The Need for Higher Standards in Correctional Heal

Authors: Josiah D Rich Scott A Allen Brie A Williams

Publish Date: 2014/12/19

Volume: 30, Issue: 4, Pages: 503-507

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Abstract

Over the last 40 years the United States has experienced an “epidemic” of incarceration in which millions of Americans have spent days to years of their lives in jails or prisons During this time correctional medicine has undergone major changes12 In 1976 the US Supreme Court affirmed that failure to provide basic medical care to a prisoner violates the Eighth Amendment to the Constitution banning cruel and unusual punishment3 Over the ensuing decades additional litigation or threat of litigation has forced correctional institutions to provide a minimum community standard of healthcare to prisoners In response accreditation bodies such as the National Commission on Correctional Health Care have codified these minimum standards for prison and jailbased health systems to follow through voluntary accreditation However a minority of the 4575 correctional institutions across the US have volunteered to become accredited using these standards As a result litigation remains the mainstay of enforcing correctional healthcare standards4 and correctional healthcare improvements have transpired piecemeal typically with a focus only on reaching the minimum standards that have been establishedWhile meeting minimum standards is critical in protecting against Eighth Amendment violations we argue that higher standards in correctional healthcare are capable of improving individual and public health while controlling overall costs With 22 million Americans behind bars and 10 million cycling through correctional systems each year5 US correctional healthcare has provided medical care to 1 in 30 living American adults the majority of whom are from impoverished communities where poor healthcare access is the norm6 7 8 9 10 Since more than 95 of prisoners eventually return to the community correctional healthcare has the opportunity and the obligation to transform care for persons and communities most in need11 Moreover given that incarcerated populations are disproportionately from traditionally underserved and/or disadvantaged backgrounds and have a high burden of disease these goals also hold the promise of reducing health disparities6812We delineate three areas—screening and treatment for hepatitis C improved mental health care including treatment for addiction disorders and attention to geriatric care—that exemplify the critical need for proactive evidencebased correctional healthcare that reaches beyond minimum standards and integrates prisoner healthcare into mainstream medicine in order to improve the health of individuals and communitiesWhen the hepatitis C epidemic was first recognized in US correctional facilities in the late 1990s 12–35 of prisoners were already infected13 Facing treatment options that were poorly tolerated costly and minimally effective correctional medicine programs were quickly overwhelmed As the epidemic spread and mortality rates increased inmate litigation contributed to the establishment of minimum standards for hepatitis C screening and treatment13 14 15Prevalence of Substance Abuse among State and Federal Prisoners 200433 Data source Mumola CKJ Drug Use and Dependence State and Federal Prisoners 2004 Special Report Washington DC Bureau of Justice Statistics US Department of Justice Office of Justice Programs Oct 2006 NCJ 213530Prevalence of Any Mental Illness among State and Federal Prisoners and Jail Inmates 2005 Source James DGL Mental Health Problems of Prison and Jail Inmates Special Report Washington DC Bureau of Justice Statistics US Department of Justice Office of Justice Programs Sept 2006 NCJ 213600Prevalence of Hepatitis C in State and Federal Prisoners and Jail Inmates 2006 Data source Varan AK Mercer DW Stein MS Spaulding AC Hepatitis C seroprevalence among prison inmates since 2001 still high but declining Public Health Reports Washington DC 1974 20141292187–95

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