Health Care in Correctional Facilities
*Please note that while the information provided is specific to those involved with the criminal justice system, much of it can also be applied to those detained in immigration facilities.
Those who are currently or have previously been involved in the justice system are at significantly higher risk than the average population for chronic health conditions, mental health issues, STI contraction, and drug addiction. In fact, the Prison Policy Initiative estimates that the United States’ overall life expectancy has dropped by 2 years because of the reduced life expectancy of those that come into the care of the correctional system. This disparity in health care for justice system-involved people can be attributed to a number of individual and system-wide risk factors, and it is far-reaching enough in its effects that it will require both facility- and system-level changes to improve.
Contributing Factors to Poor Health Services in Correctional Facilities
Individual Risk Factors
– A disproportionate amount of people involved in the justice system come from a background that makes them more susceptible to health issues, both in and out of correctional facilities. For example, drug addiction, poverty, and exposure to violence and STIs are all common experiences for those that enter into the justice system. All of these factors mean that those in correctional facilities are more likely not only to develop health concerns while in the facility, but also to enter the facility with unidentified or untreated health concerns. Without proper care, this makes for poor health outcomes for those living in correctional facilities.
Barriers to Access
– Though those involved in the justice system technically have the right to health care as needed, that care is often difficult to access. One issue is that a very limited number of providers will serve the populations of correctional facilities. Even when a provider is willing to serve correctional facilities, however, this does not mean that all residents of the facility have access to care from that provider. Often, a combination of extremely low wages for prison labor and extremely high copays relative to those wages are a deterrent for inmates to schedule or attend appointments.
In instances where inmates are able to schedule and keep appointments, they still are not guaranteed adequate treatment. Providers are required to treat diagnosed conditions, but not necessarily undiagnosed symptoms. For example, inmates might be denied treatment for substance withdrawal, despite showing clear signs of that condition, if they had not been diagnosed with a substance use disorder before their arrival at a correctional facility. Somewhat less severe but still impactful refusal of treatment might include a provider choosing to prescribe particular treatments for a condition despite the fact that they could be prescribing more effective, safer, or more updated versions of that treatment.
Lack of Federal Standards
– While the Supreme Court ruled in 1976 that the unreasonable withholding of medical care for those under the purview of the justice system counts as cruel and unusual punishment, and is therefore in violation of the 8th Amendment, there have been no meaningful additions to that ruling at a federal level that create a standard for what is reasonable or unreasonable to deny an incarcerated person. Because of this, as well as a general lack of oversight to hold institutions to the standards that do exist, medical care for incarcerated people varies widely between states and individual institutions.
Barriers to Holding Institutions Accountable
– Typically, if a person believes their rights have been violated or a company/institution/similar entity has acted unconstitutionally, the issue is settled in a court of law; however, this is an extremely difficult process for justice system-involved individuals. Complicated processes for opening a case while incarcerated, high litigation costs, and high instances of self-representation in court mean that very few potential litigants ever present their cases, much less win them. Such a low instance of successfully bringing charges against correctional facilities leaves them largely unchecked, and allows for the continued medical neglect of incarcerated persons.
Improving Health Care for Those Involved with the Justice System 
Although federal-level policies have not been set in place to ensure justice system-involved individuals have adequate health care, state governments and national organizations have made efforts to make health care more accessible to those in correctional facilities. Prominent examples of such intervention include:
National Accreditation – Organizations such as the National Commission on Correctional Health Care have developed accreditation programs that institutions can be certified through. These programs are designed to maintain a base level of care quality and provider/facility employee education. While this is a step toward creating more consistent national standards, the program efficacy is somewhat dubious, as accreditation enrollment is entirely voluntary on the part of the correctional facilities.
Medicaid Expansion – The Centers for Medicare and Medicaid Services (CMS) expanded in California to cover certain services for justice system-involved individuals early this year. Hopefully, other states will also begin expanding their Medicaid policies.
Increased Oversight – Individual states have made steps toward increasing oversight of correctional facility staff and providers by state health departments, which has led to decreased spreading of communicable diseases and better overall health outcomes for those in the care of correctional facilities.
Additional Learning
STM’s blogs are intended to provide a cursory overview of various medical, human rights, abuse, and science issues, but do not provide an in-depth or expert-level examination of these topics. If you would like to learn more about health care in correctional facilities, we recommend the following as excellent jumping-off points:
The CDC’s recommendations for maintaining health in correctional facilities, including prevention and safety measures for some of the most common health concerns in correctional facilities: https://www.cdc.gov/correctionalhealth/guidance.html
The Prison Policy Initiative’s research library, which contains a large database of empirical research on the United States prison system: https://www.prisonpolicy.org/research.html
This blog was written by STM Learning’s editorial staff for educational purposes only. It is not intended to give specific medical or legal advice. For expert information on the discussed subjects, please refer to STM Learning’s publications.
