Surgery in Shackles: What Are Surgeons' Obligations to Incarcerated Patients in the Operating Room?

Abstract

Incarcerated patients frequently require surgery outside of the correctional setting, where they can be shackled to the operating table in the presence of armed corrections officers who observe them throughout the procedure. In this circumstance, privacy protectioncentral to the patient-physician relationship-and the need to control the incarcerated patient for the safety of health care workers, corrections officers, and society must be balanced. Surgeons recognize the heightened need for gaining a patient's trust within the context of an operation. For an anesthetized patient, undergoing an operation while shackled and observed by persons in positions of power is a violation of patient privacy that can lead to increased feelings of vulnerability, mistrust of health care professionals, and reduced therapeutic potential of a procedure. What I may see or hear in the course

Human Rights in Hospitals: an End to Routine Shackling

“… 6 Shackles have led to insensitive, inappropriate, neglectful, or abusive actions by staff or associated authority figures, which in turn evokes a response of fear in patients along with a loss of trust in the care team. 11 These negative healthcare interactions further stress incarcerated patients’ post-carceral challenges within the healthcare system. 12 …”

Shackling in the Hospital

“…5 Surgeons describe a reduced therapeutic alliance and heightened vulnerability shackles incur for patients when placed in the operating room. 15 For those admitted with terminal diagnoses, shackles limit palliative providers' ability to provide dignity-driven end of life care. 16 When blanket shackling policies do not account for individual medical risk assessment, patients with disabilities are disproportionately impacted.…”

Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement’s Alternatives to Detention programme in the healthcare setting

“…Guidance regarding the punitive consequences of removal of monitoring devices, when present, typically exempts device removal in the setting of medical care or emergency response 8. There is increasing consensus across the profession that even in the common case of shackled prisoners, for whom similar ambiguity in formal guidance exists, shackles should be removed whenever possible, particularly during the physical exam or while under general anaesthesia 9–11. Unfortunately, even in the few cases where law and policy are quite clear, such as in legislature prohibiting perinatal shackling for female prisoners, studies suggest that shackling of incarcerated women during pregnancy and postpartum continues and that most nurses are not aware of state laws and/or medical society statements about this practice 12 13.…”

“…HIPAA, privacy and medical ethics concerns can also arise as healthcare providers make clinical and safety decisions associated with removal of an ankle monitoring device and potentially contact ICE to inform agents of device removal 22. As in the case of incarcerated individuals whose identifiable health information is specifically not excluded from the definition of protected health information according to the HIPAA of 1996, confidentiality must be maintained in accordance to patients’ wishes 10. In our case, the patient provided consent to our sharing her hospitalisation details with her ICE case worker, and only limited information was shared on a need-to-know basis.…”

“…However, the question arises regarding patients who may refuse sharing of such information or patients who may feel obligated to share health information for fear of negative consequences on their immigration case, and how healthcare providers might respond to the medical need of device removal while fully protecting patient privacy. Additionally, higher levels of mistrust of the medical system already exist among ethnic minorities 10. These can be exacerbated by concerns about privacy for patients with ankle monitoring devices, contributing to reluctance to seek care among these patients or hesitancy to report discomfort, pain or other issues with the ankle monitoring devices.…”