Caring for Hospitalized Incarcerated Patients: Physician and Nurse Experience

Brooks, Katherine C.; Makam, Anil N.; Haber, Lawrence A

doi:10.1007/s11606-020-06510-w

Cited by 13 publications

(22 citation statements)

References 5 publications

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“…People who are incarcerated have a right to privacy under the Health Insurance Portability and Accountability Act with some exceptions, including coordination of care, the health and safety of staff, and the safety and security of the correctional facility. 23 Incarcerated patients are accompanied by corrections officers to maintain custody and security. With few exceptions, a patient's medical status should not be discussed with corrections officers to prevent violations of privacy, which were frequently documented in our cohort.…”

Section: Implications For Patient Carementioning

confidence: 99%

Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity

Batbold,

Duke,

Riggan

et al. 2024

JAMA Intern Med

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ImportanceIncarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical decision-making processes for hospitalized incarcerated persons who lack decisional capacity.ObjectiveTo characterize the prevalence of incapacity among hospitalized incarcerated patients and describe the decision-making processes, including who served as surrogate decision-makers, involvement of prison employees in medical decisions, and ethical concerns emerging from the patients’ care.Design, Setting, and ParticipantsRetrospective descriptive and qualitative study of medical records for all patients admitted from prison for at least 24 hours between January 1, 1999, and September 1, 2019, at a large Midwestern academic medical center. Data analysis was performed from March 15, 2021, to December 14, 2022.Main Outcomes and MeasuresPrevalence of prison-to-hospital admissions for patients with a loss of capacity and characteristics of medical decision-making.ResultsDuring the 20-year study period, 462 patients from the prison were admitted to the hospital, totaling 967 unique admissions. Of these, 131 admissions (14%) involved patients with a loss of capacity and 43 admissions (4%, representing 34 unique patients) required surrogate decision-making. Ten of these patients had advance directives. Surrogate decision-makers often faced decisions about end-of-life care (n = 17) or procedural consent (n = 23). A family member was identified as surrogate decision-maker in 23 admissions. In 6 cases with a kindred surrogate, additional consent was requested from a prison employee. In total, prison employees were documented as being present during or participating in major medical decisions for half of the admissions. Five themes emerged from thematic analysis: uncertainty and misinformation about patient rights and the role of prison employees in medical decision-making with respect to these two themes, privacy violations, deference to prison officials, and estrangement from family and friends outside of the prison.Conclusions and RelevanceIn this first in-depth description, to date, of decision-making practices for hospitalized incarcerated patients lacking decisional capacity, admissions of these patients generated uncertainty about their rights, sometimes infringing on patients’ privacy and autonomy. Clinicians will encounter incarcerated patients in both hospital and clinic settings and should receive education on how to support ethically and legally sound decision-making practices for this medically vulnerable population.

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Section: Implications For Patient Carementioning

confidence: 99%

Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity

Batbold,

Duke,

Riggan

et al. 2024

JAMA Intern Med

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“…Qualitative studies of physicians and nurses reveal that shackles negatively affect empathy towards incarcerated patients, precipitate diagnostic skepticism, and elicit fears of personal harm. 6,17…”

Section: Do Shackles Lead To Harm For Patients?mentioning

confidence: 99%

“…Allowing hospitalized patients to remain indefinitely shackled during medical treatment can lead to harmful outcomes not clearly outweighed by a demonstrated safety benefit. Despite compassionate care from clinicians, 6 patients remain in shackles as a default practice. Table 1 addresses common misconceptions that perpetuate resistance to removal of shackles in the acute care setting.…”

Section: Considerations For Clinicians and Healthcare Centers To Advance Carementioning

confidence: 99%

“…Healthcare institutions should acknowledge the safety concerns of staff, 6 real or perceived, as a barrier to care. Targeted interventions that address such concerns without reliance on shackles include individualized security risk assessments on admission, strategic room allocation, protocols for supervised patient-provider interactions, and use of softrestraints when necessary.…”

Section: Considerations For Clinicians and Healthcare Centers To Advance Carementioning

confidence: 99%

“…As a result, healthcare professionals rarely unshackle patients during routine hospital care. 6 We provide a medical-legal lens through which to examine the practice of inpatient shackling, review evidence supporting indiscriminate shackling, highlight medical harms associated with the practice, and offer guidance for healthcare professionals and institutions to advance evidence-based shackling practices for incarcerated patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Shackling in the Hospital

Haber

Pratt²,

Erickson³

et al. 2022

J GEN INTERN MED

Self Cite

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Hospitalized incarcerated patients are commonly shackled throughout their duration of treatment in community medical centers to prevent escape or harm to others. In the absence of overarching policies guiding the shackling of non-pregnant, incarcerated patients, clinicians rarely unshackle patients during routine care. We provide a medical-legal lens through which to examine inpatient shackling, review the limited evidence supporting the practice, and highlight harms associated with shackling in the hospital. We conclude by offering guidance to advance evidence-based shackling practices that prevent physical harm, reduce prejudice towards incarcerated patients, and relinquish reliance on shackles in favor of tailored security measures.

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Best practice guidelines for evaluating patients in custody in the emergency department

Chao,

Weber,

Iserson

et al. 2024

JACEP Open

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Patients in custody due to arrest or incarceration are a vulnerable population that present a unique ethical and logistical challenge for emergency physicians (EPs). People incarcerated in the United States have a constitutional right to health care. When caring for these patients, EPs must balance their ethical obligations to the patient with security and safety concerns. They should refer to their institutional policy for guidance and their local, state, and federal laws, when applicable. Hospital legal counsel and risk management also can be helpful resources. EPs should communicate early and openly with law enforcement personnel to ensure security and emergency department staff safety is maintained while meeting the patient's medical needs. Physicians should consider the least restrictive restraints necessary to ensure security while allowing for medical evaluation and treatment. They should also protect patient privacy as much as possible within departmental constraints, promote the patient's autonomous medical decision‐making, and be mindful of ways that medical information could interact with the legal system.

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Caring for Hospitalized Incarcerated Patients: Physician and Nurse Experience

Cited by 13 publications

References 5 publications

Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity

Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity

Shackling in the Hospital

Best practice guidelines for evaluating patients in custody in the emergency department

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