Caring for the convicted: prisoners’ medical rights in the hospital

Screen Shot 2015-12-13 at 3.02.49 PMThere was once a young woman, a softball player, who injured her shoulder and received a week’s worth of Percocet. Within several months, she had become a heroin user, and was sentenced to a month of jail. She started to complain of chest pain, and was treated with Maalox for three weeks. By the time she arrived at the hospital, accompanied by jail guards and shackled to the bed, she was found to have severe endocarditis and died a couple of weeks later.

There is a fifty-year old man, homeless, who tells me that he used to lick his needles before plunging them into his neck and arm. He tells this to me and swears he wants to get clean in an orange prison jumpsuit with manacles on, two guards in the room also staring back at me. He has liver cancer, but is having difficulty scheduling appointments to see a specialist because the jail handles all of his appointments. When he leaves the clinic, other patients and staff stare at him.

This is my first time taking care of incarcerated patients. I was jarred by the security guards, who wore holstered guns during the visits. I had to contact the jail physician when I wanted to report lab results or follow up on my patient, because I couldn’t contact him any other way.

Let’s review the rights of the non-incarcerated hospital patient. You have a right to receive the best level of medical care that the hospital can provide regardless of language, race, religion, sexual orientation, etc. On a more practical level, rights include being able to walk around the floor as long as it is medically safe (and can get passes to sit in the hospital courtyard or cafeteria) and having visitors as long as they do not interfere with your medical care.

The rights of the incarcerated person, however, are built on the premise that this person is still technically “imprisoned” even if they are at a hospital receiving medical care. While the hospital prioritizes the safety of its individual patients, the prison prioritizes the safety of others. For example, the young woman with endocarditis: our hospital counsel informed the team that the jail guards were allowed to refuse her parents to visit her because they were her “guardians” of sorts.

There are standards for what constitutes adequate medical care for prisoners. Medical care while imprisoned cannot violate “cruel and unusual” punishment. Prisons cannot have “deliberate indifference,” which includes delaying treatment, ignoring obvious conditions, or not going far enough to investigate a medical condition to make an informed decision.

One objection that some people may raise is that prisoners shouldn’t complain, because they receive free medical care. However, as Theresa Brown writes in this thoughtful and discussion-provoking article on caring for prisoners as an oncology nurse:

Prisoners receiving free health care may seem morally objectionable. But let’s reverse that ethical formulation and instead ask why anyone in this country has to financially struggle to obtain health care that the least free among us receive without paying a dime…If we give needed, accessible care to the most despised and potentially violent among us, surely we can try a little harder to provide it to all.

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