Meeting The Medical Needs Of Wisconsin’s Growing Prison Population

Wisconsin’s prison population is growing and the University of Wisconsin-Madison School of Medicine and Public Health is responding.

This fall a new course will be offered to teach future doctors about a unique group of patients they are likely to come in contact with, whether in prison or out in the community after they’re released.

Madison doctor Joan Addington-White still remembers trying to give a physical to a man in a psychiatric ward decades ago. At the time, she was a young medical student working at Michael Reese Hospital in Chicago. In retelling the encounter to a group this spring, she recalls being frustrated she couldn’t hear the man’s heartbeat through a thick straightjacket.

“So I just said, ‘This is crazy, I can’t do this,’” Addington-White said.

During a forum previewing the new class, she told medical students she didn’t complete the physical. But before leaving, she looked at the patient’s face.

“And I realized he was so much more scared than I was. So all I could do was, I put my hand on his chest and I said ‘It’s going to be OK; it’s really going to be OK,’” said Addington-White, who oversees the primary care residency track for UW-Madison medical students.

Medical school can’t prepare students for every real life situation, emotional or otherwise, but they’re trying to reach patients where they’re at. Some courses are evolving to recognize factors that can affect health care, like a patient’s education, culture, finances and where they live. And for more than 23,000 people in Wisconsin, home is behind bars.

“We know they have more health care problems than the general population. We know that diseases that (current or former inmates) have are not necessarily going to stay with them because germs don’t respect the boundaries of our legal system,” said Robert Striker, an infectious disease specialist with the UW-Madison School of Medicine and Public Health who helps the state Department of Corrections treat conditions like hepatitis C and HIV.

Striker is also behind the new course to teach medical students, nurses and pharmacists about providing care for those in correctional settings and those who have been released after serving their time.

Striker is working with the Nehemiah Center for Urban Leadership Development, a Madison-based nonprofit organization that works to address both social and justice issues affecting African-Americans in the greater Madison community.

In 2016, forty-one percent of Wisconsin inmates were African-American, while they make up less than 7 percent of the state’s population as a whole, a 2017 study by the Wisconsin Taxpayers Alliance, now called the Public Policy Forum, found.

“Wisconsin incarceration rates are worse than almost any other place in the country in terms of race,” Addington-White told students in a panel discussion this April.

In turn, medical school educators are partnering with the DOC, former prisoners and Nehemiah to try and address how both racial disparities and the re-entry of prisoners into society affects health care practices.

“We put our heads together and realized that health care providers in the criminal justice system need to have a clear understanding of how the system works, where the good things are and where the challenges are so that they can deliver care in a more culturally responsive way,” said Karen Reece, director of research and program evaluation at Nehemiah.

Those challenges may include patients who have been incarcerated for a long period of time and may not know how to use an electronic device like a smart phone.

Matthew Ley, a third-year resident in internal medicine, recalls how he was having difficulty following up on a patient who wouldn’t return voicemails or emails. The man spent nearly two decades behind bars and had just completed his sentence.

“He’s now re-entering society in an era where we generally expect most people to be able answer emails, respond to voicemails, have a cell phone. It was becoming clear to me that in the 18 years in prison, he hadn’t learned how to do that,” said Ley.

Doctors not only have to figure out how best to communicate with patients in or recently out of prison, but steer them from habits that may be unhealthy. For Dr. Laura Maursetter, that meant finding out what was sold in the prison canteen. Now, she warns her patients against eating high sodium meals like ramen noodles.

“So those kinds of things are really helpful for me to know that’s what’s often happening and I can talk to (inmate-patients) about real issues. It helps me build rapport,” said Maursetter.

But while part of the doctor-patient relationship is learning as much as possible about their patients, Maursetter draws the line at finding out their crimes.

“I made it a rule that I never ever looked to try and see what anyone did because that changes the way I think, and I’m not there to judge anyone. I’m there to take good care of them,” she said.

UW-Madison School of Medicine and Public Health is recruiting up to 20 students to take the new class which could lead to a career many hadn’t thought about: jailhouse doctor.