How I Practice

Working with inmates: A correctional medicine physician shares insights

John G. Mills, DO, MPH, reflects on his 20 years in correctional medicine.

Correctional medicine is a highly demanding subspecialty, says John G. Mills, DO, MPH. Some inmates may be violent or deceptive. Many present with advanced disease due to lack of health care.

Nonetheless, Dr. Mills, who has served as medical director of the Tarrant County Jail in Fort Worth, Texas, since 2010, says he loves his job.

“What I like about correctional medicine is that it’s very difficult,” he says. “It’s a little like working in the emergency room. You have to bring your A game every day.”

The Tarrant County jail includes five facilities and has a capacity of 5,000 inmates. In his 20 years as a correctional medicine physician, Dr. Mills has also worked for the Federal Bureau of Prisons and served as a medical director for a federal medical center. He is also a retired U.S. Army lieutenant colonel. Following is an edited interview.

What are the biggest challenges of treating jail inmates?

Most inmates have not had health insurance or visited a doctor on a regular basis. You’re providing health care to people who haven’t had health care.

Many of our patients have psychiatric issues, and a small percentage of those are experiencing psychosis. I spend a lot of time trying to figure out how to provide care to patients who actively want to hurt people. Some patients are so violent we can’t take care of them in the jail.

John G. Mills, DO, MPH (Photo by Patrick Sinco)

You’ve treated both prison and jail inmates. What are the major differences in treating these two populations?

Jails are very urgent care oriented. At our jail, on any given day, there are about 25 people who are HIV positive, 25 pregnant women and 50 to 100 diabetics.

Everyone who comes in is screened for medical issues such as diabetes, pregnancy and drug and alcohol use. Next, we identify people who must be seen within 24 hours. If you’re arrested and you have high blood pressure or you’re HIV positive, we will see you right away.

In prisons, you’re working with people who have been convicted. They have already been screened and should be on a treatment plan if they need one. It’s much more of a chronic care model with defined goals.

What do you enjoy most about your job?

Every day, there’s something new. You can never know all there is to know about correctional medicine.

Outside the jail, I’ve written prescriptions that patients never filled because they didn’t have the money. In the jail, you know patients are going to get the medicine you prescribe and the diagnostic tests you order.

How do you make sure inmates get the best possible care?

We are constantly trying to get better at what we do. Over the five years I’ve been medical director of the Tarrant County Jail, we’ve adopted an electronic medical records system and an electronic medication administration record (EMAR). The EMAR has been a game-changer. We pass out about 3,000 pills per day in the jail. After automating the process, the number of medication errors has gone down nearly 100%.

What qualities do physicians need to succeed in correctional medicine?

You need to be positive and have an upbeat personality. The issues you encounter, such as addiction and homelessness, can be hard on your psyche. I like to tell myself, “We did the best we could today. We’re going to come back tomorrow to do more.”

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