Welcome to Prison!

Recently I attended a provider training meeting at a department of corrections facility called the Denver Reception Diagnostic Center. While it may sound like a place where pepperidge farm cookies and lemonade greet you while you wait for a mammogram, the DRDC is actually the prison where all of the inmates get a physical exam before being sent to other prisons around the state. It is surrounded by a double fence with many, many rows of razor wire. Not so friendly. Initially, I was hoping to be placed at that prison since it's a short commute from my apartment, but it wasn't in the cards.

The provider meetings are a nice opportunity to chat with the other prison docs, NPs, and PAs and to compare experiences. The prisoners seem to get very good healthcare in prison, even for all the bureaucracy required for specialist visits and non-formulary medications. I do feel like I've won when a patient I've referred to a specialist has surgery (and I receive a legible consult note!), even though that's not supposed to be the most gratifying part of primary care. Seeing improvements in hemoglobin A1cs has also made me feel like I'm "doing something," which is also satisfying.

The guest speaker at the meeting was a retired infectious disease specialist who now works for a drug company. One might think that a drug company doesn't stand to benefit much from having a relationship with the department of corrections and its limited drug formulary. However, with oral Hepatitis C drugs on the market, there is a lot of money to be made, especially if a large organization like DOC starts incorporating oral anti-virals into its Hep C protocol.

Another interesting stat I learned at the meeting:
1/4 of HIV positive patients interact with the justice system in a given year. This represents an exceedingly high burden of disease for the corrections population. All prisoners get testing for HIV, syphilis, Hep C, and Hep B on arrival to the reception diagnostic center. I did get to tell a very relieved patient last week that her HIV test was a false positive (after an indeterminate Western Blot and an undetectable viral load x 2 over 6 agonizing months of not knowing for sure). My HIV patients are actually super stable and will be more like to die with HIV than from HIV. It's amazing how well HIV can be managed, especially when detected early. Hard to believe 20% of people in the U.S who are living with HIV don't know it. (Shout out to Aurelie and our grand rounds!)