Prison health care
Prison health care refers to the medical services provided to individuals incarcerated in correctional facilities, a topic of growing concern as the number of prisoners, particularly those with chronic illnesses or disabilities, continues to rise in the United States. The provision of health care in prisons faces significant challenges, including limited resources, understaffing, and a higher prevalence of serious health conditions among inmates compared to the general population. Legal standards established by landmark court cases, such as Estelle v. Gamble, mandate that prisons provide adequate medical care, framing it as a constitutional obligation. Accreditation by professional bodies like the National Commission on Correctional Health Care aims to enhance care quality, though compliance is not legally required.
Ethical dilemmas also permeate prison health care, as providers navigate the complexities of treating patients with criminal backgrounds while ensuring their rights to informed consent and confidentiality are upheld. Furthermore, the debate over copayments for medical services raises concerns about access to care for those who are often financially disadvantaged. With the ongoing effects of the COVID-19 pandemic highlighting vulnerabilities within these systems, calls for reform in prison health care remain strong, as advocates seek to address the disparities and challenges faced by incarcerated individuals.
Prison health care
Definition: Preventive care, medical treatment, and other health services offered in correctional facilities
Significance: Prison health care has become an increasing concern as correctional institutions across the United States have experienced significant growth in the numbers of incarcerated individuals, especially those who have physical disabilities or are aging or are chronically or terminally ill.
Prison health care presents unique challenges to the medical professionals responsible for the care and treatment of those who are incarcerated. Prison health-care resources are limited, and incarcerated individuals are more likely than members of the general population to have serious illnesses, such as cancer, diabetes, heart disease, and HIV/AIDS. The treatments for such diseases are costly, and the financial resources of many prisons are limited. Moreover, prison health-care systems are often significantly understaffed. Despite these obstacles, however, correctional facilities are constitutionally required to provide adequate medical care to those incarcerated. In an effort to assist the prison system with constitutional compliance, professional health-care organizations have developed standards of care and ethical codes.
Legal Standards of Care
Prior to the 1960s, the judicial system practiced a judicial restraint or “hands-off” policy with regard to administration of prisons. During that period, judicial officials were reluctant to get involved in correctional issues. Many judges claimed they not only lacked the authority and expertise to intervene in correctional matters, but that court intervention might result in undermining the work of correctional administrators.
The lack of judicial intervention and court deference to prison administrators resulted in a number of abuses, especially in health care for incarcerated individuals. In many facilities, prisoners were routinely denied the most basic standards of medical care and treatment. However, in the landmark 1976 case of Estelle v. Gamble, the US Supreme Court affirmed federal jurisdiction over correctional health-care systems and ruled that when constitutional rights are at risk, the courts have not the right but the duty to intervene. In addition, the Supreme Court ruled that “deliberate indifference to the serious medical needs of inmates” was a violation of the ban in the Eighth Amendment on cruel and unusual punishment. The Court reasoned that because prisoners are wholly dependent on the state for their needs, the state is obligated to provide for their serious medical needs. Therefore, correctional administrators or authorities can be held civilly liable under Section 1983 of the US Code for failing to provide adequate medical care to prisoners.
Accreditation and Professional Standards of Care
During the early 1970s, the American Medical Association (AMA) surveyed the nation’s jails and found that medical services were lacking in three primary areas: adequacy, access, and availability. The AMA then developed a set of standards for the delivery of health-cares services in jails and prisons and initiated a voluntary accreditation program for correctional facilities that met these standards.
Accreditation is a process in which an independent outside agency certifies that correctional institutions have met acceptable national standards for health-care services. As of the 2020s, three national bodies offered accreditation to correctional facilities: the American Correctional Association (ACA), which accredits the entire operation of institutions, including health care services; the Joint Commission on Accreditation of Health Organizations (JCAHO), which oversees the accreditation of a variety of health-care organizations, including correctional facilities; and the National Commission on Correctional Health Care (NCCHC), which sets standards of health care for jails, prisons, and juvenile facilities. Of these organizations, the NCCHC is considered the leading authority on correctional health care. NCCHC standards are wide ranging and include administrative and personnel issues, environmental and preventive health care, routine and emergency health services, and medical-legal issues.
The courts have not ruled that correctional facilities are constitutionally required to undergo accreditation. An increasing number of prisons have sought voluntary accreditation in the hope of reducing litigation by incarcerated individuals, but the implementation of these standards does not guarantee that result. In Bell v. Wolfish (1980), for example, the Supreme Court ruled that standards developed by professional associations, such as the NCCHC, are at best only advisory and do not necessarily define what is minimally required by the Constitution. Nevertheless, correctional institutions frequently set health-care guidelines in accordance with NCCHC standards.
Ethical Considerations
In addition to developing standards of health care and accreditation, many professional organizations have stressed the need for prison health-care providers to develop and adopt a code of professional ethics to guide the conduct of professionals and establish moral duties and obligations in relation to their clients, institutions, and society. Although a number of correctional health-care organizations have adopted such codes, correctional institutions are neither constitutionally nor professionally required to do the same. However, as with accreditation, prison officials who adopt ethical standards of care and treatment of prisoners reduce the chances of litigation.
Many of the ethical issues that arise for prison health-care providers are similar to those encountered by health-care providers practicing outside of prisons. However, in contrast to the issues faced by those who are not incarcerated, the ethical challenges that correctional health-care providers face may be complicated by the settings in which they administer care and the clients whom they serve. For example, health-care providers must disregard the criminal records of their imprisoned patients. Providers are often aware of their patients’ crimes and may have difficulty administering care because of what may be disturbing knowledge. Moreover, all patients also have a right to make autonomous decisions about their own medical care, regardless of the settings in which they receive care. Their rights include the right to be fully informed about all medical treatments they receive and the right to refuse medical care. Finally, as in the medical industry as a whole, doctor-patient confidentiality is essential, and medical staff should never discuss the medical diagnoses or treatments of incarcerated patients with anyone other than the patients themselves.
As of the 2020s, debates were ongoing as to whether it was ethical for prisons to charge incarcerated individuals copayments for medical services. According to the Prison Policy Initiative in 2022, forty states as well as all federal prisons still had copayment systems in place. Such copayments, which can be as high as $100, are applied to both hospital visits and emergency treatment as well as routine care. Critics of this policy have argued that the majority of prisoners do not have the financial means to be able to afford such charges, deterring them from seeking medical care. Prison officials have countered that these fees help prisons to raise funds to make up for the cost of having to offer medical services. With legal and judicial policies continuing to contribute to mass incarceration, the number of people incarcerated remained exceptionally high, with the Prison Policy Initiative estimating in 2023 that approximately two million people were incarcerated at that time. These numbers, which subsequently kept correctional facilities' health-care costs higher as well, fueled the debate over related policies, especially amid the impact of the COVID-19 pandemic that began in 2020. The Center for Law and Social Policy reported in early 2021 that the COVID-19 death rate was 2.3 times higher among those incarcerated. While some states and prisons made adjustments to health-care policies as incarcerated individuals were particularly vulnerable to contracting the rapidly spreading virus, including lowering, suspending, or eliminating copyaments, commentators noted that these changes proved only temporary, with many reverting back to pre-pandemic policies by 2023. Calls for reform continued.
Bibliography
Altice, Frederick, Peter Selwyn, and Rita Watson, eds. Reaching In, Reaching Out: Treating HIV/AIDS in the Correctional Community. Washington, DC: Natl. Commission on Correction Health Care, 2002. Print.
Andrews, Michelle. "Even in Prison, Health Care Often Comes with a Copay." National Public Radio. NPR, 30 Sept. 2015. Web. 31 May 2016.
Faiver, K. L. Health Care Management Issues in Corrections. Lanham: Amer. Correctional Assn., 1998. Print.
Herring, Tiana. "COVID Looks Like It May Stay. That Means Prison Medical Copays Must Go." Prison Policy Initiative, 1 Feb. 2022, www.prisonpolicy.org/blog/2022/02/01/pandemic‗copays/. Accessed 27 Sept. 2023.
Johnson, Cameron. "COVID-19 Death Rate in Prisons and the General Population." The Center for Law and Social Policy, 31 Mar. 2021, www.clasp.org/article/covid-19-death-rate-prisons-and-general-population/. Accessed 27 Sept. 2023.
PEW Charitable Trusts, and John D. and Catherine T. MacArthur Foundation. State Prison Health Care Spending. Washington, DC: 2014. PDF file.
Puisis, Michael, ed. Clinical Practice in Correctional Medicine. St. Louis: Mosby, 1998. Print.
Sawyer, Wendy, and Peter Wagner. "Mass Incarceration: The Whole Pie 2023." Prison Policy Initiative, 14 Mar. 2023, www.prisonpolicy.org/reports/pie2023.html. Accessed 27 Sept. 2023.