Your own fight

If you diagnose it, you must treat it therefore avoid, stall, procrastinate diagnosing anything that will cost money to treat. That is a constant attitude with incarceration medical facilities. My cellmate just came to prison. At his first physical, four weeks after arriving, they found he had high blood pressure. While taking his history he disclosed that he hadn't seen a doctor in years. He is 56 years old. They scheduled him for a one week follow up. A week later his blood pressure was still high, They told him to quit smoking and coffee. He said, "I don't smoke!" and he had already quit coffee. A week later, checked again and still high and now in stroke danger levels. Started blood pressure medicine and checked him daily. After  2 weeks of the medicine not working they told him he must not be taking his meds. They scheduled him for 2 more weeks of blood pressure meds, this time crushed and "watch swallow." He, at this point, was in DOC for 2 1/2 months with high blood pressure in stroke danger. After the 2 weeks of blood pressure crushed watch swallow meds weren't working and his pressure was even higher, they panicked and shot him up with [word missing]. So now they rush him to an outside hospital Er. After a day of tests the hospital doctor says, in simple terms, "his lower back pain is so severe it is causing the high blood pressure." The doctor prescribes back pain medicine, codine, and refers him to a specialist. Back in his cell hi is denied codine (inmates are not given narcotics) and given Execdrin PM. His is now checked daily for blood pressure and awaits specialist, which getting Excedrin PM, Now 3 months in prison, with dangerously high blood pressure.
I tell this story to illustrate my next points: getting to a hospital, getting copies of files and treatments ordered, getting names and titles and family support.

1. Getting to a hospital or specialist is vital: Be persistant with your HNRs [Health Needs Requests]. Document everything, Prison medical staff can see on your HNRs that you are documenting, quoting and holding them accountable. This will get you through their stalling techniques quicker and into the hands of a a street doctor or specialist.
2. Get copies of files and treatment orders: When at a hospital or specialist's office, ask for copies of your file for that visit. Ask for a copy of treatment orders for your own records. If you are denied ask the name of the person and the reason for denial. Always be extremely kind and pleasant, more often than not you'll get what you want.
3. Getting names and titles: Keep records of doctors and nurses names. Correction officers that are present and witness different treatments and conversations. You have the right to take notes of what is being done to you and for you.
4. Family support: Get word to your family. Update them frequently. Save your hospital admissions bracelet and mail it to family. They can request medical record and talk to doctors. Family pressure on wardons and deputy wardons helps a lot.

My cellmate has no family fighting for him He is alone and at their mercy. No street doctor would wait three months at severely high pressure levels without serious preventative tests and care. You come in alone and may die alone if you don't, or can't, fight.

Agressive Treatment Participation and Prepardness

Having HIV for over 20 years has allowed me to see the growth of patient knowledge and treatment participation, setting an example for others. Educating yourself about your disease, staying up to date and aggressively participating in your treatment plan is vital. Aggressive participation includes complete pill compliance, showing up for all appointments and labs and keeping copies of important records and results at home.

Being an active participant will serve you well in many situations. Medical emergencies can happen while away from home such as cruises, vacations and work travel. If you find yourself in the unfortunate situation of being incarcerated, knowing your medical information is vital.  When you are being interviewed by jail or prison medical staff, you will need to have exact medical names for meds, dosages, recent lab results, secondary illnesses, your primary care physician and specialists' contact information. Prison and jail staff will not make any effort to track down info for you. You need to make sure all of your chronic issues are listed from the get-go in your file. Jails and prisons avoid new diagnosis' because diagnosis requires treatment and treatment is expensive. They save dollars by avoiding or prolonging diagnoses.

If you have the luxury of knowing in advance you may be heading to a period of incarceration, take advantage of it.  Take care of your eyes by getting any prescription eyewear (transition lenses are a good idea), dental for sure and of course update and chronicle all your chronic issues. If you find yourself surprised by incarceration, hopefully you have been active and up to date with all your medical and dental needs. Providing medical treatment is very expensive for them so supplying them with your medical info from the start will help you a lot. Prisons and jails avoid diagnosing any new issues and are slow with treating chronic ones. Always be polite, humble, thankful and informed. Pick your battles. Understand the term, “community standard of care”. Know your grievance system. Document EVERYTHING. Save your copies of “Health Needs Requests” or whatever health care requests are called in you unit. Have the contact info for a “Med Mal” medical malpractice attorney. 
If needed, family, friends and attorneys can hold on to copies of your medical files at home and mail to facility.  If the mail room at the facility tries to block it from coming in, have your attorney send it in "Legal Mail". Legal mail is protected and cant be read or reviewed by jail or prison staff.  The legal mail system is invaluable. Legal Mail is an envelope addressed to you with your attorney's return address on the outside AND when opened and casually flipped through does not contain contraband (i.e. inappropriate photos). Medical files are legal mail allowable.Keep family and friends involved as outside pressure helps. Remember, HIV/AIDS treatment often involves newest cutting edge treatments but that is NOT community standard of care, which is often 1-2 years behind and sometimes never catches up. Get ready for bare bones medical response. I say “response” because often, prison and jails do little prevention and mostly response…slow response.