Disregarded by many; patients to us

The Secure Healthcare Quality Alliance

Behind the heavy steel doors and concertina wire, correctional care providers treating those in prisons and jails encounter individuals with profound medical needs. For many, the first real healthcare they receive is within these walls. And many are in jail because of serious and untreated mental health and substance abuse issues. For these patients, and the many others with medical needs that have never been diagnosed, we don’t just schedule appointments; we establish routine care where none existed before. 

Although a tsunami of litigation attempts to portray correctional care as in disarray, the reality is that tens of thousands get their first real access to healthcare every day. Here, a missed dose is a rarity, and a follow-up appointment is a promise kept. When urgency strikes, we – the doctors and nurses caring for the incarcerated population –  are there within hours, bridging the gap between isolation and the  medical attention every human being deserves. Any primary care provider would recognize this as the ideal foundation for healing: a deep, consistent relationship that can truly transform a life. Yet, most people would never guess the setting for this care.

This is a state prison.

Our workplace is a world often avoided and misunderstood by the public and even our peers in the medical community. While there is a mountain of news coverage showing our work in a negative light, the success stories – or even the picture of a stable, well-functioning quality care delivery system, which is the norm in jails and prisons across the country – are nowhere to be found. 

The skepticism and outright disregard that haunts correctional medicine stems from a lack of exposure to the reality of our mission. In many ways, care delivery here is the most optimized form of medicine – a place where care is affordable, where we catch cancers and chronic conditions that the outside world may have missed.

On any given day, we have a handful of scheduled appointments with our patients who come in for regular check-ups. We have detailed health records on our patients just like any other facility, and we monitor their progress. While not every patient actively seeks our care, they all receive it. And in some cases, our providers catch health conditions that had gone left untreated, or more often, undiagnosed, before our patients were incarcerated.

The weight of this work is profound. We walk a fine line, caring for patients who may be a danger to themselves or others, often battling the invisible scars of mental illness that landed them in prison in the first place. We do this while navigating the thinning resources of state budgets and the constant ripple of staffing shortages faced across the entire healthcare industry. 

But the most enduring challenge is the sheer gravity of the conditions our patients carry into custody. We see diabetes worsened by years without insulin and cancers discovered only by chance while treating a minor ailment. We are the front line for the most vulnerable among us, making a silent but seismic impact on lives that may have known little else but hardship.

Yet, this vital mission is routinely under attack. A legal environment of rampant litigation, where providers who do not have the same protections as our private-care colleagues, is draining millions from our organizations, threatening to shutter the doors of contract care providers and leave thousands of patients and dedicated healthcare providers in the lurch. 

Ironically, prisoners have far more rights in litigation than the general public and due to a unique set of laws never meant to address correctional care, inmates can sue for millions of dollars for even the smallest medical issue. We cannot allow a broken litigation system to destroy the only access to care these patients have.

To protect this vital mission, the public must come together to improve the correctional care system and reinforce a shared commitment to quality of care. This is the driving force behind the Secure Healthcare Quality Alliance, which seeks to advocate for sustainable solutions that benefit both providers and the patients they serve. Reform is desperately needed to protect our doctors and nurses from the impacts of predatory lawsuits, and ensure they can continue providing high-quality care to their incarcerated patients.

Several actions are needed, and needed now. First, Congress needs to enact laws clarifying that the incarcerated have no greater rights to damages than individuals in the free world.  Federal tort laws routinely adopt state laws requirements and Congress needs to clarify the same in the correctional care context. Second, Congress can also review the Medicaid Section 1115 waiver process to ensure that it provides critical pre-release care transitions that reduce post-release emergency room surges and recidivism.

As providers, we entered into correctional care to advocate for incarcerated individuals who deserve, and often sorely need, quality care. These twin policy changes will ensure that we can continue to do just that: providing great care for our patients, putting them on a path to a healthier life after incarceration.