Working

Pamela Myers, RDH
Dental Hygiene Program Manager
University of Texas Medical Branch-Correctional Managed Care

When Pamela Myers, RDH, earned her associate degree in Dental Hygiene from Wharton County Junior College in Wharton, Texas, she never expected to find herself in prison.

“How did I end up behind bars?” she asked with a chuckle. “Well, in the world of dental hygiene, working in a corrections facility is not thought of or talked about much. While you’re in school, you don’t realize there are many options other than private practice. But in community projects, you get exposed to other opportunities.”

Myers works as the dental hygiene program manager for the University of Texas Medical Branch-Correctional Managed Care (UTMB-CMC), which provides health care for incarcerated populations housed in the Texas Department of Criminal Justice, the Texas Youth Commission and the Federal Bureau of Prisons Complex in Beaumont, Texas. The Texas Department of Criminal Justice, which in-processes 200 offenders from county jails each day, operates in over 100 facilities spread across the state of Texas. The UTMB-CMC Sector stretches from the Oklahoma/Arkansas/Louisiana state lines to the Mexican border and west to San Antonio serving a population of approximately 127,000.

“Early in my career I never had a burning desire to work with convicted felons,” Myers said. “Most people have preconceived notions of prisons. They don’t want to work here, but when they see it, they change their minds. Our facilities aren’t dark, dingy or run-down. They’re very clean; there are flower beds planted outside the walls. The only difference is the bars on the windows and the barbed wire fences.”

Myers began her 25-year tenure at UTMB-CMC in the mid-1980s, when a lawsuit, called the Ruiz Decision, prompted the state government to change the way health care was delivered in a prison infirmary. Until that point, the only licensed health care providers in prisons were a few doctors, dentists and some Army medics, assisted by a staff of offenders. After 1981, offenders were not allowed to work in infirmaries except in a janitorial capacity, and prisons had to employ licensed individuals to provide care.

At the time, Myers was working in private practice in Huntsville, Texas, where her husband was a deputy sheriff and was later elected the sheriff of the county until his retirement. Huntsville is home to the Texas Department of Justice, the only state department not located in Austin, the capital. Myers explained that, at the time, the majority of people in the town either worked at the prison or at the university. In fact, two of the three dentists with whom she worked also worked part-time at the prison.

Myers became interested in working for the prison because the benefits package offered by the state was outstanding. Initially, she applied and was offered a position, but her husband convinced her to turn it down. A few years later, she reapplied, got the job offer and has been there ever since.

“It’s been a wonderful, very gratifying career,” she said. “I’ve been allowed to grow, expand, develop statewide policy, present at national correctional care conferences and publish papers.”

About five years ago, Myers drafted the language that added a dental component to UTMB-CMC’s parameters for care, the Disease Management Guidelines (DMG). Myers describes the DMG as a series of best practices, developed through research and experience, intended to improve patient outcomes. The additions she made pertained to diabetes, HIV and chronic heart failure, because there was ever-increasing scientific evidence of the oral/systemic link in these conditions.

Myers, along with other health care staff, was also instrumental in developing and implementing the largest electronic medical record in the world, called the Electronic Health Network (EHN), which is utilized by UTMB-CMC. EHN, originally called the Electronic Medical Record (EMR), enables providers to communicate in real time regarding patient care, track treatment outcomes, and deliver quality care in a timely and cost-efficient manner. In 2005, over 50,000 new patients were entered into the system, and the number has steadily increased since. That year alone, providers surpassed 1.6 million chart entries per month.

“I am proud to have been involved in the development and implementation of the EHN, which has potential for touching millions of lives,” Myers said.

EHN has gained national recognition and receiving the Focus on Innovation Award from The National Homeland Defense Foundation, which noted, “The electronic record has a unique approach to distance medicine that has an enormous potential in the defense of our nation.” Additionally, EHN earned the Best of Texas Award, which is given to the best application serving a public organization’s business needs, from the Center for Digital Government. EHN was also placed in the Smithsonian Permanent Research Collection for Innovation in Information Technology.

“My husband will tell you he was wrong 25 years ago when he discouraged my pursuit of a career in correctional dental hygiene,” Myers said.

Being a dental hygienist in a prison is sort of like being a dental hygienist in a city, Myers explained. There are all kinds of people; men, women, all different ethnicities and ages, and even different states of mental health. However, the people Myers treats tend to be from lower socioeconomic backgrounds, with the average education level being seventh grade. Most have never received regular dental care. She went on to say that the population in correctional facilities has a need for dental care. They are not as healthy as the average person, and although an offender may be 25 years old chronologically, he or she may be physiologically 35 or 40. Many offenders have also been chemically dependent.

“I provide care to a segment of the population that most people want to forget,” Myers said. “I want to do what is right, and I treat everyone I see the best I can. They are humans even if they’re incarcerated. It’s not my place to judge them; society already has. It’s my place to provide care as a health professional.”

Of course, working in a corrections facility has stark differences from the private sector, particularly in how patients are processed. Because offenders are counted several times each day for security, Myers’ responsibilities include counting all her instruments before, during and after treating each patient since many of the instruments could be used as weapons. Patients are also seen in groups to facilitate health care delivery, because it’s more efficient. Myers added that the manner in which health providers treat offenders determines responses, and most are very appreciative.

“The same patient that may give the security guards trouble in the hallway will say, ‘Thank you. I appreciate it,’ when he’s done being treated,” Myers explained.

When asked about people criticizing the “luxuries” offenders receive in prison, like free health care, Myers points out that the Eighth Amendment of the U.S. Constitution prohibits the use of cruel and unusual punishment; denying health care falls under that category.

“When people are incarcerated, they can’t access health care because they can’t leave,” Myers said. “They get three squares a day, a place to sleep and, yes, health care. But they’re told when they can do everything. Those are little things we take for granted. Unless you see it, you don’t understand what it’s like to lose those freedoms.”

In regards to her personal safety, Myers said in all the years she’s spent at the facility, no one has so much as touched her arm. “I’m probably safer than you are,” she said.

Myers believes there are even some benefits to practicing in the prison system. Dental hygienists are able to spend as much time as they need with patients, without the hassle of rigid appointment schedules or worries about insurance companies. A key difference she appreciates is being able to be ‘brutally honest’ with patients, as opposed to the ‘diplomatic’ form of oral hygiene instruction and education used in the private sector, which she thinks sometimes doesn’t get the point across.

“We’re not worried about hurting patients’ feelings by telling them their oral hygiene is poor. We are more concerned about behavior modification that can result in positive lifetime benefits for the patient. They’re instructed on proper care and expected to follow suit,” she said. “If they make improvements, we encourage them. But if they don’t, we tell them and it pays off.”

She added that health care professionals in the Texas correctional facilities have modified the delivery of health care around court decisions, as well as a number of studies that indicated that females exhibit a greater need for health care than male offenders, and determined how long it takes offenders to improve their oral hygiene. One study showed that it takes less than three appointments for prisoners to show improvement.

Myers went on to list various options for dental hygienists interested in working in community health, including American Indian Reservations, free clinics for the underserved, faith-sponsored clinics, juvenile facilities, schools, veterans hospitals, even cancer centers. Though, she admits, one has to go looking for those opportunities, since private practice is still the dominant career path.

“I’ve tried to make hygienists aware of the opportunities there are, by giving speeches and reaching out to get more student volunteers to come to the prison and do clinical rotations,” she said. “The rotations are mutually beneficial; we get some free help and the students get a more rounded educational experience. Some of the students who participated said the few days they spent in our facilities are where they learned the most. The more we educate both patients and health care providers, the more opportunities there are for everyone.”

For more information about Myers or her career, please e-mail pjmyers@utmb.edu.

This edition of Working was prepared by Mariam Pera.