We often talk about ostomy care, including the different ostomy types.  

When I was doing research for this blog, it was surprising how many reported cases exist in which colostomy care was the basis of federal lawsuits filed by inmates in various penal settings throughout the United States.

Other recipients of healthcare not in a penal setting have filed such lawsuits as well.

Simply doing an online case law search for “stoma nursing care” or “ostomy nursing care” yields a number of interesting results.

One prisoner’s colostomy care became an issue in a case he filed against the Missouri Department of Corrections (MDOC) in Crew v. Russell.

Legal basis of inmates’ colostomy cases

The Eighth Amendment to the U.S. Constitution prohibits cruel and unusual punishment. This amendment extends to inmates to protect them from deliberate indifference to their serious medical needs.

This standard is higher than a professional negligence standard because it requires the healthcare provider knowing and recklessly disregarding a substantial risk of harm to the prisoner.

General allegations

After surgery to remove his colon, Missouri Department of Corrections inmate Jerry Crew was transferred to Northeast Correctional Center and required to wear a colostomy bag because of his surgery.

In his suit under 42 of the United States Code Section 1983, Crew alleged many employees of Missouri Department of Corrections, including the nurse who directly cared for him, was “deliberately indifferent” to his serious medical needs.

In short, Crew alleged the nurse involved in his care failed to provide him adequate medical supplies and improperly instructed him on the use of the supplies.

Allegations against the nurse

The nurse was responsible for coordinating Crew’s care and providing health education to those enrolled in a chronic care clinic.

The inmate was enrolled in several of the chronic care clinics. His supplies included:

  • Colostomy bags
  • Wafers
  • Paste
  • Adhesive remover pads
  • Towelettes

When additional supplies were needed, he had to submit a request for what he needed and pick them up at the medical unit.

The request was to be filed seven days in advance of the needed supplies. The nurse would then order the supplies.

According to testimony, Crew needed new supplies approximately every 20 days. His medical record indicated that across a span of 522 days, he picked up supplies from either his nurse or other nurses every 19 days.

When the inmate had trouble with the wafers used with the bags, he was ordered new ones. In addition, the nurse re-ordered more expensive colostomy bags for him when a “cheaper” version leaked. The nurse also provided Crew a bottle of odor control solution to “quell any odors” in his cell.

Despite these facts, the inmate’s position was he did not have adequate colostomy supplies.

The inmate also alleged he was improperly instructed on how to clean his bags. He testified that the nurse told him to clean his bag in the sink.

The nurse testified that she instructed him to:

  • Empty its contents into the toilet through the drain at the bottom of the bag
  • Use toilet paper to wipe off the end of the bag
  • Throw the toilet paper in the toilet
  • Flush the toilet
  • Clamp the end of the bag shut and continue wearing the bag

She stated that she never instructed him to wash the bag with soap and water in the sink.

District court’s decision

The court granted the nurse’s Motion for a Summary Judgment in her favor as a matter of law.  The court held that the inmate failed to show the nurse in any way was “deliberately indifferent” to his colostomy care needs.

Implications for your colostomy care

If you work in a prison setting, this case has some specific guidelines for you.

Caring for an inmate with a colostomy requires you to:

  1. Instruct the inmate in proper care of the colostomy and its supplies.
  2. Document those instructions in the medical record.
  3. Provide supplies and care as required by the inmate’s condition and pursuant to policies.
  4. When aware of an inmate’s health issue, never carelessly disregard a substantial risk to the inmate.
  5. Treat all inmates consistent with your legal and ethical mandates governing professional nursing practice.

If you do not work in a prison setting, implications exist for you as well when you care for a colostomy patient. When caring for those patients, remember to:

  1. Provide patient and family education on the care of the colostomy and needed supplies.
  2. Develop patient teaching forms that can be signed by the patient and family and a copy kept by them.
  3. Notify your APRN or physician if changes in the patient’s condition occur and document that notification to meet your overall duty to protect the patient from an unreasonable risk of harm.
  4. Treat all patients consistent with your legal and ethical mandates governing professional nursing practice.

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Nancy J. Brent, MS, JD, RN

Nancy J. Brent, MS, JD, RN, our legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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