Dr. Marc F. Stern says he feels safer as an internist working in correctional settings than he did in his previous career working for the Veterans Affairs health system.
In that setting, he said, one patient pulled a machete on him in the emergency department. Another tried to open the emergency department door with a chain saw.
“I've never had any of those experiences in prison,” said Dr. Stern, an internist who is health services director of the Washington State Department of Corrections. “Health care professionals in prison are very safe … possibly because patients view the health care folks as there to help them.”
Working in correctional settings is the best-kept secret for physicians with an interest in public health, he said, because the pathology of inmates is wide ranging and the ability to impact their health and well-being is significant.
“We have an opportunity to affect their health, their health care behaviors, and … their social behaviors. This is a population that has a high prevalence of diseases like HIV and hepatitis C. So we have an opportunity to control the disease and teach them low-risk behavior, so when they come back into our communities, they are less likely to spread disease.”
He acknowledged challenges to practicing in correctional settings, including a reliance on tight government budgets and a certain level of animosity from the general public for providing health care to prisoners when so many civilians in the United States lack adequate access to health care.
“What they don't understand is that prisoners have a constitutional right to access to basic health care. That's something the citizens of the United States have said they want through the constitution,” he said.
Dr. John May finds the field of correctional medicine so rewarding that he founded the Florida-based Health Through Walls, a not-for-profit group of volunteers providing sustainable health care in jails and prisoners located in underserved countries.
“Being conscientious in correctional medicine is one of the most important components of delivering good care,” said Dr. May, whose program assists inmates in Haiti, the Dominican Republic, Jamaica, Tanzania, and other counties. “Following through and trying to understand the issues a patient presents with are more important than the medicine you prescribe or the work-up you order.”
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 saw [dedicated] people who had the same values and satisfaction out of medicine that I was seeking.”
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.
“If we can provide good quality care while they're incarcerated, it can have a positive impact on the whole community health system,” 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 in the United States. “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.”
He remembers an inmate whose complaint was nasal congestion so bad that he had no sense of smell. “He said, 'I couldn't even smell a dead body if it was in front of me.' That statement represented his hopelessness. So I said, 'Why couldn't you say I couldn't smell a beautiful flower?' He said, 'I guess this place is getting to me.' 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.
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