When asked to describe the current system for providing healthcare to the incarcerated population, physician and hospitalist Dr. Farah Acher Kaiksow went silent.
“I can’t, really,” Kaiksow said.
Kaiksow, who has dedicated her career to studying public health and health equity, went on to explain there is no universal system for providing care to incarcerated patients, making it nearly impossible to describe the experience.
Though the Federal Bureau of Prisons published a list of clinical guidelines for inpatient treatment of nearly 50 diseases, there is no readily accessible data about whether or not these suggestions are enforced or even implemented, according to Kaiksow.
Private prisons incarcerate about 8% of the total prison population, according to the Sentencing Project. Every private prison outlines different regulations for medical care and does not necessarily operate under the published federal guidance, Kaiksow said.
This means the vast majority of the incarcerated population is subject to different standards of medical care. Even the standards for providing medical care to inmates in public hospitals are incredibly variable, according to one of Kaiksow’s previous papers that compared the practices of two carceral hospitals in the same state.
“While we might have expected two institutions that partner under the same Department of Corrections and share similar incarcerated patient populations to adopt similar language and rules, this was not the case,” the paper said.
Incarcerated patients also report experiencing several deviations from standard practice during their inpatient treatment, including but not limited to decreased provider engagement, privacy violations, application of fewer medical interventions and continuous shackled restraint, according to an article from the Annals of Internal Medicine.
Chronic diseases like HIV, diabetes, hypertension and substance use disorders are also known to be more prevalent among the incarcerated than the general public. Kaiksow’s most recent publication concluded that women with a history of incarceration had significantly higher odds of cervical cancer diagnoses compared to the non-incarcerated.
The prevalence of cervical cancer in previously incarcerated individuals demonstrates the need for preventative care within prisons, Kaiksow said.
“People who are incarcerated have poorer healthcare, which leads to fewer opportunities for vaccination and fewer opportunities for screening,” Kaiksow said.
The human papillomavirus mostly causes cervical cancer, according to the Centers for Disease Control. The HPV vaccine can prevent contraction of the virus, which the CDC says is almost 100% successful for previously uninfected individuals.
Despite the efficacy of this vaccine, a survey from 2019 found many correctional institutions do not offer the HPV vaccine under their health services, leaving unvaccinated inmates vulnerable to infection — and by extension, cervical cancer.
A 2015 paper exploring female prisoners’ perception of HPV found only two-thirds of the study group had even heard of the HPV infection, while only one had received all three doses of the HPV vaccine.
Kaiksow’s cervical cancer study is one of many suggesting prison healthcare systems are failing their patients. A 2020 study declared the prison population is severely under-immunized against communicable diseases like influenza, hepatitis B, measles, mumps and rubella and pneumococci.
The COVID-19 pandemic highlighted other systemic shortcomings within the carceral healthcare system. Accomplished social welfare scientist Tawandra Rowell-Cunsolo said the disease ravaged prison populations at a disproportionate rate relative to the non-incarcerated population.
“A lot of these buildings are old, they have poor ventilation, healthcare isn’t great and there are limited opportunities for actually segregating [sick] populations,” Rowell-Cunsolo said. “If you have someone who’s sick or starting to exhibit symptoms, where are they going to go?”
Rowell-Cunsolo called attention to another leading issue in the carceral system — overcrowding. As of 2020, the University of Nebraska Omaha reported Iowa state prisons were operating at 119% of their operational capacity, which is the number of services needed for a given population relative to the institution’s physical ability to provide them.
For communicable diseases, overcrowding facilitates the spread of disease and significantly hinders individuals’ ability to social distance, according to the CDC.
Physical condition, however, is not the only contributor to an individual’s overall health status. Much like in the general population, mental health is severely under-treated in prisons, according to Rowell-Cunsolo. A large portion of Rowell-Cunsolo’s research is dedicated to studying a common mental health condition among people with a history of incarceration — substance use disorders.
“For substance use, in both community and custodial settings, not everyone who needs [treatment] receives it,” Rowell-Cunsolo said. “If you’re incarcerated and managing your addiction, you’re probably not going to get access to all of the services and support that you need.”
Though the Federation of American Scientists estimated 17% of the incarcerated population meets the criteria for having an opioid-specific substance use disorder, only three of the 35 prisons in Wisconsin offer medication-assisted therapy for this condition, according to Kaiksow.
This ratio is concerning to Kaiksow, given the National Institute of Drug Abuse has reported that for many patients, medications as well as counseling and other behavioral therapies are important elements of treatment.
Despite the inaccessibility to drug therapies, Rowell-Cunsolo expressed some optimism for other treatment methods for substance use disorders used in prisons.
“You may find groups based on 12-step programs, maybe some education, some facilities may do cognitive behavioral therapy groups and things like that,” Rowell-Cunsolo said.
Wisconsin’s Taycheedah Correctional Institution, which estimates more than 98% of its population possesses an identifiable mental illness, offers several Health Service Units for inmates. Taycheedah’s HSUs provide both psychiatric and psychological therapies to “ensure effective, holistic care for patients.”
Both Kaiksow and Rowell-Cunsolo stressed the need for post-release transition clinics as well. Newly released inmates are often left without insurance, housing and the connections needed to successfully reassimilate, according to Rowell-Cunsolo, and the lack of these resources inhibits their ability to begin or continue treatments.
“My research has shown that people perform much better if they can go to a ‘one-stop-shop,’ where they allow people to access a range of services in one spot,” Rowell-Cunsolo said.
The increasing body of research on the effectiveness of transition clinics has facilitated the establishment of many new resource centers. Aurora Health Care, for example, has recently developed multiple transition clinics in the greater Milwaukee area.
Kaiksow and Rowell-Cunsolo said intentionally providing equitable health services, such as the opportunity to participate in transition clinic programs, to individuals with a history of incarceration is what will propel positive systemic changes.
