DAVIE — The inmate seemed cooperative but the drugs he was receiving for a seizure disorder weren't working, so Dr. David Thomas prescribed a new regimen. Throughout Thomas' examination, guards lingered. Nurses peeked into the room.
Thomas, relatively new to prison medicine, asked what the fuss was about.
"'Don't you know why he's here?'" Thomas recalls the others saying. "'His mother changed his meds and he decapitated her.'"
That, Thomas says, helped him realize he was performing a very different type of medicine — one that requires a very different type of doctor.
Thomas, a professor at Nova Southeastern University's College of Osteopathic Medicine, helped develop the college's two-year fellowship for doctors who are considering working in prison medicine, one of a few such programs in the country. The program's goal is to prepare doctors who have completed their residencies for handling the myriad ailments that appear in the prison population, difficult patients and a system where security is as important as treatment. Participants are expected to leave the program qualified for senior-level positions within corrections systems and bring a higher level of respect to this long-dismissed track of medicine and improve the quality of care.
"What most people don't realize is that 90 percent of inmates get out of prison," Thomas said. "They're your neighbors."
Florida has about 140 physicians on its correctional staff and uses contracted doctors, according to a spokeswoman.
Prisons can be challenging and at times scary for doctors. There are diseases that they have only read about in textbooks. Doors slam shut behind them, guards are ever-present. Many of the patients have never received regular medical care before: Some are risk takers, some can be manipulative. Canes or wheelchairs can be used as weapons. Drugs must be monitored and syringes and other common medical tools are routinely counted.
"Physicians have no context whatsoever about what it means to work in a … secure environment where security is really the No. 1, 2 and 3 priority," said Warren Ferguson, head of a similar program at the University of Massachusetts. "Heath care is really a distant priority."
It wasn't long ago that prisons were seen as the last hope for a foundering physician — many doctors worked behind bars because there were issues with their license or they simply weren't good enough for a hospital or private practice.
"It's considered a wasteland for doctors, which is not true," said Dr. Phyllis Anderson-Wright, Nova's first fellow, who is about halfway through the program. "And it's considered that because the thinking is, 'Well, who would want to take care of those (people)? There must be a reason why they are taking care of those patients.' "
Ron Shansky, a former medical director for the Illinois Corrections Department, during the 1980s helped conduct a review of a Florida prison's medical care. It found that 17 inmate deaths in the previous year possibly could have been prevented with proper treatment. State officials didn't believe the results, he said, so they asked the state's medical society to conduct a review.
"The medical society disagreed with us," Shansky said. "They thought 21 of the deaths were possibly or probably preventable."
Former inmate Leroy McGee, a South Florida man exonerated of robbery after three years in prison, gave mixed reviews to the doctors he met behind bars.
One physician showed real concern when he complained of chest pains, McGee said. He listened to McGee and checked his symptoms. He told him to come back if he needed more medical attention. However, when McGee saw another doctor for a severe toothache, he was told to take an aspirin and deal with the pain, because he couldn't immediately be moved to another facility for treatment. McGee's tooth wasn't pulled for days.
"I don't want to say all the doctors won't listen," McGee said, "but some of them would listen more to the guards."