Doctors Treating Prison Inmates: How Would You Feel Doing It?

Shelly Reese

Disclosures

May 30, 2019

Practicing medicine in prison is different from in a community setting, Allred says, but not necessarily in the way most people might imagine.

Nothing you have seen on TV or in the movies will adequately represent the reality of working in a prison environment.

"On my first day on the job," he recalls, "the warden said to me, 'Nothing you have seen on TV or in the movies will adequately represent the reality of working in a prison environment.'"

"He was right," says Allred, noting that the prisons, contrary to many Hollywood portrayals, are clean, well lit, and well maintained. What's more, while violence does occur, day-to-day patient care isn't about stitching up wounds inflicted with makeshift knives.

"County jails are urgent cares," explains John Mills, DO, who has worked in jails and federal prisons and is now a staff physician with University of Texas Medical Branch Correctional Managed Care Group, working in a state prison in Beaumont, Texas. Jails, typically run by a city or county, are short-term, high-turnover facilities. "You've got pregnant heroin addicts and people withdrawing from a lot of substances coming in. You've got people with undiagnosed cancer and with blood pressure way out of whack, and jails are also on the front lines of mental health."

A 2017 study by the Bureau of Justice Statistics found that 26% of jail inmates reported experiences that met the threshold for serious psychological distress, such as bipolar disorder. That compares with about 5% in the US general population of similar sex, age, and race.[4]

'It's Not an Easy Job, but It Can Be a Very Satisfying One'

While treating people in a jail can be enormously challenging, Ivens says it can be even more rewarding. He recalls working in the Alameda County Jail in Northern California in the mid-1990s, just as protease inhibitors were beginning to hit the market.

"HIV was ripping through the San Francisco area," said Ivens. "People were living on the streets, shooting drugs, and they would get arrested and sent to jail. Within a matter of weeks their HIV could be managed. It was very, very exciting to watch. We could have a hugely positive impact on people who would probably be dead if they hadn't come to jail."

In contrast, doctors working in prisons, which may confine people for decades, are more likely to treat chronic and age-related conditions. The number of prisoners over the age of 55 increased by 280% between 1999 and 2016, according to the Pew research. Consequently, while some prisons house a generally healthy population, others are outfitted to meet the needs of medically complicated inmates. Mills spent several years working in a federal prison whose 1500 inmates included 45 paraplegic and nine quadriplegic inmates.

Security likewise varies. In a minimum-security setting, a doctor may find him- or herself alone with a patient. In contrast, Allred says the patients he treated while working in the federal supermax prison wore wrist and ankle restraints when they were taken from their cells, and were accompanied by at least three guards.

That description probably conjures an image of danger and potential violence closer to the popular imagination. However, physicians working in correctional facilities say they rarely feel threatened or unsafe.

"The most common misconception is that people think there is daily violence," Mills says. "Violence happens, but it's a rare event," and it certainly doesn't dominate clinical practice. Rather, he says, correctional medicine "at the end of the day is an opportunity to bring quality healthcare to people who have never had it before. It's not an easy job, but it can be a very satisfying one."

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