The Making of a Prison Doctor

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On his first day on the job, in 1994, as medical director of Florida’s Zephyrillis Correctional Institute, Dr. David Thomas had to coax a defiant mentally ill inmate into climbing down from a tree so he might be medically evaluated and treated.

“That’s not the kind of thing you normally encounter in the practice of medicine,” said Dr. Thomas, who heads the first-of-its-kind division of correctional medicine at Nova Southeastern University’s College of Osteopathic Medicine in Fort Lauderdale, and serves as surgery department chair.

“Even in [non-prison] psychiatry someone else would have brought that person down from a tree and brought them to you,” Dr. Thomas told The Crime Report.

Certified by the American Osteopathic Association in January 2013, Nova Southeastern’s special division aims to steep correctional care physicians in the special needs of inmates.

Six years in the planning, the division is part of a mounting effort to grow the ranks of prison and jail health professionals—a workforce that not even the federal government has precisely counted and, observers say, one that historically has been difficult to develop and maintain.

(By comparison, emergency medicine became a medical specialty in the United States after 12 years of building support and getting the requisite medical accreditations for that move.)

In October, the Chicago-based osteopathic association will offer a landmark examination for osteopathic doctors already employed in correctional health but seeking certification in standardized correctional health care.

“This new board certification marks the first step in making correctional medicine a recognized sub-specialty in health care,” Dr. John Mills, director of correctional programs at the University of North Texas Health Science Center College of Osteopathic Medicine in Fort Worth, and an associate professor.

In addition to medical degrees, board-certified correctional health doctors must have a master’s degree in public health, given the interconnecting health, societal and economic profiles of the incarcerated. That group is disproportionately poor, under-educated and sick.

“For corrections, all of this is much more complicated,” said Dr. Johnny Wu, medical services director for the University of Connecticut Health Center’s correctional managed health care program.

In July, it will launch a correctional care physicians’ fellowship modeled after the one at Nova Southeastern.

At its core, the program recognizes that, in addition to hands-on medicine, there are other things to consider when doctoring the incarcerated, said Dr. Wu, who has provided hands-on correctional care or overseen it in Washington, New Jersey and Connecticut.

(The Connecticut Department of Correction is one of six nationwide that run jails, which generally are run by counties, and prisons.)

“There are issues of custody, of transportation if a prison needs to be transferred to a hospital for treatment,” Dr. Wu added. “Making sure officers are available, making sure the trip actually happens.

“There’s lockdown. There may be a fight. A demanded court appearance may take precedence over a clinical visit.”

Wu’s colleague, Dr. Robert Trestman, a medicine, psychiatry and nursing and professor and executive director of the University of Connecticut correctional care program, and Nova Southeastern’s Thomas are slated on March 20 to address this year’s Academic & Health Policy Conference on Correctional Health in Houston.

Like Thomas and Trestman, Dr. Wu didn’t specifically set out to work in correctional health.

But fresh out of medical residency training in 2001, as the junior physician in a medical office contracted to treat the incarcerated, he was tapped to help provide that care.

“I’m board certified in internal medicine and this has helped me be a true internist. It’s very rewarding work,” Dr. Wu, an MD trained in allopathic, not osteopathic medicine, told The Crime Report.

(Allopathic and osteopathic doctors are both licensed to practice medicine, and do so in many similar ways and at the same types of medical facilities. Osteopathic medicine, however, was established with a heightened emphasis on preventative care, using fewer prescription drugs and using the hands to diagnosis wellness or disease through what’s termed as osteopathic manipulative treatment.)

“The patients—90 percent of them—are enthusiastic about getting someone who is thorough,” Dr. Wu added. “It takes a special kind of person to have a little patience and some empathy and understand all the nuance of corrections.

“Dealing with these patients, to me, is what medicine is all about.”

Katti Gray is a contributing editor at The Crime Report. She welcomes responses from readers.

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