POCATELLO - When Dovey Lynn Small walked through the doors of the newly opened Pocatello Women's Correctional Center in April 1994, she was told she was headed to the prison's "special needs" section. It was new jargon for an old sanction.
"I went straight to the hole from the bus," she said.
The hole is the term inmates use for an isolation cell.
Convicted of first-degree murder and robbery in 1982, she received life sentences for both.
Now 55, Small is again a special needs case, but not for disciplinary reasons.
In 2002, she began to experience some numbness in her fingers. Over time, the numbness spread to her feet and legs.
Sitting in the prison's medical facility, the thin woman's arms and legs tremble uncontrollably. Small has Parkinson's disease.
Every woman in Idaho placed under the care of the Department of Correction is screened at PWCC, even if they are headed for other facilities. The screening Includes a physical, pap smear, a mental health evaluation, blood work and a dental exam. To tend to the inmates' medical needs, the prison must offer what is essentially a small hospital.
Attending to Small is LeAnne Malooly, the facility's family nurse practitioner. Small is currently off all of her medications so that the staff, in concert with Small's neurologist, can determine a correct regimen to eliminate the side effects, including headaches and pain. She is anxious to get her medications straightened out so the muscle rigidity and tremors of her disease can be inhibited.
Small has seen all the changes in the prison during the last 15 years, and she is thankful for the current staffing in the medical unit.
"Now we have a medical staff that cares about us," she said. "They have helped us so much."
Kim Thomas is the health service administrator for the prison. Correctional Medical Services is the contract provider for medical services at the prison, replacing Prison Health Services, Inc., the entity that formerly oversaw and staffed the Idaho Department of Correction's medical services.
The former contractor, PHS, recently was on the losing end of a lawsuit stemming from an inmate giving birth on the steps of the prison while in transit to the hospital. Her son was diagnosed with cerebral palsy which she attributed to her lack of proper diagnosis and care. A jury awarded the woman $3.6 million in actual and punitive damages.
As Thomas gave a tour, it was clear she's proud of the care that her staff is capable of providing.
"We have just about everything you'd have in a full-service hospital," she said. "Pretty much anything you could get done in an E.R. you can get done here."
The facility hosts an eight-bed infirmary, an isolation room (negative air pressure ensure pathogens, such as tuberculosis, are not allowed to become airborne), a lab, a gynecology and prenatal room, a four-bed ward and a teleconference room to allow long distance care providers to communicate with the women.
A local physician, Dr. Robert Gilbert, serves as the facility's medical director. He spends about six to eight hours per week at the unit. Dentists, eye care specialists and other health providers also schedule visits. When required, off-site visits for inmates are arranged.
Thomas said the PWCC medical staff screens between 20 and 25 inmates each week. Some stay at the facility while others are bound elsewhere.
Many of the women are in abysmal state of health, having long neglected their personal care.
"We have women who come in who haven't had health care for 10 years, 20 years," Malooly said.
Drug abuse is a primary culprit.
"Most don't have one drug of choice. They have multiple," Thomas said.
Methamphetamine is the leading cause of a myriad of health problems. (Prison officials estimate that 75 to 80 percent of inmates have had a meth abuse problem.) The most obvious sign of long-term meth use is advanced dental disease.
"Sometimes their mouths are so bad, we have to pull all their teeth," Thomas said.
Another prevalent affliction is Hepatitis C. About 30 percent of the women have it.
"It's not as quick as HIV but it's just as deadly," Thomas said.
Other ailments include hypertension and other cardiovascular problems, diabetes and hyperthyroidism. Inmates with chronic diseases are seen once a month to monitor their health.
Given the close quarters, flu is a concern at the facility, especially among the chronic patients and older inmates.
"Anything you'd worry about in a public school," Thomas said.
"Except they have more time to worry about it," Malooly added.
The women laugh. Unfounded worries of health problems are common among many of the inmates. Any celebrity who is suffering from some rare affliction sets off a flurry of "kites" - requests to be seen by medical staff.
"'I think I have what so-and-so has,'" Malooly recounts.
Malooly has gotten wise to the hustle some inmates try on her. A woman might claim to have a gamey knee in hopes Malooly will prescribe she be given the lower bunk.
"I won't be played," she said. "I recognize it."
Although she must be resolute, Malooly is gentle with her patients. It is clear she likes the women she deals with, and the fondness is returned.
Erin Bagwell is an inmate worker in the medical unit and sees the attitudes of the women, many of whom never had anyone who gave them non-judgmental care and attention.
"The majority talk about how amazing the medical (staff) is," she said. "All of the staff is so supportive."
Malooly has been a nurse for 20 years. She received her certification as a family nurse practitioner, trained in the diagnosis and management of common as well as complex medical conditions, in part to better attend to the women at the prison.
"I love my job," she said. "I love serving the women who live here."
Heather Trejo is in the facility due to a parole violation. Although ordered to a residential facility in Kuna to assist in transition and recovery efforts, she was transported to the prison due to her pregnancy. PWCC is the only facility geared to give prenatal care to women under the thumb of the Department of Correction.
Trejo is due any day.
"She's been here since right at the beginning of her pregnancy," Malooly said.
Malooly checks on the baby with aid of a fetal monitor. Although she is in prison, Trejo, 23, seems happy. Asked about the quality of her health care in the facility, she believes her incarcerated care is similar to what she would have received outside the prison walls.
After the birth, which will occur at Portneuf Medical Center, her mother and father will pick up her newborn child and take the girl back to Minnesota. She will then go to Kuna for her nine-month transitional program before rejoining her baby and the father.
Although Trejo could have done nothing during her time at the prison, she chose to work in the medical facility, acting as a companion to inmates too ill to be in the general population. One women she spent hours with was recently given a medical parole. She is being released to die.
The woman, who is in end-stage HIV, arrived at the prison approximately three months ago. The medical staff quickly began the process to get her released.
"We started the second she came in," Thomas said.
The paperwork for a medical parole is scrutinized by the parole board just as for a regular release. Two physicians must verify the illness is terminal and provisions must be made to transition the woman into hospice on her release.
"We just can't turn them out into the street," Thomas said.
It seems fitting to have Trejo as the woman's companion during her stay in the medical unit ward, playing cards and just being there for her, tending to the woman through the last portion of her life while nurturing a new life inside.