This is why healthcare services in the nations jails and prisons matter not only to the people who receive care or provide it, but also to those living in a nearby community. Given the high rate of communicable diseases and mental health issues in this population, society cannot afford to ignore how inmates are treated inside the system, according to Weaver and others who specialize in this area.
Elton Amos, chief medical director for the Indiana Department of Correction, says the departments motto is Re-entry is everyones business, and its goal is for inmates to leave the system healthier and better-educated than when they arrived. For some who work in correctional facilities, they see it as a calling to treat a population that many would choose to ignore. For other clinicians and healthcare staff, it offers an opportunity to work somewhat regular hours and avoid the hassle of third-party payers. Whatever the reason, most seem to agree that providing healthcare inside correctional facilities is a public service that brings a sense of satisfaction from helping those in greatest need.
Outside the Westville (Ind.) Correctional Facility on a warm March morning, the sound of chirping birds is nearly drowned out by the cadence of security officers taking target practice. Inside, its mostly quiet in the facilitys main entrance and shakedown area, where anyone entering the facility must stop to be searched. Through these gates walk the worlds finest staff, reads a sign above the door leading to the prison complex.
In Indiana, the state has a contract with St. Louis-based Correctional Medical Services to provide healthcare services at the 32 state facilities that house 24,000 of Indianas offenders. The Westville facility was originally built as a hospital in 1951 and is showing signs of age. Cinder-block walls, speckled linoleum floors and cramped offices are what you might expect to find in a correctional facilitys healthcare unit. But the seemingly outdated environment does not represent the type of services the inmates receive. In January, the state implemented electronic medical records throughout the system, a feature missing at most community hospitals. The facility also has an urgent-care clinic and three dental clinics. There is no service, modality or medication available to the public that isnt available here, Amos says.
Amos, a physician who had practiced family medicine in Fort Wayne, was named medical director in September 2005, the same time Correctional Medical took over healthcare services. While Amos oversees healthcare services for the entire department, Michael Mitcheff, who had specialized in emergency medicine, serves as regional medical director for the company, giving direction to all of the individual medical directors at each of the state facilities.
Each site also has a healthcare administrator. At Westville, that role is held by Cynthia Montgomery, a registered nurse for 25 years. According to Montgomery, there are 10 full-time licensed practical nurses and eight registered nurses, as well as six part-time licensed practical nurses and four part-time RNs. Westville also has two physicians, a nurse practitioner, two psychologists, five social workers and a full-time psychiatrist to care for roughly 3,200 inmates.
Mitcheff says he took the job because the somewhat consistent hours allow for more time with his family, compared with the hours he spent as an emergency medicine physician. He also doesnt have to deal with third-party payers. Mitcheff, Amos and Montgomery all say there is a great satisfaction that comes from providing care inside correctional facilities. For many inmates, its the first time they have received care in a long time. They like coming to the unit because it is an escape, Amos says. They talk to someone who talks to them as a person, not an offender.
Just as correctional healthcare offers a sense of satisfaction to healthcare providers, it also brings a set of challenges unique to prison life. First, there is the heightened sense of concern working with some of the most dangerous members of society. Montgomery says its hard to have that healing touch because the primary concern is custody of the inmate. Security officers are present for visits. Then theres the paperwork that comes from being audited to death by organizations such as the American Civil Liberties Union, the Indiana Civil Liberties Union and the state health department, Mitcheff says.
Educating employees about the standards set by the American Correctional Association and National Commission on Correctional Health Care is a must. They also need to be able to strike a balance between what is medically necessary and what is medically convenient. For example, inmates might request a wheelchair to get ahead in the food line, or complain that a medical condition requires them to sleep in the bottom bunk. (Mitcheff says the bunk is an in-house ranking system where newbies get the top.) There is also the constant concern that bandages, braces and other supplies will be used as gang symbols. Everything in prison has a value, Mitcheff says.
Despite working in these unglamorous and sometimes dangerous settings, correctional healthcare workers are not necessarily compensated more for their work. The fact that were in a healthcare provider shortage doesnt lend itself well to prisons, says Joe Winings, vice president of national sales for Staff Care, a division of staffing firm AMN Healthcare. Staff Care matches physicians in all specialties on a temporary basis. Winings says the range in annual salaries is $130,000 to $160,000 for primary-care physicians in correctional facilities. This compares with the national average of $115,000 at the low end; $145,000 as average; and $220,000 as the high to recruit family practice physicians, according to a summary report on 2006 physician recruitment incentives from Merritt, Hawkins & Associates, another division of AMN Healthcare. And malpractice insurance premiums are included for permanent employees, he adds.
In February, Robert Sillen, the federal receiver in California appointed as a result of a court case, announced salary increases for physicians in the states 33 adult facilities to better compensate qualified physicians, aid in recruitment efforts and provide improved access to care for the states 173,000 inmate patients. The appointment of a federal receiver came after a 2001 class-action lawsuit that found medical care in Californias prisons violated the Eighth Amendment of the Constitution (See first installment of this series, Feb. 19, p. 25). This was after an October 2006 announcement about salary increases for prison healthcare staff in nursing, pharmacy, medical transcribing, X-ray, medical records and dietary services. With the higher salaries, our ability to hire RNs and LPNs has (risen) dramatically, says Rachael Kagan, a receivership spokeswoman.
Although some clinicians might be enticed to the segment by better salaries, others are drawn to the greater sense of purpose. This is true for John May, chief medical officer at Armor Correctional Facilities since the company was founded in November 2004. In 2001, May founded Health Through Walls, a North Miami, Fla.-based not-for-profit volunteer organization of physicians, nurses and technicians that assists in providing healthcare services at jails and prisons in the Dominican Republic, Haiti, Jamaica, Tanzania and other developing countries.
Its public health to a whole community, May says of providing healthcare in correctional systems. In the free world, a physician takes care of an individual who is part of a community, while in corrections, you can take care of a community of individuals.