by Cathy Hester Seckman, RDH
Philips Sonicare and RDH magazine have announced the 2010 Mentor of the Year, Pamela Myers, RDH, of Huntsville, Texas. Since the mid-1980s, Pam has been a correctional dental hygiene coordinator/clinician providing care at the Texas Department of Criminal Justice in Huntsville.
Mentors typically steer their colleagues in making career decisions, choosing congenial workplaces, and expanding skill sets. Pamela, nominated by co-worker Anita Jones, RDH, of Huntsville, goes beyond the typical mentoring duties to help hygienists adjust to working with convicted murderers, thieves, and drug dealers. When she talks to students arriving for clinical rotations, or to new hires, Pamela usually begins by saying a prison health clinic is not such a bad place to work.
“If this were a bad place, why would we all be here?” she comments. “I’ve been here more than 24 years. People are always amazed to hear that. I tell them, ‘If you want to feel good about what you do every day — if you want to feel like you’ve made a difference in someone’s life, come to work here. At the end of the day, what’s really important? Can you go to sleep at night, knowing you’ve done the right thing? Can you say to your Maker, I did the best I could?’
“I feel this philosophy is important to people who are coming on board at UTMB.”
Pamela is employed by the University of Texas Medical Branch-Correctional Managed Care (UTMB-CMC). For the first 10 years, she worked directly for the Texas Department of Corrections. When dental care was outsourced to UTMB-CMC in the mid-1990s, she retired from the Employee Retirement System of Texas one day, and went back to work the next day in the same position under the UTMB Teacher Retirement System.
Before working in corrections, she was employed in private practice in Huntsville, after graduation from Wharton County Junior College in 1974. When her employer told her the prison system was hiring hygienists, she applied and was offered a job. Her husband, then a deputy sheriff, convinced her to decline the offer, but she applied again three years later and accepted.
“After more than 20 years,” she says, “I am still behind the walls, barbed wire, and fences, and it has been the most rewarding career I could have ever dreamed.”
UTMB-CMC provides health care services at 92 dental clinics for the state’s 120,316 prisoners. Ninety-one percent are male, with an average age of 37.2. They have an average IQ of 90.57, and an average educational grade level of 7.94. UTMB also provides care to 1,800 juvenile prisoners housed in Texas Youth Commission State Schools, and to 5,600 federal prisoners at a correctional complex in Beaumont, Texas.
Interaction with inmates
So what’s it really like to work with prisoners every day? Pamela outlined a good example in an essay published in 1999 in “Chicken Soup for the Dental Soul.” The story she told, titled “The Prison of His Mind,” was about an incarcerated Vietnam veteran suffering from delayed shock syndrome. He was brought to Pamela’s operatory from solitary confinement, and a prison officer told her “Inmate Smith” was having a bad day. Smith was in restraints and clearly agitated.
Smith told Pamela, “They’re coming over the hill.”
“How far back are they?” she asked him.
“A pretty good ways.”
She told him that if she worked fast, and he stayed quiet, he could be gone before “they” got there. The patient remained quiet and immobile, and she was able to complete her treatment. As Smith left with his two guards, he looked back at Pamela with visible relief and said, “We made it, didn’t we?”
Pamela believes that Smith was not aware of his surroundings that day; he was reliving a terrible memory of running for his life. God, she says, gave her the wisdom to manage the situation and allow Smith a few hours of peace. He remained calm for the rest of that day, surprising his guards.
“I know my work makes a difference,” she says, “and I would not trade my job for the best private practice in the country.”
Pamela is conscientious about treating her patients as human beings in a totally professional manner. “I don’t get into personal issues, just dental issues. Because I treat them professionally, they respond that way. I’ve never had an inmate so much as reach out and touch my arm. They sometimes say things that are not acceptable, but I make it very plain I won’t tolerate that, and it’s the last time I hear it.”
When she hires new clinicians, she always tells them to remember what their grandmothers taught them: to act like a lady.
Still, the patients at her clinics are thieves and murderers, and no one ever forgets that. Careful tracking of supplies is second nature at prison clinics. “We account for all instruments, needles, and blades continually all day long. If at any time we can’t account for something, we notify security immediately. They lock the facility down and start searching cell to cell. Any instrument can be a weapon. I work with the best assistants in the world, and we all know there are nine instruments in a hygiene setup.
“When we finish a patient, before dismissing them, there had better still be nine instruments on the tray. After the ultrasonic, there are still nine. When the autoclave is loaded, there are still nine. When setups are stored, there are still nine. All the cabinets and drawers are locked. You can imagine the number of instruments in 92 clinics, but we rarely have a problem.”
Actually, a convenient location
Record-keeping in a prison system is better than it is in private practice, Pamela believes. “UTMB-CMC maintains the largest electronic medical record in the world. We developed it years ago as a time saver and money saver. A lot of manpower used to go into maintaining paper charts: generating them, transporting them, and storing them. Now we have that all at our fingertips, electronically.
“In private practice, you have to depend on the patient providing you with an accurate medical history. They might know they take blood pressure pills, for instance, but not the name or the dosage. A diabetic doesn’t necessarily know how well-controlled his condition is. At our clinics, all I have to do is go to the lab section of the electronic record, click a button, and have the patient’s entire lab history — blood pressure readings, A1C numbers, glucometer readings. I have electronic access to a listing of their prescribed medications and dosages. I can even check their compliance in taking those medications.”
Interaction with other medical disciplines is also easier, she says, because they’re all nearby. “I never have to call a physician to find out what kind of mitral valve prolapse a patient has, or what their psychiatric diagnosis is. I can literally step out my door and walk down the hall for a personal consultation.”
Co-management protocols used in correctional care between medicine, pharmacology, and dentistry, she believes, could be ideal models for the private sector.
Except for initial intake exams and screenings, offenders come to the dental clinics by choice. “They must request an appointment in writing, and pay a $3 co-pay fee for non-emergency exams if they’re able. We address those requests within 72 hours.”
More than 98% of the offenders do request dental services, Pamela says, because it’s something to do, the clinics are air-conditioned, they have dental needs, and the care is virtually free. No one is turned away for lack of the $3 fee. Inmates also value dental care, she says, because most couldn’t afford it on the outside, and their only previous dental care might have been extractions.
Overseeing the prison hygiene system
Pamela spends 50 to 60% of her time providing direct patient care, and the rest of her time is spent overseeing the hygiene program. She does some applicant interviewing, oversees student rotations, recommends supplies for purchase, organizes continuing education courses, and writes and presents on correctional care. Besides the “Chicken Soup” essay, Pamela has published articles in RDH magazine and the Journal of Correctional Health Care. She has presented papers at conferences for the National Commission on Correctional Health Care and the American Correctional Association.
In 2004, she authored a paper for inclusion in the dental component of UTMB’s guidelines for chronic disease, covering topics such as diabetes, HIV, and chronic heart failure.
Hygienists who are new to UTMB-CMC become part of a unique program developed by Pamela and her co-workers. “We have an interesting process for mentoring new hires,” she says. “I care very much about my co-workers, but I can’t take total credit for this idea. A group of us thought it was important. After the initial orientation, someone in the clinic is assigned to the new hire, and they act as a mentor. If there’s any problem, it doesn’t matter what time of day or night, they can talk to their mentor about it, or call me. The nurses at UTMB-CMC do this now, too. They’d made the comment more than once, ‘Y’all never leave.’ And they’re right. We’re like a little family in the dental unit. We only leave when we retire. We have no dental hygiene vacancies right now, and multiple applicants.”
Retirement for Pamela is in the not-too-distant future. She and her husband, Dale, who retired as a county sheriff, have been married 40 years and have a son, Chase, 33, a daughter, Katy, 30, and a granddaughter, Savannah, 8. All live within a mile. She is an avid reader, loves to cook, and does “a lot of church work.” In a few years Pamela will retire from UTMB-CMC for good, when she and Dale hope to buy a motorhome and tour the country.
Cathy Hester Seckman, RDH, is a frequent contributor based in Calcutta, Ohio. Besides working in a pediatric dental practice, Seckman is a prolific freelance writer, a book indexer, and a speaker on dental and writing/indexing topics. She can be reached at [email protected].
by Cathy Hester Seckman, RDH