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September 16, 2019

Acute Care for Patients Who Are Incarcerated: A Review

Author Affiliations
  • 1Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
  • 2Office of the Federal Public Defender, Albuquerque, New Mexico
  • 3Jail Health Services, Department of Public Health, San Francisco, California
JAMA Intern Med. 2019;179(11):1561-1567. doi:10.1001/jamainternmed.2019.3881

Importance  The United States has the world’s highest rate of incarceration. Clinicians practicing outside of correctional facilities receive little dedicated training in the care of patients who are incarcerated, are unaware of guidelines for the treatment of patients in custody, and practice in health care systems with varying policies toward these patients. This review considers legal precedents for care of individuals who are incarcerated, frequently encountered terminology, characteristics of hospitalized incarcerated patients, considerations for clinical management, and challenges during transitions of care.

Observations  The Eighth Amendment of the US Constitution mandates basic health care for incarcerated individuals within or outside of dedicated correctional facilities. Incarcerated patients in the acute hospital setting are predominantly young men who have received trauma-related admitting diagnoses. Hospital practices pertaining to privacy, physical restraint, discharge counseling, and surrogate decision-making are affected by a patient’s incarcerated status under state or federal law, institutional policy, and individual health care professional practice. Transitions of care necessitate consideration of the disparate medical resources of correctional facilities as well as awareness of transitions unique to incarcerated individuals, such as compassionate release.

Conclusions and Relevance  Patients who are incarcerated have a protected right to health care but may experience exceptions to physical comfort, health privacy, and informed decision-making in the acute care setting. Research on the management of issues associated with hospitalized incarcerated patients is limited and primarily focuses on the care of pregnant women, a small portion of all hospitalized incarcerated individuals. Clinicians and health care facilities should work toward creating evidence-based and legally supported guidelines for the care of incarcerated individuals in the acute care setting that balance the rights of the patient, responsibilities of the clinician, and safety mandates of the institution and law enforcement.

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