"If you're the medical director of a facility, you have possibly a couple of thousand residents," said Dr. May, an internist who is chief medical officer of Miami-based Armor Correctional Health Services Inc., a physician-owned company that provides health care in jails and prisons at various locations in the United States. "You're overseeing all of their day-to-day health needs. It requires a lot of system thinking, always looking at the big picture."
Dr. May started working in correctional medicine during his internal medicine residency at Cook County Hospital in Chicago, where he accepted an opportunity to moonlight at the Cook County Jail.
"I was immediately impressed by the dedicated physicians who worked there," he said. "I saw people who had the same values and satisfaction out of medicine that I was seeking," he said.
Those values include the chance to practice effective preventive medicine such as violence prevention counseling and viewing the provision of health care in correctional settings as a community responsibility. Many patients in these settings "are indigent and don't have regular access to care," Dr. May explained. "If we can provide good quality care during that window while they're incarcerated, it can have a positive impact on the whole community health system. If we fail in the jails, they're going to be worse in the community or use more episodic care. It's more costly that way. There's a lot of preventive health you can do in jails and prisons, such as vaccination programs, counseling, and education."
Dr. May remembers one consultation with an inmate whose chief complaint was nasal congestion so bad that he had no sense of smell. "He said to me, 'I couldn't even smell a dead body if it was in front of me,' "Dr. May said. "That statement represented the hopelessness that he had. I said, 'Why couldn't you say that I couldn't smell a beautiful flower?' That gave him pause for a moment or two. He said, 'I guess this place is getting to me.' We talked a bit about how he's letting that lifestyle consume him, surrounded by all of the negative influences, and I encouraged him to consider more positive ways of living. There's a lot of hopelessness and resignation in jails and prisons. Once they're incarcerated, they've lost their job, maybe their home. It's very difficult to get back on their feet. If they've alienated people in their lives, it's easy to fall back into behavior that will get them back into the jail."
Serious Dermatology Cases
Every Tuesday afternoon, Dr. Norman D. Guzick supervises a group of dermatology residents who provide care to inmates who are bused to the Texas Department of Criminal Justice Hospital, which is connected to John Sealy Hospital on the campus of the University of Texas Medical Branch in Galveston.
"You see some pretty serious cases," said Dr. Guzick, who practices dermatology in Houston. He called the prison population "one of the real drawing cards for the UTMB dermatology residency, because they see some significant pathology here, such as chronic cutaneous T-cell lymphoma, sarcoid patients, and skin cancer. There are a significant number of frail, elderly patients."
The residents go from person to person like they would in any busy dermatology clinic. "They're not put off by it at all," he said. "Sometimes, the patients have very unusual behavior. Others make some stupid remarks, but nothing beyond that."
Most of the inmates are poor and "haven't been provided good health care or good advice about anything," Dr. Guzick said. "In years past, I have gone to the prisons myself and given lectures to their so-called graduating class on sexually transmitted disease. They wanted to be brought up to some kind of speed on STDs before they went out into the free world." n
Dr. John May, pictured at Haiti's National Penitentiary in Port-au-Prince, founded a not-for-profit group that provides health care to prisoners in underserved countries. Courtesy Dr. John May