NEWSLETTER 22: CAST CARE

Inappropriate and/or Inadequate Health Care Administered to Prisoners
Cast Care
What is a cast?
A cast is a supportive structure that surrounds an injured body part to protect it, keep it from moving, and allow it to heal. Casts are made of fiberglass or plaster. They are most often used for broken bones. They are also used sometimes for torn ligaments or tendons and may be used after surgery.
How is a cast put on?
Your health care provider will first place padding around your injured body part. Casting material is then rolled like a bandage over the padding. While the casting material hardens, it will feel warm.
Why do I need a cast?
You have been given a cast to help your broken bone or torn ligaments heal. A cast can help keep the injured area from moving so you can heal faster without risk of repeated injury. How long you'll need to wear your cast depends on the type of injury you have and how serious it is. Your doctor may want to check your cast 1 to 3 days after putting it on to be sure that the cast isn't too tight and that your broken bone or torn ligament is starting to heal.
Will the broken bone hurt?
Almost all broken bones cause pain. The cast should relieve some pain by limiting your movements. Your pain should become less severe each day. Call your doctor immediately if the pain in the casted area gets worse after the cast has been applied. You should also call your doctor right away if you have new pain that develops in another area (for example, pain in your fingers or forearm if you have a wrist or thumb injury, or pain in your toes or calf if you have an ankle or foot injury).
New pain that you didn't have before the injury may mean that the cast is too tight. If you have this symptom, raise your cast. This may reduce pain and swelling. Your doctor will probably want to see you right away to check the cast.
Is it okay to get the cast wet?
With some fiberglass casts, you can swim and bathe. However, most casts shouldn't get wet. If you get one of these casts wet, irritation and infection of the skin could develop. Talk to your doctor about how to care for your cast.
To avoid getting the cast wet during bathing, you can put a plastic bag over the cast and hold it with a rubber band. If the cast does get wet, you may be able to dry out the inside padding with a blow-dryer. (Use a low setting and blow the air through the outside of the cast.) Ask your doctor about using a blow-dryer before trying this.
What can I do about itching?
If your skin itches underneath the cast, don't slip anything inside the cast, since it may damage your skin and you could get an infection. Instead, try tapping the cast or blowing air from a blow-dryer down into the cast.
  How is a cast removed?
Your health care provider will remove the cast with a special cast saw. The saw is designed so that it will not cut your skin. The cast should be removed only by your provider.
How long will I need to wear my cast?
How long you wear your cast depends on your injury. Some injuries heal within a few weeks and some take several months.
How can I take care of myself?
Pain and swelling: Take acetaminophen or ibuprofen for the first 48 hours. You should elevate your leg or arm above the level of your heart to reduce swelling. If your leg is in a cast, sit or lie down and put pillows under your leg to keep it elevated for the first 24 hours. If your provider has given you a sling for your arm, wear it to keep the injured part elevated. Wiggling your fingers and toes can also reduce swelling.
Keep your cast dry: Most casts should not get wet. A plaster cast will fall apart if it gets wet. A fiberglass cast won't fall apart but the padding underneath may start to smell if it gets wet. Wet padding may also hurt your skin. You can bathe using a wet washcloth, rather than taking a shower or bath. If you are going to be near water (even rain), put your cast in a heavy plastic bag. Hold the bag in place with a rubber band. Try not to get the bag wet. If your cast does get wet, you can dry it with a hair dryer. If your cast gets wet and it doesn't feel dry after 4 or 5 hours, call your health care provider.
Your health care provider may give you a special cast and liner that allows you to get the cast wet and even swim.
Itching: Many people have itching inside a cast. Never reach inside a cast with your fingernails or another object to scratch. It may injure your skin and cause an infection. Sometimes shaking a small amount of talcum powder inside a cast or using a hair dryer on a cool setting helps relieve the itching.
Activity: How active you can be depends on your injury. You should avoid riding a bike or playing most sports. You may be allowed to participate in certain sports with special padding around your cast. If you have a cast on your leg, you should not walk on it or put any body weight on it for the first 48 hours. The cast needs time to dry and become strong. If your provider wants you to use a walker or crutches, you should not put any weight on the injured leg at all. Ask your health care provider about what activities you can safely do.
After my cast is put on what problems should I watch for?
Contact your health care provider immediately if you have any of these problems.

Swelling:
Signs of problem swelling include:

• You have severe or persistent pain.
• Your fingers or toes feel numb or painful or can't move.
• The color of your fingernails or toenails changes.

Infection: Sometimes the body part inside a cast becomes infected. Signs of infection include:

• drainage from the skin under the cast
• pain
• fever
• smell

Cast fit: After a while the cast may not fit well. Call your health care provider if the cast feels too loose or too tight. Talk to your provider if the cast is damaged or weakened due to wear and tear. If the cast is too tight, it can initially cause pain. As it injures the tissues and nerves the pain will stop. The dead tissue will then cause a foul smell.
If the cast hurts as a result of swelling that is beginning to injure your tissue, the doctor will “bivalve” the cast. This is cutting it along each side so that it becomes like a clam shell and can be removed to observe the tissue and the amount of pressure can be changed to accommodate the changing size of your extremity. For example: muscle disuse atrophy can make the cast too large while swelling can make it too tight. Bivalving the cast can customize the cast to your changing size needs so that the fracture is immobilized properly without injuring the tissue.
Warning signs following splint or cast application. After application of a splint or cast, it is very important to elevate your injured arm or leg for 24 to 72 hours. The injured area should be elevated well above the heart. Rest and elevation greatly reduce pain and speed the healing process by minimizing early swelling. If you experience any of the following warning signs, contact your doctor's office immediately for advice.

• Increased pain, which may be caused by swelling, and the feeling that the splint or cast is too tight
• Numbness and tingling in your hand or foot, which may be caused by too much pressure on the nerves
• Burning and stinging, which may be caused by too much pressure on the skin
• Excessive swelling below the cast, which may mean the cast is slowing your blood circulation
• Loss of active movement of toes or fingers, which requires an urgent evaluation by your doctor

Taking care of your splint or cast. After you have adjusted to your splint or cast for a few days, it is important to keep it in good condition. This will help your recovery.

• Keep your splint or cast dry. Moisture weakens plaster and damp padding next to the skin can cause irritation. Use two layers of plastic or purchase waterproof shields to keep your splint or cast dry while you shower or bathe.
• Do not walk on a "walking cast" until it is completely dry and hard. It takes about one hour for fiberglass, and two to three days for plaster to become hard enough to walk on.
• Keep dirt, sand, and powder away from the inside of your splint or cast.
• Do not pull out the padding from your splint or cast.
• Do not stick objects such as coat hangers inside the splint or cast to scratch itching skin. Do not apply powders or deodorants to itching skin.
• If itching persists, contact your doctor.
• Do not break off rough edges of the cast or trim the cast before asking your doctor.
• Inspect the skin around the cast. If your skin becomes red or raw around the cast, contact your doctor.
• Inspect the cast regularly. If it becomes cracked or develops soft spots, contact your doctor's office.

When a person becomes incarcerated they have the right to quality healthcare provided by Uncle Sam. Patients in prison have no choice and no consumer advocate, unfortunately. The medical malpractice lawsuit becomes the advocate for those incarcerated within U.S. jails and prisons for those prisoners that are receiving no medical care or inadequate medical care by the correctional medical companies contracted by the States.
Managed care companies like Correctional Medical Services (CMS) throughout the United States have been taking over prison and jail health care from government agencies coast to coast. For a fee, their workers provide everything from Band-Aids and Tylenol to heart-bypass surgery and psychiatric counseling. Taxpayers are paying billions of dollars to these firms. There is good reason to question the quality and motives behind today’s correctional health care. It is an industry that takes advantage of the public’s ill will toward inmates to give poor care (or no care) while making a profit, a big profit. At the public’s expense, CMS and other managed health care companies are very creative at avoiding treatment costs while appearing to provide a façade of care.
The cost avoidance techniques of CMS go too far when they are utilized to hasten the death of inmates. They are experts at delaying medical care to pad profits. It is interesting to note that The National Commission on Correctional Health Care, which sets standards and accredits prison and jail health care operations, does not serve as the watchdog that these private companies claim.
Another problem is that medical treatment can be delayed indefinitely by prison physicians, directors of the correctional care companies, prison officials, and prison nurses for a number of reasons.

Sincerely:

Joseph Saponaro, MD, DABIM, FACP, CPI, CCI, CCTI, CCRC, CCRP
Member, ACFEI (American College of Forensic Examiners Institute of Forensic Science)
Expert Medical Witness, ExpertMD
PI (Principal Investigator), DSI (Drug Study Institute)
Board Certified Internist, JPMC (Jupiter Preventive Medicine Center)
DABIM (Diplomat American Board of Internal Medicine)
FACP (Fellow American College of Physicians)
CPI (Certified Physician Investigator) by the APPI (American Academy of Pharmaceutical Physicians)
CCTI (Certified Clinical Trial Investigator) by the ACRP (Association of Clinical Research Professionals)
CCI (Certified Clinical Investigator) by the DIA (Drug Information Association)
CCRC (Certified Clinical Research Coordinator) by the ACRP (Association of Clinical Research Professionals)
CCRP (Certified Clinical Research Professional) by SoCRA (Society of Clinical Research Associates)
Member, SIMPD (Society for Innovative Medical Practice Design)
Member, ACPM (American College Preventive Medicine)
Ethics Committee Member, Jupiter Medical Center
IRB Member, Jupiter Medical Center
Founder, CertifiedResearchers.com