Healthcare for Incarcerated Persons: How is the U.S. criminal justice system handling medical care?
By: Helena Zeleke
(Photo Credit: PBS.org)
Modern-day correctional facilities are not fit to maintain the health and wellness of incarcerated people. Medical care is crammed into the criminal justice system as an afterthought - both research and anecdotal evidence have shown this to be true. How is medical care being administered to people serving time in correctional facilities? What problems does this system pose, and how do we go about challenging the status quo of healthcare in jails and prisons? In the following article, we attempt to answer these questions as they relate to systemic healthcare delivery issues faced by all incarcerated people, as well as the healthcare delivery issues that are unique to incarcerated pregnant women.
A Broken, Endangering System
Medical negligence begins even before incarceration, as most police officers are not adequately trained to administer first aid, and law enforcement officers often fail to make the effort to repair the physical damage they inflict on people suspected of committing crimes (Eldridge, 2020).
However, even bigger problems with the administration of medical care lie within the actual correctional facilities. Prison healthcare advocates have identified the practice of hiring ill-supervised private providers to do public work as the root of most of these issues. In a 2018 article exposing Corizon Health Inc., a major private healthcare provider for prisons in Arizona, Schwartzapfel described that the company has consistently proven unable to provide urgent medications, follow through with referrals, and staff jails and prisons with adequate numbers of health professionals. Schwartzapfel explains that Corizon and other large prison healthcare companies are able to maintain their status because of defective contracts with state governments. In many cases, the fines associated with failures to provide adequate medical care are minuscule when compared to the financial worth of contracts held between states and private providers (e.g. $3 million fine, $150 million / yr contract) (Schwartzapfel, 2018). Moreover, the inefficient bureaucracies that incarcerated people are forced to engage with in order to access medical care make it difficult for physicians to develop centralized and coordinated treatment protocols (Schwartzapfel, 2018).
It is evident that mismanagement is a systemic issue and, therefore, is one that has after-effects in all different forms of medical care, but we choose to focus on issues related to maternal care here. This is only for the sake of space and time - a lot of work has been done to expose and ameliorate problems related to the delivery of several other types of medical care, such as in the treatment of substance use disorders, psychiatric conditions, and the diagnosis and treatment of various cancers. The Marshall Project, a nonprofit news organization covering the US criminal justice system, has published several pieces on these prison healthcare issues. We encourage you to explore their website to learn more about the countless other problems that exist within our criminal justice system. Additionally, incarcerated people are/were not exempt from the healthcare strain associated with the overwhelming number of patients hospitalized for COVID-19 over the past year. You can read more about the impact of COVID-19 on the wellness of incarcerated people here.
Inadequate Maternal Care
Pregnant women and mothers of newborns are provided subpar clinical care in correctional facilities. The need for resources that support maternal care in the criminal justice system is one that grows increasingly urgent as “women are the fastest-growing population behind bars in the U.S.” (Sheldon, 2020, 2:28). In many US prisons, “nutritional and rest recommendations for pregnant women are not met; lower bunks are not provided for pregnant inmates,” and correctional officers often engage in “unsafe use of restraints for pregnant women in labor and delivery” (Ferszt et al., 2012). Additionally, research literature has documented a major deficit in the nutritional value of prison meals (Collins & Thompson, 2012). Oftentimes pregnant women in prisons are provided a “pregnancy snack pack” to counteract the deficiencies typical of prison food, but the nutritional levels/adequacy of such packs hasn’t been systematically reviewed (Shlafer et al., 2017).
According to The Marshall Project, “Women typically get 24 hours with their newborn before being sent back to prison,” and some women have to leave their babies in the NICU in order to abide by their prison’s policies (Sheldon, 2020, 27:12). The psychological and emotional strain associated with this mother-baby separation in the postpartum period is thought to contribute to an increased risk of developing postpartum depression in incarcerated women (Gillette, 2011). Although resources are scarce for the healthcare systems that service correctional facilities, expecting mothers involved in the criminal justice system are more likely to require extra medical care and counseling to avoid giving birth to children with neonatal addictions to drugs (Sheldon, 2020, 18:14). Needless to say, this isn’t an area of need that has been met or addressed by many jails and prisons nationwide.
Instead of finding ways to solve the problem, the system has left it up to incarcerated mothers to fend for themselves. In some cases, this negligence is filmed (as in the case of an incarcerated mother in Denver, Colorado who was forced to guide herself through the birthing process without medical assistance), but it is easy to imagine that several instances like this pass under the radar.
How do we change the system?
In 2017, the state of Tennessee offered a reduction of jail time for sterilization, demonstrating a desire to avoid having to “deal” with pregnant women in the criminal justice system (Perry, 2017). Disconnected attempts at corrective policy like this demonstrate the harm done by trying to make up for the lack of access to adequate services by manipulating incarcerated people rather than the institutions that serve them.
Our criminal justice system isn’t a fixed machine. With the guidance provided by the lived experiences of incarcerated people, research literature, and civil society initiatives created to address the aforementioned problems, we have the potential to make substantive changes to this system.
Changes can be made to all elements of the criminal justice system to increase accessibility to life-altering medical care. For example, to reduce mortality in the process of policing, police academies can provide comprehensive first aid training for police officers - training that not only instructs police officers on how to administer acute medical care but also instructs police officers as to how to transition from perpetrators of potentially life-threatening force to aid deliverers on the scene of a crime. A training that works with this model has been implemented with promising success by Tulsa’s Police Department in Oklahoma (Eldridge, 2020). In order to alleviate some of the burden associated with terminal illness (which isn’t discussed at length here), courts can increase the use of “compassionate release” (Blakinger & Neff, 2020). A transformation of the system would also involve more robust screening processes for inmates being sent to high-security and isolating prisons/jails. This would help reduce the likelihood that people with urgent medical or mental health needs are closed off from life-altering treatment. Some but not all prisons have eliminated copays for prisoners’ medical visits due to COVID-19. This experimental policy has the potential to dramatically expand access to medical care and will hopefully be sustained and increasingly popular as the U.S. transitions to post-pandemic life (Pitcher, 2020).
Similarly, many have proposed viable solutions for remedying the medical care disparities specifically endured by incarcerated pregnant women. The Alabama Prison Birth Project, a program that strives to transform maternal care for women who are incarcerated at the Julia Tutwiler Prison for Women, has addressed some of the most glaring problems by increasing the duration of mom-baby time post-birth to at least 6 months-1yr, connecting expecting mother to doulas, and supporting incarcerated mothers by providing lactation spaces (Sheldon, 2020). The Adullam House, also in Alabama, is a nonprofit that gives incarcerated mothers better options than the foster care system/obscure relatives if they have to be separated from their children (Sheldon, 2020, 23:06). There are organizations that function similarly to the Adullam House all over the nation. For example, Motherhood Beyond Bars is a Georgia non-profit that provides pregnancy and postpartum health education programs as well as a statewide caregiver support program to incarcerated mothers. Increasing funding for programs like these, which typically do not receive government aid, could provide better outcomes for both incarcerated mothers and their children.
There exists a substantial body of research literature in which professionals have identified treatment protocols and healthcare programs that meet the unique needs of incarcerated pregnant women. These range from the best practices for treating incarcerated pregnant women with concurrent opioid use disorders (Peeler et al., 2019) to models for clinician-led education/support groups for pregnant incarcerated women (Ferszt & Erickson-Owens, 2008). The Plan-Do-Study-Act method for improving the quality of perinatal healthcare in correctional facilities, which consists of perinatal depression screening and shared healthcare decision-making practices, has also shown to be effective in expanding the accessibility of services, as demonstrated by a 37% increase in the number of incarcerated women receiving appropriate treatment (Meine, 2018).
Blakinger, K., & Neff, J. (2020, October 7). Thousands of Sick Federal Prisoners Sought Compassionate Release. 98 Percent Were Denied. The Marshall Project. https://www.themarshallproject.org/2020/10/07/thousands-of-sick-federal-prisoners-sought-compassionate-release-98-percent-were-denied.
Collins, S. A., Thompson, S. H. (2012). What are we feeding our inmates? Journal of Correctional Health Care, 18, 210–218. doi: 10.1177/1078345812444875
Eldridge, T. E. (2020, December 15). Cops Could Use First Aid to Save Lives. Many Never Try. The Marshall Project. https://www.themarshallproject.org/2020/12/15/cops-could-use-first-aid-to-save-lives-many-never-try.
Ferszt, G. G., & Clarke, J. G. (2012). Health care of pregnant women in U.S. state prisons. Journal of health care for the poor and underserved, 23(2), 557–569. https://doi.org/10.1353/hpu.2012.0048
Gillette, Kimberly Erin, "The psychological and emotional experiences of pregnant and postpartum incarcerated women" (2011). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1040.
Meine K. Pregnancy unshackled: Increasing equity through implementation of perinatal depression screening, shared decision making, and treatment for incarcerated women. Nurs Forum. 2018 Oct; 53(4): 437-447. doi: 10.1111/nuf.12271. Epub 2018 Jul 3. PMID: 29968928.
Peeler, M., Fiscella, K., Terplan, M., & Sufrin, C. (2019). Best Practices for Pregnant Incarcerated Women With Opioid Use Disorder. Journal of correctional health care : the official journal of the National Commission on Correctional Health Care, 25(1), 4–14. https://doi.org/10.1177/1078345818819855
Perry, D. M. (2017, July 26). Our Long, Troubling History of Sterilizing the Incarcerated. The Marshall Project. https://www.themarshallproject.org/2017/07/26/our-long-troubling-history-of-sterilizing-the-incarcerated.
Pitcher, M. (2020, November 2). Should Prisoners Have to Pay For Medical Care During a Pandemic? The Marshall Project. https://www.themarshallproject.org/2020/11/02/should-prisoners-have-to-pay-for-medical-care-during-a-pandemic.
Santo, A. (2020). Tutwiler. The Marshall Project. The Marshall Project/Frontline. https://www.themarshallproject.org/2020/05/06/the-separation.
Schwartzapfel, B. (2018, February 26). How Bad is Prison Health Care? Depends on Who’s Watching. The Marshall Project. https://www.themarshallproject.org/2018/02/25/how-bad-is-prison-health-care-depends-on-who-s-watching#.
Shlafer RJ, Stang J, Dallaire D, Forestell CA, Hellerstedt W. Best Practices for Nutrition Care of Pregnant Women in Prison. J Correct Health Care. 2017 Jul; 23(3): 297-304. doi: 10.1177/1078345817716567. Epub 2017 Jun 28. PMID: 28656820; PMCID: PMC6671683.