If you have a rash, get an ear infection or need medication for your diabetes, you can get treatment at a rather exclusive, invisible hospital. But you have to be an inmate.
Earlier this summer, I spent two days and a night watching nurses, social workers and deputies at the Ada County jail’s health service unit as they treated inmate patients for everything from stomach pain to mental illness. Monday through Friday, the three dayshift nurses see upwards of 75 patients in the clinic, as well as urgent care patients. Night shift nurses may see another 20-30. And most say it’s the best job they’ve ever had.
Nurse practitioner Brad Bigford, mid thirties, moves like a basketball player off the court, deliberate, without jerkiness. He stays unruffled even as a patient curses him because he’ll not prescribe painkillers for her acne. Back in his office, Brad leans back and laces his fingers behind his head.
“Everyone has an agenda.”
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He and physicians assistant Eric Wells chuckle over a now famous letter written by an inmate and confiscated by the Minnesota Department of Corrections. The letter starts with “FLUSH DOWN TOILET” and then instructs inmates on what to say to get the antidepressant drug Wellbutrin and how much such prescriptions are worth ($360/month). The letter offers a two-page lead up, then suggests the closing script to use:
“Say ‘please help me’ and then shut up and let them do the rest. You must play the part and ‘look depressed.’”
Yet, Bigford worked in a hospital ward for years, and would never go back.
“Here, the range of problems is big. And we can do evidence-based ‘pure medicine.’ It’s easier to track meds the inmates take. We can see their progress. And, for some chronically ill patients, this may be the best care they receive.”
Brad next measures the blood pressure of a patient in his early fifties. The man’s deeply lined forehead, wispy auburn tonsure and beard don’t match his young hands, which have no wrinkles or spots.
“I'm concerned about your blood pressure. It’s 164/104, still high and going up. How about reducing your salt and getting more exercise during your ‘out time?’”
The patient’s resonant voice is like a radio announcer’s.
“it’s hard to exercise because I get dizzy. I can’t hear out of my right ear but I kind of like that because it’s so noisy in here.”
Brad checks the ear and asks the man to stand up. They both lean over the exam table as Brad draws a picture of the ear’s structure on the white roller paper.
“It’s infected. Let’s follow up next week.”
“I’m going…to prison next week.”
Not missing a beat, Brad says, “That’s ok. Your records will follow you.”
While the medical staff like the fast pace, variety and “pure medicine,” they and the deputies are taking care of people who may be at their worst. As several said, if we can do a good job on the inside, maybe the inmate can do better on the outside.
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This is the fifth of six blogs about my time at the jail. Thanks for reading. Next week: Who Shouldn’t Be in Jail.