When it’s time for work, Catherine R. Judd, MS, PA-C, goes to jail. Marybeth Floyd, FNP, BC, heads to prison, and so do Kim Dotson, PA-C, and Linda Gruenwald, ARNP. These clinicians are among the many who work in a correctional facility, providing health care to an incarcerated population—many of whom might not have readily accessed such services “outside.”
While correctional facilities vary in their set-up and security level, most practitioners agree that working in these settings has given them opportunities they would not have had in primary care.
“Our patients present very unique challenges, but working in this environment has made me a stronger clinician,” says Dotson, who has worked for the Washington Department of Corrections at Airway Heights Correction Center for seven years. “I see things in prison that I could go a whole career and never see outside that population.”
READY FOR ANYTHING
Much like the general population, the inmate population in the United States has a significant amount of chronic illness—everything from hypertension, hyperlipidemia, diabetes, and hypothyroidism, to HIV and hepatitis C. There are patients with renal insufficiency and kidney disease that requires dialysis. There are mental and behavioral health issues, gastroenterology complaints, and dermatologic disorders.
“What is unique about corrections is that if you were in the community as a family practice clinician, you would see things and then refer the patient to a specialist,” says Gruenwald, who has spent 10 years with the Oregon Department of Corrections at the Two Rivers Correctional Institution. “But in the DOC, you really get the opportunity to learn about these complicated disease processes, because you are expected to care for that patient.”
The available services vary by location, but most correctional facilities have what would be considered an outpatient clinic and an infirmary. The latter often functions in a nursing-home or assisted-living capacity, in addition to housing patients who require more acute care, such as IV antibiotics or wound care. Airway Heights Correction Center has a lab and x-ray services on site, although specimens are sent off-site for processing and films for radiologist review. At Two Rivers Correctional Institution, dental and optical services are available, as well as dialysis. The Dallas County Jail, where Judd has worked for eight years, also has a dialysis unit and a full-time obstetrician-gynecologist to provide women’s health care.
Judd herself works in mental health services, which provides care to about 1,500 inmates out of the approximate total population of 7,000. Her unit manages patients who, if they were in the community instead of in jail, might be hospitalized for major depression and/or suicidal tendencies, as well as persons with (possibly untreated) schizophrenia, bipolar disorder, and other psychiatric disorders.
“For many of the patients who come here, we are their only access to medication. We may be the only door that will open to them for mental health care, because if they come to jail, they’re going to receive care,” she says. “I would say the same for the medically ill—for many of the women, the only time they’re going to get a Pap smear or a pelvic exam is when they come to jail and get their Ob-Gyn services here.”
The volume of patients and the lack of access to care in the community (whether through circumstance or choice) results in a variety of ailments for correctional medicine clinicians to identify and address. “You get to see so much more pathology, things that when they teach you in school, they say, ‘Well, we’ll tell you about this, but you’ll never see it,” says Floyd, who is a Regional NP in Arkansas with Corizon Health, an organization that specializes in medical staffing for correctional facilities. “I see those things.”
Some of the more unusual diagnoses include Fournier’s syndrome and Henoch-Schönlein purpura. A patient with the latter condition was taken to an emergency department with gastrointestinal bleeding, at which time it was discovered that the disease had already started to damage his kidneys. When he was stabilized, he had to return to prison. In such cases, the medical/nursing staff on site needs to understand how to manage the condition.
“When that patient comes back to our facility, we have to do that follow-up care,” Gruenwald points out. “We have to determine how to monitor him, what medications he’s going to need—with the help of a specialist, of course.
“But when it comes right down to it, you are still the primary care provider and so you have to have some type of knowledge about the diagnosis and treatment.”