Health Care Delivery in the Texas Prison System The Role of Academic Medicine

  • Raimer B
  • Stobo J
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T HE MEDICAL NEEDS OF INMATES in US prisons and jails were largely ignored by society until the early 1970s, when the con-vergence of several independent forces brought the issue of correctional health care to the forefront. One of these forces was organized medicine. 1 In response to surveys indicating serious and perva-sive health care deficiencies within cor-rectional institutions, several organiza-tions became involved in efforts to improve medical care for prisoners. The first comprehensive national health care standards for correctional facilities were published in 1976 by the American Pub-lic Health Association. 2 The American Medical Association developed model health care delivery systems for jails, pub-lished its own correctional health care standards, and established a program to accredit health care systems in jails. 1,3 Another force in bringing about re-forms was the court system. 4 A series of decisions by the lower federal courts dur-ing the early 1970s established a con-stitutional basis for providing an ad-equate level of medical care to prisoners. 5 In the landmark case of Estelle v Gamble, 6 the US Supreme Court affirmed that de-liberate indifference to the serious medi-cal needs of prisoners was a violation of the Eighth Amendment and ruled that the federal courts could intervene to en-sure sufficient medical care. By 1981, 25 states were under court order or con-sent decree to improve conditions in their correctional institutions. 4 These reforms were soon threat-ened by demographic changes in the na-tion's correctional populations. Re-sponding to society's concerns about crime, lawmakers enacted legislation that limited judicial discretion in sen-tencing for certain offenses, resulting in sizeable increases in the number of mandatory and fixed sentences, and concurrent decreases in the use of al-ternatives to incarceration. 7 Between 1980 and the early 1990s, the US prison population more than doubled. 8 Addi-tionally, incarceration rates for offend-ers with special health care needs, in-cluding elderly offenders and women, increased rapidly.

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  • Ben G Raimer

  • John D Stobo

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