Jailhouse Doc

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William Wright, M.D., is at again. This time he writes about running the medical department at a large urban jail in Colorado that houses about 1,500 inmates. As I have indicated before regarding Bill’s first book Maximum Insecurity, the doctor is a renaissance man and a lyric writer.

We learn something more about Wright in his second book, Jailhouse Doc. That is, physicians like Wright, particularly those who have practiced as surgeons,* can’t be pushed around. More on that later.

Wright “retired” from his speciality surgery practice, and then, out of boredom, took a job being a doctor at a  Colorado maximum security prison. When offered the job of running a jail medical facility closer to home and one which paid better, Wright took the offer.

Remember now, Wright was moving from a maximum security prison to a jail. How hard could that be? Jails are run by county sheriffs, right? Go ahead, picture Andy of Mayberry. WRONG.

If you are a lawyer, a judge, or an inmate, you know the difference between prisons and jails. By comparison, prison are relative islands of tranquility and normality when compared to the utter chaos and abject craziness of jails.

Most of the time, jails hold prisoners for a short time. Frequently, thirty or sixty days is the length of stay, although a fair number stay a longer as they await disposition of felony charges. Think of an Army MASH unit. There is a never-ending stream of patients.

Many are really sick; that “is acutely and chronically ill street people” present themselves to the medical staff at jails each and every day. Wright tells us about “homeless men whose socks had literally grown into their feet” and women “who would come in with tampons that had been in place for months.” Addiction and psychiatric problems abound.

Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of emergency medicine practice experience before moving full-time into his “true calling” of Correctional Medicine. He is the Chief Medical Officer of Centurion as well as the Medical Director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho.

Here is Dr. Keller’s take on Dr. Wright’s book:

Everyone who has worked in corrections for any length of time accumulates a litany of anecdotes about the funny and crazy things that go on. These tend to get passed around whenever correctional personnel get together at parties or conferences. Invariably, someone eventually says, “You know, someone should write these stories down.” Well, finally someone has.

Dr. William Wright has published a sparkling and humorous memoir of his time working in a county jail entitled “Jailhouse Doc.” This book is well worth reading. In fact, it is almost a “must read” for those of us who work in correctional medicine. Not only is it the only book I am aware of about jail medicine, it is well written, funny and informative.

If there is such a thing as “medical realism” in the correctional context, Wright is the master of it. While the book is written around anecdotes, collectively those vignettes paint a whole picture. The truth is that many American jails are hell holes.**

Yet quality correctional care in jails, including medical treatment, is often provided by employees who work under some of the most stressful conditions imaginable. Ultimately, Dr. Wright’s book is paen to those honorable and courageous people–from deputy sheriffs, to nurses, to doctors and beyond.

Here, in no particular order, are few of the anecdotes that Wright uses to paint the picture:

*  It is not a good thing, medically speaking, to put drugs up your ass or, for that matter, any other orifice. In a jail, when prisoners first enter those hallowed halls, the medical staff must be very aware of the possibility that the new inmate is mulling drugs. Dr. Wright speaks knowingly of instructing a new inmate to remove a balloon of drugs from the hole through which a colostomy bag was attached.

*  The doctor laments the female inmate whose blood pressure began to drop like a rock as a result of a package of drugs that she had stashed in her vagina only to have it leak out and intoxicate her. And he notes laconically the inmate who died of a heroin overdose when the balloon popped. His body contained 8,000 times more than the lethal dose.

*  Wright describes a facially absurd accusation that he sexually assaulted a male prisoner during an examination in the busy clinic, the obligatory investigation that followed and his exoneration. Why the false claim? Sociopaths get bored too!

* He speaks of ICE (Immigration and Customs Enforcement) and the prisoners housed at the county jail by the Feds awaiting deportation. He speaks almost lovingly of these poor souls and their wonder that he willing provides medical care, perhaps for the first time in their lives, while speaking Spanish with them. Interestingly, his dislike of ICE mirrors the experience of Dr. Keller. (Secret: I don’t much like ICE either.)

*  Wright discusses an important issue regarding the treatment of Hepatitis C. There are new drugs on the market that may cure this awful disease***, but they are expensive, extremely expensive–perhaps a $100,000 per patient for a full course of treatment. Will these curative drugs be used in jails when all too frequently the causes of Hep. C–dirty needles and such from drug use–are surely to return to the jailed inmate’s life after he or she hits the streets? This is a huge policy and legal question for which we have no answer. As Wright says, “If you have a solution to this problem, write it on the back of a twenty-dollar bill and send it to me.”

*  If you were a doctor, how would you treat the medical needs of a husband and wife in jail accused of burning their children alive to recover insurance money so they could pay their drug suppliers and thus retain the luxuries of their very lucrative business? Dr. Wright speaks candidly and openly about his approach.

*  There are funny moments, many of them. Consider the one simple example of the inmate who stressed to Wright the need to see an “obstetrician” because he needed glasses.

Least you worry that the doctor is exaggerating, consider this review on Amazon from someone who worked closely with Wright:

Dr Wright, I heard about this book from a handful of others, many of them El Paso County Sheriff’s Office employees. Having worked with you as the HSA at CJC, I have to admit, this was a great read – very quick and easy to follow. Having actually worked with you there at CJC, it was very comical and reminiscent of some interesting times. Thank you for your ability to “paint a picture” with your experiences and share them with others not familiar with the correctional medicine environment. I encourage others in the medical field to share this book with others that may be interested in ‘testing the waters of correctional medicine’. Working in corrections is definitely not for everyone; however, it is also not a path often thought of for medical personnel. I have great, great respect for those I worked with (including you) at CJC (both medical and many in Security working for the Sheriff’s Office), and encourage readers to go check it out when you are done. I encourage those in the medical field, from Medical Assistants all the way to provider level, to check out corrections and give it a try. Every day was an adventure and no two days are ever the same – these stories in this book are definitely real….and only the tip of the ice berg for what you will see and encounter. Those that know you, know you have a passion for helping people and doing whatever you can to make the best of the situation at hand. You are not only missed by many of the medical unit staff (most of which are not even there anymore), but also by me.

Wendy H., Amazon, Memories are Abundant!!!, October 22, 2014

As Dr. Keller notes, Wright’s time at the jail “does not end on a positive note.” Indeed, the book ends on a decidedly dark note that raises extremely important policy questions about how medical care should be provided in jails (and for that matter in prisons).

Who really runs the medical facilities within a jail? Is it the Sheriff or Chief Deputy who may think they know more about medicine than the medical professionals? Is it the corporation that contracts to provide medical care to jails in order to make a profit?

I won’t spoil this somber story. You must read the book to find out. I can tell you this though: Physicians like Wright, especially those who were trained as surgeons****, will not be pushed around. For that, correctional docs, like Wright, deserve nothing but praise.

RGK

*Trained at the University of Michigan Medical School, Wright practiced 30 years as neuro-otologist. That is “a branch of clinical medicine which studies and treats neurological disorders of the ear. It is a subspecialty of otolaryngology-head and neck surgery.

**For one such example that I dealt with personally in 1994, as a young district judge, see Whitnack v. Douglas County, 16 F.3d 954 (8th Cir 1994) (there was “‘paper and food and stuff on the floor . . .there was ‘hair, dried mucus, spit, [and] vomit in the sink’ . . . there was ‘dried human waste’ on the toilet seat. . . . there was ‘a partially-eaten pear’ and ‘a partially-eaten sandwich’ on the floor . . .there were ‘cigarette butts and ashes on the desk’ . . . there was garbage in the toilet bowl . . . there were dried puddles of urine on the floor . . . there was dried ‘snot’ on the wall.”;  a guard refused to give the plaintiffs cleaning supplies; the Court of Appeals stated that “we find the conditions of Cell C-18 . . . , to have been deplorable”; however, the Court of Appeals ruled that the jury’s verdict of nominal damages in the sum $1.00 plus my award of attorney fees must be reversed because the 24-hour confinement in the filthy cell was not long enough to inflict a Constitutional injury).

*** My brother-in-law is a liver specialist and the head of the department that treats such ailments at the University of Nebraska Medical Center. He has spoken to me about the revolutionary potential of these drugs and their costs.

****I revere surgeons. See here.

Casual cruelty–part two

More than a few commentators responded to my earlier post Casual cruelty about the fellow who was deprived of his medications because of a silly rule at Douglas County Corrections. One of the concerns was that I had failed to see to it that he would get his medications. I cleared this up in a comment on Simple Justice. My comment read as follows:

SHG,

I knew that he would be taken back to D&E where they would administer the medications D&E authorized. As a result, I was not required to enter a order directing that he get his medications. I also offered to sentence the guy in Lincoln the next time around so we wouldn’t have to go through this nonsense again since D&E is located at the main line prison in Lincoln.

All the best.

RGK

Scott responded:

Judge,

That circumvented the problem, but neither dealt with the problem of an act of casual cruelty toward a prisoner nor saved the next human being, who might not be so lucky as to make it to your courtroom alive. I understand that the courts and BOP have to get along, but isn’t there a limit?

The sense from your post is that a judge is powerless to protect this prisoner. Is that so? Why?

Scott deserves a response.

One of the dirty little secrets in the federal judicial biz. is that federal courts such as ours are at the mercy of local jails to house our prisoners. The US Marshal spends a great deal of time trying to manage these relationships because ultimately we harm prisoners and their lawyers if the local jails refuse to take our prisoners.

Case in point: The local jail in Lincoln takes very few of our prisoners. At one point it took none of our prisoners. As Chief Judge, I begged the Lancaster County Commissioners to take more prisoners and we even offered to partially fund the building of a new jail. They were polite but not responsive. The result is that our defense lawyers must travel hundreds of extra miles to see their clients. At one point, we were holding prisoners as far away as Wisconsin. Why was the local jail administrator acting this way? Years ago, the Department of Justice, through the Marshals Service, did a contract audit and DOJ cited the local jail for violations of the contract standards. After that, I am told that the local corrections official has maintained a hard-on for the feds lasting far longer than four hours.

In fact, the only reason we can now use D&E at the prison in Lincoln as a partial substitute is because our US Marshal, a long time and highly respected cop, has a good relationship with state prison officials. By putting prisoners at D&E, the Marshal has done a huge service to prisoners and defense lawyers alike by avoiding the very serious problem of housing prisoners in far off places while providing prisoners with decent and local short-term facilities offering satisfactory medical care.

Now, let’s get back to Douglas County Corrections in Omaha, the jail that refused the medications issued by D&E to my prisoner. Douglas County Corrections does not need our business. If they cut us off, prisoners will be held all over the mid-west. So, if I order the US Marshal to land hard on Douglas County Corrections for a relatively minor problem with one prisoner’s meds spanning one day, the cost of doing so is ultimately paid by federal prisoners and defense lawyers alike.

With the foregoing in mind, this is the path I took in this case and the one I have taken in other cases when I have a problem with local jails:

  • First, I fix the problem for the prisoner. In this case, I sent him back to D&E where I knew he would get his meds. I also arranged to change the sentencing venue to avoid the problem for that prisoner in the future.
  • Second, I make noises to the US Marshal in the hopes that the US Marshal will exercise his power of private persuasion to convince Douglas County Corrections (or any another offending jail) to alter a stupid policy to avoid similar situations in the future.
  • Third, I do not shrink from upsetting corrections officials if there is no other option. Indeed, angering the Governor, I blew up the State of Nebraska’s “double bunk” policy that placed prisoners in cells without screening for safety concerns. But, I don’t exercise that type of power in situations like this one unless the benefits clearly outweigh the costs to prisoners and defense lawyers.

More than 40 years ago, I read Abraham S. Blumberg’s 1967 classic entitled The Practice of Law as a Confidence Game: Organizational Cooptation of a Profession The premise of the article was that judges, prosecutors, defense lawyers and others in the criminal justice system make all sorts of compromises to make their lives easier. They do so at the expense of the defendant. Throughout my judicial career and otherwise, I have been acutely aware of that tendency, and I have sincerely struggled to avoid knowing participation in those selfish conspiracies. That said, the perfect must never become the enemy of the good. Perhaps I delude myself, but, as I see it, my handling of this bit of casual cruelty was one of those situations

RGK

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