Reader Question: How Safe Is Correctional Medicine?

Ryan writes:

Hi Dr. Keller. I am a third year Physician Assistant student at the Rochester Institute of Technology. I am beginning to write a research paper, for which I have chosen to write about Correctional Medicine. Your blog appears to be an excellent resource, especially because there are so few publications on Jail Medicine. I was wondering if you or any of your colleagues would be willing to answer a few questions for my paper. If so, please contact me (contact information below), I would really appreciate it!

tcb-37079_resized1_325286Ryan’s questionnaire and contact information appears at the end of this blog post if anyone would like to help him with this very worthwhile project. If Ryan gives me permission, I will publish his paper here on JailMedicine!

It would take too long for me to answer all of Ryan’s questions here, but I would like to answer a couple of his questions that I found interesting. They are:

• What special training was required of you prior to starting the job? Self-defense?
• What are the security measures like while working?
• Are you accompanied by guards? Do you possess weapons? Are assaults common?

Ryan, there are several common misconceptions about medicine practiced in jails and prisons. One of these is that jails and prisons are dangerous places to work; that assaults by inmates on medical staff are common. Actually, this is not true.

In fact, I personally have found that my jail medical clinics are a much safer work environment than where I worked before. I started out as an Emergency Physician and worked in a busy ER for upwards of 25 years. During that time, I have been slapped, punched and kicked–several times! I was spat upon. I was peed upon. I was pooped upon (don’t ask).  I wrestled with out-of-control patients. I was threatened with violence many times. Though this never happened to me, one of my colleagues had a patient pull a knife on her in a small ER exam room. We found many guns in ER patient’s clothing. Guns were even found hidden in our ER waiting room! I’ve seen no shootings in my ERs, but gunfire in ERs elsewhere in the country are not uncommon. ER doctors and ER staff have been killed.

But none of these have ever happened to me in  the 15 years that I have been working in Correctional Medicine. My jail medical clinics have been much safer overall than emergency departments. The danger of assaults and violence are way less. There are several reasons for this.

1. Weapons are forbidden in correctional facilities. The Detention Deputies and Correctional Officers do not carry guns while on duty. Guns, and knives and other such weapons are not allowed in correctional facilities.
2. Inmates in jail and prison are, for the most part, sober when I see them. The most dangerous patients in the ER were those who were drunk or high. Inmates coming to scheduled “Sick-call” clinics are not.
3. Detention deputies are always nearby. We try to safeguard inmate privacy, but Safety and Security take precedence over privacy. This means that security staff are always nearby. In most clinical encounters, the detention deputy is just outside the room or down the hall, so that there is some privacy, but if something happens, the deputies can be there in an instant. In other cases, if an inmate has a high security level deputies may literally stand right by me. Especially dangerous inmates may even be shackled when I examine them.
4. Inmates are punished for acting badly in clinic. This punishment can take the shape of loss of privileges (like not being able to buy from the jail commissary or even the loss of visitation rights), transfer to maximum security status or even additional criminal charges.
5. I even can control profane language better in the jail than I could in the ER. In the jail, I can terminate a clinic visit if an inmate swears at me, knowing that I can see him again tomorrow. In the ER, I had to put up with bad language much more often because that visit was likely my one-and-only chance to make the diagnosis. If I sent the patient away, I probably would not see them again.

This does not mean that inmate on staff violence is non-existent; because it does happen. Detention deputies are assaulted by inmates. Medical personnel, on the other hand, are much, much safer than your typical Emergency Room.

How safe do you feel in your facility? Please comment!

Please Respond to Ryan’s Questionaire:

• What attracted you to working in Correctional Medicine?
-Did you have prior healthcare experience that influenced your decision?

• Could you tell me about the correctional facility you work at?
-Name, location, patient population, security level, For-profit or Public health organization, etc.

• What is your relationship like with the inmates?
-What approaches do you use to gain and maintain their respect?

• What special training was required of you prior to starting the job?
-Self-defense? Legal? Psychosocial?

• What is your daily schedule like?

• What are the security measures like while working?
-Are you accompanied by guards? Do you possess weapons? Are assaults common?

• How difficult is it to balance optimizing your patient outcomes and maintaining a good patient-provider relationship with the security guidelines of the facility?
-Ex: What happens if a patient needs services beyond what your facility can provide?
-How do you handle patients concealing personal information to you that is potentially dangerous to other inmates or out of line with the facilities rules?

• Do you have problems with patient compliance?
-Do patients administer their own pills? If not, how do you ensure compliance?
-Are special dietary requirements able to be accommodated? Are patients able to get enough exercise?
-How do you promote continuity of care upon inmate release?
-How much of your job is teaching your patients and other staff members?

• What are some of the more common or interesting presenting problems?

• Are you multilingual? Do you have interpreters at your facility?

• Do you find it hard to maintain professional objectivity while working with certain criminals?
-If you have treated patients facing execution, what has that dynamic been like?

• Do you have students rotate through your facility?
-If so what are some of the unique opportunities that a correctional medicine rotation offers?

• What has been the greatest thing you have learned from your job?

Please send responses to Ryan at

4 thoughts on “Reader Question: How Safe Is Correctional Medicine?

  1. I’ve worked in correction facilities over the past 8 years at security levels ranging from supermax to minimum. In general, the higher the level of security, the safer I am. I’m safer at the supermax than I am at Wal-Mart. As inmates gain more freedom of movement and congregation, the more likely violence will erupt. I agree with Dr. Keller that the ER can be more dangerous than any prison.

  2. I chose a few to answer here

    Do you have problems with patient compliance? YES

    -Do patients administer their own pills? If not, how do you ensure compliance?
    Some medications are “KOP” (keep on person). These are usually daily medications such as blood pressure medications, etc. KOP is a privilege and not a right. Medications that may be diverted are not KOP. Antibiotics are often given at pill call and not KOP so that we can know if the medication was actually being taken.

    -Are special dietary requirements able to be accommodated? Are patients able to get enough exercise?
    No, there are “special diets” but they are not conducive to disease processes. Diabetics still get way too many carbs. The higher security, the less rec time. In general they get an hour of rec time.

    -How do you promote continuity of care upon inmate release?
    Inmates get one month worth of medications upon discharge. We are rural, so unfortunately no free clinics, etc to refer them to.

  3. As a nurse, having worked in many different environments, including Emergency Departments, I can say that I feel much safer in corrections. It may not be as clean, it may not be as modern, and you may totally lack some things you take for granted. But our patients treat us far better than those in community hospitals.

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