ACP Provides Recommendations for Improving Health Care Quality for Incarcerated Individuals

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Policy paper details needs of incarcerated patients, addresses preventive health, chronic diseases, infectious diseases, substance use disorders and behavioral health

Dec. 2, 2022 (ACP) — The American College of Physicians has provided recommendations to improve the health and well-being of individuals incarcerated in adult correctional facilities in a new policy paper.

“ACP has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services, which extends to our patients who are incarcerated,” said Dr. Ryan D. Mire, president of ACP. “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.”

The paper, titled “Health Care During Incarceration: A Policy Position Paper from the American College of Physicians” and published in the Annals of Internal Medicine, notes that 8.7 million people were admitted to local U.S. jails in 2020, and state and federal prisons incarcerated 1,215,800 people at the end of the year.

The COVID-19 pandemic “highlighted the vulnerability of this patient population and the need for a public policy agenda that will advance correctional health care quality,” said Renee Butkus, ACP director of health policy. “Previous ACP policy recommendations have advocated for justice-involved patients in the community, but not those experiencing incarceration. ACP recognizes that its commitment to addressing health care disparities must extend to patients residing in U.S. jails and prisons.”

There is a huge need for proper health care behind bars. Federal surveys in 2016 revealed that 51 percent of state prisoners reported having a chronic medical condition, 65 percent reported using at least one drug during the 30 days before arrest, and 43 percent reported a history of a mental health problem, as noted in the policy paper.

“I spent most of my professional career in correctional health care, serving many years as a commissioned public health officer assigned by the U.S. surgeon general to the Federal Bureau of Prisons,” said Dr. Newton Kendig, clinical professor of medicine at George Washington University and the ACP representative to the National Commission on Correctional Health Care, as well as the paper's lead author. “I came to believe that tackling public health priorities such as eliminating HIV infection, curing hepatitis C and effectively treating opioid use disorder required correctional medicine excellence. Practically, this meant the adoption of evidence-based clinical practice guidelines by correctional health care professionals. It also meant the strategic engagement of internal medicine physicians and subspecialists to help manage the complicated health care conditions faced by so many of our patients.”

In the policy paper, ACP makes 22 recommendations to improve health care in prisons and jails. They address a broad range of health needs, including preventive health, chronic noncommunicable diseases, infectious diseases, substance use disorders and behavioral health conditions.

The recommendations also address specific patient populations, including LGBTQ+ patients, immigrant populations, aging patients and those living with disabilities or life-limiting illnesses.

Among other recommendations, ACP calls for adequate funding for a variety of priorities, such as dynamic clinical care teams, timely access to care, nutritious and appetizing food and opportunities for healthy exercise.

The authors make specific recommendations regarding incarcerated women. For one, “ACP recommends prohibiting the use of custody restraints on incarcerated pregnant women during labor and delivery and avoiding the use of restraints during postpartum recovery and throughout pregnancy.” Also, “ACP believes that incarcerated women should have sufficient access to evidence-based family planning and sexual health information and to pregnancy care services, and should have the ability to continue and initiate the full range of FDA-approved forms of reversible contraception.”

The paper also recommends that health care needs are included in community re-entry planning for those who are released from jail or prison. Specifically, ACP makes recommendations for policies to facilitate or reinstate state Medicaid enrollment.

Moving forward, Kendig said there are many obstacles to overcome. “Correctional facilities are often located in remote locations with limited access to local health care services; patients may have complex medical and mental health conditions that present management challenges; staffing shortages and budgetary restraints may impact health care operations; and jails and prisons may not seek accreditation or have external assessments of health care quality,” he explained.

Still, change is possible. The ACP recommendations are already being implemented in jails and prisons, according to Kendig. “It would be terrific to see the broader integration of the ACP policy agenda into the bipartisan criminal justice reform efforts that are now underway in many states,” he noted. “Many of these initiatives rightly focus on reducing incarcerated populations and making the community supervision of justice-involved persons less punitive. These reform efforts, however, could also better ensure that funding is provided to advance policies that would better ensure health care quality for incarcerated patients and address barriers to their health care access upon transition to the community.”

More Information

The position paper, “Health Care During Incarceration: A Policy Position Paper From the American College of Physicians,” is available on the Annals of Internal Medicine website.

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