Dr. John P. May is chief medical officer at Armor Correctional Health Services, a minority-owned enterprise incorporated in the state of Florida that provides comprehensive medical, dental and mental health services exclusively for inmates in jails and prisons.
Meeting the health needs of some of the sickest and most complex patients in our community is the responsibility and privilege of those who deliver healthcare in jails and prisons. Like those in uniform who also protect and serve, these healthcare providers must maintain professionalism, integrity, competency and ethics in challenging environments that are often ill-designed for healing and far from therapeutic. These healthcare providers advocate for and deliver services in the best interests of their inmate patients. The community ought to appreciate and support these efforts, even if only because the community's own health and safety ultimately benefit when proper care is given to inmates.
The impact of incarceration on public health is significant. Incarcerated populations are known to have high rates of transmissible diseases because of preexisting problems including poor access to healthcare, high risk lifestyles and living in close quarters. Frequently landing in jail or prison marks the first time these individuals have had access to medical services, mental health treatment and dental care. Often substance addiction complicates disease processes and treatments.
Each year in the United States more than 12 million people are released from jails and prisons. A slightly larger number enter each year, owing to a steady increase in our jail and prison populations. This is an important intervention point for screening, treating and preventing disease. A report to the U.S. Congress by the National Commission on Correctional Healthcare shows an estimated 98,500 to 145,500 inmates released from U.S. prisons and jails in 1996 were HIV carriers. Another 38,500 had AIDS, and an additional 155,000 were infected with hepatitis B while another 1.3 million to 1.4 illion were infected with hepatitis C. In Florida, an HIV test is mandatory prior to leaving the state's prison system and is typically available to jail and prison inmates upon request, along with other preventive health information.
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Women are screened for cervical and breast cancer, while men are tested for prostate cancer. Vaccinations are administered, along with other preventive healthcare. Failure to identify and treat disease among prisoners and failure to provide a continuum of health and social services to those transitioning from jail or prison perpetuates disease and disenfranchisement, resulting in higher healthcare costs for everyone. Through an adequate jail or prison-based health program of disease screening, treatment and discharge planning, the negative impact of health conditions that affect the public can be minimized.
Nonetheless, healthcare for inmates is often rejected by both the public and public officials. Had it not been for a Supreme Court judgment ruling that prisoners have a right to adequate healthcare, few would receive it at all. And this despite the fact that the purpose of jails and prisons is public safety, and part of public safety is protecting the public's health.
The physician's creed -- in Latin primum non nocere or ``first, do no harm'' -- guides those of us providing healthcare to incarcerated persons to build care systems that meet our patients' needs and insure that during their incarceration they are not vulnerable to health deterioration. The task is not easy, and it's made more difficult by those who do not value our mission. If only for reasons of self-interest, prison healthcare deserves public support.
Assigning disparate values to the lives of prisoners in comparison with those of the general public puts the community in peril. Infectious diseases do not respect the boundaries of prison walls, nor can we forget that the prisoner will once again walk among us.
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