washington's eight largest prisons received 85,000 doses of morphine and 329,000 doses of oxycodone (OxyContin and others) over a recent three-year period, according to a news broadcast in early November on KIRO-TV in Seattle. Investigative reporter Chris Halsne contends that the system "allows many prisoners to stay high around the clock," receiving narcotics for any complaint, from toothaches to backaches. KIRO-TV also says inmates often "cheek" pills, to "double dose" or sell. Halsne's sources described unreliable narcotics counts and prescriptions written simply to keep inmates calm and orderly. (See or the online report.)

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When contacted for comment, Washington State Nurses Association (WSNA) staff in Seattle were unaware of Halsne's expose. "If a nurse carries out the prescription order and delivers medications as prescribed, that is within [the scope of] nursing practice," says Ann Tan Piazza, a WSNA spokesperson. "Questions, suspicions, or complaints about the appropriateness, amount, or frequency of a prescription need to be [presented to] whichever licensing board governs the prescriber."


The National Commission on Correctional Health Care (NCCHC) in Chicago accredits and sets standards for about 500 correctional health systems. "We don't see every prison in America, but this is very unusual," says Edward Harrison, president. "I haven't heard about this as a practice the way they reported it. KIRO-TV mentioned cheeking pills-something a skilled nurse would be able to prevent: give the pill with liquid, check the mouth, and make sure it was swallowed."


Kleanthe Caruso, vice president of patient care services and chief nurse officer at the University of Texas Health Center at Tyler, has a slightly different take: "Prisons have high potential for [narcotics] abuse and selling. All the meds are oral-easily hidden and recovered, to be used for trafficking and trading. They're a highly desirable commodity."


Caruso supervises 1,400 correctional nurses in Texas and chairs the ANA's group revising Scope and Standards of Nursing Practice in Correctional Facilities. Aware of no abuses as serious as those alleged by KIRO-TV, Caruso says that "questions of narcotics use and pain meds come up a lot at the ANA's national review. Prison pain control options are very limited. Determining true pain is difficult and only partly objective. The potential for abuse must be weighed against the possibility that care will be restricted. The ANA's code of ethics applies in any setting where a nurse is providing care."