Prisoners get mission-based care at rare locked unit in critical access hospital

February 15, 2020


WAUPUN, Wis. — The high-security, locked unit tucked away on the third floor of Waupun Memorial Hospital here is reserved for patients who are doing hard time. Most reside in one of the town's three prisons — two maximum and one minimum security state prison — or in the medium security state prison in nearby Fox Lake, Wisconsin.

Hospital and prison leaders say that they know of no other critical access hospital in the nation with an in-house, secured unit for penitentiary inmates. The unit is one of only two such locked prison hospital wards in the state — the other is at a large academic medical center in Madison. But in Waupun, the six-bed locked ward comprises about a sixth of the hospital's 25 licensed beds. (Two of the six beds are counted as outpatient swing beds.)

Waupun Memorial Hospital is part of Agnesian HealthCare, which is a member of SSM Health.

Recovery hurdles
Orthopedic surgeon Dr. Eric Nelson and nurse practitioner Andrea Smits, who practice at Agnesian HealthCare's Fond du Lac Regional Clinic, count prisoners among their patients. Smits notes that this patient population is among the most vulnerable the hospital sees. She says that post-op care is complicated by the fact that discharged patients who return to prison do not always have ready access to even the most basic items that can be useful in recovery, such as ice packs and extra pillows.


Nelson adds there is an increased risk of infection once patients return to the prison environment after hospital discharge.

Dolores Keel and Shelly Van Den Bogart are among the Waupun Memorial Hospital nurses who staff the locked unit at the hospital. There is one Waupun Memorial Hospital nurse on the unit when patients are present, and two if there are surgical patients.

Mission-based care

Mission-based care
There are six patient rooms off the central corridor of the secured unit at Waupun Memorial Hospital in Waupun, Wisconsin, that house patients who are imprisoned in state penitentiaries. A security officer accompanies any staff member entering a room to treat a patient.

Providing clear patient education upon discharge from the hospital is vital, Keel says, because patients who are recuperating in prison have limited access to the web to get answers to medical questions and they may be among hundreds seeking care from the prison clinic nurse.

Van Den Bogart says patients weakened by surgery could be further stressed because of the risk of aggression from other prisoners while they are physically vulnerable. Nelson notes that all these impediments to healing come on top of the fact that the prison population for the most part is much less healthy than the general population.

"Being incarcerated is just not good for one's health," he says. "We are not meant to live behind bars, and it is literally harmful to one's health." Many prisoners have unmet mental and physical health concerns prior to their incarceration — sometimes due to risky lifestyles or lack of funds to access preventive care or treatment.


Caring presence
Keel and Van Den Bogart say they like the wide variety of nursing tasks they perform on the unit at Waupun Memorial Hospital. They often care for patients receiving treatment for hernias, bodily trauma and other conditions not commonly seen in the general population of the hospital.

Van Den Bogart

Protocol demands they do not share personal information with prisoners nor ask the inmates personal questions, but both nurses say many of the prisoners will volunteer information about themselves. Van Den Bogart says working on the unit has taught her to be nonjudgmental. Keel says she's met many people who "never stood a chance" in life and deserve compassion.

DeAnn Thurmer, Waupun Memorial Hospital president, says, "We've been able to help many people. We've showed them we care and that we want to help them."

Keel says she's found her own ways of offering the human connections many prisoners are longing for. She says when she's providing medical care to a prisoner, she often will "purposefully spend a little extra time with them, so they can have my presence just a little bit longer."

'Prison City'
The area's state prisons, which have a combined capacity to house over 4,500 prisoners, have been a linchpin in the local economy for generations. A 2017 profile of the city in the Wisconsin State Journal said Waupun is informally known as "Prison City" and the four prisons combined employ over 1,000 security officers. (Waupun has a population of about 11,000). The article said the city's mayor, Julie Nickel, moved to the area about 30 years ago to work as a prison security officer.

Waupun is known as Prison City because it is home to three state prisons. This one, Waupun Correctional Institution, is a maximum-security facility. It is among the penitentiaries that send inmates to Waupun Memorial Hospital for inpatient and outpatient services when they require services beyond the capability of the prison's health clinic.
Barry Adams/Wisconsin State Journal

In fact, because of the many prisons in the area, says Van Den Bogart, Waupun area residents — including those who are patients or staff of the hospital — do not become alarmed when they see a patient who is a prisoner and in chains being escorted through the hospital.

Waupun Memorial Hospital had provided emergency care to inmates throughout the hospital's 69-year history. Before the locked hospital unit opened in 2005, a prisoner requiring inpatient hospital care would be assigned to an available room anywhere in the hospital. The dispatching prison scheduled a member or members of its security staff to guard the patient round-the-clock for the duration of the hospital stay. Prisoners deemed to be higher risk might be under the watch of multiple security officers at all times.

The system was expensive and a burden to taxpayers, says Thurmer, and Waupun Memorial Hospital approached the Wisconsin Department of Corrections to discuss the situation. The hospital learned the department wanted to regionalize health care for inmates in its facilities. Together the hospital and corrections department came up with the idea to build the dedicated unit. The hospital paid the upfront construction costs, a percentage of which the state has paid back through its contract for services with the hospital. The unit is staffed by the hospital's clinicians and guarded by employees of the state department of corrections.

Dr. Ryan Holzmacher is a physician adviser for SSM Health's Agnesian HealthCare in Fond du Lac, Wisconsin, and the former chief medical officer for the state corrections department. He says, "It was a big decision for a small hospital to do this — it's a heavy lift up-front to build a unit like this. But it has benefits downstream, so Waupun Memorial Hospital built the unit and dedicated the time and space for it. They did this because they knew it would help the local community and provide the best possible care for that population" of inmates.

Equal care
Everyone who enters the secure unit at Waupun Memorial Hospital must pass through a locked door and wait in a locked vestibule until a security officer on the unit confirms their identity and permits entry into the unit's single corridor.

A nurses' station, a holding cell for patients awaiting an outpatient clinic appointment, a security post and the patient rooms are accessed from that hall. The patient rooms are used for inpatient and outpatient visits.

The unit provides nearly 2,000 medical visits annually, including inpatient, outpatient and telemedicine visits for patients who have returned to their prisons. Most of the patients come from the facilities in Waupun and Fox Lake. Although any of Wisconsin's 36 prisons can send patients to Waupun Memorial Hospital, correctional facilities normally send inmates to the nearest hospital that can supply the needed treatment.

In the Waupun Memorial Hospital unit, inmates receive care from hospital staff, physicians and nurses. Thurmer says, "We set the tone from the start — everyone is to treat them as no different from all the other patients."

Prison officials, not the hospital's admitting physicians, decide which patients need services that are not available through their prisons' health clinics. Services prisoners commonly receive at Waupun Memorial Hospital include emergency care, select laboratory tests, inpatient and outpatient surgery, and specialty care including gastroenterology and orthopedics, according to information from Waupun Memorial Hospital.

Patients who require higher acuity interventions not available at Waupun Memorial Hospital including inpatient dialysis and cardiac catheterizations are sent to Agnesian HealthCare's St. Agnes Hospital in Fond du Lac, about 20 miles from Waupun.

Most patients in the Waupun Memorial Hospital locked unit are male. Last year, the unit had 704 patient days and 403 surgical cases, and the average length of stay was 3.34 days. This compares to 2.9 days for the rest of the hospital.

With few exceptions, the patients are confined to their rooms in the locked unit until it is time to receive their treatments or procedures. The room doors are locked from the outside hallway. A unit security officer accompanies each patient to medical appointments outside the unit.

Dr. Paul Bekx, medical director for the Wisconsin Department of Corrections, says the partnership between the prison system and the hospital has helped ensure inmates get the excellent care they are entitled to, while also saving prisons money. Since the department operates the locked unit and employs the unit's dedicated officers — there are a minimum of two officers on duty whenever a patient is in the unit — the individual prisons do not have the added labor cost of providing personnel to guard patients from their respective institutions.

Hear a Waupun Memorial Hospital administrator explain the benefits of having the unit available to the many prisons in and around Waupun.

Listen to a nurse practitioner who treats people who are inmates, as she describes what makes this population so vulnerable.

Hear a physician who treats people who are incarcerated as he explains the value of using telemedicine to provide post-operative care to patients who have been discharged to prisons.

Waupun Memorial Hospital has expanded services for prisoners

Since it opened the secure unit for prisoners, Waupun Memorial Hospital in Waupun, Wisconsin, has worked with the state's corrections department to improve the efficiency of the services offered to inmates and to expand the services available to them — both inside and outside of the prison walls.


Kyle Hunter, the hospital's vice president of patient services and chief nursing officer, says the hospital added telemetry equipment to the locked unit for monitoring heart rhythms. The output can be read by clinicians outside of the unit.

The hospital's Fond du Lac Regional Clinic, established a telemedicine connection so that its clinicians can provide follow-up care post-op to prisoners in seven prisons — saving the cost, hassle and danger of prisoner transport to Waupun Memorial Hospital.


The hospital also helped some prisons set up their own dialysis units. And it assisted some prisons in establishing hospice programs, including by using a "train-the-trainer" approach to establish a corps of prisoners who provide hospice services to fellow inmates. Such expansions have been particularly important given the aging population of prisoners, notes Nicole Gill, the hospital's inpatient services director.


Hospital's locked unit is designed to safely confine patients

When building out its locked unit for prisoners, Waupun Memorial Hospital in Waupun, Wisconsin, adhered to the standards and protocols of the Wisconsin Department of Corrections, to ensure the safety of the prisoners and the public, says Heidi Bailey, the hospital's inpatient manager and liaison to the corrections department.


Bailey says the patient room walls are reinforced with more metal and thicker concrete than other patient rooms in the hospital. There are no exposed cords or wires; oxygen, suction and other machines are locked away. A television is the only wall furnishing. There are no mirrors. The toilet and sink in each room is stainless steel and tamper-proof, just like the ones in prison. Each room has a camera for continual monitoring by the on-site officers; and lights are always on in each room.

Dolores Keel and Shelly Van Den Bogart are among the Waupun Memorial Hospital nurses who staff the unit. They say delivering care on this unit is vastly different from doing so anywhere else in the hospital. An officer always accompanies them and all other clinicians entering a patient's room. The clinical care would be immediately halted if any safety concerns were to arise — though unit leadership says there have been no such incidents since the unit opened.

The clinicians must always count their sharps and their pens to ensure none have been taken by a patient or left in the room. Such items could be used as weapons.




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