Emergency Telehealth Services in the Correctional Setting

Millions of patients receive their primary health care in U.S. jails and prisons each year. Correctional health care systems frequently lack round-the-clock onsite physician services, and access to local hospital-based emergency services may be limited. Increasingly, correctional health care systems are relying on telehealth capabilities to improve their access to subspecialty services. Emergency telehealth services, however, are largely underutilized. Available reports suggest that emergency telehealth services can reduce outside medical trips and prove cost-effective in certain settings. Successful emergency telehealth programs emphasize the importance of a thorough diagnostic evaluation, effective communication with local correctional health care providers, and strategic use of point-of-care testing. This chapter provides practical recommendations for the telehealth evaluation and management of commonly occurring medical emergencies in the correctional setting.

Legal Reactivity: Correctional Health Care Certifications as Responses to Litigation

In 1976, the US Supreme Court established that incarcerated people have a constitutional right to health care, ratifying lower court decisions. Corresponding professionalization and standardization initiatives included the advent of third-party certifications of individual correctional health care (CHC) practitioners. Drawing on historical evidence about CHC reforms and contemporary data on certifications, incarcerated people’s lawsuits, and incarcerated people’s mortality rates, this study assesses relationships between certifications and key outcomes of incarceration. We find that corrections actors tend to adopt certifications when directly threatened by elevated rates of litigation in their states. This finding suggests that corrections actors are legally reactive, responding to filed lawsuits’ salient threat, rather than legally proactive, attempting to manage risk through anticipatory certification adoption. While early standardization and professionalization interventions reflected the legally proactive logic, our results indicate that contemporary corrections actors tend to “wait and see” about legal liability. Barriers to settlements or court rulings favoring incarcerated people—particularly the Prison Litigation Reform Act—help explain this tendency. Lawsuits’ observed influence on standardization and professionalization offer some support for litigation’s capacity to impel changes; litigation’s failure to predict mortality, however, gives pause regarding this capacity’s extent.

Prisons and COVID-19: A Desperate Call for Gerontological Expertise in Correctional Health Care

The large and continued growth of the older adult population within U.S. prisons affects not only criminal justice policy and correctional health practice, but also gerontology. Amidst the unfolding COVID-19 crisis, associated knowledge and skills surrounding older adulthood will be critical to assuring the needs of older adults incarcerated in prisons are met during their detention, while undergoing off-site intervention in community settings, and when preparing for release. We outline several key areas for which gerontologists and associated practitioners are especially well suited in the effort to curtail morbidity and mortality driven by the disease caused by the novel coronavirus. Critical gerontological knowledge and skills needed in prison health care include awareness regarding the unusual clinical presentations of COVID-19 among older adults, deconditioning among older adults due to immobility, challenges in prognostication, and advance care planning with older adults. Specific, targeted opportunities for gerontologists are identified to reduce growing risks for older adults incarcerated in prisons.