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a medical technical assistant, Ogbanedi
Abu, LVN, delivers medicines to inmate patients
at the California Medical Facility. The
trickiest part of the job, he said, is when
an inmate tries to hide the medication to
sell it to someone else, or crush it so
he can snort it later.
That’s when Abu must switch roles:
from nurse to custody officer.
“If I catch them, I take the medicine
and throw it away,” he said. Or he
might write up the patient and let the physician
know what’s going on.
Sometimes his patients, many of whom are
mentally ill, get upset. They might protest,
saying they’re not babies and deny
hiding or crushing the medicine. They might
scream and yell at him. They might throw
a bag of bodily fluids at him, a practice
called gassing.
MTAs, who are employed throughout the California
prison system, have the most dangerous job
of the medical staff, physicians and nurses
who work at the California Medical Facility
say. They are on the frontlines, dealing
directly with inmates in the cells. They
pass medications, take blood for testing,
escort inmates to clinics and the hospital,
and provide security for physicians and
nurses who treat the inmates. When an inmate
is sick at 2 AM or needs to see a dentist
for an emergency toothache, the MTA gets
the call.
Most MTAs are LVNs, although a few are RNs,
prison officials said. Many have military
backgrounds. MTAs go through two weeks of
training as correctional peace officers
and are members of the correctional officers
union.
“They’re nurses with badges,”
said Constance Gibbs, RN, nurse supervisor
at the California Medical Facility, California’s
main prison medical center in Vacaville
in Northern California.
Despite the potential dangers, Tom Donahue,
MTA, LVN, a senior MTA supervisor, said
workers still are safer in the prison than
they are on the street, and the salary and
benefits make an MTA position an attractive
job. “For LVNs, it’s probably
the best thing they’ve ever seen in
their lives,” he said. “If I
were an LVN, I’d be jumping on this
in a heartbeat.”
The system has its benefits and challenges,
said Joseph Bick, MD, chief medical officer
at the prison. MTAs can take medications
to inmates or escort them to appointments,
freeing clinical staff for other duties.
The prison’s main outpatient clinic
is run by MTAs, who work mostly with physicians
contracted from outside the prison. MTAs
assist the physicians — taking vital
signs, processing paperwork — but
they also can intervene if a patient starts
to get out of control.
But some inmate patients have a hard time
distinguishing between MTAs and correctional
officers, Bick said. Sometimes, MTAs find
it difficult to balance their custodial
and medical roles, he said.
“That makes things challenging for
the patients. It makes it challenging for
the staff,” he said. “Everything
they do is in the gray zone.”
MTAs in other prisons have been accused
of punishing inmates by denying access to
clinics and physicians or ignoring complaints
of pain or illness.
No matter how conscientious someone tries
to be, the two roles — custodial and
medical — “sometimes can raise
conflicting interests,” said Rebecca
Craig, RN, MPA, board member of the American
Correctional Health Services Association
and manager of the correctional health care
program for the California Medical Association’s
Institute of Medical Quality.
For instance, she said, if a medical provider
discovers an inmate sequestering drugs,
he or she could remove the drugs for safety
reasons. But putting them in handcuffs or
punishing them in some way should not be
the role of a medical provider who is working
to gain patient trust, she said. In the
California jail system, she said, most of
the time nurses dispense medications and
guards accompany them. The roles of each
are clear, she said.
Dennis Kearney, an MTA and LVN at the California
Medical Facility, said he thinks medical
training and an LVN license give MTAs a
more compassionate attitude toward inmate
patients than that of many regular correctional
officers. Kearney recently returned from
Iraq, where he worked as a flight nurse
caring for wounded soldiers.
“We understand that inmates came here
as a punishment, not for punishment,”
he said. Some correctional officers, especially
those who worked 15 or 20 years ago when
inmates were treated more harshly, seem
to have a difficult time understanding that,
he said. Some still treat them disrespectfully.
“It gives a bad name to the rest of
us,” he said.
Three-quarters of MTA duties are supposed
to be medical and one-quarter custodial,
but some MTAs said that in recent years
they have had to take on more custodial
duties as more medical duties went to RNs
or CNAs.
“Now, you feel like you’re doing
more custodial work because there’s
no medical work to do,” said Richard
Nichols, MTA, LVN. The situation does not
please him. “I’m here for the
people,” he said. “I’m
here to take care of people and they’re
making it harder and harder to take care
of people.”
-Cathryn Domrose
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In another clinic, a patient consults with a
physician behind a screen while an MTA sits at
a desk outside. She is filling out documents,
but also listening for any changes in either the
physician’s or the inmate’s tone that
might suggest trouble and the need for her to
switch roles, from medical worker to custody officer.
Inside the surgery area, a recovery room nurse
talks about common procedures the hospital performs,
including hernia operations, orthopedic surgery,
and colonoscopies, while outside, an MTA in scrubs
and booties pats down inmate patients before they
leave the area.
A few other prisons in California have on-site
hospitals, but almost all of the inmates in the
Vacaville facility need some sort of medical or
psychiatric treatment. The facility includes a
general acute care hospital, outpatient clinics,
inpatient and outpatient psychiatric facilities,
a hospice unit, treatment for inmates identified
with AIDS/HIV, and inmate housing. The California
Department of Mental Health operates a licensed
acute care psychiatric hospital within the prison.
The prison, which holds more than 3,000 inmates,
has its own dialysis, med/surg, surgery, emergency
room, and pharmacy. It contracts out major surgeries
to a nearby hospital. But most medical conditions
are treated within prison walls.
Nationally, between 30% and 40% of inmates have
hepatitis C, estimated Joseph Bick, MD, the prison’s
chief medical officer and director of HIV treatment
services. About one in four are infected with
tuberculosis. About 1% to 2% are infected with
HIV. “At the California Medical Facility,
we house between 480 and 540 inmates who are known
to be HIV-infected,” Bick said.
Other conditions include chronic diabetes, hypertension,
asthma and heart disease. About three-quarters
of them have some form of alcohol or other substance
abuse, Bick said. An increasing number are elderly
with chronic conditions.
Most developed these conditions before they entered
the prison, Bick said. For many inmates, the treatment
they receive in prison is their first encounter
with any sort of health care. He sees medical
care in prison as an extension of public health.
“Whether you care about inmates or not,
you should care that they are healthy,”
he said, “because most of them will be released.”
Bar none
The approach of Bick and other health care workers,
including nurses, to correctional health care
reflects a change in thinking during the last
20 years, said Rebecca Craig, RN, MPA, board member
of the American Correctional Health Services Association
and manager of the correctional health care program
for the Institute of Medical Quality in California.
“I have seen it continually improve,”
she said. When she first started working in jails
and prisons, she said she would hear inmates express
concern about symptoms and see nothing written
on their charts. Now, she said, “the nurses
are really doing good clinical assessment. Overall,
the nursing staff that I see are much more professional.”
They wear lab coats instead of casual street
clothes. They show respect for their inmate patients.
She also sees more teamwork between nurses and
correctional officers to provide inmates with
treatment and medicines.
“It’s catching up very rapidly with
health care in the rest of the community,”
she said.
Craig has not visited the California Medical
Facility for many years, she said, but has heard
positive things about its recent care, especially
its hospice and HIV programs. “There were
some problems a few years ago,” she said,
referring to protests by HIV/AIDS activists in
the late 1980s about the poor treatment of AIDS
patients, and the deaths of three mentally ill
patients from heatstroke in 1991.
Since then, she said, the prison has taken “aggressive
and proper steps to improve care,” she said.
“They have some very good physicians now.
Their reputation has improved.”
Inmate patients interviewed during an escorted
tour of the facility said they were happy with
the care they received. “I like it here,
it’s good,” said Gomez, the dialysis
patient. In another prison, he had received his
dialysis under guard at a community hospital.
“I feel like it’s the same here as
it would be anywhere,” he said.
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