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Healthcare in Incarcerated Populations – a Medical Student Perspective

For a well-functioning society, it is necessary to have a government, schools, hospitals, recreational centers and other amenities. The prison system is a dark addition to that list. It is a place where we send those who society has deemed criminal or offensive- those who must be detained and punished. Some may argue that the correctional system makes society safe; we can sleep comfortably at night knowing that those who have harmed others are kept far away and can never do the same to us. It can be tempting, easy even, to lock offenders up and throw away the key. Considering the ethical and humanitarian issues of imprisonment is more difficult. Do we provide the most serious criminals a second chance? Do we treat them humanely when they have taken humanity and dignity away from others? Should we allow methods like solitary confinement as a way to deal with unruly people? Furthermore, is it right that punishment continues in the form of social stigma even after persons are released? All of these very big questions have even bigger and even more complex answers; however, just because they are difficult to think about doesn’t mean that we shouldn’t.

To add complication, our correctional system is spiraling out of control – it is difficult to justify why many in jail settings are even there. It is a fact that more and more people are arrested and imprisoned for long periods of time for petty crimes and minor offenses (1). Many argue that these people need rehabilitation, not necessarily punishment. However, our current system still treats them as society’s unwanted. In New York City, after people are arrested, but before they are even charged, they are sent to a geographically isolated location - Riker’s Island. We remove them from sight as not to ruin the happy and harmonious landscape of the city. They become forgotten, somewhere far away where we don’t have to care if their humanity is compromised.

Approximately 1% of Americans are under correctional control at any given time; more than 2.2 million individuals are currently in or have passed through the jail/prison system in the United States (2). They have been arrested, processed, put behind bars, attended court, and have been charged or exonerated. They end up either in the prison system, or back in their communities, trying to re-build their lives. In addition to all of the legal and institutional systems these men and women pass through, we often forget that they also are seen by physicians, nurses, PAs, social workers and a whole slew of healthcare workers. These 2.2 million people are seen not only by doctors within the correctional system; however, they may also become patients in a primary care office or specialty clinic after they are released. As future physicians, we must educate ourselves and confront the ethical dilemmas surrounding incarceration to better serve this population and provide high-quality healthcare for all.

In the first two years of medical school, we are inundated with scientific information. We learn about many metabolic pathways in great detail, but often don’t learn as much about the backgrounds of our patients. In an effort to better understand who might be walking through future physicians’ clinic doors, the New York University chapter of Physicians for Human Rights hosted a lecture series entitled, “Healthcare and Human Rights in Incarcerated Populations in New York City.” I attended two talks given by physicians working with NYC Correctional Health Services, an art show at the School of Visual Arts showcasing the work of inmates on Riker’s Island, and a tour of the mental health facilities at Riker’s Island itself. From these experiences, I gained a more holistic view of healthcare in correctional settings, as well as the varied clinical and social needs of those who are or who been incarcerated. It reaffirmed to me the importance of exploring these issues and having access to diverse populations in medical school and expanded my ideas about how I can approach my career in the future.

Walking the dimly lit hallways of Riker’s and briefly seeing conditions in which over 50,000 people in NYC reside for a range of days to months helped put into perspective my stereotypes of the prison system. For someone who was just visiting, it was incredibly harrowing to be in a lock-down setting surrounded by guards. I could feel my adrenaline levels rise and stay high throughout my visit. I became hyper-aware of my environment, and of both the guards and inmates themselves. One can only imagine the stress and anxiety someone who lives in this setting experiences every day, and how this affects both their mental and physical health. I left the island thinking about the enormous task both the mental health and medical team at Riker’s have undertaken. They provide screenings for every person that passes through the island and must accurately diagnose and provide care for severe mental illnesses or medical diseases in a setting where patients have restricted autonomy, live under constant stress, and may be transferred or even released with very little warning. It is difficult to allocate money and find resources and a staff for a system that is frightening, stigmatized and rather forgotten about. Still, these 2.2 million individuals are part of our society whether they are or have been incarcerated. We should not, and cannot, forget them.

While not every physician will work in a jail/prison setting, we should all care about the health of incarcerated populations. The work of physicians, human rights workers and even correctional officers has led to changes in policies regarding solitary confinement in New York City jails. Our roles as healthcare providers are not confined to just providing care and compassion to individual patients. Rather, they should extend to truly advocating for populations to change inequitable policies and systems that are detrimental to our society. Our voices as medical students and physicians are powerful and learning how to harness that power to do good on an institutional level is just as important as the medical care we provide.

1.Rich JD, Wakeman SE, Dickman SL. Medicine and the epidemic of incarceration in the United States. N Engl J Med. 2011;364(22):2081-3.

2. Lee, Michelle Ye Hee. “Yes, U.S. Locks People up at a Higher Rate than Any Other Country.” The Washington Post, WP Company, 7 July 2015,

Shefali is a 2nd year medical student at NYU and a member of the PHR Student Advisory Board.

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