Photos taken within the California Medical Facility in Vacaville by Young Kim	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Nurses who work at the California Medical Facility face the challenge of working with an increasingly older and sicker population. Diane Keller-Batter, RN, works part time at the prison and has spent four years as a hospice nurse. She is pictured here with inmate and hospice patient Clyde Hoffman.

You didn’t even say hi,” Fe Au, RN, teased a patient arriving for dialysis at the California Medical Facility in Vacaville.

The man gave her a shy smile. “You were busy,” he replied, politely. He has been receiving dialysis treatments since 1984. Au, the shift leader of the unit, knows him well.

She joked with another patient already in the dialysis chair. “Smile for me, Gomez,” she said, and Jose Ramon Gomez, a soft-spoken, baby-faced man, obliged with a wide grin as a photographer snapped a picture.

The banter between nurse and patients is typical of any dialysis unit, in any medical center. In this one, however, the patients wear blue jeans and chambray shirts when they are not wearing gowns. They come in through a locked door, escorted by uniformed medical technical assistants, or MTAs, who are trained as correctional peace officers.

Some patients, including Gomez, have been convicted of homicide.

On the inside

Nurses who work at the Northern California facility, the state’s main medical and psychiatric institution for convicted adult male felons, say they face many of the same challenges as nurses who work in hospitals outside the prison: They have a severe nursing shortage that forces them to use registry nurses and mandatory overtime. They’re working with an increasingly older and sicker population. They would like to have had more time to spend talking to patients and educating them about improving their health.

Nurses who work in the prison — both RNs and the MTAs, who are mostly LVNs — have other challenges as well. They work in an enclosed facility with elevators that require keys, gates that clang shut, and corridors marked with yellow lines that their patients may not cross. They must be alert for patients who may try to take advantage of them and must take care in addressing or touching patients. Appointments and schedules must be flexible to allow for lockdowns and sudden court dates.

But the nurses say the rewards of their job — bringing health care to people who need it, the gratitude of their patients, and job security combined with great benefits — more than make up for the difficulties of nursing behind bars.

From the outside, the California Medical Facility, built in 1955, looks more like a prison than a medical facility. Guard towers and double chain-link fences topped with rolls of barbed wire surround a field of clipped dry grass and somber wheat-colored buildings pockmarked with tiny windows.

But after passing through a round of security checks, a metal detector, and an automatically locking door, visitors pass through a small landscaped area with flowers and sculptures. A caduceus — the medical insignia of two snakes entwined with a staff — marks the entrance to the building that is both a medical center and a prison.

Inside, the two concepts seem to shift constantly. At a clinic for HIV patients, inmates sit in chairs waiting for a nurse to call their names. Some grumble or argue about their appointments. It could be a clinic waiting room in almost any hospital, except the patients are all men dressed in the same blue uniform.