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Upstairs from the clinic is a 36-bed infirmary, which houses equipment for dialysis and cancer treatment, as well as a "negative air-flow" room for patients with TB. Emergency and critical cases are sent, along with a security officer, to an area hospital such as Aurora Presbyterian, Denver Health Medical Center or University Hospital. (Three inmates were taken to the hospital on July 4 this year for chest pains, a common occurrence around the holidays.) Inmates who are close to death but have not had their sentences commuted can go to a hospice program at the Colorado Territorial Correctional Facility (CTCF) in Cañon City.

Some of the criminals who have to strip in front of the nurses are "macho, gangbangers, dangerous," says one nurse, who, like her colleagues, has been told by the DOC not to talk to the press. "Some are just scared."

But despite their tough demeanor, most inmates treat the 68-member medical staff with politeness and respect. "We're the gatekeepers of what they want," explains a physician who used to work at the DRDC, "whether it be a lower bunk or a trip to the hospital -- which is kind of fun because it breaks up the routine. They know if they piss us off, they're out of luck."

Next to mealtime, an appointment at the clinic is one of the few escapes from cell-induced boredom. When a prisoner isn't feeling well, he or she can slip a "kite," or message, into a box mounted on a wall of the DRDC dining hall. A nurse checks the box after the twenty-minute meal shifts and, if someone has an urgent concern, pays a house call to the inmate's cell. Inmates can call on any DOC staffer (they are all trained in first aid and CPR) in case of an emergency. Patients with less urgent problems sometimes have to wait one or two weeks for an afternoon appointment.

Most of the 6,000 new prisoners expected to come through the DRDC this year don't have a history of good health care -- to say the least. Three out of four are alcohol-dependent, chemical-dependent or both. Because of the wear and tear of the streets, the typical forty-year-old prisoner has the body of a fifty-year-old, according to health workers in the prison system.

Thanks to the precedent-setting 1979 Colorado case Ramos vs. Lamm, prisoners across the country are entitled to a "standard of community care," or the same standard of treatment available to other Americans. Ironically, "it's because they're incarcerated that these guys are getting medical care," points out a doctor who used to work at the clinic. "A lot of them weren't when they were out on the street."

Unlike many prisons around the country, the Colorado system is not faced with a disproportionately large population of AIDS or TB patients. Here, hepatitis -- especially hep C -- is the major concern. At the Denver women's prison -- a dreaded assignment for most medical staff because of its reputation for belligerent or uncooperative inmates -- many women enter the system pregnant; they deliver at a local hospital, and the infant is immediately placed with family members or social services.

With its thick steel doors, bare floors and an intercom system paging inmates for their exams, the DRDC clinic on most mornings is busy, loud and chaotic. "It's like being in a giant bathroom," staff nurse Van Wiliford testified during Bob Gusich's hearing. Sometimes the small area is packed with up to fifty inmates. "These people," Wiliford noted, "are not always the type who listen to directions."

"They're not nice people," adds a nurse. "There's one who's a real dirtball -- and I mean a real dirtball -- but that doesn't mean he doesn't deserve good medical care. We realize that if these people had impulse control and could think things through, they probably wouldn't be here. The reason we take care of them is because they're human beings and we've taken an oath to do so."

About twenty nurses -- both male and female -- work at the DRDC, and there are open slots for a half-dozen more. Like hospitals and clinics throughout the West, the DOC is feeling the effects of a regional nursing shortage. But longtime veterans of the job say they've stuck around for the stability and good state benefits -- and some of the unique challenges of treating tough operators.

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Gayle Worland