Prison health care in crisis

Doctors and nurses juggle their ethical duty to provide "proper and humane" care against the realities of working behind bars. Take Dr. Selyutin, a Russian-born gynecologist who came to this country nine years ago. He sees prisoners with asthma and seizures. He sees "pieces of meat" -- with broken clavicles, broken legs, broken skulls -- after officers use force on "very violent" inmates. He tries to stay clear of the "psychos ... unless they swallow a piece of metal or a razor blade."

Selyutin sometimes finds himself making decisions based on security concerns rather than on medical needs. Recently, he handled the case of Robert Stokes, who was in the clinic with blood on his chest, arms and hands.

X-rays showed Stokes, 36, who has a tattoo of "BS" on his right shoulder and one of a heart on his left hand, had foreign objects in his rectum. Selyutin thought it was a razor blade and a lighter. Ever mindful of the prisoner's violent streak, the doctor had the guards uncuff the inmate, who had cut his stomach and forearm. Then he told Stokes, who is serving 25 years for murder, to remove the items himself. Even though that worked, Selyutin later said he probably should have done the procedure himself. Stokes was given a disciplinary report for mutilating himself. He is now in a prison mental health facility.