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.

Reproductive Healthcare Standards for Incarcerated Women

Incarcerated women’s healthcare has traditionally been neglected due to a lack of standards, inadequate funding, transportation barriers, and lack of advocacy. In the United States, no federal government body has established national standards for medical care in prisons. However, various nongovernmental organizations offer voluntary healthcare standards including the American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC). Accreditation from these organizations suggests a constitutionally acceptable level of care for inmates and leads to improved health status, fewer grievances and lawsuits, and reduced health risks to the community.

Reproductive Healthcare Standards for Incarcerated Women

Incarcerated women’s healthcare has traditionally been neglected due to a lack of standards, inadequate funding, transportation barriers, and lack of advocacy. In the United States, no federal government body has established national standards for medical care in prisons. However, various nongovernmental organizations offer voluntary healthcare standards including the American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC). Accreditation from these organizations suggests a constitutionally acceptable level of care for inmates and leads to improved health status, fewer grievances and lawsuits, and reduced health risks to the community.