I have begun a new blog that is being published on MedPage Today entitled “Doing Time: Healthcare Behind Bars.” The difference between that blog and JailMedicine is the audience. JailMedicine is written for medical professionals already working in a jail or prison (bless us all!). The MedPage Today blog is written for medical professionals who have no idea what Correctional Medicine is all about. The first post of Doing Time follows:
How did I End Up in Jail? Jeffrey Keller, MD, describes his journey to correctional medicine
So, let’s get the big question out of the way first: how on earth did I, a respectable physician, wind up practicing medicine in a freaking jail, of all places? Well, the answer is that it was a fortunate accident.
Nobody aspires in medical school to practice medicine in a prison or jail. Neither did I. Like most physicians practicing now in jails and prisons (collectively termed “correctional medicine”), I ended up here quite by accident.
I am an emergency physician by training. I had been happily working at a busy emergency department for about 10 years when my local county commissioners approached me to ask if I would be willing to take over medical services at the small local jail. My initial response was: “Hell no! What’re ya, nuts? Who’d want to work in a jail?” Many of you probably would have said the same thing! Fortunately for me, the commissioners gave me a second chance 6 months later. I was still leery, but I told them I would do it for 1 year, and 1 year only.
Two things happened during that year, though. First, I discovered that I liked working at the jail (and who would have thought that). In many ways, it was like working in an ER. In fact, many of the “frequent flyers” from the ER also were regular attendees at the jail. I’d see someone in the jail clinic I had seen 2 days earlier in the ER. Or I’d see someone in the ER and ask, “So when did you get out of jail?”
In addition, though, I saw a lot of needy people in the jail who did not routinely come to the ER. For many people, jail is the first time that they have had easy access to medical care. I saw medical issues that had been neglected for years. A typical exchange would be: “What do you think of this growth on my hand?” “Well, that’s cancer.” I’m not sure what I had naively expected, but what I found was a lot of untreated interesting medical pathology. I’ve diagnosed bacterial endocarditis — several times (lots of IV heroin users go to jail). I’ve diagnosed syphilis. Within a couple of months, I had treated more people for alcohol withdrawal than I had in my entire ER career. I felt good about what I was doing. Weird!
Second, my phone kept ringing. “We’re the jail just up the road. We need help, too!” “We’re the jail down the road. We need a doc.” It turns out that there are a lot of jails. But there are not a lot of physicians raising their hand to volunteer for jail medical duty. I was practically the only guy in my home state of Idaho. After a few years, I had accumulated so many small jails that I retired from the ER to do jail medicine full time. And Idaho is not the only place with a need for correctional medicine practitioners.
There are well over 2.2 million incarcerated people in the United States, and they all need healthcare. In fact, incarcerated people are the only residents of the U.S. with a constitutional guarantee of healthcare. The Supreme Court ruled in 1976 that to deny necessary medical care to an incarcerated inmate constituted cruel and unusual punishment. Because of this ruling, every correctional facility, even a tiny county jail with only 10 beds, has to have some program in place to provide medical, dental, and mental healthcare to its inmates. No wonder my jails were so eager to find a willing medical practitioner!
One other thing happened, though, when I began to practice jail medicine full time — I became almost invisible to the rest of the medical community. When I was in the ER, I bumped shoulders with the other medical staff all of the time. Now, though, the only time I see my colleagues is when I run into them at the grocery store. And when I tell them that I left the ER to work in jails full time, I often get a quizzically raised eyebrow. I can see them thinking “What’re ya, nuts? Who’d want to work in a jail?” Their next question, though, is typically “What is it like?”
The thing is: I like working in jails. I was never unhappy as an ER physician. But I get more overall satisfaction out of my work in jails and prisons. This column will be my forum to tell you why.
Love this comment. So true
Love this post. I don’t think many of us back in our college years taking classes to become a physician or nurse practitioner thought to ourselves..”Someday I hope to work in a jail!”. I know that was definitely not the case for me. I have been working as a nurse practitioner at a county jail (which currently holds 800 males and 100 females as of todays count) for the past six years. I have seen more than I dreamed off (or wished I’d seen)…and just when I think I have seen it all, someone out there still finds a way to surprise me. It’s frustrating ,exciting, challenging and rewarding all occurring on a daily basis for me. I can honestly say though I really love what I’m doing.
As a side note…is anyone dealing with inmates who have smoked the synthetic marijuana laced with rat poisoning causing severe coagulopathy? We have been getting several inmates who have experienced this. The treatment is high dose Vit K1 (Phytondione), usually 25-50mg up to TID until therapeutic INR is reached, then slowly titrate the dose down. This can take up to several weeks or even months. The challenges I am having right now are 1). People who are non-compliant prior to coming to jail or were managed at the jail then left and came back and were non-compliant with treatment (and smoked K2 again) 2). The medication is extremely expensive. Our pharmacy is quoting approximately $1600 for 30 pills (5mg). I have one patient receiving 50 mg twice daily right now which comes out to roughly $1000 per day! Just wondering if anyone else has treated any cases of this and how you are managing. I live in Illinois and I believe this a more isolated issue right now, but with all things it will likely spread to other areas or be something we will all be dealing with at some point.
I respect this. Health care in this country is set up so only the rich can afford it. The medical field is a profit focused industry. It’s sad that the poor can only get the medical help they need once they are in prison. Imagine all the law abiding poor who never get treatment for their health issues.