Reforming health care for patients in prison

Researchers discuss the lack of uniform standards for health care provided behind bars.

Only one group of people in the United States has a constitutional right to health care: incarcerated people.

In 1976, the Supreme Court ruled that depriving incarcerated persons of reasonably adequate medical care violates the Eighth Amendment prohibition on cruel and unusual punishment. But who decides what is reasonably adequate?

The answer is not so clear. Multiple Federal, State, and Local Agencies own authority over correctional health care. The Federal Bureau of Prisons (BOP) oversees the provision of medical, dental and mental health services in federal prisons. However, the vast majority of incarcerated people are tenuous in state prisons and county jails, where standards vary by state and county.

Some facilities are accredited by private organizations such as the National Prison Health Commission (NCCHC), which requires compliance with certain process and quality measures. But this accreditation process remains entirely voluntary, leaving the correctional health care system without a uniform set of standards.

This lack of mandatory standards or oversight has LEDs to widespread inadequate care. A study find that among those incarcerated with a persistent medical problem, 20% of those in public institutions and 68% of those in local prisons remained untreated. Prison medical staff also often fail to carry out routine gynecological examinations, screen for common infectious diseases, or for administer prescribed medications. few jails to supply medication-assisted comprehensive treatment for people with substance use disorders, despite the high prevalence of the disease find among the incarcerated.

Some activists attribute this model of inadequate care to increasing privatization, while states to look for limit rising health care costs in correctional settings. In an ongoing class action lawsuit in Arizona, incarcerated allege that the state’s private health care provider provided “totally inadequate” care that resulted in preventable injury, disfigurement and death. The facilities involved in the case are Accredited by the NCCHC, casting doubt on the effectiveness of the current accreditation process.

Nearly 2 million people are currently incarceratedof which 800,000 have a chronic medical condition. At a time of massive incarceration, the substandard state of the correctional health care system has a profound impact.

In this week’s Saturday seminar, experts discuss how increased regulation can protect the constitutional right of incarcerated people to receive adequate health care.

  • In one article in Public health chronicles, Susan M. Reverby of Wellesley College considered modern prison health care in the context of prison health care in the 1970s. Reverberation Comments a 1974 study of health care conditions in prison and concludes that many of the concerns identified—including too few doctors, lack of follow-up and lack of primary health care – persist today. She attributes the lack of reform in part to the increasing privatization of prison health care and mass incarceration. Reverb further argue that conditions will not improve until the humanity of those incarcerated is recognized and care prevails over control.
  • Medicaid “Inmate Exclusion” Politics makes federal Medicaid funds unavailable for medical treatment provided to incarcerated people, Explain Mira K. Edmonds from University of Michigan Law School. In one article published in the Georgetown Journal of Poverty Law and PolicyEdmonds argue that the elimination of the policy is necessary to finally end the Medicaid program’s distinction between the “deserving” and “undeserving” poor and to advance the recognition of health care as a human right. She dispute that the introduction of Medicaid funding in prisons would be accompanied by higher federal standards of care, expanded mental health care services, and drug treatment for those incarcerated.
  • In one article in Law and social inquiry, Spencer Headworth and Callie Zaborenko of Purdue University explore trends in private accreditation among health care professionals in correctional settings. Headworth and Zaborenko compare the number of NCCHC-accredited physicians in each state to the number of lawsuits alleging inadequate health care in prison and prison death rates. They report that higher rates of litigation predict an increase in accreditation, but that an increase in accreditation has no impact on prison death rates. Headworth and Zaborenko conclude that correctional institutions use private accreditation in response to legal threats rather than as a proactive measure to protect the health of inmates.
  • The health care crisis in prisons has serious consequences for reproductive health, Argue Lauren Kuhlik and caroline sufrin of Johns Hopkins University. In one article published in the Harvard Law and Policy ReviewKuhlik and Sufrin criticize the absence of federal standards for reproductive health care behind bars. They describe the individual prison policies that limit access to abortion services, permit inadequate prenatal care and To allow chaining pregnant women during childbirth. According to Kuhlik and Sufrin, such systemic neglect is a form of state violence and reproductive injustice. They Argue that state domination of reproductive health care is a deliberate and oppressive method of prison control.
  • Health care planning for prisoners is often minimizes and neglects dental care despite the physical and psychosocial benefits of oral health, writes Anne S. Douds of Gettysburg College and its co-authors in a article in Annals of Health and Life Sciences Law. They Argue that despite the significant oral health needs of the prison population, prisoners do not have access to adequate dental care. For example, some states to follow an “extraction only” rule, under which prison dentists will not “fill, crown or attempt to salvage teeth”. Douds attributes the lack of access to dental care at expensive copays and health research in prison which highlighted medical care rather than dental care. Douds and his team recommend that prison dental programs disseminate oral health education materials for incarcerated people and to improve telehealth options.
  • In one article published in the Notre-Dame Review of International and Comparative Law, Juan E. Mendez from American University of Washington College of Law proposes reforms United Nations Standard Minimum Rules for the Treatment of Prisoners. Mendez argue that the revised rules should recognize the standard of “right of access” and adequate medical, psychiatric and dental care. This recognition would require measures such as an absolute ban on engaging in torture, the provision of medical supplies to prisons and procedural safeguards, such as routine medical examinations, Mendez argue. Mendez too recommended provide special measures to protect vulnerable or high-risk groups such as children, mothers and LGBTQ+ people in the criminal justice system.

The Saturday Seminar is a weekly feature that aims to put into written form the type of content that would be conveyed in a live seminar involving regulatory experts. Every week, Regulatory Review publishes a brief overview of a selected regulatory topic and then summarizes recent research and academic writing on that topic.

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