ACP advocates for better correctional health care in US

The ACP is calling for adequately funded policies and procedures to improve disparities in access to and the quality of health care for individuals in U.S. jails and prisons.

In 2020, state and federal prisons incarcerated 1,215,800 people, and an additional 8.7 million people were admitted to jails. That means that “millions of patients in America receive their primary health care in a carceral setting,” Newton E. Kendig, MD, a clinical professor of medicine at George Washington University, and colleagues wrote in a position paper.

“Many incarcerated patients are dealing with significant unmet health care needs that can include chronic medical conditions, infectious diseases, substance use disorders and mental health conditions. We need to ensure that these patients receive the health care services they need,” Ryan D. Mire, MD, MACP, president of the ACP, said in a press release.

People from underrepresented racial and ethnic populations are “disproportionately affected by these incarceration rates, which are the highest in the world,” Kendig and colleagues wrote.

In 2020, U.S. prison rates were 938 per 100,000 for Black people, 778 per 100,000 for American Indian and Alaska Native people, 446 per 100,000 for Hispanic people, and 183 per 100,000 for white people.

“Thus, for many Black, Indigenous and Latinx persons in particular, the experience of incarceration is a major social determinant of health,” the authors wrote.

Just over 51% of people in state prisons reported having a chronic medical condition in 2016 Bureau of Justice Statistics surveys. Additionally, 43% reported a history of mental health problems and 65% reported using at least one drug in the 30 days preceding arrest.

“These data highlight the importance of correctional medicine for both addressing health care disparities in an underserved patient population and advancing our nation's public health,” Kendig and colleagues wrote. “Tackling public health priorities such as treating opioid use disorder, curing hepatitis C, eliminating HIV infection, and more humanely caring for patients with serious mental illness requires correctional medicine excellence in US jails and prisons and the strategic engagement of health care partners in the community.”

The ACP offered multiple policy recommendations, the first of which was that jails, prisons and policymakers “adopt adequately funded policies and procedures to promote the engagement of dynamic clinical care teams.”

“The quality of care and ethical principles of professional engagement must be consistent with that provided to community-based patient populations,” Kendig and colleagues wrote. “Jails and prisons must ensure that clinicians meet credentialing requirements and are granted privileges in accordance with standards required for community-based clinicians.”

Other policy recommendations were:

• ensuring timely access to care;
• providing people with nutritious, safe, medically appropriate and appetizing foods;
• offering regular opportunities for healthy exercise;
• adopting infection prevention and control programs developed jointly with local and state public health authorities that will promote prevention, diagnoses and treatment of communicable diseases; and
• screening all people entering jails or prisons for behavioral health conditions like exposure to trauma, co-occurring substance use disorder, the need for prescribed psychotropic medications, history of serious mental illness and suicide risk.

The paper also lists recommendations for specific populations in correctional facilities, including instructions to better meet the needs of LGBTQ+ people, aging people, women, people with disabilities and immigrants.

For example, the ACP recommends ensuring everyone who identifies as LGBTQ+ “be treated with dignity and respect in a correctional environment that is safe, nondiscriminatory, and gender-affirming.” The organization also recommended that immigrant detainees be “treated with dignity and respect in an environment that is safe, nondiscriminatory and culturally sensitive, including the provision of language translation and interpretation services, as needed, to promote health literacy.”

In closing, the authors detailed community reentry planning “that helps ensure the continuity of health care and social services for incarcerated patients returning to the community.”

Specifically, the ACP recommended policies that would “suspend rather than terminate enrollees who become incarcerated, and support electronic, automated data exchange with correctional systems that facilitates state Medicaid enrollment or reinstatement.”

“ACP recognizes that reducing health disparities in the quality of or access to health care for incarcerated populations will take concerted efforts by policymakers, administrators, legislative authorities, the medical community and society as a whole,” Kendig and colleagues concluded. “Achieving this goal will require funding and implementation of a national public policy agenda that recognizes the vital importance of correctional health care toward achieving health equity for all and promoting the public health of our communities.”

References:

Internal medicine physicians call for improved access and quality in health care for incarcerated patients. https://www.acponline.org/acp-newsroom/internal-medicine-physicians-call-for-improved-access-and-quality-in-health-care-for-incarcerated. Published Nov. 21, 2022. Accessed Nov. 23, 2022.

Kendig NE, et al. Ann Intern Med. 2022;doi:10.7326/M22-2370.