Prison Healthcare ‘Lacks Uniform Standards’

 Since a 1976 Supreme Court ruling, incarcerated individuals are the only group of people in the United States to have a constitutional right to health care. Under Estelle v Gamble, being deprived of “reasonably adequate medical care violates the Eighth Amendment’s ban on cruel and unusual punishment.”

But, who decides what is “reasonably adequate,” particularly when the healthcare system for patients in prison lacks uniform standards?

The answer, according to University of Pennsylvania researchers Katherine Rohde, Taylor Ross, and Caitlyn Kim, “is not so clear.”

The researchers contend that with multiple agencies at federal, state, and local levels possessing authority over correctional health care, standards of health care vary starkly across the U.S.

For example, incarcerated individuals in federal prisons have their healthcare needs, like medical, dental, and mental health services, overseen by the Federal Bureau of Prisons (BOP).

But the ability of inmates in a state or county jail to get even routine procedures or health screening can depend on the zip code. 

“This lack of mandatory standards or oversight has led to pervasive inadequate care,” the researchers write in a compilation of six recent studies and papers on correctional health published in The Regulatory Review.

The researchers argue that stronger regulation is needed to protect the constitutional right of incarcerated people to receive adequate health care.

Rohde, Ross, and Kim first cite a study which found that, among incarcerated individuals with a persistent medical problem, “20 percent of those in state facilities and 68 percent of those in local jails went without care.”

Citing an article published in Public Health Chronicles, they found that all of the problems the prison health care system struggled with in 1974 — “too few physicians, lack of follow up, and lack of primary health care” —persist today. The original researchers cited overcrowded prisons driven by mass incarceration as the main contributing problem.

An article published in 2021 by University of Michigan Law School researchers argues that the law which excludes inmates from receiving Medicaid funds is detrimental to inmate health. The article contends that introducing Medicaid funding into prisons could help many by expanding mental health care services and substance abuse treatments.

Moreover, in an article in Law & Social Inquiry, Purdue University researchers compared each state’s number of accredited physicians to the number of lawsuits alleging inadequate prison healthcare and to prison mortality rates.

The researchers found that increased accreditation has no impact on prison mortality rates, uncovering that regardless of medical expertise, the same amount of inmates died.

The Purdue University researchers also found that correctional facilities were using medical private accreditation as a “reaction to legal threats, rather than as a proactive measure to protect the health of incarcerated people.”

Of the remaining studies noted in the paper by Rohde, Ross, and Kim, Johns Hopkins University researchers found that female reproductive health was so poor that many places allowed the shackling of pregnant women during childbirth.

Gettysburg College authors argued that many state facilities follow an “extraction only” dental rule under which prison dentists will not “fill, crown, or otherwise attempt to salvage teeth.”

“Nearly two million individuals are currently incarcerated, 800,000 of whom have a chronic medical condition,” the authors concluded. “In an era of mass incarceration, the substandard state of the correctional health care system has a profound impact.”

Katherine Rohde is a J.D. Candidate at the University of Pennsylvania Carey Law School.

Taylor Ross is a law student in the Center for Public Research and Leadership at the University of Pennsylvania Graduate School of Education.

Caitlyn Kim is a J.D. Candidate at the University of Pennsylvania Carey Law School and the Associate Editor for the Asian Law Review at UPenn.

The full paper can be downloaded here.

Andrea Cipriano is Associate Editor of The Crime Report.