Provision of health care services to individuals in the correctional system is one of the main priorities of the state and the facilities involved. Over the years, there have been notable improvements in the development and delivery of health care services in the correctional facilities. However, there is still a lot that needs to be done to bring the services at par with the community needs. Several pointers are indicating that there exists a need for further improvements in the delivery of services. There are arguments over the quality of healthcare in the correction system and its relevance to enhancing the health of inmates. Despite the available provisions, there are arguments that such care does not consider issues like quality of service.
Healthcare in the correction system is critical for the wellbeing of the inmates. To some people, correctional facilities are the first place they can access care services that they could otherwise not afford to pay for while outside (Anno, 2004). Through the Eighth Amendment, incarcerated individuals’ rights are anchored in the law. However, the good cause that these systems are supposed to accomplish face significant challenges. Previous studies and time to time scandals have indeed put the correctional system on the spot over accessibility to health care services as well as the quality of the services (Wilper et al., 2009). According to the Bureau of Justice Statistics, over six million persons were under the corrections system in 2016, spread through prisons, jails, detention facilities, and other civil commitment centres. Over 2.3 million persons in the correction facilities relied upon the provided health care (Kaeble & Cowhig, 2018). The high number of inmates in the facilities does not benefit from health services and therefore do not meet the desired goal. Similarly, those who oppose the provision of healthcare argue that it is better to prevent than cure.
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Over a half-century ago, the United Nations made a step to establish the basic standards that aim at the provision of the fundamental human rights, among them health care, to persons in the correction facilities. To that effect, various agencies are tasked with the formulation and implementation of those standards. The American Public Health Association (APHA), National Commission on Correctional Health Care (NCCHC), and the American Correction Association (ACA) have formulated the most significant number of applicable standards (Stern, Greifinger & Mellow, 2010). Correctional facilities often seek accreditation from NCCHC, while in instances where the services are outsourced the providers often find certification.
The adoption and implementation of the standards, however, does not guarantee the highest quality of care. There are lapses in the quality of care even in the accredited facilities majorly due to the failure on the side of the institutions to deal with the safety of their patients with the same energy health care is dealt with in the general population (Stern, Greifinger & Mellow, 2010). Even though the standards have been widely adopted, no data has been published on their effectiveness to highlight the improvements to the health care standards that were in existence in the 1970s and 1980s.
Patient safety in the corrections has been given less attention compared to what is being done at the community level. Whereas it is worth noting that some initiatives have resulted to an improvement in the quality of care in the corrections, not enough that has been done to match what is on offer for the general population (Stern, Greifinger & Mellow, 2010). Further, there is a need for the efforts being made towards improvement of care standards in the community to be replicated in the corrections system. Several barriers exist that hinder the spread of patient safety movement to the correction facilities, key among them being the failure of the standards designed for the community level setting to seamlessly fit into the health care systems in the corrections(Smith, 2013). Additionally, some rules applicable to the community setting are inappropriate to the correctional setting. A study by Wilper et al., (2009) found that many inmates with mental illness stopped receiving treatment at the time of their arrest as a result of the disparity in applicable standards.
For the provision of quality health care in correctional facilities independence plays a critical role as per the international standards, yet it remains unmet due to the health care governance structures, lack of awareness, and different employment terms for professionals among others (Pont et al., 2018). Similarly, the detained individuals cannot choose their health care professionals. Often, this breeds conflict between the duty for care for the health and wellness of the patients and following the guidelines of the correctional institutions.
Health professionals and caregivers in corrections cannot guarantee decisions that are for the best interest of their patients. There are some instances that correctional caregivers are compelled to give their input in custodial services especially on matters regarding individual behaviour, for example, the medical fitness of inmates for some form of punishment (Pont et al., 2018). Further, the correctional health care system does not guarantee an absolute right to consent or dissent access to medical services, which is instead determined by the institution rather than through self-determination.
The number of staff available in a given facility depends on available resources to facilitate hiring. With bookings into most of the facilities being done round the clock, medical staff in some cases may not be available all the time to promote screening for health problems which may result to higher risks of the spread of some diseases within the facilities. The unavailability is as a result of resource constraints in the counties that arise from low per capita in tax revenues (Pew, 2018). Further, the research found that provision of quality health care in corrections is an uphill task because of the high turnover often experienced in most facilities where the stay of some persons is as short as a week, or even less which renders budgeting challenges. In such cases, it becomes difficult to provide the best care for the group of people with a more extended stay in the facilities.
To ensure that the quality of care is maintained in the corrections, the actions of the health workers are limited by the state laws. To minimise the risks, the efforts of the physician assistants, nurse practitioners, registered nurses, and licensed practical nurses are precisely cut out with any deviation accompanied with close supervision (Anno, 2001). The right mix of staff determined by the needs of the patients in the facilities ensures efficiency, safety, and high-quality service (Pew, 2018). Some facilities in some states are required by NCCHC and ACA to carry out screening services from time to time. The study found that most of the facilities do not conduct the screening at times due to the resource constraints. The risk is that some life-threatening health problems may go unnoticed in good time.
There are strong arguments in favour of healthcare in correctional systems. However, there are counterarguments concerning the manner in which it is delivered and the outcome of the entire process. The health care in corrections has been given attention because most people return to the community over a short period thus the need to improve their well-being and that of the general population. Even though gaps remain on the effectiveness of the applicable standards, much has been achieved in ensuring that people in the facilities get access to health care which in some cases may not be affordable to some of them away from the correctional system.
References
Anno, B. (2001). Correctional health care . Washington, D.C.: U.S. Dept. of Justice, National Institute of Corrections.
Anno, B. (2004). Prison Health Services: An Overview. Journal Of Correctional Health Care , 10 (3), 287-301. doi: 10.1177/107834580301000304
Kaeble, D., & Cowhig, M. (2018). Correctional Populations in the United States, 2016. Retrieved from https://www.bjs.gov/content/pub/pdf/cpus16.pdf
Pew. (2018). How county correctional facilities are playing a role in the safety net. Retrieved from https://www.pewtrusts.org//media/assets/2018/01/sfh_jails inadvertent_health_care_providers.pdf
Pont, J., Enggist, S., Stöver, H., Williams, B., Greifinger, R., & Wolff, H. (2018). Prison Health Care Governance: Guaranteeing Clinical Independence. American Journal Of Public Health , 108 (4), 472-476. doi: 10.2105/ajph.2017.304248
Smith, A. (2013). Health and Incarceration: A Workshop Summary . Washington (DC): National Academies Press.
Stern, M., Greifinger, R., & Mellow, J. (2010). Patient Safety: Moving the Bar in Prison Health Care Standards. American Journal of Public Health , 100 (11), 2103-2110. doi: 10.2105/ajph.2009.184242
Wilper, A., Woolhandler, S., Boyd, J., Lasser, K., McCormick, D., Bor, D., & Himmelstein, D. (2009). The Health and Health Care of US Prisoners: Results of a Nationwide Survey. American Journal of Public Health , 99 (4), 666-672. doi: 10.2105/ajph.2008.144279
