Human Rights in Hospitals: an End to Routine Shackling

Abstract

Medical students (NSB, NM, JDW) spearheaded revision of the policy and clinical practice for shackling incarcerated patients at Boston Medical Center (BMC), the largest safety net hospital in New England. In American hospitals, routine shackling of incarcerated patients with metal restraints is widespread—except for perinatal patients—regardless of consciousness, mobility, illness severity, or age. The modified policy includes individualized assessments and allows incarcerated patients to be unshackled if they meet defined criteria. The students also formed the Stop Shackling Patients Coalition (SSP Coalition) of clinicians, public health practitioners, human rights advocates, and community members determined to humanize the inpatient treatment of incarcerated patients. Changes pioneered at BMC led the Mass General Brigham health system to follow suit. The Massachusetts Medical Society adopted a resolution authored by the SSP Coalition, which condemned universal shackling and advocated for use of the least restrictive alternative. This will be presented to the American Medical Association in June 2024. The Coalition led a similar effort to coauthor a policy statement on the issue, which was formally adopted by the American Public Health Association in November 2023. Most importantly, in an unprecedented human rights victory, a BMC patient who was incarcerated, sedated, and intubated was unshackled by correctional officers for the purpose of preserving human dignity.

Medicaid for Medical-Correctional Care: Time to Manage What is Reimbursed

“…• Transportation between carceral facilities and medical centers is a potentially vulnerable time in security measures, so clinicians are instructed to withhold discharge plans from patients to mitigate the risk of coordinated attempts at escape 4 policies around shackling restraint for patients who are incarcerated with typical medical restraint policies mandating the least restrictive means of detainment along with frequent assessment for delirium and injury. 26 In carceral facilities, the Reentry Act could ensure those with opioid use disorder receive access to effective medication-assisted treatment and confirmed follow-up in community substance use treatment centers. 27 All carceral facilities should be required to report quality measures as other payers and providers are typically required to do, adding transparency to health care processes delivered in jails and prisons and ingraining the quality and safety practices standard in community health systems.…”