Everyone means everyone

UND School of Medicine & Health Sciences faculty and students on an elective rotation that has them pitching in at the North Dakota State Penitentiary.

“This rotation serves as a reminder that there are underserved populations hiding in plain sight – and they’re right here.”

The “here” in question, said Dr. Stephanie Gravning, is the North Dakota State Penitentiary in Bismarck, N.D., where Gravning serves as Correctional Health Authority.

A community faculty member for the UND School of Medicine & Health Sciences (SMHS), Gravning coordinates a North Dakota Department of Corrections & Rehabilitation (DOCR)-based course – IMED 9129 or “Community Intensive Internal Medicine” – for third-year UND medical students.

The Department of Internal Medicine course is designed, its syllabus suggests, to give students a chance to understand “the barriers and concerns that impact patient management in different community settings, including prison inmates and ICU patients.”

Language matters

Actually, clarified Gravning, the term “inmate” has fallen out of favor.

“That’s what we used to term people who are incarcerated, but now they’re residents,” she explains. “They live here. This is their home.”

This change in language is massively important not only for the rehabilitation of former offenders, said Gravning, but for their healthcare, and population health more broadly. The change helps normalize for current and future physicians the need to treat a patient population that, like any other group, requires often complex medical interventions.

“We do diabetes hypertension, annual physicals,” said Gravning. “We’re doing colon cancer screening and sleep studies on-site. We have people confined to wheelchairs. We have feeding tubes. We have IV antibiotics. Everything.”

Inspiring hope and managing systems

Preventive medicine notwithstanding, the 2009 graduate of UND’s M.D. program framed the course as more of a “systems” rotation.

“We do try to get some clinical care in for students, but it really becomes a programs overview,” continued Gravning. “How do we provide a standard of care? What’s our structure? How do we use our support staff to the edge of their certifications to be able to maximize their availability and their ability to provide services? It’s a unique program.”

This systems overview was exactly what attracted UND medical student Mercedes Hoffner to the rotation.

Nodding alongside Gravning, the Nebraska native said that whatever expectations she had when she enrolled in the elective have been more than exceeded.

“Getting to meet some of the people living here, was just, honestly, an inspiring experience,” said Hoffner. “I’m getting a good sense of how the health system works, and how they streamline things here. It’s not only cost-effective care, but also shows me evidence-based medicine in action. And seeing the administrative side has made this a really comprehensive experience.”

Admitting that she had not yet seen many patients one-on-one, Hoffner, who is actually most interested in practicing pediatrics, said she is getting good exposure to health systems management.

“It gives me a lot of hope, seeing the progress and the rehabilitation actually being done here,” she said.

‘Superior interviewing and examination skills’

Established in 2003, the rotation was managed for years by Gravning’s predecessor Dr. John Hagan.

While he was already at the DOCR, Hagan took on the role of third-year clerkship director for the SMHS Southwest Campus in Bismarck in 2008. That’s when the rotation really took off for SMHS medical students.

“These students choose these opportunities,” Hagan said. “As a result, they develop superior interviewing and examination skills, and are forced to utilize critical reasoning, structured differential diagnoses, and evidence based medicine.”

And although the experience can be intimidating, smiled Hagan, UND medical students step up – “without exception” – to meet the challenge of caring for the DOCR’s unique patient population.

Also stepping up is 2012 UND grad Luke Roller, M.D.

The Associate Dean for the SMHS Southwest Campus in Bismarck, Roller is knee-deep in a project designed to better diagnose and treat DOCR residents using ultrasound technology.

“I was talking with Stephanie and she wanted more ultrasound services out there,” said Roller, referencing the technology that was on-site but out-of-use at the penitentiary. “We don’t want to have to transport those patients to the hospital if we don’t have to because it’s a huge cost – a huge logistical challenge. But they didn’t have a radiologist at the facility, and didn’t have a technologist. So I said, ‘Yeah, I can provide all those things.’”

A radiologist by training, Roller’s solution to what amounted to a bureaucratic conundrum was to round up the right group of volunteers – himself included – to help provide a needed service at the DOCR facility.

Having undertaken a rotation at the penitentiary himself years ago as a student, Roller was sensitive to Gravning’s challenge. So he jumped in to help in 2024, identifying the facility’s needs in terms of software, hardware, and people.

Fast forward to summer 2025 and Roller said his team makes it out to DOCR to provide ultrasound services “once or twice a month.”

Everyone means everyone

Using COVID as an obvious example, Hagan said that whatever one might think of those living in correctional facilities, it is incumbent upon communities to meet the healthcare needs of penitentiary residents.

“Corrections health is public health at its finest,” he added. After all, viruses and bacteria don’t stop at the prison gate. “Since almost all DOCR inmates will be released back into the community, we’re providing care and modeling best health practices for our future neighbors or co-workers,” Hagan explained. “When we care about our patients’ health, they care about their health.”

All of this is another example of how the UND School of Medicine & Health Sciences serves the entire state of North Dakota.

Gravning was drawn to the role of Health Authority, she said, both out of a desire to do something different and to give back to North Dakota in a way that not everyone is able to do.

“I am in this position because of the internal medicine rotation,” she said, adding that she provides services alongside a full-time physician assistant and other providers at the DOCR facility.

“Without that and the mentorship and guidance of Dr. Hagan, my life in medicine would be drastically different – and not nearly as cool.”

Roller was just as direct in his commitment.

“I feel very strongly about this: I got my education from and for the state of North Dakota,” he said. “It’s not like I paid the entire cost of my education alone. The people of North Dakota, through the state legislature, helped me. A lot. Because of that, I’ve always felt like I owe the people here something.”

And by “people of North Dakota,” Roller means everyone living in the state.

Even those living in a correctional facility.