Guest editorial.

Congratulations to the 16 corrections professionals honored as this year's "Best in the Business." I would like to commend all of them for their unwavering commitment to excellence. There are many unsung heroes and heroines in corrections. Every day they enter the nation's prisons, jails, and juvenile and community corrections facilities to operate, manage and oversee the daily activities of approximately 2 million incarcerated adults and youths.

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Training is an integral component to operating correctional facilities and systems. In addition, corrections professionals must maintain a "security consciousness" at all times as they carry out their routine duties. This security consciousness is rooted in the primary common mission that all corrections professionals share: to ensure and maintain public safety. A secondary mission is to prepare incarcerated adults and youths for reentry into their communities. The success of these missions is highly dependent upon the professionalism of the correctional staff. Webster's New World College Dictionary defines a professional as "one with assured competence in a field." The keys to ensuring staff competence are education, training and experience. Correctional administrators must mandate continuous professional development activities in order to perpetuate the competencies of their staff. Only then can success at the facility or system level be achieved. It requires a multidisciplinary, professional staff working together in an atmosphere of cooperation and mutual respect. The individuals profiled in this edition are exemplary role models of correctional professionalism.

Along with recognizing these individuals, this issue also addresses the challenges faced by correctional health care professionals. Offenders are disproportionately burdened by disease, especially infectious/communicable diseases such as HIV, AIDS, tuberculosis, hepatitis, syphilis and many sexually transmitted infections. Correctional medicine has established systems to identify, screen, treat and educate offenders on prevention measures. These efforts maintain public safety and health by reducing the disease burden and/or the behaviors resulting in disease transmission upon offenders' reentry into the community. Security operations and health care staff must continue to work cooperatively in caring for the offender population. This is necessary because of the unique challenges in practicing medicine "behind the walls."

I would like to briefly highlight two of the most pressing challenges facing correctional medicine today. First, there is a nationwide shortage of nurses, which has significantly impacted correctional medicine. As a result, health-trained security personnel are integral to ensuring continuity of care. In jails, these health-trained security personnel assist with receiving and screening. They are trained in taking a medical history, making observations and determining appropriate disposition of an offender based on responses to questions and observations. They may also assist with medication delivery at times when there are no medical staff on site by providing offenders with access to medication, which the offenders self-administer. Health-trained security staff document this on a log and keep track of the pill count.

The second major challenge in correctional medicine is the escalating cost of health care. For prisons, this is related to the "graying" of the offender population. Some jurisdictions have seen exponential growth in their geriatric offender populations due to changes in sentencing laws and the baby boomer effect. Many of these offenders age 55 and older have physiologic ages that are at least 10 years older than their chronologic ages, which has placed tremendous pressure on correctional health care budgets. Many elderly offenders require skilled nursing care, sheltered housing, chronic specialty care, and assistive devices such as canes, walkers, hearing aids, prosthetics and dentures. In the foreseeable future, the management of geriatric offenders will result in the greatest operational challenge for all correctional staff.

Despite the many challenges faced by those working in the corrections field, the professionals honored in this issue have remained focused and committed. Congratulations once again to them and their families. As the corrections profession strives toward continuous quality improvement and best practices, staff must work side by side in a multidisciplinary team approach to ensure that the nation's correctional systems are humane, safe and meet the legal standards set forth by the Constitution.

Lannette Linthicum, M.D., CCHP-A, FACP 

Director, Health Services Division

Texas Department of Criminal Justice