The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 7

I
tell new hires or interviewed ap-
plicants that it’s like working in
a third-world country,” said Nan-
nette Vowell, MD , of her work as medical di-
“
rector of the Ouachita River Correctional Unit’s
Special Needs Hospital. “It’s basic medical care,
with basic equipment and dedicated staff. If you
approach it that way, it’s doable because you
sort of know what you’re getting into.” It’s chal-
lenging, rewarding, and a specialty she invites
more physicians to discover.
Located in Malvern, ORCU is the state’s only
prison-based hospital. “It’s a two-man, two-
bed-per-cell barracks that we’ve turned into a
hospital,” said Dr. Vowell. “Picture a horseshoe
grouping of rooms with a nurse’s station in the
center. We don’t have x-ray, in-house lab, or
ultrasound. We keep a small stock of certain
medicine; beyond that, we’re required to go to a
pharmacy that ships us overnight the medicine
that we need.”
ORCU is also the state’s male intake unit.
(McPherson Unit in Newport is the female intake
unit.) All inmates moving from an Arkansas jail
to another Arkansas (or out-of-state) prison stop
first at ORCU. There they are assessed by a den-
tal, mental health, and medical team before be-
ing assigned to a parent unit such as Cummins,
East Arkansas, or another Arkansas Department
of Corrections facility.
A Glimpse Inside
About 1,800 inmates reside at ORCU, and
there are 27 hospital beds to go around. Divided
into non-hospital care and special-needs care
(hospital), the facility’s medical staff includes
three physicians, two nurse practitioners, one
physician assistant, and a plenteous nursing
staff.
One physician works the non-hospital side,
which sees the healthier patients – treating
chronic health issues like diabetes and hyper-
tension in addition to acute medical illnesses. In
contrast, Dr. Vowell and her staff service roughly
900 special-needs patients, who vary in severity
from severe psychological illnesses to total care
for all activities of daily living – and all points in
between.
While prison physicians treat the same mal-
adies as other physicians, their circumstances
around providing that care are quite different.
There are many misconceptions about working
in the prison system, according to Dr. Vowell, and
generally, much to share with her “free-world”
colleagues.
She would point out first that physicians
that choose to work in corrections are generally
trained in family practice or internal medicine.
“There aren’t a lot of physicians looking to work
in corrections,” said the internal medicine physi-
cian who – training aside – has developed quite
a passion for her job caring for incarcerated pa-
tients. “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.”
(Correctional medicine is gaining a foothold
as a recognized medical specialty, particularly
on the osteopathic side. David
Thomas, MD, JD, was instrumen-
tal, with Anthony J. Silvagni, DO,
PharmD, in the American Osteo-
pathic Medicine’s first approved
designation of correctional medi-
cine as a medical specialty. That
designation happened in 2012. In
2014, the AOA awarded the first
board certification for correction-
al medicine.*
I have had to learn much about post-op ortho-
pedics, pulmonary, and other specialties,” she
said. On the other hand, it can feel isolating at
times. “There isn’t much access to colleagues
here. There are not opportunities for sidewalk
consults. I’m fortunate that I have a couple of
advisors that I can bounce ideas off. There are
prisons out there with a single MD or APN that
never sees another colleague in his day’s work.”
Who Controls Whom?
A typical 10-hour workday at ORCU finds Dr.
Vowell close to the patients she cares for (more
so than if she worked in an outside clinic). Still,
she has no control over them. “My patients are
wards of the state, with individual rights,” she
noted. “That’s important for [outside] physi-
cians to understand. The medical
staff cannot give consent for the
patient. The patient can refuse
treatment, medication, dialysis,
surgery, etc., just as any other
patient can. Of course, if it is life-
threatening, and the patient can’t
communicate at all, we do every-
thing [we can] to save a life.”
It’s frustrating, she shared,
seeing a patient continually re-
Nanette Vowell, MD
fuse life-preserving medication,
Much like serving on a medi-
particularly
when
you work in close quarters
cal mission trip, Dr. Vowell treats ORCU patients
with
that
patient.
“All
providers have non-com-
who are suffering from a variety of disease in all
pliant
patients,”
she
noted,
“but with my office in
its stages. More self-neglect is seen initially with
the
middle
of
the
room
and
the patients walking
these patients. “A patient may come in with a
up and down the halls to and from the chow,
large cancer on his neck that has gone untended
pill call, and classes, I see these guys more fre-
for a period of years,” she elaborated. “Another
quently than 30 minutes in an exam room one
may have rheumatoid arthritis so severe that he
time a month. So, I feel it hits home just a bit
is completely debilitated.
more. We get everyone involved to be sure the
“The [doctor-patient] relationship is es- patient is making a fully-informed decision –
tablished relatively quickly and can provide a the chaplain, mental health staff, officers, and
positive influence. It’s rewarding to educate sometimes his family. But ultimately, these guys
these patients to take better care of themselves. make their own medical decisions.
There’s no doubt we’re making a difference.
“We are all in the business of good health
In prison, they have access to health, dental,
care for patients,” she said. “I think the biggest
and mental health care. Some of the patients
thing for me is for the ‘free world’ providers to
have never taken the time to consider their
understand that we on the ‘inside’ need more
own health. These guys use the spiritual, men-
communication. We implement the plan that
tal health, and medical support to really make
the consulting physician recommends. We can’t
changes in their lives.”
make the patient compliant, but we can be sure
Addressing a variety of malaise without the that the tools and motivation are there for the
benefit of specialist consult is one unique chal- plan to be successful. A good discharge sum-
lenge her job setting creates. On the one hand, mary, a doc-to-doc call, and good consulting
it has strengthened her ability to sort out an- notes with detailed treatment plans are best.”
> Continued on page 32.
swers alone. “I’m a little more multi-faceted, as
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