Safety with Incarcerated Patient in HBO

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We currently have (1) patient who meets criteria for HBO Therapy under CROM and another we are working up. Both of these individuals are incarcerated in a Medium Security Detention Center. One of our physicians has requested approval by the Detention Center for payment for HBO and committment to bring patient daily Monday through Friday for therapy. No decision has been made by the Detention Center at this time. I have concerns about the safety of staff as well as the safety of another patient who might also be scheduled for HBO at the same time. Here are some questions that come to mind: 1) When patient brought into HBO suite, two guards would need to accompany them. The patient (inmate) would need to have their shackles removed to allow for removal of their street clothes and the donning of HBO acceptable attire. Generally both guards are present at all times with the inmate. Would it be appropriate to allow the guards to leave the chamber suite once the patient is secured in the chamber and to return to the chamber suite when the treatment is completed and prior to opening the chamber door? 2) Would we need to limit treatment to this patient only during treatment time so as not to pose a threat to another patient? 3) When inmates are brought to the wound centers for treatment, not even the guards know the date and time of the next appt. The guards are notified when they enter the facility the morning of the appointment. When the patient is seen, we do not discuss followup appt dates or times, nor does it appear on their paperwork that is sent back with them. We call the prison system and speak with the scheduler and set the appt up for the date and time requested by the physician. Would having the patient (inmate) scheduled daily Monday through Friday at a reoccuring time not possibly be a concern to staff safety in that family members, friends, enemies might figure out when they will be there.
Do you have any guidance or suggestions for HBO Therapy in the incarcerated individual?

Apr 8, 2025 by Barbara Keller, RN, MSN, CWS

2 replies

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Fascinating, Barbara …

My first concern is not the diagnosis that ‘could’ be treated with HBO … It’s the safety of the unit and staff.

I’ve done incarcerated patients under special circumstances, but my bottom line is not to put yourself or staff at this level of risk.

I’m assuming a monoplace unit and you do not have a multiplace chamber.

I might agree to see the patients in the wound care clinic … no shackles removing … no changing clothes … no time without a guard present. But, given all of the logistics that you mentioned, I don’t think that I would even put my staff at that risk for HBO treatments, much less 30+ treatments. Not to mention the contraband that these people might bring to the unit.

I think that these folks would need to be wanded multiple times to rule out metallic contraband before entering the chamber. And, I doubt that they would care about scratching or otherwise harming the facility.

Finally, the scheduling requirements are made such that any ‘outside colleagues’ or potential enemies of these incarcerated patients would quickly learn your schedule, and potentially disastrous ‘get even’ plot might occur.

For all these reasons, I’d say no-go.

Am I being judgmental? I suppose so … I’ve never dealt with this in my practice career.

Fascinating.

gene worth

Apr 8, 2025

Kim Simonson
RN-BC, ACHRN, CWS, FACCWS

Hi Barbara,

Your questions are very thought-provoking, and it’s interesting that you have two potential forensic patients. If you do decide to move forward with treatment, consulting policies that may already be in place for your facility is a good place to begin:

Hospital policy on treatment of forensic patients in the outpatient setting:
Is there a protocol for this situation? Consider whether your facility has a protocol that includes using a private entrance and specific security measures for these types of patients.
The prison policy:
You’re already familiar with some aspects, but it would be prudent to request a full copy of the prison’s policies to ensure you fully understand the expectations and requirements.
Consider drafting a policy for your hyperbaric unit that addresses forensic patients.
You may want to include:

Level of detention center: Determine from which level of detention your facility will accept HBO patients. For example, the patient you mentioned is from a mid-level detention center. Perhaps mid-level is acceptable, but high-security centers may not be suitable. Establish what you can safely treat.
Mental health assessment: Ensure that the patient is willing and able to follow instructions safely during treatment. Patient consent for treatment is required.
Safety protocols for poor patient behavior: If the patient’s behavior poses a safety risk, notify the HBO-supervising provider immediately. The treatment may need to be aborted or discontinued. Consult with your Medical Director and HBO Safety Director as necessary.
Prison guard presence: Require that the prison guards stay with the patient at all times, including in the chamber room during treatment. Most likely, they are not permitted to leave the patient due to their own policies.
Scheduling adjustments: Consider adjusting the schedule so that only the prisoner is treated at a given time. If this is not feasible, it could be a reason to not accept the patient for admission to your program.
Consult with legal team: Always check with your hospital’s legal team to ensure that your policy complies with all laws regarding prisoner healthcare rights.

Pre-HBOT Education

Guard training: If possible, request that the same core prison guards accompany the patient. Provide them with pre-HBO instructions similar to those given to patients.
Prison medical staff: Ensure that the prison’s medical staff receive HBO-specific treatment instructions as well.
Prohibited items: Clearly outline prohibited items (e.g., lotions, deodorants, ointments) and ensure that everyone is aware of these restrictions.

Staff Education and Safety Planning

Competency training: Consider creating a competency that includes specific instructions regarding the method to schedule appointments/what to and not to do. You can use the Competency Tool for Managers to help with this.
Staff support: Make sure to huddle, debrief, and support your staff regularly to address any safety concerns and ensure that everyone is well-prepared.
Consult with ethics and legal teams: You may need to consult with your ethics and legal teams to ensure that all steps taken are compliant with the appropriate regulations and ethical guidelines.

Lastly, don’t forget to run your Active Shooter Drill. This blog post written by Jeff Mize and Tiffany Hamm offers some resources for development of strategies to be incorporated into policies and procedures in an Active Shooter Event.

Thank you for your question. I hope our thoughts and resources help.

Stay safe!

Kim

Additional Resources:

Q2 2023 UHMS Newsletter: “Care of the Forensic Patient in Hyperbaric Oxygen Therapy”

WoundReference Topic, "Hyperbaric Oxygen Therapy: Patient Guide"

WoundReference Patient Education: Prohibited Item Reminder

Apr 10, 2025

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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