Fuhgitaboudit, spell check. You’ll never find Incarceritis in your laptop’s memory bank. Even if you’ve downloaded a medical dictionary, it would still be of no avail. Stupid computer!
Defined as when a patient intentionally falsifies or grossly exaggerates symptoms of illness or trauma in order to avoid incarceration, In-car-sir-I-tis, or EMS (environmental malingering syndrome), is a loathed condition most correctional healthcare providers, EMS and law enforcement professionals are familiar with.
Bar fight victim: I’m okay. It’s just a scratch on my head. I feel fine. The loser barely hit me.
Medic: Did you lose consciousness? Are you hurting anywhere else?
BFV: Like I said, I’m fine, %&#! Now just leave me the hell alone!
M: Well, alrighty then. He’s all yours, officer.
Police officer: Sir, I’m placing you under arrest for assault charges.
BFV: My head and neck are suddenly killing me. I can’t see out of my right eye. I think I’m gonna pass out. I can’t remember my name … or my lawyer’s. Oh no! I can’t feel my fingers!
M: Does that include no sensation of your moral principles?
The attempt at feigning illness or injury is a hapless version of trying to pick the “get out of jail free” card in Monopoly after you’ve already landed on the “Go to Jail” space. Of course, the accused consider this a brilliant, spontaneously-conceived plan that we in EMS and law enforcement would never consider as a clever ploy to avoid metallic cubical detention. Those suffering from Incarceritis may see it as an opportunity to escape police custody, gain a sympathetic charge reduction or take a mini vacation to a healthcare milieu filled with compassion, comfort and love.
Some of the more ambiguous complaints you may find from an inmate fabricating the need for 9-1-1 transport include: contrived chest or abdominal pain, agonizing migraine, unconsciousness, hallucinations, mental illness, debilitating injury discomfort, or, my personal favorite, status seizures (which I like to call “sham shaking”).
There will always be inmates who seek ambulance deportation from a prison cell when their only sickness is being sick of living behind bars. It’s easy to develop a contemptuous and jaded opinion of imprisoned malingerers who, in their attempt to avoid criminal responsibility, overtax not only your EMS resources and budget, but also your capacity to trust others who may actually be experiencing a medical emergency. I for one don’t trust the imprisoned, whether they’re habitual criminals or first time detainees, but I do give them the benefit of the doubt regarding their need for medical intervention. After all, everyone deserves the right to professional objectivity—even one or two members of Congress. However, if a prisoner is indeed faking a medical affliction to escape their confines of custody, I want to bust them from an ethical standpoint. Here are a few tips I’ve found helpful:
- Besides performing a full objective medical assessment, thoroughly document subjective data not only from the patient, but also any discrepancies officers may have observed or uncovered before and after the onset of the inmate’s medical or traumatic crisis.
- Repeatedly ask questions and document any inconsistencies that may put medical necessity and legitimacy into question.
- Don’t point out discrepancies to an inmate because they may adjust their symptoms to coincide with actual medical conditions. Unlike long-term correctional internment, the acutely apprehended don’t have access to WebMD to study and rehearse specific medical complaints.
- Observe your patient’s behavior when healthcare providers aren’t present.
- Remind yourself that this could be the real thing, regardless of how many Academy Award-winning performances of malingering the inmate may have displayed before.
- Have the inmate secured by the accompanying officer in a way that keeps the healthcare provider out of harm’s way.
- Thoroughly document suspected manipulation of inmates feigning illness. Some correctional facilities use these records to facilitate disciplinary action or even influence parole eligibility, especially for repeat offenders.
Remember, my incarcerated friends, feigning illness while behind bars won’t produce the kind of iron deficiency you were hoping for.