In 1976, the U.S. Supreme Court issued a landmark ruling (Estell v. Gamble) that made incarcerated people the only group in the United States with a constitutionally protected right to health care.
But the exact nature of this medical care has yet to be explained.
For example, in the late 1970s, Jorge Renaud was serving a 27-year sentence in a Texas prison when his head got caught in the mechanical door of his cell. The incident nearly cut his ears off his head. Reno, now the national criminal justice director for the civil rights group Latino Justice, recalled that when he arrived at the infirmary, “an inmate literally nailed my ears together.”
This is not state-of-the-art care by any standards.
Today, multiple medical organizations and correctional associations, including the National Commission on Correctional Health Care and the American Diabetes Association, have published health care standards for more than 2 million people in federal, state, and local correctional facilities.
But these standards are entirely voluntary.
The predictable result is that the level of care varies widely from state to state, from county to county, and from facility to facility.
Here are some realities of U.S. correctional health care
Prison nursing is emergency care
One of the most significant differences in correctional health care exists between jails and prisons. Prisons are by definition temporary facilities, and the average length of detention is 26 days. (Prisons typically house people serving sentences of more than one year.)
That means in jails, providers often only have time to deal with emergencies, said Warren J. Ferguson, MD, professor of family medicine and community health at the University of Massachusetts Chan School of Medicine and director of the Academic Alliance for Criminal Justice Health.
Larger facilities generally provide more care
Larger facilities, whether jails or prisons, are more likely to have staffed clinics. They might even have their own dispensary, Ferguson said.
Smaller facilities have only one licensed practical nurse and may need to call 911 in the event of an emergency. An increasing number of facilities, large and small, now rely on telemedicine.
Accreditation bodies have higher standards
Facilities accredited by the National Commission on Correctional Health Care or the American Correctional Association also tend to provide better care, Ferguson said. These facilities typically screen inmates for a variety of illnesses within 24 hours of arrival, but different organizations may require different screenings.
They may also take more steps to protect the privacy and dignity of prisoners. For example, the new board standards require that pelvic, rectal, breast, and genital area examinations be performed in a private area, such as behind a screen or curtain.
You can usually find certifications and other information on a specific facility’s website. For example, the Texas Department of Criminal Justice’s webpage on the state’s Ramsey prison shows that it houses more than 1,500 inmates, has an on-site infirmary staffed by 21 medical staff, and is accredited by the Corrections Association.
You can also search for accredited facilities on the association’s website.
Inmates may have to pay medical bills
The law requires that incarcerated people receive health care, but that doesn’t mean it’s free. Most facilities are self-funded.
In Texas, for example, prison visits cost $13, and experts say in some cases people in jails and prisons forgo care because of the cost.
It’s not always clear who makes that decision, which can be a real problem, said Mark F. Stern, MD, a correctional health care consultant and senior medical adviser to the National Sheriffs’ Association.
That’s why, he said, “some prisons provide quality care and some prisons don’t.”
“There’s no book or manual that tells you you have to do this and you can’t do that. It’s all based on case law. Case law varies from state to state.
For there to be case law, there must be cases.If the case makes sense, it means something has already That’s problematic for someone’s health care, said Aaron Fischer, J.D., chairman of the American Diabetes Association’s Legal Advocacy Subcommittee.
“A very important part of my job is representing people in jails and prisons, whether in individual cases where they have been seriously harmed, or in larger class actions that are trying to change the current system,” he said.
“The red flag to me is when a health care practitioner says something is needed and monitoring is needed [prison officials] Say no,” Fisher said.
These are the kinds of cases that can make a real difference. A class-action lawsuit over prison health care prompted California to create an extensive online dashboard to track vaccination rates across the system, trends in asthma and dental care, blood sugar levels, potentially avoidable hospitalizations and dozens more other factors.
What is an insulin pump? Led a men’s diabetes support group for 10 years.
For example, incarcerated individuals with diabetes may require multiple visits to the medical office for regular blood glucose testing. They may not be able to get snacks when their blood sugar plummets. They may not be allowed to use insulin pumps or continuous glucose monitors. Exercise may be limited.
Members of the Great Meadows Support Group have written a guide to managing diabetes while incarcerated, which includes things like exercises that can be done in cells.
Leslie Soble, senior program associate for Impact Justice’s prison food program, said larger facilities may try to offer specialized diets for diabetes or other conditions, but that’s not common.
Diabetes affects approximately 9% of incarcerated people (compared to 6.5% of the general population) and can be one of the most difficult diseases to control in prisons because it requires healthy food, exercise, and regular blood glucose monitoring to control.
Prison and prison diets are “extremely high in refined carbohydrates, sodium and sugar and very low in fruits, vegetables and high-quality protein,” Soble said, adding that there are exceptions. Impact Justice, a prison reform nonprofit that works closely with the Maine Department of Corrections, uses fresh fruits and vegetables from the on-site garden.
Even prescription treatments and medications can be a problem. Prison and jail health care systems often follow strict protocols, which can limit the types of treatment and care available. As a result, sometimes important medications or treatments may not be allowed at all.
“Prisons and jails are stagnant places when it comes to information,” said Daniel Rowan, program manager of the New Mexico Peer Education Program, which trains incarcerated people on hepatitis C, diabetes, sexually transmitted diseases, and more. many.
Most correctional facilities do not allow access to the internet, but family, friends and supporters can “mail” educational materials from reliable sources such as the Centers for Disease Control and Prevention or the National Institutes of Health.
Other incarcerated people may be a source of information, if not actual care. “Usually there’s one person in every room [peer education] There’s a lot of personal experience in the class and they’re all experts,” Rowan said.
In New Mexico, half of incarcerated people have been exposed to the hepatitis C virus. Project ECHO’s New Mexico peer education program trains inmates in state prisons to educate their peers about hepatitis C as well as other infectious diseases and addiction.
Indiana and Texas have similar programs. Research shows these programs can reduce risky behaviors. There are other benefits too. For example, Rowan received Project ECHO peer educator training while serving a five-year sentence in Roswell, New Mexico.
“It’s common for people to experience an increase in confidence when they receive peer education training,” said Rowan, who is now employed full-time by Project ECHO. “The ability to speak and communicate, shake hands and make eye contact are all transferable skills.”
Some prison systems have medical grievance procedures. This is your chance to ask for something you didn’t get.
“In Texas, every department has a patient liaison,” said Savannah Eldridge, a registered nurse and founder of Be Frank 4 Justice, a nonprofit that advocates for the rights of incarcerated people. organize.
When Eldridge receives a request for assistance from an incarcerated person, she typically seeks a resolution directly from the Texas Department of Corrections Office of Professional Standards.
When this approach fails, there are often local nonprofit organizations that can help you advocate for your needs through official or legal channels.
One thing that can help with your care is to keep Protected Health Information (PHI) forms. This allows friends, family and supporters to access an incarcerated person’s medical information. Eldridge advocates extending the validity period of Texas PHI forms from the previous 6 months to 2 years.
In the long run, internal healthcare is inseparable from external healthcare. In fact, more than 95% of prison inmates eventually return to the community.
Once an incarcerated person returns to the community, any medical services provided within the prison cease. There are other options, such as Medicaid, but they may not always be available.
“There is a significant disconnect between health care in correctional facilities and health care in the community,” said Dr. Rodlescia Sneed, assistant professor of public health at Michigan State University.
But, she said, there are ways to plan ahead. People looking to get out of prison can connect with friends, loved ones, and outside support organizations to learn about establishing health care upon reentry into the community.
Many prison systems have caseworkers and reentry programs to help you access housing, employment, and health care resources after you are released from prison.
