Most of us never think about the problems of providing health care in prisons and probably even fewer know that inmates are the only people in this country with a constitutional right to good quality healthcare.
In a 1976 landmark decision, the US Supreme Court found, by an 8-1 margin, that, “Deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eight Amendment.” This and other subsequent cases established health care as a constitutional right of correctional inmates.
Inmate Health Affects All of Us
Despite their constitutional right, inmates are generally less healthy than the general population because many of them lived in poverty, abused drugs and/or alcohol or have been more exposed to HIV and AIDS. Providing for their health care is a challenge only some prison institutions are addressing effectively.
We should be concerned because poor prison health can affect the public at large. For example, diseases such as TB, Hepatitis C and HIV are easily spread from prisons to the outside world. Prisoners released to the community with untreated illness puts the general population at further risk.
Organized medicine became involved in correctional healthcare around the time of the Supreme Court decision. An AMA survey identified serious deficiencies in medical care behind bars in the early 70s. The American Correctional Health Services Association was founded in 1975 to serve as an effective forum for current issues and needs confronting correctional health care. It provides “education, skill development, and support for personnel, organizations, and decision-makers involved in correctional health services.”
Prison Health Care Needs Have Been Growing Since the 80s
Demographic changes in prison populations in the last 30 or so years have also contributed to their increased health care needs. In the 70s this population was largely men in their 20s and 30s – the lowest users of health care in the community. The 80s saw a substantial increase in prison population – largely as a result laws limiting judicial discretion in sentencing and greater reliance on incarceration as punishment for conviction of criminal offenses.
Mandated longer sentences for drug-law convictions resulted in burgeoning prison populations and strained resources, rendering prison healthcare facilities overcrowded and ineffective. The population behind bars became sicker and older and the growing percentage of incarcerated women further increased demand for services not previously required.
Partly to deal with budget constraints in the 80s, prisons began to outsource their management, including healthcare delivery, to the private sector. Some of these companies operate with the highest industry standards; others struggle or fail to do so.
High Quality Leadership Is Required to Address Today’s Challenges
Correctional health services today provide care for a large number of people with a variety of conditions including chronic infections such as AIDS and tuberculosis; diseases more prevalent among aging populations such as hypertension, heart disease and emphysema; oral health problems; and a need for gynecological and pre-natal services. In addition, mentally ill inmates who may have difficulty expressing their needs; require screening and identification.
Correctional healthcare systems are challenged by the program requirements for public health services such as immunization, infection control, communicable disease surveillance and health education; and schedule monitoring to care for the chronically ill because inmates tend to move frequently among institutions and multiple providers are often involved in providing care. Some prisons have had difficulty recruiting competent staff.
Filling available leadership positions with experienced, highly qualified staff is probably the single most significant action many prison health systems must take to be able to respond effectively to the healthcare needs of their inmate populations. Success in this endeavor can go a long way towards laying the foundation for a sound programmatic response the challenges facing correctional healthcare today.