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Recognizing the Health Care Providers Who Care for Society’s Incarcerated

In 1976, the United States Supreme Court established the constitutional requirement that jails provide health care to those in custody. The people who provide this care are correctional health care providers. They are medication technicians, qualified mental health professionals, nurses, advanced practice providers, health service administrators, and physicians. They face unique challenges that often go unrecognized and unappreciated because jails exist in the less-trodden corners of the world of health care. It is time to recognize the people who care for society’s incarcerated.

Correctional health care providers must abide by the standard of care applicable to their colleagues outside the jail setting, while working within constraints unique to the jail setting on their safety, time, and resources. They care for society’s most marginalized people, many of whom have never had access to preventive care or treatment for chronic conditions. They must possess a certain determination to make a difference in the health of their patients while knowing those differences may be limited to the patients’ often brief incarcerations. They must exhibit the compassion and empathy expected of all health care providers while prioritizing their safety because their patients are pre-trial detainees and convicted criminals.

Correctional health care providers battle attrition among their own and learn to work alongside correctional staff in a symbiotic relationship with the single goal of keeping everyone safe. They go to work knowing that “although the central purpose of jails is to detain people who engage in criminal behavior and pose a threat to public safety, the poor health status and lack of regular care among justice-involved-individuals make the facilities a potentially important site for health care interventions.”

Consider the differences between the intake screening process and the typical introductory interaction between nurses and patients in the hospital or outpatient clinic. The health screening is only the first of many possible interactions between inmates and jail-based medical providers, yet it demonstrates some of the most foundational issues confronted by correctional providers.

As the first interaction between an inmate and medical staff at a jail, the health screening is a critical tool. It allows the nurse to assess the inmate as medically sound for incarceration, as well as to document the inmate’s medical history and identify medications and/or special needs. It is the nurse’s opportunity to flag both acute concerns, such as intoxication and withdrawal symptoms and chronic issues like hypertension and behavioral abnormalities.

Many inmates suffer from longstanding, untreated conditions, such as diabetes and hepatitis C. When compared to the general population, jail inmates are more likely to report ever having a chronic condition. For instance, in one study conducted for the United States Department of Justice, inmates were nearly two times more likely than people in the general population to report ever having high blood pressure, diabetes, or asthma. Rightly or wrongly, many of these inmates demand treatment immediately upon incarceration, beginning at their intake screening.

The intake screening nurse must especially exercise diligence in detecting substance abuse, as substance abuse among inmates significantly outpaces that of the general population. For instance, up to one-third of all people who use heroin in the United States are involved in the criminal justice system, and 90% of incarcerated women report a “drug problem” of some kind. Heroin users may experience early withdrawal symptoms as soon as eight hours after their last dose. Noting the import of the intake exam, Virginia Governor Terry McAuliffe in 2017 included $4.2 million in his budget “to provide for training of jail staff in mental health screening and to provide grants to jails for mental health assessments.”

Understandably, during booking, many inmates are scared, upset, and nervous over their recent arrest. Accordingly, their blood pressures might be higher than normal, or they may be unwilling or unable to engage in honest conversation with an unfamiliar nurse. Depending on the timing of the arrest in relation to booking, they may be intoxicated, making meaningful dialogue difficult; or they may have ingested substances that have not taken effect, making it difficult to recognize an impending overdose.

Worse still, inmates may suffer from mental illness or cognitive delays that preclude them from offering a thorough and accurate health history. Indeed, 44% of inmates in locally run jails are estimated to have a mental illness, and suicide is the leading cause of death in correctional facilities.

Based on their assessments, intake nurses usually recommend suitable housing and notify correctional staff about special accommodations, such as bottom bunks or wheelchairs. If the inmate does not accurately inform the nurse at intake, those needs may go undetected by correctional officers who are not medically trained. Moreover, privacy laws still exist in the jail setting – the fact that the medical and correctional staff work alongside each other does not mean the medical staff can disclose inmates’ medical histories absent certain circumstances. Thus, medical staff rely on correctional staff to notify them of any concerns, especially during intake when inmates are new to the facility and unknown to correctional and medical staff alike.

The intake process is merely the introduction of an inmate to incarceration – the beginning of many considerations that will be made for their health. It is time to recognize the health care providers who reach through the bars to administer care to society’s most marginalized patients.