AI Nurses and Carceral Settings.

Editor's Note

The author began their sentence before the major failings, economic, ethical and cultural impacts of LLMs and other Generative AI models were fully known.
Their access to knowledge and news about AI on the inside is limited to very few sources through a highly restricted app called "Newsstand".
I do agree with the sentiment of this post, however, as their access to healthcare is extremely limited and it's been really frustrating trying to help from the outside. Something needs to be done, even if it is a stop-gap...

Yes, please.

Thank you for rea-- wait, we're not done yet! Stick around for a few minutes, please.

As before, I am Jayel, a nonbinary person detained in a state prison in the state of Florida.

I was reading an AP News article that sums up as push back on the growing presence of AI "nurse assistants" in the free world, and I thought:
What if they brought an AI nurse app to prisons?

Picture this:

Prison environments add a level of complication and strife to medical care for all involved. There are just under 1,900 justice-impacted individuals who make this one place their home, but we are served by a medical team of less than twenty people. Our one MD on site audibly laments his lack of providers to help with the workload. We have two Nurse Practitioners, one Physician's Assistant, and a number of nurses that also aid throughout the day and night in various capacities. We have a dental hygienist, but no actual dentist apart from the traveling dentistry group that visited us in 2024.

Sick Call... Eventually.

When we get sick, to be seen by someone here, we must file a DC2-698A, Inmate Sick Call Request. This is a regulated form that we use to describe our need, such as "Persistent pain in my left shoulder; limited range of motion, feels like grating when I raise the arm," or "Think I have sinus infection. Face hurts. Nasal discharge. Ears hurt," or "Throbbing ache in my jaw, one tooth really hurts," or "Constant low back pain. Can't sleep, back hurts too bad, officers in bubble never have ibuprofen." We then define how long this has gone on for, and deposit this in the Sick Call dropbox.

From there, the general rules dictate Medical has 72 hours to put us on a callout for triaging.

Sadly, that window is so rarely met that it's actually more alarming when you do get called to be asked in person what is going on. Instead, people wait weeks or months to get that first call, where by that point they refuse medical care for any number of reasons.

One personal example is when I wrote a sick call request for a sinus infection, but wasn't seen for two weeks -- I had fought through it, and most of the symptoms were clear by the time the nurse triaged.

But what if AI helped?

Frequently, we are essentially forced to write a sick call request to get access to what's supposed to be made available per FDC rules: over the counter medicines like acetaminophen (paracetamol for my non-US friends), ibuprofen, and a basic antacid (like Rolaids™, Tums™, etc). Why forced? Our dorm officers happily proclaim they don't have the meds, or the time to hand out the meds, depending on their mood.

One staff member here, under condition of anonymity, told me that the bulk of what was seen in sick calls amounts to an ask for one of the basics I listed above. They asked why aren't we "getting them from our dorm officers?" I laughed gently and explained:

You send a box of 500 doses of ibuprofen to one dorm. There's about 400 people. If everyone asks for just one dose, your box is almost gone as fast as you send it, and officers don't call you for resupply like the rules state. Some people have chronic pain and are told by Medical to get ibuprofen from the [officer] bubble instead of being prescribed. You'd have to send a box every day or two to every dorm, honestly, to keep up with demand. A lot of us have to go without until we can come to sick call and beg for it.
If we could just buy a Costco-sized bottle for $10 or so, or be prescribed a low grade dose of an NSAID for chronic pain, I bet it would reduce the volume of sick call requests that are resolved by fistfuls of two-pill packets.

That staff member looked positively relieved to hear words like that from someone in blue, because it would be plausible. I'm a person who would be delighted, perhaps even ecstatic, to get even a 60 count bottle of naproxen sodium or ibuprofen to ease the pain I feel when my knees detonate like explosives because I've squatted, or I've been sitting with no spine support for a couple of hours at a steel table to do lessons.

How would I approach this in prison?

Honestly, start with a voluntary approach. You're going to have curious people who have minor needs that can be fixed by dispensing athlete's foot powder, ibuprofen, naproxen sodium, acetaminophen, chlorpheniramine maleate, eye drops... you know, basic over the counter medicaments. Pair a Machine Learning AI with a tamper resistant vending unit that dispenses those OTCs in a measured quantity.
Ask the person to scan their ID, then hold still for a photo; Present a list of common issues (e.g.: "My feet are itchy", "My back aches", "My scalp is dry and flaky", or "My muscles ache"), but allow for a body map so someone can pinpoint what bothers them.
Record the encounters -- everything else here is recorded.
Once we've given the "AI nurse" our ails, check our chart to see if this is a persistent thing. If so, ask us if we want to be put in to see a practitioner (recommended), or if we just want the OTC.

If someone flags up as using the AI Nurse a lot, investigation by an organic (that's our human nurses!) should be done.

This setup can free up our few, severely overstretched nurses to actually give better care than they do, given our carceral setting. They might even not delay care for a month, because people learn they can get their simple needs quickly sorted through the machine learning nurse!

An alternate solution:

Maybe if nurses want to work in an anachronistic setting where technology is eschewed and AI is currently not welcomed, then come work in a prison. We have certainly got the bodies for practice, and could use the help. Can we talk about my lower back pain?

Thanks for reading. :)