Whitney Palmer

Medical Students Find Niche in Prison Healthcare

Published in the August 2004 AAMC Reporter

Life behind bars has no privileges. Once convicted and sentenced, prisoners lose their right to privacy, their right to vote and their right to any possessions while incarcerated. Perhaps the only tolerable aspect of prison life is an inmate’s constitutional right to healthcare.

In recent years, news reports have lambasted several prison systems across the country for the quality of healthcare prisoners receive. Many are accused of ignoring prisoners with fatal injuries or life-threatening illnesses or leaving them to die without receiving medical attention. But some medical schools accepted the challenge to enter correctional care and treat these men and women while training future doctors at the same time.

Some in the medical community view correctional healthcare as the lowest run on the medical treatment ladder. At one time it was viewed as the area reserved for less-than-stellar physicians, offering lower salaries and longer working hours. But as more schools strive to introduce their medical students to the rewards of serving this frequently ignored population, correctional healthcare is fast becoming a much sought-after area of study.

Both the University of Texas Medical Branch (UTMB) in Galveston and the Texas Tech University Health Sciences Center give students the opportunity to complete elective rotations in the prison healthcare program. So far, high demand for enrollment has made the correctional program one of the most popular among medical students. Once they receive approval from the state prison system, Texas Tech students can complete nursing or dental rotations, and the university also offers medical assistants the option of the prison rotation. UTMB students can select a fellowship in correctional healthcare.

After overcoming initial safety concerns, these future physicians encountered tremendous prison health needs. Together, UTMB and Texas Tech provide healthcare for virtually all Texas prisoners. In addition, Nova Southeastern University (NSU) students in Fort Lauderdale, Fla., and Duke University students meet with prisoners.

“On the UT campus, our faculty didn’t need a lot of convincing to work with these facilities,” said Ben Raimer, M.D., UTMB’s vice president of community outreach. “Some prisoners are in the penal system for years, and the faculty recognize the need to care for this vulnerable population.”

Healthcare Mandate

In 1993, the Texas legislature charged UTMB and Texas Tech with providing medical treatment for the state’s estimated 150,000 prisoners. UTMB serves the West Texas prison population in 105 units, comprising roughly 80 percent of all Texas inmates. Texas Tech cares for the remaining 20 percent in 26 correctional facilities. UTMB has an annual buget of $325 million to provide services, and Texas Tech has $73.8 million.

UTMB doctors, however, do not provide healthcare within the prison walls. Instead, the university has a first-of-its-kind hospital, called the Texas Department of Criminal Justice Hospital, at the Galveston campus designed for correctional care. If prisoners are sick enough to require in-person care, facility officials transfer them to the secure, acute-care hospital.

The hospital offers both inpatient and outpatient services, as well as an ambulatory care center, an operating and recovery room, an eight-bed telemetry unit, a six-bed intensive care unit and 56 overnight beds. On an annual basis, hospital officials record approximately 4 million patient encounters.

If prisoners do not require one-on-one care, they often receive treatment through the telemedicine system that both UTMB and Texas Tech use, offering access to specialists in neurology, orthopedics, cardiology, immunology and other areas. With many prisons located hundreds of miles from either institution the telemedicine program is an invaluable asset, facilitating more than 3,000 doctor-patient interactions each month.

The program not only lowered the time and financial expenditures for physicians, but it also increased patient satisfaction by decreasing the time inmates spend away from the prison. Because prison is a territorial environment where inmates closely guard both their physical possessions and any clout they might have among the inmate population, many forgo medical appointments because they are reluctant to leave the facility. Telemedicine remedied most of that problem.

“With telemedicine, the prisoners avoid travel,” Dr. Raimer said. “The cell is their home, and if they’re away, they risk losing their home; they risk losing personal items or their status on the cell block. And since prisoners can refuse healthcare, we have fewer missed appointments with telemedicine.”

In contrast to UTMB, Texas Tech doctors also work in prison sick halls. Each team of university employees contains a physician, a physician-assistant and nursing personnel. Their presence ensures prisoners have access to 24-hour-a-day medical care, according to Phil Dorsey, director of Texas Tech’s managed correctional healthcare program.

In addition to regular medical care, prisoners can also receive dental and mental healthcare from Texas Tech professionals. The university stives to provide the same level of treatment that is available in any hospital, Dorsey said.

Meeting Demand

“Healthcare is a right, and it’s a responsibility of the state to make sure offenders receive it,” he said. “Many inmates haven’t had the best healthcare in their lives, and they come to us with some bad habits. So, they have more healthcare needs and demands.”

Consequently, prison inmates have a higher incidence of several debilitating diseases including HIV, tuberculosis or hepatitis C. According to Dr. Rainer, these maladies occur seven to 11 times more often among inmates than in the general population.

Some students view correctional care as a unique educational opportunity that their peers do not have. Chad Conner, a recent UTMB graduate and first-year orthopedic surgery resident, said the correctional care program gave him the kind of hands-on experience he could not receive elsewhere.

“I had the chance to see diseases that other medical students just read about,” he said. “We saw things first hand and learned to treat illnesses that were far along in their course.”

As a UTMB resident, Conner will spend between one and three months during each year of his residency in the correctional care hospital. The hours spent caring for prisoners will augment his education, he said.

Florida’s College of Osteopathic Medicine at Nova Southeastern University (NSU) schools offers students correctional training in the state’s prison system.

Prison officials assess inmates’ health conditions in reception centers before they are assigned to a particular prison. Specialty training in infectious diseases will be available, said James Howell, M.D., MPH, professor and chair of NSU’s rural medicine department.

Currently,  NSU students work in the North Florida Reception Center in Gainesville and the Central Florida Reception Center in Orlando for one month. Even though most inmates leave the facilities within three days, patients diagnosed with more serious conditions remain, allowing medical students to perform full physicals or monitor and illness. After the medical rotations end, students create a PowerPoint presentation on their specific area of interest in correctional care.

“We’re giving students a better understanding of the medical expectations and meeds in the correctional environment,” said Anthony Silvagni, D.O., NSU’s dean of the College of Osteopathic Medicine. “They’re assisting in rendering care while learning at the same time.”

Healthy Choices

While the aforementioned programs provide medical care to both male and female prisoners, Duke University’s program, called Healthy Transitions, focuses on teaching female prisoners about positive life choices that can prevent future incarcerations. The program, started in 2002, is run by students with the help of a faculty advisor who assists with grant funding.

Healthy Transitions, a voluntary program for both students and prisoners, offers two one-month programs in the fall and one in the spring. Medical students conduct two classes each week, covering topics from pregnancy to parenting skills to sexual abuse. Inmates select either topics from a list of 10, giving them input over what they learn from the medical students.

In 2001, a small group of female Duke medical students began reading about the female prison system and the reasons why women sometimes become repeat offenders. With the help of a $15,000 “Caring for Community” grant from the AAMC, they designed a curriculum-based program, modeled after a high school initiative called “Hey Durham,” that could teach prisoners in the North Carolina Corrections Institute for Women about health and wellness.

“After reading about the prison system, these women decided to do something about helping female inmates make healthy life decisions,” said Rose Payyapilli, a fourth-year Duke medical student involved in the program. “So many of these women in the system have families and lives that they will go back to. We just want to help them lead normal lives.”

Victoria Mobley, an internal medicine resident at Johns Hopkins University, was among the first group of Duke medical students to work with the inmates, and she said the initial program was rocky because prisoners were suspicious of the students’ motives. Only five or six inmates joined the first class, but the sessions have been so successful that classes are now filled to capacity with 30 women, she said.

Inmates must fall into a certain category to be selected. They must be newly incarcerated and be in the probationary period — a time when prison officials decide what level of security they require. Bringing women into the program at this time provides an advantage, Mobley said, because they have not yet experienced anything negative or harsh in prison.

Once the prisoners conquer their initial suspicions of the medical students, they relax and begin to take an active role in the class, Payyapilli said.

“Almost universally, they’re excited to be there. They interact with each other and with us,” she said. “The conversations give them a chance to learn from others’ personal experiences.”

Medical students also give prisoners journals and encourage them to write about their experiences and how they want their lives to play out upon release. Through this method, more and more women are cognizant of how the decisions they make affect both their health and their quality of life, Payyapilli said.

In addition, the student provide a question box where prisoners can submit anonymous queries.  During the week, the students find the answers and respond to the questions at the next meeting.

Healthy Transitions does have a few cardinal rules, according to Julie Dombrowski, a participant with the second group of Duke students and a current internal medicine intern at the University of California-San Francisco. Students require prisoners to keep any discussions confidential. Also, the program has a “no assumptions” policy designed to prevent both student and prisoners from making judgments about each other.

“This policy makes the women feel safer,” Dombrowski said. “They open up more quickly, and we have better discussions and good feedback from the sessions.”

March 24, 2010 - Posted by wjpalmer | Healthcare | correctional center healthcare, healthcare mandates for prisons, medical students treating prisoners, prison healthcare