The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 8

The Medical Goal “The medical goal at ORCU is to keep in- mates’ footprint in the community to a mini- mum,” said Dr. Vowell. “It would be startling for most people to see a shackled man flanked by officers sitting in the waiting room. Instead, we’re trying to establish more on-site clin- ics, so we can get physicians to come to the unit or participate in telehealth. We want to keep the patient here and bring here every- thing that he needs.” “The policy I had would not cover the prison. I could only find two companies nationally that would write a policy covering that. Malpractice alone for me to go out there is around $1,300 per day.” Depending on the specialty they’re provid- ing, some outside specialists may only need to come once per month or even less often. “We have a nephrolo- gist that comes once a month and manages our dialysis pa- tients, but we could benefit from having pulmonary, urology, en- docrinology, and neurology,” said Dr. Vowell. Surgeon Robert Breving, MD, visits ORCU’s special-needs clinic every other weekend to help with upper endoscopy and colonos- Still, at times it’s simply copy patients. While he doesn’t do necessary to take patients to an operative procedures on site, he outside clinic or hospital for treat- Robert Breving, MD does carve out time when needed ment. This is no small chore. So for on-site general surgery consultations. He will many people must know of the pending appoint- recommend the appropriate course of action. Af- ment, from the warden to the corporal who will ter that, it is up to Wellpath to determine where drive the van. “Sometimes the consulting office they will send the patient for definitive care. clears the office for the patients to be seen – it is (ADC contracts with Murfreesboro-based Well- quicker in and out for everybody,” she explained. path to provide health care services to prisoners “These trips out of the unit require security to be in the state of Arkansas.) on high alert to protect the community and the in- “It’s a different world, but I enjoy it. I love having a wide variety of patients to care for in a single day. It’s a blending of hospital and office work all in one setting.” – Nannette Vowell, MD “If we can bring services to them, it does a couple of things,” said Dr. Breving. “It less- ens chances of prisoners escaping, but also it cuts costs significantly. A study done in another state** estimated that a round-trip visit to take an inmate to a hospital or clinic and back – transportation and medical guard costs alone – could be as much as $2,000. So, if I can see 10-15 patients a day there, that’s a significant cost savings to the state.” There are some real challenges that physi- cians should be aware of when coming on-site. Malpractice coverage – and the threat of frivo- lous lawsuits – can be an issue. “I started going out there seven years ago and had to purchase a different malpractice policy,” said Dr. Breving. mate. Offices and hospitals that are willing to co- operate with the extra complications and drama of providing care to the correctional patient are really appreciated. We have limited medical runs daily, and they are planned several weeks in ad- vance. We try to have all the information needed to have a complete visit every time we send a patient out. We try to use our resources wisely.”   Even though not on-site, physicians who are willing to see patients in their clinics despite the real scheduling and patient issues are doing a good service. Speaking to those who might be considering such, Dr. Vowell attempted to lessen potential fears. “Sometimes, physicians are un- derstandably hesitant about having shackled patients visit their clinic for fear that [those pa- tients] may frighten or even harm their staff or established patient population,” she said. “Most of the time, these guys are respectful and kind. They want their health issues treated. I often get comments from consulting physicians like, ‘He was really nice!’ or ‘He hasn’t been a problem here at all!’” As for getting started receiving patient vis- its, there isn’t as much red tape as one might expect. “They simply agree to do it, and they 32 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY understand that there will be two officers and a prisoner in shackles in their facility,” said Dr. Vowell. “Payment is through Arkansas Blue Cross Blue Shield of Arkansas, which is essen- tially a Medicaid plan.” Heeding the Call While specializing in correctional medicine is probably not a path most doctors have given much thought, many who have tried it believe it’s worth considering. In a January 2016 article from the American Osteopathic Association,*** veteran correctional medicine physician John G. Mills, DO, MPH, shared the plights and rewards associated with the job. In speaking to the quali- ties a physician needs to succeed in correctional medicine, he said, “You need to be positive and have an upbeat personality. The issues you en- counter, such as addiction and homelessness, can be hard on your psyche. I like to tell myself, ‘We did the best we could today. We’re going to come back tomorrow to do more.’” “I never imagined I would be in correctional medicine,” summed Dr. Vowell. “I have been here seven years. I learn something new every day. I’m grateful to Wellpath for the opportunity to continue to work in this system. I don’t think it’s for every physician, but I do think that ev- ery physician has something to offer this unique medical practice.” Physicians who would like to learn more about correctional medicine in Arkansas or how to get involved, please contact Dr. Vowell at [email protected] or Dr. Breving at big- bertmd@md. *https://thedo.osteopathic.org/2013/02/when- patients-are-behind-bars-new-specialty-chal- lenges-physicians/ **The State Health Care Spending Project, an ini- tiative of The Pew Charitable Trusts and the John D. and Catherine, reports, “Expenses add up quickly when inmates must travel long distances to see specialists or stay overnight in hospitals. The Legislative Analyst’s Office in California, for example, reported that medically related guard- ing and transportation costs for one inmate can exceed $2,000 per day.” http://www.pewtrusts. org/~/media/assets/2014/07/stateprisonhealth- carespendingreport.pdf ***https://thedo.osteopathic.org/2016/01/ working-with-inmates-a-correctional-medicine- physician-shares-insights/ VOLUME 116