Caring for everyone: My journey in correctional medicine

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Growing up, my father was in law enforcement, and my mother worked in Court Administrations. I often listened to their conversations about the people my dad would arrest and my mom would then process through the court system. The frustration of seeing an offender for multiple offenses can be exhausting. Surely, there must be a way to help these people? Caring for everyone, regardless of what they have done, is paramount in my line of work.

I chose to advance my career in nursing and received my educational foundation from Augsburg University in downtown Minneapolis. Their nursing program emphasizes eliminating health inequities through peaceful, just, and collaborative actions that uphold and improve human potential. One of my first professors was Katie Clarke, a true mentor to me. She listened to my concerns and assisted with helping me get into a clinical setting at the local jail with their medical agency. The jail administrator at Douglas County jail, Jackie Notch (now retired), had been a long-time role model of mine and welcomed me to assist in any way.

Making a plan

During this time, I spent many hours in downtown Minneapolis working at the Central Health Commons, an Augsburg-run health center for the homeless. I was feverishly working on a foundation of what a reentry program may look like for inmates. I had multiple conversations with previous offenders to learn about jail culture and what other facilities do to assist in helping prisoners reenter society.

This experience served as the foundation for my thesis. I worked at the Douglas County Jail to gain helpful knowledge about correctional care. To this day, I continue to volunteer my time at the facility. I started in January 2018 as a student intern and completed my Doctorate of Nurse Practice project there. During this time, I collaborated with inmates to envision what a reentry program would look like for them upon their release from jail. I focused on the top ten resources that are needed when reentering back into the community. It was modeled much like the discharge of a hospital patient. That discharge started at the time of booking.

An average day

When I arrive at the jail, I enter through two locked doors. I then proceed down a hallway and enter the locked medical unit. Once I am in the medical unit, I complete various tasks for the staff nurse. These tasks range from counting medications to filing paperwork. You might be surprised to hear that much preparation goes into caring for inmates. It isn’t going from cell to cell with a medical bag. A medical unit in jail is usually operated much like a standard clinic.

Inmates often come into jail at their sickest. They don’t usually seek medical treatment; the jail is their only stable healthcare. You need expansive knowledge of infectious disease, mental health, and drug dependency. The current jail tasks depend on the number of inmates booked for the day and the degree of illness within the jail. For example, the 70 inmates in jail could all be fine and not have any chronic diseases. You could be managing five inmates with uncontrolled diabetes, two inmates on suicide watch, and three inmates suffering from drug or alcohol withdrawals. Every day is different, and you continually have to pivot to the conditions of the jail.

Caring for everyone as equals

I think one of the hardest things in correctional care sometimes is putting aside your biases. I went into correctional care because I feel everyone deserves healthcare. Sometimes these institutions are the sole health care providers for some of the nation’s sickest people. Yet through my research, I’ve observed the quality and quantity of care provided across correctional institutions to be unclear.

Within the United States, the American Public Health Association, the American Correctional Association, and the National Commission on Correctional Health Care outline the standards for inmate care. Yet, policies and standards are still unclear. It’s also difficult to determine just what each organization is doing to maintain the quality of care across facilities.

Why keep going back?

My university days are over, and my thesis is published, but my duty to others never stops. Correctional Care is really a way to give back to my community. Several social determinants are strongly associated with poor health. In the United States, being non-white, low-income, undereducated, homeless, and uninsured are among the strongest predictors. Individuals in jails and prisons exhibit these predictors of poor health disproportionately. As a result, inmates typically share several health profile characteristics, including mental health disorders, drug dependence, infectious disease, and chronic conditions that may be affecting the greater community. This work gives me the chance to educate inmates while incarcerated on daily hygiene practices, healthy eating habits, and how to navigate the health care system in their communities.

I enjoy working side by side with the wonderful staff at Douglas County Jail. They truly do an amazing job at caring for inmates and making a difference. Inmates often say, “the people here actually care about you.”

Ashley Steen knows how important it is to care for everyone!

Ashley Steen, FNP, DNP

Thanks for reading, and remember, everyone deserves to live without illness or injury. Caring for everyone makes our society whole.

Ashley Steen, FNP, DNP

Tri-County Health Care


Pharmacy Week: Mark Carlson Q&A

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Pharmacists provide a much-needed service in the healthcare industry. They are responsible for the storage, distribution and mixing of medications. They also play an important role in patient education. To celebrate National Pharmacy Week, we caught up with our pharmacist, Mark Carlson. In this interview, we discussed his career at Tri-County Health Care.

Mark Carlson

Q: Why did you become a pharmacist?

A: I wanted to become a pharmacist after working in a pharmacy as a technician.  I saw the diverse career paths in the profession with many options ranging from retail to research.

I liked where the pharmacy profession was heading from a patient experience perspective.  It is very rewarding to educate patients on medications and the nuances of how the medication works for their condition. I find drug-to-drug interactions, adherence and medication safety to be fascinating.

Q: What was your education like?

A: I went to Augsburg College for my Bachelors of Arts in Biology and then obtained my Doctorate of Pharmacy at the University of Minnesota. I was in the second class coming out of the Duluth campus. This program focused on pharmacy in rural Minnesota.

Q: What is your favorite part of the job?

A: I enjoy the variety. My day involves the clinical side of pharmacy, like knowing medication information and helping develop treatment options. Additionally, there is a lot of administrative work as well. I am very blessed to have a tremendous pharmacy team. They are very skilled and often go above and beyond.

Q: How has COVID-19 affected your work?

A: I have been able to integrate with other departments more during the pandemic. It has been a great experience to work with so many talented individuals. The vaccine and monoclonal team have done an excellent job. The pandemic has added to the daily challenge. but our collective effort is really making a difference.

Q: What is it like being a pharmacist at Tri-County Health Care?

A: Being a pharmacist at TCHC has been an excellent opportunity to expand my knowledge and skills. Everyone over the past five years has been great to work with. I was allowed to learn and develop on the job. Before coming here, I didn’t have as much hospital pharmacy experience. Tri-County Health Care places a high value on professional growth.

Q: What career achievement are you most proud of?

A: Being a part of the COVID-19 pandemic response team. Our mission is to help improve the health of the communities we serve and I firmly believe we are doing that, even during these challenging circumstances.

Please call 218-631-3510 to schedule an appointment. To learn more, visit TCHC.org and follow Tri-County Health Care on social media for regular updates.


Masks matter in schools!

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“I choose to wear a mask for a couple of different reasons. I currently have a high-risk teacher, and I want to protect the residents I work with at Mills Manor. I also don’t want to miss out on things like homecoming, prom, sports, and graduation,” said Lauryn Gravelle when asked about masks in school.

Senior year of high school is a major milestone in a person’s K-12 education. It is the grand finale that makes all the homework, cramming, and pop quizzes fade away. However, students have been missing out on this well-earned victory lap in the last couple of years. In 2020, graduations and proms were canceled in mass or held in an orthodox fashion. This year is gearing up to be no different as schools around the nation report high numbers of positive COVID-19 cases.

Lauryn is very busy with school, sports, and masks!

Lauryn Gravelle

Out of fashion

For a good chunk of 2020, masks were in style. Students across the country were sewing and bedazzling mask fabric in an act of pandemic unity. Unfortunately, things have shifted over the last several months, with mask no longer being seen as a helpful resource, only a hindrance. Right now, masks and the vaccine are two of the most powerful tools in the fight against COVID-19, but fatigue has set in. Months ago, classrooms were filled with masked students doing their best to continue studying during a pandemic. That fatigue is seen in school systems across the country.

Doing the right thing isn’t always comfortable

Lauryn’s mother, Wendy Gravelle, is a certified registered nurse anesthetist at Tri-County Health Care. She is also passionate about masking and the vaccine. “I was surprised as I didn’t know she was doing it. At a volleyball game, I saw her wearing it. I asked why she had it on, thinking maybe she wasn’t feeling well,” explained Wendy. Lauryn told her mother she wanted to protect those around her and do more to help during the pandemic.

“I honestly was just so proud at that moment to realize this is something she chose on her own, and it wasn’t me forcing her to do it.  Her sisters have also started wearing their masks, and I believe it was because of the impact she had on them.” – Wendy Gravelle

Wendy has four children, and all of them willfully chose to be vaccinated. Her family is very connected to the caregiving environment, and they would never want to accidentally transmit the virus to others, especially the elderly and immunocompromised. Lauryn works in an assisted living home and is frequently around people highly susceptible to COVID-19.

Masks have fallen out of fashion at many schools.

Masked and united

Masking is still crucial in the fight against COVID-19. It’s so important that even the vaccinated should wear one. Breakthrough infections can still occur in the vaccinated, making masks necessary for everyone when out and about. “I decided that Lauryn is empowering me to also follow her lead, and I wore my mask to her volleyball game. Everyone assumes you’re sick if you wear it. I informed them that if Lauryn can wear her mask at school, so can I,” said Wendy. Lauryn and some of her friends have been wearing masks to school, sporting events and while out shopping. They hope wearing their masks will inspire others to do the same. Lauryn is especially concerned for younger people that claim COVID-19 is a hoax.

The vaccine is currently available to children 12 and up. The vaccine is expected to be open to children ages 5 to 11 soon. Wendy spoke with Tri-County providers before getting her kids vaccinated. She recommends that parents talk to a trusted medical professional in addition to gathering information from trusted sources.

Wendy Gravelle is supporter of masks and vaccinations.

Wendy Gravelle

Getting the COVID-19 vaccine

Tri-County Health Care aims to vaccinate as many people as possible. To schedule an appointment, call 218-631-3510. Patients can also request the vaccine during regular provider appointments. Please follow Tri-County Health Care on social media or visit TCHC.org/covidvaccine for regular updates.


Doctor’s Day 2021: Thank your provider!

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National Doctor’s Day is a time to honor the millions of healthcare providers standing between us and illness. It’s easy to let observances pass by without a singular moment of reflection but this year we should all turn our attention to the doctors that have taken a stand for our collective health. Since the beginning of the COVID-19 pandemic, hundreds of healthcare workers have perished. Every day they go to work not knowing if they will be infected with a potentially deadly respiratory disease.

Use this time to honor doctors and other medical staff still battling COVID-19. Some of Tri-County Health Care’s providers took this time to reflect on their careers.

Physician Provider Doctor Tri-County Health Care Dr. Heidi Olson Doctor's Day

Heidi Olson, M.D.

Heidi Olson: Science and superior care

Why did you choose your career path?

“I love science, the human body, and having a connection with others.”

What have you learned in the last year of practicing medicine during a pandemic?

“As healthcare providers, we need to have a little grace with ourselves and others. Forgiveness is so important right now. There are a lot of hard times in life and beating up on ourselves and others is not the answer.”

Do you have any advice for someone interested in becoming a doctor?

“Follow your passions, there are so many unique areas and facets of medicine. For example, I love wilderness medicine and how it pertains to my outdoor hobbies. In my clinical practice, I enjoy focusing on wellness and quality of life, as well as palliative care in my end-of-life patients.”

Physician Provider Doctor Tri-County Health Care Dr. Shaneen Schmidt Doctor's Day

Dr. Schmidt with her patients, Alyssa and Fiana

Shaneen Schmidt: Patience

For National Doctor’s Day, people are curious, why did you go into medicine?

“I chose to be a physician because I wanted to be instrumental in improving the life and health of others. Particularly, I like being able to put the various social aspects together when taking care of a family. Understanding that a mother’s health or their child’s health affects how they take care of themselves.”

What has the pandemic taught you?

I had to learn how to increase my flexibility and patience. The state of the virus is always changing and I had to learn patience in trying to explain a novel virus that we are constantly researching. I’ve also had to learn to accept that some people may not acknowledge or appreciate my expertise.”

Any advice for newbies entering the field?

“I would recommend they focus extensively on classwork, training and the perseverance that it takes to get through eight years of education plus the several years of specialized training. If you can get through that, a very rewarding career awaits you.”

Physician Provider Doctor Tri-County Health Care Dr. David Kloss Doctor's Day

David Kloss, M.D.

David Kloss: Work with your team!

Why did you become a surgeon? ​

“I love interacting with people and their families and I’ve always had a knack for taking things apart, figuring out what was wrong, and putting them back together. I ​enjoy the changing routine and challenges of being a surgeon.”

What is the important takeaway from this pandemic? 

“People are resilient and we can get through anything if we stick together.”

Do you have any advice for surgeons in training? 

“Work hard and play hard! It is important to study, apply yourself, but also make time for fun to avoid burnout. Medicine is a very long marathon race. You have to pace yourself to make it all the way through. Eat healthy, get some exercise, and take a vacation with your family.”

Share with me a time when your knowledge of medicine changed someone’s life for the better.

“A doctor called me about a 60-year-old gentleman with sudden severe back and abdominal pain. He was sweating profusely. Not in shock but his heart rate was elevated. I made the diagnosis over the phone of a rupturing aortic aneurysm. I ordered an emergent CAT scan over the phone and met him in the ER. From there, we expedited his resuscitation and transferred him to a surgeon at a facility that could perform an aortic stent graft. He had a rupturing iliac artery aneurysm (a rare and very difficult issue, even more difficult to treat). By expediting the CT scan along with his resuscitation and communicating directly with the specialist, I saved his life.  It is not always yourself doing the surgery, but it can be the simple little things that save a life. That’s what makes medicine the greatest career.”

Physician Provider Doctor Tri-County Health Care Dr. Ben Hess Doctor's Day

Ben Hess, M.D.

Ben Hess: Trust is a valuable resource

What led you to this profession?

“I love challenges. I enjoy solving complicated puzzles and I wanted to do something that would help my community.”

What insight have you gained from the pandemic?

“As complex and cumbersome as medicine is normally, in a crisis, we can act decisively and quickly. The public trust is a precious resource we should never squander.”

On National Doctor’s Day, do you have any advice for students?

“Take the hardest classes from the best teachers, regardless of the subject. Everything you learn will help in medicine whether it is science, math, or even art because they all make you a more well-rounded person which can help you connect better to people.”

Laura DuChene: Small town, big heart

Why did you want to become a physician? 

“I’ve wanted to be a physician for as long as I can remember. I grew up in a small town in central Minnesota. We had a family physician and he always went above and beyond. I decided when I became a doctor, I wanted to be just like him. I knew I wanted to raise my children in a small town where I could be like him, and that led me to Tri-County Health Care.”

What’s the best part of being a doctor?

“I love getting to know the families and watching them grow and change. There is nothing more rewarding than delivering a baby and watching that patient become a parent for the first time.”

Has the pandemic shown you anything special?

“We are a strong community and we have a fantastic family of medical providers. Many people have come together to make our community safe and I couldn’t be prouder to live and work here.”

For National Doctor’s Day, please reach out to your provider and let them know how they have impacted your life for the better. Please follow Tri-County Health Care on social media for regular updates. To schedule an appointment with one of our providers, please call 218-631-3510.

Physician Provider Doctor Tri-County Health Care Dr. Laura DuChene Doctor's Day

Dr. DuChene with her patient, Amanda.


Car seats: Do you have the right one for your child?

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By: Denise Peltier, RN, OB/Prenatal Educator

Do you travel much? Do you have kids? If the answer is yes, then let’s talk car seats.

From 1930 to the ’50s, car seats, which originated as a sack hung on the back seat, were designed to keep kids still and maybe give them a view. In the ’60s, a few were made with safety in mind. Federal safety standards were adopted in 1971.

Tennessee enacted the first restraint law in 1979. By 1985, all states had a minimal car seat law, but only 80 percent of those children were restrained. Today, you wouldn’t think of holding your baby during a car ride. We have come a long way. Are you shopping for a seat? Start with research. The website healthychildren.org, managed by the American Academy of Pediatrics (AAP), has a product listing of car seats, which is updated every year. You will see a section that includes rear-facing only, convertible, rear-facing and forward-facing, three in one, combination and booster seats, as well as height and weight limits and approximate cost. Choose a few seats that will fit your child’s size. Then go to safercar.gov and check the Ease-of-Use Ratings. By cross referencing, you now have a better idea of what to look for in the store.

At TCHC, we want to help you. Our nurses have been trained and can answer your questions and even help you in your car. We have hosted car seat clinics for the past 13 years, where you can drive in and get one-to-one help in your car with your child and car seat. Watch for those now through September around Todd and Wadena counties.

Let’s review the law, MN State Statute 169.685, Subd. 5, which is listed at carseatsmadesimple.org:

Denise Peltier (arm on car seat) with one of the ECFE classes she educated in March about car seats.

Infants less than 20 pounds and 1 year of age must be in a rear-facing safety seat. A child who is both younger than age 8 and shorter than 4 foot 9 (57 inches) is required to be fastened in a child safety seat that meets federal safety standards. Under this law, a child cannot use a seat belt alone until they are age 8 or at least 4 foot 9. It is recommended to keep a child in a booster based on their height rather than their age.

This is an abbreviated version of the complete law. There are also exceptions to the law listed on the website. The best practice is to keep your child boosted until they reach 4 foot 9.

Compared to laws in neighboring states, Minnesota, along with 25 other states, has the safest law. A new law in California that went into effect on Jan. 1 states that children 2 years or younger or less than 40 pounds must be in the back seat in a rear-facing seat. We likely will see more of this.

AAP recommends that once your child exceeds the height and weight limit of his or her infant car seat, you should purchase a convertible or three-in-one car seat with a higher height and weight limit and continue to use it rear-facing until age 2 or until your child reaches the height or weight limit for rear-facing use.

If you’re really into car seats, here are a few more facts:

  • Each manufacturer has a website listing products and videos of use and installation.
  • If you’re into blogs, thecarseatlady.com can really keep you up to date on topics and changes in child passenger safety.
  • And if you want to help others, the National Child Passenger Safety Training is available in our area for anyone. Join the team of more than 39,000 child passenger safety technicians and be a community advocate or resource. Go to safekids.org for more.

Todd Wadena Healthy Connections, a community health collaborative organization, will sponsor a car seat clinic on Thursday, June 8, in Wadena. To register or for more information, contact Sarah Riedel at (218) 631-7538 or sarah.riedel@tchc.org or click here.