Traumatic Orthopaedic Injuries in the Prison Population

Abstract

Under the landmark 1976 Estelle v. Gamble decision, the U.S. Supreme Court affirmed that prisoners have a constitutional right to adequate medical attention and concluded that the Eighth Amendment is violated when corrections officials display "deliberate indifference" to an inmate's medical needs. 1 The manner in which states manage prison health care services that meet these legal requirements affects not only inmates' health, but also the public's health and safety and taxpayers' total corrections bill. Effectively treating inmates' physical and mental illnesses, including substance use disorders, improves their well-being and can reduce the likelihood that they will commit new crimes or violate probation once released. 2 The State Health Care Spending Project previously examined cost data from 44 states* and found that prison health care spending increased dramatically from fiscal year 2001 to 2008. However, new data from a survey of budget and finance staff officials in each state's department of corrections, administered by The Pew Charitable Trusts and the Vera Institute of Justice, show that some states may be reversing this trend. This report examines the factors driving costs by analyzing new data on all 50 states' prison health care spending from fiscal 2007 to 2011. † It also describes a variety of promising strategies that states are using to manage spending, including the use of telehealth technology, improved management of health services contractors, Medicaid financing, and medical or geriatric parole. The project's analysis of the survey data yielded the following findings: • Correctional health care spending rose in 41 states from fiscal 2007 to 2011, with median growth of 13 percent, after adjusting for inflation. • Per-inmate health care spending also rose in 39 states over the period, with a median growth of 10 percent. • In a majority of states, however, total spending and per-inmate spending peaked before fiscal 2011. Nationwide, prison health care spending totaled $7.7 billion in fiscal 2011, down from a peak of $8.2 billion in fiscal 2009. The downturn in spending was due, in part, to a reduction in state prison populations. • From fiscal 2007 to 2011, the share of older inmates-who typically require more expensive care-rose in all but two of the 42 states that submitted prisoner age data. ‡ Not surprisingly, states where older inmates represented a relatively large share of the total prisoner population tended to incur higher per-inmate health care spending. As states work to manage prison health care expenditures, a downturn in spending was a positive development as long as it did not come at the expense of access to quality care. But states continue to face a variety of challenges that threaten to drive costs back up. Chief among these is a steadily aging prison population. Data from the survey can provide state decision-makers with information to assess both their own state's * The source of these data was the Bureau of Justice Statistics. † States' fiscal years differ. (See Appendix ...

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research

“…Fifteen studies were from the United States, and 12 had IRB approval. Notably, 3 studies were exempted from IRB review (waived consent), 15 – 17 and 2 studies did not report their IRB status 18 , 19 (Supplemental Table 1, http://links.lww.com/AOSO/A345 ). Among the 12 studies with IRB approval, 6 included a waiver of consent, 13 , 20 – 24 while 6 did not report the status of consent waivers.…”

“…Among the 12 studies with IRB approval, 6 included a waiver of consent, 13 , 20 – 24 while 6 did not report the status of consent waivers. 25 – 30 Four studies identified incarcerated patients through International Classification of Diseases (ICD) codes: Y92:14 X (prion as location of injury) or E849.7 (injury occurring in residential institution), 17 , 18 , 21 , 23 4 used admission or discharge locations, 16 , 23 , 27 , 28 8 used prison referral or electronic medical record review, 13 , 19 , 22 , 24 – 26 , 29 , 30 1 used prison billing data, 15 and 1 used prospective identification during consultation. 20 Using the ROBINS-E tool risk of bias assessment, 70.6% of the studies had high or very high concerns for bias (Fig.…”

“…Twelve studies reported on nonelective surgeries: 1 on emergency general surgery, 16 8 on trauma, 15 , 17 , 19 , 21 , 23 , 25 , 29 , 30 1 on both trauma and emergency general surgery 20 and 2 on burn surgery. 18 , 27 For emergency general surgery, 3 studies described conditions, 13 , 16 , 20 with only 1 comparing postoperative outcomes to nonincarcerated individuals (Supplemental Table 3, http://links.lww.com/AOSO/A345 ).…”

“…Extremity fractures, particularly hand/wrist injuries, were more common among incarcerated individuals compared with the nonincarcerated population. 15 However, facial trauma was observed in 60% of incarcerated individuals treated at the tertiary hospital in New York City. 25 After injury, incarcerated patients showed delayed presentations (average time: 8.5 days vs 4 days for nonincarcerated individuals).…”

Know the Person, Not Just the Disease

“…Barreto Rocha et al found no studies addressing the epidemiology of traumatic orthopaedic injuries and their complications among prison populations 10 . However, developing knowledge of cultural considerations when working with someone who has been incarcerated may be important to those working in orthopaedic care because the reported incidence of violent and accident-based orthopaedic injuries is higher in the inmate population compared with the free world 11,12 .…”