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Clinical care of incarcerated adults

Ingrid Binswanger, MD, MS
Joann G Elmore, MD, MPH
Section Editor
Mark D Aronson, MD
Deputy Editor
Daniel J Sullivan, MD, MPH


Health care in the correctional system, which consists of local, state, and federal jails and prisons, should be available and provided at the same standard as health care in the general population. The provision of medical care in correctional facilities has been strongly informed in the United States by the legal case of Estelle v. Gamble, 1976 [1,2]. In this case, the Supreme Court deemed that deliberate indifference to serious illness or injury in a prisoner can be considered cruel and unusual punishment, in violation of the Eighth Amendment of the Constitution. Cases following this ruling have upheld three basic rights: the right to access to care, the right to care that has been ordered by a health professional, and the right to a professional medical judgment.

Correctional medicine provides an opportunity to promote public health in a targeted, high-risk population [3]. Unfortunately, health care data sets intended to be nationally representative in the United States frequently exclude individuals who are incarcerated, so that health information for the incarcerated population is not complete [4].

Specific medical conditions are of particular concern due to their high prevalence among incarcerated individuals and the increased risks for transmission of infection due to congregate living conditions [5]. Since the disease burden is high, correctional medicine may be more demanding and costly than care for non-incarcerated populations of similar age.

In addition to the high-risk population served, the design of jails and prisons and correctional health services themselves may unintentionally facilitate the transmission of disease [6]. Correctional facilities often lack space for isolating people with communicable diseases, and overcrowding is a risk factor for communicable diseases. Infection control in correctional facilities may be adversely impacted by limited access to showers, a supply of clean clothes, and prohibitions against bleach and condoms. People in jails and prisons may be expected to wash their own laundry by hand, rather than use institutional laundry services, and this may be insufficient to disinfect clothing. Additionally, kitchen workers and barbers in correctional facilities may have inadequate training in infection control.

This topic addresses health issues of particular relevance to the adult incarcerated population. Issues related to care of children of incarcerated parents is discussed separately. (See "Developmental and behavioral implications for children of incarcerated parents".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2016.
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