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/
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