Viewpoint: How hospitals may be violating inmate care rights

Many hospitals have a culture that too often neglects incarcerated patients' rights and leads to worse outcomes, Dan Resnick, MD, an internal medicine resident at Atlanta-based Emory University School of Medicine, and Mark Spencer, MD, an internal medicine physician at Grady Memorial Hospital in Atlanta, wrote in an opinion piece published on Medpage Today on Jan. 6.

"Our interactions with incarcerated patients who come to our hospital from various local jails have been the most morally injurious," the authors wrote. "It is a common topic of informal conversations among students, nurses, residents and other care staff, yet it remains systemically unaddressed and disturbingly normalized."

Incarcerated individuals are one of the few populations with a constitutional right to healthcare, yet healthcare in prisons and jails is often subpar because the jails are focused on security. Each year of incarceration can reduce life expectancy by two years, the authors wrote. 

Many incarcerated individuals come to hospitals for higher levels of care but often face degradations in those settings.

"While they may be at a hospital, they are still viewed by many as prisoner first, patient second," the authors wrote. "There is a long history of medical staff deferring to law enforcement policy and practices for detained and incarcerated patients. Many of the current common practices continue not because they are backed by scientific evidence, but due to a deference to law enforcement and institutional inertia. Clinicians' interactions with these patients are often guided by an unwritten curriculum, picked up by observation of mentors. At times, an institutional policy may not exist at all."

This issue erodes patient-physician relationships, violates patient autonomy and is an affront to patient dignity, the authors said. Most hospitals already have security protocols and personnel in place yet continue to focus on increasing security rather than offering care.

"Here in Atlanta, we incorporated the treatment of incarcerated patients into the Emory University Department of Medicine Health Justice Standards, a public-facing document that promotes collective accountability in the department," the authors wrote. However, policies do not always translate into practice. 

The authors recommend changes to policies to improve patient care for incarcerated individuals, including stationing on-duty guards at the door, not in the room, to end violation of patient privacy; acknowledging harms of prophylactic shackling of incarcerated patients; increasing coordination between guard and hospital security and document why restraints are needed if there is a security concern; allowing medical staff to contact next of kin to provide updates and obtain collateral information; and allowing medical staff to engage with their legal team to explore options for medical release from detention.

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