Archive for the 'RPSM Alumni' Category
2 Comments June 15th, 2009 by Matthew Anderson
Riker's Island
The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.
The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport. Riker’s is quite literally an island, connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners. Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.
Vernon C. Bain Prison Barge
Dr. Shalev divides the history of health care at Rikers into three periods. From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies. During this period numerous reports documented the poor quality of care provided to inmates. It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates. As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”
Attempts to remedy this situation made little progress until the early 1970′s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms. This resulted in the second period of medical care at Rikers. From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City. Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO). However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics. Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure. Costs did not decrease and there were ongoing concerns about the quality of care. Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated. Concerns over costs and quality of care remain. Dr. Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).
Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration. But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full. The result is a system described by some as a prison-industrial complex, by others as a penal state.
Here is the abstract of Dr. Shalev’s paper:
Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.
posted by Matt Anderson, MD
Add a comment March 26th, 2009 by Matthew Anderson
What is it that social medicine doctors do? Here is one answer from RPSM Social Internal Medicine graduate Shawn Patrick Cannon:
The Residency Program in Community Osteopathic Medicine at Southampton Hospital has just finished its first Match with The National Match Service (NMS).
Based on the tenets of the RPSM, osteopathic medicine has been added to the core mission statement of The Residency Program in Community Osteopathic Medicine, with tracks in Family Medicine, Internal Medicine and Neuromusculoskeletal Medicine. The training is approved for Board Certification by the American Osteopathic Association. By 2012, 1 in 5 American medical graduates will posses the DO degree, forming the basis of change for primary care in the United States.
Southampton Hospital, on the eastern end of Long Island serves a vast community spreading from Brookhaven to Montauk and including the Shinnecock Nation. With no local university medical center, all the pathology of the east end presents to Southampton Hospital.
For the 3 spots in Internal Medicine, Dr. Shawn P. Cannon (RPSM IM graduate 1995) interviewed over 70 applicants and matched 3 in his top 5 candidates. The program was so successful, it is applying to increase its positions for the next match. In addition, 3 second year residents were signed to the RPCOM. Dr. Patrick Frisella , who has published research at SUNY Downstate and NUMC in HIV Medicine will be a PGY-II. Dr. Enami Amir from Michigan State University who has finished his first year at University of Southern California in Los Angeles will be joining the residency program, as well as Dr. Iqbal from the Univerity of California at Davis. Dr. Iqbal was enrolled in the Family Practice/Psychiatry program but will be returning to New York to join the program at Southampton.
NYCOM has been recognized as a Center for Global Health. If our plans come to fruition, Southampton in partnership with NYCOM will offer two certificate programs to our residents. We are in the planning stages of having these certificates honored at either the Columbia University School of Public Health or SUNY at Stony Brook School of Medicine towards the granting of an MPH degree. Our Global Health certificate will be didactic and “hands-on” with a four week rotation available in Ghana.
With 1 in 5 US medical graduates having the DO degree in 2012, collaboration is the key for successful universal quality healthcare.
An UPDATE from Shawn Patrick Cannon DO, FACOI RPSM Graduate 1995
1 Comment March 18th, 2009 by Matthew Anderson
On Tuesday, March 10th Dr. Kathryn Anastos and Jon Wallen came to Social Medicine Rounds to discuss their work in Rwanda. Dr. Anastos’ story illustrates one answer to the question: “What does a social medicine doctor do?”
Dr. Anastos is an Internist who graduated from the Residency Program in Social Medicine in 1983. She is currently a Professor at Albert Einstein College of Medicine in the Department of Medicine as well the Department of Epidemiology and Population Health. She is known for her pioneering work in the study of HIV in women as principal investigator of the Women’s Interagency HIV Study (WIHS). Jonathan Wallen is a New York photographer who specializes in architectural and landmark photography. Since 2003 they have become increasingly involved in work in Africa, some of which they shared last Tuesday.
Mr. Wallen filled the walls of the third floor conference room with pictures from the Tubeho (“To live again”) Project. Tubeho documents the stories of female victims of the Rwandan genocide and consists of a series of photographs with accompanying stories (see an example at this link). These were disturbing stories. The pictures that accompanied them showed both women in the full bloom of life as well as others whose spirits and bodies seemed broken. Showings of the exhibition have been used to raise funds for the genocide victims as well as to bring attention to the links between gender-based violence and the spread of HIV.
Dr. Anastos framed her work in the context of Community Oriented Primary Care (COPC). She shared her initial skepticism, developed from her work in the Bronx, in COPC as a model of care. Rwanda, however, had changed her point of view.
The couple’s involvement in Rwanda began in 2003. Dr. Anastos had been contacted by Les Veuves (the Widows) a group of genocide survivors, many of whom were infected with HIV. They were incensed that they did not have access to treatment while their victimizers – on trial for genocide – were receiving HIV medicines. Dr. Anastos had worked as an administrator at the Montefiore Medical Group and felt she knew about building an efficient, comprehensive, high quality primary care practice for a chronic disease. As she put it, her credibility was as an HIV expert, but her skill was as a manager. With assistance from the Stephen Lewis Foundation she helped found We-ACTx (Women’s Equity in Access to Care and Treatment) in mid-2004. The goal was to create an HIV treatment program, but this implied first setting up HIV counselling and testing.
One of the lessons of this experience was to ” first, provide the services people ask for, not just those professionals think they need”. This, she felt, was the essence of COPC. And what people wanted was wanted medical care (to prevent dying and promote health), HIV testing, medical care for their children, food, income, and – a top priority - education for their children. The local women rejected the idea of going out “into the bush” to provide care. They wanted it done through existing infrastructure and using local nurses and clinics. By knitting together multiple small grants an HIV testing program was implemented in September of 2005 and has by now performed over 50,000 tests. In January of 2006 anti-retroviral care was introduced and there are currently 2,400 people on ART, essentially “everyone who needs it, gets it”. The program is implemented in coordination with 24 community partners and is staffed by 2 physicians, and 12 nurses. She feels that the necessary skills to run the program exist locally (“if we left now, the program would continue”) but that the local staff continues to need salary support.
For a beautiful look at the WE-ACTx progam in action, you can see pictures in the linked slideshow.
Because of the focus on meeting people’s expressed needs, several “off mission” programs had been created. “Just because I think it is not health service related, doesn’t mean we don’t have to find a way to provide it.” These off mission programs included the provision of food supplements, creation of income generating activities (originally doll making, now bag making, see Ineza), community based education, and a program to help with school fees.More recent activities are a cohort study (requested by the community) and programs to address cervical cancer. Cervical cancer, an essentially preventable disease is the number one cancer killer in Rwanda.
In considering the successes of their work (and of the COPC model) Dr. Anastos pointed to the strong sense of community in Rwanda. “There is no cult of the individual. It is always my family, my community, my country.”
posted by Matt Anderson, MD
Add a comment January 22nd, 2009 by Matthew Anderson
Dr. David Kindig
On Tuesday January 20, 2009 Dr. David Kindig offered the second annual Harold Wise lecture as part of our Social Medicine Rounds series. The Wise lecture is organized the Residency Program in Social Medicine Alumni Committee. His talk was entitled: To: President Obama, From: Harold Wise, MD, RPSM Founder, Re: Beyond Health Care Reform. Dr. Kindig has kindly given us permission to post his presentation which can be downloaded here. It should not be reproduced without his consent.
Dr. Kindig began with some memories of Harold Wise, a Canadian physician born in Hamilton Ontario in 1937. After receiving his MD degree at the University of Toronto in 1961, Dr. Wise completed an Internal Medicine internship at the Kaiser Permanente Foundation Hospital. In 1964 he moved to Bronx and completed his Medicine residency at Montefiore. He then served as Director of Ambulatory Services and Home Care at Morrisania City Hospital, a New York City hospital affiliated at the time with Montefiore. In 1969 he became the director of the Dr. Martin Luther King Jr. Health Center, one of the first OEO (Office of Economic Opportunity) Community Health Centers in the US. Faced with the problem of finding well-trained clinicians interested in working in underserved areas, Dr. Wise created the Residency Program in Social Medicine. He passed away in 1998.
Dr. Kindig then discussed his own path to the Bronx. As a pediatrics resident at the University of Chicago he had been told that spending a month working at a community health center was “not a legitimate PGY-2 activity.” He was becoming increasingly politically active at the time and became interested in pursuing other paths in medicine. He met up with Harold Wise who convinced him to come to the Bronx and develop a “Social Pediatrics” residency program. Dr. Kindig moved from Chicago to the Bronx both creating the residency program and becoming its first graduate in 1971. He went on to have a distinguished career in academics and government service. He is currently Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin-Madison, School of Medicine. He also serves as Senior Advisor to the Wisconsin Public Health and Health Policy Institute.
His talk focused on the need to move beyond simply reforming health care in the United States. Insuring all Americans and providing them with health care are two necessary and important steps for the new Administration in Washington. But they are not enough. True health reform would require addressing the multiple social determinants of health. He discussed how the book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations had been an epiphany for him. He had come to see that curative medical services were of limited value in addressing social disparities and that spending more on such services might actually reduce the overall health of the population. He briefly reviewed some of the recent evolution of thinking on population health and spoke about his own work in conceptualizing reimbursement systems that would pay for population health. His concepts are outlined in his book Purchasing Population Health (available on Google Books) and in a 2006 JAMA article A pay-for-population health performance system.
Currently, Dr. Kindig is active in the Robert Wood Johnson Health & Society Scholars Program and the Population Health Initiative at the University of Wisconsin. At the Population Health Institute he leads an initiative to make Wisconsin the healthiest state and he shared some of that work with us. The project produces an annual report card on Wisconsin health. The 2007 report card noted that while health in Wisconsin was improving it was not improving as fast as other states. The state was graded B- overall for health and D for addressing health disparities. The program is moving beyond merely grading the state to better understanding the determinants of health and then to suggesting specific evidence-based actions to address each one. The work of the program seemed embued with a very political sense of making health statistics understandable to the people who could actually influence public policy.
It is impossible to comment on the talk without mentioning the spirit of optimism generated by the inauguration earlier in the day of Barack Obama. Rounds took place at the Cherkasky auditorium where some five hours earlier hospital employees had watched President Obama sworn in. It in words of Montefiore President Steven Safyer it was a moment of Jungian synchronicity.
posted by Matt Anderson, MD
1 Comment October 10th, 2008 by Matthew Anderson
Dr. Bill as drawn by one of his patients
What does a Social Medicine doctor do? Here is Bill Jordan’s current answer:
I graduated from RPSM Family Medicine in 2007, and I’m currently finishing my MPH and serving as Chief Resident in Preventive Medicine at Mount Sinai School of Medicine in New York City.
While a resident at Monte, I built on community psychiatry experience from medical school, launching an HIV prevention workshop at Geel Clubhouse, a day program for people with mental illness in the South Bronx. In addition to a recent report on this work in the journal Psychiatric Services, the workshops lived on after I left Monte, led by medical students under the stewardship of Dr. Alice Fornari.
As a preventive medicine resident, I have continued my longstanding commitment to immigrant health. I volunteer with Doctors of the World, writing medical affidavits for asylum seekers, and I regularly see new refugees at my primary care clinic in Harlem, the Barbee Family Health Center. I am also spearheading the NYC DOHMH pilot program to address cervical cancer screening disparities among female immigrants.
Finally, I helped build the coalition supporting this year’s introduction of Green Carts in New York City. The new permits allow vendors to sell fresh fruits and vegetables in neighborhoods with limited economic opportunity and low availability of healthy food. I promoted adoption of the permits with a local community-based organization representing Spanish-speaking street vendors, Esperanza del Barrio, and was recently elected to the board of directors. I am currently exploring the possibility of real-time cell-phone based mapping of vendor locations as a tool for promoting microlending to vendors and healthy food consumption by local residents. After finishing residency, I hope to continue working on the intersection of economic development and nutrition as a way of addressing health disparities.
Add a comment July 28th, 2008 by Matthew Anderson
What is it that social medicine doctors do? Here is one answer from RPSM Internal Medicine graduate Dr. Ricardo Nimo:
After RPSM in the Bronx, as a foreign graduate from Uruguay, I decided to come to Mississippi as part of a waiver program in order to change my legal status in the US. Mississippi was a challenge from the start at a personal level, as an individual, and as a physician. I came to Centreville Mississippi and took over the only internal medicine practice, working along with a general surgeon (whose father, also a surgeon; is a local legend here in Mississippi and was then still practicing). Centreville is a town of 1800 with a small rural community hospital with 30 beds, an ER, PT/OT, US, CT and Nuclear Medicine Scans, among other services.
Our practice has grown from 2000 visits per year to close to 10,000. I have a roughly 50/50 mixture of outpatient primary care and inpatient practice. Six of physicians staff the ER year long. The surgeon and I receive medical students from Tulane University in New Orleans, and I have a faculty appointment with the Community Medicine Department at Tulane as an Associate Clinical Professor. I also deliver care in nursing home settings. I am medical director of the local nursing home with 80 patients. For 2 years I worked in correctional medicine at a private facility about 20 miles away with 1000 inmates. I have been involved with CME activities as well as strategic planning and policy analysis regionally and with the National Rural Health Association. Currently I am chief of staff for our hospital. Maybe I can regret not having developed any meaningful relationship with the only academic tertiary care center in MS: the University Medical Center in Jackson. This is probably a consequence of the 120 miles of distance; I am available full time over 95% of the time here locally. Also (and this is more of a personal opinion) UMC is completely disconnected from rural medicine and providers in spite of being the main academic player in a rural state. In other words, UMC functions within the academic walls of UMC in “big city” Jackson, MS. It trains MDs who have a completely different conception of medicine from the actual reality of the state.
Our hospital serves a rural community of 30,000 who live in 2 counties with Centreville located in the middle. We are in the southwest corner of MS; right on the border with Louisiana, about 50 miles from Baton Rouge and 120 miles from Jackson. It’s a place in the middle of nowhere. Although we are close to urban areas and small towns, it is still definitely rural and under-served. Most people work in Louisiana, The hospital is the second largest employer. The first is a Georgia Pacific paper mill. Agriculture, logging and timber are also dominant activities. People are generally employed in jobs with little or no benefits or don’t work as a consequence of a semi-voluntary time & generational habit. Large segments of this population are uninsured or carry policies that are of little use (i.e. a logger with a $20,000/year salary and a family of 6, whose Blue Cross policy carries a $5,ooo deductible); among active patients, dual eligibility (Medicare & Medicaid ) are predominant; sole Medicaid is a 20-30%; commercial carriers I would think less than 20%. I am speaking here of active patients. Keep in mind that the the largest group, the uninsured, don’t come to see us unless mayor crisis happens. Years ago somebody defined this community to me as one characterized by work, family, church and Friday night ball games; my personal addition is ” let’s eat something fried ” (not necessarily chicken).
Predominant problems are the usual suspects: They include obesity (Misssissippi has the highest rate in US); hypertension (unique and very difficult to treat among blacks here in the South), diabetes, coronary artery disease (also different here in the South). There is also a large amount of alcohol and drug use, but virtually no organized system to deal with substance abuse. Mental illness is common but there is a complete absence of psychiatric care in rural areas. In the year 2008 patients are still held in jail while awaiting placement after commitment. This is a whole other story. HIV disease is highly stigmatized and patients travel long distances to receive care – when they decide or can afford to do so – in order to maintain anonymity. And there is trauma of all sorts. Other characteristics of the community include a high rate of illiteracy, very low educational standards at the school system (still divided into private & white on the one hand and public & black on the other). Lots of things in Mississippi still happen in black and white; no grays. Here is a second “I owe you” for me; I have failed completely to try to introduce health related educational activities at either school system. I’m not sure if it is because of “me or them.”
The health care system organization has changed in recent years. Four original free-standing and private clinics have evolved into 3 hospital run clinics with physicians employed by Field Memorial Community Hospital (now known as Hospital & Clinics). They are staffed by one surgeon, 2 internists, 3 FPs and a GP (he’s the busiest one; his father was a nearby town sheriff; therefore part of his “allure”); 3 Nurse Practitioners; one per clinic. Having a CFNP allows the clinics to qualify for what is called “rural health denomination”; this is a cost-based reimbursement system which compensates for part of the uncompensated care we deliver. Collection rates are sometimes less than 50 % of billings. The Hospital take over of these clinics resulted from the 2002 malpractice insurance crisis. All of the MD’s lost our coverage when our former carrier left Mississippi because of the legal climate. We all became uninsurable, unless we were willing to pay six-figure rates for coverage. The solution? We all became employed by the hospital which is privately operated but county-owned. Thus, we all became state employees; and therefore qualified to have caps on our malpractice liability. In this way we were able to afford insurance. Six years later, things are more stable (or maybe we all got used to the situation). I still pay around $40,000/ year for malpractice insurance. Having shifted the administrative tasks to the hospital (which is a Critical Access Hospital and is also reimbursed based on a cost basis rate rather than DRGs ) has had a good impact on the practices and there is a mutual benefit for both parties. This has allowed us to both survive and continue serving patients locally. No physicians were lost to the malpractice insurance crisis of 2002 in this area.
Nonetheless; provider retention rate is low. Since 1999 I can think of 5 physicians and 4 CFNPs coming here; all others I have mentioned before were born and raised here. Only one of the nine remains: me. I am probably one of the few success stories of the J-1 waiver program which is meant to recruit providers to under-served rural areas. However, the vast majority leave after an initial commitment of 3-4 years. I had a 4 year contract and now I am on my 9th year and have no plans to leave. Somebody recently asked if I was planning to stay and my answer was that I was not planning to leave; staying is more complex and depends on other factors. There is such a delicate balance in a small rural practice that every so often there is a general sense of uncertainty. Having said that, I have probably survived a mayor crisis in our practice every year; so, again the “get used” factor at play is big. Our most current source of anxiety in Mississippi is the debate on a Medicaid tax for hospitals which has been proposed by the state legislature and Governor Haley Barbour. Governor Barbour has a long track record as a tobacco lobbyist in DC and has blocked efforts at taxing cigarettes as an alternative way to close the current 380 million deficit of the Medicaid program for this fiscal year. Small hospitals like ours are particularly threatened by this tax and by the loss of Medicaid dollars. They are a much need source of cash flow and are particularly useful by small institutions who get paid based on cost and disproportionate share formulas. You can imagine that it doesn’t really matter if Medicaid drops reimbursement or even if Medicare cuts MDs payments. Where are our patients going to go? Or, to look at the issue from the other side: who will be able to continue to see them?
Why stay? The easy answer includes a certain laziness. Start all over somewhere else ? After all these years here ? However, a less mentioned fact is that rural MDs are fairly well compensated and have lower operational and living costs. But they do have to work. It is not uncommon to have 80-90 hour weeks on average all year long. In the final analysis I don’t think I can live & practice anywhere else for now at least.
In my opinion primary care and internal medicine in a rural community are more challenging than in urban or suburban settings. There are far greater rewards at the personal level. You need a solid training background and constant updating. Delivering standard levels of care in tertiary care settings is easier and less challenging than taking care of patients in a small hospital or clinic in the middle of nowhere. Here resources are very often limited, but we still maintain a sense of standards of care. Furthermore, small rural community hospitals have a social and vital reason to survive and remain in business. They are needed locally. I will always be an outsider in Mississippi, and that is absolutely fine with me. It actually works to my advantage in helping to maintain my sanity and avoid burn out. But, still, for me the clinic and hospital is where my life is happening everyday for the last 9 years.
Ricardo Nimo
2 Comments July 24th, 2008 by Matthew Anderson
What does a social medicine doctor do?
“One of the things I have done that I am most proud of (and feel it would be of interest to the Social Medicine Alums) is become a trustee for the Global Aids Interfaith Alliance (www.thegaia.org). This organization was founded in 2000 by a retired Episcopal priest (Bill Rankin) and a neurosurgeon at UCSF (Charles Wilson) as a response to the AIDS crisis in Sub-saharan Africa. The organization partners religious groups of any affiliation with village level projects in Malawi (one of the poorest countries on earth with a 15-40% HIV positive rate). These projects promote women’s empowerment, orphan care, home based care of AIDS patients and income generation activities tailored to the village needs. GAIA also trains nurses in Malawi and supports AIDS support organizations and infant crisis centers for orphaned infants requiring formula. I have done volunteer work in Malawi the past two summers in an Anglican mission hospital in Nkhota-kota, a Catholic parish in Mchinji, and a Baptist clinic with mobile clinics in remote villages. I am interested in promoting Global Health in medical schools and bringing medical students there in the future. I also give many talks on the status of HIV/AIDS in Malawi to churches, hospitals, schools, nursing homes and even a local Rotary club in order to help raise awareness of the crisis and how easy it is for us to help. Anyone with an interest in this subject or to learn more should go to the website and feel free to contact me by email or phone. I will be returning to Malawi in two weeks with a group of high school students and their parents for more clinical and youth oriented activities. (July 8-22). Thanks for the opportunity to talk about this worthy organization (they count Paul Volberding and Jay Levy among their advisors!)”
Etta Eskridge MD
Assistant Professor of Medicine
NY Medical College and the Westchester Medical Center
eskridgee@aol.com
(914) 6462799
559 Gramatan Ave
Suite 202
Mount Vernon, NY 10552
Add a comment July 16th, 2008 by Matthew Anderson
What does a social medicine doctor do?
Robert Greifinger, an RPSM graduate in Social Pediatrics in 1976, has been extensively involved in examining the prison system from a public health point of view. Last year, he published Public Health Behind Bars: From Prisons to Communities, the title of which suggests his social conception of the problem of prisons and health. He is currently an adjunct Professor at the John Jay College of Criminal Justice. Previously, he was the Chief Medical Officer for the New York State of Correctional Services, which was responsible for the health care of 68,000 inmates. 
Public Health Behind Bars: From Prisons to Communities was favorably reviewed in the New England Journal of Medicine in May and in the Journal of Urban Health in April. It will be reviewed in the July issue of the Journal of Correctional Health Care [14(1) July 2008 pp. 232-235].
The health of prisoners and the impact of mass incarceration on the communities we serve is an area of very interest in the DFSM.
Here is the description of the book from the publisher’s website:
- Prisoner reentry is a topic of current interest in correctional and public health
- Coverage includes both health care and topics in law and public policy
- Contributors are experts from such fields as public health and correctional health
Projecting correctional facility-based health care into the community arena, Public Health Behind Bars: From Prisons to Communities examines the burden of illness in the growing prison population, and analyzes the considerable impact on public health as prisoners are released. More than forty practitioners, researchers, and scholars in correctional health, mental health, law, and public policy make a timely case for correctional health care that is humane for those incarcerated and beneficial to the communities they reenter. These authors offer affirmative recommendations toward that evolutionary step.
Chapter authors identify the most compelling health problems behind bars (including communicable disease, mental illness, addiction, and suicide), pinpoint systemic barriers to care, and explain how correctional medicine can shift from emergency or crisis care to primary care and prevention. In addition, strategies are outlined that link community health resources to correctional facilities so that prisoners can transition to the community without unnecessarily taxing public resources or falling through the cracks. Between the authors’ research findings and practical suggestions, readers will find realistic answers to these and similar questions:
- Can transmission of HIV, tuberculosis, and other communicable diseases be reduced and prevented among prisoners?
- How can correctional facilities treat addiction more effectively?
- What can be done to improve diagnosis and treatment of psychiatric disorders?
- Can correctional care benefit from quality management and performance measurement?
- How can care be coordinated between correctional and community health care providers?
- What are the health risks to communities if action is not taken?
Public Health Behind Bars: From Prisons to Communities is a challenge of immediate interest to readers in correctional health and medicine, public and community health, health care administration and policy, and civil rights.
posted by:Matt Anderson
3 Comments July 10th, 2008 by Matthew Anderson
What do Social Medicine doctors do?
Dr. Homer Venters, a 2007 RSPM Internal Medicine Graduate, is currently working as an Attending Physician at the Bellevue/NYU Program for Survivors of Torture and is a Public Health Fellow, New York University. During his residency at Montefiore, Dr. Venters worked with Bronx Defenders, a legal aid organization in the Bronx, helping to get people involved in the criminal justice system into primary care. This work resulted in the publication of an article about the tragic case of Scott Ortiz in the Harm Reduction Journal. His work as a resident was awarded the Dan Leight Social Medicine Award.
On June 4 2008, Dr. Venters testified in front of the House Judiciary Committee’s Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law. He discussed problems with the medical care provided to Immigration and Customs Enforcement (ICE) detainees. It is clear to people working in the field that ICE detainees are not accorded the same medical care provided to other US prisoners. Dr. Venters outlined some of the reasons why. Specifically he pointed out that the ICE medical system is designed to care for acute problems; it is not set up for persons with chronic medical issues. To quote from his testimony:
“This institutional aversion to caring for detainees with chronic disease is evidenced in recent detainee deaths. One year ago, a 23 year old transgender woman, Victoria Arellano was detained by ICE. Ms. Arellano had AIDS and was taking a life saving medicine to prevent opportunistic infections that could quickly cause pneumonia and death were she to stop. These medicines are essential for people with AIDS and even a brief interruption risks sickness and death for a patient. Despite reporting her medical history and her medication when detained (and throughout her detention), Ms. Arellano was refused her medicine. Over the following weeks, Ms. Arellano developed a cough and fever, which should have prompted hospitalization and evaluation. Instead, Ms. Arellano was given an inappropriate antibiotic by the detention center medical staff, was still refused her needed medication, and returned to her cell. By the time Ms. Arellano’s cellmates staged a protest to draw attention to her deteriorating condition, she had become very ill and died soon thereafter, comatose and shackled to her bed. Faced with a common chronic disease, ICE medical staff withheld the correct medicines, gave inappropriate medicines and failed to seek more competent care for Ms. Arellano. The care that Ms. Arellano required would be routine in almost any medical clinic or hospital in the United States.”
The full testimony is available here.
Posted by Matt Anderson
