Some states made the changes preemptively, while others were compelled by courts to eliminate the fees. In Arizona, corrections department officials removed the costs after a federal judge found that their response to the pandemic was inadequate. Waiving copays only for symptomatic prisoners can create problems; in a staggering number of positive cases in the U. The Centers for Disease Control and Prevention estimates that around 40 percent of people who have COVID are asymptomatic, but in correctional facilities, where social distancing and sanitation measures are not always enforced, that percentage can be far higher.
At Marion Correctional Institution in Ohio, where one of the first large prison outbreaks in the country took place, 95 percent of positive prisoners showed no symptoms, officials reported.
This is not the first time copays have been called into question during an infectious-disease outbreak. Between and , MRSA—a bacterial infection that is resistant to antibiotics—tore through jails and prisons. Researchers found problems including improper laundry procedures, limited access to soap and high turnover among medical staff. Prisoners were failing to recognize the severity of their own symptoms. Still, some states are struggling with the practicality of eliminating copays.
In Arkansas, officials waived them for a month and then reinstated copays; they said they were overwhelmed with medical requests that had nothing to do with the pandemic. Now prisoners who show symptoms of the virus are exempt, though all indigent prisoners can get medical treatment regardless of whether they can pay, said Cindy Murphy, the communications director for the Arkansas Department of Corrections.
Arkansas earmarks its copays to fund contracts with independent agencies that review the quality of medical services inside the prisons.
Lawyers representing prisoners in Arkansas have sued over conditions including copays, saying there should not be financial barriers to medical care. Department of Justice. In general, senior citizens need more medication and medical attention. Scholar Blogs predicts health care for the elderly can cost nine times more than the cost for younger inmates Niyeti. Prescriptions are expensive as well. In fact, one out of every three non-prisoners in the U.
Approximately 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness. Prison guards and other staff members are often not sufficiently trained to handle mental health issues. Therefore, facilities must hire staff or bring in third-party services to properly treat these inmates, adding to their costs. Below is a breakdown of how correctional facilities deliver health care services to their inmates.
The term direct services refers to when the facility supplies the staff; contracted refers to the facility hiring third-party services to provide care and hybrid is a combination of the two. Regardless of how additional staffing needs are met, more staff naturally correlates to a need for additional funding. Rehabilitation is among the main responsibilities of correctional institutions. The ultimate goal is to release inmates back into society and give them the opportunity to be law-abiding citizens.
Part of helping and rehabilitating inmates is providing them with health care. A study conducted by Yale discovered that the better the healthcare prisoners receive, the lower the rate of recidivism.
In other words, inmates are less likely to return to prison if they receive adequate health care while they are incarcerated. In the prison environment, negative tests may provide a false sense of security for the authorities and subjects alike because of a window-period of between three weeks to three months see Chapter 6.
Furthermore, single tests can be unreliable, thereby further limiting their usefulness and repeat testing even if offered on a voluntary basis is an exp ensive option. In some particularly violent prisons, breaches of confidentiality regarding HIV status can be life-threatening. This leads directly to the question of medical confidentiality.
In any doctor-patient relationship, the concept of confidentiality is the keystone of medical care. Doctors working with prisoners have a special duty to ensure that the doctor-patient relationship is preserved, and that doctors are not seen as merely part of the prison administration.
In systems where prison doctors are not realistically in a position to ensure such privacy, they should take care not to write down anything that might compromise their patients with the prison administration. The question is crucial where HIV is concerned.
If a prisoner is not convinced that personal information as sensitive as his HIV status will be protected within the secrecy of the medical file, there will be no trust in the doctor-patient relationship. If there is no trust, doctors will lose any influence they might have to protect prisoners who seek their help. Prisons are unfortunately notorious for not respecting medical confidentiality. Untoward disclosure of HIV status may drive inmates away from the medical services altogether, and make prevention and education even more difficult.
By putting the accent on education and peer training, it is possible to gain the trust of the general population and obtain co-operation in managing the HIV epidemic.
There is a great need to educate and convince medical staff, as well as their direct superiors in the prison administration and the prisoners themselves.
In the management of HIV it is necessary to convey that any limitations of individual human rights should only be used as a last resort, with a clear purpose and goal in mind. Furthermore, the basic human rights should never be restricted, and restrictions should not include a majority of prisoners not relevant to the action taken.
Any action restricting human rights should be subjected to outside scrutiny and periodically reviewed to assess whether it is effective and still necessary. Segregation has been the rule rather than the exception, but this situation might change soon, at least in the Russian Federation. Public health and human rights must work together. The emphasis of any management programme for HIV infection in prisons should be on education.
Prisoners have a right to know about HIV and how to prevent transmission education and prevention activities are discussed in Chapter 5. There emerges the apparent contradiction of it being necessary to inform inmates and staff alike about the danger of such risky behaviour, and even make available preventive measures to avoid contagion, while not appearing to condone such behaviour.
The shared goal of public health policies and human rights is to prevent transmission of HIV and thereby improve health for all in general, while at the same time ensuring the respect of human rights and dignity of those already infected and needing treatment. Prison doctors should be able to work independently, and not as instruments of coercion within the prison system. Adequate counselling before performing any voluntary testing for HIV will ensure trust within the doctor patient relationship.
Counselling should also be available for prisoners after the result of the testing is known. HIV test results should be kept confidential, or forwarded on a very strict need-to-know basis to any non-medical personnel, as far as possible with the knowledge and consent of the patients concerned. In prisons, the human environment is often one of violence and high-risk lifestyles, either engaged in voluntarily by those prisoners with positions of power, or forced upon the weaker prisoners.
Prisoners have a right to live in conditions where their individual safety is guaranteed. It is paramount for the prison administration to have a thorough knowledge of how HIV is likely to be transmitted in a given prison.
If drug injection and sharing of injection equipment is the main problem, active education may not be sufficient. It may be necessary to take measures to stop coercion by drug ringleaders, who may seek to force other prisoners to buy and inject drugs, and make available drug treatment programs and harm reduction measures for drug-addicted prisoners. HIV-positive inmates should not be denied access to recreation, education or normal access to the outside.
From a strictly medical point of view, there is no justification for segregation as long as the prisoner is healthy. Solitary confinement of HIV-positive inmates should be forbidden. Any restrictions should be exceptional, such as mandatory testing for particularly risky situations, such as prisoners working as medical orderlies in hospitals or dental clinics.
Prisoners working in other places less obviously posing a risk, such as laundries, kitchens or as cleaners, may also be exposed to injuries and therefore HIV infection see chapter The protection of HIV-positive prisoners from other prisoners with contagious diseases such as tuberculosis is discussed in Chapter 7. There may also be considerations of personal security where, for example, prisoners known to be HIV-positive request to be kept in a secure unit as they fear for their own safety.
Both prison reform and penal reform are crucial elements if the many problems affecting the prisons of Eastern Europe and the countries of the former Soviet Union are to be resolved. Diminishing the overall prison population will allow improvements of the physical and working conditions of the prisons, and help to ensure the security of all individuals in custody. Obviously, financial resources will have to be allotted to the prison systems as well.
One effective way to curb the rise in prison populations would be to offer alternatives to imprisonment for non-violent offenders. MANN, J. Health and Human Rights: a Reader. New York, Routledge, Medical ethics today: its practice and philosophy. London, British Medical Associatio n,
0コメント