Book Review. Maximum Insecurity: A Doctor in the Supermax

Quick!  Name a book that describes the experience of being a medical professional in a jail or prison!  . . . Can’t do it, can you?  There are lots of books that talk about the life of a lawyer or a doctor in general.  There are books about prison inmates and even correctional officers.  But, to my knowledge, no one has ever written a book describing the experience of working as a physician in a jail or prison. Maximum Insecurity:  A Doctor in the Supermax fills that void.  This is a wonderful book, written by Dr. William Wright, about his experiences providing medical care to inmates in the Colorado State Penitentiary maximum-security prison. And not only is this the first memoir I am aware of written about correctional medicine, Maximum Insecurity is also a gem–funny, informative and engrossing.19960515

As most of us have, Dr. Wright came to correctional medicine from another career.  He had retired after working for 30 years as an ENT surgeon, but then, like many newly retired doctors (I know a few like this, myself), he got bored.  He stumbled across an ad looking for a doctor to work in Colorado’s maximum-security prison.  Dr. Wright thought this might be an interesting challenge.  His wife thought he was nuts.  But nine years later, he is still in corrections and has written this fine memoir of his experiences.

Maximum Insecurity begins with an account of the “culture shock” that all of us in corrections have experienced when we first become acquainted with the strange world of a prison.  There are clanging doors, blaring speakers, and the rules of security.  There is also the introduction to dangerous inmates as when Dr. Wright heard this from a five-time murderer: “You scared, ain’t you doc?  You should be.  I be the baddest man you ever see.” And there is the dawning realization that correctional medicine is different . . . and the same.

“I figured that my background as a surgical specialist would come in handy with prison medicine.  I’d seen the shows.  Knifings.  Shootings.  Beatings on every hand.  A wonderland for a trauma surgeon.  What I found was a kind of third-world general practice.  High cholesterol.  Stomach aches.  Back pain.  Asthma.  High blood pressure.  It hadn’t occurred to me that these tough, battle-hardened criminals might also have regular human diseases.”

Dr. Wright discusses the unique nature of working with incarcerated inmates that the rest of us understand so well, such as trying to examine the nether regions of an inmate who must remain shackled for safety under the watchful gaze of the accompanying correctional officer–who happens to be female.  He has a section discussing the pros and cons of free medical care versus having a $3.00 inmate co-pay—including the strategies that inmates use to avoid the co-pay.  Dr. Wright hits other correctional high points as well, like dealing with requests (and demands) for extra mattresses and special shoes, inmate legal scholars, cheeking and the surprising medications that can be abused behind bars:  “I had to look at a sudden outbreak of urinary retention in twenty-year olds with some skepticism.”  There are sections on the various manifestations of hunger strikes as well as the “swallower” phenomenon—those inmates who will swallow anything, like pencils and sporks, and how hard it is to stop them.

Dr. Wright is a surprisingly good writer.  I laughed out loud several times, such as when he describes a particular patient as “a murderer and sometime preacher of the gospel” and when he describes the grievance process thus:  “if a kite is a derringer of annoyance, a grievance is a howitzer of outrage.”  Or when he talks about this universal correctional truth:  “If there’s one thing that’s endemic at the supermax, it’s constipation.”  This is good enough stuff that I read several of the more entertaining stories to my wife after she asked me what in the heck I was laughing about.118-01

Besides this, Maximum Insecurity also has several chapters devoted to non-medical aspects of prison life.  These include an interesting discussion of various prison gangs, contraband smuggling techniques, a history of executions in Colorado, and the hard life of a Correctional Officer.  Dr. Wright has not missed much, from suicides to the epidemic of hepatitis C to successful prison escapes.  I thought I knew correctional medicine pretty well, but I learned quite a lot.

Unfortunately, Maximum Insecurity may be unlikely to attract medical students to work for the Colorado penal system because Dr. Wright wonderfully conveys the frustrations of working in a mind-numbing bureaucracy.  This includes being second-guessed and critiqued by non-medically trained supervisors, barely functioning computer systems and scratch-your-head illogical rules, like the one banning the reading of books during down-time between patients.  No wonder the Colorado prisons are, as Dr. Wright says, “chronically short-staffed,” especially with physicians.

I recommend Maximum Insecurity highly.  I hope that it will encourage others of us to write our own memoirs about our experiences working in corrections.  I would like to read a similar book about prison psychiatry, something Dr. Wright does not mention. Jails are an entirely different environment, who’s going to write the first jail medicine memoir?   What about correctional nursing?  Juvenile facilities?  Maximum Insecurity is a great start.

Maximum Insecurity: A Doctor in the Supermax will soon be available for purchase on  However, Dr. Wright is offering a free advance copy of his book in PDF format to readers of Jail Medicine!  Just write in comments that you would like to read Maximum Insecurity, and we will send you a link to the book via email!


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134 thoughts on “Book Review. Maximum Insecurity: A Doctor in the Supermax

  1. Hi Dr. Keller:
    I love your jail emails and would love a pdf copy of Supermax.

    It appears most jails in SE Idaho have gone with a dietary management system that provides the menus and dietitian. I have only Fremont County Jail left. Thanks for all your referrals over the years. I am still looking for work. If I can be of nutritional help, please contact me.

  2. This looks like a great read.
    Knowledge is power and knowledge gained from someone with experience and a sense of humour is priceless. I look forward to adding this to my arsenal of tricks.

  3. Please, please send me a copy! I’d love to post a link to my social media sites when the book shows up on Amazon, too!

  4. First of all thank you very much for sharing your knowledge and experiences working in jail.
    I’ve been working as a booking NP in a detention center for 3 years and loves reading your very informative insights working in this environment.
    And would love to read Dr. Wright’s Maximim Insecurity.


  6. Having worked for over 20 years in correctional managed care all over the States, it will be very interesting to compare my anecdotes with those in the book. I look forward to the read!

  7. I would love to read this book as well!! I have often thought of writing a book from a Correctional nurse’s standpoint.

  8. Hello Dr. Keller,
    In my 3 short years working as a detention nurse I have learned so much from your blog. I would love to read Maximum insecurity!

  9. I would love to read this book. I have worked in jails and prisons on the security side and on the medical side, so it is always interesting to read other peoples perspectives.

  10. As a Jail Administrator I very much enjoy reading Jail Medicine, I forward it to our Nurses. We have learned a lot, Thank You. I would like to read Dr. Wright’s book… Thanks to both of you.

  11. Sounds like a great read if they’re anything like your stories! I’d like to read an advance copy if still available.

  12. Hi Dr. Keller, Thanks for the opportunity to get this book. I am working night shift at ACJ. No doubt, I’m building my stock of stories for a future correctional nursing memoir. Hope you are well. I enjoy your blog.

  13. I would love to read this book. Thank you for the recomendation. Think I will purchase one for our MD for Christmas. (Hope it’s out by then)

  14. I would just love to read this book! I have often joked with other staff in the medical dept at our jail that I was going to make a calendar and document all the many interesting excuses used to call off shift.

  15. As a long time practitioner from the correctional side of the house who managed large correctional health systems, I would enjoy reading this book. Thanks.

  16. I’d love to have the .pdf! We always laugh that we’re going to write a book about our experience here, and call it, “No you can’t die from a rash” or “How did that get there?” LOL

  17. Working in a Jail for over 10 years now and find your blog helpful, humorous and validating.

    Would really like a copy of Maximum Insecurity too!
    Thank you

  18. Just a note for anyone who requested a copy and didn’t receive the link, please let me know (through Dr. Keller) and I’ll get it to you. Also, if you know someone who would like an advance copy, let me know that too. To everyone: thanks so much for your comments and warm reception. I’ll let you know when it’s published on Amazon!

  19. Hi Dr. Keller,

    I’m hoping to start medical school in the fall of 2014, and I’m finding myself more and more interested in correctional medicine thanks to your blog. I would love a pdf copy of Maximum Insecurity to learn more about correctional medicine.

    Thanks and take care,

  20. Would love to read the book. I’ve worked in Max Security psychiatry over 20 years–my studies with Thomas (“Care of the Soul”) Moore have helped me bring soulfulness to my work. My latest fantasy is to start a Death Row musical group. I know these guys and some of them can sing! Down with the ennui.

  21. I will REQIRE this book. There is an ultra scary supermax that needs a doc nearby, and I’ll need something to scare me away since the job sounds like, at first glance, crazy interesting. Please send me a copy.

  22. I would love a copy of Dr. Wright’s book. I enjoy your blog. Nursing in county jail of 250 inmates is a challenging and your articles are full of good and useful information. Could you write about dispensing medication in jail settings pre-pour or not? Keep up the good work!

  23. Thank you for negotiating a copy of Maximum Security for your readers. Our medical staff would love to read it! I enjoy and learn much from your blog and articles and links. Thank you very much!

  24. Doc,
    As a new grad nurse going in to the correctional field I would absolutely love to read your book!

    Thank You for sharing

  25. I would love to read this book in PDF, but I unfortunately did not receive any link. can you please attempt to send it again? thanks

  26. I WOULD LOVE TO READ THIS!! I am not only a fairly new np, but also new to the corrections world. Any suggestion would be greatly appreciated… Websites, books, journals, ce. Also any documentation help would be wonderful. I hear our charts need to be court ready, but do not know how to write to cover all the frivolous lawsuits that are filed.

  27. I am a student NP and would love to read this book. I enjoy correctional medicine and have interned at a level 3 prison for the last 2 semesters – I hope to get a job at my current placement.

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  29. I am a NP who started in corrections approximately 5 months ago. I would love to read this book. Please send me a copy. Thanks.

  30. Are copies of the book still available via PDF? I just saw this article in in Jail Medicine. While I work with a jail health system I am sure I would see strong parallels between Dr Wrights experience and that our our providers.

  31. Dr. Keller-while relatively new to corrections, I have been a nurse for almost 30 years-I am a Gulf War veteran-and I really enjoy your web page which is full of great info for me in my dual role of corrections officer in my local jail, as well as retaining my nursing license. I would be grateful for the opportunity to read the book in pdf form. Yours, Christina Mellott

  32. Recently started working in a prison in Scotland as a medical officer. I would really like to read this book too if its still available as a PDF. From reading a few things on this site seems Scottish prisons have similar challenges to the US.


  33. If this offer is still available I would love a copy. Working in a federal prison I can relate to many of the anecdotes in your article, and actually look forward to seeing what some of his solutions are!

  34. Being a former part-time physician at a county jail and anticipating seeking employment in a federal facility, I would very much like to read the book Maximum Insecurity. Look forward to hearing from you soon!

  35. I would love to get a PDF copy of Dr. Wright’s book. Please advise if it is too late to receive a copy via email. Thanks.

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  37. I laughed just reading the brief description of this book! I am a correctional nurse in Massachusetts and it is funny how we all share commonalities through corrections even though we are on opposite sides of the country. I would love to read this entire book

  38. As new to the corrections health scene coming from primary care I would appreciate reading this book. (local jail)

    Are you still offering the PDF link

  39. Would love to have you send a copy of this book to my son. He is a doctor in Southern Calif and is getting tired of all the paperwork and charting He has small kids and is always having to work at home . He is considering a job in a prison.

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  41. If still available I would appreciate a copy of Maximum Insecurity. At times it feels like I work in a vacuum, not knowing how other clinicians handle their infirmaries. It appears this book can be a way out of this isolating void. Thank you.

  42. Well, I know this thread is more than one year old, but since the literature on the subject is still quite rare while the problems we encounter daily are more or less the same, I’m hoping it’s not too late to get the pdf copy of the book myself. Thank you very much, either way!

    Best regards and keep up the good work!

  43. I would like to read your book. Being in correctional nursing many of your experiences sound familiar.

  44. 15 years in correctional medicine & now finally a first – hand documentary on this evolving new primary care – specialization! Great idea Dr. Wright ! would love to read Maximum Insecurity if still being offered!

  45. I would love to receive a pdf copy of Jailhouse Doc and Maximum Insecurity, if possible. Thank you so much!

  46. I would like a copy of Maximum Insecurity.

    Thanks for all your informative articles. Very helpful. I refer to your website frequently for guidance and information.

  47. Thank you for providing a ready source of solid evidence-based information blended with a how-to guide for the chronically underserved curiosity of dedicated correctional healthcare providers. The humor and wisdom weaved throughout the site is inspiring and liberating (a word not often heard in correctional circles), keep on blogging till the inmate-patients go home!
    PS. Know I’m late to the game on this one but thanks for the tip on Maximum Insecurity, a great read by Dr. Wright.

  48. Sorry I believe I commented under another comment by mistake. I would love to receive a copy if this is still available! Thank you for your informative web site and thank you in advance for the book!

  49. I loved your piece in Medpage Today. It led me to this blog, and I would love to receive a copy of this book if it’s still available. Thank you for doing the work you do and for sharing it with us.

  50. Sounds so interesting! I’d love a copy, if still available!

    While not in corrections, I do work with chronic pain patients… and all too often struggle with issues of providing the care that patients “need,” rather than what they “want”.

    Thanks for the great work!

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