Virginia jail looks to community for help in providing inmate health care

The medical department of the Prince William-Manassas Adult Detention Center abides by one overriding mission: It always strives to provide a community standard of care for its inmate population.

And to accomplish that goal, the department is constantly looking outward, seeking advice, counsel

The facility contracts with a primary care physician who subcontracts with another physician and the two doctors, in turn, work as a team, providing a high level of care for the inmate population.

It also contracts with a dentist and a psychiatrist who visit the facility on a weekly basis.

But the department's most innovative-and perhaps its most effective strategy-involves the care and treatment of HIV and AIDS.

In the past few years, the department has established and maintained an ongoing relationship with two infectious disease doctors who oversee and manage the facility's HIV/AIDS cases, providing an invaluable service to the facility's health care staff and the detainees who reside there.

One of the infectious disease doctors, Abe Macher, MD, works for the Public Health Service; the other, David Wheeler, MD, is employed by a local health care system.

The two doctors conduct regular consultations with the department's nurses and doctors, reviewing inmate charts, for example, and determining appropriate treatment regimens.

The department's health care providers consult with Dr. Macher over the phone, asking him about treatment regimens and whether they should initiate or change treatments based on a patient's CD4 level or viral load counts.

They also consult with Dr. Macher about patients who are nonadherent, faxing him information about a particular patient so he can determine the best course of action. This is done in a confidential manner without violating the patient's confidentiality.

"Dr. Macher has the results of all their lab work, the medications they are on and the side effects they are experiencing," explains Debbie Kibble, one of the nurses at the facility. "He can make a recommendation to change medications or add to the existing regimens."

Kibble says working with Dr. Macher has been an "incredible learning experience." "He will talk to me for an hour about whay I should do, what I should look for and what the numbers mean," she says. "He also gives me verification of what I am doing."

The other physician, Dr. Wheeler, comes into the facility and works directly with other physicians and nurses, overseeing the patient's examination and exploring treatment options with the patient and the attending health care providers. The benefit to patients with HIV is self-evident.

One female offender who came into the facility early last year was reeling from her HIV disease, suffering from a rising viral load and a drop in her CD-4 counts. Dr. Wheeler changed the woman's medication regimen, prompting a pronounced decrease in her viral load and an increase in her CD-4 levels, thereby slowing the progression of her disease.

"They do an excellent job," says the woman. "They are right on top of my disease."

The woman has regular access to the two medical doctors who visit the facility on a weekly basis. She is also seen by Dr. Wheeler every three months.

Unlike some jails, the Prince William-Manassas detention center does not operate in isolation, separated from the community.

It is, in fact, an open facility, actively seeking and cultivating relationships with the public at large. I "People are afraid of jails," says Marmie Schuster-Walker, Nursing Supervisor for the facility. "They don't know what happens behind bars. We do a good job, our correctional officers are phenomenal, our medical department is excellent, the programs are good so we don't want to be a secret. We want the community to know what we are doing."

The facility's health department reflects that philosophy. The medical department sees itself as an extension of public health, its actions directly impacting the health of the community.

"Our inmates come in and out of the surrounding communities," Kibble explains. "If we stopped their care, then we would be doing a disservice to the community. I think the community needs to understand that."

The ability of the facility to partner with the community serves multiple purposes. It is much easier, for example, to obtain funding from local lawmakers because they are able to see how the money is being spent. The linkages with the community also enable the facility to identify available resources and help. Dr. Macher consults with the facility on a volunteer basis; Dr. Wheeler's involvement is funded through a special grant.

"The more people who know you, the more people will approach you with ideas and ways of doing things that don't cost that much to do," says Schuster-Walker.

The medical department, for instance, recruited students from nearby George Mason University to set up and run a Hepatitis B vaccination program for inmates under the age of 19.

"They wrote the policies and the procedures," says Schuster-- Walker. "That was part of their project for community health.'

The students also administered flu shots to the inmates this year and last year.

"We had only one case of flu last year," Schuster-Walker says proudly.

Like other facilities, the adult detention center "does not have an over abundance of resources," Schuster-Walker says. But as she points out, "there are resources out there if people have the time to look." James Arvantes

Inf.: Prince William Manassas Regional Adult Detention Center, 703-7926437; 703-792-7680.

James Arvantes is editor of Positive Populations In Prisons.