Chapter 301: Prison Medicine

INTRODUCTION

An established principle in civilized societies is that prisoners are entitled to the same level of medical health care as the law-abiding community.¹ Other ethical considerations involve the issue of prisoners' human rights.² The exact medical service provided will vary between countries and, in the United States, varies between states.² The concept of prison health care in general is the subject of debate and outside the remit of this chapter.

EDs may have to provide emergency health care to prisoners. Prisoners could be inmates of a local prison or recently arrested and detained in police custody. Many prisons have internal medical services of varied capability. There may be a ward or bedded observation unit for the management of uncomplicated medical conditions. Nursing staff are on duty for the full 24 hours working on a shift pattern. Doctors are present mainly for normal working hours, providing night, weekend, and holiday coverage on an on-call basis. Facilities will vary from site to site but may include radiography, a minor surgical treatment room, and consulting rooms for ambulatory care visits by local specialists. On-site or frequent access medical specialties can include a general prison medical officer(s), psychiatrists, psychologists, alcohol and drug abuse counselors, and social workers.³

DEMOGRAPHICS OF THE PRISON POPULATION

The population of a prison is not representative of the general population; typical characteristics are listed in Table 301-1.^4,5

Within the prison, there exists a pool of chronic disease and drug misuse that can lead to significant morbidity and acute medical problems.³ Disease profiling of prison inmates exhibits higher prevalence rates of certain diseases than those reported for the general population. The most common disease groups are infectious diseases (hepatitis, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome), diseases of the circulatory systems (ischemic heart disease, hypertension), diseases of the respiratory system (asthma, chronic obstructive pulmonary disease), and musculoskeletal and psychiatric conditions.⁶ A study of prisoner mortality (while incarcerated) attributed the most common causes of death to ischemic heart disease, followed by cerebrovascular disease, neoplasms, and pneumonia.⁷ Upon release, former prisoners are at significant risk for suicide or accidental drug overdose within the first year.⁸ With the prison population increasing, in particular elderly prisoners and those from an ethnic minority group,^9,10 the prevalence of chronic disease rises, increasing the likelihood of acute medical problems.

Persons in police custody are often intoxicated with alcohol and/or drugs. Common presenting complaints are injuries (sustained prior to or during arrest), exposure to police incapacitants (handcuffs, tear ...