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.

Dr. Bill Wright on another way to run a prison

wright

I have previously written about Doc Wright, and his fabulous book Maximum Insecurity. Dr. Wright has written a new book that I hope to review soon. Jailhouse Doc is a memoir of his time as Medical Director of the El Paso Criminal Justice Center in Colorado Springs.

“Hoards of desperate people fresh from the streets, homeless addicts, illegal aliens, and gangbangers all ruled by a corrupt sheriff and his concubine sidekick made the supermax look almost pastoral. Told with humor and biting wit by the best-selling author of Maximum Insecurity, Jailhouse Doc follows Dr. Wright and his struggles with scamming inmates, corporate bureaucrats, and a sheriff who wants to be a doctor.”

For now, I am privileged to post Chapter 30 of Jailhouse Doc.* If  you care about prisons and inmates and money and crime and recidivism and humanity, you will be interested in Wright’s serious observations about another way to run a prison:

 

Chapter 30 – Philosophy: Enter at Your Own Risk

America is the land of the second chance—and when the gates of the prison open, the path ahead should lead to a better life.” – George W. Bush

In my country we go to prison first and then become President.” – Nelson Mandela

 

After nine years at this game of correctional medicine, I’ve got some thoughts on jails, prisons and in particular our system in the U.S. We’ve got lots of agendas when it comes to putting people behind bars, and not all of them seem very productive.

The first thing to remember is that most people in jails and prisons get out. They’re your neighbors again, working (or not) in your community around you, your spouse, and your children.

It’s a sad fact that the majority of people released from U.S. jails and prisons commit further offenses and head back behind bars again to repeat the cycle. What’s wrong with these guys? Didn’t they learn their lesson the first time?

Well, they did. They just learned the wrong lesson.

When someone commits a crime against another person, there’s a lot of emotion on both sides. What we want is for everything to be put back the way it was, like nothing ever happened. In this world, that’s not going to happen.

As the next best thing, society wants punishment of some kind. Just like when we were children, if we did something wrong and were punished, we’d learn to not do that again.

It seems reasonable, but it makes a lot of assumptions.

It assumes we’re in an environment where we have a model for better behavior and encouragement to follow that model. Jail isn’t famous for being a nurturing and supportive environment. Mom and Dad aren’t here, but Professor Butch and Professor Bubba are. Guess what the lesson today is. Breaking and Entering 102 or maybe Sexual Predation 203. Most inmates don’t learn new skills in jail; they learn new hustles.

So what do we do with thieves, rapists, and murderers? We might take a look at the Swedish model.

At over 700 imprisoned per 100,000, the United States leads the world in incarcerating its citizens. That’s like locking up the entire population of Houston, Texas, the fourth-largest city in the U.S. It’s more than ten times the rate in Sweden. The incarceration rate, while climbing in the U.S., is falling in Sweden, down a whopping 6 percent last year. Are we missing something?

If you look at prisons in Scandinavia, like Skien maximum security prison in Sweden or the island prison of Bastoy in Norway, we see a very different physical setup from supermax prisons in the U.S.

In Colorado’s maximum security prison, Colorado State Penitentiary (CSP), inmates are confined 23/7 to individual cells with steel bunk, desk, stool and toilet. A solid steel door with a tray slot for passing medication and food is the only contact a prisoner has with the outside. Exercise is also solitary in a spare room with a chin-up bar as the only furnishing.

In Sweden, their prison rooms look like a Motel 6 with TV, computers, bookshelves, rugs on the floor, curtains at the windows and separate areas for reading and recreation. The prisoners, with some exceptions, aren’t isolated, but are part of a community where each has a job with responsibilities and free time. They live in small, brightly painted wooden bungalows that accommodate up to six people.

Every man has his own room, and they share kitchen and other facilities. The idea is to get them used to the social situation they’ll encounter when they’re released. They earn about $10 per day and get a food allowance of about $120 per month. They fix their own breakfasts and dinners from items available in the prison’s supermarket.

For these prisoners, loss of freedom is their only punishment. Administration puts emphasis on cultivating individual responsibility and functioning in a community environment. Recidivism is about 30 percent in Sweden and only 16 percent for those released from Norway’s Bastoy prison, versus 65-70 percent in the U.S.

Bastoy’s governor, Arne Nilsen, a clinical psychologist by profession, makes a point: “In the law, being sent to prison has nothing to do with putting you in a terrible prison to make you suffer. The punishment is that you lose your freedom. If we treat people like animals when they are in prison, they are likely to behave like animals when released.”

Granted when I went to work at CJC I’d already had years of experience in corrections, but many start the job with zero corrections knowledge. In contrast, Norway requires three years of training to become a prison guard.

So is treating prisoners like human beings rather than people who should be shunned the secret to the Scandinavian success? That’s certainly part of it.

A second feature is placing greater emphasis on reaching young people at risk for trouble before they get into the formal justice system. It’s a compelling fact that 80 percent of death row inmates in the U.S. are products of the juvenile justice system.

Maybe these men could have been rehabilitated if reached early enough in their lives or if they were taught a different way when they started down the slippery slope of antisocial behavior. I don’t know if this is true, but it’s something we should think about in view of the Swedish model’s superior results.

Although it’s expensive to spend on preventive measures like education and social work to intervene in bad situations, it’s more expensive to let the problems develop. One estimate claims that $1 spent in prevention saves $17 in later costs of property loss and incarceration, let alone personal misery. Like the old oil filter commercial said, you can pay me now, or you can pay me later.

Regardless of one’s outlook on punishment, I think we can all agree that the best outcome of any crime is if it never happens. I’m way out of my depth proposing sweeping social change, but I think we need to rethink our concept of imprisonment. Is vengeance better than rehabilitation?

Any crime is horrible for the victim. The desire to lock up the perpetrator and throw away the key is strong. Society has a different stake. Most of the offenders are going to be out again, and we have an interest to prevent additional offenses.

Is loss of freedom enough of a punishment? Having worked around that atmosphere for nine years, I can vouch that loss of freedom is a major deal. If we could make the time in jail or prison actually productive for the offender, maybe it will be productive for us as well. Maybe treating criminals like human beings is an idea whose time has come.

Please tell me what you think.

RGK

*Doctor Wright has given me a one-time license to publish Chapter 30. He retains the copyright. No republication of Chapter 30 is permitted without Dr. Wright’s express written permission.

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