I committed no crime. I never had a trial. I was never read my rights. Yet, here I sit four years into a twenty year minimum stint with the Bureau of Prisons at a United States Medical Center for Federal Prisoners. I am not an inmate, I am an officer in the United States Public Health Service functioning as a physical therapist in the prison system. My only regret is, I wish I had started my career here.
Having graduated from physical therapy school in 1997, I've had the opportunity to see a lot of changes in the healthcare field. Some of the changes have been good, others not so good, but change is inevitable and I've learned to roll with it.
Therefore, I was expecting more changes and frustrations when I accepted a position with the Bureau of Prisons (BOP) as a physical therapist in a Federal Medical Center. At the same time, I was commissioned as an officer in the United States Public Health Service (USPHS), a move that would serve me outside my role as a therapist in the BOP.
The health care system within the BOP provides optimal healthcare at little to no cost to the incarcerated individual. While this allows those that need medical attention to get it, it also allows people to seek care when none is needed. This phenomena affects me in multiple ways that are both good and bad.
On the good side, I am free from the limitations of visits/reimbursement. This allows me to treat those that need intensive therapy more often, and those that need more supervision/education less. No longer am I restricted from treatment approaches because the payer wouldn't cover it. I am able to treat the patient in the manner that I feel is appropriate based on my training, not what would be covered.
Those in private practice know the feeling of having their treatment options limited by an outside source that knows little to nothing about physical therapy. This has also forced me to be a better advocate of patient responsibility so that the patients don=t continue to attend physical therapy for an extended amount of time simply because they can.
Some Bad Results
On the bad side, the patients are free from the limitations of visits/reimbursement as well as financial responsibility. What results is a backlog of referrals, many of which are unnecessary. A typical day in our clinic has each therapist seeing 20 to 25 patients each. Many of these patients have legitimate complaints that are treatable conditions. Some, however, simply complain of musculoskeletal pain in order to gain access to our equipment and weight training facilities. It challenges the practitioner to identify real and exaggerated symptoms and weed out the guys that aren't truly in need of physical therapy.
As an adjunct to my responsibilities as a therapist to the prison population, I am also tasked with deploying to national disasters (e.g., hurricanes, floods) to assist local organizations with anything from logistics to wound care to physical therapy. As part of the USPHS, officers attend a training course where we are educated in dealing with disasters using coursework designed by FEMA. One aspect of the training involves triage during a disaster; something I never thought I would use but soon discovered I needed.
I was on a fishing trip down on the White River in Arkansas with my father-in-law and brother-in-law. The resort where we were staying had its own grass runway and planes would come in and take off throughout the day. Early in our first morning on the river, a plane went down on takeoff and we were the first on the scene. It was an eerie feeling to come upon a crash when no paramedics or policemen are around.
I was surprised that my training in triage would kick in so naturally. After checking on the five victims, we were able to separate those that needed immediate life preserving techniques, those that needed to be monitored, and those that were beyond our capabilities. The first aid provided consisted of monitoring a closed head injury and preventing further injury to him and checking vitals and monitoring breathing/cardiac function in another with multiple orthopedic injuries that was unconscious. In the end, two of the five victims survived and have recovered while the other three did not. I can't say that our actions upon arrival had any direct impact on the result, but it felt like we did something rather than feeling helpless.
A Unique Place to Practice
Back to my opening statement on wishing I had started my career here. The bureau offers a very unique environment for a physical therapist that is both liberating and challenging. The diagnoses that are seen are vast, ranging from sports orthopedics to neurological to wound care. A therapist deals with acute injuries, chronic injuries, exaggerated injuries, and non-existent injuries. A straight forward back pain evaluation becomes more complicated when the inmate is required to be fully shackled (hands, feet, belly chain) during the evaluation.
A large percentage of chronic pain patients reveal that they've got bullet fragments so limited diagnostic tests are available. If you can think it up, you'll likely see it in the bureau environment. The saving grace is that the therapist is free from the restraints of insurance payers. There are no limits on the number of visits, no treatments denied based on diagnoses, no complicated paperwork to justify your billing. It is a place that a therapist can utilize all their training, all their knowledge, and all of their brainstorming capabilities with no one telling them yes or no. In a sense, it's the perfect place to practice.
I've never regretted my move to the United States Public Health Service and the BOP. It is a job that is ever changing, full of challenges, and full of opportunities that I would never get as a civilian physical therapist. It is not a job for everyone, but I would not hesitate to recommend it to any new or seasoned physical therapist. I do miss the cookies from the occasional grateful grandma, but a heartfelt thanks from a convicted murderer goes a long way too.
Mike McClain is a senior physical therapist for the United States Public Health Service in Springfield.