May 22, 2009
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i'd like to start a new category in the family medicine list called "correctional medicine". it would be for us guys who deal with prisoners. any suggestions on how to start this?
 

mx_599

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i'd like to start a new category in the family medicine list called "correctional medicine". it would be for us guys who deal with prisoners. any suggestions on how to start this?
there is no need for another sub forum
 

Blue Dog

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As a former moderator, I can pretty much guarantee that there's not anywhere near enough interest in prison medicine to warrant a separate sub-forum. You could always ask, though (try the "suggestions" forum).

I suggest continuing to post here. It's as good a place as any, and you're among friends. ;)
 
May 22, 2009
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thank you for the kind comment, blue dog. and i like the "avec caffeine" since i'm trying to learn french for medecins sans frontieres.

anyway, prison medicine is the most fantastic experience i have every had. i get up early just so i can spend more time a work. seriously, there is never a dull moment.

our governator, arnold schwartzeneggar, wants to link us to the university of california system and do most stuff with telemedicine.

any of you have experience with telemedicine? do you like it? as for me, i am very skeptical. i think it is important to put hands on a pt. in telemed, you dx from a little fuzzy picture on the monitor. terrible!
 

EdibleEgg

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I work in a fairly rural area, and we use telemedicine quite a bit. I actually like having it around. I do a good bit of ER moonlighting, and having a neurologist evaluate the patient before pushing TPA sure keeps my naughty bits a lot farther from my throat. It's less useful in the out patient realm, but patients do appreciate being able to do things locally and save a 3-4 hour drive. As far as the fuzzy picture, a FM doc is always available for the PE portion of the exam. It's not the same as being in the room with the patient, but overall I'm glad we have the resource.
 
May 22, 2009
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we get some specialty consults in the same way. that is fine. but i seems that they may want to do all the general doctor's line by TM. i would have a problem with that.

in any case, its too early to speculate, i suppose.

btw, in texas i hear they have 24 psychiatrists caring for 120,000 inmates via TM.
 
May 22, 2009
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i want to let everyone know that we have a job opening for BC internist or family practice doc. pay is about 200K. pay will increase if the State furlough program is stopped (then it will be 247K). no billing hassles. you get a monthly paycheck, medical, dental insurance. in five years you are vested in the defined benefit retirement program: 2.5% times years in service times highest yearly salary obtained.

you have to like to live in a rural area (farming). you see 25 pts a day. they are brought to you in your office. there is about 1 hour of paperwork every day. you work only 4 days a week, 10 hours each day. call is voluntary: you get paid extra for it. i take one call day a week (5 pm on monday till 7 am on tuesday). you get a call room (have to stay overnight at the prison). usually you get to bed by midnight and sleep 4 hours on the average. i take the next day off.

the job is exciting and just plain fun most of the time. although there is a Committee that disciplines employees who are obviously having too much fun (just kidding!)
 

civic4982

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we get some specialty consults in the same way. that is fine. but i seems that they may want to do all the general doctor's line by TM. i would have a problem with that.

in any case, its too early to speculate, i suppose.

btw, in texas i hear they have 24 psychiatrists caring for 120,000 inmates via TM.
In West Texas I know of quite a few Pediatricians and FPs who are doing TM and have satellite clinics set up and trained personnel to deliver physical exam findings.
 
May 22, 2009
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latest news is that the univ. of california decided to "re-think" the idea of taking over prison health care in california. they're worried about hidden costs and liabilities, i guess.

i'd love to be part of the univ. of calif. , but the pay and benefits will probably be less. also, i don't want to do telemedicine: i want to "lay hands" on my pts.
 

Chromatid

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I had read somewhere that corrections doctors were literally raking in dough.. 300k+ a year in CA on 40hr weeks, no call, vacation, etc, but once their state budget went down the crapper they changed the pay. Down side was living in the middle of nowhere, unless you're lucky, and eventually getting the crap beat out of you/worrying about it on a daily basis. Also recall reading about a guy who does it who loves it just because the patient population lends itself to a little more diversity of cases, however, he did say expect to be sued quite a bit and after 2 years of doing it, even if you never lose a case, it would be hard to get onto any insurance policy after that if you wanted to go back and help those who weren't caught by the long arm of the law. Who new inmates had the right to sue, pretty idiotic if you ask me, especially for free healthcare. Just stating this if you can verify it or discredit it.
 
May 22, 2009
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true, they sue at every opportunity. that's the american legal system. go watch the movie, "cool hand luke", that's where prison reform, and prisoner lawsuits, started. (1967, Paul Newman as "Cool Hand Luke").

salary is 240K without call, more with call. state has dropped that by about 15-20% with the "furloughs": so figure close to 200k.
 

jabreal00

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true, they sue at every opportunity. that's the american legal system. go watch the movie, "cool hand luke", that's where prison reform, and prisoner lawsuits, started. (1967, Paul Newman as "Cool Hand Luke").

salary is 240K without call, more with call. state has dropped that by about 15-20% with the "furloughs": so figure close to 200k.
Not worth it in my opinion. $200-240K to work in a prison in the middle of nowhere. I'd rather make $170-200K in a better environment and not have to deal with some of the pyscho-social pathologies associated with hardened criminals.
 
May 22, 2009
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i'm different. i like rural areas. couldn't pay me enough to live in san francisco.

actually, these felons are no different than the clientele in a typical county hospital er. (except they got caught!)
 

GoodmanBrown

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i'm different. i like rural areas. couldn't pay me enough to live in san francisco.

actually, these felons are no different than the clientele in a typical county hospital er. (except they got caught!)
Paiute, could you speak to your feelings on safety at work?

I shadowed at a county jail on one occasion and never felt any threat of violence at all. All the patients we saw were quite deferential to the doctor I was shadowing. Most seemed grateful for the opportunity to see him. I thought maybe the situations would be different at a prison vs. a jail though.
 
May 22, 2009
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actually, i guess i enjoy the danger. in my 13 years with the system, i have only one credible death threat, and that was in the last 6 months.

i was taking away the methadone and morphine from some aryan brotherhood members, so the leader, decided to put me on the "green light" list. the guy that was supposed to kill me had second thoughts and ratted out the whole plan, even producing the IMW (inmate manufactured weapon): a nasty looking shank.

i laughed it off at first, figuring that they just wanted to scare me. after talking to the alleged hit man, i decided i needed to take precautions. i wear a stab proof vest and there is an officer with me anytime i am near an inmate.

my first element of the physical exam is to check the hands: i ask to see the palm, then the fingernails. this gives me a chance, aside from the medical value, to make sure the cuffs are properly placed and there is no shank in the waist band.

no one knows if they really were going to carry it out. they wanted me off the yard so they could get a doc who would feed their narc habit (and there are plenty of them).

the mexican mafia (eme) are in cahoots with the AB, so i've got to watch for them too.

however, killing a doc would be bad business for these groups. they are basically drug rings who control most of the illicit traffic thoughtout the west. they need to maintain good PR, just like any other business.

i'm not losing any sleep.
 
Oct 2, 2009
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actually, i guess i enjoy the danger. in my 13 years with the system, i have only one credible death threat, and that was in the last 6 months.

i was taking away the methadone and morphine from some aryan brotherhood members, so the leader, decided to put me on the "green light" list. the guy that was supposed to kill me had second thoughts and ratted out the whole plan, even producing the IMW (inmate manufactured weapon): a nasty looking shank.

i laughed it off at first, figuring that they just wanted to scare me. after talking to the alleged hit man, i decided i needed to take precautions. i wear a stab proof vest and there is an officer with me anytime i am near an inmate.

my first element of the physical exam is to check the hands: i ask to see the palm, then the fingernails. this gives me a chance, aside from the medical value, to make sure the cuffs are properly placed and there is no shank in the waist band.

no one knows if they really were going to carry it out. they wanted me off the yard so they could get a doc who would feed their narc habit (and there are plenty of them).

the mexican mafia (eme) are in cahoots with the AB, so i've got to watch for them too.

however, killing a doc would be bad business for these groups. they are basically drug rings who control most of the illicit traffic thoughtout the west. they need to maintain good PR, just like any other business.

i'm not losing any sleep.
:whoa:
 

GoodmanBrown

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Wow. I have new respect for you, my friend...that takes balls. :thumbup:
Holy ****.

In the jail that I visited, I don't think that it was quite as intense. I think it may have to do with the shorter jail terms. We had a lot of in and out as people came in for a short stint and left and went to prison for a longer sentence.

I obviously didn't have my finger on the pulse of the jail in my 4 hours there, but in speaking with the other health care providers, they didn't mention anything like that.

Major respect for what you do.
 

bronx43

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actually, i guess i enjoy the danger. in my 13 years with the system, i have only one credible death threat, and that was in the last 6 months.

i was taking away the methadone and morphine from some aryan brotherhood members, so the leader, decided to put me on the "green light" list. the guy that was supposed to kill me had second thoughts and ratted out the whole plan, even producing the IMW (inmate manufactured weapon): a nasty looking shank.

i laughed it off at first, figuring that they just wanted to scare me. after talking to the alleged hit man, i decided i needed to take precautions. i wear a stab proof vest and there is an officer with me anytime i am near an inmate.

my first element of the physical exam is to check the hands: i ask to see the palm, then the fingernails. this gives me a chance, aside from the medical value, to make sure the cuffs are properly placed and there is no shank in the waist band.

no one knows if they really were going to carry it out. they wanted me off the yard so they could get a doc who would feed their narc habit (and there are plenty of them).

the mexican mafia (eme) are in cahoots with the AB, so i've got to watch for them too.

however, killing a doc would be bad business for these groups. they are basically drug rings who control most of the illicit traffic thoughtout the west. they need to maintain good PR, just like any other business.

i'm not losing any sleep.
I'm addicted to Gangland on Nat Geo. That's insane that you're right in the middle of it. La eme and the AB scare the hell out of me. You always hear how far their reach extends outside of prison.
 
Jun 11, 2009
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Also recall reading about a guy who does it who loves it just because the patient population lends itself to a little more diversity of cases, however, he did say expect to be sued quite a bit and after 2 years of doing it, even if you never lose a case, it would be hard to get onto any insurance policy after that if you wanted to go back and help those who weren't caught by the long arm of the law.
Doctor Paiute, could you address this issue? Is this a concern of yours? Have you seen it happen? If so, is it something you could explain to the insurance company?

Thanks!
 
May 22, 2009
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i just have my own experience: after accumulating about 20 prisoner lawsuits over the course of about 8 years, i applied to 3-4 major insurance companies, one of which i had done business with for several years. none responded to my application.

i called an insurance broker about this issue. he told me that even though none of the cases had been decided against me, i was considered high risk simply from the fact that the suits had been filed. he said that i would have to apply to the "high risk pool". the premiums would be approximately double the normal cost.

at that time i was considering leaving the prison system and going back into private practice (which i had done for 12 years prior to accepting employment with the dept of corrections). needless to say, i gave up on the idea of re-entering private practice.

i have talked to other doc's who have had only 2-3 lawsuits from prisoners. they had no problem getting insurance. i think it is the number of suits which makes the difference.

perhaps, if i had tried harder, i would have found a decent insurance deal. it was easier, however, to give up and make this my final career path. the retirement plan is unbeatable and the work load is reasonable.

let me add that my interest at that time (2005) in leaving the prison system was not because i did not like the work. about that time, a major lawsuit over california prison healthcare had been settled by the state, with rather draconian measures taken against the doctors. the doctors were mostly blamed for the poor delivery of care and attempts were being made to "weed out" the so-called "bad doctors." Local peer review of adverse outcomes was stopped and all cases were sent to sacramento to a committee that may or may not have been impartial.

during this "time of trouble" the doctors were scared to death that an adverse outcome would be blamed on them. consequently, we transferred (to the supposedly "superior" regional medical center) any case that had the slightest chance of complications. thus, all chest pains were "sent out." i even heard of an athlete's foot case being transferred. this resulted in the waste millions in tax-payer dollars, with no proven improvement in inmate health care.
 
Jun 11, 2009
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Thanks for answering my question.

I'm glad you like the work, doc - it'd be a real crapper if you didn't. It sure seems like something ought to be done to protect you prison docs from what I'm sure are zillions of frivolous lawsuits. I know life's not fair, but it really rankles me that you'd be financially penalized if you wanted to move on.
 

GoodmanBrown

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i just have my own experience: after accumulating about 20 prisoner lawsuits over the course of about 8 years, i applied to 3-4 major insurance companies, one of which i had done business with for several years. none responded to my application.

i called an insurance broker about this issue. he told me that even though none of the cases had been decided against me, i was considered high risk simply from the fact that the suits had been filed. he said that i would have to apply to the "high risk pool". the premiums would be approximately double the normal cost.

at that time i was considering leaving the prison system and going back into private practice (which i had done for 12 years prior to accepting employment with the dept of corrections). needless to say, i gave up on the idea of re-entering private practice.
I've heard a phrase for prison medicine that goes something like, "Even if it's not your first job, it'll be your last." for the reasons you give. Inmates have a tendency to file lawsuits that often don't have much merit. They get thrown out, but the suit stays on your record nonetheless. Hence, insurance is much harder to get if you want to leave.